surgery. Any one who wants to see why should read the text-book on
surgery that {135} Chauliac wrote and which for two centuries after
his time (he died about the middle of the fourteenth century)
continued to be the most used text-book of surgery in the medical
schools of Europe. Chauliac, for instance, describes the treatment of
conditions within all three of the important cavities of the body, the
skull, the thorax and the abdomen. Pagel has three closely-printed
pages in small type of titles alone of subjects in surgery which
Chauliac treated with distinction. His description of instruments and
methods of operation is especially full and suggestive. He describes
the passage of a catheter, for instance, with the accuracy and
complete technique of a man who knew the difficulties of it in
complicated cases from practical experience. He even recognizes the
dangers for the patient from the presence of anatomical anomalies of
various kinds and describes certain of the more important of them. He
has very exact indications for trephining. For empyema he advises
opening of the chest and indicates where and how. He says very frankly
that in wounds of the abdomen the patient will die if the intestines
have been perforated and left untreated, and he describes a method of
suturing wounds of the intestines in order to save the patient's life.
His treatment of bone surgery and of fractures and dislocations is
especially interesting and shows how far these very practical men had
reached conclusions resembling those of our time. {136} It was in
hernia particularly that Chauliac's surgical genius manifested itself.
He operated for hernia and its radical cure, placing the patient in an
exaggerated Trendelenberg position, head down, feet fastened to a
slanting board. For such work anatomy had to be known very well, and
Chauliac had made special studies at Bologna under Bertruccio, the
successor of Mondino. Chauliac once declared that the surgeon ignorant
of anatomy carves the human body as a blind man would carve wood. Of
ulcers of all kinds Chauliac writes from a knowledge evidently derived
from experience. Of ulcers due to cancer he has much to say. He
considers them hopeless unless they can be excised at a very early
stage and the incision followed by caustics. For carcinomatous ulcers
there is not much that we can do beyond this, even in our day. It is
no wonder that the great historians of medicine have been unanimous in
praise of this wonderful scientific genius. For my lecture on
"Old-Time Medical Education," before the Johns Hopkins Historical
Club, last year, I quoted some of those opinions. Portal, for
instance, says of him, "It may be averred that Guy de Chauliac said
nearly everything that modern surgeons say and that his work is of
infinite price, but unfortunately too little pondered." Malgaigne
declares Chauliac's "Chirurgia Magna," "A masterpiece of learned and
luminous writing." Pagel says, "Chauliac represents the summit of
attainment in mediaeval {137} surgery, and he laid the foundation of
that primacy in surgery which the French maintained down to the
nineteenth century." Professor Clifford Allbutt says of Chauliac's
treatise, "This great work I have studied carefully and not without
prejudice; yet I cannot wonder that Fallopius compared the author with
Hippocrates or that John Freind calls him the prince of surgeons. The
book is rich, aphoristic, orderly and precise." In a word it has all
the qualities that are usually said to be lacking in the work of
mediaeval scientists, and it is a standing reproach to those who
ignorantly have made so little of the work of these wonderful men of
the olden time, who anticipated so many of the features of our modern
medicine and surgery that we are prone to think of as representing
climaxes in human progress, indications of a wonderful human
evolution.
Two other names of great professors of surgery deserve to be mentioned
because they make it very clear that this wonderful development of
surgery was not confined to France and Italy, but made itself felt all
over Europe. One of these is John Ypermann, a surgeon of the early
fourteenth century, of whom almost nothing was known until about
twenty-five years ago, when the Belgian historian, Broeck, brought to
light his works and gathered some details of his life. He was a pupil
of Lanfranc, and at the end of the thirteenth century studied at Paris
on a scholarship voted by his native town of Ypres, {138} which
provided maintenance and tuition fees for him at the great French
university expressly in order that he might become expert in surgery.
We are likely to think of Ypres as an unimportant town, but it was one
of the great industrial centres of Europe and one of the most
populous, busy towns of Flanders in the Middle Ages, noted for its
manufacture of linens and fine laces. The famous Cloth Hall, erected
in the thirteenth century, one of the most beautiful architectural
monuments in Europe, and one of the finest buildings of its kind in
the world, was the result of the same spirit that sent Ypermann to
Paris.
After his return Ypermann settled down in his native town and obtained
great renown not only at home, so that in that part of the country an
expert surgeon is still spoken of as an Ypermann, but he became famous
throughout all the Teutonic countries. He is the author of two books
in Flemish. One of these is on medicine. Pagel calls it an unimportant
compilation. The terms that occur in it, however, are enough to show
us how much more than we are likely to think, these old masters in
medicine discussed problems that are still puzzling us. He treats of
dropsy, rheumatism, under which occur the terms coryza and catarrh,
icterus, phthisis (he calls the tuberculous tysiken), apoplexy,
epilepsy, frenzy, lethargy, fallen palate, cough, shortness of breath,
lung abscess, hemorrhage, blood-spitting, liver abscess, hardening of
the spleen, affections of the kidney, {139} bloody urine, diabetes,
incontinence of urine, dysuria, strangury, gonorrhea and involuntary
seminal emissions--all these terms are quoted directly from Pagel.
His work in medicine, however, is as nothing compared to his writings
on surgery. A special feature of his book is the presence of seventy
illustrations of instruments of the most various kinds, together with
a plate showing the anatomical features of the stitching of a wound in
the head. Even Pagel's brief account of its contents will be a source
of never-ending surprise for those who think that surgery has
developed entirely in our time. Even in this work on surgery, however,
there are many things that we now treat under medicine. As this gives
us an opportunity to show how much more of medicine was known at this
time than is usually thought, I venture to quote some of Pagel's brief
resume of the contents of a single chapter. This is a chapter devoted
to intoxications, which includes the effect of cantharides as well as
alcohol, and treats of the bites of snakes, scorpions and of the fatal
effects of wounds due to the bite of mad dogs.
The other great surgeon and surgical writer of the time, for there
must have been many distinguished surgeons and only a few writers, if
we can trust to common experience in that matter, was John Ardern, an
English surgeon. He was educated in Montpellier, practised for a time
in France, then settled for some years in the {140} small town of
Newark in Nottinghamshire, and then for nearly thirty years in London.
His "Practice of Surgery," as yet existing only in manuscript, is
another one of these wonderful contributions to the applied sciences
of anatomy and medicine at a time when such applications are often
supposed to have been absent. He was an expert operator and had a wide
reputation for his success in the treatment of diseases of the rectum.
He was the inventor of a new clyster apparatus. Daremberg, the medical
historian, who saw a copy of Ardern's manuscript in St. John's
College, Oxford, says that it contained numerous illustrations of
instruments and operations. We fortunately possess an excellent
manuscript copy in the Surgeon General's Library at Washington, and
sometime it is hoped this will be edited and published.
The most interesting feature of the work of all of these men is their
dependence on personal observation and not on authority. Guy de
Chauliac's position in this matter can be very well appreciated from
his criticism of John of Gaddesden's book in which he bewails the
blind following of those who had gone before. His bitterest reproach
for many of his predecessors was that, "They followed one another like
cranes, whether for fear or love he would not say." Pagel praises
Ypermann for the well-marked striving which he has noted in him to
free himself from the bondage of authority, and because most of his
therapeutic {141} descriptions rest upon his own experience. William
of Salicet, at the beginning of this great period of surgery, had
insisted that notes of cases were the most valuable sources of wisdom
in medicine and surgery. The last of them, Ardern, gave statistics of
his cases and was quite as proud as any modern surgeon of the large
number that he had operated on. He gives these carefully and
accurately.
I have dwelt on the medical side of these universities mainly, of
course, because this is more familiar to me as a historian of medicine
than their work in other scientific departments, but also to a great
extent because the medical schools gathered unto themselves nearly all
the scientific knowledge of the time. Botany, mineralogy, climatology,
meteorology were all studied for the sake of what could be learned
from them for the benefit of medicine. Even astronomy which was then
the old astrology, was cultivated seriously, because of the supposed
effect of the stars on human constitutions. For this we surely cannot
blame these mediaeval students of science since four centuries later
Galileo and even Kepler were still making horoscopes for their patrons
and laying down laws from astronomy that were supposed to be
applicable to medicine. Even Copernicus studied astronomy and medicine
side by side and this combination of studies was not at all
infrequent.
The medical schools, then, are the real index of {142} the serious
interest of the mediaeval universities in science. Our scientific
departments in modern universities have developed other interests,
because of various applications that these have to life and its
concerns. Always in scientific universities applied science is sure to
encroach upon the domain of pure science, and no one knows that better
than we do, for we have been bewailing the presence of machine shops
and boiler factories on the university grounds. The old universities
did not teach applied mechanics or engineering, but that does not mean
that these subjects were not taught. There were special technical
schools conducted by the gilds by means of apprenticeship and the
journeyman training, which enabled them to teach those who cared to
have it all the knowledge necessary for construction work of various
kinds. The wonderful architectural engineering exhibited in the
cathedrals, university buildings, town halls and castles of this time,
and the magnificent bridges, some of which are still in existence,
show us that the technical subjects were by no means neglected.
[Footnote 9] Our mediaeval forefathers in education had the wisdom not
to let the technical subjects interfere with pure science too much, as
they inevitably do whenever the two are brought too closely together.
Culture is always overshadowed by the practical, but not to the
ultimate benefit of the race.
[Footnote 9: See Address on "Ideal Education of the Masses."]
The proof for us here in America, close at {143} hand, that these
universities of the Middle Ages were thoroughly scientific in spirit
and not only capable of, but actually active and successful in
scientific investigation, is to be found in our earliest American
universities. We are prone to think, because of the curiously
defective way in which our histories of education have been written,
that the only things worth while talking about in the origins of
education here in America are to be found in English America. Recent
investigations have shown how utterly deceived we were by foolish
self-conceit in this matter. Long before the English-American
universities were founded, and still longer before they began to do
any serious work in education, there were important universities
having literally thousands of students in attendance in the
Spanish-American countries. The University of Mexico and the
University of Lima in Peru were both founded about the middle of the
sixteenth century. Harvard came nearly a century later, Yale a full
century and a half, Princeton more than two centuries. The contrast
between our English-American institutions of learning, however, and
their Spanish-American rivals in accomplishment and numbers in
attendance is still more striking than the mere dates of foundation.
Of course there were chairs of many sciences, strange as that may seem
to us with our ridiculous traditions with regard to the history of
education. These Spanish-American universities were {144} the direct
descendants of the old mediaeval universities. They were in close
relationship with Salamanca, Valladolid and Alcala. They were the
progeny of scientific universities and they were, of course, occupied
mainly with science. In spite of the fact that already the influence
of the Renaissance, with its classical studies as the basis of
education, had begun to make itself felt, these Spanish-American
universities retained, to a great extent, the scientific curriculum.
Nor must it be thought that they were shilly-shally institutions of
learning, doing nothing in reality, but making a great pretence of
studying many things. To know the very opposite we turn to Bourne,
himself at the time a professor at Yale, and writing one of the
volumes of a series edited by Professor Albert Bushnell Hart, who
holds the chair of history at Harvard, to be told in very definite
emphatic terms how successfully investigations in science and
scientific education were carried on in Mexico. Professor Bourne says:
"Not all the institutions of learning founded in Mexico in the
sixteenth century can be enumerated here, but it is not too much to
say that in number, range of studies and standard of attainments by
the officers they surpassed anything existing in English America
until the nineteenth century. _Mexican scholars made distinguished
achievements in some branches of science, particularly medicine and
surgery, but pre-eminently linguistics, history and anthropology._
{145} Dictionaries and grammars of the native languages and
histories of the Mexican institutions are an imposing proof of their
scholarly devotion and intellectual activity. Conspicuous are
Toribio de Motolinia's 'Historia de las Indias de Nueva Espana,'
Duran's 'Historia de las Indias de Nueva Espana,' but most important
of all Sahagun's great work on Mexican life and religion."
The scientific products of these universities in America are
interesting because almost as a rule we know absolutely nothing about
them in English America, and, therefore, conclude there must have been
none. The first book written on a medical topic in America was the
"Secretos de Chirurgia," written by Dr. Pedrarias de Benavides, which
was published at Valladolid in Spain in 1567. The first book on
medicine actually published in this country was "Opera Medicinalia,"
by Francisco Bravo. [Footnote 10] On Columbus' second expedition,
however, a Dr. Chanca who had been physician-in-ordinary to the King
and Queen of Spain, was sent with the expedition as what we would now
call a scientific attache. On his return he wrote a volume of
scientific observations that he had made in America. Some of these
were doubtless written while he was over here, though the book was
published in Spain. Dr. Ybarra of New York recently published a resume
of this in the Smithsonian Publications and an article on it in the
_Journal of the American Medical Association_. {146} It shows very
well how wide were the scientific interests of the physicians of the
time and how ardent their investigation of science, for there is
scarcely a phase of modern science that would be touched on by the
corps of scientists now attached to such an expedition which does not
receive some serious treatment in Dr. Chanca's book. Thus early did
the Spanish-Americans take up scientific investigation seriously.
[Footnote 10: Published in Mexico, 1570.]
Professor Bourne of Yale, in his chapter on the "Transmission of the
European Culture," in the third volume of the American Nation Series,
[Footnote 11] says (p. 17): "Early in the eighteenth century the Lima
University [Lima, Peru] counted nearly 2,000 students and numbered
about one hundred and eighty doctors [in its faculty] in theology,
civil and canon law, medicine and the arts. Ulloa reports that 'the
university makes a stately appearance from without, and its inside is
decorated with suitable ornaments.' _There were chairs of all the
sciences_, and 'some of the professors have, notwithstanding the vast
distance, gained the applause of the literati of Europe.' The coming
of the Jesuits contributed much to the real educational work in
America. They established colleges, one of which, the little Jesuit
College at Juli, on Lake Titicaca, became a seat of genuine learning."
[Footnote 11: Harpers, New York, 1908.]
A distinguished professor of medicine in this country to whose
attention this state of medical {147} education in the
Spanish-American countries, so different from what is thought, was
called, said: "What a surprise it is to find that while we have been
accustomed to think that the _primum mobile_ [the active initiative]
in education in this country came from the Anglo-Saxons, we now find
that they were long anticipated in every department of education by
the Spaniards, though we have been rather accustomed to despise them
for their backwardness." With regard to the establishment of the first
American medical school, it is no longer a surprise to find that it
was established in Mexico, just as soon as we realize that the Mexican
University was closely in touch with the traditions of the mediaeval
universities generally and these all established medical schools as
university departments. The standards of these mediaeval medical
schools were transported to America and maintained. Our medical
schools in the United States got away from the universities, became
mere preparatory institutions, granted degrees for just as little
study as possible, two terms of four months each in most cases,
sometimes given in the same calendar year and requiring no preliminary
training. We are reforming this now for a generation, but just
inasmuch as we are, far from advancing, we are going straight back to
the mediaeval universities and their standards and methods.
With all this evidence before us it seems perfectly clear that these
old mediaeval universities {148} must be considered to have been
scientific universities in our fullest modern sense of the term. They
devoted all their time to the study of phenomena around them and the
attempt to find the principles underlying them. They went at it
somewhat differently in many departments of science than those which
are now employed, but in all their practical work at least, they
anticipated our methods as well as many of our results. The great
professors wrote text-books and students who were ardent in the
pursuit of knowledge copied out those text-books by hand. They had no
way of easily multiplying them almost indefinitely, as we have at the
present time. Probably nothing shows so well the enthusiastic zeal of
these times in the pursuit of scientific knowledge as the fact that so
many copies of these textbooks still remain for us. Much has been lost
by war and fire, and still more by wanton destruction by people who
could not understand, for there were many intervening generations that
sold these old manuscripts by the ton for the use of grocers to wrap
up butter and any other commodity. If we only had the wealth of
manuscript that was originally created it would be easy to fill in the
gaps in our knowledge, and show the wonderful scientific scholarship
of these mediaeval universities.
As it is, there cannot be the slightest doubt that these were great
scientific universities. How, then, has the opposite tradition of
science only {149} coming to cultivation in our time obtained a
foothold; above all, how has it happened that men have insisted that
there was no science in these old days because the Church was opposed
to science and would not permit its study or allow of scientific
investigation? If we were to believe many writers who have been taken
very seriously, anatomy was conducted only under the pain of death,
chemistry made one liable to all sorts of penalties and other forms of
science were absolutely banned. There is no reason at all for any such
declarations from what we know of the history of science. The place
where such groundless assertions are found is in the so-called history
of religion. The _odium theologicum_ was very bitter, and ignorant men
said things without knowing, and then their statements were copied by
others who knew even less.
Probably there is no more serious blot on the history of education
and, above all, the history of science, than the fact that men
supposed to be scholarly have been so ready to accept absolutely
ignorant statements with regard to the state of science during the
Middle Ages. It would be amusing, if it were not so amazing, to recall
the utter lack of scholarship that characterized the men who wrote
such things, but above all the generations that accepted such history
as solemn truth and even conferred academic dignities and degrees on
such men. Take a book like Dr. Draper's "Conflict of Science and
Religion." It {150} is founded on the uttermost lack of knowledge of
the subjects of which he speaks. It is true that he has consulted
historical writers. They were all secondary authorities. He had never
gone back to look up a single original document of any kind. He was a
physician; supposedly at least, then, he should know the history of
medicine. He knows nothing at all about the great medical schools of
the thirteenth and fourteenth centuries; of the great period of
surgery that occurred at this time he has no inkling. Had he cared
really to know anything about the period he could have seen some of
the text-books written by these men. Instead we have an exhibition, in
his book, of the most consummate assumption of knowledge associated
with sublime ignorance and bitter condemnation for old institutions,
educational and ecclesiastical, in matters of which he knows nothing,
though if he did know, his opinion would surely be just the opposite
to that he has expressed.
To a great degree this is true of President White's "A History of the
Warfare of Science with Theology." Secondary authorities constantly
figure in it, and they are quoted from, as a rule, with the definite
idea of proving a particular thesis--that theology is opposed to
science. Of course it is very different to that of Draper, there is
much more of true scholarship in it, but it is sad to think that the
prestige of a president of a great university who had been a professor
of {151} history should have been lent to statements so egregiously
misleading as those which are constantly to be found in his work. Even
sadder it is to think that this has been accepted by many people as a
scholarly work and as representing the last word on the subject.
The "Cambridge Modern History" in its preface said, that history has
been a long conspiracy against the truth and that we must now go back
once more to the original documents. "It has become impossible," the
editors declare, "for the historical writers of the present age to
trust without reserve even to the most respected secondary
authorities. The honest student continually finds himself deserted,
retarded, misled, by the classics of historical literature, and has to
hew his own way through multitudinous transactions, periodicals and
official publications in order to reach the truth." In no department
of history is this expression more true than in that of education, and
especially of science and the relation of educational institutions to
scientific development. No man should now dare venture to say anything
about the state of science at any time in the world's history who has
not seen some of the books written at that time. Above all, no one
should venture to make little of the past on the strength of what
religiously prejudiced writers have said about it.