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The history of osteoarthritis - Episode 4

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Osteoarthritis in the Renaissance

Renaissance: Cultural Revolution and medical progress

Appearing first in Italy, the cultural and artistic movement of the 14th, 15th and 16th centuries known as the Renaissance was intended explicitly as a reaction to the "darkness" of the Middle Ages.
The first aim was to rediscover a supposed "golden age" of Antiquity beyond the mediaeval "scholastic" discipline which only allowed ideas in conformity with the dogmas of the Church to filter through from ancient knowledge.
But that did not stop this cultural revolution which, after Italy, extended to France and Flanders and influenced all the countries of Western Europe. While building on the past, men of the Renaissance were artists of a new genre (realism, control of perspective), builders and inventors.
The creative genius of Leonardo da Vinci, but also the ingenuity of the first commercial bankers testifies to this. There were also explorers with their insatiable curiosity who discovered the New World but also the human anatomy.
In the medical field the notions of "signs" and "symptoms" appeared and, for the first time, the word "rheumatism" received a modern definition. But let's not forget in all this effervescence, the first drugs derived from mineral nutrients and unquestionable progress in the field of surgery.

The medical conceptions of the Renaissance were sometimes called "pre-scientific" in the sense that the burden of proof was not necessary to state a theory, such as "physiological: observation and personal deductions were more than sufficient."
Certainly we would have to wait much longer for pharmaceutical chemistry to replace alchemy and for effective drugs to be invented; medical theories of the Renaissance, often inspired by the ancient concepts of "vital breath" or "humours", seem a little foggy to us. However, a new and sustainable concept remained, that of progress, which is probably the main legacy of that era for us.

Birth of modern anatomy

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The first human anatomy amphitheatre was opened in Padua in 1490. In 1543, Flemish man Andreas Vesalius published De humani corporis fabrica (1514-1564), considered the most successful treatise on anatomy of that era. Andreas Vesalius (whose Frenchified name is André Vésale) taught anatomy at the University of Padua where he obtained his medical degree. His seven-volume book presents for the first time anatomical plates and descriptions based on the dissection of human cadavers.

osteoarthritis history renaissance

Let's see how Vesalius describes the role of joint cartilage in a surprisingly modern way:
"Another role of cartilage which is not negligible, is to allow the bones to remain in continuity and move continuously and get less worn less by friction. The meeting points of bones built for movement would be easily damaged due to the dryness of the bones and by their contact if the surfaces they come into contact with and which form a joint were not completely and separately covered by cartilage which is sufficiently hard and soft to withstand the impacts of the bones and which, by yielding slightly, reduces the force of their contact. Cartilage not only serves to reduce the friction of the bones where they may become worn by contact but it seems so smooth and even that the end of a bone turns easily in its socket; no roughness hinders this facility of movement if a viscous and slippery fluid, comparable to the lubricant used to slide the ropes on pulleys, is present. "

osteoarthritis history renaissance

The "viscous and slippery fluid" is none other than synovial fluid. Vesalius then describes the joint capsules, indicating that neither Galen, nor the Arab authors seem to have been aware of them.

osteoarthritis history renaissance

But doctors were not the only ones interested in anatomy: artists, in the mood for realism, were not lagging far behind. Leonardo da Vinci, whose drawing is shown here, showing us how the human body can fit into a square or a circle, was reputed to have carried out thirty dissections. His principles of representation in perspective and in elevation were even supposedly taken up by Vesalius.

 

 

William of Baillou distinguished rheumatism and gout

It was William of Baillou (1538-1616), Dean of the Faculty of Medicine of Paris, who used the word "rheumatism" in the modern sense for the first time. In his book, Liber de rheumatismo et pleuritide dorsali, he designates acute rheumatoid arthritis under this term, but his description shows that it remains attached to the old Hippocratic theory of the humours:

"The humours (especially blood) flowing through the body provoke severe pain with their harmful substances. The condition we wrongly call catarrh should be called rheumatism. Rheumatism is a kind of disease of fluid receptacles in which the malignant humours flowing from inside to outside the body are deposited in the extremities and joints. What gout represents for a particular extremity, rheumatism represents for the entire body. "

Medical concepts were also evolving in other fields.

Girolamo Fracastoro (1483-1553) described the "French disease" (syphilis) and wrote other works in which he distinguished direct contagion and indirect contagion through the intermediary of objects.

In his Universa Medicina, Jean Fernel (1497-1558) places a strong emphasis on observation and distinguishes the observable signs of symptoms experienced by the patient. However, he remained a follower of the theory of "vital breath" dear to Galen.

Michael Servetus (1509-1553), much to his misfortune, discovered pulmonary circulation. To get the blood sent by the lungs to go back to the heart is contrary to Catholic dogma; Servetus did not have better luck with the Protestants when he left to seek refuge in Geneva where he was burnt at the stake with his books.

Dr Paracelsus' medicine

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Paracelsus (1493-1541), whose real name was Theophrastus Bombastus von Hohenheim, was one of the first to criticise the concepts of the Ancients and in particular the theory of "vital breath". The impetuous Paracelsus was also struck off from the University of Basel for destroying the books of some of his medical colleagues.

Born in Switzerland, he became a doctor at the University of Vienna, and he toured Egypt, Arabia, the Promised Land and Byzantium to meet alchemists. Once back in Europe, he acquired a high reputation by applying alchemy, not to try to make gold, but to "use the virtue and power of the medications." His ideas on the necessary balance between the microcosm (human body) and macrocosm (nature) led him to believe that some diseases can be treated with chemicals or minerals. The abstruse theories of Paracelsus have no scientific basis, but his intellectual approach was innovative enough for him to be considered as one of the ancestors of modern drug therapy.

 

 

 

Arquebus and new surgical techniques

osteoarthritis history renaissance

While arquebuses et bombards had begun to cause the first wounds by firearms, a man without academic qualifications and practising the much scorned manual profession of barber-surgeon was soon to reveal his exceptional talent. For physicians of that time, gun powder was poison and they thus had to cauterise the wound with... boiling oil.

osteoarthritis history renaissance

It was in the headquarters in Turin in 1537 that Paré, not having enough oil to treat all the wounded, used a mixture of egg yolk and essence of rose only to find a much more positive outcome with this new treatment. From then on, he would consider one of the goals of surgery to be to minimise the suffering of those who were operated on. The idea was revolutionary at the time.

Building on his reputation, he was able to develop new techniques, including the use of ligatures in amputations, and new instruments and prostheses. His work, Ten Books of Surgery with the array of instruments necessary for it was quite successful, but Paré had to back-up his new techniques and theories with his opponents.

It was thanks to Ambroise Paré that surgery gained official recognition and would soon be taught at University.

When Venus had tuberculosis

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An examination of ancient pictorial works, especially when they have the realism of the works of the Renaissance, gives us reason to suspect certain disorders of the people who appear in them and identify the emergence of relatively recent diseases. Rheumatism is one of the privileged topics of this research. Thus, the model who posed for the Birth of Venus by Botticelli (1490) presented signs of tuberculous arthritis and the philosopher Erasmus would have been suffering from rheumatoid arthritis.

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It was under the guise of Vespucco Simonetta, who subsequently died of tuberculosis, that Boticelli represented Venus. Her fingers are slightly deflected and swollen and her ankles are also swollen. Some see in these subtle signs the likely presence of tuberculous arthritis.