what a general alteration and reformation in all branches of study, as
well as in the general intellectual life of the people, the founding
of the universities accomplished. For the greater part designed for
the confirmation of the faith, they often brought about a reaction
against it. Like the other integral portions of the university, the
medical departments of nearly all the mediæval institutions came into
existence through voluntary associations of physicians and would-be
teachers. For a long time medicine was included under the general head
of philosophy, whose standard-bearers were Aristotle and the Arabians.
At Tübingen, in 1481, the medical student's days were divided about as
follows: In the morning he studied Galen's _Ars Medici_, and in the
afternoon Avicenna on _Fever_. During the second year, in the forenoon
he studied Avicenna's _Anatomy and Physiology_, and in the afternoon
the ninth book of Rhazes on _Local Pathology_. The forenoons of his
third year were spent with the _Aphorisms_ of Hippocrates, and in the
afternoon he studied Galen. If any text-book on surgery at all were
used it was usually that of Avicenna. Some time was also given to
the writings of some of the other Arabian physicians. At that time
any man who had studied medicine for three years and attained the age
of twenty-one might assume the rôle of teacher if he saw fit, being
compelled only, at first, to lecture upon the preparatory branches. He
was at that time called a _baccalaureus_. After three years' further
study he became a _magister_ or _doctor_, although for the latter
title a still further course of study was usually prescribed. The
courses of medical instruction were quite stereotyped in form, and were
carefully watched over by the Church. Nevertheless, it came about that
the study of medicine once more was taken up by thinkers, although,
unfortunately, not logical thinkers, whereas previously it had been
almost entirely confined within the ranks of the clerics or clergy.
The most celebrated of all these mediæval philosophers in science and
medicine was Albert von Bollstaedt, usually known as Albertus Magnus,
who died in 1280. His works which remain to us fill twenty-one quarto
volumes, in which he discussed both anatomical and physiological
questions. It is exceedingly illustrative of the foolishly speculative
vein in which many of these discussions were carried on, that they
seriously discussed such questions as whether the removal of the rib
from Adam's side, out of which Eve was formed, really caused Adam
severe pain, and whether at the judgment day that loss of rib would be
compensated by the insertion of another. Those were the days, also,
when it was seriously discussed whether Adam or Eve ever had a navel.
In spite of such follies, however, Albertus Magnus left an impression
upon scholarship in science, in a general way, which long outlasted him.
These were the days when the students organized themselves into
so-called "nations," whence arose that conspicuous features of
German university life of today of so-called students' Corps.
These nations--each composed, for the main part, of men of one
nationality--had their own meeting-places, their own property, etc. One
of the principal means of instruction in those days was disputations,
or, as we would say, debates, held between students, often of different
nations, in which they were expected to prove their knowledge and
mental alertness. When it is recalled that universities were larger--i.
e., better attended--in those days than now, it will be seen to what
an extent these nations were developed. Oxford, in 1340, is said to
have had no less than 14,000 students; Paris about the same time had
12,000; and Bologna had some 10,000 students, the majority of whom were
studying law.
The title of doctor came into vogue about the twelfth century. At
first it was confined to teachers proper, and was bestowed upon the
learned--i. e., those who had almost solely studied internal medicine,
and who were required to take an oath to maintain the methods which
had been taught them. For the title of doctor certain fees were
paid, partly in money and partly in merchandise. The so-called
presents consisted of gloves, clothes, hats, caps, etc. At Salernum
it cost about $60 to graduate in this way, while at Paris the cost
was sometimes as high as $1,000, and this at a time when money had
much more purchasing value than it has to-day. It was then, as now, a
peculiar feature of the English universities that but little systematic
instruction in medical science was given. Just as the majority of
English students at present study in London rather than at one of
the great universities, so in those days did they go to Paris or
Montpellier.
This will be perhaps as good a place as any to emphasize the fact that
the clergy, having so long monopolized all learning and teaching, and
having, at the same time, an abhorrence for the shedding of blood,
which indeed had been prohibited by many papal bulls and royal edicts,
permitted the practice of the operative part of medicine--i. e.,
surgery--to fall into the hands of the most illiterate and incompetent
men. Inasmuch as the Church prohibited the wearing of beards, and
as many of the religious orders also shaved their heads, there were
attached to every monastery and to every religious order a number of
barbers, whose duty was to take care of the clergy in these respects.
Thus into their hands was gradually committed the performance of any
minor operation which involved the letting of blood, and from this,
as a beginning, it came about that no really educated man concerned
himself with the operations of surgery, but left them entirely to the
illiterate servants of the Church. This is really the reason that the
barbers for many centuries did nearly all the surgery, and why, at the
same time, surgery fell into such general and wide-spread disrepute.
From this it was only revived about one hundred years ago. Did time
permit, this would be a most appropriate place to digress from the
subject of this paper and rehearse to you the various stages in the
evolution of the surgeon from the barber; but time does not permit
it, and it constitutes a chapter in history by itself, which must be
relegated to some other occasion. (See p. 296).
It was about the beginning of the fifteenth century that the better
class of physicians began to belong to the laity, and were called
"physici" in contrast to the "clerici." Later they were known as
"doctores." Until the fourteenth century most of them studied in
Italian or French universities, the Germans even being compelled to
go to these foreign institutions. In Paris they were required to take
an oath that they would not join the surgeons. This regulation was
founded as much upon spite and envy as upon any other motive. Many
of the clerical physicians belonged to the lower class, and were so
ignorant that even the Church itself was forced to declare many of
their successes miracles. Although monks and the clergy in general
had been frequently forbidden to practice medicine, the decrees to
this effect were quite generally disregarded, except in the matter of
surgical operations. In the ranks of the higher clergy it must be
said that well-educated physicians were occasionally found. There is,
for instance, the record of a certain bishop of Basel, who was deputed
to seek from Pope Clement V. an archbishopric for another person, but
finding the Pope seriously ill, cured him, and received for himself in
return the electorate of Mayence, which was perhaps one of the largest
honorariums ever given to a physician.
These were the days when magic, mingled with mystery, played no small
rôle in the practice of medicine, and when disgusting and curious
remedies were quite in vogue. Superstition and ignorance everywhere
played a most prominent part. For instance, it was, in those days, an
excellent remedy to creep under the coffin of a saint. When a person
was poisoned it was considered wise to hang him up by the feet and
perhaps to gouge out one of his eyes, in order that the poison might
run out. It should be noted that putting out the eyes was frightfully
common in the Middle Ages, mainly as a matter of punishment. It
is said, for instance, that the Emperor Basil II. on one occasion
put out the eyes of 15,000 Bulgarians, leaving one eye to one of
every thousand, in order that he might lead his more unfortunate
fellow-sufferers back to their ruler, who, it is said, at the sight of
this outrage swooned and died in two days. It is said, too, that this
is the reason why the Emperor Albrecht was one-eyed.
What the revival of learning could thus and did accomplish under
these conditions as above portrayed may be readily appreciated. The
restoration of Greek literature, the revival of anatomy, the habit
of independent observation--all told materially in this renaissance
of medicine. The Italian universities became the objective point of
all who desired a thorough medical education. The students chose the
lecturers and officers of the university and had a large voice in
the construction of the curriculum. The officers of their selection
negotiated with those of the State, at least until the close of the
sixteenth century.
In spite of this general renaissance of medical learning and the
impetus felt by the inspired few during the sixteenth century, it
must be said that the general condition of medical science and of
those who practised it was not greatly improved. The superstition of
the common people and the timidity and indolence of all concerned
were about as marked as they have ever been in the history of human
error, and the practice of medicine was at least a century behind the
applied knowledge of the other arts and sciences. At that time the best
physicians and doctors were to be found in the Italian universities,
the French coming next, and, last of all, the German. The Italian
universities were the Mecca sought by those who desired the best
education of the day, and of all the Italian medical faculties those of
Bologna, Pisa, and Padua ranked highest.
Those were the days, also, of the travelling scholars--a very marked
feature of mediæval life. They migrated from one of the Latin
schools to another, and from one famous teacher to another, sometimes
travelling alone, at other times in groups or bands, and practising
often the worst barbarities while _en route_, supporting themselves by
begging and stealing. On their marches they stole almost everything
which was not tightly fastened down, and prepared their food even in
the open fields. The result was that most of them fell into dissolute
habits of life. A somewhat better class of vagrant students sang hymns
before doors and received food as pay. Some earned money singing in the
churches. They apparently both drank more beer and at less cost than at
present. At that time the cost of beer was about one cent for a large
glass.
The younger students were called "schutzen," and, like apprentices
in trades, were obliged to perform the most menial duties. The older
students were known as the "bacchanten," and each bacchant was honored
in proportion to the number of "schutzen" who waited upon him. When,
however, this bacchant himself reached the university he was compelled
to lay aside his rough clothing and rude manners and take an oath to
behave himself.
Not only the students, however, wandered from place to place, but even
the professors of the sixteenth century were nomadic, wandering from
one university to another; for example, Vesalius, the great teacher of
anatomy, taught in Padua, in Pisa, in Louvain, in Basel, in Augsburg,
and in Spain. These habits may be partly accounted for by the fact
that the students elected at least some of their teachers, and the
professors who failed of re-election certainly may be considered to
have had a motive for moving on. Salaries were certainly not large in
those days. Melanchthon, the great theologian, received during his
first eight years a salary of $43 per annum, and by strict economy was
able during this period to buy his wife a new dress. During his later
years his salary attained the sum of $170, which would be equivalent
to $750 to-day. When Vesalius died his salary was $1,000 per annum,
to which certain fees were added. It is not strange, therefore, that
many of the professors pursued reputable occupations during their odd
hours or that they took students to board. We hear to-day of frequent
illustrations of the pursuit of knowledge under difficulty, but
certainly during the ages to which I have referred the ardent student,
were he undergraduate or professor, put up with an amount of hardship,
meagre fare, and trouble of all kinds which would stagger most of the
young men of to-day.
Men were human then as now, and the universities were not above
disputes and quarrels, which sometimes became very bitter and
dishonorable, but were the indirect instrument of good, since they led
in not a few instances to the founding of other universities. Thus,
about the beginning of the sixteenth century, Pistorius and Pollich
were both teachers in Leipzig, but holding antagonistic views regarding
the nature of syphilis, became so embittered that they could not bear
each other's presence, and each resolved to seek another home. The
former influenced the elector to select Frankfort-on-the-Oder as the
site of a new university, while the latter was the means of founding
another at Wittenberg.
It is pretty hard to keep away from the relation of the barber to the
anatomist and surgeon when discussing this subject. In another place
I have dealt with the evolution of the surgeon from the barber, (See
page 296) and have endeavored to show that the principal factor which
operated to keep back the progress of surgery during the eighteen
centuries previous to the last was the influence of the Church, which
opposed the study of anatomy and degraded the practice of surgery. In
the times to which I am referring now, an operation which caused the
shedding of blood was considered beneath the dignity of an educated
physician, and, in some circles, was regarded even as disreputable.
It was, therefore, left to the only class of men who were supposed to
know how to handle a knife or sharp instrument, i. e., the barbers.
When operations were done in universities papal indulgences were often
required, and these cost money, since in those days the Pope gave
nothing for nothing. Public dissection required also papal indulgences,
although in Strasburg, in 1517, permission to dissect the body of an
executed criminal was granted by the magistrates in spite of papal
prohibition.
The ceremonies attending demonstrations of this kind were both
fantastic and amusing. A corpse was ordinarily regarded as
disreputable, and had first to be made reputable by reading a decree
to that effect from the chief magistrate or lord of the land, and
then, by order of the University, stamping the body with the seal of
the corporation. It was carried upon the cover of the box in which
it had been transported into the anatomical hall, which cover, upon
which it rested through the ceremonies, was taken back afterward to
the executioner, who remained at some distance with his vehicle. If
the corpse was that of one who had been beheaded, the head during the
performance of these solemn ceremonies lay between its legs. After the
completion of the ceremonies the occasion was graced with music by
the city fifers, trumpeters, etc., or an entertainment was given by
itinerant actors (Baas).
In time, however, this folly was given up, and by the latter half of
the sixteenth century public anatomical theatres were established. The
most celebrated was built by Fabricus ab Aquapendente, in Padua. It was
so high, however, and so dark that dissections even in broad daylight
could only be made visible by torchlight.
The zeal with which gradually the better class of physicians pursued
their scientific studies became more and more conspicuous, evidenced
in many ways by the hardships with which some of them had to deal, as
witness the struggles of many of the great anatomists of those days.
And so in time the clergy disappeared almost entirely from the ranks
of public physicians, and after the Thirty Years' War completely lost
their supremacy even in literary matters, this being gradually usurped
by the nobility and the more educated laymen; but even then knowledge
was pursued under difficulties, especially the study of anatomy. It
was not until 1658 that a mounted skeleton could be found in Vienna.
Strasburg obtained one in 1671. The handling of the dead body, which we
regard as so necessary, was in those days avoided as much as possible.
The professor of anatomy rarely, if ever, touched it himself, but he
lectured or read a lecture while the actual dissection was done with a
razor by a barber, under his supervision.
Practical instruction in obstetrics, which would seem almost as
important as that in anatomy, was not given in those days; male
students only studied it theoretically. In the Hôtel Dieu, in Paris,
that part which was devoted to instruction in midwifery was closed
against men. It was the midwives in those days who enjoyed the
monopoly of this teaching, and upon whom the greatest dependence for
obstetrical ability was placed. The physicians proper, or _medici
puri_ of the seventeenth century, were individuals of greatest dignity
and profoundest gravity, who wore fur-trimmed robes, perukes, and
carried swords, who considered it beneath them to do anything more
than write prescriptions in the old Galenic fashion. Some continuation
of this is seen in the distinction made even to-day in England
between the physicians who enjoy the title of doctor and the surgeons
who affect to disdain it. These old physicians knowing nothing of
surgery, nevertheless demanded to be always consulted in surgical
cases, claiming that only by this course could things go right. Still
when elements of danger were introduced, as in treating the plague,
they were glad enough to send the barber surgeons into the presence
of the sick, whom they merely inspected through panes of glass. Very
entertaining pictures could be furnished you illustrating the habits
of the physicians of two or three hundred years ago in dealing with
these contagious cases. The masks and armor which they wore and the
precautions which they took would seem to indicate protection rather
against the weapons of mediæval warfare. At one time they were advised
that if they must go into actual contact with these patients they
should first repeat the Twenty-second Psalm. You may find in the old
books, if you will hunt for them, curious pictures illustrating the
precautions taken a few hundred years ago against the pestilence, of
whose nature they knew nothing, and seeing them you may imagine the
vague dread and even the abject fear which led the _physici puri_
or physicians to send the barbers in to minister to plague-stricken
patients, while they contented themselves with ministering at long
range to their needs.
But gentlemen, I fear lest I weary you with a longer rehearsal of
mediæval customs and student follies. While they have all passed away
some of them have survived either in tradition or in modified form, as
will surely have occurred to you while they were rehearsed. You will
not fail to note the steady progress of an ethical evolution which has
toned down the barbarities and the asperities of the past, and which
has substituted a far more ennobling life-purpose and method of its
accomplishment than seemed to actuate your predecessors of long ago.
It is small wonder that the students of those days bore an ill-repute
with their surrounding neighbors. You may see better now, perhaps, why
the medical student even of to-day has to contend with a prejudice
against both his calling and himself, a prejudice begotten of the many
debaucheries and misdeeds of his predecessors, and, I am sorry to say,
even certain excesses of to-day. I do not know how I may more fittingly
terminate these remarks than by reminding you that the profession
which you students hope to enter has suffered most seriously in time
past from the character of the men who have entered it, and that even
to-day certain of its members fail to have a proper regard for its
dignity. It is axiomatic that those slights and indignities from which
we often suffer, and the neglect and indifference of which we often
complain, are in effect the result of our own shortcomings, and that
we are ourselves largely to blame because of that which does not suit
us. I beg you then to remember that even at the outset of student life
there should be ever before you such an ideal of intellectual force and
dignity, of power, of co-ordination of mind and body, as may keep you
ever in the right way, so that when you at last attain your goal you
may deserve that sort of benediction which I find in one of Beaumont
and Fletcher's plays (_Custom of the Country_, v. iv.):
"So may you ever
Be styled the 'Hands of Heaven,' Nature's restorers;
Get wealth and honors, and, by your success
In all your undertakings, propagate
A great opinion in the world."
IX
A STUDY OF MEDICAL WORDS, DEEDS AND MEN[6]
[6] Address in Medicine, delivered June 24, 1902, at Yale University
Commencement.
[Reprinted from the _Yale Medical Journal_, July, 1902.]
_Study nature for facts; study lives of great men for inspiration how
to use them_
Never have I more earnestly craved the gift of eloquence than on
occasions like this, when young men are about to leave the halls in
which and the men with whom they have grown into man's estate, in order
to assume the solemn and weighty responsibilities not only of their
own lives but those as well of others. The day upon which you are thus
released from duties of one kind to assume those of another, welcome
and joyous though it may be, should nevertheless be interspersed with
some serious and earnest thoughts and resolutions. Old Yale sets now
her stamp upon you. It will prove a passport to many homes, but must
never be abused. It will entitle you to the society of the cultivated
and to the respect of scholars everywhere. It will admit you to the
ranks of the learned and cause you to be treated with respect and
equality by some of the profoundest and most scholarly thinkers the
world has even known. Yale has now furnished you with that which her
ripe experience has shown to be requisite for young men commencing
professional careers. As contrasted with the total of human knowledge
its aggregate is not large, but it has not for centuries been the
custom for men to grow gray in studies before undertaking to practice
medicine, and when your own qualifications are compared with those
which we of the passing generation possessed at the corresponding
period of our lives, the comparison will furnish at the same time the
most startling illustration of the rapid advance of medicine in the
past twenty-five years.
Yale has always been eminent for the versatility and originality of
her teachers. Her medical history has been so well told during the
past year by one of her most honored sons, Dr. Welch, that it is not
necessary nor wise to go now into such historical details. The trend of
science to-day is along the lines of comparative investigation, and the
Bible is by no means the only literary collection which to-day is being
subjected to the "higher criticism." The inspiration claimed for the
contributors to that great ancient Collection is denied to the writers
of great modern works, where, nevertheless, fundamental truth is as
requisite for the welfare of the body as in the other for that of the
soul. Only by painstaking research, laboriously repeated, do we clear
the old paths of the rubbish of centuries or discover totally new ones.
Pathfinders of this description have always abounded in this great
institution, drawn by common impulses or attracted by some centripetal
force. And though it were perhaps invidious to mention names, I
nevertheless must select two of Yale's great teachers whose names are
still green in the memory of all men, and ask you to note how the
examples they have set and the work they have done may furnish the line
of thought in which I wish you to follow me for a little while.
The science of comparative philology would seem to be far removed
from that of medicine. Still, it is based upon an ultimate analysis
of parts of speech, and men like Professor Whitney were, not only the
comparative anatomists, but even the histologists--if I may use the
phrase--of words. Comparative philology then is to medical terminology
what embryology and comparative anatomy are to a study of the structure
of the human body. The philologist loves to dissect words and trace
them back through rudimentary stages and roots to their earliest forms.
He loves also to study the evolution of an idea as conveyed by a word,
and trace atavism or reversion in human speech.
Again you have here at Yale a wonderful collection of extinct animal
remains restored with marvellous accuracy to semblance of their
original form and appearance. The indefatigable industry and wonderful
ability of Professor Marsh and his co-workers have enabled us to form
ideographs of the living forms of earlier geologic ages upon this
earth, which could not have been furnished had it not been for their
remarkable knowledge of morphology and skill in synthesis. Indeed,
where have powers of analysis and synthesis been more brilliantly
displayed than by these men. It used to be said of Cuvier, the great
French comparative anatomist, that if given a tooth from any beast,
past or present, he could describe the animal and its habits as well
as reconstruct his skeleton, so wonderfully are minute differences
perpetuated, and so familiar was he with them.