Question 1
In the Preface to his Books on the Fabric of the Human Body, Andreas Vesalius discusses the problem of surgery in the medical science of his time – Late Renaissance.
He argues that, historically, there have been three major methods of curing the diseases: treatment with medications, dietary regimen and surgery, meaning that you have to apply your “own hands” to treat a particular disease. To the physicians and scientists of the Ancient Greece it was obvious that those three methods are equally useful and closely related with each other and, moreover, they cannot be separated. Vesalius notes that the modern physicians have forgotten the wisdom of the ancient medicine and in their medical practice, they started to rely solely on diet and drug methods of medication, almost completely neglecting surgery as the “primary instrument” of medicine. The surgery in medicine had been relegated to servants; the physicians became abstained from the surgery as from “the plaque”. In a mass consciousness, as well as in medical science, the surgery became labeled as a dirty and repugnant method of medication that only servants can conduct. Thus, the physicians at all costs tried to avoid the manual work for the fear to be libeled by “the high priests of profession” in front of the ignorant public. In the view of Vesalius, it is exactly this prejudiced public attitude that prevented the acquiring of a comprehensive “art of healing”. Vesalius noted that the doctors of his time studied partially; the science of medicine had lost important knowledge that is essential in the course of education of the future physicians. Doctors lost basic knowledge of medicine when they relegated their duties either to druggists or surgeons. Even though the manual work in medicine was developed by physicians, the physicians foolishly discarded this work into the hands of others which eventually ruined the anatomy – the knowledge of the structure of the human body. They started thinking that the knowledge of the fabric of bones, muscles, nerves and veins was irrelevant to their profession. Moreover, when all the operations became entrusted to the “barbers”, not only the knowledge of the inner parts of the body disappeared from the medical profession, but the science of dissection died out too. Vesalius accused the professors of the medical schools of their ignorance and lack of practical knowledge and experience. He claimed that those professors taught to the medical students facts about anatomy and dissection by blindly repeating the passages of the books others have written down, while never conducting a dissection themselves or seeing in real life, not from the book illustrations, the viscera of the human body. Very few medical schools considered the dissection of the human body as a necessary part of the education of future doctors. Therefore, Vesalius considered it his primary mission and goal to revive the ancient art of medicine and bring the knowledge of the human body back to the medical science. Dissection of the human body, in his view, was essential to the full understanding of how human body works. He emphasized that medical students must conduct dissections during their education in order to gain practical knowledge and experience about the basic structure and functions of the human body; the doctor is not a professional if he does not understand anatomy from the practical point, not from the books.
No wonder that Vesalius had to defend his innovative ideas against the fierce opposition of his contemporaries. During his time, the knowledge of human anatomy was based solely on the works and teachings of canonized Galen, a prominent Roman physician and surgeon. The authority of his works was undeniable and could not be challenged. Vesalius, however, started to have serious doubts on the validity of his findings, which at that time, was almost equal to blasphemy. This doubts turned out to be true - Vesalius found around two hundred mistakes in the Halen`s description of human body which practically refuted the commonly held view of the human body that persisted for more than thousand years in the European medicine. By writing “De Corpori Humani Fabrica”, he attempted to provide physicians and scientists with a truthful and comprehensive description of human anatomy which, in his view, was essential in further progress of medical science and practice.
Question 2
The term “hospital” in Medieval Europe had a different and more flexible meaning than it has today. Hospitals had a variety of functions, including places to stay for travelers, paupers and sick. At that time, the majority of the hospitals were affiliated with religious institutions like churches and monasteries. Originally, the buildings near churches were shelters for the poor. Later, they transformed into places where sick could get a medical help by professional physicians. As the hospitals were closely connected with church, the treatment was based mainly on the prayer and religious services rather than on treatment with medication. The hospitals existed in a form of a religious community with its own rules of conduct and worship services conducted on the regular basis. The focus on religious service rather than on medical treatment can be explained by the lack of medical knowledge. No one knew the actual reasons of disease and there was no knowledge of germs. That is why it was a common notion that people get sick because of their sins. Physicians who worked in church hospitals refused to cure patients until they confess of their sins; confession was the only way to repent sins thus purifying the soul. Therefore, the medieval hospitals were religious and charitable communities that provided care for all those in need: sick, poor, orphans, travelers, etc. The hospitals did not have a specific purpose of curing the sick. Those institutions were managed by priests and monks, in other words, laymen, who did not have necessary skills to treat patients and cure diseases. The person was hospitalized only in case of chronic disease and only if he was poor and had no other place to stay; the hospitalization was a measure of last resort and in cases of acute disease, patients were advised to stay at home. Nursing profession was unheard of in medieval hospitals. The patients were taken care of by nuns and attendants who did not have any kind of medical training and skills necessary to provide nursing care for patients. In fact, nurses at that time were more like domestic servants rather than medical workers. The situation had significantly changed during Renaissance and subsequent era of Enlightenment. The progress of medical science, as well as the radical changes in society caused by decreasing role of church, turned hospitals into secular institutions that focused on curing patients based on the medical treatment administered by professional physicians. These changes in turn led to the changes in organization and management of hospitals. The very concept of hospital has changed. Thus, the hospitals as we know them today appeared in the end of 19th and the beginning of 20th century. The hospitals turned into organized institutions with the defined structure. Professional physicians now carry out both administrative and medical functions, combined, at the same time, with the high degree of division of labor between the personnel. The hospitals are open for all social classes, regardless of patient`s material wealth or lack of thereof. The main emphasis is put on providing professional medical care based on the latest scientific and technological achievements. The hospitals are open for all patients regardless of the degree or type of their disease. The hallmark of the modern hospitals is the presence of professional nurses who are specifically trained to provide medical care for inpatients.
