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Medical History Manuals
_General Editor_--John D. Comrie,
M.A., B.SC., M.D., F.R.C.P.E.
MEDIEVAL MEDICINE
* * * * * *
IN THE SAME SERIES
PASTEUR AND AFTER PASTEUR
By STEPHEN PAGET, F.R.C.S.
With 8 full-page Illustrations.
THE EDINBURGH SCHOOL OF SURGERY BEFORE LISTER
By ALEX. MILES, M.D., F.R.C.S.
With 8 full-page Illustrations.
A. AND C. BLACK, LTD., 4 SOHO SQ., LONDON, W. 1
* * * * * *
[Illustration: AN AMPUTATION BELOW THE KNEE
This is the first picture of an amputation known
_From Gerssdorff's woodcut, reproduced in Gurlt's "Geschichte der
Chirurgie"_]
MEDIEVAL MEDICINE
by
JAMES J. WALSH
K.C.ST.G., M.D., PH.D., SC.D., LITT.D.
Medical Director, Sociological Department Fordham University, and
Professor Physiological Psychology Cathedral College, New York
Fellow A.M.A., A.A.A.S., Member of the French, German, and Italian
Societies for the History of Medicine, etc.
Author of "Makers of Modern Medicine," and Other Volumes on
Medical History
"_Multum egerunt qui ante nos fuerunt, sed non peregerunt.
Suspiciendi tamen sunt et ritu Deorum colendi._"
SENECA: _Epist. LXIV._
A. & C. Black, Ltd.
4, 5 & 6, Soho Square, London, W.C. 1
1920
Made in Great Britain.
CONTENTS
CHAPTER PAGE
PREFACE vii
I. INTRODUCTION 1
II. EARLY MEDIEVAL MEDICINE 21
III. SALERNO AND THE BEGINNINGS OF MODERN MEDICAL EDUCATION 37
IV. MONTPELLIER AND MEDICAL EDUCATION IN THE WEST 61
V. LATER MEDIEVAL MEDICINE 74
VI. MEDIEVAL SURGEONS: ITALY 88
VII. SURGEONS OUTSIDE OF ITALY: SURGEONS OF THE WEST OF EUROPE 109
VIII. ORAL SURGERY AND THE MINOR SURGICAL SPECIALITIES 136
IX. MEDICAL EDUCATION FOR WOMEN 154
X. MEDIEVAL HOSPITALS 169
XI. MEDIEVAL CARE OF THE INSANE 183
APPENDIX I 206
APPENDIX II 212
INDEX 217
LIST OF ILLUSTRATIONS
AMPUTATION BELOW THE KNEE _Frontispiece_
FACING PAGE
HOLY GHOST HOSPITAL 64
SURGICAL INSTRUMENTS OF GUY DE CHAULIAC 118
BRUNSCHWIG'S SURGICAL ARMAMENTARIUM 134
SURGICAL INSTRUMENTS OF THE ARABS 138
THIRTEENTH-CENTURY HOSPITAL INTERIOR 172
LEPER HOSPITAL OF ST. BARTHOLOMEW 176
THE HARBLEDOWN HOSPITAL 180
"When we think of all the work, big with promise of the future, that went
on in those centuries which modern writers in their ignorance used once to
set apart and stigmatize as the 'Dark Ages'; when we consider how the
seeds of what is noblest in modern life were then painfully sown upon the
soil which Imperial Rome had prepared; when we think of the various work
of a Gregory, a Benedict, a Boniface, an Alfred, a Charlemagne, we feel
that there is a sense in which the most brilliant achievements of pagan
antiquity are dwarfed in comparison with these."--FISKE: _The Beginnings
of New England, or the Puritan Theocracy in its Relations to Civil and
Religious Liberty_.
TO
MOST REVEREND P. J. HAYES
ARCHBISHOP OF NEW YORK
AS A SLIGHT TOKEN OF GRATITUDE FOR THE PRIVILEGE
OF CO-OPERATING IN THE EDUCATIONAL FOUNDATION
THAT IS A MONUMENT TO HIS PRUDENT WISDOM
PREFACE
"Medieval Medicine" is the story of the medical sciences in the Middle
Ages. The Middle Ages are usually assumed to begin with the deposition of
Romulus Augustulus, 476, and end with the fall of Constantinople, 1453. In
this little volume, then, we have to outline the history of human efforts
to prevent and treat the ills of mankind for nearly one thousand years.
Until recently, it has been the custom to believe that there was so little
of genuine interest in anything like the scientific care of ailing human
beings during these centuries, that even a volume of this kind might seem
large for the tale of it. Now we know how much these men of the Middle
Ages, for so long called the "Dark Ages," were interested in every phase
of human progress. They created a great art and literature, and above all
a magnificent architecture. We have been cultivating the knowledge of
these for several generations, and it would indeed be a surprise to find
that the men who made such surpassing achievements in all the other lines
of human effort should have failed only in medicine.
As a matter of fact, we have found that the history of medicine and
surgery, and of the medical education of the Middle Ages, are quite as
interesting as all the other phases of their accomplishments. Hence the
compression that has been necessary to bring a purview of all that we know
with regard to medieval medicine within the compass of a brief book of
this kind. The treatment has been necessarily fragmentary, and yet it is
hoped that the details which are given here may prove suggestive for those
who have sufficient interest in the subject to wish to follow it, and may
provide an incentive for others to learn more of this magnificent chapter
of the work of the medieval physicians.
MEDIEVAL MEDICINE
CHAPTER I
INTRODUCTORY
To understand the story of Medieval Medicine, the reader must recall
briefly the course of Roman history. Rome, founded some eight centuries
before Christ, was at first the home of a group of adventurers who, in the
absence of women enough to supply wives for their warriors, went out and
captured the maidens of a neighbouring Sabine town. The feud which broke
out as a result was brought to an end by the women now become the wives of
the Romans, and an alliance was made. Gradually Rome conquered the
neighbouring cities, but was ever so much more interested in war and
conquest than in the higher life. The Etruscan cities, which came under
her domination, now reveal in their ruins art objects of exquisite beauty
and the remains of a people of high artistic culture. When Rome conquered
Carthage, Carthage was probably the most magnificent city in the world,
and Rome was a very commonplace collection of houses. Culture did not
come to Rome until after her conquest of Greece, when "captive Greece led
her captor captive."
Sir Henry Maine's expression that whatever lives and moves in the
intellectual life is Greek in origin may not be unexceptionably true, but
it represents a generalization of very wide application.
Rome was stimulated in art and architecture and literature by touch with
the Greeks, and her own achievements, important though they were, were
little better than copies of Greek originals. The Romans themselves
acknowledged this very frankly. When in the course of time the barbarian
nations from the North and West of Europe came down in large numbers into
Italy, and finally gained control of the Roman Empire, they had but very
little interest in the Greek sources, and decadence of the intellectual
life was inevitable. This was particularly true as regards scientific
subjects, and above all for medicine; for the Romans had always depended
on Greek physicians, and Galen in the second century, like Alexander of
Tralles in the seventh, represent terms in the series of physicians who
reached distinction at Rome.
The key to the history of medicine in the Middle Ages, then, is always the
presence of Greek influence. This persisted in the Near East, and
consequently serious scientific medicine continued to flourish there, at
first among the Christians and later among the Arabs. It was not for any
special incentive of their own that the Arabs became the intellectual
leaders of Europe during the tenth and eleventh centuries, but the fact
that their geographical position in Asia Minor close to Greek sources
provided them with the opportunity to know the old Greek authors,
especially in philosophy and medicine, and therefore to be almost forced
to become the channels through which Greek influences were carried into
the West once more.
Before the coming of the Arabs, however--that is, before the rise of
Mohammedanism--there was an important chapter of medieval medicine which
is often not appreciated at its true worth. The contributors to it deserve
to be well known, and fortunately for us in the modern time were properly
appreciated during the early days of the art of printing, in the
Renaissance time, and accordingly their books were printed, and came to be
distributed in many copies, which have rendered them readily available in
the modern time.
In Asia Minor, where Greek influence persisted as it did not in Italy, we
have a series of distinguished contributors to medicine, or rather,
medical literature--that is, men whose books represent a valuable
compilation and digestion of the important medical writings from before
their time, often enriched by their own experience. The first of these
was Aëtios Amidenus--that is, Aëtios of Amida--born in the town of that
name in Mesopotamia on the Upper Tigris (now Diarbekir), who flourished in
the sixth century. Aëtios, or in the Latin form Aëtius, wrote a textbook
that has often been republished in the modern time, and that shows very
clearly how well the physicians of this period faced their medical and
surgical problems, how thoroughly equipped they were by faithful study of
the old Greek writers, and how successfully they coped with the
difficulties of the cases presented to them. He is eminently conservative,
a careful observer, who uses all the means at his command and who well
deserves the interest that has been manifested in him at many periods
during the almost millennium and a half elapsed since his death.
After Aëtius came Alexander of Tralles, from another of these towns of
Asia Minor that we would consider insignificant, sometimes termed
Trallianus for this reason. He must be reputed one of the great
independent thinkers in medicine whose writings have deservedly attracted
attention not only in his own time, but long afterwards in the Renaissance
period, and with whose works everyone who cares to know anything about the
development of medical history must be familiar. One detail of his life
has always seemed to me to correct a whole series of misapprehensions with
regard to the earlier Middle Ages. Alexander was one of five brothers, all
of whose names have come down to us through nearly 1,500 years because of
what they accomplished at the great Capital of the East. The eldest of
them was Anthemios, the architect of the great Church of Santa Sophia. A
second brother was Methrodoros, a distinguished grammarian and teacher at
Constantinople. A third brother was a prominent jurist in the Imperial
Courts of the capital; while a fourth brother, Dioscoros, was, like
Alexander, a physician of repute, but remained in his birthplace Tralles,
and acquired a substantial practice there.
There is sometimes the feeling that at this time in the world's history,
the end of the sixth and the beginning of the seventh century, men had but
little initiative, and above all very little power of achievement in the
intellectual order. Anyone who knows Santa Sophia in Constantinople,
however, will recognize at once that the architect who conceived and
superintended the construction of that great edifice was a genius of a
high order, not lacking in initiative, but on the contrary possessed of a
wonderful power of original accomplishment. No greater constructive work,
considering all the circumstances, has perhaps ever been successfully
planned and executed. It would scarcely be expected that the brother of
the man who conceived and finished Santa Sophia would, if he set out to
write a textbook of medicine, make an egregious failure of it. Surely his
work would not be all unworthy of his brother's reputation, and the family
genius should lift him up to important accomplishment. This is literally
what we find true with regard to Alexander. After years of travel which
led him into Italy, Gaul, Spain, and Africa, he settled down at Rome, and
practised medicine successfully until a very old age, and probably
lectured there, for some of his books are in the form of lectures.
Fortunately for us, he committed his knowledge and his experience to
writing, which has come down to us.
A third of these greater writers on medicine in the early Middle Ages was
Paul of Ægina--Æginetus as he is sometimes known. There has been some
question as to his date in history, but as he quotes Alexander of Tralles
there seems to be no doubt now that his career must be placed in the first
half of the seventh century. We shall see more of him, as also of his
great contemporaries and predecessors of the early Middle Ages, Aëtios and
Alexander of Tralles, in a subsequent chapter. Besides these men who were
known for their writings, a series of less known Christian physicians
were praised by their contemporaries for their knowledge of medicine.
Among them are particularly to be noted certain members of an Arabian
family with the title Bachtischua, a name which is derived from the Arabic
words _Bocht Jesu_--that is, servant of Jesus--who, having studied among
the Greek Christians in the cities of Asia Minor, were called to the Court
of Haroun al-Raschid and introduced Greek medicine to the Mohammedans. I
have pointed out in my volume "Old-Time Makers of Medicine"[1] that "it
was their teaching which aroused Moslem scholars from the apathy that
characterized the attitude of the Arabian people towards science at the
beginning of Mohammedanism."
After this preliminary period of early medieval medical development, the
next important phase of medicine and surgery in the Middle Ages developed
in the southern part of Italy at Salerno. Here came the real awakening
from that inattention to intellectual interests which characterized Italy
after the invasion of the northern barbarians. The reason for the early
Renaissance in this neighbourhood is not far to seek. In the older times
Sicily had been a Greek colony, and the southern portion of Italy had been
settled by Greeks and came to be known as Magna Græcia. The Greek
language continued to be spoken in many parts even during the earlier
medieval centuries, and Greek never became the utterly unknown tongue it
was in Northern Italy. With the turning of attention to education in the
later Middle Ages, the Southern Italians were brought almost at once in
contact with Greek sources, and the earlier Renaissance began. With this
in mind, it is comparatively easy to understand the efflorescence of
culture in Southern Italy, and the development of the important University
of Salerno and its great accomplishment, particularly in scientific
matters, though all this came almost entirely as a consequence of the
opportunity for Greek influence to have its effect there.
It is sometimes said that Arabian influence meant much for the development
of Salerno, and that it was because the southern part of the Italian
peninsula was necessarily rather closely in touch with Arabian culture
that an early awakening took place down there. The Mohammedans occupied so
many of the islands of the Mediterranean, as well as Spain, that their
influence was felt deeply all along its shore, and hence the first
university of Europe in modern times came into existence in this part of
the world. Montpellier is sometimes, though not so often, said to have had
the same factor in its early development. Undoubtedly there was some
Arabian influence in the foundation of Salerno. The oldest traditions of
the University show this rather clearly. This Arabian influence, however,
has been greatly exaggerated by some modern historical writers. Led by the
thought that Christianity was opposed to culture, and above all to
science, they were quite willing to suggest any other influences than
Christian as the source of so important a movement in the history of human
progress as Salerno proved to be. The main influence at Salerno, however,
was Greek, and the proof of this is, as insisted by Gurlt in his "History
of Surgery," that the great surgeons of Salerno do not refer to Arabian
sources, but to Greek authors, and their books do not show traces of
Arabian influences, but on the contrary have many Græcisms in them.
Salerno represents an especially important chapter in the history of
Medieval Medicine. As we shall see, the teachers at the great medical
school there set themselves in strenuous opposition to the Arabian
tendency to polypharmacy, by which the Oriental mind had seriously hurt
medicine, and what is still more to the credit of these Salernitan
teachers, they developed surgery far beyond anything that the Arabs had
attempted. Indeed, surgery in the later centuries of Arabian influence
had been distinctly neglected, but enjoyed a great revival at Salerno.
Besides, the Salernitan physicians used all the natural methods of cure,
air, water, exercise, and diet, very successfully. If any other proof were
needed that Arabian influence was not prominent at Salerno, surely it
would be found in the fact that women physicians enjoyed so many
privileges there. This is so entirely opposed to Mohammedan ways as to be
quite convincing as a demonstration of the absence of Arabian influence.
From Salerno, the tradition of medicine and surgery spread to Bologna
early in the thirteenth century, and thence to the other universities of
Italy and to France. Montpellier represented an independent focus of
modern progress in medicine, partly due to close relationship with the
Moors in Spain and the Greek influences they carried with them from Asia
Minor, but not a little of it consequent upon the remnants of the older
Greek culture, still not entirely dead even in the thirteenth century,
because Marseilles, not far away, had been a Greek colony originally, and
still retained living Greek influence, and wherever Greek got a chance to
exercise its stimulant incentive modern scientific medicine began to
develop.
France owed most of her development in medicine and surgery at the end of
the Middle Ages to the stream of influence that flowed out of Italian
universities. Such men as Lanfranc, who was an Italian born but exiled;
Mondeville, who studied in Italy; and Guy de Chauliac, who has so freely
acknowledged his obligation to Italian teachers, were the capital sources
of medical and surgical teaching in France in the later Middle Ages.
It is thus easy to see how the two periods of historical import in
medicine at the beginning and end of the Middle Ages may be placed in
their intimate relation to Greek influences. At the beginning, Greek
medicine was not yet dead in Asia Minor, and it influenced the Arabs. When
the revival came, it made itself first felt in the portions of Southern
Italy and Southern France where Greek influence had been strongest and
still persisted. Fortunately for us, the great Renaissance printers and
scholars, themselves touched by the Greek spirit of their time, put the
books of the writers of these two periods into enduring printed form, and
in more recent years many reprints of them have been issued. These volumes
make it possible for us to understand just how thoroughly these colleagues
of the Middle Ages faced their problems, and solved them with a practical
genius that deserves the immortality that their works have been given.
The history of medicine and surgery during the Middle Ages has been
greatly obscured by the assumption that at this time scientific medicine
and surgery could scarcely have developed because men were lacking in the
true spirit of science. The distinction between modern and medieval
education is often said to be that the old-time universities sought to
increase knowledge by deduction, while the modern universities depend on
induction. Inductive science is often said to be the invention of the
Renaissance period, and to have had practically no existence during the
Middle Ages. The medieval scholars are commonly declared to have preferred
to appeal to authority, while modern investigators turn to experience.
Respect for authority is often said to have gone so far in the Middle Ages
that no one ventured practically to assert anything unless he could find
some authority for it. On the other hand, if there was any acknowledged
authority, say Aristotle or Galen, men so hesitated to contradict him that
they usually followed one another like sheep, quoting their favourite
author and swearing by the authority of their chosen master. Indeed, many
modern writers have not hesitated to express the greatest possible wonder
that the men of the Middle Ages did not think more for themselves, and
above all did not trust to their own observation, rather than constantly
rest under the shadow of authority.
Above all, it is often asked why there was no nature study in the Middle
Ages--that is, why men did not look around them and see the beauties and
the wonders of the world and of nature, and becoming interested in them,
endeavour to learn as much as possible about them. Anyone who thinks that
there was no nature study in the Middle Ages, however, is quite ignorant
of the books of the Middle Ages. Dante, for instance, is full of the
knowledge of nature. What he knows about the ants, and the bees, and many
other insects; about the flowers, and the birds, and the habits of
animals; about the phosphorescence at sea and the cloud effects, and
nearly everything else in the world of nature around him, adds greatly to
the interest of his poems. He uses all these details of information as
figures in his "Divine Comedy," not in order to display his erudition, but
to bring home his meaning with striking concreteness by the metaphors
which he employs. There is probably no poet in the modern time who knows
more about the science of his time than Dante, or uses it to better
advantage.
It is sometimes thought that the medieval scholars did not consider that
experience and observation were of any value in the search for truth, and
that therefore there could have been no development of science. In an
article on "Science at the Medieval Universities"[2] I made a series of
quotations from the two great scientific scholars of the thirteenth
century, Albertus Magnus and Roger Bacon, with regard to the question of
the relative value of authority and observation in all that relates to
physical science. Stronger expressions in commendation of observation and
experiment as the only real sources of knowledge in such matters could
scarcely be found in any modern scientist. In Albert's tenth book of his
"Summa," in which he catalogues and describes all the trees, plants, and
herbs known in his time, he declares: "All that is here set down is the
result of our own experience, or has been borrowed from authors whom we
know to have written what their personal experience has confirmed; for in
these matters experience alone can be of certainty." In his impressive
Latin phrase, _experimentum solum certificat in talibus_. With regard to
the study of nature in general he was quite emphatic. He was a theologian
as well as a scientist, yet in his treatise on "The Heavens and the
Earth," he declared that: "In studying nature we have not to inquire how
God the Creator may, as He freely wills, use His creatures to work
miracles, and thereby show forth His power. We have rather to inquire
what nature with its immanent causes can naturally bring to pass."
Roger Bacon, the recent celebration of whose seven hundredth anniversary
has made him ever so much better known than before, furnishes a number of
quotations on this subject. One of them is so strong that it will serve
our purpose completely. In praising the work done by Petrus, one of his
disciples whom we have come to know as Peregrinus, Bacon could scarcely
say enough in praise of the thoroughly scientific temper, in our fullest
sense of the term, of Peregrinus's mind. Peregrinus wrote a letter on
magnetism, which is really a monograph on the subject, and it is mainly
with regard to this that Roger Bacon has words of praise. He says: "I know
of only one person who deserves praise for his work in experimental
philosophy, for he does not care for the discourses of men and their wordy
warfare, but quietly and diligently pursues the works of wisdom.
Therefore, what others grope after blindly, as bats in the evening
twilight, this man contemplates in their brilliancy, _because he is a
master of experiment_. Hence, he knows all of natural science, whether
pertaining to medicine and alchemy, or to matters celestial or
terrestrial. He has worked diligently in the smelting of ores, as also in
the working of minerals; he is thoroughly acquainted with all sorts of
arms and implements used in military service and in hunting, besides which
he is skilled in agriculture and in the measurement of lands. It is
impossible to write a useful or correct treatise in experimental
philosophy without mentioning this man's name. Moreover, he pursues
knowledge for its own sake; for if he wished to obtain royal favour, he
could easily find sovereigns who would honour and enrich him."
Roger Bacon actually wanted the Pope to forbid the study of Aristotle
because his works were leading men astray from the true study of
science--his authority being looked upon as so great that men did not
think for themselves, but accepted his assertions. Smaller men are always
prone to act thus at any period in the world's history, and we undoubtedly
in our time have a very large number who do not think for themselves, but
swear on the word of some master or other, and very seldom so adequate a
master as Aristotle.
Bacon insisted that the four great grounds of human ignorance are: "First,
trust in inadequate authority; second, that force of custom which leads
men to accept without properly questioning what has been accepted before
their time; third, the placing of confidence in the assertions of the
inexperienced; and fourth, the hiding of one's own ignorance behind the
parade of superficial knowledge, so that we are afraid to say, 'I do not
know.'" Prof. Henry Morley suggested that: "No part of that ground has yet
been cut away from beneath the feet of students, although six centuries
have passed. We still make sheepwalks of second, third, and fourth, and
fifth hand references to authority; still we are the slaves of habit,
still we are found following too frequently the untaught crowd, still we
flinch from the righteous and wholesome phrase, 'I do not know,' and
acquiesce actively in the opinion of others that we know what we appear to
know."
It used to be the custom to make little of the medieval scientists because
of their reverence for Aristotle. Generations who knew little about
Aristotle, especially those of the seventeenth and eighteenth centuries,
were inclined to despise preceding generations who had thought so much of
him. We have come to know more about Aristotle in our own time, however,
and as a consequence have learned to appreciate better medieval respect
for him. Very probably at the present moment there would be almost
unanimous agreement of scholars in the opinion that Aristotle's was the
greatest mind humanity has ever had. This is true not only because of his
profound intellectual penetration, but above all because of the
comprehensiveness of his intelligence. For depth and breadth of mental
view on a multiplicity of subjects, Aristotle has never been excelled and
has but very few rivals. The admiration of the Middle Ages for him,
instead of being derogatory in any way to the judgment of the men of the
time, or indicating any lack of critical appreciation, rather furnishes
good reasons for high estimation of both these intellectual modes of the
medieval mind. Proper appreciation of what is best is a much more
difficult task than condemnation of what is less worthy of regard. It is
the difference between constructive and destructive criticism. Medieval
appreciation of Aristotle, then, constitutes rather a good reason for
admiration of them than for depreciation of their critical faculty; and
yet they never carried respect and reverence to unthinking worship, much
less slavish adoration. Albertus Magnus, for instance, said: "Whoever
believes that Aristotle was a God must also believe that he never erred;
but if we believe that Aristotle was a man, then doubtless he was liable
to err just as we are." We have a number of direct contradictions of
Aristotle from Albert. A well-known one is that with regard to Aristotle's
assertion that lunar rainbows appeared only twice in fifty years. Albert
declared that he himself had seen two in a single year.
Galen, after Aristotle, was the author oftenest quoted in the Middle
Ages, and most revered. Anyone who wants to understand this medieval
reverence needs only to read Galen. There has probably never been a
greater clinical observer in all the world than this Greek from Pergamos,
whose works were destined to have so much influence for a millennium and a
half after his time. How well he deserved this prestige only a careful
study of his writings will reveal. It is simply marvellous what he had
seen and writes about. Anatomy, physiology, pathological anatomy,
diagnosis, therapeutics--all these were magnificently developed under his
hands, and he has left a record of accurate and detailed observation.
There are many absurdities easily to be seen in his writings now, but no
one has yet written on medicine in any large way who has avoided
absurdities, nor can anyone hope to, until we know much more of the
medical sciences than at present. The therapeutics of any generation is
always absurd to the second succeeding generation, it has been said. Those
in the modern time who know their Galen best have almost as much
admiration for him, in spite of all our advance in the knowledge of
medicine, as the medieval people had. No wonder, seeing the depth and
breadth of his knowledge, that he was thought so much of, and that men
hesitated to contravene anything that he said.
Even in the authorities to which they turned with so much confidence, the
medieval physicians are admirable. If man must depend on authority, then
he could not have better than they had. As with regard to this, so in all
other matters relating to the Middle Ages, the ordinarily accepted notions
prove to have been founded on ignorance of actual details, and
misconceptions as to the true significance of their point of view. To have
contempt give way to admiration, we need only to know the realities even
in such meagre details as can be given in a short manual of this kind. The
thousand years of the Middle Ages are now seen to have been full of
interesting and successful efforts in every mode of human activity, and
medicine and surgery shared in this to the full.