the middle of the thirteenth century shows us the high standard of
medical education. Students were required to have three years of
preliminary study at the university, four years in the medical
department, and then practise for a year with a physician before they
were allowed to practise for themselves. If they wanted to practise
surgery, an extra year in the study of anatomy was required. I published
the text of this law, which was issued by the Emperor Frederick II about
1241, in the _Journal of the American Medical Association_ three years
ago. It also regulated the practice of pharmacy. Drugs were manufactured
under the inspection of the government and there was a heavy penalty for
substitution, or for the sale of old inert drugs, or improperly prepared
pharmaceutical materials. If the government inspector violated his
obligations as to the oversight of drug preparations the penalty was
death. Nor was this law of the Emperor Frederick an exception. We have
the charters of a number of medical schools issued by the Popes during
the next century, all of which require seven years or more of university
study, four of them in the medical department, before the doctor's
degree could be obtained. When new medical schools were founded they had
to have professors from certain well-recognized schools on their staff
at the beginning in order to assure proper standards of teaching, and
all examinations were conducted under oath-bound secrecy and with the
heaviest obligations on professors to be assured of the knowledge of
students before allowing them to pass.
It might be easy to think, and many people are prone to do so, that in
spite of the long years of study required there was really very little
to study in medicine at that time. Those who think so should read
Professor Clifford Allbutt's address on the "Historical Relations of
Medicine and Surgery" delivered at the World's Fair at St. Louis in
1904. He has dwelt more on surgery than on medicine, but he makes it
very clear that he considers that the thinking professors of medicine of
the later Middle Ages were doing quite as serious work in their way as
any that has been done since. They were carefully studying cases and
writing case histories, they were teaching at the bedside, they were
making valuable observations, and they were using the means at their
command to the best advantage. Of course there are many absurdities in
their therapeutics, but then we must not forget there have always been
many absurdities in therapeutics and that we are not free from them in
our day. Professor Richet, at the University of Paris, said not long
ago: "The therapeutics of any generation is quite absurd to the second
succeeding generation." We shall not blame the medieval generations for
having accepted remedies that afterwards proved inert, for every
generation has done that, even our own.
Their study of medicine was not without lasting accomplishment, however.
They laid down the indications and the dosage for opium. They used iron
with success, they tried out many of the bitter tonics among the herbal
medicines, and they used laxatives and purgatives to good advantage.
Down at Montpellier, Gilbert, the Englishman, suggested red light for
smallpox because it shortened the fever, lessened the lesions, and made
the disfigurement much less. Finsen was given the Nobel prize partly for
re-discovery of this. They segregated erysipelas and so prevented its
spread. They recognized the contagiousness of leprosy, and though it was
probably as widespread as tuberculosis is at the present time, they
succeeded not only in controlling but in eventually obliterating it
throughout Europe.
It was in surgery, however, that the greatest triumphs of teaching of
the medieval universities were secured. Most people are inclined to
think that surgery developed only in our day. The great surgeons of the
thirteenth and fourteenth centuries, however, anticipated most of our
teaching. They investigated the causes of the failure of healing by
first intention, recognized the danger of wounds of the neck,
differentiated the venereal diseases, described rabies, and knew much of
blood poisoning, and operated very skilfully. We have their text-books
of surgery and they are a never-ending source of surprise. They operated
on the brain, on the thorax, on the abdominal cavity, and did not
hesitate to do most of the operations that modern surgeons do. They
operated for hernia by the radical cure, though Mondeville suggested
that more people were operated on for hernia for the benefit of the
doctor's pocket than for the benefit of the patient. Guy de Chauliac
declared that in wounds of the intestines patients would die unless the
intestinal lacerations were sewed up, and he described the method of
suture and invented a needle holder. We have many wonderful instruments
from these early days preserved in pictures at least, that show us how
much modern advance is merely re-invention.
They understood the principles of aseptic surgery very well. They
declared that it was not necessary "that pus should be generated in
wounds." Professor Clifford Allbutt says:
They washed the wound with wine, scrupulously removing every
foreign particle; then they brought the edges together, not
allowing wine or anything else to remain within--dry adhesive
surfaces were their desire. Nature, they said, produces the
means of union in a viscous exudation, or natural balm, as it
was afterwards called by Paracelsus, Pare, and Wurtz. In older
wounds they did their best to obtain union by cleansing,
desiccation, and refreshing of the edges. Upon the outer
surface they laid only lint steeped in wine. Powders they
regarded as too desiccating, for powder shuts in decomposing
matters; wine after washing, purifying, and drying the raw
surfaces evaporates.
Almost needless to say these are exactly the principles of aseptic
surgery. The wine was the best antiseptic that they could use and we
still use alcohol in certain cases. It would seem to many quite
impossible that such operations as are described could have been done
without anaesthetics, but they were not done without anaesthetics. There
were two or three different forms of anaesthesia used during the
thirteenth and fourteenth centuries. One method employed by Ugo da Lucca
consisted of the use of an inhalant. We do not know what the material
employed was. There are definite records, however, of its rather
frequent employment.
What a different picture of science at the medieval universities all
this makes from what we have been accustomed to hear and read with
regard to them. It is difficult to understand where the old false
impressions came from. The picture of university work that recent
historical research has given us shows us professors and students busy
with science in every department, making magnificent advances, many of
which were afterwards forgotten, or at least allowed to lapse into
desuetude.
The positive assertions with regard to old-time ignorance were all made
in the course of religious controversy. In English-speaking countries
particularly it became a definite purpose to represent the old Church as
very much opposed to education of all kinds and above all to scientific
education. There is not a trace of that to be found anywhere, but there
were many documents that were appealed to to confirm the protestant
view. There was a Papal bull, for instance, said to forbid dissection.
When read it proves to forbid the cutting up of bodies to carry them to
a distance for burial, an abuse which caused the spread of disease, and
was properly prohibited. The Church prohibition was international and
therefore effective. At the time the bull was issued there were twenty
medical schools doing dissection in Italy and they continued to practise
it quite undisturbed during succeeding centuries. The Papal physicians
were among the greatest dissectors. Dissections were done at Rome and
the cardinals attended them. Bologna at the height of its fame was in
the Papal States. All this has been ignored and the supposed bull
against anatomy emphasized as representing the keynote of medical and
surgical history. Then there was a Papal decree forbidding the making of
gold and silver. This was said to forbid chemistry or alchemy and so
prevent scientific progress. The history of the medical schools of the
time shows that it did no such thing. The great alchemists of the time
doing really scientific work were all clergymen, many of them very
prominent ecclesiastics.
Just in the same way there were said to be decrees of the Church
councils forbidding the practice of surgery. President White says in his
"Warfare of Science with Theology in Christendom," that, as a
consequence of these, surgery was in dishonor until the Emperor
Wenceslaus, at the beginning of the fifteenth century, ordered that it
should be restored to estimation. As a matter of fact, during the two
centuries immediately preceding the first years of the fifteenth
century, surgery developed very wonderfully, and we have probably the
most successful period in all the history of surgery except possibly our
own. The decrees forbade monks to practise surgery because it led to
certain abuses. Those who found these decrees and wanted to believe
that they prevented all surgical development simply quoted them and
assumed there was no surgery. The history of surgery at this time is one
of the most wonderful chapters in human progress.
The more we know of the Middle Ages the more do we realize how much they
accomplished in every department of intellectual effort. Their
development of the arts and crafts has never been equalled in the modern
time. They made very great literature, marvellous architecture,
sculpture that rivals the Greeks', painting that is still the model for
our artists, surpassing illuminations; everything that they touched
became so beautiful as to be a model for all the after time. They
accomplished as much in education as they did in all the other arts,
their universities had more students than any that have existed down to
our own time, and they were enthusiastic students and their professors
were ardent teachers, writers, observers, investigators. While we have
been accustomed to think of them as neglecting science, their minds were
occupied entirely with science. They succeeded in anticipating much more
of our modern thought, and even scientific progress, than we have had
any idea until comparatively recent years. The work of the later Middle
Ages in mathematics is particularly strong, and was the incentive for
many succeeding generations. Roger Bacon insisted that, without
mathematics, there was no possibility of real advance in physical
science. They had the right ideas in every way. While they were occupied
more with the philosophical and ethical sciences than we are, these were
never pursued to the neglect of the physical sciences in the strictest
sense of that term.
Is it not time that we should drop the foolish notions that are very
commonly held because we know nothing about the Middle Ages--and,
therefore, the more easily assume great knowledge--and get back to
appreciate the really marvellous details of educational and scientific
development which are so interesting and of so much significance at this
time?
APPENDIX III
MEDIEVAL POPULARIZATION OF SCIENCE
The idea of collecting general information from many sources, of
bringing it together into an easily available form, so as to save others
labor, of writing it out in compendious fashion, so that it could
readily pass from hand to hand, is likely to be considered typically
modern. As a matter of fact, the Middle Ages furnish us with many
examples of the popularization of science, of the writing of compendia
of various kinds, of the gathering of information to save others the
trouble, and, above all, of the making of what, in the modern time, we
would call encyclopedias. Handbooks of various kinds were issued,
manuals for students and specialists, and many men of broad scholarship
in their time devoted themselves to the task of making the acquisition
of knowledge easy for others. This was true not only for history and
philosophy and literature, but also for science. It is not hard to find
in each century of the Middle Ages some distinguished writer who devoted
himself to this purpose, and for the sake of the light that it throws on
these scholars, and the desire for information that must have existed
very commonly since they were tempted to do the work, it seems worth
while to mention here their names, and those of the books they wrote,
with something of their significance, though the space will not permit
us to give here much more than a brief _catalogue raisonne_ of such
works.
Very probably the first who should be mentioned in the list is Boethius,
who flourished in the early part of the sixth century. He owed much of
his education to his adoptive father, afterwards his father-in-law,
Symmachus, who, with Festus, represented scholarship at the court of the
Gothic King, Theodoric of Verona. These three--Festus, Symmachus, and
Boethius--brought such a reputation for knowledge to the court that they
are responsible for many of the wonderful legends of Dietrich of Bern,
as Theodoric came to be called in the poems of the medieval German
poets. The three distinguished and devoted scholars did much to save
Greek culture at a time when its extinction was threatened, and Boethius
particularly left a series of writings that are truly encyclopedic in
character. There are five books on music, two on arithmetic, one on
geometry, translations of Aristotle's treatises on logic, with
commentaries; of Porphyry's "Isagoge," with commentaries, and a
commentary on Cicero's "Topica." Besides, he wrote several treatises in
logic and rhetoric himself, one on the use of the syllogism, and one on
topics, and in addition a series of theological works. His great
"Consolations of Philosophy" was probably the most read book in the
early Middle Ages. It was translated into Anglo-Saxon by King Alfred,
into old German by Notker Teutonicus, the German monk of St. Gall, and
its influence may be traced in Beowulf, in Chaucer, in High German
poetry, in Anglo-Norman and Provencal popular poetry, and also in early
Italian verse. Above all, the "Divine Comedy" has many references to it,
while the "Convito" would seem to show that it was probably the book
that most influenced Dante. Though it is impossible to confirm by
documentary evidence the generally accepted idea that Boethius died a
martyr for Christianity, the tradition can be traced so far back, and it
has been so generally accepted that this seems surely to have been the
case. The fact is interesting, as showing the attitude of scholars
towards the Church and of the Church towards scholarship thus early.
The next great name in the tradition should probably be that of
Cassiodorus, the Roman writer and statesman, prime minister of
Theodoric, who, after a busy political life, retired to his estate at
Vivarium, and, in imitation of St. Benedict, who had recently
established a monastery at Monte Cassino, founded a monastery there. He
is said to have lived to the age of ninety-three. His retirement favored
this long life, for, after the death of Theodoric, troublous times came,
and civil war, and only his monastic privileges saved him from the storm
and stress of the times. He had been interested in literature and the
collection of information of many kinds before his retirement, and it is
not unlikely that his recognition of the fact that the monastic life
offered opportunities for the pursuit of this, under favorable
circumstances, led him to take it up.
While still a statesman he wrote a series of works relating to history
and politics and public affairs generally. These consisted mainly of
chronicles and panegyrics, and twelve books of miscellanies called
Variae. After his retirement to the monastery, a period of ardent
devotion to writing begins, and a great number of books were issued. He
evidently gathered round him a number of men whom he inspired with his
spirit, or, perhaps, selected, because he found that, while they had a
taste for a quiet, peaceful spiritual life, they were also devoted to
the accumulation and diffusion of knowledge. A series of commentaries on
portions of the Scriptures was written, the Jewish antiquities of
Josephus translated, and the ecclesiastical histories of Theodoric,
Sozomen, and Socrates made available in Latin. Cassiodorus himself is
said to have made a compendium of these, called the "Historia
Tripartita," which was much used as a manual of history during
succeeding centuries. Then there were treatises on grammar, on
orthography, and a series of works on mathematics. In all of his
writings Cassiodorus shows a special fondness for the symbolism of
numbers.
There is a well-grounded tradition that he insisted on the study of the
Greek classics of medical literature, especially Hippocrates and Galen,
and awakened the interest of the monks in the necessity for making
copies of these fathers of medicine. The tradition that he established
at Vivarium is also found to have existed at Monte Cassino among the
Benedictines, and, doubtless, to this is to be attributed the foundation
of the medical school of Salerno, where Benedictine influence was so
strong. It is probable, therefore, that to Cassiodorus must be
attributed the preservation in as perfect a state as we have them of the
old Greek medical writers.
His main idea was, of course, the study of Scriptures, but with just as
many helps as possible. He thought that commentators, and historians,
not alone Christian, but also Hebrew and Pagan, should be studied to
illustrate it, and then the commentaries of the Latin fathers, so that a
thoroughly rounded knowledge of it should be obtained. He thus began an
"Encyclopedia Biblica," and set a host of workers at its accomplishment.
Every country in Europe shared this movement for the diffusion of
information during the early Middle Ages, and the works of men from each
of these countries in succeeding centuries has come down to us,
preserved in spite of all the vicissitudes to which they were so liable
during the centuries before the invention of printing and the easy
multiplication of books. To many people it will seem surprising to learn
that the next evidence of deep broad interest in knowledge is to be
found in the next century in the distant west of Europe, in the Spanish
Peninsula. It is a long step from the semi-barbaric splendor of the
Gothic court at Verona, to the bishop's palace in Seville in Andalusia.
The two cities are separated by what is no inconsiderable distance in
our day. In the seventh century they must have seemed almost at the
other end of the world from each other. Those who recall what we have
insisted on in several portions of the body of this work with regard to
the high place Spanish genius won for itself in the Roman Empire, and
how much of culture among the Spaniards of that time the occurrence of
so many important writers of that nationality must imply, will not be
surprised at the distinguished work of a great Christian Spanish writer
of the seventh century.
Indeed, it would be only what might be expected for evidences of early
awakening of the broadest culture to be found in Spain. The important
name in the popularization of science in the seventh century is St.
Isidore of Seville. He made a compendium of all the scattered scientific
traditions and information of his time with regard to natural phenomena
in a sort of encyclopedia of science. This consisted of twenty
books--chapters we would call them now--treating almost _de omni re
scibili et quibusdam aliis_ (everything knowable and a few other things
besides). It is possible that the work may have been written by a number
of collaborators under the patronage of the bishop, though there is no
sure indication of this to be found either in the volume itself or even
contemporary history. All the ordinary scientific subjects are treated.
Astronomy, geography, mineralogy, botany, and even man and the animals
have each a special chapter. Pouchet, in his "History of the Natural
Sciences During the Middle Ages," calls attention to the fact that, in
grouping the animals for collective treatment in the different chapters,
sometimes the most heterogeneous creatures are brought under a common
heading. Among the fishes, for instance, are classed all living things
that are found in water. The whale and the dolphin, as well as sponges,
and oysters, and crocodiles, and sea serpents, and lobsters, and
hippopotamuses, all find a place together, because of the common watery
habitation. The early Spanish Churchman would seem to have had an
enthusiastic zeal for complete classification that would surely have
made him a strenuous modern zooelogist.
The next link in the tradition of encyclopedic work is the Venerable
Bede, whose character was more fully honored by the decree on November
13, 1899, by Pope Leo XIII declaring him a Doctor of the Church. Bede
was the fruit of that ardent scholarship which had risen in England as a
consequence of the introduction of Christianity. It had been fostered by
the coming of scholar saints from Ireland, but was, unfortunately,
disturbed by the incursions of the Danes. While Bede is known for his
greatest work, the "Ecclesiastical History of the English People," which
gives an account of Christianity in England from its beginning until his
own day, he wrote many other works. His history is the foundation of all
our knowledge of early British history, secular as well as religious,
and has been praised by historical writers of all ages, who turned to it
for help with confidence. He wrote a number of other historical works.
Besides, he wrote books on grammar, orthography, the metrical art, on
rhetoric, on the nature of things, the seasons, and on the calculation
of the seasons. These latter books are distinctly scientific. His
contributions to Gregorian Music are now of great value.
After this, Alcuin and the monks, summoned by Charlemagne, take up the
tradition of gathering and diffusing information, and the great
monasteries of Tours, Fulda, and St. Gall carry it on. Besides these,
in the ninth century Monte Cassino comes into prominence as an
institution where much was done of what we would now call encyclopedic
work. After his retirement from Salerno Constantine Africanus made his
translations and commentaries on Arabian medicine, constituting what was
really a medical encyclopedia of information not readily available at
that time.
After this, of course, the tradition is taken up by the universities,
and it is only when, with the thirteenth century, there came the
complete development of the university spirit, that encyclopedias
reached their modern expression. Three great encyclopedists, Vincent of
Beauvais, Thomas of Cantimprato, and Bartholomaeus Anglicus, are the most
famous. Vincent consulted all the authors sacred and profane that he
could lay hold on, and the number was, indeed, prodigious. I have given
some account of him in "The Thirteenth Greatest of Centuries" (Catholic
Summer School Press, New York, third edition, 1910).