When we left off, we had just finished discussing the Black Death of 1347, which was an especially
severe example of the frequent, devastating epidemics that ravaged medieval Europe.
The Middle Ages were truly a miserable time to be alive, and medicine of the time did
very little to help those who fell ill.
In this period, pharmacy made almost zero progress, and where science failed, superstition
and quackery held sway.
The historical period that followed the Middle Ages goes by the name of the Renaissance,
a word that implies revival or rebirth.
Just as the name indicates, the 15th and 16th centuries gave rise to a wealth of profound
transformations in the arts and the sciences, as new ideas and a rising interest in knowledge
and progress marked this magnificent period of cultural renewal.
The period encompassing the end of the 15th century and the beginning of the 16th century
was especially productive.
In the arts, it was the time of Leonardo da Vinci and Albrecht Dürer.
In the sciences, Nicholaus Copernicus proposed the sacrilegious heliocentric model and revolutionized
astronomy.
Religion was forever changed by the revolutionary passion of Martin Luther, who openly challenged
the corrupt practices of papal Rome and founded a new branch of Christianity called Protestantism.
And finally, one of the most dramatic leaps in the history of mankind occurred in a small
print shop in Mainz, Germany, around the middle of the 15th century.
Johannes Gutenberg invented mechanical movable type printing, which we typically refer to
as the printing press, and the book industry was born.
Suddenly, with the mass production of information, knowledge was open, at least in principle,
to all those who could read Latin and could afford the books.
Very rapidly, this industry made great steps, and the most successful books and pamphlets
sold thousands of copies at a price that was affordable even to the middle class.
This shift was so revolutionary that the basic principles of knowledge dissemination had
remained largely static since then, until the recent invention of the internet.
In addition to all of this exciting innovation, in the world of medicine and pharmacy, one
name can be said to best symbolize the profound renewal of European culture, and that is Paracelsus.
His full name was Philippus Aureolus Theophrastus Bombastus von Hohenheim.
Paracelsus was simply a pseudonym he created for himself, but the details of its origin
are not clear.
There is a legend that he chose this name because he considered himself superior to
the Roman doctor Celsus, hence the prefix para, meaning adjacent, being placed before Celsus.
But this story does not appear to be substantiated.
Paracelsus was born in a small village in what is now Switzerland in 1493, and he spent
his entire life moving around Europe, teaching, practicing medicine, and philosophizing.
His childhood was spent in Villach, which is in modern Austria, where his father taught alchemy.
Since Villach was a mining town, Paracelsus was exposed early on to the field of metallurgy,
which is the study of metals, and he absorbed this knowledge eagerly.
The field made a major impression on him, such that he always described himself as a
chemist in addition to a doctor.
It was his ability to recognize this deep relationship between chemistry and medicine,
which had already been anticipated by Arab culture, and which serves at the basis of
modern pharmacy, that made Paracelsus a pioneer in the field of medicine.
Paracelsus was a very unusual person.
As a thoroughly independent and iconoclastic thinker, he made enemies everywhere he went.
Of course, the fact that he outwardly insulted most of his colleagues did not endear him
to them.
Despite this, he quickly acquired the reputation of a competent, almost miraculous doctor.
He studied in many European universities, but he was dissatisfied with all of them.
In moving from one to another, searching for the best teachers, he commented that he was
amazed at how many asses European universities could produce each year.
It is said that he earned a bachelor of science degree from the University of Vienna, and
a doctorate from the University of Ferrara in Italy, but many Paracelsus scholars doubt
that he actually acquired any degree whatsoever, as in those days, there were apparently no
transcripts.
In this way, he was essentially a self-taught Renaissance man.
After his studies, he managed to obtain the position of town doctor in Basel, Switzerland.
This was an important position, but he alienated the entire medical profession with his bizarre
behavior.
He preferred to speak and even write in German, as opposed to the official language of the
profession, which was Latin.
He claimed Latin was self-referential and obscure, and only served to hide from the
people the emptiness of the medical knowledge of the age.
He even publicly burned the books of Galen and Avicenna, classical figures in the field
of medicine that we are familiar with, and who were revered almost as gods during the
Renaissance.
His antics led to his being referred to as “The Martin Luther of Medicine”, because
Luther had similarly burned papal bulls, which are like decrees or letters from the pope,
just ten years earlier.
His enemies could not block his publications, however, and he was able to write a book on
surgery, a treatise on syphilis, and many pamphlets on medicine and pharmacy which were
openly addressed to the general public.
His fame through Europe grew through his publications, and after he was chased out of Basel he had
no trouble working for a host of kings, princes, and generals.
He eventually returned to his favorite town of Salzburg, Austria, where he died in 1541,
leaving most of his work unpublished.
His disciples continued to disseminate his theories, and over the years after his death,
the ideas of Paracelsus gained more and more appreciation and traction.
Paracelsus was deeply religious, and stressed that medicine was a sacred discipline, decreed
directly by God.
As a consequence, the moral stature of the doctor was as important as his skills.
The relationship with the patient was of paramount importance, a notion that has fallen by the
wayside today, thereby facilitating the rise of alternative medicine.
He also espoused the belief that the mind can influence the state of the body and can
even cause or cure a disorder.
This is another notion that has found widespread application in modern alternative medicine,
although these links have not been substantiated beyond the placebo effect.
Paracelsus also believed that the body functioned “alchemically”, which essentially means
chemically rather than by some kind of vital fluid, and therefore that chemicals could
influence disease, which was a bold claim at the time.
Indeed, the use of natural extracts does involve chemistry, but this aspect was not fully comprehended
by Renaissance doctors, so it was an insightful conclusion.
Paracelsus believed most natural remedies were too weak to be of use, and advocated
the use of specific chemicals, which in those days were inorganic chemicals.
As we may recall, these ideas had been already proposed by the Arab school of thought, but
had to be brought back to life during the Renaissance in Europe.
So what were these chemicals?
Paracelsus used mercuric salts rather successfully to treat syphilis, and a variety of other
salts for a number of conditions.
Mercury and arsenic salts remained in use in Europe until the advent of modern chemotherapy
in the 20th century, and thus constituted a revolution in pharmacy.
Of course, these salts are extremely toxic and they gave rise to many side effects.
To his critics, Paracelsus responded that “the dose makes the poison”.
This is a very obvious concept today, but it was rather groundbreaking in those days,
and perhaps not fully understood even today by the public at large.
Many do not comprehend that there is no stark division between poisons and medicines, and
thus no fundamental division between good drugs and bad drugs, whether natural or synthetic
in origin.
Too much of a good medicine will kill people, just as even water or oxygen will in a high
enough dosage, as anything can be assigned a toxicity.
Thus, substances that are toxic at high doses might cure a disease at lower doses.
The dose is the key, and this concept has remained fundamental to this day.
Paracelsus also believed that disease could be located in certain organs, and he tried
to select a drug which might prefer to localize in that organ as well, in order to treat each
disease, a very crude idea that alludes to the drug targeting programs of today, which
we will discuss toward the end of this series.
In addition, the idea of the four humors, as put forward by Galen, was thoroughly debunked
by Paracelsus.
You may recall how Galen proposed that there were four humors in the body, which were blood,
phlegm, yellow bile, and black bile.
He believed that when these were in balance, one enjoyed health, and when there was an
imbalance, sickness ensued.
Draining bodily fluids was thus the practice advocated to treat disease.
Paracelsus ridiculed the idea of bloodletting.
He claimed that if your blood is diseased, draining some of it will leave the same diseased
blood behind, only a bit less of it.
He thought instead that the human body contained three chemical principles.
These were salt, representing stability, sulfur, representing combustibility, and mercury,
representing liquidity.
The balance of these principles could be ensured by applying the right inorganic chemical.
This idea of an inorganic body seems bizarre today, and although totally false, it was
actually a step in the right direction, given the rigidly chemical basis for the theory.
Indeed, science no longer subscribes to the magic of nature in order to cure diseases.
Today’s drugs are man-made chemicals, given our command over the molecular world, and
the opportunities that arise when we don’t limit ourselves to what nature happens to
have built herself by chance.
Although Paracelsus contributed to revolutionizing the field of pharmacy, we should not presume
that medicine transitioned completely to a modern practice during the Renaissance.
It was a painstakingly slow progression.
Diseases were still completely misunderstood and labeled by their symptoms rather than
by their causes.
A brief look at the established causes of mortality in 17th century London will provide
a disconcerting picture of the medical profession of the period.
From the yearly “Bill of Mortality” of London, England, by John Gaunt, if we examine
the bill for the year 1632, we can gather the following statistics regarding the causes
of death for that year.
First, one person allegedly died of “Vomiting”.
Then, for “Dead in the Street or Starved”, we have five.
Next we have 11 for “Grief”.
For these first three, it is quite obvious that symptoms have been mistaken for causes,
as clearly we do not die from vomiting or grief, we die from the thing that is also
causing vomiting or grief.
From here it gets rather odd.
13 people died of “Tympany”.
This essentially means bloating, so these people died of something that caused bloating.
Another 13 people died of “Planet”.
This presumably indicates a particularly unfavorable configuration of the planets in the sky, which
is probably equivalent to saying nobody had any clue how they died.
Then 34 people died of “Tissick”.
This refers to a persistent cough, so probably some form of bacterial or viral pneumonia.
Next, 38 people died of “King’s Evil”.
This disease presented itself as a swelling of the lymph nodes, and was said to be curable
by the touch of a king.
This ridiculous superstition lasted until the 19th century.
Charles II touched over 90,000 people during his 22-year reign with this very remedy in mind.
Nobody knows how many were cured, but one can assume it is not an impressive statistic.
Next, 62 people died “Suddenly”.
What could this mean?
A heart attack?
A stroke?
These are the most likely candidates.
Either way, compared to some other options, this seems like a pretty good way to go.
Then 74 people died of “Impostume”.
This is now defined as “a localized collection of pus formed as the product of inflammation
and usually caused by bacteria”.
In other words, an infection.
Then 86 people died of “Surfet”.
This is an old spelling of the word “surfeit”, a popular disease among the debauched rich.
Essentially, they died from eating and drinking too much.
Moving along, 87 people died of “Livergrown”.
Some believe this is referring to rickets, which is caused by Vitamin D deficiency.
Then, 98 died of “Rising of the Lights”.
This is probably croup, a type of respiratory infection of viral origin.
And now we come to the real killers.
445 were stillborn babies.
551 died of smallpox.
628 are marked “Aged”, so just old age deaths.
1108 died of a fever.
1797 died of “Consumption”, which is clearly tuberculosis, another infectious disease that
is still with us, although now completely treatable.
And finally, 2268 are marked “Infant and Chrisomes”.
Chrisomes refers to infants dying within a month of their birth.
So clearly infant mortality was a major killer, to a degree that would seem shocking to anyone
from today’s world.
Then there were the infectious diseases that we mentioned, like smallpox and tuberculosis.
Smallpox has probably been the biggest killer in human history.
Some estimate that over a billion people may have died from it, and this will be will the
focus of the next chapter.
Apart from these, fever is probably a collection of other undiagnosed infectious diseases,
given that infection typically causes a fever.
Old age is also still with us, and not yet treatable, although even this will be addressed
towards the end of the series.
We should also not forget that many people lived with horrible infectious diseases, like
syphilis and other sexually transmitted diseases, which crippled them quite severely with horrible
symptoms, but killed very slowly, allowing them to die sooner from other causes.
The bottom line is that poor hygiene and infections were responsible for the majority of adult
human deaths.
For this reason, infant mortality and infections were clearly the biggest challenge for the
medical profession over the centuries following the Renaissance.
Defeating a plethora of infectious diseases would eventually lead to a dramatically improved
quality of life and a significantly increased average life span, an exciting development
that we will begin to examine next.