1543: Vesalius sparks end to dark ages of medicine

Figure 1 --Galen: even as we traveled in time 

to the beginning of the 16th century, 

we still find his medical ideas

being worshiped as the Bible. 

So our friend Claudius Galen wrote his book of anatomy and medicine in the 2nd century, just prior to the end of the Roman era of western civilization.  For greater than a thousand years physicians amid this civilization, instead of thinking on their own and advancing medicine, worshiped Galen as a god of medicine. His writings contained all the knowledge required of medical students.

Surely over the years there were errors observed in Galen's words, although these errors were always overlooked, explained away as "probably nothing."   Medical curiosity was frowned upon, and all was forgotten as western civilization dipped into a dark ages. 

People were content to remain ignorant until a man by the name of Andreas Vesalius wrote a book that stunned the scientific and medical community back into existence.  

Figure 2 -- Jacobus Sylvius (1614-1672) 

regarded the words of Galen 

as superior to even his own eyes.  

Vesalius was born in 1514, "into a world of physicians, pharmacists and royal patronage," explains Lois N. Magner.  "His father was imperial pharmacist to Charles V and often accompanied the Emperor on his travels.  As a youth, Vesalius began to teach himself anatomy by dissecting mice and other small animals."(4, page 158)

Galen's mighty reign as god of medicine ended almost as soon as Vesalius became a student at the University in Paris.  This is where we find him entering through the large doors, entering a large observatory with a podium in the front and a dissecting table with a fresh corps lying on top of it. 

Vesalius seems oblivious of the stench of rotting flesh as he pushes his way through the crowd of medical students and takes a position close to the table and waits for the professor and his assistant to enter.

After waiting a long fifteen minutes in the crowded, smoldering hot and putrid smelling room, a young assistant with blades in hand takes his position at the head of the autopsy table.  A second assistant is right behind him.  Behind them, behind a small podium on a stage, we find professor Jacobus Sylvius.

In 1909, Kerfoot D. Shute said that "Jacobus 

Sylvius (1478-1555) was born in Amiens, France, and
began teaching anatomy at Paris in 1531  He was an
uncompromising Galenist.  He preached Galen in
everything, and trusted Galen more than he did his own
eyes. To him instruction in anatomy was reading a
chapter of Galen and though he, on rare occasions,
made use of imperfect dissections of the human body
these dissections were simply for the purpose of
illustrating and making the teachings of Galen

and not for the purpose of disproving Galen."  (7, page 200)

Today he reads Galen's words once more, and as he does so his assistant displays what Galen is explaining. His voice is strong and powerful, radiating full and strong so even at the rear of the auditorium we can hear his every word.  His assistant usually dissects an animal, we know this from our history lessons, but today his students are privy to an actual human dissection. This is something Sylvius had not done for his students since this time last year.  

As Sylvius reads, loud and clear, the first assistant does the cutting, and the second points to each part of the body being described by Galen.  It's actually a neat system, and they have it down pat, as though they have done this hundreds of times before. (3, page )

After the dissection is done all the men are clear of the room except Vesaleas and Sylvius

Andreas says, "What you read and what your assistant pointed to did not agree."

Sylvius shouts, "There are no errors in the writings of Galen."

Andreas says, "Galen taught that the liver was five-lobed, that the breastbone had seven segments, that a network of blood vessels could be found under the brain. You believe every word of it, although those features couldn't be found in the body right under your eyes.  You see exactly what Galen tells you to see!

Sylvius shouts, "Get out!" He points to the door.

"If the corpse and book don't agree, then the error is in the book!"

"If the error and book don't agree, then the error is in the corpse!"

 "God forbid you doubt Galen."

"Get out!" Sylvius points aggressively this time.

"Michelangelo and van Calcar know more about the human anatomy than you, professor!"

"GET OUT!

"Those artists need accurate description of the body!  They study it up and down so they can accurately draw the body.  You guys merely studied Galen!

"YOU ARE A MAD MAN!

"Hmph!" is the noise that escapes Vesaleus, as he rushes out through the large doors, which bang shut in his absence.  We follow his path, and catch up to him as he trudges down the middle of a dirt road, dust spewing as a horse and buggy buz past.  He coughs.

Vesalius stops in front of a fountain and says, perhaps talking to us:

I am not content to just believe everything Galen writes.  The best teacher of the human body is not Galen but the human body. I stole a skeleton and studied it, yes I did.  I learned the human breastbone did not have eight segments as Galen described, it had only three parts.  How could a teacher as magnificent as Galen have gotten it wrong?" 

Figure 3 -- Andreas Vesalius (1514-1564)
doubted  the words of Galen
and risked his own life
to prove him wrong.

There is a long pause as Vesaleas appears to be gazing at his shadow waddles in the twinkling water. 

Then by chance one day I dissected an Ape.  It occurred to me:  Galen never even dissected a human body, otherwise he would have known the human sternum had only three parts.  For thousands of years doctors treated diseases based on the anatomy of apes not of humans."  

Vesalius turns to look our way, as tough he knows we are real, although we know he's actually looking at Sevalius as he exits the observatory. Sevalius does not stop, perhaps pretending he does not hear the young Vesalius as he says:

"I have a mission.  I hope you read of my discovery for history's sake!"

Vesaleas smiles.

Back in the time machine we sit and think about the day's events.  To Galen's defense we must remember  in both ancient Greece and Rome it was considered sacrosanct and illegal to dissect a human body.  In fact, it was illegal to even touch a corpse except for preparing it for burial.

Shute said:  "Galen was a brilliant man, and did an immense amount of good and useful work; but I believe his great egoism and his now very evident lack of candor in not stating frankly that his anatomy was mostly monkey anatomy and not human anatomy, struck a deadly blow at the development of science of human anatomy, the baneful effects of which lasted for over a thousand years." (7, page 198)
Even in the 16th century dissection of a human corpse was illegal without permission. While Sylvius probably obtained a legal corpse, most dissections were performed on bodies stolen from cemeteries.

By his coming out in the open with his discovery, Vesaleas, as observed, came head to head with his colleagues in the medical community.  His fellow physicians ridiculed him to the point he had no choice but to leave Paris without a degree. (4, page 158)

Surely this set him back for a while, but it did not slow him down. Surely there were other men like Vesalius, men who lived during the past 1000 years, who had suspected Galen of being wrong.

Yet Vesalius had access to something that none of those men had: the Gutenberg Printing Press.  It was invented in 1448 by Johannes Gutenberg, but by 1537 the press had become commonplace, and just about all great minds eager to publish a book had access to it.  Vesalius needed it big time in order to return medicine to western civilization.

Vesalius was hired as professor at the University of Padua in 1537 (3,4) and decided to dissect the bodies himself. His colleagues wondered why he would waste his time considering Galen had described the human body so perfectly. "Learning from dissecting is a waste of time," they said, "and all that was needed could be learned simply by opening up one of Galen's books." (3, page)

Yet Vesalius persisted, and he got his way.

Later that same year he becomes a medical doctor and was appointed to "lecturer-demonstrator" of anatomy and surgery.  From sun up to sun down, three days a week, he demonstrated and lectured about the human body in front of ever growing crowds of medical students.  (4, page 158)

To mark his independence from Galen, Vesalius arranged a public dissection lecture in which he demonstrated over 200 differences between the skeleton of apes and humans, while reminding his audience that "Galen's work is based on the dissection of apes."

His fellow professors, including his old instructor, cried foul.   Sylvius wrote letters explaining how crazy Vesaleas was, and even called him a "mad man." (2, page 159)

Yet despite their cries, Vesaleas was the one who laughed last.  He was the one who was noted to be correct by history. He was the one who became famous for his observation.  He was the one who became so popular that within a few years he would have enough money to hire an artist by the name of jan Stephen van Calcar to draw the human body as it was being dissected by him.  

Figure 4 -- Andreas Vesalius published the first accurate book of anatomy
on the printing press at Basle in 1543.  While the book in and of itself was
controversial, the title page shown here shows an engraving of
the teacher and his students examining a cadaver. (6, title page)

This book was published in the year 1543 in Basle when Vesalius was only 28.  This first accurate book of the human anatomy was called De Humani Corporuis Fabrica, or "The Fabric of the Human Body." It consisted of 700 pages, and the title page was an image consisting of the teacher and his students studying a cadaver (figure 4), which in itself must have been controversial.  (5, page 89)

This was a major scientific breakthrough, and the spark that would end the dark ages of medicine and the dawn of the scientific revolution.  From this point on human anatomy would be taught based on accurate pictures and descriptions, as opposed to Galen's ignorant descriptions. 

He continued to meet fierce opposition from his fellow professors with chants such as: "You are ruining our reputation!" They shouted such filth at him in the halls of the university he worked.  They accused him of crimes.  Many wrote books against Vesalius.

So, instead of completing more medical work, he spent the next 20 years fighting to get others to recognize the importance of the Fabric.

One can only imagine what such a great mind could have accomplished if he had been allowed to dedicate his time to performing more work, as opposed to defending his position.

This was just the way it was in the 16th century: statements of scientific fact did not come without a fight.

Yet it was a fight worth fighting. Thanks to the courageous acts of Vesaleas  the spark that was lit under the medical community grew into a full and flourishing flame within a few years.

Figure 5 --This engraving shows Vesalius displaying the muscular system
 of a human arm.  This was among many engravings displayed inside his
book that were created by jan Stephen van Calcar. 

Historians like John Hudson Tiner now recognize Vesaleas's discoveries about Galen's lies as one of the top ten most important medical discoveries of all time. Yet unfortunately Vesalius never lived to see its acceptance into modern medicine.  His later travels took him out of Europe and nothing is known about when nor how he died.

Although there are theories.  In his history of medicine, the father of modern medicine, William Henry Osler, explained one theory:  (2, page 160).

"The story is that he had obtained permission to perform a post-mortem examination on the body of a young Spanish nobleman, whom he had attended.  When the body was opened, the spectators to their horror saw the heart beating, and there were signs of life!  Accused, so it is said, by the Inquisition of murder and also of general impiety he only escaped through the intervention of the King, with the condition that he make a pilgrimage to the Holy Land.  In carrying this out in 1564 he was wrecked on the island of Zante, where he died of a fever or of exhaustion, in the fiftieth year of his life."

Regardless, Vesalius is a hero in every medical history. Actually, it wasn't Vesalius alone who saved medicine, as there is another hero in our story, and his name was Johannes Gutenberg.  Gutenberg provided the kindling, and Vesalius used it, figuratively speaking, to create a raging fire of knowledge.

Shortly after his death, ancient Greek medicine returned west, and was transcribed from Arabic back into western languages.  Yet along with the old wisdom came a plethora of new remedies and a young pharmaceutical profession. (5, page 75, 82)

References:

1. The John Hopkins Hospital bulleton," (volume XV 1904), "from the epoch of the Alexandria School (300 B.C.)"
2. Osler, William, "The Evolution of Modern Medicine: A series of lectures at Yale University on the Silliman Foundation in April, 1913," New Have, Yale University Press, 1921,
3. Tiner, John Hudson, "Exploring the History of Medicine," (the conversation in this post is based on the writings of Tineralthough the actual words are made up by me). 
4. Magner, Lois N, "A History of Medicine," page 160
5. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
6. Vesalius, Andreas, "De Humani Corporis Fabrica Libre Septem," 1555,
7. Shute, D. Kerfoot, "The life and works of ndreas Vesalius," Old dominion journal of medicine and surgery, Tomkin, Beverly R. Tucker, Douglas Vanderhoof, Murat Willis, R.H. Wright, editors, 1910, Richmond Virginia, The Old Dominion Publishing Corporation, pages 195-211

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1453: The world wakes up to science

Nicholas Copernicus (1473-1543)

From about the time of Jesus to the Renaissance of the 16th century, there were few advances in medicine and science. The Greek terms asthma and dyspnea had made their way into the vocabularies of physicians, yet little was considered about their causes. Theories speculated air contained a life-giving substance, although what it contained was left to speculation.  That was all about to change. 

Up until this time the works of the famous Greco-Roman physician Claudius Galen of the 2nd century were considered the gold standard in medicine.  Science wasn't needed, because everything any physician could possibly need to know about any diseases and air was in one of Galen's books 

Galileo Galilei (1564-1642)

This started to change when the dark ages ended with the fall of Constantinople in 1453. This is believed by many historians to have ended the dark ages and sparked a Renaissance where lost Greek and Roman wisdom was recaptured.

It was in 1514 that Galen's reign as supreme master and god of medical superstitions took a major hit. This was the year Nicolaus Copernicus was questioning the belief that the Earth was the center of the Universe and started writing his theories about the earth rotating the sun. Out of fear of being rejected and maybe even killed, his works weren't published until eight years after his death in 1543.

This one event got many people to thinking, or, better yet, inspired thinkers to become courageous, thus gave birth to the age of reason, or the Renaissance. This was a time people started questioning the views that were etched in stone by the Ancient Greeks and followed through the Middle Ages.

This was a time of fresh ideas based on science as opposed to superstitions and false logic. New ideas were formed in physics, astronomy, biology, chemistry, alchemy and medicine.

Copernicus was the first to use scientific research as opposed to superstitions in science (at least he was the first to publish such results).

Perhaps among the most significant contributions to science came from Nicolaus Copernicus (1473-1543), who in 1543 discovered that the planets revolve around the sun.  Out of fear of persecution, his works weren't published until after his death, although they had an astounding impact on other great minds, thus opening the door for the scientific revolution that followed.

Galileo Galileo was the first to oppose the Church during his lifetime. As a result Galileo became famous, and because of this he is now called the father of modern science.

In 1609 Galileo Galilee  (1564-1642) invented the telescope,  (1, page 255), and continued on to make astronomical observations that supported the works of Copernicus.  He had the courage to face the dogmatic Church, and published his works during his lifetime.  As a result, he was arrested for heresy and spent the rest of his life under house arrest.  His energy, courage and sacrifices, however, made him a significant player in the scientific revolution.  By history, he is considered among the fathers of modern physics and science.

Fielding Hudson Garrison, in his book "Introduction to the history of medicine," said that the works of investigators such as Copernicus and Galileo, and other such great men, also had an impact on medicine.  For example, in 1600 Galileo invented a "rude thermometer or thermoscope, and as early as 1600 (Johannes) Kepler had used pulse-counting to time his astronomic observations."  (1, page 258)

Surely investigators studied the stars and planets, they also studied plants, animals and humans, learning much about anatomy, how life is created and sustained, and about diseases.  Also investigated was the air we breathe, and its relationship with the sustenance of life.

Thanks to these two men, over the next few hundred years diseases like asthma would be better understood, and theories about air and the purpose of breathing would be proven false and replaced with scientific fact.

References:

1. Garrison, Fielding Hudson, "Introduction to the history of medicine," 1921, 

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1095: Crusaders return medicine to Europe

People of all classes joined the crusades for various reasons:
some to take Jerusalem back, some to be freed from landlords,
some to make money, and some to be freed from sin.
Photo from religionwiki.mvcsnow.org

Most people don't realize this, but the Christian crusades that took place during much of the 8th, 9th, and 10th centuries were peaceful. Christians believed the trek would absolve them from their sins, and the Muslims welcomed the Christians. This was a great thing as far as our medical history is concerned, as the Christians returned to Europe, they brought with them medical wisdom.  (1, page 106)

This all went fine and dandy until the 10th century when the caliphs of Palestine imposed a tax on those seeking to visit the Holy Land.  It was this tax that ultimately lead to war between the Christians of Europe and the Muslims of Palestine. This was fine for Pilgrims with money, although the poor pilgrims often had to wait at the gates of Jerusalem for some rich person to pay their tax.  (1, page 106)

Historian Thomas Bradford explained what happened next: 

The sum from this tax was a mine of wealth to the Moslem governors of Palestine. At the close of the 10th century it was thought that the end of the world was at hand, the thousand years of the Apocalypse was near completion, and Jesus Christ would descend upon Jerusalem and judge mankind. Panic seized the weak, the credulous, and the guilty; forsaking their homes, kindred and occupation, they hastened to Jerusalem to await the coming of the Lord, imagining that their pious pilgrimage would free them from sin. The road from the West of Europe and Constantinople became a great highway of pilgrims and beggars; the monks, the almsgivers of the times, were obliged to refuse aid to the hordes; many lived upon berries that ripened on the roadways. Swarms besieged the Holy Land; the Turks were annoyed by the number that overran their country . . . they plundered them, beat them with stripes, and kept them for months at the Holy Gates in lieu of the golden bezant for admission. The day of judgment did not come, and so pilgrims a few at a time returned to Europe and told of their sufferings. These cruelities became the wrongs of Christendom. Fresh hordes now hastened on the difficult journey, sure of gaining the favor of heaven by visiting the holy sepulchre. (1, pages 106-107)

So you can see that the crusades were not an attempt by Christians to force their religion on the Muslim people.  It was merely an attempt to continue visiting the Holy land, something that the Muslims had no problem with for over 300 years.

It was these events that incited the wars.  Bradford said:

In 1095 there appeared one Peter the Hermit, a man enthusiastic, chivalrous, bigoted, and probably crazy. He had been a monk of Amiens, and previous to this a soldier. He had visited Jerusalem and was filled with indignation at the cruel persecutions inflicted on the Christian pilgrims. He returned to his home and began a crusade of wild preaching against the abominations of the infidels and their defilement of the Holy Places of Jerusalem and Palestine. He called upon the people to arm against the infidels, incited the clergy, and aroused the enthusiasm of the people and nobles. Musing in Palestine he planned to rouse the powers of all Christendom to rescue the Christians of the East from the thraldom of the Mussulmen, and the sepulchre from the infidel. Peter told his views to Simeon, Patriarch of the Greek church at Jerusalem, and this good prelate sent letters to the pope and to the monarchs of Christendom telling of the sorrows of the Christians of Jerusalem and urging that arms be taken up in their rescue. Peter now hastened to Italy. Pope Urban II. sat on St. Peter's throne. He listened to the sad story and read the letters and appeals. At the Council of Clermont Urban gave Peter full powers to go forth and preach his holy war to the Christian nations of the world. (1, page 107-108)

The crusade had now become an effort to help the Christians who feared that they would not be saved if they did not reach the Holy Land.  Bradford continued: (1, pages 108-109)

The nations were aroused; eternal rewards were promised to all who assumed the red cross; halt and lame, women and children, the pious, the fanatic, the needy, the dissolute, all enrolled themselves in this remarkable army. Walter the Penniless set out with the first army in the spring of 1096; each one was his own leader. Soon other bands were formed. It is said that 300,000 men, women and children of the lowest of Europe spread themselves over Hungary and Germany. (1, page 108)

They robbed and murdered, and in self defense the Hungarians were obliged to fight with them. Walter straggled on to Constantinople with his horde. Peter the Hermit was not far behind him. He led another rabble, and riot and rapine went with him. It was everywhere; all Europe was mad. This rabble did not conquer the Holy City, but a more orderly and soldierly expedition was organized under certain noble knights, among whom was Godfrey of Bouillon, duke of Lorraine, and count Raymond of Toulouse. Several armies were raised and marching by different routes united at Constantinople. He besieged several cities, among which was Antioch; at this place, when the Christian host were worn and tired, Peter had a vision in which he saw the lance that pierced the side of Christ, and telling where to dig they found it. He had another vision and was directed to carry the spear at the head of the army. Dreaming became contagious; other monks had dreams. So time passed; Antioch was taken, battles were fought, disruptions were prevalent. At last Godfrey set fire to his camp at Archas and set forward in the night. After a march of several hours the sun rose, and before our army lay the sun kissed towers of the holy city. The soldiers knelt upon the ground exclaiming, "Jerusalem, Jerusalem," in pious joy. After a long and bitter siege, on July the 15th, 1099, the city was taken, the Christians were free. (1, pages 108-109)

Bradford said these crusades had a very important impact on medicine.  To take care of the sick and wounded, hospitals were set up, and many were staffed by Jewish and Christian physicians from Europe. After the war many of the crusaders became free from serfdom, and for this reason many "devoted themselves to liberal arts, commerce, science and medicine." (1, page 109)

As the wars came to a close physicians returned to Europe, only they had increased their knowledge of medicine.  With them they brought medical books that were written by ancient Greek and Roman physicians, although these now needed to be interpreted back into European languages. (1, page 109)

Along with better medical knowledge, and better medicine, the profession of pharmacology made its way to Europe.  Evidence of early apothecaries can be seen in England in the 12th century, said Bradford.  Prior to this time physicians of Europe prescribed the medicine and made the medicine. (1, page 110)

Initially, however, apothecaries weren't much of an improvement, as, according to Bradford, "for the most part, the pharmacies were the places in the cloisters where the monkish physicians stored their drugs and simples."  (1 page 110)

When Constantinople fell to the Turks in 1493, this is credited by many as the beginning of the Renaissance, a time when a dark ages of medicine occurred in the east, and the light started to shine again in the west. When this occurred, many other Greek classics made their way from Byzantine to Europe, thus opening the minds of Europeans. (2, page xxi)

References:

1. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
2. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons

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570-1070: Arabs save medicine

As we study medicine it's essential to understand that one author, one physician, one scientists, cannot make accomplishments in medicine without the accumulated knowledge of all who came before him. Lacking such wisdom, no progress in medicine can be made. Stated another way, it would be impossible to hunt for cures without having prior knowledge of such cures.  

Lacking access to knowledge, every person must start from scratch, and by the time he passes away he'd learn no more than the men before him. Thanks to writings, and schools, one man can be taught all ancient wisdom in a few years. Instead of spending a lifetime relearning old wisdom, he can now study something new. He can think of, invent and discover new things.

When the last rung of the Roman Empire collapsed in 476 A.D., the west cast aside all such accumulated wisdom in favor of the Bible. This, perhaps with the help of the Black plague, helped send western civilization -- mainly Eastern Europe -- back to a primitive era where the only medicine was religion. All other knowledge, including medical knowledge, was the antithesis of the road to heaven.

During the same time western civilization was turning a blind eye to wisdom, Islamic nations were becoming united by Islamism under the name of Muhammad. By their new religion the Arabs, Muslims, ultimately gained control of Egypt, Syria, Persia, Northern Africa, Islands of Sicily, Rhodes, and Crete. They even gained control of Spain in 720.  (1, page 122)

Similar to Christians, Arabic civilization believed the Koran contained all necessary wisdom, with all other knowledge being "superfluous," proven by the destruction of Alexandrian libraries and schools during the Egyptian conquest. Yet it is believed that the people of this Arabic civilization, even though they had a newly created language, were so poorly educated they couldn't even read their own Koran. (1, page 122, 125)

This changed during the life of Mohamet, of whom, "according to Islam, was the last messenger of Allah." He lived from 570-632, according to dictionary.com. Mohamet wanted to inspire his people to read, and so he told his people he obtained his wisdom after inspiration from heaven. It was this encouragement that inspired the education of the Arabic civilization.  (1, page 124-125)

Mohamet told the story of how Gabriel came down from Heaven and said to him: (1, page 124)

Read -- added the angel -- in the name of God, the Creator.
He formed man by uniting the two sexes.
Read in the name of the adorable God.
He taught man the use of the pen.
He filled the soul with the light of science. (1, page 124)

So by the time Spain was conquered by the Arabs, learning was encouraged by Arabic leaders.  Ancient writings preserved in Egypt and Spain were transcribed to Arabic and studied by anyone eager to learn. 

Among the people driven from Rome in the 5th century were the Nestorians.  They were the followers of Nestorius (386-450) who was chosen to be Patriarch (Archbishop) of Constantinople by Emperor Theodosius II (401-450). He was consecrated in 428 and almost immediately started to make an impression.  In 430 he was condemned for heresy by a majority of his fellow bishops.  The condemnation was ratified by Theodosius and confirmed by Pope Sixtus III (died 440).  He retired to private life, although in 435 he was banished to the Oasis of Upper Egypt.  (3)(6, page 51)

His followers were allowed refuge in Persia. They established a school at Edessa in Mesopotamia, which was, according to historian Thomas Bradford, the "Athens of Syria.  It became the home of many scholars.  Many Greek and Latin works were translated into Syriac... Here on the Euphrates learning once more found a home.  A college and several schools were established." (6, page 51)

Bradford said the "Nestorians were given free exercise of their religion, and they were entrusted with the education of the children of the great Mohammedan families.  He said:

The Nestorians were the depositories of the old Greek medical knowledge. They revered the old names, and collected with great assiduity all the works on medical topics of all the former schools. Pupils hastened to their schools from all directions, and they were able to study practical medicine in a public hospital, probably the first institution of the kind... And this was the commencement of the great school of the future at Bagdhad. (2, page 51)

Speaking of Baghdad, another person who helped advance medicine in Persia was Almanzor (938-1002).  Bradford said Almanzor was responsible for the establishment of Baghdad and the establishment of the first Baghdad college.  He said: (2, page 57)

All the scholars rejoiced, and dreamed of a new Alexandria. Bagdad, the home of the caliphs, the city of the Arabian Nights, city of magnificance, and capital of the Saracens, was situated on the west bank of the Tigris river. In the old days its population was about 2,000,000. It is said that the caliph Almanzor was attacked by a dangerous disease, and sent for a physician who had been of the Nestorian school. Being restored to health by this physician, the caliph learned the value of the healing art, and became a patron of knowledge. Almanzor now made his new and beautiful city the home of the arts and sciences. He invited all the philosophers to visit him, no matter of what religion. It was not long before the cultivators of mathematics, astronomy, medicine and general literature abounded at the court of Almanzor. A medical college was established; there were public hospitals and laboratories for the benefit of students. So great was the culture of the medical faculty that power was given to it to examine all persons who intended to devote themselves to the study of medicine. So great was the number of professors and students who flocked to that centre of learning that at one time it contained six thousand professors and students. Almanzor enriched his new city with a great number of works on medicine, astronomy and philosophy, which he caused to be translated from the Greek. He had the works of Aristotle, Galen and Ptolemy translated, and these labors were continued by his successors.  (2, page 57-58)

Learned scholars banished from Europe in the 6th century were allowed to take refuge in Persia.  They were allowed to continue their studies and even set up schools where they became teachers.  When Arabs conquered Persia in the 7th century, ancient writings were transcribed and taught to Arabic scholars, who absorbed the wisdom eagerly, paying special attention to the works of Aristotle and Galen. To facilitate teaching they even set up hospitals.  (1, page 123)

The importance of education was appreciated so much that a school of medicine was set up in Baghdad. V. J. Fourgeaud said in 1864:

"So Great was the estimation in which their learning and skill were held, that, notwithstanding the intolerant spirit of Mohammedans, they were permitted the free excess of their religion, and were entrusted with the classical instruction of those of the Moslemin whose education was most cared for.  Aristotle, Pliney, Theophrastus, Dioscorides, Galen, and other element authors (were translated to Syriac, Hebrew and Arabic)." (1, page 124)

Before this time the medical profession was open to all who chose to participate in it.  The Arabs passed laws requiring a diploma from a medical school.  Greek and Roman physicians gathered their own herbs and medicinal supplies from grocers and created their own internal remedies.  The Arabs were the first to create a separate profession, the druggist, who was responsible for creating and preparing medicine. (1, page 124)

The pharmacy profession was established.  They created rules for preparing drugs, which was an advancement to the old system where each physician had his own cook book of medicinal recipes.  The first pharmacopoeia (book of drugs) was created.  (1, page 123)

The Arabs also conquered Spain, and it became the most prosperous county in the world.  Of this, Fourgeaud said:

"Agriculture, commerce, manufacturers, wealth and population are represented to have flourished to such a degree... that, in reading accounts left by historians, as suspicion of oriental exaggeration is often forced upon the  mind.  It is not, therefore, surprising that, in speaking of the Arabs, the Spaniards of that time are represented as saying: 'They have taken our land, but they have covered it with gold.'" (1, page 128)

While other countries in Europe were on the decline, Spain became the "literary and scientific sceptre."  Seventy libraries were opened in Cordova, The medical schools were so great people came from all over the world to be educated.  Even Christian princes in need of medical help traveled there and trusted their lives to the Arabic physicians.  (1, page 128)

With the treasures of the ancient world available to the conquerors of Persia, they were now thrust to the "head of the scientific world."  (1, page 124)

Such was the way for the next 500 years, until this prosperous Arab world came to a halt.  They were driven from Spain by Ferdinand and Isabella, and they then sunk back into the world of ignorance. (1, page 128)

Since the fall of Arabian medicine sometime during the end of the 13th century, "Arabia has been in mental darkness and superstition,"  said historian Thomas Bradford in 1898.  While eastern civilization moved into a dark ages of medicine, western civilization moved out of theirs. (2, page 77)

So we can honestly say that we owe true thanks to the Arabs of the middle ages for saving medical wisdom.  They borrowed medical knowledge from the ancient world, improved upon it, and returned it to the western world of which it came.

References:

1. Fourgeaud, V.J, "Historical Sketches: Medicine among the Arabs: XXI, Intnroduction," Pacific medical and surgical journal, vol. 7, ed. V.J. Fourgeaud and J.F. Morse, 1864, San Francisco, Thompson and Company, pages 122-130
2. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
3. "The Heresiarch," Catholic Encyclopedia, http://www.newadvent.org/cathen/10755a.htm, accessed 10/29/13

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502-575? A.D.: Aetius uses a painful asthma remedy

Teddy Roosevelt once said he'd rather get rid of all his asthma medicines because most seem to make him feel worse.  Perhaps there is no better example of this than a remedy proposed by an ancient physician named Aetius.

He was born a Christian in Amida in Mesopotamia, was educated at the school of Alexandria, and practiced in Constantinople near the end of the 5th century or beginning of the 6th.   He was another of those famous physician who recopied the works of all the ancient physicians who came before him, mainly Hippocrates and Galen. His works voluminous works were published in Tetrabibles. (1, page 65 and 2, page 3)

He believed in many of the ideas of both the Humoralists and Methodists, and he added in some ideas based on his own observations. He described smallpox, fevers, and he attributed "'ringing in the ears' to the oscillations of the pneuma, or vaporous spirits, in the interior of the organ of hearing." (1, page 66)

Of interest of us is to note he "made frequent use of both the actual and potential cautery -- such indeed a few surgeons would advise, and still fewer patients be willing to endure it in our day."  (1, page 66)

So what about his remedies?  Like many of his predecessors he based many of his remedies on "incredulity and superstitious practices."  Some of which include amulets, charms and incantations.

But what is his remedy for asthma?  Yes, and that's what I'm getting to.  Note above that I mentioned he made bold use of the cautery.  Yes, that means, as is noted at the Freedictionary.com : "An agent or instrument used to destroy abnormal tissue by burning, searing, or scarring."

He believed cautery was a good remedy when the disease was "incurable or among the most difficult to treat."  And it's for this reason, perhaps, he believed it was a viable remedy for asthma, pthisis (tuberculosis) and empyema (inflammation of pulmonary sac).  As noted by V.J. Fourgeaud:

"In Chronic asthma, in phthisis pulmonalis and in empyema, he applied two cauteries on the upper part of the chest near the articulation of the clavicle with the sternum, taking care not to injure the trachea; two smaller ones beneath the under jaw, near the carotid arteries, one at each side, being careful to prevent them from penetrating more than skin-deep; two more below the breasts, between the third and fourth ribs; two on the back, near the fifth and sixth ribs; one a little above the xiphoid cartilage; two between the eighth and ninth ribs, and three along the course of the spine, one in the centre and one on each side.  A circular form for the eschars, is recommended by him, as tending to protract their healing, and he makes his prognosis of the recovery or death of the patient depend on the quantity of humors furnished by the suppuration which ensued." (2, page 67)

Um, no thanks!  What do you think?

References:

1. Fourgeaud, V.J, "Historical Sketches:  XL  Medicine from the time of Galen to the Arabic Period," Medical and Surgical Journal, edited by V.J. Fouregaud and J.F. Morse, Volume VII, 1964, San Francisco, pages 60-72
2. Wilkes, John, editor, "Encyclopaedia Londinensis, or, Universal dictionary of arts, sciences, and literature, volume 1,  1810, London

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476-1543.: Medicine survives the dark ages of medicine

Between 476 and 1543 A.D., medicine in western civilizations entered a dark age. Except for a few random collections, the knowledge of Hippocrates and Galen was lost and forgotten. People resorted to primitive methods of using superstition and religion to explain health and disease. However, thanks to Arabic physicians, medicine survived these dark ages by a thin thread.

While the Greeks and Romans were concerned with cleanliness, with the Romans connecting cleanliness with good health, peasants of the middle ages had no use for such nonsense.  The lack of the peasants ability to take baths was noted by the Bible as acceptable:    (2, page 85)

"Does your skin roughen without baths?  Who is once washed in the blood of Christ needs not wash again."  And St. Paul noted: "All things were 'counted dung but to win Christ.'" (2, page 85)

European peasants had no use for performing autopsies, and no time to do it either. They saw even touching a human corpse as morbid, disgusting and counterproductive. (2, pages 84-6)

Again, this was inculcated by the Bible, which preached that the only knowledge that was useful was Biblical knowledge that lead you on your way to heaven. (2, pages 84-6)

During this period Greek knowledge, and even the ancient Greek language, was unknown in western Europe.  This was unfortunate because, as medical historian Edward Withington said:

At this time Greek was still the key to all higher knowledge, especially in medicine.  Latin versions of some Galenic treaties, indeed, existed, yet they were so little known that Constantine the African could boast in the eleventh century that he was the first to translate that author.  Celsus, whose work might have formed an excellent text-book, was almost entirely forgotten." (1, page 176)

With a few exceptions, most people didn't need natural remedies and physicians to treat diseases, and they didn't seek to know the diagnosis nor the prognosis of diseases.  Instead, they lived the hard life, and prayed to God for health and for healing. All they needed, as Osler noted, was the Bible and the Church.

Yet not all was lost of the ancient way of life.  In the old world there were basically two groups of people, the: (4, page 2)

1. Elite or aristocrats:  They controlled wealth, religious institutions, government, bureaucracy. 
2. Peasantry: They did all the work.  They were the farmers, herders, builders and merchants.  They consisted of about 80 percent of the populace. (4, page 2)

In the middle ages this same system was maintained, although it was adjusted slightly.  The elite were called kings and queens, and the peasants were called serfs.  The system was called feudalism.

An interesting facet of this is that, despite their overwhelming majority, the peasants or serfs accepted this form of government perhaps because it was all they knew.  And while other forms of government may have been tried from time to time, such as the democracies and republics of Greece and Rome, none succeeded at motivating the populace better than the monarchy. (4, pages 6-7)

Another reason why this "elitist" system was so generally accepted may have been due to the Bible, which encouraged human beings to accept peasantry as your role in life, your part in the scheme of life that God intended for you.  (4, page 2-5)

The feudal system was such that those who obtained the most land, or control of the most resources, obtained the most power.  These are the folks who formed the Aristocracy.  They formed the family of kings and queens who made the laws to organize and motivate the peasants to farm and herd the land, build structures, and sell the merchandise.  The aristocracy represented God, and you were therefore obliged to honor and respect them.  (4, page 6)

Under this system the peasants had no identity. They worked 12 hour shifts every day year round, and even their kids were trained at an early age to do the work. There was little time for recreation, and little time to to sit around and wonder of a possible better way of life. It may best be explained by Norman Cantor: (4, page 7)

Some historians describe the ancient structure as a one-class system because other than in fifth-century B.C. Athens (always a significant exception) only one group -- the ruling elite -- had such a sense of identity.  Only the aristocracy had a distinct life-style, justified its own existence, loved itself as a class.  Not until much later did the bourgeoisie begin to develop class consciousness.  In the ancient world, only the elite knew things, knew how to do things, the ruling class was the only literate, conscious group in society.

So one can only imagine how easy it was for this aristocracy to shape the opinions of such a naive and ignorant populace. And one can also only imagine how difficult it would have been for any knowledge of the old world to have made its way through this era. Although, thankfully, some ancient works were so voluminous, copied so many times, and saved by some few groups of people, and some few schools, that some ancient works managed to survive.

A thin thread of medicine survived by the following means:

1.  School of Salernum in Northern Italy:  Osler explains that the better educated in Southern Italy continued to speak Greek and understand Latin, and "the cathedral and monastic schools served to keep alive the ancient learning."  Among the most significant was the School of Salernum "which for centuries kept alight the lamp of old learning, and became the centre of medical studies in the Middle Ages; well deserving it's name 'Civitas Hippocratica.'" (2, pages 86-7)

2.  Conquer of Spain allows for the rise of Arabian Medicine:  Ancient Greek and Roman medicine continued to be studied in Spain.  Mohamet was, according to Islam, was the last messenger of Allah, and it was he who encouraged Muslims to learn as much as they could.  So by the conquer of Spain in 720 A.D., the environment in the east had already been created that was conducive to learning.

The Arabs now had access to the wisdom of the ancient sages of Greece and Rome, although they were all in Latin.  Osler explains that by the end of the 9th century the Arabs translated much of the Ancient Greek and Roman writings, and were able to use this knowledge to further advance science and medicine.  A perfect example here is Rhazes who defind smallpox,  Maimonides who wrote a treaties on asthma, and Avicenna who was known as the Prince of Physicians.

Thomas Bradford said medicine started its transfer from the west to the east as early as the time of Charlemagne (742-814), "though it became more marked in the following centuries." (7, pages 74-75)

Beginning with the crusades knowledge started to make it's way back to Europe.  Men like Constantinus Africanus translated the works such as Hippocrates and Galen  from Arabic back into Latin at Salernum.  The works of Rhazes, Maimonides, Avicenna and others were likewise translated for Western Europe.

The Muslims added little knowledge to anatomy considering the Muslim religion also prohibited autopsies, but they did add quite a bit to knowledge of diseases, and provided the Europeans with quite a few additional herbal remedies. (2, page 91- 104)

To learn more about how the Arabs saved medicine click here. 

3.  The rise of universities in the 13th century:  Around the 14th century associations of persons with particular skills started to form during the Middle ages, otherwise known as universities.  These were places where people could share ideas and study.  Universities in northern Italy were mainly controlled by students from various nations.  The students arranged lectures and hired teachers.  Yet those of Paris were controlled by the teachers.

Knowledge of ancient writers, especially Aristotle and Galen, were preserved by such schools in Italy and Spain.  The Arabs gained access to this resource.  Books of Avicenna, Albucasis and Rhazes were also studied.  Study of human anatomy was encouraged for the first time since Galen's day, and a book of anatomy (or at least a book on how to perform autopsies) was published by Mundinus in 1316, "a book that served as a text book for the next 200 years."  It was difficult to get a body for autopsy, and permission was often required, although it was accomplished.  Usually the bodies were those of condemned criminals.  (2, page 106)

Science and medicine were not advanced in the west until around 1543 when a man named Andreas Vesalias published a book called De Humani Corporis Fabrica in 1543.  For the first time in over a thousand years medicine was once again moving forward. Yet that would be a fear years down the road.  For now, the most amazing development during the Dark Ages of Medicine was Arabic Medicine, which will be discussed in an upcoming post.

Read about AndreasVesalias by clicking (to be published 3/28/13).
Read how medicine survived the dark ages by clicking (to be published 1/15/13).
Read the end of the Dark Ages of Medicine (to be published  10/1/13)

References:

1. Withington, Edward Theodore, "Medical History from the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press. 
2. Osler, William Henry, "The Evolution of Modern Medicine: A series of lectures delivered at Yale..." page 85
3. Meryon, "
4. Cantor, Norman F, "The Civilization of the Middle Ages: A Completely Revised and Expanded Edition of Medieval History," 1993, first edition, Harper Collins Publishers
5. Cantor, Norman, "The Civilization of the Middle Ages: A Completely Revised and expanded Edition of Medieval history: The Life and Deal of a Civilization," 1993, Harper Collins Publishers, New York
6. Johnston, Harold Whetstone, "The Private Life of Romans," 1908, Chicago, Atlanta, New York, Scott, Foresman and company
7. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey

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