The Century of Columbus Part 27

[Footnote 35: Translation by Hare, London, 1891.]

The influences that were at work to lift medical education to a higher plane in practical efficiency may be judged from such expressions as those of Rabelais, who, in his letter on education in "Gargantua,"

suggests as preparatory studies for medicine, Greek and Latin with even a little Hebrew, for the sake of the Holy Scriptures, and natural science, especially zoology, botany and mineralogy, and "then carefully go over again the books of the Greek, Arabian and Latin physicians, not despising the Talmudists and Cabalists; and by frequent dissections acquire perfect knowledge of the outer world, the microcosm, which is man." He himself has shown in a number of pa.s.sages that he had taken his own advice and even in his famous description of the anatomy of Lent in which his comparisons were formerly thought more or less fanciful, "they are extraordinarily apt and vivid and show deep knowledge of anatomy," while his descriptions of wounds show a competent familiarity with surgical anatomy. This might very well be expected, for Rabelais invented two surgical instruments, one for the reduction of fractures of the thigh bone and the other for operating in cases of strangulated hernia. He has at least one pa.s.sage in which it is clear that he knew much more about the circulation of the blood than is usually supposed to have {383} been known in his time and which demonstrates that there had been a gradual acc.u.mulation of knowledge on this subject before Harvey's time. (See chapter on Biological Sciences.)

The interest in medicine can be best realized from the large number of medical books that were printed almost immediately after the discovery of printing. After theology medicine was the subject most occupying the attention of printers. During Columbus' Century a whole series of the cla.s.sics of medicine was reprinted and made available for wide reading. The patience and scholars.h.i.+p required for this can only be properly appreciated by those who know the labor of reading the crabbed handwriting of the old ma.n.u.scripts and collating them and the time required to elucidate erroneous readings that had crept in through the negligence of copyists. The world owes an immense debt to the Renaissance for this work. To a great extent these books have been neglected for the last two centuries and we are only now coming to realize how much the scholarly interest of that time meant for subsequent generations. Many of these books are now being republished to the great benefit of medicine. Not only were Hippocrates and Galen and Celsus and the other cla.s.sics republished, but also the writers of the intermediate time, Aetius, Alexander of Tralles, the great Arabian writers and then the important contributors to medicine and surgery in the later Middle Ages. The value of the debt thus owed is growing in estimation every year.

The publication of medical books, even during the score of years immediately after printing began to be employed, shows the intense interest in the subject. The first medical publication was a purgation calendar, that is, a list of the days of the year on which purgations should be practised. This was printed by Gutenberg, 1457. Heinrich von Pfolspeundt's "Treatise on Surgery" was printed in 1460; in 1470 medical treatises by Valescus de Tarenta, Jacopo de Dondis and Matthaeus Sylvaticus were printed. In 1471 treatises by Mesne and Nicolaus Salernita.n.u.s were put in type. In 1472 the old _"Regimen Sanitatis"_ was printed and Bellegardo's monograph on "Pediatrics." In 1473 Simon of Genoa's "Medical Dictionary" was set up and in 1476 William of Salicet's "Cyrurgia" was given {384} to the press. In 1478 the first edition of Celsus was printed, and the first printed edition of Mondino's _"Anathomia"_ was ready for sale. In 1479 came the first edition of "Avicenna." In spite of the great losses of books that have taken place in the course of time because of fire, water, use and other enemies, we still possess many medical books printed practically in every year of the first quarter of a century after the discovery of printing. Unfortunately the neglect of these old cla.s.sics during the eighteenth and early nineteenth centuries did more than all the other inimical elements put together in reducing the number of medical incunabula that we might have had.

The first great medical teacher of Columbus' period was Nicholas Leonicenus, born in 1428, who studied medicine at Padua, lived for some ninety-six years and was professor of medicine at Ferrara for over sixty years. He translated the "Aphorisms" of Hippocrates and some of Galen's works into Latin, and occupied himself with the application of the principles laid down in these great cla.s.sics in his practice, and above all, in his teaching. He made it the business of his life to oppose the Arabian over-medication and especially the use of many drugs on general principles, and he insisted on natural modes of cure, diet, water, exercise, fresh air and the correction of any morbid habits that might have been formed. Probably more than anyone else he influenced the medicine of the first half of Columbus' Century and his work has come to be well recognized in recent years with the growth of interest in the history of medicine.

After him, one of the most important of the physicians of the time was Thomas Linacre, who, after studying some ten years in Italy, returned to England to become the attending physician to Henry VIII. His translations of Galen's works attracted wide attention and Erasmus, Linacre's friend, once declared that after Linacre's translation Galen now spoke much better Latin than he had Greek before. Linacre was a type of the learned physicians of the time and was one of the greatest scholars of the period. That scholars.h.i.+p did not make men impractical, Linacre's organization of the College of Physicians of England is abundant evidence. He found the practice of medicine on his return to England sadly degenerate, {385} because there was no competent authority to maintain proper standards of medical education and prosecute those who attempted to practise medicine without any proper training and sometimes, indeed, without any knowledge of the subject.

Through the charter from the King, at first for London and subsequently for England, the duty of caring for the protection of the public against the illegal practice of medicine was committed to the Royal College of Physicians. Linacre organized and endowed it, and it continues to exist and exert an excellent influence over medical practice in England under its original charter down to the present time.

Another of the distinguished contributors to medical practice at this time was John Caius, who also translated some of Galen's works and especially the _"De Medendi Methodo,"_ his edition containing a series of annotations from his teacher Monta.n.u.s, and from his own observations on patients. He is deservedly best known for his little book on the Sweating Sickness, in which he exhibited his power of observation and his ability to describe what he saw. Gesner, the great European biologist of the time, who was on terms of intimate relation by correspondence with Caius and knew his work on plants and animals very well, styled him, in the preface to his _"Icones Animalium,"_ "a man of consummate erudition, fidelity and diligence as well as judgment," and in an epistle to Queen Elizabeth bestows upon him the eulogium of "the most learned physician of his age." Caius has the merit of introducing the regular practice of dissection into the English teaching of medicine. As Linacre had done, Caius too, as he grew older, used the money which he had acc.u.mulated as Royal physician and in the lucrative practice of medicine in London for academic foundations. Linacre founded chairs in Greek and medicine at Oxford and Cambridge, as well as the College of Physicians, and Caius, after having been the first president of Linacre's Royal College, founded Caius College at Cambridge, where he died in 1572. His last year of life had been disturbed by the looting of his rooms of a number of pious articles connected with the old Church to which he faithfully adhered, and Mr. Andrew Lang suggests that only Dr. Caius' timely, though untimely, death (he was but 63 years of age) prevented {386} him from sharing the fate of the pious articles a.s.sociated with the old faith which he had cherished as faithfully as the tenets of that faith itself.

One of the important teachers of medicine at this time was Giovanni de Monte, according to the custom of the time known by the Latinized name of Monta.n.u.s. He was distinguished for his application of the humanities to medicine and his direct translations of Greek medical books into Latin, so as to avoid the errors which had come from the roundabout translation in the previous times of Greek into Arabian and then into Latin. To him, almost more than any other, is due the reputation that the medical school of Padua obtained at this time, for he gave a series of clinical lectures on the patients in the Hospital of St. Francis which were written down. They show how thorough were his observations and how suggestive his teaching. No wonder that he had pupils from all over Europe. His pupils thought of him as the Americans did of Louis during the early part of the nineteenth century. Many Germans went to hear him. It was a Polish student who reported some of his lectures and Dr. John Caius was, as we have said, one of his most ardent students. Monta.n.u.s insisted on making careful inspections of the dead bodies in order to control his diagnosis, and the teaching at Padua under him was thoroughly practical and such as we are likely to think of as modern.

[Ill.u.s.tration: t.i.tIAN, PARACELSUS ]

Quite different from the line of learned physicians who drew their inspiration from the Greek cla.s.sics of medicine, was another of the great physicians of Columbus' period who ran counter to all the old medical traditions and dared to think for himself. This was Paracelsus, whose motto _"qui suus esse potest, non sit alterius"_--he who can form an opinion of his own should not borrow that of others--shows the independent character of the man. He broke away from the teachings of medicine in Latin and sought far and wide for anything and everything that might help in the cure of disease. He has been an extremely hard man for historians to estimate and appreciations of him have differed very greatly. There is no doubt at all that he did much to introduce chemical remedies of many kinds into medicine, though he was a decided opponent of the polypharmacy of his day, a heritage from the Arabian {387} physicians, who delighted in giving a large number of drugs. There are expressions of his which show how carefully he had thought out the problems of the practice of medicine. He said: "to be a true alchemist is to understand the chemistry of life." "Medicine is not merely a science but an art. It does not consist in compounding pills and plasters and drugs of all kinds, but it deals with the processes of life, which must be understood before they can be guided."

Above all Paracelsus recognized that success in medicine depends on the treatment of the patient rather than his disease, and he insisted on the idea that nature was, as a rule, eminently curative of diseases rather than p.r.o.ne to make the affection worse, as physicians at so many times in the history of medicine seem to have thought. Paracelsus declared that "the knowledge of nature is the foundation of the science of medicine and a physician should be the servant of nature, not her enemy; he should be able to guide and direct her in her struggle for life and not by his unreasonable drugging throw fresh obstacles in the way of recovery." He appreciated very clearly the influence of the mind on the body and said "the powerful will may cure where a doubt will end in failure. The character of the physician may act more powerfully upon the patient than all the drugs employed." He realized also the place of the conditions surrounding the patient as helpful towards his cure. He said: "the physical surroundings of the patient may have a great influence upon the cure of his disease. Diet is an extremely important element of cure and the physician should know how to regulate the diet of the patient." He called attention to the fact that trained attendants sympathetic with the patient are far better for him than relatives who may be over-solicitous and show it, or neglectful because they wish the death of the patient.

Paracelsus was the first to write on occupation diseases and his monograph on _"Bergsucht,"_ "miner's disease," is a monument to his power of observation. His clinical acuity is further exemplified by his recognition of the relation between cretinism and endemic goitre.

He also wrote a booklet on mineral baths and a.n.a.lyzed mineral waters for bathing and drinking purposes, getting at the iron content of chalybeate {388} waters by testing with gallic acid, and the resultant ink reaction, and also demonstrating the presence of other salts. He did more than anyone else to establish properly in medicine the use of opium (as laudanum), mercury, lead, a.r.s.enic, and his chemical experiments taught him much about copper sulphate and pota.s.sium sulphate and he recognized zinc as an elementary substance.

He did quite as much for medicine by his negative conclusions and his opposition to medical practices that had been common up to his time as by his positive observations. Indeed it might possibly be thought that there was more to his credit from the negative side. He set himself up in strenuous opposition to the silly uroscopy and uromancy by which physicians had deceived others and very often deceived themselves.

Something of the value of the urine in medical diagnosis had been recognized in the Middle Ages, and then, as practically always happens in medicine, little-minded men had pretended to be able to learn much more from it than could possibly be revealed by it. Every disease came to have its specific urine and diagnosis and prognosis came to be largely dependent on changes in the color and character of the urine that were in themselves quite insignificant. Paracelsus brushed all this ridiculous nonsense aside, but of course, in doing so, made a great many enemies. Men are much more disturbed, as a rule, by having their false knowledge corrected than their real knowledge amended.

Paracelsus also refused to accept the practically universal persuasion that every disease was an indication for blood-letting. He was sure that in a great many cases this practice did more harm than good. He felt the same way with regard to the almost universal purgation that was being practised for every form of ill. No one recognized better than he that there were poisonous substances in the body which produced serious affections. He was quite willing to be persuaded, too, that these poisonous substances could be at least to some extent removed from the body by purgatives. He feared, however, lest purgation might carry off with it many materials more beneficial to the body than the poisons it would drain were harmful. The idea of an autotoxemia or an autointoxication {389} is constantly recurring in medicine, and the supposed remedies for its cure prove subsequently nearly always to have done more harm than good. Medicine owes much to Paracelsus for his firm stand in this matter. Shakespeare's genius in intuition was right when in "All's Well That Ends Well" he ranged the modern German with one of the greatest of the ancients. "So say I, both of Galen and Paracelsus."

Meyer in his "History of Chemistry" has summed up what Paracelsus accomplished by the co-ordination of chemistry and medicine. As it is not the purpose of the great German historian of chemistry to give a panegyric of Paracelsus but simply to indicate his place in the history of chemical evolution, that opinion must have great weight. He said, page 71: [Footnote 36]

[Footnote 36: "A History of Chemistry, from Earliest Times to the Present Day: Being also an Introduction to the Study of the Science," by Ernst von Meyer, Professor of Chemistry in the Technical High School, Dresden; translated, with the author's sanction, by George McGowan, Ph.D.; third edition; London: Macmillan and Co., 1906.]

"Paracelsus was the man who, in the first half of the sixteenth century, opened out new paths for chemistry and medicine by joining them together. To him is undoubtedly due the merit of freeing chemistry from the restrictive fetters of alchemy, by a clear definition of scientific aims. He taught that 'the object of chemistry is not to make gold but to prepare medicines.' True chemical remedies had been used now and again before his time, but Paracelsus differed from his predecessors in the theoretical motives which led him to employ them. He regarded the healthy human body as a combination of certain chemical matters; when these underwent change in any way, illness resulted, and the latter could therefore only be cured by means of chemical medicines. The foregoing sentence contains the quintessence of Paracelsus' doctrine; the principles of the old school of Galen were quite incompatible with it, these having nothing to do with chemistry."

His contributions to surgery are almost more important than those to medicine, for he insisted on keeping wounds clean and deprecated the meddlesome surgery of the time. Cutting loose from everything that had been taught before his time, he {390} almost necessarily made many mistakes. Besides, in spite of his insistence on scientific demonstration, he accepted many things for which there was no good reason. His works, most of which we owe not directly to himself but to his students, contain many absurdities. There is no doubt at all, however, that he was a great genius and that the medicine of this century and of succeeding generations owes much to him. He well deserves the name of the Father of Pharmaceutical Chemistry which has sometimes been given to him. He represents one of the important links in the tradition of medicine and is a man who is ever more appreciated the more we have learned about him through recent studies of his writings." [Footnote 37]

[Footnote 37: Even Paracelsus' mistakes have had something of genius in them. Above all, his influence has lived on through the generations. His doctrine of signatures and his study of the effects of poisons on the human system had more to do than anything else with the establishment of the therapeutic systems of Hahnemann and Rademacher.]

We have some two score of books attributed to him, but probably less than a score are really his. Probably no one has ever had a higher view of medicine. He bases it on the relations.h.i.+p which man bears to nature as a whole and antic.i.p.ates the very modern idea that disease is not a negation, but itself a phase of life. Magnetism represents a great force for him and some form of it is supposed to emanate from all bodies and place them in relation with each other. The influence of the stars on human const.i.tutions is only one phase of this magnetism which binds all the world together. The superabundance of vitality in certain men gave them a magnetic influence over other men and this magnetic influence might even persist after death. Hence mummies were supposed to contain a certain astral balsam and the consumption of mummy substance gave wonderful vitality to ailing persons. Like scientists at all times, Paracelsus had to have his explanation for miracles. He suggested that saints were people with an abundance of vitality and some of this remained in their bodies after their deaths just in the same way as it remained in the bodies of mummies. It was sufficient, then, to come within the sphere of the influence of these bodies to be affected by it. Miracles, then, were not exceptions to the laws of nature but merely {391} fulfilment of laws that men were only just getting to understand. That has been the favorite mode of explanation for miracles ever since, though a new set of facts has always been adduced as the basis of the explanation.

Of course Paracelsus believed in many absurdities. He suggests, for instance, that it is possible to transplant toothache into a tree after the following fas.h.i.+on. Having taken away a portion of the bark, a piece of the wood is cut and with it the gum is p.r.i.c.ked until the blood flows. Then the piece of wood stained with blood is set again in its place in the tree and the bark is also replaced. He believed also in the vulnerary ointment, which could cure wounds, not by application to the wound itself but to the weapon. It was important, however, that the weapon should be stained with the blood from the wound. He had the feeling that the morbid elements of an affection or a wound were contained in the blood and might be neutralized even outside the body.

The vulnerary ointment was composed of moss from the head of a dead person, preferably one who had been put to death for murder, mummy, human fat and human blood. It all seems so absurd to us now, but behind such prescriptions was the theory that some of the vital force of these human beings could be made over to the diseased person in order to add to his vitality. Many absurd prescriptions have been made on theories not nearly so reasonable as this of Paracelsus.

To this period also belongs the name of Basil Valentine, who has been called the last of the alchemists and the first of the chemists. Just now we are pa.s.sing through a phase of historical criticism which throws doubt on his real existence, though we have a series of books under his name published at the end of the sixteenth century.

Tradition declares that he was a Benedictine monk living about the middle of the fifteenth century, who tested many forms of drugs with the idea of securing materials for the cure of human diseases. To him is attributed the discovery of hydrochloric acid, which he called the spirit of salt, sugar of lead, and a method of preparing sulphuric acid and probably ammonia. He is best known for his work on antimony and his book, "The Triumphant Chariot of Antimony," put that metal and its salts into medical practice {392} for centuries. The indication for it was that disease was largely due to a toxaemia or acc.u.mulation of poisons in the system, the modern idea of auto-toxaemia, and that these could be best removed by brisk purgation. The use of calomel subsequently, the theory underlying venesection and a great many of our modern surgical fads for the improvement of man's condition by taking something out of him have the same notion for basis.

Basil Valentine's works are precious because they insist that physicians must know the drugs they use and their effects, not merely by reading about them, but by studying them on patients and on animals. He himself is said to have tried the effect of antimony on the swine belonging to the monastery in which he did his work, and other materials are said to have been tested in the same way. He is thus really a father of experimental medicine. He cannot say too much in deprecation of physicians who give medicines which they know little about for diseases about which they know less. In my sketch of him in "Catholic Churchmen in Science" (Dolphin Press, Philadelphia, 1907) I quote a pa.s.sage from his "Triumphant Chariot of Antimony," in which he bitterly condemns the practice of physicians who give remedies knowing practically nothing about them, only that they have been recommended by someone else. It read like a diatribe of the modern time against allowing the manufacturing chemist to suggest drugs for medical practice. The pa.s.sage makes very clear what is the secret of the mystery by which remedies come and go in medicine because of insufficient testing. Valentine said:

"And whensoever I shall have occasion to contend in the school with such a Doctor, who knows not how himself to prepare his own medicines, but commits that business to another, I am sure I shall obtain the palm from him; for indeed, that good man knows not what medicines he prescribes to the sick; whether the color of them be white, black, grey or blew, he cannot tell; nor doth this wretched man know whether the medicine he gives be dry or hot, cold or humid; but he only knows that he found it so written in his Books, and thence pretends knowledge (or as it were, Possession) by Prescription of a very long time; yet he desires to further information. {393} Here again let it be lawful to exclaim, Good G.o.d, to what a state is the matter brought! what goodness of minde is in these men! what care do they take of the sick! Wo, wo to them! in the day of judgment they will find the fruit of their ignorance and rashness, then they will see Him Whom they pierced, when they neglected their Neighbor, sought after money and nothing else; whereas, were they cordial in their profession, they would spend Nights and Days in Labour that they might become more learned in their Art, whence more certain health would accrew to the sick with their Estimation and greater Glory to themselves. But since Labour is tedious to them, they commit the matter to Chance, and being secure of their Honour and content with their Fame, they (like Brawlers) defend themselves with a certain Garrulity, without any respect to Confidence or Truth."

Another of the great physicians of the time was Cornelius Agrippa, born in 1486, of the old family of Nettesheim. Cornelius was at first the secretary of the Emperor Maximilian, then a warrior and finally a student of both law and medicine, yet all was accomplished so expeditiously that when he was but twenty-four the Parliament of Dole came in a body to hear his lectures on the Cabalistic Books of Reuchlin. He practised for a while as a physician at Geneva after having been an advocate at Metz and, with the tendency to wander that so many of the men of this time had, we find him afterwards at Freiburg, at Lyons, then for a time the physician of Louise of Savoy, but jealousy drove him from the Court and a little later we find him starving in Antwerp, and then in prison at Brussels. He pa.s.sed through Cologne, was at Bonn for a time and is heard from in prison at Lyons.

He seems to have run the whole gamut of human suffering. It is hard to know what he was imprisoned for, but he seems to have been a man who easily made enemies, refused to think that anyone else knew much and probably his necessities led him into the doing of things that were suspicious at least, if not actually criminal.

Agrippa was very much interested in magnetism, quite taken with the idea of human magnetism and above all very much persuaded of the influence of the mind on the body. He felt {394} the place that autosuggestion or strong persuasion has in enabling men to accomplish anything and he said: "We must therefore in every work and application of things affect vehemently, imagine, hope and believe strongly, for that will be a great help." He was quite sure that the mind could influence the body strongly for healing purposes and would doubtless have been looked upon as an advocate of New Thought or Psychic Healing or some of the other schools of mental therapeutics in our time, though he believed also in the use of medicines and remedial measures.

Another phase of his antic.i.p.ation of some modern ideas may be still more interesting for our generation, though it only shows how p.r.o.ne human thought is to run in cycles and how hard it is to find anything new under the sun: it may be rather surprising to many to learn that Agrippa seems to have had a definite persuasion that woman was superior to man. He was what the French would have called "a feminist of the most modern." A book of his on the subject recently appeared as a bibliographic treasure in the London bookseller, Tregaskis'

catalogue (No. 736). The t.i.tle was: "Female Pre-Eminence: or The Dignity and Excellence of that s.e.x Above the Male." An Ingenious Discourse: Written originally in Latine, by Henry Cornelius Agrippa, Knight, Doctor of Physick, Doctor of Both Laws, and Privy-Counsellor to the Emperour Charles V. Done into English with additional advantages. By H. (Enry) C. (are) Printed by T. R. and M. D. and are to be sold by Henry Milion, 1670. The catalogue contains the note: "Strong arguments in favor of women's superiority. It is rendered into English, well embroidered with poetic imagery and rich in furiously entertaining pa.s.sages."

The most important scientific development for medicine came from pathological anatomy. This science is supposed as a rule to be of much later origin than the period we are occupied with, but the interest in the history of medicine in recent years has shown us how much of attention there was given to pathology and how many observations were acc.u.mulating in the published books of the Renaissance time. There was much more of such scientific observation in the Middle Ages than is usually thought. Three men at the beginning of {395} Columbus'

Century, Professor Montagnana of Padua, Professor Savonarola of Ferrara, the grandfather of the martyred Dominican, and Professor Arcolani of Bologna, described a number of different lesions which they had noted in the many bodies that were being dissected at this time. In the next few years these observations multiply. Benedetti, the Professor of Anatomy at Padua and the founder of the anatomical theatre at that university, made reports on gall-stones and apoplexies. Benivieni, a simple practising physician at Florence, was probably the first to describe gall-stones and he has a very large number of pathological observations. He is the first that we know who made a number of autopsies with the definite idea of finding out the cause of death and he has come deservedly to be called, as a consequence, the Father of Pathological Anatomy. Allb.u.t.t, the Regius Professor of Medicine at the University of Cambridge, says of him: "Before Vesalius, before Eustachius, he opened the bodies of the dead as deliberately and clear-sightedly as any pathologist in the s.p.a.cious times of Baillie, Bright and Addison," and Malgaigne has described his book as "the only work on pathology which owes nothing to anyone."

It became the custom then to collect observations of this kind and Berengar of Carpi, the discoverer of the appendix, who had dissected a great many bodies, described a number of pathological changes. Aranzi, the professor of medicine and of anatomy in Bologna, has many observations of pathological finds in his book and paid special attention to tumors. Ingra.s.sias, professor of anatomy at Naples, was also interested in pathology and, as specializing had become the fas.h.i.+on, his observations were mainly with regard to bones.

Eustachius, the professor of anatomy in Rome, declares in the preface to his anatomical tables that he was the first to make autopsies for pathological purposes in Rome, and that he had collected an abundant amount of material. The publication of Eustachius' anatomy was delayed until long after his death and his pathological observations were never published. Columbus in Rome made a series of autopsies even on high ecclesiastics for the purpose of determining the cause of death and evidently the science of pathology was gradually coming into existence. Vesalius made a large number of pathological observations {396} and promised in his book on normal anatomy to publish them.

Unfortunately he never did so, and his notes seem lost, though it is not impossible that the ma.n.u.script or some portion of it may yet be found in Spain.

In many other countries besides Italy, however, pathological anatomy attracted much attention. Joost van Lom, often known by his Latin name of Jodocus Lommius, a physician in Brussels, who was royal physician to King Philip II, published three books of medical observations at Antwerp just after the close of Columbus' Century (1560) in which notes of all diseases and problems of prognosis are set forth. Johann Kentmann, a physician of Torgau, devoted a great deal of attention to the study of the formation of all kinds of calculi in human beings, biliary, salivary and intestinal. Francisco Valles, Professor of Medicine at the University of Alcala in Spain, published a volume of Galen's _"De Locis Affectis,"_ in which he incorporated many notes of his own pathological observations. Jacques Houillier (Hollerius) published about the same time at Paris, where he was professor of medicine, a book on "Internal Diseases" with many pathological notes.

Johann Weyer (Wierus) also added valuable pathological annotations to his writings.

At the end of the century pathological anatomy as a definite department of medicine had been firmly established. Dodoens (Dodonaeus), Royal physician to the Emperor Maximilian II and Rudolph II, made a large number of valuable observations at autopsies and described cases of pneumonia, ulcers of the stomach, inflammation of the abdominal organs, aneurisms of the coronary arteries and of the arteries of the stomach, stony concretions in the lungs, purulent conditions of the ureters and kidney, and ergotism. Even more important for the science was the work of Schenck von Graffenberg, official physician at Freiburg in Breisgau, who gathered together a larger collection of observations on the diseases of separate organs than had ever been made since Hippocrates' time. He paid special attention to the pathological anatomy of these cases and while many of the observations were his own, a great many of them had been collected from friends. His work was done after the close of Columbus' Century, but he {397} himself was over twenty before the century closed and he was only carrying out the inspiration that had been given by workers in that tune. Pieter van Foreest (Petrus Forestus), a practising physician in Delft, deserves almost as much credit as Schenck von Graffenberg and much more than many of the professors in medicine and anatomy of this tune. He made a special study of the pathological conditions of the ordinary diseases and was indefatigable in collecting information. His own observations include more than 100 cases with autopsies. With this spirit abroad the future of scientific medicine was a.s.sured.

A good idea of the accomplishment of the medical teachers of the time may be judged very well from the life of Fracastorius. Prof. Osler in his sketch of him published in his book, "An Alabama Student,"

[Footnote 38] says: "The scientific reputation of Fracastorius rests upon the work _'De Contagione.'_ It contains among other things three contributions of the first importance--a clear statement of the problems of contagion and infection, a recognition of typhus fever and a remarkable p.r.o.nouncement on the contagiousness of phthisis." In the same sketch Osler adds: "Fracastorius draws a remarkable parallel between the processes of contagion and the fermentation of wine. It is not the same as putrefaction, which differs in the absence of any new generation and is accompanied with an abominable smell. Certain poisons resemble contagion in their action, but they differ essentially in not producing in the individual the principle or germ capable of acting on another poison." This discussion is wonderfully complete and thorough, yet conservative. Later Boyle declared that a time would come when someone would discover the cause of fermentation and probably at the same time throw light on the origin of contagious disease. That prophecy was fulfilled when Pasteur made his studies in the fermentation of wine and beer and then went on to lay the foundation of bacteriology. Fracastorius' thoroughly scientific spirit will be appreciated from the fact that, like Leonardo, he saw fossils in their true light and has the first reference in the history of science to the magnetic poles of the earth.

[Footnote 38: Oxford Press, 1908.]

{398}

Men whose names are usually a.s.sociated with surgery often manifested successful interest, and above all, power of observation in pure medicine. A single example may be taken in ill.u.s.tration. Anyone who thinks that observation and theory and investigation of arthritism is new or that we have occupied ourselves much more with the study of its symptoms than they did in the olden time should read Pare's chapters on Gout. He says that the word gout, which appealed to him as French, was probably used because the humors distil drop by drop, _goutte a goutte_ over the joints. Or perhaps because sometimes a single drop (goutte) of the humor of this disease causes very great pain. He describes the deposits of gypsum-like material, or stony matter like chalk, which occur in the affection. The severe pains which occur in connection with the disease Pare does not hesitate to attribute to alteration of the humors by a poison which he calls _"virus arthritique"_ He notes that the pains are distinctly influenced by atmospheric fluctuations, so that one may well say of the gouty that they carry with them an almanac which may serve them as a weather indicator all their lives. Serious complications can arise in gout if the humors of the disease involve other organs than the joints. He attributed inflammations of the liver, of the pleura, colicky disturbances of the intestines, to this cause. Continuous fevers represented for him the effect of the gouty toxin upon the large vessels, while paralyses might occur if the gouty toxin involved the "porosities" of the nerves.

He described a sanguineous gout frequent in the springtime, especially among young people with acutely inflamed joints, the pain being most severe in the mornings and the urine red and dense. This is evidently acute rheumatic arthritis. Bilious gout occurred more among the middle-aged and the involved joints were yellow rather than red and the pain attained its maximum intensity in the early afternoons. The urine was lemon yellow in color but often cloudy. The third form was pituitary gout which occurred particularly in the winter, having as a main symptom coryza, affecting the old rather than the young, but usually without acute pain. The affected area is cold rather than hot to the touch and the discomfort is most noted during the night. The urine was pale in color and thick. {399} Melancholy gout, the fourth form of the disease, was also an affection of old age, producing a livid color in the joints and making them cold to the touch. The patients' pains were worse at intervals of three or four days and the urine had a deep cloudy color. Sanguineous gout was the most curable of these four and usually lasted two to three weeks; bilious gout was much more serious and often ended in death. Pituitary and melancholy gout were chronic diseases of long duration. It is rather easy to see Pare's powers of observation in all this. He jumped to conclusions and over-generalized, as men have always done and thus made mistakes. Down even to the present day, however, physicians have never quite got away from the tendency to group these acute and chronic painful conditions of joints under a single word, and rheumatism for many represents the key to a puzzle that still exists.

An important development in medicine was the publication early in the sixteenth century of regulations by the Bishop of Bamberg and the Elector of Brandenburg, by which physicians or midwives were authorized to be summoned as experts in medico-legal cases.

Medico-legal autopsies are on record long before this, though there was always serious objection to their performance because of the natural feeling of deterrence men have toward the destruction of the human body. In general, however, the basis of our legal medicine and the status of the physician in court as an expert was determined at this time.

Probably nothing shows so well the great interest of this time in the development of medicine and particularly therapeutics, as the number of drugs imported from America and the East Indies, the many experiments and careful observations made with them and the books written about them. As a matter of fact no century has given us more new drugs of enduring value. Schaer in the chapter on the history of pharmacology and toxicology in modern times in Puschmann's "Handbook of the History of Medicine" has summed up the work of this period.

Three well-known books of the time containing interesting scientific material were written by Gonzalo Fernandez, a personal friend of Columbus who, from his birthplace, is often known as Oviedo, Nicolas Monardes and Francisco Hernandez. Fernandez was the superintendent of the {400} government gold mines in South America, but after his return he wrote his great work, _"Historia General y Natural de las Indias."_ The second of these, Monardes, deserves well of pharmacology and all that relates to drugs through his famous collection of the natural products of America which became widely known through his description of them. [Footnote 39] Hernandez wrote on Mexican and Central American plants and his _"Historia Plantarum Novae Hispaniae"_ is an important source of information. Besides these, Pasi and Conti, Italians who had travelled in the East Indies, wrote books containing valuable observations on Oriental drugs and plants, and the Frenchman Bellonius (Pierre Belon) (See chapter on Biological Sciences) described Arabian, Persian and Indian products, while the Spaniard, Christobel Acosta, and the Portuguese, Garcia da Orta and Duarte Barbosa, visited various parts of the East and East African Malabar and wrote books which, while not specifically medical, had much to say with regard to the indigenous plants, especially such as either had been used by the natives for medical purposes or promised to be of significance in this way. The Portuguese apothecary Pirez directed a special letter with regard to Hindustan and Farther India and what might be expected for pharmacology from these regions to the king of Portugal which is of great importance.

[Footnote 39: Monardes proved of so much interest that he was translated into English before the end of the sixteenth century, and his book was widely read.]

The Belgian, Charles de l'Esclus, better known as a rule under his Latin name of Carolus Clusius, as professor of botany, director of the botanical garden and superintendent of the Museum in Vienna and later in Leyden, gathered together an immense amount of information, was in correspondence with all who were interested in botany and in pharmacology. He succeeded in making an encyclopedia of information with regard to these subjects that has ever since been considered one of the most important fundamental works in the history of this department of science.

The spirit of the physicians of the time as regards scientific methods in clinical medicine and their att.i.tude towards {401} observation as by far the most important means of obtaining medical truth is very well brought out by some pa.s.sages written by John Hall, a poet and medical writer who wrote a translation of Lanfranc's _"Chirurgia Parva"_ published shortly after the close of Columbus' Century. To this was appended "A very Frutefull and Necessary Briefe Worke of Anatomie" and "An Historiall Expostulation: against the beastlye Abusers, both of Chyrurgerie and Physyke in our Tyme: with a Goodlye Doctrine and Instruction Necessarye to be marked & folowed of all Chirurgiens." In the Expostulation, which may be found in the Percy Society's republication of old texts for 1844, Dr. Hall said: "Galen also hath freely admonished that we ought not if we will be perfectly cunning to trust only to doctrine written in books, but rather to our proper eyes which are to be trusted above all other authors, yea!

before Hippocrates and Galen."