_Age of Renovation (continued).--Erudite Period (continued): Benivieni,
11502. Jean Fern el, 1497-1553. Porta, 1536-1615. Severino, 1580-1656.
Incorporation of Brotherhood of St. Come into the University of Paris,
1515. Ambroise Paré, 1510-1590. Guillemeau, 1550-1613. Influence of the
Occult Sciences: Agrippa, 1486-1535. Jerome Cardan, f 1501. Paracelsus,
14931541. Botal, born 1530. Joubert, 1529-1583._
In the{114} domain of pathology the Arabs had added only a very small
number of observations to those contained in the works of Galen. The
most interesting of these pertain to eruptive fevers. Most of
their writers contented themselves with making an inventory of the
acquisitions of the past, as did Guy de Chauliac, and this was about all
they could do under existing circumstances; although they did not make
discoveries, they prepared the way for their successors.
Two men about this time did a great deal in the direction of creating
a desire for post-mortem study of cases, and in illustrating and
succinctly describing symptoms.
The first of these was Benivieni, a Florentine, who died in 1502--the
date of his birth being uncertain. To him, more than to any other, we
owe the commencement of the study of gross pathology and pathological
anatomy. He was the first to consider the knowledge that might be
obtained by opening bodies for the sole purpose of ascertaining
the location and cause of the diseases from which they had died. As
Malgaigne remarks: "A eulogy which he merits, and which he shared with
no other person, and which has not been accorded to him up to this time
by the many historians of surgery who have superficially searched among
these precious sources, is that he was the first who had the habit,
felt the need, and set the useful example, which he transmitted to his
successors, of searching in the cadaver, according to the title of his
book, for the concealed causes of disease." The work referred to by
Malgaigne was{115} entitled: _Concerning Some of the Secret and Strange
Causes of Disease_ and was published in Florence in 1507. It is poor in
quotations, but rich in original observations, which pertain especially
to the etiology of disease, and gives a very concise symptomatology and
history of each affection of which it treats, as well as a pathological
explanation. Benivieni's observations on gall-stone, on the anatomical
lesions of heart diseases, and on the conveyance of syphilis from
the mother to the foetus were original, as well as many observations
concerning the presence of worms and other parasites in the body.
He did not limit himself to dissection of his own cases, but sought
autopsies in the cases of others. He examined the bodies of those who
had been hung, always thinking to find in them something of interest.
In this regard he was followed by one already mentioned,--namely,
Eustachius.
After these two the men who most cultivated pathology and anatomy in the
sixteenth century were Rembert Dodoens and Marcellus Donatus. The former
was born in 1517, in Mecheln, traveled extensively, was physician to
Maximilian II and the Emperor Rudolph, and died in 1585. The latter
lived and worked in the latter half of the sixteenth century, the dates
of his birth and death being somewhat uncertain.
The next man whom we must mention is one who did a great deal for
internal medicine, pathology, and anatomy. Jean Fernel, who has been
surnamed "the modern Galen," was born in Clermont in 1497. Even as a boy
he showed great aptitude, and very early made himself a reputation in
philosophy, law, and mathematics. In 1530 he was received as doctor,
with the unanimous applause of the entire faculty of Paris. He seems to
have been stimulated by this only to more extended study; in fact,
so hard did he work at his studies that his friends became seriously
alarmed for his health, and remonstrated with him; they received
for reply: "_Destiny reserves{116} for us repose enough_." He became
physician to King Henry II, of France, and in the midst of a very
extensive practice undertook to collect all the medical knowledge
scattered in the Greek, Arabic, and Latin works, in order to form from
it a body of doctrines. His work was written with a purity and elegance
of Latin that reminds one of Cicero. Throughout its pages he was
philosophic, and sought to unite the apparently irreconcilable doctrines
of Plato and Aristotle.
[Illustration: 0137]
He divided medical science into three great sections,--physiology,
pathology, and therapeutics. In his explanations of disease he was too
often fanciful, following the speculations mainly of Galen, and making
free use of the hypotheses of humors, temperaments, vital spirits,
etc.; but the following statement of his would do credit to a trained
pathologist of to-day: "As for myself, I shall never believe I have
profound knowledge of any affection if I do not know positively, just
as if I could see it with my eyes, in what part of the human body is
the disease, its primitive seat, what suspicion of organic lesions
constitute it, whence it proceeded, if it exists idiopathically or by
sympathy, or if it be kept up by some exterior cause. He who pretends to
be a rational physician must sound each of these subjects, and discern
them by certain signs." The problem which he thus set himself he
certainly, for his own part, considered as solved, although it was not
long before his solutions were set aside and the original uncertainty
reappeared.
In therapeutics he very early laid down the fundamental maxim that every
disease must be combated by contrary remedies, justifying this by every
species of argument, amounting to this: that every disease must be
combated by its contrary because all that cures a disease is contrary
to it. This was, in part, the doctrine of "_Contraria contrariis
curantur_"--the antithesis of the equally absurd sophism: "_Similia
similibus curantur_" which three hundred years later was erected into an
excuse for the foundation of an{118} alleged new school. There can be
no doubt that Fernel rendered very great service to his time and to
subsequent generations, despite the fact that his recommendations and
statements were too often founded upon sophistry.
Just here we must digress for a moment to consider the status of
bleeding. Hippocrates and Galen had advised to bleed largely from the
arm on the affected side in pleurisy and pneumonia. That practice was
gradually abandoned as Greek traditions were lost sight of, and finally
the Arabs substituted for it something entirely different,--namely,
pricking a vein in the foot in order to let blood flow drop by drop.
Their method prevailed throughout Europe until the commencement of
the sixteenth century, or about the time when Fernel appeared upon the
scene. A Parisian physician named Brissot had revived the ancient (the
Greek) practice during an epidemic of pleurisy, and had obtained thereby
astonishing success, which he hastened to publish, commending the method
employed. He thus created a great uproar in the medical world. The
innovation found foes and defenders, and disputes grew warm, even to
the fever point. Finally, the ancient method was generally revived, and
Fernel accepted it.
Felix Plater was born in 1536, in Basel, Switzerland, and died in 1614.
He had several sons who made their mark in medicine. In his large work,
which preceded that of Fernel, he took perhaps the first step in an
unexplored route,--namely, in the classification of disease _according
to the totality of apparent symptoms_. Defective as this classification
appears in our eyes, its author lived a long life as a very
distinguished practitioner and professor in his native town.
Giovanni Batista Porta was born in Naples in 1536, traveled extensively
in Italy, France, and Spain, and founded in 1560 an Academy of the
Segreti. He was accused of magic, and was compelled to refute the
charges in Rome.{119} He died in 1615, having been one of the leading
scientists of his time, and the founder of modern optics. In the first
edition of his _Magia Naturalis_, published in Naples, 1587, is found
the first description of the camera obscura,--of course, in a very
incomplete form and without lenses.
Severino was a celebrated surgeon of Naples. He was born in 1580, in
Calabria, studied in Naples, became a doctor in Salernum, and then
became professor of anatomy in his native town. For a long time the
victim of intrigue and of persecution by the Inquisition, he was finally
driven out of Naples, but was called back by the populace. He then
became the most celebrated teacher of his time, writing extensively on a
variety of subjects. He died in 1656 of the plague, an epidemic of which
was at that time raging in central Italy.
Arriving now at the surgery of this Age, we find that matters were more
chaotic than in other departments of medicine, and for reasons which are
easily given and appreciated. While, ordinarily, external diseases are
more easily discerned than internal, and while in a corresponding degree
they can be more satisfactorily treated; while, in other words, external
pathology has ordinarily taken precedence of internal in professional
as in lay minds, this view seems to have been inverted for a time
during the Middle Ages. Previous to the period now under discussion the
sciences had generally declined in Europe, and surgery had fallen even
lower than medicine, for the reason that medicine was in the hands of
the priests, who had at that time something of a liberal education,
while the practice of surgery was abandoned to a class of ignorant
barbers, bathers, and bone-setters. No mechanic or artisan could take as
an apprentice any youth without a certificate affirming his legitimate
birth, and that he came from a family in which there were neither
barbers, bath-keepers, shepherds, nor butchers. Among the men who were
thus made social outcasts{120} were those into whose hands most of the
surgery of the fifteenth century fell. This was particularly the case
in Germany, and other European countries were little in advance. We have
seen that in France and in Italy Lanfranc and Guy de Chauliac did their
best to rescue surgery from the hands of these men, but their efforts
did not prevent it from being completely abandoned by the clergy, who
devoted themselves to the practice of medicine.
[Illustration: 0141]
When we come to inquire the reason for this--in other words, why an
art so useful as surgery, and one which made such requirements
for knowledge, sagacity, and dexterity, whose necessity was almost
continually felt, particularly during these troublous times of
almost constant warfare, should be so neglected by men who could best
comprehend its utility and respond to its requirements--it is difficult
to find a satisfactory answer. The social condition of the times sheds
some light upon the question. The nations of southern Europe were
socially divided at that time into the nobility, who were nearly always
at war; the clergy, who monopolized learning and filled the so-called
liberal professions; and, finally, the common people, who were common
prey for both the other classes, and who yet had to support both without
having any privileges of their own. While the practice of medicine was
a clerical right, the canon of the church prohibited physicians from
drawing blood, under pain of excommunication; and hence surgery, shunned
by the priests, to whom it naturally belonged in connection with the
practice of medicine, fell into the hands of the ignorant and vulgar,
who practiced it in a purely mechanical way, without knowledge or
appreciation of its possibilities. In addition to this, there was an
almost total lack of detailed and precise anatomical knowledge, and but
small reason to expect that the ignorant practitioners of surgery would
feel the need of such knowledge. Moreover, most of the operators were
itinerants, going from city to city, stopping so long as they had cases
to operate upon or until{122} some reverse forced them to depart. Most
of these men limited themselves to one or two sorts of operations. Some
operated for cataract, others for stone, others for hernia, nearly every
one having a secret method which was transmitted to his posterity as a
heritage.
In the history of medicine certain family names of itinerant operators
have been preserved; for example, the Branca, the Norsini, in Italy, and
the Colot in France.
Under such conditions there could be no such thing as the profession
of the surgeon. The prejudice against dissection did not begin to abate
until the thirteenth century, when a very few of the clergy dared, in
a very timid manner, to perform surgical operations. Their numbers
increased in the course of the fourteenth and fifteenth centuries, and
in the sixteenth had become considerable. Most of the great anatomists
of that period--such as Benivieni, de Carpi, Vesalius, Fallopius, and
Fabricius ab Aquapendente--were great surgeons.
In due time it came about that while the clerical physicians were
willing to descend to the rank of operators, the lay-surgeons aspired
to the rank of doctors of medicine. This transformation took place
especially in France, the only country where at that time there was a
special college of surgeons--the small Brotherhood of St. Come, already
alluded to, which was always contending against the faculty on one hand
and against the barber-surgeons on the other, with varying results, and
which, at last, sought peace with the university and was received by it.
This took place in 1515, and was the renaissance of surgery, not only
for Paris, but for the whole world. By this reunion the faculty acquired
authority over the barbers, who were admitted to their lectures and took
courses in anatomy and surgery, gradually attaining a knowledge which
entitled them to be called barber-surgeons; their rights were not
curtailed, but made more difficult of procurement, for, in addition
to passing their initiation for the privilege of becoming
barbersurgeons,{123} they also had to pass an examination before the
physicians and the two surgeons of the king, at Chatelet, for the right
to practice surgery. The surgeons, as the price of their submission to
the faculty, had, beside the university privilege, a sort of supremacy
over the barbers; and thus it happened that the barbers were admitted to
the rank of surgeons at St. Come, and that the surgeons of St. Come were
admitted as barber-surgeons by the faculty of medicine. In this double
capacity they approached nearer the profession of medicine, from which
they should never have been separated, while surgery became an art which
received numerous improvements. We must now devote a little time to the
consideration of at least two or three of the men who most contributed
to extend and elevate it.
Among those who most contributed to make the period of which we are now
speaking a glorious one, raising himself from the lowest walks of life
to the attainment of the highest professional honors, is Ambroise Paré,
whose name will never die while the art of surgery is taught. Paré was
born about the year 1510, at Laval, of poor parents. He was an early
apprentice to the provincial barber-surgeons, after which a natural
ambition for improvement led him to Paris (about the year 1532), where
he studied three years at the Hôtel-Dieu, and obtained the confidence of
his teachers to such an extent that he sometimes operated for them. He
never learned Latin, the language at that time of the books and of the
schools. Paré was most fond of recalling his hospital experience; he
counted it among the highest honors of his life that he should have
enjoyed what he there did enjoy, and gives us to suppose that he was
a favorite upon whom peculiar favors were conferred. In one of his
writings, a physician of Milan having expressed astonishment at so young
a man's knowledge, he remarks with pride: "But the good man did not
know that I had been house-surgeon for three years at the Hôtel-Dieu de
Paris." The functions of the barber apprentices in the hospital{124} in
those days were probably to make dressings and bleedings, and sometimes
post-mortem examinations ordered by the chiefs, to assist the latter in
their operations, and to act in case of emergency; in other words, to
do about as the _internes_ at present do. They probably found there a
precious and rare opportunity for anatomical dissection, but it does not
appear that they had regular clinical instruction.
[Illustration: 0144]
Communication between master and pupil depended absolutely on the
pleasure of the former.
In 1537 Paré was made surgeon to the Colonel-General of Infantry, René
de Montijean, with whom he made his first campaign in Italy. (This was
in the army which King Francis I assembled in Provence with which to
repulse the invasion of Charles V.) He had never seen war nor recent
gunshot wounds, and only knew of them by what he had read in the
writings of John de Vigo. This was at{125} a time when it was the custom
of surgeons to pour boiling oil into every amputation or other wound
in order to check haemorrhage; and Paré's experience in this, his first
campaign, put him in the way of his first discovery,--a discovery which
will never be forgotten. He has recounted in his _Book of Arquebus
Wounds_ and in his great _Apology_ how after the affair of Pas-de-Suze
he watched the other surgeons, dreaming of nothing else but to imitate
them as far as he could; how the boiling oil gave out; how his anxiety
about it prevented him from sleeping; and how to his great wonder he
found that the wounded who had submitted to the operation suffered more
than the others. This set him to thinking, and led him, a young man
without name or authority, without letters or philosophical studies,
to observe, to reason, and to combat a doctrine which was universally
admitted and which the highest surgical authorities of the day
sustained. At that time all authors who had spoken of gunshot wounds
considered them as poisonous and complicated with burns; consequently
they gave the precept to cauterize with boiling oil or a red-hot iron,
and at the same time to administer certain alexipharmics which should
serve as internal antidotes. John de Vigo, physician to Pope Julius
II, assures us that the danger of these wounds results from the round
formation of the balls, from heat, and from the poisonous qualities
communicated to them by the powder. His theory and the method of
treatment above given had been adopted without contradiction until the
day when Paré dared to utter the first protest against them.
After a campaign of three years, in which he lost his master, he
returned to Paris and married. In 1543 he was in the army of Perpignan,
in the service of de Rohan, grand lord of Brittany, where he gave
continuous proof of his sagacity. It was after this campaign that
his reputation, so well established among warriors and the nobility,
inspired Sylvius with the desire of seeing him. Paré has recounted{126}
how, in a conversation which they had together, he insisted upon the
then entirely new precept, of which he had made many applications, that
in order to extract bullets it was best to place the wounded in the
position in which they were at the moment of injury.
[Illustration: 0146]
Sylvius,{127} then at the height of his fame, invited the young
physician to dinner, and listened to him with great attention while he
explained his views on gunshot wounds, which made such an impression
upon the mind of the host that he besought him eagerly to write them out
and make them public. Encouraged by this advice from so high a source,
Paré prepared his text, illustrated it, and in the year 1545 brought
out his little work, which marked in a manner so glorious the revival of
French surgery. It was published by Gaulterot, the sworn bookseller
of the University of Paris, and was entitled "_The Manner of Treating
Wounds made by Arquebuses and other Fire-arms, and those made by Arrows,
Darts, and the Like; and also by Burns made Especially by Gunpowder_.
Composed by Ambroise Paré, Master Barber-Surgeon in Paris."
A few months later appeared the second edition, in which he still
recommended the actual cautery in haemorrhage; but each day he meditated
upon the subject, and on one occasion discussed it with two surgeons of
St. Come, submitting to them the idea that, since ligatures were applied
to veins and arteries, and to recent wounds, there was nothing to
prevent their being equally applied to amputations. Both agreed with
him, and opportunity soon presented itself at the siege of Damvilliers,
when a gentleman had his leg crushed by a shot from the fortress. Paré
made an amputation, omitting for the first time the use of the cautery,
and had the happiness to save his patient, who, full of joy at having
escaped the red-hot iron, said he had got clear of his leg on very good
terms. This was, in truth, the actual renaissance of surgery, which had
been to that time a torture, but which became thereafter a blessed art.
It was a barber-surgeon who produced the double marvel. This took place
in 1552.
In 1554, after other campaigns, Paré was made, without examination,
Master of the College of St. Come, and in 1559 was included among the
surgeons of King Henry II (who{128} was killed in a tourney, in Paris,
in 1559)r which position he retained with Francis II and Charles IX. The
latter raised him to the highest position among his surgeons, and King
Henry III retained him, which caused the witty and true remark that the
kings of France transferred him to their successors as a legacy of the
crown.
Many anecdotes are related of Paré to show the remarkable esteem in
which he was held by public and private citizens. For instance, in
October, 1552, one of the most eminent generals of Charles V laid seige
to the city of Metz, and the emperor came in person to join the army.
Within the walls of this beleaguered city were gathered nearly all the
nobility and princes of France. The city was defended by the Duke of
Guise, and the besieged soldiers were at that time suffering alike from
the attacks of the enemy, the results of the siege, and the rigors of
a frightful winter. The duke had established two hospitals for the
soldiers, and had put into requisition the barber-surgeons of the
city, giving them money with which to furnish their supplies. But these
surgeons were sadly incompetent against the combination of unfavorable
circumstances, consequently nearly all the wounded perished, and a
horrible suspicion was roused among the soldiers that they had been
poisoned. Under these circumstances the duke dispatched one of his
captains to the king to say that the place could hold out for ten
months, and asked at the same time for fresh medicine. The king sent for
Paré, gave him money, directed him to take all the medicine he thought
necessary, and furnished him a letter to Marshal St. Andre, who
commanded in Verdun, and who bribed an Italian captain for fifteen
hundred crowns to introduce into the besieged city the celebrated
surgeon. The expedition was perilous, and Paré himself would have
willingly remained in Paris. But he entered Metz on the 8th of December,
at midnight, without an accident. Having passed already sixteen years in
war, he was{130} known to the chiefs and common soldiers. The day after
his arrival, the duke, who knew how to strike the imagination, presented
him on the ramparts to all the princes, lords, and captains, who
embraced and received him with clamor. By the soldiers he was received
with shouts of triumph. "We shall not die," they exclaimed; "even though
wounded; Paré is among us!" From this time the defense was conducted
with renewed vigor, and it has been universally conceded that to the
presence of this single man the city was indebted for its salvation. The
siege itself was not raised until after a terrific conflict. On the very
day of Paré's arrival he began to treat the leg of one of the prominent
officers, who for four days had been in charge of a charlatan, and had
suffered horrible tortures. The next day he decided to trephine another,
who had been struck on the head by a fragment of stone, and who had been
insensible for fourteen days. Both patients recovered.
[Illustration: 0149]
The little brotherhood of surgeons of St. Come were ready to seize on
every circumstance which might redound to their advantage, and desired
to have within their ranks the man who enjoyed such great renown. They,
therefore, admitted him to an examination, in spite of the statute which
required that the candidate should understand Latin, and in spite of
opposition by the professors of the university.{132} They not only
admitted him to all their degrees, but awarded him a reception,--a
hitherto unknown honor.
Description of Fig. 17.--A, the instrument named, on account
of its figure, lizard's beak; in Latin, "_rostrum lacerti_."
It is used to extract balls which have been flattened or
imbedded in bone. A displays particularly the cannula. B,
hinge, by means of which the lizard's beak is opened and
closed as much or as little as the surgeon wishes. C, the
rod which opens and closes the lizard's beak. When drawn
upon it closes and when pushed it opens the instrument. D,
dilator and mirror: in Latin, "_dilatatorium,
speculum_." The instrument is somewhat roughened and
dentated in order to take a firm hold of whatever it grasps.
It may serve two purposes: first, to dilate and enlarge the
wound so that it may be seen to the bottom, and also to make
way for some instrument, as pincers or crow's beak, and to
grasp more easily and withdraw the foreign body; secondly,
it may itself serve to extract the foreign body,--e.g., a,
double-headed ball; b, a small chain; c, c, some pieces of
mail. E, E, crane's beak; in Latin, "rostrum gruinum." H2,
H, duck's beak; in Latin, "rostrum arserinum." K, sound. L,
ball-extraetor without cannula. M, cannula with handle.
[Illustration: 0151]
Paré in his time met with a success which to-day would be pronounced
extraordinary. He seemed to inspire the wounded with the utmost
confidence, and to possess greatness and firmness of character in the
highest degree. It is perhaps, even more extraordinary that with so
strong a character he should have so long retained favor at court. In
the midst of the excitement of camps, and a very extended practice,
he found time to read all that had been published on his art, and to
compose himself a great number of works, enriching all branches of
surgery. Instead of keeping secret his inventions, as was the custom of
the time, he made them as public as possible, saying, in the preface of
his large work on surgery: "For my part, I have dispensed liberally to
everybody the gifts that God has conferred upon me, and I am none the
worse for it; just as the light of a candle will not diminish no matter
how many may come to light their torches by it."
Besides his smaller treatises, his large, collective works passed
through a number of editions, and were everywhere reprinted and studied.
Not only was he great in surgery, but he attained a high degree of
expertness in midwifery. Among other things, he restored the forgotten
practice of podalic version in cases where this procedure is necessary.
He died in 1590.
The doctrine of Paré on gunshot wounds was rapidly disseminated. From
1550, Maggi, of Bologna, advocated it without giving credit to its real
author, and sustained it by decisive experiments. He observed that
none of the wounded felt any heat, and that the torn portions of their
clothing showed no trace of fire; and he shot balls through packages of
powder without setting them on fire. At the same time Lange spread this
view in Germany, and Botal, of Turin,{134} took it up (withholding,
however, the true author's name).
[Illustration: 0153]
While Ambroise Paré did not disdain to act as accoucheur, it was his
friend and pupil, Jacob Guillemeau (1550-1613), who, in the sixteenth
century, most occupied himself with the practice of obstetrics. We owe
to Guillemeau the first improvements that the moderns made in this art;
for instance, the proposition to rapidly and artificially terminate
parturition in cases of considerable haemorrhage or when the woman is
taken with convulsions during labor. Guillemeau supported this practice
on the authority of Hippocrates, and operated on a great number of
patients, proving its value and the danger of its neglect.
The Cæsarean operation was known to the ancient Greeks and Romans,
but had been abandoned during the Middle Ages. It' remained for the
accoucheurs and surgeons of the sixteenth century to re-establish it.
Among others, Rousset, physician to the Duke of Savoy, who recommended
it very warmly, reported several cases where it had a happy issue for
both mother and child. He even reported the most remarkable case of
all,--that of a woman who was six times delivered by this operation,
and who perished in the seventh confinement, because, as he states,
the surgeon who had been accustomed to operate on her was absent.
Unfortunately, this case is not authenticated.
[Illustration: 0155]
Nothing shows better how the art of observation and accurate description
of phenomena had progressed at the time of the revival of letters than
the number of new diseases of which the authors of that period make
mention. Then, for the first time did one read of whooping-cough,
miliaria, scurvy, plica polonica, syphilis, and raphania. It is scarcely
credible that these diseases fell upon Europe at this particular time.
It is more probable that they had a more ancient existence and were not
recognized.
Even to-day medical men are divided in their own opinions on the origin
of syphilis, some believing that it was{136} developed spontaneously
in Europe toward the close of the sixteenth century, others that it was
imported from the New World, others that it had a most ancient origin,
and others yet that it represented a degenerated form of leprosy.
Certain it is that syphilis appeared almost simultaneously in all parts
of Europe,--at Bologna, Halle, Brunswick, in Lombardy, Apulia,
Auvergne, and so on. Léonicenus attributed this sudden outbreak to an
extraordinary inundation that occurred in all parts of Italy toward
the close of the fourteenth century, and supported his views with the
authority of Hippocrates and Galen. Others attributed it to astrological
influence; while still others regarded it as a scourge of God with which
to punish men and turn them away from unbridled libertinism, Fallopius
thought venereal disease was engendered by the poison which the
perfidious Neapolitans had thrown into the wells from which the French
drew their water. These wild views simply indicate the spirit of the
age. Oviedo published in 1545 a history of the West Indies, in which he
states that syphilis originated in America. He held that when Columbus
returned from his second expedition to the New World, in 1496, his men
enlisted under Gonsalvo de Cordova to go and fight the French, who had
invaded the Kingdom of Naples, and that they communicated to the French
and Neapolitans the disease which they had brought from San Domingo.
Unhappily for his veracity, it is certain that syphilis broke out in
Naples at least two years before the arrival of the Spanish fleet. It is
equally certain that at none of the points at which Columbus touched
on his return from his first expedition was there any manifestation of
syphilis for years.
At this time the venereal disease, so-called, included those conditions
which we now differentiate under the names of syphilis, chancroid, and
gonorrhoea,--a confusion of diseases{138} which persisted even up to
the time of John Hunter. It is worth while to publish this fact, since
writers of two or three hundred years ago may not have meant by the
term "syphilis" just what we would mean to-day. Without going into this
question here, it is enough to say that one who reads intelligently may
see in the Sacred Scriptures unmistakable allusions to this disease. If
the statements of David, as contained in the Psalms, are reliable, he
was himself a serious sufferer from it. The ancient Greek and Arabian
physicians make mention of lesions which could only be attributed to
this disease; and the Latin satirists, like Horace and Juvenal,
describe symptoms of a certain kind as being the fruit only of shameful
practices.
[Illustration: 0157]
It is most likely that the sudden appearance of syphilis in nearly all
parts of Europe at about the same time, which has been regarded as so
extraordinary, can be explained by the clearer distinctions physicians
began to make between symptoms of this disease and those of leprosy.
Arrangements for the cure of lepers were very complete, and such
syphilitic patients as responded kindly to the treatment thereby
established themselves in a very different category of disease.
The first writer to systematically consider venereal disease was Astruc,
who was born in Languedoc in 1684 and died in 1766. He was the principal
advocate of the view that syphilis had an American origin, in which
view he was bitterly opposed by Sanchez, a Portuguese physician, who
collected a large amount of evidence to the effect that its first
ravages were observed in Italy.
Summing up this whole matter, we may agree with Jourdan, who has
examined all the opinions of these writers, and who, in his treatise
published in 1826, concluded that all symptoms which had been hitherto
connected with syphilis had been known and described from the remotest
antiquity, but were not supposed to proceed{139} from a common source,
and to be attached to the same cause, until after the close of the
fifteenth century.
THE INFLUENCE OF THE OCCULT SCIENCES ON THE MEDICINE OF THIS PERIOD.
Most of the partisans of occult science were restless minds, such as
are found in all ages, who chafed under the yoke of authority, and
who practiced as well as deduced their lines of thought and conduct
in accordance with their own ideas. Some of these men did not lack in
sagacity, imagination, or audacity, but almost all of them lacked in
consistency of idea and dignity of thought. Most of them lived isolated
lives, apart from each other and from the rest of the world, and were,
to a large extent, what we would now regard as "cranks." While they
made a wide departure from accredited doctrine, they depended upon
imagination rather than upon reason. This happened to be a period,
however, when such men achieved great notoriety,--more so than the same
class of individuals have done since their time.
Cornelius Agrippa (born in 1486) was an early promoter of occult
science. He came of a noble family of Cologne, received the best
éducation of his time, was a man of varied attainments, great
inconsistency in conduct, and a caustic humor which everywhere made him
enemies and prevented him from having any settled abode. He wandered
from place to place, sometimes honored with the favor of the nobility
and sometimes plunged into extreme misery. He early became a
secretary in the court of Emperor Maximilian I, and under that monarch
distinguished himself in the army by such bravery as to win him spurs as
a knight. Soon disgusted with the profession of arms, he devoted himself
to law and medicine, but his intemperate pen soon drew him into quarrels
and persecution. At Dole he fell out with the monks; at Paris{140} and
Turin he compromised himself with the theologians; at Metz he incurred
the animosity of the Jacobins for attacking the prevailing opinion that
St. Ann had three husbands. He became a vagabond and almost a beggar
in Germany, England, and Switzerland, and then went to Lyons, where the
mother of Francis I, who was then Queen Regent, made him her physician.
He soon lost favor here, and was disgraced and banished; then he went to
the Low Countries, where he was imprisoned on account of his treatise
on _The Vanity of the Sciences._ Afterward he returned to Lyons, was
imprisoned anew, for an old libel against his former patron, and finally
died in the hospital of Grenoble, in 1535, at the age of about fifty.
His treatise on _The Vanity of the Sciences_ made him most trouble,
and showed best both his bitterness of spirit and the extent of his
learning. Herein he laid down the paradox, which was later renewed
and sustained by Rousseau, that there is nothing more pernicious and
injurious to common life, or more pestilential to the salvation of
souls, than the arts and sciences. He founded this thesis on Scriptural
authority, and supported it by profane testimony.
The conclusions which Agrippa drew were not so strange to the eyes
of his contemporaries as they are to ours. Long before him, men of
character and attainments, such as Pic de la Mirandola and Bessarion,
had attempted to introduce the Platonic idea, that the best means of
acquiring science and truth were introspective. They were, moreover,
persuaded that a great number of phenomena and events have their origin
in astral influences. From this system to the extravagance of the Cabal
* is but{141} a step; indeed, the Christian doctrine, that events and
phenomena are influenced by the direct intervention of the deity or of
the devil, is but a small transposition. The cabalistic theory, summed
up, was that all the events of life and all the phenomena of nature
proceed from influences which gods, devils, or the stars exercised on
the "archetype"'--that is, on the essential spirit, or substance. He who
could withdraw his spirit possessed supernatural faculties. The day and
the hour of birth, according to this view, were under the domination
of particular stars and each of the principal members of the body was
supposed to correspond with some planet or constellation. This is the
fundamental idea underlying the pictures--which are still to be found on
almanacs used by quack-medicine firms--of the individual whose interior
is so completely and uncomfortably exposed, while around him are
arranged the signs of the zodiac, with indications as to which part of
the body is governed by each.
* Cabal, or Kabbalah: A theosophieal or mystic speculative
system, of Hebrew origin, which flourished from the tenth to
the sixteenth century. It included a mystic theosophy and
cosmogony, attributing to deity neither will, desire, nor
action, but teaching that from it emanated wisdom, grace,
intellect, power, beauty, firmness, and other attributes. It
also ascribed hidden meanings to the sacred Hebrew writings
and words. Even in the letters and forms of the sacred words
the followers of the cabal pretended to find wonderful and
hidden meanings; hence the modern expression "cabalistic."
The teachings of the cabal were esoteric, of course, and
inculcated mysticism and occultism in everything, but
appear to have been more or less influenced by neoplatonism.
Occult philosophy, built upon this foundation, was divided into four
branches: _theosophy,_ to which a man raised himself by prayer; _magic_,
or the art of controlling demons; _astrology_, or the art of reading
future events by the stars; and _alchemy_, which teaches the secret of
extracting the essence or the archetype of substances,--i.e., virtually
the secret of the philosopher's stone, by which metals were to be
transmuted and then abolished.
And so the errors of science, the prejudices of the superstitious, the
excitement of the religious, and the cupidity of the rich and powerful,
all concurred to propagate the faults of the cabal at the close of the
Middle Ages. Never were there seen so many sorcerers, astrol-ogists,
and alchemists; never were prophecies, visions, and prodigies so common.
Whatever happened, it was pretended{142} that it had been announced
by some previous sign, or that it was a revelation of the future. This
particular kind of folly persisted in Germany longer than in any other
part of the world. Even Martin Luther seemed to share many of the
cabalistic views, and his alleged struggle with the devil, his adventure
with the inkstand, and so on, contributed much to spread them, and were,
perhaps, the most prominent illustrations of their general acceptance.
Surely, these were the Dark Ages.
Jerome Cardan was born at Pavia in 1501. His life, like that of Agrippa,
was one of vicissitude and inconsistency. Being the idol of his mother
and the detestation of his father produced a peculiar effect upon his
character. When he began to study he made rapid progress, and at the
age of twenty-two was able to discuss publicly all questions. About
two years later he received his doctor's hat. He practiced medicine in
various places until he was thirty-three, and was then made professor
of mathematics at Milan. He occupied this position but two years, then
traveled in Germany, France, and England, and returning to Italy was
imprisoned for debt in Bologna, and finally obtained a pension from the
pope, in Rome, where he died in 1556. He was a man of great attainments
and sagacity; his literary style was dignified, and, if he had not
developed such a taste for the marvelous, such inconceivable credulity
and superstition, and such vanity and boasting, he would have been a
remarkable character in his age. Leibnitz said of him: "Notwithstanding
his faults, Cardan was a great man and, without his defects, would have
been incomparable." He wrote extensively on philosophy, mathematics,
and medicine. Sometimes he admitted to his writings the most absurd
statements of visions, etc., and again affirmed that he had never
devoted himself to cabalistic art, blamed those who practiced it, and
jeered at those who believed in it. He wrote extensively on chiromancy.
For his own follies and misfortunes he apologized,{143} attributing them
all to the influences of the stars.
[Illustration: 0163]
The most colossal figure in this collection of mediaeval charlatans and
knaves was Paracelsus. He was born in 1493, near Zurich, of a well-to-do
family, his father being a physician. He had a good preliminary
education, and then visited the various universities, or rather
university towns; but, instead of listening to the professors,
Paracelsus associated with clever women, barbers, magicians, alchemists,
and the like, from whom he acquired much information. He was led at once
to the vagaries of the cabal, and, according to his own statement, he
did not open a book for ten years. He neglected his studies and forgot
his Latin, so that he became incapable of expressing himself in{144}
that language. From the age of twenty-five he became a hard drinker, and
this habit ultimately worked his ruin. One of his disciples says of him
that during the two years which he passed with him he was so inclined
to drinking and debauchery that he could scarcely be seen for an hour or
two without being full of wine, although that condition did not prevent
him from being admired by every one as a second Æsculapius.
At this time Paracelsus was between thirty-three and thirty-five years
of age, and at, apparently, the most brilliant period of his life. He
had written extensively and with emphasis of his numerous cures,
after the fashion of charlatans of those days,--and, unfortunately, of
to-day,--and claimed to be possessed of infallible secrets against the
most intractable diseases. He had just been called to Basel to the chair
of physic and surgery, and crowds of curious and idle persons attended
his lectures, which he gave in the vernacular, and not, as was
customary in those days, in Latin. In order to strike his auditors with
astonishment, he began by burning the works of Galen and Avicenna, and
then reading from his own writings, breaking off from time to time into
the statement: "Know, ye doctors, that my hat knows more than you;
that my beard is more experienced than your academies. Greeks, Latins,
Arabians, French, Italians, Jews, Christians, and Mohammedans, you
must follow me; I shall not follow you, for I am your monarch, and
sovereignty belongs to me." As may be imagined, his professorship
was not one of long duration, and he soon had few or no listeners.
In consequence of some mishaps he left Basel quite precipitately, his
departure causing no such sensation as his arrival. He then resumed his
nomadic life, and we find him at Alsace in 1528, at Nuremberg in 1529,
at St. Galle in 1531, at Mindelheim in 1540, and in the following year
at Salzburg, where he died in the hospital at the age of forty-eight.
Few men there are of whom so much good and so much{145} evil has been
written as of Paracelsus. Few are there of whom it is to-day so hard
to judge, since, if we refer to his contemporaries, they disagree
completely concerning him, and if we refer to his own writings we fall
into still greater chaos and have to abandon the attempt. His writings
show ideas without connection, observations which contradict each other,
and phrases which defy comprehension. At one moment he gives proof of
admirable penetration, at the next simply abject nonsense.
That he exerted an influence upon his time is certain, but that this
influence was retrograde rather than progressive seems quite likely. His
exact duplicate has probably never existed since his time, and we
may say that never was there another man like Aurelius Phillip-pus
Theophrastus Paracelsus Bombastus ab Hohenheim--his full name.
Although this man was such a prominent character in his day, his name
must be erased from the list of those who have contributed to the
world's progress. He was simply a pretended reformer, who counted as
nothing the most erudite writings, and who relied solely on his own
experience. He had the most profound self-confidence, and played upon
the credulity of his neighbors and victims with the toys which were
furnished him by the prevalent cabalistic notions of the day. The school
which he would have founded was nothing but a school of ignorance,
dissipation, and boasting--a school of medical dishonesty. In a word, it
was, as Renouard has said, "a school of which Thessalus, of Tralles, had
been the Corypheus in antiquity, which John of Gaddesden revived in the
Middle Ages, and to which Paracelsus gave a new development."
While, as has been briefly recounted, the partisans of the occult
sciences strove to completely overturn the scientific edifice of
antiquity, other reformers, more sensible and{146} less daring, were
content to expose its defects without attacking it in its entirety.
These were, for the most part, enlightened men, and at the same time
free thinkers,--friends of progress, and not of destruction. During the
sixteenth century these men were few in number, but at least three or
four of them deserve mention.
John Argentier was born in Piedmont, and taught in Naples, Pisa,
and Turin. He did not hesitate to take issue with the theories
and statements of Galen, and criticised those who adopted them too
servilely. Of him it may be said that, although styled a reformer,
nevertheless, he kept too near to the doctrines of those against whom he
inveighed to seriously weaken their position.
Leonard Botal, also a Piedmontese, was born in 1530. First a surgeon in
the French army, he later became physician to the kings Charles IX
and Henri III. He was the first to recommend frequent and general
bloodletting. Apparently before his time this practice was greatly
restrained. He carried his views so far as to maintain that an infirm
old man should be bled from two to six times a year, and that it was
good custom to open the veins of healthy individuals every six months.
He wrote a remarkable memoir on the cure of disease by blood-letting.
It is not to be denied that he obtained some remarkable success with his
copious venesections, and it must be said, in his defense, that, if he
overdid it, his contemporaries did not resort to it often enough, and
that his own practices were instructive to others. In his writings he
united independence and energy of thought with elegance and purity of
style.
Joubert (1529-1583) was Chancellor in the University of Montpellier and
physician to King Henri III. He wrote a treatise on _Popular Errors_,
which had an unheard-of success. In less than six months there were
sold nearly five thousand copies, which, considering the times,{147}
constituted a prodigious edition. For one thing, it was written in
the common tongue, and so placed within the reach of all. It was also
diversified with anecdotes and jokes, some of which were not of the most
delicate character; in fact, the author endeavored to atone for some of
its salacity by dedicating it to Queen Marguerite. He really proposed
for his main purpose a serious and useful one,--namely, that of
combating prejudices which were both injurious and ridiculous. Although
we may make light of Joubert's treatise, it certainly achieved a useful
end by dissipating a multitude of errors, giving information to those
who could scarcely get it as well from any other source. That it was
full of defects is simply another form of saying that it was published
in the middle of the sixteenth century.
It was during this period of which we have written that the separation
of the priesthood from medicine was completed. From the sixteenth
century celibacy was not obligatory on physicians in the Kingdom of
France, and they no longer enjoyed ecclesiastical benefices. At this
time, too, surgery, which had naturally been separated from medicine,
began to approach it, the combination thus gradually brought about
inuring to the benefit of all concerned. From now on, the professors of
St. Come were on the same level as the professors of the university,
and enjoyed equal privileges. Institutions for instruction in medicine
increased, and those which already existed were developed. Amphitheaters
for dissection were open in every city in Europe. Hospitals and
dispensaries were established alongside the schools, and by the various
governments more attention was paid to the protection of the public
from imposition, and to the amelioration of every evil affecting either
public or private health.