HISTORY OF MEDICINE
The school of Salerno: 10th century
Medieval Europe’s first college of higher learning is founded, probably in the 10th century, at Salerno. It is a medical school. It will be a long time before the medical education on offer at Salerno results in any new discoveries, for the prevailing mood is uncritical veneration of every word written by Galen – even when his theories seem directly opposed to practical experience.
But Salerno is significant not only in the history of medicine. It is also the start of Europe’s university tradition.
Surgeon and dentist in Spain: AD c.1000
An Arab doctor, Abul Kasim, is court physician to the emir of Cordoba. He writes Al-Tasrif, the first illustrated manual of surgery. It is widely copied and used throughout the Middle Ages.
He is also the first surgeon to take an informed interest in dental matters. Chapters in Al-Tasrif give Advice to dentists on basic procedures such as extraction of teeth, but also deal with much more modern concerns – including the removal of plaque.
An anaesthetic of the 13th century
A manuscript of about 1265 contains the first detailed description of an anaesthetic, though similar mixtures are believed to have been used in the Alexandrian school of medicine 1000 years earlier.
The doctor should mix in a brass vessel specific proportions of opium, hemlock and the juice of mandragora, ivy and unripe mulberry. The mixture is to be boiled with a sponge, until all has been reduced and soaked up. The sponge should then be applied to the nostrils of the patient. When the time comes to wake the patient up again, after the surgery, a sponge full of vinegar should be applied to his nose.
Vesalius and the science of anatomy: AD 1533-1543
A young medical student, born in Brussels and known to history as Vesalius, attends anatomy lectures in the university of Paris. The lecturer explains human anatomy, as revealed by Galen more than 1000 years earlier, while an assistant points to the equivalent details in a dissected corpse. Often the assistant cannot find the organ as described, but invariably the corpse rather than Galen is held to be in error.
Vesalius decides that he will dissect corpses himself and trust to the evidence of what he finds. His approach is highly controversial. But his evident skill leads to his appointment in 1537 as professor of surgery and anatomy at the university of Padua.
In 1540 Vesalius gives a public demonstration of the inaccuracies of Galen’s anatomical theories, which are still the orthodoxy of the medical profession.
Galen did many of his experiments on apes. Vesalius now has on display – for comparison – the skeletons of a human being and of an ape.
Vesalius is able to show that in many cases Galen’s observations are indeed correct for the ape, but bear little relation to the man. Clearly what is needed is a new account of human anatomy.
Vesalius sets himself the task of providing it, illustrated in a series of dissections and drawings. He has at his disposal a method, relatively new in Europe, of ensuring accurate distribution of an image in printed form – the art of the woodcut. His studies inaugurate the modern science of anatomy.
At Basel, in Switzerland, Vesalius publishes in 1543 his great work – De humani corporis fabrica (The Structure of the Human Body). There are seven volumes including numerous magnificent woodcut illustrations. The book is an immediate success, though naturally it enrages the traditionalists who follow Galen. Galen’s theories have, after all, the clear merit of seniority. They are by now some 1400 years old.
But for those willing to look with clear eyes, the plates in Vesalius’s volumes are a revelation. For the first time human beings can peer beneath their own skins, in these strikingly clear images of what lies hidden.
Surgery: 16th – 17th century AD
In an age before anaesthetics, surgery is inevitably a limited branch of medicine. It is also considered a rather lowly craft, despised by doctors whose reputation is based on their knowledge of the approved authorities rather than clinical skills. Surgeons are linked with barbers, who also require sharp instruments to practise their trade.
The most frequent use of the surgeon’s knife is to open patients’ veins for blood-letting, also known as bleeding. This is the treatment most often prescribed by the learned physicians, because Galen has pronounced that fevers and apoplexy result from an excessive build-up of blood in the system.
However there is one area where surgeons are increasingly in demand from the 16th century, and where they rapidly learn and acquire new skills – on the battlefield. The arrival of artillery and muskets alters the nature of wounds. Instead of the clean cut inflicted by sword thrust or pike, there are now gaping holes of torn flesh and shattered bones.
The greatest surgeon of the 16th century, Ambroise Paré, rises from the humble status of a barber’s apprentice to become surgeon to the kings of France, and does so mainly through knowledge acquired in the treatment of war wounds.
Paré publishes in 1545 the first account of his military experiences under the title La Methode de traicter les playes faictes par Hacquebutes, et aultres bastons a feu (The Method of treating wounds caused by Arquebuses and other firearms).
His most significant discovery is that the traditional treatment of any gunshot wound (violently cauterizing it with boiling oil because it is assumed to be poisoned by the gunpowder), does considerable extra harm to the patient. Paré achieves much greater success by simply dressing the wounds with a mixture of egg yolk, oil of roses and turpentine.
Paré also makes advances in the use of ligatures for sealing blood vessels to staunch the flow of blood. As many as fifty-three are needed after the amputation of a thigh. Amputation is the only form of major surgery which surgeons of this period are able to practise, for it is not possible to make an incision with safety in the abdomen.
There is one exception to this – the removal of stones from the bladder. A medical text by Celsus, writing in Rome in the 1st century AD, reveals that this operation is performed in classical times. It is relatively easy to achieve because a large stone can be pressed by the surgeon’s finger hard against the patient’s skin for incision and extraction.
A famous patient, Samuel Pepys, is ‘cut for the stone’ in London on 26 March 1658. The operation is carried out by Thomas Hollyer of St Thomas’s Hospital. It takes place not in the hospital but in a large room in a house of one of Pepys’s relations. It needs to be large. The whole family gathers in case the event turns out to be a death scene.
With no effective pain-killer available (Pepys is offered rose water with white of egg and liquorice), the speed of the surgeon is all-important. The record for this operation in the next century is fifty-four seconds. Pepys survives, to begin his diary two years later. He has a cabinet built to display the two-ounce stone, and resolves to keep March 26 as a festival each year.
