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The Evolution of Modern Medicine
A Series Of Lectures Delivered At Yale University
- Contents
- THE SILLIMAN FOUNDATION
- ASSYRIAN AND BABYLONIAN MEDICINE
- HEBREW MEDICINE
- CHINESE AND JAPANESE MEDICINE
- CHAPTER II — GREEK MEDICINE
- ASKLEPIOS
- HIPPOCRATES AND THE HIPPOCRATIC WRITINGS
- ALEXANDRIAN SCHOOL
- GALEN
- CHAPTER III — MEDIAEVAL MEDICINE
- SOUTH ITALIAN SCHOOL
- BYZANTINE MEDICINE
- ARABIAN MEDICINE
- THE RISE OF THE UNIVERSITIES
- MEDIAEVAL MEDICAL STUDIES
- MEDIAEVAL PRACTICE
- ASTROLOGY AND DIVINATION
- CHAPTER IV — THE RENAISSANCE AND THE RISE OF ANATOMY AND PHYSIOLOGY
- PARACELSUS
- VESALIUS
- HARVEY
- CHAPTER V — THE RISE AND DEVELOPMENT OF MODERN MEDICINE
- INTERNAL SECRETIONS
- CHEMISTRY
- CHAPTER VI — THE RISE OF PREVENTIVE MEDICINE
- SANITATION
- TUBERCULOSIS
ASSYRIAN AND BABYLONIAN MEDICINE
OF equally great importance in the evolution of medicine was the practically contemporary civilization in Mesopotamia. Science here reached a much higher stage then in the valley of the Nile. An elaborate scheme of the universe was devised, a system growing out of the Divine Will, and a recognition for the first time of a law guiding and controlling heaven and earth alike. Here, too, we find medicine ancillary to religion. Disease was due to evil spirits or demons. “These ‘demons’—invisible to the naked eye were the precursors of the modern ‘germs’ and ‘microbes,’ while the incantations recited by the priests are the early equivalents of the physician’s prescriptions. There were different incantations for different diseases; and they were as mysterious to the masses as are the mystic formulas of the modern physician to the bewildered, yet trusting, patient. Indeed, their mysterious character added to the power supposed to reside in the incantations for driving the demons away. Medicinal remedies accompanied the recital of the incantations, but despite the considerable progress made by such nations of hoary antiquity as the Egyptians and Babylonians in the diagnosis and treatment of common diseases, leading in time to the development of an extensive pharmacology, so long as the cure of disease rested with the priests, the recital of sacred formulas, together with rites that may be conveniently grouped under the head of sympathetic magic, was regarded as equally essential with the taking of the prescribed remedies.”(14)
(14) Morris Jastrow: The Liver in Antiquity and the
Beginnings of Anatomy. Transactions College of Physicians,
Philadelphia, 1907, 3. s., XXIX, 117-138.
Three points of interest may be referred to in connection with Babylonian medicine. Our first recorded observations on anatomy are in connection with the art of divination—the study of the future by the interpretation of certain signs. The student recognized two divisions of divination—the involuntary, dealing with the interpretation of signs forced upon our attention, such as the phenomena of the heavens, dreams, etc., and voluntary divination, the seeking of signs, more particularly through the inspection of sacrificial animals. This method reached an extraordinary development among the Babylonians, and the cult spread to the Etruscans, Hebrews, and later to the Greeks and Romans.
Of all the organs inspected in a sacrificial animal the liver, from its size, position and richness in blood, impressed the early observers as the most important of the body. Probably on account of the richness in blood it came to be regarded as the seat of life—indeed, the seat of the soul. From this important position the liver was not dislodged for many centuries, and in the Galenic physiology it shared with the heart and the brain in the triple control of the natural, animal and vital spirits. Many expressions in literature indicate how persistent was this belief. Among the Babylonians, the word “liver” was used in hymns and other compositions precisely as we use the word “heart,” and Jastrow gives a number of illustrations from Hebrew, Greek and Latin sources illustrating this usage.
The belief arose that through the inspection of this important organ in the sacrificial animal the course of future events could be predicted. “The life or soul, as the seat of life, in the sacrificial animal is, therefore, the divine element in the animal, and the god in accepting the animal, which is involved in the act of bringing it as an offering to a god, identifies himself with the animal—becomes, as it were, one with it. The life in the animal is a reflection of his own life, and since the fate of men rests with the gods, if one can succeed in entering into the mind of a god, and thus ascertain what he purposes to do, the key for the solution of the problem as to what the future has in store will have been found. The liver being the centre of vitality—the seat of the mind, therefore, as well as of the emotions—it becomes in the case of the sacrificial animal, either directly identical with the mind of the god who accepts the animal, or, at all events, a mirror in which the god’s mind is reflected; or, to use another figure, a watch regulated to be in sympathetic and perfect accord with a second watch. If, therefore, one can read the liver of the sacrificial animal, one enters, as it were, into the workshop of the divine will.”(15)
(15) Morris Jastrow: loc. cit., p. 122.
Hepatoscopy thus became, among the Babylonians, of extraordinary complexity, and the organ of the sheep was studied and figured as early as 3000 B.C. In the divination rites, the lobes, the gall-bladder, the appendages of the upper lobe and the markings were all inspected with unusual care. The earliest known anatomical model, which is here shown, is the clay model of a sheep’s liver with the divination text dating from about 2000 B.C., from which Jastrow has worked out the modern anatomical equivalents of the Babylonian terms. To reach a decision on any point, the phenomena of the inspection of the liver were carefully recorded, and the interpretations rested on a more or less natural and original association of ideas. Thus, if the gall-bladder were swollen on the right side, it pointed to an increase in the strength of the King’s army, and was favorable; if on the left side, it indicated rather success of the enemy, and was unfavorable. If the bile duct was long, it pointed to a long life. Gallstones are not infrequently mentioned in the divination texts and might be favorable, or unfavorable. Various interpretations were gathered by the scribes in the reference note-books which serve as guides for the interpretation of the omens and for text-books of instructions in the temple schools (Jastrow).
The art of divination spread widely among the neighboring nations. There are many references in the Bible to the practice. The elders of Moab and Midian came to Balaam “with the rewards of divination in their hand” (Numbers xxii, 7). Joseph’s cup of divination was found in Benjamin’s sack (Genesis xliv, 5, 12); and in Ezekiel (xxi, 21) the King of Babylon stood at the parting of the way and looked in the liver. Hepatoscopy was also practiced by the Etruscans, and from them it passed to the Greeks and the Romans, among whom it degenerated into a more or less meaningless form. But Jastrow states that in Babylonia and Assyria, where for several thousand years the liver was consistently employed as the sole organ of divination, there are no traces of the rite having fallen into decay, or having been abused by the priests.
In Roman times, Philostratus gives an account of the trial of Apollonius of Tyana,(16) accused of human hepatoscopy by sacrificing a boy in the practice of magic arts against the Emperor. “The liver, which the experts say is the very tripod of their art, does not consist of pure blood; for the heart retains all the uncontaminated blood, and irrigates the whole body with it by the conduits of the arteries; whereas the gall, which is situated next the liver, is stimulated by anger and depressed by fear into the hollows of the liver.”
We have seen how early and how widespread was the belief in amulets and charms against the occult powers of darkness. One that has persisted with extraordinary tenacity is the belief in the Evil Eye the power of certain individuals to injure with a look. Of general belief in the older civilizations, and referred to in several places in the Bible, it passed to Greece and Rome, and today is still held fervently in many parts of Europe. The sign of “le corna,”—the first and fourth fingers extended, the others turned down and the thumb closed over them,—still used against the Evil Eye in Italy, was a mystic sign used by the Romans in the festival of Lemuralia. And we meet with the belief also in this country. A child with hemiplegia, at the Infirmary for Diseases of the Nervous System, Philadelphia, from the central part of Pennsylvania, was believed by its parents to have had the Evil Eye cast upon it.
The second contribution of Babylonia and Assyria to medicine—one that affected mankind profoundly—relates to the supposed influence of the heavenly bodies upon man’s welfare. A belief that the stars in their courses fought for or against him arose early in their civilizations, and directly out of their studies on astrology and mathematics. The Macrocosm, the heavens that “declare the glory of God,” reflect, as in a mirror, the Microcosm, the daily life of man on earth. The first step was the identification of the sun, moon and stars with the gods of the pantheon. Assyrian astronomical observations show an extraordinary development of practical knowledge. The movements of the sun and moon and of the planets were studied; the Assyrians knew the precession of the equinoxes and many of the fundamental laws of astronomy, and the modern nomenclature dates from their findings. In their days the signs of the zodiac corresponded practically with the twelve constellations whose names they still bear, each division being represented by the symbol of some god, as the Scorpion, the Ram, the Twins, etc. “Changes in the heavens . . . portended changes on earth. The Biblical expression ‘hosts of heaven’ for the starry universe admirably reflects the conception held by the Babylonian astrologers. Moon, planets and stars constituted an army in constant activity, executing military manoeuvres which were the result of deliberation and which had in view a fixed purpose. It was the function of the priest—the barqu, or ‘inspector,’ as the astrologer as well as the ‘inspector’ of the liver was called—to discover this purpose. In order to do so, a system of interpretation was evolved, less logical and less elaborate than the system of hepatoscopy, which was analyzed in the preceding chapter, but nevertheless meriting attention both as an example of the pathetic yearning of men to peer into the minds of the gods, and of the influence that Babylonian-Assyrian astrology exerted throughout the ancient world” (Jastrow).(17)
(16) Philostratus: Apollonius of Tyana, Bk. VIII, Chap.
VII, Phillimore’s transl., Oxford, 1912, II, 233. See,
also, Justin: Apologies, edited by Louis Pautigny, Paris,
1904, p. 39.
(17) M. Jastrow: Aspects of Religious Belief and Practice
in Babylonia and Assyria, New York, 1911, p. 210.
With the rationalizing influence of the Persians the hold of astrology weakened, and according to Jastrow it was this, in combination with Hebrew and Greek modes of thought, that led the priests in the three centuries following the Persian occupation, to exchange their profession of diviners for that of astronomers; and this, he says, marks the beginning of the conflict between religion and science. At first an expression of primitive “science,” astrology became a superstition, from which the human mind has not yet escaped. In contrast to divination, astrology does not seem to have made much impression on the Hebrews and definite references in the Bible are scanty. From Babylonia it passed to Greece (without, however, exerting any particular influence upon Greek medicine). Our own language is rich in words of astral significance derived from the Greek, e.g., disaster.
The introduction of astrology into Europe has a passing interest. Apparently the Greeks had made important advances in astronomy before coming in contact with the Babylonians,—who, in all probability, received from the former a scientific conception of the universe. “In Babylonia and Assyria we have astrology first and astronomy afterwards, in Greece we have the sequence reversed—astronomy first and astrology afterwards” (Jastrow).(18)
(18) M. Jastrow: Aspects of Religious Belief and Practice
in Babylonia and Assyria, New York, 1911, p. 256.
It is surprising to learn that, previous to their contact with the Greeks, astrology as relating to the individual—that is to say, the reading of the stars to determine the conditions under which the individual was born—had no place in the cult of the Babylonians and Assyrians. The individualistic spirit led the Greek to make his gods take note of every action in his life, and his preordained fate might be read in the stars.—”A connecting link between the individual and the movements in the heavens was found in an element which they shared in common. Both man and stars moved in obedience to forces from which there was no escape. An inexorable law controlling the planets corresponded to an equally inexorable fate ordained for every individual from his birth. Man was a part of nature and subject to its laws. The thought could therefore arise that, if the conditions in the heavens were studied under which a man was born, that man’s future could be determined in accord with the beliefs associated with the position of the planets rising or visible at the time of birth or, according to other views, at the time of conception. These views take us back directly to the system of astrology developed by Babylonian baru priests. The basis on which the modified Greek system rests is likewise the same that we have observed in Babylonia—a correspondence between heaven and earth, but with this important difference, that instead of the caprice of the gods we have the unalterable fate controlling the entire universe—the movements of the heavens and the life of the individual alike” (Jastrow).(19)
(19) Ibid., pp. 257-258.
From this time on until the Renaissance, like a shadow, astrology follows astronomy. Regarded as two aspects of the same subject, the one, natural astrology, the equivalent of astronomy, was concerned with the study of the heavens, the other, judicial astrology, was concerned with the casting of horoscopes, and reading in the stars the fate of the individual.
As I mentioned, Greek science in its palmy days seems to have been very free from the bad features of astrology. Gilbert Murray remarks that “astrology fell upon the Hellenistic mind as a new disease falls upon some remote island people.” But in the Greek conquest of the Roman mind, astrology took a prominent role. It came to Rome as part of the great Hellenizing movement, and the strength of its growth may be gauged from the edicts issued against astrologers as early as the middle of the second century B.C. In his introduction to his recent edition of Book II of the Astronomicon of Manilius, Garrod traces the growth of the cult, which under the Empire had an extraordinary vogue. “Though these (heavenly) signs be far removed from us, yet does he (the god) so make their influences felt, that they give to nations their life and their fate and to each man his own character.”(20) Oracles were sought on all occasions, from the planting of a tree to the mating of a horse, and the doctrine of the stars influenced deeply all phases of popular thought and religion. The professional astrologers, as Pliny(21) says, were Chaldeans, Egyptians and Greeks. The Etruscans, too, the professional diviners of Rome, cultivated the science. Many of these “Isiaci conjectores” and “astrologi de circo” were worthless charlatans, but on the whole the science seems to have attracted the attention of thoughtful men of the period. Garrod quotes the following remarkable passage from Tacitus: “My judgment wavers,” he says, “I dare not say whether it be fate and necessity immutable which governs the changing course of human affairs—or just chance. Among the wisest of the ancients, as well as among their apes, you will find a conflict of opinion. Many hold fixedly the idea that our beginning and our end—that man himself—is nothing to the Gods at all. The wicked are in prosperity and the good meet tribulation. Others believe that Fate and the facts of this world work together. But this connection they trace not to planetary influences but to a concatenation of natural causes. We choose our life that is free: but the choice once made, what awaits us is fixed and ordered. Good and evil are different from the vulgar opinion of them. Often those who seem to battle with adversity are to be accounted blessed; but the many, even in their prosperity, are miserable. It needs only to bear misfortune bravely, while the fool perishes in his wealth. Outside these rival schools stands the man in the street. No one will take from him his conviction that at our birth are fixed for us the things that shall be. If some things fall out differently from what was foretold, that is due to the deceit of men that speak what they know not: calling into contempt a science to which past and present alike bear a glorious testimony” (Ann. vi, 22).
(20) Manili Astronomicon Liber II, ed. H. W. Garrod, Oxford,
1911, p. lxix, and II, ll. 84-86.
(21) Pliny: Natural History, Bk. XVIII, Chap. XXV, Sect.
57.
Cato waged war on the Greek physicians and forbade “his uilicus all resort to haruspicem, augurem, hariolum Chaldaeum,” but in vain; so widespread became the belief that the great philosopher, Panaetius (who died about 111 B.C.), and two of his friends alone among the stoics, rejected the claims of astrology as a science (Garrod). So closely related was the subject of mathematics that it, too, fell into disfavor, and in the Theodosian code sentence of death was passed upon mathematicians. Long into the Middle Ages, the same unholy alliance with astrology and divination caused mathematics to be regarded with suspicion, and even Abelard calls it a nefarious study.
The third important feature in Babylonian medicine is the evidence afforded by the famous Hammurabi Code (circa 2000 B.C.)—a body of laws, civil and religious, many of which relate to the medical profession. This extraordinary document is a black diorite block 8 feet high, once containing 21 columns on the obverse, 16 and 28 columns on the reverse, with 2540 lines of writing of which now 1114 remain, and surmounted by the figure of the king receiving the law from the Sun-god. Copies of this were set up in Babylon “that anyone oppressed or injured, who had a tale of woe to tell, might come and stand before his image, that of a king of righteousness, and there read the priceless orders of the King, and from the written monument solve his problem” (Jastrow). From the enactments of the code we gather that the medical profession must have been in a highly organized state, for not only was practice regulated in detail, but a scale of fees was laid down, and penalties exacted for malpraxis. Operations were performed, and the veterinary art was recognized. An interesting feature, from which it is lucky that we have in these days escaped, is the application of the “lex talionis”—an eye for an eye, bone for a bone, and tooth for a tooth, which is a striking feature of the code.
Some of the laws of the code may be quoted:
Paragraph 215. If a doctor has treated a gentleman for a severe wound with a bronze lances and has cured the man, or has opened an abscess of the eye for a gentleman with the bronze lances and has cured the eye of the gentleman, he shall take ten shekels of silver.
218. If the doctor has treated a gentleman for a severe wound with a lances of bronze and has caused the gentleman to die, or has opened an abscess of the eye for a gentleman and has caused the loss of the gentleman’s eye, one shall cut off his hands.
219. If a doctor has treated the severe wound of a slave of a poor man with a bronze lances and has caused his death, he shall render slave for slave.
220. If he has opened his abscess with a bronze lances and has made him lose his eye, he shall pay money, half his price.
221. If a doctor has cured the shattered limb of a gentleman, or has cured the diseased bowel, the patient shall give five shekels of silver to the doctor.
224. If a cow doctor or a sheep doctor has treated a cow or a sheep for a severe wound and cured it, the owner of the cow or sheep shall give one-sixth of a shekel of silver to the doctor as his fee.(22)
(22) The Oldest Code of Laws in the World; translated by C.
H. W. Johns, Edinburgh, 1903.
HEBREW MEDICINE
THE medicine of the Old Testament betrays both Egyptian and Babylonian influences; the social hygiene is a reflex of regulations the origin of which may be traced in the Pyramid Texts and in the papyri. The regulations in the Pentateuch codes revert in part to primitive times, in part represent advanced views of hygiene. There are doubts if the Pentateuch code really goes back to the days of Moses, but certainly someone “learned in the wisdom of the Egyptians” drew it up. As Neuburger briefly summarizes:
“The commands concern prophylaxis and suppression of epidemics, suppression of venereal disease and prostitution, care of the skin, baths, food, housing and clothing, regulation of labour, sexual life, discipline of the people, etc. Many of these commands, such as Sabbath rest, circumcision, laws concerning food (interdiction of blood and pork), measures concerning menstruating and lying-in women and those suffering from gonorrhoea, isolation of lepers, and hygiene of the camp, are, in view of the conditions of the climate, surprisingly rational.”(23)
(23) Neuburger: History of Medicine, Oxford University
Press, 1910, Vol. I, p. 38.
Divination, not very widely practiced, was borrowed, no doubt, from Babylonia. Joseph’s cup was used for the purpose, and in Numbers, the elders of Balak went to Balaam with the rewards of divination in their hands. The belief in enchantments and witchcraft was universal, and the strong enactments against witches in the Old Testament made a belief in them almost imperative until more rational beliefs came into vogue in the eighteenth and nineteenth centuries.
Whatever view we may take of it, the medicine of the New Testament is full of interest. Divination is only referred to once in the Acts (xvi, 16), where a damsel is said to be possessed of a spirit of divination “which brought her masters much gain by soothsaying.” There is only one mention of astrology (Acts vii, 43); there are no witches, neither are there charms or incantations. The diseases mentioned are numerous: demoniac possession, convulsions, paralysis, skin diseases,—as leprosy,—dropsy, haemorrhages, fever, fluxes, blindness and deafness. And the cure is simple usually a fiat of the Lord, rarely with a prayer, or with the use of means such as spittle. They are all miraculous, and the same power was granted to the apostles—”power against unclean spirits, to cast them out, to heal all manner of sickness and all manner of disease.” And more than this, not only the blind received their sight, the lame walked, the lepers were cleansed, the deaf heard, but even the dead were raised up. No question of the mandate. He who went about doing good was a physician of the body as well as of the soul, and could the rich promises of the Gospel have been fulfilled, there would have been no need of a new dispensation of science. It may be because the children of this world have never been able to accept its hard sayings—the insistence upon poverty, upon humility, upon peace that Christianity has lost touch no less with the practice than with the principles of its Founder. Yet, all through the centuries, the Church has never wholly abandoned the claim to apostolic healing; nor is there any reason why she should. To the miraculous there should be no time limit—only conditions have changed and nowadays to have a mountain-moving faith is not easy. Still, the possession is cherished, and it adds enormously to the spice and variety of life to know that men of great intelligence, for example, my good friend, Dr. James J. Walsh of New York, believe in the miracles of Lourdes.(24) Only a few weeks ago, the Bishop of London followed with great success, it is said, the practice of St. James. It does not really concern us much—as Oriental views of disease and its cure have had very little influence on the evolution of scientific medicine—except in illustration of the persistence of an attitude towards disease always widely prevalent, and, indeed, increasing. Nor can we say that the medicine of our great colleague, St. Luke, the Beloved Physician, whose praise is in the Gospels, differs so fundamentally from that of the other writings of the New Testament that we can claim for it a scientific quality. The stories of the miracles have technical terms and are in a language adorned by medical phraseology, but the mental attitude towards disease is certainly not that of a follower of Hippocrates, nor even of a scientifically trained contemporary of Dioscorides.(25)
(24) Psychotherapy, New York, 1919, p. 79, “I am convinced
that miracles happen there. There is more than natural power
manifest.”
(25) See Luke the Physician, by Harnack, English ed., 1907,
and W. K. Hobart, The Medical Language of St. Luke, 1882.
CHINESE AND JAPANESE MEDICINE
CHINESE medicine illustrates the condition at which a highly intellectual people may arrive, among whom thought and speculation were restricted by religious prohibitions. Perhaps the chief interest in its study lies in the fact that we may see today the persistence of views about disease similar to those which prevailed in ancient Egypt and Babylonia. The Chinese believe in a universal animism, all parts being animated by gods and spectres, and devils swarm everywhere in numbers incalculable. The universe was spontaneously created by the operation of its Tao, “composed of two souls, the Yang and the Yin; the Yang represents light, warmth, production, and life, as also the celestial sphere from which all those blessings emanate; the Yin is darkness, cold, death, and the earth, which, unless animated by the Yang or heaven, is dark, cold, dead. The Yang and the Yin are divided into an infinite number of spirits respectively good and bad, called shen and kwei; every man and every living being contains a shen and a kwei, infused at birth, and departing at death, to return to the Yang and the Yin. Thus man with his dualistic soul is a microcosmos, born from the Macrocosmos spontaneously. Even every object is animated, as well as the Universe of which it is a part.”(26)
(26) J. J. M. de Groot: Religious System of China, Vol. VI,
Leyden, 1910, p. 929.
In the animistic religion of China, the Wu represented a group of persons of both sexes, who wielded, with respect to the world of spirits, capacities and powers not possessed by the rest of men. Many practitioners of Wu were physicians who, in addition to charms and enchantments, used death-banishing medicinal herbs. Of great antiquity, Wu-ism has changed in some ways its outward aspect, but has not altered its fundamental characters. The Wu, as exorcising physicians and practitioners of the medical art, may be traced in classical literature to the time of Confucius. In addition to charms and spells, there were certain famous poems which were repeated, one of which, by Han Yu, of the T’ang epoch, had an extraordinary vogue. De Groot says that the “Ling,” or magical power of this poem must have been enormous, seeing that its author was a powerful mandarin, and also one of the loftiest intellects China has produced. This poetic febrifuge is translated in full by de Groot (VI, 1054-1055), and the demon of fever, potent chiefly in the autumn, is admonished to begone to the clear and limpid waters of the deep river.
In the High Medical College at Court, in the T’ang Dynasty, there were four classes of Masters, attached to its two High Medical Chiefs: Masters of Medicine, of Acupuncture, of Manipulation, and two Masters for Frustration by means of Spells.
Soothsaying and exorcism may be traced far back to the fifth and sixth centuries B.C.
In times of epidemic the specialists of Wu-ism, who act as seers, soothsayers and exorcists, engage in processions, stripped to the waist, dancing in a frantic, delirious state, covering themselves with blood by means of prick-balls, or with needles thrust through their tongues, or sitting or stretching themselves on nail points or rows of sword edges. In this way they frighten the spectres of disease. They are nearly all young, and are spoken of as “divining youths,” and they use an exorcising magic based on the principle that legions of spectres prone to evil live in the machine of the world. (De Groot, VI, 983-985.)
The Chinese believe that it is the Tao, or “Order of the Universe,” which affords immunity from evil, and according to whether or no the birth occurred in a beneficent year, dominated by four double cyclical characters, the horoscope is “heavy” or “light.” Those with light horoscopes are specially prone to incurable complaints, but much harm can be averted if such an individual be surrounded with exorcising objects, if he be given proper amulets to wear and proper medicines to swallow, and by selecting for him auspicious days and hours.
Two or three special points may be referred to. The doctrine of the pulse reached such extraordinary development that the whole practice of the art centred round its different characters. There were scores of varieties, which in complication and detail put to confusion the complicated system of some of the old Graeco-Roman writers. The basic idea seems to have been that each part and organ had its own proper pulse, and just as in a stringed instrument each chord has its own tone, so in the human body, if the pulses were in harmony, it meant health; if there was discord, it meant disease. These Chinese views reached Europe in the seventeenth and eighteenth centuries, and there is a very elaborate description of them in Floyer’s well-known book.(27) And the idea of harmony in the pulse is met with into the eighteenth century.
(27) Sir John Floyer: The Physician’s Pulse Watch, etc.,
London, 1707.
Organotherapy was as extensively practiced in China as in Egypt. Parts of organs, various secretions and excretions are very commonly used. One useful method of practice reached a remarkable development, viz., the art of acupuncture—the thrusting of fine needles more or less deeply into the affected part. There are some 388 spots on the body in which acupuncture could be performed, and so well had long experience taught them as to the points of danger, that the course of the arteries may be traced by the tracts that are avoided. The Chinese practiced inoculation for smallpox as early as the eleventh century.
Even the briefest sketch of the condition of Chinese medicine leaves the impression of the appalling stagnation and sterility that may afflict a really intelligent people for thousands of years. It is doubtful if they are today in a very much more advanced condition than were the Egyptians at the time when the Ebers Papyrus was written. From one point of view it is an interesting experiment, as illustrating the state in which a people may remain who have no knowledge of anatomy, physiology or pathology.
Early Japanese medicine has not much to distinguish it from the Chinese. At first purely theurgic, the practice was later characterized by acupuncture and a refined study of the pulse. It has an extensive literature, largely based upon the Chinese, and extending as far back as the beginning of the Christian era. European medicine was introduced by the Portuguese and the Dutch, whose “factory” or “company” physicians were not without influence upon practice. An extraordinary stimulus was given to the belief in European medicine by a dissection made by Mayeno in 1771 demonstrating the position of the organs as shown in the European anatomical tables, and proving the Chinese figures to be incorrect. The next day a translation into Japanese of the anatomical work of Kulmus was begun, and from its appearance in 1773 may be dated the commencement of reforms in medicine. In 1793, the work of de Gorter on internal medicine was translated, and it is interesting to know that before the so-called “opening of Japan” many European works on medicine had been published. In 1857, a Dutch medical school was started in Yedo. Since the political upheaval in 1868, Japan has made rapid progress in scientific medicine, and its institutions and teachers are now among the best known in the world.(28)
(28) See Y. Fujikawa, Geschichte der Medizin in Japan,
Tokyo, 1911.
CHAPTER II — GREEK MEDICINE
OGRAIAE gentis decus! let us sing with Lucretius, one of the great interpreters of Greek thought. How grand and how true is his paean!
Out of the night, out of the blinding night
Thy beacon flashes;—hail, beloved light
Of Greece and Grecian; hail, for in the mirk
Thou cost reveal each valley and each height.
Thou art my leader, and the footprints shine,
Wherein I plant my own….
The world was shine to read, and having read,
Before thy children’s eyes thou didst outspread
The fruitful page of knowledge, all the wealth
Of wisdom, all her plenty for their bread.
(Bk. III.—Translated by D. A. Slater.)
Let us come out of the murky night of the East, heavy with
phantoms,
into the bright daylight of the West, into the company of men
whose
thoughts made our thoughts, and whose ways made our ways—the men
who first dared to look on nature with the clear eyes of the
mind.
Browning’s famous poem, “Childe Roland to the Dark Tower Came,” is an allegory of the pilgrimage of man through the dark places of the earth, on a dismal path beset with demons, and strewn with the wreckage of generations of failures. In his ear tolled the knell of all the lost adventurers, his peers, all lost, lost within sight of the dark Tower itself—
The round squat turret, blind as the fool’s heart,
Built of brown stone, without a counterpart
In the whole world.
lost in despair at an all-encircling mystery. Not so the Greek Childe Roland who set the slug-horn to his lips and blew a challenge. Neither Shakespeare nor Browning tells us what happened, and the old legend, Childe Roland, is the incarnation of the Greek spirit, the young, light-hearted master of the modern world, at whose trumpet blast the dark towers of ignorance, superstition and deceit have vanished into thin air, as the baseless fabric of a dream. Not that the jeering phantoms have flown! They still beset, in varied form, the path of each generation; but the Achaian Childe Roland gave to man self-confidence, and taught him the lesson that nature’s mysteries, to be solved, must be challenged. On a portal of one of the temples of Isis in Egypt was carved: “I am whatever hath been, is, or ever will be, and my veil no man has yet lifted.”
The veil of nature the Greek lifted and herein lies his value to us. What of this Genius? How did it arise among the peoples of the AEgean Sea? Those who wish to know the rock whence science was hewn may read the story told in vivid language by Professor Gomperz in his “Greek Thinkers,” the fourth volume of which has recently been published (Murray, 1912; Scribner, 1912). In 1912, there was published a book by one of the younger Oxford teachers, “The Greek Genius and Its Meaning to Us,”(1) from which those who shrink from the serious study of Gomperz’ four volumes may learn something of the spirit of Greece. Let me quote a few lines from his introduction:
(1) By R. W. Livingstone, Clarendon Press, Oxford, 1912 (2d
ed., revised, 1915).
“Europe has nearly four million square miles; Lancashire has 1,700; Attica has 700. Yet this tiny country has given us an art which we, with it and all that the world has done since it for our models, have equalled perhaps, but not surpassed. It has given us the staple of our vocabulary in every domain of thought and knowledge. Politics, tyranny, democracy, anarchism, philosophy, physiology, geology, history—these are all Greek words. It has seized and up to the present day kept hold of our higher education. It has exercised an unfailing fascination, even on minds alien or hostile. Rome took her culture thence. Young Romans completed their education in the Greek schools…. And so it was with natures less akin to Greece than the Roman. St. Paul, a Hebrew of the Hebrews, who called the wisdom of the Greeks foolishness, was drawn to their Areopagus, and found himself accommodating his gospel to the style, and quoting verses from the poets of this alien race. After him, the Church, which was born to protest against Hellenism, translated its dogmas into the language of Greek thought and finally crystallized them in the philosophy of Aristotle.”
Whether a plaything of the gods or a cog in the wheels of the universe this was the problem which life offered to the thinking Greek; and in undertaking its solution, he set in motion the forces that have made our modern civilization. That the problem remains unsolved is nothing in comparison with the supreme fact that in wrestling with it, and in studying the laws of the machine, man is learning to control the small section of it with which he is specially concerned. The veil of thaumaturgy which shrouded the Orient, while not removed, was rent in twain, and for the first time in history, man had a clear vision of the world about him—”had gazed on Nature’s naked loveliness” (“Adonais”) unabashed and unaffrighted by the supernatural powers about him. Not that the Greek got rid of his gods—far from it!—but he made them so like himself, and lived on terms of such familiarity with them that they inspired no terror.(2)
(2) “They made deities in their own image, in the likeness
of an image of corruptible man. Sua cuique deu fit dira
cupido. ‘Each man’s fearful passion becomes his god.’ Yes,
and not passions only, but every impulse, every aspiration,
every humour, every virtue, every whim. In each of his
activities the Greek found something wonderful, and called
it God: the hearth at which he warmed himself and cooked his
food, the street in which his house stood, the horse he
rode, the cattle he pastured, the wife he married, the child
that was born to him, the plague of which he died or from
which he recovered, each suggested a deity, and he made one
to preside over each. So too with qualities and powers more
abstract.” R.W. Livingstone: The Greek Genius and Its
Meaning to Us, pp. 51-52.
Livingstone discusses the Greek Genius as displayed to us in certain “notes”—the Note of Beauty—the Desire for Freedom—the Note of Directness—the Note of Humanism—the Note of Sanity and of Many-sidedness. Upon some of these characteristics we shall have occasion to dwell in the brief sketch of the rise of scientific medicine among this wonderful people.
We have seen that the primitive man and in the great civilizations of Egypt and Babylonia, the physician evolved from the priest—in Greece he had a dual origin, philosophy and religion. Let us first trace the origins in the philosophers, particularly in the group known as the Ionian Physiologists, whether at home or as colonists in the south of Italy, in whose work the beginnings of scientific medicine may be found. Let me quote a statement from Gomperz:
“We can trace the springs of Greek success achieved and maintained by the great men of Hellas on the field of scientific inquiry to a remarkable conjunction of natural gifts and conditions. There was the teeming wealth of constructive imagination united with the sleepless critical spirit which shrank from no test of audacity; there was the most powerful impulse to generalization coupled with the sharpest faculty for descrying and distinguishing the finest shades of phenomenal peculiarity; there was the religion of Hellas, which afforded complete satisfaction to the requirements of sentiment, and yet left the intelligence free to perform its destructive work; there were the political conditions of a number of rival centres of intellect, of a friction of forces, excluding the possibility of stagnation, and, finally, of an order of state and society strict enough to curb the excesses of ‘children crying for the moon,’ and elastic enough not to hamper the soaring flight of superior minds…. We have already made acquaintance with two of the sources from which the spirit of criticism derived its nourishment—the metaphysical and dialectical discussions practiced by the Eleatic philosophers, and the semi-historical method which was applied to the myths by Hecataeus and Herodotus. A third source is to be traced to the schools of the physicians. These aimed at eliminating the arbitrary element from the view and knowledge of nature, the beginnings of which were bound up with it in a greater or less degree, though practically without exception and by the force of an inner necessity. A knowledge of medicine was destined to correct that defect, and we shall mark the growth of its most precious fruits in the increased power of observation and the counterpoise it offered to hasty generalizations, as well as in the confidence which learnt to reject untenable fictions, whether produced by luxuriant imagination or by a priori speculations, on the similar ground of self-reliant sense-perception.”(3)
(3) Gomperz: Greek Thinkers, Vol. I, p. 276.
The nature philosophers of the Ionian days did not contribute much to medicine proper, but their spirit and their outlook upon nature influenced its students profoundly. Their bold generalizations on the nature of matter and of the elements are still the wonder of chemists. We may trace to one of them, Anaximenes, who regarded air as the primary principle, the doctrine of the “pneuma,” or the breath of life—the psychic force which animates the body and leaves it at death—”Our soul being air, holds us together.” Of another, the famous Heraclitus, possibly a physician, the existing fragments do not relate specially to medicine; but to the philosopher of fire may be traced the doctrine of heat and moisture, and their antitheses, which influenced practice for many centuries. There is evidence in the Hippocratic treatise peri sarkwn of an attempt to apply this doctrine to the human body. The famous expression, panta rhei,—”all things are flowing,”—expresses the incessant flux in which he believed and in which we know all matter exists. No one has said a ruder thing of the profession, for an extant fragment reads: “. . . physicians, who cut, burn, stab, and rack the sick, then complain that they do not get any adequate recompense for it.”(4)
(4) J. Burnet: Early Greek Philosophy, 1892, p. 137,
Bywater’s no. LVIII.
The South Italian nature philosophers contributed much more to the science of medicine, and in certain of the colonial towns there were medical schools as early as the fifth century B.C. The most famous of these physician philosophers was Pythagoras, whose life and work had an extraordinary influence upon medicine, particularly in connection with his theory of numbers, and the importance of critical days. His discovery of the dependence of the pitch of sound on the length of the vibrating chord is one of the most fundamental in acoustics. Among the members of the school which he founded at Crotona were many physicians. who carried his views far and wide throughout Magna Graecia. Nothing in his teaching dominated medicine so much as the doctrine of numbers, the sacredness of which seems to have had an enduring fascination for the medical mind. Many of the common diseases, such as malaria, or typhus, terminating abruptly on special days, favored this belief. How dominant it became and how persistent you may judge from the literature upon critical days, which is rich to the middle of the eighteenth century.
One member of the Crotonian school, Alcmaeon, achieved great distinction in both anatomy and physiology. He first recognized the brain as the organ of the mind, and made careful dissections of the nerves, which he traced to the brain. He described the optic nerves and the Eustachian tubes, made correct observations upon vision, and refuted the common view that the sperma came from the spinal cord. He suggested the definition of health as the maintenance of equilibrium, or an “isonomy” in the material qualities of the body. Of all the South Italian physicians of this period, the personality of none stands out in stronger outlines than that of Empedocles of Agrigentum—physician, physiologist, religious teacher, politician and poet. A wonder-worker, also, and magician, he was acclaimed in the cities as an immortal god by countless thousands desiring oracles or begging the word of healing. That he was a keen student of nature is witnessed by many recorded observations in anatomy and physiology; he reasoned that sensations travel by definite paths to the brain. But our attention must be confined to his introduction of the theory of the four elements—fire, air, earth and water—of which, in varying quantities, all bodies were made up. Health depended upon the due equilibrium of these primitive substances; disease was their disturbance. Corresponding to those were the four essential qualities of heat and cold, moisture and dryness, and upon this four-fold division was engrafted by the later physicians the doctrine of the humors which, from the days of Hippocrates almost to our own, dominated medicine. All sorts of magical powers were attributed to Empedocles. The story of Pantheia whom he called back to life after a thirty days’ trance has long clung in the imagination. You remember how Matthew Arnold describes him in the well-known poem, “Empedocles on Etna”—
But his power
Swells with the swelling evil of this time,
And holds men mute to see where it will rise.
He could stay swift diseases in old days,
Chain madmen by the music of his lyre,
Cleanse to sweet airs the breath of poisonous streams,
And in the mountain-chinks inter the winds.
This he could do of old—(5)
a quotation which will give you an idea of some of the powers attributed to this wonder-working physician.
(5) Poetical Works of Matthew Arnold, Macmillan & Co., 1898,
p. 440.
But of no one of the men of this remarkable circle have we such definite information as of the Crotonian physician Democedes, whose story is given at length by Herodotus; and his story has also the great importance of showing that, even at this early period, a well-devised scheme of public medical service existed in the Greek cities. It dates from the second half of the sixth century B.C.—fully two generations before Hippocrates. A Crotonian, Democedes by name, was found among the slaves of Oroetes. Of his fame as a physician someone had heard and he was called in to treat the dislocated ankle of King Darius. The wily Greek, longing for his home, feared that if he confessed to a knowledge of medicine there would be no chance of escape, but under threat of torture he undertook a treatment which proved successful. Then Herodotus tells his story—how, ill treated at home in Crotona, Democedes went to AEgina, where he set up as a physician and in the second year the State of AEgina hired his services at the price of a talent. In the third year, the Athenians engaged him at 100 minae; and in the fourth, Polycrates of Samos at two talents. Democedes shared the misfortunes of Polycrates and was taken prisoner by Oroetes. Then Herodotus tells how he cured Atossa, the daughter of Cyrus and wife of Darius, of a severe abscess of the breast, but on condition that she help him to escape, and she induced her husband to send an expedition of exploration to Greece under the guidance of Democedes, but with the instructions at all costs to bring back the much prized physician. From Tarentum, Democedes escaped to his native city, but the Persians followed him, and it was with the greatest difficulty that he escaped from their hands. Deprived of their guide, the Persians gave up the expedition and sailed for Asia. In palliation of his flight, Democedes sent a message to Darius that he was engaged to the daughter of Milo, the wrestler, who was in high repute with the King.(6)
(6) The well-known editor of Herodotus, R. W. Macan, Master
of University College, Oxford, in his Hellenikon. A Sheaf
of Sonnets after Herodotus (Oxford, 1898) has included a
poem which may be quoted in connection with this incident:
NOSTALGY
Atossa, child of Cyrus king of kings,
healed by Greek science of a morbid breast,
gave lord Dareios neither love nor rest
till he fulfilled her vain imaginings.
“Sir, show our Persian folk your sceptre’s wings!
Enlarge my sire’s and brother’s large bequest.
This learned Greek shall guide your galleys west,
and Dorian slave-girls grace our banquetings.”
So said she, taught of that o’er-artful man,
the Italiote captive, Kroton’s Demokede,
who recked not what of maladies began,
nor who in Asia and in Greece might bleed,
if he—so writes the guileless Thurian—
regained his home, and freedom of the Mede.
Plato has several references to these state physicians, who were evidently elected by a public assembly: “When the assembly meets to elect a physician,” and the office was yearly, for in “The Statesman” we find the following:(7) “When the year of office has expired, the pilot, or physician has to come before a court of review” to answer any charges. The physician must have been in practice for some time and attained eminence, before he was deemed worthy of the post of state physician.
(7) Jowett: Dialogues of Plato, 3d ed., Statesman, Vol. IV,
p. 502 (Stephanus, II, 298 E)
“If you and I were physicians, and were advising one another that we were competent to practice as state-physicians, should I not ask about you, and would you not ask about me, Well, but how about Socrates himself, has he good health? and was anyone else ever known to be cured by him whether slave or freeman?”(7a)
(7a) Jowett: Dialogues of Plato, 3d ed., Gorgias, Vol. II,
p. 407 (Stephanus, I, 514 D).
All that is known of these state physicians has been collected by Pohl,(8) who has traced their evolution into Roman times. That they were secular, independent of the AEsculapian temples, that they were well paid, that there was keen competition to get the most distinguished men, that they were paid by a special tax and that they were much esteemed—are facts to be gleaned from Herodotus and from the inscriptions. The lapidary records, extending over 1000 years, collected by Professor Oehler(8a) of Reina, throw an important light on the state of medicine in Greece and Rome. Greek vases give representations of these state doctors at work. Dr. E. Pottier has published one showing the treatment of a patient in the clinic.(8b)
(8) R. Pohl: De Graecorum medicis publicis, Berolini,
Reimer, 1905; also Janus, Harlem, 1905, X, 491-494.
(8a) J Oehler: Janus, Harlem, 1909, XIV, 4; 111.
(8b) E. Pottier: Une clinique grecque au Ve siecle,
Monuments et Memoires, XIII, p. 149. Paris, 1906 (Fondation
Eugene Piot).
That dissections were practiced by this group of nature philosophers is shown not only by the studies of Alcmaeon, but we have evidence that one of the latest of them, Diogenes of Apollonia, must have made elaborate dissections. In the “Historia Animalium”(9) of Aristotle occurs his account of the blood vessels, which is by far the most elaborate met with in the literature until the writings of Galen. It has, too, the great merit of accuracy (if we bear in mind the fact that it was not until after Aristotle that arteries and veins were differentiated), and indications are given as to the vessels from which blood may be drawn.
(9) The Works of Aristotle, Oxford, Clarendon Press, Vol.
IV, 1910, Bk. III, Chaps. II-IV, pp. 511b-515b.
ASKLEPIOS
No god made with hands, to use the scriptural phrase, had a more successful “run” than Asklepios—for more than a thousand years the consoler and healer of the sons of men. Shorn of his divine attributes he remains our patron saint, our emblematic God of Healing, whose figure with the serpents appears in our seals and charters. He was originally a Thessalian chieftain, whose sons, Machaon and Podalirius, became famous physicians and fought in the Trojan War. Nestor, you may remember, carried off the former, declaring, in the oft-quoted phrase, that a doctor was better worth saving than many warriors unskilled in the treatment of wounds. Later genealogies trace his origin to Apollo,(10) as whose son he is usually regarded. “In the wake of northern tribes this god Aesculapius—a more majestic figure than the blameless leech of Homer’s song—came by land to Epidaurus and was carried by sea to the east-ward island of Cos…. Aesculapius grew in importance with the growth of Greece, but may not have attained his greatest power until Greece and Rome were one.”(11)
(10) W. H. Roscher: Lexikon der griechischen und romischen
Mythologie, Leipzig, 1886, I, p. 624.
(11) Louis Dyer: Studies of the Gods in Greece, 1891, p.
221.
A word on the idea of the serpent as an emblem of the healing art which goes far back into antiquity. The mystical character of the snake, and the natural dread and awe inspired by it, early made it a symbol of supernatural power. There is a libation vase of Gudea, c. 2350 B.C., found at Telloh, now in the Louvre (probably the earliest representation of the symbol), with two serpents entwined round a staff (Jastrow, Pl. 4). From the earliest times the snake has been associated with mystic and magic power, and even today, among native races, it plays a part in the initiation of medicine men.
In Greece, the serpent became a symbol of Apollo, and prophetic serpents were kept and fed at his shrine, as well as at that of his son, Asklepios. There was an idea, too, that snakes had a knowledge of herbs, which is referred to in the famous poem of Nikander on Theriaka.(12) You may remember that when Alexander, the famous quack and oracle monger, depicted by Lucian, started out “for revenue,” the first thing he did was to provide himself with two of the large, harmless, yellow snakes of Asia Minor.
(12) Lines 31, etc., and Scholia; cf. W. R. Halliday: Greek
Divination, London, 1913, p. 88.
The exact date of the introduction of the cult into Greece is not known, but its great centres were at Epidaurus, Cos, Pergamos and Tricca. It throve with wonderful rapidity. Asklepios became one of the most popular of the gods. By the time of Alexander it is estimated that there were between three and four hundred temples dedicated to him.
His worship was introduced into Rome at the time of the Great Plague at the beginning of the third century B.C. (as told by Livy in Book XI), and the temple on the island of Tiber became a famous resort. If you can transfer in imagination the Hot Springs of Virginia to the neighborhood of Washington, and put there a group of buildings such as are represented in these outlines of Caton’s(13) (p. 52), add a sumptuous theatre with seating capacity for 20,000, a stadium 600 feet long with a seating capacity of 12,000, and all possible accessories of art and science, you will have an idea of what the temple at Epidaurus, a few miles from Athens, was. “The cult flourished mostly in places which, through climatic or hygienic advantages, were natural health resorts. Those favoured spots on hill or mountain, in the shelter of forests, by rivers or springs of pure flowing water, were conducive to health. The vivifying air, the well cultivated gardens surrounding the shrine, the magnificent view, all tended to cheer the heart with new hope of cure. Many of these temples owed their fame to mineral or merely hot springs. To the homely altars, erected originally by sacred fountains in the neighbourhood of health-giving mineral springs, were later added magnificent temples, pleasure-grounds for festivals, gymnasia in which bodily ailments were treated by physical exercises, baths and inunctions, also, as is proved by excavations, living rooms for the patients. Access to the shrine was forbidden to the unclean and the impure, pregnant women and the mortally afflicted were kept away; no dead body could find a resting-place within the holy precincts, the shelter and the cure of the sick being undertaken by the keepers of inns and boarding-houses in the neighbourhood. The suppliants for aid had to submit to careful purification, to bathe in sea, river or spring, to fast for a prescribed time, to abjure wine and certain articles of diet, and they were only permitted to enter the temple when they were adequately prepared by cleansing, inunction and fumigation. This lengthy and exhausting preparation, partly dietetic, partly suggestive, was accompanied by a solemn service of prayer and sacrifice, whose symbolism tended highly to excite the imagination.”(14)
(13) Caton: Temples and Ritual of Asklepios, 2d ed.,
London, 1900.
(14) Max Neuburger: History of Medicine, English
translation, Oxford, 1910, p. 94.
The temples were in charge of members of the guild or fraternity, the head of which was often, though not necessarily, a physician. The Chief was appointed annually. From Caton’s excellent sketch(15) you can get a good idea of the ritual, but still better is the delightful description given in the “Plutus” of Aristophanes. After offering honey-cakes and baked meats on the altar, the suppliants arranged themselves on the pallets.
(15) Caton: Temples and Ritual of Asklepios, 2d ed.,
London, 1900.
Soon the Temple servitor
Put out the lights and bade us fall asleep,
Nor stir, nor speak, whatever noise we heard.
So down we lay in orderly repose.
And I could catch no slumber, not one wink,
Struck by a nice tureen of broth which stood
A little distance from an old wife’s head,
Whereto I marvellously longed to creep.
Then, glancing upwards, I beheld the priest
Whipping the cheese-cakes and figs from off
The holy table; thence he coasted round
To every altar spying what was left.
And everything he found he consecrated
Into a sort of sack—(16)
a procedure which reminds one of the story of “Bel and the Dragon.” Then the god came, in the person of the priest, and scanned each patient. He did not neglect physical measures, as he brayed in a mortar cloves, Tenian garlic, verjuice, squills and Sphettian vinegar, with which he made application to the eyes of the patient.
(16) Aristophanes: B. B. Roger’s translation, London, Bell
& Sons, 1907, Vol. VI, ll. 668, etc., 732 ff.
Then the God clucked,
And out there issued from the holy shrine
Two great, enormous serpents….
And underneath the scarlet cloth they crept,
And licked his eyelids, as it seemed to me;
And, mistress dear, before you could have drunk
Of wine ten goblets, Wealth arose and saw.(17)
(17) Ibid.
The incubation sleep, in which indications of cure were divinely sent, formed an important part of the ritual.
The Asklepieion, or Health Temple of Cos, recently excavated, is of special interest, as being at the birthplace of Hippocrates, who was himself an Asklepiad. It is known that Cos was a great medical school. The investigations of Professor Rudolf Hertzog have shown that this temple was very nearly the counterpart of the temple at Epidaurus.
The AEsculapian temples may have furnished a rare field for empirical enquiry. As with our modern hospitals, the larger temple had rich libraries, full of valuable manuscripts and records of cases. That there may have been secular Asklepiads connected with the temple, who were freed entirely from its superstitious practices and theurgic rites, is regarded as doubtful; yet is perhaps not so doubtful as one might think. How often have we physicians to bow ourselves in the house of Rimmon! It is very much the same today at Lourdes, where lay physicians have to look after scores of patients whose faith is too weak or whose maladies are too strong to be relieved by Our Lady of this famous shrine. Even in the Christian era, there is evidence of the association of distinguished physicians with AEsculapian temples. I notice that in one of his anatomical treatises, Galen speaks with affection of a citizen of Pergamos who has been a great benefactor of the AEsculapian temple of that city. In “Marius, the Epicurean,” Pater gives a delightful sketch of one of those temple health resorts, and brings in Galen, stating that he had himself undergone the temple sleep; but to this I can find no reference in the general index of Galen’s works.
From the votive tablets found at Epidaurus, we get a very good idea of the nature of the cases and of the cures. A large number of them have now been deciphered. There are evidences of various forms of diseases of the joints, affections of women, wounds, baldness, gout; but we are again in the world of miracles, as you may judge from the following: “Heraicus of Mytilene is bald and entreats the God to make his hair grow. An ointment is applied over night and the next morning he has a thick crop of hair.”
There are indications that operations were performed and abscesses opened. From one we gather that dropsy was treated in a novel way: Asklepios cuts off the patient’s head, holds him up by the heels, lets the water run out, claps on the patient’s head again. Here is one of the invocations: “Oh, blessed Asklepios, God of Healing, it is thanks to thy skill that Diophantes hopes to be relieved from his incurable and horrible gout, no longer to move like a crab, no longer to walk upon thorns, but to have sound feet as thou hast decreed.”
The priests did not neglect the natural means of healing. The inscriptions show that great attention was paid to diet, exercise, massage and bathing, and that when necessary, drugs were used. Birth and death were believed to defile the sacred precincts, and it was not until the time of the Antonines that provision was made at Epidaurus for these contingencies.
One practice of the temple was of special interest, viz., the incubation sleep, in which dreams were suggested to the patients. In the religion of Babylonia, an important part was played by the mystery of sleep, and the interpretation of dreams; and no doubt from the East the Greeks took over the practice of divination in sleep, for in the AEsculapian cult also, the incubation sleep played a most important role. That it continued in later times is well indicated in the orations of Aristides, the arch-neurasthenic of ancient history, who was a great dreamer of dreams. The oracle of Amphiaraus in Attica sent dreams into the hearts of his consultants. “The priests take the inquirer, and keep him fasting from food for one day, and from wine for three days, to give him perfect spiritual lucidity to absorb the divine communication” (Phillimore’s “Apollonius of Tyana,” Bk. II, Ch. XXXVII). How incubation sleep was carried into the Christian Church, its association with St. Cosmas and St. Damian and other saints, its practice throughout the Middle Ages, and its continuation to our own time may be read in the careful study of the subject made by Miss Hamilton (now Mrs. Dickens).(18) There are still in parts of Greece and in Asia Minor shrines at which incubation is practiced regularly, and if one may judge from the reports, with as great success as in Epidaurus. At one place in Britain, Christchurch in Monmouthshire, incubation was carried on till the early part of the nineteenth century. Now the profession has come back to the study of dreams,(19) and there are professors as ready to give suggestive interpretations to them, as in the days of Aristides. As usual, Aristotle seems to have said the last word on the subject: “Even scientific physicians tell us that one should pay diligent attention to dreams, and to hold this view is reasonable also for those who are not practitioners but speculative philosophers,”(20) but it is asking too much to think that the Deity would trouble to send dreams to very simple people and to animals, if they were designed in any way to reveal the future.
In its struggle with Christianity, Paganism made its last stand in the temples of Asklepios. The miraculous healing of the saints superseded the cures of the heathen god, and it was wise to adopt the useful practice of his temple.
(18) Mary Hamilton: Incubation, or the Cure of Disease in
Pagan Temples and Christian Churches, London, 1906.
(19) Freud: The Interpretation of Dreams, translation of
third edition by A. A. Brill, 1913.
(20) Aristotle: Parva Naturalia, De divinatione per
somnium, Ch. I, Oxford ed., Vol. III, 463 a.
HIPPOCRATES AND THE HIPPOCRATIC WRITINGS
DESERVEDLY the foundation of Greek Medicine is associated with the name of Hippocrates, a native of the island of Cos; and yet he is a shadowy personality, about whom we have little accurate first-hand information. This is in strong contrast to some of his distinguished contemporaries and successors, for example, Plato and Aristotle, about whom we have such full and accurate knowledge. You will, perhaps, be surprised to hear that the only contemporary mention of Hippocrates is made by Plato. In the “Protagoras,” the young Hippocrates, son of Apollodorus has come to Protagoras, “that mighty wise man,” to learn the science and knowledge of human life. Socrates asked him: “If . . . you had thought of going to Hippocrates of Cos, the Asclepiad, and were about to give him your money, and some one had said to you, ‘You are paying money to your namesake Hippocrates, O Hippocrates; tell me, what is he that you give him money?’ how would you have answered?” “I should say,” he replied, “that I gave money to him as a physician.” “And what will he make of you?” “A physician,” he said. And in the Phaedrus, in reply to a question of Socrates whether the nature of the soul could be known intelligently without knowing the nature of the whole, Phaedrus replies: “Hippocrates, the Asclepiad, says that the nature, even of the body, can only be understood as a whole.” (Plato, I, 311; III, 270—Jowett, I, 131, 479.)
Several lives of Hippocrates have been written. The one most frequently quoted is that of Soranus of Ephesus (not the famous physician of the time of Trajan), and the statements which he gives are usually accepted, viz., that he was born in the island of Cos in the year 460 B.C.; that he belonged to an Asklepiad family of distinction, that he travelled extensively, visiting Thrace, Thessaly, and various other parts of Greece; that he returned to Cos, where he became the most renowned physician of his period, and died about 375 B.C. Aristotle mentions him but once, calling him “the great Hippocrates.” Busts of him are common; one of the earliest of which, and I am told the best, dating from Roman days and now in the British Museum, is here represented.
Of the numerous writings attributed to Hippocrates it cannot easily be determined which are really the work of the Father of Medicine himself. They were collected at the time of the Alexandrian School, and it became customary to write commentaries upon them; much of the most important information we have about them, we derive from Galen. The earliest manuscript is the “Codex Laurentianus” of Florence, dating from the ninth century, a specimen page of which (thanks to Commendatore Biagi) is annexed. Those of you who are interested, and wish to have full references to the various works attributed to Hippocrates, will find them in “Die Handschriften der antiken Aerzte” of the Prussian Academy, edited by Diels (Berlin, 1905). The Prussian Academy has undertaken the editorship of the “Corpus Medicorum Graecorum.” There is no complete edition of them in English. In 1849 the Deeside physician, Adams, published (for the Old Sydenham Society) a translation of the most important works, a valuable edition and easily obtained. Littre’s ten-volume edition “OEuvres completes d’Hippocrate,” Paris, 1839-1861, is the most important for reference. Those of you who want a brief but very satisfactory account of the Hippocratic writings, with numerous extracts, will find the volume of Theodor Beck (Jena, 1907) very useful.
I can only indicate, in a very brief way, the special features of the Hippocratic writings that have influenced the evolution of the science and art of medicine.
The first is undoubtedly the note of humanity. In his introduction to, “The Rise of the Greek Epic,”(21) Gilbert Murray emphasizes the idea of service to the community as more deeply rooted in the Greeks than in us. The question they asked about each writer was, “Does he help to make better men?” or “Does he make life a better thing?” Their aim was to be useful, to be helpful, to make better men in the cities, to correct life, “to make gentle the life of the world.” In this brief phrase were summed up the aspirations of the Athenians, likewise illuminated in that remarkable saying of Prodicus (fifth century B.C.), “That which benefits human life is God.” The Greek view of man was the very antithesis of that which St. Paul enforced upon the Christian world. One idea pervades thought from Homer to Lucian-like an aroma—pride in the body as a whole. In the strong conviction that “our soul in its rose mesh” is quite as much helped by flesh as flesh by the soul the Greek sang his song—”For pleasant is this flesh.” Just so far as we appreciate the value of the fair mind in the fair body, so far do we apprehend ideals expressed by the Greek in every department of life. The beautiful soul harmonizing with the beautiful body was as much the glorious ideal of Plato as it was the end of the education of Aristotle. What a splendid picture in Book III of the “Republic,” of the day when “. . . our youth will dwell in a land of health, amid fair sights and sounds and receive the good in everything; and beauty, the effluence of fair works, shall flow into the eye and ear like a health-giving breeze from a purer region, and insensibly draw the soul from earliest years into likeness and sympathy with the beauty of reason.” The glory of this zeal for the enrichment of this present life was revealed to the Greeks as to no other people, but in respect to care for the body of the common man, we have only seen its fulfilment in our own day, as a direct result of the methods of research initiated by them. Everywhere throughout the Hippocratic writings we find this attitude towards life, which has never been better expressed than in the fine phrase, “Where there is love of humanity there will be love of the profession.” This is well brought out in the qualifications laid down by Hippocrates for the study of medicine. “Whoever is to acquire a competent knowledge of medicine ought to be possessed of the following advantages: a natural disposition; instruction; a favourable position for the study; early tuition; love of labour; leisure. First of all, a natural talent is required, for when nature opposes, everything else is vain; but when nature leads the way to what is most excellent, instruction in the art takes place, which the student must try to appropriate to himself by reflection, becoming a nearly pupil in a place well adapted for instruction. He must also bring to the task a love of labour and perseverance, so that the instruction taking root may bring forth proper and abundant fruits.” And the directions given for the conduct of life and for the relation which the physician should have with the public are those of our code of ethics today. Consultations in doubtful cases are advised, touting for fees is discouraged. “If two or more ways of medical treatment were possible, the physician was recommended to choose the least imposing or sensational; it was an act of ‘deceit’ to dazzle the patient’s eye by brilliant exhibitions of skill which might very well be dispensed with. The practice of holding public lectures in order to increase his reputation was discouraged in the physician, and he was especially warned against lectures tricked out with quotations from the poets. Physicians who pretended to infallibility in detecting even the minutest departure from their prescriptions were laughed at; and finally, there were precise by-laws to regulate the personal behaviour of the physician. He was enjoined to observe the most scrupulous cleanliness, and was advised to cultivate an elegance removed from all signs of luxury, even down to the detail that he might use perfumes, but not in an immoderate degree.”(22) But the high-water mark of professional morality is reached in the famous Hippocratic oath, which Gomperz calls “a monument of the highest rank in the history of civilization.” It is of small matter whether this is of Hippocratic date or not, or whether it has in it Egyptian or Indian elements: its importance lies in the accuracy with which it represents the Greek spirit. For twenty-five centuries it has been the “credo” of the profession, and in many universities it is still the formula with which men are admitted to the doctorate.
(21) Oxford. Clarendon Press, 2d ed., 1911.
(22) Gomperz: Greek Thinkers, Vol. I, p. 281.
I swear by Apollo the physician and AEsculapius and Health (Hygieia) and All-Heal (Panacea) and all the gods and goddesses, that, according to my ability and judgment, I will keep this oath and this stipulation—to reckon him who taught me this art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of my art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.
I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion.
With purity and with holiness I will pass my life and practice my art.
(I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work.)
Into whatsoever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption, and, further, from the abduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.
While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!
(Adams, II, 779, cf. Littre, IV, 628.)
In his ideal republic, Plato put the physician low enough, in the last stratum, indeed, but he has never been more honorably placed than in the picture of Athenian society given by this author in the “Symposium.” Here the physician is shown as a cultivated gentleman, mixing in the best, if not always the most sober, society. Eryximachus, the son of Acumenus, himself a physician, plays in this famous scene a typical Greek part(22a)—a strong advocate of temperance in mind and body, deprecating, as a physician, excess in drink, he urged that conversation should be the order of the day and he had the honor of naming the subject—”Praise of the God of Love.” Incidentally Eryximachus gives his view of the nature of disease, and shows how deeply he was influenced by the views of Empedocles:”. . . so too in the body the good and healthy elements are to be indulged, and the bad elements and the elements of disease are not to be indulged, but discouraged. And this is what the physician has to do, and in this the art of medicine consists: for medicine may be regarded generally as the knowledge of the loves and desires of the body and how to satisfy them or not; and the best physician is he who is able to separate fair love from foul, or to convert one into the other; and he who knows how to eradicate and how to implant love, whichever is required, and can reconcile the most hostile elements in the constitution and make them loving friends, is a skilful practitioner.”
(22a) Professor Gildersleeve’s view of Eryximachus is less
favorable (Johns Hopkins University Circular, Baltimore,
January, 1887). Plato, III, 186—Jowett, I, 556.
The second great note in Greek medicine illustrates the directness with which they went to the very heart of the matter. Out of mysticism, superstition and religious ritual the Greek went directly to nature and was the first to grasp the conception of medicine as an art based on accurate observation, and an integral part of the science of man. What could be more striking than the phrase in “The Law,” “There are, in effect, two things, to know and to believe one knows; to know is science; to believe one knows is ignorance”?(23) But no single phrase in the writings can compare for directness with the famous aphorism which has gone into the literature of all lands: “Life is short and Art is long; the Occasion fleeting, Experience fallacious, and Judgment difficult.”
(23) Littre: OEuvres d’Hippocrate, Vol. IV, pp. 641-642.
Everywhere one finds a strong, clear common sense, which refuses to be entangled either in theological or philosophical speculations. What Socrates did for philosophy Hippocrates may be said to have done for medicine. As Socrates devoted himself to ethics, and the application of right thinking to good conduct, so Hippocrates insisted upon the practical nature of the art, and in placing its highest good in the benefit of the patient. Empiricism, experience, the collection of facts, the evidence of the senses, the avoidance of philosophical speculations, were the distinguishing features of Hippocratic medicine. One of the most striking contributions of Hippocrates is the recognition that diseases are only part of the processes of nature, that there is nothing divine or sacred about them. With reference to epilepsy, which was regarded as a sacred disease, he says, “It appears to me to be no wise more divine nor more sacred than other diseases, but has a natural cause from which it originates like other affections; men regard its nature and cause as divine from ignorance.” And in another place he remarks that each disease has its own nature, and that no one arises without a natural cause. He seems to have been the first to grasp the conception of the great healing powers of nature. In his long experience with the cures in the temples, he must have seen scores of instances in which the god had worked the miracle through the vis medicatrix naturae; and to the shrewd wisdom of his practical suggestions in treatment may be attributed in large part the extraordinary vogue which the great Coan has enjoyed for twenty-five centuries. One may appreciate the veneration with which the Father of Medicine was regarded by the attribute “divine” which was usually attached to his name. Listen to this for directness and honesty of speech taken from the work on the joints characterized by Littre as “the great surgical monument of antiquity”: “I have written this down deliberately, believing it is valuable to learn of unsuccessful experiments, and to know the causes of their non-success.”
The note of freedom is not less remarkable throughout the Hippocratic writings, and it is not easy to understand how a man brought up and practicing within the precincts of a famous AEsculapian temple could have divorced himself so wholly from the superstitions and vagaries of the cult. There are probably grounds for Pliny’s suggestion that he benefited by the receipts written in the temple, registered by the sick cured of any disease. “Afterwards,” Pliny goes on to remark in his characteristic way, “hee professed that course of Physicke which is called Clinice Wherby physicians found such sweetnesse that afterwards there was no measure nor end of fees,” (‘Natural History,’ XXIX, 1). There is no reference in the Hippocratic writings to divination; incubation sleep is not often mentioned, and charms, incantations or the practice of astrology but rarely. Here and there we do find practices which jar upon modern feeling, but on the whole we feel in reading the Hippocratic writings nearer to their spirit than to that of the Arabians or of the many writers of the fifteenth and sixteenth centuries A. D. And it is not only against the thaumaturgic powers that the Hippocratic writings protested, but they express an equally active reaction against the excesses and defects of the new philosophy, a point brought out very clearly by Gomperz.(24) He regards it as an undying glory of the school of Cos that after years of vague, restless speculation it introduces “steady sedentary habits into the intellectual life of mankind.” ‘Fiction to the right! Reality to the left!’ was the battle-cry of this school in the war they were the first to wage against the excesses and defects of the nature-philosophy. Though the protest was effective in certain directions, we shall see that the authors of the Hippocratic writings could not entirely escape from the hypotheses of the older philosophers.
(24) Gomperz: Greek Thinkers, Vol. I, p. 296.
I can do no more than indicate in the briefest possible way some of the more important views ascribed to Hippocrates. We cannot touch upon the disputes between the Coan and Cnidian schools.(25) You must bear in mind that the Greeks at this time had no human anatomy. Dissections were impossible; their physiology was of the crudest character, strongly dominated by the philosophies. Empedocles regarded the four elements, fire, air, earth and water, as “the roots of all things,” and this became the corner stone in the humoral pathology of Hippocrates. As in the Macrocosm—the world at large there were four elements, fire, air, earth, and water, so in the Microcosm—the world of man’s body—there were four humors (elements), viz.,blood, phlegm, yellow bile (or choler) and black bile (or melancholy), and they corresponded to the four qualities of matter, heat, cold, dryness and moisture. For more than two thousand years these views prevailed. In his “Regiment of Life” (1546) Thomas Phaer says:”. . . which humours are called ye sones of the Elements because they be complexioned like the foure Elements, for like as the Ayre is hot and moyst: so is the blooud, hote and moyste. And as Fyer is hote and dry: so is Cholere hote and dry. And as water is colde and moyst: so is fleume colde and moyste. And as the Earth is colde and dry: so Melancholy is colde and dry.”(26)
(25) The student who wishes a fuller account is referred to
the histories of (a) Neuburger, Vol. 1, Oxford, 1910; (b)
Withington, London, 1894.
(26) Thomas Phaer: Regiment of Life, London, 1546.
As the famous Regimen Sanitatis of Salernum, the popular family hand-book of the Middle Ages, says:
Foure Humours raigne within our bodies wholly,
And these compared to foure elements.(27)
(27) The Englishman’s Doctor, or the Schoole of Salerne, Sir
John Harington’s translation, London, 1608, p. 2. Edited by
Francis R. Packard, New York, 1920, p. 132. Harington’s book
originally appeared dated: London 1607. (Hoe copy in the
Henry E. Huntington Library.)
According to Littre, there is nowhere so strong a statement of these views in the genuine works of Hippocrates, but they are found at large in the Hippocratic writings, and nothing can be clearer than the following statement from the work “The Nature of Man”: “The body of man contains in itself blood and phlegm and yellow bile and black bile, which things are in the natural constitution of his body, and the cause of sickness and of health. He is healthy when they are in proper proportion between one another as regards mixture and force and quantity, and when they are well mingled together; he becomes sick when one of these is diminished or increased in amount, or is separated in the body from its proper mixture, and not properly mingled with all the others.” No words could more clearly express the views of disease which, as I mentioned, prevailed until quite recent years. The black bile, melancholy, has given us a great word in the language, and that we have not yet escaped from the humoral pathology of Hippocrates is witnessed by the common expression of biliousness—”too much bile”—or “he has a touch of the liver.” The humors, imperfectly mingled, prove irritant in the body. They are kept in due proportion by the innate heat which, by a sort of internal coction gradually changes the humors to their proper proportion. Whatever may be the primary cause of the change in the humors manifesting itself in disease, the innate heat, or as Hippocrates terms it, the nature of the body itself, tends to restore conditions to the norm; and this change occurring suddenly, or abruptly, he calls the “crisis,” which is accomplished on some special day of the disease, and is often accompanied by a critical discharge, or by a drop in the body temperature. The evil, or superabundant, humors were discharged and this view of a special materies morbi, to be got rid of by a natural processor a crisis, dominated pathology until quite recently. Hippocrates had a great belief in the power of nature, the vis medicatrix naturae, to restore the normal state. A keen observer and an active practitioner, his views of disease, thus hastily sketched, dominated the profession for twenty-five centuries; indeed, echoes of his theories are still heard in the schools, and his very words are daily on our lips. If asked what was the great contribution to medicine of Hippocrates and his school we could answer—the art of careful observation.
In the Hippocratic writings is summed up the experience of Greece to the Golden Age of Pericles. Out of philosophy, out of abstract speculation, had come a way of looking at nature for which the physicians were mainly responsible, and which has changed forever men’s views on disease. Medicine broke its leading strings to religion and philosophy—a tottering, though lusty, child whose fortunes we are to follow in these lectures. I have a feeling that, could we know more of the medical history of the older races of which I spoke in the first lecture, we might find that this was not the first-born of Asklepios, that there had been many premature births, many still-born offspring, even live-births—the products of the fertilization of nature by the human mind; but the record is dark, and the infant was cast out like Israel in the chapter of Isaiah. But the high-water mark of mental achievement had not been reached by the great generation in which Hippocrates had labored. Socrates had been dead sixteen years, and Plato was a man of forty-five, when far away in the north in the little town of Stagira, on the peninsula of Mount Athos in Macedoniawas, in 384 B.C., born a “man of men,” the one above all others to whom the phrase of Milton may be applied. The child of an Asklepiad, Nicomachus, physician to the father of Philip, there must have been a rare conjunction of the planets at the birth of the great Stagirite. In the first circle of the “Inferno,” Virgil leads Dante into a wonderful company, “star-seated” on the verdure (he says)—the philosophic family looking with reverence on “the Master of those who know”—il maestro di color che sanno.(28) And with justice has Aristotle been so regarded for these twenty-three centuries. No man has ever swayed such an intellectual empire—in logic, metaphysics, rhetoric, psychology, ethics, poetry, politics and natural history, in all a creator, and in all still a master. The history of the human mind—offers no parallel to his career. As the creator of the sciences of comparative anatomy, systematic zoology, embryology, teratology, botany and physiology, his writings have an eternal interest. They present an extraordinary accumulation of facts relating to the structure and functions of various parts of the body. It is an unceasing wonder how one man, even with a school of devoted students, could have done so much.
(28) The “Good collector of qualities,” Dioscorides,
Hippocrates, Avicenna, Galen and Averroes were the medical
members of the group. Dante, Inferno, canto iv.
Dissection—already practiced by Alcmaeon, Democritus, Diogenes and others—was conducted on a large scale, but the human body was still taboo. Aristotle confesses that the “inward parts of man are known least of all,” and he had never seen the human kidneys or uterus. In his physiology, I can refer to but one point—the pivotal question of the heart and blood vessels. To Aristotle the heart was the central organ controlling the circulation, the seat of vitality, the source of the blood, the place in which it received its final elaboration and impregnation with animal heat. The blood was contained in the heart and vessels as in a vase—hence the use of the term “vessel.” “From the heart the blood-vessels extend throughout the body as in the anatomical diagrams which are represented on the walls, for the parts lie round these because they are formed out of them.”(29) The nutriment oozes through the blood vessels and the passages in each of the parts “like water in unbaked pottery.” He did not recognize any distinction between arteries and veins, calling both plebes (Littre); the vena cave is the great vessel, and the aorta the smaller; but both contain blood. He did not use the word “arteria” (arthria) for either of them. There was no movement from the heart to the vessels but the blood was incessantly drawn upon by the substance of the body and as unceasingly renewed by absorption of the products of digestion, the mesenteric vessels taking up nutriment very much as the plants take theirs by the roots from the soil. From the lungs was absorbed the pneuma, or spiritus, which was conveyed to the heart by the pulmonary vessels—one to the right, and one to the left side. These vessels in the lungs, “through mutual contact” with the branches of the trachea, took in the pneuma. A point of interest is that the windpipe, or trachea, is called “arteria,” both by Aristotle and by Hippocrates (“Anatomy,” Littre, VIII, 539). It was the air-tube, disseminating the breath through the lungs. We shall see in a few minutes how the term came to be applied to the arteries, as we know them. The pulsation of the heart and arteries was regarded by Aristotle as a sort of ebullition in which the liquids were inflated by the vital or innate heat, the fires of which were cooled by the pneuma taken in by the lungs and carried to the heart by the pulmonary vessels.
(29) De Generatione Animalium, Oxford translation, Bk. II,
Chap. 6, Works V, 743 a.
In Vol. IV of Gomperz’ “Greek Thinkers,” you will find an admirable discussion on Aristotle as an investigator of nature, and those of you who wish to study his natural history works more closely may do so easily—in the new translation which is in process of publication by the Clarendon Press, Oxford. At the end of the chapter “De Respiratione” in the “Parva Naturalia” (Oxford edition, 1908), we have Aristotle’s attitude towards medicine expressed in a way worthy of a son of the profession:
“But health and disease also claim the attention of the scientist, and not merely of the physician, in so far as an account of their causes is concerned. The extent to which these two differ and investigate diverse provinces must not escape us, since facts show that their inquiries are, at least to a certain extent, conterminous. For physicians of culture and refinement make some mention of natural science, and claim to derive their principles from it, while the most accomplished investigators into nature generally push their studies so far as to conclude with an account of medical principles.” (Works, III,480 b.)
Theophrastus, a student of Aristotle and his successor, created the science of botany and made possible the pharmacologists of a few centuries later. Some of you doubtless know him in another guise—as the author of the golden booklet on “Characters,” in which “the most eminent botanist of antiquity observes the doings of men with the keen and unerring vision of a natural historian” (Gomperz). In the Hippocratic writings, there are mentioned 236 plants; in the botany of Theophrastus, 455. To one trait of master and pupil I must refer—the human feeling, not alone of man for man, but a sympathy that even claims kinship with the animal world. “The spirit with which he (Theophrastus) regarded the animal world found no second expression till the present age” (Gomperz). Halliday, however, makes the statement that Porphyry(30) goes as far as any modern humanitarian in preaching our duty towards animals.
(30) W. R. Halliday: Greek Divination, London, Macmillan &
Co., 1913.
ALEXANDRIAN SCHOOL
FROM the death of Hippocrates about the year 375 B.C. till the founding of the Alexandrian School, the physicians were engrossed largely in speculative views, and not much real progress was made, except in the matter of elaborating the humoral pathology. Only three or four men of the first rank stand out in this period: Diocles the Carystian, “both in time and reputation next and second to Hippocrates” (Pliny), a keen anatomist and an encyclopaedic writer; but only scanty fragments of his work remain. In some ways the most important member of this group was Praxagoras, a native of Cos, about 340 B.C. Aristotle, you remember, made no essential distinction between arteries and veins, both of which he held to contain blood: Praxagoras recognized that the pulsation was only in the arteries, and maintained that only the veins contained blood, and the arteries air. As a rule the arteries are empty after death, and Praxagoras believed that they were filled with an aeriform fluid, a sort of pneuma, which was responsible for their pulsation. The word arteria, which had already been applied to the trachea, as an air-containing tube, was then attached to the arteries; on account of the rough and uneven character of its walls the trachea was then called the arteria tracheia, or the rough air-tube.(31a) We call it simply the trachea, but in French the word trachee-artere is still used.
(31a) Galen: De usu partium, VII, Chaps. 8-9.
Praxagoras was one of the first to make an exhaustive study of the pulse, and he must have been a man of considerable clinical acumen, as well as boldness, to recommend in obstruction of the bowels the opening of the abdomen, removal of the obstructed portion and uniting the ends of the intestine by sutures.
After the death of Alexander, Egypt fell into the hands of his famous general, Ptolemy, under whose care the city became one of the most important on the Mediterranean. He founded and maintained a museum, an establishment that corresponded very much to a modern university, for the study of literature, science and the arts. Under his successors, particularly the third Ptolemy, the museum developed, more especially the library, which contained more than half a million volumes. The teachers were drawn from all centres, and the names of the great Alexandrians are among the most famous in the history of human knowledge, including such men as Archimedes, Euclid, Strabo and Ptolemy.
In mechanics and physics, astronomy, mathematics and optics, the work of the Alexandrians constitutes the basis of a large part of our modern knowledge. The school-boy of today—or at any rate of my day—studies the identical problems that were set by Euclid 300 B.C., and the student of physics still turns to Archimedes and Heron, and the astronomer to Eratosthenes and Hipparchus. To those of you who wish to get a brief review of the state of science in the Alexandrian School I would recommend the chapter in Vol. I of Dannemann’s history.(31)
(31) Friedrich Dannemann: Grundriss einer Geschichte der
Naturwissenschaften, Vol. I, 3d ed., Leipzig, 1908.
Of special interest to us in Alexandria is the growth of the first great medical school of antiquity. Could we have visited the famous museum about 300 B.C., we should have found a medical school in full operation, with extensive laboratories, libraries and clinics. Here for the first time the study of the structure of the human body reached its full development, till then barred everywhere by religious prejudice; but full permission was given by the Ptolemies to perform human dissection and, if we may credit some authors, even vivisection. The original writings of the chief men of this school have not been preserved, but there is a possibility that any day a papyrus maybe found which will supplement the scrappy and imperfect knowledge afforded us by Pliny, Celsus and Galen. The two most distinguished names are Herophilus—who, Pliny says, has the honor of being the first physician “who searched into the causes of disease”—and Erasistratus.
Herophilus, ille anatomicorum coryphaeus, as Vesalius calls him, was a pupil of Praxagoras, and his name is still in everyday use by medical students, attached to the torcular Herophili. Anatomy practically dates from these Alexandrines, who described the valves of the heart, the duodenum, and many of the important parts of the brain; they recognized the true significance of the nerves (which before their day had been confounded with the tendons), distinguished between motor and sensory nerves, and regarded the brain as the seat of the perceptive faculties and voluntary action. Herophilus counted the pulse, using the water-clock for the purpose, and made many subtle analyses of its rate and rhythm; and, influenced by the musical theories of the period, he built up a rhythmical pulse lore which continued in medicine until recent times. He was a skilful practitioner and to him is ascribed the statement that drugs are the hands of the gods. There is a very modern flavor to his oft-quoted expression that the best physician was the man who was able to distinguish between the possible and the impossible.
Erasistratus elaborated the view of the pneuma, one form of which he believed came from the inspired air, and passed to the left side of the heart and to the arteries of the body. It was the cause of the heart-beat and the source of the innate heat of the body, and it maintained the processes of digestion and nutrition. This was the vital spirit; the animal spirit was elaborated in the brain, chiefly in the ventricles, and sent by the nerves to all parts of the body, endowing the individual with life and perception and motion. In this way a great division was made between the two functions of the body, and two sets of organs: in the vascular system, the heart and arteries and abdominal organs, life was controlled by the vital spirits; on the other hand, in the nervous system were elaborated the animal spirits, controlling motion, sensation and the various special senses. These views on the vital and animal spirits held unquestioned sway until well into the eighteenth century, and we still, in a measure, express the views of the great Alexandrian when we speak of “high” or “low” spirits.
GALEN
PERGAMON has become little more than a name associated in our memory with the fulminations of St. John against the seven churches of Asia; and on hearing the chapter read, we wondered what was “Satan’s seat” and who were the “Nicolaitanes” whose doctrine he so hated. Renewed interest has been aroused in the story of its growth and of its intellectual rivalry with Alexandria since the wonderful discoveries by German archaeologists which have enabled us actually to see this great Ionian capital, and even the “seat of Satan.” The illustration here shown is of the famous city, in which you can see the Temple of Athena Polis on the rock, and the amphitheatre. Its interest for us is connected with the greatest name, after Hippocrates, in Greek medicine, that of Galen, born at Pergamon A. D. 130, in whom was united as never before—and indeed one may say, never since—the treble combination of observer, experimenter and philosopher. His father, Nikon, a prosperous architect, was urged in a dream to devote his son to the profession of medicine, upon which study the lad entered in his seventeenth year under Satyrus. In his writings, Galen gives many details of his life, mentioning the names of his teachers, and many incidents in his Wanderjahre, during which he studied at the best medical schools, including Alexandria. Returning to his native city he was put in charge of the gladiators, whose wounds he said he treated with wine. In the year 162, he paid his first visit to Rome, the scene of his greatest labors. Here he gave public lectures on anatomy, and became “the fashion.” He mentions many of his successes; one of them is the well-worn story told also of Erasistratus and Stratonice, but Galen’s story is worth telling, and it is figured as a miniature in the manuscripts of his works. Called to see a lady he found her suffering from general malaise without any fever or increased action of the pulse. He saw at once that her trouble was mental and, like a wise physician, engaged her in general conversation. Quite possibly he knew her story, for the name of a certain actor, Pylades, was mentioned, and he noticed that her pulse at once increased in rapidity and became irregular. On the next day he arranged that the name of another actor, Morphus, should be mentioned, and on the third day the experiment was repeated but without effect. Then on the fourth evening it was again mentioned that Pylades was dancing, and the pulse quickened and became irregular, so he concluded that she was in love with Pylades. He tells how he was first called to treat the Emperor Marcus Aurelius, who had a stomach-ache after eating too much cheese. He treated the case so successfully that the Emperor remarked, “I have but one physician, and he is a gentleman.” He seems to have had good fees, as he received 400 aurei (about 2000) for a fortnight’s attendance upon the wife of Boethus.
He left Rome for a time in 168 A. D. and returned to Pergamon, but was recalled to Rome by the Emperor, whom he accompanied on an expedition to Germany. There are records in his writings of many journeys, and busy with his practice in dissections and experiments he passed a long and energetic life, dying, according to most authorities, in the year 200 A.D.
A sketch of the state of medicine in Rome is given by Celsus in the first of his eight books, and he mentions the names of many of the leading practitioners, particularly Asclepiades, the Bithynian, a man of great ability, and a follower of the Alexandrians, who regarded all disease as due to a disturbed movement of the atoms. Diet, exercise, massage and bathing were his great remedies, and his motto—tuto, cito et jucunde—has been the emulation of all physicians. How important a role he and his successors played until the time of Galen may be gathered from the learned lectures of Sir Clifford Allbutt(32) on “Greek Medicine in Rome” and from Meyer-Steineg’s “Theodorus Priscianus und die romische Medizin.”(33) From certain lay writers we learn that it was the custom for popular physicians to be followed on their rounds by crowds of students. Martial’s epigram (V, ix) is often referred to:
Languebam: sed tu comitatus protinus ad me
Venisti centum, Symmache, discipulis.
Centum me tegigere manus Aquilone gelatae
Non habui febrem, Symmache, nunc habeo.
(32) Allbutt: British Medical Journal, London, 1909, ii, 1449;
1515; 1598.
(33) Fischer, Jena, 1909.
And in the “Apollonius of Tyana” by Philostratus, when Apollonius wishes to prove an alibi, he calls to witness the physicians of his sick friend, Seleucus and Straloctes, who were accompanied by their clinical class to the number of about thirty students.(34) But for a first-hand sketch of the condition of the profession we must go to Pliny, whose account in the twenty-ninth book of the “Natural History” is one of the most interesting and amusing chapters in that delightful work. He quotes Cato’s tirade against Greek physicians,—corrupters of the race, whom he would have banished from the city,—then he sketches the career of some of the more famous of the physicians under the Empire, some of whom must have had incomes never approached at any other period in the history of medicine. The chapter gives a good picture of the stage on which Galen (practically a contemporary of Pliny) was to play so important a role. Pliny seems himself to have been rather disgusted with the devious paths of the doctors of his day, and there is no one who has touched with stronger language upon the weak points of the art of physic. In one place he says that it alone has this peculiar art and privilege, “That whosoever professeth himself a physician, is straightwaies beleeved, say what he will: and yet to speake a truth, there are no lies dearer sold or more daungerous than those which proceed out of a Physician’s mouth. Howbeit, we never once regard or look to that, so blind we are in our deepe persuasion of them, and feed our selves each one in a sweet hope and plausible conceit of our health by them. Moreover, this mischief there is besides, That there is no law or statute to punish the ignorance of blind Physicians, though a man lost his life by them: neither was there ever any man knowne, who had revenge of recompence for the evill intreating or misusage under their hands. They learne their skill by endaungering our lives: and to make proofe and experiments of their medicines, they care not to kill us.”(35) He says it is hard that, while the judges are carefully chosen and selected, physicians are practically their own judges, and that of the men who may give us a quick despatch and send us to Heaven or Hell, no enquiry or examination is made of their quality and worthiness. It is interesting to read so early a bitter criticism of the famous “Theriaca,” a great compound medicine invented by Antiochus III, which had a vogue for fifteen hundred years.
(34) Bk. VIII, Chap. VII.
(35) Pliny: Natural History (XXIX, 1), Philemon Holland’s
version, London, 1601, II, 347.
But we must return to Galen and his works, which comprise the most voluminous body of writings left by any of the ancients. The great edition is that in twenty-two volumes by Kuhn (1821-1833). The most useful editions are the “Juntines” of Venice, which were issued in thirteen editions. In the fourth and subsequent editions a very useful index by Brassavola is included. A critical study of the writings is at present being made by German scholars for the Prussian Academy, which will issue a definitive edition of his works.
Galen had an eclectic mind and could not identify himself with any of the prevailing schools, but regarded himself as a disciple of Hippocrates. For our purpose, both his philosophy and his practice are of minor interest in comparison with his great labors in anatomy and physiology.
In anatomy, he was a pupil of the Alexandrians to whom he constantly refers. Times must have changed since the days of Herophilus, as Galen does not seem ever to have had an opportunity of dissecting the human body, and he laments the prejudice which prevents it. In the study of osteology, he urges the student to be on the lookout for an occasional human bone exposed in a graveyard, and on one occasion he tells of finding the carcass of a robber with the bones picked bare by birds and beasts. Failing this source, he advises the student to go to Alexandria, where there were still two skeletons. He himself dissected chiefly apes and pigs. His osteology was admirable, and his little tractate “De Ossibus” could, with very few changes, be used today by a hygiene class as a manual. His description of the muscles and of the organs is very full, covering, of course, many sins of omission and of commission, but it was the culmination of the study of the subject by Greek physicians.
His work as a physiologist was even more important, for, so far as we know, he was the first to carry out experiments on a large scale. In the first place, he was within an ace of discovering the circulation of the blood. You may remember that through the errors of Praxagoras and Erasistratus, the arteries were believed to contain air and got their name on that account: Galen showed by experiment that the arteries contain blood and not air. He studied particularly the movements of the heart, the action of the valves, and the pulsatile forces in the arteries. Of the two kinds of blood, the one, contained in the venous system, was dark and thick and rich in grosser elements, and served for the general nutrition of the body. This system took its origin, as is clearly shown in the figure, in the liver, the central organ of nutrition and of sanguification. From the portal system were absorbed, through the stomach and intestines, the products of digestion. From the liver extend the venae cavae, one to supply the head and arms, the other the lower extremities: extending from the right heart was a branch, corresponding to the pulmonary artery, the arterial vein which distributed blood to the lungs. This was the closed venous system. The arterial system, shown, as you see, quite separate in Figure 31, was full of a thinner, brighter, warmer blood, characterized by the presence of an abundance of the vital spirits. Warmed in the ventricle, it distributed vital heat to all parts of the body. The two systems were closed and communicated with each other only through certain pores or perforations in the septum separating the ventricles. At the periphery, however, Galen recognized (as had been done already by the Alexandrians) that the arteries anastomose with the veins, “. . . and they mutually receive from each other blood and spirits through certain invisible and extremely small vessels.”
It is difficult to understand how Galen missed the circulation of the blood. He knew that the valves of the heart determined the direction of the blood that entered and left the organ, but he did not appreciate that it was a pump for distributing the blood, regarding it rather as a fireplace from which the innate heat of the body was derived. He knew that the pulsatile force was resident in the walls of the heart and in the arteries, and he knew that the expansion, or diastole, drew blood into its cavities, and that the systole forced blood out. Apparently his view was that there was a sort of ebb and flow in both systems—and yet, he uses language just such as we would, speaking of the venous system as “. . . a conduit full of blood with a multitude of canals large and small running out from it and distributing blood to all parts of the body.” He compares the mode of nutrition to irrigating canals and gardens, with a wonderful dispensation by nature that they should “neither lack a sufficient quantity of blood for absorption nor be overloaded at any time with excessive supply.” The function of respiration was the introduction of the pneuma, the spirits which passed from the lungs to the heart through the pulmonary vessels. Galen went a good deal beyond the idea of Aristotle, reaching our modern conception that the function is to maintain the animal heat, and that the smoky matters derived from combustion of the blood are discharged by expiration.
I have dwelt on these points in Galen’s physiology, as they are fundamental in the history of the circulation; and they are sufficient to illustrate his position. Among his other brilliant experiments were the demonstration of the function of the laryngeal nerves, of the motor and sensory functions of the spinal nerve roots, of the effect of transverse incision of the spinal cord, and of the effect of hemisection. Altogether there is no ancient physician in whose writings are contained so many indications of modern methods of research.
Galen’s views of disease in general are those of Hippocrates, but he introduces many refinements and subdivisions according to the predominance of the four humors, the harmonious combination of which means health, or eucrasia, while their perversion or improper combination leads to dyscrasia, or ill health. In treatment he had not the simplicity of Hippocrates: he had great faith in drugs and collected plants from all parts of the known world, for the sale of which he is said to have had a shop in the neighborhood of the Forum. As I mentioned, he was an eclectic, held himself aloof from the various schools of the day, calling no man master save Hippocrates. He might be called a rational empiricist. He made war on the theoretical practitioners of the day, particularly the Methodists, who, like some of their modern followers, held that their business was with the disease and not with the conditions out of which it arose.
No other physician has ever occupied the commanding position of “Clarissimus” Galenus. For fifteen centuries he dominated medical thought as powerfully as did Aristotle in the schools. Not until the Renaissance did daring spirits begin to question the infallibility of this medical pope. But here we must part with the last and, in many ways, the greatest of the Greeks—a man very much of our own type, who, could he visit this country today, might teach us many lessons. He would smile in scorn at the water supply of many of our cities, thinking of the magnificent aqueducts of Rome and of many of the colonial towns—some still in use—which in lightness of structure and in durability testify to the astonishing skill of their engineers. There are country districts in which he would find imperfect drainage and could tell of the wonderful system by which Rome was kept sweet and clean. Nothing would delight him more than a visit to Panama to see what the organization of knowledge has been able to accomplish. Everywhere he could tour the country as a sanitary expert, preaching the gospel of good water supply and good drainage, two of the great elements in civilization, in which in many places we have not yet reached the Roman standard.
CHAPTER III — MEDIAEVAL MEDICINE
THERE are waste places of the earth which fill one with terror—not simply because they are waste; one has not such feelings in the desert nor in the vast solitude of the ocean. Very different is it where the desolation has overtaken a brilliant and flourishing product of man’s head and hand. To know that
. . . the Lion and the Lizard keep
The Courts where Jamshyd gloried and drank deep
sends a chill to the heart, and one trembles with a sense of human instability. With this feeling we enter the Middle Ages. Following the glory that was Greece and the grandeur that was Rome, a desolation came upon the civilized world, in which the light of learning burned low, flickering almost to extinction. How came it possible that the gifts of Athens and of Alexandria were deliberately thrown away? For three causes. The barbarians shattered the Roman Empire to its foundations. When Alaric entered Rome in 410 A. D., ghastly was the impression made on the contemporaries; the Roman world shuddered in a titanic spasm (Lindner). The land was a garden of Eden before them, behind a howling wilderness, as is so graphically told in Gibbon’s great history. Many of the most important centres of learning were destroyed, and for centuries Minerva and Apollo forsook the haunts of men. The other equally important cause was the change wrought by Christianity. The brotherhood of man, the care of the body, the gospel of practical virtues formed the essence of the teaching of the Founder—in these the Kingdom of Heaven was to be sought; in these lay salvation. But the world was very evil, all thought that the times were waxing late, and into men’s minds entered as never before a conviction of the importance of the four last things—death, judgment, heaven and hell. One obstacle alone stood between man and his redemption, the vile body, “this muddy vesture of decay,” that so grossly wrapped his soul. To find methods of bringing it into subjection was the task of the Christian Church for centuries. In the Vatican Gallery of Inscriptions is a stone slab with the single word “Stercoriae,” and below, the Christian symbol. It might serve as a motto for the Middle Ages, during which, to quote St. Paul, all things were “counted dung but to win Christ.” In this attitude of mind the wisdom of the Greeks was not simply foolishness, but a stumbling-block in the path. Knowledge other than that which made a man “wise unto salvation” was useless. All that was necessary was contained in the Bible or taught by the Church. This simple creed brought consolation to thousands and illumined the lives of some of the noblest of men. But, “in seeking a heavenly home man lost his bearings upon earth.” Let me commend for your reading Taylor’s “Mediaeval Mind.”(1) I cannot judge of its scholarship, which I am told by scholars is ripe and good, but I can judge of its usefulness for anyone who wishes to know the story of the mind of man in Europe at this period. Into the content of mediaeval thought only a mystic can enter with full sympathy. It was a needful change in the evolution of the race. Christianity brought new ideals and new motives into the lives of men. The world’s desire was changed, a desire for the Kingdom of Heaven, in the search for which the lust of the flesh, the lust of the eye and the pride of life were as dross. A master-motive swayed the minds of sinful men and a zeal to save other souls occupied the moments not devoted to the perfection of their own. The new dispensation made any other superfluous. As Tertullian said: Investigation since the Gospel is no longer necessary. (Dannemann, Die Naturw., I, p. 214.) The attitude of the early Fathers toward the body is well expressed by Jerome. “Does your skin roughen without baths? Who is once washed in the blood of Christ needs not wash again.” In this unfavorable medium for its growth, science was simply disregarded, not in any hostile spirit, but as unnecessary.(2) And a third contributing factor was the plague of the sixth century, which desolated the whole Roman world. On the top of the grand mausoleum of Hadrian, visitors at Rome see the figure of a gilded angel with a drawn sword, from which the present name of the Castle of St. Angelo takes its origin. On the twenty-fifth of April, 590, there set out from the Church of SS. Cosmas and Damian, already the Roman patron saints of medicine, a vast procession, led by St. Gregory the Great, chanting a seven-fold litany of intercession against the plague. The legend relates that Gregory saw on the top of Hadrian’s tomb an angel with a drawn sword, which he sheathed as the plague abated.
(1) H. O. Taylor: The Mediaeval Mind, 2 vols., Macmillan Co.,
New York, 1911. (New edition, 1920.)
(2) Ibid., Vol. 1, p. 13: “Under their action (the Christian
Fathers) the peoples of Western Europe, from the eighth to the
thirteenth century, passed through a homogeneous growth, and
evolved a spirit different from that of any other period of
history—a spirit which stood in awe before its monitors divine
and human, and deemed that knowledge was to be drawn from the
storehouse of the past; which seemed to rely on everything except
its sin-crushed self, and trusted everything except its senses;
which in the actual looked for the ideal, in the concrete saw the
symbol, in the earthly Church beheld the heavenly, and in fleshly
joys discerned the devil’s lures; which lived in the unreconciled
opposition between the lust and vain-glory of earth and the
attainment of salvation; which felt life’s terror and its
pitifulness, and its eternal hope; around which waved concrete
infinitudes, and over which flamed the terror of darkness and the
Judgment Day.”
Galen died about 200 A.D.; the high-water mark of the Renaissance, so far as medicine is concerned, was reached in the year 1542. In order to traverse this long interval intelligently, I will sketch certain great movements, tracing the currents of Greek thought, setting forth in their works the lives of certain great leaders, until we greet the dawn of our own day.
After flowing for more than a thousand years through the broad plain of Greek civilization, the stream of scientific medicine which we have been following is apparently lost in the morass of the Middle Ages; but, checked and blocked like the White Nile in the Soudan, three channels may be followed through the weeds of theological and philosophical speculation.
SOUTH ITALIAN SCHOOL
A WIDE stream is in Italy, where the “antique education never stopped, antique reminiscence and tradition never passed away, and the literary matter of the pagan past never faded from the consciousness of the more educated among the laity and clergy.”(3) Greek was the language of South Italy and was spoken in some of its eastern towns until the thirteenth century. The cathedral and monastic schools served to keep alive the ancient learning. Monte Casino stands pre-eminent as a great hive of students, and to the famous Regula of St. Benedict(4) we are indebted for the preservation of many precious manuscripts.
(3) H. O. Taylor: The Mediaeval Mind, Vol. I, p. 251.
(4) De Renzi: Storia Documentata della Scuola Medica di Salerno,
2d ed., Napoli, 1867, Chap. V.
The Norman Kingdom of South Italy and Sicily was a meeting ground of Saracens, Greeks and Lombards. Greek, Arabic and Latin were in constant use among the people of the capital, and Sicilian scholars of the twelfth century translated directly from the Greek.
The famous “Almagest” of Ptolemy, the most important work of ancient astronomy, was translated from a Greek manuscript, as early as 1160, by a medical student of Salerno.(5)
(5) Haskins and Lockwood: Harvard Studies in Classical
Philology, 1910, XXI, pp. 75-102.
About thirty miles southeast of Naples lay Salernum, which for centuries kept alight the lamp of the old learning, and became the centre of medical studies in the Middle Ages; well deserving its name of “Civitas Hippocratica.” The date of foundation is uncertain, but Salernitan physicians are mentioned as early as the middle of the ninth century, and from this date until the rise of the universities it was not only a great medical school, but a popular resort for the sick and wounded. As the scholar says in Longfellow’s “Golden Legend”:
Then at every season of the year
There are crowds of guests and travellers here;
Pilgrims and mendicant friars and traders
From the Levant, with figs and wine,
And bands of wounded and sick Crusaders,
Coming back from Palestine.
There were medical and surgical clinics, foundling hospitals, Sisters of Charity, men and women professors—among the latter the famous Trotula—and apothecaries. Dissections were carried out, chiefly upon animals, and human subjects were occasionally used. In the eleventh and twelfth centuries, the school reached its height, and that remarkable genius, Frederick II, laid down regulations for a preliminary study extending over three years, and a course in medicine for five years, including surgery. Fee tables and strict regulations as to practice were made; and it is specifically stated that the masters were to teach in the schools, theoretically and practically, under the authority of Hippocrates and Galen. The literature from the school had a far-reaching influence. One book on the anatomy of the pig illustrates the popular subject for dissection at that time.(6) The writings, which are numerous, have been collected by De Renzi.(7)
(6) “And dissections of the bodies of swine
As likest the human form divine.”—Golden Legend.
(7) S. de Renzi: Collectio Salernitana, 5 vols., Naples,
1852-1859; P. Giacosa: Magistri Salernitani, Turin, 1901.
The “Antidotarium” of Nicolaus Salernitanus, about 1100, became the popular pharmacopoeia of the Middle Ages, and many modern preparations may be traced to it.
The most prominent man of the school is Constantinus Africanus, a native of Carthage, who, after numerous journeys, reached Salernum about the middle of the eleventh century. He was familiar with the works both of the Greeks and of the Arabs, and it was largely through his translations that the works of Rhazes and Avicenna became known in the West.
One work above all others spread the fame of the school—the Regimen Sanitatis, or Flos Medicinae as it is sometimes called, a poem on popular medicine. It is dedicated to Robert of Normandy, who had been treated at Salernum, and the lines begin: “Anglorum regi scripsit schola tota Salerni . . . ” It is a hand-book of diet and household medicine, with many shrewd and taking sayings which have passed into popular use, such as “Joy, temperance and repose Slam the door on the doctor’s nose.” A full account of the work and the various editions of it is given by Sir Alexander Croke,(8) and the Finlayson lecture (Glasgow Medical Journal, 1908) by Dr. Norman Moore gives an account of its introduction into the British Isles.
(8) Regimen Sanitutis Salernitanum; a Poem on the Preservation of
Health in Rhyming Latin Verse, Oxford, D.A. Talboys, 1830.
BYZANTINE MEDICINE
THE second great stream which carried Greek medicine to modern days runs through the Eastern Empire. Between the third century and the fall of Constantinople there was a continuous series of Byzantine physicians whose inspiration was largely derived from the old Greek sources. The most distinguished of these was Oribasius, a voluminous compiler, a native of Pergamon and so close a follower of his great townsman that he has been called “Galen’s ape.” He left many works, an edition of which was edited by Bussemaker and Daremberg. Many facts relating to the older writers are recorded in his writings. He was a contemporary, friend as well as the physician, of the Emperor Julian, for whom he prepared an encyclopaedia of the medical sciences.
Other important Byzantine writers were Aetius and Alexander of Tralles, both of whom were strongly under the influence of Galen and Hippocrates. Their materia medica was based largely upon Dioscorides.
From Byzantium we have the earliest known complete medical manuscript, dating from the fifth century—a work of Dioscorides—one of the most beautiful in existence. It was prepared for Anicia Juliana, daughter of the Emperor of the East, and is now one of the great treasures of the Imperial Library at Vienna.(9) From those early centuries till the fall of Constantinople there is very little of interest medically. A few names stand out prominently, but it is mainly a blank period in our records. Perhaps one man may be mentioned, as he had a great influence on later ages—Actuarius, who lived about 1300, and whose book on the urine laid the foundation of much of the popular uroscopy and water-casting that had such a vogue in the sixteenth and seventeenth centuries. His work on the subject passed through a dozen Latin editions, but is best studied in Ideler’s “Physici et medici Graeci minores” (Berlin, 1841).
(9) It has been reproduced by Seatone de Vries, Leyden, 1905,
Codices graeci et latini photographice depicti, Vol. X.
The Byzantine stream of Greek medicine had dwindled to a very tiny rill when the fall of Constantinople (1453) dispersed to the West many Greek scholars and many precious manuscripts.
ARABIAN MEDICINE
THE third and by far the strongest branch of the Greek river reached the West after a remarkable and meandering course. The map before you shows the distribution of the Graeco-Roman Christian world at the beginning of the seventh century. You will notice that Christianity had extended far eastwards, almost to China. Most of those eastern Christians were Nestorians and one of their important centres was Edessa, whose school of learning became so celebrated. Here in the fifth century was built one of the most celebrated hospitals of antiquity.
Now look at another map showing the same countries about a century later. No such phenomenal change ever was made within so short space of time as that which thus altered the map of Asia and Europe at this period. Within a century, the Crescent had swept from Arabia through the Eastern Empire, over Egypt, North Africa and over Spain in the West, and the fate of Western Europe hung in the balance before the gates of Tours in 732. This time the barbaric horde that laid waste a large part of Christendom were a people that became deeply appreciative of all that was best in Graeco-Roman civilization and of nothing more than of its sciences. The cultivation of medicine was encouraged by the Arabs in a very special way. Anyone wishing to follow the history of the medical profession among this remarkable people will find it admirably presented in Lucien Leclerc’s “Histoire de la medecine arabe” (Paris, 1876). An excellent account is also given in Freind’s well-known “History of Medicine” (London, 1725-1726). Here I can only indicate very briefly the course of the stream and its freightage.
With the rise of Christianity, Alexandria became a centre of bitter theological and political factions, the story of which haunts the memory of anyone who was so fortunate as to read in his youth Kingsley’s “Hypatia.” These centuries, with their potent influence of neoplatonism on Christianity, appear to have been sterile enough in medicine. I have already referred to the late Greeks, Aetius and Alexander of Tralles. The last of the Alexandrians was a remarkable man, Paul of AEgina, a great name in medicine and in surgery, who lived in the early part of the seventh century. He also, like Oribasius, was a great compiler. In the year 640, the Arabs took Alexandria, and for the third time a great library was destroyed in the “first city of the West.” Shortly after the conquest of Egypt, Greek works were translated into Arabic, often through the medium of Syriac, particularly certain of Galen’s books on medicine, and chemical writings, which appear to have laid the foundation of Arabian knowledge on this subject.
Through Alexandria then was one source: but the special development of the Greek science and of medicine took place in the ninth century under the Eastern Caliphates. Let me quote here a couple of sentences from Leclerc (Tome I, pp. 91-92):
“The world has but once witnessed so marvellous a spectacle as that presented by the Arabs in the ninth century. This pastoral people, whose fanaticism had suddenly made them masters of half of the world, having once founded their empire, immediately set themselves to acquire that knowledge of the sciences which alone was lacking to their greatness. Of all the invaders who competed for the last remains of the Roman Empire they alone pursued such studies; while the Germanic hordes, glorying in their brutality and ignorance, took a thousand years to re-unite the broken chain of tradition, the Arabs accomplished this in less than a century. They provoked the competition of the conquered Christians—a healthy competition which secured the harmony of the races.
“At the end of the eighth century, their whole scientific possessions consisted of a translation of one medical treatise and some books on alchemy. Before the ninth century had run to its close, the Arabs were in possession of all the science of the Greeks; they had produced from their own ranks students of the first order, and had raised among their initiators men who, without them, would have been groping in the dark; and they showed from this time an aptitude for the exact sciences, which was lacking in their instructors, whom they henceforward surpassed.”
It was chiefly through the Nestorians that the Arabs became acquainted with Greek medicine, and there were two famous families of translators, the Bakhtishuas and the Mesues, both Syrians, and probably not very thoroughly versed in either Greek or Arabic. But the prince of translators, one of the finest figures of the century, was Honein, a Christian Arab, born in 809, whose name was Latinized as Joannitius. “The marvellous extent of his works, their excellence, their importance, the trials he bore nobly at the beginning of his career, everything about him arouses our interest and sympathy. If he did not actually create the Oriental renaissance movement, certainly no one played in it a more active, decided and fruitful part.”(10) His industry was colossal. He translated most of the works of Hippocrates and Galen, Aristotle and many others. His famous “Introduction” or “Isagoge,” a very popular book in the Middle Ages, is a translation of the “Microtegni” of Galen, a small hand-book, of which a translation is appended to Cholmeley’s “John of Gaddesden.”(11) The first printed edition of it appeared in 1475 (see Chapter IV) at Padua.
(10) Leclerc: Histoire de la medecine arabe, Tome I, p. 139.
(11) Oxford, Clarendon Press, 1912, pp. 136-166. The Mesues also
did great work, and translations of their compilations,
particularly those of the younger Mesue, were widely distributed
in manuscript and were early printed (Venice, 1471) and
frequently reprinted, even as late as the seventeenth century.
Leclerc gives the names of more than one hundred known translators who not only dealt with the physicians but with the Greek philosophers, mathematicians and astronomers. The writings of the physicians of India and of Persia were also translated into Arabic.
But close upon the crowd of translators who introduced the learning of Greece to the Arabians came original observers of the first rank, to a few only of whom time will allow me to refer. Rhazes, so called from the name of the town (Rai) in which he was born, was educated at the great hospital at Bagdad in the second half of the ninth century. With a true Hippocratic spirit he made many careful observations on disease, and to him we owe the first accurate account of smallpox, which he differentiated from measles. This work was translated for the old Sydenham Society by W.A. Greenhill (1848), and the description given of the disease is well worth reading. He was a man of strong powers of observation, good sense and excellent judgment. His works were very popular, particularly the gigantic “Continens,” one of the bulkiest of incunabula. The Brescia edition, 1486, a magnificent volume, extends over 588 pages and it must weigh more than seventeen pounds. It is an encyclopaedia filled with extracts from the Greek and other writers, interspersed with memoranda of his own experiences. His “Almansor” was a very popular text-book, and one of the first to be printed. Book IX of “Almansor” (the name of the prince to whom it was addressed) with the title “De aegritudinibus a capite usque ad pedes,” was a very favorite mediaeval text-book. On account of his zeal for study Rhazes was known as the “Experimentator.”
The first of the Arabians, known throughout the Middle Ages as the Prince, the rival, indeed, of Galen, was the Persian Ibn Sina, better known as Avicenna, one of the greatest names in the history of medicine. Born about 980 A. D. in the province of Khorasan, near Bokhara, he has left a brief autobiography from which we learn something of his early years. He could repeat the Koran by heart when ten years old, and at twelve he had disputed in law and in logic. So that he found medicine was an easy subject, not hard and thorny like mathematics and metaphysics! He worked night and day, and could solve problems in his dreams. “When I found a difficulty,” he says, “I referred to my notes and prayed to the Creator. At night, when weak or sleepy, I strengthened myself with a glass of wine.”(12) He was a voluminous writer to whom scores of books are attributed, and he is the author of the most famous medical text-book ever written. It is safe to say that the “Canon” was a medical bible for a longer period than any other work. It “stands for the epitome of all precedent development, the final codification of all Graeco-Arabic medicine. It is a hierarchy of laws liberally illustrated by facts which so ingeniously rule and are subject to one another, stay and uphold one another, that admiration is compelled for the sagacity of the great organiser who, with unparalleled power of systematisation, collecting his material from all sources, constructed so imposing an edifice of fallacy. Avicenna, according to his lights, imparted to contemporary medical science the appearance of almost mathematical accuracy, whilst the art of therapeutics, although empiricism did not wholly lack recognition, was deduced as a logical sequence from theoretical (Galenic and Aristotelian) premises. Is it, therefore, matter for surprise that the majority of investigators and practitioners should have fallen under the spell of this consummation of formalism and should have regarded the ‘Canon’ as an infallible oracle, the more so in that the logical construction was impeccable and the premises, in the light of contemporary conceptions, passed for incontrovertible axioms?”(13)
(12) Withington: Medical History, London, 1894, pp. 151-152.
(13) Neuburger: History of Medicine, Vol. I, pp. 368-369.
Innumerable manuscripts of it exist: of one of the most beautiful, a Hebrew version (Bologna Library), I give an illustration. A Latin version was printed in 1472 and there are many later editions, the last in 1663. Avicenna was not only a successful writer, but the prototype of the successful physician who was at the same time statesman, teacher, philosopher and literary man. Rumor has it that he became dissipated, and a contemporary saying was that all his philosophy could not make him moral, nor all his physic teach him to preserve his health. He enjoyed a great reputation as a poet. I reproduce a page of a manuscript of one of his poems, which we have in the Bodleian Library. Prof. A.V.W. Jackson says that some of his verse is peculiarly Khayyamesque, though he antedated Omar by a century. That “large Infidel” might well have written such a stanza as
From Earth’s dark centre unto Saturn’s Gate
I’ve solved all problems of this world’s Estate,
From every snare of Plot and Guile set free,
Each bond resolved, saving alone Death’s Fate.
His hymn to the Deity might have been written by Plato and rivals the famous one of Cleanthes.(14) A casual reader gets a very favorable impression of Avicenna. The story of his dominion over the schools in the Middle Ages is one of the most striking in our history. Perhaps we feel that Leclerc exaggerates when he says: “Avicenna is an intellectual phenomenon. Never perhaps has an example been seen of so precocious, quick and wide an intellect extending and asserting itself with so strange and indefatigable an activity.” The touch of the man never reached me until I read some of his mystical and philosophical writings translated by Mehren.(15) It is Plato over again. The beautiful allegory in which men are likened to birds snared and caged until set free by the Angel of Death might be met with anywhere in the immortal Dialogues. The tractate on Love is a commentary on the Symposium; and the essay on Destiny is Greek in spirit without a trace of Oriental fatalism, as you may judge from the concluding sentence, which I leave you as his special message: “Take heed to the limits of your capacity and you will arrive at a knowledge of the truth! How true is the saying:—Work ever and to each will come that measure of success for which Nature has designed him.” Avicenna died in his fifty-eighth year. When he saw that physic was of no avail, resigning himself to the inevitable, he sold his goods, distributed the money to the poor, read the Koran through once every three days, and died in the holy month of Ramadan. His tomb at Hamadan, the ancient Ecbatana, still exists, a simple brickwork building, rectangular in shape, and surrounded by an unpretentious court. It was restored in 1877, but is again in need of repair. The illustration here shown is from a photograph sent by Dr. Neligan of Teheran. Though dead, the great Persian has still a large practice, as his tomb is much visited by pilgrims, among whom cures are said to be not uncommon.
(14) “L’hymne d’Avicenne” in: L’Elegie du Tograi, etc., par P.
Vattier, Paris, 1660.
(15) Traites mystiques d’Abou Ali al-Hosain b. Abdallah b. Sina
ou d’Avicenne par M. A. F. Mehren, Leyden, E. J. Brill, Fasc.
I-IV, 1889-1899.
The Western Caliphate produced physicians and philosophers almost as brilliant as those of the East. Remarkable schools of medicine were founded at Seville, Toledo and Cordova. The most famous of the professors were Averroes, Albucasis and Avenzoar. Albucasis was “the Arabian restorer of surgery.” Averroes, called in the Middle Ages “the Soul of Aristotle” or “the Commentator,” is better known today among philosophers than physicians. On the revival of Moslem orthodoxy he fell upon evil days, was persecuted as a free-thinker, and the saying is attributed to him—”Sit anima mea cum philosophic.”
Arabian medicine had certain very definite characteristics: the basis was Greek, derived from translations of the works of Hippocrates and Galen. No contributions were made to anatomy, as dissections were prohibited, nor to physiology, and the pathology was practically that of Galen. Certain new and important diseases were described; a number of new and active remedies were introduced, chiefly from the vegetable kingdom. The Arabian hospitals were well organized and were deservedly famous. No such hospital exists today in Cairo as that which was built by al-Mansur Gilafun in 1283. The description of it by Makrizi, quoted by Neuburger,(16) reads like that of a twentieth century institution with hospital units.
(16) “I have founded this institution for my equals and for those beneath me, it is intended for rulers and subjects, for soldiers and for the emir, for great and small, freemen and slaves, men and women.” “He ordered medicaments, physicians and everything else that could be required by anyone in any form of sickness; placed male and female attendants at the disposal of the patients, determined their pay, provided beds for patients and supplied them with every kind of covering that could be required in any complaint. Every class of patient was accorded separate accommodation: the four halls of the hospital were set apart for those with fever and similar complaints; one part of the building was reserved for eye-patients, one for the wounded, one for those suffering from diarrhoea, one for women; a room for convalescents was divided into two parts, one for men and one for women. Water was laid on to all these departments. One room was set apart for cooking food, preparing medicine and cooking syrups, another for the compounding of confections, balsams, eye-salves, etc. The head-physician had an apartment to himself wherein he delivered medical lectures. The number of patients was unlimited, every sick or poor person who came found admittance, nor was the duration of his stay restricted, and even those who were sick at home were supplied with every necessity.”—Makrizi.
“In later times this hospital was much extended and improved. The nursing was admirable and no stint was made of drugs and appliances; each patient was provided with means upon leaving so that he should not require immediately to undertake heavy work.” Neuburger: History of Medicine, Vol. 1, p. 378.
It was in the domain of chemistry that the Arabs made the greatest advances. You may remember that, in Egypt, chemistry had already made considerable strides, and I alluded to Prof. Elliot Smith’s view that one of the great leaps in civilization was the discovery in the Nile Valley of the metallurgy of copper. In the brilliant period of the Ptolemies, both chemistry and pharmacology were studied, and it seems not improbable that, when the Arabs took Alexandria in the year 640, there were still many workers in these subjects.
The most famous of those early Arabic writers is the somewhat mythical Geber, who lived in the first half of the eighth century, and whose writings had an extraordinary influence throughout the Middle Ages. The whole story of Geber is discussed by Berthelot in his “La chimie au moyen age” (Paris, 1896). The transmission of Arabian science to the Occident began with the Crusades, though earlier a filtering of important knowledge in mathematics and astronomy had reached Southern and Middle Europe through Spain. Among the translators several names stand out prominently. Gerbert, who became later Pope Sylvester II, is said to have given us our present Arabic figures. You may read the story of his remarkable life in Taylor,(17) who says he was “the first mind of his time, its greatest teacher, its most eager learner, and most universal scholar.” But he does not seem to have done much directly for medicine.
(17) The Mediaeval Mind, Vol. I, p. 280.
The Graeco-Arabic learning passed into Europe through two sources. As I have already mentioned, Constantinus Africanus, a North African Christian monk, widely travelled and learned in languages, came to Salernum and translated many works from Arabic into Latin, particularly those of Hippocrates and Galen. The “Pantegni” of the latter became one of the most popular text-books of the Middle Ages. A long list of other works which he translated is given by Steinschneider.(17a) It is not unlikely that Arabic medicine had already found its way to Salernum before the time of Constantine, but the influence of his translations upon the later Middle Ages was very great.
(17a) Steinschneider: Virchow’s Arch., Berl., 1867, xxxvii, 351.
The second was a more important source through the Latin translators in Spain, particularly in Toledo, where, from the middle of the twelfth till the middle of the thirteenth century, an extraordinary number of Arabic works in philosophy, mathematics and astronomy were translated. Among the translators, Gerard of Cremona is prominent, and has been called the “Father of Translators.” He was one of the brightest intelligences of the Middle Ages, and did a work of the first importance to science, through the extraordinary variety of material he put in circulation. Translations, not only of the medical writers, but of an indiscriminate crowd of authors in philosophy and general literature, came from his pen. He furnished one of the first translations of the famous “Almagest” of Ptolemy, which opened the eyes of his contemporaries to the value of the Alexandrian astronomy.(18) Leclerc gives a list of seventy-one works from his hand.
(18) For an account of that remarkable work see German
translation by Manitius, Leipzig, 1912.
Many of the translators of the period were Jews, and many of the works were translated from Hebrew into Latin. For years Arabic had been the learned language of the Jews, and in a large measure it was through them that the Arabic knowledge and the translations passed into South and Central Europe.
The Arab writer whose influence on mediaeval thought was the most profound was Averroes, the great commentator on Aristotle.
THE RISE OF THE UNIVERSITIES
THE most striking intellectual phenomenon of the thirteenth century is the rise of the universities. The story of their foundation is fully stated in Rashdall’s great work (Universities of Europe in the Middle Ages, Oxford, 1895). Monastic and collegiate schools, seats of learning like Salernum, student guilds as at Bologna, had tried to meet the educational needs of the age. The word “university” literally means an association, and was not at first restricted to learned bodies. The origin appears to have been in certain guilds of students formed for mutual protection associated at some place specially favorable for study—the attraction generally being a famous teacher. The University of Bologna grew up about guilds formed by students of law, and at Paris, early in the twelfth century, there were communities of teachers, chiefly in philosophy and theology. In this way arose two different types of mediaeval university. The universities of Northern Italy were largely controlled by students, who were grouped in different “nations.” They arranged the lectures and had control of the appointment of teachers. On the other hand, in the universities founded on the Paris model the masters had control of the studies, though the students, also in nations, managed their own affairs.
Two universities have a special interest at this period in connection with the development of medical studies, Bologna and Montpellier. At the former the study of anatomy was revived. In the knowledge of the structure of the human body no advance had been made for more than a thousand years—since Galen’s day. In the process of translation from Greek to Syriac, from Syriac to Arabic, from Arabic to Hebrew, and from Hebrew or Arabic to Latin, both the form and thought of the old Greek writers were not infrequently confused and often even perverted, and Galen’s anatomy had suffered severely in the transmission. Our earliest knowledge of the teaching of medicine at Bologna is connected with a contemporary of Dante, Taddeo Alderotti, who combined Arabian erudition with the Greek spirit. He occupied a position of extraordinary prominence, was regarded as the first citizen of Bologna and a public benefactor exempt from the payment of taxes. That he should have acquired wealth is not surprising if his usual fees were at the rate at which he charged Pope Honorius IV, i.e., two hundred florins a day, besides a “gratification” of six thousand florins.
The man who most powerfully influenced the study of medicine in Bologna was Mundinus, the first modern student of anatomy. We have seen that at the school of Salernum it was decreed that the human body should be dissected at least once every five years, but it was with the greatest difficulty that permission was obtained for this purpose. It seems probable that under the strong influence of Taddeo there was an occasional dissection at Bologna, but it was not until Mundinus (professor from 1306 to 1326) took the chair that the study of anatomy became popular. The bodies were usually those of condemned criminals, but in the year 1319 there is a record of a legal procedure against four medical students for body-snatching—the first record, as far as I know, of this gruesome practice. In 1316, Mundinus issued his work on anatomy, which served as a text-book for more than two hundred years. He quotes from Galen the amusing reasons why a man should write a book: “Firstly, to satisfy his own friends; secondly, to exercise his best mental powers; and thirdly, to be saved from the oblivion incident to old age.” Scores of manuscripts of his work must have existed, but they are now excessively rare in Italy. The book was first printed at Pavia in 1478, in a small folio without figures. It was very often reprinted in the fifteenth and sixteenth centuries. The quaint illustration shows us the mediaeval method of teaching anatomy: the lecturer sitting on a chair reading from Galen, while a barber surgeon, or an “Ostensor,” opens the cavities of the body.
I have already referred to the study of medicine by women at Salernum. Their names are also early met with in the school of Bologna. Mundinus is said to have had a valuable assistant, a young girl, Alessandra Giliani, an enthusiastic dissector, who was the first to practice the injection of the blood vessels with colored liquids. She died, consumed by her labors, at the early age of nineteen, and her monument is still to be seen.
Bologna honored its distinguished professors with magnificent tombs, sixteen or seventeen of which, in a wonderful state of preservation, may still be seen in the Civic Museum. That of Mundinus also exists—a sepulchral bas-relief on the wall of the Church of San Vitale at Bologna.(19)
(19) For these figures and for points relating to the old school
at Bologna see F. G. Cavezza: Le Scuole dell’ antico Studio
Bolognese, Milano, 1896.
The other early mediaeval university of special interest in medicine is that of Montpellier. With it are connected three teachers who have left great names in our story—Arnold of Villanova, Henri de Mondeville and Guy de Chauliac. The city was very favorably situated not far from the Spanish border, and the receding tide of the Arab invasion in the eighth century had left a strong Arabic influence in that province. The date of the origin of the university is uncertain, but there were teachers of medicine there in the twelfth century, though it was not until 1289 that it was formally founded by a papal bull.
Arnold of Villanova was one of the most prolific writers of the Middle Ages. He had travelled much, was deeply read in Arabic medicine and was also a student of law and of philosophy. He was an early editor of the Regimen Sanitatis, and a strong advocate of diet and hygiene. His views on disease were largely those of the Arabian physicians, and we cannot see that he himself made any very important contribution to our knowledge; but he was a man of strong individuality and left an enduring mark on mediaeval medicine, as one may judge from the fact that among the first hundred medical books printed there were many associated with his name. He was constantly in trouble with the Church, though befriended by the Popes on account of his medical knowledge. There is a Bull of Clement V asking the bishops to search for a medical book by Arnold dedicated to himself, but not many years later his writings were condemned as heretical.
In Henri de Mondeville we have the typical mediaeval surgeon, and we know his work now very thoroughly from the editions of his “Anatomy” and “Surgery” edited by Pagel (Berlin, 1889-1892), and the fine French edition by Nicaise (Paris, 1893). The dominant Arabic influence is seen in that he quotes so large a proportion of these authors, but he was an independent observer and a practical surgeon of the first rank. He had a sharp wit and employed a bitter tongue against the medical abuses of his day. How the Hippocratic humors dominated practice at this time you may see at a glance from the table prepared by Nicaise from the works of de Mondeville. We have here the whole pathology of the period.
===============================================================
TABLEAU DES HUMEURS
D’APRES H. DE MONDEVILLE
Flegme naturel.
F. aqueux.
Flegme F. mucilagineux.
F. vitreux.
Flegme non naturel F sale.
F. doux.
F. pontique, 2 especes.
F. acide, 2 especes.
Bile naturelle.
Bile B. citrine.
B. vitelline
Bile non naturelle B. praline.
B. aerugineuse.
B. brulee, 3 especes.
Sang naturel.
non naturel, 5 especes.
Melancolie naturelle.
non naturelle, 5 especes.
===============================================================
A still greater name in the history of this school is Guy de Chauliac, whose works have also been edited by Nicaise (Paris, 1890). His “Surgery” was one of the most important text-books of the late Middle Ages. There are many manuscripts of it, some fourteen editions in the fifteenth century and thirty-eight in the sixteenth, and it continued to be reprinted far into the seventeenth century. He too was dominated by the surgery of the Arabs, and on nearly every page one reads of the sages Avicenna, Albucasis or Rhazes. He lays down four conditions necessary for the making of a surgeon—the first is that he must be learned, the second, expert, the third that he should be clever, and the fourth that he should be well disciplined.
You will find a very discerning sketch of the relation of these two men to the history of surgery in the address given at the St. Louis Congress in 1904 by Sir Clifford Allbutt.(20) They were strong men with practical minds and good hands, whose experience taught them wisdom. In both there was the blunt honesty that so often characterizes a good surgeon, and I commend to modern surgeons de Mondeville’s saying: “If you have operated conscientiously on the rich for a proper fee, and on the poor for charity, you need not play the monk, nor make pilgrimages for your soul.”
(20) Allbutt: Historical Relations of Medicine and Surgery,
London, Macmillan Co., 1905.
One other great mediaeval physician may be mentioned, Peter of Abano (a small town near Padua, famous for its baths). He is the first in a long line of distinguished physicians connected with the great school of Padua. Known as “the Conciliator,” from his attempt to reconcile the diverse views on philosophy and medicine, he had an extraordinary reputation as a practitioner and author, the persistence of which is well illustrated by the fact that eight of the one hundred and eighty-two medical books printed before 1481 were from his pen. He seems to have taught medicine in Paris, Bologna and Padua. He was a devoted astrologer, had a reputation among the people as a magician and, like his contemporary, Arnold of Villanova, came into conflict with the Church and appears to have been several times before the Inquisition; indeed it is said that he escaped the stake only by a timely death. He was a prolific commentator on Aristotle, and his exposition of the “problems” had a great vogue. The early editions of his texts are among the most superb works ever printed. He outlived his reputation as a magician, and more than a century after his death Frederick, Duke of Urbino, caused his effigies to be set up over the gate of the palace at Padua with this inscription:
PETRUS APONUS PATAVINUS PHILOSOPHIAE MEDICINAEQUE
SCIENTISSIMUS, OB IDQUE, CONCILIATORIS NOMEN
ADEPTUS, ASTROLOGIAE VERO ADEO PERITUS,
UT IN MAGIAE SUSPICIONEM INCIDERIT,
FALSOQUE DE HAERESI POSTULATUS,
ABSOLUTUS FUERIT.(21)
(21) Naude: History of Magick, London, 1657, p. 182, or the
original: Apologie pour les grands hommes soupconnez de magic,
e.g., ed. Amst., 1719, p. 275.
It is said that Abano caused to be painted the astronomical figures in the great hall of the palace at Padua.
One characteristic of mediaeval medicine is its union with theology, which is not remarkable, as the learning of the time was chiefly in the hands of the clergy. One of the most popular works, the “Thesaurus Pauperum,” was written by Petrus Hispanus, afterwards Pope John XXI. We may judge of the pontifical practice from the page here reproduced, which probably includes, under the term “iliac passion,” all varieties of appendicitis.
For our purpose two beacons illuminate the spirit of the thirteenth century in its outlook on man and nature. Better than Abelard or St. Thomas Aquinas, and much better than any physicians, Albertus Magnus and Roger Bacon represent the men who were awake to greet the rising of the sun of science. What a contrast in their lives and in their works! The great Dominican’s long life was an uninterrupted triumph of fruitful accomplishment—the titanic task he set himself was not only completed but was appreciated to the full by his own generation—a life not only of study and teaching, but of practical piety. As head of the order in Germany and Bishop of Regensburg, he had wide ecclesiastical influence; and in death he left a memory equalled only by one or two of his century, and excelled only by his great pupil, Thomas Aquinas. There are many Alberts in history—the Good, the Just, the Faithful—but there is only one we call “Magnus” and he richly deserved the name. What is his record? Why do we hold his name in reverence today?
Albertus Magnus was an encyclopaedic student and author, who took all knowledge for his province. His great work and his great ambition was to interpret Aristotle to his generation. Before his day, the Stagirite was known only in part, but he put within the reach of his contemporaries the whole science of Aristotle, and imbibed no small part of his spirit. He recognized the importance of the study of nature, even of testing it by way of experiment, and in the long years that had elapsed since Theophrastus no one else, except Dioscorides, had made so thorough a study of botany. His paraphrases of the natural history books of Aristotle were immensely popular, and served as a basis for all subsequent studies. Some of his medical works had an extraordinary vogue, particularly the “De Secretis Mulierum” and the “De Virtutibus Herbarum,” but there is some doubt as to the authorship of the first named, although Jammy and Borgnet include it in the collected editions of his works. So fabulous was his learning that he was suspected of magic and comes in Naude’s list of the wise men who have unjustly been reputed magicians. Ferguson tells(22) that “there is in actual circulation at the present time a chapbook . . . containing charms, receipts, sympathetical and magicalcures for man and animals, . . . which passes under the name of Albertus.” But perhaps the greatest claim of Albertus to immortality is that he was the teacher and inspirer of Thomas Aquinas, the man who undertook the colossal task of fusing Aristotelian philosophy with Christian theology, and with such success that the “angelic doctor” remains today the supreme human authority of the Roman Catholic Church.
(22) Bibliotheca Chemica, 1906, Vol. I, p. 15.
A man of much greater interest to us from the medical point of view is Roger Bacon and for two reasons. More than any other mediaeval mind he saw the need of the study of nature by a new method. The man who could write such a sentence as this: “Experimental science has three great prerogatives over other sciences; it verifies conclusions by direct experiment; it discovers truth which they never otherwise would reach; it investigates the course of nature and opens to us a knowledge of the past and of the future,” is mentally of our day and generation. Bacon was born out of due time, and his contemporaries had little sympathy with his philosophy, and still less with his mechanical schemes and inventions. From the days of the Greeks, no one had had so keen an appreciation of what experiment meant in the development of human knowledge, and he was obsessed with the idea, so commonplace to us, that knowledge should have its utility and its practical bearing. “His chief merit is that he was one of the first to point the way to original research—as opposed to the acceptance of an authority—though he himself still lacked the means of pursuing this path consistently. His inability to satisfy this impulse led to a sort of longing, which is expressed in the numerous passages in his works where he anticipates man’s greater mastery over nature.”(23)
(23) Dannemann: Die Naturwissenschaften in ihrer Entwicklung und
in ibrem Zusammenhange, Leipzig, 1910, Vol. I, pp. 278-279.
Bacon wrote a number of medical treatises, most of which remain in manuscript. His treatise on the “Cure of Old Age and the Preservation of Youth” was printed in English in 1683.(24) His authorities were largely Arabian. One of his manuscripts is “On the Bad Practices of Physicians.” On June 10, 1914, the eve of his birth, the septencentenary of Roger Bacon will be celebrated by Oxford, the university of which he is the most distinguished ornament. His unpublished MSS. in the Bodleian will be issued by the Clarendon Press (1915-1920), and it is hoped that his unpublished medical writings will be included.
(24) It may be interesting to note the three causes to which he
attributes old age: “As the World waxeth old, Men grow old with
it: not by reason of the Age of the World, but because of the
great Increase of living Creatures, which infect the very Air,
that every way encompasseth us, and Through our Negligence in
ordering our Lives, and That great Ignorance of the Properties
which are in things conducing to Health, which might help a
disordered way of Living, and might supply the defect of due
Government.”
What would have been its fate if the mind of Europe had been ready for Roger Bacon’s ferment, and if men had turned to the profitable studies of physics, astronomy and chemistry instead of wasting centuries over the scholastic philosophy and the subtleties of Duns Scotus, Abelard and Thomas Aquinas? Who can say? Make no mistake about the quality of these men—giants in intellect, who have had their place in the evolution of the race; but from the standpoint of man struggling for the mastery of this world they are like the members of Swift’s famous college “busy distilling sunshine from cucumbers.” I speak, of course, from the position of the natural man, who sees for his fellows more hope from the experiments of Roger Bacon than from the disputations of philosophy on the “Instants, Familiarities, Quiddities and Relations,” which so roused the scorn of Erasmus.
MEDIAEVAL MEDICAL STUDIES
IT will be of interest to know what studies were followed at a mediaeval university. At Oxford, as at most of the continental universities, there were three degrees, those of Bachelor, Licentiate and Doctor. The books read were the “Tegni” of Galen, the “Aphorisms” of Hippocrates, the “De Febribus” of Isaac and the “Antidotarium” of Nicolaus Salernitanus: if a graduate in arts, six years’ study in all was required, in other faculties, eight. One gets very full information on such matters from a most interesting book, “Une Chaire de Medecine au XVe Siecle,” by Dr. Ferrari (Paris, 1899). The University of Pavia was founded in 1361, and like most of those in Italy was largely frequented by foreigners, who were arranged, as usual, according to their nationalities; but the students do not appear to have controlled the university quite so much as at Bologna. The documents of the Ferrari family, on which the work is based, tell the story of one of its members, who was professor at Pavia from 1432 to 1472. One is surprised at the range of studies in certain directions, and still more at the absence of other subjects. A list is given of the teachers in medicine for the year 1433, twenty in all, and there were special lectures for the morning, afternoon and evening. The subjects are medicine, practical medicine, physics, metaphysics, logic, astrology, surgery and rhetoric: very striking is the omission of anatomy, which does not appear in the list even in 1467. The salaries paid were not large, so that most of the teachers must have been in practice: four hundred and five hundred florins was the maximum.
The dominance of the Arabians is striking. In 1467, special lectures were given on the “Almansor” of Rhazes, and in the catalogue of the Ferrari’s library more than one half of the books are Arabian commentaries on Greek medicine. Still more striking evidence of their influence is found in the text-book of Ferrari, which was printed in 1471 and had been circulated earlier in MS. In it Avicenna is quoted more than 3000 times, Rhazes and Galen 1000, Hippocrates only 140 times. Professor Ferrari was a man who played an important role in the university, and had a large consultation practice. You will be interested to know what sort of advice he gave in special cases. I have the record of an elaborate consultation written in his own hand, from which one may gather what a formidable thing it was to fall into the hands of a mediaeval physician. Signor John de Calabria had a digestive weakness of the stomach, and rheumatic cerebral disease, combined with superfluous heat and dryness of the liver and multiplication of choler. There is first an elaborate discussion on diet and general mode of life; then he proceeds to draw up certain light medicines as a supplement, but it must have taken an extensive apothecary’s shop to turn out the twenty-two prescriptions designed to meet every possible contingency.
One of the difficulties in the early days of the universities was to procure good MSS. In the Paris Faculty, the records of which are the most complete in Europe, there is an inventory for the year 1395 which gives a list of twelve volumes, nearly all by Arabian authors.(25) Franklin gives an interesting incident illustrating the rarity of medical MSS. at this period. Louis XI, always worried about his health, was anxious to have in his library the works of Rhazes. The only copy available was in the library of the medical school. The manuscript was lent, but on excellent security, and it is nice to know that it was returned.
(25) Franklin: Recherches sur la Bibliotheque de la Faculte de
Medecine de Paris, 1864.
It is said that one of the special advantages that Montpellier had over Paris was its possession of so many important MSS., particularly those of the Arabian writers. Many “Compendia” were written containing extracts from various writers, and no doubt these were extensively copied and lent or sold to students. At Bologna and Padua, there were regulations as to the price of these MSS. The university controlled the production of them, and stationers were liable to fines for inaccurate copies. The trade must have been extensive in those early days, as Rashdall mentions that in 1323 there were twenty-eight sworn booksellers in Paris, besides keepers of bookstalls in the open air.
MEDIAEVAL PRACTICE
THE Greek doctrine of the four humors colored all the conceptions of disease; upon their harmony alone it was thought that health depended. The four temperaments, sanguine, phlegmatic, bilious and melancholic, corresponded with the prevalence of these humors. The body was composed of certain so-called “naturals,” seven in number—the elements, the temperaments, the humors, the members or parts, the virtues or faculties, the operations or functions and the spirits. Certain “non-naturals,” nine in number, preserved the health of the body, viz. air, food and drink, movement and repose, sleeping and waking, excretion and retention, and the passions. Disease was due usually to alterations in the composition of the humors, and the indications for treatment were in accordance with these doctrines. They were to be evacuated, tenuated, cooled, heated, purged or strengthened. This humoral doctrine prevailed throughout the Middle Ages, and reached far into modern times—indeed, echoes of it are still to be heard in popular conversations on the nature of disease.
The Arabians were famous for their vigor and resource in matters of treatment. Bleeding was the first resort in a large majority of all diseases. In the “Practice” of Ferrari there is scarcely a malady for which it is not recommended. All remedies were directed to the regulation of the six non-naturals, and they either preserved health, cured the disease or did the opposite. The most popular medicines were derived from the vegetable kingdom, and as they were chiefly those recommended by Galen, they were, and still are, called by his name. Many important mineral medicines were introduced by the Arabians, particularly mercury, antimony, iron, etc. There were in addition scores of substances, the parts or products of animals, some harmless, others salutary, others again useless and disgusting. Minor surgery was in the hands of the barbers, who performed all the minor operations, such as bleeding; the more important operations, few in number, were performed by surgeons.
ASTROLOGY AND DIVINATION
AT this period astrology, which included astronomy, was everywhere taught. In the “Gouernaunce of Prynces, or Pryvete of Pryveties,” translated by James Yonge, 1422,(26) there occurs the statement: “As Galian the lull wies leche Saith and Isoder the Gode clerk, hit witnessith that a man may not perfitely can the sciens and craft of Medissin but yef he be an astronomoure.”
(26) Early English Text Society, Extra Series, No. LXXIV, p. 195,
1898; Secreta Secretorum, Rawl. MS. B., 490.
We have seen how the practice of astrology spread from Babylonia and Greece throughout the Roman Empire. It was carried on into the Middle Ages as an active and aggressive cult, looked upon askance at times by the Church, but countenanced by the courts, encouraged at the universities, and always by the public. In the curriculum of the mediaeval university, astronomy made up with music, arithmetic and geometry the Quadrivium. In the early faculties, astronomy and astrology were not separate, and at Bologna, in the early fourteenth century, we meet with a professorship of astrology.(27) One of the duties of this salaried professor, was to supply “judgements” gratis for the benefit of enquiring students, a treacherous and delicate assignment, as that most distinguished occupant of the chair at Bologna, Cecco d’Ascoli, found when he was burned at the stake in 1357, a victim of the Florentine Inquisition.(28)
(27) Rashdall: Universities of Europe in the Middle Ages, Vol.
I, p. 240.
(28) Rashdall, l.c., Vol. I, p. 244.—Rashdall also mentions that
in the sixteenth century at Oxford there is an instance of a
scholar admitted to practice astrology. l.c., Vol. II, p. 458.
Roger Bacon himself was a warm believer in judicial astrology and in the influence of the planets, stars and comets on generation, disease and death.
Many of the stronger minds of the Renaissance broke away from the follies of the subject. Thus Cornelius Agrippa in reply to the request of a friar to consult the stars on his behalf says:(29) “Judicial astrology is nothing more than the fallacious guess of superstitious men, who have founded a science on uncertain things and are deceived by it: so think nearly all the wise; as such it is ridiculed by some most noble philosophers; Christian theologians reject it, and it is condemned by sacred councils of the Church. Yet you, whose office it is to dissuade others from these vanities, oppressed, or rather blinded by I know not what distress of mind, flee to this as to a sacred augur, and as if there were no God in Israel, that you send to inquire of the god of Ekron.”
(29) H. Morley: The Life of Henry Cornelius Agrippa, London,
1856, Vol. II, p. 138.
In spite of the opposition of the Church astrology held its own; many of the universities at the end of the fifteenth century published almanacs, usually known as “Prognosticons,” and the practice was continued far into the sixteenth century. I show you here an illustration. Rabelais, you may remember, when physician to the Hotel Dieu in Lyons, published almanacs for the years 1533, 1535, 1541, 1546. In the title-page he called himself “Doctor of Medicine and Professor of Astrology,” and they continued to be printed under his name until 1556. In the preparation of these he must have had his tongue in his cheek, as in his famous “Pantagrueline Prognostication,” in which, to satisfy the curiosity of all good companions, he had turned over all the archives of the heavens, calculated the quadratures of the moon, hooked out all that has ever been thought by all the Astrophils, Hypernephilists, Anemophylakes, Uranopets and Ombrophori, and felt on every point with Empedocles.(30)
(30) Pantagrueline Prognostication, Rabelais, W. F. Smith’s
translation, 1893, Vol. II, p. 460.
Even physicians of the most distinguished reputation practised judicial astrology. Jerome Cardan was not above earning money by casting horoscopes, and on this subject he wrote one of his most popular books (De Supplemento Almanach, etc., 1543), in which astronomy and astrology are mixed in the truly mediaeval fashion. He gives in it some sixty-seven nativities, remarkable for the events they foretell, with an exposition. One of the accusations brought against him was that he had “attempted to subject to the stars the Lord of the stars and cast our Saviour’s horoscope.”(31) Cardan professed to have abandoned a practice looked upon with disfavor both by the Church and by the universities, but he returned to it again and again. I show here his own horoscope. That remarkable character, Michael Servetus, the discoverer of the lesser circulation, when a fellow student with Vesalius at Paris, gave lectures upon judicial astrology, which brought him into conflict with the faculty; and the rarest of the Servetus works, rarer even than the “Christianismi Restitutio,” is the “Apologetica disceptatio pro astrologia,” one copy of which is in the Bibliotheque Nationale. Nor could the new astronomy and the acceptance of the heliocentric views dislocate the popular belief. The literature of the seventeenth century is rich in astrological treatises dealing with medicine.
(31) De Thou, Lib. LXII, quoted by Morley in Life of Jerome
Cardan, Vol. II, p. 294.
No one has ever poured such satire upon the mantic arts as did Rabelais in chapter twenty-five of the third book of “Pantagruel.” Panurge goes to consult Her Trippa—the famous Cornelius Agrippa, whose opinion of astrology has already been quoted, but who nevertheless, as court astrologer to Louise of Savoy, had a great contemporary reputation. After looking Panurge in the face and making conclusions by metoposcopy and physiognomy, he casts his horoscope secundum artem, then, taking a branch of tamarisk, a favorite tree from which to get the divining rod, he names some twenty-nine or thirty mantic arts, from pyromancy to necromancy, by which he offers to predict his future. While full of rare humor, this chapter throws an interesting light on the extraordinary number of modes of divination that have been employed. Small wonder that Panurge repented of his visit! I show here the title-page of a popular book by one of the most famous of the English astrological physicians, Nicholas Culpeper.
Never was the opinion of sensible men on this subject better expressed than by Sir Thomas Browne:(32) “Nor do we hereby reject or condemn a sober and regulated Astrology; we hold there is more truth therein than in ASTROLOGERS; in some more than many allow, yet in none so much as some pretend. We deny not the influence of the Starres, but often suspect the due application thereof; for though we should affirm that all things were in all things; that Heaven were but Earth Celestified, and earth but Heaven terrestrified, or that each part above had an influence upon its divided affinity below; yet how to single out these relations, and duly to apply their actions, is a work ofttimes to be effected by some revelation, and Cabala from above, rather than any Philosophy, or speculation here below.”
(32) Sir Thomas Browne: Pseudodoxia Epidemica, Bk. IV, Chap.
XIII. (Wilkin’s ed., Vol. III, p. 84.)
As late as 1699, a thesis was discussed at the Paris Faculty, “Whether comets were harbingers of disease,” and in 1707 the Faculty negatived the question propounded in a thesis, “Whether the moon had any sway on the human body.”
The eighteenth and nineteenth centuries saw, among intelligent men, a progressive weakening of the belief in the subject; but not even the satire of Swift, with his practical joke in predicting and announcing the death of the famous almanac maker, nor contemptuous neglect of the subject of late years sufficed to dispel the belief from the minds of the public. Garth in the Dispensary (1699) satirizes the astrological practitioners of his day:
The Sage in Velvet Chair, here lolls at Ease
To promise future Health for present Fees
Then as from Tripod solemn Sham reveals
And what the Stars know nothing of foretell. (Canto ii.)
The almanacs of Moore and Zadkiel continue to be published, and remain popular. In London, sandwich men are to be met with carrying advertisements of Chaldeans and Egyptians who offer to tell your fortune by the stars. Even in this country, astrology is still practiced to a surprising extent if one may judge from advertisements in certain papers, and from publications which must have a considerable sale. Many years ago, I had as a patient an estimable astrologer, whose lucrative income was derived from giving people astral information as to the rise and fall of stocks. It is a chapter in the vagaries of the human mind that is worth careful study.(33) Let me commend to your reading the sympathetic story called “A Doctor of Medicine” in the “Rewards and Fairies” of Kipling. The hero is Nicholas Culpeper, Gent., whose picture is here given. One stanza of the poem at the end of the story, “Our Fathers of Old,” may be quoted:
Wonderful tales had our fathers of old—
Wonderful tales of the herbs and the stars—
The Sun was Lord of the Marigold,
Basil and Rocket belonged to Mars.
Pat as a sum in division it goes—
(Every plant had a star bespoke)—
Who but Venus should govern the Rose?
Who but Jupiter own the Oak?
Simply and gravely the facts are told
In the wonderful books of our fathers of old.
(33) It is not generally known that Stonewall Jackson practiced
astrology. Col. J. W. Revere in “Keel and Saddle” (Boston, 1872)
tells of meeting Jackson in 1852 on a Mississippi steamer and
talking with him on the subject. Some months later, Revere
received a letter from Jackson enclosing his (Revere’s)
horoscope. There was a “culmination of the malign aspect during
the first days of May, 1863—both will be exposed to a common
danger at the time indicated.” At the battle of
Chancellorsville, May 9, 1863, Revere saw Jackson mortally
wounded!
James J. Walsh of New York has written a book of extraordinary interest called “The Thirteenth, Greatest of Centuries.” I have not the necessary knowledge to say whether he has made out his case or not for art and for literature. There was certainly a great awakening and, inspired by high ideals, men turned with a true instinct to the belief that there was more in life than could be got out of barren scholastic studies. With many of the strong men of the period one feels the keenest mental sympathy. Grosseteste, the great Clerk of Lincoln, as a scholar, a teacher and a reformer, represents a type of mind that could grow only in fruitful soil. Roger Bacon may be called the first of the moderns—certainly the first to appreciate the extraordinary possibilities which lay in a free and untrammelled study of nature. A century which could produce men capable of building the Gothic cathedrals may well be called one of the great epochs in history, and the age that produced Dante is a golden one in literature. Humanity has been the richer for St. Francis; and Abelard, Albertus and Aquinas form a trio not easy to match, in their special departments, either before or after. But in science, and particularly in medicine, and in the advance of an outlook upon nature, the thirteenth century did not help man very much. Roger Bacon was “a voice crying in the wilderness,” and not one of the men I have picked out as specially typical of the period instituted any new departure either in practice or in science. They were servile followers, when not of the Greeks, of the Arabians. This is attested by the barrenness of the century and a half that followed. One would have thought that the stimulus given by Mundinus to the study of anatomy would have borne fruit, but little was done in science during the two and a half centuries that followed the delivery of his lectures and still less in the art. While William of Wykeham was building Winchester Cathedral and Chaucer was writing the Canterbury Tales, John of Gaddesden in practice was blindly following blind leaders whose authority no one dared question.
The truth is, from the modern standpoint the thirteenth was not the true dawn brightening more and more unto the perfect day, but a glorious aurora which flickered down again into the arctic night of mediaevalism.
To sum up—in medicine the Middle Ages represent a restatement from century to century of the facts and theories of the Greeks modified here and there by Arabian practice. There was, in Francis Bacon’s phrase, much iteration, small addition. The schools bowed in humble, slavish submission to Galen and Hippocrates, taking everything from them but their spirit and there was no advance in our knowledge of the structure or function of the body. The Arabians lit a brilliant torch from Grecian lamps and from the eighth to the eleventh centuries the profession reached among them a position of dignity and importance to which it is hard to find a parallel in history.
CHAPTER IV — THE RENAISSANCE AND THE RISE OF ANATOMY AND PHYSIOLOGY
THE “reconquest of the classic world of thought was by far the most important achievement of the fifteenth and sixteenth centuries. It absorbed nearly the whole mental energy of the Italians…. The revelation of what men were and what they wrought under the influence of other faiths and other impulses, in distant ages with a different ideal for their aim, not only widened the narrow horizon of the Middle Ages, but it also restored self-confidence to the reason of humanity.”(1)
(1) J. A. Symonds: The Renaissance in Italy; the Revival of
Learning, 1877, p. 52.
Everywhere throughout the Middle Ages learning was the handmaid of theology. Even Roger Bacon with his strong appeal for a new method accepted the dominant mediaeval conviction—that all the sciences did but minister to their queen, Theology. A new spirit entered man’s heart as he came to look upon learning as a guide to the conduct of life. A revolution was slowly effected in the intellectual world. It is a mistake to think of the Renaissance as a brief period of sudden fruitfulness in the North Italian cities. So far as science is concerned, the thirteenth century was an aurora followed by a long period of darkness, but the fifteenth was a true dawn that brightened more and more unto the perfect day. Always a reflex of its period, medicine joined heartily though slowly in the revolt against mediaevalism. How slowly I did not appreciate until recently. Studying the earliest printed medical works to catch the point of view of the men who were in the thick of the movement up to 1480—which may be taken to include the first quarter of a century of printing—one gets a startling record. The mediaeval mind still dominates: of the sixty-seven authors of one hundred and eighty-two editions of early medical books, twenty-three were men of the thirteenth and fourteenth centuries, thirty men of the fifteenth century, eight wrote in Arabic, several were of the School of Salernum, and only six were of classical antiquity, viz., Pliny (first 1469), Hippocrates (1473) (Hain (*)7247), Galen (1475) (Hain 7237), Aristotle (1476), Celsus (1478), and Dioscorides (1478).(**)
(*) This asterisk is used by Hain to indicate that he had seen a
copy.—Ed.
(**) Data added to a manuscript taken from the author’s summary
on “Printed Medical Books to 1480″ in Transactions of the
Bibliographical Society, London, 1916, XIII, 5-8, revised from
its “News-Sheet” (February, 1914). “Of neither Hippocrates nor
Galen is there an early edition; but in 1473 at Pavia appeared an
exposition of the Aphorisms of Hippoerates, and in 1475 at Padua
an edition of the Tegni or Notes of Galen.” Ibid., p. 6.
Osler’s unfinished Illustrated Monograph on this subject is now
being printed for the Society of which he was President.—Ed.
The medical profession gradually caught the new spirit. It has been well said that Greece arose from the dead with the New Testament in the one hand and Aristotle in the other. There was awakened a perfect passion for the old Greek writers, and with it a study of the original sources, which had now become available in many manuscripts. Gradually Hippocrates and Galen came to their own again. Almost every professor of medicine became a student of the MSS. of Aristotle and of the Greek physicians, and before 1530 the presses had poured out a stream of editions. A wave of enthusiasm swept over the profession, and the best energies of its best minds were devoted to a study of the Fathers. Galen became the idol of the schools. A strong revulsion of feeling arose against the Arabians, and Avicenna, the Prince, who had been clothed with an authority only a little less than divine, became anathema. Under the leadership of the Montpellier School, the Arabians made a strong fight, but it was a losing battle all along the line. This group of medical humanists—men who were devoted to the study of the old humanities, as Latin and Greek were called—has had a great and beneficial influence upon the profession. They were for the most part cultivated gentlemen with a triple interest—literature, medicine and natural history. How important is the part they played may be gathered from a glance at the “Lives” given by Bayle in his “Biographic Medicale” (Paris, 1855) between the years 1500 and 1575. More than one half of them had translated or edited works of Hippocrates or Galen; many of them had made important contributions to general literature, and a large proportion of them were naturalists: Leonicenus, Linacre, Champier, Fernel, Fracastorius, Gonthier, Caius, J. Sylvius, Brasavola, Fuchsius, Matthiolus, Conrad Gesner, to mention only those I know best, form a great group. Linacre edited Greek works for Aldus, translated works of Galen, taught Greek at Oxford, wrote Latin grammars and founded the Royal College of Physicians.(*) Caius was a keen Greek scholar, an ardent student of natural history, and his name is enshrined as co-founder of one of the most important of the Cambridge colleges. Gonthier, Fernel, Fuchs and Mattioli were great scholars and greater physicians. Champier, one of the most remarkable of the group, was the founder of the Hotel Dieu at Lyons, and author of books of a characteristic Renaissance type and of singular bibliographical interest. In many ways greatest of all was Conrad Gesner, whose mors inopinata at forty-nine, bravely fighting the plague, is so touchingly and tenderly mourned by his friend Caius.(2) Physician, botanist, mineralogist, geologist, chemist, the first great modern bibliographer, he is the very embodiment of the spirit of the age.(2a) On the flyleaf of my copy of the “Bibliotheca Universalis” (1545), is written a fine tribute to his memory. I do not know by whom it is, but I do know from my reading that it is true:
(*) Cf. Osler: Thomas Linacre, Cambridge University Press,
1908.—Ed.
(2) Joannis Caii Britanni de libris suis, etc., 1570.
(2a) See J. C. Bay: Papers Bibliog. Soc. of America, 1916, X,
No. 2, 53-86.
“Conrad Gesner, who kept open house there for all learned men who came into his neighborhood. Gesner was not only the best naturalist among the scholars of his day, but of all men of that century he was the pattern man of letters. He was faultless in private life, assiduous in study, diligent in maintaining correspondence and good-will with learned men in all countries, hospitable—though his means were small—to every scholar that came into Zurich. Prompt to serve all, he was an editor of other men’s volumes, a writer of prefaces for friends, a suggestor to young writers of books on which they might engage themselves, and a great helper to them in the progress of their work. But still, while finding time for services to other men, he could produce as much out of his own study as though he had no part in the life beyond its walls.”
A large majority of these early naturalists and botanists were physicians.(3) The Greek art of observation was revived in a study of the scientific writings of Aristotle, Theophrastus and Dioscorides and in medicine, of Hippocrates and of Galen, all in the Greek originals. That progress was at first slow was due in part to the fact that the leaders were too busy scraping the Arabian tarnish from the pure gold of Greek medicine and correcting the anatomical mistakes of Galen to bother much about his physiology or pathology. Here and there among the great anatomists of the period we read of an experiment, but it was the art of observation, the art of Hippocrates, not the science of Galen, not the carefully devised experiment to determine function, that characterized their work. There was indeed every reason why men should have been content with the physiology and pathology of that day, as, from a theoretical standpoint, it was excellent. The doctrine of the four humors and of the natural, animal and vital spirits afforded a ready explanation for the symptoms of all diseases, and the practice of the day was admirably adapted to the theories. There was no thought of, no desire for, change. But the revival of learning awakened in men at first a suspicion and at last a conviction that the ancients had left something which could be reached by independent research, and gradually the paralytic-like torpor passed away.
(3) Miall: The Early Naturalists, London, 1912.
The sixteenth and seventeenth centuries did three things in medicine—shattered authority, laid the foundation of an accurate knowledge of the structure of the human body and demonstrated how its functions should be studied intelligently—with which advances, as illustrating this period, may be associated the names of Paracelsus, Vesalius and Harvey.
PARACELSUS
PARACELSUS is “der Geist der stets verneint.” He roused men against the dogmatism of the schools, and he stimulated enormously the practical study of chemistry. These are his great merits, against which must be placed a flood of hermetical and transcendental medicine, some his own, some foisted in his name, the influence of which is still with us.
“With what judgment ye judge it shall be judged to you again” is the verdict of three centuries on Paracelsus. In return for unmeasured abuse of his predecessors and contemporaries he has been held up to obloquy as the arch-charlatan of history. We have taken a cheap estimate of him from Fuller and Bacon, and from a host of scurrilous scribblers who debased or perverted his writings. Fuller(4) picked him out as exemplifying the drunken quack, whose body was a sea wherein the tide of drunkenness was ever ebbing and flowing—”He boasted that shortly he would order Luther and the Pope, as well as he had done Galen and Hippocrates. He was never seen to pray, and seldome came to Church. He was not onely skilled in naturall Magick (the utmost bounds whereof border on the suburbs of hell) but is charged to converse constantly with familiars. Guilty he was of all vices but wantonnesse: . . . ”
(4) Fuller: The Holy and Profane State, Cambridge, 1642, p. 56.
Francis Bacon, too, says many hard things of him.(5)
(5) Bacon: Of the Proficience and Advancement of Learning, Bk.
II, Pickering ed., London, 1840, p. 181. Works, Spedding ed.,
III, 381.
To the mystics, on the other hand, he is Paracelsus the Great, the divine, the most supreme of the Christian magi, whose writings are too precious for science, the monarch of secrets, who has discovered the Universal Medicine. This is illustrated in Browning’s well-known poem “Paracelsus,” published when he was only twenty-one; than which there is no more pleasant picture in literature of the man and of his aspirations. His was a “searching and impetuous soul” that sought to win from nature some startling secret—”. . . a tincture of force to flush old age with youth, or breed gold, or imprison moonbeams till they change to opal shafts!” At the same time with that capacity for self-deception which characterizes the true mystic he sought to cast
Light on a darkling race; save for that doubt,
I stood at first where all aspire at last
To stand: the secret of the world was mine.
I knew, I felt (perception unexpressed,
Uncomprehended by our narrow thought,
But somehow felt and known in every shift
And change in the spirit,—nay, in every pore
Of the body, even)—what God is, what we are,
What life is—. . .(6)
(6) Robert Browning: Paracelsus, closing speech.
Much has been done of late to clear up his story and his character. Professor Sudhoff, of Leipzig, has made an exhaustive bibliographical study of his writings,(7) there have been recent monographs by Julius Hartmann, and Professors Franz and Karl Strunz,(8) and a sympathetic summary of his life and writings has been published by the late Miss Stoddart.(9) Indeed there is at present a cult of Paracelsus. The hermetic and alchemical writings are available in English in the edition of A. E. Waite, London, 1894. The main facts of his life you can find in all the biographies. Suffice it here to say that he was born at Einsiedeln, near Zurich, in 1493, the son of a physician, from whom he appears to have had his early training both in medicine and in chemistry. Under the famous abbot and alchemist, Trithemiusof Wurzburg, he studied chemistry and occultism. After working in the mines at Schwatz he began his wanderings, during which he professes to have visited nearly all the countries in Europe and to have reached India and China. Returning to Germany he began a triumphal tour of practice through the German cities, always in opposition to the medical faculty, and constantly in trouble. He undoubtedly performed many important cures, and was thought to have found the supreme secret of alchemistry. In the pommel of his sword he was believed to carry a familiar spirit. So dominant was his reputation that in 1527 he was called to the chair of physic in the University of Basel. Embroiled in quarrels after his first year he was forced to leave secretly, and again began his wanderings through German cities, working, quarrelling, curing, and dying prematurely at Saltzburg in 1541—one of the most tragic figures in the history of medicine.
(7) Professor Sudhoff: Bibliographia Paracelsica, Berlin, 1894,
1899.
(8) R. Julius Hartmann: Theophrast von Hohenheim, Berlin, 1904;
ditto, Franz Strunz, Leipzig, 1903.
(9) Anna M. Stoddart: The Life of Paracelsus, London, John
Murray, 1911.
Paracelsus is the Luther of medicine, the very incarnation of the spirit of revolt. At a period when authority was paramount, and men blindly followed old leaders, when to stray from the beaten track in any field of knowledge was a damnable heresy, he stood out boldly for independent study and the right of private judgment. After election to the chair at Basel he at once introduced a startling novelty by lecturing in German. He had caught the new spirit and was ready to burst all bonds both in medicine and in theology. He must have startled the old teachers and practitioners by his novel methods. “On June 5, 1527, he attached a programme of his lectures to the black-board of the University inviting all to come to them. It began by greeting all students of the art of healing. He proclaimed its lofty and serious nature, a gift of God to man, and the need of developing it to new importance and to new renown. This he undertook to do, not retrogressing to the teaching of the ancients, but progressing whither nature pointed, through research into nature, where he himself had discovered and had verified by prolonged experiment and experience. He was ready to oppose obedience to old lights as if they were oracles from which one did not dare to differ. Illustrious doctor smight be graduated from books, but books made not a single physician.(10) Neither graduation, nor fluency, nor the knowledge of old languages, nor the reading of many books made a physician, but the knowledge of things themselves and their properties. The business of a doctor was to know the different kinds of sicknesses, their causes, their symptoms and their right remedies. This he would teach, for he had won this knowledge through experience, the greatest teacher, and with much toil. He would teach it as he had learned it, and his lectures would be founded on works which he had composed concerning inward and external treatment, physic and surgery.”(11) Shortly afterwards, at the Feast of St. John, the students had a bonfire in front of the university. Paracelsus came out holding in his hands the “Bible of medicine,” Avicenna’s “Canon,” which he flung into the flames saying: “Into St. John’s fire so that all misfortune may go into the air with the smoke.” It was, as he explained afterwards, a symbolic act: “What has perished must go to the fire; it is no longer fit for use: what is true and living, that the fire cannot burn.” With abundant confidence in his own capacity he proclaimed himself the legitimate monarch, the very Christ of medicine. “You shall follow me,” cried he, “you, Avicenna, Galen, Rhasis, Montagnana, Mesues; you, Gentlemen of Paris, Montpellier, Germany, Cologne, Vienna, and whomsoever the Rhine and Danube nourish; you who inhabit the isles of the sea; you, likewise, Dalmatians, Athenians; thou, Arab; thou, Greek; thou, Jew; all shall follow me, and the monarchy shall be mine.”(12)
(10) And men have oft grown old among their books
To die case hardened in their ignorance.
—Paracelsus, Browning.
(11) Anna M. Stoddart: Life of Paracelsus, London, 1911, pp.
95-96.
(12) Browning’s Paracelsus, London, 1835, p. 206 (note).
This first great revolt against the slavish authority of the schools had little immediate effect, largely on account of the personal vagaries of the reformer—but it made men think. Paracelsus stirred the pool as had not been done for fifteen centuries.
Much more important is the relation of Paracelsus to the new chemical studies, and their relation to practical medicine. Alchemy, he held, “is to make neither gold nor silver: its use is to make the supreme sciences and to direct them against disease.” He recognized three basic substances, sulphur, mercury and salt, which were the necessary ingredients of all bodies organic or inorganic. They were the basis of the three principles out of which the Archaeus, the spirit of nature, formed all bodies. He made important discoveries in chemistry; zinc, the various compounds of mercury, calomel, flowers of sulphur, among others, and he was a strong advocate of the use of preparations of iron and antimony. In practical pharmacy he has perhaps had a greater reputation for the introduction of a tincture of opium—labdanum or laudanum—with which he effected miraculous cures, and the use of which he had probably learned in the East.
Through Paracelsus a great stimulus was given to the study of chemistry and pharmacy, and he is the first of the modern iatro-chemists. In contradistinction to Galenic medicines, which were largely derived from the vegetable kingdom, from this time on we find in the literature references to spagyric medicines and a “spagyrist” was a Paracelsian who regarded chemistry as the basis of all medical knowledge.
One cannot speak very warmly of the practical medical writings of Paracelsus. Gout, which may be taken as the disease upon which he had the greatest reputation, is very badly described, and yet he has one or two fruitful ideas singularly mixed with mediaeval astrology; but he has here and there very happy insights, as where he remarks “nec praeter synoviam locqum alium ullum podagra occupat.”(13) In the tract on phlebotomy I see nothing modern, and here again he is everywhere dominated by astrological ideas—”Sapiens dominatur astris.”
(13) Geneva ed., 1658, Vol. I, p. 613.
As a protagonist of occult philosophy, Paracelsus has had a more enduring reputation than as a physician. In estimating his position there is the great difficulty referred to by Sudhoff in determining which of the extant treatises are genuine. In the two volumes issued in English by Waite in 1894, there is much that is difficult to read and to appreciate from our modern standpoint. In the book “Concerning Long Life” he confesses that his method and practice will not be intelligible to common persons and that he writes only for those whose intelligence is above the average. To those fond of transcendental studies they appeal and are perhaps intelligible. Everywhere one comes across shrewd remarks which prove that Paracelsus had a keen belief in the all-controlling powers of nature and of man’s capacity to make those powers operate for his own good: “the wise man rules Nature, not Nature the wise man.” “The difference between the Saint and the Magus is that the one operates by means of God, and the other by means of Nature.” He had great faith in nature and the light of nature, holding that man obtains from nature according as he believes. His theory of the three principles appears to have controlled his conception of everything relating to man, spiritually, mentally and bodily; and his threefold genera of disease corresponded in some mysterious way with the three primary substances, salt, sulphur and mercury.
How far he was a believer in astrology, charms and divination it is not easy to say. From many of the writings in his collected works one would gather, as I have already quoted, that he was a strong believer. On the other hand, in the “Paramirum,” he says: “Stars control nothing in us, suggest nothing, incline to nothing, own nothing; they are free from us and we are free from them” (Stoddart, p. 185). The Archaeus, not the stars, controls man’s destiny. “Good fortune comes from ability, and ability comes from the spirit” (Archaeus).
No one has held more firmly the dualistic conception of the healing art. There are two kinds of doctors; those who heal miraculously and those who heal through medicine. Only he who believes can work miracles. The physician has to accomplish that which God would have done miraculously, had there been faith enough in the sick man (Stoddart, p. 194). He had the Hippocratic conception of the “vis medicatrix naturae”—no one keener since the days of the Greeks. Man is his own doctor and finds proper healing herbs in his own garden: the physician is in ourselves, in our own nature are all things that we need: and speaking of wounds, with singular prescience he says that the treatment should be defensive so that no contingency from without could hinder Nature in her work (Stoddart, p. 213).
Paracelsus expresses the healing powers of nature by the word “mumia,” which he regarded as a sort of magnetic influence or force, and he believed that anyone possessing this could arrest or heal disease in others. As the lily breaks forth in invisible perfume, so healing influences may pass from an invisible body. Upon these views of Paracelsus was based the theory of the sympathetic cure of disease which had an extraordinary vogue in the late sixteenth and seventeenth centuries, and which is not without its modern counterpart.
In the next century, in Van Helmont we meet with the Archaeus everywhere presiding, controlling and regulating the animate and inanimate bodies, working this time through agents, local ferments. The Rosicrucians had their direct inspiration from his writings, and such mystics as the English Rosicrucian Fludd were strong Paracelsians.(14)
(14) Robert Fludd, the Mystical Physician, British Medical
Journal, London, 1897, ii, 408.
The doctrine of contraries drawn from the old Greek philosophy, upon which a good deal of the treatment of Hippocrates and Galen was based—dryness expelled by moisture, cold by heat, etc.—was opposed by Paracelsus in favor of a theory of similars, upon which the practice of homeopathy is based. This really arose from the primitive beliefs, to which I have already referred as leading to the use of eyebright in diseases of the eye, and cyclamen in diseases of the ear because of its resemblance to that part; and the Egyptian organotherapy had the same basis,—spleen would cure spleen, heart, heart, etc. In the sixteenth and seventeenth centuries these doctrines of sympathies and antipathies were much in vogue. A Scotchman, Sylvester Rattray, edited in the “Theatrum Sympatheticum”(15) all the writings upon the sympathies and antipathies of man with animal, vegetable and mineral substances, and the whole art of physics was based on this principle.
(15) Rattray: Theatrum Sympatheticum, Norimberge, MDCLXII.
Upon this theory of “mumia,” or magnetic force, the sympathetic cure of disease was based. The weapon salve, the sympathetic ointment, and the famous powder of sympathy were the instruments through which it acted. The magnetic cure of wounds became the vogue. Van Helmont adopted these views in his famous treatise “De Magnetica Vulnerum Curatione,”(16) in which he asserted that cures were wrought through magnetic influence. How close they came to modern views of wound infection may be judged from the following: “Upon the solution of Unity in any part the ambient air . . . repleted with various evaporations or aporrhoeas of mixt bodies, especially such as are then suffering the act of putrefaction, violently invadeth the part and thereupon impresseth an exotic miasm or noxious diathesis, which disposeth the blood successively arriving at the wound, to putrefaction, by the intervention of fermentation.” With his magnetic sympathy, Van Helmont expressed clearly the doctrine of immunity and the cure of disease by immune sera: “For he who has once recovered from that disease hath not only obtained a pure balsaamical blood, whereby for the future he is rendered free from any recidivation of the same evil, but also infallibly cures the same affection in his neighbour . . . and by the mysterious power of Magnetism transplants that balsaam and conserving quality into the blood of another.” He was rash enough to go further and say that the cures effected by the relics of the saints were also due to the same cause—a statement which led to a great discussion with the theologians and to Van Helmont’s arrest for heresy, and small wonder, when he makes such bold statements as “Let the Divine enquire only concerning God, the Naturalist concerning Nature,” and “God in the production of miracles does for the most part walk hand in hand with Nature.”
(16) An English translation by Walter Charleton appeared in 1650,
entitled “A Ternary of Paradoxes.”
That wandering genius, Sir Kenelm Digby, did much to popularize this method of treatment by his lecture on the “Powder of Sympathy.”(17) His powder was composed of copperas alone or mixed with gum tragacanth. He regarded the cure as effected through the subtle influence of the sympathetic spirits or, as Highmore says, by “atomicall energy wrought at a distance,” and the remedy could be applied to the wound itself, or to a cloth soaked in the blood or secretions, or to the weapon that caused the wound. One factor leading to success may have been that in the directions which Digby gave for treating the wound (in the celebrated case of James Howell, for instance), it was to be let alone and kept clean. The practice is alluded to very frequently by the poets. In the “Lay of the Last Minstrel” we find the following:
(17) French edition, 1668, English translation, same year. For a
discussion on the author of the weapon salve see Van Helmont, who
gives the various formulas. Highmore (1651) says the “powder is
a Zaphyrian salt calcined by a celestial fire operating in Leo
and Cancer into a Lunar complexion.”
But she has ta’en the broken lance,
And wash’d it from the clotted gore,
And salved the splinter o’er and o’er.
William of Deloraine, in trance,
Whene’er she turn’d it round and round,
Twisted, as if she gall’d his wound,
Then to her maidens she did say,
That he should be whole man and sound,
(Canto iii, xxiii.)
and in Dryden’s “Tempest” (V, 1) Ariel says:
Anoint the Sword which pierc’d him with the Weapon-Salve,
And wrap it close from Air till I have time
To visit him again.
From Van Helmont comes the famous story of the new nose that dropped off in sympathy with the dead arm from which it was taken, and the source of the famous lines of Hudibras. As I have not seen the original story quoted of late years it may be worth while to give it: “A certain inhabitant of Bruxels, in a combat had his nose mowed off, addressed himself to Tagliacozzus, a famous Chirurgein, living at Bononia, that he might procure a new one; and when he feared the incision of his own arm, he hired a Porter to admit it, out of whose arm, having first given the reward agreed upon, at length he dig’d a new nose. About thirteen moneths after his return to his own Countrey, on a sudden the ingrafted nose grew cold, putrified, and within few days drops off. To those of his friends that were curious in the exploration of the cause of this unexpected misfortune, it was discovered, that the Porter expired, neer about the same punctilio of time, wherein the nose grew frigid and cadaverous. There are at Bruxels yet surviving, some of good repute, that were eye-witnesses of these occurrences.”(18)
(18) Charleton: Of the Magnetic Cure of Wounds, London, 1650, p.
13.
Equally in the history of science and of medicine, 1542 is a starred year, marked by a revolution in our knowledge alike of Macrocosm and Microcosm. In Frauenburg, the town physician and a canon, now nearing the Psalmist limit and his end, had sent to the press the studies of a lifetime—”De revolutionibus orbium coelestium.” It was no new thought, no new demonstration that Copernicus thus gave to his generation. Centuries before, men of the keenest scientific minds from Pythagoras on had worked out a heliocentric theory, fully promulgated by Aristarchus, and very generally accepted by the brilliant investigators of the Alexandrian school; but in the long interval, lapped in Oriental lethargy, man had been content to acknowledge that the heavens declare the glory of God and that the firmament sheweth his handiwork. There had been great astronomers before Copernicus. In the fifteenth century Nicholas of Cusa and Regiomontanus had hinted at the heliocentric theory; but 1512 marks an epoch in the history of science, since for all time Copernicus put the problem in a way that compelled acquiescence.
Nor did Copernicus announce a truth perfect and complete, not to be modified, but there were many contradictions and lacunae which the work of subsequent observers had to reconcile and fill up. For long years Copernicus had brooded over the great thoughts which his careful observation had compelled. We can imagine the touching scene in the little town when his friend Osiander brought the first copy of the precious volume hot from the press, a well enough printed book. Already on his deathbed, stricken with a long illness, the old man must have had doubts how his work would be received, though years before Pope Clement VII had sent him encouraging words. Fortunately death saved him from the “rending” which is the portion of so many innovators and discoverers. His great contemporary reformer, Luther, expressed the view of the day when he said the fool will turn topsy-turvy the whole art of astronomy; but the Bible says that Joshua commanded the Sun to stand still, not the Earth. The scholarly Melanchthon, himself an astronomer, thought the book so godless that he recommended its suppression (Dannemann, Grundriss). The church was too much involved in the Ptolemaic system to accept any change and it was not until 1822 that the works of Copernicus were removed from the Index.
VESALIUS
THE same year, 1542, saw a very different picture in the far-famed city of Padua, “nursery of the arts.” The central figure was a man not yet in the prime of life, and justly full of its pride, as you may see from his portrait. Like Aristotle and Hippocrates cradled and nurtured in an AEsculapian family, Vesalius was from his childhood a student of nature, and was now a wandering scholar, far from his Belgian home. But in Italy he had found what neither Louvain nor Paris could give, freedom in his studies and golden opportunities for research in anatomy. What an impression he must have made on the student body at Padua may be judged from the fact that shortly after his graduation in December, 1537, at the age of twenty-four, he was elected to the chair of anatomy and surgery. Two things favored him—an insatiate desire to see and handle for himself the parts of the human frame, and an opportunity, such as had never before been offered to the teacher, to obtain material for the study of human anatomy. Learned with all the learning of the Grecians and of the Arabians, Vesalius grasped, as no modern before him had done, the cardinal fact that to know the human machine and its working, it is necessary first to know its parts—its fabric.
To appreciate the work of this great man we must go back in a brief review of the growth of the study of anatomy.
Among the Greeks only the Alexandrians knew human anatomy. What their knowledge was we know at second hand, but the evidence is plain that they knew a great deal. Galen’s anatomy was first-class and was based on the Alexandrians and on his studies of the ape and the pig. We have already noted how much superior was his osteology to that of Mundinus. Between the Alexandrians and the early days of the School of Salernum we have no record of systematic dissections of the human body. It is even doubtful if these were permitted at Salernum. Neuburger states that the instructions of Frederick II as to dissections were merely nominal.
How atrocious was the anatomy of the early Middle Ages may be gathered from the cuts in the works of Henri de Mondeville. In the Bodleian Library is a remarkable Latin anatomical treatise of the late thirteenth century, of English provenance, one illustration from which will suffice to show the ignorance of the author. Mundinus of Bologna, one of the first men in the Middle Ages to study anatomy from the subject, was under the strong domination of the Arabians, from whom he appears to have received a very imperfect Galenic anatomy. From this date we meet with occasional dissections at various schools, but we have seen that in the elaborate curriculum of the University of Padua in the middle of the fifteenth century there was no provision for the study of the subject. Even well into the sixteenth century dissections were not common, and the old practice was followed of holding a professorial discourse, while the butcher, or barber surgeon, opened the cavities of the body. A member of a famous Basel family of physicians, Felix Plater, has left us in his autobiography(19) details of the dissections he witnessed at Montpellier between November 14, 1552, and January 10, 1557, only eleven in number. How difficult it was at that time to get subjects is shown by the risks they ran in “body-snatching” expeditions, of which he records three.
(19) There is no work from which we can get a better idea of the
life of the sixteenth-century medical student and of the style of
education and of the degree ceremonies, etc. Cumston has given
an excellent summary of it (Johns Hopkins Hospital Bulletin,
1912, XXIII, 105-113).
And now came the real maker of modern anatomy. Andreas Vesalius had a good start in life. Of a family long associated with the profession, his father occupied the position of apothecary to Charles V, whom he accompanied on his journeys and campaigns. Trained at Louvain, he had, from his earliest youth, an ardent desire to dissect, and cut up mice and rats, and even cats and dogs. To Paris, the strong school of the period, he went in 1533, and studied under two men of great renown, Jacob Sylvius and Guinterius. Both were strong Galenists and regarded the Master as an infallible authority. He had as a fellow prosector, under the latter, the unfortunate Servetus. The story of his troubles and trials in getting bones and subjects you may read in Roth’s “Life.”(20) Many interesting biographical details are also to be found in his own writings. He returned for a time to Louvain, and here he published his first book, a commentary on the “Almansor” of Rhazes, in 1537.
(20) M. Roth: Andreas Vesalius Bruxellensis, Berlin, 1892. An
excellent account of Vesalius and his contemporaries is given by
James Moores Ball in his superbly printed Andreas Vesalius, the
Reformer of Anatomy, St. Louis, 1910.
Finding it difficult, either in Paris or Louvain, to pursue his anatomical studies, he decided to go to Italy where, at Venice and Padua, the opportunities were greater. At Venice, he attended the practice of a hospital (now a barracks) which was in charge of the Theatiner Order. I show you a photograph of the building taken last year. And here a strange destiny brought two men together. In 1537, another pilgrim was working in Venice waiting to be joined by his six disciples. After long years of probation, Ignatius Loyola was ready to start on the conquest of a very different world. Devoted to the sick and to the poor, he attached himself to the Theatiner Order, and in the wards of the hospital and the quadrangle, the fiery, dark-eyed, little Basque must frequently have come into contact with the sturdy young Belgian, busy with his clinical studies and his anatomy. Both were to achieve phenomenal success—the one in a few years to revolutionize anatomy, the other within twenty years to be the controller of universities, the counsellor of kings, and the founder of the most famous order in the Roman Catholic Church. It was in this hospital that Vesalius made observations on the China-root, on which he published a monograph in 1546. The Paduan School was close to Venice and associated with it, so that the young student had probably many opportunities of going to and fro. On the sixth of December, 1537, before he had reached his twenty-fourth year and shortly after taking his degree, he was elected to the chair of surgery and anatomy at Padua.
The task Vesalius set himself to accomplish was to give an accurate description of all the parts of the human body, with proper illustrations. He must have had abundant material, more, probably, than any teacher before him had ever had at his disposal. We do not know where he conducted his dissections, as the old amphitheatre has disappeared, but it must have been very different from the tiny one put up by his successor, Fabricius, in 1594. Possibly it was only a temporary building, for he says in the second edition of the “Fabrica” that he had a splendid lecture theatre which accommodated more than five hundred spectators (p. 681).
With Vesalius disappeared the old didactic method of teaching anatomy. He did his own dissections, made his own preparations, and, when human subjects were scarce, employed dogs, pigs or cats, and occasionally a monkey. For five years he taught and worked at Padua. He is known to have given public demonstrations in Bologna and elsewhere. In the “China-root” he remarks that he once taught in three universities in one year. The first fruit of his work is of great importance in connection with the evolution of his knowledge. In 1538, he published six anatomical tables issued apparently in single leaves. Of the famous “Tabulae Anatomicae” only two copies are known, one in the San Marco Library, Venice, and the other in the possession of Sir John Stirling-Maxwell, whose father had it reproduced in facsimile (thirty copies only) in 1874. Some of the figures were drawn by Vesalius himself, and some are from the pencil of his friend and countryman, Stephan van Calcar. Those plates were extensively pirated. About this time he also edited for the Giunti some of the anatomical works of Galen.(21)
(21) De anatomicis administrationibus, De venarum arterinrumque
dissectione, included in the various Juntine editions of Galen.
We know very little of his private life at Padua. His most important colleague in the faculty was the famous Montanus, professor of medicine. Among his students and associates was the Englishman Caius, who lived in the same house with him. When the output is considered, he cannot have had much spare time at Padua.
He did not create human anatomy—that had been done by the Alexandrians—but he studied it in so orderly and thorough a manner that for the first time in history it could be presented in a way that explained the entire structure of the human body. Early in 1542 the MS. was ready; the drawings had been made with infinite care, the blocks for the figures had been cut, and in September, he wrote to Oporinus urging that the greatest pains should be taken with the book, that the paper should be strong and of equal thickness, the workmen chosen for their skill, and that every detail of the pictures must be distinctly visible. He writes with the confidence of a man who realized the significance of the work he had done. It is difficult to speak in terms of moderation of the “Fabrica.” To appreciate its relative value one must compare it with the other anatomical works of the period, and for this purpose I put before you two figures from a text-book on the subject that was available for students during the first half of the sixteenth century. In the figures and text of the “Fabrica” we have anatomy as we know it; and let us be honest and say, too, largely as Galen knew it. Time will not allow me to go into the question of the relations of these two great anatomists, but we must remember that at this period Galen ruled supreme, and was regarded in the schools as infallible. And now, after five years of incessant labor, Vesalius was prepared to leave his much loved Padua and his devoted students. He had accomplished an extraordinary work. He knew, I feel sure, what he had done. He knew that the MSS. contained something that the world had not seen since the great Pergamenian sent the rolls of his “Manual of Anatomy” among his friends. Too precious to entrust to any printer but the best—and the best in the middle of the sixteenth century was Transalpine—he was preparing to go north with the precious burden. We can picture the youthful teacher—he was but twenty-eight—among students in a university which they themselves controlled—some of them perhaps the very men who five years before had elected him—at the last meeting with his class, perhaps giving a final demonstration of the woodcuts, which were of an accuracy and beauty never seen before by students’ eyes, and reading his introduction. There would be sad hearts at the parting, for never had anyone taught anatomy as he had taught it—no one had ever known anatomy as he knew it. But the strong, confident look was on his face and with the courage of youth and sure of the future, he would picture a happy return to attack new and untried problems. Little did he dream that his happy days as student and teacher were finished, that his work as an anatomist was over, that the most brilliant and epoch-making part of his career as a professor was a thing of the past. A year or more was spent at Basel with his friend Oporinus supervising the printing of the great work, which appeared in 1543 with the title “De Humani Corporis Fabrica.” The worth of a book, as of a man, must be judged by results, and, so judged, the “Fabrica” is one of the great books of the world, and would come in any century of volumes which embraced the richest harvest of the human mind. In medicine, it represents the full flower of the Renaissance. As a book it is a sumptuous tome a worthy setting of his jewel—paper, type and illustration to match, as you may see for yourselves in this folio—the chef d’oeuvre of any medical library.
In every section, Vesalius enlarged and corrected the work of Galen. Into the details we need not enter: they are all given in Roth’s monograph, and it is a chapter of ancient history not specially illuminating.
Never did a great piece of literary work have a better setting. Vesalius must have had a keen appreciation of the artistic side of the art of printing, and he must also have realized the fact that the masters of the art had by this time moved north of the Alps.
While superintending the printing of the precious work in the winter of 1542-1543 in Basel, Vesalius prepared for the medical school a skeleton from the body of an executed man, which is probably the earliest preparation of the kind in Europe. How little anatomy had been studied at the period may be judged from that fact that there had been no dissection at Basel since 1531.(22) The specimen is now in the Vesalianum, Basel, of which I show you a picture taken by Dr. Harvey Cushing. From the typographical standpoint no more superb volume on anatomy has been issued from any press, except indeed the second edition, issued in 1555. The paper is, as Vesalius directed, strong and good, but it is not, as he asked, always of equal thickness; as a rule it is thick and heavy, but there are copies on a good paper of a much lighter quality. The illustrations drawn by his friend and fellow countryman, van Calcar, are very much in advance of anything previously seen, except those of Leonardo. The title-page, one of the most celebrated pictures in the history of medicine, shows Vesalius in a large amphitheatre (an imaginary one of the artist, I am afraid) dissecting a female subject. He is demonstrating the abdomen to a group of students about the table, but standing in the auditorium are elderly citizens and even women. One student is reading from an open book. There is a monkey on one side of the picture and a dog on the other. Above the picture on a shield are the three weasels, the arms of Vesal. The reproduction which I show you here is from the “Epitome”—a smaller work issued before (?) the “Fabrica,” with rather larger plates, two of which represent nude human bodies and are not reproduced in the great work. The freshest and most beautiful copy is the one on vellum which formerly belonged to Dr. Mead, now in the British Museum, and from it this picture was taken. One of the most interesting features of the book are the full-page illustrations of the anatomy of the arteries, veins and nerves. They had not in those days the art of making corrosion preparations, but they could in some way dissect to their finest ramifications the arteries, veins and nerves, which were then spread on boards and dried. Several such preparations are now at the College of Physicians in London, brought from Padua by Harvey. The plates of the muscles are remarkably good, more correct, though not better perhaps, on the whole, than some of Leonardo’s.
(22) The next, in 1559, is recorded by Plater in his
autobiography, who gave a public dissection during three days in
the Church of St. Elizabeth.
Vesalius had no idea of a general circulation. Though he had escaped from the domination of the great Pergamenian in anatomy, he was still his follower in physiology. The two figures annexed, taken from one of the two existing copies of the “Tabulae Anatomica,” are unique in anatomical illustration, and are of special value as illustrating the notion of the vascular system that prevailed until Harvey’s day. I have already called your attention to Galen’s view of the two separate systems, one containing the coarse, venous blood for the general nutrition of the body, the other the arterial, full of a thinner, warmer blood with which were distributed the vital spirits and the vital heat. The veins had their origin in the liver; the superior vena cava communicated with the right heart, and, as Galen taught, some blood was distributed to the lungs; but the two systems were closed, though Galen believed there was a communication at the periphery between the arteries and veins. Vesalius accepted Galen’s view that there is some communication between the venous and arterial systems through pores in the septum of the ventricles, though he had his doubts, and in the second edition of his book (1555) says that inspite of the authority of the Prince of Physicians he cannot see how the smallest quantity of blood could be transmitted through so dense a muscular septum. Two years before this (1553),(*) his old fellow student, Michael Servetus, had in his “Christianismi Restitutio” annatomical touch with one another!
(*) See the Servetus Notes in the Osler Anniversary Volumes, New
York, 1919, Vol. II.—Ed.
The publication of the “Fabrica” shook the medical world to its foundations. Galen ruled supreme in the schools: to doubt him in the least particular roused the same kind of feeling as did doubts on the verbal inspiration of the Scriptures fifty years ago! His old teachers in Paris were up in arms: Sylvius, nostrae aetatis medicorum decus, as Vesalius calls him, wrote furious letters, and later spoke of him as a madman (vaesanus). The younger men were with him and he had many friends, but he had aroused a roaring tide of detraction against which he protested a few years later in his work on the “China-root,” which is full of details about the “Fabrica.” In a fit of temper he threw his notes on Galen and other MSS. in the fire. No sadder page exists in medical writings than the one in which Vesalius tells of the burning of his books and MSS. It is here reproduced and translated.(23) His life for a couple of years is not easy to follow, but we know that in 1546 he took service with Charles V as his body physician, and the greatest anatomist of his age was lost in the wanderings of court and campaigns. He became an active practitioner, a distinguished surgeon, much consulted by his colleagues, and there are references to many of his cases, the most important of which are to internal aneurysms, which he was one of the first to recognize. In 1555 he brought out the second edition of the “Fabrica,” an even more sumptuous volume than the first.
(23) Epistle on China-root, 1546, p. 196. Vesalius may be quoted
in explanation—in palliation:
“All these impediments I made light of; for I was too young to seek gain by my art, and I was sustained by my eager desire to learn and to promote the studies in which I shared. I say nothing of my diligence in anatomizing—those who attended my lectures in Italy know how I spent three whole weeks over a single public dissection. But consider that in one year I once taught in three different universities. If I had put off the task of writing till this time; if I were now just beginning to digest my materials; students would not have had the use of my anatomical labours, which posterity may or may not judge superior to the rechauffes formerly in use, whether of Mesua, of Gatinaria, of some Stephanus or other on the differences, causes and symptoms of diseases, or, lastly, of a part of Servitor’s pharmacopoeia. As to my notes, which had grown into a huge volume, they were all destroyed by me; and on the same day there similarly perished the whole of my paraphrase on the ten books of Rhazes to King Almansor, which had been composed by me with far more care than the one which is prefaced to the ninth book. With these also went the books of some author or other on the formulae and preparation of medicines, to which I had added much matter of my own which I judged to be not without utility; and the same fate overtook all the books of Galen which I had used in learning anatomy, and which I had liberally disfigured in the usual fashion. I was on the point of leaving Italy and going to Court; those physicians you know of had made to the Emperor and to the nobles a most unfavourable report of my books and of all that is published nowadays for the promotion of study; I therefore burnt all these works that I have mentioned, thinking at the same time that it would be an easy matter to abstain from writing for the future. I must show that I have since repented more than once of my impatience, and regretted that I did not take the advice of the friends who were then with me.”
There is no such pathetic tragedy in the history of our profession. Before the age of thirty Vesalius had effected a revolution in anatomy; he became the valued physician of the greatest court of Europe; but call no man happy till he is dead! A mystery surrounds his last days. The story is that he had obtained permission to perform a post-mortem examination on the body of a young Spanish nobleman, whom he had attended. When the body was opened, the spectators to their horror saw the heart beating, and there were signs of life! Accused, so it is said, by the Inquisition of murder and also of general impiety he only escaped through the intervention of the King, with the condition that he make a pilgrimage to the Holy Land. In carrying this out in 1564 he was wrecked on the island of Zante, where he died of a fever or of exhaustion, in the fiftieth year of his age.
To the North American Review, November, 1902, Edith Wharton contributed a poem on “Vesalius in Zante,” in which she pictures his life, so full of accomplishment, so full of regrets—regrets accentuated by the receipt of an anatomical treatise by Fallopius, the successor to the chair in Padua! She makes him say:
There are two ways of spreading light; to be
The candle or the mirror that reflects it.
I let my wick burn out—there yet remains
To spread an answering surface to the flame
That others kindle.
But between Mundinus and Vesalius, anatomy had been studied by a group of men to whom I must, in passing, pay a tribute. The great artists Raphael, Michael Angelo and Albrecht Durer were keen students of the human form. There is an anatomical sketch by Michael Angelo in the Ashmolean Museum, Oxford, which I here reproduce.(*) Durer’s famous work on “Human Proportion,” published in 1528, contains excellent figures, but no sketches of dissections. But greater than any of these, and antedating them, is Leonardo da Vinci, the one universal genius in whom the new spirit was incarnate—the Moses who alone among his contemporaries saw the promised land. How far Leonardo was indebted to his friend and fellow student, della Torre, at Pavia we do not know, nor does it matter in face of the indubitable fact that in the many anatomical sketches from his hand we have the first accurate representation of the structure of the body. Glance at the three figures of the spine which I have had photographed side by side, one from Leonardo, one from Vesalius and the other from Vandyke Carter, who did the drawings in Gray’s “Anatomy” (1st ed., 1856). They are all of the same type, scientific, anatomical drawings, and that of Leonardo was done fifty years before Vesalius! Compare, too, this figure of the bones of the foot with a similar one from Vesalius.(24) Insatiate in experiment, intellectually as greedy as Aristotle, painter, poet, sculptor, engineer, architect, mathematician, chemist, botanist, aeronaut, musician and withal a dreamer and mystic, full accomplishment in any one department was not for him! A passionate desire for a mastery of nature’s secrets made him a fierce thing, replete with too much rage! But for us a record remains—Leonardo was the first of modern anatomists, and fifty years later, into the breach he made, Vesalius entered.(25)
(*) This plate was lacking among the author’s illustrations, but
the Keeper of the Ashmolean Museum remembers his repeatedly
showing special interest in the sketch reproduced in John
Addington Symonds’s Life of Michelangelo, London, 1893, Vol. I,
p. 44, and in Charles Singer’s Studies in the History and Method
of Science, Oxford, 1917, Vol. I, p. 97, representing Michael
Angelo and a friend dissecting the body of a man, by the light of
a candle fixed in the body itself.—Ed.
(24) He was the first to make and represent anatomical cross
sections. See Leonardo: Quaderni d’Anatomia, Jacob Dybwad,
Kristiania, 1911-1916, Vol. V.
(25) See Knox: Great Artists and Great Anatomists, London, 1862,
and Mathias Duval in Les Manuserits de Leonard de Vince: De
l’Anatomie, Feuillets A, Edouard Rouveyre, Paris, 1898. For a
good account of Leonardo da Vinci see Merejkovsky’s novel, The
Forerunner, London, 1902, also New York, Putnam.
HARVEY
LET us return to Padua about the year 1600. Vesalius, who made the school the most famous anatomical centre in Europe, was succeeded by Fallopius, one of the best-known names in anatomy, at whose death an unsuccessful attempt was made to get Vesalius back. He was succeeded in 1565 by a remarkable man, Fabricius (who usually bears the added name of Aquapendente, from the town of his birth), a worthy follower of Vesalius. In 1594, in the thirtieth year of his professoriate, he built at his own expense a new anatomical amphitheatre, which still exists in the university buildings. It is a small, high-pitched room with six standing-rows for auditors rising abruptly one above the other. The arena is not much more than large enough for the dissecting table which, by a lift, could be brought up from a preparing room below. The study of anatomy at Padua must have declined since the days of Vesalius if this tiny amphitheatre held all its students; none the less, it is probably the oldest existing anatomical lecture room, and for us it has a very special significance.
Early in his anatomical studies Fabricius had demonstrated the valves in the veins. I show you here two figures, the first, as far as I know, in which these structures are depicted. It does not concern us who first discovered them; they had doubtless been seen before, but Fabricius first recognized them as general structures in the venous system, and he called them little doors—”ostiola.”
The quadrangle of the university building at Padua is surrounded by beautiful arcades, the walls and ceilings of which are everywhere covered with the stemmata, or shields, of former students, many of them brilliantly painted. Standing in the arcade on the side of the “quad” opposite the entrance, if one looks on the ceiling immediately above the capital of the second column to the left there is seen the stemma which appears as tailpiece to this chapter, put up by a young Englishman, William Harvey, who had been a student at Padua for four years. He belonged to the “Natio Anglica,” of which he was Conciliarius, and took his degree in 1602. Doubtless he had repeatedly seen Fabricius demonstrate the valves of the veins, and he may indeed, as a senior student, have helped in making the very dissections from which the drawings were taken for Fabricius’ work, “De Venarum Osteolis,” 1603. If one may judge from the character of the teacher’s work the sort of instruction the student receives, Harvey must have had splendid training in anatomy. While he was at Padua, the great work of Fabricius, “De Visione, Voce et Auditu” (1600) was published, then the “Tractatus de Oculo Visusque Organo” (1601), and in the last year of his residence Fabricius must have been busy with his studies on the valves of the veins and with his embryology, which appeared in 1604. Late in life, Harvey told Boyle that it was the position of the valves of the veins that induced him to think of a circulation.
Harvey returned to England trained by the best anatomist of his day. In London, he became attached to the College of Physicans, and taking his degree at Cambridge, he began the practice of medicine. He was elected a fellow of the college in 1607 and physician to St. Bartholomew’s Hospital in 1609. In 1615 he was appointed Lumleian lecturer to the College of Physicians, and his duties were to hold certain “public anatomies,” as they were called, or lectures. We know little or nothing of what Harvey had been doing other than his routine work in the care of the patients at St. Bartholomew’s. It was not until April, 1616, that his lectures began. Chance has preserved to us the notes of this first course; the MS. is now in the British Museum and was published in facsimile by the college in 1886.(26)
(26) William Harvey: Prelectiones Anatomiae Universalis, London,
J. & A. Churchill, 1886.
The second day lecture, April 17, was concerned with a description of the organs of the thorax, and after a discussion on the structure and action of the heart come the lines:
W. H. constat per
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