The siege of Metz is also known for the first instance of the period when a commander showed basic humanity to prisoners. It was common practice to butcher prisoners, especially the sick and wounded, who fell into enemy hands. Guise instead ordered that the enemy sick camps not be burned and that the captured sick prisoners be taken to hospitals within the city and given medical treatment. He communicated with the enemy commander, suggesting safe passage to units designated to police the area for additional wounded and sick, and supplied wagons for this purpose. A number of boats to transport the enemy sick to their home units were supplied, marking the first time since Rome that “hospital ships” were used to evacuate and treat the wounded.55 Guise’s clemency, however, proved a disaster. Once he had transported the enemy sick to the city’s hospitals, an epidemic of typhus spread from the prisoners to the larger population, killing hundreds.
Guise’s example of humane treatment provoked a remarkable change in the treatment of the wounded that other armies gradually adopted. At the siege of Therouanne in 1553, Spanish troops who had fought at Metz remembered the French example of merciful treatment and did not kill a single prisoner. Again at Thionville in 1558, both sides followed Guise’s example. The common practice of massacring those prisoners not reserved for ransom gradually declined. By the seventeenth century, the combatants themselves had established the custom of sparing prisoners, and from it sprung the idea that the wounded and sick should be treated as noncombatants. This idea was codified into international law centuries later in the Geneva Convention.
The Renaissance was more than a “revival of learning” insofar as it saw the discovery and promulgation of new medical knowledge. More important, the period produced a new type of medical practitioner, the military barber-surgeon, who could apply the new empirical medical knowledge on the battlefield. For the first time in a millennium, the soldier had access to some effective empirical medical talent to save his life. At first this talent was reserved for the nobility, but as the feudal armies gradually became national armies drawn from the citizenry, the leadership paid more attention to the medical needs of the common soldier. The first embryonic stirrings of regular medical establishments in the armies of all the major states appeared, and the gradual introduction of humane rules and practices for dealing with the captured, sick, and wounded probably went some distance in reducing casualty rates. The first permanent military hospitals appeared, as did greater concern for caring for the disabled after their return from military service. Yet, it is important to remember that in all these aspects the Renaissance represented only the germination of new military medical ideas and practices. It took another three centuries before any of these ideas were carried to fruition in a manner sufficient enough to make a real difference in the quality of military medical care available to the soldier.
NOTES
1. The dates used here to define the Renaissance period encompass the most important military and medical events of the period. From a literary, cultural, and artistic perspective, however, the Renaissance can be said to have begun much earlier, perhaps as early as the twelfth century.
2. The first outbreak of the Great Plague in Europe occurred in 1348. Outbreaks of lesser intensity occurred in 1361–1363, 1369–1371, 1374–1375, and 1390–1400. Historians have generally come to accept Jean Froissart’s estimate that as much as a third of the population of Europe succumbed to the disease.
3. Fielding Garrison, Notes on the History of Military Medicine (Washington, DC: Association of Military Surgeons, 1922), 107.
4. The effects of disease and social disorder as they affected socialization mechanisms are found in John Rathbone Oliver, “Medical History of the Renaissance,” International Clinics 1 (March 1928): 239–62.
5. Among the more important medical humanists are Niccolò Leoniceno (1428–1524), who translated the aphorisms of Hippocrates and corrected the botanical errors in Pliny’s National History; Thomas Linacre (1460–1524), who translated the major Galenic treatises on hygiene, therapeutics, temperaments, natural faculties, and the pulse; and François Rabelais (1490–1553), who translated the other major works of Hippocrates.
6. It is probable that the first European press was not invented by Johannes Gutenberg but by Laurens Coster of Haarlem in 1440.
7. Fielding Garrison, Introduction to the History of Medicine (London: W. B. Saunders, 1967), 193.
8. Le Roy Crummer, “Joseph Schmidt: Barber Surgeon,” American Journal of Surgery 4 (February 1928): 237.
9. Charles L. Heizmann, “Military Sanitation in the Sixteenth, Seventeenth, and Eighteenth Centuries,” Annals of Medical History 1 (1917–1918): 283.
10. Garrison, Introduction to the History, 239.
11. Ibid.
12. For the dynamics of bullet flight and impact, see D. A. W. Hopkinson and T. K. Marshal, “Firearm Injuries,” British Journal of Surgery 54, no. 4 (May 1967): 344–53.
13. Firearms experts estimate the muzzle velocity of a black powder smoothbore musket firing a half-ounce .50-caliber ball at standard charge to be approximately 1,100 to 1,350 feet per second, providing an impact energy of 350 foot-pounds at 50 yards. For comparisons with modern military firearms, see E. Stephen Gurdjian, “The Treatment of Penetrating Wounds of the Brain Sustained in Warfare,” Journal of Neurosurgery 39 (February 1974): 157–66.
14. See Robert D. Forrest, “Development of Wound Therapy from the Dark Ages to the Present,” Journal of the Royal Society of Medicine 75 (April 1982): 269. Remarkably, the debate on whether gunshot wounds were poisonous continued until at least the early twentieth century, when in a curious twist it was held that the temperatures generated in firing modern weapons made bullet wounds essentially aseptic! See F. P. Thoresby and H. M. Darlow, “The Mechanism of Primary Infection of Bullet Wounds,” British Journal of Surgery 54 (1967): 359–69.
15. Henry E. Sigerist, “Ambrose Paré’s Onion Treatment of Burns,” Bulletin of the History of Medicine 15, no. 2 (February 1944): 144.
16. Ibid., 143.
17. Ibid., 148.
18. Garrison, Notes on the History, 115.
19. The best short history of Paré’s contributions to Renaissance medicine is Owen H. Wangensteen, Sarah D. Wangensteen, and Charles F. Klinger, “Wound Management of Ambroise Paré and Dominique Larrey: Great French Military Surgeons of the 16th and 19th Centuries,” Bulletin of the History of Medicine 46, no. 3 (May–June 1973): 207–34.
20. Ibid., 214.
21. J. S. Taylor, “A Retrospect of Naval and Military Medicine,” U.S. Naval Medical Bulletin 15, no. 3 (1921): 575–76. Thomas Gale (1507–1586) of England performed similar experiments with firearms at about the same time.
22. Wangensteen et al., “Wound Management,” 213.
23. Ibid., 214.
24. Garrison, Notes on the History, 99. Some famous physicians who served in military campaigns were Nicholas Colnet and Thomas Morestede with Henry V at Agincourt, Hans von Gersdorf with the Swiss at Grandson, Gabriel Miron with Charles VII at Naples, Marcello Cumano with the Milanese armies at Novara, and Symphorien Campier with Francis I at Marignano.
25. Heizmann, “Military Sanitation,” 284.
26. The only extant work on the subject of Swiss military medicine in the Renaissance was written by Dr. Conrad Brunner, Die Verwundeten in den Kriegen den alten Eidgenossenschaft (Tübingen, 1903).
27. Ibid., 57.
28. Ibid., 52–54.
29. Ibid.
30. The Soviet Army used the term “feldscher” as an official title for its combat medics at least until 1990.
31. Modern weaponry’s increased killing power necessitated tacticians’ spreading out their forces, and the consequential dispersal of the wounded still bedevils modern medical planners. Using medevac helicopters as a solution works only if one controls the air over the battlefield. Otherwise, the helicopters are themselves vulnerable to new long-range weapons, as the Soviets found to their dismay in Afghanistan.
32. The Landsknecht
e were heavy infantry armed with muskets, halberds, and bows. The state partially provided their pay, and they were permitted to loot and keep the booty as a supplement to their pay.
33. Heizmann, “Military Sanitation,” 284. These early regulations are regarded as the birth of the German military medical service.
34. Ibid., 281–83.
35. Ibid., 284.
36. Ibid.
37. Garrison, Notes on the History, 103–4.
38. The thousands of female camp followers who usually attended the armies of the period certainly contributed to the spread of syphilis, which was epidemic.
39. Heizmann, “Military Sanitation,” 285.
40. Garrison, Notes on the History, 104.
41. Heizmann, “Military Sanitation,” 284.
42. Garrison, Notes on the History, 105.
43. Ibid.
44. Taylor, “Retrospect of Naval and Military Medicine,” 598.
45. Ibid.
46. Ibid.
47. Some idea of how slowly the notion of providing long-term care to veterans developed can be obtained from noting that the disabled veterans of the famous Light Brigade at Balaclava during the Crimean War were not provided any care at all. In desperation, the disabled veterans sent representatives to their commander, Lord Cardigan, and asked him to plead their case with the government. Cardigan sent them away, promising to ask the government to grant a special dispensation so that his troops might be given preference in obtaining beggar’s licenses!
48. This remained the case until the Franco-Prussian War of 1870–1871 in which for the first time more men were lost to enemy fire than to disease. The low loss rate to disease resulted in large part from the discoveries of Robert Koch, who developed the theory of the etiology of disease and established regular sanitation officers in German units.
49. Reginald Hargreaves, “The Long Road to Military Hygiene,” The Practitioner 196 (March 1966): 441.
50. Heizmann, “Military Sanitation,” 281.
51. Carey P. McCord, “Scurvy as an Occupational Disease: Scurvy in the World’s Armies,” Journal of Occupational Medicine 13, no. 12 (December 1971): 588.
52. Heizmann, “Military Sanitation,” 285.
53. Garrison, Notes on the History, 106.
54. Heizmann, “Military Sanitation,” 286.
55. Ibid., 287.
3
THE SEVENTEENTH CENTURY
Gunpowder and Slaughter
The new empirical spirit of the Renaissance threatened much more than the storehouse of knowledge inherited from the Middle Ages. The spirit of empirical inquiry was rooted in new notions of individualism, themselves products of the wide-ranging social disruption that the plagues and wars of the period engendered. The same spirit of individual inquiry that made the new knowledge possible also undermined the collectivism that had underpinned the European social order for more than a millennium. It was this “spirit of individual disorder” as much as the plagues, wars, and new technologies of the seventeenth century that weakened the social institutions of the old order.
The old intellectual tradition of inquiry based on scholastic reasoning, first principles, and absolute causes remained strongly in place as the new century dawned. The new empirical knowledge had not yet achieved a level of generalization or acceptance capable of challenging the old approaches to medicine and science on any scale. At the same time, the new knowledge was sufficiently accurate to seriously call into question the ability of scholastic assumptions and methods to explain the physics, science, and medicine of the day. As the intellectuals of the seventeenth century conceived it, the challenge was not to discard the age-old idea of a universal order but to utilize empiricism to demonstrate the validity of that order.
The period was the age of Isaac Newton (1642–1727), himself a devoutly religious man, who wrote his Principia Mathematica precisely to demonstrate the empirical reality of a divine order that governed human affairs. The new approach to science was never intended to discredit the conclusions of the old system of reasoning as much as to introduce new methods of demonstrating the validity of those conclusions through empirical observation. The difficulty was that while the new empiricism could collect data that had yet to await eventual theoretical synthesis, the new knowledge created disturbing observable facts that undermined the assumptions upon which the old scholastic approach was based. It resulted in creating as much of a threat to the old intellectual order as if the assumptions of that order had been directly challenged in the first place.
The seventeenth century witnessed the progressive weakening of the old social, political, and epistemological system as the press of epidemics, wars, and social disruption continued to cripple the social institutions that gave expression to the assumptions of the old knowledge in everyday life. The collectivism that had underpinned the old order was also undermined. The old order had been based upon reciprocity of obligations, but the new knowledge was based on rights.
The erosion of the collective spirit brought with it a decline in those social practices that thrived on collectivism, among them organized nursing, charitable care of the sick, well-managed hospitals, and the general power of the church. In its place, the new experimenters could only offer the promise of eventually complete explanations of human events. With the exception of Newton’s work, the seventeenth century produced no new tested theories or agreed-upon set of empirical observations. While the period did generate a number of important discoveries in medicine, few of them were integrated into the medical practice of the day.
Among the more important advances in medical knowledge was William Harvey’s demonstration of the circulation of the blood in 1616. Harvey proved mathematically that given the volume and speed of blood in the body, there was no alternative to circulation. Harvey’s work destroyed the Galenic dictum that blood passed through “pores” in the heart ventricles; instead, Harvey demonstrated that the heart pumps blood to the body and the veins return blood to the heart. Another major invention, the microscope, belongs to this period. While the instrument’s origins are obscure, Athanasius Kircher (1602–1680) was probably the first to use the microscope in investigating the causes of disease. Antonj van Leeuwenhoek (1632-1723) made further advances in medical microscopy, wrote more than 250 papers from data assembled from microscopic investigation, and produced the first scientific description of red blood corpuscles. Marcello Malpighi (1628–1694), the father of histology, was the greatest microscopist of the period and introduced a theory of respiration. Franz de le Boë (1614–1672) established the science of physiological chemistry, and Robert Boyle (1627–1691) conducted experiments on gasses that made a cogent theory of respiration possible.1
The decline of collectivism was evident in these discoveries. Individuals working in private laboratories with little in the way of institutional affiliation or support achieved most of them. The universities and medical schools of the day continued to cling to Galenic and other theories, and their rigorous enforcement of these perspectives prevented them from attracting the best minds to their faculties. Men associated with universities made few of the era’s great discoveries. In an age of individualism, individualism propelled investigation and discovery. Yet, the new knowledge cried out for an integrative theory to oppose the standing scholasticism. The search for a new theoretical structure influenced medicine as well.
The search for an integrative medical theory based on empirical observation manifested itself in the development of two major schools of thought that sought to organize the new medical knowledge into a systematic whole. The pull of universal order, assumed for more than a millennium, influenced medicine as much as it did Newton’s laws of physics. The two new schools of medical theory were the Iatro-mathematical school and the Iatrochemical school.
The Iatromathematical school sought to apply the new principles of mechanics and mathematics to medical investigation. As represented by René Descartes (1576–1650), Giovanni Borelli (1608–1679), and Santorio Sanc
torius (1561–1636), the human body was conceived of as a mechanical machine in which all bodily processes—thinking, respiration, digestion, locomotion, and so forth—were regarded as mechanical processes subject to physical and mechanical laws. The Iatrochemical school, represented by Jean-Baptiste van Helmont (1577–1644), Franciscus Sylvius (1614–1672), and Thomas Willis (1621–1675), saw the body as the product of a series of chemical reactions and processes.2 Both schools ended in sterile failure, as they sought to generalize to operational principles of larger scope without sufficient empirical data upon which the structure of their analysis was built. Both schools were examples of what the new experimentalism was attempting to achieve. Because neither succeeded in enforcing a new theory of medicine upon the discipline, the process of experiment and discovery that characterized the period continued.
A number of important medical advances laid the groundwork for further development in the coming centuries, although few found large-scale application in daily medical practices. The new knowledge of physiological chemistry and of the behavior of liquids and gases was applied to medical experiments. One application was the intravenous injection of drugs, which Christopher Wren (1632–1723) first attempted on dogs. Others experimented with the technique, and Caspar Scotus carried out the first successful intravenous drug injection on a man in 1664. In England, John Graunt (1620–1674) introduced the science of vital statistics by compiling a statistical study of mortality. Stephen Bradwell (1588–1665) published the first handbook on first aid for common injuries in 1663. Daniel LeClerc (1652–1728) wrote the first comprehensive history of medicine, and the newly introduced medical dictionary became commonplace.3
The seventeenth century also saw the introduction of copperplate engraving to replace the woodcut, revolutionizing the art of anatomical illustration. Johannes Scultetus (1595–1645) wrote Armamentarium Chirugicum, the first complete book of surgical instruments with each instrument drawn to scale and complete with illustrations of their application in surgical settings. It was published posthumously in 1655.4 Until this time, armorers, blacksmiths, and razor makers had made surgical instruments to individual specification, with little in the way of standardization. Now highly skilled silversmiths, cutlers, and pewterers made these instruments and produced implements of standard design, balance, and quality.5
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