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2005 First Paper
The Plague and Development of Modern Medicine
In this paper, I would like to begin a discussion of the development of western medicine, and science in general, with the epidemic of the bubonic plague marking a turning point. The social, cultural and intellectual role of medicine, which was not always considered a science, has undergone tremendous change, passing between the realms of philosophers to police to the battlefield to the church. Prior to the plague, its role was always somewhat more fluid, playing a lesser part in some civilizations than in others. For Western Europe, it took a massive medical catastrophe to spur the institutionalization of medicine as we almost universally conceive of it today.
In an examination of the social implications of the policies of compartmentalization and surveillance in combating the plague, Michel Foucault relays some methods of "disinfecting" and preventing transmission of disease during the plague. Quarantine in the home is imposed. Teams move through the city, building by building, hoisting objects off the floor, pouring perfume around the room, sealing all openings with wax, and setting the perfume on fire. The use of perfume speaks to the long-held notion that illness was spread by bad odors, but it is interesting that it was set alight (which, of course, likely did a good deal to kill the contagion - much more than the scent of the perfume, in any case.) While Foucault's language paints a grim picture of the mechanism of power into which this model of surveillance would develop, these practices and others instituted during this time marked a certain rigor of observation and attention to detail that would set a tone for scientific developments to come.
It was in part the serial nature of infestations of the plague that spurred reexamination of the causes of the plague. Female lepers and Jews were some of the first targets, accused of having corrupted society and incurred the wrath of God. The failure of this model led in the coming decades to the aforementioned increased government involvement in public life and emphasis on sanitation, as well as a debate between the classical-inherited idea of disease as divine retribution on one side and physical transmission on the other. Clearly there was to be some future in the latter concept.
The pandemic of the plague was an understandable eventuality in the context of the medical history of Western Europe which, until the renaissance and modern ages, lagged significantly behind that its neighbors in Greece and the middle east. The problem of living in contact with sewage and other pestilent materials was first dealt with not after the destruction of the plague, but well before. The Roman Empire in particular developed sophisticated sewer systems, and a practice of good hygiene similar to what we perform today was normatively enforced. The trade of the physician, however, was held in little esteem, and many famous doctors from the Roman Empire were originally brought as slaves from the Roman conquest of Greece. In time many were able to purchase their freedom, and the first real hospitals, equipped with plumbing and built to allow circulation of air (1). These developments failed to materialize in any significant way in the societies that were to flourish in the provinces of the former empire. We understand that the best of science is the explanation that best accounts for past observations. Was the correlation between good hygiene and good health lost in the shuffle during the fall of the empire? Or was Christian dogmatism powerful enough to obscure past advancements that were completely reasonable? It is possible that I am granting reason too great a role in the ideological formation of medieval Europe.
Around the turn of the millennium the significant work in medicine was done in the Arab world, drawing on the advancements in facilities of the Romans and the philosophical work of the Greeks. In the Christian world, by contrast, prior learning was obscured and healing power was attributed, among other objects of superstition, to religious relics. The theory of the humors prevailed in treatment of the sick, and practices of medicine and surgery were cleanly divided. In addition, the still-fragmented social structure of Western Europe fostered divides and non-communication of various developments. Constantly shifting Christian cults took up and disposed of the various bodies of knowledge developed during the classical age and the present time. Due in part to the inconsistent value placed on secular learning, hygiene in these countries remained something less than universal well after the plague, despite advances made in the field scattered over a wide area. Even royalty as late as the 17th century washed only once a year based on the notion, dating back to the expatriate Greek anatomist Galen in the 3rd century, that water could obstruct the pores. A parchment dated to 1145, likely from Hereford, England, points to Hippocratic theories and philosophies as a point of departure, suggesting an interest in relying on rational (non-religious/superstitious) explanations and treatments of disease.
It has been a bit of a challenge finding the line drawn between medicine as a philosophy and medicine as a science. Like the "school of thought" that a philosopher may have, famous physicians were known for their "schools." These were originally closer to renowned apprenticeships than institutions, with the first curriculum of medicine offered at the University of Bologna in the 13th century. In what scholarship I have found of the famous physicians from the ancient and medieval western world, there is an implication that the schools each held their particular, peculiar teaching as the true medicine. No school was innocent of holding certain unproven, untested superstitions as central tenets of theory and practice. What is certainly clear is that the definition of the body of "facts" was hotly contested among the different schools, even in areas as immediately verifiable as simple anatomy. The enormously influential anatomy by Galen inferred much from dissected pigs, which he called the "animal closest to man."
The debate demands the question: what is the difference between a philosophy and a science? It could be suggested that the difference is marked by the practice of empiricism, by experimentation and logic as opposed to superstition or metaphysics. However, as we have noted in class, logic is little more than a philosophy, and even the most respected, rigorous philosophies rely on assumptions that do or do not make sense according to the cultural context, which is informed in no small part by prevailing metaphysical history. It is our cult: may we really claim its Truth?
This argument loses some weight in light of the fact modern science and medicine have reduced extremely complex chemical and biological processes to tight mathematical formulas, which compute accurately all measurable ingredients and products. Can these developments actually be disputed? The basic tenets of modern medicine seem unshakeable, but this was likely also the attitude of these "philosophical physicians." What scientific, medical arrogances await disproof by other, future doctors? Is it possible that some aspects of our medicine have some undeniable element of Truth, and that these may remain while other (equally respected) practices are thrown out? The line of division in this discussion probably falls between medical science and treatment. We westerners know our chemicals, but recent years have shown us that even within the culture there is search for better treatment than the chemicals can offer. Eastern and holistic medicine, among others, are claiming devotees scientific-minded and right-brained alike. An interesting development here is that some of these practices and remedies are actually regarded as philosophies in their cultures of origin, rather than sciences. It calls into question our modern belief in science that lets us laugh at the naiveté of medicine during the plague, equally "unscientific" as the alternative remedies currently demonstrating themselves superior to our science. What modern superstitions, what secret plagues of our time stand to be eliminated by future wisdom?
1)A history of Hellenistic, Roman, and Medieval medicine
2)Brown Italian Studies site
3)National Institute of Health site, Section on Medieval medical manuscripts
4)Middle Ages - Health, a website of general information on medieval life
5)Plague and Public Health in Renaissance Europe
6) Foucault, Michel. Discipline and Punish. New York: Vintage Books, 1977
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