is extremely interesting, because here once more he faces a modern
problem. Aquinas was very sensitive with regard to the imposition upon
Christians of things which supposedly they had to believe on the score
of faith, though they were really not of faith at all. Some of his
expressions in this matter are very strong and he was especially fond
of quoting St. Augustine, who was very emphatic on this point. One of
these typical passages deserves to find a place here because, while
the word philosophy is used, it is evidently science in our modern
sense of the word that is intended. Augustine talks of what the
philosophers have said of the heavens or the stars and the motion of
the sun and moon, meaning of course the astronomers, who were in the
old days classed as natural philosophers. This passage, then, which
contains the opinions of the two greatest teachers of the Church in
the West may well serve as a guide for those who are interested in
science, and a warning for those who would {119} obtrude faith too far
into scientific questions, and thus limit investigation and hamper
that freedom of intellect which is so important for the development of
science. St. Thomas said in his introduction to the reply to Master
John of Vercelli:
"I have endeavored to reply but with this protest at the outset,
that many of these articles do not pertain to the teachings of
faith, but rather to the dogmas of the philosophers. But it works a
great injury either to assert or deny as belonging to sacred
doctrine such things as do not bear upon the doctrine of piety. For
Augustine says, 'When I hear certain Christians ignorant of those
things (namely, what philosophers have said of the heavens, or the
stars, or the motion of the sun and moon) or misunderstanding them,
I look with patience upon such men: nor do I see any reason to
hinder them, when of thee, Lord Creator of all things, they do not
believe unworthy things, if perhaps they be ignorant of the
structure, and condition of corporal creatures. But they are a
hindrance if they think these things belong to the very doctrine of
piety; and more, pertinaciously, dare to affirm that of which they
are ignorant.' But that they may be the cause of injury Augustine
shows. 'It is very disgraceful,' he says, 'and pernicious and
especially to be avoided, that a Christian speaking of these things
as though according to Christian teaching should so rave that any
infidel may hear; so that, as it is said, seeing him altogether in
the wrong, he may {120} scarcely contain his mirth. And it is not so
hurtful that one man should be seen to err, as that our writers are
believed by those who are without [the Church] to have such
opinions, and to the ruin of those whose salvation is our care they
are scorned and contemned as unlearned.' Whence it seems safer to me
that those things which philosophers have commonly held, and are not
repugnant to our faith, should neither be asserted as dogmas of
faith, although at times they may be introduced under the names of
the philosophers, nor so denied as contrary to the faith, as to give
occasion to the wise of this world of contemning the teaching of the
faith."
Is it any wonder that Professor Saintsbury of the University of
Edinburgh, whose training in the old Scotch universities has given him
a breadth of sympathy not common in our time, and whose wide knowledge
of the literature of that period as well as its philosophy and
education, and whose training in the discussion of the criticism of
all time in his "History of Criticism" has made his opinion of special
value, should have sympathetically turned to these old teachers and
deprecated a little bitterly the modern attitude towards them? He
said:
"Yet there has always in generous souls who have some tincture of
philosophy, subsisted a curious kind of sympathy and yearning over
the work of these generations of mainly disinterested scholars, who,
whatever they were, were {121} thorough, and whatever they could not
do, could think. And there have even, in these latter days, been
some graceless ones who have asked whether the science of the
nineteenth century, after an equal interval, will be of any more
positive value--whether it will not have even less comparative
interest than that which appertains to the scholasticism of the
thirteenth."
I have always considered, however, that the easiest way to show the
modern student of science how supremely scientific in his temper was
St. Thomas, is to quote for him the passage from that great teacher
with regard to the Resurrection. In every way, that is typically
modern. St. Thomas faces the question that after death men's bodies
decay, the material of them is taken up and used in many other living
beings, so that how can we dare to believe that we shall rise again on
the last day with the same bodies that we now have? St. Thomas
discusses this knotty problem straightforwardly and solves it more
satisfactorily, even for all the knowledge that we have of it now,
than has ever been done.
"What does not bar numerical unity in a man while he lives on
uninterruptedly clearly can be no bar to the identity of the arisen
man with the man that was. In a man's body while he lives there are
not only the same parts in respect of matter, but also in respect of
species. In respect of matter there is a flux and reflux of parts.
Still that fact does not bar the man's numerical unity {122} from
the beginning to the end of his life. The form and species of the
several parts continue throughout life, but the matter of the parts
is dissolved by the natural heat, and new matter accrues through
nourishment. Yet the man is not numerically different by the
difference of his component parts at different ages, although it is
true that the material composition of the man at one stage of his
life is not his material composition at another. Addition is made
from without to the stature of a boy without prejudice to his
identity, for the boy and the adult are numerically the same man."
The most important feature of the scientific teachings of the
mediaeval universities has been left till the last because it is the
clinching confirmation of a claim that these were essentially
scientific universities. It is to be found in the position of the
medical schools and the state of medical teaching during the Middle
Ages. So curiously has the history of education been written, and,
above all, of medical education, that to most people this would seem
to be surely the department of education which would prove just the
opposite. We have heard so much about Church opposition to anatomy and
Church opposition to surgery, of its repression of the development of
medical science and even medical art, because the Church wanted to
make people believe in the value of masses, relics and prayers--and
pay for them--that most people are quite sure that there {123} was no
medical education of any significance in the Middle Ages. Nothing
shows more clearly how viciously the history of education has been
written than the existence of such false impressions. Not only are
they utterly unfounded, but they are based on supreme ignorance of one
of the greatest periods in the history of medicine that we have in all
the world's history. Not only were the schools excellent and the
teaching progressive, but there was a fine development of medical
science and, above all, of surgery. Surgery is supposed to be
particularly the department of medicine that did not develop. We have
learned better in recent years, and now we know that there was no
greater period in the history of surgery than that from 1200 to 1400
when, alas! following so-called history, we used to think there was no
surgery.
The first question that any one who knows anything about the subject
asks with regard to the progress in medicine of a particular time or
country is, what was the standard of its medical education? What was
the standard of admission to the medical schools, how many years of
medical studies were required? To this question the Middle Ages have a
wonderful answer that has not been realized until recent years. We now
have Frederick II's famous law for the regulation of the practice of
medicine and the maintaining of standards in medical schools. This law
was promulgated in the Two Sicilies, the southern part of {124} Italy
and Sicily proper. According to it no one was allowed to practise
medicine who had not studied for four years in a recognized university
and then practised for one year with a physician before receiving his
license to practise by himself. If he wanted to practise surgery he
had to spend an additional special year in the study of anatomy. The
university medical schools were graduate schools and did not admit a
student unless he had completed the undergraduate course.
Of course it may be thought that this was due entirely to the great
Emperor Frederick, who was far ahead of his time and who, therefore,
anticipated the progress of medical teaching by many centuries. We
have, however, many other documents which illustrate the state of
medical education at this time. The charters of the medical schools
were granted by the Popes and were very explicit in what they required
of the new faculties in order that standards might be maintained. Pope
John XXII, for instance, at the beginning of the fourteenth century,
issued charters for medical schools at Perugia and Cahors. He required
that there should be four years of medical study and three years of
preliminary work. He went into details to secure the maintenance of
standards. The original faculties of these schools would all have to
be doctors in medicine from either Paris or Bologna, and it must be
their duty to establish in the new schools the standards of their
{125} Almae Matres. Examinations were to be conducted under oath, men
were not to be granted degrees unless they deserved them, the votes of
professors rejecting candidates or graduating them were to be under
oath-bound secrecy, so as to have them absolutely free from personal
influence, and every precaution was taken to secure the highest
possible standards.
It was as a consequence of their direct attachment to these old
mediaeval medical schools that the medical schools founded here in
America in the sixteenth century at once began with high standards.
Three years of preliminary work was required and four years of
medicine. In the United States no preliminary requirements were
demanded; and for a full century only two years of medical study,
which really consisted of but two terms of four months each, was the
requirement. The old mediaeval medical schools were originally
attached to the universities, and it is a well-known rule in the
history of education that whenever the medical schools are independent
then standards are sure to be low. Whenever the university controls
the medical school and it is a real graduate department, then
standards of admission and of graduation are properly maintained. It
is surprising to think that the old mediaeval universities should be
able to give us lessons in this matter and should put us to shame for
our slip-shod nineteenth-century medical education in the United
States, but this is a simple fact. Contrast {126} the South American
countries where the mediaeval traditions with which they were founded
constrained them to give four, five and even six years to medicine
before granting a degree. Go a step further and see how devoted to
science were the Universities of Lima (Peru) and Mexico, centuries
before we did any serious scientific work in the United States, and
all because they were direct descendants of the old mediaeval
universities.
The feeling of certain modern educators would be that it did not
matter how much time these mediaeval universities gave to medicine
since, after all, they had nothing of any value to teach in medicine.
Even educated people have been led to believe that there was nothing
in medicine and, above all, in the surgery of those times to be of any
value. Probably no opinion is more foolishly ignorant or more
ridiculously absurd than this, though it is a commonplace among people
who are sure they know something about history, and, above all, among
those who consider themselves authorities in the history of education,
and of the development of science. In surgery a magnificent
development was made at this time of which I shall have something to
say later. In medicine there was much less anticipation of our modern
progress, but even here there was much that demands our respect. One
of the university men, Simon of Genoa, worked out the dosage of opium
and indicated its uses. Anodyne drugs were {127} employed much more
generally and successfully than we are apt to think; various methods
of anaesthesia, one of them by inhalation, of which I shall say more
when talking of surgery, were invented and a large number of drugs and
simples were experimented with. Down at Montpellier Bernard Gordon
suggested red light for smallpox.
This is not much of a record, perhaps, but we must not forget what
Professor Richet, the Director of the Physiological Laboratory of the
University of Paris, said not long since in an article on "Physicians
and Medicine" in _La Revue de Deux Mondes._ It is startling but
chasteningly true. "The therapeutics of any generation has always been
quite absurd to the second succeeding generation." Indeed it is one of
the almost disheartening things in the history of medicine to see how
treatments come in, are widely accepted and hailed as great advances
in therapeutics and then gradually disappear. They bled a great deal
and they purged not a little, in accordance with the teaching in the
medical schools of the universities of the thirteenth and fourteenth
centuries, but then they bled a great deal and purged a great deal
more, according to the teaching of the medical schools of the
beginning of the nineteenth century. There have been many periods in
the interval when purging and bleeding were, and very properly, not
nearly so popular.
It was in preventive medicine particularly that {128} these
progressive medical men of the early university days secured their
triumphs. They made separate hospitals for the lepers all over Europe,
and by segregation succeeded in wiping out that disease, though it was
as widely spread as tuberculosis in our day and presented just as
serious a problem. Indeed the most encouraging incentive for our
present tuberculosis campaign is drawn by many authorities from the
experience with leprosy, which was eventually obliterated as an
endemic popular disease, by strict segregation methods. These same
generations created special hospitals for erysipelas and thus
prevented the spread of this disease in the ordinary hospitals, where
it used to be so serious a factor for morbidity if not for mortality.
Men forgot this later and the disease became a serious problem once
more in all the hospitals of even a generation ago. The hospital
organization worked out by these university men is the finest jewel in
the crown of their accomplishment as applied scientists. Pope Innocent
III, himself a University of Paris man, founded the Santo Spirito
Hospital in Rome, summoning for that purpose the best authority on
hospitals in Europe, Guy of Montpellier, and then required the bishops
of the world to erect similar hospitals in their dioceses. This was
done, and it is Virchow, whose sympathies were anything but favorable
to the Popes, who has been most loud in his praise of the wonderful
hospital organization of these centuries. Every town in {129} Europe
of 5,000 inhabitants or more had a hospital, and there were hospitals
in many of the smaller towns.
It would be easy to think that these hospitals were rudely built, were
badly ventilated, were ill-arranged and, above all, were likely to be
houses for the perpetuation of disease rather than for the regaining
of health. We are prone to think that we are the first generation to
solve the problem of hospital construction. We know what
poorly-constructed, badly-planned institutions were the hospitals of
three generations ago. What, then, must have been the hospital
buildings of centuries ago? This argument has no place in history; the
worst hospitals in the world and in history were erected at the end of
the eighteenth and the beginning of the nineteenth century. Some of
the best hospitals ever constructed date from the thirteenth,
fourteenth and fifteenth centuries. This was a time when great
architects were successfully solving the construction problems for
cathedrals, municipal buildings, colleges and the like, and they
solved them quite as successfully for hospitals. Some of these
hospitals were models in their way. One of them, built toward the end
of the thirteenth century, by the sister of St. Louis, Marguerite of
Bourgogne, with its large windows high in the walls, in single-story
buildings, with arrangements for the segregation of patients, with the
kitchens in a separate building, with beautiful {130} frescoes on the
walls so that patients' minds might be occupied and not left to their
own often disturbing devices as with our bare wall, with a stream of
running water divided so as to pass on both sides of the hospital, is
a model of construction for all time.
It was in surgery rather than medicine, however, that these great
mediaeval university medical schools left their impress upon the
history of medicine. During the thirteenth, fourteenth and fifteenth
centuries we have a series of wonderful teachers of surgery, whose
achievements we know not by tradition nor by fragments of their
writings, but by the text-books which they wrote and which constituted
the teaching for generations and sometimes for centuries after their
time. Gurlt, the great German historian of surgery, devotes some 300
pages of the first volume of his "History of Surgery" to the surgical
accomplishments of the Middle Ages. He even protests that space
compels him to abbreviate the story of what these old-time masters of
surgery did to lay the foundation of modern surgical practices. It is
a commonplace in the American writing of history that there was no
surgery at this time. President White says that, "for over a thousand
years surgery was considered dishonorable until the German Emperor
Wenceslas, in 1403, ordered that it should be held in honor again."
The two centuries immediately preceding this date represent the {131}
greatest period in the history of surgery down to our own time, and
because of its originality probably greater in real achievement than
even our vaunted age.
It is sometimes the custom to say that this surgery was derived from
the Arabs. This is supposed to rob the mediaeval universities of any
prestige that may come to them for this marvellous progress. Gurlt,
however, in his "History of Surgery," in his sketch of Roger
(Ruggiero), who was the first of the great surgeons of the thirteenth
century, who taught at the Italian universities, says: "Though Arabian
writings on surgery had been brought over to Italy by Constantine
Africanus 100 years before Roger's time, these exercised no influence
over Italian surgery in the next century, and there is not a trace of
the influence of the Arabs to be found in Roger's work." When Gurlt
says this it is because he has deliberately studied the question, and
we can be absolutely sure, therefore, that whatever we find in surgery
at this time comes to us from these great mediaeval universities
themselves, and is not imported from abroad.
After Roger, who was at Bologna for a time after having been in Paris,
and who then became a Papal physician, there are a series of great
names that deserve to be mentioned. Four names are connected together
by association as master and pupil for what may be termed four
generations of surgical progress. From the birth {132} of the first to
the death of the last represents about 100 years. That 100 years is a
gloriously fruitful century in the history of surgery. The first of
the group is William of Salicet, of whom Professor Clifford Allbutt,
the Regius Professor of Physic at the University of Cambridge, in his
address on the "Historical Relations of Medicine and Surgery to the
End of the Sixteenth Century," delivered by special invitation at the
Congress of Arts and Sciences at the World's Fair in St. Louis in
1904, has the highest praise. Allbutt says: "Like Lanfranc and the
other great surgeons of the Italian tradition, and unlike Franco and
Pare, William had the advantage of the liberal university education of
Italy; but like Pare and Wurtz, he had a large practical experience in
hospitals and on the battlefield and fully recognized that surgery
cannot be learned from books only." Allbutt praises him and rightly
for his careful notes of cases and then tells us something of his
accomplishments in surgery. He says: "William discovered that dropsy
may be due to a _durities renum_ six centuries before Bright; he
substituted the knife for the Arabist abuse of the cautery; _he
investigated the causes of the failure of healing by first intention_
(Italics ours), he described the danger of wounds of the neck; he
sutured divided nerves; he forwarded the diagnosis of suppurative
diseases of the hip; and he referred chancre and phagedaena to their
proper causes."
{133}
His pupil Lanfranc equalled his master in devotion to practical
surgery and surpassed him in his development of the great science of
medicine. Pagel, the well-known German historian of medicine, says
that, in his text-book Lanfranc has excellent chapters on the
affections of the eyes, the ears and mouth, the nose, even the teeth,
and treats of hernia in a very practical common-sense way. He warns
against the radical operation and says, in words that come home to us
with strange familiarity at the present time, that many surgeons
decide on operations too easily, not for the sake of the patient but
for the sake of the money that is in them. Lanfranc's discussion of
cystotomy, Pagel characterizes as prudent but rational, for he
considers that the operations should not be feared too much but not
delayed too long. In patients suffering from the inconvenience which
comes from large quantities of fluid in the abdomen he advises
_paracentesis abdominis_, but warns against putting the patient in
danger from such an operation without due consideration. Pagel says
that Lanfranc must be considered as one of the greatest surgeons of
the Middle Ages and the real establisher of the prestige of the French
school of surgery which maintained its prominence down to the
nineteenth century.
Lanfranc had been invited to Paris to take the chair of surgery,
because the authorities of the university wanted to add prestige to
the medical school, which was not as well known as the school {134} of
philosophy. The fame of William of Salicet had spread throughout
academic Europe, and so Lanfranc was offered the chair at the
University of Paris in order to carry his master's message there. The
next in the succession of great teachers at Paris was Mondeville, who
found less to do in an original way than his master Lanfranc and his
protomaster William, but who accomplished much for surgery. All that
he did was thrown into the shade by what was accomplished for
succeeding generations by the next in the series, Guy de Chauliac, who
studied for a time in Paris under Mondeville, though his early medical
education was obtained at Montpellier, but had also had the advantage
of spending a year in Italy at the various medical schools which were
famous at that time. These two incidents, Lanfranc's invitation to
Paris to be a teacher there from Italy more than a thousand miles
away, and Guy de Chauliac's studies in all the important universities
of Europe of the time before he took up his own work, illustrate
better than any words of ours can the ardent enthusiasm for study, the
thoroughgoing anticipation of our most modern methods in education.
Mondeville, like Chauliac, had made very nearly the same round of the
universities. It is a custom, not a chance incident, that we have to
deal with here.