Class given October 18, 2010 as part of series on "Lesser-Known Aspects of the Renaissance" for the  Senior University Georgetown's Fall 2010 program.
   See also: 1. The Early History of Printing        2. Neoplatonism, Humanism, Other New Philosophical Trends       3. Syphilis, Sex, & Society          (this is lecture 4)              5. Witch-Hunts               6 Summary            

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Slide 1: Title
Slide 2 We’ll focus especially on the life-career work of three pioneers of the early renaissance.

Today we will focus on three main figures who did their thing in the early Renaissance—Vesalius, the anatomist; Paracelsus, the wandering physician and quasi-mystic; and Pare, the surgeon; their stories each illustrating slightly different aspects of that amazing period.

Slide 3 In the last few lectures we reviewed some of the ways that science was just beginning. It was a worldview-shift from just daring to think what seemed reasonable and bowing to the authority of traditional sources  to daring to think for oneself, 

Slide 4..  to question authority, to doubt and check the evidence, to experiment.

Slide 5. First, I want to acknowledge the relative Eurocentricity of this talk and this series of talks. History is enormously complex. I was exposed mainly to Western history, but in my other readings since my teen years I’ve been impressed with how much was happening in India, China, and elsewhere, and this has only grown. Still, in terms of systematic history, writing down and exchanging writings, that did blossom in Europe as Jared Diamond noted in his book, Guns, Germs and Steel, analyzing what there was about Europe so that it came to dominate the world for a few hundred years. (By the way, that era may be drawing to a close as India and China are moving into and through their own industrial revolutions.)

     I also want to acknowledge that our culture tends to have been overly focused on what some postmodernist revisionists have objected to as the history of white European males—followed in the last few hundred years to include also North American white males. Even then, the histories of women, the lower classes, the immigrants, and especially of the non-white populations are only recently being unearthed. I want to acknowledge that these are important histories, full of lessons to be learned.

With that disclaimer, and not to privilege the stories being brought to the fore today as being necessarily more valid or true or worthy than other stories, still, even a biopsy of sorts, a narrow fragment of the great unfolding, can be instructive.

The point today is not to valorize all the heroes and villainize all their opponents, but rather to appreciate the complexity of the whole historical process.  to be discussed today, doctors practicing in the 16th century, were products of their era. They did espouse some ideas that challenged the established body of knowledge, but in other ways they carried on believing in many of the principles that we today might find quaint. So the first point to be made is that a pioneer may be making headway in some respects while at the same time being caught up in other ways that are deeply traditional.

Slide 6: Another preamble to all this, in appreciation of the nature of complexity. Folks aren’t just either great or terrible. Most people, including those whom we call great or devote attention to, on closer examination were a mixture, just like you and me, of strengths and weaknesses and a lot in-between, carrying forward the mainstream qualities of the era in which they lived.

Slide 7, pre-scientific erudite disputations. The mark of the learned. In Latin, not the vernacular!

Slide 8. There were in fact two levels—the academic physicians for the rich, the nobles, and each other—the established sources of truth—and the lower class of lay healthcare delivery agents, midwives, folk healers, quacks, barber-surgeons, etc. We spoke last time about academics and lay practitioners and their different uses of more or less expensive medicines and treatments for syphilis, as we talked about last time.

    So let’s consider the groundwork. Though Galen lived almost 1300 or more years earlier, there had been a freezing of tradition, a romanticization of it. It happened in religion, too, so it was not something to be surprised about. In Judaism, the extensive literature that was written for the years following the end of the Temple in Jerusalem was based on commentaries on the first five books of the Bible—the other books were also commentary, in terms of Law, but the first five books only, The Torah, was authoritative, the word of God. Then there were commentaries on the commentaries. But the base was the pure foundation. So that happened in a less precious way with the classics of medicine as they had been handed down.

9. Galen was then semi-deified. He made some valid observations, but also many invalid observations. Even before Christianity was established, there was some taboo on human dissection, so Galen was forced to use dissections of pigs, dogs, and barbary apes and extrapolate. He was right sometimes, wrong sometimes. But then it got made into tradition.

10. He was demi-sanctified.
11. Along with other key writers. There weren’t that many people daring to write. A couple of them were Arabs who wrote during the time of that civilization’s blossoming in the 9th and 10th century in Baghdad. They had also captured many texts from battles and conquests in cities once dominated by the Eastern Roman or Byzantine empire—whose capital had been Constantinople before it was changed into Istanbul around 1453— and for a while in the Dark Ages the intelligentsia of the Islamic civilization led the way in realms of chemistry, astronomy, medicine, and the other sciences.

12. So Avicenna was also revered—his name in Arabic was Ibn Senna, Ibn meaning son-of —
    And Rhazes - or al-Razi– was another...

13. Another avicenna

14. They carried forth the reasoning of the earlier classical natural philosophers, what is the world made of, what are bodies made of. .  The earlier Greeks leading to

15. The later views adopted first by Hippocrates and others—but note, it wasn’t always fours. Pythagoras was intrigued with 5s because they embodied the golden ratio, a geometric theme that deserves a lecture in itself. The ratio of parts of these line in pentagons being to what the whole line is etc.

16. The point being made is that this division into four is an imposition of prior attitudes, worldviews, imposed on perceptions. The Chinese also saw a division into five:

17. And found correspondences of all these basic phenomena that seemed to have five rather than four components, including the pentatonic scale of Chinese music—all the black keys—

Correspondences prove it, right! ?  Right?

18. More correspondences. We’ll see this kind of thinking in Alchemy and Paracelsus.

19. A certain amount of complexity is needed, too, to keep the knowledge of the erudite from the hands of the uneducated. This was also a motive for not teaching the bible to non-clergy.

20. Yes, it all matched up.

21, the humors, if someone was phlegmatic, they had too much phlegm. Make ‘em vomit or have diarrhea... stuff like that... or maybe that was for too much bile...

22... ditto for diseases caused by other imbalances. It explained everything, although esteemed colleagues might disagree, sometimes civilly, sometimes bitterly..

23. Take a breath and note. Also some of these classics were still coming into circulation during the 1400s, being translated, so there also was freshness and energy infused into the tradition! See, it must be so!

24. Apothecaries were gearing up their sophistication. Most of their work is now seen as traditional, superstitious, quaint, and if not actually making people worse, then ineffective..

25 If not mere quackery, which was also widespread.  What else accounted for madness or mental retardation if not sorcery or a stone in the head or both...

26. And so medicine progressed . . . hardly at all.

27. Anatomy was dominated by tradition.

28. The art of medical illustration was also traditional, such as this posture.

29. Alas, this approach to medical training continued, reading from traditional books, through the early 18th century.

30. But evolution of art towards perspective, which I discussed in the first lecture, and towards realism, was making rapid strides. Artists led physicians in trying to find out what was under the skin.

31. The great Leonardo and others followed. Observing closely.

32 the arm, pronation and supination, the revolving of the bones of the forearm, the structure of the elbow, the muscles that made this happen.. Fascinating!

33. Surface anatomy, the rippling muscles on the skin, needed to be based on deeper anatomy.

34. But prior expectations and authority isn’t to be ignored. In death, without preservatives, it gets sticky and messy in there and one cannot always see that things are not exactly as how they are expected to be.

35. Another view

36. Now this is an important picture. It isn’t right. It comes close, but how to do it? Perspective is getting better, but not perfect. Later artists made improvements to account for movement of the head. But the point is that expectations distort observations.

37. Others have tried, but art portraying chaotic swirls in nature requires some awareness of the nature of fractal mathematics...  It has taken 500 years to get this going..

38. So now let’s consider another Renaissance figure, not an artist, but trying to do the same thing, really observe, really do anatomy well. Really getting in there and looking for himself.

39 But by no means free of his time, nor am I, nor are you. He still bought into the idea that Galen was it.

40. But as he worked, several things emerged. He got more confident, enough to challenge discrepancies between his findings and Galen’s and write them, and portray them.

41  Several things came together. He collaborated with some not-top but pretty close artists and worked with metal engraving rather than wooden. New technologies of printing and illustrating allowed for finer details to be portrayed.

42. Here he is—well, woodcut could be good...

43.  But the opening plate of the first edition required metal engraving.
Interestingly, there were further editions, some had improvements, and in some, well, some plates weren’t as good.
       There’s a lot of symbolism in this picture.. It would take too long to describe.

44. But as with water and swirls, the brain looked chaotic. Vesalius, as careful as he was, didn’t know about the lobes of the brain, the temporal and parietal, and thus didn’t show them., although his teacher, Sylvius, who mocked Vesalius, did show them. Sometimes the old farts are right! History is mixed like this.

44. Let’s go on to other modalities.

45. One of the early conflicts Vesalius got into had to do with which side of the body to take blood from. The Galenists and early Greek writers suggested that it be on the same side of the body as the symptoms or lesion, but followers of Avicenna said it should be on the other side. Some of Vesalius’ dissections of the venous system were meant to help clarify this. The idea that bleeding might not be therapeutic was inconceivable.

46. It had all been worked out. It corresponded to the astrological signs that corresponded to parts of the body.

47. It was a whole thing, to learn this. Not that there was unanimity. Sometimes when there are several theories describing something, it may be less that one is right and the others are wrongs and more that none are right and the right answer is something else entirely.

48. But the field was moving. Guilds of apothecaries, now called pharmacists, were forming, and collaborating with docs, and seeking standardization—what should go into a given medicine, what should make it up, how much, what quality. Another irony. Savanarola, the fundamentalist who took over in Florence after the death of Lorenzo di Medici, and who himself was burned at the stake for going too far, helped promote this constructive program. So was he a good guy or a bad guy?  History leaves us hanging if we don’t insist on coming to such conclusions.

49. Now let’s turn to therapeutics. What should we do?  Follow Galen. That’s the default mode. And Avicenna. But not this fellow. The bombast in his name is no relation to the word bombastic, which is full of cotton padding, which is what bombast is. But he was. He was full of BS too, but had a bit of truth laced in. He was far more dramatic of a character who rebelled against the authority. Perhaps a hypomanic type, not one to be political, and so he got kicked out, expelled, from one place after another.

He re-named himself Paracelsus, beyond Celsus. Celsus was a Roman of the late first century who wrote about all sorts of stuff, including medicine, and was well-respected—once called “The Cicero of Medicine.”  Theophrastus took on the mantle of better than, outdoing Celsus. This guy was darn near a professional rebel. Once he was invited to give some lectures and dared to publicly burn a book of Avicenna’s and a book of Galen’s, really violently rejecting these folks.

51. He wrote a lot. Again, the fellow who writes a lot has a leg up.
   And he made claims to having traveled much of the Western world and picked up knowledge from all sorts of people, from folk healers and metallurgists and alchemists as well as doctors elsewhere. This map was put together by a later follower who made a sort of map based on Parcelsus’ reminisces buried in his writing.

52 What’s interesting to me is that he probably was 85 - 90 % wrong in his thick, obscure terminology, his insistence on being original, his metaphysical speculations. Many medical historians and historians of science rejected him because he was so weird.

53. He wrote about battle wounds, and wrote about other stuff.

54. In the background, in a laboratory, you can see some of the alchemical equipment. Yet there were some, esoteric writers—remember I talked about them 2 sessions ago—who found his alchemy and metaphysical speculations charming. And romantics in the late 1700s found his story to be engaging, that standing up to authority.

Paracelsus is a strange bird. He did some good. He re-introduced liquid opium tincture into the pharmacopea. The biggest thing that he’s credited with is his making the bridge to the emerging field of chemistry—still then rather crude alchemy, but soon to become more scientific in the next two centuries. Well, not soon—this stuff happened gradually.

Alas, Paracelsus’ own chemistry relied too heavily on mercury, which is a poison. He knew it, but only that it could be poisonous in large doses—but not in small doses. He was wrong about that, and participated in the spread of mercury treatment, which, like bleeding, made medicine for the next few hundred years rather barbaric. I talked about the toxic effects of mercury last time, in relation to the widespread treatment of syphilis.

55   Alchemy  Paracelsus was in line with the neo-platonic thinkers, the astrologers, magicians, he imagined devils and earth spirits. He rejected the domination of the 4 humors, though he partook of this model, but also introduced the idea of sulfur, mercury and salt, the active, passive, and modulating principles. He saw it in astrology among the signs of the zodiac, and throughout various operations. He related the trinity of alchemy to the Spiritual Trinity of the Church.

56, please note that alchemy was the closest thing to serious science of that era and for a couple of centuries later, only gradually to be supplanted by a more systematically truly scientific approach. Isaac Newton partook. The question was simple: How to explain the transformations of matter?  They didn’t know much —only beginning to in the late 18th, making some headway in the mid-19th. Chemistry is taught now as a basic science, but it’s really relatively knew on the stage of human affairs.

57. Let’s remember that Hermes Trismegistus was still a not-insignificant figure in esoteric thinking, and

58 magic was how stuff happened. Letters and symbols had power, and these symbols were actually used by Paracelsus as treatments!

59.   Ditto

60. Let’s turn to the last of our figures, Ambroise Pare.

61. He started as a barber surgeon. His turning point was at the Battle of Turin in the mid-1500s,.  The standard practice was to stop the oozing and cauterize a wound with boiling oil.  Owch. But that’s how it was done. In the middle of battle, they ran out of oil. Well, let’s just improvise, a poultice with rose water and egg yolks. He felt bad he hadn’t really treated the wound, but he found the next morning that the soldiers so treated were doing better than the ones with standard treatment. Whoa!

63, gradually he became more confident. He reintroduced ligatures, sewing closed the big arteries and veins rather than burning them with the red hot iron. Less infection, more healing. Actually, the Romans had used ligatures, but that was lost for a thousand years or more. Later in life Pare became established, recognized by kings. 

64 He wrote books that went beyond the standard texts. He wrote in french rather than Latin. He wasn’t terribly outwardly defiant, but quietly so, said his piece.

65 One of his students also began to think innovatively— regarding plastic surgery.

Conclusion

The point is that the scientific revolution was hardly that. It was the movement of thousands of people—these three just stand out more— and ebb and flow, gradual shifts of attitudes followed.

The idea that progress was possible took a lot of time to settle in. I was going to say “kick in” but that’s the point, it all happens very gradually.

Another point 67 is that we’ve embarked on probing new horizons in every direction.

68 We are beginning to do a kind of anatomy, peering under the surface, realizing the many aspects and manifestations of nature, perhaps even of God...
     — I plan to speak to the emergence of visionaries next Fall, people who are looking beyond with some hope

69. More horizons, more tools, and this is just in medicine...

70. Next time, another lesser-known set of events happening in the Renaissance. Here’s a gentle slide about that: Winifred..
























73: The Branca family in Sicily may have used this technique in the 1400s but regarded rhinoplasty as a family secret. The tradition of making new healing techniques available, beyond proprietary interest, had not yet taken hold.
    I wonder what’s happened to this ethos in the last half of the 20th century with escalating drug and equipment prices and patents and monopolies...

History changes slowly and with a complexity worthy of what we’ve been learning about nature—i.e., very complex. There may be innumerable factors and variables at play and each person then constructs a response that best fits personal, professional, and cultural needs. The Renaissance is especially notable for this mixture of forward-looking and yet backward anchored (mired? enmeshed?) approach.

The variety of publications was still becoming available. Some of the works of Galen were still coming to the surface and being translated from Arabic or Greek. So a word about Galen. He was the authority. He wrote a lot, he wrote with confidence, he asserted some things that were so, and a lot of things that were not so.  was still largely pre-scientific, traditionalist, ruled by the idea that those guys way back then really knew what they were doing and the best we can do is to respect our elders. None of this 1960s don’t trust anyone over 30 spirit. There wasn’t as much of an information explosion, so a newly translated book of Galen was a treasure source. As I said 2 lectures ago, these resources were coming available, and they were exciting. I’m trying to think of a present day analogy that had a similar widely cultural impact—maybe the discovery of King Tut’s tomb and the exhibits still going around based on this discovery 80 years or so ago!

A little past medical history. There was Hippocrates and some others, and then there was Galen—the point being, who wrote? And whose writings survived? And in what language did it come down, and how did it set the tone for what academic, scholarly, thoughtful practice should be? These traditions were not universally accepted, but in general they were, and they had authority, and knowing this stuff gave authority. Sometimes that was pretty phoney, though, because it involved a semi-scholastic test in how well one could throw around the BS in the proper manner. Sorry to say, but I’m not at all convinced that a great deal of academic writing doesn’t have this same problem—meaning that they say stuff, but I’ve grown just old enough and jaded enough to no longer be impressed. I ask in my mind, So What? What are we going to do differently considering that this or that may be true?  If it were not so, is what is being said so ambiguous that it would be impossible to disprove? There’s a lot of that, too.


Notes: blood-letting should be simple, but a careless operator opened up a large arm artery on Queen Caroline of Bavaria in early 19th century so that she bled to death;
    Charles 9th of France’s blood-letter damaged a nerve, Pare was able to get thumb back working, but it wasn’t easy.

Pharmacopeia: A book of standards in preparing and dispensing medicines, the result of collaboration among the guild of apothecaries and the medical society. This project culminating in 1498 was supported and given advice by the powerful Dominican monk, Savanarola (who advocated the “bonfire of the vanities”)—at that time a major political leader in Florence. s

ave been be one of the last cases of smallpox.	Polio immunization in India.