Old-Time Makers of Medicine Part 18

They understood the principles of aseptic surgery very well. They declared that it was not necessary "that pus should be generated in wounds." Professor Clifford Allb.u.t.t says:

They washed the wound with wine, scrupulously removing every foreign particle; then they brought the edges together, not allowing wine or anything else to remain within--dry adhesive surfaces were their desire. Nature, they said, produces the means of union in a viscous exudation, or natural balm, as it was afterwards called by Paracelsus, Pare, and Wurtz. In older wounds they did their best to obtain union by cleansing, desiccation, and refres.h.i.+ng of the edges. Upon the outer surface they laid only lint steeped in wine. Powders they regarded as too desiccating, for powder shuts in decomposing matters; wine after was.h.i.+ng, purifying, and drying the raw surfaces evaporates.

Almost needless to say these are exactly the principles of aseptic surgery. The wine was the best antiseptic that they could use and we still use alcohol in certain cases. It would seem to many quite impossible that such operations as are described could have been done without anaesthetics, but they were not done without anaesthetics. There were two or three different forms of anaesthesia used during the thirteenth and fourteenth centuries. One method employed by Ugo da Lucca consisted of the use of an inhalant. We do not know what the material employed was. There are definite records, however, of its rather frequent employment.

What a different picture of science at the medieval universities all this makes from what we have been accustomed to hear and read with regard to them. It is difficult to understand where the old false impressions came from. The picture of university work that recent historical research has given us shows us professors and students busy with science in every department, making magnificent advances, many of which were afterwards forgotten, or at least allowed to lapse into desuetude.

The positive a.s.sertions with regard to old-time ignorance were all made in the course of religious controversy. In English-speaking countries particularly it became a definite purpose to represent the old Church as very much opposed to education of all kinds and above all to scientific education. There is not a trace of that to be found anywhere, but there were many doc.u.ments that were appealed to to confirm the protestant view. There was a Papal bull, for instance, said to forbid dissection.

When read it proves to forbid the cutting up of bodies to carry them to a distance for burial, an abuse which caused the spread of disease, and was properly prohibited. The Church prohibition was international and therefore effective. At the time the bull was issued there were twenty medical schools doing dissection in Italy and they continued to practise it quite undisturbed during succeeding centuries. The Papal physicians were among the greatest dissectors. Dissections were done at Rome and the cardinals attended them. Bologna at the height of its fame was in the Papal States. All this has been ignored and the supposed bull against anatomy emphasized as representing the keynote of medical and surgical history. Then there was a Papal decree forbidding the making of gold and silver. This was said to forbid chemistry or alchemy and so prevent scientific progress. The history of the medical schools of the time shows that it did no such thing. The great alchemists of the time doing really scientific work were all clergymen, many of them very prominent ecclesiastics.

Just in the same way there were said to be decrees of the Church councils forbidding the practice of surgery. President White says in his "Warfare of Science with Theology in Christendom," that, as a consequence of these, surgery was in dishonor until the Emperor Wenceslaus, at the beginning of the fifteenth century, ordered that it should be restored to estimation. As a matter of fact, during the two centuries immediately preceding the first years of the fifteenth century, surgery developed very wonderfully, and we have probably the most successful period in all the history of surgery except possibly our own. The decrees forbade monks to practise surgery because it led to certain abuses. Those who found these decrees and wanted to believe that they prevented all surgical development simply quoted them and a.s.sumed there was no surgery. The history of surgery at this time is one of the most wonderful chapters in human progress.

The more we know of the Middle Ages the more do we realize how much they accomplished in every department of intellectual effort. Their development of the arts and crafts has never been equalled in the modern time. They made very great literature, marvellous architecture, sculpture that rivals the Greeks', painting that is still the model for our artists, surpa.s.sing illuminations; everything that they touched became so beautiful as to be a model for all the after time. They accomplished as much in education as they did in all the other arts, their universities had more students than any that have existed down to our own time, and they were enthusiastic students and their professors were ardent teachers, writers, observers, investigators. While we have been accustomed to think of them as neglecting science, their minds were occupied entirely with science. They succeeded in antic.i.p.ating much more of our modern thought, and even scientific progress, than we have had any idea until comparatively recent years. The work of the later Middle Ages in mathematics is particularly strong, and was the incentive for many succeeding generations. Roger Bacon insisted that, without mathematics, there was no possibility of real advance in physical science. They had the right ideas in every way. While they were occupied more with the philosophical and ethical sciences than we are, these were never pursued to the neglect of the physical sciences in the strictest sense of that term.

Is it not time that we should drop the foolish notions that are very commonly held because we know nothing about the Middle Ages--and, therefore, the more easily a.s.sume great knowledge--and get back to appreciate the really marvellous details of educational and scientific development which are so interesting and of so much significance at this time?

APPENDIX III

MEDIEVAL POPULARIZATION OF SCIENCE

The idea of collecting general information from many sources, of bringing it together into an easily available form, so as to save others labor, of writing it out in compendious fas.h.i.+on, so that it could readily pa.s.s from hand to hand, is likely to be considered typically modern. As a matter of fact, the Middle Ages furnish us with many examples of the popularization of science, of the writing of compendia of various kinds, of the gathering of information to save others the trouble, and, above all, of the making of what, in the modern time, we would call encyclopedias. Handbooks of various kinds were issued, manuals for students and specialists, and many men of broad scholars.h.i.+p in their time devoted themselves to the task of making the acquisition of knowledge easy for others. This was true not only for history and philosophy and literature, but also for science. It is not hard to find in each century of the Middle Ages some distinguished writer who devoted himself to this purpose, and for the sake of the light that it throws on these scholars, and the desire for information that must have existed very commonly since they were tempted to do the work, it seems worth while to mention here their names, and those of the books they wrote, with something of their significance, though the s.p.a.ce will not permit us to give here much more than a brief _catalogue raisonne_ of such works.

Very probably the first who should be mentioned in the list is Boethius, who flourished in the early part of the sixth century. He owed much of his education to his adoptive father, afterwards his father-in-law, Symmachus, who, with Festus, represented scholars.h.i.+p at the court of the Gothic King, Theodoric of Verona. These three--Festus, Symmachus, and Boethius--brought such a reputation for knowledge to the court that they are responsible for many of the wonderful legends of Dietrich of Bern, as Theodoric came to be called in the poems of the medieval German poets. The three distinguished and devoted scholars did much to save Greek culture at a time when its extinction was threatened, and Boethius particularly left a series of writings that are truly encyclopedic in character. There are five books on music, two on arithmetic, one on geometry, translations of Aristotle's treatises on logic, with commentaries; of Porphyry's "Isagoge," with commentaries, and a commentary on Cicero's "Topica." Besides, he wrote several treatises in logic and rhetoric himself, one on the use of the syllogism, and one on topics, and in addition a series of theological works. His great "Consolations of Philosophy" was probably the most read book in the early Middle Ages. It was translated into Anglo-Saxon by King Alfred, into old German by Notker Teutonicus, the German monk of St. Gall, and its influence may be traced in Beowulf, in Chaucer, in High German poetry, in Anglo-Norman and Provencal popular poetry, and also in early Italian verse. Above all, the "Divine Comedy" has many references to it, while the "Convito" would seem to show that it was probably the book that most influenced Dante. Though it is impossible to confirm by doc.u.mentary evidence the generally accepted idea that Boethius died a martyr for Christianity, the tradition can be traced so far back, and it has been so generally accepted that this seems surely to have been the case. The fact is interesting, as showing the att.i.tude of scholars towards the Church and of the Church towards scholars.h.i.+p thus early.

The next great name in the tradition should probably be that of Ca.s.siodorus, the Roman writer and statesman, prime minister of Theodoric, who, after a busy political life, retired to his estate at Vivarium, and, in imitation of St. Benedict, who had recently established a monastery at Monte Ca.s.sino, founded a monastery there. He is said to have lived to the age of ninety-three. His retirement favored this long life, for, after the death of Theodoric, troublous times came, and civil war, and only his monastic privileges saved him from the storm and stress of the times. He had been interested in literature and the collection of information of many kinds before his retirement, and it is not unlikely that his recognition of the fact that the monastic life offered opportunities for the pursuit of this, under favorable circ.u.mstances, led him to take it up.

While still a statesman he wrote a series of works relating to history and politics and public affairs generally. These consisted mainly of chronicles and panegyrics, and twelve books of miscellanies called Variae. After his retirement to the monastery, a period of ardent devotion to writing begins, and a great number of books were issued. He evidently gathered round him a number of men whom he inspired with his spirit, or, perhaps, selected, because he found that, while they had a taste for a quiet, peaceful spiritual life, they were also devoted to the acc.u.mulation and diffusion of knowledge. A series of commentaries on portions of the Scriptures was written, the Jewish antiquities of Josephus translated, and the ecclesiastical histories of Theodoric, Sozomen, and Socrates made available in Latin. Ca.s.siodorus himself is said to have made a compendium of these, called the "Historia Tripart.i.ta," which was much used as a manual of history during succeeding centuries. Then there were treatises on grammar, on orthography, and a series of works on mathematics. In all of his writings Ca.s.siodorus shows a special fondness for the symbolism of numbers.

There is a well-grounded tradition that he insisted on the study of the Greek cla.s.sics of medical literature, especially Hippocrates and Galen, and awakened the interest of the monks in the necessity for making copies of these fathers of medicine. The tradition that he established at Vivarium is also found to have existed at Monte Ca.s.sino among the Benedictines, and, doubtless, to this is to be attributed the foundation of the medical school of Salerno, where Benedictine influence was so strong. It is probable, therefore, that to Ca.s.siodorus must be attributed the preservation in as perfect a state as we have them of the old Greek medical writers.

His main idea was, of course, the study of Scriptures, but with just as many helps as possible. He thought that commentators, and historians, not alone Christian, but also Hebrew and Pagan, should be studied to ill.u.s.trate it, and then the commentaries of the Latin fathers, so that a thoroughly rounded knowledge of it should be obtained. He thus began an "Encyclopedia Biblica," and set a host of workers at its accomplishment.

Every country in Europe shared this movement for the diffusion of information during the early Middle Ages, and the works of men from each of these countries in succeeding centuries has come down to us, preserved in spite of all the vicissitudes to which they were so liable during the centuries before the invention of printing and the easy multiplication of books. To many people it will seem surprising to learn that the next evidence of deep broad interest in knowledge is to be found in the next century in the distant west of Europe, in the Spanish Peninsula. It is a long step from the semi-barbaric splendor of the Gothic court at Verona, to the bishop's palace in Seville in Andalusia.

The two cities are separated by what is no inconsiderable distance in our day. In the seventh century they must have seemed almost at the other end of the world from each other. Those who recall what we have insisted on in several portions of the body of this work with regard to the high place Spanish genius won for itself in the Roman Empire, and how much of culture among the Spaniards of that time the occurrence of so many important writers of that nationality must imply, will not be surprised at the distinguished work of a great Christian Spanish writer of the seventh century.

Indeed, it would be only what might be expected for evidences of early awakening of the broadest culture to be found in Spain. The important name in the popularization of science in the seventh century is St.

Isidore of Seville. He made a compendium of all the scattered scientific traditions and information of his time with regard to natural phenomena in a sort of encyclopedia of science. This consisted of twenty books--chapters we would call them now--treating almost _de omni re scibili et quibusdam aliis_ (everything knowable and a few other things besides). It is possible that the work may have been written by a number of collaborators under the patronage of the bishop, though there is no sure indication of this to be found either in the volume itself or even contemporary history. All the ordinary scientific subjects are treated.

Astronomy, geography, mineralogy, botany, and even man and the animals have each a special chapter. Pouchet, in his "History of the Natural Sciences During the Middle Ages," calls attention to the fact that, in grouping the animals for collective treatment in the different chapters, sometimes the most heterogeneous creatures are brought under a common heading. Among the fishes, for instance, are cla.s.sed all living things that are found in water. The whale and the dolphin, as well as sponges, and oysters, and crocodiles, and sea serpents, and lobsters, and hippopotamuses, all find a place together, because of the common watery habitation. The early Spanish Churchman would seem to have had an enthusiastic zeal for complete cla.s.sification that would surely have made him a strenuous modern zoologist.

The next link in the tradition of encyclopedic work is the Venerable Bede, whose character was more fully honored by the decree on November 13, 1899, by Pope Leo XIII declaring him a Doctor of the Church. Bede was the fruit of that ardent scholars.h.i.+p which had risen in England as a consequence of the introduction of Christianity. It had been fostered by the coming of scholar saints from Ireland, but was, unfortunately, disturbed by the incursions of the Danes. While Bede is known for his greatest work, the "Ecclesiastical History of the English People," which gives an account of Christianity in England from its beginning until his own day, he wrote many other works. His history is the foundation of all our knowledge of early British history, secular as well as religious, and has been praised by historical writers of all ages, who turned to it for help with confidence. He wrote a number of other historical works.

Besides, he wrote books on grammar, orthography, the metrical art, on rhetoric, on the nature of things, the seasons, and on the calculation of the seasons. These latter books are distinctly scientific. His contributions to Gregorian Music are now of great value.

After this, Alcuin and the monks, summoned by Charlemagne, take up the tradition of gathering and diffusing information, and the great monasteries of Tours, Fulda, and St. Gall carry it on. Besides these, in the ninth century Monte Ca.s.sino comes into prominence as an inst.i.tution where much was done of what we would now call encyclopedic work. After his retirement from Salerno Constantine Africa.n.u.s made his translations and commentaries on Arabian medicine, const.i.tuting what was really a medical encyclopedia of information not readily available at that time.

After this, of course, the tradition is taken up by the universities, and it is only when, with the thirteenth century, there came the complete development of the university spirit, that encyclopedias reached their modern expression. Three great encyclopedists, Vincent of Beauvais, Thomas of Cantimprato, and Bartholomaeus Anglicus, are the most famous. Vincent consulted all the authors sacred and profane that he could lay hold on, and the number was, indeed, prodigious. I have given some account of him in "The Thirteenth Greatest of Centuries" (Catholic Summer School Press, New York, third edition, 1910).

It would be very easy to conclude that these encyclopedias, written by clergymen for the general information of the educated people of the times, contain very little that is scientifically valuable, and probably nothing of serious medical significance. Any such thought is, however, due entirely to unfamiliarity with the contents of these works. They undoubtedly contain absurdities, they are often full of misinformation, they repeat stories on dubious authority, and sometimes on hearsay, but usually the source of their information is stated, and especially where it is dubious, as if they did not care to state marvels without due support. Books of popular information, however, have always had many queer things,--queer, that is, to subsequent generations,--and it is rather amusing to pick up an encyclopedia of a century ago, much less a millennium ago, and see how many absurd things were accepted as true.

The first edition of the "Encyclopedia Britannica," issued one hundred and fifty years ago, furnishes an easily available source of the absurdities our more recent forefathers accepted. The men of the Middle Ages, however, were much better observers as a rule, and used much more critical judgment, according to their lights, than we have given them credit for. Often the information that they have to convey is not only valuable, but well digested, thoroughly practical, and sometimes a marvellous antic.i.p.ation of some of our most modern thoughts. There is one of these encyclopedias which, because it was written in my favorite thirteenth century, I have read with some care. It is simply a development of the work of preceding clerical encyclopedists, and often refers to them. Because it contains some typical examples of the better sorts of information in these works, I have thought it worth while to quote two pa.s.sages from it. The author is Bartholomaeus Anglicus, and the quaint English in which it is couched is quoted from "Medical Lore"

(London, 1893). The book is all the more interesting because in a dear old English version, issued about 1540, the spellings of which are among the great curiosities of English orthography, it was often read and consulted by Shakespeare, who evidently quotes from it frequently, for not a little of the quaint scientific lore that he uses for his figures can be traced to expressions used in this book.

The first of the paragraphs that deserves to be quoted, discusses madness, or, as we would call it, lunacy, and sums up the causes, the symptoms, and the treatment quite as well as that has ever been done in the same amount of s.p.a.ce:

Madness cometh sometime of pa.s.sions of the soul, as of business and of great thoughts, of sorrow and of too great study, and of dread: sometime of the biting of a wood hound, or some other venomous beast; sometime of melancholy meats, and sometime of drink of strong wine. And as the causes be diverse, the tokens and signs be diverse. For some cry and leap and hurt and wound themselves and other men, and darken and hide themselves in privy and secret places. The medicine of them is, that they be bound, that they hurt not themselves and other men. And namely, such shall be refreshed, and comforted, and withdrawn from cause and matter of dread and busy thoughts. And they must be gladded with instruments of music, and some deal be occupied.'

The second discusses in almost as thorough a way the result of the bite of a mad dog. The old English word for mad, wood, is constantly used.

The causes, the symptoms, and course of the disease, and its possible prevention by early treatment, are all discussed. The old tradition was already in existence that sufferers from rabies or hydrophobia, as it is called, dreaded water, when it is really only because the spasm consequent upon the thought even of swallowing is painful that they turn from it. That tradition has continued to be very commonly accepted even by physicians down to our own day, so that Bartholomew, the Englishman, in the thirteenth century, will not be blamed much for setting it forth for popular information in his time some seven centuries ago. The idea that free bleeding would bring about the removal of the virus is interesting, because we have in recent years insisted in the case of the very similar disease, teta.n.u.s, on allowing or deliberately causing wounds in which the teta.n.u.s microbe may have gained an entrance, to bleed freely.

The biting of a wood hound is deadly and venomous. And such venom is perilous. For it is long hidden and unknown, and increaseth and multiplieth itself, and is sometimes unknown to the year's end, and then the same day and hour of the biting, it cometh to the head, and breedeth frenzy. They that are bitten of a wood hound have in their sleep dreadful sights, and are fearful, astonied, and wroth without cause. And they dread to be seen of other men, and bark as hounds, and they dread water most of all things, and are afeared thereof full sore and squeamous also. Against the biting of a wood hound wise men and ready use to make the wounds bleed with fire or with iron, that the venom may come out with the blood, that cometh out of the wound.

FOOTNOTES:

[Footnote 1: "Medicinisches aus der Aeltesten Kirchen Geschichte."

Leipzig, 1892.]

[Footnote 2: Foulis, London and Edinburgh, 1910.]

[Footnote 3: My attention was called to the interesting story of the Jewish physicians of the Middle Ages and their scientific accomplishment while writing the article on Joseph Hyrtl for the Catholic Encyclopedia.

His "Das Arabische und Hebraische in der Anatomie" (Wien, 1879) has some interestingly suggestive material on these important chapters of the history of medicine. (I owe my opportunity to consult it to the courtesy of the Surgeon-General's library.) Biographic material has been obtained from Carmoly's "History of the Jewish Physicians," translated by Dr.

Dunbar for the _Maryland Medical and Surgical Journal_, some extra copies of which were printed by John Murphy and Co., Baltimore, about the middle of the nineteenth century. Baas and Haeser's Histories of Medicine and Puschmann and Pagel's "Handbook" provided additional material, and I have found Landau's "Geschichte der Judischen Aerzte"

(Berlin, 1895) of great service.]

[Footnote 4: Of course there are many absurd things recommended in the Talmud. We cannot remind ourselves too often, however, that there have been absurd things at all times in medicine, and especially in therapeutics. It is curious how often some of these absurdities have repeated themselves. We are liable to think it very queer that men should have presumed, or somehow jumped to the conclusion, that portions of animals might possess wonderful virtue for the healing of diseases of the corresponding special parts of man. We ourselves, however, within a little more than a decade, had a phase of opotherapy--how much less absurd it seems under that high-sounding Greek term--that was apparently very learned in its scientific aspects yet quite as absurd as many phases of old-time therapy, as we look at it. We administered cardin for heart disease and nephrin for kidney trouble, cerebrin for insanity (save the mark!), and even prostate tissue for prostatism--and with reported good results! How many of us realize now that in this we were only repeating the absurdities, so often made fun of in old medicine, with regard to animal tissue and excrement therapeutics? The Talmud has many conclusions with regard to the symptoms of patients drawn from dreams; as, for instance, it is said to be a certain sign of sanguineous plethora when one dreams of the comb of a c.o.c.k. One phase of our psycho-a.n.a.lysis in the modern time, however, has taken us back to an interpretation of dreams different of course from this, yet a.n.a.logous enough to be quite striking.]

[Footnote 5: "Maimonides," by David Yellin and Israel Abrahams, Philadelphia, 1903.]

[Footnote 6: "Das Arabische und Hebraische in der Anatomie," Dr. Joseph Hyrtl, Wien, 1879.]

[Footnote 7: "Anat. Antiq. Rariores," Vienna, 1835.]

[Footnote 8: It seems hard to understand how so useful an auxiliary to the surgeon as the ligature,--it seems indispensable to us,--could possibly be allowed to go out of use and even be forgotten. It will not be difficult, however, for anyone who recalls the conditions that obtained in old-time surgery. The ligature is a most satisfying immediate resource in stopping bleeding from an artery, but a septic ligature inevitably causes suppuration and almost inevitably leads to secondary hemorrhage. In the old days of septic surgery secondary hemorrhage was the surgeon's greatest and most dreaded bane. Some time from the fifth to the ninth day a septic ligature came away under conditions such that inflammatory disturbance had prevented sealing of the vessel. If the vessel was large, then the hemorrhage was fast and furious and the patient died in a few minutes. After a surgeon had had a few deaths of this kind he dreaded the ligature. He abandoned its use and took kindly to such methods as the actual cautery, red-hot knives for amputations, and the like, that would sear the surfaces of tissues and the blood-vessels, and not give rise to secondary hemorrhage. A little later, however, someone not familiar with secondary risks would reinvent the ligature. If he were cleanly in his methods and, above all, if he were doing his work in a new hospital, the ligature worked very well for a while. If not, it soon fell into innocuous desuetude again.]

[Footnote 9: Puschmann: "Handbuch der Geschichte der Medizin," Vol. I, page 652.]

[Footnote 10: The first dentist who filled teeth with amalgam in New York, some eighty years ago, had to flee for his life, because of a hue and cry set up that he was poisoning his patients with mercury.]

[Footnote 11: "Storia de la Scuola di Salerno."]

[Footnote 12: It is probably interesting to note that the word _universitas_ as used here has no reference to our word university, but refers to the whole world of students as it were. In the Middle Ages universities were called _studia generalia_, general studies--that is, places where everything could be studied and where everyone from any part of the world could study. Our use of the word university in the special modern sense of the term comes from the formal mode of address to the faculty of a university when Popes or rulers sent them authoritative doc.u.ments. Such doc.u.ments began with the expression _Universitas vestra_, all of you (in the old-time English, as preserved in the Irish expression, "the whole of ye"), referring to all the members of the faculty. The transfer to our term and signification university was not difficult.]

[Footnote 13: Physicians wore a particular garb consisting of a cloak and often a mask, supposed to protect them from infections at this time, so that it was not difficult to make a characteristic picture as a sign for a pharmacy. These symbolic signs were much commoner and very necessary when people generally were not able to read. It is from that period that we have the mortar and pestle as also the colored lights in the windows of the drug stores, and the many-colored barber-pole. Also the big boot, key, watch, hat, bonnet, and the like, the last symbolic sign invention apparently being the wooden Indian for the tobacco store.]

[Footnote 14: _The Medical Library and Historical Journal_, Brooklyn, December, 1906.]