Vaulted Treasures: Introduction
Early Printing Spurs Exchange
Johann Gutenberg’s invention of movable type for the printing of books took place in Mainz, Germany around 1450, and printing soon found its way to nearby towns and cities, and then across Europe. Early printers published mainly theological and legal works. But after 1470, scientific and medical books proliferated in many European cities, including Venice, Rome, Paris, Leipzig, Augsburg, Antwerp, Strasburg, Cologne, London, Frankfurt, Ulm, and Lyons. Printers often set up shop near universities or places of learning. A chief characteristic of all major printing centers was a lively mercantile exchange, which could not only provide books for a city’s own inhabitants, but also supplied merchants who could market books and pamphlets to the hinterland. Within 50 years, publishing houses established themselves in more than 120 cities.
First Printed Medical Works from Ancient Texts
The early printed books on medical and scientific topics contained, interestingly, not the most up-to-date knowledge. In fact, no real value was placed on “new” or current information. Something was better if it was old. The first printed medical books were mostly Latin versions of ancient Greek and Islamic texts from Hippocrates (460 BCE-ca. 370 BCE), Galen (ca. 130-ca. 200 CE), Aristotle (384-322 BCE), Avicenna (980-1037), and many others. They included a large number of treatises dating from the fifth or fourth BCE that were attributed to Hippocrates. These works were written by many medical authorities, not just Hippocrates, and had merit on several counts, even centuries after they were composed. The authors tried to build explanations that relied on actual causes rather than on magic. They called for accurate diagnosis and emphasized the importance of managing diet in health and sickness. In addition, the writing contained examples of “deliberate and repetitive scientific observation.”
Aristotle was among the most popular of the ancient Greeks to be printed in the early period. He had insisted on the connection between medicine and philosophy, and his arguments influenced other classical writers, especially as they were transmitted by Galen. The accounts of Galen also describe the anatomical efforts of physicians who were dissecting cadavers of animals in an attempt to understand the structure and workings of the human body. In the first century CE, Dioscorides (fl.50-70) gave expression to a full-blown herbal pharmacology.
Greek and Arabic Texts Translated into Latin
Greek medical works were first translated into Latin in the fifth century, and in the following hundred years, the work of Oribasius (325-403) as well as Galen and Hippocrates had been translated in northern Italy. Soon the work of Dioscorides also became available in Latin. After the Muslim conquests that began in the seventh century, Greek science and philosophy were assimilated into an already vibrant Islamic medical culture. Greek texts were translated into Arabic, sometimes by way of Syriac, and by the ninth century, Arabic-speaking physicians knew ancient Greek medicine and tried to improve upon it. Several important Islamic encyclopedists compiled the work of the ancients, including the Greeks. Among these Islamic writers were Razi (d. 925?), whose work was principally based on clinical experience, and Avicenna, who strove to encapsulate all of the world’s medical knowledge in his tomes. He based most of his writing on the accounts of Galen.
These Greek and Arabic medical works first entered the West during the cultural revival known as the “Renaissance of the Twelfth Century,” a burst stimulated by urbanization, and the growth of jobs requiring literacy. This scholarly revival spurred the opening of new schools and enhanced the growth of scientific and medical knowledge. The invention and spread of universities, centers for serious study and discussion of science and philosophy, boosted medical inquiry to new heights. Salerno, in southern Italy, and Montpellier, in France, became important centers for medical study unlike anything known before. Here, in the newly created universities, as well as in monasteries, Greek and Islamic texts were translated into Latin with a fervor.
Advances in Anatomy
During the Renaissance of the fifteenth and sixteenth centuries these ancient and medieval medical texts were among the first works to be printed using Gutenberg’s technology. Towards the end of the fifteenth century, an emphasis on careful observation and correct representation pushed the descriptive science of anatomy swiftly forward. Anatomists included what was known from classical times, but added to that knowledge by performing human dissections. In 1543 Vesalius published his exquisitely illustrated volume, De fabrica corporis humani, in which he challenged old dogmas and helped to foster a sense of inquiry.
Innovations in Military Medicine and Surgery
Taking advantage of his experience in military medicine, Ambroise Paré successfully devised innovative surgical procedures and printed his collected works in 1579. Paré trained under a barber-surgeon, but by 1531 the Académie Royale de Chirurgie was established in France, and 14 years later, in England, the Company of Surgeons parted from the barbers, thus putting surgery on a more professional footing. John Hunter, an anatomist and surgeon, helped transform surgery from a manual craft to an experimental science during the second half of the eighteenth century.
Physiology and the Development of the Scientific Method
In the early seventeenth century Santorio cultivated the importance of physiology. His writings indicate the transition taking place in medicine as Hippocratic and Galenic theories were seriously questioned. Part of the Iatrophysical School that emphasized the use of math and physics to gain an understanding of physiological processes, Santorio published the first systematic study of basal metabolism in 1614. William Harvey printed his treatise on the circulation of the blood in 1628. Considered by many to have made the most significant finding in the history of medicine, Harvey is to physiology what Vesalius is to anatomy. In addition to his remarkable discovery, Harvey’s work also made a huge contribution as an example of the scientific method.
Progress in Pathology
As early as the second century, Galen had recognized that a patient’s symptoms and physical findings sometimes correlated with discoveries made upon examining the patient’s body after death. But it was Giambattista Morgagni, considered the founder of pathological anatomy, who put pathology on a scientific footing. His De sedibus et causis morborum was published in 1761 and contains the well-organized records of nearly 700 autopsies.
Physical Diagnosis: Back to the Beginning
Rene Laennec’s publication of De l’auscultation in 1819 introduced the stethoscope, one of the most significant advances in physical diagnosis. Describing as never before the audible sounds of thoracic diseases, Laennec published his findings on the clinical and pathological aspects of heart and lung diseases. Laennec’s book brings us to the end of the time period of our “Vaulted Treasures.” Interestingly, it also takes us back to the beginning. According to medical historian Jacalyn Duffin, Laennec “interpreted the sounds and he always delighted in pointing out that many predecessors over the centuries, including Hippocrates, had laid their ears on the chests of patients in order to discover what was going on inside.” [Wallis, p 94]