for knowledge's sake is recent, or, at least, quite modern. As a matter
of fact, one finds it everywhere in history. Long before Herodotus did
his wanderings there were many visitors who went to Egypt, and many more
later who went to Crete, and many more a few centuries later who went to
the shores of Asia Minor seeking for the precious pearl of knowledge,
and sometimes finding it without finding the even more precious pearl of
wisdom, "whose worth is from the farthest coasts."
To the Arabs we owe the foundation of a series of institutions for the
higher learning, like those which had existed around them in Asia Minor
and in Egypt at the time they made their conquests. Alexandria,
Pergamos, Cos, Cnidos, Tarsus, and many other Eastern cities had had
what we would call at least academies, and many of them deserved the
name of universities. The Arabs continued the tradition in education
that they found, and established educational institutions which
attracted wide attention. As we have said, the two most famous of these
were at Bagdad and at Cordova. Mostanser, the predecessor of the last
Caliph of the family of the Abbassides, built a handsome palace, in
which the academy of Bagdad was housed. It is still in existence, and
gives an excellent idea of the beneficent interest of this monarch and
of other of the Abbasside rulers in education. Its fate at the present
time is typical of the attitude of the Mohammedans towards education.
Though the building is still standing, the institution of learning is no
longer there. As Hyrtl remarks, it is not ideas that are exchanged in it
now, but articles of commerce. It has become the chief office of the
Turkish customs department in Bagdad.
These institutions of the higher learning, founded by the Arabs, at
first as rather strict imitations of the museums or academies of Egypt
and Asia Minor, gradually changed their character under the Arabs. Their
courses became much more formal, examinations became much more
important. Scholarship was sought not so much for its own sake, as
because it led to positions in the civil service, to the favor of
princes, and, in general, to reputation and pecuniary reward. Formal
testimonials proclaiming education, signed by the academic authorities,
were introduced and came to mean much. Lawyers could not practise
without a license, physicians also required a license. These formalities
were adopted by the Western medieval universities to a considerable
degree and have been perpetuated in the modern time. Undoubtedly they
did much to hamper real education among the Arabs by setting in place of
the satisfaction of learning for its own sake and the commendation of
teachers the formal recognition of a certain amount of work done as
recognized by the educational authorities. There was always a tendency
among the Arabs to formulate and formalize, to over-systematize what
they were at; to think that new knowledge could be obtained simply by
speculating over what was already acquired, and developing it. There are
a number of comparisons between this and later periods of education
that might be suggested if comparisons were not odious.
The influence of Arabian medicine on modern medicine can, perhaps, best
be judged from the number of words in our modern nomenclature, which,
though bearing Latin forms, often with suggestion of Greek origins,
still are not derived from the old Latin or Greek authors, but represent
Arabic terms translated into Latin during the Renaissance period. Hyrtl,
without pretence of quoting them all, gives a list of these which is
surprising in its comprehensiveness. For instance, the mediastinum, the
sutura sagittalis, the scrobiculus cordis, the marsupium cordis, the
chambers of the heart, the velum palati, the trochanter, the rima
glottidis, the fontanelles, the alae of the nose, all have their present
names, not from original Latin expressions, but from the translation of
Arabic terms. For all such words the Greeks and Romans have quite other
expressions, in which the sense of our modern terms is not contained.
This has given rise to many misunderstandings, and to many attempts in
the modern times to return to the classic terminology rather than
preserve what in many cases are the barbarisms introduced through the
Arabic, but it is doubtful whether any comprehensive reform in the
matter can be effected, so strongly entrenched in medical usage have
these terms now become.
Freind, in his "History of Medicine," already cited, calls attention to
the fact that the Arabs had an unfortunate tendency to change by
addition or subtraction of their own views the authors that they
studied, and wished to translate to others. This seems to have been
true even of some of the most distinguished of them. Of course, the idea
of preserving an author's text untouched, and making it clear just where
note and commentary came in, had not yet come to men's view, but quite
apart from this the Arabs apparently often tried to gain acceptance for
their own ideas by having them masquerade as the supposed ideas of
favorite classic authors.
Another unfortunate tendency among the Arabs was their liking for the
discussion of many trivial questions. Hyrtl, in his volume on "Arabian
and Hebrew Words in Anatomy,"[6] declares that it is almost incredible
how earnestly some trivial questions in anatomy and physiology were
discussed by the Arabs. He gives some examples. Why does no hair grow on
the nose of men? Why does the stomach not lie behind the mouth? Why does
the windpipe not lie behind the esophagus? Why are the breasts not on
the abdomen? Why are not the calves on the anterior portion of the legs?
Even such men as Rhazes and Avicenna discuss such questions.
It was this tendency of the Arabs that passed over to the Western
Europeans with Arabian commentaries on philosophy and science, and
brought so many similar discussions in the scholastic period. These
trivialities have usually been supposed to originate with the
scholastics themselves, for they are not to be found in the Greek
authors on whom the scholastics were writing commentaries, but they are
typically Oriental in character, and it must be remembered that during
the twelfth and early thirteenth centuries, at least, Greek philosophy
found its way largely into Europe in Arab versions, and these
characteristically Arabian additions of the discussion of curious
trivial questions came with them and produced an imitative tendency
among the Europeans.
As a rule the more careful has been the study of Arabian writers in the
modern time, particularly by specialists, the clearer has it become that
they lacked nearly all originality. Especially were they faulty in their
observations; besides, they had a definite tendency to replace
observation by theory, a fatal defect in medicine. The fine development
of surgery that came at the end of the Arabian period of medicine in
Europe could never have come from the Arabs themselves. Gurlt has
brought this out particularly, but it will not be difficult to cite many
other good authorities in support of this opinion.
Hyrtl, in his "Thesis on the Rarer Old Anatomists,"[7] says that "the
Arabs paid very little attention to anatomy, and, of course, because of
the prohibition in the Koran, added nothing to it. Whatever they knew
they took from the Greeks, and especially Galen. Not only did they not
add anything new to this, but they even lost sight of much that was
important in the older authors. The Arabs were much more interested in
physiology; they could study this by giving thought to it without
soiling their hands. They delighted in theory, rather than in
observation."
While we thus discuss the lack of originality and the tendency to
over-refinement among the Arabian medical writers, it must not be
thought that we would make little of what they accomplished. They not
only preserved the old medical writers for us, but they kept alive
practical medicine with the principles of the great Greek thinkers as
its basis. There are a large number of writers of Arabian medicine whose
names have secured deservedly a high place in medical history. If this
were a formal history of Arabian medicine, their careers and works would
require discussion. For our purpose, however, it seems better to confine
attention to a few of the most prominent Arabian writers on medicine,
because they will serve to illustrate how thoroughly practical were the
Arabian physicians and how many medical problems that we are prone to
think of as modern they occupied themselves with, solving them not
infrequently nearly as we do in the modern time.
VI
THE MEDICAL SCHOOL AT SALERNO
The Medical School at Salerno, probably organized early in the tenth
century, often spoken of as the darkest of the centuries, and reaching
its highest point of influence at the end of the twelfth century, is of
great interest in modern times for a number of reasons. First it brought
about in the course of its development an organization of medical
education, and an establishment of standards that were to be maintained
whenever and wherever there was a true professional spirit down to our
own time. They insisted on a preliminary education of three years of
college work, on at least four years of medical training, on special
study for specialist's work, as in surgery, and on practical training
with a physician or in a hospital before the student was allowed to
practise for himself. At Salerno, too, the department of women's
diseases was given over to women professors, and we have the text-books
of some of these women medical teachers. The license to practise given
to women, however, seems to have been general and did not confine them
merely to the care of women and children. We have records of a number of
these licenses issued to women in the neighborhood of Salerno. This
subject of feminine medical education at Salerno, because of its special
interest in our time, will have a chapter by itself.
These are the special features of medical education in our own time
that we are rather prone to think of as originating with ourselves and
as being indices of that evolution of humanity and progress in mankind
which are culminating in our era. It is rather interesting, then, to
study just how these developments came about and what the genesis of
this great school was. The books of its professors were widely read, not
only in their own generation but for centuries afterwards. With the
invention of printing at the time of the Renaissance most of them were
printed and exerted profound influence over the revival of medicine
which took place at that time. Salerno became the first of the
universities in the modern sense of the word. Here there gathered round
the medical school, first a preparatory department representing modern
college work, and then departments of theology and law, though this
latter department particularly was never quite successful. The fact that
the first university, that of Salerno, should have been organized round
a medical school, the second, that of Bologna, around a law school, and
the third, that of Paris, around a school of theology and philosophy,
would seem to represent the ordinary natural process of development in
human interests. First man is interested in himself and in his health,
then in his property, and finally in his relations to his fellow-man and
to God.
Though much work has been done on the subject in recent years, it is not
easy to trace the origin of the medical school at Salerno. The
difficulty is emphasized by the fact that even the earliest chroniclers
whose accounts we have were not sure as to its origin, and even had
some doubt about the age of the school. Alphanus, usually designated
Alphanus I because there are several of the name, who is one of the
earliest professors whose name and fame have come down to us, gives us
the only definite detail as to the age of the school. He was a
Benedictine monk, distinguished as a literary man, known both as poet
and physician, who was afterwards raised to the Bishopric of Salerno. As
a bishop he was one of the beneficent patrons, to whom the school owed
much. He lived in the tenth century, and states that medicine flourished
in the town before the time of Guimarus II, who reigned in the ninth
century. In the ancient chronicle of Salerno, re-discovered by De Renzi
and published in his "Collectio Salernitana," it is definitely recorded
that the medical school was founded by four doctors,--a Jewish Rabbi
Elinus, a Greek Pontus, a Saracen Adala, an Arab, and a native of
Salerno, each of whom lectured in his native language. There are many
elements in this tradition, however, that would seem to indicate its
mythical origin and that it was probably invented after the event to
account for the presence of teachers in all these languages and the
coming of students from all over the world. The names, for instance, are
apparently corruptions of real names, as can be readily recognized.
Elinus, the Jew, is probably Elias or Eliseus, Adala is a corruption of
Abdallah, and Pontus, as pointed out by Puschmann in his "History of
Medical Education," should probably be Gario-Pontus.
While we do not know exactly when the medical school at Salerno was
founded, we know that a hospital was established there as early as 820.
It was founded by the Archdeacon Adelmus, and was placed under the
control of the Benedictines after it was realized that a religious
order, by its organization, was best fitted for carrying on such
charitable work continuously. Other infirmaries and charitable
institutions, mainly under control of the religious, sprang up in
Salerno. It was the presence of these hospitals in a salubrious climate
that seems first to have attracted the attention of patients and then of
physicians from all over Europe and even adjacent Africa and Asia.
Puschmann says that it is uncertain whether clinical instruction was
imparted in these institutions or not, but the whole tenor of what we
know about the practical character of the teaching at Salerno and of the
fine development of professional medicine there, would seem to argue
that probably those who came to study medicine here were brought
directly in contact with patients.
As early as the ninth century Salerno was famous for its great
physicians. We know the names of at least two physicians, Joseph and
Joshua, who practised there about the middle of the ninth century.
Ragenifrid, a Lombard by his name, was private physician to Prince
Wyamar of Salerno in the year 900. The fact that he was from North Italy
indicates that already foreigners were being attracted, but more than
this that they were obtaining opportunities unhampered by any
Chauvinism. From early in the tenth century physicians from Salerno were
frequently brought to foreign courts to become the attending physicians
to rulers. Patients of the highest distinction from all over Europe
began to flock to Salerno, and we have the names of many of them. In
the tenth century Bishop Adalberon, when ailing, went there, though he
found no cure for his ills. Abbot Desiderius, however, the great
Benedictine scholar of the time, who afterwards became Pope Victor III,
regained his health at Salerno under the care of the great Constantine
Africanus, who was so much impressed by the gentle kindness and deep
learning and the example of the saintly life of his patient that not
long after he went to Monte Cassino to become a Benedictine under
Desiderius, who was abbot there. Duke Guiscard sent his son Bohemund to
Salerno for the cure of a wound received in battle, which had refused to
heal under the ordinary surgical treatment of the time. William the
Conqueror, early in the eleventh century and while still only the Duke
of Normandy, is said to have passed some time at Salerno for a similar
reason.
The most interesting feature of the medical life at Salerno at this time
is the relations between the clergy and the physicians. In the sketch of
the life of Constantine Africanus, which follows this chapter, there is
some account of the friendship between Abbot Desiderius of Monte Cassino
and Constantine Africanus, and the latter's withdrawal from his
professorship to become a Benedictine. One of the physicians of the
early tenth century who stood high in favor with Prince Gisulf was
raised to the Bishopric of Salerno. This was Alphanus, whom we have
already mentioned as a chronicler, a monk, a poet, a physician, and
finally the Bishop of Salerno.
The best proof of how thorough was the medical education at Salerno and
how much influence it exerted even over public opinion is to be found in
the regulation of the practice of medicine, which soon began, and the
insistence upon proper training before permission to practise medicine
was granted. The medical school at Salerno early came to be a recognized
institution in the kingdom of the Two Sicilies, representing a definite
standard of medical training. It is easy to understand that the
attraction which Salerno possessed for patients soon also brought to the
neighborhood a number of irregular physicians, travelling quacks, and
charlatans. Wealthy patients were coming from all over the world to be
treated at Salerno. Many of them doubtless were sufferers from incurable
diseases and nothing could be done for them. Often they would be quite
unable to return to their homes and would be surely unwilling to give up
all hope if anybody promised them anything of relief. There was a rich
field for the irregular, and of course, as always, he came. Salerno had
already shown what a good standard of medical education should be, and
it is not surprising, then, that the legal authorities in this part of
the country proceeded to the enforcement of legal regulations demanding
the attainment of this standard, in order that unfit and unworthy
physicians might not practise medicine to their own benefit but to the
detriment of the patients.
Accordingly, as early as the year 1140, King Ruggiero (Roger) of the Two
Sicilies promulgated the law: "Whoever from this time forth desires to
practise medicine must present himself before our officials and judges,
and be subject to their decision. Anyone audacious enough to neglect
this shall be punished by imprisonment and confiscation of goods. This
decree has for its object the protection of the subjects of our kingdom
from the dangers arising from the ignorance of practitioners."
Just about a century later the Emperor Frederick II, the Hohenstaufen,
in the year 1240, extended this law, emphasized it, and brought it
particularly into connection with the great medical school of the Two
Sicilies, of which territory he was the ruler. This law has often been
proclaimed as due to his personality rather than to his times,--as
representing his very modern spirit and his progressive way of looking
at things. There is no doubt that certain personal elements for which he
should be given due credit are contained in the law. To understand it
properly, however, one must know the law of King Roger of the preceding
century; and then it is easy to appreciate that Frederick's regulation
is only such a development of the governmental attitude toward medical
practice as might have been expected during the century since Roger's
time. It has sometimes been suggested that this law made by the Emperor
Frederick, who was so constantly in bitter opposition to the Papacy, was
issued in despite of the Church authorities and represents a policy very
different from any which they would have encouraged. The early history
of Salerno, even briefly as we have given it, completely contradicts any
such idea. The history of medical regulation at the beginning of the
next century down at Montpellier moreover, where the civil authorities
being weak the legal ordering of the practice of medicine was
effectively taken up by the Church, and the authority for the issuance
of licenses to practise was in the hands of the bishops of the
neighborhood, shows clearly that it is not because of any knowledge of
the real medical history of the times that such remarks are made, but
from a set purpose to discredit the Church.
The Emperor Frederick's law deserves profound respect and consideration
because of the place that it holds in the legal regulation of the
practice of medicine. Anyone who thinks that evolution must have brought
us in seven centuries much farther in this matter than were the people
of the later Middle Ages should read this law attentively. Everyone who
is interested in medical education should have a copy of it near him,
because it will have a chastening effect in demonstrating not only how
little we have done in the modern time rather than how much, but above
all how much of decadence there was during many periods of the interval.
The law may be found in the original in "The Popes and Science" (Fordham
University Press, N.Y., 1908). Three years of preliminary university
education before the study of medicine might be taken up, four years of
medical studies proper before a degree was given, a year of practice
with a regularly licensed physician before a license to practise could
be obtained, a special course in anatomy if surgery were to be
practised; all this represents an ideal we are striving after at the
present time in medical education. Besides this, Frederick's law also
regulates medical fees, requires gratuitous attendance on the poor for
the privilege of practice accorded by the license, though the general
fees are of a thoroughly professional character and represent for each
visit of the physician about the amount of daily wage that the ordinary
laborer of that time earned. Curiously enough, this same ratio of
emolument has maintained itself. This law was also a pure drug law,
regulating the practice of pharmacy, and the price as well as the purity
of drugs, and the relations of physicians, druggists, and the royal drug
inspectors whose business it was to see that only proper drugs were
prepared and sold.
All this is so much more advanced than we could possibly have imagined,
only that the actual documents are in our possession, that most people
refuse to let themselves be persuaded in spite of the law that it could
have meant very much. Especially as regards medical education are they
dubious as to conditions at this time. To them it seems that it can make
very little difference how much time was required for medical study or
for studies preliminary to medicine, since there was so little to be
learned. The age was ignorant, men knew but little, and so very little
could be imparted no matter how much time was taken.
This is, I fear, a common impression, but an utterly false one. The
preliminary training that is the undergraduate work at the universities
consisted of the Seven Liberal Arts--the trivium and quadrivium, which
embraced logic, rhetoric, grammar, metaphysics, under which was included
not a little of physics, cosmology in which some biology was studied, as
well as psychology and mathematics, astronomy, and music. This was a
thoroughly rounded course in intellectual training. No wonder that
Professor Huxley said in his Inaugural Address as Rector of Aberdeen, "I
doubt if the curriculum of any modern university shows so clear and
generous a comprehension of what is meant by culture as this old trivium
and quadrivium does." There is no doubt at all about the value of the
undergraduate training, nor of the scholarship of the men who were
turned out under the system, nor of their ability to concentrate their
minds on difficult subjects--a faculty that we strive to cultivate in
our time and do not always congratulate ourselves on securing to the
degree, at least, that we would like.