Honorary Staff of the Leeds General Infirmary, that the unsurgical
division of us was summoned in great solemnity to discuss a method
of administration of drugs by means of a needle. This method
having obtained some vogue, it behooved those who practiced 'pure'
medicine to decide whether the operation were consistent with the
traditions of purity. For my part, I answered that the method had
come up early, if not originally, in St. George's Hospital, and in
the hands of a house physician--Dr. C. Hunter; that I had
accustomed myself already to the practice and proposed to continue
it; moreover, that I had recently come from the classes of
Professor Trousseau, who, when his cases demanded such treatment,
did not hesitate himself to perform paracentesis of the pleura, or
even incision of this sac, or of the pericardium. As, for lack not
of will but of skill and nerve, I did not intend myself to perform
even minor operations, my heresy, as one in thought only, was
indulgently ignored, and we were set free to manipulate the drug
needle if we felt disposed to this humble service."]
{197}
In conclusion, we may say that, in the Middle Ages, once men had
lifted themselves up from the condition into which they had been
plunged by the incursions of the barbarians, there was nothing like
the neglect of surgery which is sometimes said to have existed.
Surgery had its normal development, and reached as high a stage as
medicine in that beginning Renaissance, which is the characteristic
feature of the twelfth, thirteenth, and fourteenth centuries. The
traditions of a low state of surgery at this time are all false and
founded on insufficient knowledge of the real conditions, which have
been so clearly revealed to us by the investigation of original
documents in the last twenty-five years. This was, in fact, one of the
greatest periods in the history of surgery that the world has ever
known. Whatever of difficulty in development surgery encountered was
due not to any Church opposition, but to unfortunate conditions that
arose in the practice of medicine. Professional jealousy and
shortsightedness was the main element in it. Even this, however, did
not prevent the very wonderful development of surgery that came {198}
during the Middle Ages, and that made this department of human
knowledge quite as progressive and successful as any other, in that
marvelous period when the universities came into existence in the form
which they have maintained ever since.
{199}
PAPAL PHYSICIANS.
Most of what historical writers generally, who follow the old
traditions of the medieval eclipse of medicine, have to say with
regard to the supposed Papal opposition to the development of medical
science, is founded on the assumption that men who believed in
miracles and in the efficacy of prayer for the relief of disease could
not possibly be interested to any serious degree in scientific
medicine. As Dr. White says, "out of all these inquiries came
inevitably that question whose logical answer was especially injurious
to the development of medical science: why should men seek to build up
scientific medicine and surgery, when relics, pilgrimages, and sacred
observances, according to an overwhelming mass of concurrent
testimony, have cured and are curing hosts of sick folk in all parts
of Europe." He goes even farther than this, however, when he suggests
that "it would be expecting too much from human nature to imagine that
Pontiffs who derived large revenues from the sale of the Agnus Dei, or
priests who derived both wealth and honors from cures wrought at
shrines under their care, or lay dignitaries who had invested heavily
in relics, should favor the development of any science which
undermined their interests."
On the strength of assumptions such as these, that "medieval belief in
miracles of healing must have checked medical science," and that
therefore it did actually prevent the development of scientific
medicine, statements are made with regard to the history of {200}
medicine that are utterly at variance with the plain facts of history.
Once more, as in the case of the supposed failure of surgery to
develop during the Middle Ages, it is a deduction that has been made
from certain supposed principles, and not an induction from the actual
facts as we know them. Such historians would be the first to emphasize
the narrowness of the schoolmen for their supposed dependence on
deduction, but what they have to say on medical history is entirely
deductive, and unfortunately from premises that will not stand in the
presence of the story of the wonderful rise and development of medical
science and medical education, mainly under the patronage of
ecclesiastics, in the Middle Ages.
The argument may be stated formally with perfect fairness as follows:
When men believe in miracles they cannot build up scientific medicine
and surgery; but men believed in miracles in the Middle Ages,
therefore they did not build up scientific medicine and surgery. When
stated thus baldly in formal scholastic form, the argument loses most
of the glamor that has been thrown around it. This is one of the
advantages of the old scholastic method--it strips argument to its
naked significance. Logic asserts herself and rhetoric loses its
force.
With regard to the major premise that when men believe in miracles
they will not successfully pursue investigations in the medical
science, there are two answers. One of these concerns the actual
attitude of mind towards scientific medicine of men who believe in
miracles, for we have such men still with us, and have always had them
all during the past seven centuries. The other portion of the answer
concerns what men who were distinguished scientific investigators
thought of {201} miracles, and how much they accomplished for the
medical sciences while all the time maintaining their belief in the
possibility of miraculous intervention for the cure of disease.
Apparently the writers who insist on the incompatibility of the belief
in miracles with devotion to scientific medicine do not realize that
the greater number of thinking physicians during the last seven
centuries, and quite down to our own day, have been ready to confess
their belief in the possibility of miraculous healing, yet have tried
to do everything in their power to relieve suffering and cure human
ills by the natural means at their command. Their attitude has been
very much that attributed to Ignatius of Loyola, who said to the
members of his order: "Do everything that you can with the idea that
everything depends on you, and then hope for results just as if
everything depended on God." There is no lack of logic in this; and
the physician of the present day who realizes his impotency in the
presence of so many of the serious ailments of mankind is not a
scoffer at the attitude of mind that looks for help from prayer; but
if he is sensible, welcomes the placidity of mind this will give his
patient, even if he does not, as many actually do, however, believe in
the possible interposition of supernatural forces.
If Prof. White knew anything about the lives of the men whose names
are most distinguished in the history of medicine during the
thirteenth, fourteenth and fifteenth centuries, we would have heard
nothing of his almost incomprehensible negation of the existence of
scientific medicine, during centuries when so many men who have
stamped their names indelibly on the history of the medical sciences
were doing their work and {202} writing. If he had taken any pains to
learn even a few details of the personal relations of these old-time
makers of medicine to the Popes, we would have heard none of this
utter absurdity of Papal opposition to medicine or ecclesiastical
hampering of medical science. To answer Prof. White's argument, that
"it would be expecting too much from human nature to imagine that
Pontiffs should favor the development of any science which undermined
their interests," the simple story of the men the Popes choose as
their own medical advisers, and who because of the prestige of their
appointment as Papal Physicians helped to raise up in the eyes of the
people the dignity of the medical profession which they represented,
will be quite enough. It will also serve to show how different is
history founded on an assumption from history founded on actual facts.
The best, most easily obtainable, and most impressive data for the
inductive method of reaching the truth as regards the relation of the
Popes to medical science and (because of the fact that physicians were
the scientists _par excellence_ of the Middle Ages) to all science,
will be found in a brief consideration of the lives of the men who
occupied the position of Papal Physician during the last seven
centuries. I do not think that this group of men has ever been treated
together before; at least I have been unable to find any work on the
subject. While I am able to present a considerable amount of
interesting material in brief form with regard to them, I am sure that
there are many of them whom I have omitted. Practically up to the day
of going to press I have been finding new references that led to
further precious information with regard to this most wonderful group
of men in medical history. It will be well {203} understood, then,
that impressive as the consideration of the work and character of the
men whose names I have found must be, this does not represent all the
truth in the matter, but can be supplemented without much difficulty
from other sources.
If the Popes had been interested only in the miraculous healing of
disease, and had wished to teach the lesson that men should depend
solely for their recovery from serious symptoms and ailments of all
kinds on prayers and relics and pilgrimages, then they would either
have had no physicians at all in regular attendance on them, or at
least their physicians would not have been selected from among the men
who were doing most to advance the cause of practical and scientific
medicine and of medical education. The very opposite of this is the
case. The Papal physicians were as a rule the most scientific medical
men of their time. This is not a pious exaggeration, but is literally
true for seven centuries of history, as we shall see presently. The
wonder of it is that there were not some charlatans among them. The
physicians whom educated people select are not, as physicians we'll
know, always worthy examples of progressive medical men. Literary folk
particularly seem to have a distinct tendency to want to be different
from other people, and their physicians are often the veriest
theorizers. A medical friend who occasionally quotes, but perverts the
old line, "the people people have for friends are often very queer,"
says, half in jest of course, but alas! more than half in earnest,
that "the people literary folk and the clergy have for doctors are the
queerest ducks (docs.) of all."
It is only too true that clergymen are especially prone to be erratic
in the choice of their medical advisers and {204} lacking in a
critical judgment as to the remedies and methods of treatment of which
they become the willing recipients, and occasionally even the sponsors
as regards other people, who look up to their judgment for other
reasons with confidence. Prof. Osler once said that the nearer to the
Council of Trent the clergyman, the nearer he was likely to be to
truth and common sense in medical matters; but then perhaps all would
not agree with him. It is all the more surprising under the
circumstances, and very greatly to their credit, that the Popes should
have had as their physicians a list of men whose names are the
brightest on the roll of great contributors to medical literature and
some of the most distinguished among the great discoverers in medical
science.
This fact alone constitutes the most absolute contradiction of the
declarations as to supposed Church opposition to medicine that could
possibly be given. No better means of encouraging, fostering, and
patronizing medical science could be thought of than to give the
prestige and the emoluments of physician to the head of the Church to
important makers of medicine in every generation. The physicians to
the rulers of Europe have not always been selected with as good
judgment, and, as I have already said, there is no list of physicians
to any European Court, nor indeed any list of names of medical men
connected together by any bond in history--no list, for instance, of
any medical faculty of a university--which can be compared for
prestige in scientific medicine with the Papal Physicians.
Before the beginning of the thirteenth century very little is known of
the medical attendants of the Popes. We point out in the following
chapter that the Papacy was closely in touch with the medical school
at Salernum. {205} It seems not unlikely, and indeed there are some
traditions to that effect, that in cases of severe illnesses of the
Popes, important members of the medical faculty were sometimes
summoned from the South of Italy to Rome. The relations of the Popes
to the neighboring abbey of Monte Cassino might, as we have said,
suggest this. We have, however, very few details in this matter. With
the beginning of the great thirteenth century, however, the records of
human achievement in every line are better kept, and at once we begin
to know something definite about Papal Physicians. The first one of
decided prominence was Guy or Guido of Montpelier, who was summoned to
Rome by Pope Innocent III. in order that he might re-establish the
hospital of the Santo Spirito at Rome, in accordance with what were
considered to be the latest ideas in the matter of hospital building
and the enlightened care of the sick. How well he accomplished this
work, and how well he deserves to head the glorious roll of Papal
Physicians, will be seen in the chapter on The Popes and City
Hospitals.
The next of the Papal Physicians of whom much is known in the history
of medicine was Richard the Englishman, usually spoken of as Ricardus
Anglicus. He was the physician to the famous Pope Gregory IX.
(1237-1241). Richard, who was born in England not long before the
beginning of the thirteenth century, died shortly after the middle of
that century. For a time he was at Paris, and accordingly is sometimes
spoken of as Ricardus Parisiensis. According to Gabriel Naude he was
at Paris after the death of his patient, Gregory IX., and towards the
end of his life retired to the Abbey of St. Victor, to spend his last
days in recollection and prayer. In this he anticipated another great
English physician {206} with a European reputation--Linacre--who,
three centuries later, after having been the royal physician for many
years to King Henry VIII., became a clergyman. It is interesting to
realize that, early in history as Richard's life occurs, some works
attributed to him contain definite information with regard to anatomy.
Most of this, it is true, is taken from Hippocrates, Galen, and the
Arabs, but some of it seems to be the result of his own personal
experience, on the living, if not on the dead.
After Richard, the next of the physicians to the Popes who has an
important place in the history of medicine is the famous Thaddeus
Alderotti, who lived for more than eighty years during the thirteenth
century. He has the added interest for this generation of having been
a self-made man, for he was the son of very poor parents of the lowest
rank. Up to his thirtieth year he remained without any special
education. He made his living, it is said, by selling candles. Having
acquired a little competency, at the age of thirty he began with great
zeal the study of philosophy and of medicine, two sciences which in
the old days were supposed to go very well together, though,
unfortunately, they are often rigidly separated from each other in
later times. Fifteen years after he began the study of medicine we
hear of him as a medical teacher, and then ten years later he began to
be famous as a writer on all sorts of medical topics. He became the
physician of Pope Honorius IV., himself one of the most liberal and
broadly educated of men, and as the result of the confidence awakened
by his occupancy of this honorable position, he secured an immense
success in practice and made an enormous fortune. Alderotti's work
represents what is best in medicine for the whole of the thirteenth
century.
{207}
A curiously interesting episode that deserves a place in the history
of Papal Physicians occurred during Alderotti's life. One of the Popes
elected to fill the Papal chair had been earlier in life a physician.
This was the famous Peter of Spain, though he was really a Portuguese,
who, under the name of John XXI., occupied the Papal throne during the
years 1276-1277. Peter of Spain had been one of the most distinguished
natural scientists of this interesting century. Dr. J. B. Petella, in
an article published in Janus about ten years ago, entitled A Critical
and Historical Study of the Knowledge of Ophthalmology of a
Philosopher Physician who became Pope, gives an excellent account of
the life of Pope John XXI. [Footnote 27]
[Footnote 27: Janus, Archives International es pour l'histoire de la
Medicine et pour la Geographie Medicale, paraissant tous les deux
mois. Amsterdam, 1897-1898.]
Petella does not hesitate to say of him that he was "one of the most
renowned personages of Europe during the thirteenth century, from the
point of view of the triple evolution of his extraordinary mind, which
caused him to make his mark in the physical sciences, in the
metaphysical sciences, and in the religious world. In him there was an
incarnation of the savant of the time, and he must be considered the
most perfect encyclopedist of the Middle Ages in their first
renascence."
Anyone who reads Dr. Petella's account of this book by Pope John XXI.
will be surprised at how much was known about diseases of the eye at
the middle of the thirteenth century. For instance, hardening of the
eye is spoken of as a very serious affection, so that there seems to
be no doubt that the condition now known as glaucoma was recognized
and its bad prognosis appreciated. His account of the external anatomy
of the eye, eight coats of which he describes, beginning with the
{208} conjunctiva and ending with the retina, is quite complete. The
eye is said to have eight muscles, the levator of the upper eyelid and
the sphincter muscle of the eye being counted among them. The other
muscles are picturesquely described as reins, that is, guiding ribbons
for the eye. Cataract is described as water descending into the eye,
and two forms of it are distinguished--one traumatic, due to external
causes, and the other due to internal causes. Lachrimal fistula is
described and its causes discussed. Various forms of blepharitis are
touched upon. Many suggestions are made for the treatment of
trichiasis. That a man who was as distinguished in medicine as Peter
of Spain should have been elected Pope, is the best possible proof
that there was no opposition between science and religion during the
thirteenth century.
But to return to the Papal Physicians in our original meaning of the
term. Alderotti's successor as physician to the Papal Court was
scarcely, if any, less distinguished. This was Simon Januensis, the
medical attendant to Pope Nicholas IV., whose pontificate lasted from
1288-1292. Simon did much to make the use of opium more scientific
than it had been, and he established definite rules for its
administration. Before this the anodyne effects of the drug had been
well known, but the difficulty had been to regulate its dosage
properly and prevent the use of too large quantities, while at the
same time securing the administration of sufficient of the drug to
relieve pain. At the beginning there was much prejudice with regard to
opium. Indeed, as every physician knows, this prejudice has not
entirely died out even in our own day. How much of good, then, Simon
was able to accomplish because the prestige of his position as {209}
Papal Physician helped to break down this prejudice, and how much
human suffering he saved as a consequence, it is easy to understand.
Simon is best known in the history of medical science as the author of
what was probably the first important dictionary of medicine. This was
called the Synonyma Medicinae or Clavis Sanationis, the Key of Health.
Steinschneider has declared this book to be one of the most important
works in the field of Synonymies. Julius Pagel, in his chapter on
Therapeutics in the Middle Ages, in Puschmann's Handbook of the
History of Medicine, already quoted, says that this Papal Physician
succeeded in solving very happily the problem which he set himself, of
gathering together the information that had been collected during past
centuries with regard to medical words, and especially those relating
to the use of various remedial measures. The industry of the writer
may be very well appreciated from the fact that his glossary contains
some six thousand articles. Its place in the history of science, as
given by Meyer, the German historian of botany, is that for the
understanding of the older words in natural science, no better aid
than this can be found. He considers it the best work of its kind
until Caspar Bauhin's similar volume came to replace it, but that was
not until well on in the seventeenth century. Simon was greatly
encouraged in this work by Popes Nicholas IV. and Boniface VIII., to
both of whom he was body physician and at the same time an intimate
friend.
The custom of having for medical attendant one of the leading
physicians of the day, if not actually the most prominent medical
scientist of the time, which had obtained at Rome during the
thirteenth century, was maintained at Avignon during the
three-quarters of a {210} century in which the Papal See had its seat
there. Just who the regular medical attendant of Clement V., the first
of the Avignon Popes, was is not very sure. When he became seriously
ill toward the end of his life, however, Arnold of Villanova, one of
the professors of physic at Paris and probably the most distinguished
living physician of the time, was summoned in consultation, and began
his journey down to Avignon. This summons attracted widespread
attention, which was still further emphasized by the fact that Arnold
of Villanova died on the journey. It is not difficult to appreciate
even at this distance of time how much weight the summoning of a
physician from a long distance to attend His Holiness would have on
the minds of the people, and how much it would tend to call their
attention to the important medical school from which the great man
came. People generally, who heard the facts, would want at least to
have in attendance on them, if possible, a physician who had been
graduated at the school from which Arnold of Villanova was summoned on
his important medical mission. How much this would mean for the
encouragement of scientific medicine as it was developing at the
University of Paris can scarcely be overestimated.
The distinct tendency of the Popes to keep in touch with the best men
in medicine and surgery in their time is well illustrated by the case
of Guy de Chauliac. This great French surgeon and professor at the
University of Montpelier is hailed by the modern medical world as the
Father of Modern Surgery. There is no doubt at all of his intensely
modern character as a teacher, nor of his enterprise as a progressive
surgeon. Few men have done more for advance in medicine, and his name
is {211} stamped on a number of original ideas that have never been
eclipsed in surgery. After studying anatomy very faithfully,
especially by means of dissections, in Italy, where he tells us that
his master at Bologna, Bertrucci, made a larger number of dissections
scarcely more than thirty years after the supposed Papal decree of
prohibition, he returned to Montpelier to become the professor of
surgery there, and introduced the Italian methods of investigation
into the famous old university.