loyal subjects, we keep ever under our observation the health of the
individual. In consideration of the serious damage and the
irreparable suffering which may occur as a consequence of the
inexperience of physicians, we decree that in future no one who
claims the title of physician shall exercise the art of healing or
dare {420} to treat the ailing, except such as have beforehand, in
our University of Salerno, passed a public examination under a
regular teacher of medicine, and been given a certificate not only
by the professor of medicine, but also by one of our civil
officials, which declares his trustworthiness and sufficient
knowledge. This document must be presented to us, or in our absence
from the kingdom to the person who remains behind in our stead, and
must be followed by the obtaining of a license to practice medicine
either from us or from our representative aforesaid. Violation of
this law is to be punished by confiscation of goods and a year in
prison for all those who in future dare to practice medicine without
such permission from our authority.
"Since students cannot be expected to learn medical science unless
they have previously been grounded in logic, we further decree that
no one be permitted to take up the study of medical science without
beforehand having devoted at least three full years to the study of
logic." (Under logic at this time was included the study of
practically all the subjects that are now taken up in the arts
department of our universities. Huxley, in his address before the
University of Aberdeen on the occasion of his inauguration as Rector
of that University, said that "the scholars [of the early days of
the universities] studied Grammar and Rhetoric; Arithmetic and
Geometry; Astronomy, Theology and Music." He added: "Thus their
work, however imperfect and faulty, judged by modern lights, it may
have been, brought them face to face with all the leading aspects of
the many-sided mind of man. For these studies did really contain, at
any rate, in embryo--sometimes, it may be, in caricature--what we
now call Philosophy, Mathematical and Physical Science, and Art. And
I doubt if the curriculum of any modern university shows so clear
and generous a comprehension of what is meant by culture as the old
Trivium and Quadrivium does." Huxley, Science and Education Essays,
page 197. New York, D. Appleton & Co., 1896.--J. J. W.)
"After three years devoted to these studies, he (the student) may,
if he will, proceed to the study of medicine, provided always that
during the prescribed time he devotes himself also to surgery, which
is a part of medicine. After this, and not before, will he be given
the license to practice, provided he has passed an examination in
legal form as well as obtained a certificate from his teacher as to
his {421} studies in the preceding time. After having spent five
years in study, he shall not practice medicine until he has during a
full year devoted himself to medical practise with the advice and
under the direction of an experienced physician. In the medical
schools the professors shall during these five years devote
themselves to the recognized books, both those of Hippocrates as
well as those of Galen, and shall teach not only theoretic, but also
practical medicine.
"We also decree, as a measure intended for the furtherance of Public
Health, that no surgeon shall be allowed to practice, unless he has
a written certificate, which he must present to the professor in the
medical faculty, stating that he has spent at least a year at that
part of medicine which is necessary as a guide to the practice of
surgery, and that, above all, he has learned the anatomy of the
human body at the medical school, and is fully equipped in this
department of medicine, without which neither operations of any kind
can be undertaken with success nor fractures be properly treated.
"In every province of our Kingdom which is under our legal
authority, we decree that two prudent and trustworthy men, whose
names must be sent to our court, shall be appointed and bound by a
formal oath, under whose inspection electuaries and syrups and other
medicines be prepared according to law and only be sold after such
inspection. In Salerno in particular, we decree that this
inspectorship shall be limited to those who have taken their degrees
as Masters in Physic.
"We also decree by the present law, that no one in the Kingdom,
except in Salerno or in Naples (in which were the two universities
of the Kingdom), shall undertake to give lectures on medicine or
surgery, or presume to assume the name of teacher, unless he shall
have been very thoroughly examined in the presence of a Government
official and of a professor in the art of medicine.
"Every physician given a license to practice must take an oath that
he shall faithfully fulfil all the requirements of the law, and in
addition, whenever it comes to his knowledge that any apothecary has
for sale drugs that are of less than normal strength, he shall
report him to the court, and besides he shall give his advice to the
poor without asking for any compensation. A physician shall visit
his patient at least twice a day, and at the wish of his patient
once also at night, and shall charge him, in case the visit does not
{422} require him to go out of the village or beyond the walls of
the city, not more than one-half tarrene in gold for each day's
service." (A tarrene in gold was equal to about thirty cents of our
money. Money had at least twenty times the purchasing power at that
time that it has now. At the end of the thirteenth century,
according to an Act of the English Parliament, a workman received 4d
[eight cents] a day for his labor, and according to the same Act of
Parliament the following prices were charged for commodities: A pair
of shoes cost eight cents, that is, a day's wages. A fat goose cost
seven cents, less than a day's wages. A fat sheep unshorn cost
thirty-five cents; shorn, about twenty-five cents. For four days pay
a man could get enough meat for himself and family to live on for a
week, besides material out of which his wife could make excellent
garments for the family. A fat hog cost twice as much as a fat
sheep, and a bullock about six times as much.--J. J. W.) "From a
patient whom he visits outside of the village or the wall of the
town, the physician has a right to demand for a day's service not
more than three tarrenes, to which maybe added, however, his
expenses, provided that he does not demand more than four tarrenes
altogether.
"He (the regularly licensed physician) must not enter into any
business relations with the apothecary, nor must he take any of them
under his protection nor incur any money obligations in their
regard." (Apparently many different ways of getting round this
regulation had already been invented, and the idea of these
expressions seemed to be to make it very clear in the law that any
such business relationship, no matter what the excuse or method of
it, is forbidden.--J. J. W.) "Nor must any licensed physician keep
an apothecary's shop himself. Apothecaries must conduct their
business with a certificate from a physician, according to the
regulations and upon their own credit and responsibility, and they
shall not be permitted to sell their products without having taken
an oath that all their drugs have been prepared in the prescribed
form, without any fraud. The apothecary may derive the following
profits from his sales: Such extracts and simples as he need not
keep in stock for more than a year before they may be employed may
be charged for at the rate of three tarrenes an ounce." (90 cents an
ounce seems very dear, but this is the maximum.) "Other medicines,
however, which in consequence of the special conditions required for
their preparation or for any other reason the apothecary has to have
in {423} stock for more than a year, he may charge for at the rate
of six tarrenes an ounce. Stations for the preparation of medicines
may not be located anywhere, but only in certain communities in the
Kingdom, as we prescribe below.
"We decree also that the growers of plants meant for medical purpose
shall be bound by a solemn oath that they shall prepare medicines
conscientiously, according to the rules of their art, and as far as
it is humanely possible that they shall prepare them in the presence
of the inspectors. Violations of this law shall be punished by the
confiscation of their movable goods. If the inspectors, however, to
whose fidelity to duty the keeping of these regulations is
committed, should allow any fraud in the matters that are entrusted
to them, they shall be condemned to punishment by death."
{424}
APPENDIX IV.
CHURCH DECREES RELATING TO MEDICINE.
Besides the Papal documents referred to in the body of this book and
quoted in the original in the Appendix to the first edition
immediately preceding this, there is a series of decrees of Councils
and Synods of the Church which are sometimes referred to as
representing a distinct policy of opposition on the part of the Church
to science and particularly medical and surgical practice, as if their
purpose had been to force people to have recourse to prayers and
relics and pilgrimages and masses rather than to take advantage of
medical knowledge and surgical experience for the relief of their
ills. The Papal documents quoted and discussed in the previous edition
of this book proved to have no such meaning as was attributed to them
and the history of the medical sciences as traced, shows that these
Church regulations were not misconstrued either in their own or
subsequent generations in such a way as to have the effect of
interfering with the development of medical science or medical
education as has been claimed. Their citation in support of the thesis
of Church opposition to science, theoretic or applied, is entirely
without justification.
Exactly this same thing is true with regard to the other documents
that are referred to as having a parallel and confirmatory
significance of Church opposition to medical science, or medical or
surgical practice, or medical teaching. It requires no lengthy
explanation to see that the decrees referred to are simply
ecclesiastical disciplinary regulations, aimed at putting an end to
certain abuses that had arisen in religious matters, and well
calculated to prevent their further occurrence. The Church authorities
recognized as will anyone who understands the circumstances that men
who had devoted their lives in religious orders exclusively to the
work of religion, should not be permitted to neglect their religious
vocations because of devotion to some secular profession. They were
forbidden to practice and to study medicine, but the practice of law
was forbidden to them quite as well and for the same reason. There was
no question of limiting the number of persons who might take up
medical study, but all those who had bound themselves for life to
religious duties must not withdraw from these to take up secular
occupations. The case against the Church as opposed to science, and
above all medicine and surgery, must indeed be weak {425} when it has
to be bolstered up by recondite references to documents such as these,
the purport of which is so clear and the good sense of which is as
evident now as it was when they were issued.
Everyone recognizes that absorbing professional occupations such as
the practice of medicine or of law keeps men from devoting themselves
to the intellectual or the spiritual life. The opposite is also felt
to be the case and there is still a profound distrust of the lawyer or
the physician who devotes himself to literature or to any intellectual
avocation, for the feeling is that he cannot be practically successful
at his profession. This feeling is often a mere prejudice and great
lawyers and great physicians have often been litterateurs of
distinction, but as a rule there is incompatibility between the two
modes of occupation. In the medieval period it was felt that there was
the same incompatibility between proper devotion to the spiritual life
and the professions, and as members of religious orders had given up
worldly affairs and interests in order to devote themselves to
other-worldliness and had taken vows of poverty, chastity and
obedience for that purpose, it was sincerely felt that they should not
engage in gainful occupations and professional work that distracted
them from the religious profession which they had taken up. Hence
these decrees.
The only way to make perfectly clear the meaning of these decrees in
their proper place in history both as regards education in general and
medical education, is to give the text of the documents in the
accompanying translation. I owe the text of them to Father Corbett of
the Seminary of St. Charles Borromeo at Overbrook, Pa., who supplied
me with the similar documents for the first edition of this work. The
translations are made from the recognized authoritative edition of the
decrees of the Church councils and synods issued at Paris in 1671, the
title page of which reads as follows: "Sacrosancta concilia ad regiam
editionem exacta quae nunc quarta parte prodit auctior studio Philip.
Labaei et Gab. Cossartii, Soc. Jesu Prebyterorum, Tomus Decimus,
1053--1197, Lutetiae Parisiorum 1671." [Footnote 49]
[Footnote 49: I feel that I should say that when there was question of
publishing these documents I consulted Dr. Garrison, the Assistant
Librarian of the Surgeon General's Library at Washington and the
author of the best history or medicine in English, as to the Church
decrees that ought to be published in their entirety in order to make
their meaning perfectly clear. I have followed the list suggested by
him.]
_The Council of Rheims held under Pope Innocent II, A.D. 1131,_ Canon
VI, forbidding monks or regular canons to study law or medicine for
the sake of gain.
{426}
"An evil custom as we consider it and detestable has grown up by
which monks and regular canons after having received the habit and
made their profession, spurning the rule of their blessed masters
Benedict and Augustine, learn secular law and medicine for the sake
of temporal gain. Inflamed by the fire of avarice they make
themselves the patrons of causes [that is the attorneys of legal
proceedings] and when they ought to be devoting themselves to
psalmody and hymns, confiding in the support of a fine voice and the
variety of their pleas, they confound justice and injustice, right
and wrong. Imperial constitutions attest that it is absurd, nay even
an opprobrium, for members of the clerical order to wish to be
skilled in forensic disputation. We decree that violators of the
religious life of this kind should fall under the severe judgment of
the apostolical authority, for as they have neglected the cure of
souls and in no way attend to the purpose of their order, promising
health for filthy lucre, they make themselves guardians of human
bodies. And since an impure eye is the index of an impure heart and
since religion ought not to deal with those things even to talk
about which brings the blush of shame to the cheek of honesty, in
order therefore that the monastic and canonical order should be
preserved inviolably pleasing to God in its holy purpose, we
interdict by the apostolical authority that any such proceeding
should be allowed hereafter. Bishops therefore and abbots and priors
who consent to such an enormity shall be deprived of their own
dignities."
_The Council of Tours held under Pope Alexander III, A.D. 1163,_ Canon
VIII. That religious should avoid secular studies.
"Not only does the envy of the old enemy of mankind bring him to
labor greatly to destroy the infirm members of the Church, but he
also puts his hand to securing the desirable members of the Church
and strives even to supplant the elect according to the saying of
the Scriptures 'for the elect are his food.' He plumes himself if he
can bring about the fall of many, but especially if he can bring
down some more distinguished member of the Church by making him
lukewarm. Hence it is that he knows how to transfigure himself after
his usual fashion into an angel of light, so that under the pretext
of caring for the health of ailing brethren and more faithfully
carrying out ecclesiastical business he leads members of the regular
religious orders to the study of law and of physical problems which
have to be given attention outside of the cloister. For this reason,
so that spiritual men under the pretext of science may not again
become involved in mundane affairs and themselves lose their
interior life while they are thinking to provide for others in the
exterior, we have decreed by the assent of the present council in
the endeavor to meet this evil, that no one at all after taking the
vows of religion or the making of religious profession should be
allowed to absent himself from the cloister for the study of
medicine and physic. If however he has already absented himself and
shall not have returned to his cloister within the space of two
months he is to be avoided by all as excommunicate, and if he should
presume to try the effect of patronage in no case should {427} he be
heard. On his return to the cloister he must always be the last of
the brothers in the choir and unless by the special indult or
permission of the Holy See must lose hope of all promotion."
_The Council of Paris, A.D. 1212,_ Second Part, Canon XX.
"Since certain of the members of the regular orders under the
pretense of caring for the bodies of ailing brother members and of
more faithfully managing ecclesiastical affairs, to use the words of
the Lateran Council, have not hesitated to go out of their cloisters
to learn mundane law and give themselves to the study of physical
problems in order to give their time to jurisprudence and medicine
and on account of that are lacking in the interior life because they
are devoting themselves to care for external things, we walking
closely in the footsteps of that council decree that unless within
the space of two months such students of law and medicine return to
their cloisters, in spite of the permission of their abbot, which he
is not empowered to give, they are to be excommunicated and avoided
by all; and in no case if they should endeavor to use patronage to
aid them are they to be admitted.
"We prohibit also anyone who enters the cloister for the sake of
religion to go out of it in order to go to school; whatever a student
may wish he should learn in the cloister. Those who are now in the
schools should within two months return to the cloister."
_Decree of the Council of Montpellier held under Pope Alexander
III, 1162._
Since the proceedings of this Council are not extant the records of it
are preserved in two monuments. One an Epistle of Pope Alexander to
the Bishop of Verona and the other the decrees of the Council of
Montpellier held in 1195 which enacted similar legislation.
Cap. 15. "The Council prohibited besides under the full severity of
ecclesiastical discipline any monk or canon regular or other member
of a religious order to take up the study of secular laws or
medicine. Anyone violating this statute must be canonically
published by the diocesan Bishops according to the decree
promulgated in this matter under Pope Alexander in the Council of
Montpellier."
It has been suggested that this exclusion of monks and religious from
the study of medicine by Church ordinance practically shut out all the
clerics, that is, all the educated men of the medieval period, from
the medical profession. Any such idea, however, could only have
occurred to one who does not realize that at any given time there are
only a comparatively few religious and a great many secular clergymen.
Practically all those who could read and write in the Middle Ages were
known as clerks, that is clerics, and were under the protection of the
Church, most of them indeed receiving minor orders, and if all the
clergy were to have been excluded {428} from the medical profession
this contention would be true. So far is it from the truth, however,
that a number of the great physicians and surgeons of the thirteenth
and fourteenth centuries belonged to the clerical orders, not a few of
them were priests and some of the greatest of them, like Theodoric,
were actually bishops. It was only the religious, that is the men who
had specially devoted their lives to monasticism, who were forbidden
to take up the study of medicine because it did not comport with their
monastic vocation.
A second series of ecclesiastical decrees that are often referred to
in the history of medicine are those which concern the relations of
the physician and his patient whenever there is danger of death. The
Church's duty was to secure the proper dispositions on the part of
those who were in danger of death. Physicians sometimes did not let
patients and their friends know how serious the illness was and as a
consequence patients died without the sacraments and rites of the
Church. In order to prevent this the Church regulation was promulgated
that a physician was bound to have a patient take care of his soul at
the same time that his body was being treated. Physicians of the
present day, even when they are not themselves Catholics, know how
much of good, even physical good, is done to patients almost without
exception by the consolations of religion. Instead of being perturbed
as is sometimes thought by those who have not had experience with the
custom, exactly the opposite effect is produced, and patients often
drop their anxieties and solicitudes and begin to improve immediately
after the reception of the sacraments. They usually submit themselves
to whatever Providence has in store for them, put off their worries,
and this factor of itself is eminently therapeutic.
Many a non-Catholic physician obeys these decrees of the Church with
regard to the summoning of a priest to an ailing Catholic patient
without knowing anything about them. He does it because of his
experience that his patients are benefited by the consolations of
religion. The wisdom of the Church in the decrees is seen very well by
the paragraph in which it is suggested that the reason for having the
physician always advise the calling in of a priest is that if this
advice is given only when there is serious danger of death many
patients knowing this will be thrown into a state of depression very
harmful to them when the suggestion is made.
How such decrees could be thought in any way to interfere with
medicine or its practice, or with the physician and his duties, or,
above all, represent any effort on the part of the Church to hamper
medical science or discourage patients from having physicians, I {429}
cannot for the life of me imagine. The idea sometimes suggested that
the real reason for this legislation was that the Church did not want
patients to die before priests were given an opportunity to secure
money for services in the administration of the last rites or for
masses for the recovery of the patient and the like, would only enter
into the mind of someone who not only did not understand the Church
and had no experience of Catholics and Catholic life, but who had no
proper recognition of the place of religion in life as a great source
of consolation and strength in the face of the mystery of death and
the hereafter.
Those who think religion a mere hypocrisy imposed on people by
designing clergy are so lacking in the knowledge that would enable
them to judge of the meaning of such decrees that their opinion is not
worth while considering. It must not be forgotten that these decrees
are still binding on a Catholic physician, and far from resenting them
we welcome them as helps in securing the aid of the consolations of
religion for our patients. Many a worried business man suffering from
some severe disease like pneumonia or typhoid fever, goes on to
develop a much more favorable mental attitude toward himself and his
affection after he has seen the priest. The last paragraph of the
first decree also emphasizes the wisdom of the Church and shows how
much of an aid her legislation was in the support of ethical
standards, for it forbids under the severest penalties that a
physician should ever advise a patient to anything contrary to his
conscience. This paragraph is also still binding on Catholic
physicians.
_The Fourth Lateran Council held under Pope Innocent III, A.D. 1215,_
Canon XII. That the sick should rather provide for the soul than the
body.