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Old-Time Makers of Medicine
THE STORY OF THE STUDENTS AND TEACHERS
OF THE SCIENCES RELATED TO MEDICINE
DURING THE MIDDLE AGES
BY
James J. Walsh, K.C.St.G., M.D.
Ph.D., LL.D., Litt.D., Sc.D.
DEAN AND PROFESSOR OF NERVOUS DISEASES AND OF THE HISTORY OF MEDICINE AT
FORDHAM UNIVERSITY SCHOOL OF MEDICINE; PROFESSOR OF PHYSIOLOGICAL
PSYCHOLOGY AT THE CATHEDRAL COLLEGE, NEW YORK
NEW YORK
FORDHAM UNIVERSITY PRESS
1911 COPYRIGHT 1911
JAMES J. WALSH
THE QUINN & GODEN CO. PRESS
RAHWAY, N.J.
TO
REVEREND DANIEL J. QUINN, S.J.
The historical material here presented was gathered for my classes at
Fordham University School of Medicine during your term as president of
the University. It seems only fitting then, that when put into more
permanent form it should appear under the patronage of your name and
tell of my cordial appreciation of more than a quarter of a century of
valued friendship.
"When we have thoroughly mastered contemporary science it is time to
turn to past science; nothing fortifies the judgment more than this
comparative study; impartiality of mind is developed thereby, the
uncertainties of any system become manifest. The authority of facts is
there confirmed, and we discover in the whole picture a philosophic
teaching which is in itself a lesson; in other words, we learn to know,
to understand, and to judge."--LITTRE: _OEuvres
d'Hippocrate_, T. I, p. 477.
"There is not a single development, even the most advanced of
contemporary medicine, which is not to be found in embryo in the
medicine of the olden time."--LITTRE: Introduction to the Works
of Hippocrates.
"How true it is that in reading this history one finds modern
discoveries that are anything but discoveries, unless one supposes that
they have been made twice."--DUJARDIN: _Histoire de la
Chirurgie_, Paris, 1774 (quoted by Gurlt on the post title-page of his
_Geschichte der Chirurgie_, Berlin, 1898).
PREFACE
The material for this book was gathered partly for lectures on the
history of medicine at Fordham University School of Medicine, and partly
for articles on a number of subjects in the Catholic Encyclopedia. Some
of it was developed for a series of addresses at commencements of
medical schools and before medical societies, on the general topic how
old the new is in surgery, medicine, dentistry, and pharmacy. The
information thus presented aroused so much interest, the accomplishments
of the physicians and surgeons of a period that is usually thought quite
sterile in medical science proved, indeed, so astonishing, that I was
tempted to connect the details for a volume in the Fordham University
Press series. There is no pretence to any original investigation in the
history of medicine, nor to any extended consultation of original
documents. I have had most of the great books that are mentioned in the
course of this volume in my hands, and have given as much time to the
study of them as could be afforded in the midst of a rather busy life,
but I owe my information mainly to the distinguished German and French
scholars who have in recent years made deep and serious studies of these
Old Makers of Medicine, and I have made my acknowledgments to them in
the text as opportunity presented itself.
There is just one feature of the book that may commend it to
present-day readers, and that is that our medieval medical colleagues,
when medicine embraced most of science, faced the problems of medicine
and surgery and the allied sciences that are now interesting us, in very
much the same temper of mind as we do, and very often anticipated our
solutions of them--much oftener, indeed, than most of us, unless we have
paid special attention to history, have any idea of. The volume does not
constitute, then, a contribution to that theme that has interested the
last few generations so much,--the supposed continuous progress of the
race and its marvellous advance,--but rather emphasizes that puzzling
question, how is it that men make important discoveries and inventions,
and then, after a time, forget about them so that they have to be made
over again? This is as true in medical science and in medical practice
as in every other department of human effort. It does not seem possible
that mankind should ever lose sight of the progress in medicine and
surgery that has been made in recent years, yet the history of the past
would seem to indicate that, in spite of its unlikelihood, it might well
come about. Whether this is the lesson of the book or not, I shall leave
readers to judge, for it was not intentionally put into it.
OUR LADY'S DAY IN HARVEST, 1911.
CONTENTS
CHAPTER PAGE
I. INTRODUCTION 1
II. GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 23
III. GREAT JEWISH PHYSICIANS 61
IV. MAIMONIDES 90
V. GREAT ARABIAN PHYSICIANS 109
VI. THE MEDICAL SCHOOL AT SALERNO 141
VII. CONSTANTINE AFRICANUS 163
VIII. MEDIEVAL WOMEN PHYSICIANS 177
IX. MONDINO AND THE MEDICAL SCHOOL OF BOLOGNA 202
X. GREAT SURGEONS OF THE MEDIEVAL UNIVERSITIES 234
XI. GUY DE CHAULIAC 282
XII. MEDIEVAL DENTISTRY--GIOVANNI OF ARCOLI 313
XIII. CUSANUS AND THE FIRST SUGGESTION OF LABORATORY
METHODS IN MEDICINE 336
XIV. BASIL VALENTINE, LAST OF THE ALCHEMISTS,
FIRST OF THE CHEMISTS 349
APPENDICES
I. ST. LUKE THE PHYSICIAN 381
II. SCIENCE AT THE MEDIEVAL UNIVERSITIES 400
III. MEDIEVAL POPULARIZATION OF SCIENCE 427
"Of making many books there is no end."--_Eccles._ xii, 12 (circa 1000
B.C.).
"The little by-play between Socrates and Euthydemus suggests an advanced
condition of medical literature: 'Of course, you who have so many books
are going in for being a doctor,' says Socrates, and then he adds,
'there are so many books on medicine, you know.' As Dyer remarks,
whatever the quality of these books may have been, their number must
have been great to give point to this chaff."--_Aequanimitas_,
WILLIAM OSLER, M.D., F.R.S., Blakistons, Philadelphia, 1906.
"Augescunt aliae gentes, aliae minuuntur;
Inque brevi spatio mutantur saecla animantum,
Et, quasi cursores vitai lampada tradunt."
--OVID.
One nation rises to supreme power in the world, while another declines,
and, in a brief space of time, the sovereign people change,
transmitting, like racers, the lamp of life to some other that is to
succeed them.
"There is one Science of Medicine which is concerned with the inspection
of health equally in all times, present, past and future."
--PLATO.
I
INTRODUCTION
Under the term Old-Time Medicine most people probably think at once of
Greek medicine, since that developed in what we have called ancient
history, and is farthest away from us in date. As a matter of fact,
however, much more is known about Greek medical writers than those of
any other period except the last century or two. Our histories of
medicine discuss Greek medicine at considerable length and practically
all of the great makers of medicine in subsequent generations have been
influenced by the Greeks. Greek physicians whose works have come down to
us seem nearer to us than the medical writers of any but the last few
centuries. As a consequence we know and appreciate very well as a rule
how much Greek medicine accomplished, but in our admiration for the
diligent observation and breadth of view of the Greeks, we are sometimes
prone to think that most of the intervening generations down to
comparatively recent times made very little progress and, indeed,
scarcely retained what the Greeks had done. The Romans certainly justify
this assumption of non-accomplishment in medicine, but then in
everything intellectual Rome was never much better than a weak copy of
Greek thought. In science the Romans did nothing at all worth while
talking about. All their medicine they borrowed from the Greeks, adding
nothing of their own. What food for thought there is in the fact, that
in spite of all Rome's material greatness and wide empire, her world
dominance and vaunted prosperity, we have not a single great original
scientific thought from a Roman.
Though so much nearer in time medieval medicine seems much farther away
from us than is Greek medicine. Most of us are quite sure that the
impression of distance is due to its almost total lack of significance.
It is with the idea of showing that the medieval generations, as far as
was possible in their conditions, not only preserved the old Greek
medicine for us in spite of the most untoward circumstances, but also
tried to do whatever they could for its development, and actually did
much more than is usually thought, that this story of "Old-Time Makers
of Medicine" is written. It represents a period--that of the Middle
Ages--that is, or was until recently, probably more misunderstood than
any other in human history. The purpose of the book is to show at least
the important headlands that lie along the stream of medical thought
during the somewhat more than a thousand years from the fall of the
Roman Empire under Augustulus (476) until the discovery of America.
After that comes modern medicine, for with the sixteenth century the
names and achievements of the workers in medicine are
familiar--Paracelsus, Vesalius, Columbus, Servetus, Caesalpinus,
Eustachius, Varolius, Sylvius are men whose names are attached to great
discoveries with which even those who are without any pretence to
knowledge of medical history are not unacquainted. In spite of nearly
four centuries of distance in time these men seem very close to us.
Their lives will be reserved for a subsequent volume, "Our Forefathers
in Medicine."
It is usually the custom to contemn the Middle Ages for their lack of
interest in culture, in education, in literature, in a word, in
intellectual accomplishment of any and every kind, but especially in
science. There is no doubt about the occurrence of marked decadence in
the intellectual life of the first half of this period. This has
sometimes been attributed to what has been called the inhibitory effect
of Christianity on worldly interests. Religion is said to have occupied
people so much with thoughts of the other world that the beauties and
wonders, as well as much of the significance, of the world around them
were missed. Those who talk thus, however, forget entirely the
circumstances which brought about the serious decadence of interest in
culture and science at this time. The Roman Empire had been the guardian
of letters and education and science. While the Romans were not original
in themselves, at least they had shown intense interest in what was
accomplished by the Greeks and their imitation had often risen to
heights that made them worthy of consideration for themselves. They were
liberal patrons of Greek art and of Greek literature, and did not
neglect Greek science and Greek medicine. Galen's influence was due much
more to the prominence secured by him as the result of his stay in Rome
than would have been possible had he stayed in Asia. There are many
other examples of Roman patronage of literature and science that might
be mentioned. As we shall see, Rome drained Greece and Asia Minor of
their best, and appropriated to herself the genius products of the
Spanish Peninsula. Rome had a way of absorbing what was best in the
provinces for herself.
Just as soon as Rome was cut off from intimate relations with the
provinces by the inwandering of barbarians, intellectual decadence
began. The imperial city itself had never been the source of great
intellectual achievement, and the men whom we think of as important
contributors to Rome's literature and philosophy were usually not born
within the confines of the city. It is surprising to take a list of the
names of the Latin writers whom we are accustomed to set down simply as
Romans and note their birthplaces. Rome herself gave birth to but a very
small percentage of them. Virgil was born at Mantua, Cicero at Arpinum,
Horace out on the Sabine farm, the Plinys out of the city, Terence in
Africa, Persius up in Central Italy somewhere, Livy at Padua, Martial,
Quintilian, the Senecas, and Lucan in Spain. When the government of the
city ceased to be such as assured opportunity for those from outside who
wanted to make their way, decadence came to Roman literature. Large
cities have never in history been the fruitful mothers of men who did
great things. Genius, and even talent, has always been born out of the
cities in which it did its work. It is easy to understand, then, the
decadence of the intellectual life that took place as the Empire
degenerated.
For the sake of all that it meant in the Roman Empire to look towards
Rome at this time, however, it seemed better to the early Christians to
establish the centre of their jurisdiction there. Necessarily, then, in
all that related to the purely intellectual life, they came under the
influences that were at work at Rome at this time. During the first
centuries they suffered besides from the persecutions directed against
them by the Emperors at various times, and these effectually prevented
any external manifestations of the intellectual life on the part of
Christians. It took much to overcome this serious handicap, but
noteworthy progress was made in spite of obstacles, and by the time of
Constantine many important officials of the Empire, the educated
thinking classes of Rome, had become Christians. After the conversion of
the Emperor opportunities began to be afforded, but political
disturbances consequent upon barbarian influences still further weakened
the old civilization until much of the intellectual life of it almost
disappeared.
Gradually the barbarians, finding the Roman Empire decadent, crept in on
it, and though much more of the invasion was peaceful than we have been
accustomed to think, the Romans simply disappearing because family life
had been destroyed, children had become infrequent, and divorce had
become extremely common, it was not long before they replaced the Romans
almost entirely. These new peoples had no heritage of culture, no
interest in the intellectual life, no traditions of literature or
science, and they had to be gradually lifted up out of their barbarism.
This was the task that Christianity had to perform. That it succeeded in
accomplishing it is one of the marvels of history.
The Church's first grave duty was the preservation of the old records
of literature and of science. Fortunately the monasteries accomplished
this task, which would have been extremely perilous for the precious
treasures involved but for the favorable conditions thus afforded.
Libraries up to this time were situated mainly in cities, and were
subject to all the vicissitudes of fire and war and other modes of
destruction that came to cities in this disturbed period. Monasteries,
however, were usually situated in the country, were built very
substantially and very simply, and the life in them formed the best
possible safeguard against fire, which worked so much havoc in cities.
As we shall see, however, not only were the old records preserved, but
excerpts from them were collated and discussed and applied by means of
direct observation. This led the generations to realize more and more
the value of the old Greek medicine and made them take further
precautions for its preservation.
The decadence of the early Middle Ages was due to the natural shifting
of masses of population of this time, while the salvation of scientific
and literary traditions was due to the one stable element in all these
centuries--the Church. Far from Christianity inhibiting culture, it was
the most important factor for its preservation, and it provided the best
stimulus and incentive for its renewed development just as soon as the
barbarous peoples were brought to a state of mind to appreciate it.
Bearing this in mind, it is easier to understand the course of medical
traditions through the Middle Ages, and especially in the earlier
period, with regard to which our documents are comparatively scanty,
and during which the disturbed conditions made medical developments
impossible, and anything more than the preservation of the old authors
out of the question. The torch of medical illumination lighted at the
great Greek fires passes from people to people, never quenched, though
often burning low because of unfavorable conditions, but sometimes with
new fuel added to its flame by the contributions of genius. The early
Christians took it up and kept it lighted, and, with the Jewish
physicians, carried it through the troublous times of the end of the old
order, and then passed it on for a while to the Arabs. Then, when
favorable conditions had developed again, Christian schools and scholars
gave it the opportunity to burn brightly for several centuries at the
end of the Middle Ages. This medieval age is probably the most difficult
period of medical history to understand properly, but it is worth while
taking the trouble to follow out the thread of medical tradition from
the Greeks to the Renaissance medical writers, who practically begin
modern medicine for us.
It is easy to understand that Christianity's influence on medicine,
instead of hampering, was most favorable. The Founder of Christianity
Himself had gone about healing the sick, and care for the ailing became
a prominent feature of Christian work. One of the Evangelists, St. Luke,
was a physician. It was the custom a generation ago, and even later,
when the Higher Criticism became popular, to impugn the tradition as to
St. Luke having been a physician, but this has all been undone, and
Harnack's recent book, "Luke the Physician," makes it very clear that
not only the Third Gospel, but also the Acts, could only have been
written by a man thoroughly familiar with the Greek medical terms of his
time, and who had surely had the advantage of a training in the medical
sciences at Alexandria. This makes such an important link in medical
traditions that a special chapter has been devoted to it in the
Appendix.
Very early in Christianity care for the ailing poor was taken up, and
hospitals in our modern sense of the term became common in Christian
communities. There had been military hospitals before this, and places
where those who could afford to pay for service were kept during
illness. Our modern city hospital, however, is a Christian institution.
Besides, deformed and ailing children were cared for and homes for
foundlings were established. Before Christianity the power even of life
and death of the parents over their children was recognized, and
deformed or ailing children, or those that for some reason were not
wanted, were exposed until they died. Christianity put an end to this,
and in two classes of institutions, the hospitals and the asylums,
abundant opportunity for observation of illness was afforded. Just as
soon as Christianity came to be free to establish its institutions
publicly, hospitals became very common. The Emperor Julian, usually
known as the Apostate, who hoped to re-establish the old Roman Olympian
religion, wrote to Oribasius, one of the great physicians of this time,
who was also an important official of his household, that these
Christians had established everywhere hospitals in which not only their
own people, but also those who were not Christians, were received and
cared for, and that it would be idle to hope to counteract the influence
of Christianity until corresponding institutions could be erected by the
government.
From the very beginning, or, at least, just as soon as reasonable
freedom from persecution gave opportunity for study, Christian interest
in the medical sciences began to manifest itself. Nemesius, for
instance, a Bishop of Edessa in Syria, wrote toward the end of the
fourth century a little work in Greek on the nature of man, which is a
striking illustration of this. Nemesius was what in modern times would
be called a philosopher, that is, a speculative thinker and writer, with
regard to man's nature, rather than a physical scientist. He was
convinced, however, that true philosophy ought to be based on a complete
knowledge of man, body and soul, and that the anatomy of his body ought
to be a fundamental principle. It is in this little volume that some
enthusiastic students have found a description that is to them at least
much more than a hint of knowledge of the circulation of the blood.
Hyrtl doubts that the passage in question should be made to signify as
much as has been suggested, but the occurrence of any even distant
reference to such a subject at this time shows that, far from there
being neglect of physical scientific questions, men were thinking
seriously about them.
Just as soon as Christianity brought in a more peaceful state of affairs
and had so influenced the mass of the people that its place in the
intellectual life could be felt, there comes a period of cultural
development represented in philosophy by the Fathers of the Church, and
during which we have a series of important contributors to medical
literature. The first of these was Aetius, whose career and works are
treated more fully in the chapter on "Great Physicians in Early
Christian Times." He was followed by Alexander of Tralles, probably a
Christian, for his brother was the architect of Santa Sophia, and by
Paul of AEgina, with regard to whom we know only what is contained in his
medical writings, but whose contemporaries were nearly all Christians.
Their books are valuable to us, partly because they contain quotations
from great Greek writers on medicine, not always otherwise available,
but also because they were men who evidently knew the subject of
medicine broadly and thoroughly, made observations for themselves, and
controlled what they learned from the Greek forefathers in medicine by
their own experience. Just at the beginning of the Middle Ages, then,
under the fostering care of Christianity there is a period of
considerable importance in the history of medical literature. It is one
of the best proofs that we have not only that Christianity did not
hamper medical development, but that, directly and indirectly, by the
place that it gave to the care of the ailing in life as well as the
encouragement afforded to the intellectual life, it favored medical
study and writing.
A very interesting chapter in the story of the early Christian physician
is to be found in what we know of the existence of women physicians in
the fourth and fifth centuries. Theodosia, the mother of St. Procopius
the martyr, was, according to Carptzovius, looked upon as an excellent
physician in Rome in the early part of the fourth century. She suffered
martyrdom under Diocletian. There was also a Nicerata who practised at
Constantinople under the Emperor Arcadius. It is said that to her St.
John Chrysostom owed the cure of a serious illness. From the very
beginning Christian women acted as nurses, and deaconesses were put in
charge of hospitals. Fabiola, at Rome, is the foundress of the first
important hospital in that city. The story of these early Christian
women physicians has been touched upon in the chapter on "Medieval Women
Physicians," as an introduction to this interesting feature of
Salernitan medical education.
During the early Christian centuries much was owed to the genius and the
devotion to medicine of distinguished Jewish physicians. Their sacred
and rabbinical writers always concerned themselves closely with
medicine, and both the Old Testament and the Talmud must be considered
as containing chapters important for the medical history of the periods
in which they were written. At all times the Jews have been
distinguished for their knowledge of medicine, and all during the Middle
Ages they are to be found prominent as physicians. They were among the
teachers of the Arabs in the East and of the Moors in Spain. They were
probably among the first professors at Salerno as well as at
Montpellier. Many prominent rulers and ecclesiastics selected Jewish
physicians. Some of these made distinct contributions to medicine, and a
number of them deserve a place in any account of medicine in the making
during the Middle Ages. One of them, Maimonides, to whom a special
chapter is devoted, deserves a place among the great makers of medicine
of all time, because of the influence that he exerted on his own and
succeeding generations. Any story of the preservation and development of
medical teaching and medical practice during the Middle Ages would be
decidedly incomplete without due consideration of the work of Jewish
physicians.
Western medical literature followed Roman literature in other
departments, and had only the Greek traditions at second hand. During
the disturbance occasioned by the invasion of the barbarians there was
little opportunity for such leisure as would enable men to devote
themselves with tranquillity to medical study and writing. Medical
traditions were mainly preserved in the monasteries. Cassiodorus, who,
after having been Imperial Prime Minister, became a monk, recommended
particularly the study of medicine to the monastic brethren. With the
foundation of the Benedictines, medicine became one of the favorite
studies of the monks, partly for the sake of the health of the brethren
themselves, and partly in order that they might be helpful to the
villages that so often gathered round their monasteries. There is a
well-grounded tradition that at Monte Cassino medical teaching was one
of the features of the education provided there by the monks. It is
generally conceded that the Benedictines had much to do with the
foundation of Salerno. In the convents for women as well as the
monasteries for men serious attention was given to medicine. Women
studied medicine and were professors in the medical department of
Salerno. Other Italian universities followed the example thus set, and
so there is abundant material for the chapter on "Medieval Women
Physicians."
The next phase of medical history in the medieval period brings us to
the Arabs. Utterly uninterested in culture, education, or science before
the time of Mohammed, with the growth of their political power and the
foundation of their capitals, the Arab Caliphs took up the patronage of
education. They were the rulers of the cities of Asia Minor in which
Greek culture had taken so firm a hold, and captive Greece has always
led its captors captive. With the leisure that came for study, Arabians
took up the cultivation of the Greek philosophers, especially Aristotle,
and soon turned their attention also to the Greek physicians Hippocrates
and Galen. For some four hundred years then they were in the best
position to carry on medical traditions. Their teachers were the
Christian and Jewish physicians of the cities of Asia Minor, but soon
they themselves became distinguished for their attainments, and for
their medical writings. Interestingly enough, more of their
distinguished men flourished in Spain than in Asia Minor. We have
suggested an explanation for this in the fact that Spain had been one of
the most cultured provinces of the Roman Empire, providing practically
all the writers of the Silver Age of Latin literature, and evidently
possessing a widely cultured people. It was into this province, not yet
utterly decadent from the presence of the northern Goths, that the Moors
came and readily built up a magnificent structure of culture and
education on what had been the highest development of Roman
civilization.
The influence of the Arabs on Western civilization, and especially on
the development of science in Europe, has been much exaggerated by
certain writers. Closely in touch with Greek thought and Greek
literature during the eighth, ninth, and tenth centuries, it is easy to
understand that the Arabian writers were far ahead of the Christian
scholars of Europe of the same period, who were struggling up out of the
practical chaos that had been created by the coming of the barbarians,
and who, besides, had the chance for whatever Greek learning came to
them only through the secondary channels of the Latin writers. Rome had
been too occupied with politics and aggrandizement ever to become
cultured. In spite of this heritage from the Greeks, decadence took
place among the Arabs, and, as the centuries go on, what they do becomes
more and more trivial, and their writing has less significance. Just the
opposite happened in Europe. There, there was noteworthy progressive
development until the magnificent climax of thirteenth century
accomplishment was reached. It is often said that Europe owed much to
the Arabs for this, but careful analysis of the factors in that progress
shows that very little came from the Arabs that was good, while not a
little that was unfortunate in its influence was borrowed from them with
the translations of the Greek authors from that language, which
constituted the main, indeed often the only, reason why Arabian writers
were consulted.
With the foundation of the medical school of Salerno in the tenth
century, the modern history of medical education may be said to begin,
for it had many of the features that distinguish our modern university
medical schools. Its professors often came from a distance and had
travelled extensively for purposes of study; they attracted patients of
high rank from nearly every part of Europe, and these were generous in
their patronage of the school. Students came from all over, from Africa
and Asia, as well as Europe, and when abuses of medical practice began
to creep in, a series of laws were made creating a standard of medical
education and regulating the practice of medicine, that are interesting
anticipations of modern movements of the same kind. Finally a law was
passed requiring three years of preliminary work in logic and philosophy
before medicine might be taken up, and then four years at medicine, with
a subsequent year of practice with a physician before a license to
practise for one's self was issued. In addition to this there was a
still more surprising feature in the handing over of the department of
women's diseases to women professors, and the consequent opening up of
licensure to practise medicine to a great many women in the southern
part of Italy. The surprise that all this should have taken place in the
south of Italy is lessened by recalling the fact that the lower end of
the Italian peninsula had been early colonized by Greeks, that its name
in later times was Magna Graecia, and that the stimulus of Greek
tradition has always been especially favorable to the development of
scientific medicine.
Salerno's influence on Bologna is not difficult to trace, and the
precious tradition of surgery particularly, which was carried to the
northern university, served to initiate a period of surgery lasting
nearly two centuries, during which we have some of the greatest
contributions to this branch of medical science that were ever made. The
development of the medical school at Bologna anticipated by but a short
time that of a series of schools in the north Italian universities.
Padua, Piacenza, Pisa, and Vicenza had medical schools in the later
Middle Ages, the works of some of whose professors have attracted
attention. It was from these north Italian medical schools that the
tradition of close observation in medicine and of thoroughly scientific
surgery found its way to Paris. Lanfranc was the carrier of surgery, and
many French students who went to Italy came back with Italian methods.
In the fourteenth century Guy de Chauliac made the grand tour in Italy,
and then came back to write a text-book of surgery that is one of the
monuments in this department of medical science. Before his time,
Montpellier had attracted attention, but now it came to be looked upon
as a recognized centre of great medical teaching. The absence of the
Popes from Italy and the influence of their presence at Avignon made
itself felt. While culture and education declined in Italy in the midst
of political disturbances, they advanced materially at the south of
France.
For our generation undoubtedly the most interesting chapter in the
history of medieval medicine is that which tells of the marvellous
development of surgery that took place in the thirteenth and fourteenth
centuries. Considerable space has been devoted to this, because it
represents not only an important phase of the history of medicine, and
recalls the names and careers of great makers of medicine, but also
because it illustrates exquisitely the possibility of important
discoveries in medicine being made, applied successfully for years, and
then being lost or completely forgotten, though contained in important
medical books that were always available for study. The more we know of
this great period in the history of surgery, the more is the surprise at
how much was accomplished, and how many details of our modern surgery
were anticipated. Most of us have had some inkling of the fact that
anaesthesia is not new, and that at various times in the world's history
men have invented methods of producing states of sensibility in which
more or less painless operations were possible. Very few of us have
realized, however, the perfection to which anaesthesia was developed, and
the possibility this provided for the great surgeons of the later
medieval centuries to do operations in all the great cavities of the
body, the skull, the thorax, and the abdomen, quite as they are done in
our own time and apparently with no little degree of success.
Of course, any such extensive surgical intervention even for serious
affections would have been worse than useless under the septic
conditions that would surely have prevailed if certain principles of
antisepsis were not applied. Until comparatively recent years we have
been quite confident in our assurance that antisepsis and asepsis were
entirely modern developments of surgery. More knowledge, however, of
the history of surgery has given a serious set-back to this
self-complacency, and now we know that the later medieval surgeons
understood practical antisepsis very well, and applied it successfully.
They used strong wine as a dressing for their wounds, insisted on
keeping them clean, and not allowing any extraneous material of any
kind, ointments or the like, to be used on them. As a consequence they
were able to secure excellent results in the healing of wounds, and they
were inclined to boast of the fact that their incisions healed by first
intention and that, indeed, the scar left after them was scarcely
noticeable. We know that wine would make a good antiseptic dressing, but
until we actually read the reports of the results obtained by these old
surgeons, we had no idea that it could be used to such excellent
purpose. Antisepsis, like anaesthesia, was marvellously anticipated by
the surgical forefathers of the medieval period.
It has always seemed to me that the story of Medieval Dentistry
presented an even better illustration of a great anticipatory
development of surgery. This department represents only a small surgical
specialty, but one which even at that period was given over to
specialists, who were called dentatores. Guy de Chauliac's review of the
dentistry of his time and the state of the specialty, as pictured by
John of Arcoli, is likely to be particularly interesting, because if
there is any department of medical practice that we are sure is
comparatively recent in origin, it is dentistry. Here, however, we find
that practically all our dental manipulations, the filling of teeth,
artificial dentures, even orthodontia, were anticipated by the dentists
of the Middle Ages. We have only the compressed account of it which is
to be found in text-books of general surgery, and while in this they
give mainly a heritage from the past, yet even this suffices to give us
a picture very surprising in its detailed anticipation of much that we
have been inclined to think of as quite modern in invention and
discovery.
Medicine developed much more slowly than surgery, or, rather, lagged
behind it, as it seems nearly always prone to do. Surgical problems are
simple, and their solution belongs to a great extent to a handicraft.
That is, after all, what chirurgy, the old form of our word surgery,
means. Medical problems are more complex and involve both art and
science, so that solutions of them are often merely temporary and lack
finality. During the Middle Ages, however, and especially towards the
end of them, the most important branches of medicine, diagnosis and
therapeutics, took definite shape on the foundations that lie at the
basis of our modern medical science. We hear of percussion for abdominal
conditions, and of the most careful study of the pulse and the
respiration. There are charts for the varying color of the urine, and of
the tints of the skin. With Nicholas of Cusa there came the definite
suggestion of the need of exact methods of diagnosis. A mathematician
himself, he wished to introduce mathematical methods into medical
diagnosis, and suggested that the pulse should be counted in connection
with the water clock, the water that passed being weighed, in order to
get very definite comparative values for the pulse rate under varying
conditions, and also that the specific gravity of fluids from the body
should be ascertained in order to get another definite datum in the
knowledge of disease. It was long before these suggestions were to bear
much fruit, but it is interesting to find them so clearly expressed.
At the very end of the Middle Ages came the father of modern
pharmaceutical chemistry, Basil Valentine. Already the spirit that was
to mean so much for scientific investigation in the Renaissance period
was abroad. Valentine, however, owes little to anything except his own
investigations, and they were surprisingly successful, considering the
circumstances of time and place. His practical suggestions so far as
drugs were concerned did not prove to have enduring value, but then this
has been a fate shared by many of the masters of medicine. There were
many phases of medical practice, however, that he insisted on in his
works. He believed that the best agent for the cure of the disease was
nature, and that the physician's main business must be to find out how
nature worked, and then foster her efforts or endeavor to imitate them.
He insisted, also that personal observation, both of patients and drugs,
was more important than book knowledge. Indeed, he has some rather
strong expressions with regard to the utter valuelessness of book
information in subjects where actual experience and observation are
necessary. It gives a conceit of knowledge quite unjustified by what is
really known.
What is interesting about all these men is that they faced the same
problems in medicine that we have to, in much the same temper of mind
that we do ourselves, and that, indeed, they succeeded in solving them
almost as well as we have done, in spite of all that might be looked for
from the accumulation of knowledge ever since.
It was very fortunate for the after time that in the period now known as
the Renaissance, after the invention of printing, there were a number of
serious, unselfish scholars who devoted themselves to the publication in
fine printed editions of the works of these old-time makers of medicine.
If the neglect of them that characterized the eighteenth and early
nineteenth centuries had been the rule at the end of the fifteenth and
during the sixteenth century, we would almost surely have been without
the possibility of ever knowing that so many serious physicians lived
and studied and wrote large important tomes during the Middle Ages. For
our forefathers of a few generations ago had very little knowledge, and
almost less interest, as to the Middle Ages, which they dismissed simply
as the Dark Ages, quite sure that nothing worth while could possibly
have come out of the Nazareth of that time. What they knew about the
people who had lived during the thousand years before 1500 only seemed
to them to prove the ignorance and the depths of superstition in which
they were sunk. That medieval scholars should have written books not
only well worth preservation, but containing anticipations of modern
knowledge, and, though of course they could not have known that, even
significant advances over their own scientific conditions, would have
seemed to them quite absurd.
Fortunately for us, then, the editions of the early printed books, so
many of them monuments of learning and masterpieces of editorial work
with regard to medieval masters of medicine, were lying in libraries
waiting to be unearthed and restudied during the nineteenth century.
German and French scholars, especially during the last generation, have
recovered the knowledge of this thousand years of human activity, and we
know now and can sympathetically study how the men of these times faced
their problems, which were very much those of our own time, in almost
precisely the same spirit as we do ours at the present time, and that
their solutions of them are always interesting, often thorough and
practical, and more frequently than we would like to think possible,
resemble our own in many ways. For the possibility of this we are
largely indebted originally to the scholars of the Renaissance. Without
their work that of our investigators would have been quite unavailing.
It is to be hoped, however, that our recovery of this period will not be
followed by any further eclipse, though that seems to be almost the rule
of human history, but that we shall continue to broaden our sympathetic
knowledge of this wonderful medieval period, the study of which has had
so many surprises in store for us.
II
GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES
What we know of the life of the Founder of Christianity and how much He
did for the ailing poor would make us expect that the religion that He
established would foster the care and the cure of suffering humanity. As
we have outlined in the Introduction, the first of the works of
Christian service that was organized was the care of the sick. At first
a portion of the bishop's house was given over to the shelter of the
ailing, and a special order of assistants to the clergy, the
deaconesses, took care of them. As Christians became more numerous,
special hospitals were founded, and these became public institutions
just as soon as freedom from persecution allowed the Christians the
liberty to give overt expression to their feelings for the poor. While
hospitals of limited capacity for such special purposes as the
sheltering of slaves or of soldiers and health establishments of various
kinds for the wealthy had been erected before Christianity, this was the
first time that anyone who was ill, no matter what the state of his
pecuniary resources, could be sure to find shelter and care. The
expression of the Emperor Julian the Apostate, that admission to these
hospitals was not limited to Christians, is the best possible evidence
of the liberal charity that inspired them.
The ordinary passing student of the history of medicine or of hospital
foundation and organization, can have no idea of the magnitude of some
of these institutions, and their importance in the life of the time,
unless it is especially pointed out. St. Basil, about the middle of the
fourth century, erected what was spoken of as "a city for the sick,"
before the gates of Caesarea. Gregory of Nazianzen, his friend, says
"that well built and furnished houses stood on both sides of streets
symmetrically laid out about the church, and contained rooms for the
sick, and the infirm of every variety were intrusted to the care of
doctors and nurses." There were separate buildings for strangers, for
the poor, and for the ailing, and comfortable dwellings for the
physicians and nurses. An important portion of the institution was set
apart for the care of lepers, which constituted a prominent feature in
Basil's work in which he himself took a special interest. Earlier in the
same century Helena, the mother of the Emperor Constantine, had built
similar institutions around Jerusalem, and during this same century
nearly everywhere we have evidence of organization of hospitals and of
care for the ailing poor.
Not only were hospitals erected, but arrangements were made for the care
of the ailing poor in their own homes and for the visitation of them,
and for the bringing to places adapted for their care and treatment of
such as were found on the street, or neglected in their homes. The
Church evidently considered itself bound to care for men's bodies as
well as their souls, and many of the expressions in common use among
Christians referred to this fact. Religion itself was spoken of as a
medicine of the soul and the body. Christianity was defined as the
religion of healing. The word salvation had a reference to both body and
soul. Baptism was spoken of as the bath of the soul, the holy Eucharist
as the elixir of immortal life, and penance as the medicine of the soul.
It is not surprising to find, then, that Harnack has found among the
texts that illustrate the history of early Christian literature this
one: "In every community there shall be at least one widow appointed to
assist women who are stricken with illness, and this widow shall be
trained in her duties, neat and careful in her ways, shall not be
self-seeking, must not indulge too freely in wine in order that she may
be able to take up her duties at night as well as by day, and shall
consider it her duty to keep the Church officials informed of all that
seems necessary."
The saving of deformed and ailing infants or children whose parents did
not care to have the trouble of rearing them, required the establishment
by the Christians of another set of institutions, Foundling Asylums and
Hospitals for Children. Until the coming of Christianity parents were
supposed to have the right of life and death over their children, and no
one questioned it. In every country in the world until the coming of
Christianity this had always been the case. Besides, there were
institutions for the care of the old. These are the classes of mankind
who are especially liable to suffer from disease, and the opportunity
to study human ailments in such institutions could scarcely help but
provide facilities for clinical observation such as had not existed
before. Unfortunately the work of Christianity was hampered, first by
the Roman persecutions, and then later by the invasion of the
barbarians, who had to be educated and lifted up to a higher plane of
civilization before they could be brought to appreciate the value of
medical science, much less contribute to its development.
Harnack, whose writings in the higher criticism of Scripture have
attracted so much attention in recent years, began his career in the
study of Christian antiquities with a monograph on Medical Features of
Early Christianity.[1] He mentions altogether some sixteen physicians
who reached distinction in the earliest days of Christianity. Some of
these were priests, some of them bishops, as Theodotos of Laodicea;
Eusebius, Bishop of Rome; Basilios, Bishop of Ancyra, and at least one,
Hierakas, was the founder of a religious order. The first Christian
physicians came mainly from Syria, as might be expected, for here the
old Greek medical traditions were active. Among them must be enumerated
Cosmas and Damian, physicians who were martyred in the persecution of
Diocletian, and who have been chosen as the patrons of the medical
profession. Justinian erected a famous church to them. It became the
scene of pilgrimages. Organizations of various kinds since, as the
College of St. Come, and medical societies, have been named after them.