Editing History of medicine (section)

== Early modern medicine ==

=== Places ===

==== England ====
In England, there were but three small hospitals after 1550. Pelling and Webster estimate that in London in the 1580 to 1600 period, out of a population of nearly 200,000 people, there were about 500 medical practitioners. Nurses and midwives are not included. There were about 50 physicians, 100 licensed surgeons, 100 apothecaries, and 250 additional unlicensed practitioners. In the last category about 25% were women.<ref>{{cite book | vauthors = Pelling M, Webster C | chapter = Medical Practitioners | publisher = CUP Archive | date = November 1979 | title = Health, Medicine, and Mortality in the Sixteenth Century | page = 183 }}</ref> All across England—and indeed all of the world—the vast majority of the people in city, town or countryside depended for medical care on local amateurs with no professional training but with a reputation as wise healers who could diagnose problems and advise sick people what to do—and perhaps set broken bones, pull a tooth, give some traditional herbs or brews or perform a little magic to cure what ailed them.

=== People ===
<gallery widths=165 heights=200>
File:Hirschvogel Paracelsus.jpg|[[Paracelsus]] (1493–1541). Known as the "father" of [[toxicology]]. 
File:Michael Servetus.jpg|[[Michael Servetus]] (1511–1553). Known as the first European to correctly describe [[pulmonary circulation]].
File:Andreas Vesalius Bruxellensis, Anatomicorum Princeps (BM 1925,1117.92).jpg|[[Andreas Vesalius]] (1514–1564). Known as the modern founder of [[Human body|human anatomy]].
</gallery>

=== Europe ===

The Renaissance brought an intense focus on scholarship to Christian Europe. A major effort to translate the Arabic and Greek scientific works into Latin emerged. Europeans gradually became experts not only in the ancient writings of the Romans and Greeks, but in the contemporary writings of Islamic scientists. During the later centuries of the Renaissance came an increase in experimental investigation, particularly in the field of dissection and body examination, thus advancing our knowledge of human anatomy.<ref>{{cite journal | vauthors = Siraisi NG | title = Medicine, 1450–1620, and the history of science | journal = Isis | volume = 103 | issue = 3 | pages = 491–514 | date = September 2012 | pmid = 23286188 | doi = 10.1086/667970 | s2cid = 6954963 }}</ref>[[Image:William Harvey ( 1578-1657) Venenbild.jpg|thumb|An experiment from [[William Harvey]]'s ''[[Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus|de Motu Cordis]]'', 1628]]

[[File:Leeuwenhoek Microscope.png|thumb|upright|Replica of [[Antonie van Leeuwenhoek]]'s [[microscope]] of the 1670s]]

==== Ideas ====

* '''Animalcules:''' In 1677 [[Antonie van Leeuwenhoek]] identified "animalcules", which we now know as microorganisms, within their paper "letter on the protozoa".<ref>{{cite journal | vauthors = Lane N | title = The unseen world: reflections on Leeuwenhoek (1677) 'Concerning little animals' | journal = Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences | volume = 370 | issue = 1666 | pages = 20140344 | date = April 2015 | pmid = 25750239 | pmc = 4360124 | doi = 10.1098/rstb.2014.0344 }}</ref>
* '''Blood circulation:''' In 1628 the English physician [[William Harvey]] made a ground-breaking discovery when he correctly described the [[circulatory system|circulation of the blood]] in his ''[[Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus]]''. Before this time the most useful manual in medicine used both by students and expert physicians was [[Dioscorides]]' ''[[De Materia Medica]]'', a [[pharmacopoeia]].

==== Inventions ====
* '''Microscopes:''' Bacteria and [[protist]]s were first observed with a [[microscope]] by [[Antonie van Leeuwenhoek]] in 1676, initiating the scientific field of [[microbiology]].<ref name="Brock" />

==== Institutions ====
At the [[University of Bologna]] the curriculum was revised and strengthened in 1560–1590.<ref>{{cite journal | vauthors = Lines DA | year = 2012 | title = Reorganizing the Curriculum: Teaching and Learning in the University of Bologna, c. 1560–1590 | journal = History of Universities | volume = 25 | issue = 2| pages = 1–59 }}</ref> The representative professor was [[Julius Caesar Aranzi]] (Arantius) (1530–1589). He became Professor of Anatomy and Surgery at the University of Bologna in 1556, where he established anatomy as a major branch of medicine for the first time. Aranzi combined anatomy with a description of pathological processes, based largely on his own research, Galen, and the work of his contemporary Italians. Aranzi discovered the 'Nodules of Aranzio' in the semilunar valves of the heart and wrote the first description of the superior levator palpebral and the coracobrachialis muscles. His books (in Latin) covered surgical techniques for many conditions, including [[hydrocephalus]], [[nasal polyp]], [[goitre]] and [[tumor|tumours]] to [[phimosis]], [[ascites]], [[hemorrhoid|haemorrhoids]], [[anorectal abscess|anal abscess]] and [[fistula]]e.<ref>{{cite journal | vauthors = Gurunluoglu R, Shafighi M, Gurunluoglu A, Cavdar S | title = Giulio Cesare Aranzio (Arantius) (1530–89) in the pageant of anatomy and surgery | journal = Journal of Medical Biography | volume = 19 | issue = 2 | pages = 63–69 | date = May 2011 | pmid = 21558532 | doi = 10.1258/jmb.2010.010049 | s2cid = 10833758 }}</ref>

==== People ====

===== Woman =====
Catholic women played large roles in health and healing in medieval and early modern Europe.<ref>{{cite journal | vauthors = Fissell ME | title = Introduction: women, health, and healing in early modern Europe | journal = Bulletin of the History of Medicine | volume = 82 | issue = 1 | pages = 1–17 | year = 2008 | pmid = 18344583 | doi = 10.1353/bhm.2008.0024 | s2cid = 37622681 }}</ref> A life as a nun was a prestigious role; wealthy families provided dowries for their daughters, and these funded the convents, while the nuns provided free nursing care for the poor.<ref name="pmid11618104">{{cite journal | vauthors = Green M | title = Women's Medical Practice and Health Care in Medieval Europe | journal = Signs | volume = 14 | issue = 2 | pages = 434–74 | date = 1989 | pmid = 11618104 | doi = 10.1086/494516 | s2cid = 38651601 }}</ref>

The Catholic elites provided hospital services because of their theology of salvation that good works were the route to heaven. The Protestant reformers rejected the notion that rich men could gain God's grace through good works—and thereby escape purgatory—by providing cash endowments to charitable institutions. They also rejected the Catholic idea that the poor patients earned grace and salvation through their suffering.<ref>{{cite book| veditors = Dixon CS, Freist D, Greengrass M |title=Living With Religious Diversity in Early-Modern Europe|url=https://books.google.com/books?id=l9fVJYNd61oC&pg=PA129|year= 2009|publisher=Ashgate |pages=128–130 |isbn=978-0-7546-6668-4 }}</ref> Protestants generally closed all the convents<ref>{{cite book | vauthors = Leonard AE | chapter = Female Religious Orders | veditors = Hsia RP |title=A companion to the Reformation world |date=2006 |publisher=Blackwell |location=Oxford |isbn=978-1-4051-7865-5 | pages = 237–254 }}</ref> and most of the hospitals, sending women home to become housewives, often against their will.<ref>{{cite book| vauthors = Cunningham A, Grell OP |title=Health Care and Poor Relief in Protestant Europe 1500–1700|url=https://books.google.com/books?id=dd-44kXLh1QC&pg=PA130|year= 2002|publisher=Routledge|pages=130–33|isbn=978-0-203-43134-4}}</ref> On the other hand, local officials recognized the public value of hospitals, and some were continued in Protestant lands, but without monks or nuns and in the control of local governments.<ref>{{cite book| vauthors = Mäkinen V |title=Lutheran Reformation and the Law|url=https://books.google.com/books?id=5Dkk1CDZ1UsC&pg=PA227|year=2006|publisher=Brill|pages=227–29|isbn=978-90-04-14904-5}}</ref>

In London, the crown allowed two hospitals to continue their charitable work, under nonreligious control of city officials.<ref>{{cite book| vauthors = Waddington K |title=Medical Education at St. Bartholomew's Hospital, 1123–1995|url=https://books.google.com/books?id=Mi5cV5D0SkAC&pg=PA18 |year=2003 |publisher=Boydell & Brewer|page=18|isbn=978-0-85115-919-5 }}</ref> The convents were all shut down but Harkness finds that women—some of them former nuns—were part of a new system that delivered essential medical services to people outside their family. They were employed by parishes and hospitals, as well as by private families, and provided nursing care as well as some medical, pharmaceutical, and surgical services.<ref>{{cite journal | vauthors = Harkness DE | title = A view from the streets: women and medical work in Elizabethan London | journal = Bulletin of the History of Medicine | volume = 82 | issue = 1 | pages = 52–85 | year = 2008 | pmid = 18344585 | doi = 10.1353/bhm.2008.0001 | s2cid = 5695475 }}</ref>

Meanwhile, in Catholic lands such as France, rich families continued to fund convents and monasteries, and enrolled their daughters as nuns who provided free health services to the poor. Nursing was a religious role for the nurse, and there was little call for science.<ref name="pmid21724643">{{cite journal | vauthors = McHugh T | title = Expanding women's rural medical work in early modern Brittany: the Daughters of the Holy Spirit | journal = Journal of the History of Medicine and Allied Sciences | volume = 67 | issue = 3 | pages = 428–456 | date = July 2012 |id={{Project MUSE|480067}} | pmid = 21724643 | pmc = 3376001 | doi = 10.1093/jhmas/jrr032 }}</ref>

=== Asia ===

==== China ====
In the 18th century, during the Qing dynasty, there was a proliferation of popular books as well as more advanced encyclopedias on traditional medicine. Jesuit missionaries introduced Western science and medicine to the royal court, although the Chinese physicians ignored them.<ref>{{cite book |title=The Cambridge History of Science |vauthors=Dikotter F |date=2003 |isbn=978-0-521-57243-9 |veditors=Porter R |volume=4: 18th-century Science |pages=695–697 |chapter=China}}</ref>

==== India ====
[[Unani medicine]], based on [[Avicenna]]'s ''[[The Canon of Medicine|Canon of Medicine]]'' (ca. 1025), was developed in India throughout the medieval and Early Modern periods. Its use continued, especially in Muslim communities, during the Indian Sultanate and [[Mughal Empire|Mughal]] periods. Unani medicine is in some respects close to Ayurveda and to Early Modern European medicine. All share a theory of the presence of the elements (in Unani, as in Europe, they are considered to be fire, water, earth, and air) and humors in the human body. According to Unani physicians, these elements are present in different humoral fluids and their balance leads to health and their imbalance leads to illness.<ref>{{cite journal |vauthors=Rahman HS |date=1996 |title=Arab Medicine During the Ages. |journal=Studies in History of Medicine and Science |location=New Delhi |publisher=IHMMR |volume=m 14 |issue=1–2 |pages=1–39}}</ref>

Sanskrit medical literature of the Early Modern period included innovative works such as the ''Compendium of Śārṅgadhara'' (Skt. ''Śārṅgadharasaṃhitā'', ca. 1350) and especially ''The Illumination of Bhāva'' (''Bhāvaprakāśa,'' by ''[[Bhavamishra|Bhāvamiśra]],'' ca. 1550). The latter work also contained an extensive dictionary of materia medica, and became a standard textbook used widely by ayurvedic practitioners in north India up to the present day (2024). Medical innovations of this period included pulse diagnosis, urine diagnosis, the use of mercury and [[Smilax china|china root]] to treat syphilis, and the increasing use of metallic ingredients in drugs.<ref>{{Cite book |last=Meulenbeld |first=Gerrit Jan |title=A history of Indian medical literature |date=1999 |publisher=E. Forsten |isbn=978-90-6980-124-7 |series=Groningen oriental studies |volume=IIA |location=Groningen |publication-date=1999–2002 |pages=115–375 |chapter=}}</ref>

By the 18th century CE, Ayurvedic medical therapy was still widely used among most of the population. Muslim rulers built large hospitals in 1595 in [[Hyderabad, India|Hyderabad]], and in [[History of Delhi|Delhi]] in 1719, and numerous commentaries on ancient texts were written.<ref name="Deepak Kumar 2003 pp 680-3">{{cite book |title=The Cambridge History of Science |vauthors=Kumar D |date=2003 |publisher=Cambridge University Press |isbn=978-0-521-57243-9 |veditors=Porter R, Ross D |volume=4: 18th-century Science |location=Cambridge |pages=680–683 |chapter=India}}</ref>
<gallery widths="190" heights="200">
File:Physician taking pulse.jpg|Physician taking pulse in Delhi c. 1826
File:Darul Shifa.jpg|[[Dar-ul-Shifa]], [[Hyderabad]] built in 1591
</gallery>

=== Europe ===

==== Events ====

===== European Age of Enlightenment =====
During the [[Age of Enlightenment]], the 18th century, science was held in high esteem and physicians upgraded their social status by becoming more scientific. The health field was crowded with self-trained barber-surgeons, apothecaries, midwives, drug peddlers, and charlatans.

Across Europe medical schools relied primarily on lectures and readings. The final year student would have limited clinical experience by trailing the professor through the wards. Laboratory work was uncommon, and dissections were rarely done because of legal restrictions on cadavers. Most schools were small, and only [[Edinburgh Medical School]], Scotland, with 11,000 alumni, produced large numbers of graduates.<ref>{{cite book | vauthors = Broman TH | chapter = The Medical Sciences |title=The Cambridge History of Science | volume = 4, Eighteenth-Century Science |date=2003–2020 |location=Cambridge |isbn=978-0-521-57243-9 | pages = 465–468 }}</ref><ref>{{cite book | vauthors = Rosner L |title=Medical Education in the Age of Improvement: Edinburgh Students and Apprentices 1760-1826 |date=1991 |publisher=Edinburgh University Press |location=Edinburgh |isbn=978-0-7486-0245-2}}</ref>

==== Places ====

===== Spain and the Spanish Empire =====
[[File:FlorentineCodex BK12 F54 smallpox.jpg|thumb|left|Depiction of [[smallpox]] in Franciscan [[Bernardino de Sahagún]]'s history of the conquest of Mexico, Book XII of the ''[[Florentine Codex]]'', from the defeated Aztecs' point of view]]

In the [[Spanish Empire]], the viceregal capital of Mexico City was a site of medical training for physicians and the creation of hospitals. Epidemic disease had decimated indigenous populations starting with the early sixteenth-century [[Spanish conquest of the Aztec empire]], when a black auxiliary in the armed forces of conqueror [[Hernán Cortés]], with an active case of [[smallpox]], set off a virgin land epidemic among indigenous peoples, Spanish allies and enemies alike. Aztec emperor [[Cuitlahuac]] died of smallpox.<ref>{{cite book | vauthors = Altman I |title=The Early History of Greater Mexico |date=2003 |publisher=Prentice Hall |location=Upper Saddle River, N.J. |isbn=978-0-13-091543-6 | page = 99 }}</ref><ref>{{cite journal | vauthors = Cook SF | year = 1946 | title = The Incidence of Disease Among the Aztecs and Related Tribes | journal = Hispanic American Historical Review | volume = 36 | pages = 32–35 }}</ref> Disease was a significant factor in the Spanish conquest elsewhere as well.<ref>{{cite book | vauthors = Cook ND |title=Born to Die: Disease and New World Conquest, 1492–1650 |date=1998 |publisher=Cambridge University Press |location=Cambridge |isbn=978-0-521-62730-6}}</ref>

[[File:Dibujo Escudo de Armas de México.jpg|thumb|upright|Mexico City epidemic of 1737, with elites calling on the [[Virgin of Guadalupe]]]]

Medical education instituted at the [[Royal and Pontifical University of Mexico]] chiefly served the needs of urban elites. Male and female ''curanderos'' or lay practitioners, attended to the ills of the popular classes. The Spanish crown began regulating the medical profession just a few years after the conquest, setting up the Royal Tribunal of the Protomedicato, a board for licensing medical personnel in 1527. Licensing became more systematic after 1646 with physicians, druggists, surgeons, and bleeders requiring a license before they could publicly practice.<ref>{{cite book | vauthors = Schendel G, Amézquita JA, Bustamante ME |title=Medicine in Mexico: From Aztec Herbs to Betatrons |date=2014 |publisher=University of Texas Press |isbn=978-1-4773-0636-9 | page = 99 }}</ref> Crown regulation of medical practice became more general in the Spanish empire.<ref>{{cite book | vauthors = Lanning JT |title=The Royal Protomedicato: The Regulation of the Medical Professions in the Spanish Empire |date=1985 |publisher=Duke University Press |location=Durham |isbn=978-0-8223-0651-1}}</ref>

Elites and the popular classes alike called on divine intervention in personal and society-wide health crises, such as the epidemic of 1737. The intervention of the [[Virgin of Guadalupe]] was depicted in a scene of dead and dying Indians, with elites on their knees praying for her aid. In the late eighteenth century, the crown began implementing secularizing policies on the Iberian peninsula and its overseas empire to control disease more systematically and scientifically.<ref>{{cite book | vauthors = Burke ME |title=The Royal College of San Carlos: surgery and Spanish medical reform in the late eighteenth century |date=1977 |publisher=Duke University Press |location=Durham, N.C. |isbn=978-0-8223-0382-4}}</ref><ref>{{cite book | vauthors = Cooper DB |title=Epidemic Disease in Mexico City, 1761–1813: An Administrative, Social, and Medical Study (LLILAS Latin American Monograph Series) |date=1965 |publisher=University of Texas Press |location=Austin |isbn=978-1-4773-0575-1}}</ref><ref>{{cite book | chapter = Chapter 7: The Rise of Medical Empiricism | vauthors = Voekel P |title=Alone Before God: The Religious Origins of Modernity in Mexico |date=2002 |publisher=Duke University Press |location=Durham |isbn=978-0-8223-8429-8}}</ref>

===== Spanish Quest for Medicinal Spices =====
Botanical medicines also became popular during the 16th, 17th, and 18th Centuries. Spanish pharmaceutical books during this time contain medicinal recipes consisting of spices, herbs, and other botanical products. For example, nutmeg oil was documented for curing stomach ailments and cardamom oil was believed to relieve intestinal ailments.<ref name="De_Vos_2006">{{Cite journal| vauthors = De Vos P |date=2006|title=The Science of Spices: Empiricism and Economic Botany in the Early Spanish Empire|journal=Journal of World History|volume=17|issue=4|pages=399–427 |jstor=20079398|doi=10.1353/jwh.2006.0054| s2cid=201793405 }}</ref> During the rise of the global trade market, spices and herbs, along with many other goods, that were indigenous to different territories began to appear in different locations across the globe. Herbs and spices were especially popular for their utility in cooking and medicines. As a result of this popularity and increased demand for spices, some areas in Asia, like China and Indonesia, became hubs for spice cultivation and trade.<ref name="Frank_1998">{{Cite book|title=ReOrient: global economy in the Asian Age| vauthors = Frank AG |date=1998|publisher=University of California Press|isbn=978-0-520-92131-3 |location=Berkeley |pages=96–100|oclc=42922426}}</ref> The Spanish Empire also wanted to benefit from the international spice trade, so they looked towards their American colonies.

The Spanish American colonies became an area where the Spanish searched to discover new spices and indigenous American medicinal recipes. The [[Florentine Codex]], a 16th-century ethnographic research study in Mesoamerica by the Spanish [[Franciscan friar]] [[Bernardino de Sahagún]], is a major contribution to the history of [[Nahuas|Nahua]] medicine.<ref>{{cite book |vauthors=de Bernardino S |title=Historia general de las cosas de Nueva España |trans-title=General History of the Things of New Spain |series=The Florentine Codex |language=Spanish |date=2006 |publisher=Editorial Porrúa |location=México |isbn=978-9-70-07649-24 |edition=11th |url=https://www.wdl.org/es/item/10096/view/1/1/ |access-date=2020-02-01 |archive-date=2019-07-08 |archive-url=https://web.archive.org/web/20190708193906/https://www.wdl.org/es/item/10096/view/1/1/ |url-status=live }}</ref> The Spanish did discover many spices and herbs new to them, some of which were reportedly similar to Asian spices. A Spanish physician by the name of [[Nicolás Monardes]] studied many of the American spices coming into Spain. He documented many of the new American spices and their medicinal properties in his survey ''[[Historia medicinal de las cosas que se traen de nuestras Indias Occidentales]]''. For example, Monardes describes the "Long Pepper" (Pimienta luenga), found along the coasts of the countries that are now known Panama and Colombia, as a pepper that was more flavorful, healthy, and spicy in comparison to the Eastern black pepper.<ref name="De_Vos_2006" /> The Spanish interest in American spices can first be seen in the commissioning of the ''[[Libellus de Medicinalibus Indorum Herbis]]'', which was a Spanish-American codex describing indigenous American spices and herbs and describing the ways that these were used in natural Aztec medicines. The codex was commissioned in the year 1552 by Francisco de Mendoza, the son of [[Antonio de Mendoza]], who was the first Viceroy of New Spain.<ref name="De_Vos_2006" /> Francisco de Mendoza was interested in studying the properties of these herbs and spices, so that he would be able to profit from the trade of these herbs and the medicines that could be produced by them.

Francisco de Mendoza recruited the help of Monardez in studying the traditional medicines of the indigenous people living in what was then the Spanish colonies. Monardez researched these medicines and performed experiments to discover the possibilities of spice cultivation and medicine creation in the Spanish colonies. The Spanish transplanted some herbs from Asia, but only a few foreign crops were successfully grown in the Spanish Colonies. One notable crop brought from Asia and successfully grown in the Spanish colonies was ginger, as it was considered Hispaniola's number 1 crop at the end of the 16th Century.<ref name="De_Vos_2006" /> The Spanish Empire did profit from cultivating herbs and spices, but they also introduced pre-Columbian American medicinal knowledge to Europe. Other Europeans were inspired by the actions of Spain and decided to try to establish a botanical transplant system in colonies that they controlled, however, these subsequent attempts were not successful.<ref name="Frank_1998" />

===== United Kingdom and the British Empire =====
[[File:18th Century Recipes f.459 - Medical remedies.jpg|thumb|18th-century medical remedies collected by a British Gentry family]]
The London Dispensary opened in 1696, the first clinic in the British Empire to dispense medicines to poor sick people. The innovation was slow to catch on, but new dispensaries were open in the 1770s. In the colonies, small hospitals opened in Philadelphia in 1752, New York in 1771, and Boston ([[Massachusetts General Hospital]]) in 1811.<ref>{{cite book | vauthors = Davis MM, Warner AR |url= https://archive.org/details/dispensariesthei00daviuoft |title=Dispensaries, Their Management and Development: A Book for Administrators, Public Health Workers, and All Interested in Better Medical Service for the People |publisher=MacMillan |year=1918 |pages=[https://archive.org/details/dispensariesthei00daviuoft/page/2 2]–5}}</ref>

[[File:Guy's Hospital00.jpg|thumb|[[Guy's Hospital]] in 1820]]

[[Guy's Hospital]], the first great British hospital with a modern foundation, opened in 1721 in London, with funding from businessman [[Thomas Guy]]. It had been preceded by [[St Bartholomew's Hospital]] and [[St Thomas's Hospital]], both medieval foundations. In 1821 a bequest of £200,000 by William Hunt in 1829 funded expansion for an additional hundred beds at Guy's. [[Samuel Sharp (surgeon)|Samuel Sharp]] (1709–78), a surgeon at Guy's Hospital from 1733 to 1757, was internationally famous; his ''A Treatise on the Operations of Surgery'' (1st ed., 1739), was the first British study focused exclusively on operative technique.<ref>{{cite journal | vauthors = Kirkup J | title = Samuel Sharp and the Operations of Surgery, 1739 | journal = Journal of Medical Biography | volume = 4 | issue = 1 | pages = 1–7 | date = February 1996 | pmid = 11615341 | doi = 10.1177/096777209600400101 | s2cid = 26133970 }}</ref>

English physician [[Thomas Percival]] (1740–1804) wrote a comprehensive system of medical conduct, ''[[Medical Ethics; or, a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons]]'' (1803) that set the standard for many textbooks.<ref>{{cite journal | vauthors = Waddington I | title = The development of medical ethics -a sociological analysis | journal = Medical History | volume = 19 | issue = 1 | pages = 36–51 | date = January 1975 | pmid = 1095851 | pmc = 1081608 | doi = 10.1017/s002572730001992x }}</ref>