The Evolution of Modern Medicine Part 7

(5) Haskins and Lockwood: Harvard Studies in Cla.s.sical 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 ill.u.s.trates 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 Salernita.n.u.s, 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 Africa.n.u.s, 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 pa.s.sed 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 ma.n.u.script, 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 pa.s.sed 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 ma.n.u.scripts.

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 s.p.a.ce 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 wis.h.i.+ng 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 compet.i.tion of the conquered Christians--a healthy compet.i.tion 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 apt.i.tude for the exact sciences, which was lacking in their instructors, whom they henceforward surpa.s.sed."

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 n.o.bly 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 ma.n.u.script 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 t.i.tle "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 th.o.r.n.y 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 gla.s.s 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 ill.u.s.trated 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 pract.i.tioners 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, pa.s.sed for incontrovertible axioms?"(13)

(12) Withington: Medical History, London, 1894, pp. 151-152.

(13) Neuburger: History of Medicine, Vol. I, pp. 368-369.

Innumerable ma.n.u.scripts of it exist: of one of the most beautiful, a Hebrew version (Bologna Library), I give an ill.u.s.tration. 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 ma.n.u.script 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 a.s.serting 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 ill.u.s.tration 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 c.u.m 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 inst.i.tution with hospital units.

(16) "I have founded this inst.i.tution 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 cla.s.s 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.