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Title: Old-Time Makers of Medicine
The Story of The Students And Teachers of the Sciences
Related to Medicine During the Middle Ages
Author: James J. Walsh
Release Date: December 30, 2006 [EBook #20216]
Language: English
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Old-Time Makers of Medicine
THE STORY OF THE STUDENTS AND TEACHERS
OF THE SCIENCES RELATED TO MEDICINE
DURING THE MIDDLE AGES
BY
James J. Walsh, K.C.St.G., M.D.
Ph.D., LL.D., Litt.D., Sc.D.
DEAN AND PROFESSOR OF NERVOUS DISEASES AND OF THE HISTORY OF MEDICINE AT
FORDHAM UNIVERSITY SCHOOL OF MEDICINE; PROFESSOR OF PHYSIOLOGICAL
PSYCHOLOGY AT THE CATHEDRAL COLLEGE, NEW YORK
NEW YORK
FORDHAM UNIVERSITY PRESS
1911 COPYRIGHT 1911
JAMES J. WALSH
THE QUINN & GODEN CO. PRESS
RAHWAY, N.J.
TO
REVEREND DANIEL J. QUINN, S.J.
The historical material here presented was gathered for my classes at
Fordham University School of Medicine during your term as president of
the University. It seems only fitting then, that when put into more
permanent form it should appear under the patronage of your name and
tell of my cordial appreciation of more than a quarter of a century of
valued friendship.
"When we have thoroughly mastered contemporary science it is time to
turn to past science; nothing fortifies the judgment more than this
comparative study; impartiality of mind is developed thereby, the
uncertainties of any system become manifest. The authority of facts is
there confirmed, and we discover in the whole picture a philosophic
teaching which is in itself a lesson; in other words, we learn to know,
to understand, and to judge."--LITTRÉ: _OEuvres
d'Hippocrate_, T. I, p. 477.
"There is not a single development, even the most advanced of
contemporary medicine, which is not to be found in embryo in the
medicine of the olden time."--LITTRÉ: Introduction to the Works
of Hippocrates.
"How true it is that in reading this history one finds modern
discoveries that are anything but discoveries, unless one supposes that
they have been made twice."--DUJARDIN: _Histoire de la
Chirurgie_, Paris, 1774 (quoted by Gurlt on the post title-page of his
_Geschichte der Chirurgie_, Berlin, 1898).
PREFACE
The material for this book was gathered partly for lectures on the
history of medicine at Fordham University School of Medicine, and partly
for articles on a number of subjects in the Catholic Encyclopedia. Some
of it was developed for a series of addresses at commencements of
medical schools and before medical societies, on the general topic how
old the new is in surgery, medicine, dentistry, and pharmacy. The
information thus presented aroused so much interest, the accomplishments
of the physicians and surgeons of a period that is usually thought quite
sterile in medical science proved, indeed, so astonishing, that I was
tempted to connect the details for a volume in the Fordham University
Press series. There is no pretence to any original investigation in the
history of medicine, nor to any extended consultation of original
documents. I have had most of the great books that are mentioned in the
course of this volume in my hands, and have given as much time to the
study of them as could be afforded in the midst of a rather busy life,
but I owe my information mainly to the distinguished German and French
scholars who have in recent years made deep and serious studies of these
Old Makers of Medicine, and I have made my acknowledgments to them in
the text as opportunity presented itself.
There is just one feature of the book that may commend it to
present-day readers, and that is that our medieval medical colleagues,
when medicine embraced most of science, faced the problems of medicine
and surgery and the allied sciences that are now interesting us, in very
much the same temper of mind as we do, and very often anticipated our
solutions of them--much oftener, indeed, than most of us, unless we have
paid special attention to history, have any idea of. The volume does not
constitute, then, a contribution to that theme that has interested the
last few generations so much,--the supposed continuous progress of the
race and its marvellous advance,--but rather emphasizes that puzzling
question, how is it that men make important discoveries and inventions,
and then, after a time, forget about them so that they have to be made
over again? This is as true in medical science and in medical practice
as in every other department of human effort. It does not seem possible
that mankind should ever lose sight of the progress in medicine and
surgery that has been made in recent years, yet the history of the past
would seem to indicate that, in spite of its unlikelihood, it might well
come about. Whether this is the lesson of the book or not, I shall leave
readers to judge, for it was not intentionally put into it.
OUR LADY'S DAY IN HARVEST, 1911.
CONTENTS
CHAPTER PAGE
I. INTRODUCTION 1
II. GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 23
III. GREAT JEWISH PHYSICIANS 61
IV. MAIMONIDES 90
V. GREAT ARABIAN PHYSICIANS 109
VI. THE MEDICAL SCHOOL AT SALERNO 141
VII. CONSTANTINE AFRICANUS 163
VIII. MEDIEVAL WOMEN PHYSICIANS 177
IX. MONDINO AND THE MEDICAL SCHOOL OF BOLOGNA 202
X. GREAT SURGEONS OF THE MEDIEVAL UNIVERSITIES 234
XI. GUY DE CHAULIAC 282
XII. MEDIEVAL DENTISTRY--GIOVANNI OF ARCOLI 313
XIII. CUSANUS AND THE FIRST SUGGESTION OF LABORATORY
METHODS IN MEDICINE 336
XIV. BASIL VALENTINE, LAST OF THE ALCHEMISTS,
FIRST OF THE CHEMISTS 349
APPENDICES
I. ST. LUKE THE PHYSICIAN 381
II. SCIENCE AT THE MEDIEVAL UNIVERSITIES 400
III. MEDIEVAL POPULARIZATION OF SCIENCE 427
"Of making many books there is no end."--_Eccles._ xii, 12 (circa 1000
B.C.).
"The little by-play between Socrates and Euthydemus suggests an advanced
condition of medical literature: 'Of course, you who have so many books
are going in for being a doctor,' says Socrates, and then he adds,
'there are so many books on medicine, you know.' As Dyer remarks,
whatever the quality of these books may have been, their number must
have been great to give point to this chaff."--_Aequanimitas_,
WILLIAM OSLER, M.D., F.R.S., Blakistons, Philadelphia, 1906.
"Augescunt aliae gentes, aliae minuuntur;
Inque brevi spatio mutantur saecla animantum,
Et, quasi cursores vitai lampada tradunt."
--OVID.
One nation rises to supreme power in the world, while another declines,
and, in a brief space of time, the sovereign people change,
transmitting, like racers, the lamp of life to some other that is to
succeed them.
"There is one Science of Medicine which is concerned with the inspection
of health equally in all times, present, past and future."
--PLATO.
I
INTRODUCTION
Under the term Old-Time Medicine most people probably think at once of
Greek medicine, since that developed in what we have called ancient
history, and is farthest away from us in date. As a matter of fact,
however, much more is known about Greek medical writers than those of
any other period except the last century or two. Our histories of
medicine discuss Greek medicine at considerable length and practically
all of the great makers of medicine in subsequent generations have been
influenced by the Greeks. Greek physicians whose works have come down to
us seem nearer to us than the medical writers of any but the last few
centuries. As a consequence we know and appreciate very well as a rule
how much Greek medicine accomplished, but in our admiration for the
diligent observation and breadth of view of the Greeks, we are sometimes
prone to think that most of the intervening generations down to
comparatively recent times made very little progress and, indeed,
scarcely retained what the Greeks had done. The Romans certainly justify
this assumption of non-accomplishment in medicine, but then in
everything intellectual Rome was never much better than a weak copy of
Greek thought. In science the Romans did nothing at all worth while
talking about. All their medicine they borrowed from the Greeks, adding
nothing of their own. What food for thought there is in the fact, that
in spite of all Rome's material greatness and wide empire, her world
dominance and vaunted prosperity, we have not a single great original
scientific thought from a Roman.
Though so much nearer in time medieval medicine seems much farther away
from us than is Greek medicine. Most of us are quite sure that the
impression of distance is due to its almost total lack of significance.
It is with the idea of showing that the medieval generations, as far as
was possible in their conditions, not only preserved the old Greek
medicine for us in spite of the most untoward circumstances, but also
tried to do whatever they could for its development, and actually did
much more than is usually thought, that this story of "Old-Time Makers
of Medicine" is written. It represents a period--that of the Middle
Ages--that is, or was until recently, probably more misunderstood than
any other in human history. The purpose of the book is to show at least
the important headlands that lie along the stream of medical thought
during the somewhat more than a thousand years from the fall of the
Roman Empire under Augustulus (476) until the discovery of America.
After that comes modern medicine, for with the sixteenth century the
names and achievements of the workers in medicine are
familiar--Paracelsus, Vesalius, Columbus, Servetus, Cæsalpinus,
Eustachius, Varolius, Sylvius are men whose names are attached to great
discoveries with which even those who are without any pretence to
knowledge of medical history are not unacquainted. In spite of nearly
four centuries of distance in time these men seem very close to us.
Their lives will be reserved for a subsequent volume, "Our Forefathers
in Medicine."
It is usually the custom to contemn the Middle Ages for their lack of
interest in culture, in education, in literature, in a word, in
intellectual accomplishment of any and every kind, but especially in
science. There is no doubt about the occurrence of marked decadence in
the intellectual life of the first half of this period. This has
sometimes been attributed to what has been called the inhibitory effect
of Christianity on worldly interests. Religion is said to have occupied
people so much with thoughts of the other world that the beauties and
wonders, as well as much of the significance, of the world around them
were missed. Those who talk thus, however, forget entirely the
circumstances which brought about the serious decadence of interest in
culture and science at this time. The Roman Empire had been the guardian
of letters and education and science. While the Romans were not original
in themselves, at least they had shown intense interest in what was
accomplished by the Greeks and their imitation had often risen to
heights that made them worthy of consideration for themselves. They were
liberal patrons of Greek art and of Greek literature, and did not
neglect Greek science and Greek medicine. Galen's influence was due much
more to the prominence secured by him as the result of his stay in Rome
than would have been possible had he stayed in Asia. There are many
other examples of Roman patronage of literature and science that might
be mentioned. As we shall see, Rome drained Greece and Asia Minor of
their best, and appropriated to herself the genius products of the
Spanish Peninsula. Rome had a way of absorbing what was best in the
provinces for herself.
Just as soon as Rome was cut off from intimate relations with the
provinces by the inwandering of barbarians, intellectual decadence
began. The imperial city itself had never been the source of great
intellectual achievement, and the men whom we think of as important
contributors to Rome's literature and philosophy were usually not born
within the confines of the city. It is surprising to take a list of the
names of the Latin writers whom we are accustomed to set down simply as
Romans and note their birthplaces. Rome herself gave birth to but a very
small percentage of them. Virgil was born at Mantua, Cicero at Arpinum,
Horace out on the Sabine farm, the Plinys out of the city, Terence in
Africa, Persius up in Central Italy somewhere, Livy at Padua, Martial,
Quintilian, the Senecas, and Lucan in Spain. When the government of the
city ceased to be such as assured opportunity for those from outside who
wanted to make their way, decadence came to Roman literature. Large
cities have never in history been the fruitful mothers of men who did
great things. Genius, and even talent, has always been born out of the
cities in which it did its work. It is easy to understand, then, the
decadence of the intellectual life that took place as the Empire
degenerated.
For the sake of all that it meant in the Roman Empire to look towards
Rome at this time, however, it seemed better to the early Christians to
establish the centre of their jurisdiction there. Necessarily, then, in
all that related to the purely intellectual life, they came under the
influences that were at work at Rome at this time. During the first
centuries they suffered besides from the persecutions directed against
them by the Emperors at various times, and these effectually prevented
any external manifestations of the intellectual life on the part of
Christians. It took much to overcome this serious handicap, but
noteworthy progress was made in spite of obstacles, and by the time of
Constantine many important officials of the Empire, the educated
thinking classes of Rome, had become Christians. After the conversion of
the Emperor opportunities began to be afforded, but political
disturbances consequent upon barbarian influences still further weakened
the old civilization until much of the intellectual life of it almost
disappeared.
Gradually the barbarians, finding the Roman Empire decadent, crept in on
it, and though much more of the invasion was peaceful than we have been
accustomed to think, the Romans simply disappearing because family life
had been destroyed, children had become infrequent, and divorce had
become extremely common, it was not long before they replaced the Romans
almost entirely. These new peoples had no heritage of culture, no
interest in the intellectual life, no traditions of literature or
science, and they had to be gradually lifted up out of their barbarism.
This was the task that Christianity had to perform. That it succeeded in
accomplishing it is one of the marvels of history.
The Church's first grave duty was the preservation of the old records
of literature and of science. Fortunately the monasteries accomplished
this task, which would have been extremely perilous for the precious
treasures involved but for the favorable conditions thus afforded.
Libraries up to this time were situated mainly in cities, and were
subject to all the vicissitudes of fire and war and other modes of
destruction that came to cities in this disturbed period. Monasteries,
however, were usually situated in the country, were built very
substantially and very simply, and the life in them formed the best
possible safeguard against fire, which worked so much havoc in cities.
As we shall see, however, not only were the old records preserved, but
excerpts from them were collated and discussed and applied by means of
direct observation. This led the generations to realize more and more
the value of the old Greek medicine and made them take further
precautions for its preservation.
The decadence of the early Middle Ages was due to the natural shifting
of masses of population of this time, while the salvation of scientific
and literary traditions was due to the one stable element in all these
centuries--the Church. Far from Christianity inhibiting culture, it was
the most important factor for its preservation, and it provided the best
stimulus and incentive for its renewed development just as soon as the
barbarous peoples were brought to a state of mind to appreciate it.
Bearing this in mind, it is easier to understand the course of medical
traditions through the Middle Ages, and especially in the earlier
period, with regard to which our documents are comparatively scanty,
and during which the disturbed conditions made medical developments
impossible, and anything more than the preservation of the old authors
out of the question. The torch of medical illumination lighted at the
great Greek fires passes from people to people, never quenched, though
often burning low because of unfavorable conditions, but sometimes with
new fuel added to its flame by the contributions of genius. The early
Christians took it up and kept it lighted, and, with the Jewish
physicians, carried it through the troublous times of the end of the old
order, and then passed it on for a while to the Arabs. Then, when
favorable conditions had developed again, Christian schools and scholars
gave it the opportunity to burn brightly for several centuries at the
end of the Middle Ages. This medieval age is probably the most difficult
period of medical history to understand properly, but it is worth while
taking the trouble to follow out the thread of medical tradition from
the Greeks to the Renaissance medical writers, who practically begin
modern medicine for us.
It is easy to understand that Christianity's influence on medicine,
instead of hampering, was most favorable. The Founder of Christianity
Himself had gone about healing the sick, and care for the ailing became
a prominent feature of Christian work. One of the Evangelists, St. Luke,
was a physician. It was the custom a generation ago, and even later,
when the Higher Criticism became popular, to impugn the tradition as to
St. Luke having been a physician, but this has all been undone, and
Harnack's recent book, "Luke the Physician," makes it very clear that
not only the Third Gospel, but also the Acts, could only have been
written by a man thoroughly familiar with the Greek medical terms of his
time, and who had surely had the advantage of a training in the medical
sciences at Alexandria. This makes such an important link in medical
traditions that a special chapter has been devoted to it in the
Appendix.
Very early in Christianity care for the ailing poor was taken up, and
hospitals in our modern sense of the term became common in Christian
communities. There had been military hospitals before this, and places
where those who could afford to pay for service were kept during
illness. Our modern city hospital, however, is a Christian institution.
Besides, deformed and ailing children were cared for and homes for
foundlings were established. Before Christianity the power even of life
and death of the parents over their children was recognized, and
deformed or ailing children, or those that for some reason were not
wanted, were exposed until they died. Christianity put an end to this,
and in two classes of institutions, the hospitals and the asylums,
abundant opportunity for observation of illness was afforded. Just as
soon as Christianity came to be free to establish its institutions
publicly, hospitals became very common. The Emperor Julian, usually
known as the Apostate, who hoped to re-establish the old Roman Olympian
religion, wrote to Oribasius, one of the great physicians of this time,
who was also an important official of his household, that these
Christians had established everywhere hospitals in which not only their
own people, but also those who were not Christians, were received and
cared for, and that it would be idle to hope to counteract the influence
of Christianity until corresponding institutions could be erected by the
government.
From the very beginning, or, at least, just as soon as reasonable
freedom from persecution gave opportunity for study, Christian interest
in the medical sciences began to manifest itself. Nemesius, for
instance, a Bishop of Edessa in Syria, wrote toward the end of the
fourth century a little work in Greek on the nature of man, which is a
striking illustration of this. Nemesius was what in modern times would
be called a philosopher, that is, a speculative thinker and writer, with
regard to man's nature, rather than a physical scientist. He was
convinced, however, that true philosophy ought to be based on a complete
knowledge of man, body and soul, and that the anatomy of his body ought
to be a fundamental principle. It is in this little volume that some
enthusiastic students have found a description that is to them at least
much more than a hint of knowledge of the circulation of the blood.
Hyrtl doubts that the passage in question should be made to signify as
much as has been suggested, but the occurrence of any even distant
reference to such a subject at this time shows that, far from there
being neglect of physical scientific questions, men were thinking
seriously about them.
Just as soon as Christianity brought in a more peaceful state of affairs
and had so influenced the mass of the people that its place in the
intellectual life could be felt, there comes a period of cultural
development represented in philosophy by the Fathers of the Church, and
during which we have a series of important contributors to medical
literature. The first of these was Aëtius, whose career and works are
treated more fully in the chapter on "Great Physicians in Early
Christian Times." He was followed by Alexander of Tralles, probably a
Christian, for his brother was the architect of Santa Sophia, and by
Paul of Ægina, with regard to whom we know only what is contained in his
medical writings, but whose contemporaries were nearly all Christians.
Their books are valuable to us, partly because they contain quotations
from great Greek writers on medicine, not always otherwise available,
but also because they were men who evidently knew the subject of
medicine broadly and thoroughly, made observations for themselves, and
controlled what they learned from the Greek forefathers in medicine by
their own experience. Just at the beginning of the Middle Ages, then,
under the fostering care of Christianity there is a period of
considerable importance in the history of medical literature. It is one
of the best proofs that we have not only that Christianity did not
hamper medical development, but that, directly and indirectly, by the
place that it gave to the care of the ailing in life as well as the
encouragement afforded to the intellectual life, it favored medical
study and writing.
A very interesting chapter in the story of the early Christian physician
is to be found in what we know of the existence of women physicians in
the fourth and fifth centuries. Theodosia, the mother of St. Procopius
the martyr, was, according to Carptzovius, looked upon as an excellent
physician in Rome in the early part of the fourth century. She suffered
martyrdom under Diocletian. There was also a Nicerata who practised at
Constantinople under the Emperor Arcadius. It is said that to her St.
John Chrysostom owed the cure of a serious illness. From the very
beginning Christian women acted as nurses, and deaconesses were put in
charge of hospitals. Fabiola, at Rome, is the foundress of the first
important hospital in that city. The story of these early Christian
women physicians has been touched upon in the chapter on "Medieval Women
Physicians," as an introduction to this interesting feature of
Salernitan medical education.
During the early Christian centuries much was owed to the genius and the
devotion to medicine of distinguished Jewish physicians. Their sacred
and rabbinical writers always concerned themselves closely with
medicine, and both the Old Testament and the Talmud must be considered
as containing chapters important for the medical history of the periods
in which they were written. At all times the Jews have been
distinguished for their knowledge of medicine, and all during the Middle
Ages they are to be found prominent as physicians. They were among the
teachers of the Arabs in the East and of the Moors in Spain. They were
probably among the first professors at Salerno as well as at
Montpellier. Many prominent rulers and ecclesiastics selected Jewish
physicians. Some of these made distinct contributions to medicine, and a
number of them deserve a place in any account of medicine in the making
during the Middle Ages. One of them, Maimonides, to whom a special
chapter is devoted, deserves a place among the great makers of medicine
of all time, because of the influence that he exerted on his own and
succeeding generations. Any story of the preservation and development of
medical teaching and medical practice during the Middle Ages would be
decidedly incomplete without due consideration of the work of Jewish
physicians.
Western medical literature followed Roman literature in other
departments, and had only the Greek traditions at second hand. During
the disturbance occasioned by the invasion of the barbarians there was
little opportunity for such leisure as would enable men to devote
themselves with tranquillity to medical study and writing. Medical
traditions were mainly preserved in the monasteries. Cassiodorus, who,
after having been Imperial Prime Minister, became a monk, recommended
particularly the study of medicine to the monastic brethren. With the
foundation of the Benedictines, medicine became one of the favorite
studies of the monks, partly for the sake of the health of the brethren
themselves, and partly in order that they might be helpful to the
villages that so often gathered round their monasteries. There is a
well-grounded tradition that at Monte Cassino medical teaching was one
of the features of the education provided there by the monks. It is
generally conceded that the Benedictines had much to do with the
foundation of Salerno. In the convents for women as well as the
monasteries for men serious attention was given to medicine. Women
studied medicine and were professors in the medical department of
Salerno. Other Italian universities followed the example thus set, and
so there is abundant material for the chapter on "Medieval Women
Physicians."
The next phase of medical history in the medieval period brings us to
the Arabs. Utterly uninterested in culture, education, or science before
the time of Mohammed, with the growth of their political power and the
foundation of their capitals, the Arab Caliphs took up the patronage of
education. They were the rulers of the cities of Asia Minor in which
Greek culture had taken so firm a hold, and captive Greece has always
led its captors captive. With the leisure that came for study, Arabians
took up the cultivation of the Greek philosophers, especially Aristotle,
and soon turned their attention also to the Greek physicians Hippocrates
and Galen. For some four hundred years then they were in the best
position to carry on medical traditions. Their teachers were the
Christian and Jewish physicians of the cities of Asia Minor, but soon
they themselves became distinguished for their attainments, and for
their medical writings. Interestingly enough, more of their
distinguished men flourished in Spain than in Asia Minor. We have
suggested an explanation for this in the fact that Spain had been one of
the most cultured provinces of the Roman Empire, providing practically
all the writers of the Silver Age of Latin literature, and evidently
possessing a widely cultured people. It was into this province, not yet
utterly decadent from the presence of the northern Goths, that the Moors
came and readily built up a magnificent structure of culture and
education on what had been the highest development of Roman
civilization.
The influence of the Arabs on Western civilization, and especially on
the development of science in Europe, has been much exaggerated by
certain writers. Closely in touch with Greek thought and Greek
literature during the eighth, ninth, and tenth centuries, it is easy to
understand that the Arabian writers were far ahead of the Christian
scholars of Europe of the same period, who were struggling up out of the
practical chaos that had been created by the coming of the barbarians,
and who, besides, had the chance for whatever Greek learning came to
them only through the secondary channels of the Latin writers. Rome had
been too occupied with politics and aggrandizement ever to become
cultured. In spite of this heritage from the Greeks, decadence took
place among the Arabs, and, as the centuries go on, what they do becomes
more and more trivial, and their writing has less significance. Just the
opposite happened in Europe. There, there was noteworthy progressive
development until the magnificent climax of thirteenth century
accomplishment was reached. It is often said that Europe owed much to
the Arabs for this, but careful analysis of the factors in that progress
shows that very little came from the Arabs that was good, while not a
little that was unfortunate in its influence was borrowed from them with
the translations of the Greek authors from that language, which
constituted the main, indeed often the only, reason why Arabian writers
were consulted.
With the foundation of the medical school of Salerno in the tenth
century, the modern history of medical education may be said to begin,
for it had many of the features that distinguish our modern university
medical schools. Its professors often came from a distance and had
travelled extensively for purposes of study; they attracted patients of
high rank from nearly every part of Europe, and these were generous in
their patronage of the school. Students came from all over, from Africa
and Asia, as well as Europe, and when abuses of medical practice began
to creep in, a series of laws were made creating a standard of medical
education and regulating the practice of medicine, that are interesting
anticipations of modern movements of the same kind. Finally a law was
passed requiring three years of preliminary work in logic and philosophy
before medicine might be taken up, and then four years at medicine, with
a subsequent year of practice with a physician before a license to
practise for one's self was issued. In addition to this there was a
still more surprising feature in the handing over of the department of
women's diseases to women professors, and the consequent opening up of
licensure to practise medicine to a great many women in the southern
part of Italy. The surprise that all this should have taken place in the
south of Italy is lessened by recalling the fact that the lower end of
the Italian peninsula had been early colonized by Greeks, that its name
in later times was Magna Græcia, and that the stimulus of Greek
tradition has always been especially favorable to the development of
scientific medicine.
Salerno's influence on Bologna is not difficult to trace, and the
precious tradition of surgery particularly, which was carried to the
northern university, served to initiate a period of surgery lasting
nearly two centuries, during which we have some of the greatest
contributions to this branch of medical science that were ever made. The
development of the medical school at Bologna anticipated by but a short
time that of a series of schools in the north Italian universities.
Padua, Piacenza, Pisa, and Vicenza had medical schools in the later
Middle Ages, the works of some of whose professors have attracted
attention. It was from these north Italian medical schools that the
tradition of close observation in medicine and of thoroughly scientific
surgery found its way to Paris. Lanfranc was the carrier of surgery, and
many French students who went to Italy came back with Italian methods.
In the fourteenth century Guy de Chauliac made the grand tour in Italy,
and then came back to write a text-book of surgery that is one of the
monuments in this department of medical science. Before his time,
Montpellier had attracted attention, but now it came to be looked upon
as a recognized centre of great medical teaching. The absence of the
Popes from Italy and the influence of their presence at Avignon made
itself felt. While culture and education declined in Italy in the midst
of political disturbances, they advanced materially at the south of
France.
For our generation undoubtedly the most interesting chapter in the
history of medieval medicine is that which tells of the marvellous
development of surgery that took place in the thirteenth and fourteenth
centuries. Considerable space has been devoted to this, because it
represents not only an important phase of the history of medicine, and
recalls the names and careers of great makers of medicine, but also
because it illustrates exquisitely the possibility of important
discoveries in medicine being made, applied successfully for years, and
then being lost or completely forgotten, though contained in important
medical books that were always available for study. The more we know of
this great period in the history of surgery, the more is the surprise at
how much was accomplished, and how many details of our modern surgery
were anticipated. Most of us have had some inkling of the fact that
anæsthesia is not new, and that at various times in the world's history
men have invented methods of producing states of sensibility in which
more or less painless operations were possible. Very few of us have
realized, however, the perfection to which anæsthesia was developed, and
the possibility this provided for the great surgeons of the later
medieval centuries to do operations in all the great cavities of the
body, the skull, the thorax, and the abdomen, quite as they are done in
our own time and apparently with no little degree of success.
Of course, any such extensive surgical intervention even for serious
affections would have been worse than useless under the septic
conditions that would surely have prevailed if certain principles of
antisepsis were not applied. Until comparatively recent years we have
been quite confident in our assurance that antisepsis and asepsis were
entirely modern developments of surgery. More knowledge, however, of
the history of surgery has given a serious set-back to this
self-complacency, and now we know that the later medieval surgeons
understood practical antisepsis very well, and applied it successfully.
They used strong wine as a dressing for their wounds, insisted on
keeping them clean, and not allowing any extraneous material of any
kind, ointments or the like, to be used on them. As a consequence they
were able to secure excellent results in the healing of wounds, and they
were inclined to boast of the fact that their incisions healed by first
intention and that, indeed, the scar left after them was scarcely
noticeable. We know that wine would make a good antiseptic dressing, but
until we actually read the reports of the results obtained by these old
surgeons, we had no idea that it could be used to such excellent
purpose. Antisepsis, like anæsthesia, was marvellously anticipated by
the surgical forefathers of the medieval period.
It has always seemed to me that the story of Medieval Dentistry
presented an even better illustration of a great anticipatory
development of surgery. This department represents only a small surgical
specialty, but one which even at that period was given over to
specialists, who were called dentatores. Guy de Chauliac's review of the
dentistry of his time and the state of the specialty, as pictured by
John of Arcoli, is likely to be particularly interesting, because if
there is any department of medical practice that we are sure is
comparatively recent in origin, it is dentistry. Here, however, we find
that practically all our dental manipulations, the filling of teeth,
artificial dentures, even orthodontia, were anticipated by the dentists
of the Middle Ages. We have only the compressed account of it which is
to be found in text-books of general surgery, and while in this they
give mainly a heritage from the past, yet even this suffices to give us
a picture very surprising in its detailed anticipation of much that we
have been inclined to think of as quite modern in invention and
discovery.
Medicine developed much more slowly than surgery, or, rather, lagged
behind it, as it seems nearly always prone to do. Surgical problems are
simple, and their solution belongs to a great extent to a handicraft.
That is, after all, what chirurgy, the old form of our word surgery,
means. Medical problems are more complex and involve both art and
science, so that solutions of them are often merely temporary and lack
finality. During the Middle Ages, however, and especially towards the
end of them, the most important branches of medicine, diagnosis and
therapeutics, took definite shape on the foundations that lie at the
basis of our modern medical science. We hear of percussion for abdominal
conditions, and of the most careful study of the pulse and the
respiration. There are charts for the varying color of the urine, and of
the tints of the skin. With Nicholas of Cusa there came the definite
suggestion of the need of exact methods of diagnosis. A mathematician
himself, he wished to introduce mathematical methods into medical
diagnosis, and suggested that the pulse should be counted in connection
with the water clock, the water that passed being weighed, in order to
get very definite comparative values for the pulse rate under varying
conditions, and also that the specific gravity of fluids from the body
should be ascertained in order to get another definite datum in the
knowledge of disease. It was long before these suggestions were to bear
much fruit, but it is interesting to find them so clearly expressed.
At the very end of the Middle Ages came the father of modern
pharmaceutical chemistry, Basil Valentine. Already the spirit that was
to mean so much for scientific investigation in the Renaissance period
was abroad. Valentine, however, owes little to anything except his own
investigations, and they were surprisingly successful, considering the
circumstances of time and place. His practical suggestions so far as
drugs were concerned did not prove to have enduring value, but then this
has been a fate shared by many of the masters of medicine. There were
many phases of medical practice, however, that he insisted on in his
works. He believed that the best agent for the cure of the disease was
nature, and that the physician's main business must be to find out how
nature worked, and then foster her efforts or endeavor to imitate them.
He insisted, also that personal observation, both of patients and drugs,
was more important than book knowledge. Indeed, he has some rather
strong expressions with regard to the utter valuelessness of book
information in subjects where actual experience and observation are
necessary. It gives a conceit of knowledge quite unjustified by what is
really known.
What is interesting about all these men is that they faced the same
problems in medicine that we have to, in much the same temper of mind
that we do ourselves, and that, indeed, they succeeded in solving them
almost as well as we have done, in spite of all that might be looked for
from the accumulation of knowledge ever since.
It was very fortunate for the after time that in the period now known as
the Renaissance, after the invention of printing, there were a number of
serious, unselfish scholars who devoted themselves to the publication in
fine printed editions of the works of these old-time makers of medicine.
If the neglect of them that characterized the eighteenth and early
nineteenth centuries had been the rule at the end of the fifteenth and
during the sixteenth century, we would almost surely have been without
the possibility of ever knowing that so many serious physicians lived
and studied and wrote large important tomes during the Middle Ages. For
our forefathers of a few generations ago had very little knowledge, and
almost less interest, as to the Middle Ages, which they dismissed simply
as the Dark Ages, quite sure that nothing worth while could possibly
have come out of the Nazareth of that time. What they knew about the
people who had lived during the thousand years before 1500 only seemed
to them to prove the ignorance and the depths of superstition in which
they were sunk. That medieval scholars should have written books not
only well worth preservation, but containing anticipations of modern
knowledge, and, though of course they could not have known that, even
significant advances over their own scientific conditions, would have
seemed to them quite absurd.
Fortunately for us, then, the editions of the early printed books, so
many of them monuments of learning and masterpieces of editorial work
with regard to medieval masters of medicine, were lying in libraries
waiting to be unearthed and restudied during the nineteenth century.
German and French scholars, especially during the last generation, have
recovered the knowledge of this thousand years of human activity, and we
know now and can sympathetically study how the men of these times faced
their problems, which were very much those of our own time, in almost
precisely the same spirit as we do ours at the present time, and that
their solutions of them are always interesting, often thorough and
practical, and more frequently than we would like to think possible,
resemble our own in many ways. For the possibility of this we are
largely indebted originally to the scholars of the Renaissance. Without
their work that of our investigators would have been quite unavailing.
It is to be hoped, however, that our recovery of this period will not be
followed by any further eclipse, though that seems to be almost the rule
of human history, but that we shall continue to broaden our sympathetic
knowledge of this wonderful medieval period, the study of which has had
so many surprises in store for us.
II
GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES
What we know of the life of the Founder of Christianity and how much He
did for the ailing poor would make us expect that the religion that He
established would foster the care and the cure of suffering humanity. As
we have outlined in the Introduction, the first of the works of
Christian service that was organized was the care of the sick. At first
a portion of the bishop's house was given over to the shelter of the
ailing, and a special order of assistants to the clergy, the
deaconesses, took care of them. As Christians became more numerous,
special hospitals were founded, and these became public institutions
just as soon as freedom from persecution allowed the Christians the
liberty to give overt expression to their feelings for the poor. While
hospitals of limited capacity for such special purposes as the
sheltering of slaves or of soldiers and health establishments of various
kinds for the wealthy had been erected before Christianity, this was the
first time that anyone who was ill, no matter what the state of his
pecuniary resources, could be sure to find shelter and care. The
expression of the Emperor Julian the Apostate, that admission to these
hospitals was not limited to Christians, is the best possible evidence
of the liberal charity that inspired them.
The ordinary passing student of the history of medicine or of hospital
foundation and organization, can have no idea of the magnitude of some
of these institutions, and their importance in the life of the time,
unless it is especially pointed out. St. Basil, about the middle of the
fourth century, erected what was spoken of as "a city for the sick,"
before the gates of Cæsarea. Gregory of Nazianzen, his friend, says
"that well built and furnished houses stood on both sides of streets
symmetrically laid out about the church, and contained rooms for the
sick, and the infirm of every variety were intrusted to the care of
doctors and nurses." There were separate buildings for strangers, for
the poor, and for the ailing, and comfortable dwellings for the
physicians and nurses. An important portion of the institution was set
apart for the care of lepers, which constituted a prominent feature in
Basil's work in which he himself took a special interest. Earlier in the
same century Helena, the mother of the Emperor Constantine, had built
similar institutions around Jerusalem, and during this same century
nearly everywhere we have evidence of organization of hospitals and of
care for the ailing poor.
Not only were hospitals erected, but arrangements were made for the care
of the ailing poor in their own homes and for the visitation of them,
and for the bringing to places adapted for their care and treatment of
such as were found on the street, or neglected in their homes. The
Church evidently considered itself bound to care for men's bodies as
well as their souls, and many of the expressions in common use among
Christians referred to this fact. Religion itself was spoken of as a
medicine of the soul and the body. Christianity was defined as the
religion of healing. The word salvation had a reference to both body and
soul. Baptism was spoken of as the bath of the soul, the holy Eucharist
as the elixir of immortal life, and penance as the medicine of the soul.
It is not surprising to find, then, that Harnack has found among the
texts that illustrate the history of early Christian literature this
one: "In every community there shall be at least one widow appointed to
assist women who are stricken with illness, and this widow shall be
trained in her duties, neat and careful in her ways, shall not be
self-seeking, must not indulge too freely in wine in order that she may
be able to take up her duties at night as well as by day, and shall
consider it her duty to keep the Church officials informed of all that
seems necessary."
The saving of deformed and ailing infants or children whose parents did
not care to have the trouble of rearing them, required the establishment
by the Christians of another set of institutions, Foundling Asylums and
Hospitals for Children. Until the coming of Christianity parents were
supposed to have the right of life and death over their children, and no
one questioned it. In every country in the world until the coming of
Christianity this had always been the case. Besides, there were
institutions for the care of the old. These are the classes of mankind
who are especially liable to suffer from disease, and the opportunity
to study human ailments in such institutions could scarcely help but
provide facilities for clinical observation such as had not existed
before. Unfortunately the work of Christianity was hampered, first by
the Roman persecutions, and then later by the invasion of the
barbarians, who had to be educated and lifted up to a higher plane of
civilization before they could be brought to appreciate the value of
medical science, much less contribute to its development.
Harnack, whose writings in the higher criticism of Scripture have
attracted so much attention in recent years, began his career in the
study of Christian antiquities with a monograph on Medical Features of
Early Christianity.[1] He mentions altogether some sixteen physicians
who reached distinction in the earliest days of Christianity. Some of
these were priests, some of them bishops, as Theodotos of Laodicea;
Eusebius, Bishop of Rome; Basilios, Bishop of Ancyra, and at least one,
Hierakas, was the founder of a religious order. The first Christian
physicians came mainly from Syria, as might be expected, for here the
old Greek medical traditions were active. Among them must be enumerated
Cosmas and Damian, physicians who were martyred in the persecution of
Diocletian, and who have been chosen as the patrons of the medical
profession. Justinian erected a famous church to them. It became the
scene of pilgrimages. Organizations of various kinds since, as the
College of St. Come, and medical societies, have been named after them.
Some idea of the interest of ecclesiastics in medical affairs may be
gathered from a letter of Bishop Theodoret of Cyrus, directed to the
prefect of the city, when he was about to leave the place. He wrote (see
Puschmann, Vol. I., p. 494): "When I took up the Bishopric of Cyrus I
made every effort to bring in from all sides the arts that would be
useful to the people. I succeeded in persuading skilled physicians to
take up their residence here. Among these is a very pious priest, Peter,
who practises medicine with great skill, and is well known for his care
for the people. Now that I am about to leave the city, some of those who
came at my invitation are preparing also to go. Peter seems resolved to
do this. I appeal to your highness, therefore, in order to commend him
to your special care. He handles patients with great skill and brings
about many cures."
Distinguished Christian writers and scholars, and the Fathers of the
Church in the early centuries, evidently paid much attention to
medicine. Tertullian speaks of medical science as the sister of
philosophy, and has many references to the medical doctrines discussed
in his time. Lactantius, in his work, "De Opificio Dei," has much to say
with regard to the human body as representing the necessity for design
in creation. His teleological arguments have much more force now than
they would have had for people generally twenty years ago. We have come
back to recognize the place of teleology. Clement of Alexandria was an
early Christian temperance advocate, who argued that the use of wine
was only justified when it did good as a medicine. The problems of
embryology and of diseases of childhood interested him as they did many
other of the early Christian writers.
AËTIUS
The first great Christian physician whose works meant much for his own
time, and whose writings have become a classic in medicine, was Aëtius
Amidenus, that is, Aëtius of Amida, who was born in the town of that
name in Mesopotamia, on the upper Tigris (now Diarbekir), and who
flourished about the middle of the sixth century. His medical studies,
as he has told us himself, were made at Alexandria. After having
attracted attention by his medical learning and skill, he became
physician to one of the emperors at Byzantium, very probably Justinian,
(527-565). He seems to have been succeeded in the special post that was
created for him at court by Alexander of Tralles, the second of the
great Christian physicians. There is no doubt that Aëtius was a
Christian, for he mentions Christian mysteries, and appeals to the name
of the Saviour and the martyrs. He was evidently a man of wide reading,
for he quotes from practically every important medical writer before his
time. Indeed, he is most valuable for the history of medicine, because
he gives us some idea of the mode of treatment of various subjects by
predecessors whose fame we know, but none of whose works have come to
us. His official career and the patronage of the Emperor, the breadth
of his scholarship, and the thoroughly practical character of his
teaching, show how medical science and medical art were being developed
and encouraged at this time.
Aëtius' work that is preserved for us is known in medical literature as
his sixteen books on medical practice. In most of the manuscript it is
divided into four Tetrabibloi, or four book parts, each of which
consists of four sections called Logoi in Greek, Sermones in Latin. This
work embraces all the departments of medicine, and has a considerable
portion devoted to surgery, but most of the important operations and the
chapters on fractures and dislocations are lacking. Aëtius himself
announces that he had prepared a special work on surgery, but this is
lost. Doubtless the important chapters that we have noted as lacking in
his work would be found in this. He is much richer in pathology than
most of the older writers, at least of the Christian era; for instance,
Gurlt says that he treats this feature of the subject much more
extensively even than Paulus Æginetus, but most of his work is devoted
to therapeutics.
At times those who read these old books from certain modern standpoints
are surprised to find such noteworthy differences between writers on
medicine, who are separated sometimes only by a generation, and
sometimes by not more than a century, in what regards the comparative
amount of space given to pathology, etiology, and therapeutics. Just
exactly the same differences exist in our own day, however. We all know
that for those who want pathology and etiology the work of one of our
great teachers is to be consulted, while for therapeutics it is better
to go to someone else. When we find such differences among the men of
the olden time we are not so apt to look at them with sympathetic
discrimination, as we do with regard to our contemporaries. We may even
set them down to ignorance rather than specialization of interest. These
differences depend on the attitude of mind of the physician, and are
largely the result of his own personal equation. They do not reflect in
any way either on his judgment or on the special knowledge of his time,
but are the index of his special receptivity and teaching habit.
Aëtius' first and second books are taken up entirely with drugs. The
first book contains a list of drugs arranged according to the Greek
alphabet. In the third book other remedial measures, dietetic,
manipulative, and even operative, are suggested. In these are included
venesection, the opening of an artery, cupping, leeches, and the like.
The fourth and fifth books take up hygiene, special dietetics, and
general pathology. In the sixth book what the Germans call special
pathology and therapy begins with the diseases of the head. The first
chapter treats of hydrocephalus. In this same book rabies is treated.
What Aëtius has consists mainly of quotations from previous authors,
many of whom he had evidently read with great care.
Concerning those "bitten by a rabid dog or those who fear water," Gurlt
has quoted the following expression, with regard to which most people
will be quite ready to agree with him when he says that it contains a
great deal of truth, usually thought to be of much later origin: "When,
therefore, any one has been bitten by a rabid dog the treatment of the
wound must be undertaken just as soon as possible, even though the bite
should be small and only superficial. One thing is certain, that none of
those who are not rightly treated escape the fatal effect. The first
thing to do is to make the wound larger, the mouth of it being divided
and dilated by the scalpel. Then every portion of it and the surrounding
tissues must be firmly pressed upon with the definite purpose of causing
a large efflux of blood from the part. Then the wound should be deeply
cauterized, etc."
There are special chapters devoted to eye and ear diseases, and to
various affections of the face. Under this the question of tattooing and
its removal comes in. It is surprising how much Aëtius has with regard
to such nasal affections as polyps and ulcers and bleedings from the
nose. In this book, however, he treats only of their medicinal
treatment. What he has to say about affections of the teeth is so
interesting that it deserves a paragraph or two by itself.
He had much to say with regard to the nervous supply of the mucous
membranes of the gums, tongue, and mouth, and taught that the teeth
received nerves through the small hole existing at the end of every
root. For children cutting teeth he advised the chewing of hard objects,
and thought that the chewing of rather hard materials was good also for
the teeth of adults. For fistulas leading to the roots of teeth he
suggests various irritant treatments, and, if they do not succeed,
recommends the removal of the teeth. He seems to have known much about
affections of the gums and recognizes a benignant and malignant epulis.
He thought that one form of epulis was due to inflammation of a chronic
character, and suggests that if remedies do not succeed it should be
removed. His work is of interest mainly as showing that even at this
time, when the desire for information of this kind is usually supposed
to have been in abeyance, physicians were gathering information about
all sorts even of the minor ailments of mankind, gathering what had been
written about them, commenting on it, adding their own observations, and
in general trying to solve the problems as well as they could.
Aëtius seems to have had a pretty good idea of diphtheria. He speaks of
it in connection with other throat manifestations under the heading of
"crusty and pestilent ulcers of the tonsils." He divides the anginas
generally into four kinds. The first consists of inflammation of the
fauces with the classic symptoms, the second presents no inflammation of
the mouth nor of the fauces, but is complicated by a sense of
suffocation--apparently our croup. The third consists of external and
internal inflammation of the mouth and throat, extending towards the
chin. The fourth is an affection rather of the neck, due to an
inflammation of the vertebræ--retropharyngeal abscess--that may be
followed by luxation and is complicated by great difficulty of
respiration. All of these have as a common symptom difficulty of
swallowing. This is greater in one variety than in another at different
times. In certain affections even "drinks when taken are returned
through the nose."
Hypertrophy of the tonsils--Aëtius speaks of them as glands--is to be
treated by various astringent remedies, but if these fail the structures
should be excised. His description of the excision is rather clear and
detailed. The patient should be put in a good full light, and the mouth
should be held open and each gland pulled forward by a hook and excised.
The operator should be careful, however, only to excise those portions
that are beyond the natural size, for if any of the natural substance of
the gland is cut into, or if the incision is made beyond the projecting
portion of the tonsil, there is grave danger of serious hemorrhage.
After excision a mixture of water and vinegar should be kept in the
mouth for some time. This should be administered cold in order to
prevent the flow of blood. After this very cold water should be taken.
In this same book, Chapter L, he treats of foreign bodies in the
respiratory and upper digestive tracts. If there is anything in the
larynx or the bronchial tubes the attempt must be made to secure its
ejection by the production of coughing or sneezing. If the foreign body
can be seen it should be grasped with a pincers and removed. If it is in
the esophagus, Aëtius suggests that the patient should be made to
swallow a sponge dipped in grease, or a piece of fat meat, to either of
which a string has been attached, in order that the foreign body may be
caught and drawn out. If it seems preferable to carry the body on into
the stomach, the swallowing of large mouthfuls of fresh bread or other
such material is recommended.
With regard to goitre, Aëtius has some interesting details. He says
that "all tumors occurring in the throat region are called bronchoceles,
for every tumor among the ancients was called a cele, and, though the
name is common to them, they differ very much from one another." Some of
them are fatty, some of them are pultaceous, some of them are cancerous,
and some of them he calls honey tumors, because of a honey-like humor
they contain. "Sometimes they are due to a local dilatation of the blood
vessels, and this is most frequently connected with parturition,
apparently being due to the drawing of the breath being prevented or
repressed during the most violent pains of the patient. Such local
dilatation at this point of the veins is incurable, but there are also
hard tumors like scirrhus and malignant tumors, and those of great size.
With the exception of these last, _all the tumors of this region are
easily cured_, yielding either to surgery or to remedies. Surgery must
be adapted to the special tumor, whether it be honey-like or fatty, or
pultaceous." The prognosis of goitrous tumors is much better than might
be expected, but evidently Aëtius saw a number of the functional
disturbances and enlargements of the thyroid gland, which are so
variable in character as apparently to be quite amenable to treatment.
Aëtius' treatment of the subject of varicosities is quite complete in
its suggestions. "The term varices," he says, "is applied to dilated
veins, which occur sometimes in connection with the testes and sometimes
in the limbs. Operations on testicular varices patients do not readily
consent to; those on the limbs may be cured in several ways. First,
simple section of the skin lying above the dilated vessel is made, and
with the hook it is separated from the neighboring tissues and tied.
After this the dilated portion is removed and pressure applied by means
of a bandage. The patient is ordered to remain quiet, but with the legs
higher than the head. Some people prefer treatment by means of the
cautery." Gurlt, in his "History of Surgery," calls attention to the
fact that two of our modern methods of treating varicose veins are thus
discussed in Aëtius, that by ligation and that by the cautery. The
cautery was applied over a space the breadth of a finger at several
points along the dilated veins.
Aëtius' chapters on obstetrics and gynæcology are of special interest,
because, while we are prone to think that gynæcology particularly is a
comparatively modern development of surgery, this surgical authority of
the early Middle Ages treats it rather exhaustively. His sixteenth book
is for the most part (one hundred and eleven chapters of it) devoted to
these two subjects. He has a number of interesting details in the first
thirty-six chapters with regard to conception, pregnancy, labor, and
lactation, which show how practical were the views of the physicians of
the time. Gurlt has given us some details of his chapters on diseases of
the breast. Aëtius differentiates phagedenic and rodent ulcers and
cancer. All the ordinary forms of phagedenic ulcer yield to treatment,
while malignant growths are rendered worse by them. Where ulcers are
old, he suggests the removal of their thickened edges by the cautery,
for this hastens cure and prevents hemorrhage. With regard to cancer,
he quotes from Archigenes and Leonides. He says that these tumors are
very frequent in women, and quite rare in men. Even at this time cancer
had been observed and recognized in the male breast. He emphasizes the
fact that cancerous nodules become prominent and become attached to
surrounding tissues. There are two forms, those with ulcer, and those
without. He describes the enlargement of the veins that follows, the
actual varicosities, and the dusky or livid redness of the parts which
seem to be soft, but are really very hard. He says that they are often
complicated by very painful conditions, and that they cause enlargement
of the glands and of the arms. The pain may spread to the clavicle and
the scapula, and he seems to think that it is the pain that causes the
enlargement of the glands at a distance.
His description of ulcerative cancer of the breast is very striking. He
says that it erodes without cause, penetrating ever deeper and deeper,
and cannot be stopped until it emits a secretion worse than the poison
of wild beasts, copious and abominable to the smell. With these other
symptoms pains are present. This form of cancer is especially made worse
by drugs and by all manner of manipulation. The paragraph from Leonides
quoted by Aëtius gives a description of operation for cancer of the
breast, in which he insists particularly on the extensive removal of
tissue and the free use of the cautery. "The cautery is used at first in
order to prevent bleeding, but also because it helps to destroy the
remains of diseased tissues. When the burning is deep, prognosis is
much better. Even in cases where indurated tumors of the breast occur
that might be removed without danger of bleeding, it is better to use
the cautery freely, though the amputation of such a portion down to the
healthy parts may suffice." Aëtius quotes this with approval.
Others before Aëtius had suggested the connection between hypertrophy of
the clitoris and certain exaggerated manifestations of the sexual
instinct, and the development of vicious sexual habits. As might be
expected from this first great Christian physician and surgeon, he
emphasizes this etiology for certain cases, and outlines an operation
for it. This operation had been suggested before, but Aëtius goes into
it in detail and describes just how the operation should be done, so as
to secure complete amputation of the enlarged organ, yet without injury.
He warns of the danger of removing more than just the structure itself,
because this may give rise to ugly and bothersome scars. After the
operation a sponge wet with astringent wine should be applied, or cold
water, especially if there is much tendency to bleeding, and afterwards
a sponge with manna or frankincense scattered over it should be bound
on. He treats of other pathological conditions of the female genitalia,
varicose veins, growths of various kinds, hypertrophy of the _portio
vaginalis uteri_, an operation for which is described, and of various
tumors. He describes epithelioma very clearly, enumerates its most
frequent locations in their order, lays down its bad prognosis, and
hence the necessity for early operation with entire removal of the new
growth whenever possible. He feared hemorrhage very much, however, and
warns with regard to it, and evidently had had some very unfortunate
experiences in the treatment of these conditions.
Aëtius seems to have had as thoroughly scientific an interest in certain
phases of chemistry apart from medicine as any educated physician of the
modern time might have. Mr. A.P. Laurie, in his "Materials of the
Printer's Craft,"[2] calls attention to the fact that the earliest
reference to the use of drying oil for varnish is made by the physician
Aëtius.
Aëtius, or Aëtios, to use for the nonce the Greek spelling of his name,
which sometimes occurs in medical literature, and should be known, has
been the subject of very varied estimation at different times. About the
time of the Renaissance he was one of the first of the early writers on
medicine accorded the honor of printing, and then was reprinted many
times, so that his estimation was very high. With the reawakening of
clinical medicine in the seventeenth century his reputation waxed again,
and Boerhaave declared that the works of Aëtius had as much importance
for physicians as had the Pandects of Justinian for lawyers. This high
estimation had survived almost from the time of the Renaissance, when
Cornelius went so far as to say: "Believe me, that whoever is deeply
desirous of studying things medical, if he would have the whole of Galen
abbreviated and the whole of Oribasius extended, and the whole of Paulus
(of Ægina) amplified, if he would have all the special remedies of the
old physicians as well in pharmacy as in surgery boiled down to a summa
for all affections, he will find it in Aëtius." Naturally enough, this
exaggerated estimation was followed by a reaction, in which Aëtius came
to be valued at much less than he deserved. After all is taken into
account in the vicissitudes of his fame, it is clear, however, that he
is one of the most important links in the chain of medical tradition,
and himself worthy to be classed among makers of medicine for his
personal observations and efforts to pass on the teachings of the old to
succeeding generations.
ALEXANDER OF TRALLES
An even more striking example than the life and work of Aëtius as
evidence for the encouragement and patronage of medicine in early
Christian times, is to be found in the career of Alexander of Tralles,
whose writings have been the subject of most careful attention in the
Renaissance period and in our own, and who must be considered one of the
great independent thinkers in medicine. While it is usually assumed that
whatever there was of medical writing during the Middle Ages was mere
copying and compilation, here at least is a man who could not only
judiciously select, but who could critically estimate the value of
medical opinions and procedure, and weighing them by his own experience
and observation, turn out work that was valuable for all succeeding
generations. The modern German school of medical historians have agreed
in declaring him an independent thinker and physician, who represents a
distinct link in medical tradition.
He came of a distinguished family, in which the following of medicine as
a profession might be looked upon as hereditary. His father was a
physician, and it is probable that there were physicians in preceding
generations, and one of his brothers, Dioscoros, was also a successful
physician. Altogether four of his brothers reached such distinction in
their life work that their names have come down to us through nearly
fifteen hundred years. The eldest of them was Anthemios, the builder of
the great church of Santa Sophia in Constantinople. As this is one of
the world's great churches, and still stands for the admiration of men a
millennium and a half after its completion, it is easy to understand
that Anthemios' reputation is well founded. A second brother was
Metrodoros, a distinguished grammarian and teacher, especially of the
youthful nobility of Byzantium, as it was then called, or
Constantinople, as we have come to call it. A third brother was a
prominent jurist, also in Constantinople. The fourth brother, Dioscoros,
like Alexander, a physician, remained in his birthplace, Tralles, and
acquired there a great practice.
It was with his father at Tralles that Alexander received his early
medical training. The father of a friend and colleague, Cosmas, who
later dedicated a book to Alexander, was also his teacher, while he was
in his native city. As a young man, Alexander undertook extensive
travels, which led him into Italy, Gaul, Spain, and Africa, everywhere
gathering medical knowledge and medical experience. Then he settled down
at Rome, probably in an official position, and practised medicine
successfully until a very old age. He was probably eighty years of age
when, some time during the first decade of the seventh century, he died.
Puschmann, who has made a special study of Alexander's life and work,
suggests that since some of his books have the form of academic lectures
he was probably a teacher of medicine at Rome. As might be expected from
what we know of the relations of the rest of the family to the nobility
of the time, it is easy to understand, especially in connection with
hints in Alexander's favorite modes of therapeutics, that costliness of
remedies made no difference to his patients, that he must have had the
treatment of some of the wealthiest families in Rome.
His principal work is a Treatise on the Pathology and Therapeutics of
Internal Diseases, in twelve books. The first eleven books were
evidently material gathered for lectures or teaching of some kind. The
twelfth book, in which considerable use of Aëtius' writings is made, was
written, according to Puschmann, toward the end of Alexander's life, and
was meant to contain supplementary matter, comprising especially his
views gathered from observation as to the pathology of internal
diseases. A shorter treatise of Alexander is with regard to intestinal
parasites. There are many printed editions of these books, and many
manuscript copies are in existence. Alexander was often quoted during
the Middle Ages, and in recent years, with the growth of our knowledge
of medical history, he has come to be a favorite subject of study.
Alexander's first book of pathology and therapeutics treats of head and
brain diseases. For baldness, the first symptom of which is falling out
of the hair, he counsels cutting the hair short, washing the scalp
vigorously, and the rubbing in of sulphur ointments. For grey hair he
suggests certain hair dyes, as nutgalls, red wine, and so forth. For
dandruff, which he described as the excessive formation of small
flake-like scales, he recommends rubbing with wine, with certain salves,
and washing with salt water.
He gives a good deal of attention to diseases of the nervous system. He
has a rather interesting chapter on headache. The affection occurs in
connection with fevers, after excess in drinking, and as a consequence
of injury to the skull. Besides, it develops as a result of disturbances
of the natural processes in the head, the stomach, the liver, and the
spleen. Headache, as the first symptom of inflammation of the brain, is
often the forerunner of convulsions, delirium, and sudden death. Chronic
or recurrent headache occurs in connection with plethora, diseases of
the brain, biliousness, digestive disturbances, insomnia, and continued
worry. Hemicrania has its origin in the brain, because of the presence
of toxic materials, and specially their transformation into gaseous
substances. It also occurs in connection with abdominal affections. This
latter remark particularly is directed to the cases which occur in
women.
For apoplexy and the consequent paralysis, Alexander considered
venesection the best remedy. Massage, rubbings, baths, and warm
applications are recommended for the paralytic conditions. He had
evidently had considerable experience with epilepsy. It develops either
from injuries of the head or from disturbances of the stomach, or
occasionally other parts of the body. When it occurs in nursing infants,
nourishment is the best remedy, and he gives detailed directions for the
selection of a wet nurse, and very careful directions as to her mode of
life. He emphasizes very much the necessity for careful attention to the
gastro-intestinal tract in many cases of epilepsy. Planned diet and
regular bowels are very helpful. He rejects treatment of the condition
by surgery of the head, either by trephining or by incisions, or
cauterization. Regular exercise, baths, sexual abstinence are the
foundation of any successful treatment. It is probable that we have
returned to Alexander's treatment of epilepsy much more nearly than is
generally thought. There are those who still think that remedies of
various kinds do good, but in the large epileptic colonies regular
exercise, bland diet, regulation of the bowels, and avoidance of
excesses of all kinds, with occupation of mind, constitute the mainstay
of their treatment.
Alexander has much to say with regard to phrenitis, a febrile condition
complicated by delirium, which, following Galen, he considers an
affection of the brain. It is evidently the brain fever of the
generations preceding the last, an important element of which was made
up of the infectious meningitises. Alexander suggests its treatment by
opiates after preliminary venesection, rubbings, lukewarm baths, and
stimulating drinks. Every disturbance of the patient must be avoided,
and visitors must be forbidden. The patient's room should rather be
light than dark. His teaching crops up constantly in the centuries after
his time, until the end of the nineteenth century, and while we now
understand the causes of the condition better, we can do little more for
it than he did.
Alexander divided mental diseases into two, the maniacal and
melancholic. Mania was, however, really a further development of
melancholia, and represented a high grade of insanity. Under melancholy
he groups not only what we denominate by that term, but also all
depressed conditions, and the paranoias, as also many cases of
imbecility. The cause of mental diseases was to be found in the blood.
He counselled the use of venesection, of laxatives and purgatives, of
baths and stimulant remedies. He insisted very much, however, on mental
influence in the disease, on change of place and air, visits to the
theatre, and every possible form of mental diversion, as among the best
remedial measures.
After his book on diseases of the head, his most important section is on
diseases of the respiratory system. In this he treats first of angina,
and recommends as gargles at the beginning light astringents; later
stronger astringents, as alum and soda dissolved in warm water, should
be employed. Warm compresses, venesection from the sublingual veins, and
from the jugular, and purgatives in severe cases, are the further
remedies. He treats of cough as a symptom due to hot or cold, dry or wet
dyscrasias. Opium preparations carefully used are the best remedies.
The breathing in of steam impregnated with various ethereal resins, was
also recommended.
He gives a rather interestingly modern treatment of consumption. He
recommends an abundance of milk with a strong nutritious diet, as
digestible as possible. A good auxiliary to this treatment was change of
air, a sea voyage, and a stay at a watering-place. Asses' and mares'
milk are much better for these patients than cows' and goats' milk.
There is not enough difference in the composition of these various milks
to make their special consumption of import, but it is probable that the
suggestive influence of the taking of an unusual milk had a very
favorable effect upon patients, and this effect was renewed frequently,
so that much good was ultimately accomplished. For hemoptysis,
especially when it was acute and due as Alexander thought to the rupture
of a blood vessel in the lungs, he recommended the opening of a vein at
the elbow or the ankle--in order to divert the blood from the place of
rupture to the healthy parts of the circulation. He insisted that the
patients must rest, that they should take acid and astringent drinks,
that cold compresses should be placed upon the chest (our ice bags), and
that they should take only a liquid diet at most lukewarm, or, better,
if agreeable to them, cold. When the bleeding stopped, a milk cure was
very useful for the restoration of these patients to strength.
It is not surprising, then, to find that Alexander suggests a thoroughly
rational treatment for pleurisy. He recognizes this as an inflammation
of the membrane covering the ribs, and its symptoms are severe pain,
disturbance of breathing, and coughing. In certain cases there is severe
fever, and Alexander knows of purulent pleurisy, and the fact that when
pus is present the side on which it is is warmer than the other.
Pleurisy can be, he says, rather easily confounded with certain liver
affections, but there is a peculiar hardness of the pulse characteristic
of pleurisy, and there is no expectoration in liver cases, though it
also may be absent in many cases of pleurisy. Sufferers from liver
disease usually have a paler color than pleuritics. His treatment
consists in venesection, purgatives, and, when pus is formed, local
incision. He recommends the laying on of sponges dipped in warm water,
and the internal use of honey lemonade. Opium should not be used unless
the patient suffers from sleeplessness.
Some of the general principles of therapeutics that Alexander lays down
are very interesting, even from our modern standpoint. Trust should not
be placed in any single method of treatment. Every available means of
bringing relief to the patient should be tried. "The duty of the
physician is to cool what is hot, to warm what is cold, to dry what is
moist, and to moisten what is dry. He should look upon the patient as a
besieged city, and try to rescue him with every means that art and
science places at his command. The physician should be an inventor, and
think out new ways and means by which the cure of the patient's
affection and the relief of his symptoms may be brought about." The most
important factor in his therapeutics is diet. Watering-places and
various forms of mineral waters, as well as warm baths and sea baths,
are constantly recommended by him. He took strong ground against the use
of many drugs, and the rage for operating. The prophylaxis of disease is
in Alexander's opinion the important part of the physician's duty. His
treatment of fever shows the application of his principle: cold baths,
cold compresses, and a cooling diet, were his favorite remedies. He
encouraged diaphoresis nearly always, and gave wine and stimulating
drugs only when the patient was very weak. He differentiates two kinds
of quartan fever. One of these he attributes to an affection of the
spleen, because he had noticed that the spleen was enlarged during it,
and that, after purgation, the enlarged spleen decreased in size.
Alexander was a strong opponent of drastic remedies of all kinds. He did
not believe in strong purgatives, nor in profuse and sudden
blood-lettings. He opposed arteriotomy for this reason, and refused to
employ extensive cauterization. His diagnosis is thorough and careful.
He insisted particularly on inspection and palpation of the whole body;
on careful examination of the urine, of the feces, and the sputum; on
study of the pulse and the breathing. He thought that a great deal might
be learned from the patient's history. The general constitution is also
of importance. His therapeutics is, above all, individual. Remedies must
be administered with careful reference to the constitution, the age, the
sex, and the condition of the patient's strength. Special attention must
always be paid to nature's efforts to cure, and these must be
encouraged as far as possible. Alexander had no sympathy at all with
the idea that remedies must work against nature. His position in this
matter places him among the dozen men whose name and writings have given
them an enduring place in the favor of the profession at all times, when
we were not being carried away by some therapeutic fad or imagining that
some new theory solved the whole problem of the causation and cure of
disease.
Gurlt, in his "History of Surgery," has abstracted from Alexander
particularly certain phases of what the Germans call external pathology
and therapeutics. For instance, Alexander's treatment of troubles
connected with the ear is very interesting. Gurlt declares that this
chapter alone provides striking evidence for Alexander's practical
experience and power of observation, as well as for his knowledge of the
literature of medicine. He considers that only a short abstract is
needed to show that.
For water that has found its way into the external ear, Alexander
suggests a mode of treatment that is still popularly used. The patient
should stand upon the leg corresponding to the side on which there is
water in his ear, and then, with head leaning to that side, should hop
or kick out with the other leg. The water may be drawn out by means of
suction through a reed. In order to get foreign bodies out of the
external auditory canal, an ear spoon or other small instrument should
be wrapped in wool and dipped in turpentine, or some other sticky
material. Occasionally he has seen sneezing, especially if the mouth and
nose are covered with a cloth, and the head leant toward the affected
side, bring about a dislodgment of the foreign body. If these means do
not succeed, gentle injections of warm oil or washing out of the canal
with honey water should be tried. Foreign bodies may also be removed by
means of suction. Insects or worms that find their way into the ear may
be killed by injections of acid and oil, or other substances.
Gurlt also calls attention to Alexander's careful differentiation of
certain very dangerous forms of inflammation of the throat from others
which are rather readily treated. He says, "Inflammation of the throat
may, under certain circumstances, belong to the severest diseases. The
patients succumb to it as a consequence of suffocation, just as if they
were choked or hanged. For this reason, perhaps, the affection bears the
name synanche, which means constriction." He then points out various
other forms of inflammation of the throat, acute and chronic, suggesting
various names and the differential diagnostic signs.
One of the most surprising chapters of Alexander's knowledge of
pathology and therapeutics is to be found in his treatment of the
subject of intestinal worms, which is contained in a letter sent by him
to his friend, Theodore, whose child was suffering from them. He
describes the _oxyuris vermicularis_ with knowledge manifestly derived
from personal observation. He dwells on the itching in the region of the
anus, caused by the _oxyuris_, and the fact that they probably find
their way into the upper part of the digestive tract because of the
soiling of the hands. He knew that the tapeworms often reached great
length,--he has seen one over sixteen feet long,--and also that they had
a life cycle, so that they existed in two different forms. He describes
the roundworms as existing in the intestines, but occasionally wandering
into the stomach to be vomited. His vermifuges were the flowers and the
seeds of the pomegranate, the seeds of the heliotrope, castor-oil, and
certain herbs that are still used, by country people, at least, as worm
medicines. For roundworms he recommended especially a decoction of
_artemisia maritima_, coriander seeds, and decoctions of thyme. Our
return to thymol for intestinal parasites is interesting. For the
_oxyuris_ he prescribed clysters of ethereal oils. We have not advanced
much in our treatment of intestinal worms in the fifteen hundred years
since Alexander's time.
PAUL OF ÆGINA
Another extremely important writer in these early medieval times, whose
opportunities for study in medicine and for the practice of it, were
afforded him by Christian schools and Christian hospitals, was Paul of
Ægina. He was born on the island of Ægina, hence the name Æginetus, by
which he is commonly known. There used to be considerable doubt as to
just when Paul lived, and dates for his career were placed as widely
apart as the fifth and the seventh centuries. We know that he was
educated at the University of Alexandria. As that institution was broken
up at the time of the capture of the city by the Arabs, he cannot have
been there later than during the first half of the seventh century. An
Arabian writer, Abul Farag, in "The Story of the Reign of the Emperor
Heraclius," who died 641, says that "among the celebrated physicians who
flourished at this time was Paulus Æginetus." In his works Paul quotes
from Alexander of Tralles, so that there seems to be no doubt now that
his life must be placed in the seventh century.
The most important portion of Paul's work for the modern time is
contained in his sixth book on surgery. In this his personal
observations are especially accumulated. Gurlt has reviewed it at
considerable length, devoting altogether nearly thirty pages to it, and
it well deserves this lengthy abstract. Paul quotes a great many of the
writers on surgery before his time, and then adds the results of his own
observation and experience. In it one finds careful detailed
descriptions of many operations that are usually supposed to be modern.
Very probably the description quoted by Gurlt of the method of treating
fishbones that have become caught in the throat will give the best idea
of how thoroughly practical Paul is in his directions. He says: "It will
often happen in eating that fishbones or other objects may be swallowed
and get caught in some part of the throat. If they can be seen they
should be removed with the forceps designed for that purpose. Where they
are deeper, some recommend that the patient should swallow large
mouthfuls of bread or other such food. Others recommend that a clean
soft sponge of small circumference to which a string is attached be
swallowed, and then drawn out by means of the string. This should be
repeated until the bone or other object gets caught in the sponge and is
drawn out. If the patient is seen immediately after eating, and the
swallowed object is not visible, vomiting should be brought on by means
of a finger in the throat or irritation with the feather, and then not
infrequently the swallowed object will be brought up with the vomit."
In the chapter immediately following this, XXXIII, there is a
description of the method of opening the larynx or the trachea, with the
indications for this operation. The surgeon will know that he has opened
the trachea when the air streams out of the wound with some force, and
the voice is lost. As soon as the danger of suffocation is over, the
edges of the wound should be freshened and the skin surfaces brought
together with sutures. Only the skin without the cartilage should be
sutured, and general treatment for encouraging union should be employed.
If the wound fails to heal immediately, a treatment calculated to
encourage granulations should be undertaken. This same method of
treatment will be of service whenever we happen to have a patient who,
in order to commit suicide, has cut his throat. Paul's exact term is,
perhaps, best translated by the expression, slashed his larynx.
One of the features of Paul's "Treatise on Surgery" is his description
of a radical operation for hernia. He describes scrotal hernia under the
name enterocele, and says that it is due either to a tearing or a
stretching of the peritoneum. It may be the consequence either of injury
or of violent efforts made during crying. When the scrotum contains
only omentum, he calls the condition epiplocele; when it also contains
intestine, an epiplo-enterocele. Hernia that does not descend into the
scrotum he calls bubonocele. For operation the patient should be placed
on the back, and, the skin of the inguinal region being stretched by an
assistant, an oblique incision in the direction in which the blood
vessels run should be made. The incision should then be stretched by
means of retractors, until the contents of the sac can be lifted out.
All adhesions should be broken up and the fat be removed, and the hernia
replaced within the abdomen. Care should be taken that no loop of
intestine is allowed to remain. Then a large needle with double thread
made of ten strands should be run through the middle of the incision in
the end of the peritoneum, and tied firmly in cross sutures. The outer
structures should be brought together with a second ligature, and the
lower end of the incision should have a wick placed in it for drainage,
and the site of operation should be covered with an oil bandage.
The Arab writer, Abul Farag, to whose references we owe the definite
placing of the time when Paul lived, said that "he had special
experience in women's diseases, and had devoted himself to them with
great industry and success. The midwives of the time were accustomed to
go to him and ask his counsel with regard to accidents that happen
during and after parturition. He willingly imparted his information, and
told them what they should do. For this reason he came to be known as
the Obstetrician." Perhaps the term should be translated the
man-midwife, for it was rather unusual for men to have much knowledge of
this subject. His knowledge of the phenomena of menstruation was as wide
and definite. He knew a great deal of how to treat its disturbances. He
seems to have been the first one to suggest that in metrorrhagia, with
severe hemorrhage from the uterus, the bleeding might be stopped by
putting ligatures around the limbs. This same method has been suggested
for severe hemorrhage from the lungs as well as from the uterus in our
own time. In hysteria he also suggested ligature of the limbs, and it is
easy to understand that this might be a very strongly suggestive
treatment for the severer forms of hysteria. It is possible, too, that
the modification of the circulation to the nervous system induced by the
shutting off of the circulation in large areas of the body might very
well have a favorable physical effect in this affection. Paul's
description of the use of the speculum is as complete as that in any
modern text-book of gynæcology.
FURTHER CHRISTIAN PHYSICIANS
Another distinguished Christian medical scientist was Theophilus
Protosbatharius, who belonged to the court of the Greek Emperor
Heraclius, in the seventh century. He seems to have had a life very full
of interest and surprisingly varied duties. He was a bishop, and, at the
same time, commander of the imperial bodyguard, and the author of a
little work on the fabric of the human body. The most surprising chapter
in the history of the book is that for some two centuries, in quite
modern times, it was used as a text-book of anatomy at the University of
Paris. It was printed in a number of editions early in the history of
printing, at least one very probably before 1500, and several later.
There are very interesting phases of medicine delightfully surprising in
their modernity to be found here and there in many of these early
Christian writers on medicine. For instance, in a compend of medicine
written by one Leo, who, under the Emperor Theophilus, seems to have
been a prominent physician of Byzantium (the compend was written for a
young physician just beginning practice), we find the following
classification of hydrops or abdominal dilatation: "There are three
kinds; the first is ascites, due to the presence of watery fluid, for
which we do paracentesis; second, tympany, when the abdomen is swollen
from the presence of air or gas. This may be differentiated by
percussion of the belly. When air is present the sound given forth is
like that of a drum, while in the first form ascites the sound is like
that from a sack [the word used is the same as for a wine sack]; the
third form is called anasarca, when the whole body swells."
It has often been the subject of misunderstanding as to why medicine
should have developed among the Latin Christian nations so much more
slowly than among the Arabs during the early Middle Ages. Anyone who
knows the conditions in which Christianity came into existence in Italy
will not be surprised at that. The Arabs in the East were in contact
with Greek thought, and that is eminently prolific and inspiring. At the
most, the Christians in Italy got their inspiration at second hand
through the Romans. The Romans themselves, in spite of intimate contact
with Greek physicians, never made any important contributions to medical
science, nor to science of any kind. Their successors, the Christians of
Rome and Italy, then could scarcely be expected to do better, hampered
especially, as they were, by the trying social conditions created by the
invasion of the barbarians from the North. Whenever the Christians were
in contact with Greek thought and Greek medicine, above all, as at
Alexandria, or in certain of the cities of the near East, we have
distinguished contributions from them.
ARABIAN CHRISTIAN PHYSICIANS
That this is not a partial view suggested by the desire to make out a
better case for Christianity in its relation to science will be very
well understood, besides, from the fact that a number of the original
physicians of Arab stock who attracted attention during the first period
of Arabian medicine, that is, during the eighth and ninth centuries,
were Christians. There are a series of physicians belonging to the
Christian family Bachtischua, a name which is derived from Bocht Jesu,
that is, servant of Jesus, who, from the middle of the eighth to the
middle of the eleventh century, acquired great fame. The first of them,
George (Dschordschis), after acquiring fame elsewhere, was called to
Bagdad by the Caliph El-Mansur, where, because of his medical skill, he
reached the highest honors. His son became the body-physician of Harun
al-Raschid. In the third generation Gabriel (Dschibril) acquired fame
and did much, as had his father and grandfather, for the medicine of the
time, by translations of the Greek physicians into Arabian.
These men may well be said to have introduced Greek medicine to the
Mohammedans. It was their teaching that aroused Moslem scholars from the
apathy that had characterized the attitude of the Arabian people toward
science at the beginning of Mohammedanism. As time went on, other great
Christian medical teachers distinguished themselves among the Arabs. Of
these the most prominent was Messui the elder, who is also known as
Janus Damascenus. Both he and his father practised medicine with great
success in Bagdad, and his son became the body-physician to Harun
al-Raschid either after or in conjunction with Gabriel Bachtischua. Like
his colleague or predecessor in official position, he, too, made
translations from the Greek into Arabic. Another distinguished Arabian
Christian physician was Serapion the elder. He was born in Damascus, and
flourished about the middle of the ninth century. He wrote a book on
medicine called the "Aggregator," or "Breviarium," or "Practica
Medicinæ," which appeared in many printed editions within the century
after the invention of printing. During the ninth century, also, we have
an account of Honein Ben Ischak, who is known in the West as
Johannitius. After travelling much, especially in Greece and Persia, he
settled in Bagdad, and, under the patronage of the Caliph Mamum, made
many translations. He translated most of the old Greek medical writers,
and also certain of the Greek philosophic and mathematical works. The
accuracy of his translations became a proverb. His compendium of Galen
was the text-book of medicine in the West for many centuries. It was
known as the "Isagoge in Artem Parvam Galeni." His son, Ishac Ben
Honein, and his nephew, Hobeisch, were also famous as medical
practitioners and translators.
Still another of these Arabian Christians, who acquired a reputation as
writers in medicine, was Alkindus. He wrote with regard to nearly
everything, however, and so came to be called the philosopher. He is
said altogether to have written and translated about two hundred works,
of which twenty-two treat of medicine. He was a contemporary of Honein
Ben Ischak in the ninth century. Another of the great ninth-century
Christian physicians and translators from the Greek was Kostaben Luka.
He was of Greek origin, but lived in Armenia and made translations from
Greek into Arabic. Nearly all of these men took not alone medical
science, but the whole round of physical science, for their special
subject. A typical example in the ninth century was Abuhassan Ben Korra,
many of whose family during succeeding generations attracted attention
as scholars. He became the astronomer and physician of the Caliph
Motadhid. His translations in medical literature were mainly excerpts
from Hippocrates and Galen meant for popular use. These Christian
translators, thoroughly scientific as far as their times permitted them
to be, were wonderfully industrious in their work as translators, great
teachers in every sense of the word, and they are the men who formed
the traditions on which the greater Arabian physicians from Rhazes
onward were educated.
It would be easy to think that these men, occupied so much with
translations, and intent on the re-introduction of Greek medicine, might
have depended very little on their own observations, and been very
impractical. All that is needed to counteract any such false impression,
however, is to know something definite about their books. Gurlt, in his
"History of Surgery," has some quotations from Serapion the elder, who
is often quoted by Rhazes. In the treatment of hemorrhoids Serapion
advises ligature and insists that they must be tied with a silk thread
or with some other strong thread, and then relief will come. He says
some people burn them _medicinis acutis_ (touching with acids, as some
do even yet), and some incise them with a knife. He prefers the
ligature, however. He calmly discusses the removal of stones from the
kidney by incision of the pelvis of the kidney through an opening in the
loin. He considers the operation very dangerous, however, but seems to
think the removal of a stone from the bladder a rather simple procedure.
His description of the technique of the use of a catheter and of a
stylet with it, and apparently also of a guide for it in difficult
cases, is extremely interesting. He suggests the opening of the bladder
in the median line, midway between the scrotum and the anus, and the
placing of a canula therein, so as to permit drainage until healing
occurs.
Even this brief review of the careers and the writings of the
physicians of early Christian times shows how well the tradition of old
Greek medicine was being carried on. There was much to hamper the
cultivation of science in the disturbances of the time, the gradual
breaking up of the Roman Empire, and the replacement of the peoples of
southern Europe by the northern nations, who had come in, yet in spite
of all this, medical tradition was well preserved. The most prominent of
the conservators were themselves men whose opinions on problems of
practical medicine were often of value, and whose powers of observation
frequently cannot but be admired. There is absolutely no trace of
anything like opposition to the development of medical science or
medical practice, but, on the contrary, everywhere among political and
ecclesiastical authorities, we find encouragement and patronage. The
very fact that, in the storm and stress of the succeeding centuries,
manuscript copies of the writings of the physicians of this time were
preserved for us in spite of the many vicissitudes to which they were
subjected from fire, and war, and accidents of various kinds for
hundreds of years, until the coming of printing, shows in what
estimation they were held. During this time they owed their preservation
to churchmen, for the libraries and the copying-rooms were all under
ecclesiastical control.
III
GREAT JEWISH PHYSICIANS[3]
Any account of Old-Time Makers of Medicine without a chapter on the
Jewish Physicians would indeed be incomplete. They are among the most
important factors in medieval medicine, representing one of the most
significant elements of medical progress. In spite of the disadvantages
under which their race labored because of the popular feeling against
them on the part of the Christians in the earlier centuries and of the
Mohammedans later, men of genius from the race succeeded in making their
influence felt not only on their own times, but accomplished so much in
making and writing medicine as to influence many subsequent generations.
Living the segregated life that as a rule they had to, from the earliest
times (the Ghettos have only disappeared in the nineteenth century), it
would seem almost impossible for them to have done great intellectual
work. It is one of the very common illusions, however, that great
intellectual work is accomplished mainly in the midst of comfortable
circumstances and as the result of encouraging conditions. Most of our
great makers of medicine at all times, and never more so than during the
past century, have been the sons of the poor, who have had to earn their
own living, as a rule, before they reached manhood, and who have always
had the spur of that necessity which has been so well called the mother
of invention. Their hard living conditions probably rather favored than
hampered their intellectual accomplishments.
It is not unlikely that the difficult personal circumstances in which
the Jews were placed had a good deal to do at all times with stimulating
their ambitions and making them accomplish all that was in them. Certain
it is that at all times we find a wonderful power in the people to rise
above their conditions. With them, however, as with other peoples,
luxury, riches, comfort, bring a surfeit to initiative and the race does
not accomplish so much. At various times in the early Middle Ages,
particularly, we find Jewish physicians doing great work and obtaining
precious acknowledgment for it in spite of the most discouraging
conditions. Later it is not unusual to find that there has been a
degeneration into mere money-making as the result of opportunity and
consequent ease and luxury. At a number of times, however, both in
Christian and in Mohammedan countries, great Jewish physicians arose
whose names have come to us and with whom every student of medicine who
wants to know something about the details of the course of medical
history must be familiar. There are men among them who must be
considered among the great lights of medicine, significant makers always
of the art and also in nearly all cases of the science of medicine.
A little consideration of the history of the Jewish people and their
great documents eliminates any surprise there may be with regard to
their interest in medicine and successful pursuit of it during the
Middle Ages. The two great collections of Hebrew documents, the Old
Testament and the Talmud, contain an immense amount of material with
reference to medical problems of many kinds. Both of these works are
especially interesting because of what they have to say of preventive
medicine and with regard to the recognition of disease. Our prophylaxis
and diagnosis are important scientific departments of medicine dependent
on observation rather than on theory. While therapeutics has wandered
into all sorts of absurdities, the advances made in prophylaxis and in
diagnosis have always remained valuable, and though at times they have
been forgotten, re-discovery only emphasizes the value of preceding
work. It is because of what they contain with regard to these two
important medical subjects that the Old Testament and the Talmud are
landmarks in the history of medicine as well as of religion.
Baas, in his "Outlines of the History of Medicine," says: "It
corresponds to the reality in both the actual and chronological point of
view to consider the books of Moses as the foundation of sanitary
science. The more we have learned about sanitation in the prophylaxis of
disease and in the prevention of contagion in the modern time, the more
have we come to appreciate highly the teachings of these old times on
such subjects. Moses made a masterly exposition of the knowledge
necessary to prevent contagious disease when he laid down the rules with
regard to leprosy, first as to careful differentiation, then as to
isolation, and finally as to disinfection after it had come to be sure
that cure had taken place. The great lawgiver could insist emphatically
that the keeping of the laws of God not only was good for a man's soul
but also for his body."
With this tradition familiarly known and deeply studied by the mass of
the Hebrew people, it is no surprise to find that when the next great
Hebrew development of religious writing came in the Talmud during the
earlier Middle Ages, that also contains much with regard to medicine,
not a little of which is so close to absolute truth as never to be out
of date. Friedenwald, in his "Jewish Physicians and the Contributions of
the Jews to the Science of Medicine," a lecture delivered before the
Gratz College of Philadelphia fifteen years ago, summed up from Baas'
"History of Medicine" the instructions in the Talmud with regard to
health and disease. The summary represents so much more of genuine
knowledge of medicine and surgery than might be expected at the early
period at which it was written, during the first and second century of
our era, that it seems well to quote it at some length.
"Fever was regarded as nature's effort to expel morbific
matter and restore health; which is a much safer
interpretation of fever, from a practical point of view, than
most of the theories bearing on this point that have been
taught up to a very recent period. They attributed the halting
in the hind legs of a lamb to a callosity formed around the
spinal cord. This was a great advance in the knowledge of the
physiology of the nervous system. An emetic was recommended as
the best remedy for nausea. In many cases no better remedy is
known to-day. They taught that a sudden change in diet was
injurious, even if the quality brought by the change was
better. That milk fresh from the udder was the best. The
Talmud describes jaundice and correctly ascribes it to the
retention of bile, and speaks of dropsy as due to the
retention of urine. It teaches that atrophy or rupture of the
kidneys is fatal. Induration of the lungs (tuberculosis) was
regarded as incurable. Suppuration of the spinal cord had an
early, grave meaning. Rabies was known. The following is a
description given of the dog's condition: 'His mouth is open,
the saliva issues from his mouth; his ears drop; his tail
hangs between his legs; he runs sideways, and the dogs bark at
him; others say that he barks himself, and that his voice is
very weak. No man has appeared who could say that he has seen
a man live who was bitten by a mad dog.' The description is
good, and this prognosis as to hydrophobia in man has remained
unaltered till in our day when Pasteur published his startling
revelation. The anatomical knowledge of the Talmudists was
derived chiefly from dissection of the animals. As a very
remarkable piece of practical anatomy for its very early date
is the procuring of the skeleton from the body of a
prostitute by the process of boiling, by Rabbi Ishmael, a
physician, at the close of the first century. He gives the
number of bones as 252 instead of 232. The Talmudists knew the
origin of the spinal cord at the foramen magnum and its form
of termination; they described the oesophagus as being
composed of two coats; they speak of the pleura as the double
covering of the lungs; and mention the special coat of fat
about the kidneys. They had made progress in obstetrics;
described monstrosities and congenital deformities; practised
version, evisceration, and Cæsarian section upon the dead and
upon the living mother. A.H. Israels has clearly shown in his
'Dissertatio Historico-Medica Inauguralis' that Cæsarian
section, according to the Talmud, was performed among the Jews
with safety to mother and child. The surgery of the Talmud
includes a knowledge of dislocation of the thigh bone,
contusions of the skull, perforation of the lungs,
oesophagus, stomach, small intestines, and gall bladder;
wounds of the spinal cord, windpipe, of fractures of the ribs,
etc. They described imperforate anus and how it was to be
relieved by operation. Chanina Ben Chania inserted natural and
wooden teeth as early as the second century, C.E."
There is a famous summing up of the possibilities of life and happiness
in the Talmud that has been often quoted--its possible wanting in
gallantry being set down to the times in which it was written. "Life is
compatible with any disease, provided the bowels remain open; any kind
of pain, provided the heart remain unaffected; any kind of uneasiness,
provided the head is not attacked; all manner of evils, except it be a
bad woman."
There are many other interesting suggestions in the Talmud. Sometimes
they have come to be generally accepted in the modern time, sometimes
they are only curious notions that have not, however, lost all their
interest. The crucial incision for carbuncle is a typical example of the
first class and the suggestion of the removal of superfluous fat from
within the abdomen or in the abdominal wall itself by operation is
another. That they had some idea of the danger of sepsis may be gathered
from the fact that they suspected iron surgical instruments and advised
the use of others of less enduring character.
The Talmud itself was indeed a sort of encyclopedia in which was
gathered knowledge of all kinds from many sources. It was not
particularly a book of medicine, though it contains so many medical
ideas. In many parts of it the authors' regard for science is
emphatically expressed. Landau, in his "History of Jewish Physicians,"
closes his account of the Talmud with this paragraph:
"I conclude this brief review of Talmudic medicine with some
reference to how high the worth of science was valued in this
much misunderstood work. In one place we have the expression
'occupation with science means more than sacrifice.' In
another 'science is more than priesthood and kingly
dignity.'"[4]
After all this of national tradition in medicine before and after
Christ, it is only what we might quite naturally expect to find, that
there is scarcely a century of the Middle Ages which does not contain at
least one great Jewish physician and sometimes there are more. Many of
these men made distinct contributions to medical science and their names
have been held in high estimation ever since. Perhaps I should say that
they were held in high estimation until that neglect of historical
studies which characterized the eighteenth century developed, and that
there has been a reawakening of interest in our time. We forget this
curious decadence of the later seventeenth and eighteenth centuries
which did so much to obscure history and especially the history of the
sciences. Fortunately the scholars of the sixteenth and early
seventeenth centuries accomplished successfully the task of printing
many of the books of these old-time physicians and secured their
publication in magnificent editions. These were bought eagerly by
scholars and libraries all over Europe in spite of the high price they
commanded in that era of slow, laborious printing. The Renaissance
exhibits some of its most admirable qualities in its reverence for these
old workers in science and above all for the careful preparation by its
scholars of the text of these first editions of old-time physicians. The
works have often been thus literally preserved for us, for some of them
at least would have disappeared among the vicissitudes of the
intervening time, most of which was anything but favorable to the
preservation of old-time works, no matter what their content or value.
During the second and third centuries of our era, while the Talmudic
writings were taking shape, three great Jewish physicians came into
prominence. The first of them, Chanina, was a contemporary of Galen.
According to tradition, as we have said, he inserted both natural and
artificial teeth before the close of the second century. The two others
were Rab or Raw and Samuel. Rab has the distinction of having studied
his anatomy from the human body. According to tradition he did not
hesitate to spend large sums of money in order to procure subjects for
dissection. At this time it is very doubtful whether Galen, though only
of the preceding generation, ever had the opportunity to study more than
animals or, at most, a few human bodies. Samuel, the third of the group,
was an intimate friend of Rab's, perhaps a disciple, and his fame
depends rather on his practice of medicine than of research in medical
science. He was noted for his practical development of two specialties
that cannot but seem to us rather distant from each other. His
reputation as a skilful obstetrician was only surpassed by the
estimation in which he was held as an oculist. He seems to have turned
to astronomy as a hobby, and was highly honored for his knowledge of
this science. Probably there is nothing commoner in the story of great
Jewish physicians than their successful pursuit of some scientific
subject as a hobby and reaching distinction in it. Their surplus
intellectual energy needed an outlet besides their vocation, and they
got a rest by turning to some other interest, often accomplishing
excellent results in it. Like most great students with a hobby, the
majority of them were long-lived. Their lives are a lesson to a
generation that fears intellectual overwork.
During the fourth century we have a number of very interesting
traditions with regard to a great Jewish physician, Abba Oumna, to whom
patients flocked from all over the world. He seems particularly to have
been anxious to make his services available to the scholars of his time.
He looked upon them as brothers in spirit, fellow-laborers whose
investigations were as important as his own and whose labors for mankind
he hoped to extend by the helpfulness of his profession. In order that
it might be easy for them to come to him without feeling abashed by
their poverty, and yet so that they might pay him anything that they
thought they were able to, he hung up a box in his anteroom in which
each patient might deposit whatever he felt able to give. His kindliness
towards men became the foundation for many legends. Needless to say he
was often imposed upon, but that seems to have made no difference to
him, and he went on straightforwardly doing what he thought he ought to
do, regardless of the devious ways of men, even those whom he was
generously assisting. While we do not know much of his scientific
medicine, we do know that he was a fine example of a practitioner of
medicine on the highest professional lines.
With the foundation of the school at Djondisabour in Arabistan or
Khusistan by the Persian monarch Chosroes, some Jewish physicians come
into prominence as teachers, and this is one of the first important
occasions in history when they teach side by side with Christian
colleagues. Djondisabour seems distant from us now, lying as it does in
the province just above the head of the Persian Gulf, and it is a little
hard to understand its becoming a centre of culture and education, yet
according to well-grounded historical traditions students flocked here
from all parts of the world, and its medical instruction particularly
became famous. According to the documents and traditions that we
possess, clinical teaching was the most significant feature of the
school work and made it famous. As a consequence graduates from here
were deemed fully qualified to become professors in other institutions
and were eagerly sought by various medical schools in the East.
With the rise of the strong political power of the Mohammedans enough of
peace came to the East at least to permit the cultivation of arts and
sciences to some extent again, and then at once the eminence of Jewish
physicians, both as teachers and practitioners of medicine, once more
becomes manifest. The first of the race who comes into prominence is
Maser Djawah Ebn Djeldjal, of Basra. To him we owe probably more than to
anyone else the preservation of old scientific writings and the
cultivation of arts and sciences by the Mohammedans. He prevailed on
Caliph Moawia I, whose physician he had become, to cause many foreign
works, and especially those written in Greek, to be translated into
Arabic. He seems to have taken a large share of the labor of the
translation on himself and prevailed upon his pupil, the son of Moawia,
to translate some works on chemistry. The translation for which Maser
Djawah is best known is that of the Pandects of Haroun, a physician of
Alexandria. The translation of this work was made toward the end of the
seventh century. Unfortunately the "Pandects" has not come down to us,
either in original or translation, but we have fragments of the
translation preserved by Rhazes, the distinguished Arabian medical
writer and physician of the ninth century, and there seems no doubt that
it contained the first good description of smallpox, a chapter in
medicine that is often--though incorrectly--attributed to Rhazes
himself. Rhazes quoted Maser Djawah freely and evidently trusted his
declarations implicitly.
The succeeding Caliphs of the first Arabian dynasty did not exhibit the
same interest in education, and above all in science, that characterized
Moawia. Political ambition and the desire for military glory seem to
have filled up their thoughts and perhaps they had not the good fortune
to fall under the influence of physicians so wise and learned as Maser
Djawah. More probably, however, they themselves lacked interest. Toward
the end of the seventh century they were succeeded by the Abbassides.
Almansor, the second Caliph of this dynasty, was attacked by a dangerous
disease and sent for a physician of the Nestorian school. After his
restoration to health he became a liberal patron of science and
especially medical science. The new city of Bagdad, which had become the
capital of the realm of the Abbassides, was enriched by him with a large
number of works on medicine, which he caused to be translated from the
Greek. He did not confine himself to medicine, however, but also brought
about translations of works with regard to other sciences. One of these,
astronomy, was a favorite. He made it a particular point to search out
and encourage the translation of such books as had not previously been
translated from Greek into Arabic. While he provided a translation of
Ptolemy he also had translations made of Aristotle and Galen.
It is not surprising, then, that the school of Bagdad became celebrated.
Jewish physicians seem to have been most prominent in its foundation,
and the most distinguished product of it is Isaac Ben Emran, almost as
celebrated as a philosopher as he is as a physician. One of his
expressions with regard to the danger of a patient having two physicians
whose opinions disagree with regard to his illness has been deservedly
preserved for us. Zeid, an Emir of one of the chief cities of the Arabs
in Barbary, fell ill of a tertian fever and called Isaac and another
physician in consultation. Their opinions were so widely in disaccord
that Isaac refused to prescribe anything, and when the Emir, who had
great confidence in him, demanded the reason, he replied, "disagreement
of two physicians is more deadly than a tertian fever." This Isaac, who
is said to have died in 799, is the great Jewish physician, one of the
most important members of the profession in the eighth century. His
principal work was with regard to poisons and the symptoms caused by
them. This is often quoted by medical writers in the after time.
The prominent Jewish physician of the ninth century was Joshua Ben Nun.
Haroun al-Raschid, whose attempts to secure justice for his people are
the subject of so much legendary lore, and whose place in history may be
best recalled by the fact that he is a contemporary of Charlemagne, was
particularly interested in medicine. He founded the city of Tauris as a
memorial of the cure of his wife. He was a generous patron of the school
of Djondisabour and established a medical school also at Bagdad. He
provided good salaries for the professors, insisted on careful
examinations, and raised the standard of medical education for a time to
a noteworthy degree. The greatest teacher of this school at Bagdad was
Joshua Ben Nun, sometimes known as the Rabbi of Seleucia. His teaching
attracted many students to Bagdad and his fame as one of the great
practitioners of medicine of this time brought many patients. Among his
disciples was John Masuée, whose Arabian name is so different, Yahia Ben
Masoviah, that in order to avoid confusion in reading it is important to
know both. Almost better known, perhaps, at this time was Abu Joseph
Jacob Ben Isaac Kendi. Fortunately for the after time, these men devoted
themselves not only to their own observations and writings but made a
series of valuable translations. Joshua Ben Nun seems to have been
particularly zealous in this matter, following the example of Maser
Djawah of Basra.
Bagdad then became a centre for Arabian culture. Mahmoud, one of
Haroun's successors, provided in Bagdad a refuge for the learned men of
the East who were disturbed by the wars and troubles of the time. He
became a liberal patron of literature and education. When the Emperor
Michael III of Constantinople was conquered in battle, one of the
obligations imposed upon him was to send many camel loads of books to
Bagdad, and Aristotle and Plato were studied devotedly and translated
into Arabic. The era of culture affected not only the capital but all
the cities, and everywhere throughout the Arabian empire schools and
academies sprang up. We have records of them at Basra, Samarcand,
Ispahan. From here the thirst for education spread to the other cities
ruled by the Mohammedans, and each town became affected by it.
Alexandria, the cities of the Barbary States, those of Sicily and
Provence, where Moorish influences were prominent, and of distant Spain,
Cordova, Seville, Toledo, Granada, Saragossa, all took up the rivalry
for culture which made this a glorious period in the history of the
intellectual life.
Already, in the chapter on "Great Physicians in Early Christian Times,"
I have pointed out that many of the teachers of the Arabs were Christian
physicians. Here it is proper to emphasize the other important factor in
Arabian medicine, the Jewish physicians, who influenced the great
Arabian rulers, and were the teachers of the Arabs in medicine and
science generally. These Christian and Jewish physicians particularly
encouraged the translation of the works of the great Greek physicians
and thus kept the Greek medical tradition from dying out. It is not
until the end of the ninth, or even the beginning of the tenth, century
that we begin to have important contributors to medicine from among the
Arabs themselves. Even at this time they have distinguished rivals among
Jewish physicians. Indeed these acquired such a reputation that they
became the physicians to monarchs and even high ecclesiastics, and we
find them nearly everywhere throughout Europe. Their success was so
great that it is not surprising that after a time the vogue of the
Jewish physicians should have led to jealousy of them and to the passage
of laws and decrees limiting their sphere of activity.
The great Jewish physician of the ninth century was Isaac Ben Soliman,
better known as Isaac el Israili, and who is sometimes spoken of as
d'Israeli. He was a pupil of Isaac Ben Amram the younger, probably a
grandson of another Isaac Ben Amram, who, after having become famous in
Bagdad, went to Cairo and became the physician of the Emir Zijadeth III.
The younger Isaac established a school, and it was with him that Israeli
obtained his introduction to medicine. He practised first as an oculist
and then became body-physician to the Sultan of Morocco. Because of the
sympathy of his character and his unselfishness he acquired great
popularity. Hyrtl refers to him respectfully as "that scholarly son of
Israel." Curiously enough, considering racial feeling in the matter, he
never married, and when asked why he had not, and whether he did not
think that he might regret it, he replied, "I have written four books
through which my memory will be better preserved than it would be by
descendants." The four books are his "Treatise on Fevers," his "Treatise
on Simple Medicines and Ailments," a treatise on the "Elements," and a
treatise "On the Urine." Besides these, we have from him shorter works,
"On the Pulse," "On Melancholy," and "On Dropsy." His hope with regard
to his fame from these works was fulfilled, for they were printed as
late as 1515 at Leyden, and Sprengel declared them the best compendium
of simple remedies and diet that we have from the Arabian times. One of
his translators into Latin has called him the monarch of physicians.
Some of his maxims are extremely interesting in the light of modern
notions on the same subjects. He declared emphatically that "the most
important duty of the physician is to prevent illness." "Most patients
get better without much help from the physician by the power of nature."
He emphasized his distrust of using many medicines at the same time in
the hope that some of them would do good. He laid it down as a rule:
"Employ only one medicine at a time in all your cases and note its
effects carefully." He was as wise with regard to medical ethics as
therapeutics. He advised a young physician, "Never speak unfavorably of
other physicians. Every one of us has his lucky and unlucky hours." It
is pleasant to learn that the old gentleman lived to fill out a full
hundred years of life, and that in his declining years he was
surrounded by the good will and the affection of many who had learned to
know his precious qualities of heart and mind. More than of any other
class of physicians do we find the large human sympathies of the Jewish
physicians of the Middle Ages praised by their contemporaries and
succeeding generations.
During the next centuries a number of Jewish physicians became
prominent, though none of them until Maimonides impressed themselves
deeply upon the medical life of their own and succeeding centuries. Very
frequently they were the physicians to royal personages. Zedkias, for
instance, was the physician to Louis the Pious and later to his son
Charles the Bald. His reputation as a physician was great enough to give
him the popular estimation of a magician, but it did not save him from
the accusation of having poisoned Charles when that monarch died
suddenly. There seem to be no good grounds, however, for the accusation.
There were a number of schools of medicine, in Sicily and the southern
part of Italy, in which Jewish, Arabian, and Christian physicians taught
side by side. One of these teachers was Jude Sabatai Ben Abraham,
usually known by the name of Donolo, who was famous both as a writer on
medicine and on astronomy. Donolo studied and probably taught at
Tarentum, and there were similar schools at Palermo, at Bari, and then
later on the mainland at Salerno. The foundation of Salerno, in which
Jewish physicians also took part, we shall discuss later in the special
chapter devoted to that subject.
One of the great translators whose work meant very much for the medical
science of his own and succeeding generations was the distinguished
Jewish physician, Faradj Ben Salim, sometimes spoken of as Farachi
Faragut or Ferrarius, who was born at Girgenti in Sicily. He made his
medical studies in Salerno and did his work under the patronage of
Charles of Anjou towards the end of the thirteenth century. His greatest
work is the translation of the whole of the "Continens" of Rhazes. The
translation is praised as probably the best of its time made in the
Middle Ages. Faradj came at the end of a great century, when the
intellectual life of Europe had reached a high power of expression, and
it is not surprising that he should have proved equal to his
environment. This translation has also some additions made by Faradj
himself, notably a glossary of Arabian names.
In Spain also Jewish physicians rose to distinction. The most
distinguished in the tenth century was Chasdai Ben Schaprut. Like many
other of the great physicians of this time, he had studied astronomy as
well as the medical sciences. He became the physician of the Caliph
Abd-er-Rahman III of Cordova. He seems also to have exercised some of
the functions of Prime Minister to the Caliph, and took advantage of
diplomatic relations between his sovereign and the Byzantine Emperor to
obtain some works of Dioscorides. These he translated into Arabian with
the help of a Greek monk, whom he seems also to have secured through the
diplomatic relations. Undoubtedly he did much to usher in that
enthusiasm for education and study which characterized the next
centuries, the eleventh and twelfth, at Cordova in Spain, when such men
as Avenzoar, Avicenna, and Averroës attracted the attention of the
educational world of the time. Jewish writers have sometimes claimed one
of the most distinguished of these, Avenzoar himself, as a Jew, but
Hyrtl and other good authorities consider him of Arabic extraction and
point to the fact that his ancestors bore the name of Mohammed. This is
not absolutely conclusive evidence, but because of it I have preferred
to class Avenzoar among the Arabian physicians.
The one historical fact of importance for us is that everywhere in
Europe at that time Jews were being accorded opportunities for the study
and practice of medicine. There are local incidents of persecution, but
we are not so far away from the feelings that brought these about as to
misunderstand them or to think that they were anything more than local,
popular manifestations. The more we know about the details of the
medical history of these times the deeper is the impression of academic
freedom and of opportunities for liberal education.
Much has been said about the intolerance of ecclesiastical authorities
toward the Jews, and of Church decrees that either absolutely forbade
their practice of the medical profession and their devotion to
scientific study, or at least made these pursuits much more difficult
for them than for others. Of course it has to be conceded, even by those
who most insistently urge the existence of formal legislation in the
matter, that in spite of these decrees and intolerance and opposition,
Jews continued to practise medicine and to be the chosen physicians of
kings and even of high ecclesiastical dignitaries, as well indeed of
the Popes themselves. This, it is usually declared, must be attributed
to the surpassing skill of the Jewish physicians, causing men to
overcome their prejudices and override even their own legal regulations.
There is no doubt at all about the skill of Jewish physicians at many
times during the Middle Ages. There is no doubt also of the sentiment of
opposition that often developed between the Christian peoples and the
Jews. Any excuse is good enough to justify men, to themselves at least,
in putting obstacles in the paths of those who are more successful than
they are themselves. Religion often became a cloak for ill-will and
persecution.
The state of affairs that has been presumed however, according to which
laws and decrees were being constantly issued forbidding the practice of
medicine to Jews by the ecclesiastical authorities, while at the same
time they themselves and those who were nearest to them were employing
Jewish physicians, is an absurdity that on the face of it calls for
investigation of the conditions and from its very appearance would
indicate that the ordinary historical assumption in the matter must be
wrong.
I have been at some pains, then, to try to find out just what were the
conditions in Europe with regard to the practice of medicine by the
Jews. There is no doubt that at Salerno, where the influence of the
Benedictines was very strong and where the influence of the Popes and
the ecclesiastical authorities was always dominant, full liberty of
studying and teaching was from the earliest days allowed to the Jews.
Down at Montpellier it seems clear that Jewish physicians had a large
part in the foundation of the medical school, and continued for several
centuries to be most important factors in the maintenance of its
reputation and the upbuilding of that fame which draw students from even
distant parts of Europe to this medical school of the south of France.
During the ninth, tenth, eleventh, and twelfth centuries Jewish
physicians were frequently in attendance on kings and the higher
nobility, on bishops and archbishops, cardinals, and even Popes. Every
now and then the spirit of intolerance among the populace was aroused,
and occasionally the death of some distinguished patient while in a
Jewish physician's hands was made the occasion for persecution. We must
not forget, after all, that even as late as Elizabeth's time, when
Shakespeare wrote "The Merchant of Venice," he was taking advantage of
the popular sentiment aroused by the execution of Lopez, the Queen's
physician, for a real or supposed participation in a plot against her
Majesty's life. Shylock was presented the next season for the sake of
adventitious popularity that would thus accrue to the piece. The
character was played so as to depict all the worst traits of the Jew,
and was scornfully laughed at at every representation. This is an index
of the popular feeling of the time. Bitter intolerance of the Jew has
continued. Down almost to our own time the Ghettos have existed in
Europe, and popular tumults against them continue to occur. Quite
needless to say, these do not depend on Christianity, but on defective
human nature.
During the Middle Ages the best possible criterion of the attitude of
the Church authorities towards the Jews is to be found in the
legislation of Pope Innocent III. He is the greatest of the Popes of the
Middle Ages; he shaped the policy of the Church more than any other; his
influence was felt for many generations after his own time. His famous
edict with regard to them was well known: "Let no Christian by violence
compel them to come dissenting or unwilling to Baptism. Further, let no
Christian venture maliciously to harm their persons without a judgment
of the civil power or to carry off their property or change their good
customs which they have hitherto in that district which they inhabit."
Innocent himself and several of his predecessors and successors are
known to have had Jewish physicians. Example speaks even louder than
precept, and the example of such men must have been a wonderful
advertisement for the Jewish physicians of the time.
Besides Innocent III, many of the Popes of the twelfth and thirteenth
centuries issued similar decrees as to the Jews. It may be recalled that
this was the time when the Papacy was most powerful in Europe and when
its decrees had most weight in all countries. Alexander II, Gregory IX,
and Innocent IV all issued formal documents demanding the protection of
the Jews, and especially insisting that they must not be forced to
receive Baptism nor disturbed in the celebration of their festivals.
Clement VI did the same thing in the next century, and even offered them
a refuge from persecution throughout the rest of France at Avignon.
Distinguished Jewish scholars, who know the whole story from careful
study, have given due credit to the Popes for all that they did for
their people. They have even declared that if the Jews were not
exterminated in many of the European countries it was because of the
protection afforded by the Church. We have come to realize in recent
years that persecution of the Jews is not at all a religious matter, but
is due to racial prejudice and jealousy of their success by the peoples
among whom they settle. All sorts of pretexts are given for this
persecution at all times. Formal Church documents and the personal
activities of the responsible Church officials show that during the
Middle Ages the Church was a protector and not a persecutor of the Jews.
There is abundant historical authority for the statement that the Popes
were uniformly beneficent in their treatment of the Jews. In order to
demonstrate this there is no need to quote Catholic historians, for
non-Catholics have been rather emphatic in bringing it out. Neander, the
German Protestant historian, for instance, said:
"It was a ruling principle with the Popes after the example of
their great predecessor, Gregory the Great, to protect the
Jews in the rights which had been conceded to them. When the
banished Popes of the twelfth century returned to Rome, the
Jews went forth in their holiday garments to meet them,
bearing before them the 'thora,' and Innocent II, on an
occasion of this sort, blessed them."
English non-Catholic historians can be quoted to the same effect. The
Anglican Dean Milman, for instance, said: "Of all European sovereigns,
the Popes, with some exceptions, have pursued the most humane policy
towards the Jews. In Italy, and even in Rome, they have been more rarely
molested than in the other countries."
Hallam has expressed himself to the same effect, especially as regards
the protection afforded to the Jew by the laws of the Church from the
injustice of those around him. Laws sometimes fail of their purpose and
the persecuting spirit of the populace is often hard to control, but
everything that the central authority could do to afford protection was
done and essential justice was enshrined in the Church laws.
Prominent ecclesiastics would naturally follow the lines laid down by
their Papal superiors. The attitude of those whose lives mark epochs in
the history of Christianity and who had more to do almost with the
shaping of the policy of the Church at many times than the Popes
themselves, can be quoted readily to this same effect. Neander has
called particular attention to St. Bernard's declarations with regard to
the evils that would follow any tolerance of such an abuse as the
persecution of the Jews.
"The most influential men of the Church protested against such
un-Christian fanaticism. When the Abbot Bernard of Clairvaux
was rousing up the spirit of the nations to embark in the
second crusade, and issued for this purpose, in the year 1146,
his letters to the Germans (East Franks), he at the same time
warned them against the influence of those enthusiasts who
strove to inflame the fanaticism of the people. He declaimed
against the false zeal, without knowledge, which impelled them
to murder the Jews, a people who ought to be allowed to live
in peace in the country."
But it has been said that there are decrees against Jewish physicians,
issued especially in the south of France, by various councils and
synods of the Church. Attention needs to be called at once to the fact
that these are entirely local regulations and have nothing to do with
the attitude of the Church as a whole, but represent what the
ecclesiastical authorities of a particular part of the country deem
necessary for some special reason in order to meet local conditions.
Indeed at the end of the thirteenth and the early fourteenth century,
when these decrees were being issued in France, full liberty was allowed
in Italy, and there were no restrictions either as to medical practice
or education founded on adhesion to Judaism.
What need to be realized in order to understand the issuance of certain
local ecclesiastical regulations forbidding Jews to practise medicine
are the special conditions which developed in France at this time. Many
Jews had emigrated from Spain to France, and the reputation acquired by
Jewish physicians at Montpellier led to a number of the race taking up
the practice of medicine without any further qualification than the fact
that they were Jews. That gave them a reputation for curative powers of
itself because of the fame of some Jewish doctors and their employment
by the nobility and the highest ecclesiastics. It was hard to regulate
these wandering physicians. As a consequence of this, the faculty at
Paris, always jealous of its own rights and those of its students, at
the beginning of the fourteenth century absolutely forbade Jews from
practising on Christian patients within its jurisdiction. Of course the
faculty of the University of Paris was dominated by ecclesiastical
authorities. The medical school was, however, almost entirely
independent of ecclesiastical influence, and was besides largely
responsible for this decree. It was felt that something had to be done
to stop the evil that had arisen and the charlatanry and quackery which
was being practised. This was, however, rather an attempt to regulate
the practice of medicine and keep it in the hands of medical school
graduates than an example of intolerance towards the Jews. Practically
no Jews had graduated at its university, Montpellier being their
favorite school, and Paris was not a little jealous of its rights to
provide for physicians from the northern part of France. We have not got
away from manifestations of that spirit even yet, as our
non-reciprocating state medical laws show.
During the next quarter of a century decrees not unlike those of the
University of Paris were issued in the south of France, especially in
Provence and Avignon. Anyone who knows the conditions which existed in
the south of France at this time with regard to medical practice will be
aware that a number of attempts were made by the ecclesiastical
authorities just at this time to regulate the practice of medicine.
Great abuses had crept in. Almost anyone who wished could set up as a
physician, and those who were least fitted were often best able to
secure a large number of patients by their cleverness, their knowledge
of men, and their smooth tongues. The bishops of various dioceses met,
and issued decrees forbidding anyone from practising medicine unless he
was a graduate of the medical school of the neighboring University of
Montpellier. After a time it was found that the greatest number of
violators of these decrees were Jews. Accordingly special regulations
were made against them. They happen to be ecclesiastical regulations,
because no other authority at that time claimed the right to regulate
medical education and the practice of medicine.
What is sure is that many Jewish physicians reached distinction under
Christian as well as Arabian rulers at all times during the Middle Ages.
It would be quite impossible in the limited space at command here to
give any adequate mention of what was accomplished by these Jewish
physicians, whose names we have scarcely been able to more than
catalogue, nor of the place they hold in their times. As the physicians
of rulers, their influence for culture and the cultivation of science
was extensive, and as a rule they stood for what was best and highest in
education. The story of one of them, who is generally known in the
Christian world at least, Maimonides, given in some detail, may serve as
a type of these Jewish physicians of the Middle Ages. He lived just
before the flourishing period of university life in the thirteenth
century brought about that wonderful development of medicine and surgery
in the west of Europe that meant so much for the final centuries of the
Middle Ages. His works influenced not a little the great thinkers and
teachers whose own writings were to be the foundations of education for
several centuries after their time. Maimonides was well known in the
Western universities. Though his life had been mainly spent in the East,
and he died there, there was scarcely a distinguished scholar of Europe
who was not acquainted directly or indirectly with his works, and the
greater the reputation of the scholar, as a rule, the more he knew of
Maimonides, Moses Ægyptæus, as he was called, and the more frequently he
referred to his writings.
IV
MAIMONIDES
The life of one of the great Jewish physicians, who has come to be known
in history as Maimonides, is of such significance in medical biography
that he deserves to have a separate sketch. Born in Spain, his life was
lived in the East, where his connection as royal physician with the
great Sultan Saladin of Crusades fame made his influence widely felt. He
is a type of the broadly educated man, conversant with the culture of
his time and of the past, knowing much besides medicine, who has so
often impressed himself deeply on medical practice. While the narrow
specialists in each generation, the men who are quite sure that they are
curing the special ills of men to which they devote themselves, have
always felt that whatever of progress there was in any given time was
due to them, they occupy but little space as a rule in the history of
medicine. The men who loom large were the broad-minded, humanely
sympathetic, deeply educated physicians, who treated men and their ills
rather than their ills without due consideration of the individual, and
who not only relieved the discomfort of their patients and greatly
lessened human suffering, and added to the sum of human happiness in
their time, but also left precious deeply significant lessons for
succeeding generations of their profession. Hippocrates, Galen,
Sydenham, Auenbrugger, Morgagni, these are representatives of this great
class, and Maimonides must be considered one of them.
Moses Ben Maimum, whose Arabic name was Abu Amran Musa Ben Maimum Obaid
Alla el-Cordovi, who was called by his Jewish compatriots Ramban or
Rambam, was born at Cordova in Spain, on the 30th of March in 1135 or
1139, the year is in doubt. It might not seem of much import now after
nearly eight centuries, but not a little ink is spilt over it yet by
devoted biographers.
We are rather prone to think in our time that the conditions in which
men were born and reared before what we are pleased to call modern
times, and, above all, in the Middle Ages, must have made a distinct
handicap for their intellectual development. Most of us are quite sure
that the conditions in medieval cities were eminently unsuited for the
stimulation of the intellect, for incentive to art impulse, for uplift
in the intellectual life, or for any such broad interest in what has
been so well called the humanities--the humanizing things that lift us
above animal necessities--as would make for genuinely liberal education.
We are likely to be set in the opinion that the environment of the
growing youth of an old-time city, especially so early as the middle of
the twelfth century, was poor and sordid. The cares of the citizens are
presumed to have been mainly for material concerns, and, indeed, mostly
for the wants of the body. They were only making a start on the way from
barbarism to something like our glorious culmination of civilization. As
"the heirs to all the ages in the foremost files of time" we are
necessarily far in advance of them, and we are only sorry that they did
not have the opportunity to live to see our day and enjoy the benefits
of the evolution of humanity that is taking place during the eight
centuries that have elapsed.
As a matter of fact, there was much more of abiding profound interest in
real civilization in many a medieval city, much more general
appreciation of art, much more breadth of intelligence and sympathy with
what we call the humanities, than in most of our large cities. The large
city, as we know it, is eminently a discourager of breadth of
intelligence. Specialism in the various phases of money-making obscures
culture. Maimonides, born in Cordova, was brought up amid surroundings
that teemed with incentives of every kind to the development of
intelligence, of artistic taste, and everything that makes for
cultivation of intellect rather than of interest in merely material
things.
It is well said that it is hard to judge the Cordova of old by its
tawdry ruins of to-day. The educated visitor still stands in awe and
admiration of the great mosque which expressed the high cultivation of
the Moors of this time. It is a never-ending source of wonder to
Americans. The city itself has many reminders of that fine era of
Moorish culture and refinement of taste and of art expression, which
made it in the best sense of the word a city beautiful. The Arab
invaders had found a great prosperous country which had been the most
cultured province of the Roman Empire, and on this foundation they made
a marvellous development. "The banks of the Guadalquivir," says Mr. S.
Lane-Poole in "The Moors in Spain" (London, 1887), "were bright with
marble houses, mosques, and gardens, in which the rarest flowers and
trees of other countries were carefully cultivated, and the Arabs
introduced their system of irrigation which the Spaniards both before
and since have never equalled." The greatest beauty of the city, of
course, had come, and some of it had gone, before Maimonides' time. So
much remains in spite of time and war, and many unfortunate influences,
that we can have some idea how beautiful it must have been in his youth
seven centuries ago, and how even more beautiful in the foretime. Of the
great mosque writers of travel can scarcely say enough. Mr. Lane-Poole
says: "Travellers stand amazed among the forest of columns which open
out apparently endless vistas on all sides. The porphyry, jasper, and
marbles are still in their places; the splendid glass mosaics, which
artists from Byzantium came to make, still sparkle like jewels in the
walls; the daring architecture of the sanctuary, with its fantastic
crossed arches, is still as imposing as ever; the courtyard is still
leafy with the orange trees that prolong the vistas of columns. As one
stands before the loveliness of the great mosque, the thought goes back
to the days of the glories of Cordova, the palmy days of the Great
Khalif, which will never return."
Of all the countries in which the Jews all down the centuries have lived
there is probably none of which they have been more loud in praise than
Spain. Their poets sang of it as if it were their own country; for
centuries the people were happier here than probably they have been
anywhere else for so long a period. Elsewhere in this book I have called
attention to all that Spain meant in Europe during all the centuries
from the beginning of the Roman Empire down to the end of the Middle
Ages. Maimonides was fortunate in his birthplace, then, and while
circumstances compelled the family to move away, this change did not
come until a good effect had been produced on the mind of the growing
youth. Even when persecution came, Maimonides clung to Spain with a
tenacity born of deep affection and emphasized by admiration for all
that she was and had been. Cordova was the jewel of the Spain of this
time, and though much less than she had been in the long preceding time,
when she was the birthplace of Lucan and the two Senecas, or even than
what she had been in Abd-er-Rahman's days, or when she was the
birthplace of Averroës, still she remained wonderfully beautiful and
attractive, winning and holding the affections of men.
Maimonides' father, Maimum Ben Joseph, was a member of the Rabbinical
College of Cordova, and famous for his knowledge of the Talmud. There
are some writings of his on mathematics and astronomy extant. He
directed the education of his son, who, like many another distinguished
scholar in later life, seems to have exhibited very little talent in his
early years. There is no rule in the matter. Precocity often
disappoints. Genius is often dull in childhood, but there are exceptions
that prove both rules. The basis of education in Spain at that time
among the Jews was the Bible, the Talmud, mathematics, and astronomy, a
good rounded education in literature, the basis of law, and some exact
physical science. After his preliminary education at home Maimonides
studied the natural sciences and medicine with Moorish teachers.
Nature-study, in spite of frequent expressions that declare it new in
modern times, is as old as man. He also received a grounding in
philosophy as a preparation for his scientific studies. At the age of
twenty-three he began the composition of a commentary on the Talmud,
which he continued to work at on his journeys in Spain and in Egypt.
This is considered to be one of the most important of this class of
works extant, though, almost needless to say, similar writings are very
numerous.
In the light of wanderings in philosophy during the centuries since, it
is rather interesting to quote from that work the end of man as this
Jewish philosopher of the middle of the twelfth century saw it. Recent
teleological tendencies in biology add to the interest of his views.
According to Maimonides, "Man is the end of the whole creation, and we
have only to look to him for the reason for its existence. Every object
shows the end for which it was created. The palm-trees are there to
provide dates; the spider to spin her webs. All the properties of an
animal or a plant are directed so as to enable it to reach its purpose
in life. What is the purpose of man? It cannot lie alone in eating and
drinking or yielding to passion, nor in the building of cities and the
ruling of others, since these objects lie outside of him, and do not
touch his essential being. Such material striving he has in common with
the animal. A man is lifted from a lower to a higher condition by his
reason. Only through his reason is he placed above the animals. He is
the only reasonable animal. His reason enables him to understand all
things, especially the Unity of God, and all knowledge and science serve
only to direct man to the knowledge of God. Passions are to be subdued,
since the man who yields to passion subjects his spirit to his body, and
does not reveal in himself the divine power which in him lies in his
reason, but is swallowed up in the ocean of matter."
Not long after Maimonides passed his twentieth year the family,
consisting of the father and his two sons, Moses and David, and a
daughter, moved from Cordova to Fez, compelled by Jewish persecutions.
Here it is said that they had to submit to wearing the mask of Islam in
order to lead a peaceful existence. This has been doubted, however, and
his whole life is in flagrant contradiction with any such even apparent
apostasy from the faith of his fathers. Father and son took advantage of
the opportunity of intercourse with Moorish physicians and philosophers
to increase their store of knowledge, but could not be content in the
political and religious conditions in which they were compelled to live.
About 1155, then, they went to Jerusalem, but found conditions even more
intolerable there, and turned back to Egypt, where they settled down in
Old Cairo. In 1166 the father died, and after this we learn that the
sons made a livelihood, and even laid the foundation of a fortune, by
carrying on a jewelry trade. Moses still devoted most of his time to
study, while his brother did most of the business, but the brother was
lost in the Indian Ocean, and with him went not only a large sum of his
own money, but also much that had been entrusted to him by others.
Maimonides undertook to pay off these debts and at the same time had to
meet the necessities not only of himself and sister, but also of the
family of his dead brother. It was then that he took up the practice of
medicine and succeeded in making a great name and reputation for
himself. He continued to write, however, and completed his commentary on
the Talmud.
About the age of fifty Maimonides, as seems to be true of a good many
men who live to old age, became rather discouraged and despondent about
himself. He refers to himself in his letters and writings rather
frequently as an old and ailing man. He had nearly twenty years of
active life ahead of him, but he had the persuasion that comes to many
that he was probably destined to an early death. His son was born
shortly after this time, and that seems to have had not a little to do
with brightening his life. While in Egypt Maimonides married the sister
of one of the royal secretaries, who, in turn, wedded Maimonides'
sister. Maimonides took on himself the education of his son, who also
became a physician, though his father was not to have the satisfaction
of watching his success in the practice of his chosen profession. This
son, Abraham, became the physician of Malie Alkamen, the brother of
Saladin, and, besides, was a physician to the hospital at Cairo. _His_
son, David, the grandson of Maimonides, practised medicine also at Cairo
till 1300. He in turn left two sons, Abraham and Solomon, who achieved
reputation in the chosen profession of their great-grandfather.
Maimonides, after the birth of his son, became one of the busiest of
practising physicians. Indeed, it is hard to understand how he had the
time to do any writing in his busy life. Still less can we understand
his time for teaching. He was the physician to Saladin, whose relations
with Richard Coeur de Lion have made him known to English-speaking
people. Every morning, as the Court physician, Maimonides went to the
palace, situated half a mile away from his dwelling, and if any of the
many officials and dependents that then, as now, were at Oriental
courts, were ill, he stayed there for some time. As a rule he could only
get back to his own home in the afternoon, and then he was, as he says
himself, "almost dying with hunger." Knowing the scantiness of the
Oriental breakfast, we are not surprised. There he found his
waiting-room full of patients, "Jews and Mohammedans, prominent and
unimportant, friends and enemies," he says himself, "a varied crowd, who
are looking for my medical advice. There is scarcely time for me to get
down from my carriage and wash myself and eat a little, and then until
night I am constantly occupied, so that, from sheer exhaustion, I must
lie down. Only on the Sabbath day have I the time to occupy myself with
my own people and my studies, and so the day is away from me." What a
picture it is of the busy medical teacher at all times in the world's
history, yet it must not be forgotten that it is from these busy men
that we have derived our most precious lessons in caring for patients
rather than disease, in the art of medicine rather than medical
science--and their practical lessons have been valuable long after the
fine-spun theories of the scientist that took so long to elaborate have
been placed definitely in the lumber room.
His reputation as a writer on medical topics is not as great as that
which has been accorded him for his writings on philosophy and in
Talmudic literature, but he well deserves a place among the great
practical masters of medicine, as well as high rank among the physicians
of his time. There is little that is original in his writing, but his
thoroughgoing common sense, his wide knowledge, and his discriminating,
eclectic faculty make his writings of special value. As might have been
expected, the Aphorisms of Hippocrates attracted his attention, and,
besides, he wrote a series of aphorisms of his own. The most interesting
of his writings, however, is a series of letters on dietetics written
for the son of his patron Saladin. The young prince seems to have
suffered from one of the neurotic conditions that so often develop in
those who have their lives all planned for them, and little incentive to
do things for themselves. The main portion of his complaints centred, as
in the case of many another individual of leisure, in disturbances of
digestion. Besides, he suffered from constipation and feelings of
depression. Doubtless, like many a young person of the modern time, he
was quite sure that these symptoms portended some insidious organic
ailment that would surely bring an early death. When fathers, having
done all that there is to do, just expect their sons to enjoy the
fruits of the paternal accomplishments, conditions of this kind very
often develop, unless the young man proceeds to occupy himself with even
more dangerous distractions than he finds in unending thought about his
own feelings.
The rules of life and health that Maimonides laid down in these letters
have become part of our popular medical tradition. Probably more of the
ordinarily current maxims as to health have been derived from them than
would possibly be suspected by anyone not familiar with them. In various
forms his rules have been published a number of times. A good idea of
them can be obtained from the following compendium of them, which I
abbreviate from a biographical sketch of Maimonides by Dr. Oppler, which
appeared in the "Deutsches Archiv für Geschichte der Medizin und
Medicinische Geographie" (Bd. 2, Leipzig, 1879).
1. Man is bound to lead a life pleasing to God if he wants to
have a healthy body, and he must hold himself far from
everything that can hurt his health and accustom himself to
whatever renews his strength. He should eat and drink only
when hungry and thirsty and should be particularly careful of
the regular evacuation of his bowels and of his bladder. He
must not delay either of these operations, but as far as
possible satisfy the inclination at once.
2. A man must not overload his stomach but be content always
with something less than is necessary to make him feel quite
satisfied. He should not drink much during the meal and only
of water and wine mixed, taking somewhat more after digestion
has begun and after digestion is completed, in moderation
according to his needs. Before a man sits down to table he
should note whether he has any tendency to evacuation and
should make the body warm by movement and activity. After this
exercise he should rest a little before taking food. It is
very beneficial after work to take a bath and then the meal.
3. Food should be taken always in the sitting position. There
should be no riding nor walking, nor movements of the body
until digestion is finished. The man who takes a walk or any
strenuous occupation immediately after eating subjects himself
to serious dangers of disease.
4. Day and night should be divided into twenty-four hours. Men
should sleep for eight hours, and so arrange their sleep that
the end of it comes with the dawn, so that from the beginning
of sleep until sunrise there should be an eight-hour interval.
We should all leave our beds about the time that the sun
rises.
5. During sleep a man should lie neither on his face nor on
his back but on his side, the beginning of the night on his
left and at the end on his right. He should not go to sleep
for three or four hours after eating and should not sleep
during the day.
6. Fruits that are laxative, as grapes, figs, melons, gourds,
should be taken only before meal time and not mixed with other
food. It would be better to let these get into the abdominal
organs and then take other food.
7. Eat what is easily digestible before what is difficult of
digestion. The flesh of birds before beef and the flesh of
calves before that of cows and steers. (Birds were then
thought more digestible than other flesh; we have reversed the
ruling. The note shows how light and digestible their flesh
was considered and the reason therefor.)
8. In summer eat cooling food, acids, and no spices. In
winter, on the contrary, eat warming foods, rich in spices,
mustard, and other heating substances. In cold and warm
climates one should eat according to the climatic conditions.
9. There are certain harmful foods that should be avoided.
Large salt fish, old cheese, old pickled meat, young new wine,
evil-smelling and bitter foods are often poisonous. There are
also some which are less harmful, but are not to be
recommended as ordinary nutritive materials. Large fish,
cheese, milk more than twenty-four hours after milking, the
flesh of old oxen, beans, peas, unleavened bread, sauerkraut,
onions, radishes and the like. These are to be taken only in
small quantities and only in the winter time and they should
be avoided in the summer. Beans and lentils are to be
recommended neither in winter nor summer.
10. As a rule one should avoid the eating of tree fruits, or
not eat much of them, especially when they are dry and even
less when they are green. If they are unripe they may cause
serious damage. Johannesbrod is very harmful at all times, as
are also all the sour fruits, and only small amounts of them
should be eaten in summer or in warm countries.
11. The fruits that are to be recommended dry as well as
fresh, are figs, grapes, and almonds. These may be eaten as
one has the appetite for them, but one should not accustom
himself to eat them much, though they are healthier than all
other fruits.
12. Honey and wine are not good for children, though they are
beneficial for older people, especially in winter. In summer
one-third less of them should be eaten than in winter.
13. Special care should be taken to have regular movements of
the bowels that carry off the impurities of the body. It is an
axiom in medicine, that so long as evacuations are absent, or
difficult, or require strong efforts, the individual is liable
to serious disease. Every medical means should be taken to
overcome constipation in order to escape its dangers. For
this purpose young people should be given salty food,
materials that have been soaked in olive oil, salt itself, or
certain vegetable soups with olive oil and salt. Older people
should take honey mixed with warm water early in the morning
and four hours later should take their breakfast. This
proceeding should be followed up from one to four days until
the constipation is overcome.
14. Another axiom of medicine is that so long as a man is able
to be active and vigorous, does not eat until he is over-full,
and does not suffer from constipation, he is not liable to
disease. Even such men, however, are much safer if they do not
take food that may disagree with them.
15. Whoever gives himself up to inactivity, or puts off
evacuations of the bowels, or suffers from constipation, will
be sure to suffer from many diseases and will see his strength
disappear even should he eat the best food in the world and
make use of all the remedies that physicians have. Immoderate
eating is a poison for men and the cause of many diseases
which attack them. Most diseases come from either eating too
much or partaking of unsuitable food. That was what Solomon
meant with his proverb: "He who puts a guard over his mouth
and his tongue protects himself from many evils," that is to
say, whoever protects his mouth from the overindulgence in
food and his tongue from unsuitable speech protects himself
from many evils.
16. Every week at least a man should take a warm bath. One
should not bathe when hungry, nor after eating until the food
is digested, and bathe the whole body in warm but not too hot
water and the head in hot water. Afterwards the body should be
washed in lukewarm and cool water until finally cold water is
used. One should pour neither cold nor even lukewarm water on
the head, nor bathe in cold water in the winter time, nor when
the body is tired and in perspiration. At such times the bath
should be put off for a while.
17. As soon as one leaves the bath one should cover oneself,
and especially cover the head, so that no draught may strike
it. Even in summer, care must be taken to observe this rule.
After this one should rest for a while until the heat of the
body passes off and then should go to table. If one could
sleep a little just before a meal it is often very beneficial.
Neither during the bath nor immediately after it should cold
water be drunk, and if there is an inappeasable thirst a
little wine and water or water and honey should be taken. In
winter it is beneficial to rub the body with oil after the
bath.
18. Venesection should not be practised frequently, for it is
only meant for serious illness. It should not be permitted in
winter or summer, nor during the months of April or September
(the "r" months). After passing his fiftieth year an
individual should abstain from venesection. Venesection should
not be practised on the day when one takes a bath or goes on a
journey or returns from it. On the day when it is practised
less than usual should be eaten and drunk, and the patient
should give himself to rest, undertake no work nor bothersome
occupation, and take no walk.
19. Whoever observes these rules of life faithfully I
guarantee him a long life without disease. He shall reach a
good old age, and when he comes to die will not need a
physician. His body will remain always strong and healthy,
unless of course he has been born with a weak nature, or has
had an unfortunate bringing up, or should be attacked by
epidemic disease or by famine.
20. Only the healthy should keep these rules. Whoever is ill
or a sufferer from any injuries, or has lost his health
through bad habits, for him there are special rules for each
disease, only to be found in the medical books. Let it be
remembered that every change in a life habit is the beginning
of an ailment.
21. If no physician can be secured, then ailing people may use
these rules as well as the healthy.
These rules are, of course, full of the common sense of medicine that
endures at all times. For the tropical climate of the Eastern countries
they probably represent as good advice as could be given even at the
present time. With them before us it is not surprising to find that on
other subjects Maimonides was just as sensible. Perhaps in nothing is
this more striking than in his complete rejection of astrology.
Considering how long astrology, in the sense of the doctrine of the
stars influencing human health and destinies, had dominated men's minds,
and how universal was the acceptance of it, Maimonides' strong
expressions show how much genius lifts itself above the popular
persuasions of its time, even among the educated, and how much it
anticipates subsequent knowledge.
It is well to remind ourselves that as late as the middle of the
eighteenth century Mesmer's thesis on "The Influence of the Stars on
Human Constitutions" was accepted by the faculty of the University of
Vienna as a satisfactory evidence not only of his knowledge of medicine,
but of his power to reason about it. At the end of the twelfth century
Maimonides was trying to argue it out of existence on the best possible
grounds. "Know, my masters," he writes, "that no man should believe
anything that is not attested by one of these three sanctions:--rational
proof as in mathematical science, the perception of the senses, or
traditions from the prophets and learned men." His biographer in the
monograph "Maimonides," published by the Jewish Publication Society of
America[5], expresses his further views on the subject in compendious
form, and then gives his final conclusion as follows:
"'Works on astrology are the product of fools, who mistook
vanity for wisdom. Men are inclined to believe whatever is
written in a book, especially if the book be ancient; and in
olden times disaster befell Israel because men devoted
themselves to such idolatry instead of practising the arts of
martial defence and government.' He says, that he had himself
studied every extant astrological treatise, and had convinced
himself that none deserved to be called scientific. Maimonides
then proceeds to distinguish between astrology and astronomy,
in the latter of which lies true and necessary wisdom. He
ridicules the supposition that the fate of man could be
dependent on the constellations, and urges that such a theory
robs life of purpose, and makes man a slave of destiny. 'It is
true,' he concludes, 'that you may find strange utterances in
the Rabbinical literature which imply a belief in the potency
of the stars at a man's nativity, but no one is justified in
surrendering his own rational opinions because this or that
sage erred, or because an allegorical remark is expressed
literally. A man must never cast his own judgment behind him;
the eyes are set in front, not in the back.'"
While Maimonides could be so positive in his opinions with regard to a
subject on which he felt competent to say something, he was extremely
modest with regard to many of the great problems of medicine. He often
uses the expression in his writings, "I do not see how to explain this
matter." He quotes with approval from a Rabbi of old who had counselled
his students, "teach thy tongue to say, I do not know." In this, of
course, he has given the best possible evidence of his largeness of mind
and his capacity for making advance in knowledge. It is when men are
ready to say, "I do not know," that progress becomes possible. It is
very easy to rest in a conscious or unconscious pretence of knowledge
that obscures the real question at issue. A great thinker, who lived in
the century in which Maimonides died, Roger Bacon, set down as one of
the four principal obstacles to advance in knowledge indeed, as _the_
one of the four that hampered intellectual progress the most, the fact
that men feared to say, "I do not know."
One of the most interesting features of Maimonides' career for the
modern time is the influence that his writings exerted over the rising
intellectual life of Europe within a half century after his death. Most
people would be rather inclined to think that this Jewish author of the
East would have very little influence over the thinkers and teachers of
Europe within a generation after his death. He died in 1204, just at the
beginning of one of the great productive centuries of humanity, perhaps
one of the greatest of them all. In literature, in art, in architecture,
in philosophy, and in education, this century made wonderful strides.
Two of its greatest teachers, Albertus Magnus and his pupil, Thomas
Aquinas, quote from Moses Ægyptæus, the European name for Maimonides at
that time, and evidently knew his writings very well. Maimonides was for
them an important connecting link with the world of old Greek thought.
Others of the writers and teachers of this time, as William of Auvergne,
and the two great Franciscans, Alexander of Hales and Duns Scotus, were
also influenced by Maimonides. In a word, the educational world of that
time was much more closely united than we might think, and it did not
take long for a great writer's thoughts to make themselves felt several
thousand miles away. Maimonides was, then, in his own time one of the
world teachers, and, in a certain sense, he must always remain that, as
representing a special development of what is best in human nature.
V
GREAT ARABIAN PHYSICIANS
In order to understand the place of the Arabs in medicine and in
science, a few words as to the rise of this people to political power,
and then to the cultivation of literature and of science, are necessary.
We hear of the Arabs as hireling soldiers fighting for others during the
centuries just after Christ, and especially in connection with the story
of the famous Queen Zenobia at Palmyra. After the destruction of this
city we hear nothing more of them until the time of Mohammed. During
these six and a half centuries there is little question of education of
any kind among them except that at the end of the sixth century, the
Persian King Chosroes I, who was much interested in medicine, encouraged
the medical school in Djondisabour, in Arabistan, founded at the end of
the fifth century by the Nestorian Christians, who continued as the
teachers there until it became one of the most important schools of the
East. It was here that the first Arab physicians were trained, and here
that the Christian physicians who practised medicine among the Arabs
were educated.
Among the Arabs themselves, before the time of Mohammed, there had been
very little interest in medicine. Gurlt notes that even the physician of
the Prophet himself was, according to tradition, a Christian.
Mohammed's immediate successors were not interested in education, and
their people mainly turned to Christian and Jewish physicians for
whatever medical treatment they needed. When the Caliphs came to be
rulers of the Mohammedan Empire, they took special pains to encourage
the study of philosophy and medicine; though dissection was forbidden by
the Koran, most of the other medical sciences, and especially botany and
all the therapeutic arts, were seriously cultivated.
Until the coming of Mohammed, the Arabs had been wandering tribes,
getting some fame as hireling soldiers, but now, under the influence of
a feeling of community in religion, and led by the military genius of
some of Mohammed's successors, whose soldiers were inspired by the
religious feelings of the sect, they made great conquests. The
Mohammedan Empire extended from India to Spain within a century after
Mohammed's death. Carthage was taken and destroyed, Constantinople was
threatened. In 661, scarcely forty years after the _hegira_ or flight of
Mohammed, from which good Mohammedans date their era, the capital was
transferred from Medina to Damascus, to be transferred from here to
Bagdad just about a century later, where it remained until the Mongols
made an end of the Abbasside rulers about the middle of the thirteenth
century. At the beginning the followers of Mohammed were opposed to
knowledge and education of all kinds. Mohammed himself had but little.
According to tradition, he could not read or write. The story told with
regard to the Caliph Omar and the great library of Alexandria, seems to
have a foundation in reality, though such legends usually are not to be
taken literally. Certainly it represents the traditional view as to the
attitude of the earlier Moslem rulers to education. Omar was asked what
should be done with the more than two million volumes. He said that the
books in it either agreed with the Koran, or they did not. If they
agreed with it they were quite useless. If they did not, they were
pernicious. In either case, they should be done away with, because there
was an element of danger in them. Accordingly, the precious volumes that
had been accumulating for nearly ten centuries, served, it is said, to
heat the baths of Alexandria for some six months--probably the most
precious fuel ever used. Fortunately for posterity, the edict was not
quite as universal in its application as the story would indicate, and
exceptions were made for books of science.
In the course of their conquests, however, the Mohammedan Arabs captured
the Greek cities of Asia Minor. They were brought closely in contact
with Greek culture, Greek literature, and Greek thought. As has always
been the case, captive Greece took its captors captive. What happened to
the Romans earlier came to pass also among the Arabs. Inspired by Greek
philosophy, science, and literature, they became ardent devotees of
science and the arts. While not inventing or discovering anything new,
like the Romans they carried on the old. Damascus, Basra, Bagdad,
Bokhara, Samarcand all became centres of culture and of education. Large
sums were paid for Greek manuscripts, and for translations from them.
Under the famous Harun al-Raschid, at the end of the eighth century,
whose name is better known to us than that of any others, because of the
stories of his wandering by night among his people in order to see if
justice were done, three hundred scholars were sent at the cost of the
Caliph to the various parts of the world in order to bring back
treasures of science, and especially of geography and medicine. It is an
interesting historical reflection that the Japanese and Chinese are
doing the same thing now.
The Arabs were very much taken by the philosophy of Aristotle, and it
became the foundation of all their education. Greek thought, as always,
inspired its students to higher things. Soon everywhere in the dominions
of the Caliphs, philosophy, science, art, literature, and education
nourished. Medicine was taken up with the other sciences and cultivated
assiduously. Freind, in his "Historia Medicinæ," says that the writings
of the old Greeks which treated of medicine were saved from destruction
with the other books at Alexandria, for the desire of health did not
have less strength among the Arabs than among other nations. Since these
books taught them how to preserve health, and were not otherwise
contrary to the laws of the Prophet, that served to bring about their
preservation. Freind also calls attention to the fact that grammars and
books which treated of the science of language were likewise saved from
destruction. Besides the library, the Arabs, after their conquest of
Alexandria in the eighth century, came under the influence of the
university still in existence there.
In the West, in Spain, the Arabs enjoyed the same advantages as regards
contact with culture and education as their conquest of the Eastern
cities and Alexandria brought them in the East. While it is not
generally realized, Spain was, as we have pointed out, the province of
the Roman Empire in the West that advanced most in culture before the
breaking up of the Empire. The Silver Age of Latin literature owes all
of its geniuses to Spain. Lucan, the Senecas, Martial, Quintilian, are
all Spaniards. Spain itself was a most flourishing province, and under
the Spanish Cæsars, from the end of the first to about the end of the
second century, increased rapidly in population. Spain was the leader in
these prosperous times, and the tradition of culture maintained itself.
When Spain became Christian the first great Christian poet, Prudentius,
born about the middle of the fourth century, came from there. He has
been called the Horace and Virgil of the Christians.
The coming down of the barbarians from the North disturbed Spain's
prosperity and the peace and culture of her inhabitants, but it should
not be forgotten that the first medieval popularization of science, a
sort of encyclopedia of knowledge, the first of its kind after that of
Pliny in the classical period, came from St. Isidore of Seville, a
Spanish bishop.
There has been considerable tendency to insist that Spanish culture and
intellectuality owe nearly all to the presence of the Moors in Spain.
This can only be urged, however, by those who know nothing at all of the
Spanish Cæsars, the place of Spain in the history of the Roman Empire,
and the continuance of the culture that then reached a climax of
expression during succeeding centuries. On the contrary, the Moors who
came to Spain owe most of their tendency to devote themselves to culture
and education to the state of affairs existent in Spain when they came.
There is no doubt that they raised standards of education and of culture
above the level to which they had sunk under the weight of the invading
barbarians from the North, and Spain owes much to the wise ruling and
devotion to the intellectual life of her Moorish invaders. All the
factors, however, must be taken together in order to appreciate properly
the conditions which developed under the Arabs in both the East and the
West. The Arabs invented little that was new in science or philosophy;
they merely carried on older traditions. It is for that that the modern
time owes them a great debt of gratitude.
RHAZES
The most distinguished of the Arabian physicians was the man whose
rather lengthy Arabian name, beginning with Abu Bekr Mohammed, finished
with el-Razi, and who has hence been usually referred to in the history
of medicine as Rhazes. He was born about 850 at Raj, in the Province of
Chorasan in Persia. He seems to have had a liberal early education in
philosophy and in philology and literature. He did not take up medicine
until later in life, and, according to tradition, supported himself as a
singer until he was thirty years of age. Then he devoted himself to
medical studies with the ardor and the success so often noted in those
whose opportunity to study medicine has been delayed. His studies were
made at Bagdad, where Ibn Zein el-Taberi was his teacher. He returned to
his native town and was for some time the head of the hospital there.
Later he was called by the Sultan to Bagdad to take charge of the
renovated and enlarged hospital of the capital. His medical career,
then, is not unlike that of many another successful physician,
especially of the modern time. At Bagdad he had abundant opportunities
for study, and the ambition to make medicine as well as to make money
and gain fame.
His studies in science were all founded on Aristotle. Though he was
called the Galen of his time, and looked up to the Greek physician as
his master, even the authority of Galen did not override that of the
Stagirite in his estimation. One of his aphorisms is said to have been,
"If Galen and Aristotle are of one mind on a subject, then surely their
opinion is true. When they differ, however, it is extremely difficult
for the scholar to decide which opinion should be accepted." He drew
many pupils to Bagdad, and, when one knows his teaching, this is not
surprising. Some of his aphorisms are very practical. While the
expressions just quoted with regard to Galen and Aristotle might seem to
indicate that Rhazes was absolutely wedded to authority, there is
another well-known maxim of his which shows how much he thought of the
value of experience and observation. "Truth in medicine," he said, "is a
goal which cannot be absolutely reached, and the art of healing, as it
is described in books, is far beneath the practical experience of a
skilful, thoughtful physician." Some of his other medical aphorisms are
worth noting. "At the beginning of a disease choose such remedies as
will not lessen the patient's strength." "When you can heal by diet,
prescribe no other remedy, and, where simple remedies suffice, do not
take complicated ones."
Rhazes knew well the value of the influence of mind over body even in
serious organic disease, and even though death seemed impending. One of
his aphorisms is: "Physicians ought to console their patients even if
the signs of impending death seem to be present. For the bodies of men
are dependent on their spirits." He considered that the most valuable
thing for the physician to do was to increase the patient's natural
vitality. Hence his advice: "In treating a patient, let your first
thought be to strengthen his natural vitality. If you strengthen that,
you remove ever so many ills without more ado. If you weaken it,
however, by the remedies that you use you always work harm." The simpler
the means by which the patient's cure can be brought about, the better
in his opinion. He insists again and again on diet rather than
artificial remedies. "It is good for the physician that he should be
able to cure disease by means of diet, if possible, rather than by means
of medicine." Another of his aphorisms seems worth while quoting: "The
patient who consults a great many physicians is likely to have a very
confused state of mind."
Some idea of Rhazes' strenuous activity as a writer on medical subjects
may be obtained from the fact that thirty-six of his works are still
extant, and there are nearly two hundred others of which only the
titles have been preserved. Some of these are doubtless the works of
pupils and students of succeeding generations, published under his name
to attract attention. His principal work is "Continens," or
"Comprehensor," which owes its title to the fact that it was meant to
contain the whole practice of medicine and surgery. It includes
references to the writings of all previous distinguished medical
writers, from Hippocrates to Honein Ben Ishac, also known as
Johannitius, a Christian Arabian physician, one of Rhazes' teachers. The
most frequently quoted of these authorities are Galen, Oribasius,
Aëtius, and Paul of Ægina. The work, however, is not made up entirely of
quotations, but contains many observations made by the author himself.
Gurlt says that the foundation of the theoretic medicine of Rhazes is
the system of Galen, while in practice he seems to cling more to the
aphorisms of Hippocrates. He has many practical points which show that
he thought for himself. For instance, in wounds of the abdomen, if the
intestines are extruded and cannot be replaced, he suggests the
suspension of the patient by his hands and feet in a bath in order to
facilitate their return. If they do not go back readily, compresses
dipped in warm wine should be used. Cancer he declares to be almost
incurable. He has much to say about the bites of animals and their
tendency to be poisonous, knew rabies very well, and knew also that the
bites of men might have similar serious consequences.
It is impossible to give any adequate idea of the thoroughly practical
character of Rhazes' medical writing in a few lines, but it may suffice
to say that there is scarcely any feature of modern medicine and surgery
that he does not touch, and oftener than not his touch is sure and
rational and frequently much better than the advice of successors long
after him in the same matters. An example or two will suffice to
illustrate this. In the treatment of nasal polyps he says that whenever
drug treatment of these is not successful, they should be removed with a
snare made of hair. For fall of the uvula he suggests gargles, but when
these fail he advises resection and cauterization. Among the affections
of the tongue he numbers abscess, fissure, ulcer, cancer, ranula,
shortening of the ligaments, hypertrophy, erythema of the mucous
membrane, and inflammatory swelling. In general his treatment of the
upper respiratory tract is much farther advanced than we might think
possible at this time. He advises tracheotomy whenever there is great
difficulty of respiration, and describes how it should be done. After
the dyspnea has passed the edges of the wound should be brought together
with sutures. It is not surprising, then, to find that the treatment of
fractures and luxations is eminently practical, and, indeed, on any
subject that he touches he throws practical light.
In the introduction to his edition of the works of Ambroise Paré,
Malgaigne says that the first reference to a metal band in connection
with trusses is to be found in Rhazes. Hernia was, of course, one of the
serious ailments that, because of its superficial character, was rather
well understood, and so it is not surprising to find that much of our
modern treatment of it was anticipated. The manipulations for taxis, the
use of a warm bath for the relaxation of the patient by means of heat
and by putting the head and feet higher than the abdomen while in the
bath, and the employment of various kinds of trusses to prevent
strangulation of the hernia recur over and over again, in the authors of
the Middle Ages. Many of the suggestions are to be found in the early
Greek authors, but subsequent writers give a certain personal expression
to them which shows how much they had learned by personal observation in
the employment of various methods.
Pagel, in Puschmann's "Handbook of the History of Medicine," declares
that Rhazes' most important work for pure medicine is his monograph on
smallpox. Its principal value is due to the fact that, though he has
consulted old authorities carefully, his discussion of the disease is
founded almost entirely on his own experience. His description of the
various stages of the disease, of the forms of the eruption, and of the
differential diagnosis, is very accurate. He compares the course of the
fever with that of other fevers, and brings out exactly what constitutes
the disease. His suggestions as to prognosis are excellent. Those cases,
he declares, are particularly serious in which the eruption takes on a
dark, or greenish, or violet color. The prognosis is also unfavorable
for those cases which, having considerable fever, have only a slight
amount of rash. His treatment of the disease in young persons was by
venesection and cool douches. Cold water and acid drinks should be
administered freely, so that sweat and other excretions may carry off
poisonous materials. Care must be taken to watch the pulse, the
breathing, the appearance of the feet, the evacuations from the bowels,
and to modify therapy in accordance with these indications. The eruption
is to be encouraged by external warmth and special care must be taken
with regard to complications in the eyes, the ears, the nose, the mouth,
and the pharynx.
A fact that will, perhaps, give the best idea to modern readers of the
place of Rhazes in the history of medicine is that Vesalius considered
it worth his while to make a translation of his principal work.
Unfortunately that translation has not come down to us. When Vesalius,
pestered by the controversies that had come upon him because of his
venturing to make his observations for himself, accepted the post of
physician to the Emperor Charles V, he burnt a number of his
manuscripts. Among these were his translation of Rhazes and some
annotations on Galen, which, as he says himself, had grown into a huge
volume. The Galenists were bitterly decrying his refusal to accept Galen
on many points, and both of these works would have added fuel to the
flame of controversy. He deemed it wiser, then, not to give any further
opportunities for rancorous criticism, and, feeling presumably that in
his new and important post it was not worth while to bother further over
the matter, he burnt them. He tells the reason in his letters to Joachin
Roelant: "When I was about to leave Italy to go to Court, since a number
of the physicians whom you know had made the worst kind of censure of
my books, both to the Emperor himself, and to other rulers, I burned
all the manuscripts that were left, although I had never suffered a
moment under the displeasure of the Emperor because of these complaints,
and in spite of the fact that a number of friends who were present urged
me not to destroy them."
Vesalius' translation of Rhazes was probably undertaken because he
recognized in him a kindred spirit of original investigation and
inquiry, whose work, because it was many centuries old, would command
the weight of an authority and at the same time help in the controversy
over Galenic questions. This, of itself, would be quite enough to make
the reputation of Rhazes, even if we did not know from the writings
themselves and from the admiration of many distinguished men as well as
the incentive that his works have so often proved to original
observation, that he is an important link in the chain of observers in
medicine, who, though we would naturally expect them to be so frequent,
are really so rare.
ALI ABBAS
Rhazes lived well on into the tenth century. His successor in prestige,
though not his serious rival, was Ali Ben el-Abbas, usually spoken of in
medical literature as Ali Abbas, a distinguished Arabian physician who
died near the end of the tenth century. He wrote a book on medicine
which, because of its dedication to the Sultan, to whom he was
body-physician, is known as the "Liber Regius," or "Royal Book of
Medicine." This became the leading text-book of medicine for the Arabs
until replaced by the "Canon of Avicenna" some two centuries later. The
"Liber Regius" was an extremely practical work and, like most of the
Arabian books of the early times, is simple and direct, quite without
many of the objectionable features that developed later in Arabian
medicine. It is valuable mainly for its contributions to diet and the
fact that Ali Abbas tested many of his medicines on ailing animals
before applying them to men. Of course, it owes much to earlier writers
on medicine, and especially to Paul of Ægina.
An example of its practical value is to be found in his description of
the treatment of a wound of the brachial artery, when, as happened often
in venesection from the median basilic vein, it was injured through
carelessness or inadvertence. If astringent or cauterizing methods do
not stop the bleeding, the artery should be exposed, carefully isolated,
tied in two places above and below the wound, and then cut across
between them. He has many similar practical bits of technique. For
instance, in pulling a back tooth he recommends that the gums be incised
so as to loosen them around the roots, and then the tooth itself may be
drawn with a special forceps which he calls a molar forceps. In ascites
he recommends that when other means fail an opening should be made three
finger-breadths below the navel with a pointed phlebotomy knife, and a
portion of the fluid allowed to evacuate itself. A tube should then be
inserted, but closed. The next day more of the fluid should be allowed
to come away, and then the tube removed and the abdomen wrapped with a
firm bandage.
It is easy to understand that Ali Abbas' book should have been popular,
and the more we know of it the easier it is to explain why Constantine
Africanus should have selected it for translation. It contains ten
theoretic and ten practical books, and gives an excellent idea of the
medical knowledge and medical practice of the time. Probably the fact
that Constantine had translated it led to its early printing, so that we
have an edition of it published at Venice in 1492, and another at Lyons
in 1523. During the Middle Ages the book was often spoken of as "Regalis
Dispositio," the "Royal Disposition of Medicine."
MOORISH PHYSICIANS
After Rhazes, the most important contributors to medical literature from
among the Arabs, with the single exception of Avicenna, were born in
Spain. They are Albucasis or Abulcasis, the surgeon; Avenzoar, the
physician, and Averroës, the philosophic theorist in medicine. Besides,
it may be recalled here that Maimonides, the great Jewish physician, was
born and educated at Cordova, in Spain. It might very well be a surprise
that these distinguished men among the Arabs should have flourished in
Spain, so far from the original seat of Arabian and Mohammedan dominion
in the East, where, owing to conditions in the modern time, the
English-speaking world particularly is not likely to assume that the
environment was favorable for the development of science and
philosophy. Anyone who recalls, however, the history of Spanish
intellectual influence in the Roman Empire, as we have traced it at the
beginning of this chapter, will appreciate how favorable conditions were
in Spain for the fostering of intellectual development. With the
disturbances that had come from political strife and the invasion of the
barbarians in Italy, Spain had undoubtedly come to hold the primacy in
the intellectual life of Europe at the time when the Arabs took
possession of the peninsula.
ABULCASIS
The most important of the Arabian surgeons of the Middle Ages is
Albucasis or Abulcasis, also Abulkasim, who was born near Cordova, in
Spain. The exact year of his birth is not known, but he flourished in
the second half of the tenth century. He is said to have lived to the
age of 101. The name of his principal work, which embraces the whole of
medicine, is "Altasrif," or "Tesrif," which has been translated "The
Miscellany." Most of what he has to say about medical matters is taken
from Rhazes. His work on surgery, however, in three books, represents
his special contribution to the medical sciences. It contains a number
of illustrations of instruments, and is the first illustrated medical
book that has come to us. It was translated into Latin, and was studied
very faithfully by all the surgeons of the Middle Ages. Guy de Chauliac
has quoted Albucasis about two hundred times in his "Chirurgia Magna."
Even as late as the beginning of the sixteenth century Fabricius de
Acquapendente, the teacher of Harvey, confessed that he owed most to
three great medical writers, Celsus (first century), Paul of Ægina
(seventh century), and Abulcasis (tenth century).
Abulcasis insisted that for successful surgery a detailed knowledge of
anatomy was, above all, necessary. He said that the reason why surgery
had declined in his day was that physicians did not know their anatomy.
The art of medicine, he added further, required much time.
Unfortunately, to quote Hippocrates, there are many who are physicians
in name only, and not in fact, especially in what regards surgery. He
gives some examples of surgical mistakes made by his professional
brethren that were particularly called to his attention. They are the
perennially familiar instances of ignorance causing death because
surgeons were tempted to operate too extensively.
His description of the procedure necessary to stop an artery from
bleeding is an interesting example of his method of teaching the
practical technique of surgery. Apply the finger promptly upon the
opening of the vessel and press until the blood is arrested. Having
heated a cautery of the appropriate size, take the finger away rapidly
and touch the cautery at once to the end of the artery until the blood
stops. If the spurting blood should cool the cautery, take another.
There should be several ready for the purpose. Take care, he says, not
to cauterize the nerves in the neighborhood, for this will add a new
ailment to the patient's affection. There are only four ways of
arresting arterial hemorrhage. First, by cautery; second, by division
of the artery, when that is not complete--for then the extremities
contract and the blood clots--or by a ligature, or by the application of
substances which arrest blood flow, aided by a compressive bandage.
Other means are inefficient, and seldom and, at most, accidentally
successful. His instruction for first aid to the injured in case of
hemorrhage in the absence of the physician, is to apply pressure
directly upon the wound itself.
The development of the surgical specialties among the Arabs is
particularly interesting. Abulcasis has much to say about nasal polyps.
He divided them into three classes: (1) cancerous, (2) those with a
number of feet, and (3) those that are soft and not living,--these
latter, he says, are neither malignant nor difficult to treat. He
recommends the use of a hook for their removal, or a snare for those
that cannot be removed with that instrument. His instructions for the
removal of objects from the external ear are interestingly practical. He
advises the use of bird lime on the end of a sound to which objects will
cling, or, where they are smaller, suction through a silver or copper
canula. Hooks and pincettes are also suggested. Insects should be
removed with a hook, or with a canula, or, having been killed by warm
oil, removed by means of a syringe. Some of his observations with regard
to genito-urinary surgery are quite as interesting. He even treated
congenital anomalies. He suggests cutting of the meatus when narrowed,
dilatation of strictures with lead sounds, and even suggests plans of
operations to improve the condition in hypospadias. He gives the signs
for differentiation between epitheliomata and condylomata, and
distinguishes various forms of ulceration of the penis.
Abulcasis discusses varicose veins in very much the same spirit as a
modern surgeon does. They occur particularly in people who work much on
their feet, and especially who have to carry heavy burdens. They should
not be operated on unless they produce great discomfort, and make it
impossible for the sufferer to make his living. They may be operated on
by means of incision or extirpation. Incision consists of cutting the
veins at two or three places when they have been made prominent by means
of tight bandages around the limb. The blood should be allowed to flow
freely out of the cut ends, and then a bandage applied. For extirpation,
the skin having been shaved beforehand, the vein should be made
prominent, and then carefully laid bare. When freed from all adhesions,
it should be lifted out on a hook, and either completely extirpated or
several rather long pieces removed. He lays a good deal of stress on the
necessity for freeing the vein thoroughly and lifting it well out of
tissues before incising it. In old cases special care must be taken not
to tear the vein.
Minute details of technique are often found in these old authors.
Abulcasis, for instance, treats of adherent fingers with up-to-date
completeness. They can occur either congenitally or from injury, as, for
instance, burning. They should be separated, and then separation
maintained by means of bandages or by the insertion between them of a
thin lead plate, which prevents their readhesion. Adhesions of the
fingers with the palm of the hand, which Abulcasis has also seen,
should be treated the same way.
At times there is surprise at finding some rare lesion treated with
modern technique, and a hint at least of our modern apparatus. Fracture
of the pubic arch, for instance, is described in Abulcasis quite as if
he had had definite experience with it. When this occurs in a woman, the
reposition of the bone is often greatly facilitated by a cotton tampon
in the vagina. This tampon must be removed at every urination. There is
another way, however, of better securing the same purpose of
counterpressure. One may take a sheep's bladder into the orifice of
which a tube is fastened. One should introduce the bladder into the
vagina, and then blow strongly through the tube, until the bladder
becomes swollen and fills up the vaginal cavity. The fracture will, as a
rule, then be readily reduced. Here is, of course, not alone the first
hint of the colpeurynter, but a very practical form of the apparatus
complete. Old-time physicians used the bladders of animals very
generally for nearly all the medical purposes for which we now use
rubber bags.
AVICENNA
Undoubtedly the most important of Abulcasis' contemporaries is the
famous physician whose Arabic name, Ibn Sina, was transformed into
Avicenna. He was born toward the end of the tenth century in the Persian
province of Chorasan, at the height of Arabian influence, and is
sometimes spoken of as the chief representative of Arabian medicine, of
as much importance for it as Galen for later Greek medicine. His
principal book is the so-called "Canon." It replaced the compendium
"Continens" of Rhazes, and, in the East, continued until the end of the
fifteenth century to be looked upon as the most complete and best system
of medicine. Avicenna came to be better known in the West than any of
the other Arabian writers, and his name carried great weight with it.
There are very few subjects in medicine that did not receive suggestive,
if not always adequate, treatment at the hands of this great Arabian
medical thinker of the eleventh century. He copied freely from his
predecessors, but completed their work with his own observations and
conclusions. One of his chapters is devoted to leprosy alone. He has
definite information with regard to bubonic plague and the _filaria
medinensis_. Here and there one finds striking anticipations of what are
supposed to be modern observations. Nothing was too small for his
notice. One portion of the fourth book is on cosmetics, in which he
treats the affections of the hair and of the nails. He has special
chapters with regard to obesity, emaciation, and general constitutional
conditions. His book, the "Antidotarium," is the foundation of our
knowledge of the drug-giving of his time.
Some idea of the popularity and influence of Avicenna, five centuries
after his time, can be readily derived from the number of commentaries
on him issued during the Renaissance period by the most distinguished
medical scholars and writers of that time. Hyrtl, in his "Das Arabische
und Hebräische in der Anatomie," quotes some of them,--Bartholomæus de
Varignana, Gentilis de Fulgineis, Jacobus de Partibus, Didacus Lopez,
Jacobus de Forlivio, Ugo Senesis, Dinus de Garbo, Matthæus de Gradibus,
Nicolaus Leonicenus, Thaddæus Florentinus, Galeatus de Sancta Sophia. A
more complete list, with the titles of the books, may be found in
Haller's "Bibliotheca Anatomica." For over three centuries after the
foundation of medical schools in Europe (and even after Mondino's book
had been widely distributed), Avicenna was still in the hands of all
those who had an enthusiasm for medical science.
AVENZOAR
Another of the distinguished Arabian physicians was Avenzoar--the
transformation of his Arabic family name, Ibn-Zohr. He was probably born
in Penaflor, not far from Seville. He died in Seville in 1162 at the
age, it is said, of ninety-two years. He was the son of a physician
descended from a family of scholars, jurists, physicians, and officials.
He received the best education of the time not only in internal
medicine, but in all the specialties, and must be counted among the
greatest of the Spanish Arabian physicians. He was the teacher of
Averroës, who always speaks of him with great respect. He is interesting
as probably being the first to suggest nutrition _per rectum_. A few
words of his description show how well he knew the technique. His
apparatus for the purpose consisted of the bladder of a goat or some
similar animal structure, with a silver canula fastened into its neck,
to be used about as we use a fountain syringe. Having first carefully
washed out the rectum with cleansing and purifying clysters, he injected
the nutriment--eggs, milk, and gruels--into the gut. His idea was that
the intestine would take this, and, as he said, suck it up, carrying it
back to the stomach, where it would be digested. He was sure that he had
seen his patients benefited by it.
Some light on his studies of cases that would require such treatment may
be obtained from what he has to say about the handling of a case of
stricture of the esophagus. He says that this begins with some
discomfort, and then some difficulty of swallowing, which is gradually
and continuously increased until finally there comes complete
impossibility of swallowing. It was in these cases that he suggested
rectal alimentation, but he went farther than this, and treated the
stricture of the esophagus itself.
The first step in this treatment is that a canula of silver or tin
should be inserted through the mouth and pushed down the throat till its
head meets an obstruction, always being withdrawn when there is a
vomiting movement, until it becomes engaged in the stricture. Then
_freshly milked_ milk, or gruel made from farina or barley, should be
poured through it. He says that in these cases the patient might be put
in a warm milk or gruel bath, since there are some physicians who
believe that through the lower parts of the body, and also through the
pores of the whole body, nutrition might be taken up. While he considers
that this latter method should be tried in suitable cases, he has not
very much faith in it, and says that the reasons urged for it are weak
and rather frivolous. It is easy to understand that a man who has
reached the place in medicine where he can recommend manipulative
treatments of this kind, and discuss nutritional modes so rationally,
knew his practical medicine well, and wrote of it judiciously.
AVERROËS
Among the distinguished contributors to medicine at this time, though
more a philosopher than a physician, is the famous Averroës, whose full
Arabic name among his contemporaries was Abul-Welid Mohammed Ben Ahmed
Ibn Roschd el-Maliki. Like Avenzoar, of whom he was the intimate
personal friend, and Abulcasis and Maimonides, he was born in the south
of Spain. He was in high favor with the King of Morocco and of Spain,
El-Mansur Jacub, often known as Almansor, who made him one of his
counsellors. His works are much more important for philosophy than for
medicine, and his philosophical writings gave him a place only second to
that of Aristotle in the Western world during the Middle Ages. Averroism
is still a subject of at least academic interest, and Renan's monograph
on it and its author was one of the popular books of the latter half of
the nineteenth century in philosophic circles. In spite of his
friendship with the Moorish King and with Avenzoar, he fell under the
suspicion of free thinking and was brought to trial with a number of
personal friends, who occupied high positions in the Moorish
government. He escaped with his life, but only after great risks, and he
was banished to a suburb of Cordova, in which only Jews were allowed to
live. By personal influence he succeeded in securing the pardon of
himself and friends, and then was summoned to the court of the son and
successor of El-Mansur in Morocco. He died, not long after, in 1198.
Altogether there are some thirty-three works of Averroës on philosophy
and science. Only three of these are concerned with medicine. One is the
"Colliget," so-called, containing seven books, on anatomy, physiology,
pathology, diagnostics, materia medica, hygiene, and therapy. Then there
is a commentary on the "Cantica of Avicenna," and a tractate on the
"Theriac." Averroës' idea in writing about medicine was to apply his
particular system of philosophy to medical science. His intimate
relations with other great physicians of the time, and in particular his
close friendship with Avenzoar, enabled him to get abundant medical
information in faultless order so far as knowledge then went, but his
theoretic speculations, instead of helping medicine, as he thought they
would, and as philosophers have always been inclined to think as regards
their theoretic contributions, were not only not of value, but to some
extent at least hindered human progress by diverting men from the field
of observation to that of speculation. It is interesting to realize that
Averroës did in his time what Descartes did many centuries later, and
many another brilliant thinker has done before and since.
ARABIAN INFLUENCE
The fame of these great thinkers and writers in philosophy and in
medicine came to be known not only through the distribution of their
books long after their death, but during their lifetime, and in
immediately subsequent generations, ardent seekers after knowledge, who
were themselves afterwards to become famous by their teaching and
writing, found their way into the Arabian dominions in order to take
advantage of the educational opportunities afforded. These were better
than they could secure at home in Christian countries, because the
process of bringing culture and devotion to literature and science into
the minds of the Northern nations, who had replaced the old Romans in
Europe, was not yet completed. Bagdad and Cordova were the two favorite
places of educational pilgrimage. The names that are most familiar among
the scholars in the Middle Ages in Europe are those of whom it is
recorded that they made long journeys in order to get in touch with what
the Arabs had preserved of the old Greek civilization and culture. Among
them are such men as Michael Scot or Scotus, Matthew Platearius, who was
afterwards a great teacher at Salerno; Daniel Morley, Adelard of Bath,
Egidius, otherwise known as Gilles de Corbeil; Romoaldus, Gerbert of
Auvergne, who later became Pope under the name of Sylvester II; Gerard
of Cremona, and the best known of them all, at least in medicine,
Constantine Africanus, whose wanderings, however, were probably not
limited to Arabian lands, but who seems also to have been in Hindustan.
We are rather prone to think that this great spirit of going far afield
for knowledge's sake is recent, or, at least, quite modern. As a matter
of fact, one finds it everywhere in history. Long before Herodotus did
his wanderings there were many visitors who went to Egypt, and many more
later who went to Crete, and many more a few centuries later who went to
the shores of Asia Minor seeking for the precious pearl of knowledge,
and sometimes finding it without finding the even more precious pearl of
wisdom, "whose worth is from the farthest coasts."
To the Arabs we owe the foundation of a series of institutions for the
higher learning, like those which had existed around them in Asia Minor
and in Egypt at the time they made their conquests. Alexandria,
Pergamos, Cos, Cnidos, Tarsus, and many other Eastern cities had had
what we would call at least academies, and many of them deserved the
name of universities. The Arabs continued the tradition in education
that they found, and established educational institutions which
attracted wide attention. As we have said, the two most famous of these
were at Bagdad and at Cordova. Mostanser, the predecessor of the last
Caliph of the family of the Abbassides, built a handsome palace, in
which the academy of Bagdad was housed. It is still in existence, and
gives an excellent idea of the beneficent interest of this monarch and
of other of the Abbasside rulers in education. Its fate at the present
time is typical of the attitude of the Mohammedans towards education.
Though the building is still standing, the institution of learning is no
longer there. As Hyrtl remarks, it is not ideas that are exchanged in it
now, but articles of commerce. It has become the chief office of the
Turkish customs department in Bagdad.
These institutions of the higher learning, founded by the Arabs, at
first as rather strict imitations of the museums or academies of Egypt
and Asia Minor, gradually changed their character under the Arabs. Their
courses became much more formal, examinations became much more
important. Scholarship was sought not so much for its own sake, as
because it led to positions in the civil service, to the favor of
princes, and, in general, to reputation and pecuniary reward. Formal
testimonials proclaiming education, signed by the academic authorities,
were introduced and came to mean much. Lawyers could not practise
without a license, physicians also required a license. These formalities
were adopted by the Western medieval universities to a considerable
degree and have been perpetuated in the modern time. Undoubtedly they
did much to hamper real education among the Arabs by setting in place of
the satisfaction of learning for its own sake and the commendation of
teachers the formal recognition of a certain amount of work done as
recognized by the educational authorities. There was always a tendency
among the Arabs to formulate and formalize, to over-systematize what
they were at; to think that new knowledge could be obtained simply by
speculating over what was already acquired, and developing it. There are
a number of comparisons between this and later periods of education
that might be suggested if comparisons were not odious.
The influence of Arabian medicine on modern medicine can, perhaps, best
be judged from the number of words in our modern nomenclature, which,
though bearing Latin forms, often with suggestion of Greek origins,
still are not derived from the old Latin or Greek authors, but represent
Arabic terms translated into Latin during the Renaissance period. Hyrtl,
without pretence of quoting them all, gives a list of these which is
surprising in its comprehensiveness. For instance, the mediastinum, the
sutura sagittalis, the scrobiculus cordis, the marsupium cordis, the
chambers of the heart, the velum palati, the trochanter, the rima
glottidis, the fontanelles, the alæ of the nose, all have their present
names, not from original Latin expressions, but from the translation of
Arabic terms. For all such words the Greeks and Romans have quite other
expressions, in which the sense of our modern terms is not contained.
This has given rise to many misunderstandings, and to many attempts in
the modern times to return to the classic terminology rather than
preserve what in many cases are the barbarisms introduced through the
Arabic, but it is doubtful whether any comprehensive reform in the
matter can be effected, so strongly entrenched in medical usage have
these terms now become.
Freind, in his "History of Medicine," already cited, calls attention to
the fact that the Arabs had an unfortunate tendency to change by
addition or subtraction of their own views the authors that they
studied, and wished to translate to others. This seems to have been
true even of some of the most distinguished of them. Of course, the idea
of preserving an author's text untouched, and making it clear just where
note and commentary came in, had not yet come to men's view, but quite
apart from this the Arabs apparently often tried to gain acceptance for
their own ideas by having them masquerade as the supposed ideas of
favorite classic authors.
Another unfortunate tendency among the Arabs was their liking for the
discussion of many trivial questions. Hyrtl, in his volume on "Arabian
and Hebrew Words in Anatomy,"[6] declares that it is almost incredible
how earnestly some trivial questions in anatomy and physiology were
discussed by the Arabs. He gives some examples. Why does no hair grow on
the nose of men? Why does the stomach not lie behind the mouth? Why does
the windpipe not lie behind the esophagus? Why are the breasts not on
the abdomen? Why are not the calves on the anterior portion of the legs?
Even such men as Rhazes and Avicenna discuss such questions.
It was this tendency of the Arabs that passed over to the Western
Europeans with Arabian commentaries on philosophy and science, and
brought so many similar discussions in the scholastic period. These
trivialities have usually been supposed to originate with the
scholastics themselves, for they are not to be found in the Greek
authors on whom the scholastics were writing commentaries, but they are
typically Oriental in character, and it must be remembered that during
the twelfth and early thirteenth centuries, at least, Greek philosophy
found its way largely into Europe in Arab versions, and these
characteristically Arabian additions of the discussion of curious
trivial questions came with them and produced an imitative tendency
among the Europeans.
As a rule the more careful has been the study of Arabian writers in the
modern time, particularly by specialists, the clearer has it become that
they lacked nearly all originality. Especially were they faulty in their
observations; besides, they had a definite tendency to replace
observation by theory, a fatal defect in medicine. The fine development
of surgery that came at the end of the Arabian period of medicine in
Europe could never have come from the Arabs themselves. Gurlt has
brought this out particularly, but it will not be difficult to cite many
other good authorities in support of this opinion.
Hyrtl, in his "Thesis on the Rarer Old Anatomists,"[7] says that "the
Arabs paid very little attention to anatomy, and, of course, because of
the prohibition in the Koran, added nothing to it. Whatever they knew
they took from the Greeks, and especially Galen. Not only did they not
add anything new to this, but they even lost sight of much that was
important in the older authors. The Arabs were much more interested in
physiology; they could study this by giving thought to it without
soiling their hands. They delighted in theory, rather than in
observation."
While we thus discuss the lack of originality and the tendency to
over-refinement among the Arabian medical writers, it must not be
thought that we would make little of what they accomplished. They not
only preserved the old medical writers for us, but they kept alive
practical medicine with the principles of the great Greek thinkers as
its basis. There are a large number of writers of Arabian medicine whose
names have secured deservedly a high place in medical history. If this
were a formal history of Arabian medicine, their careers and works would
require discussion. For our purpose, however, it seems better to confine
attention to a few of the most prominent Arabian writers on medicine,
because they will serve to illustrate how thoroughly practical were the
Arabian physicians and how many medical problems that we are prone to
think of as modern they occupied themselves with, solving them not
infrequently nearly as we do in the modern time.
VI
THE MEDICAL SCHOOL AT SALERNO
The Medical School at Salerno, probably organized early in the tenth
century, often spoken of as the darkest of the centuries, and reaching
its highest point of influence at the end of the twelfth century, is of
great interest in modern times for a number of reasons. First it brought
about in the course of its development an organization of medical
education, and an establishment of standards that were to be maintained
whenever and wherever there was a true professional spirit down to our
own time. They insisted on a preliminary education of three years of
college work, on at least four years of medical training, on special
study for specialist's work, as in surgery, and on practical training
with a physician or in a hospital before the student was allowed to
practise for himself. At Salerno, too, the department of women's
diseases was given over to women professors, and we have the text-books
of some of these women medical teachers. The license to practise given
to women, however, seems to have been general and did not confine them
merely to the care of women and children. We have records of a number of
these licenses issued to women in the neighborhood of Salerno. This
subject of feminine medical education at Salerno, because of its special
interest in our time, will have a chapter by itself.
These are the special features of medical education in our own time
that we are rather prone to think of as originating with ourselves and
as being indices of that evolution of humanity and progress in mankind
which are culminating in our era. It is rather interesting, then, to
study just how these developments came about and what the genesis of
this great school was. The books of its professors were widely read, not
only in their own generation but for centuries afterwards. With the
invention of printing at the time of the Renaissance most of them were
printed and exerted profound influence over the revival of medicine
which took place at that time. Salerno became the first of the
universities in the modern sense of the word. Here there gathered round
the medical school, first a preparatory department representing modern
college work, and then departments of theology and law, though this
latter department particularly was never quite successful. The fact that
the first university, that of Salerno, should have been organized round
a medical school, the second, that of Bologna, around a law school, and
the third, that of Paris, around a school of theology and philosophy,
would seem to represent the ordinary natural process of development in
human interests. First man is interested in himself and in his health,
then in his property, and finally in his relations to his fellow-man and
to God.
Though much work has been done on the subject in recent years, it is not
easy to trace the origin of the medical school at Salerno. The
difficulty is emphasized by the fact that even the earliest chroniclers
whose accounts we have were not sure as to its origin, and even had
some doubt about the age of the school. Alphanus, usually designated
Alphanus I because there are several of the name, who is one of the
earliest professors whose name and fame have come down to us, gives us
the only definite detail as to the age of the school. He was a
Benedictine monk, distinguished as a literary man, known both as poet
and physician, who was afterwards raised to the Bishopric of Salerno. As
a bishop he was one of the beneficent patrons, to whom the school owed
much. He lived in the tenth century, and states that medicine flourished
in the town before the time of Guimarus II, who reigned in the ninth
century. In the ancient chronicle of Salerno, re-discovered by De Renzi
and published in his "Collectio Salernitana," it is definitely recorded
that the medical school was founded by four doctors,--a Jewish Rabbi
Elinus, a Greek Pontus, a Saracen Adala, an Arab, and a native of
Salerno, each of whom lectured in his native language. There are many
elements in this tradition, however, that would seem to indicate its
mythical origin and that it was probably invented after the event to
account for the presence of teachers in all these languages and the
coming of students from all over the world. The names, for instance, are
apparently corruptions of real names, as can be readily recognized.
Elinus, the Jew, is probably Elias or Eliseus, Adala is a corruption of
Abdallah, and Pontus, as pointed out by Puschmann in his "History of
Medical Education," should probably be Gario-Pontus.
While we do not know exactly when the medical school at Salerno was
founded, we know that a hospital was established there as early as 820.
It was founded by the Archdeacon Adelmus, and was placed under the
control of the Benedictines after it was realized that a religious
order, by its organization, was best fitted for carrying on such
charitable work continuously. Other infirmaries and charitable
institutions, mainly under control of the religious, sprang up in
Salerno. It was the presence of these hospitals in a salubrious climate
that seems first to have attracted the attention of patients and then of
physicians from all over Europe and even adjacent Africa and Asia.
Puschmann says that it is uncertain whether clinical instruction was
imparted in these institutions or not, but the whole tenor of what we
know about the practical character of the teaching at Salerno and of the
fine development of professional medicine there, would seem to argue
that probably those who came to study medicine here were brought
directly in contact with patients.
As early as the ninth century Salerno was famous for its great
physicians. We know the names of at least two physicians, Joseph and
Joshua, who practised there about the middle of the ninth century.
Ragenifrid, a Lombard by his name, was private physician to Prince
Wyamar of Salerno in the year 900. The fact that he was from North Italy
indicates that already foreigners were being attracted, but more than
this that they were obtaining opportunities unhampered by any
Chauvinism. From early in the tenth century physicians from Salerno were
frequently brought to foreign courts to become the attending physicians
to rulers. Patients of the highest distinction from all over Europe
began to flock to Salerno, and we have the names of many of them. In
the tenth century Bishop Adalberon, when ailing, went there, though he
found no cure for his ills. Abbot Desiderius, however, the great
Benedictine scholar of the time, who afterwards became Pope Victor III,
regained his health at Salerno under the care of the great Constantine
Africanus, who was so much impressed by the gentle kindness and deep
learning and the example of the saintly life of his patient that not
long after he went to Monte Cassino to become a Benedictine under
Desiderius, who was abbot there. Duke Guiscard sent his son Bohemund to
Salerno for the cure of a wound received in battle, which had refused to
heal under the ordinary surgical treatment of the time. William the
Conqueror, early in the eleventh century and while still only the Duke
of Normandy, is said to have passed some time at Salerno for a similar
reason.
The most interesting feature of the medical life at Salerno at this time
is the relations between the clergy and the physicians. In the sketch of
the life of Constantine Africanus, which follows this chapter, there is
some account of the friendship between Abbot Desiderius of Monte Cassino
and Constantine Africanus, and the latter's withdrawal from his
professorship to become a Benedictine. One of the physicians of the
early tenth century who stood high in favor with Prince Gisulf was
raised to the Bishopric of Salerno. This was Alphanus, whom we have
already mentioned as a chronicler, a monk, a poet, a physician, and
finally the Bishop of Salerno.
The best proof of how thorough was the medical education at Salerno and
how much influence it exerted even over public opinion is to be found in
the regulation of the practice of medicine, which soon began, and the
insistence upon proper training before permission to practise medicine
was granted. The medical school at Salerno early came to be a recognized
institution in the kingdom of the Two Sicilies, representing a definite
standard of medical training. It is easy to understand that the
attraction which Salerno possessed for patients soon also brought to the
neighborhood a number of irregular physicians, travelling quacks, and
charlatans. Wealthy patients were coming from all over the world to be
treated at Salerno. Many of them doubtless were sufferers from incurable
diseases and nothing could be done for them. Often they would be quite
unable to return to their homes and would be surely unwilling to give up
all hope if anybody promised them anything of relief. There was a rich
field for the irregular, and of course, as always, he came. Salerno had
already shown what a good standard of medical education should be, and
it is not surprising, then, that the legal authorities in this part of
the country proceeded to the enforcement of legal regulations demanding
the attainment of this standard, in order that unfit and unworthy
physicians might not practise medicine to their own benefit but to the
detriment of the patients.
Accordingly, as early as the year 1140, King Ruggiero (Roger) of the Two
Sicilies promulgated the law: "Whoever from this time forth desires to
practise medicine must present himself before our officials and judges,
and be subject to their decision. Anyone audacious enough to neglect
this shall be punished by imprisonment and confiscation of goods. This
decree has for its object the protection of the subjects of our kingdom
from the dangers arising from the ignorance of practitioners."
Just about a century later the Emperor Frederick II, the Hohenstaufen,
in the year 1240, extended this law, emphasized it, and brought it
particularly into connection with the great medical school of the Two
Sicilies, of which territory he was the ruler. This law has often been
proclaimed as due to his personality rather than to his times,--as
representing his very modern spirit and his progressive way of looking
at things. There is no doubt that certain personal elements for which he
should be given due credit are contained in the law. To understand it
properly, however, one must know the law of King Roger of the preceding
century; and then it is easy to appreciate that Frederick's regulation
is only such a development of the governmental attitude toward medical
practice as might have been expected during the century since Roger's
time. It has sometimes been suggested that this law made by the Emperor
Frederick, who was so constantly in bitter opposition to the Papacy, was
issued in despite of the Church authorities and represents a policy very
different from any which they would have encouraged. The early history
of Salerno, even briefly as we have given it, completely contradicts any
such idea. The history of medical regulation at the beginning of the
next century down at Montpellier moreover, where the civil authorities
being weak the legal ordering of the practice of medicine was
effectively taken up by the Church, and the authority for the issuance
of licenses to practise was in the hands of the bishops of the
neighborhood, shows clearly that it is not because of any knowledge of
the real medical history of the times that such remarks are made, but
from a set purpose to discredit the Church.
The Emperor Frederick's law deserves profound respect and consideration
because of the place that it holds in the legal regulation of the
practice of medicine. Anyone who thinks that evolution must have brought
us in seven centuries much farther in this matter than were the people
of the later Middle Ages should read this law attentively. Everyone who
is interested in medical education should have a copy of it near him,
because it will have a chastening effect in demonstrating not only how
little we have done in the modern time rather than how much, but above
all how much of decadence there was during many periods of the interval.
The law may be found in the original in "The Popes and Science" (Fordham
University Press, N.Y., 1908). Three years of preliminary university
education before the study of medicine might be taken up, four years of
medical studies proper before a degree was given, a year of practice
with a regularly licensed physician before a license to practise could
be obtained, a special course in anatomy if surgery were to be
practised; all this represents an ideal we are striving after at the
present time in medical education. Besides this, Frederick's law also
regulates medical fees, requires gratuitous attendance on the poor for
the privilege of practice accorded by the license, though the general
fees are of a thoroughly professional character and represent for each
visit of the physician about the amount of daily wage that the ordinary
laborer of that time earned. Curiously enough, this same ratio of
emolument has maintained itself. This law was also a pure drug law,
regulating the practice of pharmacy, and the price as well as the purity
of drugs, and the relations of physicians, druggists, and the royal drug
inspectors whose business it was to see that only proper drugs were
prepared and sold.
All this is so much more advanced than we could possibly have imagined,
only that the actual documents are in our possession, that most people
refuse to let themselves be persuaded in spite of the law that it could
have meant very much. Especially as regards medical education are they
dubious as to conditions at this time. To them it seems that it can make
very little difference how much time was required for medical study or
for studies preliminary to medicine, since there was so little to be
learned. The age was ignorant, men knew but little, and so very little
could be imparted no matter how much time was taken.
This is, I fear, a common impression, but an utterly false one. The
preliminary training that is the undergraduate work at the universities
consisted of the Seven Liberal Arts--the trivium and quadrivium, which
embraced logic, rhetoric, grammar, metaphysics, under which was included
not a little of physics, cosmology in which some biology was studied, as
well as psychology and mathematics, astronomy, and music. This was a
thoroughly rounded course in intellectual training. No wonder that
Professor Huxley said in his Inaugural Address as Rector of Aberdeen, "I
doubt if the curriculum of any modern university shows so clear and
generous a comprehension of what is meant by culture as this old trivium
and quadrivium does." There is no doubt at all about the value of the
undergraduate training, nor of the scholarship of the men who were
turned out under the system, nor of their ability to concentrate their
minds on difficult subjects--a faculty that we strive to cultivate in
our time and do not always congratulate ourselves on securing to the
degree, at least, that we would like.
As to the medical teaching, Ægidius, often called Gilles of Corbeil, who
was a graduate of Salerno and afterward became the physician-in-ordinary
to Philip Augustus, King of France, thought that he could not say too
much for the training in medicine that was given at this first of the
medical schools. One thing is sure, the professors were eminently
serious, the work taken up was in many ways thoroughly scientific, and
some of the results of the medical investigations of that early day are
interesting even now. The descriptions of diseases that we have from the
Salernitan school are true to nature and are replete with many original
observations. Puschmann says: "The accounts given of intermittent fever,
pneumonia, phthisis, psoriasis, lupus, which they called the malum
mortuum, of ulcers on the sexual organs, among which it is easy to
recognize chancre, and of the disturbances of the mental faculties,
especially deserve mention." They seem to have been quite expert in
their knowledge of phthisis. In the treatment of it they laid great
stress upon the giving up of a strenuous life, the living a rather easy
existence in the open air, and a suitable diet. When the commencement of
consumption was suspected, the first prescription was a good course of
strengthening nourishment for the patient. On the other hand, they
declared that the cases in which diarrhea supervened during consumption
soon proved fatal. In general, with regard to people who were liable to
respiratory diseases, they insisted upon life in an atmosphere of
equable temperature. Though the custom was almost unheard of in the
Salerno of that time, and indeed at the present time there is very
little heating during the winter in southern Italy, they insisted that
patients who were liable to pulmonary affections should have their rooms
heated.
On the other hand, they suggested the cooling of the air of the
sick-room, as we have noted in the chapter on Constantine Africanus, and
Afflacius recommended the employment of an apparatus from which water
trickled continuously in drops to the ground and then evaporated. Baths
and bleeding were employed according to definite indications and diet
was always a special feature. They had a number of drugs and simples,
and the employment of some of them is interesting. Iron was prescribed
for enlargement of the spleen. The internal use of sea sponge, in which
of course there is a noteworthy proportion of iodine, was recommended
for relief from the symptoms of goitre by reducing its size. Iodine has
been used so much ever since in this affection, even down to our own
day, that this employment of one of its compounds is rather striking.
Massage of the goitre was also recommended, and this mode of treatment
was commonly employed for a number of ailments.
Probably the best idea that can be obtained in brief space of the
achievements of the University of Salerno is to be found in Pagel's
appreciation of Salerno's place in the history of medicine in his
chapters on "Medicine in the Middle Ages" in Puschmann's "Handbuch der
Geschichte der Medizin" (Berlin, 1902). He said: "If we take up now the
accomplishments of the school of Salerno in the different departments
there is one thing that is very remarkable. It is the rich independent
productivity with which Salerno advanced the banners of medical science
for hundreds of years almost as the only autochthonous centre of medical
influence in the whole West. One might almost say that it was like a
_versprengten Keim_--a displaced embryonic element--which, as it
unfolded, rescued from destruction the ruined remains of Greek and Roman
medicine. This productivity of Salerno, which may well be compared in
quality and quantity with that of the best periods of our science, and
in which no department of medicine was left without some advance, is one
of the striking phenomena of the history of medicine. While positive
progress was not made, there are many noteworthy original observations
to be chronicled. It must be acknowledged that pupils and scholars set
themselves faithfully to their tasks to further as far as their strength
allowed the science and art of healing. In the medical writers of the
older period of Salerno who had not yet been disturbed by Arabian
culture or scholasticism, we cannot but admire the clear, charmingly
smooth, light-flowing diction, the delicate and honest setting forth of
cases, the simplicity of their method of treatment, which was to a great
extent dietetic and expectant, and while we admire the carefulness and
yet the copiousness of their therapy, we cannot but envy them a certain
austerity in their pharmaceutic formulas and an avoidance of
medicamental polypragmasia. The work in internal medicine was especially
developed. The contributions to it from a theoretic and a literary
standpoint, as well as from practical applications, found ardent
devotees."
Less than this could scarcely have been expected from the medical school
which brought such an uplift of professional dignity and advance in the
standards of medical education that are to be noticed in connection with
Salerno. Registration, licensure, preliminary education, adequate
professional studies, clinical experience under expert guidance, even
special training for surgical work, all came in connection with this
great medical school. Such practical progress in medical education could
not have been made but by men who faced the problems of the practice of
medicine without self-deception and solved them as far as possible by
common-sense, natural, and rational methods.
It is usually said that at Salerno surgery occupied an inferior
position. It is true that we have less record of it in the earlier years
of Salerno than we would like to see. It was somewhat handicapped by the
absence of human dissection. This very important defect was not due to
any Church opposition to anatomy, as has often been said, but to the
objection that people have to seeing the bodies of their friends or
acquaintances used for anatomical purposes. In the comparatively small
towns of the Middle Ages there were few strangers, and therefore very
seldom were there unclaimed bodies. The difficulty was in the obtaining
of dissecting material. We had the same difficulty in this country until
about two generations ago, and the only way that bodies could be
obtained regularly was by "resurrecting" them, as it was called, from
graveyards. In the absence of human subjects, anatomy was taught at
Salerno upon the pig. The principal portion of the teaching in anatomy
consisted of the demonstration of the organs in the great cavities of
the body and their relations, with some investigations of their form and
the presumed functions of the corresponding organs in man. Copho's
well-known "Anatomy of the Pig" was a text-book written for the students
of Salerno. In spite of its limitations, it shows the beginnings of
rather searching original inquiry and even some observations in
pathological anatomy. It is simple and straightforward and does not
profess to be other than it is, though it must be set down as the first
reasonably complete contribution to comparative anatomy.
When their surgery came to be written down, however, it gave abundant
evidence of the thoroughness with which this department of medicine had
been cultivated by the Salernitan faculty. We have the text-book of
Roger, with the commentary of Rolando, and then the so-called commentary
of the Four Masters. These writings were probably made rather for the
medical school at Bologna than that of Salerno, though there is no
doubt that at least Roger and Rolando received their education at
Salerno and embodied in their writings the surgical traditions of that
school. While I have preferred, in order to have a connected story of
surgical development, to treat of their contributions to their specialty
under the head of the "Great Surgeons of the Medieval Universities," it
seems well to point out here that they must be considered as
representing especially the surgical teaching of the older medical
school of Salerno. There are many interesting features of the old
teaching that they have embodied in their books. For instance, at
Salerno both sutures and ligatures were employed in order to prevent
bleeding. We are rather accustomed to think of such uses of thread, and
especially the ligature, as being much later inventions. The fact of the
matter is, however, that ligatures and sutures were reinvented over and
over again and then allowed to go out of use until someone who had no
idea of their dangers came to reinvent them once more.[8]
Much is often said about the place of Arabian surgery and medicine at
this time, and the influence that they had over the medical teaching and
thinking of the period. To trust many of the shorter histories of
medicine the Arabs must be given credit for more of the medical thought
of this time than any other medical writers or thinkers. It is
forgotten, however, apparently, that in the southern part of Italy,
where Salerno was situated, Greek influence never died out. This had
been a Greek colony in the olden time and continued to be known for many
centuries after the Christian era as Magna Græcia. Greek medicine, then,
had more influence here than anywhere else. As a matter of fact, the
beginnings of Salernitan teaching are all Greek and not at all Arabian.
This is as true in surgery as in medicine. I have quoted Gurlt in the
chapter on "Great Surgeons of the Medieval Universities," insisting that
the Salernitan school owed nothing at all to Arabian surgery. Salernitan
medicine was, during the twelfth century, just as free from Arabian
influence. When Arabian medicine makes itself felt, as pointed out by
Pagel in his "Geschichte der Heilkunde im Mittelalter,"[9] far from
exerting a beneficial influence, it had a rather unfortunate effect. It
led especially to an oversophistication of medicine from the standpoint
of drug therapeutics. The Arabian physicians trusted nature very little.
In this they were like our forefathers of medicine one hundred years
ago, of whom Rush was the typical representative--so history repeats
itself.
Before the introduction of Arabian medicine the Salernitan school of
medicine was noted for its common-sense methods and its devotion to all
the natural modes of healing. It looked quite as much to the prevention
of disease as its treatment. Diet and air and water were always looked
upon as significant therapeutic aids. With the coming of Arabian
influence there began, says Pagel, "as the literature of the times shows
very well, that rule of the apothecary in therapeutics which was an
unfortunate exaggeration. Now all the above-mentioned complicated
prescriptions came to be the order of the day. Apparently the more
complicated a prescription the better. Dietetics especially was
relegated to the background. Salerno, at the end of the twelfth century,
had already reached its highest point of advance in medicine and was
beginning to decline. Decadence was evident in so far as all the medical
works that we have from that time are either borrowings or imitations
from Arabian medicine with which eventually Salernitan medical
literature became confounded. Only a few independent authors are found
after this time." This is so very different from what is ordinarily
presumed to have been the case and openly proclaimed by many historians
of medicine because apparently they would prefer to attribute
scientific advance to the Arabs than to the Christian scholars of the
time, that it is worth while noting it particularly.
Salerno was particularly rich in its medical literary products. Very
often we have not the names of the writers. Apparently there is good
reason to think that a number of the professors consulted together in
writing a book, and when it was issued it was considered to be a
text-book of the Salernitan school of medicine rather than of any
particular professor. This represents a development of co-operation on
the part of colleagues in medical teaching that we are likely to think
of as reserved for much later times.
The most important medical writing that comes to us from Salerno, in the
sense at least of the work that has had most effect on succeeding
generations, has been most frequently transcribed, most often translated
and committed to memory by many generations of physicians, is the
celebrated Salernitan medical poem on hygiene. The title of the original
Latin was "Regimen Sanitatis Salernitanum." It was probably written
about the beginning of the twelfth century. A century or so later it
came to be the custom to call medical books after flowers, and so we had
the "Lilium Medicinæ" and the "Flos Medicinæ" down at Montpellier, and
this became the "Flos Medicinæ" of Salerno. Pagel calls it the
quintessence of Salernitan therapeutics.
For many centuries portions at least of this Latin medical poem were as
common in the mouths of physicians all over Europe as the aphorisms of
Hippocrates or the sayings of Galen. Probably this enables us to
understand the great reputation that the Salernitan school enjoyed and
the influence that it wielded better than anything else. The poem is
divided into ten principal parts, containing altogether about 3,500
lines. The first part on hygiene has 855 lines in eight chapters. The
second part on _materia medica_, though containing only four chapters,
has also about 800 lines. Anatomy and physiology are crowded into about
200 lines, etiology has something over 200, semiotics has about 250,
pathology has but thirty lines more or less, and therapeutics about 400;
nosology has about 600 more, and finally there is something about the
physician himself, and an epilogue. As Latin verses go, when written for
such purposes, these are not so bad, though some of them would grate on
a literary ear. The whole work makes a rather interesting compendium of
medicine, with therapeutic indications and contra-indications, and
whatever the physician of the medieval period needed to have ready to
memory. Some of its prescriptions, both in the sense of formulæ and of
directions to the patient, have quite a modern air.
One very interesting contribution to medical literature that comes to us
from Salerno bears the title, "The Coming of a Physician to His Patient,
or An Instruction for the Physician Himself." We have had a number of
such works published in recent years, but it is a little surprising to
have the subject taken up thus early in the history of modern
professional life. It is an extremely valuable document, as
demonstrating how practical was the teaching at Salerno. The work is
usually ascribed to Archimattheas, and it certainly gives a vivid
picture of the medical customs of the time. The instruction for the
immediate coming of the physician to his patient runs as follows: "When
the doctor enters the dwelling of his patient, he should not appear
haughty, nor covetous, but should greet with kindly, modest demeanor
those who are present, and then seating himself near the sick man accept
the drink which is offered him (_sic_) and praise in a few words the
beauty of the neighborhood, the situation of the house, and the
well-known generosity of the family,--if it should seem to him suitable
to do so. The patient should be put at his ease before the examination
begins and the pulse should be felt deliberately and carefully. The
fingers should be kept on the pulse at least until the hundredth beat in
order to judge its kind and character; the friends standing round will
be all the more impressed because of the delay and the physician's words
will be received with just that much more attention."
The old physician evidently realized very well how much influence on the
patient's mind meant for the course of the disease. For instance, he
recommends that the patient should be asked to confess and receive the
sacraments of the Church before the doctor sees him, for if mention is
afterwards made of this the patient may believe that it is because the
doctor thinks that there is no hope for him. For the purpose of
producing an effect upon the patient's mind, the old physician does not
hesitate even to suggest the taking advantage of every possible source
of information, so as to seem to know all about the case. "On the way to
see the sick person he [the physician] should question the messenger
who has summoned him upon the circumstances and the conditions of the
illness of the patient; then, if not able to make any positive diagnosis
after examining the pulse and the urine, he will at least excite the
patient's astonishment by his accurate knowledge of the symptoms of the
disease and thus win his confidence."
At the end of these preliminary instructions there is a rather
diplomatic--to say the least--bit of advice that might perhaps to a
puritanic conscience seem more politic than truthful. Since the old
professor insists so much on not disturbing the patient's mind by a bad
prognosis or any hint of it, and since even some exaggeration of what he
might think to be the serious outlook of the case to friends would only
lead to greater care of the patient, there is probably much more
justification for his suggestion than might be thought at first glance.
He says, "When the doctor quits the patient he should promise him that
he will get quite well again, but he should inform his friends that he
is very ill; in this way, if a cure is affected, the fame of the doctor
will be so much the greater, but if the patient dies people will say
that the doctor had foreseen the fatal issue."
The story of the medical school of Salerno, even thus briefly and
fragmentarily told, illustrates very well how old is the new in
education,--even in medical education. There is scarcely a phase of
modern interest in medical education that may not be traced very clearly
at Salerno though the school began its career a thousand years ago, and
ceased to attract much attention over six hundred years ago. We owe
most of our knowledge of the details of its organization and teaching to
De Renzi. Without the devotion of so ardent a scholar it would have been
almost impossible for us to have attained so complete a picture of
Salernitan activities. As it is, as a consequence of his work we are
able to see this first of modern medical schools developing very much as
do our most modern medical schools. There has been an accumulation of
medical information in the thousand years, but the ways and modes of
facing problems and many of the solutions of them do not differ from
what they were in the distant past. The more we know about any
particular period, the more is this brought home to us. It is for this
that study of particular periods and institutions of the olden time, as
of Salerno, grows increasingly interesting, because each new detail
helps to fill in sympathetically the new-old picture of human activity
as it may be seen at all times.
VII
CONSTANTINE AFRICANUS
Probably the most important representative of the medical school at
Salerno, certainly the most significant member of its faculty, if we
consider the wide influence for centuries after his time that his
writings had, was Constantine Africanus. He is interesting, too, for
many other reasons, for he is the first representative, in modern times,
that is, who, after the incentive of antiquity had passed, devoted
himself to creating a medical literature by translations, by editions,
and by the collation of his own and others' observations on medical
subjects. He is the connecting link between Arabian medicine and Western
medical studies. The fact that he was first a traveller over most of the
educational world of his time, then a professor at the University of
Salerno who attracted many students, and finally a Benedictine monk in
the great abbey at Monte Cassino, shows how his life ran the gamut of
the various phases of interest in the intellectual world of his time. It
was his retirement to the famous monastery that gave him the
opportunity, the leisure, the reference library for consultation that a
writer feels he must have near him, and probably also the means
necessary for the publication of his works. Not only did the monks of
Monte Cassino itself devote themselves to the copying of his many
books, but other Benedictine monasteries in various parts of the world
made it a point to give wide diffusion to his writings.
As a study in successful publication, that is, in the securing of wide
attention to writings within a short time, the career of Constantine and
the story of his books would be extremely interesting. Medieval
distribution of books is usually thought to have been rather halting,
but here was an exception. It was largely because Benedictines all over
the world were deeply interested in what this brother Benedictine was
writing that wide distribution was secured for his work within a very
short time. His superiors among the Benedictines had a profound interest
in what he was doing. The great Benedictine Abbot Desiderius of Monte
Cassino, who afterwards became Pope, used all of his extensive influence
in both positions to secure an audience for the books--hence the many
manuscript copies of his writings that we have. It is probable that
Constantine established a school of writers at Monte Cassino, for he
could scarcely have accomplished so much by himself as has been
attributed to him. Besides, his works attracted so much attention that
writers of immediately succeeding generations who wanted to secure
attention for their works sometimes attributed them to him in order to
take advantage of his popularity. It is rather difficult, then, to
determine with absolute assurance which are Constantine's genuine works.
Some of those attributed to him are undoubtedly spurious. What we know
with certainty, however, is that his authentic works meant much for his
own and after generations.
Constantine was born in the early part of the eleventh century, and died
near its close, having lived probably well beyond eighty years of age,
his years running nearly parallel with his century. His surname,
Africanus, is derived from his having been born in Africa, his
birthplace being Carthage. Early in life he seems to have taken up with
ardor the study of medicine in his native town, devoting himself,
however, at the same time to whatever of physical science was available.
Like many another young man since his time, not satisfied with the
knowledge he could secure at home, he made distant journeys, gathering
medical and scientific information of all kinds wherever he went.
According to a tradition that seems to be well grounded, some of these
journeys took him even into the far East. During his travels he became
familiar with a number of Oriental languages, and especially studied the
Arabian literature of science very diligently.
At this time the Arabs, having the advantage of more intimate contact
with the Greek medical traditions in Asia Minor, were farther advanced
in their knowledge of the medical sciences than the scholars in the
West. They had better facilities for obtaining the books that were the
classics of medicine, and, with any desire for knowledge, could scarcely
fail to secure it.
What was best in Arabian medicine was brought to Salerno by Constantine
and, above all, his translation of many well-known Arabian medical
authors proved eminently suggestive to seriously investigating
physicians all over the world in his time. Before he was to be allowed
to settle down to his literary work, however, Constantine was to have a
very varied experience. Some of this doubtless was to be valuable in
enabling him to set the old Arabian teachers of medicine properly before
his generation. After his Oriental travels he returned to his native
Carthage in order to practise medicine. It was not long, however, before
his superior medical knowledge, or, at least, the many novelties of
medical practice that he had derived from his contact with the East,
drew upon him the professional jealousy of his colleagues. It is very
probable that the reputation of his extensive travels and wide knowledge
soon attracted a large clientele. This was followed quite naturally by
the envy at least of his professional brethren. Feeling became so
bitter, that even the possibility of serious personal consequences for
him because of false accusations was not out of the question. Whenever
novelties are introduced into medical science or medical practice, their
authors are likely to meet with this opposition on the part of
colleagues, and history is full of examples of it. Galvani was laughed
at and called the frogs' dancing-master; Auenbrugger was made fun of for
drumming on people; Harvey is said to have lost half of his consulting
practice;--all because they were advancing ideas that their
contemporaries were not ready to accept. We are rather likely to think
that this intolerant attitude of mind belongs to the older times, but it
is rather easy to trace it in our own.
In Constantine's day men had ready to hand a very serious weapon that
might be used against innovators. By craftily circulated rumors the
populace was brought to accuse him of magical practices, that is, of
producing his cures by association with the devil. We are rather prone
to think little of a generation that could take such nonsense seriously,
but it would not be hard to find analogous false notions prevalent at
the present time, which sometimes make life difficult, if not dangerous,
for well-meaning individuals.[10] Life seems to have been made very
uncomfortable for Constantine in Carthage. Just the extent to which
persecution went, however, we do not know. About this time Constantine's
work attracted the attention of Duke Robert of Salerno. He invited him
to become his physician. After he had filled the position for a time a
personal friendship developed, and, as has often happened to the
physicians of kings, he became a royal counsellor and private secretary.
When the post of professor of medicine at Salerno fell vacant, it is not
surprising, then, that Constantine should have been made professor, and
from here his teaching soon attracted the attention of all the men of
his time.
Constantine seems to have greatly enhanced the reputation of the medical
school, and added to the medical prestige of Salerno. After teaching for
some ten years there, however, he gave up his professorship--the highest
position in the medical world of the time--apparently with certain plans
in mind. He wanted leisure for writing the many things in medicine that
he had learned in his travels in the East, so as to pass his precious
treasure of knowledge on to succeeding generations; and then, too, he
seems to have longed for that peace that would enable him not only to do
his writing undisturbed, but to live his life quietly far away from the
strife of men and the strenuous existence of a court and of a great
school.
There was probably another and more intimate personal reason for his
retirement. Abbot Desiderius of the Benedictine Abbey of Monte Cassino,
not far away, had become a close and valued friend. Before having been
made abbot, Desiderius and Constantine probably were fellow professors
at Salerno, for we know that Desiderius himself and many of his fellow
Benedictines taught in the undergraduate department there. Desiderius
enjoyed the reputation of being one of the most learned men of the time
when his election to the abbacy at Monte Cassino took him away from
Salerno. His departure was a blow to Constantine, who had learned by
years of friendship that to be near his intimate friend, the pious
scholarly Benedictine, was a solace in life and a never failing
incentive to his own intellectual work. Desiderius seems, indeed, to
have been a large factor in influencing the great physician to write his
books rather than devote himself to oral teaching, since the circulation
of his writing would confer so much more of benefit on a greater number
of people. Perhaps another element in the situation was that Desiderius
was desirous of having the learned physician, the travelled scholar, at
Monte Cassino, for the sake of his influence on the scholarship of the
abbey, and for the incentive that he would be to the younger monks to
apply themselves to the varied field of knowledge which the Benedictines
had chosen for themselves at this time.
Whatever hopes of mutual solace and helpfulness and of the joys of
intimate close friendship may have been in the minds of these two most
learned men of their time, they were destined to be grievously
disappointed. Only a few years after Constantine's entrance into the
monastery at Monte Cassino Desiderius was elected Pope. The humble
Benedictine did not want to take the exalted position, but it was
plainly shown to him that it was his duty, and that he must not shirk
it. Accordingly, under the name of Pope Victor III, he became one of the
great Popes of the eleventh century. One might think that he could have
summoned Constantine to Rome, but perhaps he knew that his friend would
prefer the quietude of the cloister, and then, too, probably he wanted
to allow him the opportunity to accomplish that writing for which
Constantine and himself had planned when the great physician entered the
monastery.
All that we know for sure is that some twenty years of Constantine's
life were spent as a monk in Monte Cassino, where he devoted his time
mainly to the writing of his books. One bond of union there was. Each of
the works, as soon as completed, was sent off to the Pope as long as he
lived. On the other hand, though busy with his Papal duties, Pope Victor
constantly stimulated Constantine, even from distant Rome, to go on with
his work. There were messages of brotherly interest and solicitude just
as in the old days. The great African physician's best known work, the
so-called "Liber Pantegni," which is really a translation of the
"Khitaab el Maleki" of Ali Ben el-Abbas, is dedicated to Desiderius.
Constantine wrote a number of other books, most of them original, but it
is difficult now to decide just which of those that pass under his name
are genuine. Many were subsequently attributed to him that are surely
not his.
These translators of the Middle Ages proved to be not only the channels
through which information came to their generations, but they were also
incentives to study and investigation. It is when men can get a certain
amount of information rather easily that they are tempted to seek
further in order to solve the problems that present themselves. There
are three great translators whose work meant much for the Middle Ages at
this time. They were, besides Constantine in the eleventh century,
Gerard of Cremona, in the twelfth, and the Jewish Faradj Ben Salim, at
Naples, in the thirteenth. Gerard did in Spain for the greater Arabian
writers what Constantine had accomplished for those of lesser import.
Under the patronage of the Emperor Frederick Barbarossa, he published
translations of Rhazes, Isaac Judæus, Serapion, Abulcasis, and Avicenna.
His work was done in Toledo, the city in which, during the twelfth and
thirteenth centuries, so many translators were at work making books for
the Western world.
Constantine did much more than merely bring out his translations of
Arabian works. He gave a zest to the study of the old masters, issued
editions of certain, at least, of the works of Hippocrates ("Aphorisms")
and Galen ("Microtechnics"), and, in general, called attention to the
precious treasure of medical lore that must be used to advantage if men
were to teach the rising generation out of the accumulated knowledge of
the past. Pagel, in Puschmann's "Handbook," does not hesitate to say
that "a farther merit of Constantine must be recognized, inasmuch as
that not long after his career the second epoch of the school of Salerno
begins, marked not only by a wealth of writers and writings on medicine,
but, above all, because from this time on the study of Greek medicine
received renewed encouragement through the Latin versions of the Arabian
literature. We may think as we will of the worth of these works, but
this much is sure, that in many ways they brought about a broadening and
an improvement of Greek knowledge, especially from the pharmacopeia
standpoint."
Probably the best evidence that we have for Constantine's influence on
his generation is to be found in what was accomplished by men who
acknowledged with pride that he was their master, and who thought it a
mark of distinction to be reckoned as his disciples.
Among these especially noteworthy is Johannes Afflacius, or Saracenus
(whose surname of the Saracen probably means that he, too, came from
Africa, as his master did). He was the author of two treatises on
"Fevers and Urines," and the so-called "Cures of Afflacius." Some of
these cures he directly attributed to Constantine. Then there is a
Bartholomew who wrote a "Practica," or "Manual of the Practice of
Medicine," with the sub-title, "Introductions to and Experiments in the
Medical Practice of Hippocrates, Constantine, and the Greek Physicians."
Bartholomew represents himself as a disciple of Constantine. This
"Practica" of Bartholomew was one of the most commonly used books of the
twelfth and thirteenth centuries throughout Europe. There are manuscript
commentaries and translations, and abstracts from it not only in the
Latin tongues, but especially in the Teutonic languages. Pagel refers to
manuscripts in High and Low Dutch, and even in Danish. The Middle High
Dutch manuscripts of this "Practica" of Bartholomew come mainly from the
thirteenth century, and have not only a special interest because of
their value in the history of philology, but because they are the main
sources of all the later books on drugs which appeared in very large
numbers in German. They have a very great historico-literary interest,
especially for pharmacology.
To Afflacius we owe a description of a method of reducing fever that is
not only ingenious, but, in the light of our recently introduced bathing
methods for fever, is a little startling. In his book on "Fevers and
Urines," Afflacius suggests that when the patient's fever makes him very
restless, and especially if it is warm weather, a sort of shower bath
should be given to him. He thought that rain water was the best for this
purpose, and he describes its best application as in rainy fashion,
_modo pluviali_. The water should be allowed to flow down over the
patient from a vessel with a number of minute perforations in the
bottom. A number of the practical hints for treatment given by Afflacius
have been attributed to Constantine.
Constantine's reputation has, in the opinion of some writers, been hurt
by two features of his published works, as they have come to us, that we
find it difficult to understand. One of these is that his translations
from the Arabic were made mainly not of the books of the great leaders
of Arabian medicine, but from certain of the less important writers. The
other is that it does not seem always to have been made clear in the
manuscripts that have come down to us, whether these writings were
translations or original writings. Some have even gone so far as to
suggest that Constantine himself would have been quite willing to
receive the credit for these writings.
As to the first of these objections, it may be said that very probably
Constantine, in his travels, had come to realize that the books of the
great Arabian physicians, Rhazes, Abulcasis, Avicenna, and others,
already received so much attention that the best outlook for medicine
was to call particular notice to the writings of such lesser lights as
Ali Abbas, Isaac Judæus, Abu Dschafer, and others of even less note.
Certainly we cannot but feel that his judgment in the matter must have
been directed by reasons that we may not be able to understand at
present, but that must have existed, for all that we know of the man
proves his character as a practical, far-sighted scholar. Besides, it
seems not unlikely that but for his interest in them we would not at the
present time possess the translations of these minor Arabian writers,
and that would be an unfortunate gap in medical history.
The other misunderstanding with regard to Constantine refers to the fact
that it is now almost impossible to decide which are his own and which
are the writings of others. It has been said that he even tried to palm
off some of the writings of others as his own. This seems extremely
unlikely, however, knowing all that we do about his life; and the
suspicion is founded entirely on manuscripts as we have them at the
present time, about a thousand years after he lived. What mutilations
these manuscripts underwent in the course of various copyings is hard
now to estimate. Monastic copyists might very well have left out Arabian
names, because they were mainly interested in the fact that they were
providing for their readers works that had received the approval of
Constantine, and the translation of which at least had been made under
his direction. It is quite clear that he did not do all the translating
himself, and that he probably must have organized a school of medical
translators at Monte Cassino. Then just how the various works would be
looked at is very dubious. Undoubtedly many of the translations were
done after his death, or certainly finished after his time, and at last
attributed to him, because he was the moving spirit and had probably
selected the books that should be translated, and made suggestions with
regard to them. For all of his monks he was, as masters have ever been
for disciples, much more important, and rightly so, than those writers
to whom he referred them.
The whole question of plagiarism in these medieval times, as I have
pointed out elsewhere, is entirely different from that of the present
time. Now a writer may consciously or unconsciously claim another
writing as his own. We have come to a time when men think much of their
individual reputations. It was no uncommon thing, however, in the Middle
Ages, and even later in the Renaissance, for a writer to attribute what
he had written to some distinguished literary man of the preceding time,
and sign that writer's name to his own work. The idea of the later
author was to secure an audience for his thoughts. He seemed to be quite
indifferent whether people ever knew just who the writer was, but he
wanted to influence humanity by his writings. He thought much more of
this than of any possible reputation that might come to him. Of course,
there was no question of money. There never has been any question of
money-making whenever the things written have been really worth while.
Literature that has deeply influenced mankind has never paid.
Publications that have paid are insignificant works that have touched
superficially a whole lot of people. To think of Constantine as a
plagiarist in our modern sense of the word, as trying to take the credit
for someone else's writings, is to misunderstand entirely the times in
which he lived, and to ignore the real problem of plagiarism at that
time.
With the accumulation of information with regard to the history of
medicine in his time, Constantine's reputation has been constantly
enhanced. It is not so long since he was considered scarcely more than a
monkish chronicler, who happened to have taken medicine rather than
history for his field of work. Gradually we have come to appreciate all
that he did for the medicine of his time. Undoubtedly his extensive
travels, his wide knowledge, and then his years of effort to make
Oriental medicine available for the Western civilization that was
springing up again among the peoples who had come to replace the Romans,
set him among the great intellectual forces of the Middle Ages. Salerno
owed much to him, and it must not be forgotten that Salerno was the
first university of modern times, and, above all, the first medical
school that raised the dignity of the medical profession, established
standards of medical education, educated the public mind and the rulers
of the time to the realization of the necessity for the regulation of
the practice of medicine, and in many ways anticipated our modern
professional life. That the better part of his life work should have
been done as a Benedictine only serves to emphasize the place that the
religious had in the preservation and the development of culture and of
education during the Middle Ages.
VIII
MEDIEVAL WOMEN PHYSICIANS
Very probably the most interesting chapter for us of the modern time in
the history of the medical school at Salerno is to be found in the
opportunities provided for the medical education of women and the
surrender to them of a whole department in the medical school, that of
Women's Diseases. While it is probable that Salerno did not owe its
origin to the Benedictines, and it is even possible that there was some
medical teaching there for all the centuries of the Middle Ages from the
Greek times, for it must not be forgotten that this part of Italy was
settled by Greeks, and was often called Magna Græcia, there is no doubt
at all that the Benedictines exercised great influence in the counsels
of the school, and that many of the teachers were Benedictines, as were
also the Archbishops, who were its best patrons, and the great Pope
Victor III, who did much for it. For several centuries the Benedictines
represented the most potent influence at Salerno.
For most people who are not intimately familiar with monastic life, and,
above all, with the story of the Benedictines, their prestige at Salerno
might seem to be enough of itself to preclude all possibility of the
education of women in medicine at Salerno. For those who know the
Benedictines well, however, such a departure as the accordance of
opportunities for women to study medicine would seem eminently in
keeping with the practical wisdom of their rules and the development of
their work. From the beginning the Benedictines recognized that a
monastic career should be open to women as well as to men, and
Benedict's sister, Scholastica, established convents for them, as her
brother did the Benedictine monasteries, thus providing a vocation for
women who did not feel called upon to marry. That the members of the
order should recognize the advisability of affording women the
opportunity to study medicine, and of handing over to them the
department of women's diseases in a medical school in which they had a
considerable amount of authority, seems, then, indeed, only what might
have been expected of them.
We are prone in the modern time to think that our generation is the
first to offer to women any facilities or opportunities for education in
medicine. We are prone, however, just in the same way, to consider that
a number of things that we are doing are now being done for the first
time. As a matter of fact, it is extremely difficult to find any
important movement or occupation that is not merely a repetition of a
previous interest of mankind. The whole question of feminine education
we are apt to think of as modern, forgetting that Plato insisted in his
"Republic," as absolutely as any modern feminist, that women should have
the same opportunities for education as men, and that at Rome, at the
end of the Republic and the beginning of the Empire, the women occupied
very much the same position in social life as our own at the present
time. Their husbands supplied the funds, and they patronized the
artists, gave receptions to the poets, lionized the musicians, and, in
general, "went after culture" in a way that is a startling reminder of
what we are familiar with in our own time. Just as soon as Christianity
began to influence education, women were given abundant opportunities
for higher education in all forms. In Ireland, the first nation
completely converted to Christianity,--where, therefore, the national
policy in education could be shaped by the Church without
hindrance,--St. Brigid's school at Kildare was scarcely less famous than
St. Patrick's at Armagh. It had several thousand students, and, to a
certain extent at least, co-education existed. In Charlemagne's time,
with the revival of education on the Continent, the women of the
Imperial Court attended the Palace School, as well as the men. In the
thirteenth century we find women professors in every branch at Italian
universities. Some of them were at least assistants in anatomy. The
Renaissance women were, of course, profoundly educated. In a word, we
have many phases of feminine education, though with intervals of
absolutely negative interest, down the centuries.
There had evidently been quite a considerable amount of opportunity, if
not of actual encouragement, for women in medicine, both among the
Greeks and the Romans, in the early centuries of the Christian era.
Galen, for instance, quotes certain prescriptions from women physicians.
One Cleopatra is said to have written a book on cosmetics. This name
came afterwards to be confounded with that of Queen Cleopatra, giving
new prestige to the book, but neither Galen nor Aëtius, the early
Christian physician, both of whom quote from her work, speak of her as
anything except a medical writer. Some monuments to women physicians
from these old times have escaped the tooth of time. There was the tomb
of one Basila, and also of a Thecla, both of whom are said to have been
physicians. Two other names of Greek women physicians we have, Origenia
and Aspasia, the former mentioned by Galen, the latter by Aëtius in his
"Tetrabiblion." Daremberg, the medical historian, announced in 1851 that
he had found a Greek manuscript with the title, "On Women's Diseases,"
written by one Metrodora, a woman physician. He promised to publish it.
It was unpublished at the time of his death, but could not be found
among his papers. There is a manuscript on medical subjects, bearing
this name, mentioned in the catalogue of the Greek Codices of the
Laurentian Library at Florence, but this is said to give no indication
of the time when its author lived. We have evidence enough, however, to
show that Greek women physicians were not very rare.
The Romans imitated the Greeks so faithfully--one might almost say
copied them so closely--that it is not surprising to find a number of
Roman women physicians. The first mention of them comes from Scribonius
Largus, in the first century after Christ. Octavius Horatianus, whom
most of us know better as Priscian, dedicated one of his books on
medicine to a woman physician named Victoria. The dedication leaves no
doubt that she was a woman in active practice, at least in women's
diseases, and it is a book on this subject that Priscian dedicates to
her. He mentions another woman physician, Leoparda. The word _medica_
for a woman physician was very commonly used at Rome. Martial, whose
epigrams have been a source of so much information in medical history,
especially on subjects with regard to which information was scanty,
mentions a _medica_ in an epigram. Apuleius also uses the word. There
are a number of inscriptions in which women physicians are mentioned.
Among the Christians we find women physicians, and Theodosia, the mother
of St. Procopius, the martyr, is said to have been very successful in
the practice of both medicine and surgery. She is numbered among the
martyrs, and occurs in the Roman Martyrology on the 29th of May. Father
Bzowski, the Polish Jesuit, who compiled "Nomenclatura Sanctorum
Professione Medicorum" (Rome, 1621; the book is usually catalogued under
the Latin form of his name, Bzovius), has among his list of saints who
were physicians by profession a woman, St. Nicerata, who lived at
Constantinople in the reign of the Emperor Arcadius, and who is said to
have cured St. John Chrysostom of a serious disease.
The organization of the department of women's diseases at Salerno, under
the care of women professors, and the granting of licenses to women to
practise medicine, is not so surprising in the light of this tradition
among Greeks and Romans, taken up with some enthusiasm by the
Christians. We are not sure just when this development took place. The
first definite evidence with regard to it comes in the life of Trotula,
who seems to have been the head of the department. Some of her books are
well known, and often quoted from, and she contributed to a symposium on
the treatment of disease, in which there are contributions, also, from
men professors of Salerno at the time. She seems to have flourished
about the middle of the eleventh century. Ordericus Vitalis, a monk of
Utica, who wrote an ecclesiastical history, tells of one Rudolph
Malcorona, who, in 1059, came to Utica and remained there for a long
time with Father Robert, his nephew. "This Rudolph had been a student
all his life, devoting himself with great zeal to letters, and had
become famous for his visits to the schools of France and Italy, in
order to gather there the secrets of learning. As a consequence he was
well informed not only in grammar and dialectics, but also in astronomy
and in music. He also possessed such an extensive knowledge of the
natural sciences that in the town of Salerno, where, since ancient
times, the best schools of medicine had existed, there was no one to
equal him with the exception of a very wise matron."
This wise matron has been identified with Trotula, many of the details
of whose life have been brought to light by De Renzi, in his "Story of
the School of Salerno."[11] According to very old tradition, Trotula
belonged to the family of Ruggiero. This was a noble family of Salerno,
many of the members of which were distinguished in their native town at
least, but the name is not unusual in Italy, as readers of Dante and
Boccaccio are likely to know. It was, indeed, as common as our own
Rogers, of which it is the Italian equivalent.
De Renzi has made out a rather good case for the tradition that Trotula
was the wife of John Platearius I--so called because there were probably
three professors of that name. Trotula was, according to this, the
mother of the second Platearius, and the grandmother of the third, all
of them distinguished members of the faculty at Salerno.
Her reputation extended far beyond her native town, and even Italy
itself, and, in later centuries, her name was used to dignify any form
of treatment for women's diseases that was being exploited. Rutebeuf,
one of the _trouvères_, thirteenth-century French poets, has a
description of the scene in which one of the old herbalist doctors who
used to go round and collect a crowd by means of songs and music, and
then talk medicine to them--just as is done even yet in many of the
smaller towns of this country--is represented as saying to the crowd
when he wants to make them realize that he is no ordinary quacksalver,
that he is one of the disciples of the great Madame Trot of Salerno. The
old-fashioned speech runs somewhat as follows: "Charming people: I am
not one of these poor preachers, nor the poor herbalists, who carry
little boxes and sachets, and who spread out before them a carpet. I am
the disciple of a great lady, who bears the name of Madame Trot of
Salerno. And I would have you know that she is the wisest woman in all
the four quarters of the world."
Two books are attributed to Trotula; one bears the title, "De
Passionibus Mulierum," and the other has been called "Trotula Minor," or
"Summula Secundum Trotulam," and is a compendium of what she wrote. This
is probably due to some disciple, but seems to have existed almost in
her own time. Her most important work bears two sub-titles, "Trotula's
Unique Book for the Curing of Diseases of Women, Before, During, and
After Labor," and the other sub-title, "Trotula's Wonderful Book of
Experience (_experimentalis_) in the Diseases of Women, Before, During,
and After Labor, with Other Details Likewise Relating to Labor."
The book begins with a prologue on the nature of man and of woman, and
an explanation of how the author, taking pity on the sufferings of
women, came to devote herself to the study of their diseases. There are
many interesting details in the book, all the more interesting because
in many ways they anticipate modern solutions of difficult problems in
women's diseases, and the care of the mother and child before, during,
and after labor. For instance, there are a series of rules on the choice
of the nurse, and on the diet and the régime which she should follow if
the child is to be properly nourished without disturbance.
Probably the most striking passage in her book is that with regard to a
torn perineum and its repair. This passage may be found in De Renzi or
in Gurlt. It runs as follows: "Certain patients, from the severity of
the labor, run into a rupture of the genitalia. In some even the vulva
and anus become one foramen, having the same course. As a consequence,
prolapse of the uterus occurs, and it becomes indurated. In order to
relieve this condition, we apply to the uterus warm wine in which butter
has been boiled, and these fomentations are continued until the uterus
becomes soft, and then it is gently replaced. After this the tear
between the anus and vulva we sew in three or four places with silk
thread. The woman should then be placed in bed, with the feet elevated,
and must retain that position, even for eating and drinking, and all the
necessities of life, for eight or nine days. During this time, also,
there must be no bathing, and care must be taken to avoid everything
that might cause coughing, and all indigestible materials."
There is a passage, also, almost more interesting with regard to
prophylaxis of rupture of the perineum. She says, "In order to avoid the
aforesaid danger, careful provision should be made, and precautions
should be taken during labor somewhat as follows: A cloth should be
folded in somewhat oblong shape, and placed on the anus, so that, during
every effort for the expulsion of the child, that should be pressed
firmly, in order that there may not be any solution of the continuity of
tissue."
Her book contains, also, some directions for various cosmetics. How many
of these are original, however, is difficult to say. Trotula's name had
become a word to conjure with, and many a quack in the after time tried
to make capital for his remedies in this line by attributing them to
Trotula. As a consequence, many of these remedies gradually found their
way into the manuscript copies of her book, and subsequent copyists
incorporated them into the text, until it became practically impossible
to determine which were original. There are manuscripts of Trotula's
work in Florence, Vienna, and Breslau. Some of these contain chapters
not in the others, undoubtedly added by subsequent hands. In one of
these, that at Florence, from which the edition of Strasburg was printed
in 1544, and of Venice, 1547, one of the Aldine issues, there is a
mention in the last chapter of spectacles. We have no record of these
until the end of the thirteenth century, when this passage was probably
added. It was also printed at Basle, 1566, and at Leipzig as late as
1778, which would serve to show how much attention it has attracted even
in comparatively recent times.
After Trotula we have a number of women physicians of Salerno whose
names have come down to us. The best known of these bear the names
Constanza, Calendula, Abella, Mercuriade, Rebecca Guarna, who belonged
to the old Salernitan family of that name, a member of which, in the
twelfth century, was Romuald, priest, physician, and historian, Louise
Trencapilli, and others. The titles of some of their books, as those of
Mercuriade, who occupied herself with surgery as well as medicine, and
who is said to have written on "Crises," on "Pestilent Fever," on "The
Cure of Wounds," and of Abella, who acquired a great reputation with her
work on "Black Bile," and on the "Nature of Seminal Fluid," have come
down to us. Rebecca Guarna wrote on "Fevers," on the "Urine," and on the
"Embryo." The school of Salernitan women came to have a definite place
in medical literature.
While, as teachers, they had charge of the department of women's
diseases, their writings would seem to indicate that they studied all
branches of medicine. Besides, there are a number of licenses preserved
in the archives of Naples in which women are accorded the privilege of
practising medicine. Apparently these licenses were without limitation.
In many of these mention is made of the fact that it seems especially
fitting that women should be allowed to practise in women's diseases,
since they are by constitution likely to know more and to have more
sympathy with feminine ills. The formula employed as the preamble of
this license ran as follows: "Since, then, the law permits women to
exercise the profession of physicians, and since, besides, due regard
being had to purity of morals, women are better suited for the treatment
of women's diseases, after having received the oath of fidelity, we
permit, etc."
Salerno continued to enjoy a reputation for training women physicians
thoroughly, until well on in the fifteenth century, for we have the
record of Constance Calenda, the daughter of Salvator Calenda, who had
been dean of the faculty of medicine at Salerno about 1415, and
afterwards dean of the faculty at Naples. His daughter, under the
diligent instruction of her father, seems to have obtained special
honors for her medical examination. Not long after this, Salerno itself
lost all the prestige that it had. The Kings of Naples endeavored to
create a great university in their city in the thirteenth century. They
did not succeed to the extent that they hoped, but the neighboring rival
institution hurt Salerno very much, and its downfall may be traced from
this time. Gradually its reputation waned, and we have practically no
medical writer of distinction there at the end of the fourteenth
century, though the old custom of opportunities for women students of
medicine was maintained.
This custom seems also to have been transferred to Naples, and licenses
to practise were issued to woman graduates of Naples. This never
achieved anything like the reputation in this department that had been
attained at Salerno. Salerno influenced Bologna and the north Italian
universities profoundly in all branches of medicine and medical
education, particularly in surgery, as can be seen in the chapter on
"Great Surgeons of the Medieval Universities," and the practice of
allowing such women as wished to study medicine to enter the university
medical schools is exemplified in the case of Mondino's assistant in
anatomy, Alessandra Giliani, though there are also others whose names
have come down to us.
The University of Salerno had developed round a medical school. It was
the first of the universities, and, in connection with its medical
school, feminine education obtained a strong foothold. It is not
surprising, then, that with the further development of universities in
Italy, feminine education came to be the rule. This rule has maintained
itself all down the centuries in Italy, so that there has not been a
single century since the twelfth in which there have not been one or
more distinguished women teachers at the Italian universities.
University life gradually spread westward, and Paris came into existence
as an organized institution of learning after Bologna, and, doubtless,
with some of the traditions of Salerno in the minds of its founders.
Feminine education, however, did not spread to the West. This is a
little bit difficult to understand, considering the reverence that the
Teutonic peoples have always had for their women folk and the privileges
accorded them. A single unfortunate incident, that of Abélard and
Héloïse, seems to have been sufficient to discourage efforts in the
direction of opportunities for feminine education in connection with the
Western universities. Perhaps, in the less sophisticated countries of
the North and West of Europe, women did not so ardently desire
educational opportunities as in Italy, for whenever they have really
wanted them, as, indeed, anything else, they have always obtained them.
In spite of the absence of formal opportunities for feminine education
in medicine at the Western universities, a certain amount of scientific
knowledge of diseases, as well as valuable practical training in the
care of the ailing, was not wanting for women outside of Italy. The
medical knowledge of the women of northern France and Germany and
England, however, though it did not receive the stamp of a formal degree
from the university and the distinction of a license to practise, was
none the less thorough and extensive. It came in connection with certain
offices in their own communities, held by members of religious orders.
Genuine information with regard to what the religious were doing during
the Middle Ages was so much obscured by the tradition of laziness and
immorality, created at the time of the so-called reformation in order
to justify the confiscation of their property by those whose one object
was to enrich themselves, that we have only come to know the reality of
their life and accomplishments in comparatively recent years. We now
know that, besides being the home of most of the book knowledge of the
earlier Middle Ages, the monasteries were the constant patrons of such
practical subjects as architecture, agriculture in all its phases,
especially irrigation, draining, and the improvement of land and crops;
of art, and even what we now know as physical science. Above all, they
preserved for us the old medical books and carried on medical traditions
of practice. The greatest surprise has been to find that this was true
not only for the monks, but also for the nuns.
One of the most important books on medicine that has come to us from the
twelfth century is that of a Benedictine abbess, since known as St.
Hildegarde, whose life was spent in the Rhineland. Her works serve to
show very well that in the convents of the tenth, eleventh, and twelfth
centuries there was much more of interest in things intellectual than we
have had any idea of until recent years, and that, indeed, one of the
important occupations of convent life was the serious study of books of
all kinds, some of them even scientific, as well as the writing of works
in all departments. The century before St. Hildegarde there is the
record of Hroswitha, who wrote a series of dramas in imitation of
Terence, that were meant to replace, for the monks and nuns of that
period, the reading of that rather too human author. Hroswitha, like
Hildegarde, was a German, and we have the record, also, of another
religious writer, abbess of the Odilian Cloister, at Hohenberg, who
wrote a book called "Hortus Deliciarum, the Garden of Delights," a book
of information on many subjects not unlike our popular encyclopedias of
the modern time, the title of which shows that the place of information
in life was considered to be the giving of pleasure. While this work
deals mainly with Biblical and theological and mystical questions, there
are many purely scientific passages and many subjects of strictly
medical interest treated.
The life of the Abbess Hildegarde is worthy of consideration, because it
illustrates the period and makes it very clear that, in spite of the
grievous misunderstanding of their life and work, so common in the
modern time, these old-time religious had most of the interests of the
modern time, and pursued them with even more than modern zeal and
success, very often. Her career illustrates very well what the
foundation of the Benedictines had done for women. When St. Benedict
founded his order for men, his sister, Scholastica, wanted to do a
similar work for women. We know that the Benedictine monks saved the old
classics for us, kept burning the light of the intellectual life, and
gave a refuge to men who wanted to devote themselves in leisure and
peace to the things of the spirit, whether of this world or the other.
We have known much less of the Benedictine nuns until now the study of
their books shows that they provided exactly the same opportunities for
women and furnished a vocation, a home, an occupation of mind, and a
satisfaction of spirit for the women who, in every generation, do not
feel themselves called to be wives and mothers, but who want to live
their lives for others rather than for themselves and their kin, seeking
such development of mind and of spirit as may come with the leisure and
peace of celibacy.
Hildegarde was born of noble parents at Böckelheim, in the county of
Sponheim, about the end of the eleventh century (probably 1098). In her
eighth year she went for her education to the Benedictine cloister of
Disibodenberg. When her education was finished, she entered the
cloister, of which, at the age of about fifty, she became abbess. Her
writings, reputation for sanctity, and her wise saintly rule attracted
so many new members to the community that the convent became
overcrowded. Accordingly, with eighteen of her nuns, Hildegarde withdrew
to a new convent at Rupertsberg, which English and American travellers
will remember because it is not far from Bingen on the Rhine. Here she
came to be a centre of attraction for most of the world of her time. She
was in active correspondence with nearly every important man of her
generation. She was an intimate friend of Bernard of Clairvaux, who was
himself, perhaps, the most influential man in Europe in this century.
She was in correspondence with four Popes, and with the Emperors Conrad
and Frederick I, and with many distinguished archbishops, abbots, and
abbesses, and teachers and teaching bodies of various kinds. These
correspondences were usually begun by her correspondents, who consulted
her because her advice in difficult problems was considered so valuable.
In spite of all this time-taking correspondence, she found leisure to
write a series of books, most of them on mystical subjects, but two of
them on medical subjects. The first is called "Liber Simplicis
Medicinæ," and the second "Liber Compositæ Medicinæ." These books were
written in order to provide information mainly for the nuns who had
charge of the infirmaries of the monasteries of the Benedictines. Almost
constantly someone in the large communities, which always contained aged
religious, was ailing, and then, besides, there were other calls on the
time and the skill of the sister infirmarians. There were no hotels at
that time, and no hospitals, except in the large cities. There were
always guest houses in connection with monasteries and convents, in
which travellers were permitted to pass the night, and given what they
needed to eat. There are many people who have had experiences of
monastic hospitality even in our own time. Sometimes travellers fell
ill. Not infrequently the reason for travelling was to find health in
some distant and fabulously health-giving resort, or at the hands of
some wonder-working physician. Such high hopes are nearly always set at
a distance. This of itself must have given not a little additional need
for knowledge of medicine to the infirmarians of convents and
monasteries. There were around many of the monasteries, moreover, large
estates; often they had been cleared and made valuable by the work of
preceding generations of monks, and on these estates peasants came to
live. Workingmen and workingwomen from neighboring districts came to
help at harvest time, and, after a chance meeting, were married and
settled down on a little plot of ground provided for them near the
monastery. As these communities grew up, they looked to the monasteries
and convents for aid of all kinds, and turned to them particularly in
times of illness. The need for definite instruction in medicine on the
part of a great many of the monks and nuns can be readily understood,
and it was this need that Hildegarde tried to meet in her books. The
first of her books that we have mentioned, the "Liber Simplicis
Medicinæ," attracted attention rather early in the Renaissance, and was
deemed worthy of print. It was edited at the beginning of the sixteenth
century by Dr. Schott at Strasburg, under the title, "Physica S.
Hildegardis." Another manuscript of this part was found in the library
of Wolfenbuttel, in 1858, by Dr. Jessen. This gave him an interest in
Hildegarde's contributions to medicine, and, in 1859, he noted in the
library at Copenhagen a manuscript with the title "Hildegardi Curæ et
Causæ." On examination, he was sure that it was the "Liber Compositæ
Medicinæ" of the saint. The first work consists of nine books, treating
of plants, elements, trees, stones, fishes, birds, quadrupeds, reptiles,
and metals, and is printed in Migne's "Patrologia," under the title
"Subtilitatum Diversarum Naturarum Libri Novem." The second, in five
books, treats of the general diseases of created things, of the human
body and its ailments, of the causes, symptoms, and treatment of
diseases.
It would be very easy to think that these are small volumes and that
they contain very little. We are so apt to think of old-fashioned
so-called books as scarcely more than chapters, that it may be
interesting to give some idea of the contents and extent of the first of
these works. The first book on Plants has 230 chapters, the second on
the Elements has 13 chapters, the third on Trees has 36 chapters, the
fourth on various kinds of Minerals, including precious stones, has 226
chapters, the fifth on Fishes has 36 chapters, the sixth on Birds has 68
chapters, the seventh on Quadrupeds has 43 chapters, the eighth on
Reptiles has 18 chapters, the ninth on Metals has 8 chapters. Each
chapter begins with a description of the species in question, and then
defines its value for man and its therapeutic significance. Modern
scientists have not hesitated to declare that the descriptions abound in
observations worthy of a scientific inquiring spirit. We are, of course,
not absolutely sure that all the contents of the books come from
Hildegarde. Subsequent students often made notes in these manuscript
books, and then other copyists copied these into the texts.
Unfortunately we have not a number of codices to collate and correct
such errors. Most of what Hildegarde wrote comes to us in a single copy,
of none are there more than four copies, showing how near we came to
missing all knowledge of her entirely.
Dr. Melanie Lipinska, in her "Histoire des Femmes Médecins," a thesis
presented for the doctorate in medicine at the University of Paris in
1900, subsequently awarded a special prize by the French Academy,
reviews Hildegarde's work critically from the medical standpoint. She
says that the saint distinguishes a double mode of action of different
substances, one chemical, the other physical, or what we would very
probably call magnetic. She discusses all the ailments of the various
organs, the brain, the eyes, the teeth, the heart, the spleen, the
stomach, the liver. She has special chapters on redness and paleness of
the face, on asthma, on cough, on fetid breath, on bilious indigestion,
on gout. Besides, she has other chapters on nervous affections, on
icterus, on fevers, on intestinal worms, on infections due to swamp
exhalations, on dysentery, and a number of forms of pulmonary diseases.
Nearly all of our methods of diagnosis are to be found, hinted at at
least, in her book. She discusses the redness of the blood as a sign of
health, the characteristics of various excrementitious material as signs
of disease, the degrees of fever, and the changes in the pulse. Of
course, it was changes in the humors of the body that constituted the
main causes for disease in her opinion, but it is well to remind
ourselves that our frequent discussion of auto-intoxication in recent
years is a distinct return to this.
Some of Hildegarde's anticipations of modern ideas are, indeed,
surprising enough. For instance, in talking about the stars and
describing their course through the firmament, she makes use of a
comparison that is rather startling. She says: "Just as the blood moves
in the veins which causes them to vibrate and pulsate, so the stars
move in the firmament and send out sparks as it were of light like the
vibrations of the veins." This is, of course, not an anticipation of the
discovery of the circulation of the blood, but it shows how close were
men's ideas to some such thought five centuries before Harvey's
discovery. For Hildegarde the brain was the regulator of all the vital
qualities, the centre of life. She connects the nerves in their passage
from the brain and the spinal cord through the body with manifestations
of life. She has a series of chapters with regard to psychology normal
and morbid. She talks about frenzy, insanity, despair, dread, obsession,
anger, idiocy, and innocency. She says very strongly in one place that
"when headache and migraine and vertigo attack a patient simultaneously
they render a man foolish and upset his reason. This makes many people
think that he is possessed of a demon, but that is not true." These are
the exact words of the saint as quoted in Mlle. Lipinska's thesis.
It is no wonder that Mlle. Lipinska thinks St. Hildegarde the most
important medical writer of her time. Reuss, the editor of the edition
of Hildegarde published in Migne's "Patrology," says: "Among all the
saintly religious who have practised medicine or written about it in the
Middle Ages, the most important is without any doubt St. Hildegarde...."
With regard to her book he says: "All those who wish to write the
history of the medical and natural sciences must read this work in which
this religious woman, evidently well grounded in all that was known at
that time in the secrets of nature, discusses and examines carefully
all the knowledge of the time." He adds, "It is certain that St.
Hildegarde knew many things that were unknown to the physicians of her
time."
When such books were read and widely copied, it shows that there was an
interest in practical and scientific medicine among women in Germany
much greater than is usually thought to have existed at this time. Such
writers, though geniuses, and standing above their contemporaries,
usually represent the spirit of their times and make it clear that
definite knowledge of things medical was considered of value. The
convents and monasteries of this time are often thought of by those who
know least about them as little interested in anything except their own
ease and certain superstitious practices. As a matter of fact, they
cared for their estates, and especially for the peasantry on them, they
provided lodging and food for travellers, they took care of the ailing
of their neighborhood, and, besides, occupied themselves with many
phases of the intellectual life. It was a well-known tradition that
country people who lived in the neighborhood of convents and
monasteries, and especially those who had monks and nuns for their
landlords, were much happier and were much better taken care of than the
tenantry of other estates. For this a cultivation of medical knowledge
was necessary in certain, at least, of the members of the religious
orders, and such books as Hildegarde's are the evidence that not only
the knowledge existed, but that it was collected and written down, and
widely disseminated.
Nicaise, in the introduction to his edition of Guy de Chauliac's
"Grande Chirurgie," reviews briefly the history of women in medicine,
and concludes:
"Women continued to practise medicine in Italy for centuries,
and the names of some who attained great renown have been
preserved for us. Their works are still quoted from in the
fifteenth century.
"There was none of them in France who became distinguished,
but women could practise medicine in certain towns at least on
condition of passing an examination before regularly appointed
masters. An edict of 1311, at the same time that it interdicts
unauthorized women from practising surgery, recognizes their
right to practise the art if they have undergone an
examination before the regularly appointed master surgeons of
the corporation of Paris. An edict of King John, April, 1352,
contains the same expressions as the previous edict. Du
Bouley, in his 'History of the University of Paris,' gives
another edict by the same King, also published in the year
1352, as a result of the complaints of the faculties at Paris,
in which there is also question of women physicians. This
responded to the petition: 'Having heard the petition of the
Dean and the Masters of the Faculty of Medicine at the
University of Paris, who declare that there are very many of
both sexes, some of the women with legal title to practise and
some of them merely old pretenders to a knowledge of medicine,
who come to Paris in order to practise, be it enacted,' etc.
(The edict then proceeds to repeat the terms of previous
legislation in this matter.)
"Guy de Chauliac speaks also of women who practised surgery.
They formed the fifth and last class of operators in his time.
He complains that they are accustomed to too great an extent
to give over patients suffering from all kinds of maladies to
the will of Heaven, founding their practice on the maxim 'The
Lord has given as he has pleased; the Lord will take away when
he pleases; may the name of the Lord be blessed.'
"In the sixteenth century, according to Pasquier, the practice
of medicine by women almost entirely disappeared. The number
of women physicians becomes more and more rare in the
following centuries just in proportion as we approach our own
time. Pasquier says that we find a certain number of them
anxious for knowledge and with a special penchant for the
study of the natural sciences and even of medicine, but very
few of them take up practice."
Just how the lack of interest in medical education for women gradually
deepened, until there was almost a negative phase of it, only a few
women in Italy devoting themselves to medicine, is hard to say. It is
one of the mysteries of the vicissitudes of human affairs that ups and
downs of interest in things practical as well as intellectual keep
constantly occurring. The number of discoveries and inventions in
medicine and surgery that we have neglected until they were forgotten,
and then had to make again, is so well illustrated in chapters of this
book, that I need only recall them here in general. It may seem a little
harder to understand that so important a manifestation of interest in
human affairs as the education and licensure of women physicians should
not only cease, but pass entirely out of men's memory, yet such
apparently was the case. It would not be hard to illustrate, as I have
shown in "Cycles of Feminine Education and Influence" in "Education, How
Old the New" (Fordham University Press, 1910), that corresponding ups
and downs of interest may be traced in the history of feminine education
of every kind. In that chapter I have discussed the possible reasons for
these vicissitudes, which have no place here, but I may refer those who
are interested in the subject to that treatment of it.
IX
MONDINO AND THE MEDICAL SCHOOL OF BOLOGNA
The most important contributions to medical science made by the Medical
School of Salerno at the height of its development were in surgery. The
text-books written by men trained in her halls or inspired by her
teachers were to influence many succeeding generations of surgeons for
centuries. Salerno's greatest legacy to Bologna was the group of
distinguished surgical teachers whose text-books we have reviewed in the
chapter, "Great Surgeons of the Medieval Universities." Bologna herself
was to win a place in medical history, however, mainly in connection
with anatomy, and it was in this department that she was to provide
incentive especially for her sister universities of north Italy, though
also for Western Europe generally. The first manual of dissection, that
is, the first handy volume giving explicit directions for the dissection
of human cadavers, was written at Bologna. This was scattered in
thousands of copies in manuscript all over the medical world of the
fourteenth and early fifteenth centuries. Even after the invention of
printing, many editions of it were printed. Down to the sixteenth
century it continued to be the most used text-book of anatomy, as well
as manual of dissection, which students of every university had in hand
when they made their dissection, or wished to prepare for making it, or
desired to review it after the body had been taken away, for with lack
of proper preservative preparation, bodies had to be removed in a
comparatively short time. Probably no man more influenced the medical
teaching of the fourteenth and fifteen centuries than Mundinus, or, as
he was called in the Italian fashion, Mondino, who wrote this manual of
dissection.
_Mundinus quem omnis studentium universitas colit ut deum_ (Mundinus,
whom all the world of students cultivated as a god), is the expression
by which the German scholar who edited, about 1500, the Leipzig edition
of Mundinus' well-known manual, the _Anathomia_, introduces it to his
readers. The expression is well worth noting, because it shows what was
still the reputation of Mundinus in the medical educational world nearly
two centuries after his death.[12]
Until the time of Vesalius, whose influence was exerted about the middle
of the sixteenth century, Mondino was looked up to by all teachers as
the most important contributor to the science of anatomy in European
medicine since the Greeks. He owed his reputation to two things: his
book, of which we have already spoken, and then, the fact that he
reintroduced dissection demonstrations as a regular practice in the
medical schools. His book is really a manual of making anatomical
preparations for demonstration purposes. These demonstrations had to be
hurried, owing to the rapid decomposition of material consequent upon
the lack of preservatives. The various chapters were prepared with the
idea of supplying explicit directions and practical help during the
anatomical demonstrations, so that these might be made as speedily as
possible. The book does not comprise much that was new at that time, but
it is a good compendium of previous knowledge, and contains some
original observations. It was entirely owing to its form as a handy
manual of anatomical knowledge and, besides, because it was an incentive
to the practice of human dissection, that it attained and maintained its
popularity.
Mondino followed Galen, of course, and so did every other teacher in
medicine and its allied sciences, until Vesalius' time. Even Vesalius
permitted himself to be influenced overmuch by Galen at points where we
wonder that he did not make his observations for himself, since,
apparently, they were so obvious. The more we know of Galen, however,
the less surprised are we at his hold over the minds of men. Only those
who are ignorant of Galen's immense knowledge, his practical common
sense, and the frequent marvellous anticipations of what we think most
modern, affect to despise him. His works have never been translated
into any modern language except piecemeal, there is no complete
translation, and one must be ready to delve into some large Latin, if
not Greek, volumes to know what a marvel of medical knowledge he was,
and how wise were the men who followed him closely, though, being human,
there are times when necessarily he failed them.
For those who know even a little at first hand of Galen, it is only what
might be expected, then, that Mondino, trying to break away from the
anatomy of the pig, which had been before this the basis of all
anatomical teaching in the medical schools (Copho's book, used at
Salerno and Bologna before Mondino's was founded on dissections of the
pig), should have clung somewhat too closely to this old Greek teacher
and Greek master. The incentive furnished by Mondino's book helped to
break the tradition of Galen's unquestioned authority. Besides this, the
group of men around Mondino, his master, Taddeo Alderotti, with his
disciples and assistants, form the initial chapter in the history of the
medical school of Bologna, which gradually assumed the place of Salerno
at this time. There is no better way of getting a definite idea of what
was being done in medicine, and how it was being done, than by knowing
some of the details of the life of this group of medical workers.
Mondino di Liucci, or Luzzi, is usually said to have been born about
1275. His first name is a diminutive for Raimondo. It used to be said of
him that, like many of the great men of history, many cities claimed to
be his birthplace. Five were particularly mentioned--Florence, Milan,
Bologna, Forli, and Friuli. There is, however, another Mondino, a
distinguished physician, who was born and lived at Friuli, and it is
because of confusion with him that the claim for Friuli has been set up.
Florence and Milan are considered out of the question. Mondino was
probably born in or near Bologna. The fact that there should have been
this multiple set of claims shows how much was thought of him. Indeed,
his was the best known name in the medical schools of Europe for nearly
two centuries and a half. He seems to have been a particularly brilliant
student, for tradition records that he had obtained his degree of doctor
of medicine when he was scarcely more than twenty. This seems quite out
of the question for us at the present time, but we have taken to pushing
back the time of graduation, and it is not sure whether this is, beyond
peradventure, so beneficial as is usually thought.
That his early graduation did not hamper his intellectual development,
the fact that, in 1306, when he was about thirty-one years of age, he
was offered the professorial chair in anatomy, which he continued to
occupy with such distinction for the next twenty years, would seem to
prove. His public dissections of human bodies, probably the first thus
regularly made, attracted widespread attention, and students came to him
not only from all over Italy, but also from Europe generally. In this,
after all, Mondino was only continuing the tradition of world teaching
that Bologna had acquired under her great surgeons in the preceding
century. (See "Great Surgeons of the Medieval Universities.")
Mondino came from a family that had already distinguished itself in
medicine at Bologna. His uncle was a professor of physic at the
university. His father, Albizzo di Luzzi, seems to have come from
Florence not long after the middle of the thirteenth century, for the
records show that, about 1270, he formed a partnership with one
Bartolommeo Raineri for the establishment of a pharmacy at Bologna.
Later this passed entirely under the control of the Mondino family, and
came to be known as the Spezieria del Mondino. In it were sold, besides
Eastern perfumes, spices, condiments, probably all sorts of toilet
articles, and even rugs and silks and feminine ornaments. The stricter
pharmacy of the earlier times developed into a sort of department store,
something like our own. The Mondini, however, insisted always on the
pharmacy feature as a specialty, and the fact was made patent to the
general public by a sign with the picture of a doctor on it. This drug
shop of the Mondini continued to be maintained as such, according to Dr.
Pilcher, until the beginning of the nineteenth century.[13]
One of the fellow students of Mondino at the University of Bologna had
been Mondeville. He came from distant France to take a course in surgery
with Theodoric, whose high reputation in the olden time, vague with us
half a century ago, is now amply justified by what we know of him from
such ardent students and admirers as Pagel and Nicaise. Not long after
Mondino's death, Guy de Chauliac came from France to reap similar
opportunities to these, which had proved so fruitful for Mondeville. The
more that we learn about this time the more do we find to make it clear
how deeply interested the generation was in education in every form,
artistic, philosophic, but, also, though this is often not realized,
scientific.
The long distances, so much longer in that time than in ours, to which
men were willing, and even anxious, to go, in order to obtain
opportunities for research, and to get in touch with a special master,
the associations with stimulating fellow pupils of other lands, the
scientific correspondences, almost necessarily initiated by such
circumstances, all indicate an enthusiasm for knowledge such as we have
not been accustomed to attribute to this period. On the contrary, we
have been rather inclined to think them neglectful of all education, and
have, above all, listened acquiescently while men deprecated the lack of
interest in things scientific displayed by these generations. Indeed,
many writers have gone out of their way to find a reason for the
supposed lack of interest in science at this time, and have proclaimed
the Church's opposition to scientific education and study as the cause.
At this time Italy was the home of the graduate teaching for all Europe.
The Italian Peninsula continued to be the foster-mother of the higher
education in letters and art, but also, though this is less generally
known, in science, for the next five centuries. Germany has come to be
the place of pilgrimage for those who want higher opportunities in
science than can be afforded in their own country only during the latter
half of the nineteenth century. France occupied it during the first half
of the nineteenth century. Except for short intervals, when political
troubles disturbed Italy, as about the middle of the fourteenth century,
when the removal of the Popes to Avignon brought their influence for
education over to France and a short period at the beginning of the
eighteenth century, when the Netherlands for a time came into
educational prominence, Italy has always been the European Mecca for
advanced students. Practically all our great discoverers in medicine,
until the last century, were either Italians, or else had studied in
Italy. Mondino, Bertrucci, Salicet, Lanfranc, Baverius, Berengarius,
John De Vigo, who first wrote on gun-shot wounds; John of Arcoli, first
to mention gold filling and other anticipations of modern dentistry;
Varolius, Eustachius, Cæsalpinus, Columbus, Malpighi, Lancisi, Morgagni,
Spallanzani, Galvani, Volta, were all Italians. Mondeville, Guy de
Chauliac, Linacre, Vesalius, Harvey, Steno, and many others who might be
named, all studied in Italy, and secured their best opportunities to do
their great work there.
It would be amusing, if it were not amazing, to have serious writers of
history in the light of this plain story of graduate teaching of science
in Italy for over five centuries, write about the opposition of the
Church to science during the Medieval and Renaissance periods. It is
particularly surprising to have them talk of Church opposition to the
medical sciences. The universities of the world all had their charters
from the Popes at this time, and were all ruled by ecclesiastics, and
most of the students and practically all of the professors down to the
end of the sixteenth century belonged to the clerical order. The
universities of Italy were all more directly under the control of
ecclesiastical authority than anywhere else, and nearly all of them were
dominated by papal influence. Bologna, while doing much of the best
graduate work in science, especially in medicine, was, in the Papal
States, absolutely under the rule of the Popes. The university was,
practically, a department of the Papal government. The medical school at
the University of Rome itself was for several centuries, at the end of
the Middle Ages, the teaching-place where were assembled the pick of the
great medical investigators, who, having reached distinction by their
discoveries elsewhere, were summoned to Rome in order to add prestige to
the Papal University. All of them became special friends of the Popes,
dedicated their books to them, and evidently looked to them as
beneficent patrons and hearty encouragers of original scientific
research.
While this is so strikingly true of medical science as to make contrary
declarations in the matter utterly ridiculous, and to suggest at once
that there must be some motive for seeing things so different to the
reality, the same story can be told of graduate science in other
departments. It was to Italy that men came for special higher studies
in mathematics and astronomy, in botany, in mineralogy, and in applied
chemistry, so far as it related to the arts of painting, illuminating,
stained-glass making, and the like. No student of science felt that he
had quite exhausted the opportunities for study that were possible for
him until he had been down in Italy for some time. To meet the great
professors in Italy was looked on as sure to be a source of special
incentive in any department of science. This is coming to be generally
recognized just in proportion as our own interest in the arts and
crafts, and in the history of science, leads us to go carefully into the
details of these subjects at first hand. The editors of the "Cambridge
Modern History," in their preface, declared ten years ago that we can no
longer accept with confidence the declaration of any secondary writer on
history. This is particularly true of the medieval period. We must go
back to the writers of those times.
If it seems surprising that the University of Bologna should have come
into such great prominence as an institute for higher education at this
time, it would be well to recall some of the great work that is being
done in this part of Italy in other departments at this time. Cimabue
laid the foundation of modern art towards the end of the thirteenth
century, and during Mondino's life Giotto, his pupil, raised an artistic
structure that is the admiration of all generations of artists since.
Dante's years are almost exactly contemporary with those of Giotto and
of Mondino. If men were doing such wondrous work in literature and in
art, why should not the same generation produce a man who will
accomplish for the practical science of medicine what his friends and
contemporaries had done in other great intellectual departments.
In recent years we have come to think much more of environment as an
influence in human development and accomplishment than was the custom
sometime ago. The broader general environment in Italy, with genius at
work in other departments, was certainly enough to arouse in younger
minds all their powers of original work. The narrower environment at
Bologna itself was quite as stimulating, for a great clinical teacher,
Taddeo Alderotti, had come, in 1260, from Florence to Bologna, to take
up there the practice and teaching of medicine. It was under him that
Mondino was to be trained for his life work.
To understand the place of Mondino, and of the medical school of
Bologna, in his time, and the reputation that came to them as world
teachers of medicine, we must know, first, this great teacher of Mondino
and the atmosphere of progressive medicine that enveloped the university
in the latter half of the thirteenth century. In the chapter on "Great
Surgeons of the Medieval Universities" we call particular attention to
the series of distinguished men, the first four of whom were educated at
Salerno, and who came to Bologna to teach surgery. They were doing the
best surgery in the world, much better than was done in many centuries
after their time; indeed, probably better than at any period down to our
own day. Besides, they seem to have been magnetic teachers who attracted
and inspired pupils. We have the surgical contributions of a series of
men, written at Bologna, that serve to show what fine work was
accomplished. At this time, however, the field of medicine was not
neglected, though we have but a single great historical name in it that
has lived. This was Taddeo Alderotti, a man who lifted the medical
profession as high in the estimation of his fellow citizens at Florence
as the great painters and literary men of his time did their
departments, and who then moved to Bologna, because of the opportunity
to teach afforded him by the university.
It is sometimes a little difficult for casual students of the time to
understand the marvellous reputation acquired by this medieval
physician. It should not be, however, when we recall the enthusiastic
reception and procession of welcome accorded to Cimabue's Madonna, and
the almost universal acclaim of the greatness of Dante's work, even in
his own time. In something of that same spirit Bologna came to
appreciate Taddeo, as he is familiarly known, looked upon him as a
benefactor of the community, and voted to relieve him of the burden of
paying taxes. He came to be considered as a public institution, whose
presence was a blessing to his fellow citizens, and whose goodness to
them should be recognized in this public way. One is not surprised to
hear Villani, the well-known contemporary historian, speak of him as the
greatest physician in Christendom.
The feelings of the citizens of Bologna, it may well be confessed, were
not entirely unselfish, or due solely to the desire to encourage a great
scientific genius. Few men of his generation had done more for the city
in a material way quite apart from whatever benefits he conferred upon
the health of its citizens than Dr. Taddeo. It was he who organized
medical teaching in the city on such a plane that it attracted students
from all over the world. Bologna had had a great law school before this,
founded by Irnerius, to which students had come from all over the world.
With the advent of Taddeo from Florence, and his success as a medical
practitioner, there began to flock to his lectures many students who
spread his fame far and wide. The city council could scarcely do less
than grant the same privileges to the medical students and teachers of
Taddeo's school as they had previously accorded to the faculty of law
and its students. The city council recognized quite as clearly as any
board of aldermen in the modern time how much, even of material benefit,
a great university was to the building up of a city, though their
motives were probably much higher than that, and their enlightened
policy had its reward in the rapid growth of Bologna until, very
probably at the end of the thirteenth century, it had more students than
any university of the modern time. The number was not less than fifteen
thousand, and may have been twenty thousand.
To this great university success Taddeo and his medical school
contributed not a little. The especially attractive feature of his
teaching seems to have been its eminent practicalness. He himself had
made an immense success of the practice of medicine, and accumulated a
great fortune, so much so that Dante, in his "Paradiso," when he wishes
to find a figure that would represent exactly the opposite to what St.
Dominic, the founder of the Dominicans, did for the love of wisdom and
humanity, he takes that of Taddeo, who had accomplished so much for
personal reputation and wealth.
This might easily lead to the impression that Taddeo's teaching was
unscientific, or merely empiric, or that he himself was a narrow-minded
maker of money, intent only on his immediate influence, and hampered by
exclusive devotion to practical medicine. Nothing could be farther from
the truth than any such impression. Taddeo was not only the head of a
great medical school, a great teacher whom his students almost
worshipped, a physician to whom patients flocked because of his
marvellous success, a fine citizen of a great city, whom his fellow
citizens honored, but he was a broad-minded scholar, a philosopher, and
even an author in branches apart from medicine.
In that older time it was the custom to combine the study of philosophy
and medicine. For centuries after that period in Italy it was the custom
for men to take both degrees, the doctorate in philosophy and in
medicine at the same time. Indeed, most of those whose work has made
them famous, down to and including Galvani, did so. Taddeo wrote
commentaries on the works of Hippocrates and Galen, but he also
translated the ethics of Aristotle, and did much to make the learning of
the Arabs easily available for his students. His was a broad, liberal
scholarship. Dr. Lewis Pilcher, in his article on "The Mondino
Myth,"[14] does not hesitate to say that "to the spirit which, from his
professorial chair, Taddeo infused into the teaching and study of
medicine undoubtedly is due the high position which for many generations
thereafter the school of Bologna continued to maintain as a centre of
medical teaching."
Of course, erudition had its revenge, and carried Taddeo too far. The
difficult thing in human nature is to stay in the mean and avoid
exaggeration. His methods of illustrating medical truths from many
literary and philosophical sources often caused the kernel of
observation to be hidden beneath a blanket of speculation or, at least,
to be concealed to a great extent. Even the Germans, who have insisted
most on this unfortunate tendency of Taddeo, have been compelled to
confess that there is much that is valuable in what he accomplished, and
that even his modes of expression were not without a certain vivacity
which attracted attention and doubtless added materially to his success
as a teacher. Pagel, in Puschmann's "Handbuch," says: "It cannot be
denied [this is just after he has quoted a passage of Taddeo with regard
to dreams] that Taddeo's expressions have a certain liveliness all their
own that gives us some idea why he was looked upon as so good a teacher,
a teacher who, as we know now, also gave instruction by the bedside of
patients." Pagel adds, "Taddeo's greatest merit and his highest
significance in medical education consist in the fact that a great many
(_zahlreiche_) physicians followed directly in his footsteps and were
counted as his pupils. They were all men, as we know them, who as
writers and practitioners of medicine succeeded in going far beyond the
level of mediocrity in what they accomplished."
This was the teacher who most influenced young Mondino when he came to
the University of Bologna, for it seems not unlikely that as a medical
student he was actually the pupil of Taddeo, then in a vigorous old age.
If not, he was at least brought under the direct influence of the
teaching tradition created during more than thirty years by that
wonderful old man. Knowing what we do of Taddeo it is not surprising
that his pupil should have accomplished work that was to influence
succeeding generations more than any other of that wonderful thirteenth
century. Dr. Pilcher in the article on "The Mondino Myth," so often
placed under contribution in this sketch, says that "It needs no great
stretch of the imagination to picture somewhat of the effect that
contact with such a man as Taddeo di Alderotto[15] might have, in
molding the character of his young neighbor and pupil, the chemist's
son, who a few years later, by his devotion to the study of human
anatomy, was to re-establish the practical pursuit of study on the
human cadaver as the common privilege of the skilled physician, and was
to engrave his own name deeply on the records of medicine."
Under this worthy compatriot and contemporary of the great Florentines,
Mondino was inspired to be the teacher that did so much for Bologna.
Until recent years it has usually been the custom to give too much
significance to the work of the men whose names stand out most
prominently in the early history of departments of the intellectual
life. Mondino's reputation has shared in this exaggerative tendency to
some extent, hence the necessity for realizing what was accomplished
before his time and the fact that he only stands as the culmination of a
progressive period. Carlyle spoke of Dante as the man in whom "ten
silent centuries found a voice." The centuries, however, were only
silent because the moderns did not know how to listen to their message.
We know now that every country in Europe had a great contributor to
literature in the century before Dante. The Cid, the Arthur Legends, the
Nibelungen, the Troubadours, naturally led up to Dante. He was only the
culmination of a great period of literature. We know now that men had
worked in art before Cimabue and Giotto, and had done impressive work
that made for the progress of art. These names, however, have come to
represent in many minds the sort of solitary phenomena that Dante has
seemed sometimes even to scholars.
Because Mondino did such good work in medical teaching it is sometimes
declared, even in rather serious histories, that he was the first to
accomplish anything in his department, and that before his time there is
a blank. Some historians, for instance, have insisted that Mondino was
the first to do human dissections, and that he did at most but two or
three. Only those who are unacquainted with the magnificent development
of surgery that took place during the preceding century, the evidence
for which is so abundantly given in modern historians of medicine and
especially in Gurlt's great work on the history of surgery, from which
we have quoted enough to give a good idea of the extent to which the
movement went, are likely to accept any such declaration. There could
not have been all that successful surgery without much dissection not
only of animals but also of human bodies. The teaching of dissection was
not regularly organized until Mondino's time, but it seems very clear
that even he must have dissected many more bodies than the number
usually attributed to him. Professor Lewis Stephen Pilcher of Brooklyn,
who made a special study of Mondino traditions in Bologna itself, and
collected some of the early editions of his books, feels so acutely the
absurdity of the ordinarily accepted tradition in this matter, that he
has written a paper on the subject bearing the suggestive title, "The
Mondino Myth." He says:[16]
"We are accustomed to think of the practice of dissection as
having been re-created by Mondino, and at once fully
developed, springing into acceptance. The year 1315 is the
generally accepted date for the first public anatomical
demonstration upon a human body made by Mondino, and yet it is
true that among the laws promulgated by Frederick II, more
than seventy-five years before (A.D. 1231), was included a
decree that a human body should be dissected at Salernum at
least once in five years in the presence of the assembled
physicians and surgeons of the kingdom, and that in the
regulations established for admission to the practice of
medicine and surgery in the kingdom it was decreed that no
surgeon should be admitted to practise unless he should bring
testimonials from the masters teaching in the medical faculty,
that he was 'learned in the anatomy of human bodies, and had
become perfect in that part of medicine without which neither
incisions could safely be made nor fractures cured.'
"Salernum was notable in its legalization of the dissection of
human bodies before the first public work of Mondino, for,
according to a document of the Maggiore Consiglio of Venice of
1308, it appears that there was a college of medicine at
Venice which was even then authorized to dissect a body every
year. Common experience tells us that the embodiment of such
regulations into formal law would occur only after a
considerable preceding period of discussion, and in this
particular field of clandestine practice. It is too much to
ask us to believe that in all this period, from the date of
the promulgation of Frederick's decree of 1231 to the first
public demonstration by Mondino, at Bologna in 1315, the
decree had been a dead letter and no human body had been
anatomized. It is true there is not, as far as I am aware, any
record of any such work, and commentators and historians of a
later date have, without exception, accepted the view that
none was done, and thereby heightened the halo assigned to
Mondino as the one who ushered in a new era. Such a view seems
to me to be incredible. Be that as it may, it is undeniable
that at the beginning of the 14th century the idea of
dissecting the human body was not a novel one; the importance
of a knowledge of the intimate structure of the body had
already been appreciated by divers ruling bodies, and specific
regulations prescribing its practice had been enacted. It is
more reasonable to believe that in the era immediately
preceding that of Mondino human bodies were being opened and
after a fashion anatomized. All that we know of the work of
Mondino suggests that it was not a new enterprise in which he
was a pioneer, but rather that he brought to an old practice a
new enthusiasm and better methods, which, caught on the rising
wave of interest in medical teaching at Bologna, and preserved
by his own energy as a writer in the first original systematic
treatise written since the time of Galen, created for him in
subsequent uncritical times the reputation of being the
Restorer of the practice of anatomizing the human body, the
first one to demonstrate and teach such knowledge since the
time of the Ptolemaic anatomists, Erasistratus and Herophilus.
"The changes have been rung by medical historians upon a
casual reference in Mondino's chapter on the uterus to the
bodies of two women and one sow which he had dissected, as if
these were the first and the only cadavers dissected by him.
The context involves no such construction. He is enforcing a
statement that the size of the uterus may vary, and to
illustrate it remarks that 'a woman whom I anatomized in the
month of January last year, viz., 1315 Anno Christi, had a
larger uterus than one whom I anatomized in the month of March
of the same year.' And further, he says that 'the uterus of a
sow which I dissected in 1316 (the year in which he was
writing) was a hundred times greater than any I have seen in
the human female, for she was pregnant and contained thirteen
pigs.' These happen to be the only reference to specific
bodies that he makes in his treatise. But it is a far cry to
wring out of these references the conclusion that these are
the only dissections he made. It is quite true that if we
incline to enshroud his work in a cloud of mystery and to
figure it as an unprecedented awe-inspiring feature to break
down the prejudices of the ages, it is easy to think of him as
having timidly profaned the human body by his anatomizing zeal
in but one or two instances. His own language, however,
throughout his book is that of a man who was familiar with the
differing conditions of the organs found in many different
bodies; a man who was habitually dissecting."
(Quotations from the work of Mundinus showing his familiarity
with dissections. The leaf and line references are to the
Dryander edition, Marburg, 1541.)
"I do not consider separately the anatomy of component parts,
because their anatomy does not appear clearly in the fresh
subject, but rather in those macerated in water." (Leaf 2,
lines 8-13.)
"... these differences are more noticeable in the cooked or
perfectly dried body, and so you need not be concerned about
them, and perhaps I will make an anatomy upon such a one at
another time and will write what I shall observe with my own
senses, as I have proposed from the beginning." (Leaf 60,
lines 14-17.)
"What the members are to which these nerves come cannot well
be seen in such a dissection as this, but it should be
liquefied with rain water, and this is not contemplated in the
present body." (Leaf 60, lines 31-33.)
"After the veins you will note many muscles and many large and
strong cords, the complete anatomy of which you will not
endeavor to find in such a body but in a body dried in the sun
for three years, as I have demonstrated at another time; I
also declared completely their number, and wrote the anatomy
of the muscles of the arms, hands, and feet in a lecture which
I gave over the first, second, third, and fourth subjects."
(Leaf 61, lines 1-7.)
Very probably the best evidence that we have of the comparative
frequency at least of dissection at this time is to be found in the
records of a trial for body-snatching that occurred in Bologna. The
details would remind one very much of what we know of the difficulties
with regard to dissection in America a couple of generations ago, when
no bodies were provided by law for dissection purposes. In the course of
some studies for the history of the New York State Medical Society (New
York, 1906) I found that nearly every one of the first half dozen
presidents of the New York Academy of Medicine, which is not much more
than sixty years old, had had body-snatching experiences when they were
younger. Dr. Samuel Francis, the medico-historical writer, tells of a
personal expedition across the ferry in the winter time, bringing a body
from a Long Island graveyard. In order to avoid the constables on the
Long Island side and the police on the New York side, because there had
been a number of cases of body-snatching recently and the authorities
were on the lookout, the corpse was placed sitting beside the physician
who drove the wagon, with a cloak wrapped around it, as if it were a
living person specially protected against the cold. Similar experiences
were not unusual. The lack of bodies for dissection is sometimes
attributed to religious scruples, but they have very little to do with
it, as at all times men have refused to allow the bodies of their
friends to be treated as anatomical material. This is the natural
feeling of abhorrence and not at all religious. It is only when there
are many unclaimed bodies of strangers and the poor, as happens in large
cities, that there can be an abundance of anatomical material.
The details of this body-snatching case are strangely familiar to those
who know the history of similar cases before the middle of the
nineteenth century. The case occurred in 1319 in Bologna, just four
years after Mondino's public dissections. Four students were involved in
the charge of body-snatching, all of them from outside the city of
Bologna itself, three from Milan and one from Piacenza. In modern
experience, too, as a rule, students from outside of the town where the
medical college was situated, were always a little readier than natives
to violate graveyards. These four students were accused of having gone
at night to the Cemetery of St. Barnabas, outside the gate of San
Felice,--suburban graveyards were usually the scene of such
exploits,--and to have dug up the body of a certain criminal named
Pasino, who had been hanged a few days before. They carried the body to
the school in the Parish of San Salvatore, where Alberto Zancari was
teaching. The resurrection had been accomplished without witnesses, but
there were several witnesses who testified that they recognized the body
of Pasino in the school and students occupied with its dissection. If
evidence for the zeal of the medical students of that time for
dissection were needed, surely we have it in the testimony at this
trial. At a time when body-snatching has become a criminal offence
usually there have been many repeated occurrences of it before the
parties are brought to trial, so that it seems not unlikely that a good
many dissections of illegally secured bodies were being done at Bologna
at this time.
We know of a regulation of the University in force at this time, which
required the teachers at the University to do an anatomy or dissection
for students if they secured a body for that purpose. The students seem
to have used all sorts of influence, political, monetary, diplomatic,
and ecclesiastical, in order to secure the bodies of criminals.
Sometimes when they failed in their purpose they waited until after
burial and then took the body without leave. When we recall the awfully
deterrent condition in which bodies must have been that were thus
provided for dissecting purposes, it is easy to understand that the
enthusiasm of the students for dissection must have been at a very high
pitch. Certainly it was far higher than at the present day, when, in
spite of the fact that our dissecting-rooms have very few of the
old-time dangers and unpleasantnesses, dissection is only practised with
assiduity if special care is exercised in requiring attendance and
superintending the work of the department.
In my book on "The Popes and Science" I have gathered the traditions
relating to Mondino's assistants in the chair of anatomy at Bologna.
They furnish abundant evidence of the fact that dissections, far from
being uncommon, must have been not at all infrequent at the north
Italian universities at this time. Curiously enough, one of these
assistants was a young woman who, as was not infrequently the custom at
this time in the Italian universities, was matriculated as a student at
Bologna. She took up first philosophy, and afterwards anatomy, under
Mondino. While it is not generally realized, co-education was quite
common at the Italian universities of the thirteenth and fourteenth
centuries, and at no time since the foundation of the universities has a
century passed in Italy without distinguished women occupying
professors' chairs at some of the Italian universities. This young
woman, Alessandra Giliani, of Persiceto, a country district not far from
Bologna, took up the study of anatomy with ardor and, strange as it may
appear, became especially enthusiastic about dissection. She became so
skilful that she was made the prosector of anatomy, that is, one who
prepares bodies for demonstration by the professors.
According to the "Cronaca Persicetana," quoted by Medici in his "History
of the Anatomical School at Bologna":
"She became most valuable to Mondino because she would cleanse most
skilfully the smallest vein, the arteries, all ramifications of the
vessels, without lacerating or dividing them, and to prepare them for
demonstration she would fill them with various colored liquids, which,
after having been driven into the vessels, would harden without
destroying the vessels. Again, she would paint these same vessels to
their minute branches so perfectly and color them so naturally that,
added to the wonderful explanations and teachings of the master, they
brought him great fame and credit." The whole passage shows a wonderful
anticipation of our most modern methods--injection, painting,
hardening--of making anatomical preparations for class and demonstration
purposes.
Some of the details of the story have been doubted, but her memorial
tablet, erected at the time of her death in the Church of San Pietro e
Marcellino of the Hospital of Santa Maria de Mareto, gives all the
important facts, and tells the story of the grief of her fiancé, who was
himself Mondino's other assistant.[17] This was Otto Agenius, who had
made for himself a name as an assistant to the chair of anatomy in
Bologna, and of whom there were great hopes entertained because he had
already shown signs of genius as an investigator in anatomy. These hopes
were destined to grievous disappointment, however, for Otto died
suddenly, before he had reached his thirtieth year. The fact that both
these assistants of Mondino died young and suddenly, would seem to point
to the fact that probably dissection wounds in those early days proved
even more fatal than they occasionally did a century or more ago, when
the proper precautions against them were not so well understood. The
death of Mondino's two prosectors in early years would seem to hint at
some such unfortunate occurrence.
As regards the evidence of what the young man had accomplished before
his untimely death, probably the following quotation, which Medici has
taken from one of the old chroniclers, will give the best idea:
"What advantage indeed might not Bologna have had from Otto
Agenius Lustrulanus, whom Mondino had used as an assiduous
prosector, if he had not been taken away by a swift and
lamentable death before he had completed the sixth lustrum of
his life!"
How well the tradition created by Mondino continued at the university
will be best understood from what we know of Guy de Chauliac's visit to
the medical school here about the middle of the century. The great
French surgeon tells us that he came to Bologna to study anatomy under
the direction of Mondino's successor, Bertruccius. When he wrote his
preface to his great surgery he recalled this teaching of anatomy at
Bologna and said, "It is necessary and useful to every physician to
know, first of all, anatomy. For this purpose the study of books is
indeed useful, but it is not sufficient to explain those things which
can only be appreciated by the senses and which need to be seen in the
dead body itself." He advises his students to consult Mundinus' treatise
but to demonstrate its details for themselves on the dead body. He
relates that he himself had often, _multitoties_, done this, especially
under the direction of Bertruccius at Bologna. Curiously enough, as
pointed out by Professor Pilcher, Mondino had used this same word
_multitotiens_ (the variant spelling makes no difference in the meaning)
in speaking about his own work. In describing the hypogastric lesion he
mentions that he had demonstrated certain veins in it many times,
_multitotiens_.
Mondino was just past fifty when he finished his little book and
permitted copies of it to be made. Though the book occurs so early in
the history of modern book-making the author offers his excuses to the
public for writing it, and quotes the authority of Galen, to whom he
turns in other difficult situations, for justification. As prefaces go,
Mondino's is so like that of many an author of more recent date that his
words have a bibliographic, as well as a personal, interest. He said:
"A work upon any science or art--as saith Galen--is issued for
three reasons: first, that one may satisfy his friends.
Second, that he may exercise his best mental powers. Third,
that he may be saved from the oblivion incident to old age.
Therefore, moved by these three causes, I have proposed to my
pupils to compose a certain work on medicine.
"And because a knowledge of the parts to be subjected to
medicine (which is the human body, and the names of its
various divisions) is a part of medical science, as saith
Averrhoes in his first chapter, in the section on the
definition of medicine, for this reason among others, I have
set out to lay before you the knowledge of the parts of the
human body which is derived from anatomy, not attempting to
use a lofty style, but the rather that which is suitable to a
manual of procedure."
Some of the early editions of Mondinus' book are said, according to old
writers, to have contained illustrations. None of these copies have come
down to us, but the assertion is made so definitely that it seems likely
to have been the case. The editions that we have contain wood engravings
of the method of making a dissection as frontispiece, so that it would
not be difficult to think of further such illustrations having been
employed in the book itself. As we note in the chapter on "Great
Surgeons of the Medieval Universities," Mondeville, according to Guy de
Chauliac, had pictures of anatomical preparations which he used for
teaching purposes. It is easy to understand that the value of such aids
would be recognized at a time when the difficulty of preserving bodies
made it necessary to do dissections hurriedly so as to get the rapidly
decomposing material out of the way.
Beyond his book and certain circumstances connected with it we know very
little about Mondino. What we know, however, enables us to conclude
that, like many another great teacher, he must have had the special
faculty of inspiring his students with an ardent enthusiasm for the work
that they were taking under him. Hence the body-snatching and other
stories. Mondino continued to be held in high estimation by the
Bolognese for centuries after his death. Dr. Pilcher calls attention to
the fact that his sepulchral tablet, which is in the portico of the
Church of San Vitari in Bologna, and a replica of which he was allowed
to have made in order to bring it to America, is the only one of the
sepulchral tablets in the great churches of Florence, San Domenico, San
Martino, the Cathedral and the Cloister of San Giacomo degli Ermitani,
which has not been removed from its original location and placed in the
halls of the Civic Museum. Their removal he considers "a kind of
desecration which does violence to one's sense of sanctity and
propriety." "Fortunately, thus far, the Mondino Tablet has escaped the
spoiler." Very probably Dr. Pilcher's replica of the tablet which he
was required to deposit in the Civic Museum at the time when the copy
was made to be brought to America may save the tablet to be seen in its
original position for many generations.
Mondino's career is of special interest because it foreshadows the life
and accomplishment of many another maker of medicine of the after time.
He did a great new thing in medicine in organizing regular public
dissections, and then in making a manual that would facilitate the work.
He waited patiently for years before completing his book in order that
it might be the fruit of long experience, and so be more helpful to
others. He was so modest as to require urging to secure the publication.
He had the reward of his patience in the popularity of his little work
for centuries after his time. The glimpse that we get of his relations
to his young assistants, Agenius and Alessandra, seems to show us a
teacher of distinct personal magnetism. Undoubtedly the reputation of
his book did much for not only the medical school of the University of
Bologna, but also for the medical schools of other north Italian
universities, and helped to bring to them the crowds of students that
flocked there during the fourteenth and fifteenth centuries.
Taddeo and Mondino turned the attention of the medical students of their
generations Bolognawards. Before that time they had mainly gone to
Salerno. After their time most of the ardent students of medicine felt
that they must study for a time at least at Bologna. Other important
medical schools of Italian universities at Padua, at Vicenza, at
Piacenza, arose and prospered. During the time when the political
troubles of Italy reached a climax about the middle of the fourteenth
century, while the Popes were at Avignon, there was a remission in the
attendance at all the Italian universities, but with the Popes' return
to Rome and the coming of even comparative peace to Italy, Bologna once
more became the term of medical pilgrimages for students from all over
the world. In the meantime Mondino's book went forth to be the most used
text-book of its kind until Vesalius' great work came to replace it. To
have ruled in the world of anatomy for two centuries as the best known
of teachers is of itself a distinction that shows us at once the
teaching power and the scientific ability of this professor of anatomy
of Bologna in the early fourteenth century.
X
GREAT SURGEONS OF THE MEDIEVAL UNIVERSITIES
Strange as it may appear to those who have not watched the development
of our knowledge of the Middle Ages in recent years the most interesting
feature in the medical departments and, indeed, of the post-graduate
work generally of the medieval universities, is that in surgery. There
is a very general impression that this department of medicine did not
develop until quite recent years, and that particularly it failed to
develop to any extent in the Middle Ages. A good many of the historians
of this period, indeed, though never the special historians of medicine,
have even gone far afield in order to find some reason why surgery did
not develop at this time. They have insisted that the Church by its
prohibition of the shedding of blood, first to monks and friars, and
then to the secular clergy, prevented the normal development of surgery.
Besides they add that Church opposition to anatomy completely precluded
all possibility of any genuine natural evolution of surgery as a
science.
There is probably no more amusing feature of quite a number of
supposedly respectable and presumably authoritative historical works
written in English than this assumption with regard to the absence of
surgery during the later Middle Ages. Only the most complete ignorance
of the actual history of medicine and surgery can account for it. The
writers who make such assertions must never have opened an authoritative
medical history. Nothing illustrates so well the expression of the
editors of the "Cambridge Modern History" referred to more than once in
these pages that "in view of changes and of gains such as these [the
jointing of original documents] it has become impossible for historical
writers of the present day to trust without reserve even to the most
respected secondary authority. The honest student finds himself
continually deserted, retarded, misled by the classics of historical
literature." Fortunately for us this sweeping condemnation does not hold
to any great extent for the medical historical classics. All of the
classic historians of medicine tell us much of the surgery of the
thirteenth and fourteenth centuries, and in recent years the
republication of old texts and the further study of manuscript documents
of various kinds have made it very clear that there is almost no period
in the history of the world when surgery was so thoroughly and
successfully cultivated as during the rise and development of the
universities and their medical schools in the thirteenth and fourteenth
centuries.
It is interesting to trace the succession of great contributors to
surgery during these two centuries. We know their teaching not from
tradition, but from their text-books so faithfully preserved for us by
their devoted students, who must have begrudged no time and spared no
labor in copying, for many of the books are large, yet exist in many
manuscript copies.
Modern surgery may be said to owe its origin to a school of surgeons,
the leaders of whom were educated at Salerno in the early part of the
thirteenth century, and who, teaching at various north Italian
universities, wrote out their surgical principles and experiences in a
series of important contributions to that department of medical science.
The fact that the origin of the school was at Salerno, where, as is well
known, Arabian influence counted for much and for which Constantine's
translations of Arabian works proved such a stimulus a century before,
makes most students conclude that this later medieval surgical
development is simply a continuation of the Arabian surgery that, as we
have seen, developed very interestingly during the earlier Middle Ages.
Any such idea, however, is not founded on the realities of the
situation, but on an assumption with regard to the extent of Arabian
influence. Gurlt in his "History of Surgery" (Vol. I, page 701)
completely contradicts this idea, and says with regard to the first of
the great Italian writers on surgery, Rogero, that "though Arabian works
on surgery had been brought over to Italy by Constantine Africanus a
hundred years before Roger's time, these exercised no influence over
Italian surgery in the next century, and there is scarcely a trace of
the surgical knowledge of the Arabs to be found in Roger's works."
It is in the history of medicine particularly that it is possible to
trace the true influence of the Arabs on European thought in the later
Middle Ages. We have already seen in the chapter on Salerno that Arabian
influence did harm to Salernitan medical teaching. The school of Salerno
itself had developed simple, dietetic, hygienic, and general remedial
measures that included the use of only a comparatively small amount of
drugs. Its teachers emphasized nature's curative powers. With Arabian
influence came polypharmacy, distrust of nature, and attempts to cure
disease rather than help nature. In surgery, which developed very
wonderfully in the thirteenth and fourteenth centuries, Salerno must be
credited with the incentive that led up to the marvellous development
that came. With this, however, Arabian influence has nothing to do.
Gurlt, besides calling attention to the fact that the author of the
first great text-book on the subject not only did not draw his
inspiration from Arab sources, insisted that "instead of any Arabisms
being found in his [Roger's] writings many Græcisms occur." The
Salernitan school of surgery drank at the fountain-head of Greek
surgery. Apart from Greek sources Roger's book rests entirely upon his
own experiences, those of his teachers and his colleagues, and the
tradition in surgery that had developed at Salerno. This tradition was
entirely from the Greek. Roger himself says in one place, "We have
resolved to write out deliberately our methods of operation such as they
have been derived from our own experience and that of our colleagues and
illustrious men."
ROGER, ROLAND, AND THE FOUR MASTERS
Ruggero, or Rogero, who is also known as Rogerio and Rogerus with the
adjective Parmensis, or Salernitanus, of Parma or of Salerno, and often
in German and English history simply as Roger, lived at the end of the
twelfth or the beginning of the thirteenth century and probably wrote
his text-book about 1180. This text-book was, according to tradition,
originally drafted for his lessons in surgery at Salerno. It attracted
much attention and after being commented on by his pupil Rolando, the
work of both of them being subsequently annotated by the Four Masters,
this combined work became the basis of modern surgery. Roger was
probably born either in Palermo or Parma. There are traditions of his
having taught for a while at Paris and at the University of Montpellier,
though these are not substantiated. His book was printed at Venice in
1546, and has been lately reprinted by De Renzi in his "Collectio
Salernitana."
Roland was a pupil of Roger's, and the two names that often occur in
medieval romance became associated in a great historic reality as a
consequence of Roland's commentary on his master's work, which was a
favorite text-book in surgery for a good while in the thirteenth century
at Salerno. Some space will be given to the consideration of their
surgical teaching after a few words with regard to some disciples who
made a second commentary, adding to the value of the original work.
This is the well-known commentary of the Four Masters, a text-book of
surgery written somewhat in the way that we now make text-books in
various departments of medicine, that is, by asking men who have made
specialties of certain subjects to write on that subject and then bind
them all together in a single volume. It represents but another striking
reminder that most of our methods are old, not new as we are likely to
imagine them. The Four Masters took the works of Roger and Rolando,
acknowledged their indebtedness much more completely than do our modern
writers on all occasions, I fear, and added their commentaries.
Gurlt says ("Geschichte der Chirurgie," Vol. I, p. 703) that "in spite
of the fact that there is some doubt about the names of the authors,
this volume constitutes one of the most important sources for the
history of surgery of the later Middle Ages and makes it very clear that
these writers drew their opinions from a rich experience." It is rather
easy to illustrate from the quotations given in Gurlt or from the
accounts of their teaching in Daremberg or De Renzi some features of
this experience that can scarcely fail to be surprising to modern
surgeons. For instance, what is to be found in this old text-book of
surgery with regard to fractures of the skull is likely to be very
interesting to surgeons at all times. One might be tempted to say that
fewer men would die every year in prison cells who ought to be in
hospitals, if the old-time teaching was taken to heart. For there are
rather emphatic directions not to conclude because the scalp is
unwounded that there can be no fracture of the skull. Where nothing can
be felt care must be exercised in getting the history of the case. For
instance, if a man is hit by a metal instrument shaped like the clapper
of a bell or by a heavy key, or by a rounded instrument made of
lead--this would remind one very much of the lead pipe of the modern
time, so fruitful of mistakes of diagnosis in head injuries--special
care must be taken to look for symptoms in spite of the lack of an
external penetrating wound. Where there is good reason to suspect a
fracture because of the severity of the injury, the scalp should be
incised and a fracture of the cranium looked for carefully. That is
carrying the exploratory incision pretty far. If a fracture is found the
surgeon should trephine so as to relieve the brain of any pressure of
blood that might be affecting it.
There are many warnings, however, of the danger of opening the skull and
of the necessity for definitely deciding beforehand that there is good
reason for so doing. How carefully their observations had been made and
how well they had taken advantage of their opportunities, which were, of
course, very frequent in those warlike times when firearms were unknown,
hand-to-hand conflict common, and blunt weapons were often used, can be
appreciated very well from some of the directions. For instance, they
knew of the possibility of fracture by _contrecoup_. They say that
"quite frequently though the percussion comes in the anterior part of
the cranium, the cranium is fractured on the opposite part."[18] They
even seem to have known of accidents such as we now discuss in
connection with the laceration of the middle meningeal artery. They warn
surgeons of the possibilities of these cases. They tell the story of "a
youth who had a very small wound made by a thrown stone and there seemed
no serious results or bad signs. He died the next day, however. His
cranium was opened and a large amount of black blood was found
coagulated about his dura mater."
There are many interesting things said with regard to depressed
fractures and the necessity for elevating the bone. If the depressed
portion is wedged then an opening should be made with the trephine and
an elevating instrument called a spatumen used to relieve the pressure.
Great care should be taken, however, in carrying out this procedure lest
the bone of the cranium itself, in being lifted, should injure the soft
structures within. The dura mater should be carefully protected from
injury as well as the pin. Care should especially be exercised at the
brow and the rear of the head and at the commissures (_proram et pupim
et commissuras_), since at these points the dura mater is likely to be
adherent. Perhaps the most striking expression, the word _infect_ being
italicized by Gurlt, is: "In elevating the cranium be solicitous lest
you should infect or injure the dura mater."
For wounds of the scalp sutures of silk are recommended because this
resists putrefaction and holds the wound edges together. Interrupted
sutures about a finger-breadth apart are recommended. "The lower part of
the wound should be left open so that the cure may proceed properly."
Red powder was strewed over the wound and the leaf of a plant set above
it. In the lower angle of the wound a pledget of lint for drainage
purposes was inlaid. Hemorrhage was prevented by pressure, by the
binding on of _burnt_ wool firmly, and by the ligature of veins and by
the cautery.
There are rather interesting discussions of the prognosis of wounds of
the head, especially such as may be determined from general symptoms in
this commentary of the Four Masters on Roger's and Rolando's treatises.
If an acute febrile condition develops, the wound is mortal. If the
patient loses the use of the hands and feet or if he loses his power of
direction, or his sensation, the wound is mortal. If a universal
paralysis comes on, the wound is mortal. For the treatment of all these
wounds careful precautions are suggested. Cold was supposed to be
particularly noxious to them. Operations on the head were not to be done
in cold weather and, above all, not in cold places. The air where such
operations were done must be warmed artificially. Hot plates should
surround the patient's head while the operation was being performed. If
this were not possible they were to be done by candlelight, the candle
being held as close as possible in a warm room. These precautions are
interesting as foreshadowing many ideas of much more modern time and
especially indicating how old is the idea that cold may be taken in
wounds. In popular medicine this still has its place. Whenever a wound
does badly in the winter time patients are sure that they have taken
cold. Such popular medical ideas are always derived from supposedly
scientific medicine, and until we learned about microbes physicians used
the same expressions. We have not got entirely away from them yet.
These old surgeons must have had many experiences with fractures at the
base of the skull. Hemorrhages from the mouth and nose, for instance,
and from the ears were considered bad signs. They were inclined to
suggest that openings into the skull should be discovered by efforts to
demonstrate a connection between the mouth and nares and the brain
cavity. For instance, in their commentary the Four Masters said: "Let
the patient hold his mouth and nostrils tight shut and blow strongly."
If there was any lessening of the pressure or any appearance of air in
the wound in the scalp, then a connection between the mouth and nose was
diagnosticated. This is ingenious but eminently dangerous because of the
infectious material contained in the nasal and oral cavities, so likely
to be forced by such pressure into the skull. They were particularly
anxious to detect linear fractures. One of their methods of negative
diagnosis for fractures of the skull was that if the patient were able
to bring his teeth together strongly, or to crack a nut without pain,
then there was no fracture present. One of the commentators, however,
adds to this "_sed hoc aliquando fallit_--but this sign sometimes
fails." Split or crack fractures were also diagnosticated by the method
suggested by Hippocrates of pouring some colored fluid over the skull
after the bone was exposed, when the linear fracture would show by
coloration. The Four Masters suggest a sort of red ink for this purpose.
While they have so much to say about fractures of the skull and insist,
over and over again, that though all depressed fractures need treatment
and many fissure fractures require trepanation, still great care must be
exercised in the selection of cases. They say, for instance, that
surgeons who in every serious wound of the head have recourse to the
trephine must be looked upon as "fools and idiots" (_idioti et
stolidi_). In the light of what we now know about the necessity for
absolute cleanliness,--asepsis as we have come to call it,--it is rather
startling to note the directions that are given to a surgeon to be
observed on the day when he is to do a trepanation. For obvious reasons
I prefer to quote it in the Latin: "_Et nota quod die ilia cavendum est
medico a coitu et malis cibis aera corrumpentibus, ut sunt allia, cepe,
et hujusmodi, et colloquio mulieris menstruosæ, et manus ejus debent
esse mundæ, etc._" My quotation is from Gurlt, Vol. I, p. 707. The
directions are most interesting. The surgeon's hands must be clean, he
must avoid the taking of food that may corrupt the air, such as onions,
leeks, and the like; must avoid menstruating and other women, and in
general must keep himself in a state of absolute cleanliness.
To read a passage like this separated from its context and without
knowing anything about the wonderful powers of observation of the men
from whom it comes, it would be very easy to think that it is merely a
set of general directions which they had made on some general principle,
perhaps quite foolish in itself. We know, however, that these men had by
observation detected nearly every feature of importance in fractures of
the skull, their indications and contra-indications for operation and
their prognosis. They had anticipated nearly everything of importance
that has come to be insisted on even in our own time in the handling of
these difficult cases. It is not unlikely, therefore, that they had also
arrived at the recognition by observations on many patients that the
satisfactory after-course of these cases which were operated on by the
surgeon after due regard to such meticulous cleanliness as is suggested
in the paragraph I have quoted, made it very clear that these aseptic
precautions, as we would call them, were extremely important for the
outcome of the case and, therefore, were well worth the surgeon's
attention, though they must have required very careful precautions and
considerable self-denial. Indeed this whole subject, the virtual
anticipation of our nineteenth-century principles of aseptic surgery in
the thirteenth century, is not a dream nor a far-fetched explanation
when one knows enough about the directions that were laid down in the
surgical text-books of that time.
THE NORTH ITALIAN SURGEONS
After Roger and Rolando and the Four Masters, who owe the inspiration
for their work to Salerno and the south of Italy, comes a group of north
Italian surgeons: Bruno da Longoburgo, usually called simply Bruno;
Theodoric and his father, Hugo of Lucca, and William of Salicet.
Immediately following them come two names that belong, one almost feels,
to a more modern period: Mondino, the author of the first text-book on
dissection, and Lanfranc (the disciple of William of Salicet), who
taught at Paris and "gave that primacy to French surgery which it
maintained all the centuries down to the nineteenth" (Pagel). It might
very well be thought that this group of Italian surgeons had very little
in their writings that would be of any more than antiquarian interest
for the modern time. It needs but a little knowledge of their writings
as they have come down to us to show how utterly false any such opinion
is. To Hugo da Lucca and his son Theodoric we owe the introduction and
the gradual bringing into practical use of various methods of
anæsthesia. They used opium and mandragora for this purpose and later
employed an inhalant mixture, the composition of which is not absolutely
known. They seem, however, to have been very successful in producing
insensibility to pain for even rather serious and complicated and
somewhat lengthy operations. Indeed it is to this that must be
attributed most of their surprising success as surgeons at this early
date.
We are so accustomed to think that anæsthesia was discovered about the
middle of the nineteenth century in America that we forget that
literature is full of references in Tom Middleton's (seventeenth
century) phrase to "the mercies of old surgeons who put their patients
to sleep before they cut them." Anæsthetics were experimented with
almost as zealously, during the latter half of the thirteenth century at
least, as during the latter half of the nineteenth century. They were
probably not as successful as we are, but they did succeed in producing
insensibility to pain, otherwise they could never have operated to the
extent they did. Moreover the traditions show that the Da Luccas
particularly had invented a method that left very little to be desired
in this matter of anæsthesia. A reference to the sketch of Guy de
Chauliac in this volume will show how practical the method was in his
time.
Nearly the same story as with regard to anæsthetics has to be repeated
for what are deemed so surely modern developments,--asepsis and
antisepsis. I have already suggested that Roger seems to have known how
extremely important it was to approach operations upon the skull with
the most absolute cleanliness. There are many hints of the same kind in
other writers which show that this was no mere accidental remark, but
was a definite conclusion derived from experience and careful
observation of results. We find much more with regard to this same
subject in the writings of the group of northern Italian surgeons and
especially in the group of those associated with William of Salicet.
Professor Clifford Allbutt, Regius Professor of Medicine at the
University of Cambridge, England, in his address before the St. Louis
World's Fair Congress of Arts and Science in 1904, did not hesitate to
declare that William discussed the causes for union by first intention
and the modes by which it might be obtained. He, too, insisted on
cleanliness as the most important factor in having good surgical
results, and all of this group of men, in operating upon septic cases,
used stronger wine as a dressing. This exerted, as will be readily
understood, a very definite antiseptic quality.
Evidently some details of the teaching of this group of great surgeons
in northern Italy in the second half of the thirteenth century will make
clearer to us how much the rising universities of the time were
accomplishing in medicine and surgery as well as in their other
departments. The dates of the origin of some of these universities
should perhaps be recalled so as to remind readers how closely related
they are to this great group of surgical teachers. Salerno was founded
very early, probably in the tenth century, Bologna, Reggio, and Modena
came into existence toward the end of the twelfth century; Vicenza,
Padua, Naples, Vercelli, and Piacenza, as well as Arezzo, during the
first half of the thirteenth century; Rome, Perugia, Trevizo, Pisa,
Florence, Sienna, Lucca, Pavia, and Ferrara during the next century. The
thirteenth century was the special flourishing period of the
universities, and the medical departments, far from being behind, were
leaders in accomplishment. (See my "The Thirteenth Greatest of
Centuries," N.Y., 1908.)
BRUNO DA LONGOBURGO
The first of this important group of north Italian surgeons who taught
at these universities was Bruno of Longoburgo. While he was born in
Calabria, and probably studied in Salerno, his work was done at Vicenza,
Padua, and Verona. His text-book, the "Chirurgia Magna," dedicated to
his friend Andrew of Piacenza, was completed at Padua in January, 1252.
Gurlt notes that he is the first of the Italian surgeons who quotes,
besides the Greeks, the Arabian writers on surgery. Eclecticism had
definitely come into vogue to replace exclusive devotion to the Greek
authors, and men were taking what was good wherever they found it. Gurlt
tells us that Bruno owed much of what he wrote to his own experience and
observation. He begins his work by a definition of surgery, _chirurgia_,
tracing it to the Greek and emphasizing that it means handwork. He then
declares that it is the last instrument of medicine to be used only when
the other two instruments, diet and potions, have failed. He insists
that surgeons must learn by seeing surgical operations and watching them
long and diligently. They must be neither rash nor over bold and should
be extremely cautious about operating. While he says that he does not
object to a surgeon taking a glass of wine, the followers of this
specialty must not drink to such an extent as to disturb their command
over themselves, and they must not be habitual drinkers. While all that
is necessary for their art cannot be learned out of books, they must not
despise books however, for many things can be learned readily from
books, even about the most difficult parts of surgery. Three things the
surgeon has to do:--"to bring together separated parts, to separate
those that have become abnormally united, and to extirpate what is
superfluous."
In his second chapter on healing he talks about healing by first and
second intention. Wounds must be more carefully looked to in summer than
in winter, because _putrefactio est major in aestate quam in hyeme_,
putrefaction is greater in summer than in winter. For proper union care
must be exercised to bring the wound edges accurately together and not
allow hair, or oil, or dressings to come between them. In large wounds
he considers stitching indispensable, and recommends for this a fine,
square needle. The preferable suture material in his experience was silk
or linen.
The end of the wound was to remain open in order that lint might be
placed therein in order to draw off any objectionable material. He is
particularly insistent on the necessity for drainage. In deep wounds
special provision must be made, and in wounds of extremities the limb
must be so placed as to encourage drainage. If drainage does not take
place, then either the wound must be thoroughly opened, or if necessary
a counter opening must be made to provide drainage. All his treatment of
wounds is dry, however. Water, he considered, always did harm. We can
readily understand that the water generally available and especially as
surgeons saw it in camps and on the battlefield, was likely to do much
more harm than good. In penetrating wounds of the belly cavity, if there
was difficulty in bringing about the reposition of the intestines, they
were first to be pressed back with a sponge soaked in warm wine. Other
manipulations are suggested, and if necessary the wound must be
enlarged. If the omentum finds its way out of the wound, all of it that
is black or green must be cut off. In cases where the intestines are
wounded they are to be sewed with a small needle and a silk thread and
care is to be exercised in bringing about complete closure of the wound.
This much will give a good idea of Bruno's thoroughness. Altogether,
Gurlt, in his "History of Surgery," gives about fifteen large octavo
pages of rather small type to a _brief_ compendium of Bruno's teachings.
One or two other remarks of Bruno are rather interesting in the light of
modern developments in medicine. For instance, he suggests the
possibility of being able to feel a stone in the bladder by means of
bimanual palpation. He teaches that mothers may often be able to cure
hernias, both umbilical and inguinal, in children by promptly taking up
the treatment of them as soon as noticed, bringing the edges of the
hernial opening together by bandages and then preventing the reopening
of the hernia by prohibiting wrestling and loud crying and violent
motion. He has seen overgrowth of the mamma in men, and declares that it
is due to nothing else but fat, as a rule. He suggests if it should hang
down and be in the way on account of its size it should be extirpated.
He seems to have known considerable about the lipomas and advises that
they need only be removed in case they become bothersomely large. The
removal is easy, and any bleeding that takes place may be stopped by
means of the cautery. He divides rectal fistulæ into penetrating and
non-penetrating, and suggests salves for the non-penetrating and the
actual cautery for those that penetrate. He warns against the
possibility of producing incontinence by the incision of deep fistulæ,
for this would leave the patient in a worse state than before.
HUGH OF LUCCA
Bruno brought up with him the methods and principles of surgery from the
south of Italy, but there seems to have been already in the north at
least one distinguished surgeon who had made his mark. This was Ugo da
Lucca or Ugo Luccanus, sometimes known in the modern times in German
histories of medicine as Hugo da Lucca and in English, Hugh of Lucca. He
flourished early in the thirteenth century. In 1214 he was called to
Bologna to become the city physician, and joined the Bolognese
volunteers in the crusade in 1218, being present at the siege of
Damietta. He returned to Bologna in 1221 and was given the post of legal
physician to the city. The civic statutes of Bologna are, according to
Gurlt, the oldest monument of legal medicine in the Middle Ages. Ugo
died not long after the middle of the century, and is said to have been
nearly one hundred years old. Of his five sons, three became physicians.
The most celebrated of these was Theodoric, who wrote a text-book of
surgery in which are set down the traditions of surgery that had been
practised in his father's life. Theodoric is especially enthusiastic in
praise of his father, because he succeeded in bringing about such
perfect healing of wounds with only wine and water and the ligature and
without the employment of any ointments.
Ugo seems to have occupied himself much with chemistry. To him we owe a
series of discoveries with regard to anodyne and anæsthetizing drugs. He
is said to have been the first who taught the sublimation of arsenic.
Unfortunately he left no writings after him, and all that we know of him
we owe to the filial devotion of his son Theodoric.
THEODORIC
This son, after having completed his medical studies at the age of about
twenty-three, entered the Dominican Order, then only recently
established, but continued his practice of medicine undisturbed. His
ecclesiastical preferment was rapid. He attracted the attention of the
Bishop of Valencia, and became his chaplain in Rome. At the age of about
fifty he was made a bishop in South Italy and later transferred to the
Bishopric of Cervia, not far from Ravenna. Most of his life seems to
have been passed in Bologna however, and he continued to practise
medicine, devoting his fees, however, entirely to charity. His text-book
of surgery was written about 1266 and is signed with his full name and
title as Bishop of Cervia. Even at this time however, he still retained
the custom of designating himself as a member of the Dominican Order.
The most interesting thing in the first book of his surgery is
undoubtedly his declaration that all wounds should be treated only with
wine and bandaging. Wine he insists on as the best possible dressing for
wounds. It was the most readily available antiseptic that they had at
that time, and undoubtedly both his father's recommendation of it and
his own favorable experience with it were due to this quality. It must
have acted as an excellent inhibitive agent of many of the simple forms
of pus formation. At the conclusion of this first book he emphasizes
that it is extremely important for the healing of wounds that the
patient should have good blood, and this can only be obtained from
suitable nutrition. It is essential therefore for the physician to be
familiar with the foods which produce good blood in order that his
wounded patients may be fed appropriately. He suggests, then, a number
of articles of diet which are particularly useful in producing such a
favorable state of the tissues as will bring about the rebirth of flesh
and the adhesion of wound surfaces. Shortly before he emphasizes the
necessity for not injuring nerves, though if nerves have been cut they
should be brought together as carefully as possible, the wound edges
being then approximated.
Probably the most interesting feature for our generation of the great
text-books of the surgeons of the medieval universities is the
occurrence in them of definite directions for securing union in surgical
wounds, at least by first intention and their insistence on keeping
wounds clear. The expression union by first intention comes to us from
the olden time. They even boasted that the scars left after their
incisions were often so small as to be scarcely noticeable. Such
expressions of course could only have come from men who had succeeded in
solving some of the problems of antisepsis that were solved once more in
the generation preceding our own. With regard to their treatment of
wounds, Professor Clifford Allbutt says:[19]
"They washed the wound with wine, scrupulously removing every
foreign particle; then they brought the edges together, not
allowing wine nor anything else to remain within--dry adhesive
surfaces were their desire. Nature, they said, produces the
means of union in a viscous exudation, or natural balm, as it
was afterwards called by Paracelsus, Paré, and Wurtz. In older
wounds they did their best to obtain union by cleansing,
desiccation, and refreshing of the edges. Upon the outer
surface they laid only lint steeped in wine. Powders they
regarded as too desiccating, for powder shuts in decomposing
matters wine after washing, purifying, and drying the raw
surfaces evaporates."
Theodoric comes nearest to us of all these old surgeons. The surgeon
who in 1266 wrote: "For it is not necessary, as Roger and Roland have
written, as many of their disciples teach, and as all _modern_ surgeons
profess, that pus should be generated in wounds. No error can be greater
than this. Such a practice is indeed to hinder nature, to prolong the
disease, and to prevent the conglutination and consolidation of the
wound" was more than half a millennium ahead of his time. The italics in
the word modern are mine, but might well have been used by some early
advocate of antisepsis or even by Lord Lister himself. Just six
centuries almost to the year would separate the two declarations, yet
they would be just as true at one time as at another. When we learn that
Theodoric was proud of the beautiful cicatrices which he obtained
without the use of any ointment, _pulcherrimas cicatrices sine unguento
aliquo inducebat_, then further that he impugned the use of poultices
and of oils on wounds, while powders were too drying and besides had a
tendency to prevent drainage, the literal meaning of the Latin words
_saniem incarcerare_ is to "incarcerate sanious material," it is easy to
understand that the claim that antiseptic surgery was anticipated six
centuries ago is no exaggeration and no far-fetched explanation with
modern ideas in mind of certain clever modes of dressing hit upon
accidentally by medieval surgeons.
Theodoric's treatment of many practical problems is interesting for the
modern time. For instance, in his discussion of cancer he says that
there are two forms of the affection. One of them is due to a
melancholy humor, a constitutional tendency as it were, and occurs
especially in the breasts of women or latent in the womb. This is
difficult of treatment and usually fatal. The other class consists of a
deep ulcer with undermined edges, occurring particularly on the legs,
difficult to cure and ready of relapse, but for which the outlook is not
so bad. His description of _noli me tangere_ and of lupus is rather
practical. Lupus is "eating herpes," occurs mainly on the nose, or
around the mouth, slowly increases, and either follows a preceding
erysipelas or comes from some internal cause. _Noli me tangere_ is a
corroding ulcer, so called perhaps because irritation of it causes it to
spread more rapidly. He thinks that deep cauterization of it is the best
treatment. Since these are in the department of skin diseases this seems
the place to mention that Theodoric describes salivation as occurring
after the use of mercury for certain skin diseases. He has already shown
that he knows of certain genital ulcers and sores on the genital regions
and of distinctions between them.
WILLIAM OF SALICET
The third of the great surgeons in northern Italy was William of
Salicet. He was a pupil of Bruno's and the master of Lanfranc. The first
part of his life was passed at Bologna and the latter part as the
municipal and hospital physician of Verona. He probably died about 1280.
He was a physician as well as a surgeon and was one of those who
insisted that the two modes of practising medicine should not be
separated, or if they were both medicine and surgery would suffer. He
thought that the physician learned much by seeing the interior of the
body during life, while the surgeon was more conservative if he were a
physician. It is curiously interesting to find that the Regius
Professors at both Oxford and Cambridge in our time have expressed
themselves somewhat similarly. Professor Clifford Allbutt is quite
emphatic in this matter and Professor Osler is on record to the same
effect. Following Theodoric, William of Salicet did much to get away
from the Arabic abuse of the cautery and brought the knife back to its
proper place again as the ideal surgical instrument. Unlike those who
had written before him, William quoted very little from preceding
writers. Whenever he quotes his contemporaries it is in order to
criticise them. He depended on his own experience and considered that it
was only what he had actually learned from experience that he should
publish for the benefit of others.
A very good idea of the sort of surgery that William of Salicet
practised may be obtained even from the beginning of the first chapter
of his first book. This is all with regard to surgery of the head. He
begins with the treatment of hydrocephalus or, as he calls it, "water
collected in the heads of children newly born." He rejects opening of
the head by an incision because of the danger of it. In a number of
cases, however, he had had success by puncturing the scalp and membranes
with a cautery, though but a very small opening was made and the fluid
was allowed to escape only drop by drop. He then takes up eye diseases,
a department of surgery rather well developed at that time, as can be
seen from our account of the work of Pope John XXI as an
ophthalmologist during the thirteenth century. See _Ophthalmology_
(January, 1909), reprinted in "Catholic Churchmen in Science,"
Philadelphia, The Dolphin Press, 1909.
William devotes six chapters to the diseases of the eyes and the
eyelids. Then there are two chapters on affections of the ears. Foreign
bodies and an accumulation of ear wax are removed by means of
instruments. A polyp is either cut off or its pedicle bound with a
ligature, and it is allowed to shrivel. The next chapter is on the nose.
Nasal polyps were to be grasped with a sharp tenaculum, _cum tenacillis
acutis_, and either wholly or partially extracted. Ranula was treated by
being lifted well forward by means of a sharp iron hook and then split
with a razor. It is evident that the tendency of these to fill up again
was recognized, and accordingly it was recommended that vitriol powder,
or alum with salt, be placed in the cavity for a time after evacuation
in order to produce adhesive inflammation.
In the same chapter on the mouth one finds that William did not hesitate
to perform what cannot but be considered rather extensive operations
within the oral cavity. For instance, he tells of removing a large
epulis and gives an account in detail of the case. To quote his own
words: "I cured a certain woman from Piacenza who was suffering from
fleshy tumor on the gums of the upper jaw, the tumor having grown to
such a size above the teeth and the gums that it was as large or perhaps
larger than a hen's egg. I removed it at four operations by means of
heated iron instruments. At the last operation I removed the teeth that
were loose with certain parts of the jawbone."
In the next chapter there is an account of the treatment of a remarkable
case of abscess of the uvula. In the following chapter the swelling of
cervical glands is taken up. In his experience expectant treatment of
these was best. He advises internal medication with the building up of
the general health, or suggests allowing the inflamed glands to empty
themselves after pustulation. After much meddlesome surgery we are
almost back to his methods again. He did not hesitate to treat goitre
surgically, though he considered there were certain internal remedies
that would benefit it. In obstinate cases he suggests the complete
extirpation of cystic goitre, but if the sac is allowed to remain it
should be thoroughly rubbed over on the inside with green ointment. He
warns about the necessity for avoiding the veins and arteries in this
operation, and says that "in this affection many large veins make their
appearance and they find their way everywhere through the fleshy mass."
What I have given here is to be found in a little more than half a page
of Gurlt's abstract of the first twenty chapters of Salicet's first
book. Altogether Gurlt has more than ten pages of rather small print
with regard to William; most of it is as interesting and as practical
and as representative of anticipations of what is done in the modern
time as what I have here quoted. William, as I have said, depended much
more upon his own experience than upon what was to be found in
text-books. He knew the old text-books very well however, but as a rule
did not quote from them unless he had tried the recommendations for
himself, or unless similar cases to these mentioned had come under his
own observation. He was evidently a thoroughly observant physician, a
skilled surgeon who was practical enough to see the simplest way to do
things, and he proceeded to do them. It is no wonder that he influenced
succeeding generations so much, nor that his great pupil, Lanfranc,
continuing his tradition, founded a school of surgery in Paris, the
influence of which was to endure almost down to our time, and give
France a primacy in surgery until the nineteenth century.
LANFRANC
After Salicet's lifetime the focus of interest in surgery changes from
Italy to France, and what is still more complimentary to William, it is
through a favorite disciple of his that the change takes place. This was
Lanfranchi, or Lanfranco, sometimes spoken of as Alanfrancus, who
practised as physician and surgeon in Milan until banished from there by
Matteo Visconti about 1290. He then went to Lyons, where in the course
of his practice he attracted so much attention that he was offered the
opportunity to teach surgery in Paris. He attracted what Gurlt calls an
almost incredible number of scholars to his lessons in Paris, and by
hundreds they accompanied him to the bedside of his patients and
attended his operations. The dean of the medical faculty, Jean de
Passavant, urged him to write a text-book of surgery, not only for the
benefit of his students at Paris but for the sake of the prestige which
this would confer on the medical school. Deans still urge the same
reasons for writing. Lanfranc completed his surgery, called "Chirurgia
Magna," in 1296, and dedicated it to Philippe le Bel, the then reigning
French King. Ten years later he died, but in the meantime he had
transferred Italian prestige in surgery from Italy to France and laid
the foundations in Paris of a thoroughly scientific as well as a
practical surgery, though this department of the medical school had been
in a sadly backward state when he came.
In the second chapter of this text-book, the first containing the
definition of surgery and general introduction, Lanfranc describes the
qualities that in his opinion a surgeon should possess. He says, "It is
necessary that a surgeon should have a temperate and moderate
disposition. That he should have well-formed hands, long slender
fingers, a strong body, not inclined to tremble and with all his members
trained to the capable fulfilment of the wishes of his mind. He should
be of deep intelligence and of a simple, humble, brave, but not
audacious disposition. He should be well grounded in natural science,
and should know not only medicine but every part of philosophy; should
know logic well, so as to be able to understand what is written, to talk
properly, and to support what he has to say by good reasons." He
suggests that it would be well for the surgeon to have spent some time
teaching grammar and dialectics and rhetoric, especially if he is to
teach others in surgery, for this practice will add greatly to his
teaching power. Some of his expressions might well be repeated to young
surgeons in the modern time. "The surgeon should not love difficult
cases and should not allow himself to be tempted to undertake those that
are desperate. He should help the poor as far as he can, but he should
not hesitate to ask for good fees from the rich."
Many generations since Lanfranc's time have used the word nerves for
tendons. Lanfranc, however, made no such mistake. He says that the
wounds of nerves, since the nerve is an instrument of sense and motion,
are, on account of the greater sensitiveness which these structures
possess, likely to involve much pain. Wounds along the length of the
nerves are less dangerous than those across them. When a nerve is
completely divided by a cross wound Lanfranc is of the opinion, though
Theodoric and some others are opposed to it, that the nerve ends should
be stitched together. He says that this suture insures the
redintegration of the nerve much better. After this operation the
restoration of the usefulness of the member is more complete and
assured.
His description of the treatment of the bite of a rabid dog is
interesting. A large cupping glass should be applied over the wound so
as to draw out as much blood as possible. After this the wound should be
dilated and thoroughly cauterized to its depths with a hot iron. It
should then be covered with various substances that were supposed to
draw, in order as far as possible to remove the poison. His description
of how one may recognize a rabid animal is rather striking in the light
of our present knowledge, for he seems to have realized that the main
diagnostic element is a change in the disposition of the animal, but
above all a definite tendency to lack playfulness. Lanfranc had seen a
number of cases of true rabies, and describes and suggests treatment for
them, though evidently without very much confidence in the success of
the treatment.
The treatment of snake bites and the bites of other poisonous animals
was supposed to follow the principles laid down for the bite of a mad
dog, especially as regards the encouragement of free bleeding and the
use of the cautery.
Lanfranc has many other expressions that one is tempted to quote,
because they show a thinking surgeon of the old time, anticipating many
supposedly modern ideas and conclusions. He is a particular favorite of
Gurlt's, who has more than twenty-five large octavo, closely printed
pages with regard to him. There is scarcely any development in our
modern surgery that Lanfranc has not at least a hint of, certainly
nothing in the surgery of a generation ago that does not find a mention
in his book. On most subjects he has practical observations from his own
experience to add to what was in surgical literature before his time. He
quotes altogether more than a score of writers on surgery who had
preceded him and evidently was thoroughly familiar with general surgical
literature. There is scarcely an important surgical topic on which Gurlt
does not find some interesting and personal remarks made by Lanfranc.
All that we can do here is refer those who are interested in Lanfranc to
his own works or Gurlt.
MONDEVILLE
The next of the important surgeons who were to bring such distinction to
French surgery for five centuries was Henri de Mondeville. Writers
usually quote him as Henricus. His latter name is only the place of his
birth, which was probably not far from Caen in Normandy. It is spelled
in so many different ways, however, by different writers that it is well
to realize that almost anything that looks like Mondeville probably
refers to him. Such variants as Mundeville, Hermondaville, Amondaville,
Amundaville, Amandaville, Mandeville, Armandaville, Armendaville,
Amandavilla occur. We owe a large amount of our information with regard
to him to Professor Pagel, who issued the first edition of his book ever
published (Berlin, 1892). It may seem surprising that Mondeville's work
should have been left thus long without publication, but unfortunately
he did not live long enough to finish it. He was one of the victims that
tuberculosis claimed among physicians in the midst of their work. Though
there are a great number of manuscript copies of his book, somehow
Renaissance interest in it in its incompleted state was never aroused
sufficiently to bring about a printed edition. Certainly it was not
because of any lack of interest on the part of his contemporaries or any
lack of significance in the work itself, for its printing has been one
of the surprises afforded us in the modern time as showing how
thoroughly a great writer on surgery did his work at the beginning of
the fourteenth century. Gurlt, in his "History of Surgery," has given
over forty pages, much of it small type, with regard to Mondeville,
because of the special interest there is in his writing.[20]
His life is of particular interest for other reasons besides his
subsequent success as a surgeon. He was another of the university men of
this time who wandered far for opportunities in education. Though born
in the north of France and receiving his preliminary education there, he
made his medical studies towards the end of the thirteenth century under
Theodoric in Italy. Afterwards he studied medicine in Montpellier and
surgery in Paris. Later he gave at least one course of lectures at
Montpellier himself and a series of lectures in Paris, attracting to
both universities during his professorship a crowd of students from
every part of Europe. One of his teachers at Paris had been his
compatriot, Jean Pitard, the surgeon of Philippe le Bel, of whom he
speaks as "most skilful and expert in the art of surgery," and it was
doubtless to Pitard's friendship that he owed his appointment as one of
the four surgeons and three physicians who accompanied the King into
Flanders.
Besides his lectures, Mondeville had a large consultant practice and
also had to accompany the King on his campaigns. This made it extremely
difficult for him to keep continuously at the writing of his book. It
was delayed in spite of his good intentions, and we have the picture
that is so familiar in the modern time of a busy man trying to steal or
make time for his writing. Unfortunately, in addition to other
obstacles, Mondeville showed probably before he was forty the first
symptoms of a serious pulmonary disease, presumably tuberculosis. He
bravely fought it and went on with his work. As his end approached he
sketched in lightly what he had hoped to treat much more formally, and
then turned to what was to have been the last chapter of his book, the
Antidotarium or suggestions of practical remedies against diseases of
various kinds because his students and physician friends were urging him
to complete this portion for them. We of the modern time are much less
interested in that than we would have been in some of the portions of
the work that Mondeville neglected in order to provide therapeutic hints
for his disciples. But then the students and young physicians have
always clamored for the practical--which so far at least in medical
history has always proved of only passing interest.
It is often said that at this time surgery was mainly in the hands of
barbers and the ignorant. Henri de Mondeville, however, is a striking
example in contradiction of this. He must have had a fine preliminary
education and his book shows very wide reading. There is almost no one
of any importance who seriously touched upon medicine or surgery before
his time whom Mondeville does not quote. Hippocrates, Aristotle,
Dioscorides, Pliny, Galen, Rhazes, Ali Abbas, Abulcasis, Avicenna,
Constantine Africanus, Averroës, Maimonides, Albertus Magnus, Hugo of
Lucca, Theodoric, William of Salicet, Lanfranc are all quoted, and not
once or twice but many times. Besides he has quotations from the poets
and philosophers, Cato, Diogenes, Horace, Ovid, Plato, Seneca, and
others. He was a learned man, devoting himself to surgery.
It is no wonder, then, that he thought that a surgeon should be a
scholar, and that he needed to know much more than a physician. One of
his characteristic passages is that in which he declares "it is
impossible that a surgeon should be expert who does not know not only
the principles, but everything worth while knowing about medicine," and
then he added, "just as it is impossible for a man to be a good
physician who is entirely ignorant of the art of surgery." He says
further: "This our art of surgery, which is the third part of medicine
(the other two parts were diet and drugs), is, with all due reverence to
physicians, considered by us surgeons ourselves and by the non-medical
as a more certain, nobler, securer, more perfect, more necessary, and
more lucrative art than the other parts of medicine." Surgeons have
always been prone to glory in their specialty.
Mondeville had a high idea of the training that a surgeon should
possess. He says: "A surgeon who wishes to operate regularly ought first
for a long time to frequent places in which skilled surgeons operate
often, and he ought to pay careful attention to their operations and
commit their technique to memory. Then he ought to associate himself
with them in doing operations. A man cannot be a good surgeon unless he
knows both the art and science of medicine and especially anatomy. The
characteristics of a good surgeon are that he should be moderately bold,
not given to disputations before those who do not know medicine, operate
with foresight and wisdom, not beginning dangerous operations until he
has provided himself with everything necessary for lessening the danger.
He should have well-shaped members, especially hands with long, slender
fingers, mobile and not tremulous, and with all his members strong and
healthy so that he may perform all the good operations without
disturbance of mind. He must be highly moral, should care for the poor
for God's sake, see that he makes himself well paid by the rich, should
comfort his patients by pleasant discourse, and should always accede to
their requests if these do not interfere with the cure of the disease."
"It follows from this," he says, "that the perfect surgeon is more than
the perfect physician, and that while he must know medicine he must in
addition know his handicraft."
Thinking thus, it is no wonder that he places his book under as noble
patronage as possible. He says in the preface that he "began to write it
for the honor and praise of Christ Jesus, of the Virgin Mary, of the
Saints and Martyrs, Cosmas and Damian, and of King Philip of France as
well as his four children, and on the proposal and request of Master
William of Briscia, distinguished professor in the science of medicine
and formerly physician to Pope Boniface IV and Benedict and Clement, the
present Pope." His first book on anatomy he proposed to found on that of
Avicenna and "on his personal experience as he has seen it." The second
tractate on the treatments of wounds, contusions, and ulcers was founded
on the second book of Theodoric "with whatever by recent study has been
newly acquired and brought to light through the experience of modern
physicians." He then confesses his obligations to his great master, John
Pitard, and adds that all the experience that he has gained while
operating, studying, and lecturing for many years on surgery will be
made use of in order to enhance the value of the work. He hopes,
however, to accomplish all this "briefly, quietly, and above all,
charitably." There are many things in the preface that show us the
reason for Mondeville's popularity, for they exhibit him as very
sympathetically human in his interests.
While Mondeville is devoted to the principle that authority is of great
value, he said that there was nothing perfect in things human, and
successive generations of younger men often made important additions to
what their ancestors had left them. While his work is largely a
compilation, nearly everywhere it shows signs of the modification of his
predecessors' opinions by the results of his own experience. His method
of writing is, as Pagel declares, "always interesting, lively, and often
full of meat." He had a teacher's instinct, for in several of the
earlier manuscripts his special teaching is put in larger letters in
order to attract students' attention.... He seems to have introduced or
re-introduced into practice the idea of the use of a large magnet in
order to extract portions of iron from the tissues. He made several
modifications in needles and thread holders and invented a kind of
small derrick for the extraction of arrows with barbs. Besides, he
suggested the surrounding of the barbs of the arrows with tubes, to
facilitate extraction. In his treatment of wounds, Pagel considers that
as a writer and teacher he is far ahead of his predecessors and even of
those who came after him in immediately subsequent generations. One of
his great merits undoubtedly is that Guy de Chauliac, the father of
modern surgery, in his text-book turned to him with a confidence that
proclaims his admiration and how much he felt that he had gained from
him.
One of the most interesting features of Mondeville's work is his
insistence on the influence of the mind on the body and the importance
of using this influence to the best advantage. It is especially
important in Mondeville's opinion to keep a surgical patient from being
moody. "Let the surgeon," says he, "take care to regulate the whole
regimen of the patient's life for joy and happiness by promising that he
will soon be well, by allowing his relatives and special friends to
cheer him and by having someone to tell him jokes, and let him be
solaced also by music on the viol or psaltery. The surgeon must forbid
anger, hatred, and sadness in the patient, and remind him that the body
grows fat from joy and thin from sadness. He must insist on the patient
obeying him faithfully in all things." He repeats with approval the
expression of Avicenna that "often the confidence of the patient in his
physician does more for the cure of his disease than the physician with
all his remedies." Obstinate and conceited patients prone to object to
nearly everything that the surgeon wants to do, and who often seem to
think that they surpass Galen and Hippocrates in science and wisdom, are
likely to delay their cure very much, and they represent the cases with
which the surgeon has much difficulty.
Mondeville thought that nursing was extremely important and that without
it surgery often failed of its purpose. He says, "For if the assistants
are not solicitous and faithful, and obedient to the surgeons in each
and every thing which may make for the cure of the disease, they put
obstacles and difficulties in the way of the surgeon." It is especially
important that the patient's nutrition should be cared for and that the
bandages should be managed exactly as the surgeon directs. He has no use
for garrulous, talkative nurses, and does not hesitate to say that
sometimes near relatives are particularly likely to disturb patients.
"Especially are they prone to let drop some hint of bad news which the
surgeon may have revealed to them in secret, or even the reports that
they may hear from others, friends or enemies, and this provokes the
patient to anger or anxiety and is likely to give him fever. If the
assistants quarrel among themselves, or are heard murmuring, or if they
draw long faces, all of these things will disturb the patients and
produce worry and anxiety or fear. The surgeon therefore must be careful
in the selection of his nurses, for some of them obey very well while he
is present, but do as they like and often just exactly the opposite of
what he has directed when he is away."
We do not know enough of the details of Mondeville's life to be sure
whether he was married or not. It is probable that he was not, for all
of these surgeons of the thirteenth century before Mondeville's time,
Theodoric, William of Salicet, Lanfranc, and Guy de Chauliac, after him
belonged to the clerical order; Theodoric was a bishop; the others,
however, seem only to have been in minor orders. It is therefore from
the standpoint of a man who views married life from without that
Mondeville makes his remarks as to the difficulty often encountered when
wives nurse their husbands. He says that the surgeon has difficulty
oftener when husbands or wives care for their spouses than at other
times. This is much more likely to take place when the wives are caring
for the husbands. "In our days," he says, "in this Gallican part of the
world, wives rule their husbands, and the men for the most part permit
themselves to be ruled. Whatever a surgeon may order for the cure of a
husband then will often seem to the wives to be a waste of good
material, though the men seem to be quite willing to get anything that
may be ordered for the cure of their wives. The whole cause of this
seems to be that every woman seems to think that her husband is not as
good as those of other women whom she sees around her." It would be
interesting to know how Mondeville was brought to a conclusion so
different from modern experience in the matter.
For those who are particularly interested in medical history one of the
sections of Henry's book has a special appeal, because he gives in it a
sketch of the history of surgery. We are little likely to think, as a
rule, that at this time, full two centuries before the close of the
Middle Ages, men were interested enough in the doings of those who had
gone before them to try to trace the history of the development of their
specialty. It is characteristic of the way that the scholarly Mondeville
views his own life work that he should have wanted to know something
about his predecessors and teach others with regard to them. He begins
with Galen, and as Galen divides the famous physicians of the world into
three sects, the Methodists, the Empirics, and the Rationalists, so
Mondeville divides modern surgery into three sects: first, that of the
Salernitans, with Roger, Roland, and the Four Masters; second, that of
William of Salicet and Lanfranc; and third, that of Hugo de Lucca and
his brother Theodoric and their modern disciples. He states briefly the
characteristics of these three sects. The first limited patients' diet,
used no stimulants, dilated all wounds, and got union only after pus
formation. The second allowed a liberal diet to weak patients, though
not to the strong, but generally interfered with wounds too much. The
third believed in a liberal diet, never dilated wounds, never inserted
tents, and its members were extremely careful not to complicate wounds
of the head by unwise interference. His critical discussion of the three
schools is extremely interesting.
Another phase of Mondeville's work that is sympathetic to the moderns is
his discussion of the irregular practice of medicine and surgery as it
existed in his time. Most of our modern medicine and surgery was
anticipated in the olden time; but it may be said that all of the modes
of the quack are as old as humanity. Galen's description of the
travelling charlatan who settled down in his front yard, not knowing
that it belonged to a physician, shows this very well. There were
evidently as many of them and as many different kinds in Mondeville's
time as in our own. In discussing the opposition that had arisen between
physicians and surgeons in his time and their failure to realize that
they were both members of a great profession, he enumerates the many
different kinds of opponents that the medical profession had. There were
"barbers, soothsayers, loan agents, falsifiers, alchemists, meretrices,
midwives, old women, converted Jews, Saracens, and indeed most of those
who, having wasted their substance foolishly, now proceed to make
physicians or surgeons of themselves in order to make their living under
the cloak of healing."
What surprises Mondeville however, as it has always surprised every
physician who knows the situation, is that so many educated, or at least
supposedly well-informed people of the better classes, indeed even of
the so-called best classes, allow themselves to be influenced by these
quacks. And it is even more surprising to him that so many well-to-do,
intelligent people should, for no reason, though without knowledge,
presume to give advice in medical matters and especially in even
dangerous surgical diseases, and in such delicate affections as diseases
of the eyes. "It thus often happens that diseases in themselves curable
grow to be simply incurable or are made much worse than they were
before." He says that some of the clergymen of his time seemed to think
that a knowledge of medicine is infused into them with the sacrament of
Holy Orders. He was himself probably a clergyman, and I have in the
modern time more than once known of teachers in the clerical seminaries
emphasizing this same idea for the clerical students. It is very evident
that the world has not changed very much, and that to know any time
reasonably well is to find in it comments on the morning paper. We are
in the midst of just such a series of interferences with medicine on the
part of the clergy as this wise, common-sense surgeon of the thirteenth
century deprecated.
In every way Mondeville had the instincts of a teacher. He took
advantage of every aid. He was probably the first to use illustrations
in teaching anatomy. Guy de Chauliac, whose teacher in anatomy for some
time Mondeville was, says in the first chapter of his "Chirurgia Magna"
that pictures do not suffice for the teaching of anatomy and that actual
dissection is necessary. The passage runs as follows: "In the bodies of
men, of apes, and of pigs, and of many other animals, tissues should be
studied by dissections and not by pictures, as did Henricus, who was
seen to demonstrate anatomy with thirteen pictures."[21] What Chauliac
blames is the attempt to replace dissections by pictorial
demonstrations. Hyrtl, however, suggests that this invention of
Mondeville's was probably very helpful, and was brought about by the
impossibility of preserving bodies for long periods as well as the
difficulty of obtaining them.
YPERMAN
One of the maxims of the old Greek philosophers was that good is
diffusive of itself. As the scholastics put it, _bonum est diffusivum
sui_. This proved to be eminently true of the old universities also, and
especially of their training in medicine and in surgery. We have the
accounts of men from many nations who went to the universities and
returned to benefit their own people. Early in the thirteenth century
Richard the Englishman was in Italy, having previously been in Paris and
probably at Montpellier. Bernard Gordon, probably also an Englishman,
was one of the great lights in medicine down at Montpellier, and his
book, "Lilium De Medicina," is well known. Two distinguished surgeons
whose names have come down to us, having studied in Paris after Lanfranc
had created the tradition of great surgical teaching there, came to
their homes to be centres of beneficent influence among their people in
this matter. One was Yperman, of the town of Ypres in Belgium; the other
Ardern of England. Yperman was sent by his fellow-townsmen to Paris in
order to study surgery, because they wanted to have a good surgeon in
their town and Paris seemed the best school at that time. Ypres was at
this period one of the greatest commercial cities of Europe, and
probably had a couple of hundred thousand inhabitants. The great hall of
the cloth gild, which has been such an attraction for visitors ever
since, was built shortly before the town determined upon the very
sensible procedure of securing good surgery beyond all doubt by having a
townsman specially educated for that purpose.
Yperman's work was practically unknown to us until Broeck, the Belgian
historian, discovered manuscript copies of his book on surgery and
gathered some details of his life. After his return from Paris, Yperman
obtained great renown, which maintained itself in the custom extant in
that part of the country even yet of calling an expert surgeon an
Yperman. He is the author of two works in Flemish. One of these is a
smaller compendium of internal medicine, which is very interesting,
however, because it shows the many subjects that were occupying
physicians' minds at that time. He treats of dropsy, rheumatism, under
which occur the terms coryza and catarrh (the flowing diseases),
icterus, phthisis (he calls the tuberculosis, tysiken), apoplexy,
epilepsy, frenzy, lethargy, fallen palate, cough, shortness of breath,
lung abscess, hemorrhage, blood-spitting, liver abscess, hardening of
the spleen, affections of the kidney, bloody urine, diabetes,
incontinence of urine, dysuria, strangury, gonorrhea, and involuntary
seminal emissions--all these terms are quoted directly from Pagel's
account of his work; the original is not available in this country.
JOHN ARDERN
In English-speaking countries of course we are interested in what was
done by Englishmen at this time. Fortunately we have the record of one
great English surgeon of the period worthy to be placed beside even the
writers already mentioned. This is John Ardern, whose name is probably a
modification of the more familiar Arden, whose career well deserves
attention. I have given a sketch of his work in "The Popes and
Science."[22] He was educated at Montpellier, and practised surgery for
a time in France. About the middle of the century however, according to
Pagel, he went back to his native land and settled for some twenty years
at Newark, in Nottinghamshire, and then for nearly thirty years longer,
until about the end of the century, was in London. He is the chief
representative of English surgery during the Middle Ages. His
"Practica," as yet unprinted, contains, according to Pagel, a short
sketch of internal medicine, but is mainly devoted to surgery. Contrary
to the usual impression with regard to works in medicine and surgery at
this time, the book abounds in references to case histories which Ardern
had gathered, partly from his own and partly from others' experience.
The therapeutic measures that he suggests are usually very simple, in
the majority of cases quite rational, though, of course, there are many
superstitions among them; but Ardern always furnished a number of
suggestions from which to choose. He must have been an expert operator,
and had excellent success in the treatment of diseases of the rectum. He
seems to have been the first operator who made careful statistics of his
cases, and was quite as proud as any modern surgeon of the large
numbers that he had operated on, which he gives very exactly. He was the
inventor of a new clyster apparatus.
Fortunately we possess here in America, in the Surgeon General's Library
at Washington, a very interesting manuscript containing Ardern's
surgical writings, though it has not yet been published. Even a little
study of this and of the notes on it prepared by an English bibliophile
before its purchase by the Surgeon General's Library, serves to show how
valuable the work is in the history of surgery. There are illustrations
scarcely less interesting than the text. Some of these illustrations
were inserted by the original writer or copyist, and some of them later.
In general, however, they show a rather high development of the
mechanics of surgery at that time. Some of the pages have spaces for
illustrations left unfilled, so that evidently the copyist did not
complete his work. The titles of certain of the chapters are
interesting, as illustrating the fact that our medical and surgical
problems were stated clearly in the olden time, and thinking physicians,
even six centuries ago, met them quite rationally. There is, for
instance, a chapter headed "Against Colic and the Iliac Passion,"
immediately followed by the subheading, "Method of Administering
Clysters." The iliac passion, _passio iliaca_ of the old Latin, is
usually taken to signify some obstruction of the intestines causing
severe pain, vomiting, and eventually fecal vomiting. A good many
different forms of severe painful conditions, especially all those
complicated by peritonitis, were included under the term, and the modern
student of surgery is likely to wonder whether these old observers had
not noted that the right iliac region was particularly prone to be the
source of fatal conditions. There is a chapter entitled "Against Pain in
the Loins and the Kidneys," followed by the chapter subheading, "Against
Stone in the Kidneys." There is a chapter with the title, "Against
Ulceration of the Bladder or the Kidneys." Another one, with the title
"Against Burning of the Urine and Excoriation of the Lower Part of the
Yard." Gonorrhea is frankly treated under the name _Shawdepisse_,
evidently an English alliteration of the corresponding French word. As
to the instrumentation of such conditions and for probing in general,
Ardern suggests the use of a lead probe, because it may readily be made
to bend any way and not injure the tissues.
MEDIEVAL SURGERY
Even this brief account of the surgeons who taught and studied at the
medieval universities demonstrates what fine work they did. It is surely
not too much to say that the chapter on university education mainly
concerned with them is one of the most interesting in the whole history
of the universities. Their story alone is quite enough to refute most of
the prevalent impressions and patronizing expressions with regard to
medieval education. Their careers serve to show how interested were the
men of many nations in the development of an extremely important
application of science for the benefit of suffering humanity. Their work
utterly contradicts the idea so frequently emphasized that the great
students of the Middle Ages were lacking in practicalness. Besides,
they make very clear that we have been prone to judge the Middle Ages
too much from its speculative philosophies. It has been the custom to
say that speculation ruled men's minds and prevented them from making
observations, developing science, or applying scientific principles.
There was much speculation during the Middle Ages, but probably not any
more in proportion than exists at the present day. We were either not
acquainted with, or failed to appreciate properly, until comparatively
recent years, the other side of medieval accomplishment. Our ignorance
led us into misunderstanding of what these generations really did. It
was our own fault, because during the Renaissance practically all of
these books were edited and printed under the direction of the great
scholars of the time in fine editions, but during the eighteenth century
nearly all interest was lost in them, and we are only now beginning to
get back a certain amount of the precious knowledge that they had in the
Renaissance period of this other side of medieval life. We have learned
so much about surgery because distinguished scholars devoted themselves
to this phase of the history of science. Doubtless there are many other
phases of the history of science which suffered the same fate of neglect
and with regard to which the future will bring us equally startling
revelations. For this reason this marvellous chapter in the history of
surgery is a warning as well as a startling record of a marvellous epoch
of human progress.
XI
GUY DE CHAULIAC
One of the most interesting characters in the history of medieval
medicine, and undoubtedly the most important and significant of these
Old-Time Makers of Medicine, is Guy de Chauliac. Most of the false
notions so commonly accepted with regard to the Middle Ages at once
disappear after a careful study of his career. The idea of the careful
application of scientific principles in a great practical way is far
removed from the ordinary notion of medieval procedure. Some
observations we may concede that they did make, but we are inclined to
think that these were not regularly ordered and the lessons of them not
drawn so as to make them valuable as experiences. Great art men may have
had, but science and, above all, applied science, is a later development
of humanity. Particularly is this supposed to be true with regard to the
science and practice of surgery, which is assumed to be of comparatively
recent origin. Nothing could well be less true, and if the thoroughly
practical development of surgery may be taken as a symbol of how capable
men were of applying science and scientific principles, then it is
comparatively easy to show that the men of the later Middle Ages were
occupied very much as have been our recent generations with science and
its practical applications.
The immediate evidence of the value of old-time surgery is to be found
in the fact that Guy de Chauliac, who is commonly spoken of in the
history of medicine as the Father of Modern Surgery, lived his
seventy-odd years of life during the fourteenth century and accomplished
the best of his work, therefore, some five centuries before surgery in
our modern sense of the term is supposed to have developed. A glance at
his career, however, will show how old are most of the important
developments of surgery, as also in what a thoroughly scientific temper
of mind this subject was approached more than a century before the close
of the Middle Ages. The life of this French surgeon, indeed, who was a
cleric and occupied the position of chamberlain and
physician-in-ordinary to three of the Avignon Popes, is not only a
contradiction of many of the traditions as to the backwardness of our
medieval forbears in medicine, that are readily accepted by many
presumably educated people, but it is the best possible antidote for
that insistent misunderstanding of the Middle Ages which attributes
profound ignorance of science, almost complete failure of observation,
and an absolute lack of initiative in applications of science to the men
of those times.
Guy de Chauliac's life is modern in nearly every phase. He was educated
in a little town of the south of France, made his medical studies at
Montpellier, and then went on a journey of hundreds of miles into Italy,
in order to make his post-graduate studies. Italy occupied the place in
science at that time that Germany has taken during the nineteenth
century. A young man who wanted to get into touch with the great
masters in medicine naturally went down into the Peninsula. Traditions
as to the attitude of the Church to science notwithstanding, Italy where
education was more completely under the influence of the Popes and
ecclesiastics than in any other country in Europe, continued to be the
home of post-graduate work in science for the next four centuries.
Almost needless to say, the journey to Italy was more difficult of
accomplishment and involved more expense and time than would even the
voyage from America to Europe in our time. Chauliac realized, however,
that both time and expense would be well rewarded, and his ardor for the
rounding out of his education was amply recompensed by the event. Nor
have we any reason for thinking that what he did was very rare, much
less unique, in his time. Many a student from France, Germany, and
England made the long journey to Italy for post-graduate opportunities
during the later Middle Ages.
Even this post-graduate experience in Italy did not satisfy Chauliac,
however, for, after having studied several years with the most
distinguished Italian teachers of anatomy and surgery, he spent some
time in Paris, apparently so as to be sure that he would be acquainted
with the best that was being done in his specialty in every part of the
world. He then settled down to his own life work, carrying his Italian
and French masters' teachings well beyond the point where he received
them, and after years of personal experience he gathered together his
masters' ideas, tested by his own observations, into his "Chirurgia
Magna," a great text-book of surgery which sums up the whole subject
succinctly, yet completely, for succeeding generations. When we talk
about what he accomplished for surgery, we are not dependent on
traditions nor vague information gleaned from contemporaries and
successors, who might perhaps have been so much impressed by his
personality as to be made over-enthusiastic in their critical judgment
of him. We know the man in his surgical works, and they have continued
to be classics in surgery ever since. It is an honorable distinction for
the medicine of the later fourteenth, the fifteenth, and sixteenth
centuries that Guy de Chauliac's book was the most read volume of the
time in medicine. Evidently the career of such a man is of import, not
alone to physicians, but to all who are interested in the history of
education.
Chauliac derives his name from the little town of Chauliac in the
diocese of Mende, almost in the centre of what is now the department of
Lozère. The records of births and deaths were not considered so
important in the fourteenth century as they are now, and so we are not
sure of either in the case of Chauliac. It is usually considered that he
was born some time during the last decade of the thirteenth century,
probably toward the end of it, and that he died about 1370. Of his early
education we know nothing, but it must have been reasonably efficient,
since it gave him a good working knowledge of Latin, which was the
universal language of science and especially of medicine at that time;
and though his own style, as must be expected, is no better than that of
his contemporaries, he knew how to express his thoughts clearly in
straightforward Latin, with only such a mixture of foreign terms as his
studies suggested and the exigencies of a new development of science
almost required. Later in life he seems to have known Arabic very well,
for he is evidently familiar with Arabian books and does not depend
merely on translations of them.
Pagel, in the first volume of Puschmann's "Handbook of the History of
Medicine," says, on the authority of Nicaise and others, that Chauliac
received his early education from the village clergyman. His parents
were poor, and but for ecclesiastical interest in him it would have been
difficult for him to obtain his education. The Church supplied at that
time to a great extent for the foundations and scholarships, home and
travelling, of our day, and Chauliac was amongst the favored ones. How
well he deserved the favor his subsequent career shows, as it completely
justifies the judgment of his patrons. He went first to Toulouse, as we
know from his affectionate mention of one of his teachers there.
Toulouse was more famous for law, however, than for medicine, and after
a time Chauliac sought Montpellier to complete his medical studies.
For English-speaking people an added interest in Guy de Chauliac will be
the fact that one of his teachers at Montpellier was Bernard Gordon,
very probably a Scotchman, who taught for some thirty-five years at this
famous university in the south of France, and died near the end of the
first quarter of the fourteenth century. One of Chauliac's
fellow-students at Montpellier was John of Gaddesden, the first English
Royal Physician by official appointment of whom we have any account.
John is mentioned by Chaucer in his "Doctor of Physic," and is usually
looked upon as one of the fathers of English medicine. Chauliac did not
think much of him, though his reason for his dislike of him will
probably be somewhat startling to those who assume that the men of the
Middle Ages always clung servilely to authority. Chauliac's objection to
Gaddesden's book is that he merely repeats his masters and does not dare
to think for himself. It is not hard to understand that such an
independent thinker as Chauliac should have been utterly dissatisfied
with a book that did not go beyond the forefathers in medicine that the
author quotes. This is the explanation of his well-known expression,
"Last of all arose the scentless rose of England ['Rosa Angliæ' was the
name of John of Gaddesden's book], in which, on its being sent to me, I
hoped to find the odor of sweet originality, but instead of that I
encountered only the fictions of Hispanus, of Gilbert, and of
Theodoric."
The presence of a Scotch professor and an English fellow-student,
afterwards a royal physician, at Montpellier, at the beginning of the
fourteenth century, shows how much more cosmopolitan was university life
in those times than we are prone to think, and what attraction a great
university medical school possessed even for men from long distances.
After receiving his degree of Doctor of Medicine at Montpellier Chauliac
went, as we have said, to Bologna. Here he attracted the attention and
received the special instruction of Bertruccio, who was attracting
students from all over Europe at this time and was making some
excellent demonstrations in anatomy, employing human dissections very
freely. Chauliac tells of the methods that Bertruccio used in order that
bodies might be in as good condition as possible for demonstration
purposes, and mentions the fact that he saw him do many dissections in
different ways.
In Roth's life of Vesalius, which is usually considered one of our most
authoritative medical historical works not only with regard to the
details of Vesalius' life, but also in all that concerns anatomy about
that time and for some centuries before, there is a passage quoted from
Chauliac himself which shows how freely dissection was practised at the
Italian universities in the fourteenth century. This passage deserves to
be quoted at some length because there are even serious historians who
still cite a Bull of Pope Boniface VIII, issued in 1300, forbidding the
boiling and dismembering of bodies in order to transport them to long
distances for burial in their own country, as being, either rightly or
wrongly, interpreted as a prohibition of dissection and, therefore,
preventing the development of anatomy. In the notes to his history of
dissection during this period in Bologna Roth says: "Without doubt the
passage in Guy de Chauliac which tells of having frequently seen
dissections, must be considered as referring to Bologna. This passage
runs as follows: 'My master Bertruccius conducted the dissection very
often after the following manner: the dead body having been placed upon
a bench, he used to make four lessons on it. In the first the
nutritional portions were treated, because they are so likely to become
putrefied. In the second, he demonstrated the spiritual members; in the
third, the animate members; in the fourth, the extremities.'" (Roth,
"Andreas Vesalius." Basel, 1896.)
Bertruccio's master, Mondino, is hailed in the history of medicine as
the father of dissection. His book on dissection was for the next three
centuries in the hands of nearly every medical scholar in Europe who was
trying to do good work in anatomy. It was not displaced until Vesalius
came, the father of modern anatomy, who revolutionized the science in
the Renaissance time. Mondino had devoted himself to the subject with
unfailing ardor and enthusiasm, and from everywhere in Europe the
students came to receive inspiration in his dissecting-room. Within a
few years such was the enthusiasm for dissection aroused by him in
Bologna that there were many legal prosecutions for body-snatching, the
consequence doubtless of a regulation of the Medical Department of the
University of Bologna, that if the students brought a body to any of
their teachers he was bound to dissect it for them. Bertruccio,
Mondino's disciple and successor, continued this great work, and now
Chauliac, the third in the tradition, was to carry the Bolognese methods
back to France, and his position as chamberlain to the Pope was to give
them a wide vogue throughout the world. The great French surgeon's
attitude toward anatomy and dissection can be judged from his famous
expression that "the surgeon ignorant of anatomy carves the human body
as a blind man carves wood." The whole subject of dissection at this
time has been fully discussed in the first three chapters of my "Popes
and Science," where those who are interested in the matter may follow it
to their satisfaction.[23]
After his Bologna experience Chauliac went to Paris. Evidently his
indefatigable desire to know all that there was to be known would not be
satisfied until he had spent some time at the great French university
where Lanfranc, after having studied under William of Salicet in Italy,
had gone to establish that tradition of French surgery which, carried on
so well by Mondeville his great successor, was to maintain Frenchmen as
the leading surgeons of the world until the nineteenth century (Pagel).
Lanfranc, himself an Italian, had been exiled from his native country,
apparently because of political troubles, but was welcomed at Paris
because the faculty realized that they needed the inspiration of the
Italian medical movement in surgery for the establishment of a good
school of surgery in connection with the university. The teaching so
well begun by Lanfranc was magnificently continued by Mondeville and
Arnold of Villanova and their disciples. Chauliac was fortunate enough
to come under the influence of Petrus de Argentaria, who was worthily
maintaining the tradition of practical teaching in anatomy and surgery
so well founded by his great predecessors of the thirteenth century.
After this grand tour Chauliac was himself prepared to do work of the
highest order, for he had been in touch with all that was best in the
medicine and surgery of his time.
Like many another distinguished member of his profession, Chauliac did
not settle down in the scene of his ultimate labors at once, but was
something of a wanderer. His own words are, "_Et per multa tempora
operatus fui in multis partibus_." Perhaps out of gratitude to the
clerical patrons of his native town to whom he owed so much, or because
of the obligations he considered that he owed them for his education, he
practised first in his native diocese of Mende; thence he removed to
Lyons, where we know that he lived for several years, for in 1344 he
took part as a canon in a chapter that met in the Church of St. Just in
that city. Just when he was called to Avignon we do not know, though
when the black death ravaged that city in 1348 he was the body-physician
of Pope Clement VI, for he is spoken of in a Papal document as
"_venerabilis et circumspectus vir, dominus Guido de Cauliaco, canonicus
et præpositus ecclesiæ Sancti Justi Lugduni, medicusque domini Nostri
Papæ_." All the rest of his life was passed in the Papal capital, which
Avignon was for some seventy years of the fourteenth century. He served
as chamberlain-physician to three Popes, Clement VI, Innocent VI, and
Urban V. We do not know the exact date of his death, but when Pope Urban
V went to Rome in 1367, Chauliac was putting the finishing touches on
his "Chirurgia Magna," which, as he tells us, was undertaken as a
_solatium senectutis_--a solace in old age. When Urban returned to
Avignon for a time in 1370 Chauliac was dead. His life work is summed up
for us in this great treatise on surgery, full of anticipations in
surgical procedures that we are prone to think much more modern.
Nicaise has emphasized the principles which guided Guy de Chauliac in
the choice and interpretation of his authorities by a quotation from Guy
himself, which is so different in its tone from what is usually supposed
to have been the attitude of mind of the men of science of the time that
it would be well for all those who want to understand the Middle Ages
better to have it near them. Speaking of the surgeons of his own and
immediately preceding generations, Guy says: "One thing particularly is
a source of annoyance to me in what these surgeons have written, and it
is that they follow one another like so many cranes. For one always says
what the other says. I do not know whether it is from fear or from love
that they do not deign to listen except to such things as they are
accustomed to and as have been proved by authorities. They have to my
mind understood very badly Aristotle's second book of metaphysics where
he shows that these two things, fear and love, are the greatest
obstacles on the road to the knowledge of the truth. Let them give up
such friendships and fears. 'Because while Socrates or Plato may be a
friend, truth is a greater friend.' Truth is a holy thing and worthy to
be honored above everything else. Let them follow the doctrine of Galen,
which is entirely made up of experience and reason, and in which one
investigates things and despises words."
After all, this is what great authorities in medicine have always
insisted on. Once every hundred years or so one finds a really great
observer who makes new observations and wakes the world up. He is
surprised that men should not have used their powers of observation for
themselves, but should have been following old-time masters. His
contemporaries often refuse to listen to him at first. His observations,
however, eventually make their way. We blame the Middle Ages for
following authority, but what have we been always doing but following
authority, except for the geniuses who come and lift us out of the rut
and illuminate a new portion of the realm of medicine. After they have
come, however, and done their work, their disciples proceed to see with
their eyes and to think that they are making observations for themselves
when they are merely following authority. When the next master in
medicine comes along his discovery is neglected because men have not
found it in the old books, and usually he has to suffer for daring to
have opinions of his own. The fact of the matter is that at any time
there is only a very limited number of men who think for themselves. The
rest think other people's thoughts and think they are thinking and doing
things. As for observation, John Ruskin once said, "Nothing is harder
than to see something and tell it simply as you saw it." This is as true
in science as in art, and only genius succeeds in doing it well.
Chauliac's book is confessedly a compilation. He has taken the good
wherever he found it, though he adds, modestly enough, that his work
also contains whatever his own measure of intelligence enabled him to
find useful (_quæ juxta modicitatem mei ingenii utilia reputavi_).
Indeed it is the critical judgment displayed by Chauliac in selecting
from his predecessors that best illustrates at once the practical
character of his intellect and his discerning spirit. What the men of
his time are said to have lacked is the critical faculty. They were
encyclopedic in intellect and gathered all kinds of information without
discrimination, is a very common criticism of medieval writers. No one
can say this of Chauliac, however, and, above all, he was no respecter
of authority, merely for the sake of authority. His criticism of John of
Gaddesden's book shows that the blind following of those who had gone
before was his special _bête noir_. His bitterest reproach for many of
his predecessors was that "they follow one another like cranes, whether
for love or fear, I cannot say."
Chauliac's right to the title of father of surgery will perhaps be best
appreciated from the brief account of his recommendations as to the
value of surgical intervention for conditions in the three most
important cavities of the body, the skull, the thorax, and the abdomen.
These cavities have usually been the dread of surgeons. Chauliac not
only used the trephine, but laid down very exact indications for its
application. Expectant treatment was to be the rule in wounds of the
head, yet when necessary, interference was counselled as of great value.
His prognosis of brain injuries was much better than that of his
predecessors. He says that he had seen injuries of the brain followed by
some loss of brain substance, yet with complete recovery of the patient.
In one case that he notes a considerable amount of brain substance was
lost, yet the patient recovered with only a slight defect of memory,
and even this disappeared after a time. He lays down exact indications
for the opening of the thorax, that _noli me tangere_ of surgeons at all
times, even our own, and points out the relations of the ribs and the
diaphragm, so as to show just where the opening should be made in order
to remove fluid of any kind.
In abdominal conditions, however, Chauliac's anticipation of modern
views is most surprising. He recognized that wounds of the intestines
were surely fatal unless leakage could be prevented. Accordingly he
suggested the opening of the abdomen and the sewing up of such
intestinal wounds as could be located. He describes a method of suture
for these cases and seems, like many another abdominal surgeon, even to
have invented a special needleholder.
To most people it would seem absolutely out of the question that such
surgical procedures could be practised in the fourteenth century. We
have the definite record of them, however, in a text-book that was the
most read volume on the subject for several centuries. Most of the
surprise with regard to these operations will vanish when it is recalled
that in Italy during the thirteenth century, as we have already seen,
methods of anæsthesia by means of opium and mandragora were in common
use, having been invented in the twelfth century and perfected by Ugo da
Lucca, and Chauliac must not only have known but must have frequently
employed various methods of anæsthesia.
In discussing amputations he has described in general certain methods of
anæsthesia in use in his time, and especially the method by means of
inhalation. It would not seem to us in the modern time that this method
would be very successful, but there is an enthusiastic accord of
authorities attesting that operations were done at this time with the
help of this inhalant without the infliction of pain. Chauliac says:
"Some prescribe medicaments which send the patient to sleep,
so that the incision may not be felt, such as opium, the juice
of the morel, hyoscyamus, mandrake, ivy, hemlock, lettuce. A
new sponge is soaked by them in these juices and left to dry
in the sun; and when they have need of it they put this sponge
into warm water and then hold it under the nostrils of the
patient until he goes to sleep. Then they perform the
operation."
Many people might be prone to think that the hospitals of Chauliac's
time would not be suitable for such surgical work as he describes. It
is, however, only another amusing assumption of this self-complacent age
of ours to think that we were the first who ever made hospitals worthy
of the name and of the great humanitarian purpose they subserve. As a
matter of fact, the old-time hospitals were even better than ours or, as
a rule, better than any we had until the present generation. In "The
Popes and Science," in the chapter on "The Foundation of City
Hospitals," I call attention to the fact that architects of the present
day go back to the hospitals of the Middle Ages in order to find the
models for hospitals for the modern times. Mr. Arthur Dillon, a
well-known New York architect, writing of a hospital built at Tonnerre
in France, toward the end of the thirteenth century (1292), says:
"It was an admirable hospital in every way, and it is doubtful
if we to-day surpass it. It was isolated; the ward was
separated from the other buildings; it had the advantage we so
often lose of being but one story high, and more space was
given to each patient than we can now afford.
"The ventilation by the great windows and ventilators in the
ceiling was excellent; it was cheerfully lighted; and the
arrangement of the gallery shielded the patients from dazzling
light and from draughts from the windows and afforded an easy
means of supervision, while the division by the roofless low
partitions isolated the sick and obviated the depression that
comes from sight of others in pain.
"It was, moreover, in great contrast to the cheerless white
wards of to-day. The vaulted ceiling was very beautiful; the
woodwork was richly carved, and the great windows over the
altars were filled with colored glass. Altogether it was one
of the best examples of the best period of Gothic
Architecture."[24]
The fine hospital thus described was but one of many. Virchow, in his
article on hospitals quoted in the same chapter, called attention to the
fact that in the thirteenth and fourteenth centuries every town of five
thousand or more inhabitants had its hospital, founded on the model of
the great Santo Spirito Hospital in Rome, and all of them did good work.
The surgeons of Guy de Chauliac's time would indeed find hospitals
wherever they might be called in consultation, even in small towns. They
were more numerous in proportion to population than our own and, as a
rule, at least as well organized as ours were until the last few years.
It is no wonder that with such a good hospital organization excellent
surgery was accomplished. Hernia was Chauliac's specialty, and in it his
surgical judgment is admirable. Mondeville before his time did not
hesitate to say that many operations for hernia were done not for the
benefit of the patient, but for the benefit of the surgeon,--a very
striking anticipation of remarks that one sometimes hears even at the
present time. Chauliac discussed operations for hernia very
conservatively. His rule was that a truss should be worn, and no
operation attempted unless the patient's life was endangered by the
hernia. It is to him that we owe the invention of a well-developed
method of taxis, or manipulation of a hernia, to bring about its
reduction, which was in use until the end of the nineteenth century. He
suggested that trusses could not be made according to rule, but must be
adapted to each individual case. He invented several forms of truss
himself, and in general it may be said that his manipulative skill and
his power to apply his mechanical principles to his work are the most
characteristic of his qualities. This is particularly noteworthy in his
chapters on fractures and dislocations, in which he suggests various
methods of reduction and realizes very practically the mechanical
difficulties that were to be encountered in the correction of the
deformities due to these pathological conditions. In a word, we have a
picture of the skilled surgeon of the modern time in this treatise of a
fourteenth-century teacher of surgery.
Chauliac discusses six different operations for the radical cure of
hernia. As Gurlt points out, he criticises them from the same standpoint
as that of recent surgeons. The object of radical operations for hernia
is to produce a strong, firm tissue support over the ring through which
the cord passes, so that the intestines cannot descend through it. It is
rather interesting to find that the surgeons of this time tried to
obliterate the canal by means of the cautery, or inflammation producing
agents, arsenic and the like, a practice that recalls some methods still
used more or less irregularly. They also used gold wire, which was to be
left in the tissues and is supposed to protect and strengthen the
closure of the ring. At this time all these operations for the radical
cure of hernia involved the sacrifice of the testicle because the old
surgeons wanted to obliterate the ring completely, and thought this the
easiest way. Chauliac discusses the operation in this respect and says
that he has seen many cases in which men possessed of but one testicle
have procreated, and this is a case where the lesser of two evils is to
be chosen.
Of course Guy de Chauliac would not have been able to operate so freely
on hernia and suggest, following his own experience, methods of
treatment of penetrating wounds of the abdomen only that he had learned
the lessons of antiseptic surgery which had been gradually developed
among the great surgeons of Italy during the preceding century. The use
of the stronger wines as a dressing together with insistence on the most
absolute cleanliness of the surgeon before the operation, and careful
details of cleanliness during the operation, made possible the
performance of many methods of surgical intervention that would
otherwise surely have been fatal. Probably nothing is harder to
understand than that after these practical discoveries men should have
lost sight of their significance, and after having carefully studied the
viscous exudation which produces healthy natural union, should have come
to the thought of the necessity for the formation of laudable pus before
union might be expected. The mystery is really no greater than that of
many another similar incident in human history, but it strikes us more
forcibly because the discovery and gradual development of antiseptic
surgery in our own time has meant so much for us. Already even in
Chauliac's practice, however, some of the finer elements of the
technique that made surgery antiseptic to a marked degree, if not
positively aseptic in many cases, were not being emphasized as they were
by his predecessors, and there was a beginning of surgical
meddlesomeness reasserting itself.
It must not be thought, however, that it was only with the coarse
applications of surgery that Chauliac concerned himself. He was very
much interested in the surgical treatment of eye diseases and wrote a
monograph on cataract, in which he gathers what was known before his
time and discusses it in the light of his own experience. The writing of
such a book is not so surprising at this time if we recall that in the
preceding century the famous Pope John XXI, who had been a physician
before he became Pope, and under the name of Peter of Spain was looked
up to as one of the distinguished scientists of his time, had written a
book on eye diseases that has recently been the subject of much
attention.
Pope John had much to say of cataract, dividing it into traumatic and
spontaneous, and suggesting the needling of cataract, a gold needle
being used for the purpose. Chauliac's method of treating cataract was
by depression. His care in the selection of patients may be appreciated
from his treatment of John of Luxembourg, King of Bavaria, blind from
cataract, who consulted Chauliac in 1336 while on a visit to Avignon
with the King of France. Chauliac refused to operate, however, and put
off the King with dietary regulations.
In the chapter on John of Arcoli and Medieval Dentistry we call
attention to the fact that Chauliac discussed dental surgery briefly,
yet with such practical detail as to show very clearly how much more was
known about this specialty in his time than we have had any idea of
until recent years. He recognized the dentists as specialists, calls
them dentatores, but thinks that they should operate under the direction
of a physician--hence the physician should know much about teeth and
especially about their preservation. He enumerates instruments that
dentists should have and shows very clearly that the specialty had
reached a high state of development. A typical example of Chauliac's
common sense and dependence on observation and not tradition is to be
found in what he has to say with regard to methods of removing the teeth
without the use of extracting instruments. It is characteristic of his
method of dealing with traditional remedies, even though of long
standing, that he brushes them aside with some impatience if they have
not proved themselves in his experience.
"The ancients mention many medicaments, which draw out the
teeth without iron instruments or which make them more easy to
draw out; such as the milky juice of the tithymal with
pyrethrum, the roots of the mulberry and caper, citrine
arsenic, aqua fortis, the fat of forest frogs. But these
remedies promise much and accomplish but little--_mais ils
donnent beaucoup de promesses, et peu, d'opérations_."
It is no wonder that Chauliac has been enthusiastically praised. Nicaise
has devoutly gathered many of these praises into a sheaf of eulogies at
the end of his biography of the great French surgeon. He tells us that
Fallopius compared him to Hippocrates. John Calvo of Valencia, who
translated the "Great Surgery" into Spanish, looks upon him as the first
law-giver of surgery. Freind, the great English physician, in 1725
called him the Prince of Surgeons. Ackermann said that Guy de Chauliac's
text-book will take the place of all that has been written on the
subject down to his time, so that even if all the other works had been
lost his would replace them. Dezimeris, commenting on this, says that
"if one should take this appreciation literally, this surgeon of the
fourteenth century would be the first and, up to the present time, the
only author who ever merited such an eulogy." "At least," he adds, "we
cannot refuse him the distinction of having made a work infinitely
superior to all those which appeared up to this time and even for a long
time afterwards. Posterity rendered him this justice, for he was for
three centuries the classic _par excellence_. He rendered the study easy
and profitable, and all the foreign nations the tributaries of our
country." Peyrihle considered Guy's "Surgery" as the most valuable and
complete work of all those of the same kind that had been published
since Hippocrates and added that the reading of it was still useful in
his time in 1784. Bégin, in his work on Ambroise Paré, says "that Guy
has written an immortal book to which are attached the destinies of
French surgeons." Malgaigne, in his "History of Surgery," does not
hesitate to say, "I do not fear to say that, Hippocrates alone excepted,
there is not a single treatise on surgery,--Greek, Latin, or
Arabic,--which I place above, or even on the same level with, this
magnificent work, 'The Surgery of Guy de Chauliac.'" Daremberg said,
"Guy seems to us a surgeon above all erudite, yet expert and without
ever being rash. He knows, above all, how to choose what is best in
everything." Verneuil, in his "Conférence sur Les Chirurgiens Érudits,"
says, "The services rendered by the 'Great Surgery' were immense; by it
there commenced for France an era of splendor. It is with justice, then,
that posterity has decreed to Guy de Chauliac the title of Father of
French surgery."
The more one reads of Chauliac's work the less is one surprised at the
estimation in which he has been held wherever known. It would not be
hard to add a further sheaf of compliments to those collected by
Nicaise. Modern writers on the history of medicine have all been
enthusiastic in their admiration of him, just in proportion to the
thoroughness of their acquaintance with him. Portal, in his "History of
Anatomy and Surgery," says, "Finally, it may be averred that Guy de
Chauliac said nearly everything which modern surgeons say, and that his
work is of infinite price but unfortunately too little read, too little
pondered." Malgaigne declares Chauliac's "Chirurgia Magna" to be "a
masterpiece of learned and luminous writing." Professor Clifford
Allbutt, the Regius Professor of Physic at the University of Cambridge,
says of Chauliac's treatise: "This great work I have studied carefully
and not without prejudice; yet I cannot wonder that Fallopius compared
the author to Hippocrates or that John Freind calls him the Prince of
Surgeons. It is rich, aphoristic, orderly, and precise."[25]
If to this account of his professional career it be added that
Chauliac's personality is, if possible, more interesting than his
surgical accomplishment, some idea of the significance of the life of
the great father of modern surgery will be realized. We have already
quoted the distinguished words of praise accorded him by Pope Clement
VI. That they were well deserved, Chauliac's conduct during the black
death which ravaged Avignon in 1348, shortly after his arrival in the
Papal City, would have been sufficient of itself to attest. The
occurrence of the plague in a city usually gave rise to an exhibition of
the most arrant cowardice, and all who could, fled. In many of the
European cities the physicians joined the fugitives, and the ailing were
left to care for themselves. With a few notable exceptions, this was
the case at Avignon, but Guy was among those who remained faithful to
his duty and took on himself the self-sacrificing labor of caring for
the sick, doubly harassing because so many of his brother physicians
were absent. He denounces their conduct as shameful, yet does not boast
of his own courage, but on the contrary says that he was in constant
fear of the disease. Toward the end of the epidemic he was attacked by
the plague and for a time his life was despaired of. Fortunately he
recovered, to become the most influential among his colleagues, the most
highly admired of the physicians of his generation, and the close
personal friend of all the high ecclesiastics, who had witnessed his
magnificent display of courage and of helpfulness for the
plague-stricken during the epidemic. He wrote a very clear account of
the epidemic, which leaves no doubt that it was true bubonic plague.
After this fine example, Chauliac's advice to brother physicians in the
specialty of surgery carried added weight. In the Introductory chapter
of his "Chirurgia Magna" he said:
"The surgeon should be learned, skilled, ingenious, and of
good morals. Be bold in things that are sure, cautious in
dangers; avoid evil cures and practices; be gracious to the
sick, obliging to his colleagues, wise in his predictions. Be
chaste, sober, pitiful, and merciful; not covetous nor
extortionate of money; but let the recompense be moderate,
according to the work, the means of the sick, the character of
the issue or event, and its dignity."
No wonder that Malgaigne says of him, "Never since Hippocrates has
medicine heard such language filled with so much nobility and so full of
matter in so few words."
Chauliac was in every way worthy of his great contemporaries and the
period in which his lot was cast. Ordinarily we are not apt to think of
the early fourteenth century as an especially productive period in human
history, but such it is. Dante's Divine Comedy was entirely written
during Chauliac's life. Petrarch was born within a few years of Chauliac
himself; Boccaccio in Italy, and Chaucer in England, wrote while
Chauliac was still alive. Giotto did his great painting, and his pupils
were laying the deep, firm foundations of modern art. Many of the great
cathedrals were being finished. Most of the universities were in the
first flush of their success as moulders of the human mind. There are
few centuries in history that can show the existence of so many men
whose work was to have an enduring influence for all the after time as
this upon which Chauliac's career shed so bright a light. The preceding
century had seen the origin of the universities and the rise of such
supremely great men as Albertus Magnus, Roger Bacon, Thomas Aquinas, and
the other famous scholars of the early days of the mendicant orders, and
had made the intellectual mould of university training in which men's
minds for seven centuries were to be formed, so that Chauliac, instead
of being an unusual phenomenon is only a fitting expression of the
interest of this time in everything, including the physical sciences
and, above all, medicine and surgery.
For some people it may be a source of surprise that Chauliac should
have had the intellectual training to enable him to accomplish such
judicious work in his specialty. Many people will be apt to assume that
he accomplished what he did in spite of his training, genius succeeding
even in an unfavorable environment, and notwithstanding educational
disadvantages. Those who would be satisfied with any such explanation,
however, know nothing of the educational opportunities provided in the
period of which Chauliac was the fruit. He is a typical university man
of the beginning of the fourteenth century, and the universities must be
given due credit for him. It is ordinarily assumed that the universities
paid very little attention to science and that scientists would find
practically nothing to satisfy in their curricula. Professor Huxley in
his address on "Universities, Actual and Ideal," delivered as the
Rectorial Address at Aberdeen University in 1874, declared that they
were probably educating in the real sense of the word better than we do
now. (See quotation in "The Medical School at Salerno.")
In the light of Chauliac's life it is indeed amusing to read the
excursions of certain historians into the relationship of the Popes and
the Church to science during the Middle Ages. Chauliac is typically
representative of medieval science, a man who gave due weight to
authority, yet tried everything by his own experience, and who sums up
in himself such wonderful advance in surgery that during the last twenty
years the students of the history of medicine have been more interested
in him than in anyone who comes during the intervening six centuries.
Chauliac, however, instead of meeting with any opposition, encountered
encouragement, liberal patronage, generous interest, and even enjoyed
the intimate friendship of the highest ecclesiastics and the Popes of
his time. In every way his life may be taken as a type of what we have
come to know about the Middle Ages, when we know them as we should, in
the lives of the men who counted for most in them, and do not accept
merely the broad generalizations which are always likely to be deceptive
and which in the past have led men into the most absurd and ridiculous
notions with regard to a wonderful period in human history.
That Guy de Chauliac was no narrow specialist is abundantly evident from
his book, for while the "Great Surgery" treats of the science and art of
surgery as its principal subject, there are remarks about nearly
everything else relating to medicine, and most of them show a deep
interest, a thorough familiarity, and an excellent judgment. Besides we
have certain expressions with regard to intellectual matters generally
which serve to show Guy as a profound thinker, who thoroughly
appreciated just how accumulations of knowledge came to men and how far
each generation or member of a generation should go and yet how limited
must, after all, be the knowledge obtained by any one person. With
regard to books, for instance, he said, "for everyone cannot have all
the books, and even if he did have them it would be too tiresome to read
them all and completely, and it would require a godlike memory to
retain them all." He realized, however, that each generation, provided
it took the opportunities offered it, was able to see a little bit
farther than its predecessor, and the figure that he employs to express
this is rather striking. "Sciences," he said, "are made by additions. It
is quite impossible that the man who begins a science should finish it.
We are like infants, clinging to the neck of a giant; for we can see all
the giant sees and a little more."
One of the most interesting features of the history of Guy de Chauliac
is the bibliography of his works which has been written by Nicaise. This
is admirably complete, labored over with the devotion that characterized
Nicaise's attitude of unstinted admiration for the subject. Altogether
he has some sixty pages of a quarto volume with regard to the various
editions of Guy's works.
The first manuscript edition of Guy de Chauliac was issued in 1363, the
first printed edition in 1478. Even in the fourteenth century Guy's
great work was translated into all the languages generally used in
Europe. Nicaise succeeded in placing 34 complete manuscripts of the
"Great Surgery": 22 of these are in Latin, 4 are in French, 3 are in
English, 2 only in Provençal, though that was the language spoken in the
region where much of Chauliac's life was passed, and one each in
Italian, in Low Dutch, and in Hebrew. Of the English manuscripts, one is
number twenty-five English of the Bibliothèque Nationale, Paris; a
second is number 3666 English of the Sloane collection in the British
Museum, and a third is in the Library of the University of
Cambridge.[26]
Paulin Paris, probably one of the best of recent authorities on the age
and significance of old manuscripts, says in the third volume of his
"Manuscrits Français," page 346, "This manuscript [of Guy de Chauliac's
"Great Surgery"] was made, if not during the life, then certainly very
shortly after the death of the author. It is one of the oldest that can
be cited, and the fact that an English translation was made so near to
the time of the original composition of the book attests the great
reputation enjoyed by Guy de Chauliac at this time, and which posterity
has fully confirmed."
The Sloane copy in the British Museum contains some medical recipes at
the end by Francis Verney. It was probably written in the fifteenth
century. Its title is:
"The inventorie or the collectorie in cirurgicale parte of
medicine compiled and complete in the yere of our Lord 1363,
with some additions of other doctours, necessary to the
foresaid arte or crapte (crafte?)."[27]
What we find in the period of manuscripts, however, is as nothing
compared to the prestige of Guy de Chauliac's work, once the age of
printing began. Nicaise was able to find sixty different printed
editions of the "Great Surgery." Nine others that are mentioned by
authors have disappeared and apparently no copies of them are in
existence. Besides there are sixty editions of portions of the work, of
compendiums of it and commentaries on it. Altogether 129 editions are
extant. Of these there are sixteen Latin editions, forty-three French,
five Italian, four Low Dutch, five Catalan, and one English. Fourteen
appeared in the fifteenth century, thirty-eight in the sixteenth
century, and seventeen in the seventeenth century. The fourteen editions
belonging to the _incunabula_ of printing, issued, that is, before the
end of the fifteenth century, show what lively interest there was in the
French surgeon of the preceding century, since printing presses at this
precious time were occupied only with the books that were considered
indispensable for scholars. The first edition of the "Great Surgery" was
printed in 1478 at Lyons. Printing had only been introduced there five
years before. This first edition, _primus primarius_ or _editio
princeps_, was a French translation by Nicholas Panis. In 1480 an
Italian edition was printed at Venice. The first Latin edition was
printed also in Venice in 1490.
It would be only natural to expect that the successors of Guy de
Chauliac, and especially those who had come personally in contact with
him, would take advantage of his thorough work to make still further
advances in surgery. As matter of fact, decadence in surgery is noted
immediately after his death. Three men taught at the University of
Montpellier at the end of the fourteenth and the beginning of the
fifteenth century, John de Tornamira, Valesco de Taranta, and John
Faucon. They cannot be compared, Gurlt says, with Guy de Chauliac,
though they were physicians of reputation in their time. Faucon made a
compendium of Guy's work for students. Somehow there seemed to be the
impression that surgery had now reached a point of development beyond
which it could not advance. Unfortunate political conditions, wars, the
withdrawal of the Popes from Avignon to Rome, and other disturbances,
distracted men's minds, and surgery deteriorated to a considerable
extent, until the new spirit at the time of the Renaissance came to
inject fresh life into it.
XII
MEDIEVAL DENTISTRY--GIOVANNI OF ARCOLI
If there is one phase of our present-day medicine and surgery that most
of us are likely to be quite sure is of very recent development it is
dentistry. Probably most people would declare at once that they had
every reason to think that the science and art of dentistry, as we have
it now, developed for the first time in the world's history during the
last generation or two. It is extremely interesting to realize then, in
the light of this almost universal persuasion, founded to a great extent
on the conviction that man is in process of evolution and that as a
consequence we must surely be doing things now that men never did
before, to find that dentistry, both as an art and science, is old; that
it has developed at a number of times in the world's history, and that
as fortunately for history its work was done mainly in indestructible
materials, the teeth themselves and metal prosthetic apparatus, we have
actual specimens of what was accomplished at a number of periods in the
olden times. Surprising as it will seem to those who hear of it for the
first time, dentistry reached high perfection even in what we know as
ancient history. It is rather easy to trace scientific and craftsmanlike
interest in it during the medieval period and in the magnificent
development of surgery that came just at the end of the Middle Ages,
dentistry shared to such degree that some of the text-books of the
writers on surgery of this time furnish abundant evidence of
anticipations of many of the supposedly most modern developments of
dentistry.
There are a number of historical traditions with regard to dentistry and
the treatment of the teeth in Egypt that can be traced back to good
authorities in Egyptology of a generation or more ago, but it is rather
hard to confirm the accounts we have by actual specimens; either none
were found or for some reason those actually discovered are now not
readily available for study. Among the Phenicians however, though we
have good reasons to think that they learned their arts and crafts from
the Egyptians, there is convincing evidence of a high development of
dentistry. M. Ernest Renan, during an exploring expedition in Phenicia,
found in the old necropolis at Sidon a set of teeth wired together, two
of which were artificial. It was a striking example of bridgework, very
well done, and may now be seen in the Louvre. It would be more than a
little surprising, from what we know of the lack of inventiveness on the
part of the Phenicians and their tendency to acquire their arts by
imitation, if they had reached such a climax of invention by themselves.
Since they adapted and adopted most of their arts and crafts from Egypt,
with which they were in close commercial relations, it has been argued
with some plausibility that the Egyptians may have had many modes of
dental prosthesis, but removed all artificial teeth and dental
appliances from the mouth of corpses before embalming them, in
preparation for the next world, because there was some religious
objection to such human handiwork being left in place for the hereafter,
as they hoped for it.
There is a well-authenticated tradition of intimate intercourse in a
commercial way between the old Etruscans who inhabited the Italian hill
country and the Phenicians, so that it is no surprise to find that the
oldest of Etruscan tombs contain some fine examples of bridgework. An
improvement has come over Phenician work however, and bands of gold
instead of wire are used for holding artificial teeth in place. Guerini,
whose "History of Dentistry" is the standard work on the subject, on a
commission from the Italian government, carefully studied these
specimens of Etruscan dental work in the museums of Italy, and has made
some interesting observations on them. In one specimen, which is
especially notable, two incisor teeth are replaced by a single tooth
from a calf. This was grooved in such a way as to make it seem like two
separate teeth. Guerini suggests a very interesting and quite unexpected
source for this. While examining the specimen he wondered where the old
Etruscan dentist had obtained a calf's tooth without a trace of wear on
it. He came to the conclusion that he must have cut into the gums of a
young calf before the permanent tooth was erupted in order to get this
structure absolutely unworn for his purpose. A number of examples of
bridgework have been found in the old Etruscan tombs. The dates of their
construction are probably not later than 500 B.C., and some of them are
perhaps earlier than 700 B.C.
The Etruscans affected the old Romans in the matter of dentistry, so
that it is easy to understand the passage in the "Laws of the Twelve
Tables," issued about 450 B.C., which, while forbidding the burial of
gold with corpses, made a special exception for such gold as was
fastened to the teeth. Gold was rare at Rome, and care was exercised not
to allow any unnecessary decrease of the visible supply almost in the
same way as governments now protect their gold reserves. It may seem
like comparing little things with great, but the underlying principle is
the same. Hence this special law and its quite natural exception.
In Pope Julius' Museum in Rome there is a specimen of a gold cap made of
two plates of gold riveted together and also riveted to bands of metal
which were fastened around the neighboring teeth in order to hold the
cap in place. This is from later Republican times at Rome. At the end of
the Republic and the beginning of the Empire there appear to have been
many forms of dental appliances. Martial says that the reason why one
lady's teeth--whose name he does not conceal--are white and
another's--name also given--were dark, was that the first one bought
hers and the second still had her own. In another satiric poem he
describes an elderly woman as so much frightened that when she ran away
her teeth fell out, while her friends lost their false hair. Fillings of
many kinds were used, dentrifices of nearly every kind were invented,
and dentistry evidently reached a high stage of development, though we
have nowhere a special name for dentist, and the work seems to have been
done by physicians, who took this as a specialty.
While in the Middle Ages there was, owing to conditions, a loss of much
of this knowledge of antiquity with regard to dentistry, or an
obscuration of it, it never disappeared completely, and whenever men
have written seriously about medicine, above all about surgery in
relation to the face and the mouth, the teeth have come in for their
share of scientific and practical consideration. Aëtius, the first
important Christian writer on medicine and surgery, discusses, as we
have seen in the sketch of him, the nutrition of the teeth, their
nerves, "which came from the third pair and entered the teeth by a small
hole existing at the end of the root," and other interesting details of
anatomy and physiology. He knows much about the hygiene of the teeth,
discusses extraction and the cure of fistula and other details. Paul of
Ægina in the next century has much more, and while they both quote
mainly from older authors there seems no doubt that they themselves had
made not a few observations and had practical experience.
It was from these men that the Arabian physicians and surgeons obtained
their traditions of medicine, and so it is not surprising to find that
they discuss dental diseases and their treatment rationally and in
considerable detail. Abulcasis particularly has much that is of
significance and interest. We have pictures of two score of dental
instruments that were used by them. The Arabs not only treated and
filled carious teeth and even replaced those that were lost, but they
also corrected deformities of the mouth and of the dental arches.
Orthodontia is sometimes said to be of much later origin and to begin
many centuries after Abulcasis' time, yet no one who knows of his work
can speak of Orthodontia as an invention after him. In this, however, as
in most of the departments of medicine and surgery, the Arabs were
merely imitators, though probably they expanded somewhat the practical
knowledge that had come to them.
When the great revival in surgery came in the twelfth and thirteenth
centuries it is not surprising that there should also have been an
important renewal of interest in dentistry. A detailed review of this
would take us too far afield, but at least something may be said of two
or three of the great representative surgical writers who touched on
this specialty.
About the middle of the fourteenth century that prince of surgeons, and
model of surgical writers, Guy de Chauliac, wrote his great text-book of
surgery, "Le Grande Chirurgie." An extremely interesting feature of this
work is to be found in the chapters that treat of diseases of the teeth.
These are not very comprehensive, and are evidently not so much the
result of his experience, as the fruit of his reading, yet they contain
many practical valuable ideas that are supposed to be ever so much later
than the middle of the fourteenth century. His anatomy and physiology at
least are not without many errors. His rules for the preservation of the
teeth show that the ordinary causes of dental decay were well recognized
even as early as this. Emphasis was laid on not taking foods too hot or
too cold, and above all not to follow either hot or cold food by
something very different from it in temperature. The breaking of hard
things with the teeth was recognized as one of the most frequent causes
of such deterioration of the enamel as gives opportunity for the
development of decay. The eating of sweets, and especially the sticky
sweets--preserves and the like--was recognized as an important source of
caries. The teeth were supposed to be cleaned frequently, and not to be
cleaned too roughly, for this would do more harm than good. We find
these rules repeated by succeeding writers on general surgery, who touch
upon dentistry, or at least the care of the teeth, and they were not
original with Guy de Chauliac, but part of the tradition of surgery.
As noted by Guerini in his "History of Dentistry," the translation of
which was published under the auspices of the National Dental
Association of the United States of America,[28] Chauliac recognized the
dentists as specialists. Besides, it should be added, as is evident from
his enumeration of the surgical instruments which he declares necessary
for them, they were not as we might easily think in the modern time mere
tooth pullers, but at least the best among them treated teeth as far as
their limited knowledge and means at command enabled them to do so, and
these means were much more elaborate than we have been led to think, and
much more detailed than we have reason to know that they were at
certain subsequent periods.
In fact, though Guy de Chauliac frankly confesses that he touches on the
subject of dentistry only in order to complete his presentation of the
subject of surgery and not because he has anything of his own to say
with regard to the subject, there is much that is of present-day
interest in his brief paragraphs. He observes that operations on the
teeth are special and belong to the _dentatores_, or dentists, to whom
doctors had given them over. He considers, however, that the operations
in the mouth should be performed under the direction of a physician. It
is in order to give physicians the general principles with which they
may be able to judge of the advisability or necessity for dental
operations that his short chapters are written. If their advice is to be
of value, physicians should know the various methods of treatment
suitable for dental diseases, including mouth washes, gargles,
masticatories, anointments, rubbings, fumigations, cauterizations,
fillings, filings, and the various manual operations. He says that the
_dentator_ must be provided with the appropriate instruments, among
which he names scrapers, rasps, straight and curved spatumina,
elevators, simple and with two branches, toothed tenacula, and many
different forms of probes and canulas. He should also have small
scalpels, tooth trephines, and files.
Chauliac is particularly emphatic in his insistence on not permitting
alimentary materials to remain in cavities, and suggests that if
cavities between the teeth tend to retain food material they should even
be filed in such a way as to prevent these accumulations. His
directions for cleansing the teeth were rather detailed. His favorite
treatment for wounds was wine, and he knew that he succeeded by means of
it in securing union by first intention. It is not surprising, then, to
find that he recommends rinsing of the mouth with wine as a precaution
against dental decay. A vinous decoction of wild mint and of pepper he
considered particularly beneficial, though he thought that dentifrices,
either powder or liquid, should also be used. He seems to recommend the
powder dentifrices as more efficacious. His favorite prescription for a
tooth powder, while more elaborate, resembles to such an extent, at
least some, if not indeed most of those, that are used at the present
time, that it seems worth while giving his directions for it. He took
equal parts of cuttle bone, small white sea-shells, pumice stone, burnt
stag's horn, nitre, alum, rock salt, burnt roots of iris, aristolochia,
and reeds. All of these substances should be carefully reduced to powder
and then mixed. His favorite liquid dentifrice contained the following
ingredients,--half a pound each of sal ammoniac and rock salt, and a
quarter of a pound of sacharin alum. All these were to be reduced to
powder and placed in a glass alembic and dissolved. The teeth should be
rubbed with it, using a little scarlet cloth for the purpose. Just why
this particular color of cleansing cloth was recommended is not quite
clear.
He recognized, however, that cleansing of the teeth properly often
became impossible by any scrubbing method, no matter what the dentifrice
used, because of the presence of what we call tartar and what he called
hardened limosity or limyness (_limosité endurcie_). When that condition
is present he suggests the use of rasps and spatumina and other
instrumental means of removing the tartar.
Evidently he did not believe in the removal of the teeth unless this was
absolutely necessary and no other method of treatment would avail to
save the patient from continuous distress. He summarizes the authorities
with regard to the extraction of teeth and the removal of dental
fragments and roots. He evidently knew of the many methods suggested
before his time of removing teeth without recourse to instrumental
extraction. There were a number of applications to the gums that were
claimed by older authors to remove the teeth without the need of metal
instruments. We might expect that Chauliac would detect the fallacy with
regard to these and expose it. He says that while much is claimed for
these methods he has never seen them work in practice and he distrusts
them entirely.
The most interesting phase of what Guy de Chauliac has to say with
regard to dentistry is of course to be found in his paragraphs on the
artificial replacement of lost teeth and the subject of dental
prosthesis generally. When teeth become loose he advises that they be
fastened to the healthy ones with a gold chain. Guerini suggests that he
evidently means a gold wire. If the teeth fall out they may be replaced
by the teeth of another person or with artificial teeth made from
oxbone, which may be fixed in place by a fine metal ligature. He says
that such teeth may be serviceable for a long while. This is a rather
curt way of treating so large a subject as dental prosthesis, but it
contains a lot of suggestive material. He was quoting mainly the Arabian
authors, and especially Abulcasis and Ali Abbas and Rhazes, and these of
course, as we have said, mentioned many methods of artificially
replacing teeth as also of transplantation and of treatment of the
deformities of the dental arches.
On the whole, however, it must be confessed that we have here in the
middle of the fourteenth century a rather surprising anticipation of the
knowledge of a special department of medicine which is usually
considered to be distinctly modern, and indeed as having only attracted
attention seriously in comparatively recent times.
After Guy de Chauliac the next important contributor to dentistry is
Giovanni of Arcoli, often better known by his Latin name, Johannes
Arculanus, who was a professor of medicine and surgery at Bologna and
afterwards at Padua, just before and after the middle of the fifteenth
century, and who died in 1484. He is famous principally for being the
first we know who mentions the filling of teeth with gold.
It might possibly be suggested that coming at this time Arculanus should
rather be reckoned as a Maker of Medicine in the Renaissance than as
belonging to the Middle Ages and its influences. His education, however,
was entirely completed before the earliest date at which the Renaissance
movement is usually said to begin, that is with the fall of
Constantinople in 1452, and he was dead before the other date, that of
the discovery of America in 1492, which the Germans have in recent years
come to set down as the end of the Middle Ages. Besides, what he has to
say about dentistry occurs in typical medieval form. It is found in a
commentary on Rhazes, written just about the middle of the fifteenth
century. In the later true Renaissance such a commentary would have been
on a Greek author. In his commentary Arculanus touches on most of the
features of medicine and surgery from the standpoint of his own
experience as well as from what he knows of the writings of his
predecessors and contemporaries. With the rest he has a series of
chapters on diseases of the teeth. Guerini in his "History of Dentistry"
says that "this subject [dentistry] is treated rather fully, and with
great accuracy." Even some short references to it will, I think,
demonstrate this rather readily.[29]
Arculanus is particularly full in his directions for the preservation of
the teeth. We are rather prone to think that prophylaxis is
comparatively a modern idea, and that most of the principles of
conservation of human tissues and the prevention of deterioration and
disease are distinctly modern. It needs only a little consideration of
Arculanus' instruction in the matter of the teeth, however, to undo any
such false impression. For obvious reasons I prefer to quote Guerini's
summation of this medieval student of dentistry's rules for dental
hygiene:
"For the preservation of teeth--considered by him, quite
rightly, a matter of great importance--Giovanni of Arcoli
repeats the various counsels given on the subject by preceding
writers, but he gives them as ten distinct canons or rules,
creating in this way a kind of decalogue of dental hygiene.
These rules are: (1) It is necessary to guard against the
corruption of food and drink within the stomach; therefore,
easily corruptible food--milk, salt fish, etc.--must not be
partaken of, and after meals all excessive movement, running
exercises, bathing, coitus, and other causes that impair the
digestion, must also be avoided. (2) Everything must be
avoided that may provoke vomiting. (3) Sweet and viscous
food--such as dried figs, preserves made with honey,
etc.--must not be partaken of. (4) Hard things must not be
broken with the teeth. (5) All food, drink, and other
substances that set the teeth on edge must be avoided. (6)
Food that is too hot or too cold must be avoided, and
especially the rapid succession of hot and cold, and vice
versa. (7) Leeks must not be eaten, as such a food, by its own
nature, is injurious to the teeth. (8) The teeth must be
cleaned at once, after every meal, from the particles of food
left in them; and for this purpose thin pieces of wood should
be used, somewhat broad at the ends, but not sharp-pointed or
edged; and preference should be given to small cypress twigs,
to the wood of aloes, or pine, rosemary, or juniper and
similar sorts of wood which are rather bitter and styptic;
care must, however, be taken not to search too long in the
dental interstices and not to injure the gums or shake the
teeth. (9) After this it is necessary to rinse the mouth by
using by preference a vinous decoction of sage, or one of
cinnamon, mastich, gallia, moschata, cubeb, juniper seeds,
root of cyperus, and rosemary leaves. (10) The teeth must be
rubbed with suitable dentrifices before going to bed, or else
in the morning before breakfast. Although Avicenna recommended
various oils for this purpose, Giovanni of Arcoli appears
very hostile to oleaginous frictions, because he considers
them very injurious to the stomach. He observes, besides, that
whilst moderate frictions of brief duration are helpful to the
teeth, strengthen the gums, prevent the formation of tartar,
and sweeten the breath, too rough or too prolonged rubbing is,
on the contrary, harmful to the teeth, and makes them liable
to many diseases."
All this is so modern in many ways that we might expect a detailed exact
knowledge of the anatomy of the teeth and even something of their
embryology from Arculanus. It must not be forgotten, however, that
coming as he does before the Renaissance, the medical sciences in the
true sense of the word are as yet unborn. Men are accumulating
information for practical purposes but not for the classification and
co-ordination that was to make possible the scientific development of
their knowledge.
Giovanni of Arcoli's acquaintance with the anatomy of the teeth was
rather sadly lacking. He does not know even with certainty the number of
roots that the teeth have. This has been attributed to the fact that he
obtained most of his information from books, and had not the time to
verify descriptions that he had found. It has been argued from this that
he was himself probably not a practical dentist, and turned to that
specialty only as a portion of his work as a general surgeon, and that
consequently he was not sufficiently interested to verify his
statements. His chapters on dentistry would seem to bear out this
conclusion to some extent, though the very fact that one who was himself
not specially interested in dental surgery should have succeeded in
gathering together so much that anticipates modern ideas in dentistry,
is of itself a proof of how much knowledge of the subject there was
available for a serious student of that time. The anatomy of the teeth
continued to be rather vague until about the middle of the next century
when Eustachius, whose investigations of the anatomy of the head have
deservedly brought him fame and the attachment of his name to the
Eustachian canal, wrote his "Libellus de Dentibus--Manual of the Teeth,"
which is quite full, accurate, and detailed. Very little has been added
to the microscopic anatomy of the teeth since Eustachius' time. He had
the advantage, of course, of being intimately in contact with the great
group of Renaissance anatomists,--Vesalius, Columbus, Varolius,
Fallopius, and the others, the great fathers of anatomy. Besides, his
position as Papal Physician and Professor of Anatomy at the Papal
Medical School at Rome gave him opportunities for original
investigation, such as were not easily obtained elsewhere.
Arculanus can scarcely be blamed, therefore, for not having anticipated
the Renaissance, and we must take him as merely the culmination of
medieval knowledge with regard to anatomy and surgery. Medieval medical
men did not have the time nor apparently the incentive to make formal
medical science, though it must not be forgotten, as has been said, that
they did use the knowledge they obtained by their own and others'
observation to excellent advantage for the practical benefit of ailing
humanity. The sciences related to medicine are conscious developments
that follow the evolution of practical medicine, nor must it be
forgotten that far from always serving as an auxiliary to applied
medical science, often indeed in the history of medicine scientific
pursuits have led men away into side issues from which they had to be
brought back by some genius medical observer. As might be expected,
then, it is with regard to the practical treatment and general
consideration of ailments of the teeth that Giovanni of Arcoli is most
interesting. In this some of his chapters contain a marvellous series of
surprises.
Arculanus was probably born towards the end of the fourteenth century.
The date of his death is variously placed as either 1460 or 1484, with
the probability in favor of the former. From 1412 to 1427 he was
professor at Bologna, where in accordance with the non-specializing
tendencies of the time he did not occupy a single chair but several in
succession. He seems first to have taught Logic, then Moral Philosophy,
and finally Medicine. His reputation in medicine drew many students to
the university, and his fame spread all over Italy. The rival University
of Padua then secured him, and he seems to have been for some twenty
years there. Later apparently he accepted a professor's chair at
Ferrara, where the D'Estes were trying to bring their university into
prominence. It was at Ferrara that he died. He was a man of wide
reading, of extensive experience, both of men and medicine, and one of
the scholars of his time. His works are, as we have said, mainly
excerpts from earlier writers and particularly the Arabians, but they
contain enough of hints drawn from his own observation and experience
to make his work of great value.
While, as Gurlt remarks in his "History of Surgery," Arculanus' name is
one of those scarcely known--he is usually considered just one of many
obscure writers of the end of the Middle Ages--his writings deserve a
better fate. They contain much that is interesting and a great deal that
must have been of the highest practical value to his contemporaries.
They attracted wide attention in his own and immediately succeeding
generations. The proof of this is that they exist in a large number of
manuscript copies. Just as soon as printing was introduced his books
appeared in edition after edition. His "Practica" was printed in no less
than seven editions in Venice. Three of them appeared before the end of
the fifteenth century, which places them among the _incunabula_ of
printing.
Probably nothing in the history of human intellectual interest is more
striking than the excellent judgment displayed by the editors who
selected the works to be printed at this time. Very few of them were
trivial or insignificant. Fewer still were idle speculations, and most
of them were almost of classical import for literature and science. Four
editions of this work were printed in Venice in the sixteenth century,
one of them as late as 1560, when the work done by such men as Vesalius,
Columbus, Eustachius, and Fallopius would seem to have made Arculanus
out of date. The dates of the various editions are Venice, 1483, 1493,
1497, 1504, 1542, 1557, and 1560. Besides there was an edition printed
at Basel in 1540.
Arculanus is said to have re-introduced the use of the seton, that is
the method of producing intense counter-irritation by the introduction
of some foreign body into an incision in the skin. We owe to him, too,
according to Pagel in the chapters on medieval medicine in Puschmann's
"Handbook of the History of Medicine," an excellent description of
alcoholic insanity.
His directions for the treatment of conditions in the mouth and nose
apart from the teeth are quite as explicit and practical, and in many
ways quite as great an anticipation of some of our modern notions as
what he has to say with regard to the teeth. For instance, in the
treatment of polyps he says that they should be incised and cauterized.
Soft polyps should be drawn out with a toothed tenaculum as far as can
be without risk of breaking them off. The incision should be made at the
root so that nothing or just as little as possible of the pathological
structure be allowed to remain. It should be cut off with a fine
scissors, or with a narrow file just small enough to permit its ingress
into the nostrils, or with a scalpel without cutting edges on the sides,
but only at its extremity, and this cutting edge should be broad and
well sharpened. If there is danger of hemorrhage, or if there is fear of
it, the instruments with which dissection is made should be fired
(_igniantur_), that is, heated at least to a dull redness. Afterwards
the stump, if any remains, should be touched with a hot iron or else
with cauterizing agents so that as far as possible it should be
obliterated.
After the operation a pledget of cotton dipped in the green ointment
described by Rhazes should be placed in the nose. This pledget should
have a string fastened to it, hanging from the nose in order that it may
be easily removed. At times it may be necessary to touch the root of the
polyp with a stylet on which cotton has been placed that has been dipped
in _aqua fortis_ (nitric acid). It is important that this cauterizing
fluid should be rather strong so that after a certain number of touches
a rather firm eschar is produced. In all these manipulations in the nose
Arculanus recommends that the nose should be held well open by means of
a nasal speculum. Pictures of all these instruments occur in his extant
works, and indeed this constitutes one of their most interesting and
valuable features. They are to be seen in Gurlt's "History of Surgery."
In some cases he had seen the polyp was so difficult to get at or was
situated so far back in the nose that it could not be reached by means
of a tenaculum or scissors, or even the special knife devised for that
purpose. For these patients Arculanus describes an operation that is to
be found in the older writers on surgery, Paul of Ægina (Æginetus),
Avicenna, and some of the other Arabian surgeons. For this three
horse-tail hairs are twisted together and knotted in three or four
places, and one end is passed through the nostrils and out through the
mouth. The ends of this are then pulled on backward and forward after
the fashion of a saw. Arculanus remarks evidently with the air of a man
who has tried it and not been satisfied that this operation is quite
uncertain, and seems to depend a great deal on chance, and much reliance
must not be placed on it. Arculanus suggests a substitute method by
which latent polyps or occult polyps as he calls them may be removed.
There is scarcely an important disease for which Arculanus has not some
interesting suggestions, and the more one reads of him the more is one
surprised to find how many things that we might think of as coming into
the purview of medicine long after his time or at least as having been
neglected from the time of the Greeks almost down to our own time are
here treated explicitly, definitely, and with excellent practical
suggestions. He has a good deal to say with regard to the treatment of
angina, which he calls synanche, or synanchia, or cynanche, or angina.
Parasynanche is a synonymous term, but refers to a milder synanche. He
distinguished four forms of it. In one called canine angina, because the
patient's tongue hangs out of his mouth, somewhat the same as from an
overheated dog in the summer time, while at the same time the mouth is
held open and he draws his breath pantingly, Arculanus suggests an
unfavorable prognosis, and would seem to refer to those cases of
Ludwig's angina in which there is involvement of the tongue and in which
our prognosis continues to be of the very worst even to our own day. At
times the angina causes such swelling in the throat that the breathing
is interfered with completely. For this Arculanus' master, Rhazes,
advised tracheotomy. Arculanus himself, however, apparently hesitated
about that.
It is not surprising, then, to find that Arculanus is very explicit in
his treatment of affections of the uvula. He divides its affections into
_apostema, ulcus, putredo sive corrosio, et casus_. _Apostema_ was
abscess, _ulcus_ any rather deep erosion, _putredo_ a gangrenous
condition, and _casus_ the fall of the uvula. This is the notorious
falling of the soft palate which has always been in popular medical
literature at least. Arculanus describes it as a preternatural
elongation of the uvula which sometimes goes to such an extent as to
make it resemble the tail of a mouse. For shorter elongations he
suggests the cautery; for longer, excision followed by the cautery so
that the greater portion of the extending part may be cut off. If people
fear the knife he suggests following Rhazes, the application of an
astringent powder directly to the part by blowing through a tube. His
directions for the removal of the uvula are very definite. Seat the
patient upon a stool in a bright light while an assistant holds the
head; after the tongue has been firmly depressed by means of a speculum
let the assistant hold this speculum in place. With the left hand then
insert an instrument, a stilus, by which the uvula is pulled forward,
and then remove the end of it by means of a heated knife or some other
process of cauterization. The mouth should afterwards be washed out with
fresh milk.
The application of a cauterizing solution by means of a cotton swab
wrapped round the end of a sound may be of service in patients who
refuse the actual cautery. To be successful the application must be
firmly made and must be frequently repeated.
After this it is not surprising to find that Arculanus has very
practical chapters on all the other ordinary surgical affections.
Empyema is treated very thoroughly, liver abscess, ascites, which he
warns must be emptied slowly, ileus especially when it reaches
stercoraceous vomiting, and the various difficulties of urination, he
divides them into dysuria, ischuria, and stranguria, are all discussed
in quite modern fashion. He gives seven causes for difficulty of
urination. One, some injury of the bladder; two, some lesion of the
urethra; three, some pathological condition in the power to make the
bladder contract; four, some injury of the muscle of the neck of the
bladder; five, some pathological condition of the urine; six, some
kidney trouble, and seven, some pathological condition of the general
system. He takes up each one of these and discusses the various phases,
causes, disposition, and predispositions that bring them about. One
thing these men of the Middle Ages could do, they reasoned logically,
they ordered what they had to say well, and they wrote it out
straightforwardly.
That Arculanus' work with regard to dentistry was no mere chance and not
solely theoretic can be understood very well from his predecessors, and
that it formed a link in a continuous tradition which was well preserved
we may judge from what is to be found in the writings of his great
successor, Giovanni or John de Vigo, who is considered one of the great
surgeons of the early Renaissance, and to whom we owe what is probably
the earliest treatise on "Gun-shot Wounds." John of Vigo was a Papal
physician and surgeon, generally considered one of the most
distinguished members of the medical profession of his time. Two
features of his writing on dental diseases deserve mention. He insists
that abscesses of the gums shall be treated as other abscesses by being
encouraged to come to maturity and then being opened. If they do not
close promptly, an irritant Egyptian ointment containing verdigris and
alum among other things should be applied to them. In the cure of old
fistulous tracts near the teeth he employs not only this Egyptian
ointment but also arsenic and corrosive sublimate. What he has to say
with regard to the filling of the teeth is, however, most important. He
says it with extreme brevity, but with the manner of a man thoroughly
accustomed to doing it. "By means of a drill or file the putrefied or
corroded part of the tooth should be completely removed. The cavity left
should then be filled with gold leaf." It is evident that the members of
the Papal court, the Cardinals and the Pope himself, had the advantage
of rather good dentistry at John de Vigo's hands even as early as the
beginning of the sixteenth century.
John de Vigo, however, is not medieval. He lived on into the sixteenth
century and was influenced deeply by the Renaissance. He counts among
the makers of modern medicine and surgery, as his authorship of the
treatise on gun-shot wounds makes clear. He comes in a period that will
be treated of in a later volume of this series on "Our Forefathers in
Medicine."
XIII
CUSANUS AND THE FIRST SUGGESTION OF LABORATORY METHODS IN MEDICINE
As illustrating how, as we know more about the details of medical
history, the beginnings of medical science and medical practice are
pushed back farther and farther, a discussion in the _Berliner klinische
Wochenschrift_ a dozen years ago is of interest. Professor Ernest von
Leyden, in sketching the history of the taking of the pulse as an
important aid in diagnostics, said that John Floyer was usually referred
to as the man who introduced the practice of determining the pulse rate
by means of the watch. His work was done about the beginning of the
eighteenth century. Professor von Leyden suggested, however, that
William Harvey, the English physiologist, to whom is usually attributed
the discovery of the circulation of the blood, had emphasized the value
of the pulse in medical diagnosis, and also suggested the use of the
watch in counting the pulse. Professor Carl Binz, of the University of
Bonn, commenting on these remarks of Professor von Leyden, called
attention to the fact that more than a century before the birth of
either of these men, even the earlier, to whom the careful measurement
of the pulse rate is thus attributed as a discovery, a distinguished
German churchman, who died shortly after the middle of the fifteenth
century, had suggested a method of accurate estimation of the pulse
that deserves a place in medical history.
This suggestion is so much in accord with modern demands for greater
accuracy in diagnosis that it seems not inappropriate to talk of it as
the first definite attempt at laboratory methods in the department of
medicine. The maker of the suggestion, curiously enough, was not a
practising physician, but a mathematician and scholar, Cardinal Nicholas
of Cusa, who is known in history as Cusanus from the Latin name of the
town Cues on the Moselle River, some twenty-five miles south of Trèves,
where he was born. His family name, Nicholas Krebs, has been entirely
lost sight of in the name derived from his native town, which is the
only reason why most of the world knows anything about that town.
Cardinal Cusanus suggested that in various forms of disease and at
various times of life, as in childhood, boyhood, manhood, and old age,
the pulse was very different. It would be extremely valuable to have
some method of accurately estimating, measuring, and recording these
differences for medical purposes. At that time watches had not yet been
invented, and it would have been very difficult to have estimated the
time by the clocks, for almost the only clocks in existence were those
in the towers of the cathedrals and of the public buildings. The first
watches, Nuremberg eggs, as they were called, were not made by Peter
Henlein until well on into the next century. The only method of
measuring time with any accuracy in private houses was the clepsydra or
water-clock, which measured the time intervals by the flow of a
definite amount of water. Cardinal Cusanus suggested then that the
water-clock should be employed for estimating the pulse frequency. His
idea was that the amount of water which flowed while a hundred beats of
the pulse were counted, should be weighed, and this weight compared with
that of the average weight of water which flowed while a hundred beats
of the normal pulse of a number of individuals of the same age and
constitution were being counted.
This was a very single and a very ingenious suggestion. We have no means
of knowing now whether it was adopted to any extent or not. It may seem
rather surprising that a cardinal should have been the one to make such
a suggestion. Cusanus, however, was very much interested in mathematics
and in the natural sciences, and we have many wonderful suggestions from
his pen. He was the first, for instance, to suggest, more than a century
before Copernicus, that the earth was not the centre of the universe,
and that it would not be absolutely at rest or, as he said, devoid of
all motion. His words are: "_Terra igitur, quæ centrum esse nequit, motu
omni carere non potest_." He described very clearly how the earth moved
round its own axis, and then he added, what cannot fail to be a
surprising declaration for those in the modern times who think such an
idea of much later origin, that he considered that the earth itself
cannot be fixed, but moves as do the other stars in the heavens. The
expression is so astonishing at that time in the world's history that it
seems worth the while to give it in its original form, so that it may be
seen clearly that it is not any subsequent far-fetched interpretation
of his opinion, but the actual words themselves, that convey this idea.
He said: "_Consideravi quod terra ista non potest esse fixa, sed movetur
ut aliæ stellæ._"
How clearly Cusanus anticipated another phase of our modern views may be
judged from what he has to say in "De Docta Ignorantia" with regard to
the constitution of the sun. It is all the more surprising that he
should by some form of intuition reach such a conclusion, for the
ordinary sources of information with regard to the sun would not suggest
such an expression except to a genius, whose intuition outran by far the
knowledge of his time. The Cardinal said: "To a spectator on the surface
of the sun the splendor which appears to us would be invisible, since it
contains, as it were, an earth for its central mass, with a
circumferential envelope of light and heat, and between the two an
atmosphere of water and clouds and of ambient air." After reading that
bit of precious astronomical science announced nearly five centuries
ago, it is easy to understand how Copernicus could have anticipated
other phases of our knowledge, as he did in his declarations that the
figure of the earth is not a sphere, but is somewhat irregular, and that
the orbit of the earth is not circular.
Cusanus was an extremely practical man, and was constantly looking for
and devising methods of applying practical principles of science to
ordinary life. As we shall see in discussing his suggestion for the
estimation of the pulse rate later on, he made many other similar
suggestions for diagnostic purposes in medicine, and set forth other
applications of mathematics and mechanics to his generation.
Many of Cusanus' books have curiously modern names. He wrote, for
instance, a series of mathematical treatises, in Latin of course, on
"Geometric Transmutations," on "Arithmetical Complements," on
"Mathematical Complements," on "Mathematical Perfection," and on "The
Correction of the Calendar." In his time the calendar was in error by
more than nine days, and Cusanus was one of those who aroused sufficient
interest in the subject, so that in the next century the correction was
actually made by the great Jesuit mathematician, Father Clavius. Perhaps
the work of Cusanus that is best known is that "On Learned Ignorance--De
Docta Ignorantia," in which the Cardinal points out how many things that
educated people think they know are entirely wrong. It reminds one very
much of Josh Billings's remark that it is not so much the ignorance of
mankind that makes them ridiculous, as the knowing so many things that
ain't so. It is from this work that the astronomical quotations which we
have made are taken. The book that is of special interest to physicians
is his dialogue "On Static Experiments," which he wrote in 1450, and
which contains the following passages:
"Since the weight of the blood and the urine of a healthy and
of a diseased man, of a young man and an old man, of a German
and an African, is different for each individual, why would it
not be a great benefit to the physician to have all of these
various differences classified? For I think that a physician
would make a truer judgment from the weight of the urine
viewed in connection with its color than he could make from
its color alone, which might be fallacious. So, also, weight
might be used as a means of identifying the roots, the stems,
the leaves, the fruits, the seeds, and the juice of plants if
the various weights of all the plants were properly noted,
together with their variety, according to locality. In this
way the physician would appreciate their nature better by
means of their weight than if he judged them by their taste
alone. He might know, then, from a comparison of the weights
of the plants and their various parts when compared with the
weight of the blood and the urine, how to make an application
and a dosage of drugs from the concordances and differences of
the medicaments, and even might be able to make an excellent
prognosis in the same way. Thus, from static experiments, he
would approach by a more precise knowledge to every kind of
information.
"Do you not think if you would permit the water from the
narrow opening of a clepsydra [water-clock] to flow into a
basin for as long as was necessary to count the pulse a
hundred times in a healthy young man, and then do the same
thing for an ailing young man, that there would be a
noticeable difference between the weights of the water that
would flow during the period? From the weight of the water,
therefore, one would arrive at a better knowledge of the
differences in the pulse of the young and the old, the healthy
and the unhealthy, and so, also, as to information with regard
to various diseases, since there would be one weight and,
therefore, one pulse in one disease, and another weight and
another pulse in another disease. In this way a better
judgment of the differences in the pulse could be obtained
than from the touch of the vein, just as more can be known
from the urine about its weight than from its color alone.
"Just in the same way would it not be possible to make a more
accurate judgment with regard to the breathing, if the
inspirations and expirations were studied according to the
weight of the water that passed during a certain interval? If,
while water was flowing from a clepsydra, one were to count a
hundred expirations in a boy, and then in an old man, of
course, there would not be the same amount of water at the end
of the enumeration. Then this same thing might be done for
other ages and states of the body. As a consequence, when the
physician once knew what the weight of water that represented
the number of expirations of a healthy boy or youth, and then
of an individual of the same age ill of some infirmity or
other, there is no doubt that, by this observation, he will
come to a knowledge of the health or illness and something
about the case, and, perhaps, also with more certainty would
be able to choose the remedy and the dose required. If he
found in a healthy young man apparently the same weight as in
an old and decrepit individual, he might readily be brought to
the conclusion that the young man would surely die, and in
this way have some evidence for his prognosis in the case.
Besides, if in fevers, in the same way, careful studies were
made of the differences in the weight of water for pulse and
respiration in the warm and the cold paroxysms, would it not
be possible thus to know the disease better and, perhaps, also
get a more efficacious remedy?"
As will be seen from this passage, Cusanus had many more ideas than
merely the accurate estimation of the pulse frequency when he suggested
the use of the water-clock. Evidently the thought had come to him that
the specific gravity of the substances, that is, their weight in
comparison to the weight of water, might be valuable information.
Before his time, physicians had depended only on the color and the taste
of the urine for diagnostic purposes. He proposed that they should weigh
it, and even suggested that they should weigh, also, the blood, I
suppose in case of venesection, for comparison's sake. He also thought
that the comparative weight of various roots, stems, leaves, juices of
plants might give hints for the therapeutic uses of these substances.
This is the sort of idea that we are apt to think of as typically
modern. Specific gravities and atomic weights have been more than once
supposed to represent laws in therapeutics, which so far, however, we
have not succeeded in finding, but it is interesting to realize that it
is nearly five hundred years since the first thought in this line was
clearly expressed by a distinguished thinker and scientific writer.
There are many interesting expressions in Cusanus' writings which
contradict most of the impressions commonly entertained with regard to
the scholars of the Middle Ages. It is usually assumed that they did not
think seriously, but speculatively, that they feared to think for
themselves, neglected the study of nature around them, considered
authority the important source of knowledge, and were as far as possible
from the standpoint of modern scientific students and investigators.
Here is a passage from Nicholas, on knowing and thinking, that might
well have been written by a great intellectual man at any time in the
world's history, and that could only emanate from a profound scholar at
any time.
"To know and to think, to see the truth with the eye of the
mind, is always a joy. The older a man grows the greater is
the pleasure which it affords him, and the more he devotes
himself to the search after truth, the stronger grows his
desire of possessing it. As love is the life of the heart, so
is the endeavor after knowledge and truth the life of the
mind. In the midst of the movements of time, of the daily work
of life, of its perplexities and contradictions, we should
lift our gaze fearlessly to the clear vault of heaven, and
seek ever to obtain a firmer grasp of and a keener insight
into the origin of all goodness and beauty, the capacities of
our own hearts and minds, the intellectual fruits of mankind
throughout the centuries, and the wondrous works of nature
around us; at the same time remembering always that in
humility alone lies true greatness, and that knowledge and
wisdom are alone profitable in so far as our lives are
governed by them."
The career of Nicholas of Cusa is interesting, because it sums up so
many movements, and, above all, educational currents in the fifteenth
century. He was born in the first year of the century, and lived to be
sixty-four. He was the son of a wine grower, and attracted the attention
of his teachers because of his intellectual qualities. In spite of
comparatively straitened circumstances, then, he was afforded the best
opportunities of the time for education. He went first to the school of
the Brethren of the Common Life at Deventer, the intellectual cradle of
so many of the scholars of this century. Such men as Erasmus, Conrad
Mutianus, Johann Sintheim, Hermann von dem Busche, whom Strauss calls
"the missionary of human wisdom," and the teacher of most of these,
Alexander Hegius, who has been termed the schoolmaster of Germany, with
Nicholas of Cusa and Rudolph Agricola and others, who might readily be
mentioned, are the fruits of the teaching of these schools of the
Brethren of the Common Life, in one of which Thomas à Kempis, the author
of "The Imitation of Christ," was, for seventy years out of his long
life of ninety, a teacher.
Cusanus succeeded so well at school that he was later sent to the
University of Heidelberg, and subsequently to Padua, where he took up
the study of Roman law, receiving his doctorate at the age of
twenty-three. This series of educational opportunities will be
surprising only to those who do not know educational realities at the
beginning of the fifteenth century. There has never been a time when a
serious seeker after knowledge could find more inspiration. On his
return to Germany, Father Krebs became canon of the cathedral in
Coblenz. This gave him a modest income, and leisure for intellectual
work which was eagerly employed. He was scarcely more than thirty when
he was chosen as a delegate to the Council at Basel. After this he was
made Archdeacon of the Cathedral of Lüttich, and from this time his rise
in ecclesiastical preferment was rapid. He had attracted so much
attention at the Council of Basel that he was chosen as a legate of the
Pope for the bringing about certain reforms in Germany. Subsequently he
was sent on ecclesiastical missions to the Netherlands, and even to
Constantinople. At the early age of forty he was made a Cardinal. After
this he was always considered as one of the most important consultors
of the Papacy in all matters relating to Germany. During the last
twenty-five years of his life in all the relations of the Holy See to
Germany, appeal was constantly made to the wisdom, the experience, and
the thoroughly conservative, yet foreseeing, judgment of this son of the
people, whose education had lifted him up to be one of the leaders of
men in Europe.
It was during this time that he wrote most of his books on mathematics,
which have earned for him a prominent place in Cantor's "History of
Mathematics," about a score of pages being devoted to his work. Much of
his thinking was done while riding on horseback or in the rude vehicles
of the day on the missions to which he was sent as Papal Legate. He is
said to have worked out the formula for the cycloid curve while watching
the path described by flies that had lighted on the wheels of his
carriage, and were carried forward and around by them. His scientific
books, though they included such startling anticipations of Copernicus'
doctrines as we have already quoted (Copernicus did not publish the
first sketch of his theory for more than a quarter of a century after
Cusanus' death), far from disturbing his ecclesiastical advancement or
injuring his career as a churchman, seem actually to have been
considered as additional reasons for considering him worthy of
confidence and consultation.
As the result of his careful studies of conditions in Germany, he
realized very clearly how much of unfortunate influence the political
status of the German people, with their many petty rulers and the
hampering of development consequent upon the trivial rivalries, the
constant bickerings, and the inordinate jealousies of these numerous
princelings, had upon his native country. Accordingly, towards the end
of his life he sketched what he thought would be the ideal political
status for the German people. As in everything that he wrote, he went
straight to the heart of the matter and, without mincing words, stated
just exactly what he thought ought to be done. Considering that this
scheme of Cusanus for the prosperity and right government of the German
people was not accomplished until more than four centuries after his
death, it is interesting, indeed, to realize how this clergyman of the
middle of the fifteenth century should have come to any such thought.
Nothing, however, makes it clearer than this, that it is not time that
fosters thinking, but that great men at any time come to great thoughts.
Cusanus wrote:
"The law and the kingdom should be placed under the protection
of a single ruler or authority. The small separate governments
of princes and counts consume a disproportionately large
amount of revenue without furnishing any real security. For
this reason we must have a single government, and for its
support we must have a definite amount of the income from
taxes and revenues yearly set aside by a representative
parliament and before this parliament (reichstag) must be
given every year a definite account of the money that was
spent during the preceding year."
Cusanus' life and work stand, then, as a type of the accomplishment, the
opportunities, the power of thought, the practical scholarship, the
mathematical accuracy, the fine scientific foresight of a scholar of
the fifteenth century. For us, in medicine, it is interesting indeed to
realize that it is from a man of this kind that a great new departure in
medicine with regard to the employment of exact methods of diagnosis had
its first suggestion in modern times. The origin of that suggestion is
typical. It has practically always been true that it was not the man who
had exhausted, or thought that he had done so, all previous medical
knowledge, who made advances in medicine for us. It has nearly always
been a young man early in his career, and at a time when, as yet, his
mind was not overloaded with the medical theories of his own time.
Cusanus was probably not more than thirty when he made the suggestion
which represents the first practical hint for the use of laboratory
methods in modern medicine. It came out of his thoughtful consideration
of medical problems rather than from a store of garnered information as
to what others thought. It is a lesson in the precious value of breadth
of education and serious training of mind for real progress at all
times.
XIV
BASIL VALENTINE, LAST OF THE ALCHEMISTS, FIRST OF THE CHEMISTS
"Fieri enim potest ut operator erret et a via regia deflectat,
sed ut erret natura quando recte tractatur fieri non potest."
"For it is quite possible that the physician should err and be
turned aside from the straight (royal) road, but that nature
when she is rightly treated should err is quite impossible."
This is one of the preliminary maxims of a treatise on medicine written
by a physician born not later than the first half of the fifteenth
century, and who may have lived even somewhat earlier. We are so prone
to think of the men of that time as utterly dependent on authority, not
daring to follow their own observation, suspecting nature, and almost
sure to be convinced that only by going counter to her could success in
the treatment of disease be obtained, that it is a surprise to most
people to find how completely the attitude of mind, that is supposed to
be so typically modern in this regard, was anticipated full four
centuries ago. There are other expressions of this same great physician
and medical writer, Basil Valentine, which serve to show how faithfully
he strove with the lights that he had to work out the treatment of
patients, just as we do now, by trying to find out nature's way, so as
to imitate her beneficent processes and purposes. It is quite clear
that he is but one of many faithful, patient observers and
experimenters--true scientists in the best sense of the word--who lived
in all the centuries of the Middle Ages.
Speculations and experiments with regard to the elixir of life, the
philosopher's stone, and the transmutation of metals, are presumed to
have filled up all the serious interests of the alchemists, supposed to
be almost the only scientists of those days. As a matter of fact,
however, men were making original observations of profound significance,
and these were considered so valuable by their contemporaries that,
though printing had not yet been invented, even the immense labor
involved in the manifold copying of large folio volumes by the slow hand
process did not suffice to deter them from multiplying the writings of
these men so numerously that they were preserved in many copies for
future generations, until the printing press came to perpetuate them.
Of this there is abundant evidence in the preceding pages as regards
medicine, and, above all, surgery, while a summary of accomplishments of
workers in other departments will be found in Appendix II, "Science at
the Medieval Universities."
At the beginning of the twentieth century, with some of the supposed
foundations of modern chemistry crumbling to pieces under the influence
of the peculiarly active light thrown upon our nineteenth century
chemical theories by the discovery of radium, and our observations on
radio-active elements generally, there is a reawakening of interest in
some of the old-time chemical observers, whose work used to be laughed
at as so unscientific, or, at most, but a caricature of real science,
and whose theory of the transmutation of elements into one another was
considered so absurd. It is interesting in the light of this to recall
that the idea that the elementary substances were essentially distinct
from each other, and that it would be impossible under any circumstances
to convert one element into another, belongs entirely to the nineteenth
century. Even so deeply scientific a mind as that of Newton, in the
preceding century, could not bring itself to acknowledge the tradition,
that came to be accepted subsequent to his time, of the absurdity of
metallic transformation. On the contrary, he believed quite formally in
transmutation as a basic chemical principle, and declared that it might
be expected to occur at any time. He had seen specimens of gold ores in
connection with metallic copper, and concluded that this was a
manifestation of the natural transformation of one of these yellow
metals into the other.
With the discovery that radium transforms itself into helium, and that,
indeed, all the so-called radioactivities of the heavy metals are
probably due to a natural transmutation process constantly at work, the
ideas of the older chemists cease entirely to be a subject for
amusement. The physical chemists of the present day are very ready to
admit that the old teaching of the absolute independence of something
over seventy elements is no longer tenable, except as a working
hypothesis. The doctrine of "matter and form," taught for so many
centuries by the scholastic philosophers, which proclaimed that all
matter is composed of two principles, an underlying material substratum,
and a dynamic or informing principle, has now more acknowledged
verisimilitude, or lies at least closer to the generally accepted ideas
of the most progressive scientists, than it has at any time for the last
two or three centuries. Not only the great physicists, but also the
great chemists, are speculating along lines that suggest the existence
of but one form of matter, modified according to the energies that it
possesses under a varying physical and chemical environment. This is,
after all, only a restatement in modern times of the teaching of St.
Thomas of Aquin, in the thirteenth century.
It is not surprising, then, that there should be a reawakening of
interest in the lives of some of the men, who, dominated by some of the
earlier scholastic ideas, by the tradition of the possibility of finding
the philosopher's stone, which would transmute the baser metals into the
precious metals, devoted themselves with quite as much zeal as any
modern chemist to the observation of chemical phenomena. One of the most
interesting of these--indeed, he might well be said to be the greatest
of the alchemists--is the man whose only name that we know is that which
appears on a series of manuscripts written in the High German dialect of
the end of the fifteenth and the beginning of the sixteenth century.
That name is Basil Valentine, and the writer, according to the best
historical traditions, was a Benedictine monk. The name Basil Valentine
may only have been a pseudonym, for it has been impossible to trace it
among the records of the monasteries of the time. That the writer was a
monk, however, there seems to be no room for doubt, for his writings
give abundant evidence of it, and, besides, in printed form they began
to have their vogue at a time when there was little likelihood of their
being attributed to a monastic source, unless an indubitable tradition
connected them with some monastery.
This Basil Valentine (to accept the only name we have) did so much for
the science of the composition of substances that he eminently deserves
the designation that has been given him of the last of the alchemists
and the first of the chemists. There is practically a universal
recognition of the fact now that he deserves also the title of the
Founder of Pharmaceutical Chemistry, not only because of the value of
the observations contained in his writings, but also because of the fact
that they proved so suggestive to certain scientific geniuses during the
century succeeding Valentine's life. Almost more than to have added to
the precious heritage of knowledge for mankind, it is a boon for a
scientific observer to have awakened the spirit of observation in
others, and to be the founder of a new school of thought. This Basil
Valentine undoubtedly did, and, in the Renaissance, the incentive from
his writings for such men as Paracelsus is easy to appreciate.
Besides, his work furnishes evidence that the investigating spirit was
abroad just when it is usually supposed not to have been, for the
Thuringian monk surely did not do all his investigation alone, but must
have owed, as well as given, many a suggestion to his contemporaries.
Some ten years ago, when Sir Michael Foster, professor of physiology in
the University of Cambridge, England, was invited to deliver the Lane
Lectures at the Cooper Medical College in San Francisco, he took for his
subject "The History of Physiology." In the course of his lecture on
"The Rise of Chemical Physiology" he began with the name of Basil
Valentine, who first attracted men's attention to the many chemical
substances around them that might be used in the treatment of disease,
and said of him:
"He was one of the alchemists, but in addition to his
inquiries into the properties of metals and his search for the
philosopher's stone, he busied himself with the nature of
drugs, vegetable and mineral, and with their action as
remedies for disease. He was no anatomist, no physiologist,
but rather what nowadays we should call a pharmacologist. He
did not care for the problem of the body, all he sought to
understand was how the constituents of the soil and of plants
might be treated so as to be available for healing the sick
and how they produced their effects. We apparently owe to him
the introduction of many chemical substances, for instance of
hydrochloric acid, which he prepared from oil and vitriol of
salt, and of many vegetable drugs. And he was apparently the
author of certain conceptions which, as we shall see, played
an important part in the development of chemistry and of
physiology. To him, it seems, we owe the idea of the three
'elements,' as they were and have been called, replacing the
old idea of the ancients of the four elements--earth, air,
fire, and water. It must be remembered, however, that both in
the ancient and the new idea the word 'element' was not
intended to mean that which it means to us now, a fundamental
unit of matter, but a general quality or property of matter.
The three elements of Valentine were: (1) sulphur, or that
which is combustible, which is changed or destroyed, or which
at all events disappears during burning or combustion; (2)
mercury, that which temporarily disappears during burning or
combustion, which is dissociated in the burning from the body
burnt, but which may be recovered, that is to say, that which
is volatile, and (3) salt, that which is fixed, the residue or
ash which remains after burning."
It is a little bit hard in our time for most people to understand just
how such a development of thoroughly scientific chemical notions, with
investigations for their practical application, should have come before
the end of the Middle Ages. This difficulty of understanding, however,
we are coming to realize in recent years, is entirely due to our
ignorance of the period. We have known little or nothing about the
science of the Middle Ages, because it was hidden away in rare old
books, in rather difficult Latin, not easy to get at, and still less
easy to understand always, and we have been prone to conclude that since
we knew nothing about it, there must have been nothing. Just inasmuch as
we have learned something definite about the medieval scholars, our
admiration has increased. Professor Clifford Allbutt, the Regius
Professor of Medicine at the University of Cambridge, in his Harveian
Oration, delivered before the Royal College of Physicians in 1900, on
"Science and Medieval Thought" (London, 1901), declared that "the
schoolmen, in digging for treasure, cultivated the field of knowledge
even for Galileo and Harvey, for Newton and Darwin." He might have added
that they had laid foundations in all our modern sciences, in chemistry
quite as well as in astronomy, physiology, and the medical sciences, in
mathematics and botany.
In chemistry the advances made during the thirteenth, fourteenth, and
fifteenth centuries were, perhaps, even more noteworthy than those in
any other department of science. Albertus Magnus, who taught at Paris,
wrote no less than sixteen treatises on chemical subjects, and,
notwithstanding the fact that he was a theologian as well as a
scientist, and that his printed works fill some _fifteen folio volumes_,
he somehow found the time to make many observations for himself, and
performed numberless experiments in order to clear up doubts. The larger
histories of chemistry accord him his proper place, and hail him as a
great founder in chemistry, and a pioneer in original investigation.
Even St. Thomas of Aquin, much as he was occupied with theology and
philosophy, found some time to devote to chemical questions. After all,
this is only what might have been expected of the favorite pupil of
Albertus Magnus. Three treatises on chemical subjects from Aquinas' pen
have been preserved for us, and it is to him that we are said to owe the
use, in the Western world at least, of the word amalgam, which he first
employed in describing various chemical methods of metallic combination
with mercury that were discovered in the search for the genuine
transmutation of metals.
Albertus Magnus' other great scientific pupil, Roger Bacon, the English
Franciscan friar, followed more closely in the scientific ways of his
great master, devoting himself almost entirely to the physical
sciences. Altogether he wrote some eighteen treatises on chemical
subjects. For a long time it was considered that he was the inventor of
gunpowder, though this is now known to have been introduced into Europe
by the Arabs. Roger Bacon studied gunpowder and various other explosive
combinations in considerable detail, and it is for this reason that he
obtained the undeserved reputation of being an original discoverer in
this line. How well he realized how much might be accomplished by means
of the energy stored up in explosives, can, perhaps, be best appreciated
from the fact that he suggested that boats would go along the rivers and
across seas without either sails or oars, and that carriages would go
along the streets without horse or man power. He considered that man
would eventually invent a method of harnessing these explosive mixtures,
and of utilizing their energies for his purposes without danger. It is
curiously interesting to find, as we begin the twentieth century, and
gasolene is so commonly used for the driving of automobiles and motor
boats, and is being introduced even into heavier transportation as the
most available source of energy for suburban traffic, at least, that
this generation should only be fulfilling the idea of the old Franciscan
friar of the thirteenth century, who prophesied that in explosives there
was the secret of eventually manageable energy for transportation
purposes.
Succeeding centuries were not as fruitful in great scientists as the
thirteenth, and yet, in the second half of the thirteenth, there was a
Pope, John XXI, who had been a physician and professor of medicine
before his election to the Papacy, three of whose scientific
treatises--one on the transmutation of metals, which he considers an
impossibility, at least as far as the manufacture of gold and silver was
concerned; a treatise on diseases of the eyes, to which good authorities
have not hesitated to give lavish praise for its practical value,
considering the conditions in which it was written; and, finally, his
treatise on the preservation of the health, written when he was himself
over eighty years of age--are all considered by good authorities as
worthy of the best scientific spirit of the time.
During the fourteenth century, Arnold of Villanova, the inventor of
nitric acid, and the two Hollanduses, kept up the tradition of original
investigation in chemistry. Altogether there are some dozen treatises
from these three men on chemical subjects. The Hollanduses particularly
did their work in a spirit of thoroughly frank, original investigation.
They were more interested in minerals than in any other class of
substances, but did not waste much time on the question of transmutation
of metals. Professor Thompson, the professor of chemistry at Edinburgh,
said, in his "History of Chemistry," many years ago, that the
Hollanduses give very clear descriptions of their processes of treating
minerals in investigating their composition, and these serve to show
that their knowledge was by no means entirely theoretical, or acquired
only from books.
It is not surprising, then, to have a great investigating pharmacologist
come along sometime about the beginning of the fifteenth century, when,
according to the best authorities, Basil Valentine was born. From
traditions he seems to have had a rather long life, and his years run
nearly parallel with his century. His career is a typical example of the
personally obscure and intellectually brilliant lives which the old
monks lived. Probably in nothing have recent generations been more
deceived in historical matters than in their estimation of the
intellectual attainments and accomplishment of the old monks. The more
that we know of them, not from second-hand authorities, but from their
own books and from what they accomplished in art and architecture, in
agriculture, in science of all kinds, the more do we realize what busy
men they were, and appreciate what genius they often brought to the
solution of great problems. We have had much negative pseudo-information
brought together with the definite purpose of discrediting monasticism,
and now that positive information is gradually being accumulated, it is
almost a shock to find how different are the realities of the story of
the intellectual life during the Middle Ages from what many writers had
pictured them.
To those who may be surprised that a man who did great things in
medicine should have lived during the fifteenth century, it may be well
to recall the names and a little of the accomplishment of the men of
this period, who were Basil Valentine's contemporaries, at least in the
sense that some portion of their lives and influence was coeval with
his. Before the end of this century Columbus had discovered America, and
by no happy accident, for many men of his generation did
correspondingly great work. Cardinal Nicholas of Cusa had developed
mathematics and applied mathematical ideas to the heavens, so that he
could announce the conclusion that the earth was a star, like the other
stars, and moved in the heavens as they do. Contemporary with Cusanus
was Regiomontanus, who has been proclaimed the father of modern
astronomy, and a distinguished mathematician. Toscanelli, the Florentine
astronomer, whose years run almost parallel with those of the fifteenth
century, did fine scholarly work, which deeply influenced Columbus and
the great navigators of the time. The universities in Italy were
attracting students from all over Europe, and such men as Linacre and
Dr. Caius went down there from England. Raphael was but a young man at
the end of the century, but he had done some noteworthy painting before
it closed. Leonardo da Vinci was born just about the middle of the
century, and did some marvellous work before the end of that century.
Michael Angelo was only twenty-five at the close of the century, but he,
too, did fine work, even at this early age. Among the other great
Italian painters of this century are Fra Angelico, Perugino, Raphael's
master, Pinturicchio, Signorelli, the pupil of his uncle, Vasari, almost
as distinguished, Botticelli, Titian, and very many others, who would
have been famous leaders in art in any other but this supremely great
period.
It was not only in Italy, however, that there was a wonderful outburst
of genius at this time, for Germany also saw the rise of a number of
great men during this period. Jacob Wimpheling, the "Schoolmaster of
Germany," as he has been called, whose educational work did much to
determine the character of German education for two centuries, was born
in 1450. Rudolph Agricola, who influenced the intellectual Europe of
this time deeply, was born in 1443. Erasmus, one of the greatest of
scholars, of teachers, and of controversialists, was born in 1467.
Johann Reuchlin, the great linguist, who, next to Erasmus, is the most
important character in the German Renaissance, was born in 1455. Then
there was Sebastian Brant, the author of "The Ship of Fools," and
Alexander Hegius, both of this same period. The most influential of them
all, Thomas à Kempis, who died in 1471, and whose little book, "The
Following of Christ," has influenced every generation deeply ever since,
was probably a close contemporary of Basil Valentine. When one knows
what European, and especially German scholars, were accomplishing at
this time, no room is left for surprise that Basil Valentine should have
lived and done work in medicine at this period that was to influence
deeply the after history of medicine.
Most of what Basil Valentine did was accomplished in the first half of
the fifteenth century. Coming, as he did, before the invention of
printing, when the spirit of tradition was more rife and dominating than
it has been since, it is almost needless to say that there are many
curious legends associated with his name. Two centuries before his time,
Roger Bacon, doing his work in England, had succeeded in attracting so
much attention even from the common people, because of his wonderful
scientific discoveries, that his name became a byword, and many strange
magical feats were attributed to him. Friar Bacon was the great wizard,
even in the plays of the Elizabethan period. A number of the same sort
of myths attached themselves to the Benedictine monk of the fifteenth
century. He was proclaimed in popular story to have been a wonderful
magician. Even his manuscript, it was said, had not been published
directly, but had been hidden in a pillar in the church attached to his
monastery, and had been discovered there after the splitting open of the
pillar by a bolt of lightning from heaven. It is the extension of this
tradition that has sometimes led to the assumption that Valentine lived
in an earlier century, some even going so far as to say that he, too,
like Roger Bacon, was a product of the thirteenth century. It seems
reasonably possible, however, to separate the traditional from what is
actual in his existence, and thus to obtain some idea at least of his
work, if not of the details of his life. The internal evidence from his
works enables the historian of science to place his writing within half
a century of the discovery of America.
One of the myths that have gathered around the name of Basil Valentine,
because it has become a commonplace in philology, has probably made him
more generally known than any of his actual discoveries. In one of the
most popular of the old-fashioned text-books of chemistry in use about
half a century ago, in the chapter on antimony, there was a story that
students, if I may judge from my own experience, never forgot. It was
said that Basil Valentine, a monk of the Middle Ages, was the discoverer
of this substance. After having experimented with it in a number of
ways, he threw some of it out of his laboratory one day when the swine
of the monastery, finding it, proceeded to gobble it up, together with
some other refuse. Just when they were finishing it, the monk discovered
what they were doing. He feared the worst from it, but took the occasion
to observe the effect upon the swine very carefully. He found that,
after a preliminary period of digestive disturbance, these swine
developed an enormous appetite, and became fatter than any of the
others. This seemed a rather desirable result, and Basil Valentine, ever
on the search for the practical, thought that he might use the remedy to
good purpose on the members of the community. Some of the monks in the
monastery were of rather frail health and delicate constitution, and
most of them were rather thin, and he thought that the putting on of a
little fat, provided it could be accomplished without infringement of
the rule, might be a good thing for them. Accordingly, he administered,
surreptitiously, some of the salts of antimony, with which he was
experimenting, in the food served to these monks. The result, however,
was not so favorable as in the case of the hogs. Indeed, according to
one, though less authentic, version of the story, some of the poor
monks, the unconscious subjects of the experiment, perished as the
result of the ingestion of the antimonial compounds. According to the
better version, they suffered only the usual unpleasant consequences of
taking antimony, which are, however, quite enough for a fitting climax
to the story. Basil Valentine called the new substance which he had
discovered antimony, that is, _opposed to monks_. It might be good for
hogs, but it was a form of monks' bane, as it were.[30]
Unfortunately for most of the good stories of history, modern criticism
has nearly always failed to find any authentic basis for them, and they
have had to go the way of the legends of Washington's hatchet and Tell's
apple. We are sorry to say that that seems to be true also of this
particular story. Antimony, the word, is very probably derived from
certain dialectic forms of the Greek word for the metal, and the name is
no more derived from _anti_ and _monachus_ than it is from _anti_ and
_monos_ (opposed to single existence), another fictitious derivation
that has been suggested, and one whose etymological value is supposed to
consist in the fact that antimony is practically never found alone in
nature.
Notwithstanding the apparent cloud of unfounded traditions that are
associated with his name, there can be no doubt at all of the fact that
Valentinus--to give him the Latin name by which he is commonly
designated in foreign literatures--was one of the great geniuses, who,
working in obscurity, make precious steps into the unknown that enable
humanity after them to see things more clearly than ever before. There
are definite historical grounds for placing Basil Valentine as the first
of the series of careful observers who differentiated chemistry from the
old alchemy and applied its precious treasures of information to the
uses of medicine. It is said to have been because of the study of Basil
Valentine's work that Paracelsus broke away from the Galenic traditions,
so supreme in medicine up to his time, and began our modern
pharmaceutics. Following Paracelsus came Van Helmont, the father of
modern medical chemistry, and these three did more than any others to
enlarge the scope of medication and to make observation rather than
authority the most important criterion of truth in medicine. Indeed, the
work of this trio of men of the fifteenth and sixteenth centuries--the
Renaissance in medicine as in art--dominated medical treatment, or at
least the department of pharmaceutics, down almost to our own day, and
their influence is still felt in drug-giving.
While we do not know the absolute data of either the birth or the death
of Basil Valentine and are not sure of the exact period even in which he
lived and did his work, we are sure that a great original observer about
the time of the invention of printing studied mercury and sulphur and
various salts of the metals, and above all introduced antimony to the
notice of the scientific world, and especially to the favor of
practitioners of medicine. His book, "The Triumphal Chariot of
Antimony," is full of conclusions not quite justified by his premises
nor by his observations. There is no doubt, however, that the
observational method which he employed furnished an immense amount of
knowledge, and formed the basis of the method of investigation by which
the chemical side of medicine was to develop during the next two or
three centuries. Great harm was done by the abuse of antimony, but then
great harm is done by the abuse of anything, no matter how good it may
be. For a time it came to be the most important drug in medicine and was
only replaced by venesection.
The fact of the matter is that doctors were looking for effects from
their drugs, and antimony is, above all things, effective. Patients,
too, wished to see the effect of the medicines they took. They do so
even yet, and when antimony was administered there was no doubt about
its working.
The most interesting of Basil Valentine's books, and the one which has
had the most enduring influence, is undoubtedly "The Triumphal Chariot
of Antimony."[31] It has been translated and has had a wide vogue in
every language of modern Europe. Its recommendation of antimony had such
an effect upon medical practice that it continued to be the most
important drug in the pharmacopoeia down almost to the middle of the
nineteenth century. If any proof were needed that Basil Valentine or
that the author of the books that go under the name was a monk it would
be found in the introduction to this volume, which not only states that
fact very clearly, but also in doing so makes use of language that shows
the writer to have been deeply imbued with the old monastic spirit. I
quote the first paragraph of this introduction because it emphasizes
this. The quotation is taken from the English translation of the work as
published in London in 1678. Curiously enough, seeing the obscurity
surrounding Valentine himself, we do not know for sure who made the
translation. The translator apologizes somewhat for the deeply religious
spirit of the book, but considers that he was not justified in
eliminating any of this. The paragraph is left in the quaint,
old-fashioned form so eminently suited to the thoughts of the old
master, and the spelling and use of capitals is not changed.
"Basil Valentine: His Triumphant Chariot of Antimony.--Since
I, Basil Valentine, by Religious Vows am bound to live
according to the order of St. Benedict and that requires
another manner of Spirit of Holiness than the common state of
Mortals exercised in the profane business of this World; I
thought it my duty before all things, in the beginning of this
little book, to declare what is necessary to be known by the
pious Spagyrist [old-time name for medical chemist], inflamed
with an ardent desire of this Art, as what he ought to do, and
whereunto to direct his striving, that he may lay such
foundations of the whole matter as may be stable; lest his
Building, shaken with the Winds, happen to fall, and the whole
Edifice to be involved in shameful Ruine which otherwise being
founded on more firm and solid principles, might have
continued for a long series of time. Which Admonition I judged
was, is and always will be a necessary part of my religious
Office; especially since we must all die, and no one of us
which are now, whether high or low, shall long be seen among
the number of men. For it concerns me to recommend these
Meditations of Mortality to Posterity, leaving them behind me,
not only that honor may be given to the Divine Majesty, but
also that men may obey him sincerely in all things.
"In this my meditation I found that there were five principal
heads, chiefly to be considered by the wise and prudent
spectators of our Wisdom and Art. The first of which is
Invocation of God. The second, Contemplation of Nature. The
third, True Preparation. The fourth, the Way of Using. The
fifth, Utility and Fruit. For he who regards not these, shall
never obtain place among true Chymists, or fill up the number
of perfect Spagyrists. Therefore, touching these five heads,
we shall here following treat and so far declare them, as that
the general Work may be brought to light and perfected by an
intent and studious Operator."
This book, though the title might seem to indicate it, is not devoted
entirely to the study of antimony, but contains many important additions
to the chemistry of the time. For instance, Basil Valentine explains in
this work how what he calls the spirit of salt might be obtained. He
succeeded in manufacturing this material by treating common salt with
oil of vitriol and heat. From the description of the uses to which he
put the end product of his chemical manipulation, it is evident that
under the name of spirit of salt he is describing what we now know as
hydrochloric acid. This is said to be the first definite mention of it
in the history of science, and the method suggested for its preparation
is not very different from that employed even at the present time. He
also suggests in his volume how alcohol may be obtained in high
strengths. He distilled the spirit obtained from wine over carbonate of
potassium, and thus succeeded in depriving it of a great proportion of
its water. We have said that he was deeply interested in the
philosopher's stone. Naturally this turned his attention to the study of
metals, and so it is not surprising to find that he succeeded in
formulating a method by which metallic copper could be obtained. The
material used for the purpose was copper pyrites, which was changed to
an impure sulphate of copper by the action of oil of vitriol and moist
air. The sulphate of copper occurred in solution, and the copper could
be precipitated from it by plunging an iron bar into it. Basil Valentine
recognized the presence of this peculiar yellow metal, and studied some
of its qualities. He does not seem to have been quite sure, however,
whether the phenomenon that he witnessed was not really a transmutation
of at least some of the iron into copper as a consequence of the other
chemicals present. There are some observations on chemical physiology,
and especially with regard to respiration, in the book on antimony which
show their author to have anticipated the true explanation of the theory
of respiration. He states that animals breathe because air is needed to
support their life, and that all the animals exhibit the phenomenon of
respiration. He even insists that the fishes, though living in water,
breathe air, and he adduces in support of this idea the fact that
whenever a river is entirely frozen the fishes die. The reason for this
being, according to this old-time physiological chemist, not that the
fishes are frozen to death, but that they are not able to obtain air in
the ice as they did in the water, and consequently perish.
There are many testimonials to the practical character of all his
knowledge and his desire to apply it for the benefit of humanity. The
old monk could not repress the expression of his impatience with
physicians who gave to patients for "diseases of which they knew little,
remedies of which they knew less." For him it was an unpardonable sin
for a physician not to have faithfully studied the various mixtures
that he prescribed for his patients, and not to know not only their
appearance and taste and effect, but also the limits of their
application. Considering that at the present time it is a frequent
source of complaint that physicians often prescribe remedies with even
whose physical appearance they are not familiar and whose composition is
often quite unknown to them, this complaint of the old-time chemist
alchemist will be all the more interesting for the modern physician. It
is evident that when Basil Valentine allows his ire to get the better of
him it is because of his indignation over the quacks who were abusing
medicine and patients in his time, as they have ever since. There is a
curious bit of aspersion on mere book learning in the passage that has a
distinctly modern ring, and one feels the truth of Russell Lowell's
expression that to read a classic, no matter how antique, is like
reading a commentary on the morning paper, so up-to-date does genius
ever remain:
"And whensoever I shall have occasion to contend in the School
with such a Doctor, who knows not how himself to prepare his
own medicines, but commits that business to another, I am sure
I shall obtain the Palm from him; For indeed that good man
knows not what medicines he prescribes to the sick; whether
the color of them be white, black, gray, or blew (_sic_), he
cannot tell; nor doth this wretched man know whether the
medicine he gives be dry or hot, cold or humid; but he only
knows that he found it so written in his books, and then
pretends to knowledge or as it were Possession by Prescription
of a very long time; yet he desires to further information.
Here again let it be lawful to exclaim, Good God, to what a
state is the matter brought! what Goodness of Minde is in
these men! what care do they take of the sick! Wo, wo to them!
in the day of Judgement they will find the fruit of their
Ignorance and Rashness, then they will see him whom they
pierced, when they neglected their Neighbor, sought after
money and nothing else; whereas were they cordial in their
profession, they would spend Nights and Days in Labour that
they might become more learned in their Art, whence more
certain health would accrew to the sick with their estimation
and greater glory to themselves. But since Labour is tedious
to them they commit the matter to chance, and being secure of
their Honour, and content with their Fame, they (like
Brawlers) defend themselves with a certain garrulity, without
any respect had to Confidence or Truth."
Perhaps one of the reasons why Valentine's book has been of such
enduring interest is that it is written in an eminently human vein and
out of a lively imagination. It is full of figures relating to many
other things besides chemistry, which serve to show how deeply this
investigating observer was attentive to all the problems of life around
him. For instance, when he wants to describe the affinity that exists
between many substances in chemistry, and which makes it impossible for
them not to be attracted to one another, he takes a figure from the
attractions that he sees exist among men and women. It is curious to
find affinities discussed in our modern sense so long ago. There are
some paragraphs with regard to the influence of the passion of love that
one might think rather a quotation from an old-time sermon than from a
great ground-breaking book in the science of chemistry.
"Love leaves nothing entire or sound in man; it impedes his
sleep, he cannot rest either day or night; it takes off his
appetite that he hath no disposition either to meat or drink
by reason of the continual torments of his heart and mind. It
deprives him of all Providence, hence he neglects his affairs,
vocation, and business. He minds neither study, labor, nor
prayer; casts away all thoughts of anything but the body
beloved; this is his study, this his most vain occupation. If
to lovers the success be not answerable to their wish, or so
soon and prosperously as they desire, how many melancholies
henceforth arise, with griefs and sadness, with which they
pine away and wax so lean as they have scarcely any flesh
cleaving to the bones. Yea, at last they lose the life itself,
as may be proved by many examples! for such men (which is an
horrible thing to think of) slight and neglect all perils and
detriments, both of the body and life, and of the soul and
eternal salvation."
It is evident that human nature is not different in our sophisticated
twentieth century from that which this observant old monk saw around him
in the fifteenth. He continues:
"How many testimonies of this violence which is in love, are
daily found? for it not only inflames the younger sort, but it
so far exaggerates some persons far gone in years as through
the burning heat thereof, they are almost mad. Natural
diseases are for the most part governed by the complexion of
man and therefore invade some more fiercely, others more
gently; but Love, without distinction of poor or rich, young
or old, seizeth all, and having seized so blinds them as
forgetting all rules of reason, they neither see nor hear any
snare."
But then the old monk thinks that he has said enough about this rather
foreign subject, and apologizes for his digression in another paragraph
that should remove any lingering doubt there might be with regard to the
genuineness of his monastic character. At the end of the passage he
makes the application in a very few words. The personal element in his
confession is so naïve and so simply straightforward that instead of
seeming to be the result of conceit, which would surely have repelled
the reader, it rather attracts and enhances his kindly feeling for its
author. The paragraph would remind one in certain ways of that personal
element that was to become more popular in literature after Montaigne in
the next century made it rather the fashion.
"But of these enough; for it becomes not a religious man to
insist too long upon these cogitations, or to give place to
such a flame in his heart. Hitherto (without boasting I speak
it) I have throughout the whole course of my life kept myself
safe and free from it, and I pray and invoke God to vouchsafe
me his Grace that I may keep holy and inviolate the faith
which I have sworn, and live contented with my spiritual
spouse, the Holy Catholick Church. For no other reason have I
alleged these than that I might express the love with which
all tinctures ought to be moved towards metals, if ever they
be admitted by them into true friendship, and by love, which
permeates the inmost parts, be converted into a better state."
The application of the figure at the end of his long digression is
characteristic of the period in which he wrote, as also to a
considerable extent of the German literary methods of the time.
In this volume on the use of antimony there are in most of the editions
certain biographical notes which have sometimes been accepted as
authentic, but oftener rejected. According to these, Basil Valentine was
born in a town in Alsace, on the southern bank of the Rhine. As a
consequence of this, there are several towns that have laid claim to
being his birthplace. M. Jean Reynaud, the distinguished French
philosophical writer of the first half of the nineteenth century, once
said that Basil Valentine, like Ossian and Homer, had many towns claim
him years after his death. He also suggested that, like those old poets,
it was possible that the writings sometimes attributed to Basil
Valentine were really the work not of one man, but of several
individuals. There are, however, many objections to this theory, the
most forcible of which is the internal evidence derived from the books
themselves showing similarities of style and method of treating subjects
too great for us to admit non-identity in the writers. M. Reynaud lived
at a time when it was all the fashion to suggest that old works that had
come down to us, like the Iliad and the Odyssey, and even such national
epics as the Cid and the Arthur Legends and the Nibelungenlied were to
be attributed to several writers rather than to one. We have passed that
period of criticism, however, and have reverted to the idea of single
authorship for these works, and the same conclusion has been generally
come to with regard to the writings attributed to Basil Valentine.
Other biographic details contained in "The Triumphal Chariot of
Antimony" are undoubtedly more correct. According to them Basil
Valentine travelled in England and Holland on missions for his order,
and went through France and Spain on a pilgrimage to St. James of
Compostella.
Besides this work, there is a number of other books of Basil
Valentine's, printed during the first half of the sixteenth century,
that are well known and copies of which may be found in most of the
important libraries. The United States Surgeon General's Library at
Washington contains not a few of the works on medical subjects, and the
New York Academy of Medicine Library has some valuable editions of
certain of his works. Some of his other well-known books, each of which
is a good-sized octavo volume, bear the following descriptive titles (I
give them in English, though as they are usually found, they are in
Latin, sixteenth-century translations of the original German): "The
World in Miniature: or, The Mystery of the World and of Human Medical
Science," published at Mayburg, 1609; "The Chemical Apocalypse: or, The
Manifestation of Artificial Chemical Compounds," published in Erfurt in
1624; "A Chemico-Philosophic Treatise Concerning Things Natural and
Preternatural, Especially Relating to the Metals and the Minerals,"
published at Frankfurt in 1676; "Haliography: or, The Science of Salts:
A Treatise on the Preparation, Use, and Chemical Properties of All the
Mineral, Animal, and Vegetable Salts," published at Bologna in 1644;
"The Twelve Keys of Philosophy," Leipsic, 1630. These are of interest to
the chemist and physicist rather than to the physician, and it is as a
Maker of Medicine that we are concerned with Valentine here.
The great attention aroused in Basil Valentine's work at the
Renaissance period can be best realized from the number of manuscript
copies and their wide distribution. His books were not all printed at
one place, but, on the contrary, in different portions of Europe. The
original edition of "The Triumphal Chariot of Antimony" was published in
Leipsic in the early part of the sixteenth century. The first editions
of the other books, however, appeared at places so distant from Leipsic
as Amsterdam and Bologna, while various cities of Germany, as Erfurt and
Frankfurt, claim the original editions of still other works. Many of the
manuscript copies still exist in various libraries in Europe; and while
there is no doubt that some unimportant additions to the supposed works
of Basil Valentine have come from the attribution to him of scientific
treatises of other German writers, the style and the method of the
principal works mentioned is entirely too similar not to have been the
fruit of a single mind and that possessed of a distinct investigating
genius, setting it far above any of its contemporaries in scientific
speculation and observation.
The most interesting feature of all of Basil Valentine's writings that
are extant is the distinctive tendency to make his observations of
special practical utility. His studies in antimony were made mainly with
the idea of showing how that substance might be used in medicine. He did
not neglect to point out other possible uses, however, and knew the
secret of the employment of antimony in order to give sharpness and
definition to the impression produced by metal types. It would seem as
though he was the first scientist who discussed this subject, and there
is even some question of whether printers and typefounders did not
derive their ideas in this matter from our chemist.
Interested though he was in the transmutation of metals, he never failed
to try to find and suggest some medicinal use for all of the substances
that he investigated. His was no greedy search for gold and no
cumulation of investigations with the idea of benefiting only himself.
Mankind was always in his mind, and perhaps there is no better
demonstration of his fulfilment of the character of the monk than this
constant solicitude to benefit others by every bit of investigation that
he carried out. For him, with medieval nobleness of spirit, "the first
part of every work must be the invocation of God, and the last, though
no less important than the first, must be the utility and fruit for
mankind that can be derived from it."
The career of the last of the Makers of Medicine in the Middle Ages may
be summed up briefly in a few sentences that show how thoroughly this
old Benedictine was possessed of the spirit of modern science. He
believed in observation as the most important source of medical
knowledge. He valued clinical experience far above book information. He
insisted on personal acquaintanceship on the part of the physician with
the drugs he used, and thought nothing more unworthy of a practitioner
of medicine,--indeed he sets it down as almost criminal--than to give
remedies of whose composition he was not well aware and whose effect he
did not thoroughly understand. He thought that nature was the most
important aid to the physician, much more important than drugs, though
he was the first to realize the significance of chemical affinities, and
he seems to have understood rather well how individual often were the
effects obtained from drugs. He was a patient student, a faithful
observer, a writer who did not begrudge time and care to the composition
of large books on medicine, yet withal he was no dry-as-dust scholar,
but eminently human in his sympathies with ailing humanity, and a
strenuous upholder of the dignity of the profession to which he
belonged. Scarcely more can be said of anyone in the history of
medicine, at least so far as good intentions go; though many
accomplished more, none deserve more honor than the Thuringian monk whom
we know as Basil Valentine.
There are many other of these old-time Makers of Medicine of whom nearly
the same thing can be said. Basil Valentine is only one of a number of
men who worked faithfully and did much both for medical science and
professional life during the thousand years from the fall of Rome to the
fall of Constantinople, when, according to what used to be commonly
accepted opinion, men were not animated by the spirit of research and of
fine incentive to do good to men that we are so likely to think of as
belonging exclusively to more modern times. A man whom he greatly
influenced, Paracelsus, took up the tradition of scientific
investigation where Basil Valentine had left it. His work, though more
successfully revolutionary, was not done in such a fine spirit of
sympathy with humanity nor with that simplicity of life and purity of
intention that characterized the old monk's work. Paracelsus' birth in
the year of the discovery of America places him among the makers of the
foundations of our modern medicine, and he will be treated of in a
volume on "The Forefathers in Medicine."
APPENDIX I
ST. LUKE THE PHYSICIAN[32]
In the midst of what has been called the "higher criticism" of the Bible
in recent times, one of the long accepted traditions that has been most
strenuously assailed and, indeed, in the minds of many scholars, seemed,
for a time at least, quite discredited, was that St. Luke the
Evangelist, the author of the Third Gospel and the Acts of the Apostles,
was a physician. Distinguished authorities in early Christian
apologetics have declared that the pillars of primitive Christian
history are the genuine Epistles of St. Paul, the writings of St. Luke,
and the history of Eusebius. It is quite easy to understand, then, that
the attack upon the authenticity of the writings usually assigned to St.
Luke, which in many minds seemed successful, has been considered of
great importance. In the very recent time there has been a decided
reaction in this matter. This has come, not so much from Roman
Catholics, who have always clung to the traditional view, and whose
great Biblical students have been foremost in the support of the
previously accepted opinion, but from some of the most strenuous of the
German higher critics, who now appreciate that destructive, so-called
higher criticism went too far, and that the traditional view not only
can be maintained, but is the only opinion that will adequately respond
to all the new facts that have been found, and all the recently gathered
information with regard to the relations of events in the olden time.
By far the most important contribution to the discussion in recent
years came not long since from the pen of Professor Adolph Harnack, the
professor of church history in the University of Berlin. Professor
Harnack's name is usually cited as that of one of the most destructive
of the higher critics. His recent book, however, "Luke the
Physician,"[33] is an entire submission to the old-fashioned viewpoint
that the writer of the Third Gospel and of the Acts of the Apostles was
a Greek fellow-worker of St. Paul, who had been in company for years
with Mark and Philip and James, and who had previously been a physician,
and was evidently well versed in all the medical lore of that time.
Harnack does not merely concede the old position. As might be expected,
his rediscussion of the subject clinches the arguments for the
traditional view, and makes it impossible ever to call it in question
again. It is easy to understand how important are such admissions when
we recall how much this traditional view has been assailed, and how
those who have held it have been accused of old-fogyism and lack of
scholarship, and unwarranted clinging to antiquated notions just because
they thought they were of faith, and how, lacking in true scholarship,
seriously hampering genuine investigation, such conservatism has been
declared to be.
The question of Luke's having been a physician is an extremely valuable
one, and no one in our time is better fitted by early training and long
years of study to elucidate it than Professor Harnack. He began his
excursions into historical writing years ago, as I understand, as an
historian of early Christian medicine. Some of his works on medical
conditions just before and after Christ are quoted confidently by the
distinguished German medical historians. From this department he
graduated into the field of the higher criticism. He is eminently in a
position, therefore, to state the case with regard to St. Luke fully,
and to indicate absolutely the conclusions that should be drawn from the
premises of fact, writings, and traditions that we have. He does so in a
very striking way. Perhaps no better example of his thoroughly lucid and
eminently logical mode of argumentation is to be found than the
paragraph in which he states the question. It might well be recommended
as an example of terse forcefulness and logical sequence that deserves
the emulation of all those who want to write on medical subjects. If we
had more of these characteristic qualities of Harnack's style, our
medical literature, so called, would not need to occupy so many pages of
print as it does--yet would say more. Here it is:
St. Luke, according to St. Paul, was a physician. When a
physician writes a historical work it does not necessarily
follow that his profession shows itself in his writing; yet it
is only natural for one to look for traces of the author's
medical profession in such a work. These traces may be of
different kinds: 1, The whole character of the narrative may
be determined by points of view, aims, and ideals which are
more or less medical (disease and its treatment); 2, marked
preference may be shown for stories concerning the healing of
diseases, which stories may be given in great number and
detail; 3, the language may be colored by the language of
physicians (medical technical terms, metaphors of medical
character, etc.). All these three groups of characteristic
signs are found, as we shall see, in the historical work which
bears the name of St. Luke. Here, however, it may be objected
that the subject matter itself is responsible for these
traits, so that their evidence is not decisive for the medical
calling of the author. Jesus appeared as a great physician and
healer. All the evangelists say this of Him; hence it is not
surprising that one of them has set this phase of His ministry
in the foreground, and has regarded it as the most important.
Our evangelist need not therefore have been a physician,
especially if he were a Greek, seeing that in those days
Greeks with religious interests were disposed to regard
religion mainly under the category of healing and salvation.
This is true, yet such a combination of characteristic signs
will compel us to believe that the author was a physician if,
4, the description of the particular cases of disease shows
distinct traces of medical diagnosis and scientific knowledge;
5, if the language, even where questions of medicine or of
healing are not touched upon, is colored by medical
phraseology; and, 6, if in those passages where the author
speaks as an eye-witness medical traits are especially and
prominently apparent. These three kinds of tokens are also
found in the historical work of our author. It is accordingly
proved that it proceeds from the pen of a physician.
The importance of the concession that Luke was a physician should be
properly appreciated. His whole gospel is written from that standpoint.
For him the Saviour was the healer, the good physician who went about
curing the ills of the body, while ministering to people's souls. He has
more accounts of miracles of healing than any of the other Evangelists.
He has taken certain of the stories of the other Evangelists who were
eye-witnesses, and when they were told in naïve and popular language
that obscured the real condition that was present, he has retold the
story from the physician's standpoint, and thus the miracle becomes
clearer than ever. In one case, where Mark has a slur on physicians,
Luke eliminates it. In a number of cases the correction of Mark's
popular language in the description of ailments is made in terms that
could not have been used except by one thoroughly versed in the Greek
medical terminology of the times. As a matter of fact, there seems to be
no doubt now that Luke had been, before he became an Evangelist, a
practising physician in Malta of considerable experience. His testimony,
then, to the miracles is particularly valuable as almost a medical
eye-witness.
In medical science, St. Luke's time was by no means barren of knowledge.
The Alexandrian school of medicine had done some fine work in its time.
It was the first university medical school in the world's history, and
there dissection was first practised regularly and publicly for the sake
of anatomy, and even the vivisection of criminals who were supplied by
the Ptolemei for human physiology, was a part of the school curriculum.
A number of important discoveries in brain anatomy are attributed to
Herophilus, after whom the torcular herophili within the skull is named,
and who invented the term calamus scriptorius for certain appearances
in the fourth ventricle. His colleague, Erasistratus, the co-founder of
this school at Alexandria, did work in pathological anatomy, and laid
the foundation for serious study there. For three centuries there is
some good worker, at or in connection with Alexandria, whose name is
preserved for us in the history of medicine. Other Greek schools of
medicine in the East, as, for instance, that of Pergamos, also did
excellent work. Galen is the great representative of this school, and he
came in the century after St. Luke. A physician educated in Greek
medicine at that time, then, would be in an excellent position to judge
critically of the miracles of healing of the Christ, and it would seem
to have been providential that Luke was called for this purpose.
The evidence for his membership of our profession will doubtless be
interesting to all physicians. Some of the distinctive passages in which
Luke's familiarity with medical terms to such an extent that to express
his meaning he found himself compelled to use them, will appeal at once
to these, for whom such terms are part of everyday speech. The use of
the word _hydropikos_, which is not to be met with anywhere else in the
New Testament, nor in the non-medical Greek literature of that time,
though the word is of frequent occurrence as a designation for a person
suffering from dropsy (and always, as in Luke, the adjective for the
substantive), in Hippocrates, Dioscorides, and Galen is a typical
example.
Where such vague terms as paralyzed occur Luke does not use the familiar
word, but the medical term that meant stricken with paralysis,
indicating not any inability to use the limbs, but such a one as was due
to a stroke of apoplexy. We who, as physicians, have heard of so many
cures of paralysis from our friends, the Eddyites, are prone to ask, as
the first question, what sort of a paralysis it was. Luke made inquiries
from men who were eye-witnesses, and then has described the scene with
such details as convinced him as a physician of the reality of the
miracle, and his description was meant to carry conviction to the minds
of others.
Occasionally St. Luke uses words which only a physician would be likely
to know at all. That is to say, even a man reasonably familiar with
medical terminology and medical literature would not be likely to know
them unless he had been technically trained. One of these is the word
_sphudron_, a word which is only medical, and is not to be found even in
such large Greek lexicons of ordinary words as that of Passow. Sphudron
is the anatomical term of the Græco-Alexandrian school for the condyles
of the femur. Galen and other medical authors use it, and Luke, in
giving the details of the story of the lame man cured, in the third
chapter of the Acts, seventh verse, selects it because it exactly
expresses the meaning he wished to convey. In this story there are a
number of added medical details. These are all evidently arranged so as
to give the full medical significance to the miracle. For instance, the
man had been _lame from birth_, literally _from the womb of his mother_.
At this time he was forty years of age, an age at which the spontaneous
cure of such an ailment or, indeed, any cure of it, could scarcely be
expected, if, during the preceding time, there had been no improvement.
In the story of the cure of Saul's blindness Luke says in the Acts that
his blindness fell from him like scales. The figure is a typically
medical one. The word for fall that is used is, as was pointed out by
Hobart ("Medical Language of St. Luke," Dublin, 1882), exactly the term
that is used for the falling of scales from the body. The term for
scales is the specific designation of the particles that fall from the
body during certain skin diseases or after certain of the infectious
fevers, as in scarlet fever. Hippocrates and Galen have used it in many
places. It is distinctively a medical word. In the story of the vision
of St. Peter, told also in the Acts, the word _ecstasis_, from which we
derive our word ecstasy, is used. This is the only word St. Luke uses
for vision and he alone uses it. This term is of constant employment in
a technical sense in the medical writers of St. Luke's time and before
it. When the other evangelists talk of lame people they use the popular
term. This might mean anything or nothing for a physician. Luke uses one
of the terms that is employed by physicians when they wish to indicate
that for some definite reason there is inability to walk.
In the story of the Good Samaritan there are some interesting details
that indicate medical interest on the part of the writer. It is Luke's
characteristic story and a typical medical instance. He employs certain
words in it that are used only by medical writers. The use of oil and
wine in the treatment of the wounds of the stranger traveller was at one
time said to indicate that it could not have been a physician who wrote
the story, since the ancients used oil for external applications in such
cases but not wine. More careful search of the old masters of medicine,
however, has shown that they used oil and wine not only internally but
externally. Hippocrates, for instance, has a number of recommendations
of this combination for wounds. It is rather interesting to realize
this, and especially the wine in addition to the oil, because wine
contains enough alcohol to be rather satisfactorily antiseptic. There
seems no doubt that wounds that had been bathed in wine and then had oil
poured over them would be likely to do better than those which were
treated in other ways. The wine would cleanse and at least inhibit
bacterial growth. The subsequent covering with oil would serve to
protect the wound to some degree from external contamination.
Sometimes there is an application of medical terms to something
extraneous from medicine that makes the phrase employed quite amusing.
For instance, when Luke wants to explain how they strengthened the
vessel in which they were to sail he describes the process by the term
which was used in medical Greek to mean the splinting of a part or at
least the binding of it up in such a way as to enable it to be used. The
word was quite a puzzle to the commentators until it was pointed out
that it was the familiar medical term, and then it was easy to
understand. Occasionally this use of a medical term gives a strikingly
accurate significance to Luke's diction. For instance, where other
evangelists talk of the Lord looking at a patient or turning to them,
Luke uses the expression that was technically employed for a physician's
examination of his patient, as if the Lord carefully looked over the
ailing people to see their physical needs, and then proceeded to cure
them. Manifestly in Luke's mind the most interesting phase of the Lord's
life was His exhibition of curative powers, and the Saviour was for him
the divine healer, the God physician of bodies as well as of souls.
There are many little incidents which he relates that emphasize this.
For instance, where St. Mark talks about the healing of the man with a
withered hand, St. Luke adds the characteristic medical note that it was
the right hand. When he tells of the cutting off of the ear of the
servant of the high priest in the Garden of Olives St. Luke takes the
story from St. Mark, but adds the information that would appeal to a
physician that it was the right ear. Moreover, though all four
evangelists record the cutting off of the ear, only St. Luke adds the
information that the Lord healed it again. It is as if he were defending
the kindly feelings of the Divine Physician and as if it would have been
inexcusable had He not exerted His miraculous powers of healing on this
occasion. It is St. Luke, too, who has constantly distinguished between
natural illnesses and cases of possession. This careful distinction
alone would point to the author of the third gospel and the Acts as
surely a physician. As it is it confirms beyond all doubt the claim that
the writer of these portions of the New Testament was a physician
thoroughly familiar with all the medical writings of the time and
probably a physician who had practised for a long time.
Certain miracles of healing are related only by St. Luke as if he
realized better than any of the other evangelists the evidential value
that such instances would have for future generations as to the divinity
of the personage who worked them. The beautiful story of the raising
from death of the son of the widow of Nain is probably one of the
oftenest quoted passages from St. Luke. It is a charming bit of
literature. While it suggests the writer physician it makes one almost
sure that the other tradition according to which St. Luke was also a
painter must be true. The scene is as picturesque as it can be. The Lord
and His Apostles and the multitudes coming to the gate of the little
city just as in the evening sun the funeral cortège with the widow
burying her only son came out of it. The approach of the Lord to the
weeping mother, His command to the dead son to arise, and the simple
words, "and he gave him back to his mother," constitute as charming a
scene as a painter ever tried to visualize. Besides this, Luke alone has
the story of the man suffering with dropsy and the woman suffering from
weakness. The intensely picturesque quality of many of these scenes that
he describes so vividly would indeed seem to place beyond all doubt the
old tradition that he was an artist as well as a physician.
It is interesting to realize that it is to Luke alone that we owe the
account of the well-known message sent by Christ Himself to John the
Baptist when John sent his disciples to inquire as to His mission. After
describing His ministry He said: "Go and relate to John what you have
heard and seen: the blind see, the lame walk, the deaf hear, the lepers
are made clean, the dead rise again, to the poor the Gospel is
preached." To no one more than to a physician would that description of
His mission appeal as surely divine.
To those who care to follow the subject still further, and above all, to
read opinions given before the reversal of the verdict of the higher
criticism on the Lucan writings, indeed before ever that trial was
brought, there is much in "Horæ Lucanæ--A Biography of St. Luke," by
Henry Samuel Baynes (Longmans, 1870), that will surely be of interest.
He has some interesting quotations which show how thoroughly previous
centuries realized all the force of modern arguments. For instance, the
following paragraph from Dr. Nathaniel Robinson, a Scotch physician of
the eighteenth century, will illustrate this. Dr. Robinson said:
It is manifest from his Gospel, that Luke was both an acute
observer, and had even given professional attention to all our
Saviour's miracles of healing. Originally, among the
Egyptians, divinity and physic were united in the same order
of men, so that the priest had the care of souls, and was also
the physician. It was much the same under the Jewish economy.
But after physic came to be studied by the Greeks, they
separated the two professions. That a physician should write
the history of our Saviour's life was appropriate, as there
were divers mysterious things to be noticed, concerning which
his education enabled him to form a becoming judgment.
It is even interesting to realize that St. Luke's tendency to use
medical terms has been of definite value in determining the question
whether both the third gospel and the Acts of the Apostles are by the
same man. They have been attributed to St. Luke traditionally, but in
the higher criticism some doubt has been thrown on this and an elaborate
hypothesis of dual authorship set up. It has been asserted that it is
very improbable on extrinsic grounds that they were both written by one
hand and certain intrinsic evidence, changes in the mode of narration,
especially the use of the first personal pronoun in the plural in
certain passages, has been pointed to as making against single
authorship. This tendency to deny old-time traditions of authorship with
regard to many classical writings was a marked characteristic of the
early part of the nineteenth century, but the close of the century saw
practically all of these denials discredited. The nineteenth century
ushered in studies of Homer, with the separatist school perfectly
confident in their assertion that the Iliad and the Odyssey were not by
the same person, and even that the Iliad itself was the work of several
hands.
At the beginning of the twentieth century we are quite as sure that both
the Iliad and Odyssey were written by the same person and that the
separatists were hurried into a contrary decision not a little by the
feeling of the sensation that such a contradiction of previously
accepted ideas would create. This is a determining factor in many a
supposed novel discovery, that it is hard always to discount
sufficiently. A thing may be right even though it is old, and most new
discoveries, it must not be forgotten, that is, most of those announced
with a great blare of trumpets, do not maintain themselves. The simple
argument that the separatists would have to find another poet equal to
Homer to write the other poem has done more than anything else to bring
their opinion into disrepute. It is much easier to explain certain
discrepancies, differences of style, and of treatment of subjects, as
well as other minor variants, than to supply another great poet. Most of
the works of our older literatures have gone through a similar trial
during the over-hasty superficially critical nineteenth century. The
Nibelungenlied has been attributed to two or three writers instead of
one. The Cid, the national epic of Spain, and the Arthur Legends, the
first British epic, have been at least supposed to be amenable to the
same sort of criticism. In every case, scholars have gone back to the
older traditional view of a single author. The phases of literary and
historic criticism with regard to Luke's writings are, then, only a
repetition of what all our great national classics have gone through
from supercilious scholarship during the past hundred years.
It is not surprising, then, that there should be dual or even triple
ascriptions of authorship for various portions of the Scriptures, and
Luke's writings have on this score suffered as much or more even than
others, with the possible exception of Moses. It is now definitely
settled, however, that the similarities of style between the Acts and
the third gospel are too great for them to have come from two different
minds. This is especially true, as pointed out by Harnack, in all that
regards the use of medical terms. The writer of the Acts and the writer
of the third gospel knew Greek from the standpoint of the physician of
that time. Each used terms that we find nowhere else in Greek literature
except among medical writers. What is thus true for one critical attack
on Luke's reputation is also true in another phase of recent higher
criticism. It has been said that certain portions of the Acts which are
called the "we" portions because the narration changes in them from the
third to the first person were to be attributed to another writer than
the one who wrote the narrative portions. Here, once more, the test of
the medical words employed has decided the case for Luke's sole
authorship. It is evidently an excellent thing to be able to use medical
terms properly if one wants to be recognized with certainty later on in
history for just what one's business was. It has certainly saved the
situation for St. Luke, though there may be some doubt as to the real
force of objections thus easily overthrown.
It is rather interesting to realize that many scholars of the present
generation had allowed themselves to be led away by the German higher
criticism from the old tradition with regard to Luke as a physician and
now will doubtless be led back to former views by the leader of German
biblical critics. It shows how much more distant things may influence
certain people than those nearer home--how the hills are green far away.
Harnack confesses that the best book ever written on the subject of Luke
as a physician, the one that has proved of most value to him, and that
he still recommends everyone to read, was originally written in English.
It is Hobart's "Medical Language of St. Luke,"[34] written more than a
quarter of a century before Harnack. The Germans generally had rather
despised what the English were doing in the matter of biblical
criticism, and above all in philology. Yet now the acknowledged
coryphæus of them all, Harnack, not only admits the superiority of an
old-time English book, but confesses that it is the best statement of
the subject up to the present time, including his own. He constantly
quotes from it, and it is evident that it has been the foundation of all
of his arguments. It is not the first time that men have fetched from
afar what they might have got just as well or better at home.
Harnack has made complete the demonstration, then, that the third
gospel and the Acts were written by St. Luke, who had been a practising
physician. In spite of this, however, he finds many objections to the
Luke narratives and considers that they add very little that is valuable
to the contemporary evidence that we have with regard to Christ. He
impairs with one hand the value of what he has so lavishly yielded with
the other. He finds inconsistencies and discrepancies in the narrative
that for him destroy their value as testimony. A lawyer would probably
say that this is that very human element in the writings which
demonstrates their authenticity and adds to their value as evidence,
because it shows clearly the lack of any attempt to do anything more
than tell a direct story as it had come to the narrator. No special
effort was made to avoid critical objections founded on details. It was
the general impression that was looked for.
Sir William Ramsay, in his "Luke the Physician and Other Studies in the
History of Religion" (New York: Armstrong and Sons, 1908), has answered
Harnack from the side of the professional critic with much force. He
appreciates thoroughly the value of Professor Harnack's book, and above
all the reactionary tendency away from nihilistic so-called higher
criticism which characterized so much of German writing on biblical
themes in the nineteenth century. He says (p. 7): "This [book of
Harnack's] alone carries Lukan criticism a long step forwards, and sets
it on a new and higher plane. Never has the unity and character of the
book been demonstrated so convincingly and conclusively. The step is
made and the plane is reached by the method which is practised in other
departments of literary criticism, viz., by dispassionate investigation
of the work and by discarding fashionable _a priori_ theories."
The distinguished English traveller and writer on biblical subjects
points out, however, that in detail many of Harnack's objections to the
Lukan narratives are due to insufficient consideration of the
circumstances in which they were written and the comparative
significance of the details criticised. He says, "Harnack lays much
stress on the fact that inconsistencies and inexactnesses occur all
through Acts. Some of these are undeniable; and I have argued that they
are to be regarded in the same light as similar phenomena in the poem of
Lucretius and in other ancient classical writers, viz., as proofs that
the work never received the final form which Luke intended to give it,
but was still incomplete when he died. The evident need for a third book
to complete the work, together with those blemishes in expression, form
the proof."
Ramsay's placing of Harnack's writing in general is interesting in this
connection. (P. 8) "Professor Harnack stands on the border between the
nineteenth and twentieth century. His book shows that he is to a certain
degree sensitive of and obedient to the new spirit; but he is only
partially so. The nineteenth century critical method was false, and is
already antiquated....
"The first century could find nothing real and true that was not
accompanied by the marvellous and the 'supernatural.' The nineteenth
century could find nothing real and true that was. Which view was right
and which was wrong? Was either complete? Of these two questions, the
second alone is profitable at the present. Both views were right--in a
certain way of contemplating; both views were wrong--in a certain way.
Neither was complete. At present, as we are struggling to throw off the
fetters which impeded thought in the nineteenth century, it is most
important to free ourselves from its prejudices and narrowness."
He adds (pp. 26 and 27): "There are clear signs of the unfinished state
in which this chapter was left by Luke; but some of the German scholar's
criticisms show that he has not a right idea of the simplicity of life
and equipment that evidently characterized the jailer's house and the
prison. The details which he blames as inexact and inconsistent are
sometimes most instructive about the circumstances of this provincial
town and Roman colonia.
"But it is never safe to lay much stress on small points of inexactness
or inconsistency in any author. One finds such faults even in the works
of modern scholarship if one examines them in the microscopic fashion in
which Luke is studied here. I think I can find them in the author
[Harnack] himself. His point of view sometimes varies in a puzzling
way."
As a matter of fact, Harnack, as pointed out by Ramsay, was evidently
working himself more and more out of the old conclusion as to the lack
of authenticity of the Lucan writings into an opinion ever more and more
favorable to Luke. For instance, in a notice of his own book, published
in the _Theologische Literaturzeitung_, "he speaks far more favorably
about the trustworthiness and credibility of Luke, as being generally in
a position to acquire and transmit reliable information, and as having
proved himself able to take advantage of his position. Harnack was
gradually working his way to a new plane of thought. His later opinion
is more favorable."
Ramsay also points out that Professor Giffert, one of our American
biblical critics, had felt compelled by the geographical and historical
evidence to abandon in part the older unfavorable criticism of Luke and
to admit that the Acts is more trustworthy than previous critics
allowed. Above all, "he saw that it was a living piece of literature
written by one author." In a word, Luke is being vindicated in every
regard.
Some of the supposed inaccuracies of Luke vanish when careful
investigation is made. Some of his natural history details, for
instance, have been impugned and the story of the viper that "fastened"
itself upon St. Paul in Malta has been cited as an example of a story
that would not have been told in that way by a man who knew medicine and
the related sciences in Luke's time. Because the passage illustrates a
number of phases of the discussion with regard to Luke's language I make
a rather long quotation from Ramsay:
Take as a specimen with which to finish off this paper the
passage Acts xxviii, 9 _et seq._, which is very fully
discussed by Harnack twice. He argues that the true meaning of
the passage was not understood until medical language was
compared, when it was shown that the Greek word by which the
act of the viper to Paul's hand is described, implies "bit"
and not merely "fastened upon." But it is a well-assured fact
that the viper, a poisonous snake, only strikes, fixes the
poison fangs on the flesh for a moment, and withdraws its head
instantly. Its action could never be what is attributed by
Luke the eye witness to this Maltese viper; that it hung from
Paul's hand and was shaken off into the fire by him. On the
other hand, constrictors, which have no poison fangs, cling in
the way described, but as a rule do not bite. Are we, then, to
understand in spite of the medical style and the authority of
Professor Blass (who translates "momordit" in his edition),
that the viper fastened upon the apostle's hand? Then, the
very name viper is a difficulty. Was Luke mistaken about the
kind of snake which he saw? A trained medical man in ancient
times was usually a good authority about serpents, to which
great respect was paid in ancient medicine and custom.
Mere verbal study is here utterly at fault. We can make no
progress without turning to the realities and facts of Maltese
natural history. A correspondent obligingly informed me some
years ago that Mr. Bryan Hook, of Farnham, Surrey (who, my
correspondent assures me, is a thoroughly good naturalist),
had found in Malta a small snake, _Coronella austriaca_, which
is rare in England, but common in many parts of Europe. It is
a constrictor, without poison fangs, which would cling to the
hand or arm as Luke describes. It is similar in size to the
viper, and so like in markings and general appearance that Mr.
Hook, when he caught his specimen, thought he was killing a
viper.
My friend, Prof. J.W.H. Trail, of Aberdeen, whom I consulted,
replied that _Coronella lævis_ or _austriaca_, is known in
Sicily and the adjoining islands; but he can find no evidence
of its existence in Malta. It is known to be rather irritable,
and to fix its small teeth so firmly into the human skin as to
need a little force to pull it off, though the teeth are too
short to do any real injury to the skin. Coronella is at a
glance very much like a viper; and in the flames it would not
be closely examined. While it is not reported as found in
Malta except by Mr. Hook, two species are known there
belonging to the same family and having similar habits
(_leopardinus_ and _zamenis_ (or _coluber_) _gemonensis_). The
coloring of _Coronella leopardinus_ would be the most likely
to suggest a viper.
The observations justify Luke entirely. We have here a snake
so closely resembling a viper as to be taken for one by a good
naturalist until he had caught and examined a specimen. It
clings, and yet it also bites without doing harm. That the
Maltese rustics should mistake this harmless snake for a
venomous one is not strange. Many uneducated people have the
idea that all snakes are poisonous in varying degrees, just as
the vulgar often firmly believe that toads are poisonous.
Every detail as related by Luke is natural, and in accordance
with the facts of the country.
In a word, then, the whole question as to Luke's authority as a writer,
as an eye-witness of many things, and as the relator of many others with
regard to which he had obtained the testimony of eye-witnesses is fully
vindicated. Twenty years ago many scholars were prone to doubt this
whole question. Ten years ago most of them were convinced that the Luke
traditions were not justified by recent investigation. Now we have come
back once more to the complete acceptance of the old traditions.
Perhaps the most unfortunate characteristic of much nineteenth-century
criticism in all departments, even those strictly scientific, was the
marked tendency to reject previous opinions for new ones. Somehow men
felt themselves so far ahead of old-time writers and thinkers that they
concluded they must hold opinions different from their ancestors. In
nearly every case the new ideas that they evolved by supposedly newer
methods are not standing the test of time and further study. There had
been a continuous belief in men's minds, having its basis very probably
on a passage in one of St. Peter's Epistles, that the earth would
dissolve by fire. This was openly contradicted all during the nineteenth
century and the time when the earth would freeze up definitely
calculated by our mathematicians. Now after having studied
radioactivity and learned from the physicist that the earth is heating
up and will eventually get too hot for life, we calmly go back to the
old Petrine declaration. Some of the most distinguished of the German
biologists of the present day, such men as Driesch and others, calmly
tell us that the edifice erected by Darwin will have to come down
because of newly discovered evidence, and indeed some of them go so far
as to declare that Darwinism was a crude hypothesis very superficial in
its philosophical aspects and therefore acceptable to a great many
people who, because it was easy to understand and was very different
from what our fathers had believed, hastened to accept it. Nothing shows
the necessity for being conservative in the matter of new views in
science or ethics or religion more than the curious transition state in
which we are with regard to many opinions at the present time, with a
distinct tendency toward reaction to older views that a few years ago
were thought quite untenable. We are rather proud of the advance that we
are supposed to be making along many lines in science and scholarship,
and yet over and over again, after years of work, we prove to have been
following a wrong lead and must come back to where we started. This has
been the way of man from the beginning and doubtless will continue. The
present generation are having this curious regression that follows
supposed progress strongly emphasized for them.
APPENDIX II
SCIENCE AT THE MEDIEVAL UNIVERSITIES[35]
With the growth of interest in science and in nature study in our own
day, one of the expressions that is probably oftenest heard is surprise
that the men of preceding generations and especially university men did
not occupy themselves more with the world around them and with the
phenomena that are so tempting to curiosity. Science is usually supposed
to be comparatively new and nature study only a few generations old. Men
are supposed to have been so much interested in book knowledge and in
speculations and theories of many kinds, that they neglected the
realities of life around them while spinning fine webs of theory.
Previous generations, of course, have indulged in theory, but then our
own generation is not entirely free from that amusing occupation.
Nothing could well be less true, however, than that the men of preceding
generations were not interested in science even in the sense of physical
science, or that nature study is new, or that men were not curious and
did not try to find out all they could about the phenomena of the world
around them.
The medieval universities and the school-men who taught in them have
been particularly blamed for their failure to occupy themselves with
realities instead of with speculation. We are coming to recognize their
wonderful zeal for education, the large numbers of students they
attracted, the enthusiasm of their students, since they made so many
handwritten copies of the books of their masters, the devotion of the
teachers themselves, who wrote at much greater length than do our
professors even now and on the most abstruse subjects, so that it is all
the more surprising to think they should have neglected science. The
thought of our generation in the matter, however, is founded entirely on
an assumption. Those who know anything about the writers of the Middle
Ages at first hand are not likely to think of them as neglectful of
science even in our sense of the term. Those who know them at second
hand are, however, very sure in the matter.
The assumption is due to the neglect of history that came in the
seventeenth and eighteenth centuries. We have many other similar
assumptions because of the neglect of many phases of mental development
and applied science at this time. For instance, most of us are very
proud of our modern hospital development and think of this as a great
humanitarian evolution of applied medical science. We are very likely to
think that this is the first time in the world's history that the
building of hospitals has been brought to such a climax of development,
and that the houses for the ailing in the olden time were mere refuges,
prone to become death traps and at most makeshifts for the solution of
the problem of the care of the ailing poor. This is true for the
hospitals of the seventeenth and eighteenth centuries, but it is not
true at all for the hospitals of the thirteenth and fourteenth and
fifteenth centuries. Miss Nutting and Miss Dock in their "History of
Nursing"[36] have called attention to the fact that the lowest period in
hospital development is during the eighteenth and early nineteenth
centuries. Hospitals were little better than prisons, they had narrow
windows, were ill provided with light and air and hygienic arrangements,
and in general were all that we should imagine old-time hospitals to be.
The hospitals of the earlier time, however, had fine high ceilings,
large windows, abundant light and air, excellent arrangements for the
privacy of patients, and in general were as worthy of the architects of
the earlier times as the municipal buildings, the cathedrals, the
castles, the university buildings, and every other form of construction
that the late medieval centuries devoted themselves to.
The trouble with those who assume that there was no study of science and
practically no attention to nature study in the Middle Ages is that they
know nothing at all at first hand about the works of the men who wrote
in the medieval period. They have accepted declarations with regard to
the absolute dependence of the scholastics on authority, their almost
divine worship of Aristotle, their utter readiness to accept
authoritative assertions provided they came with the stamp of a mighty
name, and then their complete lack of attention to observation and above
all to experiment. Nothing could well be more ridiculous than this
ignorant assumption of knowledge with regard to the great teachers at
the medieval universities. Just as soon as there is definite knowledge
of what these great teachers wrote and taught, not only does the
previous mood of blame for them for not paying much more attention to
science and nature at once disappear, but it gives place to the
heartiest admiration for the work of these great thinkers. It is easy to
appreciate, then, what Professor Saintsbury said in a recent volume on
the thirteenth century:
And there have even been in these latter days some graceless
ones who have asked whether the science of the nineteenth
century after an equal interval will be of any more positive
value--whether it will not have even less comparative interest
than that which appertains to the scholasticism of the
thirteenth.
Three men were the great teachers in the medieval universities at their
prime. They have been read and studied with interest ever since. They
wrote huge tomes, but men have pored over them in every generation. They
were Albertus Magnus, the teacher of the other two, Thomas Aquinas and
Roger Bacon. All three of them were together at the University of Paris
shortly after the middle of the thirteenth century. Anyone who wants to
know anything about the attitude of mind of the medieval universities,
their professors and students, and of all the intellectual world of the
time towards science and observation and experiment, should read the
books of these men. Any other mode of getting at any knowledge of the
real significance of the science of this time is mere pretence. These
constitute the documents behind any scientific history of the
development of science at this time.
It is extremely interesting to see the attitude of these men with regard
to authority. In Albert's tenth book (of his "Summa"), in which he
catalogues and describes all the trees, plants, and herbs known in his
time, he observes: "All that is here set down is the result of our own
experience, or has been borrowed from authors whom we know to have
written what their personal experience has confirmed; for in these
matters experience alone can be of certainty." In his impressive Latin
phrase "_experimentum solum certificat in talibus_." With regard to the
study of nature in general he was quite as emphatic. He was a theologian
as well as a scientist, yet in his treatise on "The Heavens and the
Earth" he declared that "in studying nature we have not to inquire how
God the Creator may, as He freely wills, use His creatures to work
miracles and thereby show forth His power. We have rather to inquire
what nature with its immanent causes can naturally bring to pass."[37]
Just as striking quotations on this subject might be made from Roger
Bacon. Indeed, Bacon was quite impatient with the scholars around him
who talked over-much, did not observe enough, depended to excess on
authority, and in general did as mediocre scholars always do, made much
fuss on second-hand information--plus some filmy speculations of their
own. Friar Bacon, however, had one great pupil whose work he thoroughly
appreciated because it exhibited the opposite qualities. This was
Petrus--we have come to know him as Peregrinus--whose observations on
magnetism have excited so much attention in recent years with the
republications of his epistle on the subject. It is really a monograph
on magnetism written in the thirteenth century. Roger Bacon's opinion of
it and of its author furnishes us the best possible index of his
attitude of mind towards observation and experiment in science.
I know of only one person who deserves praise for his work in
experimental philosophy for he does not care for the
discourses of men and their wordy warfare, but quietly and
diligently pursues the works of wisdom. Therefore what others
grope after blindly, as bats in the evening twilight, this man
contemplates in their brilliancy _because he is a master of
experiment_. Hence, he knows all of natural science whether
pertaining to medicine and alchemy, or to matters celestial or
terrestrial. He has worked diligently in the smelting of ores
as also in the working of minerals; he is thoroughly
acquainted with all sorts of arms and implements used in
military service and in hunting, besides which he is skilled
in agriculture and in the measurement of lands. It is
impossible to write a useful or correct treatise in
experimental philosophy without mentioning this man's name.
Moreover, he pursues knowledge for its own sake; for if he
wished to obtain royal favor, he could easily find sovereigns
who would honor and enrich him.
Similar expressions might readily be quoted from Thomas Aquinas, but his
works are so easy to secure and his whole attitude of mind so well
known, that it scarcely seems worth while taking space to do so. Aquinas
is still studied very faithfully in many universities, and within the
last few years one of his great text-books of philosophy has been
replaced in the curriculum of Oxford University, in which it occupied a
prominent position in the long ago, as a work that may be offered for
examination in the department of philosophy. It is with regard to him
particularly that there has been the greatest revulsion of feeling in
recent years and a recognition of the fact that here was a great thinker
familiar with all that was known in the physical sciences, and who had
this knowledge constantly in his mind when he drew his conclusions with
regard to philosophical and theological questions.
It used to be the fashion to make little of the medieval scholars for
the high estimation in which they held Aristotle. Occasionally even yet
one hears narrowly educated men, I am sorry to say much more frequently
scientific specialists than others, talk deprecatingly of this ardent
devotion to Aristotle. No one who knows anything about Aristotle ever
indulges in such an exhibition of ignorance of the realities of the
history of philosophy and science. To know Aristotle well is to think of
him as probably possessed of the greatest human mind that ever existed.
We do not need to go back to the Middle Ages to be confirmed in that
opinion. Modern scientists who know their science well, but who also
know Aristotle well, and who are ardent worshippers at his shrine, are
not hard to find. Romanes, the great English biologist of the end of the
nineteenth century, said: "It appears to me that there can be no
question that Aristotle stands forth not only as the greatest figure in
antiquity but as the greatest intellect that has ever appeared upon this
earth."
Before Romanes, George H. Lewes, in his interesting monograph in the
history of thought, "Aristotle, a Chapter in the History of Science," is
quite as complimentary to the great Greek thinker. We may say that Lewes
was by no means partial to Aristotle. Anything but inclined to accept
authority as of value in philosophy, he had been rendered impatient by
the fact that so much of the history of philosophy was dominated by
Aristotle, and it was only that the panegyric was forced from him by
careful study of all that the Stagirite wrote that he said: "History
gazed on him with wonder. His intellect was piercing and comprehensive;
his attainments surpassed those of every philosopher; his influence has
been excelled only by the founders of religion ... his vast and active
intelligence for twenty centuries held the world in awe."
Professor Osborn, whose scholarly study of the theory of evolution down
the ages "From the Greeks to Darwin" rather startled the world of
science by showing not only how old was a theory of evolution, but how
frequently it had been stated and how many of them anticipated phases of
our own thought in the matter, pays a high compliment to the great Greek
scientist. He says: "Aristotle clearly states and rejects a theory of
the origin of adaptive structures in animals altogether similar to that
of Darwin." He then quotes certain passages from Aristotle's "Physics,"
and says: "These passages seem to contain absolute evidence that
Aristotle had substantially the modern conception of the evolution of
life, from a primordial, soft mass of living matter to the most perfect
forms, and that even in these he believed that evolution was incomplete
for they were progressing to higher forms."
Modern French scientists are particularly laudatory in their estimation
of Aristotle. The group of biologists, Buffon, Cuvier, St. Hilaire, and
others who called world attention to French science and its attainments
about a century ago, are all of them on record in highest praise of
Aristotle. Cuvier said: "I cannot read his work without being ravished
with astonishment. It is impossible to conceive how a single man was
able to collect and compare the multitude of facts implied in the rules
and aphorisms contained in this book."
It is possible, however, to get opinions ardently laudatory of Aristotle
from the serious students of any nation, provided only they know their
Aristotle. Sir William Hamilton, the Scotch philosopher, said:
"Aristotle's seal is upon all the sciences, his speculations have
determined those of all subsequent thinkers." Hegel, the German
philosophic writer, is not less outspoken in his praise: "Aristotle
penetrated the whole universe of things and subjected them to
intelligence." Kant, who is often said to have influenced our modern
thinking more than any other in recent generations, has his compliment
for Aristotle. It relates particularly to that branch of philosophy with
which Kant had most occupied himself. The Koenigsberg philosopher said:
"Logic since Aristotle, like Geometry since Euclid, is a finished
science."
I do not want to tire you or I could quote many other authorities who
proclaim Aristotle the genius of the race. They would include poets like
Dante and Goethe, scholars like Cicero and Anthon, literary men like
Lessing and Reich and many others. The scholars of the Middle Ages, far
from condemnation for their devotion to Aristotle, deserve the highest
praise for it. If they had done nothing else but appreciate Aristotle as
our greatest modern scholars have done, that of itself would proclaim
their profound scholarship.
The medieval writers are often said to have been uncritical in their
judgment, but in their lofty estimation of Aristotle they displayed the
finest possible critical judgment. On the contrary, the generations who
made much of the opportunity to minimize medieval scholarship because of
its worship at the shrine of Aristotle, must themselves fall under the
suspicion at least of either not knowing Aristotle or of not thinking
deeply about the subjects with regard to which he wrote. For in all the
world's history the rule has been that whenever men have thought deeply
about a subject and know what Aristotle has written with regard to that
subject, they have the liveliest admiration for the great Greek thinker.
This is true for philosophy, logic, metaphysics, politics, ethics,
dramatics, but it is also quite as true for physical science. He lacked
our knowledge, though not nearly to the degree that is usually thought,
and he had a marvellous accumulation of information, but he had a
breadth of view and a thoroughness of appreciation with a power of
penetration that make his opinions worth while knowing even on
scientific subjects in our enlightened age.
As for the supposed swearing by Aristotle, in the sense of literally
accepting his opinions without daring to examine them critically, which
is so constantly asserted to have been the habit of the medieval
scholars and teachers, it is extremely difficult in the light of the
expressions which we have from them, to understand how this false
impression arose. Aristotle they thoroughly respected. They constantly
referred to his works, but so has every thinking generation ever since.
Whenever he had made a declaration they would not accept the
contradiction of it without a good reason, but whenever they had good
reasons, Aristotle's opinion was at once rejected without compunction.
Albertus Magnus, for instance, said: "Whoever believes that Aristotle
was a God must also believe that he never erred, but if we believe that
Aristotle was a man, then doubtless he was liable to err just as we
are." A number of direct contradictions of Aristotle we have from
Albert. A well-known one is that with regard to Aristotle's assertion
that lunar rainbows appeared only twice in fifty years. Albert declared
that he himself had seen two in a single year.
Indeed, it seems very clear that the whole trend of thought among the
great teachers of the time was away from the acceptance of scientific
conclusions on authority unless there was good evidence for them
available. They were quite as impatient as the scientists of our time
with the constant putting forward of Aristotle as if that settled a
scientific question. Roger Bacon wanted the Pope to forbid the study of
Aristotle because his works were leading men astray from the study of
science, his authority being looked upon as so great that men did not
think for themselves but accepted his assertions. Smaller men are always
prone to do this, and indeed it constitutes one of the difficulties in
the way of advance in scientific knowledge at all times, as Roger Bacon
himself pointed out.
These are the sort of expressions that are to be expected from Friar
Bacon from what we know of other parts of his work. His "Opus Tertium"
was written at the request of Pope Clement IV, because the Pope had
heard many interesting accounts of what the great thirteenth-century
teacher and experimenter was doing at the University of Oxford, and
wished to learn for himself the details of his work. Bacon starts out
with the principle that there are four grounds of human ignorance. These
are, "first, trust in inadequate authority; second, that force of custom
which leads men to accept without properly questioning what has been
accepted before their time; third, the placing of confidence in the
assertions of the inexperienced; and fourth, the hiding of one's own
ignorance behind the parade of superficial knowledge, so that we are
afraid to say I do not know." Professor Henry Morley, a careful student
of Bacon's writings, said with regard to these expressions of Bacon:
No part of that ground has yet been cut away from beneath the
feet of students, although six centuries have passed. We still
make sheep-walks of second, third and fourth, and fiftieth
hand references to authority; still we are the slaves of
habit, still we are found following too frequently the
untaught crowd, still we flinch from the righteous and
wholesome phrase "I do not know" and acquiesce actively in the
opinion of others that we know what we appear to know.
In his "Opus Majus" Bacon had previously given abundant evidence of his
respect for the experimental method. There is a section of this work
which bears the title "Scientia Experimentalis." In this Bacon affirms
that "without experiment nothing can be adequately known. An argument
may prove the correctness of a theory, but does not give the certitude
necessary to remove all doubt, nor will the mind repose in the clear
view of truth unless it finds its way by means of experiment." To this
he later added in his "Opus Tertium": "The strongest argument proves
nothing so long as the conclusions are not verified by experience.
Experimental science is the queen of sciences, and the goal of all
speculation."
It is no wonder that Dr. Whewell, in his "History of the Inductive
Sciences," should have been unstinted in his praise of Roger Bacon's
work and writings. In a well-known passage he says of the "Opus Majus":
Roger Bacon's "Opus Majus" is the encyclopedia and "Novum
Organon" of the thirteenth century, a work equally wonderful
with regard to its wonderful scheme and to the special
treatises by which the outlines of the plans are filled up.
The professed object of the work is to urge the necessity of a
reform in the mode of philosophizing, to set forth the reasons
why knowledge had not made greater progress, to draw back
attention to the sources of knowledge which had been unwisely
neglected, to discover other sources which were yet almost
untouched, and to animate men in the undertaking of a prospect
of the vast advantages which it offered. In the development of
this plan all the leading portions of science are expanded in
the most complete shape which they had at that time assumed;
and improvements of a very wide and striking kind are proposed
in some of the principal branches of study. Even if the work
had no leading purposes it would have been highly valuable as
a treasure of the most solid knowledge and soundest
speculations of the time; even if it had contained no such
details it would have been a work most remarkable for its
general views and scope.
As a matter of fact the universities of the Middle Ages, far from
neglecting science, were really scientific universities. Because the
universities of the early nineteenth century occupied themselves almost
exclusively with languages and especially formed students' minds by
means of classical studies, men in our time seem to be prone to think
that such linguistic studies formed the main portion of the curriculum
of the universities in all the old times and particularly in the Middle
Ages. The study of the classic languages, however, came into university
life only after the Renaissance. Before that the undergraduates of the
universities had occupied themselves almost entirely with science. It
was quite as much trouble to introduce linguistic studies into the old
universities in the Renaissance time to replace science, as it was to
secure room for science by pushing out the classics in the modern time.
Indeed the two revolutions in education are strikingly similar when
studied in detail. Men who had been brought up on science before the
Renaissance were quite sure that that formed the best possible means of
developing the mind. In the early nineteenth century men who had been
formed on the classics were quite as sure that science could not replace
them with any success.
There is no pretence that this view of the medieval universities is a
new idea in the history of education. Those who have known the old
universities at first hand by the study of the actual books of their
professors and by familiarity with their courses of study, have not been
inclined to make the mistake of thinking that the medieval university
neglected science. Professor Huxley in his "Inaugural Address as Rector
of Aberdeen University" some thirty years ago stated very definitely his
recognition of medieval devotion to science. His words are well worth
remembering by all those who are accustomed to think of our time as the
first in which the study of science was taken up seriously in our
universities. Professor Huxley said:
The scholars of the medieval universities seem to have studied
grammar, logic, and rhetoric; arithmetic and geometry;
astronomy, theology, and music. Thus their work, however
imperfect and faulty, judged by modern lights, it may have
been, brought them face to face with all the leading aspects
of the many-sided mind of man. For these studies did really
contain, at any rate in embryo, sometimes it may be in
caricature, what we now call philosophy, mathematical and
physical science, and art. _And I doubt if the curriculum of
any modern university shows so clear and generous a
comprehension of what is meant by culture, as this old Trivium
and Quadrivium does._
It would be entirely a mistake, however, to think that these great
writers and teachers who influenced the medieval universities so deeply
and whose works were the text-books of the universities for centuries
after, only had the principles of physical and experimental science and
did not practically apply them. As a matter of fact their works are full
of observation. Once more, the presumption that they wrote only nonsense
with regard to science comes from those who do not know their writings
at all, while great scientists who have taken the pains to study their
works are enthusiastic in praise. Humboldt, for instance, says of
Albertus Magnus, after reading some of his works with care:
Albertus Magnus is equally active and influential in promoting
the study of natural science and of the Aristotelian
philosophy. His works contain some exceedingly acute remarks
on the organic structure and physiology of plants. One of his
works bearing the title of "Liber Cosmographicus De Natura
Locorum" is a species of physical geography. I have found in
it considerations on the dependence of temperature
concurrently on latitude and elevation and on the effect of
different angles of the sun's rays in heating the ground which
have excited my surprise.
It is with regard to physical geography of course that Humboldt is
himself a distinguished authority.
Humboldt's expression that he found some exceedingly acute remarks on
the organic structure and physiology of plants in Albert the Great's
writings will prove a great surprise to many people. Meyer, the German
historian of botany, however, has re-echoed Humboldt's praise with
emphasis. The extraordinary erudition and originality of Albert's
treatise on plants drew from Meyer the comment:
No botanist who lived before Albert can be compared with him
unless Theophrastus, with whom he was not acquainted; and
after him none has painted nature in such living colors or
studied it so profoundly until the time of Conrad Gessner and
Cæsalpino.
These men, it may be remarked, come three centuries after Albert's time.
A ready idea of Albert's contributions to physical science can be
obtained from his life by Sighart, which has been translated into
English by Dixon and was published in London in 1870. Pagel, in
Puschmann's "History of Medicine," already referred to, gives a list of
the books written by Albert on scientific matters with some comments
which are eminently suggestive, and furnish solid basis for the remark
that I have made, that men's minds were occupied with nearly the same
problems in science in the thirteenth century as we are now, while the
conclusions they came to were not very different from ours, though
reached so long before us.
This catalogue of Albertus Magnus' works shows very well his own
interest and that of his generation in physical science of all kinds.
There were eight treatises on Aristotle's physics and on the underlying
principles of natural philosophy and of energy and of movement; four
treatises concerning the heavens and the earth, one on physical
geography which also contains, according to Pagel, numerous suggestions
on ethnography and physiology. There are two treatises on generation and
corruption, six books on meteors, five books on minerals, three books on
the soul, two books on the intellect, a treatise on nutritives, and then
a treatise on the senses and another on the memory and on the
imagination. All the phases of the biological sciences were especially
favorite subjects of his study. There is a treatise on the motion of
animals, a treatise in six books on vegetables and plants, a treatise on
breathing things, a treatise on sleep and waking, a treatise on youth
and old age, and a treatise on life and death. His treatise on minerals
contains, according to Pagel, a description of ninety-five different
kinds of precious stones. Albert's volumes on plants were reproduced
with Meyer, the German botanist, as editor (Berlin, 1867). All of
Albert's books are available in modern editions.
Pagel says of Albertus that
His profound scholarship, his boundless industry, the almost
incontrollable impulse of his mind after universality of
knowledge, the many-sidedness of his literary productivity,
and finally the almost universal recognition which he received
from his contemporaries and succeeding generations, stamp him
as one of the most imposing characters and one of the most
wonderful phenomena of the Middle Ages.
In another passage Pagel has said:
While Albert was a Churchman and an ardent devotee of
Aristotle, in matters of natural phenomena he was relatively
unprejudiced and presented an open mind. He thought that he
must follow Hippocrates and Galen, rather than Aristotle and
Augustine, in medicine and in the natural sciences. We must
concede it a special subject of praise for Albert that he
distinguished very strictly between natural and supernatural
phenomena. The former he considered as entirely the object of
the investigation of nature. The latter he handed over to the
realm of metaphysics.
Roger Bacon is, however, the one of these three great teachers who
shows us how thoroughly practical was the scientific knowledge of the
universities and how much it led to important useful discoveries in
applied science and to anticipations of what is most novel even in our
present-day sciences. Some of these indeed are so startling, that only
that we know them not by tradition but from his works, where they may be
readily found without any doubt of their authenticity, we should be sure
to think that they must be the result of later commentators' ideas.
Bacon was very much interested in astronomy, and not only suggested the
correction of the calendar, but also a method by which it could be kept
from wandering away from the actual date thereafter. He discovered many
of the properties of lenses and is said to have invented spectacles and
announced very emphatically that light did not travel instantaneously
but moved with a definite velocity. He is sometimes said to have
invented gunpowder, but of course he did not, though he studied this
substance in various forms very carefully and drew a number of
conclusions in his observations. He was sure that some time or other man
would learn to control the energies exhibited by explosives and that
then he would be able to accomplish many things that seemed quite
impossible under present conditions.
He said, for instance:
Art can construct instruments of navigation, such that the
largest vessels governed by a single man will traverse rivers
and seas more rapidly than if they were filled with oarsmen.
One may also make carriages which without the aid of any
animal will run with remarkable swiftness.
In these days when the automobile is with us and when the principal
source of energy for motor purposes is derived from explosives of
various kinds, this expression of Roger Bacon represents a prophecy
marvellously surprising in its fulfilment. It is no wonder that the book
whence it comes bears the title "De Secretis Artis et Naturæ." Roger
Bacon even went to the extent, however, of declaring that man would some
time be able to fly. He was even sure that with sufficient pains he
could himself construct a flying machine. He did not expect to use
explosives for his motor power, however, but thought that a windlass
properly arranged, worked by hand, might enable a man to make sufficient
movement to carry himself aloft or at least to support himself in the
air, if there were enough surface to enable him to use his lifting power
to advantage. He was in intimate relations by letter with many other
distinguished inventors and investigators besides Peregrinus and was a
source of incentive and encouragement to them all.
The more one knows of Aquinas the more surprise there is at his
anticipation of many modern scientific ideas. At the conclusion of a
course on cosmology delivered at the University of Paris he said that
"nothing at all would ever be reduced to nothingness" (_nihil omnino in
nihilum redigetur_). He was teaching the doctrine that man could not
destroy matter and God would not annihilate it. In other words, he was
teaching the indestructibility of matter even more emphatically than we
do. He saw the many changes that take place in material substances
around us, but he taught that these were only changes of form and not
substantial changes and that the same amount of matter always remained
in the world. At the same time he was teaching that the forms in matter
by which he meant the combinations of energies which distinguish the
various kinds of matter are not destroyed. In other words, he was
anticipating not vaguely, but very clearly and definitely, the
conservation of energy. His teaching with regard to the composition of
matter was very like that now held by physicists. He declared that
matter was composed of two principles, prime matter and form. By _forma_
he meant the dynamic element in matter, while by _materia prima_ he
meant the underlying substratum of material, the same in every
substance, but differentiated by the dynamics of matter.
It used to be the custom to make fun of these medieval scientists for
believing in the transmutation of metals. It may be said that all three
of these greatest teachers did not hold the doctrine of the
transmutation of metals in the exaggerated way in which it appealed to
many of their contemporaries. The theory of matter and form, however,
gave a philosophical basis for the idea that one kind of matter might be
changed into another. We no longer think that notion absurd. Sir William
Ramsay has actually succeeded in changing one element into another and
radium and helium are seen changing into each other, until now we are
quite ready to think of transmutation placidly. The Philosopher's Stone
used to seem a great absurdity until our recent experience with radium,
which is to some extent at least the philosopher's stone, since it
brings about the change of certain supposed elements into others. A
distinguished American chemist said not long ago that he would like to
extract all the silver from a large body of lead ore in which it occurs
so commonly, and then come back after twenty years and look for further
traces of silver, for he felt sure that they would be found and that
lead ore is probably always producing silver in small quantities and
copper ore is producing gold.
Most people will be inclined to ask where the fruits of this
undergraduate teaching of science are to be found. They are inclined to
presume that science was a closed book to the men and women of that
time. It is not hard, however, to point the effect of the scientific
training in the writings of the times. Dante is a typical university man
of the period. He was at several Italian universities, was at Paris and
perhaps at Oxford. His writings are full of science. Professor Kühns, of
Wesleyan, in his book "The Treatment of Nature in Dante," has pointed
out how much Dante knows of science and of nature. Few of the poets not
only of his own but of any time have known more. There are only one or
two writers of poetry in our time who go with so much confidence to
nature and the scientific interpretation of her for figures for their
poetry. The astronomy, the botany, the zoölogy of Albertus Magnus and
Thomas Aquinas, Dante knew very well and used confidently for figurative
purposes. Anyone who is inclined to think nature study a new idea in the
world forgets, or has never known, his Dante. The birds and the bees,
the flowers, the leaves, the varied aspects of clouds and sea, the
phenomena of phosphorescence, the intimate habits of bird and beast and
the ways of the plants, as well as all the appearances of the heavens,
Dante knew very well and in a detail that is quite surprising when we
recall how little nature study is supposed to have attracted the men of
his time. Only that his readers appreciated it all, Dante would surely
not have used his scientific erudition so constantly.
So much for the undergraduate department of the universities of the
Middle Ages, and the view is absolutely fair, for these were the men to
whom the students flocked by thousands. They were teaching science, not
literature. They were discussing physics as well as metaphysics,
psychology in its phenomena as well as philosophy, observation and
experiment as well as logic, the ethical sciences, economics,
practically all the scientific ideas that were needed in their
generation--and that generation saw the rise of the universities, the
finishing of the cathedrals, the building of magnificent town halls and
castles and beautiful municipal buildings of many kinds, including
hospitals, the development of the Hansa League in commerce, and of
wonderful manufacturers of all the textiles, the arts and crafts, as
well as the most beautiful book-making and art and literature. We could
be quite sure that the men who solved all the other problems so well
could not have been absurd only in their treatment of science. Anyone
who reads their books will be quite sure of that.
While most people might be ready, then, to confess that possibly Huxley
was not mistaken with regard to the undergraduate department of the
universities, most of them would feel sure that at least the graduate
departments were sadly deficient in accomplishment. Once more this is
entirely an assumption. The facts are all against any such idea.
There were three graduate departments in most of the
universities--theology, law, and medicine. While physical scientists are
usually not cognizant of it apparently, theology is a science, a
department of knowledge developed scientifically, and most of these
medieval universities did more for its scientific development than the
schools of any other period. Quite as much may be said for philosophy,
for there are many who hesitate to attribute any scientific quality to
modern developments in the matter. As for law, this is the great period
of the foundation of scientific law development; the English common law
was formulated by Bracton, the deep foundations of basic French and
Spanish law were laid, and canon law acquired a definite scientific
character which it was always to retain. All this was accomplished
almost entirely by the professors in the law departments of the
universities.
It was in medicine, however, where most people would be quite sure
without any more ado that nothing worth while talking about was being
done, that the great triumphs of graduate teaching at the medieval
universities were secured. Here more than anywhere else is there room
for supreme surprise at the quite unheard-of anticipations of our modern
medicine and, stranger still, as it may seem, of our modern surgery.
The law regulating the practice of medicine in the Two Sicilies about
the middle of the thirteenth century shows us the high standard of
medical education. Students were required to have three years of
preliminary study at the university, four years in the medical
department, and then practise for a year with a physician before they
were allowed to practise for themselves. If they wanted to practise
surgery, an extra year in the study of anatomy was required. I published
the text of this law, which was issued by the Emperor Frederick II about
1241, in the _Journal of the American Medical Association_ three years
ago. It also regulated the practice of pharmacy. Drugs were manufactured
under the inspection of the government and there was a heavy penalty for
substitution, or for the sale of old inert drugs, or improperly prepared
pharmaceutical materials. If the government inspector violated his
obligations as to the oversight of drug preparations the penalty was
death. Nor was this law of the Emperor Frederick an exception. We have
the charters of a number of medical schools issued by the Popes during
the next century, all of which require seven years or more of university
study, four of them in the medical department, before the doctor's
degree could be obtained. When new medical schools were founded they had
to have professors from certain well-recognized schools on their staff
at the beginning in order to assure proper standards of teaching, and
all examinations were conducted under oath-bound secrecy and with the
heaviest obligations on professors to be assured of the knowledge of
students before allowing them to pass.
It might be easy to think, and many people are prone to do so, that in
spite of the long years of study required there was really very little
to study in medicine at that time. Those who think so should read
Professor Clifford Allbutt's address on the "Historical Relations of
Medicine and Surgery" delivered at the World's Fair at St. Louis in
1904. He has dwelt more on surgery than on medicine, but he makes it
very clear that he considers that the thinking professors of medicine of
the later Middle Ages were doing quite as serious work in their way as
any that has been done since. They were carefully studying cases and
writing case histories, they were teaching at the bedside, they were
making valuable observations, and they were using the means at their
command to the best advantage. Of course there are many absurdities in
their therapeutics, but then we must not forget there have always been
many absurdities in therapeutics and that we are not free from them in
our day. Professor Richet, at the University of Paris, said not long
ago: "The therapeutics of any generation is quite absurd to the second
succeeding generation." We shall not blame the medieval generations for
having accepted remedies that afterwards proved inert, for every
generation has done that, even our own.
Their study of medicine was not without lasting accomplishment, however.
They laid down the indications and the dosage for opium. They used iron
with success, they tried out many of the bitter tonics among the herbal
medicines, and they used laxatives and purgatives to good advantage.
Down at Montpellier, Gilbert, the Englishman, suggested red light for
smallpox because it shortened the fever, lessened the lesions, and made
the disfigurement much less. Finsen was given the Nobel prize partly for
re-discovery of this. They segregated erysipelas and so prevented its
spread. They recognized the contagiousness of leprosy, and though it was
probably as widespread as tuberculosis is at the present time, they
succeeded not only in controlling but in eventually obliterating it
throughout Europe.
It was in surgery, however, that the greatest triumphs of teaching of
the medieval universities were secured. Most people are inclined to
think that surgery developed only in our day. The great surgeons of the
thirteenth and fourteenth centuries, however, anticipated most of our
teaching. They investigated the causes of the failure of healing by
first intention, recognized the danger of wounds of the neck,
differentiated the venereal diseases, described rabies, and knew much of
blood poisoning, and operated very skilfully. We have their text-books
of surgery and they are a never-ending source of surprise. They operated
on the brain, on the thorax, on the abdominal cavity, and did not
hesitate to do most of the operations that modern surgeons do. They
operated for hernia by the radical cure, though Mondeville suggested
that more people were operated on for hernia for the benefit of the
doctor's pocket than for the benefit of the patient. Guy de Chauliac
declared that in wounds of the intestines patients would die unless the
intestinal lacerations were sewed up, and he described the method of
suture and invented a needle holder. We have many wonderful instruments
from these early days preserved in pictures at least, that show us how
much modern advance is merely re-invention.
They understood the principles of aseptic surgery very well. They
declared that it was not necessary "that pus should be generated in
wounds." Professor Clifford Allbutt says:
They washed the wound with wine, scrupulously removing every
foreign particle; then they brought the edges together, not
allowing wine or anything else to remain within--dry adhesive
surfaces were their desire. Nature, they said, produces the
means of union in a viscous exudation, or natural balm, as it
was afterwards called by Paracelsus, Paré, and Wurtz. In older
wounds they did their best to obtain union by cleansing,
desiccation, and refreshing of the edges. Upon the outer
surface they laid only lint steeped in wine. Powders they
regarded as too desiccating, for powder shuts in decomposing
matters; wine after washing, purifying, and drying the raw
surfaces evaporates.
Almost needless to say these are exactly the principles of aseptic
surgery. The wine was the best antiseptic that they could use and we
still use alcohol in certain cases. It would seem to many quite
impossible that such operations as are described could have been done
without anæsthetics, but they were not done without anæsthetics. There
were two or three different forms of anæsthesia used during the
thirteenth and fourteenth centuries. One method employed by Ugo da Lucca
consisted of the use of an inhalant. We do not know what the material
employed was. There are definite records, however, of its rather
frequent employment.
What a different picture of science at the medieval universities all
this makes from what we have been accustomed to hear and read with
regard to them. It is difficult to understand where the old false
impressions came from. The picture of university work that recent
historical research has given us shows us professors and students busy
with science in every department, making magnificent advances, many of
which were afterwards forgotten, or at least allowed to lapse into
desuetude.
The positive assertions with regard to old-time ignorance were all made
in the course of religious controversy. In English-speaking countries
particularly it became a definite purpose to represent the old Church as
very much opposed to education of all kinds and above all to scientific
education. There is not a trace of that to be found anywhere, but there
were many documents that were appealed to to confirm the protestant
view. There was a Papal bull, for instance, said to forbid dissection.
When read it proves to forbid the cutting up of bodies to carry them to
a distance for burial, an abuse which caused the spread of disease, and
was properly prohibited. The Church prohibition was international and
therefore effective. At the time the bull was issued there were twenty
medical schools doing dissection in Italy and they continued to practise
it quite undisturbed during succeeding centuries. The Papal physicians
were among the greatest dissectors. Dissections were done at Rome and
the cardinals attended them. Bologna at the height of its fame was in
the Papal States. All this has been ignored and the supposed bull
against anatomy emphasized as representing the keynote of medical and
surgical history. Then there was a Papal decree forbidding the making of
gold and silver. This was said to forbid chemistry or alchemy and so
prevent scientific progress. The history of the medical schools of the
time shows that it did no such thing. The great alchemists of the time
doing really scientific work were all clergymen, many of them very
prominent ecclesiastics.
Just in the same way there were said to be decrees of the Church
councils forbidding the practice of surgery. President White says in his
"Warfare of Science with Theology in Christendom," that, as a
consequence of these, surgery was in dishonor until the Emperor
Wenceslaus, at the beginning of the fifteenth century, ordered that it
should be restored to estimation. As a matter of fact, during the two
centuries immediately preceding the first years of the fifteenth
century, surgery developed very wonderfully, and we have probably the
most successful period in all the history of surgery except possibly our
own. The decrees forbade monks to practise surgery because it led to
certain abuses. Those who found these decrees and wanted to believe
that they prevented all surgical development simply quoted them and
assumed there was no surgery. The history of surgery at this time is one
of the most wonderful chapters in human progress.
The more we know of the Middle Ages the more do we realize how much they
accomplished in every department of intellectual effort. Their
development of the arts and crafts has never been equalled in the modern
time. They made very great literature, marvellous architecture,
sculpture that rivals the Greeks', painting that is still the model for
our artists, surpassing illuminations; everything that they touched
became so beautiful as to be a model for all the after time. They
accomplished as much in education as they did in all the other arts,
their universities had more students than any that have existed down to
our own time, and they were enthusiastic students and their professors
were ardent teachers, writers, observers, investigators. While we have
been accustomed to think of them as neglecting science, their minds were
occupied entirely with science. They succeeded in anticipating much more
of our modern thought, and even scientific progress, than we have had
any idea until comparatively recent years. The work of the later Middle
Ages in mathematics is particularly strong, and was the incentive for
many succeeding generations. Roger Bacon insisted that, without
mathematics, there was no possibility of real advance in physical
science. They had the right ideas in every way. While they were occupied
more with the philosophical and ethical sciences than we are, these were
never pursued to the neglect of the physical sciences in the strictest
sense of that term.
Is it not time that we should drop the foolish notions that are very
commonly held because we know nothing about the Middle Ages--and,
therefore, the more easily assume great knowledge--and get back to
appreciate the really marvellous details of educational and scientific
development which are so interesting and of so much significance at this
time?
APPENDIX III
MEDIEVAL POPULARIZATION OF SCIENCE
The idea of collecting general information from many sources, of
bringing it together into an easily available form, so as to save others
labor, of writing it out in compendious fashion, so that it could
readily pass from hand to hand, is likely to be considered typically
modern. As a matter of fact, the Middle Ages furnish us with many
examples of the popularization of science, of the writing of compendia
of various kinds, of the gathering of information to save others the
trouble, and, above all, of the making of what, in the modern time, we
would call encyclopedias. Handbooks of various kinds were issued,
manuals for students and specialists, and many men of broad scholarship
in their time devoted themselves to the task of making the acquisition
of knowledge easy for others. This was true not only for history and
philosophy and literature, but also for science. It is not hard to find
in each century of the Middle Ages some distinguished writer who devoted
himself to this purpose, and for the sake of the light that it throws on
these scholars, and the desire for information that must have existed
very commonly since they were tempted to do the work, it seems worth
while to mention here their names, and those of the books they wrote,
with something of their significance, though the space will not permit
us to give here much more than a brief _catalogue raisonné_ of such
works.
Very probably the first who should be mentioned in the list is Boëthius,
who flourished in the early part of the sixth century. He owed much of
his education to his adoptive father, afterwards his father-in-law,
Symmachus, who, with Festus, represented scholarship at the court of the
Gothic King, Theodoric of Verona. These three--Festus, Symmachus, and
Boëthius--brought such a reputation for knowledge to the court that they
are responsible for many of the wonderful legends of Dietrich of Bern,
as Theodoric came to be called in the poems of the medieval German
poets. The three distinguished and devoted scholars did much to save
Greek culture at a time when its extinction was threatened, and Boëthius
particularly left a series of writings that are truly encyclopedic in
character. There are five books on music, two on arithmetic, one on
geometry, translations of Aristotle's treatises on logic, with
commentaries; of Porphyry's "Isagoge," with commentaries, and a
commentary on Cicero's "Topica." Besides, he wrote several treatises in
logic and rhetoric himself, one on the use of the syllogism, and one on
topics, and in addition a series of theological works. His great
"Consolations of Philosophy" was probably the most read book in the
early Middle Ages. It was translated into Anglo-Saxon by King Alfred,
into old German by Notker Teutonicus, the German monk of St. Gall, and
its influence may be traced in Beowulf, in Chaucer, in High German
poetry, in Anglo-Norman and Provençal popular poetry, and also in early
Italian verse. Above all, the "Divine Comedy" has many references to it,
while the "Convito" would seem to show that it was probably the book
that most influenced Dante. Though it is impossible to confirm by
documentary evidence the generally accepted idea that Boëthius died a
martyr for Christianity, the tradition can be traced so far back, and it
has been so generally accepted that this seems surely to have been the
case. The fact is interesting, as showing the attitude of scholars
towards the Church and of the Church towards scholarship thus early.
The next great name in the tradition should probably be that of
Cassiodorus, the Roman writer and statesman, prime minister of
Theodoric, who, after a busy political life, retired to his estate at
Vivarium, and, in imitation of St. Benedict, who had recently
established a monastery at Monte Cassino, founded a monastery there. He
is said to have lived to the age of ninety-three. His retirement favored
this long life, for, after the death of Theodoric, troublous times came,
and civil war, and only his monastic privileges saved him from the storm
and stress of the times. He had been interested in literature and the
collection of information of many kinds before his retirement, and it is
not unlikely that his recognition of the fact that the monastic life
offered opportunities for the pursuit of this, under favorable
circumstances, led him to take it up.
While still a statesman he wrote a series of works relating to history
and politics and public affairs generally. These consisted mainly of
chronicles and panegyrics, and twelve books of miscellanies called
Variæ. After his retirement to the monastery, a period of ardent
devotion to writing begins, and a great number of books were issued. He
evidently gathered round him a number of men whom he inspired with his
spirit, or, perhaps, selected, because he found that, while they had a
taste for a quiet, peaceful spiritual life, they were also devoted to
the accumulation and diffusion of knowledge. A series of commentaries on
portions of the Scriptures was written, the Jewish antiquities of
Josephus translated, and the ecclesiastical histories of Theodoric,
Sozomen, and Socrates made available in Latin. Cassiodorus himself is
said to have made a compendium of these, called the "Historia
Tripartita," which was much used as a manual of history during
succeeding centuries. Then there were treatises on grammar, on
orthography, and a series of works on mathematics. In all of his
writings Cassiodorus shows a special fondness for the symbolism of
numbers.
There is a well-grounded tradition that he insisted on the study of the
Greek classics of medical literature, especially Hippocrates and Galen,
and awakened the interest of the monks in the necessity for making
copies of these fathers of medicine. The tradition that he established
at Vivarium is also found to have existed at Monte Cassino among the
Benedictines, and, doubtless, to this is to be attributed the foundation
of the medical school of Salerno, where Benedictine influence was so
strong. It is probable, therefore, that to Cassiodorus must be
attributed the preservation in as perfect a state as we have them of the
old Greek medical writers.
His main idea was, of course, the study of Scriptures, but with just as
many helps as possible. He thought that commentators, and historians,
not alone Christian, but also Hebrew and Pagan, should be studied to
illustrate it, and then the commentaries of the Latin fathers, so that a
thoroughly rounded knowledge of it should be obtained. He thus began an
"Encyclopedia Biblica," and set a host of workers at its accomplishment.
Every country in Europe shared this movement for the diffusion of
information during the early Middle Ages, and the works of men from each
of these countries in succeeding centuries has come down to us,
preserved in spite of all the vicissitudes to which they were so liable
during the centuries before the invention of printing and the easy
multiplication of books. To many people it will seem surprising to learn
that the next evidence of deep broad interest in knowledge is to be
found in the next century in the distant west of Europe, in the Spanish
Peninsula. It is a long step from the semi-barbaric splendor of the
Gothic court at Verona, to the bishop's palace in Seville in Andalusia.
The two cities are separated by what is no inconsiderable distance in
our day. In the seventh century they must have seemed almost at the
other end of the world from each other. Those who recall what we have
insisted on in several portions of the body of this work with regard to
the high place Spanish genius won for itself in the Roman Empire, and
how much of culture among the Spaniards of that time the occurrence of
so many important writers of that nationality must imply, will not be
surprised at the distinguished work of a great Christian Spanish writer
of the seventh century.
Indeed, it would be only what might be expected for evidences of early
awakening of the broadest culture to be found in Spain. The important
name in the popularization of science in the seventh century is St.
Isidore of Seville. He made a compendium of all the scattered scientific
traditions and information of his time with regard to natural phenomena
in a sort of encyclopedia of science. This consisted of twenty
books--chapters we would call them now--treating almost _de omni re
scibili et quibusdam aliis_ (everything knowable and a few other things
besides). It is possible that the work may have been written by a number
of collaborators under the patronage of the bishop, though there is no
sure indication of this to be found either in the volume itself or even
contemporary history. All the ordinary scientific subjects are treated.
Astronomy, geography, mineralogy, botany, and even man and the animals
have each a special chapter. Pouchet, in his "History of the Natural
Sciences During the Middle Ages," calls attention to the fact that, in
grouping the animals for collective treatment in the different chapters,
sometimes the most heterogeneous creatures are brought under a common
heading. Among the fishes, for instance, are classed all living things
that are found in water. The whale and the dolphin, as well as sponges,
and oysters, and crocodiles, and sea serpents, and lobsters, and
hippopotamuses, all find a place together, because of the common watery
habitation. The early Spanish Churchman would seem to have had an
enthusiastic zeal for complete classification that would surely have
made him a strenuous modern zoölogist.
The next link in the tradition of encyclopedic work is the Venerable
Bede, whose character was more fully honored by the decree on November
13, 1899, by Pope Leo XIII declaring him a Doctor of the Church. Bede
was the fruit of that ardent scholarship which had risen in England as a
consequence of the introduction of Christianity. It had been fostered by
the coming of scholar saints from Ireland, but was, unfortunately,
disturbed by the incursions of the Danes. While Bede is known for his
greatest work, the "Ecclesiastical History of the English People," which
gives an account of Christianity in England from its beginning until his
own day, he wrote many other works. His history is the foundation of all
our knowledge of early British history, secular as well as religious,
and has been praised by historical writers of all ages, who turned to it
for help with confidence. He wrote a number of other historical works.
Besides, he wrote books on grammar, orthography, the metrical art, on
rhetoric, on the nature of things, the seasons, and on the calculation
of the seasons. These latter books are distinctly scientific. His
contributions to Gregorian Music are now of great value.
After this, Alcuin and the monks, summoned by Charlemagne, take up the
tradition of gathering and diffusing information, and the great
monasteries of Tours, Fulda, and St. Gall carry it on. Besides these,
in the ninth century Monte Cassino comes into prominence as an
institution where much was done of what we would now call encyclopedic
work. After his retirement from Salerno Constantine Africanus made his
translations and commentaries on Arabian medicine, constituting what was
really a medical encyclopedia of information not readily available at
that time.
After this, of course, the tradition is taken up by the universities,
and it is only when, with the thirteenth century, there came the
complete development of the university spirit, that encyclopedias
reached their modern expression. Three great encyclopedists, Vincent of
Beauvais, Thomas of Cantimprato, and Bartholomæus Anglicus, are the most
famous. Vincent consulted all the authors sacred and profane that he
could lay hold on, and the number was, indeed, prodigious. I have given
some account of him in "The Thirteenth Greatest of Centuries" (Catholic
Summer School Press, New York, third edition, 1910).
It would be very easy to conclude that these encyclopedias, written by
clergymen for the general information of the educated people of the
times, contain very little that is scientifically valuable, and probably
nothing of serious medical significance. Any such thought is, however,
due entirely to unfamiliarity with the contents of these works. They
undoubtedly contain absurdities, they are often full of misinformation,
they repeat stories on dubious authority, and sometimes on hearsay, but
usually the source of their information is stated, and especially where
it is dubious, as if they did not care to state marvels without due
support. Books of popular information, however, have always had many
queer things,--queer, that is, to subsequent generations,--and it is
rather amusing to pick up an encyclopedia of a century ago, much less a
millennium ago, and see how many absurd things were accepted as true.
The first edition of the "Encyclopedia Britannica," issued one hundred
and fifty years ago, furnishes an easily available source of the
absurdities our more recent forefathers accepted. The men of the Middle
Ages, however, were much better observers as a rule, and used much more
critical judgment, according to their lights, than we have given them
credit for. Often the information that they have to convey is not only
valuable, but well digested, thoroughly practical, and sometimes a
marvellous anticipation of some of our most modern thoughts. There is
one of these encyclopedias which, because it was written in my favorite
thirteenth century, I have read with some care. It is simply a
development of the work of preceding clerical encyclopedists, and often
refers to them. Because it contains some typical examples of the better
sorts of information in these works, I have thought it worth while to
quote two passages from it. The author is Bartholomæus Anglicus, and the
quaint English in which it is couched is quoted from "Medical Lore"
(London, 1893). The book is all the more interesting because in a dear
old English version, issued about 1540, the spellings of which are among
the great curiosities of English orthography, it was often read and
consulted by Shakespeare, who evidently quotes from it frequently, for
not a little of the quaint scientific lore that he uses for his figures
can be traced to expressions used in this book.
The first of the paragraphs that deserves to be quoted, discusses
madness, or, as we would call it, lunacy, and sums up the causes, the
symptoms, and the treatment quite as well as that has ever been done in
the same amount of space:
Madness cometh sometime of passions of the soul, as of
business and of great thoughts, of sorrow and of too great
study, and of dread: sometime of the biting of a wood hound,
or some other venomous beast; sometime of melancholy meats,
and sometime of drink of strong wine. And as the causes be
diverse, the tokens and signs be diverse. For some cry and
leap and hurt and wound themselves and other men, and darken
and hide themselves in privy and secret places. The medicine
of them is, that they be bound, that they hurt not themselves
and other men. And namely, such shall be refreshed, and
comforted, and withdrawn from cause and matter of dread and
busy thoughts. And they must be gladded with instruments of
music, and some deal be occupied.'
The second discusses in almost as thorough a way the result of the bite
of a mad dog. The old English word for mad, wood, is constantly used.
The causes, the symptoms, and course of the disease, and its possible
prevention by early treatment, are all discussed. The old tradition was
already in existence that sufferers from rabies or hydrophobia, as it is
called, dreaded water, when it is really only because the spasm
consequent upon the thought even of swallowing is painful that they turn
from it. That tradition has continued to be very commonly accepted even
by physicians down to our own day, so that Bartholomew, the Englishman,
in the thirteenth century, will not be blamed much for setting it forth
for popular information in his time some seven centuries ago. The idea
that free bleeding would bring about the removal of the virus is
interesting, because we have in recent years insisted in the case of the
very similar disease, tetanus, on allowing or deliberately causing
wounds in which the tetanus microbe may have gained an entrance, to
bleed freely.
The biting of a wood hound is deadly and venomous. And such
venom is perilous. For it is long hidden and unknown, and
increaseth and multiplieth itself, and is sometimes unknown to
the year's end, and then the same day and hour of the biting,
it cometh to the head, and breedeth frenzy. They that are
bitten of a wood hound have in their sleep dreadful sights,
and are fearful, astonied, and wroth without cause. And they
dread to be seen of other men, and bark as hounds, and they
dread water most of all things, and are afeared thereof full
sore and squeamous also. Against the biting of a wood hound
wise men and ready use to make the wounds bleed with fire or
with iron, that the venom may come out with the blood, that
cometh out of the wound.
FOOTNOTES:
[Footnote 1: "Medicinisches aus der Aeltesten Kirchen Geschichte."
Leipzig, 1892.]
[Footnote 2: Foulis, London and Edinburgh, 1910.]
[Footnote 3: My attention was called to the interesting story of the
Jewish physicians of the Middle Ages and their scientific accomplishment
while writing the article on Joseph Hyrtl for the Catholic Encyclopedia.
His "Das Arabische und Hebräische in der Anatomie" (Wien, 1879) has some
interestingly suggestive material on these important chapters of the
history of medicine. (I owe my opportunity to consult it to the courtesy
of the Surgeon-General's library.) Biographic material has been obtained
from Carmoly's "History of the Jewish Physicians," translated by Dr.
Dunbar for the _Maryland Medical and Surgical Journal_, some extra
copies of which were printed by John Murphy and Co., Baltimore, about
the middle of the nineteenth century. Baas and Haeser's Histories of
Medicine and Puschmann and Pagel's "Handbook" provided additional
material, and I have found Landau's "Geschichte der Jüdischen Aerzte"
(Berlin, 1895) of great service.]
[Footnote 4: Of course there are many absurd things recommended in the
Talmud. We cannot remind ourselves too often, however, that there have
been absurd things at all times in medicine, and especially in
therapeutics. It is curious how often some of these absurdities have
repeated themselves. We are liable to think it very queer that men
should have presumed, or somehow jumped to the conclusion, that portions
of animals might possess wonderful virtue for the healing of diseases of
the corresponding special parts of man. We ourselves, however, within a
little more than a decade, had a phase of opotherapy--how much less
absurd it seems under that high-sounding Greek term--that was apparently
very learned in its scientific aspects yet quite as absurd as many
phases of old-time therapy, as we look at it. We administered cardin for
heart disease and nephrin for kidney trouble, cerebrin for insanity
(save the mark!), and even prostate tissue for prostatism--and with
reported good results! How many of us realize now that in this we were
only repeating the absurdities, so often made fun of in old medicine,
with regard to animal tissue and excrement therapeutics? The Talmud has
many conclusions with regard to the symptoms of patients drawn from
dreams; as, for instance, it is said to be a certain sign of sanguineous
plethora when one dreams of the comb of a cock. One phase of our
psycho-analysis in the modern time, however, has taken us back to an
interpretation of dreams different of course from this, yet analogous
enough to be quite striking.]
[Footnote 5: "Maimonides," by David Yellin and Israel Abrahams,
Philadelphia, 1903.]
[Footnote 6: "Das Arabische und Hebräische in der Anatomie," Dr. Joseph
Hyrtl, Wien, 1879.]
[Footnote 7: "Anat. Antiq. Rariores," Vienna, 1835.]
[Footnote 8: It seems hard to understand how so useful an auxiliary to
the surgeon as the ligature,--it seems indispensable to us,--could
possibly be allowed to go out of use and even be forgotten. It will not
be difficult, however, for anyone who recalls the conditions that
obtained in old-time surgery. The ligature is a most satisfying
immediate resource in stopping bleeding from an artery, but a septic
ligature inevitably causes suppuration and almost inevitably leads to
secondary hemorrhage. In the old days of septic surgery secondary
hemorrhage was the surgeon's greatest and most dreaded bane. Some time
from the fifth to the ninth day a septic ligature came away under
conditions such that inflammatory disturbance had prevented sealing of
the vessel. If the vessel was large, then the hemorrhage was fast and
furious and the patient died in a few minutes. After a surgeon had had a
few deaths of this kind he dreaded the ligature. He abandoned its use
and took kindly to such methods as the actual cautery, red-hot knives
for amputations, and the like, that would sear the surfaces of tissues
and the blood-vessels, and not give rise to secondary hemorrhage. A
little later, however, someone not familiar with secondary risks would
reinvent the ligature. If he were cleanly in his methods and, above all,
if he were doing his work in a new hospital, the ligature worked very
well for a while. If not, it soon fell into innocuous desuetude again.]
[Footnote 9: Puschmann: "Handbuch der Geschichte der Medizin," Vol. I,
page 652.]
[Footnote 10: The first dentist who filled teeth with amalgam in New
York, some eighty years ago, had to flee for his life, because of a hue
and cry set up that he was poisoning his patients with mercury.]
[Footnote 11: "Storia de la Scuola di Salerno."]
[Footnote 12: It is probably interesting to note that the word
_universitas_ as used here has no reference to our word university, but
refers to the whole world of students as it were. In the Middle Ages
universities were called _studia generalia_, general studies--that is,
places where everything could be studied and where everyone from any
part of the world could study. Our use of the word university in the
special modern sense of the term comes from the formal mode of address
to the faculty of a university when Popes or rulers sent them
authoritative documents. Such documents began with the expression
_Universitas vestra_, all of you (in the old-time English, as preserved
in the Irish expression, "the whole of ye"), referring to all the
members of the faculty. The transfer to our term and signification
university was not difficult.]
[Footnote 13: Physicians wore a particular garb consisting of a cloak
and often a mask, supposed to protect them from infections at this time,
so that it was not difficult to make a characteristic picture as a sign
for a pharmacy. These symbolic signs were much commoner and very
necessary when people generally were not able to read. It is from that
period that we have the mortar and pestle as also the colored lights in
the windows of the drug stores, and the many-colored barber-pole. Also
the big boot, key, watch, hat, bonnet, and the like, the last symbolic
sign invention apparently being the wooden Indian for the tobacco
store.]
[Footnote 14: _The Medical Library and Historical Journal_, Brooklyn,
December, 1906.]
[Footnote 15: Taddeo, who was born in 1215, according to our usually
accepted traditions in the matter, would have been seventy-five years of
age when Mondino as a youth of scarcely more than fifteen went to the
University. It might seem that so old a man would have very little
influence over the young man. Taddeo, however, had, as we have said, a
very strenuous old age. Everything in life had come to him late. He was
well past thirty before he began to study philosophy and medicine,
having been a seller of candles from necessity because of poverty in his
younger years. His great success in practice came when he was past
forty. He first began to teach when he was forty-five, and he was nearly
fifty-five before he began to write. According to tradition he married
when he was nearly eighty--whether for the first or second time is not
said--and while this might be considered, and would in some cases be, an
indication of weakness of character (it would probably depend on whether
he married or was married), it seems in his case to have indicated a
vigor of body and character which shows very clearly how great was the
possibility of his influence as a teacher having been maintained even up
to this late time of life, and thus influencing a pupil who is to
represent the most potent influence at the beginning of the next
century.]
[Footnote 16: _Medical Library and Historical Journal_, 1906.]
[Footnote 17: Pilcher (_loc. cit._) tells of her tomb. I venture to
change his translation of the inscription in certain unimportant
particulars. He says:
"We know the very place where she was buried in front of the Madonna
delle Lettre in the Church of San Pietro e Marcellino of the Hospital of
Santa Maria de Mareto, where her associate, Agenio, mourning and
inconsolable, placed a tablet with this inscription:
D . O . M .
Vrceo . Contenti
Alexandrae . Galinae . Pvellae . Persicetanae
Penicillo . Egregiae . Ad . Anatomen . Exhibendam
Et . Insignissimi . Medici . Mundini . Lucii
Paucis . Comparandae . Discipulae . Cineres
Carnis . Hic . Expectant . Resurrectionem
Vixit . Ann . XIX . Obiit . Studio . Absunta
Die XXVI Martii . A . S . MCCCXXVI
Otto . Agenius . Lustrulanus . Ob . Eam . Demptam
Sui . Potiori . Parte . Spoliatus . Sodali . Eximiae
Ac . De . Se . Optime . Meritae . Inconsolabilis . M . P .
This inscription may be translated as follows:
In this urn enclosed
The ashes of the body of
Alexandra Giliani, a maiden of Periceto;
Skilful with her brush in anatomical demonstrations
And a disciple equalled by few,
Of the most noted physician, Mundinus of Luzzi,
Await the resurrection.
She lived 19 years: she died consumed by her labors
March 26, in the year of grace 1326.
Otto Agenius Lustrulanus, by her taking away
Deprived of his better part, his excellent companion,
Deserving of the best,
Has erected this tablet."
]
[Footnote 18: This is so striking that I quote their actual words from
Gurlt, p. 704: "_Multoties fit percussio in anteriori parte cranei et
craneum in parte frangitur contraria._"]
[Footnote 19: "Historical Relations of Medicine and Surgery Down to the
Sixteenth Century," London, 1904.]
[Footnote 20: Of course, for any extended knowledge of Mondeville, a
modern reader must turn to Nicaise's translation of his "Chirurgia,"
which, with an introduction and a biography, was published at Paris in
1893. Nicaise's publication of this and of Guy de Chauliac's treatise
has worked a revolution in medical history and, above all, has made
these old authors available for those who hesitate to take up a work
written entirely in Latin.]
[Footnote 21: In the very first book containing some account of human
anatomy, a German volume by Conradus Mengenberger, called "Puch der
Natur," the date of printing of which is about 1478,--that is, less than
ten years after the printing of the very first book, the "Biblia
pauperum," which appeared in 1470,--there are, according to Haller in
his "Bibliotheca Anatomica," a series of illustrations. This is the
first illustrated medical work ever published.]
[Footnote 22: Fordham University Press, New York, 1908.]
[Footnote 23: Fordham University Press, New York, 1908.]
[Footnote 24: See picture of the hospital ward at Tonnerre, in "The
Thirteenth Greatest of Centuries," 3rd edit., New York, 1911.]
[Footnote 25: "The Historical Relations of Medicine and Surgery," by T.
Clifford Allbutt, M.A., M.D. London: Macmillan & Co., Ltd., 1905.]
[Footnote 26: The beginning of the manuscript copy in the "Bibliothèque
Nationale" is extremely interesting as an example of the English of the
period, and alongside of it it seems worth while to quote the closing
sentence as Nicaise reproduces them:
"In godes name here bygyneth the inventarie of gadryng to gedre medecyne
in the partye of cyrurgie compilede and fulfilled in the zere (yere?) of
our Loord 1363 by Guide de Cauliaco cirurgene and doctor of physik in
the fulclere studye of Mountpylerz.
"On page 191, verso.--Here endeth the cyrurgie of Maistre Guyd' de
Cauliaco dottoure of phisik."
The University of Cambridge copy has the title in the colophon. It runs
as follows: "Ye inventorye of Guydo de Caulhiaco Doctor of Phisyk and
Cirurgien in Ye Universitie of Mount Pessulanee of Montpeleres." The
fly-leaf contains the words, "Jesu Christ save ye soule of mich." It is
rather interesting to note how much closer to modern English is this
copy, made probably not much more than half a century later than the
first one and, above all, how much more nearly the spelling has come. At
this time, however, and, indeed, for more than a century later, spelling
had no fixed rule, and a man might spell the same word quite differently
even on the same page. The difference between doctor spelled thus in the
early edition, and doctours in the later one, probably means nothing
more than personal peculiarities of the original translator or copyist.]
[Footnote 27: In Nicaise this last word is written _crapte_. I have
ventured to suggest _crafte_, since a misreading between the two letters
would be so easy. In the same way I have suggested tentatively a
changing of the _z_ in the title of the Bibliothèque Nationale copy to
_y_, making the word _yere_ instead of _zere_.]
[Footnote 28: "A History of Dentistry from the Most Ancient Times Until
the End of the Eighteenth Century," by Dr. Vincenzo Guerini, editor of
the Italian Review _L'Odonto-Stomatologia_, Philadelphia and New York,
Lea and Febriger, 1909.]
[Footnote 29: The first printed edition of Arculanus is that of Venice,
1542, bearing the Latin title, "Joannis Arculani Commentaria in Nonum
Librum Rasis," etc.]
[Footnote 30: It is curious to trace how old are the traditions on which
some of these old stories, that must now be rejected, are founded. I
have come upon the story with regard to Basil Valentine and the antimony
and the monks in an old French medical encyclopedia of biography,
published in the seventeenth century, and at that time there was no
doubt at all expressed as to its truth. How much older than this it may
be I do not know, though it is probable that it comes from the sixteenth
century, when the _kakoëthes scribendi_ attacked many people because of
the facility of printing, and when most of the good stories that have so
worried the modern dry-as-dust historian in his researches for their
correction became a part of the body of supposed historical tradition.
It is probably French in origin because in that language _antimoine_ is
a tempting bait for that pseudo-philology which has so often led to
false derivations.]
[Footnote 31: There is in the New York Academy of Medicine a thick 24mo
volume in which three of the classics of older medicine are bound
together. They are Kerckringius's "Commentary on the Triumphal Chariot
of Antimony," published at Amsterdam, 1671; Steno's "Dissertation on the
Anatomy of the Brain," published in Leyden in 1671, and Father Kircher's
"Scrutinium Physico Contagiosae Luis quae dicitur Pestis"
(Physico-medical Discussions of the Contagious Disease which is called
Pest). This was published at Leipzig in 1659. Just how the three works
came to be bound together is hard to say. Very probably they belonged to
some old-time scholar, though there is nothing about the books to tell
anything of the story. The fact that all three of the authors were
ecclesiastics of the Catholic Church, Valentine a Monk, Steno a Bishop,
and Kircher a Jesuit, would seem to be one common bond and perhaps a
reason for the binding of these rather disparate treatises together. In
that case it is probable that the book came from an old monastic library
dispersed after the suppression of the order by some government. It
seems not unlikely that the volume belonged at some time to an old
Jesuit library, for they have suffered the most in that way. That these
three classics of medicine should have been republished in handy volume
editions within practically ten years shows an interest in medical
literature that has not existed again until our own time, for during the
eighteenth and early nineteenth centuries there was almost utter neglect
of them.]
[Footnote 32: Paper read before the first meeting of the American Guild
of St. Luke.]
[Footnote 33: Published by Putnams, New York, 1909.]
[Footnote 34: Dublin, 1882.]
[Footnote 35: The material for this chapter was gathered for a paper
read before the Medical Improvement Society of Boston in the spring of
1911. In nearly its present form it was published in _The Popular
Science Monthly_ for May, 1911, and thanks are returned to the editor of
that magazine for permission to reprint it here. The additions that have
been made refer particularly to the estimation of Aristotle in the
Middle Ages.]
[Footnote 36: New York, Putnam, 1908.]
[Footnote 37: "De Coelo et Mundo," 1, tr. iv., x.]
INDEX
=A=
Abbassides, 73
Abba Oumna, 70
Abbas, 324
Abélard, 189
Abraham, 97, 98
Abu Dschafer, 173
Abulcasis, 123, 170, 226, 317, 318, 323
Abul Farag, 51
Abulkasim, 124
Academy of Bagdad, 135
Acid, hydrochloric, 369
Ackermann, 302
Adalberon, 145
Adelard of Bath, 134
Adhesions, 128
Ægidius, 150
Aëtius, 10, 117, 180, 317
Aëtius, Amidenus, 28
Afflacius, 151, 171
Affinity, 372
Agenius, Otto, 227
Agricola, 345
À Kempis, Thomas, 345, 361
Alanfrancus, 260
Albertus Magnus, 267, 306, 356, 403
Alchemist, 354
Alcuin, 432
Alderotti, 213
Alexander II, Pope, 83
Alexander of Hales, 108
Alexander of Tralles, 10, 28, 39
Alexandria, 135, 385
Allbutt, Sir Clifford, 247, 254, 257, 304, 355, 421
Ali Abbas, 121, 173, 266, 323
Ali Ben el Abbas, 170
Almansor, 132
Alphanus, 143, 145
Amandaville, 264
Anæsthesia, 17;
inhalation of, 295, 296
Anæsthetics, 246
Anathomia, 203
Anatomy, ignorance of, 289;
of the teeth, 326
Anatomical material, 224
Anatomical injection, 227
Anatomical preparations, 277
Andrew of Piacenza, 248
Animals, motion of, 414
Anthemios, 40
Angelico, Fra, 360
Angina, 32, 44, 332
Anthon, 407
Antimony, 362
Antiseptic, 253
Antisepsis, 17, 246
Apocalypse, the chemical, 376
Aquinas, 306, 403
Arabian lack of originality, 140
Arabian words in anatomy, 138
Arabs, 7
Arabisms, 237
Archimattheas, 160
Arcoli, John of, 208
Arculanus, 323
Arezzo, 248
Arithmetical complements, 340
Armandaville, 264
Arnold of Villanova, 290, 358
Arrows, extraction of, 270
Arpinum, 4
Arsenic, 335
_Artemisia maritima_, 50
Arterial hemorrhage, 126
Arthur Legends, 218, 375, 392
Arts, 7;
liberal, 149;
and crafts, 425
Asepsis, 17, 244, 246, 387
Aspasia, 180
Astrology, 105;
and astronomy, 106, 418
Asylums, 8
Auenbrugger, 91, 166
Authority, 269, 292, 404
Authorship, dual, 391
Automobile, 415
Avenzoar, 80, 123, 130, 132
Averroës (Averrhoes), 80, 123, 132, 230, 267
Avicenna, 80, 128, 170, 266, 268, 331
Avignon, 16, 233
=B=
Baas, 61, 63
Bachtischua, 56
Bacon, Roger, 107, 306, 356, 361, 403
Bagdad, 110, 111, 115, 134, 135
Barbarians, 5
Bartholomæus Anglicus, 433
Bartholomew, 172
Basilios, 26
Basil. St., 24
Basila, 180
Basil Valentine, 20, 180, 349
Basra, 111
Bath, 103
Bath, milk, 131;
in fever, 172;
of the soul, 25
Baverius, 209
Baynes, Henry Samuel, 390
Bede, 432
Benedict, St., 178
Benedictines, 12, 164
Benedictine Nuns, 191
Beowulf, 428
Berengarius, 209
Bernard of Clairvaux, 192
Bernard, St., 85
Bertruccio, 209, 287
Bertruccius, 229
Binz, Prof. Carl, 333
Birthplace, Latin writers, 4
Black Death, 304
Boccaccio, 183, 306
Body-snatching, 224
Boerhaave, 38
Boëthius, 427
Bokhara, 111
Bologna, 16, 142, 202, 206, 248
Book-learning, 371
Botany, 413;
medieval, 414, 418
Botticelli, 360
Bracton, 419
Brain substance, loss of, 294
Brant, 361
Brethren of the Common Life, 344
Bridgework, dental, 315
Broeck, 277
Bronchoceles, 34
Bruno da Longoburgo, 245, 248
Bubonocele, 53
Buffon, 406
Bull, supposed against dissection, 424
Busche, 344
Bzowski, S.J., 181
=C=
Cæsalpinus, 2, 209
Caius, 360
Calenda, Constance, 187
Calendar, correction of, 340
Calvo, 302
Cancer, 255
Cantor, 346
Carmoly, 61
Carthage, 165
Cases, desperate, 262
Cassiodorus, 12, 429
Cataract, 300
Cato, 267
Chanina Ben Chania, 66, 69
Charlatans, numbers of, 274
Charters, medical school, 420
Charts, 19
Chasdai Ben Schaprut, 79
Chaucer, 306, 428
Chauliac, 18, 285, 301, 319
Chauliac, bibliography, 308;
editio princeps, 312
Chemical compounds, artificial, 376
Chirurgia Magna, 261, 284
Chirurgy, 19
Chosroes I, 109
Church and Jews, 80;
and anatomy, 234;
and surgery, 234
Cicatrices, beautiful, 255
Cicero, 4, 427
Cid, The, 218, 375, 392
Cimabue. 211
Circulation of the blood, 147
Cities, large, 5
City hospitals, 8;
for the sick, 24, 296
City physician, 251
Clavius, S.J., Father, 340
Classics of Medicine, 165
Clement of Alexandria, 83;
VI, Pope, 83
Cleopatra, 179
Clepsydra, 341
Clinical experience, 378
Clitoris hypertrophy, 37
Clysters, 279
Cnidos, 135
Colic, 279
Collectio Salernitana, 143, 238
College of St. Come, 26
Colpeurynter, 128
Columbus, 2, 209, 327, 329, 359
Conception, 35
Constantine Africanus, 5, 24, 123, 134, 145, 151, 163, 236, 266, 433
Constitution of the sun, 339
Consolations, 428
Consumption, 44
Conrad, 192
Conrad Mutianus, 344
_Contrecoup_, 240
_Convito_, 428
Copernicus, 346
Copho, 154, 205
Cordova, 75, 92, 134, 135
Cornelius, 38
Corrosive sublimate, 335
Cos, 135
Cosmas and Damian, 26
Criticism, higher, 7
Crown, dental, 316;
cap, 316
Cusanus, 336
Cures of Afflacius, 171
Cuvier, 406
Cycloid curve, 346
=D=
Da Lucca, 246
Damascus, 111
Daniel Morley, 134
Dante, 183, 211, 306, 407, 417
Daremberg, 180, 303
Darwin, 355, 399
David, 97
Decadence, 6
De Renzi, 143, 162, 182, 238, 239
Dental appliances, 316;
decay, 318;
hygiene, 325;
surgery, 327;
instruments, 320
_Dentatores_, 320
Dentrifices, 316
Descartes, 133
Desiderius, 145, 164, 168
Deventer, 344
Dezimeris, 302
Diaphoresis, 47
Diarbekir, 28
Didacus Lopez, 130
Diet, 46, 116
Dietetics, 99, 157
Di Liucci, 205
Dinus de Garbo, 130
Diogenes, 267
Dioscorides, 79, 266, 385
Diphtheria, 32
Diseases made incurable, 274;
eye, 300
D'Israeli, 76
Dissecting material, 134;
wounds, 227
Dissection, 224;
supposed prohibition of, 424
Divine Comedy, 428
Divorce, 5
Djondisabour, 71, 109
Dock (Miss), 401
Dog, rabid, 31
Donolo, 78
Drainage, 241, 249
Dreams, 68
Driesch, 399
Dschibril, 57
Dschordschis, 56
Du Bouley, 199
Duke, Robert, 167
Duns Scotus, 108
=E=
Eclecticism, 248
Eclipse, 22
_Ecstasis_, 386
Eddyites, 385
Edessa, 9
Egidius, 134
Elixir of immortal life, 25
Embryology, 28
Encyclopedia biblica, 430
Energy, Conservation of, 417
Epilepsy, 43
Epiplocele, 53
Epiplo-enterocele, 53
Epithelioma, 37
Epulis, 32
Erasistratus, 221, 385
Erasmus, 344, 361
Esophagus, 33
Ethics, medical, 77
Ethnography, 414
Etruscans, 315
Eusebius, 26
Eustachius, 2, 209
Eustachian canal, 327, 329
Examinations, 136
Experience, 403
Experiment, master of, 404
=F=
Fabiola, 11
Fabricius de Acquapendente, 125
Fallopius, 302, 327
Faradj Ben Salim, 79, 170
Faragut, 79
Father of Modern Surgery, 283
Faucon, 312
Feminine education, 178, 188;
cycles of, 200
Ferrara, 248, 328
Festus, 428
Filling of the teeth, 335
Finsen, 421
First intention, 18
Fish bones, 51
Florence, 206, 248
Floyer, 336
Forefathers in medicine, 380
Foreign body, 33
Foreign bodies, 48
Forli, 206
Foster, Sir Michael, 354
Foundlings, 8
Foundling asylums, 25
Founder of Pharmaceutical Chemistry, 353
Four Masters, 154, 238, 242, 243, 273
Fractures, 240;
of pubic arch, 128;
of base, 242;
of skull, 244;
split or crack, 243
Francis, Dr. Samuel, 223
Frederick I, 192;
II, 147
Freind, 112, 302
Friedenwald, 64
Friuli, 206
=G=
Gaddesden, 287
Galeatus de Sancta Sophia, 130
Galileo, 355
Galen, 3, 13, 35, 43, 73, 91, 115, 117, 129, 179, 266, 230, 204, 430, 385
Galenists, 120
Galvani, 166, 209
Gario Pontus, 43
Gentilis de Fulgineis, 130
Geography, physical, 413
Geometric transmutation, 340
Gerard of Cremona, 134, 170
Ghetto, 62
Giffert, Prof., 396
Gilbert, 421
Giliani, Alessandra, 188
Gilles de Corbeil, 134, 150
Giotto, 211, 306
Giovanni of Arcoli, 313, 324, 328
Glands, cervical, 259
Goitre, 33, 151;
cystic, 259
Gold reserve, 316
Gordon, Bernard, 276, 286
Graduate, 208
Græcisms, 237
Granada, 75
Gratz College, 75
Gravity, specific, 342
Greeks, From the, to Darwin, 406
Gregory IX, 83;
of Nazianzen, 24
Gruel, 131
Guadalquivir, 93
Guerini, 315
Guimarus II, 143
Guiscard, 145
Gurlt, 29, 48, 109, 139, 156, 219, 236, 239, 244, 248, 259, 312, 329, 331
Guy de Chauliac, 16, 208, 229, 270, 275, 232, 422
=H=
Haeser, 61
Haliography, 376
Hallam, 85
Hamilton, Sir Wm., 407
Harnack, 25, 26, 382, 392
Haroun al-Raschid, 74
Harvey, 166, 209, 355
Harun al-Raschid, 56, 112
Headache, 42
Hegel, 407
_Hegira_, 170
Hegius, 345, 361
Heidelberg, 345
Helena, 24
Héloïse, 189
Hemicrania, 42
Hemoptyses, 45
Heraclius, 54
Hermondaville, 264
Hernia, 298;
radical cure of, 299
Herophilus, 221, 384
Hierakas, 26
Hildegarde, 190
Hippocrates, 13, 91, 99, 117, 266, 385, 429
"Histoire des Femmes Médecins," 195
Historia Tripartita, 429
History of the Inductive Sciences, 410
Hobart, 393
Hobeisch, 58
Hollanduses, 358
Homer, 375, 391
Honein Ben Ischak, 57
Honein Ben Ishac, 117
Honey, 103
Horæ Lucanæ, 390
Horace, 267
_Hortus Deliciarum_, 191
Hospitals, 8
Hospitals for children, 25
Hroswitha, 190
Hugh of Lucca, 257
Hugo of Lucca, 245, 267, 273
Humboldt, 412
Huxley, 150, 307, 412
Hydrocephalus, 257
_Hydropikos_, 385
Hydrophobia, 435
Hysteria, 54
=I=
Ibn Sina, 128
Ibn Zeinel-Taberi, 115
Ibn-Zohr, 130
Ignorance, on learned, 340;
grounds of, 409
_Ignorantia, De Docta_, 339
Iliac passion, 279
Iliad, 375
Illustrations, 230;
dental, 331;
first medical, 275
_Incunabula_, 311, 329
Infection, 241
Innocent III, 83;
IV, 83
Insanity, 434
Inspection, 47
Invasion of the barbarians, 26
Isaac Ben Amram, 76
Isaac Ben Emran, 73
Isaac Ben Soliman, 76
Isaac Judæus, 170, 173
Isagoge, 58
Ishac Ben Honein, 53
Isidore of Seville, St., 113, 431
Israels, A.H., 66
Israeli, 76
=J=
Jacobus de Forlivio, 130
Jacobus de Partibus, 130
Jewish physicians, 7
Johannes Afflacius, 171
Johannesbrod, 102
Johannitius, 57
John Chrysostom, St., 11, 181
John de Vigo, 209
John Masuée, 74
John of Arcoli, 18, 209
John of Gaddesden, 286
Josephus, 29
Joshua Ben Nun, 74
Jude Sabatai, 78
Julian the Apostate, 8, 23
Justinian, 26, 23
=K=
Kant, 407
Kerckringius, 366
Kircher, 366
Koran, 106, 139
Kostaben Luka, 58
Kühns, 418
=L=
Lactantius, 27
Lancisi, 209
Landau, 67
Lane Lectures, 354
Lanfranc, 16, 209, 245, 260, 267
Laurentian Library, 180
Lead pipe, 239
Leo, 55
Leonardo da Vinci, 360
Leonides, 36
Leoparda, 181
Lewes, 406
Libraries, 6
Life, intellectual, 5
Ligatures, 155;
around the limbs, 54
Lilium Medicinæ, 158
Linacre, 209, 360
Lipinska, Dr. Melanie, 195
Livy, 4
Lopez, 82
Love, 373
Lowell, Russell, 371
Lucan, 4, 94, 113
Lucca, 248
Lucretius, 395
Ludwig's angina, 332
Luke, St., 7;
the physican, 8;
supposed inaccuracies, 397
Lupus, 256
=M=
Machine, Flying, 416
Madness, 434
Magna Græcia, 15, 156, 177
Magnet, 269
Magnetism, 404
Mahmoud, 75
Maimonides, 12, 88, 90;
rules of life, 100
Malcorona, 182
Malgaigne, 118, 303, 306
Malpighi, 209
Malta, 97
Man, 95
Mandeville, 264
Mania, 44
Manipulation, surgical, 250
Mantua, 4
_Marsupium cordis_, 147
Martial, 4, 113, 181
Maser Djawah, 72
Matter and form, 351, 417
Matter, indestructibility of, 416
Matthæus de Gradibus, 130
Matthew Platearius, 134
Mediastinum, 137
_Medica_, 181
Medical, first illustrations, 275
Medicine, legal, 252;
New York Academy of, 223
Melancholia, 44
Mengenberger, 276
Meningitis, 43
Mental influence, 44
"Merchant of Venice, The," 82
Mercuriade, 186
Mesmer, 105
Meteors, 414
Metrodora, 180
Metrorrhagia, 54
Meyer, 413
Michael Angelo, 360
Michael Scot, 134
Microtechnics, 171
Middle meningeal artery, 37
Middleton, 246
Migne, 194
Milan, 206
Milk, bath, 131;
cure, 45
Milman, 84
Ministry of Christ, 390
Miscellany, 124
Modena, 248
Mohammed, 13
Monasteries, 6
Mondeville, 207, 209, 231, 264, 298, 422
Mondino, 202, 209, 245;
career, 232;
myth, 216
Monks' bane, 364
Montaigne, 374
Monte Cassino, 12, 145, 163, 168, 433
Montpellier, 11, 16, 87, 265
Morgagni, 91, 209
Moses, 64
Moses Ben Maimum, 91
=N=
Nain, widow of, 389
Naples, 248
Nature, 47, 77, 378;
in Dante, 418
Neander, 84
Needleholder, 295
Nemesius, 9
Nerve suture, 253, 262
Nestorian, 73, 109
Newton, 351, 355
Nibelungen, 218
Nibelungenlied, 375, 392
Nicaise, 198, 208, 265, 286, 292, 302, 309
Nicerata, 181
Nicholas of Cusa, 19, 337, 344
Nicolaus, Leonicenus, 130
Nobel Prize, 421
_Noli me tangere_, 256
Nosology, 159
Notker Teutonicus, 428
Novelties, medical, 166
Nuremberg eggs, 337
Nursing, 271;
history of, 401
Nutrition per rectum, 130
Nutting, 401
=O=
Observations, 282, 293, 378
Octavius Horatianus, 180
Odyssey, 375
Oil and wine, 387
Old Testament, 63
Omar, 110
Omentum, 250
Operation for hernia, 52
Ophthalmology, 258
Opotherapy, 68
Oppler, 100
_Opus Majus_, 410
_Opus Tertium_, 409
Ordericus Vitalis, 182
Organization of medical education, 141
Oribasius, 8, 38, 117
Origenia, 180
Orthodontia, 318
Osborn, 406
Osler, 257
Ossian, 375
Ovid, 267
Oxygen, 49
=P=
Padua, 4, 16, 232, 248, 328, 345
Pagel, 61, 111, 119, 152, 156, 157, 172, 208, 216, 245, 264, 277, 286, 330
Palmyra, 109
Palpation, 47
Pandects, 38;
of Haroun, 72
Paracelsus, 2, 254, 379
Paracentesis, 122, 365
Paradiso, 215
Paré, Ambroise, 254, 303
Paris, 141
Paris, Paulin, 310
Passavant, Jean de, 260
Passow, 386
Pasquier, 200
Paul of Ægina, 10, 50, 117, 122, 125, 317, 331
Paulus Æginetus, 29, 38
Pavia, 248
Percussion, 19
Peregrinus, 404
Pergamos, 135, 385
Perineum, torn, 184
Persecutions, Christian, 4;
of Jews, 83
Persius, 4
Perugia, 248
Perugino, 360
Peter of Spain, 300
Petrarch, 306
Petrus de Argentaria, 290
Phagedenic ulcer, 35
Pharmacy, 207
Pharmacologist, 354
Phenicia, 314
Philip Augustus, 150
Philosopher's stone, 369, 412
Philosopher's keys, 376
Phrenitis, 43
Physicians and surgery, 267
Physiology, history of, 354, 414
Piacenza, 16, 232, 248
Pilcher, Dr. Lewis, 215, 216, 219, 229
Pinturicchio, 360
Pisa, 16, 248
Pitard, Jean, 265, 269
Plagiarism, medieval, 174
Plague, 305
Platearius I, 183
Plato, 267, 292
Pleurisy, 45
Pliny, 4, 113
Polyps, 31, 118, 258, 330;
nasal, 126, 258
Pool, 93
Pope Boniface VIII, 288
Pope Clement VI, 300
Pope Innocent VI, 300
Pope John XXI, 300, 357
Pope Urban V, 300
Popes and Jews, 80;
and science, 148
_Popular Science Monthly_, 400
Porphyry, 428
Portal, 304
Portio vaginalis hypertrophy, 37
Pouchet, 431
Practice, medical, 15
Preface, 230
Priscian, 180
Probe, 280
Professional spirit, 141
Professione Medicorum, 181
Prohibition of chemistry, 424
Prophylaxis, 47;
perineal, 185
Prudentius, 113
Pseudo-philology, 364
Psycho-analysis, 68
Ptolemy, 73, 384
"Puch der Natur," 275
Pulse, 19, 160
Pure Drug Law, 420
Puschmann, 41, 61, 144, 150
Pus, unnecessary, 255
=Q=
Quackery, 273
Quacks, 371
Quadrivium, 149
Quintilian, 4, 113
=R=
Rab, 69
Rabbi Ishmael, 66
Rabies, 30;
diagnosis of, 263, 435;
treatment, 262
Radio-active elements, 350
Radio-activity, 399
Radium, 350
Ragenifrid, 144
Ramsay, Sir William, 394, 417
Raphael, 360
Rebecca Guarna, 186
Reggio, 248
_Regimen Sanitatis_, 158
Regiomontanus, 360
Religion of healing, 25
Religious scruples, 224
Renaissance, 20, 142
Renan, 132, 314
Respiration rate, 342
Reuchlin, 361
Reynaud, M. Jean, 375
Rhazes, 59, 114, 170, 266, 323, 331;
aphorisms, 116
Richard Coeur de Lion, 98
Richard the Englishman, 276
_Rima glottidis_, 147
Robinson, Dr. Nathaniel, 390
Rodent ulcer, 35
Rogero, 237
Roland, 273
Rolando, 154, 238, 242
Romanes, 405
Roman Empire decadent, 5
Roman patronage, 2
Roman persecutions, 26
Rome, 248
Romoaldus, 134
_Rosa Angliæ_, 287
Roth, 288
Rudolph, 82
Ruggero, 237
Ruggiero, 146
Rules of life, 100
Rupertsberg, 192
Rutebeuf, 183
=S=
St. Benedict, 191
St. Brigid, 179
St. Dominic, 215
St. Gall, 433
St. Luke, 381, 382
St. Patrick, 179
St. Peter's Epistle, 398
St. Thomas of Aquin, 352
Saintsbury, 402
Sacrament, 164
Saladin, 90
Salerno, 11, 13, 78, 141, 236, 273
Salicet, 209, 247
Salvation, 25
Samarcand, 111
Sanctions of belief, 105
Sanitary science, 64
Santa Sophia, 10, 40
Saracenus, 171
Saragossa, 75
Scholarship, 136
Scholastica, 178, 191
Science, biological, 413;
popular medieval, 425;
medieval, 400
Scientia Experimentalis, 410
Scotus, 134
Scribonius Largus, 180
_Scrobiculus cordis_, 137
Sea sponge, 151
Semiotics, 159
Seneca, 4, 94, 113, 267
Serapion, 170
Servetus, 2
Seville, 75
Shakespeare, 82
Shawdepisse, 280
Shower bath, 172
Sidon, 314
Sienna, 248
Sighart, 413
Signorelli, 360
Silver Age, 13, 113
Sintheim, 344
Small-pox, 119
Snake bites, 263
Snare, 126
Socrates, 292, 429
Solomon, 98
Sozomen, 429
Spagyrist, 369
Spallanzani, 209
Spanish peninsula, 4
Speculum, 331
_Sphudron_, 386
Sprengel, 77
Standards of medical education, 420
Static experiments, 340
Steno, 366
_Studia generalia_, 203
Studies, post-graduate, 283
Superstitions, 21
Surgeon, as teacher, 261;
qualities of, 261, 305;
good, 268;
perfect, 268;
training of, 267
Surgery, aseptic, 245;
antiseptic, 255;
dishonor of, 424;
epoch of, 281;
Genito-urinary, 126, 234;
history of, 273;
of the mind, 270;
quality of, 305;
union in, 249, 260
Surgical, meddlesomeness, 300;
nursing, 271
Sydenham, 91
Sylvester II, 134
Sylvius, 2
Symmachus, 428
Synanche, 332
=T=
Taddeo Alderotti, 212, 215, 232
Talmud, 11, 63, 65, 94
Tarsus, 135
Tartar, 321
Tattooing, 31
Taxes, 298
Technique, Surgical, 125
Teleology, 27, 95
Tell's apple, 364
Tenaculum, 258, 330
Terence, 4, 190
Tertullian, 27
Testament, Old, 11
Thaddæus Florentinus, 130
Thecla, 180
Theodoret, 27
Theodoric, 245, 252, 267, 273, 429
Theodosia, 10, 181
Theodotos, 26
"Theology and Science," 419
Theophilus, 54, 55
"Thirteenth Greatest of Centuries," 433
Thomas Cantimprato, 433
Thompson, 358
Thorax, 295
Thymol, 50
Titian, 360
Toledo, 76, 170
Tonnerre Hospital, 296
Tonsils, 29
Tooth powder, 321;
replacement of, 322
Tornamira, 312
Toscanelli, 360
Toulouse, 286
Tours, 433
=U=
Ugo da Lucca, 251, 295
Ugo Senesis, 130
Ulcer, eroding, 256
Union by first intention, 254
_Universitas_, 203
Universities, ecclesiastical, 210;
medieval, 411
University of Bologna, 142;
of Paris, 887, 142, 199;
of Salerno, 142
University man, typical, 307
Urine, 19
Urination, difficulty of, 334
Uvula, 118, 259, 332;
removal of, 333
=V=
Valentine, 20, 349;
bibliography, 376
Valesco de Taranta, 312
Van Helmont, 365
Varices, 34
Varicose veins, 127
Varignana, 130
Varolius, 2, 209, 327
Vasari, 360
_Velum Palati_, 137
Venerable Bede, 432
Venesection, 104
Vercelli, 248
Verneuil, 303
Verney, Francis, 311
Verona, 248
Vesalius, 2, 120, 204, 209, 233, 289, 327
Vicenza, 16, 232, 248
Victoria, 180
Vigo, John De, 334
Villani, 313
Vincent of Beauvais, 433
Virchow, 297
Virgil, 4
Vitality, natural, 116
Volta, 209
Von Leyden, 336
=W=
"Warfare of Science and Religion," 434
Washington's hatchet, 364
Water clock, 341
Water in the ear, 48
Watering places, 47
Wenceslaus, Emperor, 424
Whewell, 410
White, Pres., 424
Wine for wounds, 187
William of Auvergne, 108
William of Briscia, 268
William of Salicet, 245, 256, 267
William the Conqueror, 145
Wimpheling, 361
Wives as nurses, 272
Women professors, 15
Women physicians, 177, 179
Wood hound, 435
Wounds, penetrating, 250;
adhesion, 253;
gunshot, 334;
of intestines, 250;
wine and oil, 387
Wurtz, 254
=Y=
Yahia Ben Masoviah, 74
Yard, 280
Yperman, 276
Ypres, 276
=Z=
Zedkias, 78
Zenobia, 109
Zoölogy, 418
* * * * *
Other Books by Dr. Walsh
FORDHAM UNIVERSITY PRESS SERIES
=MAKERS OF MODERN MEDICINE--A series of Biographies of the men to whom
we owe the important advances in the development of modern medicine. By
James J. Walsh, M.D., Ph.D., LL.D., Dean and Professor of the History of
Medicine at Fordham University School of Medicine, N.Y. Second Edition,
1909. 362 pp. Price, $2.00 net.=
_The London Lancet_ said: "The list is well chosen, and we have to
express gratitude for so convenient and agreeable a collection of
biographies, for which we might otherwise have to search through many
scattered books. The sketches are pleasantly written, interesting, and
well adapted to convey the thoughtful members of our profession just the
amount of historical knowledge that they would wish to obtain. We hope
that the book will find many readers."
_The New York Times_: "The book is intended primarily for students of
medicine, but laymen will find it not a little interesting."
_Il Morgagni_ (Italy): "Professor Walsh narrates important lives in
modern medicine with an easy style that makes his book delightful
reading. It certainly will give the young physician an excellent idea of
who made our modern medicine."
_The Lamp_: "This exceptionally interesting book is from the practiced
hand of Dr. James J. Walsh. It is a suggestive thought that all of the
great specialists portrayed were God-fearing men, men of faith, far
removed from the shallow materialism that frequently flaunts itself as
inherently worthy of extra consideration for its own sake."
_The Church Standard_ (_Protestant Episcopal_): "There is perhaps no
profession in which the lives of its leaders would make more fascinating
reading than that of medicine, and Dr. Walsh by his clever style and
sympathetic treatment by no means mars the interest which we might thus
expect."
_The New York Medical Journal_: "We welcome works of this kind; they are
evidence of the growth of culture within the medical profession, which
betokens that the time has come when our teachers have the leisure to
look backward to what has been accomplished."
_Science_: "The sketches are extremely entertaining and useful. Perhaps
the most striking thing is that every one of the men described was of
the Catholic faith, and the dominant idea is that great scientific work
is not incompatible with devout adherence to the tenets of the Catholic
religion."
=THE POPES AND SCIENCE--The story of the Papal Relations to Science
from the Middle Ages down to the Nineteenth Century. By James J. Walsh,
M.D., Ph.D., LL.D. 440 pp. Price, $2.00 net.=
PROF. PAGEL, Professor of History at the University of Berlin:
"This book represents the most serious contribution to the history of
medicine that has ever come out of America."
SIR CLIFFORD ALLBUTT, Regius Professor of Physic at the
University of Cambridge (England): "The book as a whole is a fair as
well as a scholarly argument."
_The Evening Post_ (New York) says: "However strong the reader's
prejudice ... he cannot lay down Prof. Walsh's volume without at least
conceding that the author has driven his pen hard and deep into the
'academic superstition' about Papal Opposition to science." In a
previous issue it had said: "We venture to prophesy that all who swear
by Dr. Andrew D. White's History of the Warfare of Science with Theology
in Christendom will find their hands full, if they attempt to answer Dr.
James J. Walsh's The Popes and Science."
_The Literary Digest_ said: "The book is well worth reading for its
extensive learning and the vigor of its style."
_The Southern Messenger_ says: "Books like this make it clear that it is
ignorance alone that makes people, even supposedly educated people,
still cling to the old calumnies."
_The Nation_ (New York) says: "The learned Fordham Physician has at
command an enormous mass of facts, and he orders them with logic, force
and literary ease. Prof. Walsh convicts his opponents of hasty
generalizing if not anti-clerical zeal."
_The Pittsburg Post_ says: "With the fair attitude of mind and
influenced only by the student's desire to procure knowledge, this book
becomes at once something to fascinate. On every page authoritative
facts confute the stereotyped statement of the purely theological
publications."
PROF. WELCH, of Johns Hopkins, quoting Martial, said: "It is
pleasant indeed to drink at the living fountain-heads of knowledge after
previously having had only the stagnant pools of second-hand authority."
PROF. PIERSOL, Professor of Anatomy at the University of
Pennsylvania, said: "I have been reading the book with the keenest
interest, for it indeed presents many subjects in what to me at least is
a new light. Every man of science looks to the beacon--truth--as his
guiding mark, and every opportunity to replace even time-honored
misconceptions by what is really the truth must be welcomed."
_The Independent_ (New York) said: "Dr. Walsh's books should be read in
connection with attacks upon the Popes in the matter of science by those
who want to get both sides."
=MAKERS OF ELECTRICITY--By Brother Potamian, F.C.S., Sc.D. (London),
Professor of Physics in Manhattan College, and James J. Walsh, M.D.,
Ph.D., Litt.D., Dean and Professor of the History of Medicine and of
Nervous Diseases at Fordham University School of Medicine, New York.
Fordham University Press, 110 West 74th Street. Illustrated. Price,
$2.00 net. Postage, 15 cents extra.=
_The Scientific American_: "One will find in this book very good
sketches of the lives of the great pioneers in Electricity, with a clear
presentation of how it was that these men came to make their fundamental
experiments, and how we now reach conclusions in Science that would have
been impossible until their work of revealing was done. The biographies
are those of Peregrinus, Columbus, Norman and Gilbert, Franklin and some
contemporaries, Galvini, Volta, Coulomb, Oersted, Ampére, Ohm, Faraday,
Clerk Maxwell, and Kelvin."
_The Boston Globe_: "The book is of surpassing interest."
_The New York Sun_: "The researches of Brother Potamian among the
pioneers in antiquity and the Middle Ages are perhaps more interesting
than Dr. Walsh's admirable summaries of the accomplishment of the heroes
of modern science. The book testifies to the excellence of Catholic
scholarship."
_The Evening Post_: "It is a matter of importance that the work and
lives of men like Gilbert, Franklin, Galvini, Volta, Ampére and others
should be made known to the students of Electricity, and this office has
been well fulfilled by the present authors. The book is no mere
compilation, but brings out many interesting and obscure facts,
especially about the earlier men."
_The Philadelphia Record_: "It is a glance at the whole field of
Electricity by men who are noted for the thoroughness of their research,
and it should be made accessible to every reader capable of taking a
serious interest in the wonderful phenomena of nature."
_Electrical World_: "Aside from the intrinsic interest of its matter,
the book is delightful to read owing to the graceful literary style
common to both authors. One not having the slightest acquaintance with
electrical science will find the book of absorbing interest as treating
in a human way and with literary art the life work of some of the
greatest men of modern times; and, moreover, in the course of his
reading he will incidentally obtain a sound knowledge of the main
principles upon which almost all present-day electrical development is
based. It is a shining example of how science can be popularized without
the slightest twisting of facts or distortion of perspective. Electrical
readers will find the book also a scholarly treatise on the evolution of
electrical science, and a most refreshing change from the 'engineering
English' of the typical technical writer."
=EDUCATION, HOW OLD THE NEW--A Series of Lectures and Addresses on
Phases of Education in the Past Which Anticipate Most of Our Modern
Advances, by James J. Walsh, M.D., Ph.D., Litt. D., K.C.St.G., Dean and
Professor of the History of Medicine and of Nervous Diseases at Fordham
University School of Medicine. Fordham University Press, 1910. 470 pp.
Price, $2.00 net. Postage, 15 cents extra.=
CARDINAL MORAN (Sydney, Australia): "I have to thank you for
the excellent volume 'Education, How Old the New.' The lectures are
admirable, just the sort of reading we want for English readers of the
present day."
_New York Sun_: "It is all bright and witty and based on deep
erudition."
_The North American_ (Philadelphia): "Wide historical research, clear
graphic statement are salient elements of this interesting and
suggestive addition to the modern welter of educational literature."
_Detroit Free Press_: "Full of interesting facts and parallels drawn
from them that afford much material for reflection."
_Chicago Inter-Ocean_: "Incidentally it does away with a number of
popular misconceptions as to education in the Middle Ages and as to
education in the Latin-American countries at a somewhat later time. The
book is written in a straight, unpretentious and interesting style."
_Wilkes-Barre Record_: "The volume is most interesting and shows deep
research bearing the marks of the indefatigable student."
_Pittsburg Post_: "There is no bitterness of controversy and one of the
first things to strike the reader is that the dean of Fordham quotes
from nearly everybody worth while, Protestant or Catholic, poetry,
biography, history, science or what not."
_The Wall Street News_ (New York): "The book is calculated to cause a
healthy reduction in the conceit which each generation enjoys at the
expense of that which preceded it."
_Rochester Post Express_: "The book is well worth reading."
_The New Orleans Democrat_: "The book makes very interesting reading,
but there is a succession of shocks in store in it for the complacent
New Englander or Bostonian and for the orthodox or perfunctory reader of
American literature."
=CATHOLIC SUMMER SCHOOL PRESS SERIES=
The highest value attaches to historical research on the lines you so
ably indicate, especially at the present time, when the enemies of Holy
Church are making renewed efforts to show her antagonism to science and
human progress generally. I shall have much pleasure in perusing your
work entitled "The Thirteenth Greatest of Centuries."
Wishing you every blessing, I am, Yours sincerely in Xt.,
R. Card. MERRY DEL VAL.
Rome, January 18th, 1908.
Jas. J. Walsh, Esq., New York.
=THE THIRTEENTH GREATEST OF CENTURIES--By James J. Walsh, M.D., Ph.D.,
Litt.D., Dean and Professor of Nervous Diseases and of the History of
Medicine at Fordham University School of Medicine; Professor of
Physiological Psychology at Cathedral College, New York. Catholic Summer
School Press, 110 West 74th Street, N.Y., Georgetown University Edition.
Over 100 additional illustrations and twenty-six chapters that might
have been, nearly 600 pages. Price, $3.50, post free.=
PROF. WILLIAM OSLER, of Oxford, delivering the Linacre Lecture
before the University of Cambridge, said: "That good son of the Church
and of the profession, Dr. James J. Walsh, has recently published a
charming book on The Thirteenth as the Greatest of Centuries. He makes a
very good case for what is called the First Renaissance."
_The Saturday Review_ (of London): "The volume contains a mass of
interesting facts that will start a train of profitable thought in many
readers' minds."
_The Educational Review_ said: "The title of Dr. Walsh's book, The
Thirteenth Greatest of Centuries, will startle many readers, but we
respectfully commend to the open-minded his presentation of that great
epoch. A century that witnessed such extraordinary achievements in
architecture, in arts and crafts, in education, and in literature and
law, as did the Thirteenth, is not to be lightly dismissed or
unfavorably compared with periods nearer our own."
_The Pittsburg Post_ said: "Dr. Walsh writes infused with all the
learning of the past, enthusiastic in modern research, and sympathetic,
in true scholarly style, with investigation in every line. One need only
run over a few of the topical headings to feel how plausible the thesis
is. The assemblage of the facts and the elucidation of their mutual
relations by Dr. Walsh shows the master's skill. The work bristles on
every page with facts that may be familiar to many, but which were never
before so arranged in just perspective with their convincing force so
clearly shown."
CARDINAL MORAN, of Sydney, Australia: "Just the sort of
literature we want for English readers at the present day."
BY THE SAME AUTHOR
FORDHAM UNIVERSITY PRESS SERIES
MAKERS OF MODERN MEDICINE
Lives of the men to whom nineteenth century medical science
owes most. Second Edition. New York, 1910. $2.00 net.
THE POPES AND SCIENCE
The story of Papal patronage of the sciences and especially
medicine. 45th thousand. New York, 1911. $2.00 net.
MAKERS OF ELECTRICITY
Lives of the men to whom important advances in electricity
are due. In collaboration with Brother Potamian, F.S.C.,
Sc.D. (London), Professor of Physics at Manhattan College.
New York, 1909. $2.00 net.
EDUCATION, HOW OLD THE NEW
Addresses in the history of education on various occasions.
3rd thousand. New York, 1911. $2.00 net.
_IN PREPARATION_
MAKERS OF ASTRONOMY
PROBLEMS OLD AND NEW IN EDUCATION
THE THIRTEENTH GREATEST OF CENTURIES
Georgetown University edition. 5th thousand. 116 illustrations,
nearly 600 pages. Catholic Summer School Press, New
York, 1911. Postpaid, $3.50.
THE DOLPHIN PRESS SERIES
CATHOLIC CHURCHMEN IN SCIENCE
First and second series, each $1.00 net.
_IN COLLABORATION_
ESSAYS IN PASTORAL MEDICINE
O'MALLEY AND WALSH
A manual of information on medical subjects for the clergy,
religious superiors, superintendents of hospitals, nurses and charity
workers. Longmans, New York, 1911. $2.50 net.
TRANSCRIBER'S NOTES
The list of the works by the same author has been moved from the beginning
to the end of the book.
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