Medicine

V

Renaissance Medicine

No abrupt change in medical thought occurred during the Renaissance, but criticism directed against Galen and the Arabists increased, and the doctrines of Hippocrates were revived. Renaissance artists undertook the study of human anatomy, particularly of muscles, in order better to portray the human body. Leonardo da Vinci made remarkably accurate anatomical drawings based on dissection of human corpses. Unfortunately, his work, the bulk of which was lost for centuries, exerted little effect at the time.

The publication in 1543 of the treatise on anatomy, De Humani Corporis Fabrica (On the Structure of the Human Body) by the Belgian anatomist Andreas Vesalius, was a milestone in medical history. Hundreds of Galen's anatomical errors were clearly demonstrated by this remarkable observer and by his contemporary, Gabriel Fallopius, who discovered the uterine tubes subsequently named after him and the tympanum, diagnosed ear diseases with an ear speculum, and described in detail the muscles of the eye, tear ducts, and Fallopian tubes. Galen was also contradicted by the Spanish physician Michael Servetus, who was the first correctly to describe the circulatory system in the lungs and to explain digestion as the source of bodily heat.

During his stormy career, the Swiss physician and alchemist Philippus Aureolus Paracelsus, the founder of chemotherapy, broke with tradition by burning the classical treatises on medicine, by lecturing in German, and by discovering new chemical remedies. Ambroise Paré, the French surgeon, facilitated surgical amputation by his use of forceps and ligature instead of cautery to stop haemorrhage, or bleeding. The Italian physician and poet Girolamo Fracastoro, sometimes called the founder of scientific epidemiology, demonstrated the specific character of fevers and discovered typhus; the term syphilis, applied to the virulent disease then devastating Europe, was derived from his famous poem, “Syphilis sive Morbus Gallicus” (Syphilis or Disease of Gauls, 1530). His theory that infectious diseases are transmitted by invisible seeds of contagion, capable of self-reproduction, was a precursor of modern bacteriological theories.

VI

The Dawn of Modern Medicine

The event that dominated 17th-century medicine and marked the beginning of a new epoch in medical science was the discovery of the circulation of the blood by the English doctor and anatomist William Harvey. In 1553 Michael Servetus had described the pulmonary transit of the blood. Harvey's Essay on the Motion of the Heart and the Blood (1628) established the fact that the heart pumps the blood in continuous circulation. The Italian anatomist Marcello Malpighi advanced Harvey's work by his discovery of the capillaries, and the Italian anatomist Gasparo Aselli gave the first adequate description of the lacteals (see lymphatic system). In England the doctor Thomas Willis investigated the anatomy of the brain and the nervous system, was the first to identify diabetes mellitus, and described conversion disorder and a number of nervous afflictions. The English doctor Francis Glisson laid the foundations for the modern knowledge of the anatomy of the liver, described rickets (sometimes called Glisson's disease), and was the first to prove that muscles contract when activity is performed.

The English doctor Richard Lower did fundamental work on the anatomy of the heart, demonstrated the interaction of air and blood, and performed one of the first successful blood transfusions. His work supplemented that of other members of the so-called Oxford group, the English physiologists Robert Boyle and Robert Hooke, who were pioneers in the physiology of respiration.

The French mathematician and philosopher René Descartes, who also made anatomical dissections and investigated the anatomy of the eye and the mechanism of vision, maintained that the body functioned as a machine. This view was adopted by the so-called iatrophysicists, whose views were opposed by the iatrochemists, who regarded life as a series of chemical processes. The exponents of the former view were the Italian doctor Sanctorius, who investigated metabolism, and the Italian mathematician and physicist Giovanni Alfonso Borelli, who worked in the area of physiology. Jan Baptista van Helmont, a Flemish doctor and chemist, founded the opposing iatrochemical school, the work of which was advanced by the Prussian anatomist Franciscus Sylvius, who studied the chemistry of digestion and emphasized the treatment of disease by drugs.

The English doctor Thomas Sydenham, called the English Hippocrates, and subsequently the Dutch doctor Hermann Boerhaave re-established the significance of bedside instruction in their emphasis on the clinical approach to medicine. Sydenham carried out extensive studies on malaria and on the mechanisms of epidemics, and he distinguished scarlet fever from measles. The introduction into Europe in 1632 of what came to be known as quinine, obtained from cinchona bark, was another event in therapeutic progress.

A

New Insights

After the discoveries of Polish astronomer Nicolaus Copernicus, Galileo, and the English mathematician Isaac Newton, 18th-century medicine made efforts to adapt itself to scientific investigation. Nevertheless, strange and unsupported theories still gained credence. The German doctor and chemist Georg Ernst Stahl believed that the soul is the vital principle and that it controls organic development; in contrast, the German doctor Friedrich Hoffmann considered the body a machine and life a mechanical process. These opposing theories of the vitalists and the mechanists were influential in 18th-century medicine. The British doctor William Cullen attributed disease to the excess or deficiency of nervous energy; and the doctor John Brown of Edinburgh taught that disease was caused by weakness or inadequate stimulation of the organism. According to his theories, known as the Brunonian system, stimulation should be increased by treatment with irritants and large dosages of drugs. The German doctor Samuel Hahnemann developed the system of homoeopathy late in the 18th century; it emphasized small dosages of drugs, in opposition to the Brunonian system. Other irregular systems proposed towards the end of the 18th and in the early 19th centuries includes phrenology, a theory formulated by the German doctors Johann Caspar Spurzheim and Franz Joseph Gall, who believed that examination of the skull of an individual would reveal information about his or her mental functions; and the theory of animal magnetism developed by the Austrian doctor Franz Mesmer, who believed in the existence of a magnetic force having a powerful influence on the human body.

B

Later 18th-Century Efforts

Of importance in the 18th century was the work of the British doctor William Smellie, whose innovations in obstetrics broke the monopoly of midwives, and of the British anatomist and obstetrician William Hunter, who studied with Smellie and was the brother of the celebrated British anatomist and surgeon John Hunter. William Hunter, a Scot, revitalized the study of anatomy in England and carried on Smellie's work to establish obstetrics as a separate branch of medicine.

Among other important contributions of this period were: the establishment of the science of pathology by the Italian anatomist and pathologist Giovanni Battista Morgagni; the studies in experimental physiology of the Italian naturalist and biologist Spallanzani, who refuted the doctrine of spontaneous generation; the research in neuromuscular physiology by the Swiss scientist Albrecht von Haller; and the studies of blood pressure by the British botanist, chemist, and physiologist Stephen Heles. Important work in botany was performed by the Swedish botanist and taxonomist Carolus Linnaeus, who devised the modern binomial system of biological nomenclature (see classification), and the British doctor, botanist, and mineralogist William Withering, who introduced the drug digitalis.

John Hunter made great advances in surgery; the British doctor James Lind dealt with scurvy, combating the vitamin-C deficiency that caused the disease by prescribing the drinking of lemon juice. The British social reformer John Howard furthered humane treatment for hospital and prison inmates throughout Europe. In 1796 the British doctor Edward Jenner discovered the principle of vaccination as a preventive measure against smallpox. His contribution both enabled control of this dreaded disease and established the science of immunization.

VII

19th-Century Medicine

Many discoveries made in the 19th century led to great advances in diagnosis and treatment of disease and in surgical methods. Diagnostic procedures for chest disorders were advanced to an extent in the 18th century by the method of percussion first described by the Austrian doctor Leopold Auenbrugger von Auenbrugg in 1761. His work was ignored, however, until 1808, when it was publicized in a French translation by the personal doctor to Napoleon. In about 1819 the French doctor René Théophile Hyacinthe Laënnec invented the stethoscope, still the most useful single tool of the doctor. A number of brilliant British clinicians assimilated the new methods of diagnosing diseases, with the result that their names have become familiar through their identification with commonly recognized diseases. The doctor Thomas Addison discovered the disorder of the adrenal glands now known as Addison's disease; Richard Bright diagnosed nephritis, or Bright's disease; Thomas Hodgkin described a malignant disease of lymphatic tissue now known as Hodgkin's disease; the surgeon and palaeontologist James Parkinson described the chronic nervous disease called Parkinson's disease; and the Irish doctor Robert James Graves diagnosed exophthalmic, or toxic, goitre, sometimes called Graves's disease.