understood by Arabic-speaking students than it had been by any since
Galen. Nor were the Arabic-speaking peoples content to rest on the
texts that had thus descended to them from antiquity. A considerable
number of Arabic writers produced works of their own, some not wholly
devoid of originality. Unfortunately these men were without effective
anatomical or physiological basis for their medical knowledge, though
many of them were acute clinical observers, and, even from the modern
point of view, some of their works are not wholly contemptible. Thus
Rhazes (860-932), a native of Basra on the Persian Gulf, wrote a work
containing the first known description of Measles, which he carefully
distinguishes from Small-pox. The Persian Avicenna (980-1036) composed
a vast encyclopaedia of medical knowledge, the so-called _Canon_, which
served as the main text-book of Medicine both among the Arabic-speaking
peoples and in the Latin West until the seventeenth century. The Jew,
Isaac of Kairouan (852-952), composed a treatise on fevers which was
the best account of the subject available in Europe during the entire
Middle Ages. The Moor, Albucasis (11th cent.), left a text-book of
surgery which was an important element in the revival of the subject in
Italy and France.
These are only prominent members of a vast school of writers who
flourished in Arabic-speaking countries between the ninth and
thirteenth centuries. The bulk and number of their writings is
portentous. Many of their works were translated into Latin, often
by Jewish translators (Fig. 26). These Latin translations caused a
reawakening of the intellect of Europe, and provided the staple reading
in the medieval universities throughout the Middle Ages.
[Illustration:
FIG. 26. A JEWISH TRANSLATOR receiving an Arabic medica volume from an
Eastern potentate (right) and handing it, translated into Latin, to a
Western monarch (left). From a thirteenth-century manuscript.
]
§ 3. _The Medieval Awakening._
The Spanish peninsula had been inundated by the Islamic tide as early
as the eighth century. After a while the waters began to recede. The
speech and culture of Islam had become stamped upon the natives of the
peninsula, and were only gradually replaced by the Latin civilization
and dialect which we now call Spanish. During the centuries of Islamic
retreat, there was thus a bilingual population in the peninsula, so
that access to the Arabic learning became possible. The translations
that were to have influence on Europe were always into Latin. To make
or to obtain such translations many adventurous spirits journeyed from
Christian Europe into Spain, or sometimes into Sicily where conditions
were very similar. These men were aided in their work by native Jews or
by Mohammedans. The heretical company which they kept, together with
the strange and mysterious material which they brought back with them,
earned them a reputation as magicians. The memory, for instance, of
Michael Scot is connected with the Black Art, and has been presented by
Sir Walter Scott in his poem _The Lay of the Last Minstrel_.
The wizard Michael Scot (died 1235) journeyed in both Spain and
Sicily, learned Arabic and Hebrew, and had commerce with Mohammedans
and Jews. He turned a number of Arabic works into Latin, and, in
particular, he prepared versions of the biological works of Aristotle
(pp. 28-33) which, though corrupt and second-hand, had much influence
in determining the direction of medical thought during the Middle Ages.
There was a large class of such translators and commentators who made
Arabic Medicine accessible to the West. This Arabic-Latin literature
is generally characterized by the qualities most often associated
with the words _medieval_ and _scholastic_. It is extremely verbose
and almost wholly devoid of the literary graces. An immense amount of
attention is paid to the mere arrangement of the material, which often
occupies its authors more than the ideas that are to be conveyed.
Great stress is laid on argument, especially in the form of the
syllogism, while observation of Nature is entirely in the background.
Above all, there is a constant appeal to the authority of the ancient
masters, especially Aristotle and Galen. Lip service is often paid to
Hippocrates, but his spirit is absent from these windy discussions.
When the Latin translations from the Arabic reached the readers for
whom they were intended, they were eagerly studied. The texts were,
however, by no means permitted to remain in their pristine state,
but were submitted to exactly the same process to which their Arabic
authors had themselves subjected their Aristotelian and Galenic models.
The Christian writers of the West treated the Latin translations of
Rhazes, of Avicenna, of Isaac and of Albucasis (p. 67), as subjects
for commentary. Their works were expanded, annotated, castigated
again and again, and without any new inflow of ideas. The result is a
progressive elaboration of form and deterioration of content throughout
the centuries. Vast masses of argument, rebuttal, refutation and
confirmation drowned again the human spirit which hardly recovered from
its submersion until the sixteenth century.
§ 4. _The Universities._
Nevertheless, when these translations were new to Europe, and
especially in the thirteenth century, they caused much stir. In
this awakening a large part was played by the Universities. These
were established in numbers during the thirteenth and the following
centuries. University life gradually came to exercise a profound
effect on social, political and intellectual conditions. In most of
the Universities Medical Faculties grew up. The medical teaching was
entirely theoretical and there was no clinical instruction, though at
the beginning of the fourteenth century some advance was made by the
introduction of brief and superficial anatomical demonstrations (p. 74).
As a type of Medieval University, we may take Bologna, which was an
important center of learning from a very early date (Fig. 27). As the
Universities multiplied, they began to some extent to ‘specialize’.
Bologna had appeared first as a Law School and continued to develop
along the same line. In the second half of the thirteenth century it
was by far the most important seat of legal learning in Europe.
An organized Medical Faculty existed there as far back as 1156. The
teaching at Bologna, as in other medical schools, consisted entirely
of readings of Latin translations from Arabic which were becoming ever
more accessible. Yet it was at Bologna that public dissection was first
practised. The early advent of dissection has often impressed the
historian. There was still no botany worthy of the name, no zoology,
hardly any naturalistic art, no experimental science, no systematic
record of observation in any department. Yet dissection had become
recognized at Bologna by the end of the first quarter of the fourteenth
century. The question is why men, so little interested in Nature and
Nature’s ways, should have lent themselves to so repellent a process as
dissection of the human body? The answer is that the earliest reason
for examining the human body was simply the gathering of evidence for
legal processes. As time went on, post-mortem examination passed into
anatomical study. But still dissection did no more, and was asked to
do no more, than verify Avicenna--whom nobody doubted. It was, in fact,
little but an aid to the memory of students.
At Bologna we can trace the rise of a surgical school beginning about
the end of the twelfth century. Prominent among its early surgeons was
William of Saliceto (1215?-1280?). He wrote a very able treatise on
Surgery, containing a section on Anatomy. The anatomical portion is
borrowed from the current Arabian anatomies, but contains some evidence
of direct access to the dead human body. He includes in his work a good
description of trephining the skull (Fig. 23).
A most interesting contemporary of William of Saliceto was Thaddeus
of Florence (1223-1303), who also taught at Bologna. This man
perceived the importance of access to Greek sources, as distinct
from Graeco-Arabic, and he encouraged the preparation of good Latin
translations of medical works direct from the Greek. He stamped his
personality on the whole development of Medicine at Bologna, and he
is bound up with the beginning of dissection. But if Medicine owed a
debt to Thaddeus for introducing better texts and better Anatomy, he
did grave harm to the subject in another direction. The scholastic
and argumentative form assumed by medieval Medicine is largely due to
him, and it is to the assumption of this form that we owe the almost
complete absence of scientific advance between the thirteenth and
sixteenth centuries.
[Illustration: FIG. 27. MEDIEVAL BOLOGNA, from a mural painting of
about 1500 in the town-hall of the city. The city contained a number of
towers, nearly all of which have now been destroyed.]
§ 5. _Medieval Anatomy, Surgery and Internal Medicine._
At the very end of the thirteenth century there came to Bologna a
Norman student, Henri de Mondeville (about 1270-1320). In 1301 he
settled at the famous Medical School at Montpellier in Southern France,
and thus transplanted to France the medical, surgical and anatomical
traditions of Bologna. Those traditions were of Arabic origin, and
mainly borrowed from Avicenna.
Contemporary with de Mondeville was one whose method of teaching shines
as a good deed in a naughty world. Mondino di Luzzi (_c._ 1270-1326)
was a pupil of Thaddeus and a fellow-student of Henri de Mondeville.
He worked systematically at Anatomy and dissected the human body
in public. His treatise on Anatomy, written in 1316, is the first
modern work on the subject. Those who preceded him incorporated their
anatomical work in larger treatises on Surgery, and do not refer
directly to their own anatomical experiences. With Mondino this is
changed. His work is essentially a practical manual of the subject
and he is with justice called the ‘Restorer of Anatomy’. He had read
widely among the Arabian anatomists, and naturally borrowed from them.
Nevertheless, his work contains a considerable number of references to
actual anatomical procedure. Moreover, he deals not only with Anatomy
in our modern sense, but also includes Physiology and much discussion
of the application of anatomical and physiological principles to
Medicine and Surgery. His book thus gives a good deal of insight into
the scientific knowledge of the day.
[Illustration: FIG. 28. AN ANATOMICAL LECTURE AT PADUA in the fifteenth
century, from a contemporary Italian woodcut.
The professor stands in his ‘chair’, a great pulpit or ‘cathedra’,
reading from his book--hence the English academic titles ‘Reader’
and ‘Lecturer’ or ‘Lector’ (that is, ‘one who reads’). The body is
dissected by a menial, whose work is guided by an assistant, who,
with wand, points out (Latin _demonstrat_, hence our modern title
_Demonstrator_) the lines of incision. Students in academic dress stand
around, but do not themselves dissect. ]
We would emphasize the fact that Mondino dissected _in person_. In this
respect he was wiser than his successors until the time of Vesalius.
As dissection gained formal inclusion in the curriculum, the professor
became more haughty, further removed from the object of his study.
Leaving his position by the body, where he might demonstrate to his
students, he ascended his high professorial chair, a great elevated
structure provided with steps and a reading-desk. From there he read
from his text-book while a junior colleague pointed out the line of
incision and a menial performed the actual dissection (Fig. 28). All
was thus done at third-hand and according to the written word. We are
in the scholastic period, and must not expect any frequent appeal to
Nature. Having once got into his chair, it took a good deal to persuade
the professor to descend from that dignified position. Thus, it is
saying much for Mondino that he was his own demonstrator. He took the
first and perhaps the greatest step. It was two centuries and more
before the next step was taken.
Most typical of medieval surgeons was Guy de Chauliac (1300-68),
who studied at Montpellier, Paris, and Bologna, and practised at
Montpellier and afterwards at Avignon, where he was a member of the
Papal Court. He was a man of much learning, and his _Great Surgery_
became the standard treatise on the subject during the later Middle
Ages. It fixed medieval practice. It is to be found in scores of
manuscripts and was frequently translated and printed. Among the good
points of his practice is his acceptance of responsibility for certain
operations, such as those for rupture and for cataract, which at that
time were usually left to wandering charlatans who regarded themselves
as specialists. A famous passage in his work describes the use of a
narcotic inhalation frequently used during the Middle Ages and into
modern times. Of such a narcotic it is written that:
I’ll imitate the pities of old surgeons
To this lost limb, who, ere they show their art,
Cast one asleep, then cut the diseased part.
(Thomas Middleton, _Women beware women_. First acted 1622.)
The general character of Internal Medicine during the later Middle Ages
was below that of Surgery. Modern clinical Medicine is firmly based
on such sciences as Physiology, Pharmacology, Pathology, Biochemistry
and Epidemiology. In the Middle Ages and far beyond, Physiology was
still that of Galen, which had lost in exactness what it had gained
in bulk from the Arabic and Latin commentators. Pathology was still
that of the four humors. The knowledge of drugs was empirical, and the
sciences of Pharmacology and Biochemistry as yet were not; while the
medieval conception of the nature of epidemics was the very perversion
of reason and common sense. Nevertheless, as we shall see, the Middle
Ages ultimately succeeded in instituting a limited number of effective
preventive measures.
§ 6. _Medieval Hospitals and Hygiene._
Undoubtedly an important development of medieval Medicine is its
hospital system. The public hospital arose in pagan antiquity out
of the Temples of Aesculapius and the military valetudinaria (p.
49). The conception was seized on by Christianity and developed
beyond all knowledge. In the early Christian centuries, _hospitalia_,
‘guest chambers’ or ‘guest houses’, were set aside for the numerous
_hospites_, or ‘pilgrims’. Similar buildings under the same title came
to be instituted for the care of orphans, the aged, the blind, and
other victims of fortune. Thus arose the medieval hospital system, of
which ours is the direct outgrowth.
In matters of Hygiene the Middle Ages are a byword. The health
conditions of a medieval town were far below those of the same town
under the Roman Empire. Water-supply was deficient, drains were
absent, streets and houses filthy and overcrowded, rooms unventilated.
Nevertheless, there is one important hygienic conception for which our
own age owes a considerable debt to that which preceded it. Despite
their scientific acumen in many departments, it is yet true to say
that among the physicians of classical antiquity we find no consistent
view of the transmission of infection by contact. Indeed the whole
idea of infection was effectively absent from them, so that preventive
measures based upon it could not be developed. It was reserved for the
Middle Ages to conceive serious official measures against the spread
of epidemics. These measures were consciously derived from the leper
ritual of the Bible with its fundamental concept of isolation.
[Illustration:
FIG. 29. A HOSPITAL WARD in sixteenth century Paris. In the left aisle,
a nun folds the hands of a dying patient, while a priest gives the
Sacrament to another in the same bed. In front, nuns sew shrouds. The
right aisle is more cheerful. Nuns minister to two patients in one bed,
while a convalescent, fortunate in having a bed to himself, vigorously
takes nourishment. In the centre nuns receive postulants and a royal
founder kneels in prayer.
]
During the early centuries of the Christian era, Leprosy, which had
till then been confined to the East, crept along the Mediterranean
littoral and thence northward throughout Europe. The disease was
from the first regarded as contagious, and various regulations were
introduced to isolate and separate the unfortunate sufferers. The
medieval treatment of lepers is one of the dark incidents of man’s
inhumanity to man. The leper was banished from human society. He was
declared legally dead. He was excluded even from church or allowed to
attend only in special seats where a special basin of holy water was
assigned to him. How rigorously this segregation from the ranks of free
people was carried out by law is well known. The cruel edicts were,
however, effective. In the course of centuries it freed Europe from
Leprosy, of which it is said there were at one time some 20,000 cases
in France alone. Thus about one person in 200 would have been a leper,
and the burden of the leper on the community was comparable to that,
let us say, of the feeble-minded and insane with us.
Leper inspection, the regular examination of all suspects and carriers
of leprosy, became a most elaborate business. It was entrusted to
a special branch of the civil service and was gradually freed from
ecclesiastical control.
This preventive method of combating a chronic disease, which, as we
know now, has a very low infectivity, had a peculiar and unlooked-for
result. The meticulous system of warding off the contagion of leprosy
so occupied the attention of physicians that they came to see allied
conditions in the same light. So it was that in the thirteenth century
the general concept became current of disease as contagious. A number
of other diseases besides leprosy were recognized as infectious. Among
these were Plague, fevers with obvious rashes, Phthisis, Granular
Conjunctivitis, the Itch and Erysipelas. Municipal authorities were
from time to time ordered to put patients suffering from one or other
such diseases outside the city gates. They were forbidden to traffic
in articles of food and drink and were placed under restrictions not
unlike those of lepers. The devastating epidemic of the Black Death of
1347-8 brought restrictions of this order into special force. Thus the
Black Death had somewhat the same effect on the health administration
of the day that the Cholera outbreaks of the thirties of the nineteenth
century had upon modern Europe. The health service began to be put
into more efficient order.
In the later Middle Ages there were actually instances in which the
Pest was averted or successfully combated by these means. This seems
to have been the case of Milan and Venice between the years 1370 and
1374. At that time the Plague was again advancing through Europe. The
most drastic regulations were invoked to prevent infected persons from
entering the cities, and these regulations came into force well in
advance of the disease.
There is one incident in this medieval attempt to prevent Plague that
has left a mark on our language. The Republic of Ragusa, on the eastern
side of the Adriatic, adopted and extended the regulations that had
been so successful at Venice. A landing-station was established far
from the city and the harbor. There incoming suspects had to spend
thirty days in the open air and sunlight, and any who had traffic with
them were isolated. The period of thirty days was spoken of as the
_Trentina_. Later this was found to be not long enough. The thirty
days became forty days, the _Quarantina_, whence we have the word
_Quarantine_. The system of quarantine gradually spread through Europe.
It was accompanied by very drastic destruction, by burning, of all
goods belonging to the infected.
These attempts to arrest epidemic disease were sometimes successful and
the elaboration of quarantine measures was among the few advances with
which we may credit the Middle Ages. The fact that we can now dispense
with quarantine must not blind us to its value in conditions other than
our own.
IV
THE REBIRTH OF SCIENCE
(FROM ABOUT 1500 TO ABOUT 1700)
§ 1. _The Anatomical Awakening._
During the Middle Ages beliefs about physiology were always based
on Galen. They were frequently confused and often the result of a
misunderstanding of his work. In the fifteenth century, however, took
place the so-called _Renaissance_ or _Revival of Learning_. Greek works
which had been trickling in since the thirteenth century began to be
recovered more rapidly, and to be more accurately studied. The first
step towards any improvement on the views of Galen was naturally a
proper understanding of what he had really said. For that there was
needed a better knowledge of Greek than had been possessed by the
Middle Ages. In the fifteenth century Greek scholarship made great
advances and there was enthusiasm for classical learning. Accurate
translations of the Greek works of Galen were made. The printing press
was invented about the middle of the fifteenth century. Towards its end
printed copies of the improved translations began to appear. So it came
about that the Revival of Learning produced a revival of the ancient
scientific knowledge.
This scientific revival led to a new interest in Anatomy. During
the Middle Ages the occasional dissections at the Universities were
merely supposed to illustrate Avicenna and Galen (Fig. 28 and p. 72).
Dissection became much more widely practised in the fifteenth century,
but it was nearly the middle of the sixteenth century before any real
and open discussion of Galen’s views took place in the Universities.
There were, moreover, other influences at work. Along with the revival
of learning there was also a renaissance of art. Some of the great
Renaissance artists--Michelangelo, Raphael and Dürer among them--began
to study the human form very closely. They soon found that to represent
it accurately some knowledge of Anatomy, and especially of the bones
and muscles, was needed. The artists, therefore, began also to dissect.
Among these great artists were some who took more than a purely
artistic interest in the structure and workings of the body. Of these
the most important for us was Leonardo da Vinci (1452-1518). He was a
man of enormously powerful and inquiring mind, and his achievements
in science are at least as remarkable as his works of art. He had
determined to write a text-book of anatomy and physiology. Though he
did not publish it, many of his beautifully illustrated note-books on
these subjects have survived.
Leonardo was the first to question the views of Galen. He made
careful first-hand investigations on the bodies of men and animals,
and performed many physiological experiments. Though a man of the
most lofty genius, centuries ahead of his time, yet his outlook is,
in many respects, typical of his age. His interest in anatomical
investigation is therefore not surprising, for such inquiries were
then astir. It happened that he was particularly interested in the
heart and blood-vessels. He reached the correct conclusion that,
contrary to Galen, the branches of the air-tubes in the lungs do not
come into relation with the heart, but, after branching and gradually
diminishing in size, they finally end _blindly_. He inflated the lungs
with air and found that, whatever the force used, air could not be
driven from the air-tubes into the heart. He therefore inferred quite
correctly that Galen’s _arteria venalis_ (our ‘pulmonary vein’) did not
convey air to the heart, as the followers of Galen believed.