PART II

MEDIAEVAL MEDICINE

CHAPTER XVII

THE CONDITION OF MEDICINE AT BYZANTIUM DURING THE

EARLY PART OF THE MIDDLE AGES

The Byzantine period of the history of medicine begins about the middle

of the fourth century A. D. and retains some degree of importance up to

or perhaps a little beyond the beginning of the eighth century. During

this period of nearly four centuries there appeared on the scene five

physicians whose writings form a very creditable part of the late Greek

medical literature. The names of these authors are: Oribasius, Aëtius,

Alexander of Tralles, Theodore Priscianus and Paulus Aegineta.

_Oribasius._--The first physician named in this list, Oribasius,

was born about the year 325 A. D. in Pergamum, an important city

of Asia Minor and the birthplace of Galen. He received his medical

training at Alexandria, settled in Constantinople (the new name given

to Byzantium), and soon afterward became the personal physician of

the Emperor Julian the Apostate, the nephew of Constantine the Great.

Subsequently he was appointed Quaestor of Constantinople, but, upon

the death of Julian (363 A. D.) and the accession of Valens and

Valentinianus to power, his property was confiscated and he himself was

obliged to take refuge among the Ostrogoths, who dwelt on the shores of

the Black Sea. These people received him with open arms, and he soon

acquired great influence among them. After a time, however, he was

recalled to Constantinople and all his former privileges were once more

granted to him. He died about the year 403 A. D.

Despite his duties as a practicing physician of the very highest

rank--duties which he could not wholly set aside when he accepted the

office of Quaestor of Constantinople--and despite the necessity of

devoting considerable time to the work which this non-medical official

position entailed, Oribasius, like Pliny, appears to have been a most

energetic contributor to medical literature. We possess to-day, for

example, a large part of the medical cyclopaedia (72 books) which he

prepared at the command of the Emperor Julian, and which--even in its

incomplete state--contains very full information regarding anatomy,

physiology, surgery, pathology and pharmacology. Although the work

is simply a compilation, its present value is great, for it contains

numerous extracts from earlier and contemporary treatises, many of

which have entirely disappeared,--treatises of which we should have had

no knowledge whatever if Oribasius had not introduced numerous extracts

from them into his cyclopaedia.

About the year 390 A. D., when Oribasius was already an old man, he

published (in nine books) a “Synopsis” of the larger work, chiefly

for the benefit of his son Eustathios, who was at that time studying

medicine. Surgery is omitted from this work, as that branch of medicine

was assumed to belong entirely to specialists. At a still later date

(about 395 A. D.), Oribasius published a third work (in four books)

entitled “Euporista,” which was intended chiefly for the use of

laymen. The subject-matter of this treatise consists of diet, hygiene

and general therapeutics. Neuburger speaks well of all three of the

published works of Oribasius, and furnishes a fairly full analysis of

the contents of each one.

Bussemaker and Daremberg have published, in six volumes (Paris,

1856–1876), an excellent French version of the works of Oribasius.

_Priscianus._--Theodorus Priscianus lived during the latter part

of the fourth and the first part of the fifth century of the present

era. Very little is known about his professional career beyond the

facts that he was a pupil of Vindicianus, a distinguished physician

who lived during the reign of the Emperor Valentinianus I. at

Constantinople (364–375 A. D.), and that subsequently he was chosen

the private physician of the Emperor Gratianus (375–383 A. D.). The

treatise which he composed, and which bore the title of “Euporiston,”

was originally written in Greek, but was afterward translated by

its author into Latin. An excellent German version of the work by

Meyer-Steineg was published in Jena in 1909. As the book was intended

by Priscianus to serve chiefly as a guide to practitioners of the

art, it contains practically nothing about anatomy and physiology.

In his pathology he follows closely the teachings of the Methodists;

his first question, in the presence of a case of illness, being: “Do

the symptoms point to a condition of _strictum_ rather than to

one of _laxum_, or _vice versa_?” “In his treatment,” says

Meyer-Steineg, “Priscianus follows very closely the rule that every

patient, no matter what may be the disease with which he is affected,

should first undergo a certain amount of general treatment.” In his

choice of remedies Priscianus invariably gives the preference to those

agents which are of a simple character and easy to obtain. On the other

hand, he does not hesitate to admit that he sometimes employs certain

magical remedies, as is shown by the following quotation taken from

Book IV., Chapter I., section 4:--

If a person wears, during the waning of the moon, a wreath

of polygonum on his head, he will obtain relief from his

headache.... If one drinks of the water from which an ox has

just drank, he will be relieved of the pain in his head.... If

a loadstone be held upon the head it will draw out the hidden

pain, and the same effect may be obtained by rubbing over the

forehead a swallow’s nest thoroughly mixed with vinegar.

In Book I, paragraph 2, Priscianus draws a picture of the rude

and uncivilized behavior of the practitioners of his day in the

sick-room. The following are his words as translated from the German of

Meyer-Steineg:--

As the patient lies on his bed prostrated by the severity of

the disease, there quickly comes into the room a crowd of us

physicians. No feeling of sympathy for the sick man have we,

nor do we realize how impotent we all are in the presence of

these forces of nature. Instead, we struggle to the utmost of

our ability to obtain charge of the case; one depending for

success on his powers of persuasion, a second on the strength

of the arguments which he is able to bring forward, a third on

his readiness to agree with everything that is said, and the

fourth on his skill in contradicting the opinion of everybody

else. And, as this quarrel goes on, the patient continues to lie

there in a state of exhaustion. “For shame!” Nature seems to

say, “you men are an ungrateful lot! You do not even permit the

patient to die quietly; you simply kill him. And then, moreover,

you accuse me of not furnishing sufficient means of effecting a

cure. Illness is certainly a painful affair, but I have provided

plenty of remedies. Poisons, I admit, are hidden in some of the

plants, but the healing agents which may be extracted from them

are much more numerous. Away, then, with your angry disputes and

your self-glorifying chatter; for in these are not to be found

the remedial agents which I have bestowed upon man, but rather

in the powerful forces which reside in the seeds, fruits, plants

and other objects which I have created in his interests.”

_Aëtius._--Aëtius was a native of Amida, in Mesopotamia, and

he lived during the early part of the sixth century A. D., under

the Emperor Justinian I. He studied medicine at Alexandria and then

settled in Constantinople, where he was appointed to the double office

of private physician to the emperor and commanding officer of his

body-guard (_Comes obsequii_),--an arrangement which made it

practicable for the emperor to have his physician near his person on

all possible occasions. Almost nothing is known about the subsequent

private life and professional career of Aëtius beyond the facts that

he was a Christian and that he wrote a treatise on medicine in sixteen

books, which together form a large volume. The work, says Le Clerc, is

almost entirely a compilation from the treatises of earlier writers

on medicine and surgery; the best parts of the book being those which

relate to the pathology and treatment of internal diseases, to materia

medica, and to ophthalmology. The Christianity of Aëtius, like that of

Alexander of Tralles, and other physicians of a later period, appears

to have permitted a belief in magical remedies. For example, Aëtius

gives formulae containing the names of the Saviour and the Holy Martyrs

for exorcising certain maladies, and he recommends the employment of

amulets. The subject of baths is treated by him quite thoroughly, and

he lays stress upon the importance of physical exercise as a means of

maintaining one’s health. Freind, the author of an English history of

medicine which was very popular in its day,[44] quotes the following

remedy for gout from the treatise of Aëtius:--

In September to drink milk;

in October to eat garlick;

in November to abstain from bathing;

in December not to eat cabbage;

in January to take a glass of pure wine in the morning;

in February to eat no beet;

in March to mix sweet things both in eatables and drinkables;

in April not to eat horseradish;

nor in May the fish called Polypus;

in June to drink cold water;--and so on through the remainder of

the year.

At the end of the French version of “_Les Oeuvres de Rufus

d’Éphèse_” (translated from the Greek by Daremberg and Ruelle)

will be found fragments of some of the books of Aëtius; in 1899 J.

Hirschberg translated into German Book VII. (eye diseases) of the

same author; and, two years later (1901) Max Wegscheider published a

German version of Book XVI. (obstetrics and gynaecology). No other

translations of the writings of Aëtius into either French, German or

English are--so far as I am able to learn--available.

_Alexander of Tralles._--Alexander of Tralles, a city of Lydia,

in Asia Minor, was born about 525 A. D. His father Stephanus was

highly esteemed as a practicing physician, and his four brothers,

all of them older than himself, were men of distinction in their

several callings; Anthemius, the oldest, being one of the greatest

mathematicians and mechanicians of his day and the man to whom the

Emperor Justinian intrusted the rebuilding of the church of St.

Sophia in Constantinople;[45] Metrodorus, a celebrated grammarian and

the honored teacher of the youth belonging to the highest circles

of that metropolis; Olympius, a leading authority in jurisprudence;

and Dioscorus, a prominent physician in his native city. Alexander

received his first instruction in medicine from his father, but he

obtained his real training from a physician who was the father of his

most intimate friend Cosmas, and who, throughout Alexander’s entire

subsequent career, proved most helpful in advancing his interests. At

first he traveled extensively, visiting in succession--probably in

the capacity of a military surgeon--Italy, Northern Africa, Gaul and

Spain. Afterward, he settled permanently at Rome and practiced medicine

there during the remainder of a long life. Puschmann, the translator

of his writings, seems disposed to believe that he was both a teacher

and a practitioner of medicine during his residence in that city. When

he became too old to bear the heavy burdens of medical practice, he

wrote an account of his life,--a life which was rich in professional

experience,--and thus built for himself “a monument more striking and

more durable than the splendid temple erected by his eldest brother.”

(Meyer, quoted by Puschmann.)

Various circumstances justify the conclusion that Alexander of Tralles

was a Christian. His style of writing is simple and direct, and he

states his views with a degree of modesty which wins for him at once

the sympathy and confidence of his readers. He gives full and generous

recognition to the great physicians who lived and wrote before his

time, and more especially to Hippocrates. On the other hand, he does

not hesitate, when he believes that he is right, to put forward views

which are in direct antagonism with those of even so great an authority

as Galen. In the domain of therapeutics, says Puschmann, Alexander was

decidedly superior to Galen. His teachings are based on experience

gained in actual practice, whereas Galen was very often disposed to

trust to considerations of a theoretical nature; for he was chiefly

interested in establishing the pathology of the different diseases and

in opening up new territories in medicine in which the human mind might

display its activity.

The twelve books of which the treatise of Alexander of Tralles

consists, were printed in the original Greek for the first time in

1548, by Robert Étienne, the celebrated printer of Francis I., King of

France. The last and most perfect edition of the Greek text is that

of the late Dr. Theodore Puschmann, which was published in Vienna

in 1878 (two Vols.). It contains, in addition to the Greek version,

a careful analysis of the twelve individual books, and an admirable

German translation of the entire work. It is from the latter that the

following brief extracts (translated into English) are taken:--

_Introduction to the writings of Alexander of

Tralles._--Upon a certain occasion, my dearest Cosmas, thou

didst urge me to publish my rich experiences in the domain of

practical medicine, and I am now gladly complying with thy wish,

for I feel under deep obligations to both thyself and thy father

for the kindness which you have shown to me on every possible

occasion in the past. Thy father was always a most helpful

patron to me, not only in my practice, but also in all other

relations of life. And thou also, even when thou wert living

abroad, stood staunchly by me through all the trials which I

experienced and the severe blows dealt me by Fate. For these

reasons I will now in my old age, when it is no longer possible

for me to endure the labor and worries of practice, do as thou

desirest, and will write a book in which shall be set forth the

experience which I have gained during my long service in the

treatment of disease. I hope that many of those who read what

is here written, with minds free from jealousy, will experience

real pleasure in noting the well-founded and scientific

character of the rules which I have laid down and the brevity

and preciseness of my descriptions. For I have done my very best

always to employ simple words, in order that everybody may find

it easy to understand my book.

_Some Magical Remedies or Amulets Recommended by Alexander

of Tralles, as Effective in the Treatment of Colic._--The

Thracians remove the heart from a lark while the bird is still

alive, and wear it, prepared as an amulet, on the left thigh.

Procure a little of the dung of a wolf, preferably some which

contains small bits of bone, and pack it in a tube which the

patient may easily wear as an amulet on his right arm, thigh, or

hip during the attack. He must be very careful, however, not to

allow the parts around the seat of the pain to come in contact

with the earth or with the water of a bath. This amulet is, in

my experience, an unfailing remedy, and almost all physicians of

any celebrity have commended its virtues.

Remove the nipple-like projection from the caecum of a young

pig, mix myrrh with it, wrap it in the skin of a wolf or dog,

and instruct the patient to wear it as an amulet during the

waning of the moon. Striking effects may be looked for from this

remedy.

Let the design of Hercules throttling a lion be engraved upon a

Median stone, and then instruct the patient to wear it on his

finger after it has been properly set in a ring of gold.

Take an iron ring and have the hoop made eight-sided. Then

engrave upon the eighth side these words: “Flee, flee, oh

Gaul! the lark has sought thee out.” On the under surface of

the head or seal of the ring engrave the letters J. C., thus:

[illustration] I have often made use of this amulet; and, while

I should consider it wrong to keep silence about a remedial

agent of such extraordinary efficacy in cases of colic, I

feel bound to say that it should not be recommended to the

first comer, but only to believers and to those individuals

who know how to guard it carefully. The Great Hippocrates,

with remarkable insight, gave the advice that things which are

holy should be intrusted only to those who are of a religious

character, and should be withheld from the profane. As regards

the ring, however, the patient must be careful, before wearing

it, to have a sketch made of it on either the seventeenth or the

twenty-first day of the moon.

Alexander has been severely criticised for his advocacy of the

employment of amulets in the treatment of diseases; but he defends

himself against such criticism by saying that physicians owe it as a

duty to their patients to study carefully what he calls the hidden

forces of nature, and to pay unprejudiced attention to the effects

produced by amulets and other magical remedies. He reminds his critics

that Galen and other eminent medical authorities have insisted that

a place be given to this class of agents in the list of authorized

remedies; and he adds that Galen further emphasizes the duty of the

physician to employ them when other measures fail, or when the patients

themselves frankly confess that they have faith in their efficacy and

therefore wish them to be tried. Alexander also makes the statement

that Galen, after treating for a long time all reports about the

beneficial results obtained from the employment of magical measures

as old women’s tales, had finally decided that these benefits were at

times marvelous and should be accepted as genuine by physicians even if

they are unable to explain them.

How much Alexander of Tralles really believed in these supernatural

agents, or to what extent he relied upon their effect in influencing

the imagination, we may not know; but his was an age of superstition,

and the conditions governing society at that time were very different

from those which control the world at the present day.

_Paulus Aegineta._--Paulus Aegineta[46] was born in the Island of

Aegina, not far from Athens, in the early part of the seventh century

A. D., and practiced medicine in Alexandria, Egypt. He is known to us

as the author of a compend of medicine which was very popular during

a long period of time, especially among the Arabs, who, as early as

two hundred years after his death, translated his work from the Greek

into their own language. At a still later period it was also translated

into Latin, the two best versions in this language which we now possess

being those of Guintherus Andernacus (Paris, 1532) and of J. Cornarius

(Basel, 1556). There is also an English translation by F. Adams (“The

Seven Books of Paulus Aegineta,” London, 1845–1847), which is favorably

spoken of by Neuburger, and which is apparently at the present time

the only existing version of the work of Paulus of Aegina in a modern

European language; for the French translation by René Briau (“_La

Chirurgie de Paul d’Égine_,” Paris, 1855) comprises only Book VI.

The contents of the entire work are as follows: _Book

I._--Dietetics of Pregnant Women and of Children; Children’s

Diseases; Massage, Gymnastics, Sexual Hygiene, Bathing, etc.; _Book

II._--General Pathology, the Doctrine of Fevers, Semeiology; _Book

III._--Diseases of the Hair, Diseases of the Brain and Nerves,

Diseases of the Eyes, Ears, Nose, Mouth, Teeth and Face; _Book

IV._--Leprosy, Skin Diseases, Inflammations, Swellings, Tumors,

Wounds, Ulcers, Fistulae, Hemorrhage, Worms, Affections of the Joints,

etc.; _Book V._--Toxicology; _Book VI._--Surgery; _Book

VII._--Materia Medica.

To furnish even a very superficial analysis of the contents of this

treatise would call for more space than can well be given up here

to such a purpose. I shall therefore simply mention a few points of

special interest to which Neuburger calls attention in the course

of his very full analysis of the work. He states, for example, that

Paulus mentions several instances in which patients affected with lung

disease, coughed up calculi or small stone-like masses. He also states

that the same author was familiar with the fact that in the course of

“phthisis,” the pus may find its way into the bladder and there cause

ulceration [in other words, that pus containing tubercle baccilli

may flow down by way of the ureters and cause tuberculous ulceration

of the bladder]. Paulus’ theory regarding the origin of gout, adds

Neuburger, is quite remarkable for that early period. He maintains, for

example, that in persons who lead a rather inactive life and who are

often affected with digestive disorders, there is produced, through the

inadequate power of the tissues of the body to assimilate the excess

of nutriment brought to them, a _materies morbi_ which is drawn

first to the parts that are weakest or least capable of resistance (the

joints, for example) and then also to other structures, as the liver,

spleen, throat, ears and teeth. These ideas--let it be remembered--were

set down in writing in 650 A. D.

At the beginning of his analysis of Book VI., Neuburger makes this

remark: “Although the description given by Paulus of the surgery of

the ancients is based upon the writings of Hippocrates and Galen, as

well as upon those of Leonides, Soranus and Antyllus, one finds at

every step ample evidence that the writer possessed both independence

of judgment and the manual skill which belongs to a physician who is

familiar with surgical work.” He calls particular attention to the

section (No. 88) which deals with the manner of removing the heads of

arrows from wounds, and he gives special praise to Paulus for his most

instructive account of the diagnostic signs to be looked for in a case

of suspected wounding of a vital organ. He is extremely thorough, says

Neuburger, in his teachings about fractures and dislocations, and he

not infrequently differs from the views expressed by his predecessors.

In the section devoted to gynaecological operations Paulus makes it

perfectly clear that he was in the habit of using a speculum of a very

practical form. Here are his words:--

... and, while the operator is holding the instrument in

position, an assistant turns the screw until the blades of the

instrument have been separated to the distance desired.

In other chapters of Book VI., Paulus furnishes most interesting and

minute descriptions of a great variety of operations in general surgery

and also in obstetrics, ophthalmology, otology and rhinology. Those who

desire to learn further details about these surgical matters should

consult the English version mentioned on a previous page.

It is not at all unlikely that at some future day it will be found

desirable--by reason of the discovery of the treatises which they

are known to have written, but which have been lost--to add to this

short list of ancient medical authors the names of the following men

who are frequently quoted by them in their works: Antyllus, who made

some really valuable additions to our knowledge of the proper manner

of treating aneurysms, and who must have been a surgeon of great

resourcefulness; Leonides, the Alexandrian, who lived about the time of

Galen, and who appears to have been highly considered for his practical

common sense in the choice of surgical measures; Hesychios of Byzantium

and his distinguished son, Jacobus Psychrestus, who was highly spoken

of by his contemporaries (fifth century A. D.), in whose honor a

public statue was erected (Haller), and to whom is attributed the

saying: “A good physician should either decline at the start to take

charge of a patient, or else he should not leave him until he shall

have brought about some measure of improvement”; finally, Heliodorus,

and perhaps a few others who are less well known.

CHAPTER XVIII

BEGINNING OF THE ARAB RENAISSANCE UNDER THE CALIPHS OF BAGDAD

Toward the end of the sixth century A. D. the prospects for the

perpetuation and further evolution of Greek medicine looked decidedly

dark. In Rome and in the larger Italian towns of the Roman Empire,

physicians were doubtless still to be found, but they must have led

very precarious lives and they certainly could not have had any leisure

or opportunity for scientific work. In these earlier years of the

Middle Ages the monks conducted the larger part of whatever medical

practice was required in the districts in which the monasteries were

located. In Byzantium, also, the outlook at this period of Roman

history was very unfavorable; and nowhere else, as a matter of fact,

would it have been possible for the casual observer to discover any

signs that indicated the approach of a revival in the study of the

sciences. And yet, even at that seemingly darkest moment in the history

of medicine, there were forces at work which would soon revive these

precious seeds of Greek knowledge, and, after transplanting them to

a richer soil, cause them to produce even better fruit and in larger

quantities than ever before.

The rulers under whose auspices the first steps in the great Arab

Renaissance were taken, belonged to what is known as the Abbaside

Dynasty, the founder of which was Abbas (566–652 A. D.), the uncle of

Mohammed. His descendants ruled as Caliphs of Bagdad, on the eastern

bank of the Tigris, for many centuries (from 750 A. D. onward).[47]

Almansur, the second Caliph of this dynasty, felt a very strong desire

that his people, the Arabs, should acquire knowledge of all the useful

branches of learning, and more especially of medicine and philosophy;

and accordingly, as the Greeks were then universally admitted to be

the only nation which possessed that knowledge, and as scarcely any

scientific books written in the Arabic language existed at that early

date, he directed all his efforts to the finding of Greek originals and

of the men qualified to translate them into Arabic. Already as early

as the sixth century A. D., Sergius, a Christian of Ras el Ain, had

translated a considerable number of Greek treatises into the Syrian

tongue, but his work was found to be of an inferior character, and for

this reason could not be utilized to any great extent in the present

undertaking. Honein (ninth century), one of the most eminent scholars

of the Arabic Renaissance, revised a few of these translations and

thus rendered them of some service; but by far the larger part of this

gigantic task of creating Arabic versions of the classical works of

Greek literature, was performed during the ninth century, a period

during which the reign of the Arabs extended from the Ganges on the

east to the Atlantic on the west. By the end of the eighth century

the work of translating had advanced only to the point of producing a

single treatise on medicine and a few relating to alchemy; but before

the ninth was completed, the Arabs had in their possession, in the form

of translations, nearly all the scientific literature of Greece, and,

more than this, they could boast that not a few men belonging to their

own nation had already become celebrated as scientists of the very

first rank.

The medical school at Djondisabour[48] at the time (765 A. D.) when

the Caliph Almansur decided to carry out the ambitious scheme which

he had been meditating, was practically under the control of a family

of Nestorian Christians. A large hospital formed the nucleus of the

institution and furnished all the material needed for familiarizing the

student with the different diseases and injuries commonly encountered

in that part of the world and with the methods of treatment which, as

long experience had shown, offered the best chances of affording relief

or effecting a cure. It was a clinical school of a most practical type,

and at the head of it was George Bakhtichou, who had been recommended

to Almansur as the physician best fitted to take responsible charge of

the new work which was then about to begin. George Bakhtichou was not

the organizer of the school at Djondisabour, but simply its head at

the time of which I am now speaking. Medicine had been taught there,

it appears, since the early part of the seventh century A. D. The

languages commonly spoken in that town were the Syrian, the Arabian

and the Persian, and probably only a few persons understood Greek. The

Caliph believed that, as the first and most important step in the new

work, medical text books, translations of the works of the best Greek

physicians, should be provided with as little loss of time as possible,

and George Bakhtichou agreed with this opinion entirely. The latter,

therefore, upon the urgent invitation of the Caliph, left the hospital

at Djondisabour in the charge of his son, Bakhtichou ben Djordis, and

went to Bagdad in company with two of his pupils, Ibrahim and Issa ben

Chalata. He was well received at Court, partly because he displayed a

readiness to further the Caliph’s educational plans, and partly also

because he was promptly successful in relieving him of a distressing

dyspepsia. Not long after he had arrived in Bagdad, however, he was

himself taken ill and was obliged to return to Djondisabour. Before

his departure the Caliph presented him with a gift of 10,000 pieces of

gold. Issa ben Chalata, one of the two pupils whom George Bakhtichou

had brought with him to Bagdad, was left behind to look after the

Caliph’s health. He proved faithless to his trust, however; and, as

soon as it was discovered that he was selling his supposed influence

with the Caliph, he was not only dismissed in disgrace but all his

property was confiscated. After this disagreeable experience the Caliph

did his best to induce George to return to Court, but the latter was

then unable to travel, owing to the injuries which he had received

from an accidental fall. His pupil Ibrahim went to Bagdad in his place.

It is known that George Bakhtichou personally took an active part in

the work of translating Greek medical treatises into Arabic, but it has

not yet been ascertained which books in particular were assigned to his

care in the distribution of the different tasks. Ossaibiah, the Arabian

historian, makes the statement that the work of translating Greek

medical treatises was entirely under the control and guidance of George

Bakhtichou; and in the “Continens” of Rhazes frequent mention is made

of the latter’s name. All of which confirms the belief that, at the

beginning of the Arabic Renaissance, George Bakhtichou was in reality

the head and front of the movement, so far at least as medicine was

concerned. When he became too old and infirm to continue his attendance

at the Djondisabour hospital, he intrusted the management of that

institution to Issa ben Thaherbakht, who was one of his best pupils. He

died in 771 A. D.

In 786 A. D., Haroun Alraschid succeeded to the caliphate; and not long

afterward, on the occasion of some temporary illness, he requested

Bakhtichou ben Djordis, the son of George and his successor in the work

of translating from the Greek, to consult with the regularly appointed

physicians of the Court in regard to the nature and proper treatment of

his malady. The consultation took place at the appointed time, and one

of the Caliph’s physicians, thinking that he might catch Bakhtichou in

a trap, submitted to him a specimen of urine which purported to come

from the Caliph, but which in reality had been obtained from a beast of

burden. Alraschid, who knew of the deception, asked:--

“What remedy would you administer to the person from whom this urine

came?”

Bakhtichou, who had been clever enough to recognize the true character

of the specimen, replied promptly: “Some oats, your Majesty.”

The Caliph laughed heartily over the episode, loaded George’s son

with presents, and appointed him the chief of all his physicians,--the

first instance among the Arabians, it is said, of the appointment of an

Archiater.

Bakhtichou ben Djordis was the author of a collection of short medical

treatises, and he also wrote, for the special use of his son Gabriel, a

medical “remembrancer.” He was as highly esteemed by the Arabs as his

father had been before him. The date of his death is not known.

Gabriel, the son of Bakhtichou and a grandson of the famous George

Bakhtichou, was the most distinguished member of this remarkable

family of physicians. In the year 792 A. D., five years after the

consultation mentioned above had taken place, Gabriel was sent by his

father to give medical advice to Jafar, the son of the Grand Vizier.

The treatment which he recommended proved to be entirely successful,

and, pleased with the result, Jafar soon afterward had an opportunity

to speak to Haroun Alraschid of Gabriel as the physician best fitted to

effect a cure in the case of his own favorite wife, who, in a fit of

yawning, had dislocated her shoulder. The Arabian physician had tried

friction, different sorts of ointments, and manipulations of every

imaginable kind, but all in vain. The dislocation still persisted.

When Gabriel arrived on the scene he told the Caliph that he could

bring the shoulder back into place provided no offense would be taken

at the means which he was about to employ. Alraschid gave the desired

promise and Gabriel made a movement as if he were about to lift up the

bedclothes. Instantly the patient, through a natural sense of modesty,

stretched out her dislocated arm to keep the bed-covering in place.

“There! she is cured!” exclaimed Gabriel, and such indeed was the

truth. The sudden movement of the limb had reduced the dislocation.--It

only remains for me to add that the sum of 500,000 drachmae[49] was

paid to Gabriel by Haroun Alraschid for his successful treatment.

Some surprise having been expressed by the Caliph’s relatives that

he should display such extravagant generosity toward a Christian, he

replied: “The fate of the empire is bound up in my fate, and my life is

in the hands of Gabriel.”

Gabriel Bakhtichou died in the early part of the ninth century, not

long after the Caliph El Mâmoun had started on his expedition against

the Greeks (828 A. D.). He was the author of several medical treatises,

and, like his famous grandfather, George Bakhtichou, he did everything

in his power to promote the work of translating from the Greek

into the Arabic. Gabriel’s brother, also named George, and his son

Bakhtichou ben Djabriel were both of them physicians of considerable

distinction. The latter accompanied El Mâmoun on his expedition against

the Greeks. It is a fact worth noting here, that throughout this war

the Caliph never for a moment lost sight of the great national scheme

of education which his predecessor Almansur had inaugurated and which

was still engaging the time and best efforts of many scholars and

copyists in Bagdad. Whenever he captured a city he insisted upon the

delivery to him of whatever copies of scientific treatises its citizens

might possess. But even these extraordinary methods of securing the

books which they needed did not satisfy the Arabs, their eagerness

to accumulate as many text books as possible being insatiable.

Accordingly, from time to time, one of the translators--some member

of the Bakhtichou family, for example--would be sent to the different

cities of Syria and Persia to search out and get possession of as

many Greek manuscripts as possible. Thus, Honein is reported to have

said: “I have not been able to procure a complete copy of Galen’s

‘Demonstration.’ Gabriel endeavored to find a copy, but did not

succeed; and I myself hunted through Irak, Syria, Palestine and Egypt,

but was at last only partially successful. I found one-half of the text

in Damascus.”

The work of translation was kept up with unremitting zeal until the

middle of the ninth century (reigns of El Ouatocq and of Moutaouakkel).

Among the physicians who received their training at the Djondisabour

medical school the Bakhtichous were not the only ones who attained

considerable distinction. John Mesué the Elder,[50] for example,

who was a Nestorian Christian and the son of an apothecary, became

more famous than any member of that family. He not only did his full

share of the translating, but he was also a prolific author and a

very faithful and efficient teacher, Galen’s writings furnishing the

basis of his lectures. He lived to be about eighty years of age, his

death occurring in 857 A. D. Most of his writings have been lost. Of

the twenty or more which have come down to our time those bearing the

following titles deserve to receive special mention:--

Book of Fevers.

On the Different kinds of Food and Drink.

On Venesection and Scarifications.

On Tubercular Leprosy.

On Abnormal Prominence of the Abdomen.

On Purgative Remedies.

On Baths.

On the Regulation of Diet.

On Poisons and Poisoning.

On Vertigo.

On the Treatment of Sterility.

On Dentifrices and Gargles.

Sabour ben Sahl, whose death occurred in 869 A. D., was also connected

with the hospital at Djondisabour. He was distinguished on account

of his special knowledge of the properties of simple drugs and their

combinations. He was also the author of the exhaustive formulary

known as _Acrabadin Kebir_--probably the first one of its kind,

says Le Clerc, of which history makes any mention. This formulary or

dispensatory--of which a large and a small edition existed--was in

general use in all the hospitals, physicians’ offices, etc., of that

time.

Still another most distinguished physician and author of medical

treatises received his training at the Djondisabour school--viz.,

John, son of Serapion (or Serapion the Elder, as he is commonly

called). He lived about the middle of the ninth century of the

Christian era and wrote entirely in the Syrian language, but at a later

date his works were all translated into Arabic. The smaller of his two

most important treatises, and at the same time the one which appears

to have attracted the most attention, was called the Kounnach. About

the middle of the twelfth century A. D. it was translated into Latin by

Gerard of Cremona, and named by him _Breviarium_; a still later

translation received the name of _Practica_. The first part of

this smaller treatise (the Breviarium or the Practica) is divided into

six books, the titles of which are as follows:--

1. On Nodosities, Ophiasis, and Alopecia.

2. On the Falling Out of the Eyelashes.

3. On the Mild Form of Tinea, the form which resembles Favus.

4. Scaly Affections of the Head and of Other Parts of the Skin.

5. Lice of the Head and of the Body.

6. Headache caused by Exposure to the Sun; and other forms of

Cephalalgia.

Salmouïh ben Bayan, a Christian, was the last one of the pupils of the

Djondisabour school who attained considerable celebrity as a physician.

When the Caliph Motassem came to the throne in 833 A. D., he appointed

Salmouïh his personal physician and soon became very much attached

to him; leaning upon him more and more for advice in all sorts of

troubles. Salmouïh was the author of several medical treatises, but

they have all been lost, not even their titles are now known to us.

When dying (early in 840 A. D.), he sent word to the Caliph not to

put his entire trust in the medical judgment of Mesué if he should

find it necessary to call upon the latter for advice in the event of a

serious attack of illness. This celebrated physician was universally

admitted to be most learned in everything relating to medicine, but

there were many of his professional brethren--and Salmouïh was among

the number--who did not esteem him so highly as a practitioner. “The

most important thing in medicine,” said the latter, “is to appreciate

correctly the intensity of the disease, and that is something which

Mesué, with all his learning, is not able to do.” However, despite the

death-bed warning given by Salmouïh to Motassem, this ruler died less

than two years later from the effects of the treatment which Mesué

the Elder, who had been called in to prescribe for his Highness, had

ordered.

In addition to the pupils already mentioned there are a few others who,

according to the testimony of Le Clerc, reflected some credit upon the

institution in which they acquired their medical training. But enough

has already been said, I believe, to establish the fact that, in this

remote Persian province of Khorassan (to the west of the country known

to-day as Afghanistan), there existed during the eighth and ninth

centuries of the present era a most efficient medical school, which was

entirely managed by Nestorian Christians, and which sent out into the

world trained physicians of the very highest type.

CHAPTER XIX

FURTHER ADVANCE OF THE ARAB RENAISSANCE DURING THE NINTH AND

SUCCEEDING CENTURIES OF THE CHRISTIAN ERA

During the latter part of the eighth century the Arab Renaissance, so

far at least as the science of medicine was concerned, was controlled

and kept in vigorous life almost entirely by physicians who were

connected with the school at Djondisabour--one might almost say, by

physicians who were members of the Bakhtichou family. To this family,

therefore, belongs the chief credit for the admirable results attained

during this, the first stage of the Renaissance. But during the ninth

century A. D. men who had not received their professional training

at this famous school came to the fore and gave a fresh and a more

vigorous impulse to the work than their predecessors had given. Under

the Bakhtichous the translating had been well started, and in addition

a few original medical treatises had been written in the Arabic

language. During the period which followed, however, the translating

and copying became more active than before, and, in addition, several

really valuable treatises were produced by men who wrote in Arabic,

and who were--if not racially Arabs--at least the adopted sons of that

nation. Of these men none stands out more prominently than Honein, who,

according to Le Clerc, “accomplished a marvellous amount of work of

the most varied character and of a very high degree of excellence, and

that too despite many obstacles. While he was not the originator of the

Renaissance in the East, he took the most active part in keeping it up.”

Honein, who may rightly be considered as having at least inaugurated

the second stage of the Arab Renaissance, was born in 809 A. D. at

Hira, where his father Isaac, a Christian Arab, conducted a pharmacy.

The inhabitants of this town were known to be somewhat lacking in

cultivation, and it was therefore not surprising that, when Honein

went to Bagdad and presented himself to John, the son of Mesué, as one

who wished to become his pupil, his request was promptly declined on

the general ground that the people of Hira had not received sufficient

education to warrant any one of their number in undertaking the study

of medicine. This decision was of course a great disappointment to

Honein, but it disturbed him only for a short time. Soon afterward he

went to Greece where he worked hard to perfect himself in the knowledge

of the Greek language. Then, after a residence of two years in that

country, he returned to Bagdad, taking with him a considerable supply

of Greek books. His next step was directed toward gaining a better

knowledge of Arabic, and with this object in view he spent some time

in Bassora, a town which was situated not far to the south of Bagdad,

and which possessed good educational facilities. While residing there

he devoted a certain portion of his time to the translation of Galen’s

treatise on anatomy; and he was accordingly prepared, upon his return

to Bagdad, to submit to John, the son of Mesué, and to Gabriel, the son

of Bakhtichou (who by that time was well advanced in years), a specimen

of the work upon which he had been engaged. Both of these men were

greatly pleased with the excellence of the translation, and encouraged

Honein to go on with the work. El Mâmoun (the second son of Haroun

Alraschid), who was the then reigning Caliph, engaged his services both

as a translator of Greek writings (into Syriac as well as Arabic) and

as a reviser of the translations which had been made by others, and he

paid him most generously for these services. According to Le Clerc,

the amount of literary work done by Honein was simply prodigious.

He translated large portions of the treatises of Galen, Oribasius

and Paulus Aegineta, as well as several of the works of Aristotle

and of Plato, of the mathematicians and astronomers, and also of the

philosophers; and in addition he wrote a large number of original

treatises--such, for example, as a complete set of commentaries on the

writings of Hippocrates, a practical work on the diseases of the eyes,

etc.

The following account of Honein’s experience at the Court of the Caliph

Moutaouakkel (middle of the ninth century A. D.) furnishes some insight

into his character:--

The Caliph, who had heard of the great learning, ability, and

industry of Honein, but who had at the same time feared that he

might be in secret communication with the Greeks, decided to

subject him to a test that would reveal how far he was venal.

Accordingly he sent for him, clothed him in robes of honor, gave

him 50,000 drachmae, and then said:

“I wish that thou wouldst prepare for me a secret combination of

drugs which will enable me to get rid of one of my enemies.”

Honein replied: “I have no knowledge of any but salutary

remedies, and it never occurred to me that the Prince of

Believers might ask me to furnish those of a different kind.

However, if it be the wish of your Majesty, I will see what I

can do; but I shall require plenty of time.”

After waiting in vain for the desired preparation and finding

that even threats failed to accomplish anything the Caliph put

Honein in prison. Then, at the end of a year, which interval

the latter had employed diligently in the work of translating,

Moutaouakkel gave orders for the prisoner to be brought into

his presence. Before this was done, however, a heap of objects

of value was placed on one side of the room and instruments of

torture on the other. When Honein was brought in, the Caliph

said to him: “Time is passing, and my wishes have not yet been

gratified. If thou art now ready to obey my behest, these

treasures and many others in addition shall be thine. But, if

thou continuest to refuse, I will subject thee to tortures and

will finally put thee to death.”

“I have already told the Prince of Believers,” replied Honein,

“that my knowledge is limited to the preparation of salutary

remedies.”

Whereupon the Caliph said: “Have no fear! I simply wished to

test thee! But tell me, what are the reasons upon which thy

refusal is based?”

“There are two reasons,” replied Honein: “my religion and my

profession. The first teaches us to do good to our enemies;

and the second, not to do any harm to the human race. Every

physician has registered an oath that he will never administer a

poison.”

“Those are two excellent laws,” remarked the Caliph; and he

proceeded to load Honein with presents.

Among those who were associated with Honein in his work of translating

Greek medical books into Arabic there are three whose names also

deserve to be remembered. They are: his son Isaac; his nephew Hobeïch;

and a Christian Greek named Costa ben Luca, whose residence was at

Baalbek. To men of the present time all these names of oriental

physicians are, as a rule, mere meaningless words, conveying no idea

of an important relationship to the evolution of medicine. During the

ninth and tenth centuries of the present era, however, and indeed

for many years subsequent to that time, they were accorded by the

physicians of that period almost as much honor for the part which they

took in furthering the revival of medicine among the Arabs as was given

to Honein himself. It seems therefore appropriate that at least a brief

account of the lives of these men and of the work which they did should

be given here.

Isaac received his education from his father Honein, and soon after

reaching manhood he was set to work translating from the Greek into

both Syrian and Arabic--two sister languages. He was a man of great

intelligence, and was thought by many to be the equal of his father

in the knowledge of Greek, Syriac and Arabic. He also had, like his

father, the good fortune to find favor with the rulers of that period.

He died in 912 A. D. as the result of a stroke of cerebral apoplexy.

In addition to his translations he wrote original treatises on the

following topics:--

Simple Medicaments.

Origins of Medicine.

Correctives of Purgative Remedies.

Treatment by Cutting Instruments.

The means of Preserving the Health and the Memory.

Hobeïch was the son of Honein’s sister. The date of his birth is not

known. He received his training in the languages from his uncle, and

in the course of time became associated with the latter in the work

of translating. Eventually he reached his uncle’s high standard of

scholarship, and the text of his translations was from that time forth

accepted without any revision. The Caliph Moutaouakkel appointed him

Court Physician, and the immediate successors of this Caliph retained

him in the same position. His death occurred during the second half of

the ninth century of the Christian era.

Hobeïch translated the “Oath of Hippocrates” and a large number of the

more important of Galen’s treatises. In addition, he left to posterity

several original writings. Quotations from these are to be found in the

works of Rhazes, of Ebn el Beithar, and of Serapion the Younger, and

they reveal two important facts: first, that Hobeïch was an excellent

practicing physician; and, second, that the Arabs had already at this

comparatively early date begun to gather their medical information

from other sources than the Greek treatises. The following drugs, for

example, are described by Hobeïch in the quotations just mentioned, and

yet they do not appear to have been known to the Greek medical writers:

Turbith, Convolvulus of the Nile, Nux Vomica, Colocynth, Croton

Tiglium, Aloes and Myrobolans.

Costa, the son of Luca, was a Christian Greek from Baalbek, in Syria.

The dates of his birth and death are not known, but it is believed that

he lived during the first half of the tenth century of the present era.

He was an excellent Greek and Arabic scholar and was also familiar with

the Syriac language. His translations were esteemed equal to those

of Honein. After spending some time in Greece he settled in Irak, a

province of Persia, and devoted himself to the translation of the books

which he had brought with him from Greece. At a later period of his

life he removed to Armenia, a country which lies to the north of Irak,

between it and the Black Sea, and it was during his residence there

that he wrote a number of treatises. It was in Armenia, also, so far as

may be judged from the accounts which we possess, that his death took

place. As an evidence of the fact that he was highly esteemed by his

contemporaries, his biographer states that a cupola was built over his

tomb.

Among the medical works which he translated from the Greek the

following are the only ones of special importance: The Aphorisms of

Hippocrates, and Galen’s commentaries upon them.

The ninth century, the period during which the major portion of the

work described in the preceding part of this chapter was accomplished,

is considered by Lucien Le Clerc the most remarkable in the worlds

history. He speaks of it in the following terms:--

Its greatness is emphasized by the fact that, except in this one

corner of the globe, everything was in a state of decadence....

Great as is the credit due the Abbaside Dynasty and its

ministers, still greater is our admiration for the Arab nation

on account of the eagerness with which it met the wishes of its

rulers and also because it pursued resolutely, and despite all

the obstacles (political and religious) which were placed in

its way, the course laid down for it to follow.... The Arabs

also knew how to choose men who were really eminent and to

rescue them from lives which otherwise would probably have been

sterile; they claimed the inheritance of Greek science; and they

revealed to the world that they were worthy of this inheritance.

Some idea of the completeness of the list of Greek medical works which

the Arabs translated may be gained from the fact that Galen’s writings

are more complete in the Arabic than they are in the Greek, the

language in which they were originally composed.

With Costa the second stage in the Arab Renaissance came to an end.

All the work accomplished at Bagdad up to this period in our history

received its inspiration from the different Caliphs belonging to

the Abbaside Dynasty. But now the political conditions in the East

underwent a change, and other Arabian dynasties, each in its turn,

gained control of the power previously wielded by Almansur, Haroun

Alraschid and their successors. Fortunately, all of these new rulers

seem to have been favorably inclined toward the revival of literature,

and consequently the Arabs continued to take an active part in the

advance of medical knowledge during the tenth and eleventh centuries.

Bagdad, however, ceased to be the centre of all this intellectual

activity, and eventually Cordova in Spain almost rivaled the capital

of ancient Greece in the eagerness with which she sought to increase

her stores of books, and in her readiness to honor scholars. By this

time the Arabs controlled, not only Persia and Arabia, but also Egypt,

Palestine, Syria, Marseilles, the coast of Asia Minor, Greece, Sicily,

the northern part of Africa and Spain. Owing to the limited space at my

command I shall be obliged to confine my account to the more salient

features of the progress made during this later or third stage of the

Arab Renaissance.

Already as early as toward the end of the ninth century the number of

physicians in the East had increased so greatly, and the territory

where well-educated medical men were to be found had broadened to

such an extent, that I shall now be obliged, in order to maintain

some approach to chronological order in my account of the evolution

of medical science, to treat the subject according to countries. If

the men who stand out foremost in this third stage of the scientific

renaissance are not in every instance Arabs or Persians or Syrians, I

may at least claim that they are the product, directly or indirectly,

of the great Arab movement. The countries in which their best work was

done are the following: Persia (apart from Bagdad and its immediate

neighborhood), Egypt, Magreb (the modern Algiers and Tunis), Fez

and Spain. But, before I consider the progress of medicine in these

different parts of the Orient, I should say at least a few words about

the events which characterized the cessation of literary work at

Bagdad. As might be expected, that city, after the Greek medical and

scientific treatises had all been translated into Arabic, gradually

lost its pre-eminence as a centre of learning, and new centres

developed in other cities throughout the vast Musulman Empire. It must

not be inferred, however, that this change was wholly or even largely

due to the cessation of literary work. Other factors contributed to

this result, viz.: the decadence of the caliphate and the fact that

the caliphs themselves appeared to lose their interest in promoting

the sciences actively. It was not until during the tenth century that

any further interest in the advancement of medical science was taken

by those in authority at Bagdad. Then the Emir Adhad Eddoula built a

splendid hospital, and organized it on the basis of several separate

services--one for fever cases, another for accidental injuries, a third

for ophthalmic cases, and so on. Twenty-four physicians, who had been

selected because of their special aptitude for some particular class of

medical work, were appointed to take charge of the different services;

and it is interesting to note that nearly all of these men bear Arab

names. Nevertheless, for a still further period of many years, says Le

Clerc, there continued to be as many Christian as Mohammedan physicians

in Bagdad.

In the tenth century other hospitals were established in Bagdad. Thus,

in 914 A. D., the Vizir Ali ben Issa founded one which he endowed

in the most liberal manner. This Vizir must have been a most humane

person, for, when the physician-in-charge wrote to him for further

instructions regarding the course which he should pursue with respect

to people of different religions, the Vizir replied: “Use the fund for

the benefit of all classes alike, and be sure to remember the animals.”

_Persia._--Rhazes, whose full name is Abou Beer Mohammed ben

Zakarya, is generally admitted to have been the most illustrious of

Persia’s physicians, and probably the most distinguished representative

of Arab medical learning. He was born at Raj, in the Province of

Khorassan, about 850 A. D. After he had received his professional

training at Bagdad, he settled at Raj and was soon afterward appointed

director of the local hospital. At a later date he was placed in

charge of the hospital at Bagdad, but before many months had elapsed

he returned to Raj, his native town, and here he spent most of the

remaining years of his long life. The date of his death is stated by

Haeser as either 923 or 932 A. D., but Le Clerc mentions only the

latter date.

Rhazes was a very hard worker and was highly esteemed by his fellow

countrymen, who called him the Arabian Galen. The total number of

writings which he left behind him at the time of his death was

237, most of them dealing with medical subjects. A few of them,

however, were devoted to the discussion of chemical, anatomical and

philosophical questions. To-day we possess only 36 of the treatises

written by Rhazes, and of this number only six have been printed in

Latin. His greatest work, as all critics admit, is that which is

commonly known as the “Continens” (or “El Haouy”). In this work, which

is divided into twenty-two books, Rhazes gives in a condensed form the

views entertained by all his predecessors regarding the more important

questions in medical science, and then adds thereto the conclusions

which his own experience has led him to form.

He also wrote a second treatise (in ten books) which was esteemed

by the physicians of that and later periods almost as highly as

the Continens. It was called the “Mansoury,” and its contents are

distributed as follows: I., Anatomy; II., the Different Temperaments;

III., Alimentary Substances and Drugs; IV., Hygiene; V., Cosmetics;

VI., the Regimen to be adopted in Traveling; VII., Surgery; VIII.,

Poisons; IX., Maladies in General; X., Fevers.

A third treatise of considerable importance is that which is devoted

by Rhazes to the description and treatment of small-pox and measles.

So far as is known at the present time this is the first treatise that

has been written on these diseases, and its celebrity rests, not only

upon this circumstance, but also upon the facts that its author is

evidently familiar with the different types of small-pox and with the

characteristic features which distinguish this disease from measles.

Freind, in commenting upon this treatise, says that Rhazes assigned

for small-pox a cause “entirely new in physick, a sort of an _innate

contagion_. This is a _ferment_ in the blood, like that in

must, which purifies itself sooner or later by throwing off the peccant

matter at the glands of the skin; an hypothesis since applied, though

upon very slight grounds, to feavers in general by many moderns.” From

this account it is fair to conclude that Rhazes, in the tenth century

of the Christian era, as clearly suspected the germ origin of certain

febrile diseases as Liebermeister did toward the end of the nineteenth,

or as Fracastoro did in the sixteenth. And one cannot help exclaiming:

How many centuries had to elapse, and what an immense amount of other

facts had still to be discovered--facts in anatomy, in physiology, in

chemistry, in optics, etc.--before it became possible to convert this

suspicion, this simple product of the reasoning faculty, into an actual

demonstration of the truth in pathology!

Among the Arabian physicians of the eleventh century Avicenna is

certainly one who should be placed in the first rank. He was born in

980 A. D. at Afschena, a village in the Province of Khorassan, Persia,

and spent his youth in Bokhara, where his father held some high office

under the Government. His great intellectual capacity was revealed at

an early age. It is said, for example, that already before he was ten

years old he had committed the entire Koran to memory; and it is added,

further, that when he was only seventeen years old he had already

acquired such knowledge of medicine that he was invited to take part

in a consultation regarding some malady with which the Emir Nuch ben

Mansur was affected. The advice which he gave on this occasion was

followed, and in the sequel it proved so good that he was granted, as

a reward, unrestricted access to the royal library,--a privilege which

he utilized to the very best advantage. When his father died Avicenna

came into possession of a large fortune, which enabled him to indulge

in a great deal of traveling. In this way he visited one Persian Court

after another throughout a period of several years. Finally, during a

residence at Hamadan, the Prince Schems ed-Daula, whom Avicenna had

successfully treated for some malady, made him his Vizir. While he

held this office he managed, without neglecting his official duties,

to continue his scientific studies; but he was not able entirely to

keep out of political intrigues, and as a consequence his life was for

a short time in some danger. He was confined for several months in a

fortress, from which, however, he managed eventually to make his escape

to the Court of Ibn Kakujah, in Ispahan. He resided in that city during

the following fourteen years, and it was there that he wrote his two

principal works--the famous medical treatise known as the “Canon,” and

the equally celebrated cyclopaedic work on philosophy. Worn out by

his incessant and most exhausting literary labors and by his excesses

in other directions, Avicenna died in June, 1037 A. D., while he was

accompanying the Emir on his expedition to Hamadan. His tomb may still

be seen in the latter city.

Neuburger, from whose excellent History of Medicine the preceding

details have been gleaned, makes the statement that the treatise in

which Avicenna’s clinical experience was recorded has not come down to

our time, and that, consequently, we lack the means of estimating just

how great a physician--just how close a clinical observer and how wise

a practitioner--he really was. So far, however, as may be judged from

the evidence furnished by the Canon, Avicenna was not the equal, in all

practical matters relating to medicine, of Haly Abbas and of Rhazes.

He was perhaps too much inclined to “look at bedside phenomena through

the spectacles of preconceived theories.” In brief, he was, first and

foremost, a philosopher, and only in a subordinate degree a physician,

although a most excellent one. In Book III., where he discusses certain

surgical procedures, statements are made which justify the belief that

Avicenna was acquainted with intubation of the larynx.

Le Clerc mentions six other Persians who, during the tenth century of

the present era, gained more or less distinction as physicians. In the

following paragraphs brief notices are given of each of these men.

Eben el Khammar, born in 942 A. D., was a Christian and an excellent

practitioner. He was well versed in the science of medicine and a

writer of some importance. Date of death unknown.

Abou Sahl el Messihy, who was also a Christian, was a contemporary and

intimate friend of Avicenna. He died in 1000 A. D. He was the author

of a complete and very useful summary of medicine, entitled “Kitab el

Meya”; and the Arab historian Ossaibiah speaks in terms of admiration

of another treatise which he wrote and which bears the title,

“Exposition of God’s wisdom as Manifested in the Creation of Man.”

Abou Soleiman Essedjestany, commonly called “El Mantaky.” The dates

of his birth and death are not known. He wrote a number of treatises,

and--among others--one on “The Organization of the Human Faculties.”

Aboul Hassan Ahmed Etthabary, a native of Thabaristan, in the Province

of Khorassan. He was employed as a physician by the Emir Rokn eddoula

ben Bouïh, and is known as the author of a compendium of medicine

entitled: “Hippocratic Methods of Treatment.” He died in 970 A. D.

El Comry was one of the most eminent medical practitioners of his time,

and was in high favor with the royal household. He wrote a compendium

of medicine which bears the title “R’any ou Many,” and he was also

the author of a treatise on the causes of disease. His death occurred

toward the end of the tenth century of the Christian era.

Alfaraby, who is highly commended by Avicenna, should be classed among

the philosophers rather than among the physicians. He died in 950 A. D.

The sixth Persian physician of some distinction mentioned by Le Clerc

is Ali ben el Abbas--usually spoken of as Haly Abbas. The dates of his

birth and death are not stated by any of the authorities, but it is

known that he was a native of Ahouaz, a small town on the Karun river,

to the southeast of Bagdad, and that he was still living in 994 A. D.

Haly Abbas, it is claimed, was the first medical writer who ventured to

prepare a complete and systematically arranged Practice of Medicine.

He gave it the title of Al-Maleky--“The Royal Book,”--and dedicated

it to the Emir Adhad-ad-Daula, whose private physician he was. It is

a much smaller treatise than the “Continens” of Rhazes, and somewhat

more complete than the same author’s shorter work--the “Mansoury.” It

covers the entire field of medicine and is distinguished by its very

practical character. It was first translated into Latin in 1127 A. D.

Haly Abbas, in one of his treatises, speaks of Hippocrates in the

following terms: “Hippocrates, who is the prince of the medical art and

the first physician who ever wrote a book on this art, is the author of

many treatises on all sorts of medical topics.... But he writes in such

a very concise manner that much of what he says is obscure, and as a

consequence the reader, if he wishes to understand him, is obliged to

seek the aid of a commentary.”

_Egypt._--The dynasty of the Fatimides--the descendants of Fatima

(the daughter of Mohammed) and of Ismael, a great-grandson of Ali, the

fourth of Mohammed’s successors--reigned over Egypt for nearly two

centuries (10th to 12th of the present era), and they showed toward

the scientists the same spirit of generosity that had been manifested

toward them by the Abbasides in the earlier part of their reign. In 970

A. D. Moëz Eddoula drove out the reigning family, assumed the title of

Caliph, and founded the city of Cairo. In 972 he built the celebrated

mosque Al Azhar and constructed, as a sort of annex to it, a school, a

veritable university, where ultimately all the sciences were taught.

It throve vigorously, and students flocked to it in great numbers from

all quarters of the Moslem empire. During the eleventh and twelfth

centuries Egypt was once more, as it had been in the palmy days of

Alexandria, the home of many excellent and vigorous institutions of

learning. Among the physicians, however, who received their education

in medicine at Cairo during this long period, there was not one who

attained great eminence.

At the end of the eleventh century the Crusaders, under the leadership

of Godfrey de Bouillon and others, made their first serious attack

on Palestine and Syria, and from that time onward, for about two

centuries, they and the different armies sent out successively

from Europe carried on almost constant warfare, which Michaud the

distinguished French historian (about 1800 A. D.) calls the product

of a pious delirium. Wars of religion are the most savage and pitiless

of all wars, says Le Clerc, and this was emphatically true of those

waged by the Crusaders. On the other hand, says the same writer, “the

tolerance exhibited at that period by the Arabs in religious matters

is a well-attested fact, and it owes its origin to the circumstance

that their scientific education was conducted by Christians. Of

Saladin’s fifteen physicians two-thirds were either Jews or Christians.

Cultivation and good training were the characteristics of the Arabs

at that period of their history, whereas fanaticism and brute force

were the distinguishing features of the European soldiers. Several

hundred thousand adventurers first ravaged Europe and then pounced

upon Asia. At Antioch Godfrey de Bouillon committed all sorts of

excesses, and then, when he had taken Jerusalem, he massacred 70,000

of its inhabitants--Jews and Musulmans. Eighty years later, Saladin

retook Jerusalem; and, with the exception of a comparatively small

number, he allowed all of his captives to go free. His brother, Malek

el Adel, paid the ransom of 2000 of the prisoners. Contrast these

fruits of civilization with the barbarism of the European conquerors

under Godfrey de Bouillon. Another result of the Crusades was this:

The Franks lost a good deal of their savagery through contact with the

Arabs. At a still later period Western Europe drew a large part of her

supplies of knowledge from Spain--_i.e._, from the Musulmans.”

_Syria._--In the thirteenth century Damascus, the capital of

Syria, assumed considerable importance as a centre of medical activity.

Bagdad and Cairo had by this time lost the greater part of their

attractiveness for those who wished to perfect their knowledge of

the healing art, and the vandalism of the so-called Soldiers of the

Cross had put an end for many years to come to all hopes of making

Constantinople once more the home of scientific or artistic effort.

There was one branch of medical practice, however, in which the Cairo

physicians excelled all others--that, namely, of ophthalmology. This is

explained by the well-known fact that at all periods of her history

Egypt has been afflicted with ophthalmias to a much greater degree than

any of the other countries of the Mediterranean basin. The great wealth

accumulated in Damascus, the large number of hospitals which were

located in the city, and the attractiveness of the town as a place of

residence undoubtedly had much to do with the fact that it attained at

this period so great popularity as a centre of medical activity.

_Spain._--During the tenth century of the present era the Moslem

reign in Spain flourished greatly under the two enlightened rulers

of the Ommiade Dynasty--Abdurrahman Ennasser and Hakem, and medicine

shared fully in this prosperity. During Abdurrahman’s reign the Emperor

Romanus at Constantinople sent an embassy to Cordova in Spain, and

among the gifts which they took with them for the Prince, was a copy

of the treatise of Dioscorides in the original Greek, illustrated by

marvelously beautiful paintings of the different medicinal plants.

But there was nobody in Cordova at that time who could read Greek.

Accordingly, Abdurrahman begged the Emperor to send him a man who was

familiar with both the Greek and the Latin tongues, and it was in

answer to this request that the monk Nicholas was sent to Cordova (951

A. D.). Working in conjunction with several of the most distinguished

physicians of that city he succeeded in identifying nearly all of the

plants mentioned by Dioscorides.

Among the physicians of Arab, Persian or Jewish extraction who, during

the eleventh and twelfth centuries, practiced their profession in Spain

and attained considerable celebrity, the following deserve to receive

special mention here: Abulcasis, Avenzoar, Averroes and Maimonides.

_Abulcasis._--Abulcasis is universally credited with being the

greatest surgeon of whom the Arabs may rightfully boast. He was born

at Zahra near Cordova in 936 A. D., and his death occurred 1013 A.

D. Quite early in his professional career (before he had reached his

twenty-fifth year) he was appointed one of Abdurrahman’s private

physicians. Although he owes his reputation chiefly to the treatises

which he wrote on surgery Abulcasis was also the author of several

medical works. He published a collection of all his writings under the

title of “The Tesrif,” which is divided into thirty parts or books,

and which--according to Lucien Le Clerc--constitutes a veritable

encyclopaedia. During the course of the twelfth century Gerard of

Cremona translated into Latin the part relating to surgery; it is not

known at what time or by whom the remainder of the collection was

translated. The author’s name in the Latin edition is given, not as

Abulcasis, but as Alsaharavius.

During the lifetime of Abulcasis his writings, and especially his work

on surgery, were not very highly appreciated in Spain. This was largely

due to the fact that the Mohammedan inhabitants of that country did not

look upon surgery with any degree of favor. The Arabs of the East held

Abulcasis in much greater honor. Guy de Chauliac, the famous French

surgeon of the fourteenth century, in his treatise on surgery, quotes

Abulcasis no less than two hundred times. Le Clerc, in the course

of his remarks upon the value of the surgical treatise written by

Abulcasis, says: “This book will always be considered, in the history

of medicine, to represent the first formal and distinct scientific

treatise on surgery.” At the same time, the prevailing testimony makes

it appear that the book contains only a small portion of original

matter, a large part of its substance having been borrowed from the

work of the Greek author, Paulus Aegineta. Its chief merit consists in

the orderly and very clear manner in which the facts are presented, and

doubtless the popularity of the book was materially increased by the

fact that many of the instruments required for the different operations

were illustrated pictorially.

Lucien Le Clerc has published (Paris, 1861) a French translation of

Abulcasis’ Treatise on Surgery, and on page 71 of this version the

following statement will be found:--

... you may also introduce into the cannula a specially adapted

piston in copper, or a stylet the end of which is armed with

cotton. Then fill the cannula with oil or some other suitable

fluid, introduce into one end the stylet armed with cotton, and

push it onward until the liquid enters the ear.

Edouard Nicaise, commenting on these words in his version of Guy de

Chauliac’s _La Grande Chirurgie_ (page 690), says that they

constitute the first reference, thus far discovered in medical

literature, to the use of the instrument known as a syringe.

_Avenzoar._--Avenzoar was born in Seville, in the southern part

of Spain, during the latter part of the eleventh century. The exact

date is not known. His father was a physician of some distinction, and

his son also attained considerable eminence in the same profession.

According to Neuburger, Avenzoar died, at an advanced age, in 1162 A.

D., and was buried in Seville.

It is said that in actual practice Avenzoar, who was a man of some

wealth, confined himself to consultation work. He considered it beneath

the dignity of a physician to prepare drugs, to apply leeches, or

to perform certain surgical operations--as, for example, lithotomy;

but Le Clerc seems disposed to believe that Avenzoar did not adopt

this view until after he had become somewhat celebrated and had

accumulated a fortune. Neuburger ranks him next to Rhazes as a clinical

observer and a practitioner of sound common sense, and he speaks of

his great medical work, the Teïssir, as a treatise that abounds in

most interesting histories of cases of disease. Among these will be

found the account of an attack of mediastinitis which occurred in

his own person, and which ended in suppuration that found a vent for

its products by way of one of the bronchi.[51] As this disease is of

rare occurrence, and as Freind’s account of the attack is presumably

a translation of the original report in Arabic made by Avenzoar, its

reproduction here may be interesting. I shall take the liberty of

modernizing the text very slightly and of abbreviating it in one or two

places.

I felt some pain in the region of the mediastinum (the membrane

which divides the thorax in the middle) while I was on a

journey. As it increased a cough developed, and I observed

that my pulse was very hard and that I had an acute fever. On

the fourth night I took away a pint of blood, but this gave me

very little relief. Being obliged to travel all day I was much

fatigued when I retired at night, and I fell asleep. During my

sleep the bandage on the arm came off, and when I awoke I found

the bed deluged with blood and my strength greatly exhausted.

The next day I began to cough up a sanious matter, and my mind

wandered at times. Gradually all the symptoms subsided and I

recovered my health. Although I partook of large quantities of

barley water, I believe that my recovery was not due to this,

but rather to the great loss of blood which I had experienced.

Freind adds that “Avenzoar not only takes notice of an abscess in the

mediastinum, but in the pericardium likewise; which I don’t find had

been described or even observed by any of the Greeks or Arabians: and

there is no doubt but this membrane and the mediastinum to which it

is contiguous, are subject, as well as the pleura and lungs, to an

inflammation.”

It is one of the distinguishing features of Avenzoar’s character that,

in his writings, he does not hesitate to differ from his predecessors

whenever he believes that their views are erroneous.

_Averroes._--Averroes was one of Avenzoar’s most distinguished

pupils. Indeed, the latter’s famous work, the Teïssir, is dedicated to

Averroes. Thanks to the distinguished French historian and philosopher,

Ernest Renan, our knowledge of Averroes has been greatly expanded since

1852. Averroes was born at Cordova in 1126 A. D. His father and his

grandfather had both held the office of Cadhi (Alcalde, in Spanish),

and were therefore people of importance in that city. His studies were

confined at first largely to philosophy, and when he reached mature

age he gained a great reputation as the commentator and interpreter of

the writings of Aristotle. Still later in life much of his attention

was devoted to medicine, and he wrote a book which bears the title

“Kitab al-kullidschat” (General principles of Medicine). Among the

physicians of the later Middle Ages this work was commonly spoken of as

the “Colliget” (from kullidschat), and was almost as highly esteemed as

the Canon of Avicenna. The idea of writing a treatise on the individual

diseases was first entertained, among Arabian physicians, by Averroes;

but on reflection he abandoned the idea, and, instead, urged Avenzoar,

his friend and former instructor, to undertake the work in his place.

It was in this way that the Teïssir--the finest work on the practice of

medicine produced by an Arab writer--came to be written.

The topics treated in the “Colliget” are distributed throughout the

seven books in the following manner:--

Book I. Anatomy.

Book II. Health (Physiology).

Book III. Diseases.

Book IV. Signs or Symptoms.

Book V. Remedial agents and Foods.

Book VI. The Preservation of Health.

Book VII. The Treatment of Diseases.

Neuburger speaks of the “Colliget” as a fine piece of philosophical

writing, but adds that it is not at all suited to the needs of the

practical physician. Indeed, he doubts whether any person who has not

received a thorough training in natural philosophy--the philosophy of

Aristotle--would be able to follow the author intelligently.

_Maimonides._--Maimonides, who is ranked by Le Clerc as the

greatest Jew, after Moses, of whom the history of that nation makes

mention, was born at Cordova, Spain, in 1135 A. D. In early youth

his teachers were his father and a disciple of Ebn Badja. At the age

of thirteen, and from that time until he had reached his thirtieth

year, he was obliged under the pressure of circumstances, to profess,

at least outwardly, the faith of Islam. Death or banishment was

the only alternative. During the intervening period of seventeen

years he devoted himself exclusively to his studies. In 1160 A. D.

he accompanied his family to Fez, Morocco, and five years later he

settled at Fostath, near Cairo, Egypt. As a means of gaining his

livelihood he engaged in the business of trafficking in precious

stones, continuing his studies at the same time and carrying on a

certain amount of medical practice. Not long afterward he gained the

favor of the Vizir El Fadhl Beissâny, the friend of Saladin, Sultan of

Egypt and Syria, and was by him appointed one of the Court physicians.

This enabled him to give up entirely his commercial business. He

prospered in the practice of medicine and was very highly esteemed in

the community in which he lived. His death occurred in 1204 A. D.

Among the books which he wrote (generally in Arabic) on medical

subjects, the following deserve to receive special mention:--

I. Commentary on the Aphorisms of Hippocrates.

II. A work known as “Aphorisms of Maimonides” (borrowed partly

from Hippocrates and partly from Galen).

III. Résumé of the writings of Galen.

IV. A letter relating to the subject of personal hygiene.

V.-IX. Treatises on asthma; on hemorrhoids; on venoms and

poisons in general; on drugs; and on forbidden articles

of diet.

X. A translation of one of Avicenna’s works.

Neuburger speaks in very favorable terms of the medical writings of

Maimonides, and adds that he also wrote a treatise which bears the

title: “Guide to Those in Perplexity”--a work which aims to reconcile

reason and faith. The book has been translated into French by Munk; and

the treatise on poisons has also been translated into the same language

by J. M. Rabbinowicz (Paris, 1867).

Speaking of the remarkable manner in which philosophy and medicine had

flourished in Spain during the tenth and eleventh centuries, under the

reigns of Haken II. and his successors, Ernest Renan says:

The love of science and of things beautiful had established,

in that privileged corner of the world, a degree of tolerance

that can scarcely be matched in modern times. Christians, Jews,

Musulmans all spoke the same language, sang the same poems, and

took part in the same literary and scientific studies. All the

barriers which commonly separate men were thrown down, and all

worked with equal zeal in behalf of our common civilization.

With the death of Averroes (1198 A. D.), however, Arab philosophy lost

its last representative, and the Koran resumed its full authority over

freedom of thought. In the succeeding period of decadence (thirteenth

century of the Christian era) there were no physicians of first

importance, at least in Spain and Persia; and even in Egypt and Syria,

over which reigned at this time the enlightened family of Saladin,

the leading physicians were not of the same calibre as the men whose

names I have just mentioned. Bagdad and Cordova had by this time become

cities of less importance than Damascus, and botany and ophthalmology

were esteemed of greater value in the scheme of medical education

than at any previous time. It will not appear strange, however,

that medicine should have stood still during this later part of the

Middle Ages if we bear in mind the fact that warfare was then such a

frequently occurring event that nobody had either time or inclination

for scientific studies. The invasions of the Mongolians and the

Crusaders were most disturbing factors.

During the twelfth century of the present era there were--so we are

assured by Le Clerc--women physicians among the Arabs in Spain. It is

said, for example, that Abou Bekr, a distinguished medical practitioner

of that period, had a sister who was well trained in medicine, and that

it was she who acted as midwife at all the confinements of the wives of

the Caliph Almansur. After her death her niece officiated in the same

capacity in her place. There can scarcely be any reasonable doubt that,

almost from time immemorial, women as well as men have taken active

part in the practice of medicine.

According to Puschmann, Spain possessed, during the twelfth century of

the Christian era, seventy public libraries and seventeen institutions

for instruction in the higher branches of learning. Among the residents

of the city of Cordova there were, during the same period, no fewer

than one hundred and fifty authors; and the smaller cities of Almeria,

Murcia and Malaga could each claim proportionally an equally large

number, viz., fifty-two, sixty-one and fifty-three.

_The Effects of the Arab Renaissance as a Whole upon the Evolution of

Medicine._--Although the series of events which I have endeavored

to sketch here in brief outlines reveals an extraordinary degree of

zeal and persistence on the part of the Arab rulers and their subjects

to endow the nation with the knowledge and skill of their models,

the Greeks, the final results gained, at least so far as they relate

to the evolution of medicine as a whole, were not very great. The

movement lasted for five or six centuries, but nevertheless only a few

relatively unimportant facts were added by the Arabs to the stock of

knowledge which was possessed at the time of Galen’s death. Alhazen’s

brilliant researches in the eleventh century of our era in optics (more

particularly with reference to refraction) paved the way for a more

perfect knowledge, in modern times, of the physiology of vision; Geber,

who lived during the eighth century of the Christian era, and who is

spoken of by Le Clerc as “occupying the same place in the history of

chemistry that Hippocrates does in the history of medicine,” laid the

foundations of that important branch of science; Abulcasis discovered

the Medina worm (_dracunculus Medinensis_) and wrote an excellent

description of the pathological effects which it produces when it

lodges under the skin of a man’s leg; and, finally, our pharmacopoeia

was enriched, during these centuries, by the addition to it of a number

of new drugs and pharmaceutical preparations. These are among the more

important contributions which the Arabs made to the general stock of

medical knowledge. On the other hand, they contributed, in an indirect

manner, to the advance of the science of medicine. From the thirteenth

century onward, for a long period, the Latin language was destined to

serve as the vehicle by means of which all scientific knowledge was

to be spread abroad in the countries which are now known as Italy,

Spain, France, Switzerland, Germany, Belgium and Holland, and therefore

an immense amount of translating had to be done before the works of

Hippocrates, Galen and other Greek medical authors could be brought

within reach of the physicians of these different countries. At that

late date it was by no means always feasible to get possession of an

original copy of one of these classical treatises, and consequently in

such cases it became necessary to employ an Arabic version in the place

of the Greek original. It was in this indirect manner, therefore, that

the Mohammedan Renaissance contributed most effectively in advancing

the development of medical science in general.

One cannot dismiss the subject of Arabic medicine without calling

attention once more to the spectacle which this remarkable Renaissance

offers--that of an entire nation deliberately working to educate itself

up to the level of such intellectual and artistic giants as the ancient

Greeks; a work which continued with unabated zeal throughout several

centuries in spite of obstacles and discouragements, and which never

ceased for a moment. It is a spectacle without parallel in the world’s

history.

CHAPTER XX

HOSPITALS AND MONASTERIES IN THE MIDDLE AGES

Long before the Christian era it was the practice among the Greeks

to make suitable provision for those who, by reason of poverty or

illness, were unable to provide for their own wants or to secure the

services of a physician. Their slaves, for example, were sent, when

overtaken with illness, or when they had become too feeble to work, to

what was termed _Xenodochia_--institutions where they received

kindly care and such medical treatment as was necessary. (Mommsen.) In

strong contrast with this humane practice stands the action of those

wealthy Roman property owners who, adopting the course recommended by

Cato, the famous censor (96–46 B. C.), “sold their slaves when they

became old and feeble or ill, as they would old iron, or oxen that

can no longer be utilized for work.” This cruel practice not only

continued throughout a period of nearly three centuries, but apparently

became more and more common, for we are told that the Emperor Claudius

(268–270 A. D.) was obliged, in order to mitigate the evil, to issue a

decree that, when a slave was driven out of the house by his owner, he

should be declared free.

_Hospitals and Other Kindred Institutions._--Toward the end of the

fourth century of the present era the first hospital was established in

Rome by the widow Fabiola, a member of the distinguished Fabian family,

and her example induced other wealthy Roman ladies to found similar

institutions. But already several years before this time the influence

of Christianity had made itself felt so strongly in the eastern branch

of the Roman Empire that the Emperor Julian, who had previously been

among its most bitter opponents, was forced to say, in one of his

letters:--

Now we can see what it is that makes these Christians such

powerful enemies of our gods; it is the brotherly love which

they manifest toward strangers and toward the sick and the poor,

the thoughtful manner in which they care for the dead, and the

purity of their own lives.

Moved by these considerations, he decided forthwith to erect hospitals

in all the cities of the empire. We do not know whether he acted upon

this resolution or not, but it is a matter of record that St. Basil,

Bishop of Caesarea (370–379 A. D.), founded in that city, which is

about thirty miles distant from Jerusalem, a settlement composed of

numerous dwellings that were devoted to the use of the poor and the

sick. This institution was managed in an admirable manner, a special

corps of physicians and nurses being assigned to the duty of caring for

its inmates. At Edessa, the capital of Northern Mesopotamia, another

hospital was founded in 375 A. D. The date of the establishment of the

celebrated hospital at Djondisabour in Persia, of which mention is made

elsewhere (see page 204 _et seq._), is not known. About the middle

of the sixth century of the present era, Childebert I., King of the

Franks and son of Clovis, founded at Lyons, France, the Hôtel-Dieu, a

hospital which has afforded shelter and comfort to thousands of human

beings during the past fourteen hundred years, and which is in active

operation at the present time; a hospital, too, which has served as a

training school for a long line of distinguished physicians, surgeons

and gynaecologists. It is an interesting fact that Childebert intrusted

the management of this great institution to laymen (instead of the

ecclesiastical powers). Finally, toward the end of the sixth century,

Bishop Masona founded in Merida, Spain, a hospital in which Jews,

slaves and freemen were received and treated on the same footing; and

he laid down the rule that one-half of the moneys and other gifts

received by the church was to be devoted to the maintenance of this

institution. The list of hospitals and other charitable organizations

which were established in these early centuries is very long, and it

reveals the fact that in every known land there existed, throughout

these years, a strong wish to give aid and comfort to the poor, the

sick and the helpless. The Musulmans appear to have been as zealous

as the Christians in promoting works of this kind; for the records

show that in Bagdad, Cairo, Damascus, Cordova and many of the other

cities which were under their control, they provided ample hospital

accommodations. Indeed, one of the largest and most perfectly equipped

institutions of this character of which the history of the Middle

Ages furnishes any record, was that planned and constructed at Cairo,

Egypt, in 1283 A. D., by the Sultan El Mansur Gilavun. While it was

building, the workmen employed were not permitted to engage in any

undertaking for private citizens, and the Sultan himself never failed

to visit the spot every day during the progress of the work. The site

chosen was that of one of the royal palaces, and in tearing down this

structure, in order to make room for the new building, the workmen

brought to light a large chest filled with gold and precious stones,

the value of which was sufficient to pay the entire expense of erecting

the hospital. Upon the completion of the building and the equipment

of its spacious wards in the most perfect manner possible, the Sultan

expressed himself in the following terms:--

I have founded this institution for people of my own class

and for those who occupy an humbler station in life--for the

king and for the servant, for the common soldier and for the

Emir, for the rich man and for the poor, for the freeman and

for the slave, for men and also for women. I have made ample

provision for all the remedial agents that may be required, for

physicians, and for everything else that may prove useful in any

form of illness....

One of the characteristic features in the management of this hospital,

says Le Clerc, was the custom of giving to each of the poorer inmates,

when he left the institution, five pieces of gold, in order that he

might be spared the necessity of undertaking immediately work of an

exhausting character.

_Monasteries in Their Relation to Medicine._--While at first

these institutions were designed chiefly as places of refuge from

the turmoil of the world and from the violence of frequent warfare,

it became evident in the course of time that the evils incident to

such a secluded and self-centered life hindered rather than promoted

the development of those particular virtues which Jesus Christ urged

his followers to cultivate. This experience led to the adoption of

a different kind of cloister life; and so it came about, as stated

by Neuburger, that in 529 A. D. Benedictus of Nursia founded, at an

isolated spot high up on the slope of Monte Cassino, in Campania,

Italy, the now famous parent monastery of the Benedictine Order.

According to the original regulations of this order, the monks were

obliged to perform every day a certain amount of manual labor as well

as devotional exercises. Nine years later Cassiodorus, who had for

a long period been a sort of Secretary of State under Theodoric the

Great and his successors, became a monk, and, from that time to the

day of his death, “devoted all his energies to the service of God

and the advancement of science.” He secured a house not far from the

Benedictine monastery on Monte Cassino, gathered together there a

considerable library, and made it a rule of the place that the copying

of original codices (the majority of them theological) constituted

the most useful and honorable form of manual labor. A few years

later, this smaller establishment was made a part of the monastery at

Monte Cassino, and the rule just mentioned was thereafter adopted by

the enlarged institution. But the care of the sick, the feeble, and

children was the particular work which Benedictus, the founder of this

institution, had most at heart. Cassiodorus went even farther and urged

upon the brethren the desirability of studying the healing art and of

utilizing, for this purpose, the works of ancient medical authors.

Learn all you can, he said, about the characteristics of

different plants and about the methods of preparing medicinal

mixtures, but set all your hopes upon the Lord who is the

preserver of our lives. In your search for knowledge about

drugs consult the herbarium of Dioscorides, who has described

and pictured the different herbs with great accuracy. Afterward

read Latin translations of the works written by Hippocrates and

by Galen, particularly the latter’s treatise on therapeutics,

the one which he addresses to the philosopher Glaucon; and, in

addition, study the work of Caelius Aurelianus on the practice

of medicine, that of Hippocrates on medicinal plants and methods

of treatment, and some of the other writings on medicine which

you will find in my library and which I have left behind me for

the benefit of my brethren in this institution.

The advice given by Cassiodorus was heeded, not only by those to whom

it was addressed, but also by many succeeding generations of monks.

Even at the present time, says Neuburger, the books which Cassiodorus

recommended are still to be found, either in the form of original

manuscript copies or in that of translations, in the library of the

parent institution. Furthermore, when it is remembered how large a

number of affiliated Benedictine monasteries were established in

different parts of Europe, it will readily be appreciated that the good

accomplished by the advice which Cassiodorus gave must have been very

great.

Among the later abbots of Monte Cassino there were three who attained

considerable distinction as physicians. They were Bertharius, who wrote

two treatises on medical topics; Alphanus II., Archbishop of Salerno,

who was celebrated both as a physician and as a poet; and Desiderius

(1027–1087 A. D.), who was skilled, not only in medicine, but also in

jurisprudence, and who was elected Pope under the title of Victor III.

The monastery attained the height of its celebrity at the time when

Constantinus the African became one of its regular members. Although

Constantinus was a native Arab (born at Carthage about 1018 A. D.),

he became converted to Christianity quite early in life. It is said

that he was a great traveler as well as a great scholar, and that he

devoted several years to visiting foreign lands--Babylonia, India,

Egypt and Ethiopia. It was in this way that he became so well versed in

the languages of the East. Upon visiting Spain as a fugitive from his

native city, he took with him several of the works of Hippocrates and

Galen, and in course of time translated them into Latin. Finally, he

accepted the position of secretary to Robert Guiscard, the first Norman

Duke of Calabria and Apulia, who appears to have selected Salerno as

his place of residence. At the same time he became one of the teachers

at the medical school of that city, and served in this capacity for a

certain length of time; but, at the end of a few years, he was formally

accepted by the Abbot Desiderius as a member of the Monte Cassino

community, and it was here that he did the larger part of his literary

work. His death occurred in 1087 A. D., the same year in which the

Abbot Desiderius--or, rather, Pope Victor III.--died.

Constantinus was a prodigious worker, but it is doubtful whether he did

anything of an original character. Not a few of the treatises which

were, at that time, credited to him as original productions, are now

known--thanks largely to the researches of the great French historian

and linguist, Daremberg--to be simply translations from the Arabic.

It is believed by some authorities that at Monte Cassino medicine was

taught to laymen as well as to those who were preparing to become

members of the Benedictine Order of monks. It is not likely, however,

that this was done to any great extent, as much better facilities for

acquiring knowledge of medicine were available at Salerno in the near

neighborhood.

In some parts of Gaul, in the early Middle Ages, physicians received

very little consideration; indeed, to us moderns it seems strange

that any one should have possessed sufficient courage to accept

the responsibility of prescribing for a member of one of the royal

families. It is related by Neuburger, on the authority of Gregory of

Tours’ History of the Franks, that when Austrichildis, the wife of King

Guntram (sixth century A. D.), was ill with the plague and perceived

that her death was near at hand, she sent for her husband and extracted

from him a promise that he would behead the two physicians, Nicolaus

and Donatus, who had treated her and whose prescriptions had failed to

effect a cure. Her wish was carried out, in order--as the statement

reads--“that her Majesty might not enter the Realm of the Dead entirely

alone.” Many centuries later, however, when civilization had certainly

advanced far beyond the stage which it had reached in Gaul in the sixth

century of the present era, there were instances in which able and

conscientious physicians were subjected to equally cruel treatment for

their failure to effect a cure.

It was at about this same period, as is amply verified by the

statements made by Bishop Gregory of Tours, that faith in the power of

saintly relics to heal diseases became almost universal. So great was

the effect produced upon the minds of the people by the public display

of these objects--bones of saints, portions of their grave-stones,

etc.--that a large number of marvelous cures were reported as the

result of such displays; and doubtless--so great is the power of

suggestion over the human mind--many of these reports were true. A

century later (673–735 A. D.), the Venerable Bede, author of the famous

work entitled “Ecclesiastical History of the English Nation,” gave, in

the course of his narrative, an account of a case of aphasia in which

“a remarkable cure was effected”; and, although he mentions a course

of “systematic exercises in speaking” as the means used to effect that

cure, he attributes it to supernatural causes and not to the practical

treatment adopted. He also describes some of the epidemics of his time,

and gives most interesting though brief accounts of the methods of

treatment employed by the priests and the monks.

During the ninth and tenth centuries, as we learn from the very full

descriptions given by Neuburger in his History of Medicine, much zeal

was manifested by the monks at St. Gall in Switzerland, at Reichenau in

Saxony, and at Fulda, in Hesse Nassau, in the study of the different

branches of knowledge, medicine included. The following are the names

of those monks who attained the greatest distinction in this work:

Hrabanus Maurus, Abbot of the Fulda Monastery, afterward Archbishop

of Mayence, and the author of an encyclopaedia in which the science of

medicine receives quite full consideration; and Walahfrid Strabo, a

pupil of Maurus, Abbot of Reichenau, and the author of a treatise in

verse on medicinal plants.

CHAPTER XXI

MEDICAL INSTRUCTION AT SALERNO, ITALY, IN THE MIDDLE AGES

The date of origin of the Medical School at Salerno is not known,

but such evidence as we possess shows without a doubt that already

in the earliest part of the Middle Ages some sort of facilities for

studying medicine were provided in that little town--the _Civitas

Hippocratica_, as it was called at a later period. It seems to

be the general impression, says Daremberg, that during those early

centuries only ignorance and superstition prevailed in Italy and Gaul;

in other words, that all desire for scientific research had vanished,

and that there no longer existed such a thing as the regular practice

of medicine. This impression, he adds, is erroneous. History shows

that schools modeled after those established by the Merovingian and

Carlovingian kings (448–639 A. D.), existed up to as recent a date as

the middle of the seventh century, and that subsequently the bishops

organized the teaching in such a manner that it should be entirely

under their control. As time went on, however, the schools assumed a

more public character, although the actual teaching was still carried

on in the cloisters and church edifices. It is well known, furthermore,

that the chief of the Ostrogoths, Visigoths and Lombards--the so-called

Barbarians, who at that time occupied these parts of Europe as

conquerors--showed themselves on many an occasion to be the enlightened

protectors of public instruction and the enthusiastic admirers of

classical literature and science.

At Milan there is preserved a manuscript which furnishes

satisfactory proof that the writings of Hippocrates and Galen

were made the subject of public teaching at Ravenna toward

the end of the eighth century of the present era.... And the

transcribing of medical manuscripts was known to be carried

on at the Monastery of St. Gall, in Switzerland, during the

eighth century.... It is plain, therefore, that throughout

those extensive regions which previously had formed a part of

the Roman Empire, but which during the Middle Ages were under

the dominion of Barbarian kings, there was never an entire lack

of physicians, or of medical knowledge, or of facilities for

teaching medicine. (Daremberg.)

In the light of these statements it is easy to believe that the

original development of the Medical School at Salerno was a perfectly

natural event like that of the founding of any of the medical

schools of a more recent date. The remarkably healthy and singularly

attractive character of the spot where the town of Salerno is located;

the proximity of mineral springs; the comparatively short distance

which separated it from such important centres of population as

Naples and the cities of the Island of Sicily, and from the famous

Benedictine Monasteries at La Cava, Beneventum and Monte Cassino; and

the circumstance that a Ducal Court was established there--all these

are facts which amply explain both why a medical school was founded

here rather than at some other spot, and why physicians of exceptional

ability were easily induced to make the place their home. At no time

in the history of the school, it is important to state, do the church

authorities appear to have been in control of its affairs. At most,

one or two of the monks seem to have taken part in the teaching for

limited periods of time; but in its main characteristics the school

may truthfully be described as an institution created and managed

by physicians for the advancement of medical science and the best

interests of the profession as a whole.[52]

The organization of hospitals and their utilization for purposes of

clinical instruction must have been the most important events which

followed next in order. It is only upon this assumption that we can

satisfactorily explain why, for many years in succession, physicians

traveled all the way from France, Germany and England to Salerno. They

were eager to gain additional knowledge of medicine, and clinical

instruction afforded the only sure way of obtaining it; but instruction

of this kind was nowhere else to be obtained at that remote period, and

consequently men of this earnest and ambitious stamp were compelled to

make the long journey and to incur the expense and the risk incident to

such a trip. As a further evidence of the value which the physicians of

the later Middle Ages set upon the writings of the teachers at Salerno,

the fact deserves to be mentioned that, toward the end of the twelfth

century and all through the thirteenth and fourteenth centuries, these

works were frequently quoted.

But the ability and learning of the Salerno physicians were highly

appreciated by the public at large as well as by their confrères in

other lands; for many people of wealth and of high social standing

visited Salerno for the purpose of consulting them. Among the number

were Adalberon, Bishop of Verdun, France, who journeyed thither in 984

A. D., but failed to obtain the relief which he required; Desiderius,

the Abbot of Monte Cassino; Bohemund, the son of Duke Robert Guiscard;

and William the Conqueror, afterward King of England. The two last

named remained for some time in Salerno, in order to secure needed

treatment for the wounds which they had received in battle.

Toward the end of the tenth, or at the beginning of the eleventh,

century the teaching of medicine at Salerno began to assume the

character of regularly organized work. The names of the men and women

who conducted it--for there were women as well as men in the corps of

teachers--are mentioned in various contemporaneous documents which have

come down to our time. They are as follows: Petroncellus, Gariopuntus,

Alphanus, Bartholomaeus, Cophon, Trotula, John and Matthew Platearius,

Abella, Mercuriade, Costanza Calenda, Rebecca Guarna, Afflacius,

Maurus, Musandinus and many others. According to Puschmann, the list

of physicians who, during the existence of the Medical School at

Salerno,--a period of nearly one thousand years,--acted as teachers

in the institution, comprised no less than 340 names. The presence

of several women among the instructors of this school, and the great

esteem in which they were held by the men of that time, both for their

ability as practitioners and for the excellence of the treatises which

they wrote, furnish strong confirmation of the statement which Plato

makes in his work entitled “The Republic,” and which I have already

quoted in one of the earlier chapters, viz.: “For women have as

pronounced an aptitude as men for the profession of medicine.” And, if

further evidence of the correctness of Plato’s opinion were needed, the

success attained by women physicians during the past thirty or forty

years in the United States of America might be cited.

To the general statement made above I may with advantage add a few

details regarding both the individual physicians at Salerno and the

books which they wrote. During recent years, thanks to the researches

of Henschel, de Renzi and Piero Giacosa, our knowledge of these matters

has been greatly enlarged. In 1837 Henschel found, in the library

at Breslau, Germany, a manuscript collection of Salerno medical

treatises (“Compendium Salernitanum”) dating back as far as the latter

part of the twelfth century of the present era. De Renzi, working

in association with Daremberg and Baudry de Balzac, succeeded in

collecting from the different libraries of Italy quite a large number

of additional Salerno treatises, all of which have since been published

under the title “_Collectio Salernitana, ossia documenti inediti e

trattati di medicina appartenenti alla scuola medica Salernitana_”

(5 vols., Naples, 1852–1859). Finally, Piero Giacosa has added to this

stock of Salerno writings by the publication (Turin, 1901) of a work

which bears the title “_Magistri Salernitani nondum editi etc._”

Beside the treatises to be found in these three collections there is

one other which, according to Neuburger, contributed more than all the

others combined to the fame of the Medical School of Salerno. The title

of this extraordinary work is: “_Regimen sanitatis Salernitanum_.”

The Salernian writings, it appears, may readily be divided into two

groups--those of the earlier and those of the later epoch of this

famous school. The treatises which belong to the older epoch are

written in the degraded Latin of the Middle Ages, and seem to have

been composed entirely for didactic purposes. In the main they are

compilations of still earlier Graeco-Latin works, but here and there,

especially in the parts which relate to therapeutics, evidences of a

certain measure of originality are discoverable. The pathology adopted

shows a hodge-podge of the humoral doctrine and that of the Methodists.

The chief representative of this early epoch is Gariopontus (first

half of the eleventh century), whose treatise on special pathology

and therapeutics--entitled “_Passionarius_”--was very popular

for a long period of years. Next in order comes Petroncellus, whose

“_Practica_” calls for no special comment. Of the works of

Alphanus, John Platearius (the elder) and Cophon (the elder), we

possess only fragments. Trotula, who lived about 1059 A. D. and was

believed to be the wife of John Platearius I., attained greater

celebrity than any of those just mentioned. She was related to Roger

I., Count of Sicily, and was therefore probably of Norman extraction,

and she was considered by her contemporaries to be very learned

(“_sapiens matrona_”).[53] Her writings, which are quite numerous,

are frequently quoted by later authors, this being especially true of

her work on diseases of women. The four other women who took an active

and creditable part in the work of the Salerno Medical School also

wrote treatises on various subjects: Abella, on “Black Bile”, (written

in verse); Mercuriade, on “Pestilential Fever,” and also on “The

Treatment of Wounds”; and Rebecca Guarna, on “Fevers.” In the case of

Costanza Calenda, the daughter of the Dean of the medical school and

a woman remarkable for her wisdom as well as for her great beauty, no

record of the treatises which she wrote appears to have been preserved.

The later epoch of the literature created by the Medical School of

Salerno begins about the year 1100 of the present era, after the Latin

translations and compilations made by Constantinus the African had

taught the physicians who were then at the head of affairs something

about the medicine of the Arabs, and had, at the same time, through

the latter medium, brought to their attention afresh the teachings

and practice of the ancient Greeks.[54] Among the works of the latter

character--works which in their Latin dress proved most valuable to the

Salerno physicians--are the following: “The Aphorisms of Hippocrates”;

“Galen’s _Ars Parva_” (_Mikrotechne_); and the same author’s

“Commentaries on the Hippocratic Writings.”

John Afflacius, a monk who lived during the latter half of the eleventh

century of the present era, was one of the pupils of Constantinus. His

treatise “On Fevers,” according to Neuburger, contains ample evidence

of the author’s ability as a clinical observer.

Something still remains to be said concerning Bartholomaeus, Cophon

the Younger, John Platearius the Younger and Archimathaeus. They

have already been mentioned in the list of authors whose writings

contributed materially to the celebrity of the Medical School of

Salerno, and it is now only necessary to furnish a few particulars

with regard to their lives and the nature of the work which they

accomplished.

Bartholomaeus wrote a treatise (entitled “_Practica_”) on the

practice of medicine as taught by Hippocrates, Galen, Constantinus and

the Greek physicians. Its enduring popularity is evidenced by the facts

that it was translated at an early period into several languages and

that portions of its text are often quoted by later authors. The book

contains ample evidence that its author was a very close observer and

a physician who strove to make accurate diagnoses.

Cophon the Younger (about 1100 A. D.) was the author of two works: a

treatise on anatomy which bore the title “_Anatomia Porci_,” and

one on the practice of medicine (“_Practica_”). The ancients, it

is stated, selected a pig for purposes of anatomical study “because its

internal organs present a very close resemblance to those of the human

being.” Both books are written in a clear and simple style.

John Platearius the Younger was the author of a work on internal

medicine (“_Practica Brevis_”) and also of one on the subject of

urine (“_Regulae Urinarum_”).

Archimathaeus wrote and published three treatises: one on “Urines,”

another on practical medicine (“_Practica_”), and the third

on “The Demeanor which a Physician should Observe when he Visits a

Sick Person” (“_De Aventu Medici_”). The latter treatise, says

Neuburger, is “a mixture of piety, artlessness, and slyness; but it

furnishes a capital picture of the carefully regulated behavior of the

mediaeval physician at the patient’s bedside, of the manner in which he

conducted his examination of the case, and of his intercourse with the

household as well as with the sick person.”

In addition to the treatises referred to above,--treatises which are

known to have been written by the authors to whom I have credited

them,--the _Collectio Salernitana_ contains several of which the

authorship is not known. One of these, which bears the title “_De

Aegritudinum Curatione_,” is reputed to furnish a better account

of the special pathology and therapeutics taught at the Medical

School of Salerno during the height of its celebrity than is to be

found in any of the other treatises. In one part of the book--that,

namely, in which local affections are discussed--the anonymous author

gives in succession the opinions held by the seven leading teachers

of the school (Platearius II., Cophon II., Petronius, Afflacius,

Bartholomaeus, Ferrarius and Trotula) with regard to each one of a

certain number of local diseases; thus enabling the reader to obtain a

very fair idea of what was the condition of medical science at Salerno

during the twelfth century of the present era.

The famous didactic poem known as the “School of Salerno” (_Schola

Salernitana_) and also as the “Code of Health of the School of

Salerno” (_Regimen Sanitatis Salernitanum_), was composed

originally about 1100 A. D. It was clearly intended in the first

instance for the guidance of laymen in matters relating to diet, the

conservation of health and the prevention of disease; but from time to

time, as the years rolled on, there were added to it several sections

which changed materially the character of the poem. From a mere code of

health it became eventually a fairly complete cyclopaedia of medicine

in versified form; the number of the verses having increased fully

tenfold during this long period. The poem, in its latest state, is

arranged in ten principal sections, as follows: Hygiene (8 chapters);

materia medica (4 chapters); anatomy (4 chapters); physiology (9

chapters); etiology (3 chapters); significance of different signs (24

chapters); pathology (8 chapters); therapeutics (22 chapters); nosology

(20 chapters); and the practice of medicine as actually experienced (5

chapters).

The work has been translated into nearly every modern language, and,

according to an estimate which was made in 1857, there are in existence

no fewer than 240 different editions. The most recent of these is the

French translation made by Meaux Saint-Marc and published by him (2d

edition) in Paris in 1880. There are two English versions--that by

A. Croke (Oxford, 1830), and the more recent one by John Ordronaux

(Philadelphia, 1871).

Some authorities make the statement that the poem was written

originally for the guidance of Robert, the son of William the

Conqueror; but Neuburger says that the dedication of the work to this

prince is lacking in many of the original manuscript copies and that

in some instances the word “Francorum” is to be found in the place

of “Anglorum”; for which reason he believes that the introduction

of a dedication was made long after the poem had been written. It

will probably appear strange to most readers that the author of the

“_Regimen Sanitatis_” (or “_Flos Medicinae_,” as it was

sometimes called) should have written his text in the form of verse

rather than in that of prose. He himself states briefly, at the end

of the poem,[55] some of the reasons why he preferred to adopt this

course. Rhythm, he maintains, makes it easy to say a great deal in a

few words; besides which, it facilitates by its novelty the memorizing

of new facts, and also enables one quickly to recall to mind those

which have been learned at some previous time. His judgment seems

to have been entirely correct, for the book proved to be immensely

popular, and retained its popularity throughout an extraordinarily long

period of time. Furthermore, as already stated, it accomplished a great

deal toward enhancing the reputation of the Salerno School of Medicine.

When we consider how difficult it must have been in those days for

students of medicine to memorize facts which were stored in books that

were very costly and oftentimes not obtainable at any price, we cease

to wonder at the great popularity of this miniature cyclopaedia in

leonine verse.[56] Here were to be found, at one-fourth or one-tenth

the price of any similar book written in prose, all the essentials

(anatomy, physiology, pathology, etc.) required by the candidate for

medical honors; and if, perchance, he possessed a good memory, he

might, without a very great mental effort, transfer the entire poem to

his own private storehouse of facts.

A few extracts from this remarkable piece of medical literature are

given below, in the belief that many of our readers will find them of

interest.

ORIGINAL TEXT DR. JOHN ORDRONAUX’S TRANSLATION

Si vis incolumen, si vis te If thou to health and vigor wouldst

vivere sanum, attain,

Curas tolle graves, irasci Shun weighty cares--all anger deem

crede profanum, profane,

Parce mero, coenato parum; From heavy suppers and much sit

non tibi vanum wine abstain.

Surgere post epulas; somnum Nor trivial count it, after pompous

fuge meridianum; fare,

Ne mictum retine, ne comprime To rise from table and to take the

fortiter anum. air.

Haec bene si serves, tu longo Shun idle, noonday slumber, nor

tempore vives. delay

The urgent calls of Nature to obey.

_Conditiones Necessariae Medico._ _Demeanor Necessary For the

Physician._

Clemens accedat medicus cum Let doctors call in clothing fine

vesta polita; arrayed,

Luceat in digitis splendida With sparkling jewels on their

gemma suis. hands displayed;

Si fieri valeat, quadrupes And, if their means allow, let

sibi sit pretiosus; there be had,

Ejus et ornatus splendidus To ride, a showy, rich-attired pad.

atque decens.

Ornatu nitido conabere carior For when well dressed and looking

esse, over-nice,

Splendidus ornatus plurima You may presume to charge a higher

dona dabit price,

Viliter inductus munus sibi Since patients always pay those

vile parabit, doctors best,

Nam pauper medicus vilia Who make their calls in finest

dona capit. clothing dressed,

While such as go about in simple

frieze,

Must put up with the meanest grade

of fees;

For thus it is, poor doctors

everywhere

Get but the smallest pittance for

their share.

At Salerno the anatomical demonstration made, apparently only once a

year, for the benefit of the students, consisted in exposing to view

the abdominal viscera of the pig and commenting upon the features

which distinguish them from the same organs in the human body. In the

“_Regimen Sanitatis_” only eight lines of text are devoted to

anatomy.

In section IV., which relates to physiology, the text is more

instructive and entertaining, but still--as compared with the splendid

work accomplished by Galen--extremely incomplete and superficial.

In the early part of the twelfth century, Nicolaus Praepositus[57]

composed, at the request of his colleagues in the school of Salerno,

an “Antidotarium”--that is, a collection of formulae for combining

together, in a single pharmaceutical preparation, various drugs, both

those commonly employed in that part of Europe and others which were

then known only to the Arabian physicians. This book of formulae,

containing as it did descriptions of the effects which might be

expected from the different preparations, and furnishing instructions

with regard to the proper mode of employing them, served its purpose

admirably, not only in Salerno but throughout Europe, at least

during the Middle Ages. All the pharmacopoeias of a later date were

based upon his “Antidotarium,” and indirectly upon the still earlier

celebrated treatises written by Matthew Platearius and bearing the

titles “_Glossae_” and “_Circa instans_” (also that of “_De

simplici medicina_”). The most remarkable item, however, which

is to be found in the Antidotarium is that in which mention is made

of the use of soporific sponges (“_spongia soporifera_”), for

anaesthetizing purposes by means of inhalations, in certain surgical

procedures. (Neuburger.) They were made by impregnating the sponges

thoroughly with the juices of narcotic plants (opium, hyoscyamus,

mandragora, lactuca, cicuta, etc.), drying them, and putting them aside

until they were actually needed. Then the sponge was saturated for

about an hour with hot water or steamed, after which it was applied

over the patient’s nostrils and held there until the inhalation of the

fumes had induced sleep.

Another Salernian treatise worth mentioning is that written by Peter

Musandinus, under the title “On Foods and Beverages suitable for

Persons affected with a Fever.” This writer, who was one of the

teachers at the school of Salerno about the middle of the twelfth

century, says that great attention was paid in his time to the

preparation of foods in such a manner as to tempt the appetite of

people who were ill. He speaks of a meat extract which is prepared

from the flesh of the chicken, and also recommends that a soup

made by boiling a fowl in rose water be given to patients who are

affected with diarrhoea. He even goes so far as to lay stress upon

the importance of serving food to a sick person in dishes which are

pleasing to the eye. Apropos of the subject of foods that are easily

digestible and therefore suitable for invalids I may mention how Meaux

Saint-Marc translates or interprets the line in the “Regimen Sanitatis

Salernitanum” which reads _O fluvialis anas, quanta dulcedine

manas!_ His version may be rendered into English thus:

“Oh wood-duck, how gently doth thy soft flesh glide over the internal

surface of the stomach!”