Toward the end of the twelfth century (1180 A. D.) there was published

at Salerno a work on surgery--the oldest treatise on this subject

that is known to have been written in Italy during the Middle Ages.

It is now called “Roger’s Practice of Surgery,” but originally it was

spoken of (in accordance with a custom quite common in those days) as

“_Post mundi fabricam_,” which are the first three words of the

text. This book is of a very practical character and is written in a

simple, straightforward style. While it contains the usual amount of

traditional knowledge about surgical matters, it gives at the same time

the results of the personal experience of Roger, of his teachers, and

of his associates. As published in the “_Collectio Salernitana_”

the work represents, not the treatise as it was originally written,

but a revision made by Rolando of Parma. It is divided into four

parts or books, the topics treated in which comprise most of those

usually discussed in works on surgery. Under the heading “Wounds of

the Intestine,” in Book III., there occurs this most remarkable piece

of advice, viz., “to insert into the intestinal canal a small tubular

piece of elder and then to stitch the raw edges of the bowel together

over it.”

Another treatise on surgery, entitled “_Chirurgia Jamati_,”

was published at Salerno before the end of the twelfth century. Its

authorship is attributed to Jamerius, and in many respects it resembles

closely the treatise of Roger.

The “_Regimen Sanitatis_” was not, it appears, the only treatise

on medicine which was published at that period in the form of a poem.

Gilles de Corbeil (Petrus Aegidius Corboliensis), who had received

his professional training at the school of Salerno and was afterward

appointed the personal physician of King Philip Augustus in Paris

(1180–1223 A. D.), wrote versified treatises on these two groups of

topics--“The pulse, the urine, and the beneficial characteristics of

composite remedies,” and “The signs and symptoms of the different

maladies.” Both of these treatises were received everywhere throughout

Europe with great favor and they maintained their popularity for a

period of over four centuries. A French translation (by C. Vieillard)

of the treatise on urology was published in Paris in 1903. An edition

of the “_De signis et symptomatibus aegritudinum_” was printed in

Leipzig in 1907. The following five lines are quoted by Neuburger; and

they certainly display the remarkable gift possessed by Aegidius for

condensing a large amount of information into a very small space:--

DE CONDITIONIBUS URINAE

_Quale, quid, aut quid in hoc, quantum, quotiens, ubi, quando,_

_Aetas, natura, sexus, labor, ira, diaeta,_

_Cura, fames, motus, lavacrum, cibus, unctio, potus,_

_Debent artifici certa ratione notari,_

_Si cupit urinae judex consultus haberi._

To translate this into easily comprehensible English prose would

certainly require the employment of at least five times as many words.

Another physician who received a part of his training at Salerno and

who is mentioned by Neuburger as “The greatest eye surgeon of the

Middle Ages,” is Benevenutus Grapheus (twelfth century), a native of

Jerusalem, and probably of Jewish parentage. He wrote a practical

treatise (“_Practica oculorum_”) which had a wide circulation, and

which has been translated into Provençal, French and English.

Toward the end of the thirteenth century the famous Medical School

of Salerno began to show signs of decadence. Various circumstances

were responsible for this change. In the first place, its career of

great usefulness had already covered a period of about seven hundred

years, and--according to the law affecting all things human--its

time of decrepitude was already more than due. Then, in the next

place, vigorous rivals were beginning to appear in different parts

of Europe,--at Bologna, at Montpellier and at Paris,--and these new

schools must have attracted large numbers of students who otherwise

would have frequented the University of Salerno for the educational

facilities which they required. Commercialism--if such a term may be

employed to characterize the action of those who were not willing

to undergo the entire course of training required for obtaining the

full privileges belonging to a physician--may perhaps also be named

as one of the influences which contributed to the slow breaking up of

the school. That this force had already begun to exert some effect

upon the management of the institution may be inferred from the fact

that in 1140 A. D., Roger, King of Sicily and Naples, promulgated

the law that nobody would be permitted to practice medicine in his

kingdom until he should have satisfied the royal authorities that he

was properly qualified to undertake such practice. The establishment

of such a law surely indicated that the number of those who were

incompetent to assume the responsibilities of a practitioner of

medicine was alarmingly on the increase; and, after it had gone into

effect, many must have been deterred from choosing a medical career,

and perhaps others have been diverted to schools which were located

in countries where the laws were more lax. In 1240 A. D. the Roman

Emperor Frederic II., who was also King of Sicily, made it a law that

the course of medical studies at Salerno should cover a period of

five years. All these factors taken together would seem to have been

sufficient slowly to diminish the popularity of this celebrated school.

But to these there were added, in the latter half of the thirteenth

century,--if we may believe Puschmann,--two new factors, which exerted

a powerful influence in destroying all hope of further regeneration,

viz., the establishment of a university at Naples, in 1258 A. D., by

Manfred, King of Sicily, and the narrow and illiberal spirit in which

the Church, by this time in almost full control of the education at

Salerno, managed the medical school.

During the following four centuries the University of Salerno--for

during the thirteenth century it became a university in fact, if not

in name--retrograded steadily, until finally the French Government, on

November 29, 1811, officially put an end to its existence. The traveler

who to-day visits Salerno, in the hope of seeing some remains of the

oldest medical school in Europe, will find there only a collection of

squalid buildings which serve as dwellings for the poorer classes, a

dirty and uncomfortable inn, and shops of nearly the same dimensions

as those which once lined the narrow streets of Pompeii. As he gazes,

however, at the superb view presented by the Gulf of Salerno he may

readily, by an effort of the imagination, reconstruct the picture of

the famous “Hippocratic City” as it was when William the Conqueror and

other distinguished persons visited it nearly a thousand years ago.

Neuburger, in his review of the career of the Salerno Medical School,

sums up its contributions to the science of medicine in about these

terms: Those who taught at Salerno were the first physicians in the

Christian part of Western Europe who procured for medicine a home in

which scientific considerations alone prevailed, where the Church

exercised no control whatever, and where all the different branches of

the science were favored to an equal degree. They devoted their best

energies, by oral teaching and by their writings, to the single object

of communicating practical knowledge of the healing art to all who

desired to obtain it; and, by the admirable example of their own lives,

they furnished a high standard for the guidance of those who wished to

reflect honor upon the name of physician.

CHAPTER XXII

EARLY EVIDENCES OF THE INFLUENCE OF THE RENAISSANCE UPON THE

PROGRESS OF MEDICINE IN WESTERN EUROPE

In previous chapters we have seen how the Arabs, inspired with an

extraordinary zeal for acquiring knowledge of the different sciences,

devoted time and money freely, throughout a period of several

centuries, to the accomplishment of this purpose. They were fired

with ambition to become a great nation, and their studies of the

world’s history taught them that the ancient Greeks had accumulated

in their literature vast stores of the very knowledge which they were

so anxious to acquire. Accordingly all their energies were directed

toward converting these stores from the Greek into their own language,

the Arabic. This widespread eagerness of the nation, at a given period

of its history, to improve itself intellectually is spoken of as the

Arabic Renaissance, and, at the time which I am now about to consider,

the movement had practically come to a standstill. A short time,

however, before this occurred, the physicians of Italy and of the more

northerly countries of Western Europe began to show a similar desire

to add to their medical literature; and their first step, like that

of the Arabs four or five centuries earlier, was directed to the work

of translating Arabic medical treatises into debased Latin, which was

the language commonly employed by the learned during the Middle Ages.

The knowledge which they desired to acquire could not at that time be

obtained in any other way, for nobody was acquainted with the Greek

language, and, besides, Greek originals had not yet been brought into

Western Europe. These first evidences of the Renaissance in that part

of the world were not confined to physicians; they were to be found

in every walk of life. The development of the movement reminds one of

what takes place near the sea coast, where a period of heat and calm is

suddenly broken by the appearance of a few gentle puffs of wind, which

are quickly succeeded by the full force of a steady and refreshing

sea-breeze. In like manner feeble indications of the coming movement

appeared in Italy, France, Germany and even England, and these were

soon followed by unmistakable evidences that a genuine Renaissance of

widespread proportions had begun. It was as if a great awakening had

taken place among the nations which had for centuries lain dormant;

an awakening which was followed by a desire to lay aside the trivial

pursuits in which they had so far been engaged, and to attain those

results which were, later on, to excite the wonder and admiration

of the world. Such were, for example, the development of the art of

printing with movable types; the discovery of America; the production

of such clever painters, sculptors, engravers, workers in metal,

etc., as Michael Angelo, Raphael, Albrecht Dürer, Benvenuto Cellini,

Rembrandt, and literally scores of others of nearly equal merit; the

development of a Shakespeare, a Milton and a Dante in the field of

literature; the production of a Luther, a man who had the courage to

protest against evil practices which had crept into the Christian

church. And medicine, as I have already stated, felt the influence

of the approaching Renaissance, and responded to it by efforts which

had for their object the acquisition of such knowledge as might be

furnished by translations from Arabic treatises. Constantinus, the

African, of whom mention has been made on a previous page, seems to

have been the first person (toward the end of the eleventh century) who

did any work of this kind; but his associates in Salerno do not appear

to have valued these translations very highly, or else, perhaps, they

were not yet prepared to give serious consideration to works which were

new to them. In the twelfth century, as will now be seen, the attitude

of the physicians of Western Europe underwent a change.

The city of Toledo, in Spain, was richly stocked with the manuscript

treasures of Arabic literature at the time (1085 A. D.) when it fell

into the hands of the Christians. One of the earliest scholars to

engage in the work of translating these treasures into Latin was

Gerard of Cremona, in Lombardy, who lived during the twelfth century

(1114–1187 A. D.). He spent most of his lifetime in Toledo, “learning

and teaching, reading and translating.” (Neuburger.) Among the medical

works which he translated from the Arabic the most important are the

following: Several of the writings of Hippocrates and Galen; the

Breviarium of Serapion; several of the writings of Rhazes and of Isaac

Judaeus; the treatise on surgery by Abulcasis; the Canon of Avicenna,

etc. This stimulated many others to follow in the footsteps of Gerard

of Cremona; and thus, during the thirteenth century, a number of works

of importance were translated in addition to those already mentioned.

Such, for example, were the “Colliget” of Averroes by Bonacosa, a Jew

(1255) of Padua; the “_Teïssir_” of Avenzoar, and the “Dietetics”

of Maimonides by John of Capua, a Jewish convert to Christianity

(1262–1278); the “_De veribus cordis_” of Avicenna by Arnaldus

of Villanova (about 1282); the treatise “_De simplicibus_” of

Serapion the Younger, and the “_Liber servitoris_” of Abulcasis,

by Simon Januensis; and many others. This wave of keen interest in

the writings of Arabic physicians and in the Arabic versions of Greek

medical authors soon reached Languedoc in France, and then passed over

from there into Italy. For a long time the Salerno physicians resisted

its influence, but they finally yielded to it, as the leaders in the

schools of Bologna, Naples, Montpellier and Paris had already done.

It was at Palermo, in Sicily, however, that the movement received its

greatest impetus. Frederick II., at that time King of Sicily, and a

ruler who was most tolerant in religious matters, had at his Court an

entire staff of Arabic physicians, philosophers, astrologers and poets;

and, in addition, he kept a number of learned Christians and Jews

constantly busy translating Arabic works into Latin. The most widely

known member of the latter group was Michael Scotus (or Scottus),

who at one time had been a teacher in the Medical School of Salerno.

Among the books which he translated while he was at Palermo there were

several of Aristotle’s treatises, more particularly those which dealt

with psychological topics and with natural history. Frederick not

only did everything in his power to promote the work of translating,

he also took pains to distribute copies of the Latin versions, when

completed, among the universities of Western Europe. His son, Manfred,

who succeeded him on the throne, seems to have been almost as much

interested in the work as his father had been. It was from him, for

example, that the University of Paris received a set of the Aristotle

volumes in Latin. When Charles I., King of Naples (1265–1285 A. D.),

conquered Sicily he manifested considerable interest in continuing the

work of his predecessors, particularly as regards treatises relating

to medicine. Among the translators whom he employed for this work

was Farragut (in Arabic, Faradsch ben Salem), from Girgenti, a small

town on the south coast of Sicily, about sixty miles from Palermo. In

addition to several treatises of minor importance he translated into

Latin the colossal work of Rhazes--the “Continens.” Charles I. kept at

his Court not only expert translators, but also skilled illuminators;

and it was by them that the celebrated manuscript copy of this work

which is to-day in the _Bibliothèque Nationale_ at Paris, was

illustrated with miniatures, three of which are portraits of Farragut.

This particular copy of the “Continens” was completed in 1282 A. D.

Not a few of the translations made during this period, it should be

stated, are now very difficult to understand. In the first, place, the

Latin in which they are written is of the barbaric type (neo-Latin),

something quite different from that employed by Cicero, Tacitus and

other Roman authors of the classical period; and, in the next, it is

not infrequently evident that the translator himself did not clearly

apprehend the meaning of the original Arabic text. Despite all these

drawbacks, however, the placing of Latin versions of Arabic writings

within the reach of European physicians accomplished much good. Even

the imperfections to which reference has just been made probably

served to increase the eagerness of these men to gain access to the

real sources of Arabic learning--viz., the writings in the original

Greek. To anticipate a little, I may say here that this object was

not attained until after the lapse of about two more centuries--that

is, not until the scholars of Western Europe had learned to read the

Greek, and had also brought out from their hiding places in churches

and monasteries of the East the needed originals. At that period of the

world’s history centuries corresponded to decades as modern events are

recorded.

One may gain some idea of the extent to which these Latin translations

of Arabic original treatises and of Arabic versions of Greek medical

works influenced the physicians of Western Europe, by consulting one

of the important medical treatises of the fourteenth century--that,

for example, of Guy de Chauliac (written 1363 A. D.). Edouard Nicaise,

the accomplished editor of this and several other mediaeval medical

treatises, has printed in his preface Joubert’s table showing just how

often Guy quotes each one of about four score earlier authors, and from

this analysis it appears that Abulcasis was quoted 175 times, Aristotle

62 times, Avicenna 661 times, Galen 890 times, Haly Abbas 149 times,

Mesué 61 times, Hippocrates 120 times, and Rhazes 161 times; or, to

state the facts somewhat differently, the quotations from treatises

introduced into Western Europe by the Arabs represent, in the present

instance, 70 per cent of all the quotations (2279 of a total of 3243)

made by this author. Another equally strong piece of evidence is that

afforded by Vincent de Beauvais’ encyclopaedia,--a work published

in Paris toward the middle of the thirteenth century,--in which the

parts relating to medicine appear to have been taken very largely from

treatises written by Arabic authors. (See statement on page 270.) There

can therefore be no reasonable doubt that the Arabs played a most

important part in the renaissance of medical learning which began a

century or two earlier, which already in the thirteenth century had

made great progress, and which very soon--as time is reckoned in the

calendar of all important world movements--was to culminate in that

still greater renaissance called “modern medicine.”

During the later portion of the Middle Ages (thirteenth and fourteenth

centuries) there were four universities which possessed medical schools

of considerable importance--viz., those of Bologna and Padua in Italy,

and those of Montpellier and Paris in France. All of these seats of

learning, like the famous school at Salerno, developed so gradually

and from such modest beginnings that it is scarcely possible to assign

to any of them a date of origin. Medicine was taught at several other

places--as, for instance, at Oxford, England; at Naples, Vicenza,

Siena, Rome, Florence, Ferrara, Pisa and Pavia, in Italy; at Salamanca

and Lerida, in Spain; at Prague, in Bohemia; at Cologne, in Germany;

at Vienna, in Austria, etc. But the part which these smaller schools

played in the work of advancing our knowledge of medicine was certainly

of far less importance than that which fell to the lot of the four

institutions just mentioned.

The University of Montpellier, if not the oldest of the four schools

mentioned, was apparently the first to attain some degree of

celebrity. It is known, for example, that the Archbishop of Lyons,

who was suffering at the time from some malady which the physicians

of that city were not able to cure, visited Montpellier 1153 A. D.

in the belief that he might there obtain the desired relief. John of

Salisbury, who lived during the latter half of the twelfth century and

who was considered one of the greatest scholars of his time, declared

that those who wished to acquire a satisfactory knowledge of medicine,

found that Salerno and Montpellier were the only places where the

desired instruction might be obtained. Gilles de Corbeil (mentioned

in the last chapter), Von der Aue, and other eminent men of the same

period spoke in equally favorable terms of the merits of Montpellier.

The celebrated monk, Caesarius of Heisterbach, calls the university of

that city “the headquarters of medical wisdom”; but at the same time

he expresses regret that the physicians of that school not only do not

believe in miraculous cures, but speak of them ironically. It was one

of the characteristics of the institution that the teachers, both the

medical and the philosophical, were, at a very early period, allowed

great freedom of thought and speech; but, as time went on, this liberty

became very much curtailed. During the thirteenth and fourteenth

centuries there were, it appears, many Jews among the students at

Montpellier, not merely in the department of medicine, but also in the

other departments of the university.

The medical schools of Salerno and Montpellier seemed, at this early

period (thirteenth century), to possess more individuality than did the

similar organizations at Bologna, Padua and Paris; for limited periods

of time each of them in turn enjoyed a certain amount of fame by

reason of the fact that some teacher or writer of special distinction

happened then to be officially connected with the school. In other

words, it was the fame of the man and not of the school, that induced

students to visit Bologna or Padua, or Paris, during the thirteenth

and fourteenth centuries. At a somewhat later period (fifteenth

and sixteenth centuries) all three of these institutions stood out

prominently before the world as celebrated medical schools, with

distinctive characteristics. To be invited to occupy a chair in one of

these institutions conferred honorable distinction upon the incumbent

selected, and when I reach that period, farther on in this history,

I shall describe each one of the more important schools separately.

In dealing with the earlier epoch, however, it seems best to devote

our attention more particularly to individual physicians than to the

schools with which they may happen to be connected.

Among the physicians belonging to the latter half of the thirteenth and

the first quarter of the fourteenth century there is one whose proper

place in the history of medicine is by no means easy to determine, and

who yet played a part of no small importance. This man was Pietro

d’Abano, or Petrus Aponensis, who was born at Abano, a small village

near Padua, 1250 A. D. Very little is known about his early youth,

but from this little we are warranted in drawing the conclusion that

his father, a notary, must have taken great pains to afford him every

possible educational advantage. He gave his son, for example, the

opportunity of studying Greek in Constantinople,--a thing of rare

occurrence in those early days,--and allowed him to remain there until

he had so far mastered the language that he was able to translate the

“_Problemata_” of Aristotle from the original text. Then, upon his

return home from Constantinople, he was sent to Paris for the purpose

of perfecting his knowledge of philosophy, mathematics and medicine.

After this thorough training for his life work, Pietro d’Abano began

teaching philosophy in Padua, and almost immediately he gained such

success that people spoke of him as “the great Lombard.” However, like

most of the men of that time who became conspicuous through their

intellectual attainments, Pietro d’Abano was soon accused by the

Dominicans of being a heretic and of cultivating the magician’s art. He

was able to parry this blow by making a journey to Rome and obtaining

from Pope Boniface VIII. a decree of absolution. About the same

time he began writing his two great works--the “_Conciliator_”

and the “Commentaries on Aristotle’s _Problemata_.” He did not

begin to teach medicine at the University of Padua until 1306, when

he was already fifty-six years of age. But his lectures, reflecting

as they did the depth and extent of his learning and the keenness of

his powers of analysis, were a source of great astonishment to his

contemporaries. It is reported by Neuburger, for example, that Gentile

da Foligno, one of the most distinguished professors in the Medical

School of Padua, happening to pass near the auditorium while Pietro

d’Abano was delivering his lecture, listened for a short time and then

exclaimed: “_Salve o santo tempio_”--“Hail to this time which has

brought forth such wonders!” With the increase of Pietro’s fame came

also a decided increase in the bitterness of the persecution carried

on against him by his ecclesiastical foes, largely due perhaps to his

open and courageous defense of the Averroism which they so much hated.

There is very little doubt that he would have been burned at the stake

about this time if the friendly disposition of the Popes and the mighty

influence possessed by the city of Padua had not shielded him from this

danger. In 1314 the newly founded school of Treviso invited Pietro

d’Abano to occupy the Chair of Medicine and Physics, and he accepted;

but he was taken ill and died during the following year. Shortly before

the occurrence of this event he was placed on trial for heresy by the

Inquisition, and the proceedings were continued even after his death.

Indeed, according to one account of this famous trial, not only was

the charge sustained, but the prescribed penalty was inflicted either

upon the disinterred corpse or upon an effigy of the condemned man. One

century later, the city of Padua erected a permanent memorial in Pietro

d’Abano’s honor.

The principal work of this remarkable physician--viz., the

“_Conciliator differentiarium philosophorum et praecipue

medicorum_”--was first printed at Venice in 1471. (It is said to

be one of the earliest printed books known.) It was a most popular

treatise, as is shown by the fact that between the year last mentioned

and 1621 it passed through a number of editions. Of the other treatises

which he wrote--some seven or eight in all--it will be sufficient

to mention here that one alone to which reference has already been

made in the preceding account, viz., the work entitled “_Expositio

problematum Aristotelis_” (Mantua, 1475, and Paris, 1520).

At this early period in the history of the Padua Medical School there

were one or two other men who attained a considerable degree of

celebrity for the excellence of the work which they did, either as

authors or as class-room teachers. A brief account of one of these,

Aegidius Corboliensis, has already been given on a preceding page, and

it seems only fair that I should furnish here similar brief accounts of

some of the others--Gentile da Foligno, Massilio and Galeazzo de St.

Sophia, Giacomo and Giovanni de’ Dondi, and Giacomo della Torre, from

Forli, all of whom contributed greatly to the steadily increasing fame

of the Padua School of Medicine; but, under the conditions which govern

the preparation of this brief history, I must reluctantly pass over

these names in silence.

CHAPTER XXIII

FURTHER PROGRESS OF MEDICINE AND SURGERY IN WESTERN EUROPE

DURING THE THIRTEENTH, FOURTEENTH AND A PART OF THE FIFTEENTH

CENTURIES

Among the men who, during the thirteenth century, exerted more or

less influence upon the growth of medical knowledge there are three

who deserve to receive some consideration at our hands. They were not

physicians, but yet some of their writings deal with topics which

are closely related to the science of medicine. They are: Albert von

Bollstädt, a German who is generally known as Albertus Magnus, one of

the greatest scholastic philosophers of the Middle Ages; Vincent of

Beauvais (Vincentius Bellovacensis), a French Dominican monk, who was

reader to Louis IX., and who compiled a general encyclopaedia which

brought him great fame at that period; and Roger Bacon, an Englishman

who, by reason of the extraordinary extent of his knowledge and his

remarkable powers of observation, was given the name of “Doctor

mirabilis.”

_Albertus Magnus._--Albertus Magnus was born at Lauingen, Swabia,

in 1193 A. D., obtained his education in Italy (at the University of

Padua, during the latter part of his stay), joined the Order of the

Dominicans on arriving at the age of thirty, and afterwards, throughout

his long life, devoted himself largely to teaching, particularly at

Paris and Cologne. He was a prolific writer and his works, particularly

those which treat of topics belonging to the domain of natural history,

were greatly appreciated. The effect, however, which they produced

upon a certain class of readers was to persuade them that he was a

great magician. The chief distinction of his writings lies in the

fact that they contain a large number of original observations which

he made during the course of his journeys afoot through Germany in

the character of Provincial of the Dominican Order. This habit of

exercising entire independence in the use of his reasoning powers

was something quite rare in those days. His observations were

directed chiefly to matters belonging to the domains of zoölogy,

botany, climatology, mineralogy, chemistry and physics. The following

significant advice, says Neuburger, is attributed to him: “As regards

the doctrines which relate to questions of belief and of morality, it

is the part of wisdom to attach greater authority to Saint Augustine

than to the philosophers; in matters belonging to the domain of

medicine put your chief trust in Galen and in Hippocrates; in natural

history, however, your best guide is Aristotle.” Neuburger adds that,

throughout the writings of Albertus Magnus, there appear interesting

statements relating to anatomy, physiology, psychology, and the plants

and minerals which may be used for remedial purposes.

An edition of the writings of Albertus Magnus (21 folio volumes) was

published in Lyons by Petrus Jamy in 1651. The work was republished in

Paris in 1892 and following years.

_Vincent of Beauvais._--Vincent of Beauvais, France, a Dominican

monk who lived during the first half of the thirteenth century and

was the tutor of Louis the Ninth’s children, devoted the major part

of his time to literary work. He wrote many theological treatises

and also edited a large encyclopaedia in which information is

furnished regarding everything that was known at that time. Several

hundred authors aided him in compiling this work, which is entitled

“_Speculum Majus_.” It is arranged in three parts, one of which

(“_Speculum Naturale_”) consists of 33 books that are divided

into 3740 chapters; and quite a number of the divisions are devoted

to topics relating to medicine. The authors, from whose writings this

medical information has been abstracted, are Hippocrates, Aristotle,

Dioscorides, Haly Abbas, Rhazes, Avicenna and several others--not to

mention the Church Fathers and other encyclopaedic writers connected

with the Church. The first printed edition of this great work appeared

toward the end of the fifteenth century (1473–1475 A. D.); the last,

or one of the last, in 1624. Lack of space will not permit me to give

any details concerning the works of a somewhat similar character

which were prepared, about the same time, by the English Franciscan

monk Bartholomaeus of Glanvilla (1260); by the Dominican, Thomas of

Cantimpré (1204–1280 A. D.), a pupil of Albertus Magnus; and by others.

_Roger Bacon._--Roger Bacon was born about 1210 A. D. in

Ilchester, Somersetshire, England, and received his early training at

Oxford. When he was thirty years of age he went to Paris and, after

devoting himself assiduously for seven years to the study of various

branches of learning, he received the Doctor’s degree (1247). The

wish to acquire a thorough knowledge of whatever subject he undertook

to study constituted a prominent feature of his character. He was

fond of languages, but he had an even greater love for mathematics,

particularly in connection with astronomy, and for experimental work

in the department of chemistry. It is said that he expended a large

sum of money (£2000) upon these chemical investigations. He left

Paris in 1250, returned to England, and not long afterward joined the

Order of the Franciscans. Robert Grossetête, Bishop of Lincoln, and

the Franciscan monk Adam of Marisco--two men whom Neuburger describes

as theologians of a very liberal type--exercised a strong influence

upon Bacon at this period of his life. They confirmed him in the

belief that familiarity with the learned languages was an acquisition

greatly to be prized, and at the same time they gave him every

encouragement to pursue his researches in mathematics and in natural

history. For a certain length of time he was an instructor at Oxford,

but his views with regard to ecclesiastic and moral questions and

the discoveries which he made in physics (especially in optics) were

beyond the comprehension of his contemporaries, who did not hesitate to

pronounce them works of the Devil and to subject Bacon to all sorts of

punishments and deprivations. Fortunately for him and for the cause of

science the newly elected Pope, Clement IV. (1266), came to his rescue

in those dark days and granted him--under the promise of absolute

secrecy--permission to continue his researches without hindrance and to

perfect the plans which he had in mind for reforms of different kinds.

I cannot follow this pioneer of scientific research work, this man who

was several centuries ahead of the time in which he lived, through all

the vicissitudes of his interesting and extraordinarily fruitful life;

I may simply add that his death occurred about the year 1294; that

he left behind him many important treatises, only a small portion of

which have thus far been published,[58] and that from these alone one

is justified in classing Roger Bacon as one of the greatest thinkers

whom history has recorded. So far as is now known, he wrote very little

concerning medicine, and--strange to say--he seems to have attached

considerable importance to astrology; indeed, he went so far as to

blame the physicians of his day for their ignorance regarding this

science, “as a result of which they neglect the best part of medicine.”

In strange contrast with these views, which to-day we characterize as

foolishness, is Bacon’s famous dictum: “Experiment is a firmer and more

trustworthy basis of knowledge than argument”--a maxim which is the

guiding principle of modern medicine.

The Medical School of Bologna.--The Medical School of Bologna first

began to assume a certain degree of prominence in the early part of

the thirteenth century, under the teaching of Thaddeus Alderotti--also

frequently called Thaddeus of Florence.

_Thaddeus Alderotti._--Thaddeus Alderotti, who was born at

Florence, Italy, 1223 A. D., of humble parentage, began the study

of philosophy and medicine at Bologna only after he had reached

manhood; but he was such an earnest student and made such good use of

his opportunities that in 1260 he was chosen to serve as one of the

teachers in the school. Throughout a period of many years he filled

the office so acceptably that his colleagues bestowed upon him the

name of “Master of Physicians.” Before this time arrived, however,

his lack of funds was sorely felt, for he was obliged, in order to

support himself, to offer consecrated wax candles for sale at the

entrance of the church. He is reported to have been not merely a most

learned physician, but also a very successful practitioner. He was

called into consultation from all parts of the country, so highly

was his opinion valued by other physicians; and thus in due time he

accumulated a large fortune. His charges were by no means small. It is

related, for example, that Pope Honorius IV. sent for him to come to

Rome, and, after the treatment was completed, paid him a fee of 10,000

gold pieces[59]--but not until after he had expressed surprise that

Thaddeus should have charged as much as 100 gold pieces per day for his

services. To this demurrer on the part of the Pope, Thaddeus replied

that the petty princes and even the simple nobles made no objection to

paying him 50 or more gold pieces per day. It is scarcely necessary to

add that the Holy Father did not wish to be outdone by his inferiors.

Alderotti died 1303 A. D.

Among the writings of Thaddeus Alderotti which have come down to our

time there are to be found a number of autobiographical references

which are not without interest. In one place, for example, he mentions

the fact that he occasionally walks in his sleep, and then proceeds

(in Latin) to discuss the phenomenon of sleep-walking as observed in

his own case. I give here a free translation of the text printed in

Neuburger’s History:--

The fourth question which suggests itself is this: Can the

senses during sleep come into active operation? Touching this

fourth question I reason thus: It appears as if, when one

is asleep, the senses must act, for a person may move about

without incurring any harm when he is in that state, as is

often observed in the case of those who, like myself, walk in

their sleep.... Furthermore, it has been remarked that these

people are able to harness a horse and then to ride the animal

safely,--acts which it is not possible to perform without the

aid of the senses. On the other hand, Aristotle maintains that

a man, when asleep, is not capable of using his senses. To this

I reply by conceding that during sleep a man certainly does not

perceive what is going on about him. Wherefore, if you answer me

by saying that the mere fact of a man’s ability to walk while

he is asleep furnishes conclusive evidence that he possesses

his senses, I reply that movements like that of walking are not

the result of an impression made upon the mind (“_impressio

imaginativa_”), but the product of a different mechanism, of

a nature which permits it to operate during sleep.... As to the

second point to which you call attention--that, namely, with

regard to the power of bridling and riding a horse while one is

asleep--I make this reply: These acts are performed as a result

of an impression made upon the mind through the working of the

imagination, and not as a direct consequence of any images

created upon the eye; for, if the sleep-walker happens to be in

a strange house when the impulse to walk seizes him, he will not

go to the stable. The route which he is sure to take will be one

with which he is familiar, as happened in the case of the blind

teacher who, unaccompanied by any person, walked habitually

through the streets of Bologna. And then, besides, I am able to

speak from personal experience, for in one of my sleep walks I

jumped down from an elevation about four feet above the ground

without awaking from my sleep.... When, in the course of one

of these walks, I am exposed to cold, or when I hear somebody

speaking near me, I refer these phenomena entirely to something

within myself, and I return to my bed.

Of the four medical schools to which a brief reference was made on a

preceding page, that of Bologna was probably the first to attain a

certain degree of celebrity; and it owed this distinction very largely

to the work done by men who were primarily surgeons, viz.: Hugo of

Lucca; Theodoric, Hugo’s son; William of Saliceto; and possibly, to

a very slight extent, Roland of Parma, who spent only a part of his

professional life in Bologna. But there was one other who, while he was

not a surgeon, yet contributed very greatly to the fame of the Bologna

school and at the same time to the real advance in surgical knowledge

which characterized the work of the men whose names have just been

mentioned--viz., Mondino. These men, especially Mondino, cultivated

the study of anatomy much more earnestly than their rivals at Salerno

had ever done, and the surgical methods which they adopted were of

a more scientific character than those practiced by Roger. In the

treatment of wounds, for example, instead of striving to bring about

healing by the application of remedies which stimulate suppuration,

they favored the dry method; in which practice they were justified

not only by their own experience but also by Galen’s teaching: “A dry

state of the wound approaches more nearly to what may be considered

the normal condition, whereas a moist state is surely unhealthy.”

(_Methodi medend._, IV., 5.) As an offset to the latter authority

the Salerno surgeons quoted that particular aphorism of Hippocrates

(V., 67) which reads: “_Laxa bona, cruda vero mala._”--almost the

very opposite of Galen’s doctrine. Then again, the Bologna surgeons

effected improvements in other directions: They materially restricted

the use of the red-hot cautery iron, and they cast aside as useless

many of the complicated apparatuses which had previously been employed

in the treatment of fractures and dislocations. It is evident from

these facts that the Bologna surgeons were not, as were most of the

physicians of the twelfth and thirteenth centuries (Thaddeus of

Florence perhaps excepted), slavish followers of the ancients or even

of the more modern Arabs, but men who thought independently and who

were not afraid to use their own powers of observation.

_Hugo of Lucca._--Hugo Borgognoni, more commonly called Hugo of

Lucca--was born in that city about the middle of the twelfth century,

served as municipal physician to the city of Bologna, accompanied

the Bolognese Crusaders on their expedition to Syria and Egypt, was

present at the siege of Damietta in 1219 A. D., and died a short time

before 1258, at the age of nearly one hundred. He acquired a great

reputation as a surgeon and brought up several sons who followed in

the same walk of life, among the number being Theodoric, who gained

even greater celebrity than his father in the domain of surgery. As

Hugo himself left no writings of any kind, we are largely dependent,

for a knowledge of his achievements, on the treatises which his son

Theodoric wrote. From this source we learn that Hugo recommended, for

use in surgical operations, the employment of narcotizing sponges like

those described on page 253, and was also an advocate of the plan of

treating wounds by the dry method (compresses soaked in wine over

which simple dressings were applied). In the treatment of empyema, of

abscesses, of penetrating wounds of the chest, and of both complicated

and simple wounds of the skull, he emphasized the wisdom of adopting

simple measures, of interfering with the parts as little as possible,

of abstaining from the use of the probe, and of observing strict

cleanliness. In cases of fracture of a rib it was his practice to

place the patient in a bath, and then, with fingers which had been

thoroughly oiled, to attempt the replacement of the separated ends of

the fractured bone. Neuburger regards Hugo of Lucca as the founder of

the Bologna School of Surgery.

_Theodoric of Lucca_, known also as Bishop Theodoric, was born

1206 A. D. While still quite a young man he joined the recently

established order of preachers, and not long afterward was appointed

Almoner (_Poenitentiarius_)[60] to Pope Innocent IV. Eventually

he became Bishop of Cervia, near Ravenna. By special permission of

the Pope, he was able to complete the surgical training which he had

received from his father, Hugo of Lucca; and thus, while he still held

the office of Bishop, he practiced surgery to some extent in Bologna.

In course of time his practice became very extensive and also very

lucrative; as a result of which he was able to leave a large fortune to

various charitable institutions. The first printed edition of his work

on surgery appeared in Venice in 1498, and was followed by numerous

later issues.

Theodoric, says Neuburger, was a most uncompromising advocate of the

dry method of treating wounds. His (Theodoric’s) words are these: “For

it is not necessary--as Roger and Roland have said, as most of their

disciples teach, and as almost all modern surgeons practice--to favor

the generation of pus in wounds. This doctrine is a very great error.

To follow such teaching is simply to put an obstacle in the way of

nature’s efforts, to prolong the diseased action, and to prohibit the

agglutination and final consolidation of the wound.”[61]

In his enumeration of the different means that may be employed for

arresting hemorrhage, Theodoric mentions cauterization, tamponading,

the application of a ligature, and the complete division of the injured

blood-vessel. He attached great importance to the proper feeding of the

patient. In Book III., chapter 49, of his treatise on surgery, he gives

minute instructions with regard to the proper manner of employing a

salve made with quicksilver, and at the same time he mentions the fact

that he observed a flow of saliva as one of the results of its use.

The expressions “healing by first intention” and “healing by second

intention” are encountered for the first time in the writings of

Brunus, a surgeon who practiced in the cities of Verona and Padua about

the middle of the thirteenth century, and who was a vigorous advocate

of the dry method of treating wounds. His two treatises (“_Chirurgia

magna_” and “_Chirurgia minor_”) were printed in Venice in

1546. Neuburger says that although a large part of the text in these

volumes consists of extracts from Galen, Avicenna, Hippocrates,

Abulcasis and other authorities, there are to be found at the same time

not a few observations of an original character.

_William of Saliceto._--William of Saliceto (_Guglielmo da

Saliceto_) is accorded by Neuburger the honor of being Bologna’s

greatest surgeon--if not, indeed, the greatest surgeon of that period.

He was born in the early part of the thirteenth century and spent a

large portion of his professional life in Bologna, where he not only

practiced medicine but also acted in the capacity of a teacher of this

science. During the latter part of his career he lived in Verona, where

he held the position of Municipal Physician and Attending Physician of

the City Hospital. He died about the year 1280.

Saliceto’s work on surgery is of a thoroughly practical character and

reveals the author to have been a born surgeon.[62] In addition to the

“_Cyrurgia_,” which was first printed in Piacenza 1476 A. D., he

wrote a treatise which bears the title “_Summa conservationis et

curationis_” (printed first in Piacenza in 1475). The “Surgery”

is divided into five books, preceded by a short chapter on general

methods, etc. Book I. is devoted to affections of the cranium,

eruptions on the head, eye diseases, ear diseases (snaring of ear

polypi), nasal polypi, abscesses in the axilla, affections of the

mammary gland, tumors in different parts of the body, venereal lesions

in the groin, and a long list of other surgical maladies. Book II.

describes wounds of all sorts, including those produced by arrows

(with reports of cases), penetrating wounds of the chest and abdomen

(with instructions about sewing both longitudinal and transverse

wounds of the intestine), etc. Under the head of penetrating wounds

of nerves (declared by the author to be very dangerous), Saliceto

recommends enlargement of the wound, the application of oil, and

the employment of opium or hyoscyamus to quiet the pain. Book III.

treats the subject of fractures and dislocations in a most thorough

manner. Mention is made of the crepitation noise heard in fractures

(_sonitus ossis fracti_) and a warning is given not to apply

the bandages too tightly and to be careful to change the dressings

every three or four days. The instructions given with regard to the

reduction of dislocations are said by Neuburger to be most sensible.

Book IV. contains such anatomical descriptions as may be helpful to

the practical surgeon. From these, however, it is evident that the

writer had never dissected the human cadaver. Book V. is devoted to

the subject of cauterizing and to the consideration of those remedial

agents which are commonly employed in surgery. The instruments used

for cauterizing purposes were made of different metals, gold or silver

being preferred for the more delicate ones, and brass and iron for the

others. Immediately after the cauterization it was customary to apply

butter, or the fat of some animal, or oil scented with roses, to the

burned part.

Saliceto’s other treatise--the _Summa conservationis etc._--is

also divided into five books, which contain chapters devoted to all

the more important branches of internal medicine and to questions

of diet, of the physician’s behavior in the presence of a patient,

etc. Especially interesting are his remarks about the importance of

considering the psychological effect produced upon the patient by

such matters as the physician’s manner of feeling the pulse, his

carefulness to inquire about the patient’s various symptoms (how the

night was passed, what food and drink had been taken, etc.)--an effect

which oftentimes is “greater than that produced by instruments and

medicines.” In discussing the subject of prognosis, Saliceto makes the

remark that it is always proper for the physician to hold out to the

patient hope of recovery, although he urges at the same time the wisdom

of telling the whole truth to the friends of the patient. He also lays

great stress upon the importance of “not holding any conversation with

the lady of the house upon confidential matters.” Neuburger gives a

number of other extracts from this most interesting work; but I must

abstain from devoting any more space to this one mediaeval author,

whose manner of writing makes it difficult to realize that the treatise

which he has written belongs to the thirteenth century and not to a

very recent period.

_Roland of Parma._--Roland, who was born in the city of Parma

and who spent a part of his life in Bologna, not only edited the work

of his teacher, Roger of Salerno, but also wrote a concise treatise

on surgery that is entitled “_Rolandina_.” Neuburger speaks

of this book as differing but little from Roger’s “_Practica

chirurgiae_.”[63] “It contains, however, the report of a case of

penetrating wound of the chest in which Roland showed not a little

courage by daring to cut off, flush with the skin, a portion of lung

tissue which happened to protrude from the wound, and then applying a

simple dressing.”

The treatise known by the title “_Glossulae quatuor magistrorum super

chirurgiam Rogerii et Rolandi_” was written by an unknown author or

perhaps by several authors. It represents a collection of commentaries

on the works of the two who are mentioned in the title of the book, and

should probably be classed as a part of the literature of the Salerno

School of Medicine.

_Mondino the Anatomist._--Mondino, who was the first physician,

after an interval of about fifteen hundred years, to revive the

practice of dissecting human bodies, was born at Bologna at about 1275

A. D. He received his professional training at the medical school of

his native city and was given the degree of Doctor in 1290, at the age

of fifteen(!). Not long afterward he began to teach anatomy in the same

institution and continued to serve in this capacity up to the time

of his death in 1326. The physicians who aided him in his anatomical

researches were Ottone Agenio Lustrulano, his prosector, and a woman

named Alessandra Gilliani, from Perriceto.

Mondino’s method of teaching anatomy was to deliver his lectures with

the dissected cadaver directly before him; that is, he demonstrated

the correctness of his statements as fast as he made them. (See Fig.

9.) Such a method was entirely new at the time and proved immensely

popular, attracting students to Bologna in large numbers. Partly in

this way and partly by means of the treatise on anatomy which he wrote

(“_Anatomia Mundini_”), he became the instructor of numerous

generations of physicians. His treatise remained the authoritative

guide in anatomy up to the middle of the sixteenth century.

[Illustration: FIG. 9. THE OLDEST KNOWN PICTORIAL REPRESENTATION OF A

FORMAL DISSECTION OF THE HUMAN BODY.

The original, which is in the library of the University of

Montpellier, France, appears in a manuscript copy of Guy de

Chauliac’s _Chirurgia magna_ (fourteenth century). Eugen

Holländer of Berlin, the author of _Die Medizin in der

klassischen Malerei_, has courteously given permission to

copy the reproduction. The many defects which appear in this

picture are due to the fact that the reproduction was taken

directly from the original miniature, now six hundred years old.

Holländer gives the following description of this interesting

scene:

“In one of the rooms of the hospital a woman’s dead body is

lying upon a table. Alongside the bed in which she died a nun

is praying for her soul. Two physicians are busily engaged in

the work of dissecting the body. An instructor is reading out

of a book, for the benefit of the students who are crowding

into the room, such portions of the text as apply to the case

in hand, and at the same time he is directing their attention

to the uterus which one of the dissectors is lifting out of the

abdominal cavity. Owing to the defective state of the original

miniature it is not possible to state positively what part the

three women who stand near the head of the corpse are taking in

the scene, but it is not unlikely that they too are physicians,

especially as their presence on such an occasion would be quite

in harmony with the customs of that period of time.”]

In one place in his “Anatomy” Mondino states explicitly that he

dissected two human cadavers in the month of January, 1315. This

statement renders it possible to fix the exact date when the

practice of making such dissections--which had been carried on for a

considerable period of time about 250 B. C.--was first resumed. If

one reflects upon the nature of the obstacles which in 1315 stood in

the way of a revival of this practice,--for example, the deep-seated

prejudice against it entertained by all classes of the community, and

the very strong opposition of the ecclesiastic authorities to what

they honestly believed to be a desecration of the human body,--one

will readily appreciate how great was the courage displayed by Mondino

when he almost openly undertook his first dissection. The subsequent

career of this famous teacher of anatomy justifies the belief that

his determination to take the course which he did was based upon

the profound conviction that the first step toward increasing the

scanty stock of knowledge possessed at that time with regard to the

structure of the human body in all its parts, must necessarily be one

in continuation of that which Erasistratus and his associates had taken

centuries earlier, but which had not been succeeded by a sufficient

number of other steps in the same direction. The series of discoveries

in anatomy, physiology and pathology which resulted from Mondino’s

courageous and intelligent act, form a part of the history of modern

medicine, and do not therefore call for consideration in this place. We

may simply add that much information of a very interesting character is

furnished by Neuburger (_op. cit._) with regard to the manner in

which Mondino and his immediate successors carried on their instruction

in anatomy from that time forward.

The Medical School at Bologna, as may well be imagined, gained great

fame from the possession of such distinguished teachers as those

whose careers I have briefly sketched--Hugo and Theodoric of Lucca,

William of Saliceto, and Mondino; and it retained a large part of this

celebrity throughout the fourteenth and fifteenth centuries, despite

the appearance on the scene, toward the end of this time, of several

formidable claimants for high honors in the domain of medical research

and education--viz., the schools at Montpellier and Paris, in France,

and that of Padua, in Italy.

_Lanfranchi and the Medical School of Paris._--According to

Edouard Nicaise[64] medicine was not taught publicly at Paris

previously to 1160 A. D. The teaching was carried on at that time

by associations of physicians, and it was only during the following

century (about 1250 A. D.) that something like a university was

established in that city. Up to the end of the sixteenth century (1595

A. D.), during the reign of Henry IV., this institution remained under

the control of the Church. Its functions--so far at least as medicine

was concerned--were limited to the bestowing of degrees, for it

possessed at that time no organization of instructors and no permanent

quarters in which the teaching might be carried on systematically; a

church (see Fig. 10) or the Dean’s residence serving as the locality in

which the lectures were commonly delivered.

During the middle part of the thirteenth century and for a long

time afterward, the practice of surgery, which was then of a rather

primitive type, was entirely in the hands of two classes of men--the

barbers and the so-called surgeons.[65] As time went on, the surgeons

began to feel the necessity of securing better protection for their

material interests, which were being more and more encroached upon by

the barbers--a class of men who were not privileged by the authorities

to include in their field of activities anything beyond hair-cutting,

shaving, cupping, the extraction of teeth, the application of

leeches, the incision of boils and perhaps one or two other simple

operations. For this reason, therefore, and also probably because

they too felt in some measure the effects of the Renaissance spirit

which was then abroad in the land, they organized themselves (1254

A. D.) into an association which bore the name of “College of Saint

Cosmas” (_Collège de St. Côme_).[66] One of the early acts of

this association was to establish the rule that all applicants for

membership should pass successfully an examination as to their fitness

before they could be admitted. Very little is known about the doings of

the organization during the early years of its existence. Later, as we

shall see, it played a very important part in the history of medicine

in France.

[Illustration: FIG. 10. THE MANNER OF GIVING PUBLIC INSTRUCTION IN

MEDICINE DURING THE MIDDLE AGES.

(From Meaux Saint-Marc’s _L’École de Salerne_.)

The present cut is evidently a modern copy of a much earlier

original.]

From the account given by Nicaise it appears that no regular

instruction in anatomy was given in the University of Paris until after

the fourteenth century, and then only from three to five times a year,

when the body of a person who had been hung was publicly dissected.

“Such a dissection lasted seven days and was a veritable scientific

festival.” No official cliniques were held and the only way in which

the student of medicine could obtain some practical acquaintance with

disease and with the methods of treatment was by attaching himself to a

physician or a surgeon, or to a barber.

From the preceding brief and very incomplete account the reader will, I

trust, be able to form some idea of the condition of affairs, medical

and surgical, in Paris at the time when Lanfranchi arrived in that city.

Lanfranchi, says Neuburger, was born in Milan, Italy, and was

undoubtedly the most distinguished among the pupils of Saliceto at

Bologna. After leaving the medical school he practiced both medicine

and surgery for a certain length of time in his native city; but

finally, becoming involved in the quarrels between the Guelphs and

the Ghibellines, he--like many other Italian physicians--was obliged

to take refuge in France. In Lyons, which was his first place of

residence, he engaged for a short time in the practice of medicine and

also wrote his first treatise on surgery--“_Chirurgia Parva_.”

Then, after traveling from one place to another in the provinces, he

finally (1295 A. D.) settled permanently in Paris. In that city he very

soon acquired a large practice, and, at the same time, built up for

himself a great reputation as a teacher of medicine. The _Collège de

St. Côme_ elected him a member of that organization and profited

greatly from the fame which his teaching brought to the institution.

It is said that Jean Passavant, who was at that time the Dean of the

Medical Faculty of Paris, aided Lanfranchi in his work by every means

in his power. As a result Paris, during a considerable period of time,

was one of the few places in which genuine clinical instruction was

given to all those who desired to acquire a practical acquaintance

with disease. His larger treatise, the “_Chirurgia Magna_,” was

completed in 1296. It was dedicated to the King of France, Philip

IV., commonly called “_Phillippe le Bel_,” and its intrinsic

merits assured him a permanent reputation as a surgeon. This work,

which was translated years ago into English and has recently (1894)

been published by the “Early English Text Society,” under the title

“Lanfrank’s Science of Cirurgie,” consists of five separate fasciculi

or parts. A few extracts from the text of this celebrated work may

prove of interest to the reader. Not having access to the English

version just mentioned, I shall have to translate from the version

(partly Latin and partly German) supplied by Neuburger.

Part I. of the _Chirurgia Parva_ mentions some of the

characteristics which a surgeon should possess. He should, for example,

have well-formed hands, with fingers that are long and slender; his

body should be strong and firm in its movements; his hands and fingers

should respond quickly to the workings of the mind; his mind should

be of a subtle type; in character he should not be over-bold, but

self-reliant and yet modest; he should have a good supply of common

sense; he should be well-informed not only in medicine, but also in all

the branches of philosophy; he should be a good logician; he should be

familiar with the writings of medical authors; he should be virtuous

and ethical; he should be trustworthy; he should not be avaricious nor

envious; ... and, finally, he should be thoroughly familiar with all

the diseases to which the human body is liable. In one place Lanfranchi

refers to the fact that exposure to the air favors the production of

pus in a wound. Among the methods which may be employed for arresting

hemorrhage he mentions digital compression and ligaturing of the

bleeding vessels. He recommends that a wounded individual should

abstain from wine and from an over-nutritious diet. No attempt, he

says, should be made to extirpate, with the knife or by means of the

actual cautery, an ulcerated cancer, unless it appears probable that

by such means complete destruction of the tumor may be effected. In

traumatic tetanus dependent upon an injury of a tendon or nerve trunk

he recommends complete division of the wounded structure.

Part II. is devoted to the consideration of wounds of the different

parts of the body, taken in regular order from the head to the feet.

The descriptions, in each instance, are preceded by an adequate account

of the region affected. In his discussion of fractures of the skull he

speaks of the diagnostic value of the rough and jarring sound perceived

by the patient when the physician taps with a rod upon the injured

skull; and he also states that an aid to diagnosis may be derived from

the fact that a person whose skull is fractured experiences pain at the

seat of the injury when somebody passes the ends of his finger-nails

along a string which the patient holds suspended between his teeth.[67]

According to Neuburger the description which Lanfranchi gives of

the various symptoms observed in cases of fracture of the skull is

admirable. In the section relating to the treatment of such fractures

he warns against the tendency to resort too readily to the use of the

trephine, and expresses the belief that this instrument should be

employed only when the fractured bone is depressed or when there is

evidence of irritation of the dura mater.

Part III. deals with skin diseases and various forms of tumors,

including those of the thyroid gland; and with diseases of the eye,

the ear and the nasal cavities; with the various kinds of hernia; with

renal and cystic calculi; with hemorrhoids, varicose veins, etc.; with

abdominal dropsy; and with still other affections. In bloodletting he

recommends the practice of opening the vein longitudinally. He is very

emphatic in his manner of insisting that medicine and surgery should

not be divorced, and that the operation of drawing blood should not be

intrusted to barbers.

After the death or retirement of Lanfranchi during the first decade

of the fourteenth century, Paris appears to have played, at least for

a few years, a comparatively small part in the history of medical

teaching. Her rivals at Montpellier, in the south of France, and at

Bologna and Padua, in Italy, far outstripped her during this period.

There was one physician at Paris, however,--Henri de Mondeville,--who

would probably have proved a worthy successor of Lanfranchi if

circumstances had not seriously interfered with his acting the part of

a teacher.

_Henri de Mondeville._--Henri de Mondeville, says Edouard

Nicaise, was born about 1260 A. D. in Normandy. In his native

village--Mondeville or Mandeville, or Amondaville, all of which names

are found in the manuscripts--he was known simply as Henri, but in the

outside world and in medical literature he is mentioned, in accordance

with the prevailing custom of that period, as Henri de Mondeville.

After studying medicine for a certain length of time in Paris and

Montpellier, he went to Italy and became the pupil of Theodoric of

Bologna. He is said to have been passionately fond of surgery, which

at that period was, in France, a much despised branch of medicine. In

Italy, on the contrary, such men as William of Saliceto, Hugo of Lucca,

Theodoric and Lanfranchi had raised surgery to a position of great

honor, and Henri de Mondeville cherished the hope that he also might be

able to accomplish the same result in France. Upon his return to Paris

he was chosen one of the physicians (there were four in all) of the

royal household, and from that time onward he was frequently obliged to

set aside, for longer or shorter periods, all his personal interests

(private practice, lecturing to medical students, hospital service at

Hôtel-Dieu, etc.) in order to attend the King or the Comte de Valois

on some military expedition. This sort of service, however, was by no

means time lost, for it afforded him the opportunity to acquire great

experience in the treatment of wounds, an experience which reveals

itself on almost every page of his treatise on surgery. And yet there

came a time (1312) when de Mondeville complained bitterly of these

interruptions, for which he received no pay and which interfered

seriously with his literary work. Despite these hindrances, he appears

to have made a fair degree of progress in the writing of his book,

for at the date last named he gave a public reading of the first two

sections “before a large and noble assemblage of medical students and

other distinguished personages.” The portrait of de Mondeville which

is here reproduced is a copy of the miniature which appears in one of

the manuscripts of his treatise that was prepared 1314 A. D., and is

now preserved in the _Bibliothèque Nationale_ at Paris. Nicaise

furnishes the following details regarding the original miniature.

Inasmuch as the MS. bears the date 1314 the portrait must have

been painted while De Mondeville was still living. The master is

represented wearing a violet-colored gown, red stockings, and a

black skull-cap. He is thin, his beard is scanty and of a grey

color like the hair of his head, his features are finely cut,

and he appears to be a fairly tall man. So far as one may judge

from this portrait De Mondeville’s age was then about fifty.

The date of his death is not known exactly, but it must have been

somewhere about 1320 A. D.

Nicaise sums up de Mondeville’s personal history and his contributions

to the science of medicine somewhat as follows: He was a man of

warm impulses, who loved the truth and despised all shams. He never

hesitated to speak his opinion about others, the King himself not being

excluded from his criticisms. He was also quite frank in his exposures

of the ignorance of both nobles and members of the clergy. He was not

in the least degree superstitious. He remained unmarried throughout

life and seems to have entertained a slight disposition to find fault

with women, for he attacks somewhat violently their mode of life and

their extravagance, especially in the case of the women of Montpellier.

Although he possessed a great reputation and a very large clientele of

patients, he did not acquire a fortune. He is quoted as saying: “I was

obliged from the very first to work hard for a living.” Suppuration,

according to the view of de Mondeville, was not a necessary phenomenon

in the healing of wounds.

[Illustration: FIG. 11. HENRI DE MONDEVILLE.

(From Nicaise’s Version, Paris, 1893.)

From a miniature at the head of a manuscript which bears the

date A. D. 1313, now preserved in the Bibliothèque Nationale at

Paris.]

About the year 1316 the condition of de Mondeville’s health--he

probably had pulmonary tuberculosis--began to give him serious cause

for anxiety lest he might not live long enough to complete his book;

and, as a matter of fact, the treatise which we now possess shows

that his fears proved to be well grounded. The important subjects

of fractures, dislocations and hernia, for example, are mentioned

only casually. Those subjects, however, which he did discuss are

treated in a very clear and practical manner. Thus, for example, his

instructions with regard to the proper manner of treating wounds is

most satisfactory. Theodoric and he were the great champions of the

so-called dry treatment, which had been introduced at some remote

period of antiquity, but which apparently had not met with general

acceptance. Then, again, in his remarks on the subject of amputations,

he taught that the ligaturing of the severed arteries after the removal

of the amputated part, was universally recognized as the proper course

to adopt and should never be neglected.

In Chapter VII. of the first section of his treatise, de Mondeville

gives a description of the anatomy of the heart and related

blood-vessels, and at the same time furnishes an unusually clear

account of the physiology of the circulation which was universally

accepted by the physicians of that period, as it had already been

by those of earlier centuries. It seems desirable to reproduce this

account here in order that it may serve for purposes of comparison with

that which Harvey was to give three centuries later. It is only by

making such a comparison that the physicians of our time can appreciate

the vast importance which attaches to Harvey’s wonderful discovery. De

Mondeville’s account, abbreviated wherever it seemed practicable to do

this, reads as follows:--

The heart is the most important of all the organs. It transmits

to the other members of the body vitalizing blood, heat and

spirit. Its muscular tissue, unlike ordinary muscle, is composed

of three kinds of fibres, and it is not under the control of

the will. It has the shape of a pineapple and is located in

the centre of the chest, like a prince in the middle of his

kingdom. Its lower extremity is directed somewhat to the left

of the chest, as we are assured by the Philosopher (Aristotle)

in his history of animals. There are two reasons why it points

toward the left: 1., in order that it may not press upon the

liver or be pressed upon by it; and 2., in order that it may not

communicate its heat to the left side (the cool side) of that

organ.

It is important to note the fact that the heart is the only

structure which contains blood in its substance; in all the

other members of the body the blood is contained in the veins.

The base of the heart is situated at its highest point and

represents the broadest portion of the organ; it is attached to

the posterior wall of the chest by a few ligaments, than which

no stronger are to be found in any part of the body. These bands

do not touch the heart at any point except at the top, where

they take their origin; and their great strength is explained by

the fact that it is their duty to hold the heart firmly in its

proper position.

The heart possesses two ventricles or cavities, of which the

left one--by reason of the natural position of the organ as a

whole--is a little higher than the right. Between these two

cavities there is placed a partition which in its turn contains

a small cavity--termed by some _the third ventricle_.

Above each of the larger ventricles there is a sort of

appendix--cartilaginous in structure, but flexible and at

the same time strong,--which contains a cavity and has some

resemblance to a cat’s ear. These structures, to which the

common people have given the name _auricles_, alternately

contract and dilate. The purpose for which they exist is to

serve as reservoirs for the blood and air that are needed for

the nourishment and cooling of the heart.

To the right ventricle there comes a many-branched vein which

conducts to the heart a coarse, thick and warm blood destined

to nourish that organ. The portion of this abundant fluid which

is not needed for this purpose is then rendered less coarse and

thick by some subtle power possessed by the heart itself, after

which it is driven into the cavity that is located within the

partition wall which separates the ventricles the one from the

other. From this smaller cavity, this so-called third ventricle,

in which it receives additional heat and at the same time

undergoes further thinning as well as some kind of digestion and

purification, the blood passes on into the left ventricle and

there undergoes a further change--one which is characterized by

the development of that element which we call _spirit_,

something clearer, more subtle, more pure, more glorious than

any known substance in the human body, and therefore more nearly

allied in its nature to celestial things. This new element

forms a friendly and very appropriate link between the body and

the soul; it is the direct agent or instrument of the latter,

conveying to man the different faculties with which he may be

endowed.

From the left ventricle of the heart, alongside its auricle, two

arteries are given off. One of them, which is only furnished

with one tunic (as in the case of a vein) and which is called

the _arteria venalis_ (pulmonary vein), carries to the

lungs the blood which they require for their nourishment, and

breaks up into many branches after entering these structures;

the other artery is provided with two tunics and is called

_the grand artery_ (the aorta). From the latter vessel

are given off the numberless arteries which are distributed

throughout the entire body--vessels which transport to every

organ and structure both the blood which they need for their

nourishment and the spirit required for their revivification.

When this spirit passes into the ventricles of the brain it is

subjected to a new species of digestion, which converts it into

the _spirit of the soul_. Similarly, when it enters the

liver it becomes _a nutritive spirit_; when it enters the

testicles, _a generative spirit_, and so on through all the

different organs.

CHAPTER XXIV

DURING THE LATTER HALF OF THE MIDDLE AGES SURGERY ASSUMES THE

MOST PROMINENT PLACE IN THE ADVANCE OF MEDICAL SCIENCE

During the first half of the fourteenth century, as has been shown

in the preceding chapter, Henri de Mondeville was largely successful

in rendering Paris the most prominent centre of medical activity in

France, if not in Western Europe generally. His life, however, was

short, and his position as one of the leading surgeons of the French

Army subjected him to many and prolonged interruptions, for which

reasons he was not able to complete his excellent treatise on surgery.

No physician of the same intellectual capacity and of equally strong

character appears to have been living in Paris at the time of De

Mondeville’s death, and consequently the importance of that city as a

centre of medical education diminished rapidly after that event. On

the other hand, the Medical School at Montpellier in the southern part

of France began at about this period, under the influence of Arnold of

Villanova (probably a small town in Catalonia, Spain, in the diocese of

Valencia), to acquire importance.

_Arnold of Villanova and the Medical School of

Montpellier._--Arnold of Villanova was born about 1240 A. D., of

humble parentage. He obtained his early education in a Dominican

cloister, and afterward devoted all his energies to the study of

languages (especially Hebrew), theology, philosophy, the natural

sciences (physics, alchemy), and medicine. Paris and Montpellier were

the principal cities in which he prosecuted those studies. Already as

early as the year 1270, Arnold had attained considerable celebrity

as a physician. Between the years 1289 and 1299 he appears to have

made his home in Montpellier, and to have been very actively engaged

both as a practicing physician and as a teacher of medicine. It was

in that city also that he wrote the more important of his numerous

medical treatises. At a later period of his life he appears largely

to have lost his interest in medicine, for in 1299 we find him acting

as an ambassador from the King of Aragon, whose private physician

he was, to the Court of Philippe le Bel, King of France, and deeply

entangled, during his stay in Paris, in disputes with the theologians

of that city respecting certain religious doctrines. He was also at

the same time busily engaged in championing various ecclesiastic

reforms which he was anxious to see inaugurated. His opponents haled

him before the tribunal of the Inquisition and succeeded in having him

cast into prison, where he remained until he expressed a willingness

to retract the obnoxious opinions which he had advanced. The same

tribunal pronounced his treatise “_De Adventu Antichristi_” to

be heretical. After these persecutions Arnold endeavored to procure

aid and comfort from Popes Boniface VIII. and Benedict XI. The former

was inclined in his favor, but Benedict manifested no disposition to

aid him. Boniface’s sentiments were doubtless influenced by the fact

that Arnold had treated him successfully for stone in the bladder; and

Neuburger incidentally states that, in the effecting of this cure,

not only medical and dietetic treatment had been employed, but also

two other measures--viz., the application of a bandage or truss which

encircled the loins snugly, and the wearing (by the patient) of a

magic seal ring upon which was engraved the effigy of a lion.[68] When

Pope Clement V. (1305–1315 A. D.) removed the papal seat from Rome

to Avignon, in France, Arnold was relieved from the charge of heresy

and reinstated in the respect of his contemporaries. He became the

trusted adviser of royalty, won the sympathy of Jayme II. and of his

brother, Frederic III., King of Sicily, for his broad-minded views

regarding religious matters, and was both hated and feared by his

enemies. According to trustworthy chronicles, Arnold of Villanova died

at sea in 1311, within sight of the coast of Genoa, while he was on a

voyage (probably from Sicily) to visit the Court of Clement V. In 1316

the Inquisition pronounced most of his philosophical and theological

writings heretical, and ordered them to be destroyed.

A complete collection of the medical writings of Arnold of Villanova,

so far at least as they were then known to exist, was printed at

Lyons, France, in 1586. It is said that many of the treatises which

this author wrote have been lost. Of those which have come down to our

time there are only three which call for any special comment--Arnold’s

“_Breviarium_,” a compendium of the practice of medicine; his

“_Commentary on the Regimen Salernitanum_,” the sales of which,

according to Neuburger, reached an enormous figure; and a work which

bears the title “_Parabolae medicationis secundum instinctum

veritatis aeternae, quae dicuntur a medicis regulae generales

curationis morborum_.” (Basel, 1560.) The latter treatise, which

might with propriety be given the simple title of “General Rules

regarding the Treatment of Diseases,” is dedicated (1300 A. D.) to

Philippe le Bel, King of France. It contains a number of chapters on

the principles of general pathology, and others on special pathology

and therapeutics, with relation both to internal diseases and to

those which particularly interest the surgeon. It also furnishes 345

aphorisms, many of which embody truths of the highest importance and

reveal the author to have been a man of independent judgment, of wide

experience, and of a philosophical type of mind.

In the “_Parabolae_” and the “_Breviarium_,” says Neuburger,

are to be found the most marked evidences of the knowledge and ability

which this great physician possessed. He then adds:--

Arnold attached much importance to hygiene and the proper

regulation of the diet as effective measures in preventing

diseases, and he formulated an admirable set of rules for

the ordering of one’s manner of living. In these he gives

prominence to the value of baths, to the importance of taking

a certain amount of physical exercise, and to the selection

of the right kinds of food. He also describes in detail how

wine may be utilized advantageously in cases of illness. As

regards the choice of remedies to be employed he says that the

physician should be guided by a very careful consideration

of the patient’s age, temperament, habits of living, etc.;

and, so long as there remains any doubt about the correctness

of the diagnosis, he should employ only mild and indifferent

remedies. The greatest care, he adds, should be exercised in the

preparation of the drugs that are to be administered, and one

should be very cautious about prescribing substances which have

not been sufficiently tried.

Arnold’s writings are full of precepts which, like those quoted above,

show him to have been an excellent practitioner of medicine as well as

a man of sound common sense. And yet at the same time he appears to

have been more or less tainted with the prevailing belief in astrology,

in the efficacy of amulets (as in the case of Pope Boniface referred

to on a previous page), etc. His enemies gave him the reputation

of being a sorcerer upon whom the Devil had bestowed the power of

transmuting metals,--a reputation which undoubtedly was based upon the

fact that Arnold interested himself greatly in alchemistic processes,

often referring to them as closely resembling such organic phenomena

as generation, birth, growth, etc. But, in our judgment of the man,

we should be careful to remember that during the thirteenth century a

belief in alchemy, astrology, the efficacy of amulets, the influence

of supernatural agencies, etc., was almost universal. Even theologians

maintained that it was a sin for a practitioner of medicine to neglect

the influence of certain constellations. Indeed, there are even to-day,

not a few very sensible people in whose minds exists a lingering belief

in the interference of supernatural agencies in human affairs.

The importance of the influence which Arnold of Villanova exerted upon

the progress of medical science, and more especially upon the fame of

the Medical School of Montpellier, should not be estimated exclusively

from the value of his writings nor from the character of the work

which he performed as an instructor in that school. In the thirteenth

and fourteenth centuries physicians as a class did not hold so high

a position socially in Western Europe as they were probably entitled

to hold, and consequently Arnold’s later career, in which he showed

himself to be a wise, broad-minded, and very able statesman and as

an enthusiastic champion of greater liberty of thought in the domain

of religion, must be looked upon as having aided very materially in

raising the profession of medicine to a higher rank and in adding éclat

to the School of Montpellier.

_Contemporaries and Successors of Arnold of Villanova at

Montpellier._--During Arnold’s lifetime there does not appear to

have been another physician at Montpellier who could be compared with

him in professional ability or in general culture. There was one,

however, who attained considerable fame as a medical author, and who

certainly deserves at least a brief notice in this place--Bernard de

Gourdon, also known as Gordonius.

Bernard de Gourdon[69] began teaching medicine in Montpellier in 1285

A. D. He was the author of a treatise which bore the title “_Lilium

Medicinae_,” and which enjoyed an unusual degree of popularity for

a long period of time. The earliest printed edition appeared in Lyons

in 1474 and was followed by several others in 1491, 1550, 1559 and

1574. One of the latest editions is that of Frankfort, 1617. The book

was also translated into both French and Spanish. In his description

of the seven parts into which the book is divided, the author says, by

way of praising his own work: “In the lily there are many different

kinds of blossoms and in each one of these there are seven grains of a

golden character.” The book treats of fevers, poisonings, abscesses,

tumors, wounds and ulcers, of diseases of the liver, spleen, kidneys

and bladder, of affections of the eyes, and of numerous other topics.

The work as a whole, says Neuburger, lacks depth and thoroughness,

and reveals the author to be overfond of employing drugs, especially

in combination, and by no means free from a belief in the efficacy of

amulets and other supernatural remedies. It contains, however, one

or two references to matters of historical interest. For example, in

Chapter V., Part III., mention is made of spectacles. So far as now

appears, this is the first time that these useful contrivances are

referred to in medical literature; and the casual manner in which the

author speaks of them suggests the idea that they had already been

known for some time. Possibly Roger Bacon, who interested himself in

researches in the department of optics and who was a contemporary

of Gordonius, may have had something to do with the invention of

spectacles.

At the ceremony of the marriage of the Duchess Juta of Austria to

Count Louis of Oettingen, at Vienna in 1319, Pietro Buonaparte, the

Podesta of Padua, created considerable excitement by wearing a pair of

spectacles which he had received a short time previously from Salvino

degli Armati of Florence, the reputed inventor of these contrivances.

It is not generally known that the printing of books in very large

and bold type during the latter part of the fifteenth and the early

part of the sixteenth centuries was done expressly for the benefit of

far-sighted readers--this defect in vision characterizing a very large

percentage of the learned men of that period. The great number of books

which, during those early days of the art of printing, were published

in this style, emphasizes the fact that the usefulness of spectacles

was not generally appreciated until after the lapse of many scores of

years. Being very expensive they were within the reach of only persons

of wealth, and, in addition, they were extremely difficult to obtain.

As late as during the year 1572, Augustus, Elector of Saxony, moved by

a strong wish to possess a pair of spectacles, despatched a special

messenger first to Leipzig and then to Augsburg with instructions to

purchase them for him at the great annual fair. This agent, however,

was unsuccessful in the attempt, and, accordingly, in the summer of

1574, he was instructed to ride on as far as Venice. But, on arriving

there, he was informed that no glasses would be ground before the

month of October. He was consequently obliged to remain in that city

until the autumn, at which time he sent word to his master that the

optician’s charge for the instrument would be 50 thalers (equivalent to

$250 at the present value of money). The Elector, it appears, was only

too glad to pay this sum for the coveted article. The first spectacles

made were equipped with only convex glasses, for the use of far-sighted

persons. It was not until about two hundred years later that the art of

grinding concave glasses for the relief of short-sighted individuals

was discovered.

_Guy de Chauliac._--After the lapse of a few years there appeared

a man who was destined to add greatly to the fame of the Medical

School of Montpellier--not in the way in which Arnold of Villanova

had accomplished this result, but by the publication of the first

systematic treatise on surgery which was written in Western Europe

during the Middle Ages. This man was Guy de Chauliac, about whose early

life very little is known. He was born in the village of Chauliac, in

Auvergne, France, toward the end of the thirteenth century, his parents

being simple peasants; and during early boyhood he probably attended

the school connected with the village church. His medical studies were

begun at Toulouse and completed at Montpellier. But, at some time later

than 1326, he went to Bologna and perfected his knowledge of anatomy

under the guidance of Bertrucius, Mondino’s successor. After leaving

Bologna Guy visited Paris, arriving there subsequently to the deaths

of Lanfranchi, Pitard and Henri de Mondeville. Although he remained in

that great city only a short time, he appears to have formed a warm

friendship with several of the instructors in the medical school.

About the year 1330 he took up his residence in Lyons. His appointment

to the position of Canon of Saint-Just, a church which is located in

that city, doubtless made it necessary for him to adopt this course.

And yet it is most improbable that he spent much of his time in Lyons,

for his other duties--his attendance at the Papal Court in Avignon,

as private physician to three Popes in succession, and the numerous

calls made upon him for professional advice and especially for surgical

assistance by people living at a long distance from Lyons--compelled

him repeatedly to absent himself from his home, sometimes for several

days at a time. In 1348 the plague visited Avignon and carried off

large numbers of people, the poet Petrarch’s Laura being one of

the victims. During that terrible epidemic Guy was most faithful

in his devotion to Clement VI. and to many others who needed his

professional services. In 1357 he was promoted by Innocent VI. to the

office of Provost of Saint-Just. In 1363 when--according to, his own

declaration--he was an old man, he wrote the treatise on surgery which

has rendered his name famous in the history of medicine. His death

occurred about July 23, 1368.

Guy was not, as some writers have asserted, a professor of surgery in

the University of Montpellier; he was simply a physician who had won at

that institution the title of “Master in Medicine”--the highest grade

conferred by the university authorities, and one which necessarily

implied that the recipient had given a certain number of public

readings on medical topics. And yet in actual practice Guy manifested

a strong preference for the management of diseases which demanded

surgical treatment. His writings, furthermore, make it clear that he

had a strong affection for the institution in which he had been both a

student and in some measure an instructor.

The book which Guy de Chauliac wrote, and which bears the title

“_La Grande Chirurgie_,” is described by Malgaigne,[70] one of

the most distinguished French surgeons of the nineteenth century, in

the following terms: “I do not hesitate to say that, with the single

exception of the book written by Hippocrates, there is not a work on

surgery, no matter in what language written, which ranks higher than,

or is even equal to, the magnificent treatise of Guy de Chauliac.”

Although most surgeons of the present day will scarcely assent to

praise of such an extravagant nature, they will undoubtedly agree

in according to this admirable author of the fourteenth century a

high place of honor in the Temple of Fame. Nicaise, the editor of the

most recent version of Guy de Chauliac’s treatise, speaks of him as

the “founder of didactic surgery.” From 1363 A. D., the date of its

first publication in manuscript, to 1478, a period of more than one

hundred years, Guy’s book was universally regarded as the authoritative

treatise on surgery. But this branch of medicine, it must not be

forgotten, was, at that period of the Middle Ages, held in very small

esteem by physicians generally, and therefore it is almost certain that

Guy received no encouragement whatever from any outside source. All

the greater credit, therefore, is due him for the admirable manner in

which he carried on the task which he had set before himself during the

last years of his life. Extraordinary as it appears to us to-day, the

Montpellier School of Medicine, toward the end of the fifteenth century

(that is, only a comparatively short time after Guy’s death), issued a

decree that thereafter their pupils were not to study nor to practice

surgery. From this and other well-authenticated facts it appears that

the prejudice which existed at that period among physicians against

surgery, was strong enough to render them blind to the reality that

it was through the instrumentality of this very branch of medical

activity that the school at Montpellier had gained such an increase

in celebrity. They were unable to dispossess their minds of the idea

that operative and all other surgical procedures were derogatory to the

dignity of the educated physician.

Guy de Chauliac wrote his treatise originally in Latin--not the

Latin of the classical authors, but a Latin greatly deformed by the

introduction of French, Arabic and Provençal terms--barbaric Latin,

as it is often called. This language was commonly employed at the

University of Montpellier and at all other universities at that period;

but, as Nicaise states, the style of his writing is so concise, and at

the same time so intelligible, that it would scarcely be possible to

translate it into modern French without the loss of much of that which

constitutes the charm of the book. It was for the latter reason that

he decided to write his version of Guy’s treatise in old French--the

French of the thirteenth and fourteenth centuries. In order that our

readers, most of whom are doubtless more or less familiar with the

finished language of modern French literature, may see for themselves

to what extent the latter differs from its fourteenth century ancestor,

I shall introduce here a single paragraph of Nicaise’s text. I have

chosen it, more or less at random, from the admirable chapter which Guy

has written on wounds in general.

Consequemment playes mortelles non necessairement, ains pour la

pluspart, sont petites playes, et superficielles és susdites

parties, et qui penetrent iusques à icelles et aux chefs

des muscles. La raison est, parce que si elles ne sont bien

traitées, il advient qu’on en meurt: et si sont bien traitées,

on en guerit: ainsi que i’ay veu de la partie posterieure du

cerveau, de laquelle sortit un peu de la substance du cerveau,

ce qui fut reconnu par l’offense de la mémoire, laquelle il

recouvra apres la curation. Ie ne dis pas toutesfois qu’on

vesquit, s’il en sortoit toute une cellule, comme Theodore

raconte d’un cellier. Aussi Galen ne dit pas, de deux blessez

qu’il vit guerir en Smyrne du vivant de son maistre Pelope,

qu’il en fust sorty de la substance de cerveau, ains seulement

que le cerveau avoit esté blessé: Ne, de celuy qu’il vist guery

en Smyrne (comme il recite au huitiesme de _l’Usage_), il

ne dit pas qu’il en sortit de la substance du cerveau, ains

qu’il fust blessé en l’un des ventricules gemeaux. Et avec ce

on pensoit qu’il fust guery par le vouloir de Dieu. Car si tous

deux eussent esté blessez, il n’eust gueres duré, comme il dit:

et de ce il conclud l’utilite de la duplication de quelques

instruments, ainsi qu’a esté dit cy dessus en l’anatomie. Et

tant de cettui-cy, que de ceux-là, la guerison rare est fort

rarement faite, comme il est dit au commentaire dessus allegué.

There are many places in Guy’s treatise where his description of a

surgical condition, or of the proper measures to adopt for the relief

or cure of such condition, would doubtless prove interesting to our

readers, and would in any event aid them materially in forming an

independent judgment as to the man’s character in general and also

with regard to his qualifications as a surgeon. But all of these

descriptions, when rendered in their entirety into English, occupy much

space, and for this reason I shall be obliged to furnish here merely a

few extracts from some of the more interesting portions of the text.

In the chapter which Guy devotes to wounds of nerves, cords and

ligaments--all of which structures were classed by him, as well as by

Galen, as belonging to the category of nerves--this author divides them

into punctured and incised wounds, bruises and concussions. As to the

first variety he says that they may be divided into closed punctured

and open punctured wounds.

In the incised wounds two kinds may be distinguished: those in

which the nerve is incised in the direction of its length and

those in which the cut is made across the fibres. A further

subdivision is practicable, viz., into wounds accompanied by

more or less destruction of the substance of the nerve or its

envelopes, and those in which such loss has not occurred. Among

other differences worthy of mention are these: pain, spasmodic

phenomena, and abscess formation are present in certain cases

and absent in others. From all of which symptoms useful

indications as to the treatment needed may be deduced.

In the section relating to the treatment of such traumatic affections

of nerves, Guy makes the remark that the measures called for are, for

the most part, the same as those required for wounds involving simply

the fleshy parts of the body.

The element of pain, however, is one of the factors which

distinguish wounds of a nerve from ordinary flesh wounds, and

it may necessitate some slight modification of the treatment.

Aside from this, one of the first things that should be done is

to remove from the wound all foreign substances; after which

the edges of the cavity should be brought together and held

firmly in this position by appropriate means. Last of all, care

should be taken to protect the parts. These are the general

principles which are to guide the surgeon’s action. As to the

special details, they must depend upon the different conditions

presented by each individual case. Thus, for example, if we are

dealing with a punctured wound of a nerve, there will be no

edges of an excavation to bring together.

If the object which produced the puncture is still lodged in the

tissues, it must, as a matter of course, be withdrawn. After

which, the further measures to be adopted may be enumerated

under the following heads: careful regulation of the manner of

living; removal from the system of all material which--attracted

to the wounded part by the pain--might there cause irritation or

inflammation; and protection of the body against any harm that

might come to it through the occurrence of convulsions. These

three measures are indicated for all wounds of nerves. But, in

the case of a punctured wound, still other procedures should be

employed, as will be discussed under a fourth head.

The four heads mentioned by Guy may be briefly stated in the following

terms: I. The patient should be put upon a light and very simple diet;

and, in addition, he should be given a bed that is soft and humid

(“_humidus et mollis_”). His surroundings should be kept quiet,

and nothing should be permitted to disturb his peace of mind. II. To

protect his tissues from the injurious influence of any superfluous

matters of an irritating nature that may be circulating in the blood

(_i.e._, cacochyme), a vein on the opposite side of the body

should be opened and a certain amount of this fluid withdrawn. In

certain cases, furthermore, it may be well, in addition, to administer

an aperient remedy. III. If convulsions develop, the head, neck and the

entire back should be anointed with well-warmed linseed oil or common

(? olive) oil, as recommended by Galen. IV. Special measures should be

adopted for providing a free outlet for any pus that may form in the

deeper parts of the wound; and here again Galen recommends for this

purpose the employment of one of several medicinal preparations which

he enumerates. “But the more certain course,” Guy adds, “is to make an

opening in the skin either with the razor or with the actual cautery

(which latter, according to Henri de Mondeville, is the better plan of

the two), and then to apply some subtle drying remedy which possesses

the power to penetrate into the deepest recesses of the injured

nerve--for example, savin oil.” (Guy has a good deal more to say on the

subject of wounds of nerves, but the few extracts given above should

suffice.)

It is now a well-known fact that Guy de Chauliac was in the habit of

treating fractures of the thigh by the employment of the weight and

pulley as means of keeping up a continuing extension of the damaged

limb. As his description of the method in question is very brief, it

may not seem out of place to reproduce it here. Translated into English

it reads as follows:--

As to the plan which I employ, it is this: After making fast

to the fractured thigh splints which extend down as far as the

feet, I reinforce the support which they give, either by placing

the limb in a box or by applying to its sides bundles of straw

(_appuyements_). [These are shown in the left-hand lower

corner of Fig. 12.] I then attach to the foot a mass of lead as

a weight, taking care to pass the cord which supports the lead

over a small pulley in such a manner that it shall pull upon the

leg in a longitudinal direction. And if it then be found that

there is not complete equality between the fractured limb and

its fellow as regards length, the discrepancy may be corrected

by gently pulling upon the former. Every nine days the limb

should be cautiously handled; and at the end of about fifty days

it will be found that firm union has taken place.

One more remark seems to be called for in reference to the fact that

Guy de Chauliac, although he was avowedly a surgeon, managed to win

as great a reputation and as high a social position as was possessed

by any physician of that period. The medical practitioner, it will be

remembered, held himself, during the Middle Ages, and was universally

held, to be a much higher type of man than the surgeon. The relative

standing of the two is well shown in the accompanying sketch (Fig.

13), in which all the details (attitude, head gear, gown, etc.) have

evidently been carefully studied by the artist. Guy, however, through

the sheer force of his character, and also probably because he was

known to have won the highest medical honor (the grade of “Master of

Medicine”) which it was in the power of the university to confer,

pushed his way to the top, and held, for a period of twenty years, the

position of private physician to three Popes in succession--Clement

VI., Innocent VI. and Urban V. In other words, the prevailing

prejudices and jealousies were not sufficiently powerful to block the

triumphant career of this man of solid merit and high character.

[Illustration: FIG. 12. ONE OF THE WARDS IN THE HÔTEL-DIEU OF PARIS.

As it appeared in the sixteenth century.

(From _Chirurgie de Pierre Franco_, edited by E. Nicaise, Paris,

1895.)]

_The State of Medicine and Surgery in Countries Other than Italy

and France During the Later Portion of the Middle Ages._--From the

account given by Neuburger it appears that the seeds planted by the

famous teachers of medicine and surgery in Italy and France during

the thirteenth and fourteenth centuries had begun to take root in

England and in the Low Countries to the north of France, and were

in fact already producing some good fruit in those lands. Thus, for

example, there have been handed down to our time the names of four

physicians who attained a certain degree of eminence in England during

the thirteenth and fourteenth centuries--Gilbertus Anglicus, John of

Gaddesden, John Mirfeld and John Arderne.

_Gilbertus Anglicus_, who was the first English medical writer

to secure a certain degree of celebrity among the physicians of

continental Europe, wrote a compendium of medicine that was commonly

called the “_Laurea anglica_.” The book contains, along with some

good original observations and the records of his own experience, not a

few wearisome theoretical discussions; and at the same time it reveals

the fact that the author was inclined to favor remedial measures

of a superstitious nature. In the last chapter of his compendium,

however, he makes the very practical suggestion that distillation may

be resorted to when one desires to purify water that is contaminated.

Gilbertus, after obtaining his preliminary training in England

in the early part of the thirteenth century, visited some of the

leading schools on the continent, among others those of Salerno and

Montpellier, in which latter city he appears to have practiced medicine

for a certain length of time.

_John of Gaddesden_, who is also spoken of as Johannes Anglicus,

was born about 1280 A. D. and died in 1361. He was therefore a

contemporary of Guy de Chauliac. He is said to have been a Fellow of

Merton College, Oxford, and to have held the positions of Prebendary

of St. Paul’s, London, and of private physician to the royal family.

He was also the author of a medical treatise which was generally known

by the title, “_Rosa Anglica_” (first printed in 1492). Neuburger

speaks of this book as being an imitation of Gourdon’s “_Lilium

Medicinae_,” but of a somewhat inferior grade, and he quotes two

or three passages which show that medicine was in a very low stage of

development in England at the beginning of the fourteenth century.

Gaddesden, for example, advises his confrères to adopt the rule of

always securing their honorarium before they undertake the treatment of

a sick person. In another part of the book he states that he treated

one of the sons of Edward II. for small-pox and secured excellent

results, not merely as regards the perfect restoration of his health,

but also as regards the complete prevention of any pitting of his face.

He attributes this success to the fact that he enveloped the patient in

a red cloth and took pains to have every object in the vicinity of the

bed draped in red.[71]

_John Mirfeld_, who lived during the second half of the fourteenth

century, completed his medical studies in Oxford, then entered

the Monastery of St. Bartholomew’s in London, and devoted himself

thenceforward to work in connection with the hospital belonging to that

institution. Among the books which he wrote there are a few that deal

with matters of interest to the physician. Such, for example, are a

glossary which bears the title “_Synonyma Bartholomaei_,” a work

called the “_Breviarium Bartholomaei_,” and a shorter treatise

on prognosis--the “_Speculum_.” None of these, however, possesses

any special importance.

[Illustration: FIG. 13. THE PHYSICIAN, THE SURGEON AND THE

PHARMACIST.

Reproduction of a miniature at the head of Guy de Chauliac’s

_La Grande Chirurgie_, edited by E. Nicaise, Paris, 1890.]

_John Arderne_ was born in England 1307 A. D., probably obtained

his medical training in Montpellier, accompanied the English Army to

France in the character of a “Sergeant-Surgion,” and was present at the

battle of Crécy (1346 A. D.). During the succeeding twenty-four years

he practiced medicine in Wiltshire and Newark, and then settled for

the remainder of his life in London. Although his practice included

both internal diseases and those which required surgical treatment, the

great reputation which he acquired was based chiefly upon his success

in the latter field. Most of his writings, it appears, are still in the

form of manuscript. They deal chiefly with surgery and are accompanied

by drawings of the instruments which he employed. They possess one

feature which distinguishes them from the majority of medical writings

of the Middle Ages, viz., they abound in reports of cases observed and

treated by the author; and, furthermore, the methods of treatment which

he recommends are in most instances rational and of a relatively simple

nature. The only one of Arderne’s treatises which has been printed

is that relating to _fistula in ano_. It bears the title, “John

Arderne--Treatises of Fistula in Ano, Haemorrhoids, and Clysters; from

an early fifteenth-century manuscript translation,” and is edited by

D’Arcy Power, Early English Text Society, Original Series, 139; London

and Oxford, 1910. Arderne, we are told by Neuburger, puts forward two

claims: 1, that he succeeded in curing a large number of cases of anal

fistula, in proof of which he gives the names of the persons upon whom

he operated successfully, many of whom are high up in the social scale;

and, 2, that no other surgeon of whom he has any knowledge, either in

England or on the continent of Europe, is able to cure the disease.

The three English physicians of whom I have here given very brief

accounts, can scarcely be said to compare favorably with those men

who, during the same period, brought fame to the medical schools of

Bologna, Padua, Montpellier and Paris; and this fact suggests the

question, Do these men really represent the best type of physicians who

lived in England during the fourteenth century? The great English poet

Chaucer, in his “Canterbury Tales” (written at about the same period

of time), furnishes us with a portrait of a man who appears to have

been well informed with regard to the earlier Greek and Arabian medical

authorities as well as with the leading physicians of his own time,

and who in addition was clever both in ascertaining the causes and

nature of his patients’ maladies and in prescribing for them the proper

remedies. As this physician’s name is not mentioned, we cannot be sure

that he was not one of the three to whom reference has just been made.

By the description given by the poet, who probably was personally

acquainted with the man whose portrait he draws, one is tempted to

believe that he was a physician of a higher type than any one of the

three named above. Chaucer’s account reads as follows:--

There was also a Doctor of Phisik,

In al this worlde was ther non him like

To speke of phisik and of surgerye;

For he was grounded in astronomye.

He kepte his pacient wondrously and we

In all houres by his magik natural.

Well coude he gesse the ascending of the star

Wherein his patientes fortunes settled were.

He knew the cause of every maladye,

Were it of cold, or hete, or moyst, or drye,

And where they engendered, and of what humour;

He was a very parfit practisour.

The cause once knowen and his right mesúre,

Anon he gaf the syke man his cure.

Ful redy hadde he his apothecaries,

To sende him drugges, and electuaries,

For eche of them made the other for to wynne;

Their friendshipe was not newe to begynne.

Wel knew he the old Esculapius,

And Discorides, and eek Rufus;

Old Ypocras, Haly and Galien;

Serapyon, Razis, and Avycen;

Averrois, Damascen, and Constantyn;

Bernard, and Gatisden, and Gilbertyn.

Of his diete mesuráble was he,

For it was of no superfluitee,

But of gret norishing and digestible.

With the names of the three English physicians mentioned above, there

should be associated that of Jehan Yperman, who was born in Ypern,

Flanders, during the latter half of the thirteenth century, obtained

his professional training in Paris under Lanfranchi, and then, in

1303 or 1304, accepted the position of Physician to the Hospital of

Belle, a small Flemish town. In 1318 he settled permanently in Ypern,

his native city, and in a comparatively short time won completely the

confidence and esteem of his fellow townsmen through his attentiveness

to their wants when they were ill and through the great skill which he

manifested in his work as a surgeon. He died 1329 A. D.

Yperman’s writings deal with both medical and surgical topics. Of

those which have been translated from the Latin into French are: “La

chirurgie de maitre J. Yperman,” Anvers, 1863; “Traité de médecine

pratique de maitre J. Yperman,” Anvers, 1863; and “Traité de médecine

pratique de maitre J. Yperman,” Anvers, 1867. A perusal of these

works, says Neuburger, easily convinces one that Yperman was not only

a skilful and clever surgeon, but also a physician of independent

judgment and wide experience.

_Revival of the Practice of Dissecting Human Bodies._--It was in

Italy that dissecting was carried on during the fourteenth century more

vigorously than elsewhere in Europe. At first the only persons who made

such investigations for scientific purposes were individual physicians

or groups of physicians; and, in addition, they were obliged to carry

on the work in a secret manner--that is, by stealing from recently

dug graves the corpses which were necessary for such studies. It is

related, for example, that in 1319 one of the teachers in the Medical

School at Bologna and four of his pupils were brought before the Court

of Law under the charge of having clandestinely disinterred, for

purposes of dissection, the body of a man who had been hung for some

crime. At first the authorities merely winked at such transgressions,

but at the same time they made no attempts to have the law against

dissecting annulled or at least modified. Then, at a somewhat later

period, the conviction became general among the intelligent members

of the community that, unless work of this nature were officially

sanctioned, no real advance in the knowledge of human anatomy could

be made, and--what was probably of even greater importance in their

estimation--that Bologna might at the same time lose a good deal of its

superiority over its rivals as a centre of learning; and accordingly

it was found practicable to grant the desired sanction with many

modifying restrictions attached. Then, with the further lapse of time,

other medical schools fell into line and secured from the authorities

similar privileges for their teachers and pupils. Thus, in 1368, the

Senate of Venice authorized the medical school of that city to make a

public dissection of a human body once every year; and, eight years

later, the University of Montpellier acquired the same privilege. In

1391 John I. of Spain was equally generous in his treatment of the

Medical School at Lerida. After the opening of the fifteenth century

no further difficulties of a serious nature were experienced by the

teachers of anatomy in procuring at least some material for dissecting

purposes, and with each succeeding year such facilities steadily

increased. Unfortunately, however, there did not follow a corresponding

increase in the knowledge of human anatomy. As a matter of fact, it

was not until during the sixteenth century that any really valuable

work was accomplished in this branch of medicine. Guy de Chauliac,

in the first chapter of his treatise (“_La Grande Chirurgie_”),

gives the following description of the manner in which Bertrucius

taught anatomy in Bologna at the beginning of the fourteenth century,

and from this account it is easy to understand why the additions to

our stock of information in this department of medicine were so few

and so unimportant during this long period. The so-called dissecting,

it clearly appears, was in reality a not very profitable combination

of purely anatomical work of a primitive character and a search

for evidences of pathological changes. The clinical history of the

individual whose body was undergoing examination does not seem to have

played any part in the investigation. Here is De Chauliac’s account:--

After placing the dead body on a bench, my master proceeded with

his instructions, devoting thereto four separate sittings. At

the first of these he passed in review those parts or organs

which are concerned in nutrition; his reason for considering

them first being that they are the earliest to undergo

decomposition. At the second sitting he devoted himself to the

spiritual organs of the body; at the third, to the animal parts;

and at the fourth, to the extremities. Following the example

furnished by Galen in his commentary on the book entitled “The

Sects,” he maintained that there were nine things which should

be taken into consideration when one examines the different

parts of the body, to wit: their situation; their nature,

color, bulk, number, and shape; their connections or relations;

their actions and their utility; and the diseases which may

affect them. Conducted in this manner the study of anatomy, he

maintained, may prove helpful to the physician in recognizing

diseases, in making prognoses, and in selecting a suitable plan

for treatment.

Puschmann, quoting from Hyrtl, says that when Professor Galeazzo di

Santa Sofia, who had been called from Padua to Vienna to fill the

Chair of Anatomy in the medical school of that city, made his first

public dissection of a human body (1404 A. D.) in the Bürgerspital,

the sittings covered a period of eight days; at the end of which time

he collected as much money as he could from those who had attended

the course, and turned it over to the treasurer of the Faculty. Then

followed a period of twelve years during which not a single public

dissection of a human body was made in Vienna. In 1440 the Faculty were

greatly rejoiced over the prospect of receiving from the authorities

the body of a criminal who was to be hung on a certain day; but, when

the time arrived and the body had actually been delivered to them,

they were grievously disappointed by the sudden coming to life of the

supposed corpse. Instead of dissecting him for the benefit of science,

the doctors bestirred themselves in the man’s behalf, obtained a pardon

in due form, and sent him back to his home in Bavaria under the escort

of the college janitor. Not very long afterward, however, he committed

a fresh crime, and this time was effectively hung. History does not

state whether the dissection then came off, or not.

The Medical Faculty of the University of Tübingen established the rule

in 1497 that one human body should be publicly dissected every three

or four years; it being understood that during the progress of the

dissection the professor should read aloud to the class appropriate

portions of Mondino’s treatise on anatomy. The instruction in this

department of medical science was of the same general character in

all the other universities of Germany at that period. Anatomical

drawings, of a very crude type, were employed as substitutes for actual

dissection.

At Padua, in Northern Italy, the science of medicine had already before

the end of the first half of the fifteenth century made a decided

advance, in proof of which several circumstances may be mentioned. In

the first place, the importance of the study of anatomy had by this

time become so generally recognized that no special difficulty appears

to have been encountered in securing the erection, in 1446, of an

anatomical theatre; and during this same period several physicians

connected with the medical school acquired considerable celebrity by

their publication of important treatises on topics belonging to the

domain of general pathology and therapeutics, and by the wide influence

which they exerted as teachers. Among the number of those who helped

in these ways to spread the fame of the Medical School of Padua may

be mentioned Hugo Benzi, Antonio Cermisone, Giovanni Savonarola and

Bartolommeo Montagnana.

_Hugo Benzi_ (or Hugo of Siena) taught philosophy as well as

medicine in different institutions of learning--at Pavia, Piacenza,

Florence, Bologna, Parma, Padua and Perugia. His death probably

occurred at Ferrara about the year 1439. In addition to commentaries

on Hippocrates, Galen and Avicenna, he wrote several practical works

(“_Consilia_”) on such topics as periodical insanity, stomachic

vertigo, naso-pharyngeal polypi, epilepsy, lachrymal fistula, etc.

_Antonio Cermisone_ was a native of Padua, became a teacher of

medicine first in Pavia and afterward in Padua, wrote several useful

treatises about various diseases, and finally died about 1441.

_Giovanni Michele Savonarola_--the grandfather of the celebrated

Girolamo Savonarola, who was burned at the stake for heresy 1498 A.

D.--held the Chair of Medicine in Padua from about 1390 to 1462, and

also subsequently for a certain length of time in Ferrara. He was the

author of a number of treatises on practical medical topics--such,

for example, as fevers (first published in Venice in 1498), the art

of preparing simple and compound _aqua vitae_ (Basel, 1597), an

introduction to the practice of medicine (1553), the baths of Italy and

of the rest of the world (Venice, 1592), the different kinds of pulse,

etc. (Venice, 1497)--and he also wrote a large work covering the entire

field of medicine and modeled on the pattern of Avicenna’s “Canon.”

The book is divided into six parts, each of which is preceded by an

introduction that is devoted to the anatomico-physiological bearings

of that particular part; and here, in addition, there are to be found

scattered throughout the text references to surgical procedures.

Among the references of this character the following deserve to be

mentioned as worthy of some notice: the description of a speculum for

use in operations upon the interior of the nose; a reference to direct

laryngoscopy; the description of an instrument closely resembling the

well-known syringotome; the treatment of curvature of the spine by

mechanical means, etc. The book also reveals the fact that, already at

this period of the history of medicine (the middle of the fifteenth

century), physicians were beginning to take a more active part than

they had previously done in the management of confinement cases, which

as a rule were left entirely to the care of midwives. The records

also show that medical men were interesting themselves more and

more, as time went on, in sanitary science as applied to municipal

affairs. In most communities the need for such was indeed most urgent

at that time. The reforms of this nature were pushed with special

vigor in those parts of Italy which were governed by that enlightened

ruler of the Hohenstaufen family, Frederic II., King of Sicily and

Roman Emperor. The cultivation of personal hygiene was also pursued

very systematically during the later Middle Ages, the _Regimen

Salernitanum_ serving as the guide in such matters.

Taken all together the conditions in the physician’s world were in

anything but a promising state toward the end of the fifteenth century;

but the dawn of better times, of modern medicine, was near at hand,

and already signs of its approach were beginning to be recognizable in

different parts of Western Europe.

CHAPTER XXV

BRIEF HISTORY OF THE ALLIED SCIENCES--PHARMACY, CHEMISTRY AND

BALNEOTHERAPEUTICS

During the excavations carried on at the site of Pompeii, there were

discovered three houses which bore every appearance of having been

occupied by apothecaries. Among the objects found in these buildings

were: A bronze box equipped with the apparatus required for mixing

ointments; a few surgical instruments; several glass receptacles

which had evidently at some earlier period contained fluid or

semi-fluid pharmaceutical preparations, but which, at the time when

the excavations were made, presented merely a deposit of some solid

but easily friable substance at the bottom of the vessel; and quite

a variety of drugs in the form of pills, tablets, powders, etc. At

first, the impression prevailed that these must have been the houses

of apothecaries, but subsequently the discovery, in each instance, of

the house sign representing a snake with a pine cone in its mouth (the

symbol of Aesculapius) satisfied the authorities that these particular

buildings had belonged to physicians. Indeed, as a matter of fact, no

good reasons have thus far been found for believing that apothecaries,

in the modern acceptation of the term, existed in even the largest

cities of Greece and Italy until a much later date.

_Pharmacy in Its Infancy._--All through the Hippocratic period and

during the years when Alexandria was at the height of its prosperity

as the great centre of medical activity, it was customary for the

physicians to prepare their own drugs. The same is true of the best

physicians belonging to the Augustan period; they were not willing to

put their trust in the drugs which had been prepared in the shops where

such things were usually sold.

In the second century of the present era Galen gave the definition

that a remedial drug, or “Pharmakon,” was something which, when taken

into the living body, produces an alteration in its component tissues

or organs, whereas foods or nutrient elements simply cause an increase

of the parts. He attached great importance to such characteristics as

purity, freshness, care in handling, etc. It was his custom to prepare

with his own hands the different combinations of simple remedial agents

which he administered to his patients, and he kept these combinations,

as well as the simple drugs of the more costly kinds, carefully stored

in locked wooden boxes in a room which was devoted to this special

purpose and which was termed the “Apotheke.” Originally, therefore,

the “apothecary” was simply the person who had charge of this room

in which the drugs and spices were carefully “placed to one side”

(ἀπό, τίθημι) for safe keeping. At a later period, when the

caretaker became also the compounder of drugs, another word of a more

comprehensive significance--that of “pharmacist”--gradually supplanted

the term apothecary.

There is another word, “antidote,” which has very materially changed

its significance during the lapse of centuries. Galen, for example,

employed this word as a synonym of pharmakon--a simple remedial agent,

and medical writers continued using the term in this sense during

the following thirteen or fourteen centuries. The word commonly

employed, by mediaeval physicians, to signify “pharmacopoeia,” was

“antidotarium.” In modern times the word “antidote” signifies only an

agent which neutralizes a poison.

Galen took a very great interest in everything relating to the

subject of drugs, and sometimes made long journeys for the purpose

of securing certain plants or roots which he was unable to procure

near home or which he was very anxious to obtain in a more perfect

condition than was possible when they were purchased from the regular

dealers. “Simple remedies,” he declared, “are pure and unadulterated,

and produce effects in only one direction. It is the business of

pharmacology to combine drugs in such a manner--according to their

elementary qualities of heat, cold, moistness and dryness--as shall

render them effective in combating or overcoming the conditions which

exist in the different diseases.” Galen’s interest in pharmacology

materially aided the advance of medical science in other ways. He

systematized the existing knowledge of materia medica and infused some

measure of orderliness into the therapeutics of his day. The success

of his efforts in this direction did not become manifest until after

he had been dead about fifty years; but, if his ideas were slow in

meeting with general acceptance, they took such deep root in the minds

of physicians that to-day in Persia Galen’s system of therapeutics is

the only one generally received as authoritative. Although the facts do

not warrant our making the same statement with regard to Western and

Southern Europe, it is nevertheless true that our dispensatories still

continue to honor the memory of this great physician by bestowing the

name of “Galenical Preparations” on a large group of pharmaceutical

combinations.

It is scarcely possible to state with any degree of positiveness at

what date pharmacists, in the modern sense of the term, came to be

recognized as constituting a separate and honorable class in every

well-organized community. It is known, however, that in Syria and

Persia, during the eighth and ninth centuries of the present era, not

a few of the leading physicians were the sons of apothecaries. Honein,

for example, of whose career I furnished a brief sketch in Chapter

XIX., was the son of an apothecary; and the careful manner in which he

was educated during his youth justifies the belief that his father must

have been a man of some cultivation and not at all like the general

average of that class of men of whom Galen speaks so disparagingly. But

even at that early period there certainly were individuals who were

skilled in the pharmaceutic art, for Berendes (_op. cit._) tells

us that Dioscorides (_circa_ 100 A. D.) describes minutely the

manner of preparing “Oisypum.” Oisypum is identical with the modern

“Lanolin” or “Lanolinum,” and is a pure fat of wool. Mention is made of

the preparation by four different authors of medical treatises during

the following sixteen centuries--viz., by Aëtius in the sixth, by

Paulus Aegineta in the seventh, by Nicolaus Myrepsus in the thirteenth,

and by Valerius Cordus in the seventeenth. Subsequently to the latter

date no further mention of the preparation is to be found in any of

the pharmacopoeias except the French Codex of the year 1758, in which

it is classed among the simple remedies under the title of “Oesipe.”

Finally Liebreich, toward the end of the nineteenth century, brought

the preparation once more into favor under the name of “lanolin.” The

fact that it remained in complete oblivion for such very long periods

of time is easily explained by the statement which Berendes makes:

“It was a troublesome ointment to manufacture, and consequently the

apothecaries disliked it and resorted to all sorts of falsifications.”

With the advance of the Arab Renaissance pharmacy gradually became a

regular established occupation in every fairly large city in the East.

It is known, for example, that the first public apothecary shop in the

city of Bagdad was established during the eighth century of the present

era under the caliphate of Almansur; and about the same time, probably

a little earlier, there existed at Djondisabour a similar pharmacy in

connection with the school and hospital of the Bakhtichou family. The

training of an apothecary in those days was probably the same as that

of the physician. Originally pharmacists were called “Szandalani,”

probably because they dealt largely in sandal wood.

The materia medica furnished by the Arab physician Rhazes in the

different works which he has written, is unusually rich in simple

elements, the majority of which are always drugs of a rather mild

action; Greece, Persia, Syria, East India and Egypt were the sources

from which they were derived. Beside the simple elements, Rhazes

mentions a number of composite preparations of drugs. As not a few

of the latter required very careful manipulation, it may safely be

inferred that the Arabian apothecaries of the ninth century had already

acquired considerable skill and experience in their special field of

work.

At Salerno, during the first half of the twelfth century, pharmacy

began to assume a position of considerable importance. The work

which was prepared by Nicolaus Praepositus, and which was known as

an “Antidotarium,” furnished quite full information with regard to

the characters and therapeutic uses of nearly 150 different drugs.

According to Berendes this work served for several centuries as the

basis of later pharmacopoeias. One of its notable features is the

importance which the author attaches to the duty of weighing very

carefully each of the drugs that enter into the composition of a given

preparation, of gathering certain vegetable products at the right

season, and of paying strict attention to their quality and to the

manner of preserving them.

In 1140 A. D., Roger, King of Naples and Sicily, promulgated a law

which defined what should be the proper relations between physicians

and apothecaries; and about one hundred years later (1241 A. D.)

Frederick II. amplified and gave greater precision to this law, thus

establishing what was practically an Institute of Apothecaries. The

following provisions constitute the essential features of the law:--

1. The physician and the apothecary shall have no business

interests in common.