Mechanical Printing and Its Impact on Medicine

Overview

Before the fifteenth century, medical practitioners relied on texts that were laboriously handwritten and recopied through the centuries. This method of distributing medical information was slow, limited to only a few translations, and frequently altered the content and illustrations to the point of inaccuracy. After the invention of the printing press around 1450, however, medical texts, especially classical works by Hippocrates, Galen, and Aristotle, among others, experienced a new life and reproductions closer to the original text. Distribution of medical literature increased, translations in several languages stretched across the world, and subsequently, medical science and practice progressed rapidly.

Background

For nearly 5,000 years preceding the invention of the printing press, medical books were written by hand. Prescriptions, incantations, and spiritually inspired healing rituals were exchanged orally, but were difficult to remember. Eventually these complicated treatments were written down, transcribed in painstaking, elaborate manuscript on expensive parchment. This method of transcription changed little through the fifth century b.c., when Hippocrates (c. 460-c. 377 b.c.), the "father of medicine," wrote several texts that treated medicine with a more realistic philosophy, free from superstition and magic. But the early Hippocratic works, as well as many other early medical texts, were written in Ionic dialect and limited to the number of copies that could be hand copied.

By the Middle Ages, the few books published were mainly religious records or biblical transcriptions. The act of transcribing and bounding books became an art form of sorts, and flourished in monasteries. During this era, the number of monasteries increased and book production subsequently grew, but within the censorship of the church. The availability of medical information changed at the whim of the current religious tide, and many medical books were banned and even destroyed if deemed heretical or obscene. Soon, however, as literacy spread, the demand for books outgrew the production capabilities of the monasteries. Professional scribes, unassociated with the church, became widespread, and censorship was somewhat sidestepped.

By the thirteenth century, cheaper, more easily produced paper became plentiful, and many authors were now their own scriveners. Doctors who had copies of the most used medical texts of the day—Avicenna's all-purpose Canon of Medicine, Guy de Chauliac's surgical manual Chirurgia, and Galen's and Hippocrates' classic medical works—would add their own observations and corrections in the notes, much as a chef would alter a recipe. Without widely distributed, identical texts, or easily modified and critiqued information, medical professionals had no baseline with which to work. Translations were frequently limited to Latin, and as demand for medical books continued, scribes would often hasten through details, omitting information and altering illustrations.

By the fourteenth century, most copied books suffered from poor handwriting and illustrations that were so stylized that they were totally inaccurate. Surgeons, in many cases, were improvising through procedures since text and illustrations were only barely coherent. There was a great need for more accuracy, wider dissemination and critique of existing manuals, and corrected copies of the classical medical tomes in a wide variety of languages.

Impact

It is believed that the first mechanical printing press was developed in Germany sometime near 1450. Soon thereafter, books were being printed around the world at a fast clip. For medicine, one of the most immediate and important additions to medical writing were more illustrations, clearer diagrams of surgical procedures, instruments, and disease identification. Obviously, identifying parts of the anatomy was critical to successfully treating a patient, and poor reproductions from over-copied and hastily illustrated manuals had decreased the value of these before the printing press. Now that a book could be reproduced identically to its original, great care was taken to keep anatomical illustrations accurate. In addition, skin diseases, medicinal plants, and instruments were identified more clearly and consistently than ever before.

Avicenna (980-1037), an Arab physician, philosopher, poet, and politician also known as Ibn Sina, wrote Canon of Medicine in the eleventh century. It was translated into Latin and republished in 1473. The work combined the teachings of Galen, Hippocrates, and Aristotle, and became the single most authoritative text for universities. The Canon included Avicenna's own observations on everything from nervous ailments to skin diseases and disease distribution through water and soil, and he recorded 760 different kinds of medicines. The text was translated into several different languages, and remained the foremost medical text through the seventeenth century. While Avicenna's work was well regarded and had a tremendous influence on the spread of medical knowledge, it also had a negative effect. The author demonstrated an aversion to surgery, instead prescribing medicinal cures, implying that surgery was an inferior approach to medicine. Because of the expansive printing and subsequent influence of his work, surgical progress suffered a severe setback.

Nevertheless, the standard surgical manual of the day, Guy de Chauliac's Chirurgia, written in 1363, was printed mechanically in France in 1478 and had a tremendous impact. Chauliac (c. 1300-1368) recorded his own observations of the Black Death (the plague, either bubonic or pneumonic) and the patients he treated. He promoted the excision of abnormal growths, and described what was probably the earliest anesthesia. The dissemination of Chirurgia, especially under the influence of Avicenna's works, invoked a wide critique of his procedures, a positive step in medicine, in that previously, timely improvements were rarely included in subsequent copies of texts. By 1683 Chirurgia had gone through 68 editions published in many different languages, with critical forewords and bibliographic references.

Included with nearly every medical text were elaborate illustrations. In the fifteenth and sixteenth centuries anatomical renderings were especially in vogue. Leonardo da Vinci (1452-1519) and Michelangelo (1475-1564), for example, both illustrated anatomical manuals, and would frequently dissect cadavers to understand their subjects more completely. But while anatomical renderings seemed to clarify the workings of the human body, the approaches to understanding the symbiotic systems of the body were in question. Thanks to the revival of the classical works of Hippocrates, who emphasized a humanist and practical approach to medicine, and Galen (c. 130-c. 200), who stressed the importance of observation and application in his works, medical learning shifted toward diagnosis and curing of disease. Medical literature now described every fine detail, including the color, smell, and structure of diseases, and doctors had a philosophical guide from which to work.

Combining both the fine artistic renderings and the new detail of medical texts, William Harvey (1578-1657), an English physician, eventually used the wealth of texts produced in the fifteenth and sixteenth centuries to formulate a theory about the circulation of the blood. Harvey, in his De Motu Cordis, explained the collective function of the veins, blood, heart, lungs, and liver, and was the first person to attempt a blood transfusion.

Another result of the invention of the mechanical press was that medicine was brought to the masses. Even women, who during the Black Plague medicated patients in the home, used the studied medical practices that were suddenly available in "vulgar" languages, rather than the Latin of tradition. That tradition continues: The influence of Hippocrates is as vital today as it was in its creation. Galen's works are frequently drawn from, and Avicenna's Canon is still an important text in some Arab countries.

The two most important books in the history of medicine are De humani corporis fabrica libri septem (Seven books on the structure of the human body) (1543) by Andreas Vesalius and Exercitatio anatomica de motu cordis et sanguinis in animalibus (Anatomical exercise on the motion of the heart and blood in animals) (1628) by William Harvey. The copy of the Fabrica that Vesalius himself presented to Holy Roman Emperor Charles V eventually found its way into the collection of Haskell F. Norman. When Christie's auction house sold Norman's collection in New York in 1998, that Fabrica sold for $1.5 million. Norman also owned the copy of De motu cordis that once belonged to Johann Friedrich Blumenbach. It fetched $480,000 at the same auction. In 1989 the firm of Pickering and Chatto sold a slightly damaged copy for $100,000. In 1988 Christie's received $181,000 for the copy owned by cardiologist Myron Prinzmetal. In 1934 the New York Academy of Medicine and the University of Munich, Germany, jointly published Andreae Vesalii Bruxellensis icones anatomicae (Anatomical images of Andreas Vesalius of Brussels), using 227 of the original sixteenth-century woodblocks carved for the illustrations of Vesalius's Fabrica and Epitome. These woodblocks were accidentally destroyed by Allied bombs in World War II. First priced at only a hundred dollars, one of the 615 numbered copies of Icones anatomicae typically sells for $5,000-6,000.

LOLLY MERRELL

RARE MEDICAL BOOKS

Classics in the history of medicine are among the books most highly prized by collectors. Several prominent libraries, including the College of Physicians of Philadelphia, the Wellcome Trust (London), and the largest medical library in the world, the National Library of Medicine of the United States (Bethesda, Maryland), have built their reputations for excellence by acquiring and protecting works of this kind.