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Learn more. The disease then took up residence. At first, it came about every two or three years, absolutely ravishing the population. Then it settled down to a much more what you might call congenial pattern, of a really bad epidemic about every 20 or 25 years. The year in which Queen Elizabeth died, , saw one of the worst ever epidemics on record.
I say 'at least' because that is what the Searchers declared, and as many people had a very clear interest in not having their houses shut up, so they were very careful in many cases to cross palms with silver to have the disease put down to something else.
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But then, after , it went away and it never reappeared. And then of course, there has been endless speculation as to whether perhaps changes in the rat population or better nourishment may have been at the heart of the fact that it never came back. It was certainly in Egypt in , because Napoleon Bonaparte's army encountered it, and it was also in other parts of the Middle East, but why it left Europe, we simply do not know. Doctors of the day tended to have a strong historical sense, after all, if you had been educated on Greek philosophers, Greek doctors, and Arab doctors, such as Avicenna, you would have a strong historical perspective.
So it was that they were aware of and were, frankly, baffled by these comings and goings of diseases and their episodic nature. This is one of the reasons of course why astrology often had a strong profile in medical explanation, because you could normally tie up these manifestations to things happening in the heavens. If you live in a world where you see the Ancients as lying at the heart of all truth, innovation becomes fundamentally unacceptable. Like Harvey found, if you start to innovate, you are doing something which is going against the wisest of the past.
Why therefore did people begin to innovate in medicine?
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Also, why did they innovate in astronomy - people like Copernicus and Tycho Brahe and Galileo - and why did we have also this challenge to ancient learning? This is an issue that I believe many historians simply duck. They talk about the Renaissance or the New Learning and things of this sort, but what fascinates me as a historian is why things happen. This was the discovery of America by Columbus in Why this is so crucial is that it shows the ancient geographers had utterly and completely got it wrong. We have to bear in mind of course nobody in believed the Earth was flat - this is only a piece of American history legend going back to Washington Irvine and the Legend of Sleepy Hollow and tales of that sort.
No educated person with three brain cells believed the Earth was flat in Ptolemy had shown it was a sphere and Aristotle and various others even made good guesses as to its size. The key thing of course was that all the ancients had worked on the assumption that it had actually more land on its surface than it had water, so effectively, the European and Asiatic landmass occupied a much bigger part of the Earth's surface.
In their reckoning the entire sovereign part of the world, terra-incognito Australis, the Southern part of the globe, and the known oceans - the Atlantic, the Mediterranean, the Indian, and by legend, what bits of the Pacific there were around China and Japan - were simply small pieces of water. On the whole, water occupied about one-seventh of the Earth's total surface, this was believed. So, when Columbus discovered the Americas, and shortly afterwards, Magellan discovered and navigated the Pacific, it showed that Strabo and Ptolemy and various other ancient geographers have made fundamental errors.
There is another central feature that you have to bear in mind here as well. You had, first of all, longevity in the days of the Old Testament patriarchs. After all, Methuselah lived to the age of years, and in fact Thomas Paynell, a medical doctor and close friend of the court of Henry VIII, wrote a little book in , where he commented on the fact of how puny modern man are: 'Not only are we not the size of the giants, do we not compare with Goliath or with King David, but we are just runts when it comes to longevity.
Why therefore did we discover things that the wisest men of the ancient world had not known? In this respect I think the discovery of the Americas was a tremendous re-orientation of Western culture. They saw we could find things out that they never knew of, and not only did they find it out, they found it out by a particular method.
They did not do it by collecting - I am speaking here of Columbus et al, Drake and so on - they didn't do it by philosophising; they did it by taking ships and finding places - they did it by physical discovery. It is very hard to reconcile this approach to physical discovery, with let us say the philosophy of Plato, which held that that essentially intellective knowledge, deductive, philosophical knowledge is of the highest kind and it was in Plato, of course, that the neo-Platonists of the universities would have been trained.
Now you have a pack of navigators finding continents and oceans not known. This I think therefore is a shot in the arm. There is also a biblical parallel again which comes into this. Francis Bacon, in the introduction and on the title page of his Advancement of Learning of has a Latin quote from the Book of Job, which of course was extremely powerful within that culture. The English translation of this Latin quote says effectively, 'Many shall run to and fro and knowledge shall be increased.
Before the end of the world, before God wraps up the world like a curtain, many shall run to and fro and knowledge shall be increased.
Dutch Anatomy and Clinical Medicine in 17th-Century Europe — EGO
So the rise of their science, and the medical knowledge which they start to see as part of that science was not just simply discovery. It was seen as fulfilment of biblical prophesy; it was seen as the last new vigorous gasp of a dying human race before the world is wrapped up as a curtain; and of course we have to bear in mind that, to most people living in the Renaissance, they were not living into a new wonderful time of the birth of culture, but rather to what you might call the last act of the drama before the celestial curtain came down.
So therefore we have to see this as taking part of what they thought of medicine. At the same time, you also find Vesalius in Italy doing something never done before, certainly since the time of Galen, and this is the dissection of human bodies on a systematic scale. It is true that the Royal College of Physicians had been permitted bodies to lecture on in London - four criminals a year to lecture on to medical students in London.
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But of course you have to bear in mind that this kind of dissection, in let us say , had been largely theatrical. You would have had a corpse placed up on a table, you would have had a professor on a high dais, reading from an appropriate passage of Galen or Hippocrates or so on, and you would then also have had a reader who would have assisted in the reading, and then down there, you would have had the corpse on its slab, a man with a knife, probably who did not understand the Greek or the Latin, who was told, 'Get the heart,' 'Now get the liver,' he would saw away and out it came, it would be put it on the platter and he would show it round.
That is theatrical dissection. What you start to find though with Vesalius is the idea of the painstaking taking to pieces of a corpse bit by bit, where the professor does not merely work on his dais; he closes the book, he comes down, and cuts up the body with his students. This starts a radical new approach to dissection. It also finds that ancient doctors have got a lot of key things wrong. For instance, the uterus does not have the structure that Galen said it did, the breastbone is not serrated in the way that Galen said it was, and the heart simply does not have the required plumbing facilities that Galen said it should have had.
What of course too Vesalius, who was not only cutting up humans but cutting up virtually any creature he could lay his hands on, had realised was that what the ancients were doing was often dissecting apes, monkeys, pigs, cows, and creatures of this sort. In other words, the great inheritance of classical anatomy was a veterinary. You can understand the shock force of the realisation that we, from this runt end of human history, have discovered structures in the human body that no one had ever known were there before.
It is not for nothing that Padua in Northern Italy became the greatest centre of this radical dissection, and it is not for nothing of course that William Harvey, discoverer of the circulation of the blood, was a student in that University from to What you start to find therefore, with this new radical approach to knowledge, is the suggestion that new things can be found.
In another dimension of course, Copernicus was suggesting that the Earth moves around the Sun, backed up very powerfully by Galileo's realisation in with the telescope that many of the things he saw - the moons of Jupiter, the craters on the Moon, the phases of Venus, and so on - fit much better with the Copernican heliocentric theory than they fit with the classical geocentric theory. So in other words, knowledge was in ferment and this is why we were starting to get new discoveries - not because people are just discontented with antiquity, but because, starting from the geographers onwards, you are finding that a new style of learning - empirical, hands-on, comparative, and in the astronomical sciences, mathematical studies - are bringing out truths never known before.
Undoubtedly the greatest of all of these discoveries in the period that we are concerned with is William Harvey of London. Harvey was born in There he took a Doctorate in Medicine and learned the new radical techniques of dissection and the study of the human body. On the other hand, people sometimes give the impression - and this is part of an approach to the history of science which I personally strongly find erroneous - that somehow all of these great scientific innovators were, on the one hand, radical, discontented and difficult men, and also, they were trying to prove the Church to be somehow wrong.
This is a thing which simply fails to stand up to scrutiny. For instance, we find that so many of these discoveries were made by men who have no particular axe to grind. It is true that Galileo is an exception to this, but many others were remarkably conservative.
They were also often deeply devout as well, as Galileo was as well. But what you start to find is that they were realising that, against all of their instincts, what they are finding in their respective profession - astronomy, medicine, or whatever - simply did not quite match up to what they had been told it should. This tended to mean that you also used the ancients creatively, and I think Harvey was an immensely conservative doctor who also used the ancients creatively to produce radical conclusions.
For instance, one of the central tenets of the medical writings of Aristotle is effectively that structure and function were connected; a body of any creature should not have a part that is overworked or under-worked. Why therefore, when you look at the function of the heart in classical Galen physiology, is the aorta overworked and vena cava under-worked? Harvey started to look at how you can rethink the body in terms of the heart, and I will quickly say here how he came to the conclusions of the circulation of the blood, here in London, just down the road.
He studied in Padua and learned the business of how to cut things to pieces with a number of leading Italian anatomists and dissecting anatomists. He had found that the Italian anatomists in the wake of Vesalius had been puzzled by one phenomenon: why in the great trunk veins of the body were there valves, unknown to the ancients, and why do these valves all open and close toward the heart? According to classical medicine, the heart was a furnace that heated the blood, and it caused the blood to effervesce and froth. The lungs were seen as bellows that blew air, through the pulmonary artery and the pulmonary vein they thought, into the heart and frothed and bubbled it up, and this then caused it to sort of effervesce into the veins, where there was a tidal flux and reflux through the veins.
This meant that you had something like that vena cava that was overworked, in and out, and others that were under-worked. Harvey started to ask whether this could really be quite the situation. For instance, if all of the blood goes into the veins and goes down the body, why do all the veins have what he calls 'clacks' or 'mock gates', as in a pump, which close? He spoke of the mechanical analogies - the clacks of a pump that stops the reflux of water when you have done a pumping action.
Why does the body clacks against the flow? Could it be that the blood is supposed to go up the vein rather than down it? He had a long way to go. He then started to do another brilliant piece of experimentation, and although, he was a conservative doctor, Harvey was an instinctive experimentalist - he had picked that up in Italy.
For instance, the idea was in classical medicine that your food produces your blood, pretty well directly, in the spleen and the liver.
Where therefore do you have what you might call the missing mass of the blood? This was another of his problems. Then also, he started to do experiments on arms. If you have someone hold a staff or a pole, and someone put a moderately tight ligature around your arm, after a few minutes, you would see your principal veins in your arm starting to stand up as little nodules, and you would see that they were rather like strings of sausages and they have closed gaps between them. Harvey showed that you could push the blood up but you could never push it down, because when you pushed it down, as he said, the pump clacks, closed.
This clearly indicated that the flow of blood was towards the heart. The great problem was, what was the job of the arteries? The ancients had believed that the arteries contained a variety of things - generally speaking, numa, the life force - and this carried some kind of vague, gaseous, sometimes partially liquid, thing through the arteries. On the other hand, Harvey was aware of another thing, and this comes from Galen, and from military surgeons.
Why is it that when you are dissecting a cadaver, especially one that has been dead perhaps for quite some time, you find no blood in most of the arteries, but why is it that when a man has an arm injury that it is the artery that spurts blood? Why therefore are the arteries engorged with blood in life and apparently empty of it in death?
Do you therefore get the blood in the veins in death because they are trapped between the clacks up the limbs? The great problem facing Harvey though is how the blood gets from the arteries to the veins. He was able to trace increasingly reduced structures and membranes. The problem was he could not see a connection, and Harvey was a very good experimentalist and did not like postulating things he could not be sure of. He recognised the weakness of his theory and he suggested that there could be connections on such a small level they could not be seen.
The book outlines, in detail, everything I have told you. It is an extraordinary piece of experimental physiology. Without it, modern medicine could not exist. Can you imagine any aspect of modern medicine requiring drips, hypodermic injections, experiments, which did not take, as a premise, that the blood circulated around the body, under the mechanical action of the heart?
The heart, says Harvey, is not a furnace, but is a pump, and it is a pump which in its systolic and diastolic expansions and contractions makes the blood move through the body. Harvey's work was utterly fundamental on influencing European thinkers. As I said, it did damage his practice, and a lot of his most fashionable clients will no longer come to him.
In , Marcello Malphigi, using the newly devised microscope, saw for the first time the circulation taking place in the tail of a fish. Therefore, using the biological experimental analogy that what is happening in one creature can be applied to another, he gave the first proper microscopic determination of the circulation of the blood in living creatures.
But by this time Harvey had been dead for five years. What happened after this was that there was an explosion in fascination with experimental physiology, in England and across Europe. Harvey's work, as I said, was inspiration in a very important degree. That group of men who started to meet in Gresham College, around , which called itself a philosophical club, and part of it migrated to Oxford in into my own College of Wadham, under the aegis of John Wilkins, the Warden, started to create two experimental centres in England.
These centres look at all kinds of things - astronomy, gardening, animal culture, all sorts of things - but in , they came to London at the Restoration, where they became the Royal Society the Royal Society though, I may say, was always referred to euphemistically as Gresham College, simply because that is where it met. Of course I am sure most of you are familiar with its illustrious curator of experiments, Robert Hooke, who we celebrated last year, and he was one of the great experimental driving forces.
Dutch Anatomy and Clinical Medicine in 17th-Century Europe
But in that world of experimental science at Gresham and at Wadham, we find a number of key new approaches. The first of these is the study of the physiology of respiration - what is air, what does it do in living creatures, and how does it bond? It was well known that your venus blood in your veins is darker than your arterial blood. Traditionally it was said that this was because one had numa blown into it and the other did not. Boyle and Hooke, working with an air pump, were able to discover that there seems to be some property in air, which they called generically aerial nitra, which when it is in contact with blood, lightens its colour.
They performed a series of experiments, and found that when he had a mouse or a candle burning in the same volume, an upturned vessel with a sealed bottom, that they both expired - the mouse died and the candle went out - when a certain volume of the air had gone. This suggested that the whole of the air was not necessarily used for respiration, only part of it; and it also asked the wider question - why is burning and breathing connected?
Could it be perhaps that what causes a fire to burn in the air is also the thing that generates life and makes living bodies warm? Dead bodies of course do not breathe, hence they are not able to generate that kind of reaction. By , the general books of the Royal Society contained a series of experiments where they were asking the question 'What does air do in the lungs? Does it actually invigorate the blood or does it simply cool the body down, as a sort of blast going into the mouth? This is , thirty odd years after Harvey. Likewise also, Thomas Willis of Oxford, and later of London, Fellow of the Royal Society, started to do fundamental work on the nature of the human brain.
He started to dissect brains in about He tells us how he came to this by a rather bizarre route. He says that his wife had died and, in his mourning, he had looked for intellectual distraction, and he says, 'I took myself upon the opening of heads,' which is hardly what most people would consider as a way of relieving mourning, but it provided him with tremendous intellectual impetus.
He was dissecting one man who he seemed to have known in life and known something about the man's prior illness, and found that this man's left carotid artery was completely blocked by a massive and long-standing thrombosis. According to traditional medical belief from Aristotle and Galen, that man should have had half a brain dead, because it was thought that each carotid supplied the left and the right hemispheres respectively. Why therefore was he not dead? He then tells us that he sent out his servant to find him a dog.
This was a common practice, especially at Oxford - you would give your servant sixpence and he would come back with dog on a piece of string. You would then open the dog's neck, he ligatured its carotid, stitched it up again, and kept the dog around for a few weeks. He studied of course that clearly the creature did not seem disoriented, it ate its food, and absolutely witless cur as it was, he said it even licked his hand after all of this. It would not have done had it known what was coming to it! After about a month, he killed it. He found that the ligature was holding and that the dog's carotid had withered away, but just as in the case of the man, the right carotid had swollen to thrice its normal size and seemed to be putting blood into a great circular vessel at the base of the brain, and from this circular vessel, the rest of the brain drew its blood nourishment.
This is now of course immortalised the Circle of Willis. It was the first discovery that one part of the body can compensate for the loss of function of another part of the body, and again, it comes out of this experimental tradition. The use of the microscope, the air pump, and a variety of experiments at this period all suggest that there was a tremendous new interest in taking the body to pieces, comparing it with animal bodies, and trying to conduct experiments in particular diseases. The establishment of the Philosophical Transactions of the Royal Society became, and remains, a benchmark for articles on all forms of experimental knowledge.
If one looks through the early volumes of Philosophical Transactions especially, you find articles on diseases, on monstrous births, as they call them, creatures that were born - a sheep born with six legs and things of this sort. This was at the time when the scientists are trying to define what was normal nature, and therefore how does unnormal nature compares to normal nature, and what you can do to a body. These would occasionally be extraordinary things, such as a story from Philosophical Transactions from the s, of a rather foolish boy playing around with a knife who swallowed the knife down his gullet and could not get it out.
Then, a few months later, the side of his stomach became very sore and it became a sort of festering sore and a local surgeon opened it, and lo and behold, he finds a sharp metal point beneath the sore. He then probes and widens the wound and extracts the knife from the lad's stomach wall, and apparently he survived. This is the type of thing that goes into Philosophical Transactions - it is the weird, the wonderful, and the scientific.
They were trying to delimit what nature was. This medical world, you may say, should have started to produce prodigious cures, but it did not. Over the course of the next two lectures, I am going to be looking at the way in which science began to progress in medicine, and so many aspects of illness came to be understood - anatomy, physiology, the classification of disease, and of course alternative practitioners and quacks.
But there were so many things that these people could not do: they could not control pain; they could not control infection; they had no proper understanding of trauma; and they were totally, utterly, and absolutely at sea when it came to understanding the vast plethora of fevers and infectious diseases that simply wiped out that population - smallpox, Phthisis, pulmonary consumption, typhus, typhoid, malaria, all of the rest of them.
They could do nothing against these things.