gathered from an interesting phase of Papal interest in science which,
though not directly concerned with medicine, eventually resulted in
important theoretic advances in medical science. This was the
encouragement of Father Kircher's work at Rome. Father Kircher was the
Jesuit who made the first scientific museum. As the result of his
general interest in things scientific he wrote a little book on the
pest. In this book he stated in very clear terms the modern doctrine
of the origin of disease from little living things, which he called
corpuscles. Because of this Tyndall attributes to Father Kircher the
first realization of the role that bacteria play in disease. Even more
wonderful than this, however, was Father Kircher's anticipation of
modern ideas with regard to the conveyance of disease. He insisted
that contagious diseases, as a rule, were not carried, as had been
thought, by the air, but {239} were conveyed from one person to
another, either directly, or by the intermediation of some living
thing. He considered that cats and dogs were surely active in
conveying diseases, and he even reached the conclusion that insects
were also important in this matter. His expressions with regard to
this are not of the indefinite character which one often encounters in
the supposed anticipation of important principles in medicine, but are
very precise and definite. Father Kircher is quoted by Dr. Howard
Kelly, of Baltimore, in his life of Major Walter Reed, whose work in
showing that yellow fever is transmitted by mosquitoes is well known,
as saying in one place, "Flies carry the plague," and in another
place, "There can be no doubt that flies feed on the internal
secretions of the diseased dying, then flying away they deposit their
excretions on the food in neighboring dwellings, and persons who eat
it are thus infected." It is interesting to find that the Professor of
the Practice of Medicine in the Papal University at Rome when this
book was published, far from resenting, as many professors of medicine
might, the excursion of an outsider into his science, said Father
Kircher's book "not only contains an excellent resume of all that is
known about the pest or plague, but also many valuable hints and
suggestions on the regional spread of the disease which had never
before been made." He did not hesitate to add that it was marvelous
for a man, not educated as a physician, to have reached such
surprising conclusions, which seemed worthy of general acceptance. All
this, it may be said in passing, was within a few years after the
trial of Galileo. In this next century the Popes continued their
special efforts to secure the greatest teachers of anatomy and
physiology for their Roman medical school. One of the {240} results
was the appointment of Malpighi, whose name has deservedly become
attached to more structures in the human body because of tissues which
he first studied in detail, than any other man in the history of
medicine. Malpighi represents the beginning of most of the comparative
biological sciences, and his original observations upon plants, upon
the lower animals, on fishes and then on the anatomical structure of
man and the higher animals, stamp him as an investigating genius of
the highest order. He was the personal friend of Innocent XI., who
wished to have him near him at Rome as his own medical adviser, and
besides desired the prestige of his fame and the stimulating example
of his investigating spirit for the students of the medical school of
the Sapienza. The closing years of Malpighi's life were rendered
happier, and his wonderful researches were as well rewarded as such
work can be, by the estimation in which he was held at Rome.
Malpighi was succeeded as Papal Physician and Professor in Rome by
Tozzi, who is distinguished in the history of medicine for his
commentaries on the ancients rather than for original observation, but
who was looked upon in his time as one of the most prominent
physicians in Italy. Tozzi had been the Professor of Medicine and
Mathematics at the University of Naples, where he became famous. From
here he received a flattering invitation to the chair of physic at
Padua. In order that he might not desert Naples, his salary was raised
and he was given the post of Protomedicus or Chief Physician to the
Court. It was after this that the death of Malpighi left an important
chair vacant in Rome, and there being no one apparently more worthy
than this man for whom other important universities were contending,
he {241} was offered the chair on such excellent conditions that he
accepted it. It is another case of the Popes being not only willing
and even anxious, but also able because of their position, to secure
the best talent available for their medical school at the Roman
University.
Undoubtedly one of the greatest members of the faculty that the Papal
Medical School ever had is Lancisi, one of the supreme medical
teachers of history, who is usually considered one of the founders of
modern clinical medicine. When at the beginning of the eighteenth
century Boerhaave attracted the attention of the world by his bedside
teaching of medicine at Leyden, there were two occupants of thrones in
Europe who proved to have particular interest in this new departure.
They were perhaps the last two who might ordinarily be expected to
have much use for such improvements in medical education. One of them
was the Empress Maria Theresa, of Austria, whose patronage of
Boerhaave 's pupil, Van Swieten, secured the establishment of that
system of clinical teaching which has since made the Vienna Medical
School famous. The other was the Pope. With his approbation Lancisi
established clinical teaching at Rome, and thus did much to maintain
at Rome a great center of medical progress during the eighteenth
century.
Lancisi was graduated at the Sapienza, the Roman University, at the
early age of eighteen. When only twenty-two he became assistant
physician at the Santo Spirito Hospital and began to show the first
hint of the brilliant genius he was to display later in life.
Some ten years later, as the result of a competitive examination which
still further demonstrated his talents, he was chosen Professor of
Anatomy in his Alma Mater, {242} the Sapienza. He was only
thirty-three at the time, and the fact that he should be chosen shows
that the Papal University was ready to take advantage of talent
wherever it found it and did not allow itself to be won only by
notoriety at a distance. The excellence of the choice was demonstrated
before long by Lancisi's brilliant career as a teacher and an original
investigator. Some of the most distinguished medical men from all over
the world came to listen to his lectures (according to Hirsch's
Biographical Lexicon of the Most Prominent Physicians of All Times and
Peoples), and even Malpighi and Tozzi, the Papal physicians during the
time, were among his auditors. [Footnote 29]
[Footnote 29: Most of these details are taken from Hirsch's
Biographisches Lexicon der hervorragenden Aertzte aller Zeiten und
Voelker. Wien und Leipzig, 1886.]
After the departure of Tozzi from Rome Lancisi became the Papal
physician. He continued to be the medical adviser of Popes Innocent
XI. and XII. and of Clement XI. until his death in 1720. It was under
Clement that he had the new clinic built, in which teaching after the
manner of Boerhaave was to be established. At his death Lancisi left
his fortune and his library to Santo Spirito Hospital, on condition
that a new portion of the hospital should be erected for women. There
is no doubt that he belongs among the most distinguished of
contributors to medical science, and Hirsch declares that anatomy,
practical medicine, and hygiene are indebted to him for notable
achievements. His books are still classics. The one on Sudden Death
worked a revolution in the medical diseases of the brain and heart.
His work _De Motu Cordis et Aneurysmatibus_ has been pronounced
epoch-making, and his suggestion of percussion over the sternum in
order to {243} determine the presence of an aneurysm, made him almost
an anticipator of Auenbrugger and prompted Morgagni's famous book _De
Sedibus et Causis Morborum_, which appeared after his death. Lancisi's
work on Aneurysms was not published until after his death.
Two others of his books deserve mention because they show how broad
were the interests of the man in many phases of progress in medicine.
Their titles are Diseases and Infections of Domestic Animals and The
Climate of Rome.
The next great name in Italian medicine is that of Morgagni. He was
not a regular Papal physician, nor a member of the faculty of the
Papal Medical School, but he was often consulted, as we told in the
chapter on Papal Physicians, both as to the health of the Popes and
the methods of teaching at the Roman Medical School. His life brings
us down almost to the nineteenth century, and the cordial relations of
the Popes to him, far from being an exception in the history of
medicine, are only typical of the attitude of the Roman Pontiffs to
medical and all other scientists from the dawn of the history of
science in modern times.
While the Papal Medical School at Rome, attached to the university of
the city and directly under the control of the Papal Curia, more
especially deserves the name thus given it, it must not be forgotten
that there was in the Papal States a series of medical schools in
various cities. One of these, at Perugia, founded by a bull of Pope
John XXII., has come under consideration in the chapter on A Papal
Patron of Medical Education. Another medical school, that of Ferrara,
which also was in the Papal States, had considerable prestige. Some
distinguished professors taught there before going to {244} Padua or
Bologna. At the beginning of the sixteenth century, Bologna, after
having been during the preceding three centuries under the domination
of one powerful family or another, from the Pepoli to the Bentivogli,
and then to the Visconti and back again to the Bentivogli, was
incorporated in the Papal States under Pope Julius II. At this time
the Medical School of Bologna was at the height of its reputation and
was one of the two greatest medical schools in Italy. Padua was its
only rival. Shortly after this Rome became a serious competitor in
medical education. Practically, then, this was a second Papal medical
school, almost as directly under the control of the Popes as the Roman
Medical School. Far from there being any diminution in the glory or
the efficiency of the Bolognese Medical School, its reputation even
became enhanced after the city came under the control of the Popes.
This is all the more surprising because, as we have shown, just about
this time the Popes began the work of making their Medical School at
Rome the most important center for medical education, especially in
the scientific phases of medicine--anatomy, physiology, and
comparative anatomy--that there was at that time in the world. In
spite of this rivalry, however, nothing was done directly to hurt the
prestige of the school of Bologna, and indeed the rivalry seems to
have been more of an encouraging competition than in any sense a
destructive struggle for existence. When the Popes took possession of
Bologna, Alexander Achillini was professor of anatomy and medicine in
the Bolognese school, and his discoveries and methods of investigation
attracted the attention of students from all over the world. His
assistant for many years and his successor in the {245} post was
Berengar of Carpi, of whom we have already said much in the chapter
Anatomy Down to the Renaissance. For some time Vesalius lectured on
medicine and anatomy at Bologna, and one of Berengar's most
distinguished successors in the sixteenth century was Aranzi, who
occupied the post of anatomical professor for thirty-two years and who
corrected a number of errors in anatomical detail that had been made
by Vesalius and others of the preceding generation. He confirmed
Columbus's discoveries at Rome with regard to the course which the
blood follows in passing from the right to the left side of the heart,
and made many important additions to the knowledge of the anatomical
relations of the cavities of the heart, the valves, and the great
blood vessels. There are a number of important structures in the brain
which owe their names to him, and his descriptions of them are better,
according to Prof. Turner, than those of other anatomists for a
century after his time.
The tradition of great teachers thus carried on during the first
century after the absorption of Bologna into the Papal States,
continued uninterruptedly in the next century, when we find on the
list of professors at Bologna such names as those of Malpighi, the
greatest mind in the medical sciences of the seventeenth century, and
his colleague Fracassati, who, though over-shrouded by Malpighi, still
claims a prominent place in the history of medicine. Bologna has a
special feature of medical development to its credit which, because of
its importance for science in general as well as for medicine,
deserves to be mentioned here. During the century after the Popes
became the rulers of the city scientific societies were founded here,
and as the professors and {246} students of the medical school were
also the most interested in science in general, the membership of
these societies was largely made up of individuals connected with the
medical school. A special society for the cultivation of anatomical
knowledge, the first of its kind ever founded, was established in
Bologna scarcely more than a century after the city came under the
Papal dominion. It was called the Coro Anatomico, or anatomical choir,
and had at first only nine members. Among these, however, were such
distinguished men as Malpighi, Fracassati, Capponi, and Massari, to
the last of whom the initiative of the foundation of the society is
said to have been due. Bologna was noted during the sixteenth and
seventeenth centuries for the number of foreign students of medicine
who were attracted to its hospitable medical school and who carried
the tradition of science for its own sake, so characteristic of this
Papal Medical School, to all parts of the world.
After this consideration of the relation of the Popes to medical
science during many centuries when medicine practically included all
the physical sciences, it may seem utterly inexplicable to any
fair-minded person that the tradition of the opposition of the Popes
to science and scientific educational development should have
apparently become a commonplace in history. This will not be a
surprise, however, to those who know how perversive and influential
has been the Protestant tradition which from the beginning of the
sixteenth century has devoted itself to blackening the reputation of
the Church, the Popes, and Catholic ecclesiastics generally. Nowhere
is this more true than in history as written for English-speaking
people. Those who left the old Church and their immediate descendants,
justified their {247} withdrawal to themselves as well as others, by
taking every possible excuse and inventing every possible pretext, to
show how unworthy of their continued allegiance the old Church had
been. The point of view thus assumed was taken quite seriously by
succeeding generations, until at length a whole body of historical
traditions, utterly unfounded in fact, accumulated, especially in
England, where it must be remembered that for several centuries
Catholics were not in a position to impugn and eradicate it. This
unfortunate state of affairs, and not real opposition on the part of
the Popes to science, is the source of the tradition with regard to
the supposed opposition between the Church and science.
{248}
THE FOUNDATION OF CITY HOSPITALS.
Probably the most important work that the Popes did for medical
science in the Middle Ages was their encouragement of the development
of a hospital system throughout Christianity. The story of this
movement is not only interesting because it represents a coordination
of social effort for the relief of suffering humanity, but also
because it represents the provision of opportunities for the study of
disease and the skilled care of the ailing such as can come in no
other way. Those who are familiar with the history of medicine, and
especially of surgery, know that a great period of progress in these
departments came during the thirteenth century. The next two centuries
indeed represent an epoch of surgical advance such as was probably
never surpassed and only equalled by the last century. This seems much
to say of a medieval century 700 years ago, but our chapter on surgery
will, I think, amply justify the assertion. The reasons for this great
development in surgical knowledge are properly understood only when we
come to realize that there was a corresponding development in hospital
organization. These two features of medicine always go hand in hand.
The hospitals, as might be expected, preceded the surgical
development, and owed their great progress at this time mainly to the
Popes.
The city hospital as we have it at the present time, that is, the
public institution meant for the reception of those suffering from
accidents, from acute diseases of various kinds, and also for
providing shelter for those {249} who have become ill and have no
friends to take care of them, is an establishment dating from the
beginning of the thirteenth century. It will doubtless be a surprise
to most people to be told that the modern world owes this beneficent
institution to the fatherly watchfulness, the kindly foresight, and
the very practical charity of one of the greatest of the Popes, whose
name is usually associated with ambitious schemes for making the
Papacy a great political power in Europe, rather than as the prime
mover in what was probably the most far-reaching good work of supreme
social significance that was ever accomplished.
At the beginning of the thirteenth century, mainly as the result of
those much abused sources of many benefits to mankind in the Middle
Ages, the Crusades, the people of Europe had begun to dwell together
in towns much more than before. It is closeness of population that
gives rise to the social needs. While people were scattered throughout
the country diseases were not so prevalent, epidemics were not likely
to spread, and the charitable spirit of the rural people themselves
was quite sufficient to enable them to care for the few ailing persons
to be found. With the advent of even small city life, however, came
the demand for hospitals in the true sense of the word, and this need
did not long escape the watchful eye of Innocent III. He recognized
the necessity for a city hospital in Rome, and in accordance with his
very practical character and wonderful activity, at once set about its
foundation.
As was to be expected from his wise foresight, he did not do so
without due consideration. He consulted many visitors to Rome and many
distinguished medical authorities as to what they considered to be the
best conducted {250} and most ably managed institution for the care of
the sick in Europe at that time. Almost by common consent he was
assured that the most successful hospital management was to be found
at Montpelier. This French town near the shores of the Mediterranean
had succeeded to the medical prestige formerly held by Salerno, and
was now the favorite place of pilgrimage for the nobility and reigning
sovereigns of Europe, whenever they became so ill that their ordinary
medical attendants seemed to be able to do nothing for them. Pope
Innocent was further told that the institution at Montpelier which was
best conducted was undoubtedly the Hospital of the Fathers of the Holy
Spirit.
Accordingly, the Pope extended an invitation which, under the
circumstances, must have been practically a command, to Guy or Guido
of Montpelier, the administrative head to whom the hospital there owed
its successful organization, to come to Rome and establish a hospital
of his order in the Papal capital. He provided the order with a
sufficient foundation in what is now known as the Borgo, not far from
the present Vatican. On this was erected, at the beginning of the
thirteenth century, a hospital of the Holy Spirit, which still exists
there, though, of course, the building has been many times renewed
since the original foundation. This hospital of the Holy Spirit soon
attained a world-wide reputation for careful nursing and medical
attendance and for the discretion with which its surgical cases were
treated. It was understood that all the ailing picked up on the
streets should be brought to the hospital, and that all the wounded
and injured would be welcomed there. Besides, certain of the
attendants of the hospital went out every day to look for any patients
who might {251} be neglected or be without sufficient care, especially
in the poorer quarters of the city, and these were also transported to
the hospital. This old Santo-Spirito hospital then was exactly the
model of our modern city hospitals.
Pope Innocent's idea, however, was not to establish a hospital at Rome
alone, but his fatherly solicitude went out to every city in
Christendom. In accordance with this pre-determined plan, by personal
persuasion, by the display of an interest in hospital work, and by
official Papal encouragement he succeeded in having, during his own
pontificate, a number of hospitals established in all parts of the
then civilized world on the model of this hospital of the Holy Ghost
at Rome. The initiative thus given proved lasting, and even after the
Pontiff's death hospitals of the Holy Ghost continued to multiply in
various parts of Europe, until scarcely a city of any importance was
without one.
It is no less a person than Virchow, the greatest of modern medical
scientists, who has traced the origins of the modern German city
hospitals back to Innocent and given us a list of those which were
established during the century following his pontificate. Here are the
names of those towns from Virchow's list in which hospitals were
founded during the thirteenth century in Germany alone, which will
show very convincingly how widespread the hospital establishment
movement was: Zurich, St. Gallen, Bern, Basel, Constanz, Villingen,
Pfullendorf, Freiburg, Breisch, Stephansfelden, Oppenheim, Mainz,
Speyer, Coblenz (an der Leer), Cologne, Crefeld, Ulm, Biberach,
Rothenburg, Kirchheim, Mergentheim, Wimpfen, Reutlingen, Memmingen,
Augsburg, Rothenburg a. Tauber, Muenchen, Frankfort a. M., {252}
Hoxter, Dortmund, Brandenburg, Spandau, Salzwedel, Stendal, Berlin,
Perleberg, Pritzwalk, Halberstadt, Halle, Quedlinburg, Helmstedt,
Magdeburg, Sangerhauson, Eisenach, Naumburg, Hanover, Gottingen,
Northeim, Bremen, Hamburg, Luebeck, Parchim, Wismar, Rostock, Schwerin,
Mollen, Oldeslo, Ratzelburg, Ribnitz, Stettin, Stralsund, Greifswald,
Demmin, Anclam, Breslau, Bunzlau, Gorlitz, Brieg, Glatz, Sagan,
Steinau, Glogau, Inowraclaw, Wien, Meran, Brixen, Sterzing, Elbing,
Thorn, Koenigsberg, Danzig, Marienburg, Riga.
Many of these towns were comparatively small. In fact, there were no
cities that we moderns would call large in the thirteenth century.
London had probably not more than some twenty thousand; Paris, even at
the most flourishing period of the university, under fifty thousand.
Most of the German towns had less than ten thousand, and of these
which are the sites of hospital foundations mentioned by Virchow,
probably not more than a dozen, if that many, had more than five
thousand inhabitants. Since the movement spread even to such small
towns, it can be readily understood how far-reaching in its effects
was the policy initiated by Innocent III. and how thoroughly he laid
the secure foundations of a great Christian hospital system.
[Illustration: Holy Ghost Hospital (Luebeck)]
Since the Papal example and recommendations produced so much effect
upon Germany, which was not so closely united to the Holy See as were
the Latin nations, it is easy to understand what an impetus to the
hospital movement must have been given in the southern countries, even
though we have not had the advantage of so patient a collector of
information as Virchow to give us all the details. In the larger
cities hospitals were already in existence, and these took on a new
life because of the {253} hospital movement. In Paris, for instance,
the Hotel Dieu, which had been in existence for some time, became so
cramped for room in its original location, just beyond the Petit Pont,
that at this time it had to be transferred to its present commodious
quarters next to the Cathedral, on the square of Notre Dame. The
hospital became a city hospital in the genuine sense of the word, and
the citizens became interested in it to a noteworthy degree. It began
to be the subject of bequests and benefactions of all kinds on the
part of the clergy and laity, and many interesting details of these
benefactions are still at hand in documents contained in the hospital
archives of Paris. [Footnote 30]
[Footnote 30: Bordier, Archives Hospitalieres De Paris, Paris;
Champion, Publications for the Society of the History of Paris, 1877.]
There are some curious historical details in these old documents,
since they serve to show the method in use for designating houses at
that time when, it must be recalled, street numbers had not as yet
been invented. Most of the houses had on their facades some image or
figure by which they were known. The Hotel Dieu, for instance,
acquired during the thirteenth century the houses with the image of
St. Louis, with the sign of the golden lion of Flanders, with the
image of the butterfly with that of the wolf, with the images of the
three monkeys, with the image of the iron lion, with the cross of
gold, with the three chimneys, etc. A certain amount for the support
of the hospital was allowed out of the city revenues, and a favorite
method was to permit, in times of special stress upon the hospital,
the collection of a tax on all of a certain commodity that came into
the city. For a time, for instance, during an epidemic or other period
of necessity, a hospital would obtain {254} permission to collect a
tax on all the salt, or, occasionally, on all the wheat that entered
Paris. This serves to show the renewed interest in city hospital
affairs that had arisen mainly as the result of Papal initiative and
encouragement.