The rebirth of medicine

Introduction

 Andreas Vesalius
De humani corporis
fabrica, 1543
page 190

The great scientific advances of Western medicine trace their roots to the Renaissance, the period of thought that rejected medieval monasticism andrediscovered the cultures that preceded it. The ancient Egyptians and Greeks had some notions on how the human body worked, but only during the Renaissance did the breakthroughs occur that led to the growth of anatomy, physiology, and surgery.1

 

Anatomy and the Renaissance

The precepts of Galen dominated medicine for more than a thousand years. Born in the ancient Greek city of Pergamon but working in Rome,  Galen (131-200 AC) derived his knowledge of human anatomy by working as a gladiator surgeon and dissecting animals, mostly  pigs and apes.  As human dissection was illegal, he transferred the anatomical knowledge so gained to humans.2 His books on anatomy went unchallenged and accepted by doctors as correct, widely used for centuries and not proven wrong until the Renaissance.

 

Andreas Vesalius (1514 – 1564), the founder of modern human anatomy, was born in Flanders and became professor of anatomy in Padua. He dissected human bodies, many stolen from graves, and so was able to compare his findings to those of Galen.3 He also travelled to Bologna (in 1538 and 1540) where he gained more experience of dissection, which in Vesalius’ view was the best way to learn about anatomy.  After his visit to Bologna, Vesalius wrote, ‘De Human Corporis Fabrica.’  In this he described how his findings were different from those of Galen.1  Vesalius showed that the lower human jaw consisted of a single bone, not two as Galen had stated, and that the sternum was made up of three parts, not seven. He also demonstrated that the human liver did not have five lobes and that valves were present in veins, although their purpose was unknown.  He noted that arteries and veins supplied organs, and saw this is as ‘mutual flux and reflux of materials.’1,4,5 Galen believed there were pores present in the septum of the heart. Vesalius disproved this as he attempted to force a probe through the thick ventricular septum; and also showed that human femur was straight, unlike that of many animals. Vesalius was very important in developing the understanding of anatomy and had a great impact on changing the thinking present in his time.  These discoveries inspired others, leading Realdo Colombo to discover the pulmonary transit of the blood, later used by William Harvey when he investigated the circulation of the blood.1

 

Realdo Colombo (1516-1559), a pupil of Vesalius and his successor, also became professor of anatomy and surgery at Padua and wrote, ‘De re anatomica,’ which revealed his discoveries. He discovered that “when the heart dilates it receives blood from the vena cava into the right ventricle, and at the same time the left ventricle receives the blood mixed with the air by means of the arteria venosa.” Colombo saw how arteries expanded with each heartbeat and that during diastole the pulmonary valve closed and prevented reflux. Colombo continued to believe that it was the venous circulation that carried a nutrient rich blood supply around the body.6

Galen had regarded the liver as the main organ of the body and viewed it as central in understanding the movement of the blood.6 The liver was seen as the site where blood was made, where the veins started, where the blood was mixed with chyle and transported to other parts of the body.7,8 Galen recognized that blood needed air to keep the body alive and knew the purpose of the semi-lunar valve in the pulmonary artery.6,7 He believed that arterial life-giving blood contained pneuma, spirituous air.  Like venous blood, he believed it supplied all areas of the body when needed and it was constantly used and remade rather than circulating around the body.9

Various developments led to the fully understanding of the circulation of the blood. Michael Servetus (1511-1553) was the first to publish on the pulmonary circulation.  Servetus went against the Galenic teachings that aeration of blood occurred in the heart.  Examining the heart and taking measurements of the pulmonary artery, he realized that the lungs are responsible for gaseous exchange.8 Andrea Celaspino (1519-1603) supported that view of the pulmonary circulation and accepted the idea that the blood was returned to the heart. Celaspino understood the valves in the heart and their purpose in preventing reflux.  He also began to use the term, ‘circulatio,’ 6,8 and in 1603 a treatise on the venous valves was published by Fabricus.8

The major breakthrough came from William Harvey in 1628, when he published his book, ‘Exercitatio anatomica de motu cordis et sanguinis in animabilus,’ (An Anatomical Essay Concerning the Movement of the Heart and the Blood in Animals.)  William Harvey (1578-1657) discovered that the blood circulated around the body, using a variety of experiments to prove his theories.  He noted the volume of blood forced out of the heart in an hour and saw how this exceeded the volume of blood present in the entire animal.  So much blood left the heart in a minute that was impossible for it to be absorbed by the body and replaced by blood produced in the liver from digested food.8,10 The liver could not possibly generate more than a person’s entire weight of blood in an hour.10 Observation of animals showed that during cardiac diastole the heart relaxed and received the blood, but during ventricular systole blood was forced out of the heart into the arteries.11 Harvey knew from his experiments that arteries and veins linked together.  One of Harvey’s most famous experiments involved tying a ligature tightly at the upper arm preventing the venous blood from moving back above the ligature but allowing the arterial blood to flow down the arm.8,11  When the ligature was tight the veins swelled, proving that the blood had entered the arm from the arteries, then flowed into the veins, but was unable to leave as the veins were blocked by the ligature.8 Harvey guessed that the connection between arteries and veins was through invisible pores.  It was not until three years after Harvey’s death that Marcello Malpighi (1628- 1694) the discovered capillaries by seeing them observing them under the microscope.  Five years later he discovered the red blood cells that carried oxygen to respiring tissues, thus completing the circulatory cycle.10

 

Surgery and the Renaissance

Ambroise Paré (1510-1590) made a huge contribution to the world of surgery during the Renaissance. He trained in Paris, where he was apprenticed to become a barber surgeon.  After working at the largest hospital in France for four years, before he was sent to work at war sites.12 His first battle was the siege of Turin, 1537, where he provided alternative ways of treating wounds.  Surgeons at that time believed that gunpowder was poisonous and accordingly treated gunshot wounds by cauterizing them with boiling oil.13 As the oil Paré needed for cauterizing ran out he had to find a new mixture to help the soldiers. This consisted of egg yolk, oil of roses, and turpentine.12,13 Paré saw that with his new mixture the wounds treated healed much quicker, and justified this by explaining that gunpowder was not poisonous. This he wrote in his book, ‘Treatise on Gunshot Wounds.’13

Paré also made advances in closing wounds after amputation. Instead of using hot irons to prevent the patient from bleeding to death, he used silk ligatures to tie around the blood vessels.  This was not a completely new way of thinking, as other surgeons had also found various ways of dealing with this kind of wound.  For example, after controlling bleeding by using pressure and styptics, Gersdorff enclosed amputated stumps in animal bladder.13,14 Using ligatures did have disadvantages, for example fifty-three had to be used on a thigh amputation, and the problem of infection was still present.13

Gaspere Tagliacozzi (1545-1599) was able to make significant achievements in the surgery of rhinoplasty.  He took a flap of skin from the top of the arm and sewed it to the nose while still attached to the arm.  Two weeks later the skin was detached from the arm and the nose could be reshaped. Tagliacozzi also repaired ears. He did not invent the rhinoplasty technique, but he found ways to improve it.13

 

Conclusion

Vesalius, Harvey, Paré, and many others, were willing to challenge the old ways of thinking, often despite criticism, and made real differences in the medical world.  Without them medicine might not be quite as advanced as it is today.  Renaissance means rebirth, and it was also the rebirth of medicine.

 

References

  1. Wear A. Chapter 6: Early modern Europe, 1500-1700. In: Conrad L.I, Neve M, Nutton V, Porter R, Wear A. The western medical tradition 800 BC to AD 1800.  Cambridge; Cambridge University Press: 1995:215-359.
  2. Guthrie D. Chapter 5: Alexandrian and Roman medicine. In: A history of medicine. London, Edinburgh, Paris, Melbourne, Toronto, New York; Thomas Nelson & Sons Ltd: 1945:63-83.
  3. Adler R.E. Chapter 9: Andreas Versalius: Driven to dissection. In: Medical firsts from Hippocrates to the human genome. Hoboken, New Jersey; John Wiley & Sons, Inc: 2004:53-59.
  4. Guthrie D. Chapter 8: Medicine of the XV and XVI centuries: Performers and revolutionaries. In: A history of medicine. London, Edinburgh, Paris, Melbourne, Toronto, New York; Thomas Nelson & Sons Ltd: 1945:134-155.
  5. Major R. The Renaissance. In: A history of medicine, volume 1. Illinois, U.S.A; Thomas C.C, Oxford, England; Blackwell Scientific Publications, Ltd and Toronto, Canada: The Ryerson Press: 1954:357-478
  6. Castiglioni A. Chapter 16: The Renaissance, the revival of anatomy and physiology.  Biological and clinical trends. 3. The beginnings of physiology – The discovery of the circulation of the blood.  In: Krumbhaar E.B, editor.  A history of medicine.  New York; Alfred A. Knopf Inc, Canada: The Ryerson Press: 1947:408-503.
  7. Neil E. Chapter 1: Theories of the heart and blood before Harvey. In: William Harvey and the circulation of blood. London; Priory Press Ltd: 1975:16-37
  8. Porter R. Chapter 9: The new science. In: The greatest benefit to mankind. A medical history from antiquity to the present. London; HarperCollinsPublishers: 1997:201-244
  9. Porter R.  Chapter 3:  Antiquity. In: The greatest benefit to mankind.  A medical history from antiquity to the present. London; HarperCollinsPublishers: 1997:44-82
  10. Adler R.E. Chapter 11: William Harvey and the movements of the heart. In: Medical firsts from Hippocrates to the human genome. Hoboken, New Jersey; John Wiley & Sons, Inc: 2004:69-75
  11. Neil E. Chapter 3: De Motu Cordis. In: William Harvey and the circulation of blood. London; Priory Press Ltd: 1975:55-66
  12. Major R. The Renaissance. In: A history of medicine, volume 1. Illinois, U.S.A; Thomas C.C, Oxford, England; Blackwell Scientific Publications, Ltd and Toronto, Canada: The Ryerson Press: 1954:357-478
  13. Porter R. Chapter 8: Renaissance. In: The greatest benefit to mankind. A medical history from antiquity to the present. London; HarperCollinsPublishers: 1997:163-200
  14. Dawson I and Coulson I. Chapter 3: Medicine and health AD1400-1750. In: Shephard C (Eds). Medicine and health through time (an SHP development study).  London; John Murray Ltd: 1996:83-110

 


 

DR. CONSTANTINA PITSILLIDES, MBChB graduated from Sheffield University and is now working as a doctor in general medicine in Hull.  I have yet to specialise, but hope to continue working as a general medical physician.

 

Highlighted in Frontispiece Spring 2014 – Volume 6, Issue 2

Hektorama  | History Essays