In considering the Process of Change in the Development of Ideas and Practices in Medical Surgery over the whole period c. 1000-1650 how far can the Black Death be considered a Turning Point? Although the Black Death was one of the biggest catastrophes known in Europe, its short term influence was of little consequence. Despite there being many different ideas, practices and surgical procedures present during and after the Black Death, in the long term there was minute progression. In the period c.
1000 – 1650 many distinctive turning points occurred in terms of individual achievements, however several relied on recent improvements in such things as technology, and consequently were not turning points unto themselves. Galen’s Four Humours still led the majority of medical ideas during the Black Death, which immediately suggests little change. However, individuals such as Geoffrey de Meaux were expanding this theory further through the use of subjects such as Astrology and Alchemy, both of which concentrated slightly on medical advancement.
Medicines were concocted on a basis of “temperate” and “intemperate” cures focusing on balancing the Four Humours. Alchemy relied on there being four elements in order to attempt their transformational experiments, hence the cliched idea of them turning base metal into gold. De Meaux talks of curing phlegm profusion, “Turbith naturally expels phlegm… mixed with ginger the mixture expels phlegm… since ginger is not… a repellent, it has taken on the nature of turbith” demonstrating this transformational quality of objects. In terms of “cause and cure” this demonstrates careful observation and documentation.
Progression is seen here as some begin to write their findings in Latin, this would circulate through to some of the wealthier people, but was not widely accessible as each copy was hand-written and not in plain English. Whilst alchemy drew knowledge from the natural medicines in plants, Hippocrates remarked that the “arts of Medicine and Astrology balance each other” therefore both had to be studied in order to be able to administer treatment. Astrologers studied stars and “heavenly powers” which they believed influenced a person’s well-being.
Friar Roger Bacon remarked on the phenomenon of twins; “every point on the Earth is at the apex of a pyramid… of various heavenly powers; and this explains why you get… twins who differ in character and behaviour. ” Although not a correct diagnosis by modern standards, Bacon helps disperse the myth that Medieval Britain was completely ignorant because of the mathematical precision that would have to have been applied to that theory. In fact, during the Black Death, doctors nearly observed and discovered contagion in the form of Miasma (bad air).
This was established due to the disgusting smells which would be emitted from a plague victims’ sores, the link between was the two was logical as someone who came close enough to smell the sores probably came within reach of the contagious bacterium Y. Pestis. Despite all of these ideas seeming advanced, this may be simply because of modern preconceived ideas about the ignorance of the Middle Ages increasing perceived achievements, in fact, miasma was an idea that prompted Roman baths and was simply a surviving influence of the fall of the Roman Empire.
Consequently, the turning point in medical ideas came from the disproving of the ancient miasma theory. Although the documented discovery of germs and their purpose isn’t published until 1864 when Louie Pasteur pioneered his “Germ Theory”, significant steps were taken towards it in the 17th Century. Spectacles were used just after the end of the Black Death, however the event itself had no impact on the following invention. Claudius Ptolemy originally used curved glass lenses for magnifying over a millennia before hand, but the fall of the Roman Empire had left his knowledge obsolete as far as Europe was concerned.
During the 16th and 17th Century the Renaissance began, a period of invention and discovery as the shrouds of the Middle Ages broke away. Astrology was still an influence, as Galileo’s use of lenses in his ten power telescope proved that the Earth rotated around the sun rather than the previous assumption of the Earth as the centre of the Universe. Evidently, this was not a direct influence on Medical ideas but began to rupture the confines of the Roman Catholic Church’s restriction on anything except Galenic ideas. His discovery was described as blasphemous and was immediately arrested, sparking large scale riots and protest.
Summed up by Jo Kent, thanks to the technology of lenses, ““… the importance of God to science was… invalidated. ” Surgical procedures lessened in quality during the Black Death due to the fact that most Doctors fled for their lives, few remaining to save others. Plague Doctors were un-aptly named as they were ordinary citizens trying to benefit financially from the pestilence. Guy de Chauliac was a celebrated doctor, one who didn’t flee, despite, according to Pagel (taken from Puschmann’s “Handbook of the History of Medicine”) “ecclesiastical interest” funded his medical education.
Perhaps the Church’s adamant focus on Galen meant Chauliac was eager to expand on Galen’s ideas rather than disprove them, thus avoiding confrontation. The fact that the Black Death actually produced “the most eminent surgeon of the European Middle Ages” (Encyclopaedia Britannica) seems a great achievement, despite the fact that competition was sparse and de Chauliac’s achievements relatively few. In his book commonly known as “Chirurgia Magna” written in 1363, he cites the difference between bubonic and pneumonic plagues, describes hernias and cataracts, and treatments for all.
In fact, he did have many surviving patients during the pestilence due to his realisation that “laudible pus” was necessary in the healing process of buboes and wounds. Surgeons were outraged as cauterization, an aggressive procedure, had always been the correct method and that the wound was never allowed to heal naturally. However, in his works he not only references Galen but also Hippocrates, Abulcasis and Ibn Sina (Avicenna) he only expanded on surgical practice already specified by others. Consequently, his influence is narrowed, and what seems like an abundance of progress is less so.
In the long term it is of little significance, therefore the Black Death is not a turning point in surgical methods. In the years following the Black Death, attempts were made to disprove Galenic ideas. Paracelsus, supported de Chauliac’s theory of pus, as in the early 1500s he writes, “If you prevent infection, Nature will do the healing”, to a modern audience this is a fairly obvious conclusion, but de Chauliac never actually diagnosed infection. Many people died after surgical procedures of infection rather than the actual procedure, despite the lack of anaesthetics.
Unfortunately Paracelsus’ work was considered modest at best and God remained the controller of cause and cure. Ambroise Pare was another who pioneered surgical ideas. Working on the French battlefield, his chance discovery of the healing properties of turpentine in a egg yolk ointment, used 100 years previously by Muslim doctors, on gunshot wounds, rather than the traditional cauterization process revolutionised life for injured soldiers as their wounds were treated not aggravated. Pare, despite using treatments discovered in the East before him, still encouraged progress by introducing the ligature of arteries, preventing blood loss after amputation.
Thanks to the invention of the printing press in 1440, his work was published in 1545, but his techniques were not practiced widely until several years later. However the lack of this technology previously contributed to the slow progress of surgery previously. The impact of the printing press is not to be underestimated: as Steven Kreis remarked, the “printing press certainly initiated an “information revolution” on par with the Internet today”.
Hence in the case of surgery, 1440 was the most crucial turning point. Nevertheless the church still controlled the majority of the medical texts and pressed for Galenic practice. Even though others ideas were now circulating, the language choice of Latin still meant there was a highly specific audience. The Black Death occurred during the “Middle Ages”, so called as it is the beginning of the emergence from the loss of Roman knowledge; the “Dark Ages”. However, medical practices in the form of Galen’s work were still widely used.
Some of them were sophisticated and led on to similar ideas still used in modern society. Bleeding had been the solution to most ailments due to the belief that the four humours needed to be balanced in order to prevent illness. This was done either by leech or cutting of the vein; the amount was determined by an examination of the urine. Then, a urine chart was established to link colour to disease, along with the alignment of the planets, again, urine is still used today to establish what precise illness a patient has except the planets have been replaced with scientific tests.
A Physician wrote in a poem about cures; “Several kinds of medicine may be good such as diet… and letting blood. These taken in due time, not overflowing each malady and infection is withstood. ” The reference to diet highlights the idea that Romanic ideas, passed through the Black Death, survive today as modern society aims for healthy lifestyles. Hence, disproving the unknowledgeable cliche of the “Middle Ages”. Despite this, only the wealthy would be able to begin living in the advised way because of a lack of public health.
Clinical observation is another practice seen today. The term is applied to the seemingly simple process of assessing the symptoms of a patient and diagnosing accordingly, the importance of this was that, as mentioned earlier, it must have been systematically documented and therefore quite sophisticatedly diagnosed. Although these practices were quite refined in terms of the knowledge the civilisation had, medical practices never advanced during the Black Death, bu t stayed nearly stagnant.
A cause of this were the restrictions of the Catholic Church, Chris Trueman writes that “when the Roman Catholic Church stated that illnesses were punishments from God and that those who were ill were so because they were sinners, few argued otherwise”, and it was almost heretical to turn to medicine. However, Vesalius’ publishing of “The Fabric of the Human Body” 200 years later caused a near revolution in medical practices in the field of anatomy, on which Galen was the previous undoubted expert.
Yet, the Roman Catholic Church banned human dissection, and Galen had based all knowledge on dissections of animals such as pigs. The fear of the majority to go against the Church’s belief that he was right therefore prevented any proof to the contrary. In 1315 an Italian surgeon, Mondino de Luzzi, recorded the first human dissection since the ban. Following the start of the Renaissance, the 1500s sparked a new interest in anatomy, fuelled by da Vinci’s drawings of muscular structures.
Vesalius’ book, although timidly, challenged all Galen’s ideas, significantly, the structure of the brain and an attempt at describing the nervous system. The church, livid at his heresy, attempted to sentence him to death, unfortunately for them it was on the eve of the Reformation and the threat was never carried out, and as people flocked to the Protestant Churches dissection became less of a taboo. The Reformation consequently helped the biggest leap in medical practice emerge since Galen’s dissection of a pig.
In conclusion, there were several turning points in all three, surgery, theories and practices but specifically none during the Black Death which remained a small influence on medicine, even long term. It could be argued for instance, that Harvey’s discovery of the heart as a pump was the biggest turning point in medical practices, however even Harvey himself did not stop bloodletting, and so Vesalius had the bigger impact. From the Renaissance era of 1500 onwards, medicine began to flourish as new technology and a new attitude in the general public towards medicine arose. WORDS: 1,958.