SCIF Study Notes - Susan Hardy

Hippocrates in the Marketplace

Medicine began as explanations for misfortunes which were
generally attributed to negative tribal/family relationships or poor
relationships with the natural world. Ancient medicine was
institutionalised in the Mediterranean World (between Ancient
Greece and other southern Europe countries and Asia) as the sea
allowed for easy exchange of ideas and a fusion of innovation.
Aesclapius (Greek god of medicine) had two
daughters:
Hygiea
(hygiene)
and
Panacea
(pills/medicine/universal remedy), however these two aspects
didnt converge for 1000s of years. He had brand
recognition in the form of the caduceus. Healing took place in
colonnades (buildings with pillars; the temples), and involved books,
baths, incubation (sleep, sometimes with steam) and drugs.
Hippocrates (c460-377AD) had a tripartite approach:
Ethics - the oath (selling point to patients)
o based on respect for teachers
o sworn to silence of practice (dont share secrets)
o help not harm (DO NO HARM)
no euthanasia/abortions
o no sexual contact
o confidentiality of consultation
Theory - the four humours of the body (almost
scientific/logical)
o in balance with the elements and seasons
o reflected temperaments/metal health
Cholericus - yellow bile (quick to anger,
candle in cup on skin which pulls with low
pressure)
Phlegmaticus
phlegm
(slow
to
anger/unexcited, took wine which contained
yellow bile, cheered up)
Sanguineus - blood (overly optimistic,
leached/cut)
Melancholicus - black bile (depressed)
Practice
o advice - to get microcosm in balance with
macrocosm, about a healthy lifestyle; nature tends
towards perfection and health is perfection in the
human body
o therapeutics - simples/herbs
o surgery - e.g. leaching blood (not supernatural)
His teachings were popular because they were accessible in
the marketplace (healers were peripatetic, (walked around) and
male so not sexually harassed), human not divine (and had some
kind of logic), gave both diagnosis and prognosis for patient

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satisfaction, provided an early psychological approach as an

optional extra, and also looked at the environment a patient lived in.
Medicine Goes into the Universities
After Hippocrates died, there was no more innovation in
theory or practice, and his original writings became Holy Writ. This
wasnt revived until Claudius Galenus or Galen (c130-201) from
Pergamon (in Ancient Greece), a middle-class, well-educated
philosopher, physician and author (22 works remain), came along.
He trained in Alexandria (Egypt) in physiology and anatomy (they
often got one body a year from criminals, otherwise pigs, apes and
other animals), and was considered one of the three fathers of
medicine (along with Hippocrates and Avicenna). He adapted
Hippocrates work (like many others at the time), and took these
ideas to Rome, where he was the physician to the Emperor, but also
treated gladiators in the Colosseum and hence had extensive
practical experience with bodies. He believe prognosis was not
divination or prophecy, but rather he synthesised and systemised
current medical knowledge (popular with students). He also wrote
attacks on other professionals, whilst claiming to be returning to the
true Hippocratic approach (using logic), which was an unthreatening
way of suggesting change of theory and practice.
Galens treatise (formal written work) That the Best Physician
is also a Philosopher states that natural philosophy was critical
thought (however today we say modern science is thought and
experiment). However, most of his work was with animals, and he
used comparative anatomy (animal anatomy and physiology due to
legal restrictions in the Roman Empire), which was not correct for a
human. He also had a teleological that everything works exactly as
it should (which is ultimately circular) that later proved popular with
the early church. Another misconception he had was miasmas (the
state of the air was bad) that he used to explain the great plague of
166CE, although this was a more logical approach than other divine
explanations and more similar to the real result.
When the Roman Empire fell in the 5 th century, many felt the
succeeding Dark Ages were a step backwards in art, culture, religion
and healing as tribes took over. Instead, medicine took place in
monasteries (where manuscripts of Galens works were copied), and
infirmaries became the first hospitals (mostly for older monks and
travellers).
In the 800s, Charlemagne (Charles the Great, King of Franks)
founded many Cathedrals, and the schools for clergy became the
first universities (a self-regulating community of students and
scholars), resulting in more universities opening in the 11 th Century
in Bologna, Paris and Oxford, where there were Faculties of Arts,
Law, Theology and Medicine (although Medicine was partly
considered a trade), and students were young males proficient in
classical languages.

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Artists, Anatomists and Surgeons

Anatomy was studied by plastination (preserving bodies with
no smell or decay) which was used as a teaching tool but also as
theatre or entertainment. Originally plastination was used for
kinds/noblemen so people travelling far could validate that person
was dead. Illustrations at the time were thought of as juvenile, as
intelligent people read prose because they were literate and
educated.
There were many problems with the understanding of
anatomy:
few bodies (criminals or destitute (poor) people), mostly
male, were examined, but often decaying
dissecting wasnt done expertly (large knives)
taught from Galens teachings (based on animals)
o wasnt questioned much (e.g. if couldnt find holes
in heart, claimed looking at wrong organ or some
other explanation), hard to find or work out the
truth as there are no labels in the human body
and blood everywhere
Andreas Vesalius (1514-1564) was the first to challenge
Galens work, and was a young anatomy professor from Brussels
(Belgium) at Padua (northern Italy), and he wrote De Humani
Corporis Fabrica (About the Workings of the Human Body, written in
Latin) in 1543, which contained detailed drawings by Renaissance
artist Jan van Calcar. With invention of the printing press at the
same time:
copies were identical (no mistakes) and mass produced
became must-have for lectern and intelligent people
he published a cheap, pocket-sized students edition
(early textbook, clever marketing)
It made anatomy the centre (both literally in lecture theatres and
metaphorically) of medical education for physicians (not surgeons)
at universities, and emphasised the body as a collection of parts
rather than a whole (as Hippocrates did). However, it made no
difference to patient treatment as it doesnt suggest treatments like
Hippocrates did. Instead, sick people congregated in cities and went
to apothecaries (pharmacists/GPs) or surgeons (which were not
physicians who were upper-class, educated, and didnt touch
patients except to take a pulse (because Galen said you could), and
hence werent a trade).
Ambrose Pare (1510-1590) was a French surgeon of the
long robe (had dignity and was trained) lived in the time of wars of
religion of the 16th century (Protestant vs. Catholic, although they
often fought people just for the sake of fighting, even amongst
themselves), and new technologies of war (explosives driven
projectiles like muskets or arquebus, however they had dangerous
recoils and produced messy, infected wounds and burns) resulted in
more wounded and hence more extreme conditions to work with
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people (no time to consider ethics, anything was better than

nothing, many patients). He invented cauterisation, and replaced
suppuration (removal of pus) with ointments as they were more
successful. He wrote a book called Apologie et Treatise (in French,
not Latin or Greek; Apologia (written defence of opinion) and
Treatise), stating, I dressed him and God healed him- evidence of
the Christian influence. He became the idol for rational, professional
and educated surgeons for 200 years.
Science and Witchcraft in the 17th Century
In the 17th century, natural philosophy became science, and
was taught in university to boys and men (although some women
inherited family practices) using classical languages. It was mostly
based on Hippocratic/Galenic theory with some anatomy. One
student of anatomy, William Harvey (1578-1657) from Padua,
became a high physician at St. Bartholomews Hospital, London,
which allowed his voice to be heard. He later became physician to
the kind (the British Charles I), and published De Motu Cordis et
Sanguinis (About the Motion of the Heart and Lungs) in 1628 (based
on lectures he had given 15-20 years earlier), postulating a
circulatory movement of blood (not first, but first to base it on
vivisection - experiments of live animals - of warm- and cold-blooded
animals). His experiments were repeatable, and refuted Galen
(blood did not move in tides, there were no holes in the septum in
the heart). He found valves in veins (pumping arms to show veins,
blocking one part to drain blood, found in some places it did not
come back), although this had been known in Padua, and postulated
the existence of capillaries (but unable to prove without a
microscope). He was approved of by future physicians as he was an
experimenter, not just a speculator. However, he stuck to some of
the older Hippocratic, Galenic and Vesalian teachings as he believes
in cycles in nature, the heart is an innate heat (like the sun to the
solar system or fireplace to house), equates the heart to a monarch
in a hierarchy of organs, uses teleological arguments (the ultimate
reason for all things is that it is right to be so), investigated with
natural senses, and practical medicine was still Hippocratic/Galenic.
Alternative and magical medical approaches were considered
the low tradition, communicated by memory and oral means (not
written). It was considered the grass roots healthcare (came back
from the dead) in marketplace, and they put on a show to attract
attention (e.g. tooth pullers, bone setters - dislocated bones,
quacks (derogatory term to describe person who sold medical
service but you didnt approve of - could even be physicians about
other physicians) who sold pills/potions. It was also practical and
cheap. Many were wise women (who didnt have husbands or
families and needed a means of self-sustenance) through herbal
cures that often came with spells or midwifery. However this caused
turmoil in the state and church as they were outcast as witches,

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further spurred on by the book Malleus Maleficarum (Hammer of the

Witches), however this was mostly founded on fevered imaginations
and moral panic, but still resulted in tests/trials (often ducking,
drowning and if survived they were a witch, or hung - burning was
difficult).
It was considered heresy (belief against the church) and there
was rivalry with physicians and surgeons over midwifery (who
tended to be less accessible), so alternative care was undermined
and midwives went underground (they were considered influenced
by the devil).

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