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Lecture 5

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HIST 249
Faith Wallis

Week 4 – Lecture 2 HIST 249 Medieval Medicine – the Birth ofAcademic Medicine 01/10/2013 New and vibrant Europe in the central MiddleAges Some nations have very centralised monarchies and coherent frontiers, whilst others are less organised e.g. Holy Roman Empire = a vast patchwork of differing jurisdictions Italy is important because of Salerno  reputation from antiquity as a health resort = doctors congregated because there was a clientele even in antiquity as a professional congregation Southern Italy = many greek speaking communities whilst also close to Muslim NorthAfrica and has contact with theArabic speaking world Set up to become the place where medical translations would occur  Constantine theAfrican (d. ca. 1085) TranslatedArabic works into Latin  had patrons paying him to do this inc. theArchbishop of Salerno An awareness of the richness ofArabic literature? Enterprise is driven by patrons willing to bankroll a project like this  actually it is coming through the Church which is leading to an interest in medicine One of the works that is being published = Hunayn ibn Ishaq’s Introduction (Isagoge) – introduction summary text  anthology of texts using Galen’s ideas Isagoge = summary of Galen’s Art of Medicine When translated into Latin, Hunayn is the same as John or Johannes  became known as Joannitius (Little John) Identity is somewhat effaced  book and style was intended to look Greek because it was very Greek texts Hippocrates –Aphorisms and Prognostics Theophilus – On Urines Philaretus – On Pulses Later – Galen –Art of Medicine (Microtechne, Tegni) = altogether the body of work is called the Articella theArticella = medicine 101  became the first book medical students read in faculties in universities  was a foundation text Hunayn’s Isagoge = contained Galen’s doctrine (what Galen deemed to be important of Hippocrates) Much more systemised than Galen though sinceArab translators ‘tidied it up’somewhat Teaching medicine as a group academic activity first appears in Salerno  there is no university there but there are schools though = schools which are independently run by doctors whom take on groups of trainees Teaching the texts and teaching through the texts = form a precise curriculum Constantine’s translations from Arabic Salerno Style Also have commentaries on theArticella texts = fingerprints of classroom teaching since these commentaries also include questions Causality Form part of the interest in ancient science = interrogation of the nature Questions tie together medicine and the natural world E.g. much interest in the humours and spirits  how do these connect with the natural world?  appreciate this connection because at the same time as translations of medical works, some of the works ofAristotle are also being translated Aristotle’s logic and natural philosophy DISSECTION of animals once again  commentaries that seem to be scripts for the professor that is doing a dissection of a pig  anatomy of a pig is a springboard for the discussion of the anatomy of a human Idea of using dissection as a teaching tool = innovation  seem to be imitating Galen’s dissections in Rome when he did public ‘shows’= BUT instead of the form of public lectures, these doctors are doing these in front of their students in order to teach them about anatomy Production of original medical literature  same trajectory that was followed in the Islamic world  translation  teaching  new literature Medicine 101  Isagoge as a way to unpack medical theory Hippocrates and Galen = dressed up slightly differently to the oirignal and packed together Isagoge: Theory and Practice = Galen’s Art of Medicine Fundamental difference = medicine has two distinct parts  theory and practice Theory: 3 parts of Galen, systemised by Johannitius and then taught systematically at Salerno Physiology – body Etiology – causes How to read signs of disease on the body Semeiology – signs Practice Hygiene Therapeutics Diet (Hippocratic Regimen)  curing disease by modifying the patient’s lifestyle Drugs  largely drugs to evacuate the corrupt humours Surgery  same way as Hippocrates defined it  letting blood or the work of the hands in reducing fractures, dislocations and taking care of wounds = same old, same old! Western medicine steaming on without much change from classical antiquity although it does make it more systematic Does give it 3 new names from Arabic terminology Galen’s term ‘body’ in the Isagoge it is called ‘the naturals’ Physiology andAnatomy Causes (environmental and behavioural factors)  ‘non-naturals’in the Isagoge  terms means that these are not universal e.g. quality of the air depends on where you live or season, food depends on availability and choice Whilst the body is generic for all humanity, non-naturals are matters of contingency  matters of choice or accident Diseases themselves and presenting symptoms  Galen called them the ‘signs’ ‘Contra-naturals’in the Isagoge  work against the nature of the body to cause disease = technical vocab which medieval doctors are going to work with… The Naturals 4 elements 4 qualities the above 2 combine to create the 4 humours from which the members of the body are formed e..g bodily shape  elements, qualities and humours merge together to form the TEMPERAMENT OR COMPLEXION enegies = Galen’s faculties  new name of the ‘energies’in the Isagoge  physical view of the body controlled by and operated by natural spirits Operations  Spirits besides systemising Galen’s system, theArabic translators they developed the idea that each human being had their own humoural combination  will change over the life span and can be upset by or transoformed by the environment = basic temperament or complexion phlegmatic temparement = placid and no drama  medieval medical talk!  dominant humour is phlegm and thus their dominant humour reflects this skin colour  reflected the temperament  ‘complexion’= complexion now = the word doesn’t really have anything to do with skin or face, it means the interconnection of the four humours with their qualities = consideration of what combination of these can be discerned e.g. Sanguine – blood as the dominant humour – hot and wet – air – springtime – childhood  cheerful and optimistic, friendly Choleric – yellow bile/choler  hot and dry – fire – summer – youth (more ardent and on a short fuse) Phlegmatic  phlegm – cold and wet – water – winter – old age – people are supposed to be cool and imperturbability Melancholic – melancholy – cold and dry – earth – black bile (from the spleen) – autumn – Middle age – somewhat more mysterious – temperament is depressive but also associated with productivity and romance (mysterious, bipolar character) – persistent Development of the idea of the 4 temperaments  strongly medieval stimulated byArabic translations  not incompatible with classical medicine but is more an elaboration of the core ideas although it is not really found in Galen orAristotle The Non-Naturals – can translate sickness to health and vice versa  depending on humoral profile  what is eat and drunk can be used to dictate a regimen which will preserve or reassure health Arabic tradition really elaborate the idea of the non-naturals - air – environment, season specific e.g. crisp, cold, dry, moist  can’t escape but can design houses around this OR leave a place which is temporarily unhealthy becasuse the air has become corrupted with some environmental aspect - food and drink  class bias: only the wealthy can really afford to choose what to eat or drink but everything has their own properties; doctor needed as a health advisor - exercise and rest  regimen would also include these two - retention and elimination  excretion  evacuation is the major way in which doctors treat patients in order to relieve the body of corrupt humours, controlling the body becomes a principle of borh hygiene and therapeutics - sleep and wakefulness – sleep is supposed to cool one down, wakefulness – heats up - psychological states  can produce changes  anger is supposed to make one hot  can it overheat one to the point of a fever or inflammation? = depends on humoral profile… o different psychological states begin to emerge  psychology studies begin to emerge slightly = non-natural turns into the infrastructure for total lifestyle management Contra-Naturals - Fever  attention to classifying the fevers themselves in the spirits  ephemeral (material feature like a wind  NOT the soul in its intangibility) in the humours  putrid in the solid parts  particular organs  hectic - swelling (apostames)  swelling is a congregation of humours within the body  doctor wishes the swelling to come to the surface of the body, so that it can be lanced e.g. bubonic plague  focus on the pustules that emerged similar diseases  aching e.g. can hurt in the stomach, head or legs affect any organ (although not all at once?!)  must remember that diseases are defined in their presented symptoms official diseases  e.g. gout on the feet  affect one single office – e..g organ is the tool which performs an office/duty  official disease affects this universal diseases  paralysis = affect the entire body = high importance given to fever and to morbid swellings (apostemes) distinguished between cancers which were melancholic (cold, hard and dry like earth e.g. breast cancer) Medicine in the University - Salerno is a selection of private schools run by clinicians = not university universities emerged at the end of 12thC beginning of 13C grow out of earlier schools and grow rapidly in size and numbers important to consider universities through cities  they are often established in major cities University = Self-governing academic corporations or guilds of teachers, students or both (independent legal being  legal recognition as a body and is a self-governing academic corporation)  a guild = a collective organisation of people who practice the same occupation or bound together by the same occupation Establish themselves on a level of professional identity Control standards of admission to its ranks through collective recognition of competence (examinations) Univeristiy’s in the MiddleAges could certify who was competent in a certain subject and – above all – competent to teach in certain subjects Creates terms like ‘master of arts’and ‘doctors’ University is a template for the growth of professionalism And renew their own membership and are therefore permanent and self-perpetuating Hippocrates  essentially a private and personal foundations which depended on him University is a publically recognised corporation with an identity outside of the teachers  renews itself by recruiting the people that it has trained  generation after generation as it establishes its own way of doing things = continuity! Universities also imitate one another  all follow roughly the same plan and create common intellectual And share common methods and intellectual styles – scholasticism – and common academic values Arts, theology, law and medicine Medicine has to ‘get in to this club’by making good on certain claims  one must reocgnise that this is a corporation which has permanence  kings and popes acknowledge that this group exists as a corporation and thus gives them certain rights e.g. certify that their graduates are masters and doctors in their fields… How does medicine enter universities? Slides in 3 big medical schools – Paris, Bologna and Montpelier North: medicine grows out ofArts esp. PHILOSOPHY (physica – NATURALPHILOSOPHY)  a kind of natural philosophy as the Salerno teachers emphasise the connection between medicine and natural philosophy along with logic  issues of causality in the natural world  doctors are thus called physician which means a philosopher of the natural world  first called physicians in the natural world Not until 1270 that there is a self-standing medicine faculty in the University of Paris South: Medicine modelled on LAW – a LEARNED PROFESSION with recognised SOCIAL UTILITY  place for high-class education in law is Bologna  medicine again stakes a claim to be part of a teaching enterprise because it is a learned profession for the public good  we need doctors for help and lawyers for justice Based onAristotle Based in Bologna around 1250-1270s = alongside the law faculty University of Montpelier begins as a medicine school  an anomaly! HOW MEDICINE BEGINS TO STAKE ACLAIM When medicine is taught in universities, it will be taught in the university style  through texts and discussing questions = teach how to be analytical (of the database texts –Arabic encyclopaedias, Articella and Galen) with lectures and discussion of ‘dubia’– doubtful points Questions = disputatio and quodlibet  massive importance given to logically debating questions  classroom debates called disputations (disputatio) and debating jousts (quodlibet) SUMMA synthesis organised as a sequence of disputed questions e.g. ThomasAquinas Impact on how doctors’understand their own knowledge… Measured also through mastery of texts = SLIDE Competence = mastery of texts Galenic texts andArabic encyclopeadists Medicine = Week 5 – Lecture 1 History 249 – Health and the Healer Medicine – Practice and Practitioner in MiddleAges 01/10/2013 Week 5 – Lecture 1 History 249 – Health and the Healer Medicine – Practice and Practitioner in MiddleAges 01/10/2013 CONT. from Medieval Medicine: Some dissection during Hellenistic times – very brief project done inside the royal academy  made possible because bodies could be provided by the King’s to the scientists Comes back in the medieval period – not everywhere at the same time but middle of the 13thC in Italy Different compared to previously Alaboratory demonstration for students Salerno  teachers in the 12thC did dissections for instruction purporses on pigs, interestingly, they were now done on humans for the first time in Italian medical purposes Human Dissection – Why Italy? 1 – legal traditions of forensic autopsy Roman law  made exception to general prohibition of autopsy in the case of suspicious death so there can be a forensic autopsy 2 – elite families concerned with heritable diseases domination by merchant and noble families = concerned with the continuity of the family and ability to hand down property = somewhat of an obsession with inheritable disease esp. the womenfolk whom could not bear healthy children autopsies  permission by male head of the family – autopsy on dead wives or dead children = is the cause of death inherited?! Would this jeopardise the family fortune? Autopsy within a certain social milieu 3 – canonisation inquiries when the Church formally declares someone to be a saint normally an enquiry prior to this  did miracles take place? In Italy  post-mortem dissections of those whom were thought to be saints = they become fairly commonplace esp. of women mystics e.g. St Cara of Montefore 4 – Italian vs. northern attitudes to death Week 5 – Lecture 1 History 249 – Health and the Healer Medicine – Practice and Practitioner in MiddleAges 01/10/2013 dissection did not catch on so fast in northern universities – only in the 15thC that human dissections occurred in Paris Elizabeth Brown and Katherine Park  different anthropological attitudes towards death in different parts of Europe Med = moment of death was seen as the absolute rupture  soul was separated from the body and the body left behind had no soul left in it at all = one can dissect the body WITHOUT harming the person The body left behind was given honourable burial – implication that the bodies provided for dissection medv universities were those of criminals North = different folkloric traditions  Celtic and Germanic cultural spheres = death was not a moment of absolute rupture between body and soul If soft tissues remained, then part of the soul was still there  only when the skeleton was solely left was this the point when the person was completely dead e.g. myths of vampires thus emerge and legends of corpses that would start to bleed when the murderer came near the corpse = still sentienty and life in the corpse Northerners were more squeamish re. dissection though both shared the idea that a public dissection in the university would not be something that an honourable person should be subject to  only criminals could be used for this = ex
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