medical education will serve to show that, not only was there no
ecclesiastical interference with the new developing science, but, on
the contrary, {226} without the personal aid and the intelligent
patronage of ecclesiastics of all degree, and especially of
archbishops and Popes, the development of medical teaching that took
place at Salerno would probably not have had the significance in
history that it now enjoys. While there was no institutional
connection between the medical school of Salerno and the Benedictine
Monastery at Monte Cassino, it is known that at the end of the seventh
century there was a branch Benedictine monastery at Salerno, and some
of the prelates and higher clergy occupied posts as teachers in the
school, and even became distinguished for medical acquirements.
Though the Salernitan medical school proper was a secular institution,
there is no doubt that the Benedictines had great influence in it and
had fostered its formation. How close the monks of Monte Cassino were
allied to the Popes, everyone knows. The Benedictines considered
themselves the special wards of the Papacy, and a number of the Abbots
of Monte Cassino, or monks belonging to the community, and of men who
had been educated in the monastery, had been raised to the Papacy
during the Middle Ages. The origin of modern medical teaching is thus
closely associated not only with the Benedictines, but through them
with the Popes, without whose encouragement and sanction the work
would not have flourished as it did.
In advance of the formal establishment of medical schools, in the
modern sense of the word, two Popes were distinguished before their
elevation to the Papacy for their attainments in all the sciences, and
especially in medicine, one of whom actually founded an important
school of thought in medicine, while the other was a professor at
Salerno. The first of these is the famous {227} Gerbert, who, under
the name of Sylvester II., was Pope at the end of the millenium and
carried Christianity over what was supposed to be the perilous period
of the completion of the first thousand years, when the end of the
world was so universally looked for. Gerbert was famous for his
attainments in every branch of science, and indeed so many wonderful
traditions have collected around his name in this matter that one
hesitates to accept most of them. There seems to be no doubt, however,
that he was the beloved master of Fulbert of Chartres, who did much
for medicine in France at the beginning of the eleventh century and
who was the founder of the so-called school of Chartres and himself
the teacher of John of Chartres, who became the physician to King
Henry I., of France, and of Peter of Chartres and Hildier and
Goisbert.
Before the end of the eleventh century Pope Victor III., who had been
the Abbot of Monte Cassino, was elected Pope much against his will. He
occupied the Papal throne only for about a year and a half. He had
been especially recommended by Pope Gregory VII., the famous
Hildebrand, as a very suitable successor. Desiderius, as he was called
before becoming Pope, was one of the best scholars of his time, and
had taught for some years with great distinction at Salerno. It is not
known absolutely that he taught medicine, but, as the university of
Salerno is usually considered not to have been founded until the
middle of the next century, and as before that time the main teaching
faculty was that of the medical school and all other teaching was
subordinated to it, Desiderius must surely be considered as a teacher
at least of medical students. At that time a physician was expected to
know something more than merely his {228} profession. Mathematics and
philosophy were the two favorite subjects to which, besides medicine,
they devoted themselves. The presence of the future Pope at Salerno
is, moreover, the best possible index of the sympathy between the
ecclesiastical authorities and the medical school.
Besides there are definite records of the friendship which existed
between Alphanus, Archbishop of Salerno, and Desiderius, while they
were both members of the Benedictine Community of Monte Cassino.
Alphanus subsequently taught medicine at Salerno, and some of his
writings on medicine have been preserved for us. He was the author of
a work bearing the title _De Quatuor Elementis Corporis Humani_, a
treatise on the four elements of the human body, which is a compendium
of most of the knowledge of anatomy and physiology of the time, though
it also contains much more than the information with regard to the
merely physical side of man's being. The fact that Alphanus should
have been promoted from the professorship in the medical faculty to
the Archbishopric of Salerno is only another proof of the entire
sympathy which existed between the Church and the professors of
medical science at that time.
During the thirteenth century universities were founded in some twenty
important cities in Europe, and in connection with most of them a
medical school was established. These educational institutions were
the result of the initiative of ecclesiastics; their officials all
belonged to the clerical body, most of their students were considered
as clerics--and indeed this was the one way to secure them against the
calls for military service which would otherwise have disturbed the
enthusiasm for study--and the Popes were considered the supreme {229}
authority over all the universities. In spite of this thoroughly
ecclesiastical character of the universities and educational
institutions, there is not a hint of interference with the teaching of
medical science and abundant evidence of its encouragement. Indeed,
for anyone who knows the story of the universities of the thirteenth
century, it is practically impossible to understand how there could
have arisen any tradition of ecclesiastical opposition to education in
any form, and there is not a trace of foundation for the stories with
regard to ecclesiastical intolerance of science, which are supposed to
be supported by certain Papal decrees.
The best possible demonstration of the maintenance of the most
amicable relations between churchmen and physicians during the century
in which these decrees were issued is also the most interesting fact
in the history of medicine during the thirteenth century. It is not
generally known that one of the most distinguished physicians of the
thirteenth century, one who wrote a book on the special subject of eye
diseases that is still a classic, afterwards became Pope under the
name of John. He is variously known as John XIX., John XX., or John
XXI., according as certain occupants of the Papal throne are
considered to be of authority or not. He was educated at Paris, and
probably spent some time at Montpelier. Under the name of Peter of
Spain, though he was what we should now call a Portuguese, he
subsequently taught physic at the University of Sienna. Here he wrote
the famous little work on the Diseases of the Eye, which was reviewed
by Dr. Petella, physician-in-chief of the Royal Italian Marine, in
Janus, the International Archives for the History of Medicine and for
Medical Geography in 1898. Petella does not {230} hesitate to proclaim
him one of the greatest men of his time. Daunou, one of the
continuators of the Benedictines' literary history of France,
[Footnote 28] says that this Peter of Spain was one of the most
notable persons in Europe in his generation.
[Footnote 28: Histoire Litteraire de la France, Vol. XVI. This is the
famous work begun by the Benedictines of St. Maur.]
Pope John XXI., before his accession to the Papacy, had certainly
accomplished remarkable work in medicine, and of a kind that makes his
writings of great interest even at the present day. There is scarcely
an important pathological condition of the eye which does not receive
some consideration in this little book, and it is a constant source of
surprise in reading it to find, with their limited knowledge and lack
of instruments, what good diagnosticians the ophthalmologists of the
thirteenth century were. Cataract is described, for instance, under
the name of "water that descends into the eye," and a distinction is
made between cataract from internal and external causes. Hardening of
the eye is mentioned and is declared to be very serious in its
effects. There seems no doubt that this was glaucoma. Conditions of
the lids, particularly, were differentiated and treated by rational
measures, some of them quite modern in substance. A curious
anticipation of modern therapeutics is the frequent recommendation of
extracts of the livers of various fishes for external and internal
use, that is a reminder of the present employment of cod-liver oil.
The book is acknowledged to be a classic in medicine. The fact that
its author should have become Pope later, is the best proof that
instead of opposition there was the greatest sympathy between medicine
and ecclesiasticism in his time.
{231}
With these thoroughly amicable relations between the Church and the
medical schools during the thirteenth and preceeding centuries, it
will not be so much of a surprise as it might otherwise be, to learn
of the foundation of the Medical School of Rome and of the
continuation of Papal patronage of it even while the Popes were absent
at Avignon. University records do not say much about it during the
next two centuries. With the coming of the Renaissance, however, and
the entrance of a new spirit into education, the Popes also were
touched by the educational time-spirit, and there came a rejuvenation
of the University of the City, which now acquired a new name, that of
the Sapienza, and became the home of some of the most distinguished
teaching in Europe in every department. Early in the sixteenth century
the medical department of the Sapienza, or Papal University at Rome,
became one of the most noteworthy institutions of Europe because of
the work in medicine accomplished there, and had among its faculty the
most distinguished investigators in medical science, and especially in
that department of medicine--anatomy--which by an unfortunate
tradition the Popes are said to have hampered.
The most important event in the history of the institution, after its
foundation, was its establishment in the home which it was to occupy
down to our own time. Its new habitation was prepared for it by the
Pope who has probably been the most maligned in history--Alexander VI.
A magnificent site was appropriated for it, and the construction of
suitable buildings begun. A little more than a decade later, Leo X.,
another one of the misunderstood Popes, came to the conclusion that
the two universities in Rome, that of the Papal Court and that of
{232} the City, would do better work if combined into one, and
accordingly this combination was effected. This made provision for one
very strong teaching faculty in Rome. The final steps for the
completion of the union of the two universities were taken by Pope
Alexander VII., and the buildings which the new university was to
occupy were finished in a manner worthy of the great institution of
learning which it was hoped to create in Rome.
The first of the great professors who made the Papal Medical School
famous was Realdo Colombo, often spoken of as Columbus simply, who was
invited to teach in Rome by Pope Paul III., the same Pope who issued
the bull founding the Jesuits. Some people might consider the two
actions as representing contrary tendencies in education, but they are
not such as know either the history of the Jesuits, or of the constant
endeavor of the Popes to foster education. Columbus came to Rome, as
we have said, with the prestige of having succeeded Vesalius at Padua,
and later having been specially tempted by the reigning prince in
Pisa, who wanted to create a great medical school in connection with
his university in that city, which he was at that moment trying to
raise to distinction, to accept the professorship of anatomy there.
Vesalius was still alive at this time, and the period when, if we
would credit certain historians who emphasize the opposition between
the Church and science, it was dangerous to dissect human bodies had
not yet passed. It is interesting to read the account of Columbus's
reception in Rome, and the interest manifested in his work by all
classes in the Roman University at this time. His course in anatomy
was so enthusiastically {233} attended that, as he himself tells in a
letter to a friend, he often had several hundred persons in his
audience when he gave his anatomical demonstrations on the cadaver.
These were not all medical students, but many of them were
ecclesiastics, and some of them important members of the hierarchy.
Even cardinals manifested their interest in anatomy, and occasionally
attended the public dissections--public, that is, as far as the
University is concerned--which were made by Columbus.
Columbus's enthusiasm for anatomy was such that, as Dr. Fisher said of
him in the Annals of Anatomy and Surgery, Brooklyn, 1878-1880, "he
dissected an extraordinary number of human bodies, and so devoted
himself to the solution of problems in anatomy and physiology that he
has been most aptly styled the Claude Bernard of the sixteenth
century." In one year, for instance, he is said to have dissected no
less than fourteen bodies, demonstrating, as Dr. Fisher has said, that
"it was an age of remarkable tolerance for scientific investigation."
Besides being an investigator, Columbus was a great teacher, and many
of our modern methods of instruction in medical schools had their
origin in the system of demonstrations introduced by him. His
descriptions of the demonstrations for students upon living animals,
show that some of the most recent ideas in medical teaching were
anticipated by this Roman professor of anatomy and medicine in the
Renaissance period. His demonstrations of the heart and blood-vessels
and of the actions of the lungs are particularly complete, and must
have given his students a very practical working knowledge of these
important physiological functions. In a word, the medical teaching of
the Roman {234} University, under him at this time, far from being
merely theoretic and distant from actual experience and demonstration,
was thoroughly modern in its methods.
It is no wonder, then, that practically all the ecclesiastical
visitors who came in such numbers to Rome, made it a custom at this
time to attend one or more of Columbus's anatomical lectures. They
were looked upon as one of the features of the Roman university life
of the time. How much good was accomplished by this can scarcely be
estimated. The example must have had great influence especially on
members of faculties of various educational institutions who came to
the Papal See. To some degree at least these interesting teaching
methods must have aroused in such men the desire to see them emulated
in their own teaching institutions, and therefore must have done much
to advance medical education. The fact that these things were done in
the Papal Medical School only emphasized the significance of them for
ecclesiastics, and made them more ready to bring about their imitation
in other teaching centers.
How well the Popes were justified in their estimation of Columbus's
genius as an anatomical investigator will be best appreciated from his
discovery of the pulmonary circulation, which formed, as Harvey
confesses at the beginning of his work on the circulation, the
foundation on which Harvey's great discovery naturally arose. It is
probable that Columbus would not have come to Rome, in spite of the
flattering offers held out to him, only that he was already the
personal friend of a number of high ecclesiastics, and even of the
Pope who extended the invitation. How well the Popes continued to
think of Columbus after his years of work in the {235} Roman Medical
School will be well understood from the fact that, when his great work
_De Re Anatomica_ was published after his death by his sons, Pope Pius
IV. accepted the dedication of it. This was of course not an unusual
thing, for many books on other sciences were dedicated to the Popes,
and the example thus set was subsequently imitated. Twenty-five years
later, Professor Piccolomini dedicated his Anatomical Lectures to Pope
Sixtus V. Subsequent anatomical publications of the Papal Medical
School were issued under like patronage. The famous edition of
Eustachius's anatomical sketches, published under the editorship of
Lancisi, is a notable example of this, and went to press mainly at the
expense of Pope Clement XI., who realized how valuable they were
likely to be for the teaching of anatomy.
These two great discoverers in anatomy, Columbus and Eustachius, were
succeeded, as is so often the case in the history of university
faculties, by a man more capable of writing about great discoveries
than of making them himself. This was Piccolomini, who devoted himself
to showing how much the ancients had taught about anatomy, though at
the same time he also made clear the place occupied by modern
anatomical discoveries. While his name is not attached to any great
discovery in the science of anatomy, he is generally acknowledged to
have been one of the great teachers of his time and one who was needed
just then in order to make people realize how the old and the new in
anatomy must be coordinated. Piccolomini's successor in the chair of
anatomy at Rome was another original genius and investigator whose
name, however, and fame has never been as great among English-speaking
people as in Italy, or among the Latin races generally. The fact that
he was a rival {236} of Harvey's in the matter of the discovery of the
circulation of the blood has always made the Italians exaggerate his
position in medical history, while it has undoubtedly made English
writers of medical history diminish the importance of his work.
Historians of science consider him worthy to be called the greatest
living scientist of his time--the end of the sixteenth century. He was
not only a scientific physician, but he was an authority in all the
sciences related to medicine, and indeed had profound interests in
every branch of physical science. His contemporaries looked up to him
as a leader in scientific thought. To anyone who examines the question
of the discovery of the circulation of the blood with freedom from
bias, there can be no doubt but that the honor for this discovery has
been unduly taken away from Caesalpinus in English-speaking countries,
to be conferred solely on Harvey. Not that there is any wish to lessen
the value of Harvey's magnificent original work, nor make little of
his wonderful powers of observation, nor of the marvelous experimental
and logical method by which he followed out his thoughts to their
legitimate conclusion, but that I would insist on giving honor where
honor is due, though most writers in English refuse to give
Caesalpinus's claims a proper share of attention.
The Italians have always declared that Caesalpinus was the real
discoverer of the circulation, and there is no doubt that his career
occurs just at that point in the evolution of the medical sciences,
and especially anatomy and physiology in Italy, where this discovery
would naturally come. Lest it should be thought, however, that my
interest in the Popes and the Papal Medical School has led me to
exaggerate the claims of {237} Caesalpinus as a great naturalist and
medical scientist, I prefer to quote the description of him given by
Professor Michael Foster in his lectures on the History of Physiology,
delivered in this country as the Lane Lectures, at the Cooper Medical
College in San Francisco, and published by the Cambridge University
Press, 1901. Professor Foster was not one to exaggerate the claims of
any Italian, and least of all of any Italian who might be supposed to
have a claim that would stand against Harvey's. The soupcon of
Chauvinism in his treatment of Servetus and Columbus in this regard is
indeed rather amusing. He said:--
"Of a very different stamp to Columbus was Andreas Caesalpinus. Born
at Arezzo in 1519, he was for many years Professor of Medicine at
Pisa, namely, from 1567 to 1592, when he passed to Rome, where he
became Professor at the Sapienza University and Physician to Pope
Clement VIII., and where at a ripe old age he died in 1603.
"If Columbus lacked general culture, Caesalpinus was drowned in it.
Learned in all the learning of the ancients and an enthusiastic
Aristotelian, he also early laid hold of all the new learning of the
time. Naturalist as well as physician, he taught at Pisa botany as
well as medicine, being from 1555 to 1575 Professor of Botany, with
charge of the Botanic garden founded there in 1543, the first of its
kind--one remaining until the present day."
Professor Foster admits that Caesalpinus had a wonderful power of
synthetising knowledge already in hand and anticipating conclusions in
science that were to be confirmed subsequently. In his Medical
Questions, though the work is written in rambling, discursive vein, he
enunciated views which, however he arrived at them, certainly
foreshadowed or even anticipated those which {238} were later to be
established on a sound basis. Foster quotes a passage in which
Caesalpinus made it very clear that he thoroughly understood the
mechanism of the circulation and grasped every detail essential to it.
After quoting this passage, which it must be confessed is rambling,
Foster thus sums up what Caesalpinus has to say with regard to the
circulation:--
"He thus appears to have grasped the important truth, hidden, it
would seem, from all before him, that the heart, at its systole,
discharges its contents into the aorta (and pulmonary artery), and
at its diastole receives blood from the vena cava (and pulmonary
vein)."
"Again, in his Medical Questions he seems to have grasped the facts
of the flow from the arteries to the veins, and of the flow along
the veins to the heart."