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Health and wealth in the Renaissance

Stephen Mortlock looks back over health and wellbeing in the period of transition from the Middle Ages to modernity.

Between the 14th and 16th centuries there was a rediscovery of classical philosophy, literature, science and art: this was the Renaissance (rebirth).

A global exploration opened up new lands and cultures to European commerce, which then led to the emergence of prosperous cities and a wealthy merchant class, especially in Italy.  

This Italian Renaissance started in Florence, a city which already had a rich cultural history, but now wealthy citizens could become patrons to the arts and science. Some of the greatest thinkers, authors, statesmen, scientists and artists in human history thrived during this era; artists like Da Vinci, Botticelli and Michelangelo were all born in Florence.  

This period also saw the development of a modern commercial infrastructure, with an international banking system, a systematised foreign exchange market, insurance, and ultimately government debt. The Italian cities acted as the main hubs for international trade in commodities such as wool, cloth, silk, spices, silver and armour. The merchants wanted to show off their wealth and furnished their homes with the most modern art, furniture and books, created either by local artisans or from further afield. In 1450, the invention of the moveable-type printing press by Johannes Gutenberg allowed little-known texts from early humanist authors (Francesco Petrarch and Giovanni Boccaccio) to be printed and distributed to the masses and their ideas spread quickly throughout Europe. Venice became dominant in the production of printed books.

The Renaissance was a unique time when the fields of art, architecture and science fused together. Art became characterised by realism and naturalism, while artists strived to depict people and objects in a true-to-life way using perspective, shadows and light to add depth to their work.

Leonardo da Vinci incorporated scientific principles, such as anatomy, into his work, so he could recreate the human body with extraordinary precision. Filippo Brunelleschi (1377–1446) studied mathematics to accurately engineer and design immense buildings with expansive domes, such as those found on the Cathedral of Santa Maria del Fiore. Scientific discoveries led to major shifts in thinking: Galileo and Descartes presented a new view of astrology and mathematics, while Copernicus (1473 –1543) proposed that the Sun, not the Earth, was the centre of the solar system. The protestant movement under Martin Luther (1483–1546) was attacking the Catholic clergy and, thanks to the printing press, “95 Theses” (originally posted on the door of a church in Wittenberg in 1517) and other writings began to influence more and more European people. In 1534, he published a complete translation of the Bible into German, underlining his belief that people should be able to read it in their own language. The translation contributed significantly to the spread and development of the German language. Renaissance style and ideas, however, were slow to reach England, and the Elizabethan era in the second half of the 16th century is usually regarded as the height of the English Renaissance, with the beginning taken to be 1485, when the Battle of Bosworth Field ended the Wars of the Roses and inaugurated the Tudor dynasty.

Alongside this was a medical Renaissance, where great medical personalities and scholar humanists made unique advances to medicine and surgery. The foundations of surgery as we know it in theory were laid during the Renaissance by the anatomists who robbed graves to obtain bodies for study.

“The foundations of surgery as we know it in theory were laid during the Renaissance”

Medical Renaissance

The city and University of Padua have a long tradition and a great reputation in anatomic studies, dating from the founding of the university in the year 1222. During the second half of the 15th century, the flourishing trade and cultural, social, and political life of Venice attracted a great number of scientists and students from all over Europe who contributed to the establishment of Padua as an international centre for culture and the sciences. Andreas Vesalius (1514–1564) was Professor of Surgery and published a fully illustrated description of human anatomy called The Fabric of the Human Body (1543), and although he based much of his work on the ideas of Galen, by dissecting executed criminals, he was also able to show some discrepancies; the human jaw bone was made from one bone, not two and the breastbone had three parts, not seven, as had originally been theorised. Towards the end of the Renaissance and beginning of the modern era, William Harvey (1578–1657), the noted British medical doctor and cardiovascular researcher, published his findings showing detailed anatomy and physiology of the circulatory system in The Motu Cordis (1628). Although his work was extensive it was not quite complete, because he was unable to show visual evidence of a link between the minute final terminations and initial branches of the arterial and venous systems. It was Malpighi (1628–1694) who provided the missing link with his work on capillaries using the new “microscope”.

Giovanni Battista Morgagni (1682–1771) conducted extensive diagnostic sessions with patients as well as postmortem examinations of over 700 cases, as he tried to interpret the underlying anatomical lesions from the diseases the patient had suffered. His 1761 book De Sedibus et Causis Morborum per Anatomen Indagatis (The Seats and Causes of Diseases Investigated by Anatomy) contained the results of 60 years of scientific work.

Further afield, Franciscus Sylvius (1614–1672) was a professor of medicine at the University of Leiden (1658–72). He was a physician, physiologist, anatomist and chemist who developed the 17th-century iatrochemical school of medicine, which held that all phenomena of life and disease are based on chemical action. According to the legend, Dr Sylvius created the first iteration of genever (the forefather of gin) when researching a cure for stomach and kidney disorders. There is certainly evidence to suggest that he was distilling medicines with botanicals, such as juniper berry oil, and, allegedly, the demand was so great for his cure that he went to local distillers who helped him make it in larger volumes and the rest is history. Except it is probably wrong as although some of his papers make reference to juniper berries, blood circulation and academic theories, there is no mention any of mass distillation, nor do they ever refer to genever.

Diseases

Every generation in European history between 1350 and 1720 seemed to endure outbreaks of the Black Death and in 1510 Europe was still recovering from massive depopulation caused by an outbreak in the 1340s and struggling with a less fatal but still horrifying epidemic of syphilis. Then, in July and August of that year, people became stricken with a respiratory illness described as a “gasping oppression” with cough, fever, and a sensation of constriction of the heart and lungs. Said to have first arisen in Asia, the disease spread to almost every part of the known world (except the New World).

It arrived in Sicily and Italy along trade routes from Africa and quickly spread throughout Europe. The pandemic was well documented by people who lived through it and wrote about it after the event. These books became available to scholars and the general public, including physician John Caius (1510–1573), surgeon Ambroise Paré (1510–1590) and historian Jean Bouchet (1476–1557). Fortunately, the infection burned out soon after it started. Among the people who contracted the illness was the eight-year-old future Pope Gregory XIII (1502–1585) who became dangerously ill with the disease but 
fully recovered.

The sixteenth-century epidemiologist Guillaume de Baillou (1538–1616) did extensive studies of the epidemics that plagued Paris, and is credited with providing the first clinical description 
of “whooping cough” in 1578. His descriptions of plague (which killed about 30,000 people in Paris in 1580), diphtheria, and measles and other works on epidemiology, were described in Epidemiorum (Of Epidemics) (1640). His work influenced later scholars including the great 17th-century Hippocratic physician Thomas Sydenham (1624–1689). In 1679, Sydenham, a devout Parliamentarian during the English Civil War, gave whooping cough the name “pertussis”, meaning a violent cough of any type. He was among the first to describe scarlet fever, differentiating it from measles. In his 1676 Observationes Medicae he also described malaria and how “anyone dwelling in the locality of marshes and lakes became impressed with a certain miasma which produces a quartan ague”.

Treatments

As with all periods of history, home remedies were often handed down through generations from mother to daughter. Girls learned how to mix up remedies using natural ingredients such as honey and local herbs, for family and friends. But now more people were writing them down because more people could now read and write. The increasing literacy of the population and the fact that they were published in a familiar language, no longer Greek and Latin, made herbal books a great success for the publishers. With their detailed descriptions and their medicinal information they became the predecessors of pharmacopoeias and science books. The English botanist William Cole (1626–1666), wrote that “the mercy of God... maketh… Herbes for the use of men, and hath… given them particular signatures, whereby a man may read… the use of them”. The daisy-like Euphrasia flower (or “eyebright”), for example, was used in various concoctions for treating the eyes through the 17th century. European travels to America and Asia led to the arrival of new ingredients for medicines. Rhubarb from Asia was widely used to purge the bowels. The bark of the cinchona tree (quinine) was imported from South America because of its effectiveness in treating fevers, especially malaria. Opium was imported from Turkey and used as an anaesthetic amongst other things. Tobacco was initially promoted as a cure-all 
when it arrived from America, being recommended for toothache, poisoned wounds, joint pains and as protection from plague. The one magical cure that the physicians believed in was the enema. It could be used for constipation, bowel management, headache, sexual dysfunction, asthma, allergy, and fever. Although the enema had been around for a long time, it gained more popularity in the Renaissance era. The French monarch Louis XIV (1638–1715) was fond of this therapy and practised it daily. Taking cues from a similar Native American tradition, Western healers also made a habit of performing tobacco-smoke enemas for respiratory conditions, while they preferred liquid tobacco enemas for treating hernias. And on the subject of enemas, smoke was not the only thing being introduced to Renaissance rectums in the name of good health. As an effective method of getting medicine in the body and targeting intestinal issues, the enema was central to the era’s medical arsenal and was considered appropriate treatment for everything from constipation to cancer.

Following a tobacco enema, what better than an emetic to induce vomiting to help remove more perceived excesses from the body, be it snake venom or over-indulgence of alcohol or an illness brought on by a misalignment of the planets? Leonardo Fioravanti (1517–1588) encouraged the use of emetics and tended to prescribe these as a first course of action for almost every ailment. He collected together an imposing armoury of purgatives and emetics, some based around the genus Helleborus (black hellebores), but also included white hellebores or veratum (in the family Melanthiaceae), metallic antinomy and mercury. He labelled these with half-scientific and half-religious names: “angelic electuary”, “magistral syrup”, “blessed oil” and his favourite “fragrant goddess”. Another devotee of the curative nature of emetics was Tomasso Bovio (1521–1609) whose concoction “Hercules” was reputed to have caused the patient to “vomit a catarrh as big as a goose liver”.

With the emergence and spread of syphilis throughout the Western world, there was a need for a treatment. In the early 16th century, treatments for syphilis included guaiacum (or holy wood) and sweat baths as it was thought these induced salivation and sweating, which helped to eliminate the syphilitic poisons. Paracelsus (born Philippus von Hohenheim, 1493–1541) derided the use 
of guaiacum as useless and expensive, but instead promoted mercury (he also believed in gnomes, spirits and fairies). He and his peers believed in the interrelationships between the perceived seven planets, the seven Earth metals, and the seven major human organs, for example the Sun/gold/heart and Mercury/mercury/lungs. This allowed healers to prescribe metal-based treatments to target different areas of the body. The Mercury treatment, however, had terrible side effects causing neuropathies, kidney failure, and severe mouth ulcers with the loss of teeth, and many patients died of mercurial poisoning rather than from the disease.

In 1566 a visitor to King Charles of France gave the king a bezoar stone. These are found in the

stomachs and intestines of animals and humans and are made from things that cannot be digested in the body, such as hair, and fibres from fruit and vegetables. The visitor insisted that it would cure all poisons, but when King Charles asked Ambroise Paré, his surgeon, Paré said that it could not possibly cure all poisons because a hot poison needed a cold antidote and vice versa. Paré then suggested a test on a live patient! A cook in the King’s court had been caught stealing fine silver and was sentenced to death by hanging. As an alternative, the cook was granted the opportunity to receive a poison followed by a bezoar as a potential antidote under the supervision of Paré. It was agreed that if the cook survived the poison, his life would be spared. According to records he died in agony seven hours later; thus, Paré proved that the bezoar stone could not cure all poisons. It was another triumph for experiment and enquiry, though not necessarily for the cook.

“The one magical cure that the physicians believed in was the enema. It could be used for constipation, headache, sexual dysfunction and fever” 

There was a definite waste-not, want-not philosophy amongst Renaissance healers who put to good use any available plants, minerals, scraps and waste products from human and animal bodies and even religions in their remedies. Monique Rossignol, in her book Medecine et Medicaments au XVIe Siècle à Lyon (Medicine and Medications in Sixteenth Century Lyon), described the use of remedies of human origin (derived from faeces, urine, saliva, and ear wax), those of an animal origin (made from the milk, droppings, urine, fat, and body parts), vegetable medicines (compounded from herbs and other plants) and mineral medicines, fashioned from elemental matter. Who would not want to use a mixture of mud and earwax for treating that irritating migraine? It was believed that pig urine fought fevers, and the roasted flesh of kittens relieved jaundice. Meanwhile, the droppings of dogs and crows were prized for treating colic and dysentery, respectively. And if you got depressed from some of these remedies, there was always saffron to add to your meat and drink to raise your spirits. But you were warned that eating too much could cause you to die of “excessive joy”. Spring water was infused with bruised saffron and used to remove drunkenness, which was lucky since alcohol was also an integral part of some remedies, from improving digestion, to defending the body from corruption and strengthening the body’s natural heat (alcohol flush?). Weakened patients could drink human blood, which was also available for leprosy sufferers as a salve for their scarred limbs and faces, but was loosely based on a study from the 11th Century where Valescus de Tharanta suggested “an ointment made from the blood of a young healthy person because the blood of a leper is corrupt”.

End of the Renaissance

Everything must come to an end and by the end of the 15th century, the flower of the Italian Renaissance was beginning to wilt. Trade throughout northwest Europe had been disrupted by the Hundred Years’ War (1337–1453) Italy was being torn apart by one war after another. The kings of England, France and Spain, along with the Pope and the Holy Roman Emperor, battled for control of the wealthy peninsula. There was also the expansion of the Ottoman Empire. King Edward III of England had reneged on his war debts, which had a ripple effect that caused the two largest Florentine banks (Bardi and Peruzzi) to collapse. This and the changing trade routes led to a period of economic decline and limited the amount of money that wealthy contributors could spend on the arts. There was a change in climate, which resulted in harsh winters and the decline of agriculture, which led to repeated famines and shortages. On the heels of a previous swell in the population, these shortages exacerbated the food shortages. The Black Death was still wiping out inhabitants in densely populated Northern Italian cities and it kept returning. As with any major health crisis in a city, disorder and pandemonium resulted.  

“Who would not want to use a mixture of mud and earwax for treating migraine?”

The Catholic Church, which was racked with scandal and corruption, had begun a violent crackdown on dissenters. In 1545, the Council of Trent established the Roman Inquisition, which made humanism and any views that challenged the Catholic church punishable by death. Many Renaissance thinkers feared being too bold, which stifled creativity. By the early 17th Century, the Renaissance movement had died out, giving way to the Age of Enlightenment.  

Stephen Mortlock is the Pathology Manager at the Nuffield Health, Guildford Hospital. He would like to thank the Senior Management Team and all of the staff at the Guildford Hospital for their continued support.

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Image credit | Alamy | iStock

 

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