How the study of the human body structure became acceptable through the ages:

An Autopsy conducted in Medieval Italy to determine the cause of death.

The material human body has always held a sacred place in a culture’s belief system, particularly when it comes to notions of an afterlife. By the same reasoning, the deceased were required by religious or civil law to be buried promptly after death, certainly within three days. The early civilizations of the Mediterranean area found this especially necessary due to their temperate climates and sanitary concerns, where decay came on rapidly. Moreover, many cultures, such as the Egyptians and indigenous tribes of the Americas, believed that an intact material body was necessary in order to achieve the afterlife. Decay and mutilation of a body were considered anathema–unless it concerned the enemy. Egyptian priests, in the process of mummifying the bodies of high-ranking personages, removed organs that would rapidly rot, such as the intestines, but preserved the main organs such as the heart. However, little was learned of human anatomy except for the most basic positions of vital organs.

In the Roman era, the most prominent surgeon and anatomist was Galen, physician to the gladiators and to Emperor Commodus (of “Gladiator” fame), who based his anatomy on the dissections of Barbary apes and the exposed body structures of the wounded gladiators he treated. The anatomy texts of Aristotle and Galen subsequently were considered as inviolable up until the 16th century, with the spread of the Renaissance throughout Europe. Common errors were made by implying structures found in animals as comparable to those in humans. For instance, a woman’s uterus was thought to have to sides, the right side for producing male children, the left for female propagation, and the female breast was thought to be connected by channels to the uterus (we know now they’re both under the control of hormones). Aristotle believed that venous blood was transferred from the right side of the heart to the left side, which pumps newly oxygenated blood into the arteries, through tiny pores in walls between the heart chambers. Overall, the true nature of blood circulation would not be understood until the 17th century, a little over three hundred years ago! And, the Greeks and Romans often had difficulty differentiating between tendons and nerves, not fully clear on what the functions of nerves were. The brain, however, was known to be the seat of consciousness and thinking.

Galen treating a wounded gladiator at the colosseum in Pergamum.

The texts of Hippocrates (a compilation of many Greek authors) mentions human anatomy with varying accuracy and not in great detail. Certain sections of the texts are accurate enough to suggest that at some point, someone had limited access to an area of a body for cursory study. By the time of Alexander the Great, the Egyptian city of Alexandria founded by him became a cosmopolitan center of trade and learning. It was here that by the 3rd century BC, human dissection had been carried out by the Greek natural philosophers, as scientists were then called, Herophilus and Erasistratus. Celsus, the Roman encyclopedists, wrote several centuries later that the dissections were performed on living criminals who had been condemned by the king. Whether this is true or not, the first valid insights into the true anatomy of the body were established. Aristotle, the great Greek philosopher, conducted his own animal dissections, including the neck bones of a lion, which helped establish the basis, often incorrect, of human anatomy for centuries to come.

Interestingly, in the Middle Ages–the Medieval or “middle period” between the fall of Rome c. 450 AD and the beginning of the Renaissance and fall of Constantinople to Islam in the 15th century–human dissection was performed frequently. It began in Italy around the 11th-12th centuries, where autopsies were mandatory whenever anyone died under suspicious circumstances. Poisoning, whether real or imagined, appears to have been prevalent during that time, leading to autopsies to determine whether the death was natural or a homicide. The Catholic Church even encouraged studies of the human body, contrary to popular opinion, as dissections became widespread in order to teach anatomy. The position of the Church was that a formal study of the human body would allow people to appreciate and revel in the wondrous miracles wrought by God in His creation. Despite the increasing use of human dissections, the knowledge gained by these public exhibitions was limited. The writings of Galen and Aristotle were considered infallible, and any deviation found during human dissection was rationalized to conform to their teachings. In the Islamic world, at this same time, there do not appear to be any teachings in the Quran for or against human dissection, but Galen and Aristotle were held to the same level of reverence as in Medieval Europe.

All this would change by the beginning of the 16th century with the coming of the Renaissance and humanism, where all the teachings of the ancients would be challenged. More on this next time.

Astrology and the Human Body, as conceived just before the advent of the Renaissance

An Arrow shot to the face nearly killed a future king of England

Posted on February 15, 2020 by gerald stulc

I am a retired surgeon, former flight surgeon in the USNR Medical Corps, and lifelong student of military and medical history. In considering the many misperceptions about the history of medicine, stereotypes of medicine in the Middle Ages are one of the most common I encounter. Medieval physicians and surgeons are usually represented as incompetent, highly superstitious charlatans using exotic, even ridiculous medicaments of no value, and employing barbarous surgery which usually results in the death of their patients. The truth is far more nuanced. Certainly, medicine and surgery in the Middle Ages competed with medical astrology and alchemy, and there were charlatans plying their trades to the desperate and gullible–much like the online and television medical info commercials and “experts” of today. Recall, however, that during the Middle Ages magnificent cathedrals were constructed, great literature was created by writers such as Dante and Chaucer, universities and Western music were founded, artists produced superb paintings employing perspective, gunpowder and mining technology advanced rapidly, and the overall economy was booming. Medical schools were established, beginning in the 12th century, in Italy, France, England, and Bohemia. The most famous and exemplary case of adept Medieval military surgery relates to a future English monarch severely wounded in a battle at the turn of the 15th century. In 1403, Prince Hal, the Prince of Wales and future King Henry V of Agincourt fame, led his army in support of an army with commanded by his father, Henry IV, into Wales in to suppress a rebellion of English noblemen. Feeling betrayed by the king, Henry “Hotspur” Percy led other disgruntled lords and their armies against the crown. The confrontation occurred on a sunny Saturday, the 21st of June, outside the village of Shrewsbury.

Percy took the high ground, on a ridge overlooking a long gentle slope down to a boggy field of peas and ponds. Prince Hal led the charge up the left side of the slope to outflank Percy’s right. Hal was sixteen years old at the time. In short order, the Cheshire longbows released volleys of bodkins, arrows with square steel arrowheads tapering into a sharp point. The head was socketed into the arrow shaft, and meant to penetrate chain mail, even plate armor at close range. The deadly hail brought down Prince Hal’s men, who fell “like leaves in Autumn in a Hoare frost.” Perhaps the heat, or limited vision in the charge, caused Hal to lift his visor. We’ll never know. A bodkin struck his face square on, penetrating the cheekbone just to the side of the nose and below the eye. Hal refused to be taken off the field, and continued fighting until he and his father won the battle. Ironically, Percy was killed that day allegedly by an arrow which pierced his mouth.

Prince Hal was taken fifty miles to rest at Kenilworth castle, where he was attended to by numerous surgeons. The shaft, in the interim, had been plucked out, leaving the arrowhead embedded deeply in the skull. Ointments, salves, and dressings were applied, but probes determined that the head of the bodkin was too deeply lodged to remove by standard surgical instruments designed for that purpose. It was known that failure to remove an arrowhead, contaminated with dirt and clothing, would result in fatal infection.

After several days, John Bradmore, one of the royal court surgeons in London, was sent for. Bradmore immediately set to dilate the wound tract, swollen shut from inflammation and incipient healing. Using fine linen wrapped around thin sticks of elm wood, these probes were dipped in honey and introduced daily into the depths of the wound, gradually increasing the size of the probes until the wound was sufficiently widened. In the meantime, Bradmore designed a long narrow pair of smooth tongs with a screw passing down between them. As the screw was advanced between the tongs, their smooth ends separated–a sort of corkscrew. Now, Bradmore threaded the tong device gently down the tract of the wound until the ends of the tongs entered the socket of the bodkin. As the screw was carefully advanced, the tong ends separated until they were compressed against the inside of the socket. With gradual rocking and pulling, the bodkin came out intact. The wound was further irrigated with honey, an ancient medicine known to suppress infection and promote healing, and with white wine, another antiseptic. Report this ad

Prince Hal, being young, strong, and sustaining an incredibly lucky shot that missed all major nerves, blood vessels, and the brain, recovered rapidly. Subsequent portraits of him show him in profile, from the left side, concealing the vivid scar in his right cheek. In 1413, he became king, and defeated the French in the Hundred Years’ War Battle of Agincourt two years later. Bradmore continued surgical practice with a princely annual pension for his success, dying a wealthy man. He wrote an account of Prince Hal’s wounding and treatment, “Phiomena,” a case study of military surgery in the Middle Ages. Certainly, not all surgeons in that time were as talented or innovative as Bradmore. The case became well known because of the importance of the patient, and the success of the operation. However, there must have been many more men like Bradmore who performed successful surgeries through experience, empiricism, and common sense, men like Mondeville, John of Arderne, de Chauliac who studied ancient medical works and wrote the surgical texts that guided surgeons into the era of the Renaissance. May the civilizations hundreds of years from now not judge us as harshly for our ignorance of cancer, mental illness, autism, Alzheimer’s and addiction.