HSOC 400 Exam
Medicine in History: Comprehensive Notes
Before Hippocrates and Ancient Greek Medicine
Hippocrates (460-377 B.C.)
Author of Airs, Waters, and Places
Embraced observation as a key principle
Theory of the four humors (blood, phlegm, yellow bile, black bile) first appears in the Hippocratic treatise On The Nature of Man
Valued prognosis highly
Paid attention to a patient's habits, their environment (where they lived), and their temperament
Believed treatments must be tailored to the individual patient
Humoral Medicine
The appeal of humoralism, which dominated classical medicine and formed its heritage, lay in its comprehensive explanatory scheme
Drew upon bold archetypal contrasts (hot/cold, wet/dry)
Hippocrates adhered to this view (NOT the supernatural)
Extremely enduring concept that lasted for centuries
Galen
Took parts of the Hippocratic corpus and molded it together, adding his own thoughts
Prided himself on his knowledge
His knowledge was based on animal dissections because dissections [of humans] at the time were taboo
Gained knowledge of the body through dissection [of animals]
Followed the Hippocratic ideal that most medical cases are self-limiting
Adhered to the idea that patients valued prognosis and reassurance
In dissection, Galen was looking for anatomical rationality
According to Galen, the body was intelligible because it was created by a rational Creator
Other scholars and physicians readily viewed Galen as credible, and few doubted his claims about the human body for over a thousand years
Islamic Golden Age of Medicine
Avicenna, Ibn Sina (980?-1037)
In the Islamic world, the works of Galen, Hippocrates, and Aristotle were being read, discussed, translated, and taught to scholars and physicians
There was a flourishing of knowledge about medicine in the Islamic world at this time
Avicenna (Ibn Sina)
Focused on breaking things down to their fundamental basics/truths and then applying reasoning, like Galen and Aristotle
Author of The Canon of Medicine
Consisted of 5 parts
Translated into different languages
Brought together theories and practices of Greek medicine
Maimonides (c. 1137-1204)
Rabbi, philosopher, and physician
Born in Spain
Based upon his writings, scholars have surmised that Maimonides had profound knowledge of ancient Greek authors and Muslim writers
He was influenced by Muslim physicians and trained in traditional Jewish texts
Made recommendations about times for eating, amounts and types of food to be consumed, exercise, sleep habits, cathartics, climate and weather effects on eating habits, detrimental and beneficial foods, bathing, and bloodletting
Stressed PREVENTION rather than TREATMENT
Ibn Ridwan
Ibn Ridwan and other Islamic doctors embraced a naturalistic view of health and sickness
Much of his work was translated into Latin, Hebrew, and Turkish and made its way into the libraries of Venice and Istanbul
Based much of his knowledge on Galen; frequently challenged peers who dared to question Galen
Excluded the supernatural or spiritual as causative factors
Ibn Ridwan said that doctors have to understand the temperament of Egypt to treat people, which is similar to Hippocrates in Airs, Waters, and Places
Similarities exist between his work On the Prevention of Bodily Ills in Egypt and Hippocrates' Airs, Waters, and Places
Dissection in Medieval Islam
Dissection Practices
Scholarly works on legal rules about dissection in Medieval Islam are relatively small
It is likely that, from a legalistic viewpoint, human post-mortem dissection was not an impossibility within the medieval Islamic world
There appears to have been no actual explicit prohibition in Islam against dissection or post-mortem examination
The matter would have been left to jurists using legal reasoning to determine its appropriateness
There are certainly references to dissection in the writings of medieval Islamic physicians (references to dissections of apes, etc.)
There is little to suggest offense at the practice in the texts
William Harvey (1578-1657)
Performed vivisections on dogs
Calculated how many times the heart beats in an hour and estimated the heart's capacity
Used experimental ligation (tying off the blood flow)
A pioneer in physiology; he championed the idea that blood circulates throughout the body through the action of the heart
Published De Motu Cordis (1628)
Advocated to "search and study out the secrets of nature by way of experiment"
Proved that the heart does not "make blood"
Demonstrated there are no pores between the right and left side of the heart in which blood flows (a belief Galen put forth and which remained relatively unchallenged until Harvey's treatise)
Chinese Medical Practices
Traditional Practices
Bloodletting does happen (appears to be a decline in the practice in the Han dynasty)
Moxibustion (burning of mugwort—an herb—close to the skin)
Still used today for a variety of complaints, chronic pain, and even issues in pregnancy
Cupping
Acupuncture
Similarities and Divergences with Greek Medicine
Both appreciated that food was the source of blood
Both were concerned by the concept of plethora (or excess); "Shi" roughly translates to this concept of fullness
Both understood the need to prevent plethora or "shi"
Chinese Medical Knowledge
Myth that Chinese medicine was less concerned with anatomical structure—this is not true
Chinese medicine relied on pharmacological knowledge
Used numbing medicines (including aconite) and other toxic plants when setting bones and draining abscesses, and to numb injured flesh before surgeries
Reference: toxic medicinal plants from Li Shizhen (1518-93), Compendium of Materia Medica, Edition 1690
Bloodletting in the Medieval Era
Two Kinds of Bloodletting
Periodic bloodletting: Those who were devoted to a life of religion might engage in this practice. This is typically a symbolic religious practice (found in monasteries)
Prophylactic bloodletting: More common, this was more of a medical preventative (to preserve the body)
Instruments and Methods
Use of a lancet or fleam
Cupping (both wet and dry)
In wet cupping, dry cupping was followed by the forming of several incisions in the skin and a reapplication of the cups to collect blood
Dissection and Anatomy (1300-1600)
Attitudes About Dissection in Italy
Evidence from legal practice and medical training in cities of northern and central Italy shows that autopsy and dissection were not infrequent
First recorded case in Italy of a human body being opened for inspection dates from 1286
In Bologna, doctors might be called to open bodies in trials related to dubious deaths
These are cases of postmortems—procedures carried out on a corpse to gain information about the physical state of a particular body
Evolution of Dissection Practices
Between 1300 and 1600, dissection grew less taboo
Attention to the details, contours, and accuracies of the external human body emerged in art and other forms of cultural production
There was not a blanket ban on dissection from religious authorities per se
Taboos around dissection were more social, cultural, and regional, and less religious
In Italy, dissection was adopted more frequently due to beliefs that once a person died, the soul left the body—complete separation
In Northern Europe, the opposite view prevailed: there was an idea that the body still had some vestiges of the person
16th Century Dissection Practices
Dissections in the 16th century could be carried out in public or private
Before Vesalius: Three People Involved in Carrying Out Dissection for Anatomical Teaching
Professor: Monitored progress and explained commentaries and texts
Demonstrator: Letting people see what the professor explained
Surgeon or Barber: Prepared the corpse and performed the cutting
Andreas Vesalius and Human Anatomy
De Humani Corporis Fabrica (On the Fabric of the Human Body)
This is Vesalius's great work
Vesalius performed his own dissections but also worked with artists to depict the human body with startling accuracy
Before Fabrica, Vesalius produced works that still conformed to Galen's notions of the human body (5 lobes in the liver!)
FYI: the human liver has 4 lobes!
The Bubonic Plague
Impact of the Plague
The 2nd pandemic is estimated to have wiped out 1/3 of Europe's population—the "BLACK DEATH"
Best estimates now are that at least 25 million people died in Europe from 1347 to 1352
Was almost 40% of the population (some estimates indicate 60%)
Understanding Plague
The idea that "miasmas" or foul air were a trigger to disease; created an epidemic constitution of the atmosphere
Poisoning of the atmosphere from the earth, decaying organic matter, miasma (or foul airs), poisonous emanations arising from swamps, etc., interacting negatively with humors as one possible cause of plague
Religious rationales were also blended in as well as celestial explanations
Symptoms and Progression
Bite from a flea
Then nausea/vomiting; flu-like symptoms
Bacteria multiply and invade lymph nodes, destroying the lymph system in the body
Buboes form in neck, armpits, groin, etc.
Buboes are extremely painful, emit a powerful stench
Powerful toxin is released into the blood vessels
Causes coma, neurological damage, dehumanizes and disfigures its victims
Historical Sources
Our knowledge about Bubonic Plague and societal impact is based on primary sources
Sources include accounts of the Black Death in Italy
Later iterations of the Bubonic plague are documented, including accounts from Samuel Pepys
Pepys is noted for his extensive and detailed diary which provided first-hand accounts of the Great Plague of London (1665-1666) and the Great Fire of London (1666)
Inoculation and Vaccination
Inoculation
Entailed taking pus collected from a pustule of a smallpox sufferer and placing it under the skin of a healthy individual to create a local infection and a mild form of the disease—thereby conferring life-long immunity against what might otherwise be a virulent and fatal case
The procedure was invasive and painful
Edward Jenner - English Physician
Noted for systematically testing the practice of vaccination—a new preventative measure that protected people against smallpox
Edward Jenner and Vaccination
In May 1796, Jenner encountered Sarah Nelms, a dairymaid with fresh cowpox lesions on her hands and arms
Jenner used matter from Nelms' lesions to inoculate an 8-year-old pauper, James Phipps
Phipps fell ill, but it was mild. He recovered
In July 1796, Jenner inoculated the boy again, this time with matter from a fresh smallpox lesion. No disease developed
This careful experimentation plus the already circulating hypothesis that people who recently had cowpox could not get smallpox, led to Jenner's discovery
This took him roughly 25 years to unravel
This use of cowpox (vaccinia) to protect against smallpox becomes the basis of vaccination
Race and Medicine in 19th Century America
The Myth of Innate Black Immunity to Yellow Fever
Notable figures: Richard Allen (portrait from 1823) and Benjamin Rush (portrait from 1814)
Dr. Samuel G. Morton
Philadelphia physician and founder of the "American School of Ethnology"
Published widely read works on craniometry (the study of brain size/intellect based on skull capacity)
Works include Crania Americana (1839) and Crania Aegyptiaca (1844)
His works reaffirmed pre-existing convictions that African-Americans, as well as other non-Caucasians, were inferior races
Trafficked in anti-Blackness
"Secret" polygenist who believed smaller skull size meant less intelligence
Morton received his 1st MD from University of Pennsylvania and 2nd MD from University of Edinburgh
Samuel A. Cartwright (1793-1863) - (Pro)Slavery Medicine
Prominent Louisiana physician with polygenesis leanings
Advanced the concept of "proslavery medicine"
Aimed to use medicine to justify slavery
Coined slave "diseases" including:
"Rascality" or Dysaesthesia aethiopica
"Drapetomania"—the disease which causes slaves to run away
Categorized these as mental illnesses
Important Concept: Clinical Racial Gaze
Willoughby: Clinical Racial Gaze is a combination of mastery of anatomy and the ability to "see" clinically with the cultural/social gaze which diminished Black people's humanity; largely due to slavery
Theories of Race by the 19th Century Two major schools of thought emerged regarding race:
Polygenesis - distinct origins of humans. Each race evolved separately. Josiah C. Nott, for example
Monogenesis - common origin of all human races (Traditional Biblical view of human race). Benjamin Rush, James Cowles Prichard, for example
In the antebellum era, both views trafficked in anti-Blackness.
Josiah C. Nott and Types of Mankind
Types of Mankind (1854) by Josiah C. Nott and George R. Gliddon argued that Black people formed a separate species, midway between whites and chimpanzees (Separate origins from whites)
Nott and Jeffries Wyman frequently compared Black people to animals
Nott had clear-cut anti-Black, proslavery medical views
Legitimized polygenesis, even if it was unorthodox
Types of Mankind was popular in the North!
Americans in Paris (and at Home)
American medical students with means traveled to Paris, France, spending time in clinics and hospitals for hands-on medical training
Upon their return, these students incorporated what they had learned in their practices and transmitted this knowledge in the domestic medical arena
Hands-on learning in the United States often meant "learning on" Black people's bodies
Joseph M. Leidy - M.D. 1844 (from Penn)
Professor of anatomy 1853-1891
His anatomy text (1861) was used for generations
Founder and head of Department of Biology 1885-1891
Believed the alleged anatomical differences between the races were small but significant
Different enough for separate taxonomy, but not different surgical technique
Leidy believed an anatomist could learn about both general human anatomy and the specific anatomy of Black people
Medical Education and Slavery African Americans (free and enslaved):
Were subject to abuse, experimentation, and neglect at the hands of physicians
They made up a population that was both visible and invisible
Their bodies were disproportionately used as anatomical teaching material
Their graves were more likely to be disturbed by body snatchers
They had no legal recourse to sue or stop medical schools from preying upon their bodies
Foucault's Clinical Gaze
"Clinical gaze": how the doctor views the patient is dependent upon the senses—seeing and hearing
The "gaze" dehumanizes and objectifies the patient
The disease is understood through what is going on internally in the patient and correlates with visible symptoms that are legible on the human body
Medical authority and patient submission is precisely the totalizing relationship of the clinical gaze as determined by Foucault in The Birth of the Clinic
The "clinical gaze" allows the physician to see what is hidden in the patient
Willoughby: Clinical Racial Gaze is a combination of mastery of anatomy and the ability to "see" clinically with the cultural/social gaze which diminished Black people's humanity; largely due to slavery
Infamous Cases of Grave Robbing
Burke and Hare were the two Scottish grave robbers or "resurrection men" who supplied the University of Edinburgh's medical school in the 19th century
They were encouraged by Robert Knox, who taught anatomy at the University of Edinburgh
Both men began to supply cadavers via murdering people rather than just stealing dead bodies
Specimens, Teaching Race and Anatomy
Education in anatomy relied on stolen skulls from around the world (Warren Anatomical Museum at Harvard)
Readily relied on accounts of victims of human trafficking ("Aztec Children" from El Salvador with microcephaly)
The children Bartola and Maximo were exhibited by P.T. Barnum (they were purchased from their mother and sold)
They were discussed as examples of "indigenous degeneracy"
Unclear if they were physically exhibited at Harvard during lectures, but their case was used to teach medical students
Summary: The Acceptance of Dissection Across Different Time Periods
The practice of human dissection experienced dramatically different levels of acceptance across cultures and time periods, shaped by religious, social, and cultural factors rather than uniform prohibitions.
Ancient Greece and Rome (Galen's Era)
During Galen's time, human dissection was taboo. As a result, Galen's extensive anatomical knowledge was based entirely on animal dissections. This limitation meant that some of his conclusions about human anatomy were incorrect (such as his claim that the human liver has 5 lobes, when it actually has 4). Despite these errors from working with animal subjects, Galen's authority remained largely unchallenged for over a thousand years.
Medieval Islamic World (10th-15th centuries)
In the medieval Islamic world, dissection occupied an ambiguous legal space. There was no explicit prohibition in Islam against dissection or post-mortem examination. The matter was left to jurists who used legal reasoning to determine appropriateness on a case-by-case basis. Medieval Islamic physicians wrote about dissection practices (including dissections of apes), and texts suggest little offense at the practice. From a legalistic viewpoint, human post-mortem dissection was not an impossibility, though scholarly works on the legal rules remain relatively small.
Medieval and Renaissance Italy (1286-1600)
Italy showed progressive acceptance of dissection. The first recorded case of a human body being opened for inspection dates to 1286. Evidence from legal practice and medical training in northern and central Italian cities shows that autopsy and dissection were not infrequent. In Bologna, doctors were called to open bodies in trials related to dubious deaths. Between 1300 and 1600, dissection grew less taboo, and there was not a blanket ban from religious authorities.
The acceptance in Italy was facilitated by the belief that once a person died, the soul left the body completely, allowing for separation between the spiritual and physical. This theological perspective made dissection more socially acceptable. Artists and physicians worked together, leading to increased attention to anatomical accuracy in both medical and artistic contexts.
16th Century Dissection Practices
By the 16th century, dissections had become formalized educational events. Dissections could be carried out in public or private settings. Before Vesalius revolutionized the practice, dissections for anatomical teaching involved three distinct roles:
The Professor - monitored progress and explained commentaries and texts from above
The Demonstrator - pointed out and displayed what the professor was explaining
The Surgeon or Barber - prepared the corpse and performed the actual cutting
This hierarchical structure reflected the academic separation between theoretical knowledge (held by the professor) and manual labor (performed by the surgeon/barber). Vesalius notably broke with this tradition by performing his own dissections and working directly with artists to create accurate anatomical illustrations.
Northern Europe (1300-1600)
Northern Europe presented a stark contrast to Italy. Taboos around dissection were stronger due to the belief that the body still retained some vestiges of the person after death. This made dissection more culturally and socially problematic. The resistance was not primarily religious but rather rooted in cultural and regional attitudes about the relationship between body and soul after death.
19th Century Scotland
By the 19th century, the demand for cadavers for medical education at institutions like the University of Edinburgh had grown so intense that it created a black market. The infamous case of Burke and Hare—"resurrection men" who supplied cadavers first through grave robbing and then through murder—illustrates both the acceptance of dissection as essential to medical training and the ethical problems created by insufficient legal supply of bodies.
19th Century United States
In America, dissection was fully accepted as essential to medical education, but this acceptance came with deeply disturbing racial dimensions. While dissection itself was normalized, African Americans (both free and enslaved) were disproportionately used as anatomical teaching material. Their bodies were more likely to be stolen by body snatchers, they had no legal recourse to protect their bodies, and they were subject to abuse and experimentation. Medical students traveled to Paris for hands-on training, but in the United States, "hands-on learning" often meant "learning on Black people's bodies."
Conclusion
Dissection's acceptance evolved from completely taboo in ancient times (forcing Galen to rely on animals), to legally ambiguous but not explicitly prohibited (medieval Islamic world), to increasingly accepted for legal and medical purposes (Italy, 1286-1600), to formalized educational practice (16th century with structured roles), to essential but ethically problematic (19th century). The barriers were primarily social, cultural, and regional rather than uniformly religious. However, acceptance did not mean ethical practice—particularly in 19th century America, where dissection became entangled with slavery, racism, and the exploitation of Black bodies for medical education.