THE GROWTH OF MEDICINE
                 FROM THE EARLIEST TIMES TO ABOUT 1800




                      PUBLISHED ON THE FOUNDATION

                       ESTABLISHED IN MEMORY OF

                       WILLIAM CHAUNCEY WILLIAMS

               OF THE CLASS OF 1822, YALE MEDICAL SCHOOL

                                AND OF

                         WILLIAM COOK WILLIAMS

               OF THE CLASS OF 1850, YALE MEDICAL SCHOOL




                        THE GROWTH OF MEDICINE

                        FROM THE EARLIEST TIMES
                             TO ABOUT 1800


                                  BY

                      ALBERT H. BUCK, B.A., M.D.

     _Formerly Clinical Professor of Diseases of the Ear, Columbia
            University, New York--Consulting Aural Surgeon,
                 New York Eye and Ear Infirmary; etc._


  [Illustration]


                   NEW HAVEN: YALE UNIVERSITY PRESS
                       LONDON: HUMPHREY MILFORD
                        OXFORD UNIVERSITY PRESS
                              MDCCCCXVII




                            COPYRIGHT, 1917
                       BY YALE UNIVERSITY PRESS

                    First published, February, 1917




                THE WILLIAMS MEMORIAL PUBLICATION FUND


The present volume is the first work published by the Yale University
Press on the Williams Memorial Publication Fund. This Foundation
was established June 15, 1916, by a gift made to Yale University by
Dr. George C. F. Williams, of Hartford, a member of the Class of
1878, Yale School of Medicine, where three generations of his family
studied--his father, William Cook Williams, in the Class of 1850, and
his grandfather, William Chauncey Williams, in the Class of 1822.




                                PREFACE


Very few persons will challenge the truth of the statement that in the
United States and Canada there are not many physicians who possess
even a slight knowledge concerning the manner in which the science
of medicine has attained its present power as an agency for good, or
concerning the men who played the chief parts in bringing about this
great result. Up to the present time no blame may justly be attached to
any individuals or to any educational institutions for this prevailing
lack of knowledge, and for two very good reasons, _viz._: first,
in a newly settled country, in which the population grows by leaps and
bounds through the influx of foreign immigrants, the training of young
men for the degree of M.D. must necessarily be almost entirely of a
practical character, and consequently the teaching of such a subject
as the history of medicine would be quite out of place; and, second,
the treatises on this subject which are purchasable by English-speaking
physicians are of rather too scientific a character to appeal either
to the undergraduate or to the busy practitioner. The first of the
reasons named, it may now safely be assumed, is rapidly losing its
validity, if indeed it has not already ceased entirely to afford a
legitimate excuse for neglecting the study of this branch of medical
science. On the other hand, the second reason mentioned is still in
force,--so far at least as the present writer knows,--and, if such be
the case, it certainly cannot fail to act as a deterrent influence of
great potency. Here, then, is my apology for attempting to prepare an
account of the history of medicine which shall present the essential
facts truthfully and with a sufficient degree of attractiveness to
win the continuing interest of the reader; which shall place before
him, and especially before those who are just at the threshold of
their professional career, word pictures of those physicians of past
ages whose lives may safely be taken as models worthy to be copied;
and which shall describe, so far as I am able to do this, the methods
which they employed to advance the science of medicine, to gain genuine
professional success, and to merit the enduring esteem of later
generations of physicians. If my efforts prove successful in producing
this kind of history it is fair to expect that, in a comparatively
short time, those physicians whose interest may have been aroused by
the perusal of this less complete and more popular work, will demand
something of a more exhaustive character--a book, for example, like the
admirable history which Max Neuburger, of Vienna, is now publishing,
and of which two volumes have already issued from the press (the
first in 1906 and the second in 1911).[1] It is to this work and the
excellent history written by the late Dr. Haeser, of Breslau, that I
am chiefly indebted for the information supplied in these pages; and
I therefore desire to make special mention here of this indebtedness.
The other sources from which I have been an occasional borrower are
all mentioned in the “List of Authorities Consulted.” Footnotes and
cross-references in the text interfere greatly with one’s pleasure in
reading a book, and I have therefore not hesitated to introduce them
sparingly.

It gives me a special pleasure to call attention here to the
far-sighted generosity displayed by the founder of The Williams
Memorial Fund in making it practicable henceforth for the Yale
University Press to accept for publication medical treatises which
deal with the historical and scientific questions of this branch of
knowledge, but which for sound business reasons cannot be published on
a merely commercial basis.

And I have the further pleasure of expressing my real appreciation
of the skill with which the University Press has solved the problems
of a suitable size and style of type for this volume, and of the
sound advice which it has given with regard to the extent to which
the effectiveness of the book may be increased by the introduction of
pictorial illustrations.

To my friend, Lawrence F. Abbott, of New York, I am deeply indebted for
the valuable assistance which he has rendered me throughout the entire
progress of this work. Indeed, without this assistance, I doubt whether
I should have had the courage to remain at my post to the very end.

                                                    ALBERT H. BUCK.
Cornwall, N. Y., December 29, 1916.




                               CONTENTS


                       PART I. ANCIENT MEDICINE

                                                                PAGE

    Preface                                                       ix

    Chapter I. Development of the Science and Art of Medicine      3

    Chapter II. Oriental Medicine                                 11

    Chapter III. Oriental Medicine (continued)                    25

    Chapter IV. Greek Medicine at the Dawn of History             46

    Chapter V. The Significance of the Serpent in the Statues
        and Votive Offerings Exposed to View in the
        Aesculapian Temples                                       62

    Chapter VI. The Beginnings of a Rational System of Medicine
        in Greece                                                 67

    Chapter VII. Hippocrates the Great                            81

    Chapter VIII. Brief Extracts from Some of the Hippocratic
        Writings                                                  89

    Chapter IX. The State of Greek Medicine after the Events
        of the Peloponnesian War; the Founding of Alexandria
        in Egypt, at the Mouth of the Nile; and the Development
        of Different Sects in Medicine                            96

    Chapter X. Erasistratus and Herophilus, the Two Great
        Leaders in Medicine at Alexandria; the Founding of
        New Sects                                                104

    Chapter XI. Asclepiades, the Introducer of Greek Medicine
    into Rome                                                    116

    Chapter XII. The State of Medicine at Rome after the Death
        of Asclepiades; the Founding of the School of the
        Methodists                                               129

    Chapter XIII. The Further History of Methodism at Rome,
        and the Development of Two New Sects, viz., the
        Pneumatists and the Eclectics.--A General Survey of
        the Subject of Sects in Medicine                         138

    Chapter XIV. Well-known Medical Authors of the Early
    Centuries of the Christian Era                               151

    Chapter XV. Claudius Galen                                   160

    Chapter XVI. The Influence of Christianity upon the
    Evolution of Medicine                                        179


                      PART II. MEDIAEVAL MEDICINE

    Chapter XVII. The Condition of Medicine at Byzantium
        during the Early Part of the Middle Ages                 191

    Chapter XVIII. Beginning of the Arab Renaissance under the
        Caliphs of Bagdad                                        203

    Chapter XIX. Further Advance of the Arab Renaissance
        during the Ninth and Succeeding Centuries of the
        Christian Era                                            212

    Chapter XX. Hospitals and Monasteries in the Middle Ages     235

    Chapter XXI. Medical Instruction at Salerno, Italy, in the
        Middle Ages                                              243

    Chapter XXII. Early Evidences of the Influence of the
        Renaissance upon the Progress of Medicine in Western
        Europe                                                   259

    Chapter XXIII. Further Progress of Medicine and Surgery
        in Western Europe during the Thirteenth,  Fourteenth
        and a Part of the Fifteenth Centuries                    269

    Chapter XXIV. During the Latter Half of the Middle Ages
        Surgery Assumes the Most Prominent Place in the
        Advance of Medical Science                               292

    Chapter XXV. Brief History of the Allied Sciences--Pharmacy,
        Chemistry and Balneotherapeutics                         315


               PART III. MEDICINE DURING THE RENAISSANCE

    Chapter XXVI. Important Events that Preceded the
        Renaissance--Early Attempts to Dissect the Human Body    327

    Chapter XXVII. The Founders of Human Anatomy and Physiology  340

    Chapter XXVIII. Further Details Concerning the Advance in
        Our Knowledge of Anatomy.--Dissecting Made a Part of
        the Regular Training of a Medical Student.--Iatrochemists
        and Iatrophysicists.--The Employment of Latin in
        Lecturing and Writing on Medical Topics                  355

    Chapter XXIX. The Contributions Made by Different Men
        during the Renaissance, and More particularly by
        William Harvey of England, to Our Knowledge of the
        Circulation of the Blood, Lymph and Chyle                371

    Chapter XXX. Advances Made in Internal Medicine and in
        the Collateral Branches of Botany, Pharmacology,
        Chemistry and Pathological Anatomy                       387

    Chapter XXXI. Chemistry and Experimental Pharmacology        398

    Chapter XXXII. Some of the Leaders in Medicine in Italy,
        France and England during the Sixteenth and
        Seventeenth Centuries                                    411

    Chapter XXXIII. The Three Leading Physicians of Germany
        during the Latter Half of the Seventeenth Century:
        Franz de le Boë Sylvius, Friedrich Hoffmann and Georg
        Ernst Stahl                                              426

    Chapter XXXIV. Hermann Boerhaave of Leyden, Holland, one
        of the Most Distinguished Physicians of the Seventeenth
        Century                                                  438

    Chapter XXXV. General Remarks on the Development of
        Surgery in Europe during the Fifteenth and Sixteenth
        Centuries                                                446

    Chapter XXXVI. Surgery in Germany and Switzerland during
        the Fifteenth and Sixteenth Centuries                    454

    Chapter XXXVII. The Development of Surgery in Italy during
        the Renaissance                                          472

    Chapter XXXVIII. The Development of Surgery in Spain and
        Portugal during the Renaissance                          484

    Chapter XXXIX. The Development of Surgery in France during
        the Renaissance.--Pierre Franco                          490

    Chapter XL. The Development of Surgery in France
    (continued).--Ambroise Paré                                  499

    Chapter XLI. Surgery in Great Britain during the Sixteenth
        and Seventeenth Centuries                                516

    Chapter XLII. Reforms Instituted by the Italian Surgeon
        Magati in the Treatment of Wounds.--Final Ending of
        the Feud between the Surgeons and the Physicians of
        Paris.--Revival of Interest in the Science of
        Obstetrics                                               529

    Chapter XLIII. The First Appearance of Syphilis in Europe
        as an Epidemic Disease.--Medical Journalism.--The
        Beginnings of a Modern Pharmacopoeia.--Itinerant
        Lithotomists                                             542

    List of the More Important Authorities Consulted             557

    General Index                                                563




                         LIST OF ILLUSTRATIONS


    Fig. 1. View of the Temple of Aesculapius on the Island
              of Cos                              _facing page_   52

    Fig. 2. Bird’s-eye View of the Temple of Aesculapius and
              Associated Buildings on the Island of Cos
                                                  _facing page_   54

    Fig. 3. Ground Plan of the Asclepieion on the Island of Cos
                                                  _facing page_   55

    Fig. 4. Ancient Statue of the God Aesculapius in the Berlin
              Museum                              _facing page_   62

    Fig. 5. Head of the Marble Statue of the God Aesculapius in
            the Naples Museum                     _facing page_   62

    Fig. 6. Bas-relief of Aesculapius, Accompanied by Women and
              Children, in the Presence of an Enormous Serpent
                                                  _facing page_   68

    Fig. 7. Female Bust Showing Cancer of One Breast
                                                  _facing page_   68

    Fig. 8. Paralysis of the Left Facial Nerve    _facing page_   70

    Fig. 9. The Oldest Known Pictorial Representation of a
              Formal Dissection of the Human Body _facing page_   280

    Fig. 10. The Manner of Giving Public Instruction in Medicine
               during the Middle Ages                             281

    Fig. 11. Henri de Mondeville                  _facing page_   288

    Fig. 12. One of the Wards in the Hôtel-Dieu of Paris
                                                  _facing page_   304

    Fig. 13. The Physician, the Surgeon and the Pharmacist
                                                  _facing page_   306

    Fig. 14. Andreas Vesalius                     _facing page_   344

    Fig. 15. William Harvey                       _facing page_   380

    Fig. 16. “The Lovesick Maiden”                _facing page_   412

    Fig. 17. Thomas Sydenham                      _facing page_   418

    Fig. 18. Consultation by Three Physicians upon a Case of
               Wound in the Chest                                 457

    Fig. 19. Barber Surgeon (_Wundarzt_) Extracting an Arrow
             from a Wounded Soldier’s Chest while the Battle
             is Still in Progress                                 461

    Fig. 20. Amputation of the Leg                                463

    Fig. 21. The Manner in Which the So-called Tagliacotian
               Operation for Repairing a Defective Nose Should
               be Carried Out                                     480

    Fig. 22. Pierre Franco’s Forceps for Crushing Calculi in
               the Urinary Bladder                                497

    Figs. 23–24. Forceps Devised in 1552 by Ambroise Paré for
               Drawing Out the Cut Ends of Arteries after the
               Amputation of a Limb, and Holding Them while
               the Ligature is Being Applied                      512

    Fig. 25. Ambroise Paré the Famous French Surgeon of the
               Sixteenth Century                  _facing page_   514

    Fig. 26. Frère Jacques de Beaulieu            _facing page_   550

    Fig. 27. Jean Baseilhac, commonly Known in France as Frère
               Côme                                 _facing page_ 552

    Fig. 28. Concealed Lithotome Invented by Frère Côme in 1748   553




                                PART I

                           ANCIENT MEDICINE




                               CHAPTER I

            DEVELOPMENT OF THE SCIENCE AND ART OF MEDICINE


Friedlaender says that “in the temple of history, now hoary with age,
medicine also possesses its own chapel, not an accidental addition to
the edifice but a large and important part of the noble building.” In
this chapel is preserved the record of the efforts made by man, through
the ages, to maintain his body in good condition, to restore it to
health when it has become affected by disease or damaged by violence,
and to ward off the various maladies to which it is liable. It is a
record, therefore, in which every practitioner of medicine should
take a deep interest. Rokitansky, the famous pathologist of Vienna,
expressed the same idea very tersely when he said: “Those about to
study medicine and the younger physicians should light their torches at
the fires of the ancients.” Members of the medical profession, however,
are not the only persons in the community who take an interest in the
origin and growth of the science of medicine and the art of healing
the diseased or damaged body; the educated layman is but little less
interested than the physician, being ever ready to learn all he can
about the progress of a branch of knowledge which so profoundly affects
his welfare. But hitherto the only sources of information available for
those who are not familiar with French or German have been treatises
of so technical a character that even physicians have shown relatively
little disposition to read them.

The science of medicine developed slowly from very humble beginnings,
and for this earliest period the historian has no records of any kind
which may be utilized for his guidance. It is reasonably certain,
furthermore, that this prehistoric period lasted for a very long time,
probably several thousand years; and when, finally, some light on the
subject appeared, it was found to emanate from several widely separated
regions--_e.g._, from India, Mesopotamia, Egypt and Greece. Then,
after the lapse of additional hundreds or even thousands of years,
there was inaugurated the practice of making written records of all
important events, and, among others, of the different diseases which
affect mankind, of the means employed for curing them or for relieving
the effects which they produce, and of the men who distinguished
themselves in the practice of this art. While the “science of the
spade” and that of deciphering the writing of the papyri, monuments
and tablets thus brought to light, have already during the last half
century greatly altered our ideas with regard to ancient medicine,
there are good reasons for believing that much additional information
upon this subject may be looked for in the not distant future. It is
plain, therefore, that a history of the primitive period of medicine,
if written to-day, may have to be modified to-morrow in some important
respects. On the other hand, the facts relating to the later periods
are now so well established that a fair-minded writer should experience
no serious difficulty in judging correctly with regard to their value
and with regard to the claims of the different men to be honored for
the part which each has played in bringing the science and art of
medicine to their present high state of completeness and efficiency.

The subdivision of the history of medicine into separate periods
is certainly desirable, provided it be found practicable to assign
reasonably well-defined limits to the periods chosen. But, when the
attempt is made to establish such subdivisions, one soon discovers that
the boundaries pass so gradually the one into the other at certain
points, or else overlap so conspicuously at other points, that one
hesitates to adopt any fixed plan of classification. Of the four
schemes which I have examined--viz., those of Daremberg, of Aschoff,
of Neuburger, and of Pagel--that of Neuburger seems to me to be the
best. That which has been adopted, however, in the preparation of the
present outline sketch combines some of the features of both the Pagel
and the Neuburger schemes.

_Periods in the History of Medicine._--There are nine more or less
distinctly defined periods in the history of medicine, to wit:--

FIRST EPOCH: _Primitive medicine_.--This period extends through
prehistoric ages to a date which differs for different parts of the
world. The duration of this period, in any case, is to be reckoned by
thousands of years.

SECOND EPOCH: _The medicine of the East_--that is, of the cultivated
oriental races of whose history we possess only a very fragmentary
knowledge.

THIRD EPOCH: _The medicine of the classical period of antiquity_--the
pre-Hippocratic period of Greek medicine.

FOURTH EPOCH: _The medicine of the Hippocratic writings_--the most
flourishing period of Greek medicine.

FIFTH EPOCH: _The medicine of the period during which the centre of
greatest intellectual activity was located at Alexandria, Egypt_.

SIXTH EPOCH: _The medicine of Galen_--an author whose teachings exerted
a preponderating influence upon the thought and practice of physicians
in every part of the civilized world up to the seventeenth century of
the Christian era. This period is also characterized by the gradual
diminution of the influence of Greek medicine.

SEVENTH EPOCH: _The medicine of the Middle Ages_--a period which
includes a large part of the preceding epoch. Its most characteristic
feature is the important part played by the Arabs in moulding the
teachings and practice of the medical men of that time (ninth to
fifteenth century).

EIGHTH EPOCH (fifteenth and sixteenth centuries): _The medicine of the
Renaissance period_--characterized chiefly by the adoption of the only
effective method of studying the anatomy of man--the actual dissection
of human bodies.

NINTH EPOCH (from the beginning of the seventeenth century to the
present time): _Modern medicine_.--This epoch may with advantage be
divided into two periods--the first extending to about the year 1775,
soon after which time Jenner began his important work on the subject
of vaccination; and the second to the present time. No attempt will be
made in the following account to cover this second period.

_The Beginnings of Medicine._--In the early period of man’s existence
upon this earth he must have possessed an exceedingly small stock of
knowledge with regard to the maintenance of his body in health and with
regard to the means which he should adopt in order to restore it to a
normal condition after it had been injured by violence or impaired in
its working machinery by disease. With the progress of time, utilizing
his powers of observation and his reasoning faculty, he slowly made
additions to his stock of facts of this nature. Thus, for example, he
gradually learned that cold, under certain circumstances, is competent
to produce pain in the chest, shortness of breath, active secretion of
mucus, etc., and his instinct led him, when he became affected in this
manner, to crave the local application of heat as a means of affording
relief from these distressing symptoms. Again, when he used certain
plants as food he could scarcely fail to note the facts that some of
them produced a refreshing or cooling effect, that others induced a
sensation of warmth, and finally that others still, by reason of their
poisonous properties, did actual harm. Sooner or later, such phenomena
as nausea, vomiting and diarrhoea would also be attributed by him to
their true causes. In due course of time his friends and neighbors,
having made similar observations and having tried various remedial
procedures for the relief of their bodily ills, would come together and
compare with him their several experiences; and so eventually the fact
would be brought out that the particular method adopted by one of their
number for the relief of certain symptoms had proved more effective
than any of the others. Thus gradually this isolated community or tribe
of men must have learned how to treat, more or less successfully, the
simpler ills to which they were liable.

Lucien Le Clerc quotes from the Arab historian Ebn Abi Ossaïbiah the
following account of the manner in which bloodletting probably first
came to be adopted as a remedial measure:--

   Let us suppose that in the earliest period of man’s history
   somebody experienced the need of the medical art. He may, for
   example, have felt a general sense of heaviness in his body
   (plethora), associated perhaps with redness of the eyes, and
   he probably did not know what he should do in order to obtain
   relief from these sensations. Then, when his trouble was at its
   worst, his nose began to bleed, and the bleeding continued until
   he experienced decided relief from his discomfort. In this way
   he learned an important fact, and cherished it in his memory.

   On a later occasion he experienced once more the same sense of
   heaviness, and he lost no time in scratching the interior of his
   nose in order to provoke a return of the bleeding. The nosebleed
   thus excited again gave him entire relief from the unpleasant
   sensations, and upon the first convenient occasion he told his
   children and all his relatives about the successful results
   obtained from this curative procedure. Little by little this
   simple act, which was a first step in the healing art, developed
   into the intelligently and skilfully performed operation of
   venesection.

Primitive man also increased his stock of knowledge in the healing art
by reading attentively the book of nature,--_i.e._, by observing
how animals, when ill, eat the leaves or stems of certain plants and
thus obtain relief from their disorders. The virtues of a species of
origanum, as an antidote for poisoning from the bite of a snake, were
revealed, it is asserted, by the observation that turtles, when bitten
by one of these reptiles, immediately seek for the plant in question
and, after feeding upon it, experience no perceptible ill effects from
the poisonous bite. The natives of India ascribe the discovery of the
remarkable virtues of snakeroot (the bitter root of the ophiorrhiza
Mungos) as an antidote for poisoning by the bite of a snake, to the
ichneumon, a small animal of the rat species. The instinctive desire
to escape pain taught man, as it does the lower animals, to keep a
fractured limb at rest, thus giving the separated ends of the bone
an opportunity to reunite; after which the limb eventually becomes
as strong as it ever was. Simple as this mode of acquiring useful
medical knowledge may appear to us moderns, there are good reasons
for believing that hundreds of years must have elapsed before the
accumulated stock of such experiences became really considerable.
On the other hand, it is reasonable to suppose that this growth in
medical knowledge took place more rapidly in certain tribes or races
than in others, and that when, under the action of wars, the inferior
men became tributary to those of greater intellectual powers, they
acquired, through contact with their conquerors, additional knowledge
at a much more rapid rate. One great hindrance, however, stood in the
way of such progress. I refer to the deeply rooted belief, entertained
by man in this primitive period of his existence, in the agency of
malevolent spirits (demons) in the production of disease,--a belief
which continued to exist for many thousands of years. Out of such a
belief developed the necessity of discovering some practical method
of appeasing the evil spirits and of thus obtaining the desired cure
of the ills of the body. Usually some member of the tribe who had
displayed special skill in the treatment of disease, and who at the
same time was liberally endowed with the qualities which characterize
the charlatan, was chosen to be the priest or “medicine man.” It was
his duty to employ measures suitable for expelling the demon from the
patient’s body and for restoring the latter to health. Possessing
great influence, as these superstitious people believed he did, with
the unseen gods, such a physician-priest must have discouraged all
efforts to increase the stock of genuine medical knowledge; for such
an increase would necessarily mean a diminution of his own power and
influence.

In what must still be termed the age of primitive medicine, but
undoubtedly at an advanced stage of that epoch, there were performed
surgical operations which imply a remarkable advance in the invention
of cutting instruments and in the knowledge of the location and nature
of certain comparatively rare diseases, and at the same time great
courage and wonderful enterprise on the part of those early physicians.
As evidence of the correctness of these statements the fact may be
mentioned that trepanned skulls belonging to the neolithic period have
been dug up in various parts of the world--in most of the countries
of Europe, in Algiers, in the Canary Islands, and in both North and
South America. From a careful study of these skulls it has been learned
that the individuals upon whom such severe surgical work had been
done--sometimes as often as three separate times--recovered from the
operation. The instruments used were made of sharpened flint (saws or
chisels). Pain in the head, spasms or convulsions, and mental disorders
are suggested by Neuburger as the indications which probably led to
the performance of the trepanning. This author also makes the further
statement that the ancient Egyptians employed knives made of flint for
opening the dead bodies which they were about to embalm and for the
operation of circumcision. Recent excavations have thrown additional
light upon the state of medical knowledge during this neolithic
age. Thus, there have been found specimens of anchylosed joints, of
fractured bones, of flint arrow heads lodged in different parts of
the skeleton, of rhachitis, of caries and necrosis of bone, etc. The
following quotation is taken from the printed report of a lecture
recently delivered in London by Dr. F. M. Sandwith, Consulting Surgeon
to the Khedive of Egypt. Speaking of certain excavations made in the
Nubian Desert and of the oldest surgical implements yet discovered, he
says:--

   In one place a graveyard was found, and here were remains of
   bodies with fractured limbs that had been set with bark splints.
   One was a right thigh bone that had been broken, and was still
   held in position by a workmanlike splint and bandages. All the
   knots were true reef-knots, and the wrappings showed how the
   strips of palm-fibre cloth were set just as a good surgeon would
   set them in these days so as to use the full strength of the
   fabric.

Among the most ancient remedies may be mentioned talismans, amulets
and medicine stones, which were furnished--presumably at a price--by
the physician-priests, and which were believed to afford the wearers
protection against evil spirits (the “evil eye,” for example). Various
objects were used for this purpose, and among them the following
deserve to be mentioned: disks of bone removed with the aid of a
trephine from the skull of a dead human body and worn with a string
around the neck; the teeth of different animals; bones of the weasel;
cats’ claws; the lower jaw of a squirrel; the trachea of some bird; one
of the vertebrae of an adder, etc. And where these measures failed,
the priests resorted to incantations, religious dances, and the
beating of drums or the rattling of dried gourds filled with pebbles.
Primitive races of men inhabiting the most widely separated parts of
the earth appear to have adopted means almost identical with those
just described for driving away evil spirits. The holding of these
superstitious beliefs is one of the most extraordinary characteristics
of the human race. It played an important part throughout the classical
period of Greek and Roman civilization, and also during the Middle
Ages. Christianity undoubtedly was a most potent agency in hastening
the eradication of the feeling, but even this great power has not yet
sufficed entirely to do away with superstition; for traces of this
weakness may still easily be detected in some of the men and women with
whom we daily come in contact.




                              CHAPTER II

                           ORIENTAL MEDICINE


The researches of the scholar working in combination with the engineer
have unearthed--more particularly in Mesopotamia, in Egypt and in
Greece--evidences of an ancient medical science far advanced beyond
that briefly described in the preceding chapter. These evidences relate
to nations that flourished as far back as four thousand years B. C.
While they are very fragmentary and cover historical events which
are often separated from one another by long periods of time, these
data nevertheless suffice to give one a fairly good idea of the then
prevailing state of medical knowledge. Both Pagel and Neuburger adopt
the plan of discussing these different nationalities separately, and I
shall follow their example.

_Medicine in Mesopotamia._--As appears from the most recent
investigations the Sumerians were the first occupants of the region
lying between the Euphrates and the Tigris rivers. It was from them
that their Semitic conquerors, the Babylonians and the Assyrians,
received a civilization which, already about 4000 B. C., had
reached a wonderful degree of development. The canalization of the
low-lying lands of that region, the organization of a religious and
civil government of a most efficient type, the invention first of
picture-writing and then of the cuneiform characters, the cultivation
of the arts and natural sciences and especially of astronomy and
mathematics to a high degree of perfection,--these are among the things
which were accomplished by this very clever race of men. In addition,
however, to these useful activities the Babylonians developed and
cultivated diligently the science of astrology--that is, the science
of predicting human events (such as the death of the king, the
occurrence of the plague or of war, etc.) from various telluric and
cosmic phenomena--an eclipse of the sun, peculiarities of the weather,
the condition of vegetation, etc. The deeply rooted love of the human
race for the supernatural--a characteristic to which I have already
briefly referred--facilitated the development of this harmful practice,
and kept it alive through many succeeding centuries. Walter Scott, in
his romance entitled Quentin Durward, gives an admirable portrait of
a typical astrologer whom Louis XI. of France maintained at his court
during a part of the seventeenth century.

While in other parts of the Orient the science of medicine, as
already stated at the beginning of this chapter, made a noteworthy
advance beyond the conditions observed among the primitive races, in
Mesopotamia this science, which was far more important to the welfare
of its inhabitants than all the other branches of knowledge combined,
received very little attention and consequently made only insignificant
advances. The British Museum has in its possession several thousand
tablets which were dug up from the ruins of Nineveh and which represent
a part of the library of the Assyrian King, Assurbanipal (668–626 B.
C.). Translations of the text of only a very few of these tablets have
thus far been published, and from these, which embody the greater
part of our knowledge of Assyrian medicine, it appears that, for the
present at least, the estimate recorded above must stand. A few new
facts, however, have been brought to light, and they appear to be of
sufficient importance to merit brief consideration here.

In the first place, Herodotus, who visited Babylon about 300 B. C., has
this to say in relation to the state of medicine in that city:--

   The following custom seems to me the wisest of their
   institutions next to the one lately praised. They have no
   physicians, but, when a man is ill, they lay him in the public
   square, and the passers-by come up to him, and if they have
   ever had his disease themselves or have known any one who has
   suffered from it, they give him advice, recommending him to do
   whatever they found good in their own case, or in the case
   known to them; and no one is allowed to pass the sick man in
   silence without asking him what his ailment is.[2]

The Babylonians held some rather strange beliefs regarding the
construction of the human body and the manner in which its functions
are performed. The living being, as they maintained, is composed of
soul and body. The intellect has its seat in the heart, the liver
serving as the central organ for the blood, which they considered to be
the true life principle. They divided this fluid into two kinds--blood
of the daytime (bright arterial) and that of the night (dark venous).
Although the blood was held by them to be the basis of life, they
evidently attached a certain value to respiration, for one of their
prayers begins with these words: “God, my creator, lead me by the
hand; guide the breath of my mouth.” Disease was always looked upon as
something (usually personified as a demon) that entered the body from
without and that consequently had to be expelled. There were special
demons for the different diseases. Thus, Asakku brought fever to the
head, Namtar threatened life with the plague, and Utukku attacked the
throat, Alu the breast, Gallu the hand, Rabisu the skin, and so on. The
most dreaded demons were the spirits of the dead. Special amulets were
employed as protective remedies. Prayer formulae were also used. Here
is one among several that I find mentioned in Neuburger’s treatise:--

   Wicked Consumption, villainous Consumption, Consumption which
   never leaves a man, Consumption which cannot be driven away,
   Consumption which cannot be induced to leave, Bad Consumption,
   in the name of Heaven be placated, in the name of Earth I
   conjure thee!

The genuine remedial agents employed in Babylonia were of a most
varied nature: a mixture of honey and syrup of dates; medicinal herbs
of different kinds for internal administration; bloodletting; the use
of cups for drawing blood to the surface of the body; warm baths and
cold shower baths; rubbing oil over the body; medicated clysters; the
use of various salves; the use of secret remedies which were composed
of various ingredients and which bore such names as “the Sun God’s
remedy,” “the dog’s tongue,” “the skin of the yellow snake,” “the
medicine brought from the mountain of the human race,” etc.

Some of the predictions made by the Babylonian astrologers are of
sufficient interest to be placed on record. Here are a few examples:--

   If the west wind is blowing when the new moon is first seen,
   there is likely to be an unusual amount of illness during that
   month.

   If Venus approaches the constellation of Cancer, there will be
   respect for law and prosperity in the land; those who are ill
   will recover, and pregnant women will have easy confinements.

   If Mercury makes its appearance on the fifteenth day of the
   month, there will be corpses in the land. And again, if the
   constellation of Cancer is obscured, a destructive demon will
   take possession of the land, and there will be corpses.

   If Jupiter and the other planets stand opposite one another,
   some calamity will overtake the land. If Mars and Jupiter come
   into conjunction, there will be deaths among the cattle.

   If an eclipse of the Sun take place on the twenty-eighth day
   of the month Ijar, the king will have a long reign; but, if it
   take place on the twenty-ninth day of the month, there will be
   corpses on the first day of the following month.

   If there should be thunder during the month of Tisri, a spirit
   of enmity will prevail in the land; and if it should rain during
   that month, both men and cattle will fall ill.

Besides these predictions, which were based upon phenomena connected
with the movements of the stars and the conditions of the weather,
there were others which the people themselves were competent to make
without the aid of the professional astrologer or the official priest.
Such, for example, are the following “omens”:--

   If a woman gives birth to a child the right ear of which is
   lacking, long will be the reign of the prince of that land.

   If a woman gives birth to a child both of whose ears are
   lacking, sadness will come upon the land and it will lose some
   of its importance.

   If a woman gives birth to a child whose face resembles the beak
   of a bird, there will surely be peace in the land.

   If a woman gives birth to a child the right hand of which lacks
   fingers, the sovereign of that country will be taken prisoner by
   his enemies.

The keen interest taken by the priests in the matter of predicting the
outcome of various diseases led in due time to their making records
of the nature, symptoms and progress of the latter. Although this
practice was inaugurated purely for the purpose of enabling them to
foretell with greater accuracy the probable issue of any given malady,
it nevertheless served also to establish on a firm basis the custom
of keeping records of the case-histories. Only one thing more was now
needed to render this practice the first step in a genuine advance of
medical knowledge; but this step could not be made in Babylonia, where
priestcraft and superstition had struck such deep roots in the public
life. It was only in free Greece, and at a time in its history when
the spirit of Hippocrates exerted an overpowering influence over the
minds of men, that the separation of the functions of the physician
from those of the priest became possible and was in due time effected.
(Neuburger.)

Before closing this very incomplete account of the state of medical
knowledge in Babylonia, it will be well to mention some of the items of
the law laid down by Hammurabi (circa 2200 B. C.) for the guidance of
the physicians of that land with regard to the remuneration which they
should receive. At the same time I shall make no attempt to reconcile
the statement of Herodotus (given on page 12) with the wording of
this law, which distinctly recognizes the existence of physicians in
Mesopotamia. Possibly the conditions in Nineveh in the fourth century
B. C. were different from what they had been eighteen centuries earlier.

   If a physician makes a deep cut with an operating knife of
   bronze and effects a cure, or if with such a knife he opens a
   tumor and thus avoids damaging the patient’s eye, he shall
   receive as his reward 10 shekels of silver. If the patient is
   an emancipated slave, the fee shall be reduced to 5 shekels. In
   the case of a slave the master to whom he belongs shall pay the
   physician 2 shekels.

   If a physician makes a deep wound with an operating knife of
   bronze and the patient dies, or if he opens a tumor with such a
   knife and the patient’s eye is thereby destroyed, the operator
   shall be punished by having his hands cut off.

   If a physician, in operating upon the slave of a freedman, makes
   a deep wound with an operating knife of bronze and thus kills
   the patient, he shall give the owner a slave in exchange for the
   one killed. And if, in opening a tumor with such a knife, the
   physician destroys the slave’s eye, he shall pay to the latter’s
   owner one-half the slave’s value.

   If a physician effects the healing of a broken bone or cures a
   disease of the intestines, he shall receive from the patient a
   fee of 5 shekels of silver.[3]

It would be difficult to imagine anything better adapted to arrest the
development of medical knowledge in a nation than the promulgation of a
law like that ascribed to Hammurabi; and one cannot be surprised at the
statement made by Herodotus, eighteen centuries later, “that there were
no physicians in Babylon.” Foolhardy, indeed, would be the man who, for
the sake of earning a possible reward of six shekels of silver, would
be willing to risk the danger of having both his hands cut off; and yet
every conscientious and faithful practitioner of medicine in Babylon at
the time mentioned must necessarily have been obliged to run this risk.

_Medicine in Ancient Egypt._--Of the sources of information with
regard to the knowledge of medicine possessed by the ancient Egyptians
the most important are the following: Homer’s Odyssey; Herodotus;
Diodorus; Clemens of Alexandria; Pliny’s Natural History; Dioscorides;
the Papyrus Ebers; the Papyrus Brugsch; and the Papyrus Birch, in the
British Museum. Then, in addition to these sources, there are the
inscriptions found in recent times on the walls of the temples and
the pictures painted on the wrappings of mummies, from both of which
considerable information with regard to various therapeutic procedures
and to the details of the process of embalming has been derived. Some
of this information extends back to about 3000 B. C. The healing art
was at that time entirely in the hands of the temple priests, who
formed an organized body with a sort of physician-in-chief at its head.
Two of these--Athotis and Tosorthos--attained such a high standing and
possessed such influence that they were chosen Kings of Egypt. The
practice of obstetrics was entrusted to the care of women who had been
trained to this work and who acknowledged the authority of a skilled
head-nurse of their own sex. The patients who had received treatment
for their ailments at one or other of the temples presented to these
institutions gifts in the form of sculptured or painted representations
of the diseased or injured parts of the body. In these and in other
ways medicine and pharmacy received contributions which were of no mean
value. Botanical gardens were established at various places in Egypt
and were cultivated with care. Chemistry--a name which derives its
origin from a word in the Egyptian language--also made considerable
progress as a science. On the other hand, the knowledge of the
structure and functions of the different parts of the human body was
very imperfect and remained unchanged for many centuries. This would
probably not have been the case if the work of preparing the bodies
for the process of embalming had not been entrusted entirely to mere
menials, men who had no interest in anything but the mechanical part of
their occupation.

According to the statement of Clemens of Alexandria[4] the Egyptian
science of medicine is set forth in the last six of the forty-two
hermetic books, which were composed, according to the prevailing
belief, by the god Thot or Thoüt (= Hermes of the Greeks). The first
one of these six books is devoted to the anatomy of the human body,
the second one to the diseases to which it is liable, the third to
surgery, the fourth to remedial agents, the fifth to the diseases of
the eye, and the sixth to diseases of women. As to the remedial agents,
Neuburger says that it has not been found practicable to identify more
than a very few of the Egyptian drugs enumerated by Dioscorides. Homer,
who wrote at least five hundred years B. C., has something to say on
this subject in the Odyssey.[5] His words are as follows:--

    Such drugs Jove’s daughter owned, with skill prepar’d,
    And of prime virtue, by the wife of Thone,
    Aegyptian Polydamna, given her.
    For Aegypt teems with drugs, yielding no few
    Which, mingled with the drink, are good, and many
    Of baneful juice, and enemies to life.
    There every man in skill medicinal
    Excels; for they are sons of Pason[6] all.

A physician of the present age, on reading the histories of the
ancient Egyptians, Greeks and other oriental nations, finds it almost
impossible to realize that many of the characters designated as gods
and goddesses, possibly all of them, were not mythological persons, as
they would have been termed only a few years ago, but real human beings
like ourselves. Such, for example, was the opinion of Cicero who, when
asked why these people were spoken of as gods, gave the following
reply:[7] “It was a well-established custom among the ancients to deify
those who had rendered to their fellow men important services, as
Hercules, Castor and Pollux, Aesculapius, Bacchus and many others had
done.” And I find that those modern authors of the history of medicine
whose works I have consulted, are quite ready to accept even the gods
called by the Egyptians Osiris (or Serapis), Isis, and Thoüt (or
Hermes) as genuine historical personages. Such a belief receives some
degree of confirmation from the following inscriptions which, according
to the authority of Le Clerc,[8] were found engraved upon two columns
discovered in the city of Nyoa, in Arabia:--

   (On the first column): My father is Cronos, the youngest of
   all the gods. I am King Osiris, who have visited with my
   armies every country on the face of the earth--the remotest
   inhabitable parts of India, the regions lying beneath the Bear,
   the neighborhood of the sources of the Danube, and the shores
   of the Ocean. I am the oldest son of Cronos, the scion of a
   fine and noble race. I am related to the day. There is no part
   of the earth which I have not visited, and I have filled the
   entire universe with my benefits. (On the second column): I
   am Isis, Queen of all this country, and I have been taught by
   Thoüt. There is nobody who has the power to loosen what I shall
   bind. I am the oldest daughter of Cronos, the youngest of the
   gods. I am the wife and at the same time the sister of King
   Osiris. To me is due the credit of having been the first to
   teach men agriculture. I am the mother of King Horus. I shine in
   the dog-star. It is I who built the city of Bubastis. Farewell,
   Egypt, my native land.

The discovery of the art of medicine, says Le Clerc, was attributed to
Osiris and Isis, and they were also credited with having taught it to
Aesculapius.

At the cities of On (Heliopolis), Sais, Memphis and Thebes were located
the most celebrated of the Egyptian temples, which were dedicated
not merely to the worship of their numerous gods, but also to the
dissemination of knowledge of various kinds and to the care of the
sick and maimed. In a word, they were--like the Aesculapian temples at
Trikka, Epidaurus and Cos, of which some account will be given farther
on--both hospitals for the treatment of disease and schools for the
training of physicians. The chief priest of the temple bore also the
title of the “physician-in-chief,” and exercised the prerogatives of
a chief magistrate. Under this system medical knowledge advanced to
a certain stage and then made no further progress. The preponderance
of the priestly (_i.e._, the superstitious) influence was too
pronounced to permit anything like real progress.

The papyrus Ebers makes mention of a number of diseases, and among them
the following may be noted: abdominal affections (probably dysentery),
intestinal worms, inflammations in the region of the anus, hemorrhoids,
painful disorders at the pit of the stomach, diseases of the heart,
pains in the head, urinary affections, dyspepsia, swellings in the
region of the neck, angina, a form of disease of the liver, about
thirty different affections of the eyes, diseases of the hair, diseases
of the skin, diseases of women, diseases of children, affections of the
nose, ears and teeth, tumors, abscesses and ulcers.

In the matter of diagnosis the Egyptian physicians not only employed
inspection and palpation, but were in the habit of examining the urine.
A statement made in the papyrus Ebers is good ground for the belief
that they also employed auscultation to some extent.

Therapeutics constituted beyond all question the strongest part of
Egyptian medicine. As might be expected from the strange mixture of the
priest and the medical man in every physician, the remedial measures
commonly employed consisted in part of prayers and incantations, and
in part of rational procedures and the use of drugs. Among the latter
class of remedies the following deserve to be mentioned: emetics,
cathartics and clysters. Bloodletting, sudorifics, diuretics and
substances which cause sneezing were also often employed in Egypt. To
produce vomiting the favorite agents were the copper salts and oxymel
of squills. Castor oil disguised in beer was given as an aperient.
Pomegranate was the drug preferred for the expulsion of worms.
Mandragora and opium were also employed as remedies. Foreign drugs
were largely imported by the Phoenicians, and in their successful
campaigns against Asiatic nations the Egyptians learned much about
the use of these rarer remedies. The different forms in which the
Egyptians administered their remedies included potions, electuaries,
gums to be chewed but not swallowed, gargles, snuffs, inhalations,
salves, plasters, poultices, injections, suppositories, clysters and
fumigations. The physicians, in their practice, were subjected to very
strict rules regarding the amount of the doses to be given and the
manner of administering the different remedies, and consequently they
received no encouragement to indulge in any individuality of action.
The prescriptions were written in very much the same manner as are
those of to-day; that is, they contained the fundamental or important
drugs, certain accessory materials, and something which was intended
merely to correct the unpleasant taste of the mixture. In comparison
with those commonly written at a somewhat later period these ancient
prescriptions were of a very simple character.

Up to the present time the researches of the archaeologists have thrown
comparatively little light on the surgery of the ancient Egyptians.
The facts already ascertained, however, are sufficient to warrant the
statement that they had reached a degree of knowledge and skill in
this department of medicine well in advance of that reached by any of
their contemporaries. They performed the operations of circumcision
and castration, and they removed tumors, and their eye surgeons were
especially renowned for the work which they accomplished in their
special department. Their skill in manufacturing surgical instruments
is amply revealed in the specimens--instruments for cupping, knives,
hooks, forceps of different kinds, metal sounds and probes, etc.--which
have been dug up at the various sites of ancient ruins. They must also
have possessed considerable manual skill, for without it they could
not, in embalming a corpse, have removed the entire brain from the
skull with a long hook, by way of the nasal passages, and at the same
time have left the form of the face undisturbed.

From Joachim’s German translation of the papyrus Ebers,[9] as quoted by
Neuburger, I copy the following passages:--

   If thou findest, in some part of the surface of a patient’s
   body, a tumor due to a collection of pus, and dost observe
   that at one well-defined spot it rises up into a noticeable
   prominence, of rounded form, thou should’st say to thyself: This
   is a collection of pus, which is forming among the tissues; I
   will treat the disease with the knife.... If thou findest, in
   the throat of a patient, a small tumor containing pus, and dost
   observe that it presents at one point a well-defined prominence
   like a wart, thou may’st conclude that pus is collecting at
   this point.... If thou findest, in a patient’s throat, a fatty
   growth which resembles an abscess, but which yields a peculiar
   sensation of softness under the pressure of the finger, say to
   thyself: this man has a fatty tumor in his throat; I will treat
   the disease with the knife, but at the same time I will be
   careful to avoid the blood-vessels.

These short extracts will suffice to show that the Egyptian physicians
of that early period--at least 1550 B. C.--reasoned about pathological
lesions in very much the same manner as a physician of to-day would
reason. In this same ancient papyrus, however, foolish as well as
sensible statements appear. Thus, for example, mention is made on the
one hand of the fact that, in order to give a certain remedy to an
infant, it is sufficient to administer it to the nurse who suckles the
child (a proceeding which is not uncommon in our own day); and then,
in another part of the text, it is stated that “if, on the day of its
birth, the infant does not cry, it will surely live; but, if it says
‘ba,’ it will die.”

In matters relating to personal hygiene the ancient Egyptians often
displayed a remarkable degree of common sense. They maintained, for
example, that the majority of diseases are due to the taking of
food in excessive quantity; and, in harmony with this belief, they
introduced the custom of devoting three days out of every thirty to
the taking of emetics and clysters. Perhaps it was to this custom
that they owed their good health,--a fact to which both Herodotus and
Diodorus testify. In principle this practice agrees with that adopted
by modern physicians, who omit the emetics and substitute for the
clysters the drinking of certain mineral waters during a limited period
of the summer season and under the very agreeable surroundings of a
comfortable hotel at Carlsbad, Ems, Wiesbaden or Saratoga. While the
monthly plan of purging the system of harmful elements must certainly
have been the more effective of the two, it cannot for a moment be
doubted that exceedingly few moderns would be willing to subject
themselves to such a régime.

In still other ways the ancient Egyptians displayed a most intelligent
respect for every measure that tended to promote the general health of
the community. They took care, for example, to prevent the entrance
of decomposing materials into the soil and the ground water; priests
skilled in work of this character made careful inspections of all meats
that were to be used for food; stress was laid upon the importance of
keeping the dwelling houses clean; the people were taught the value
of bathing the body frequently, of cultivating gymnastic exercises,
of clothing themselves suitably, and of employing the right sort of
diet. At a still later period of their history they adopted the custom
of drinking only water that had been either boiled or filtered. A
particular kind of beer, the gift of their first king, Osiris, was
the favorite beverage of the people. It was made from barley and
doubtless possessed intoxicating properties, as is suggested by one
of the papyrus texts in which the following charge is brought against
a student: “Thou hast abandoned thy books and art devoting thyself to
idle pleasures, going from one beer-house to another. Thou smellest so
strongly of beer that men avoid thee.”

A large proportion of the sources of information regarding the medicine
of the ancient Egyptians have been brought to light during recent
years, but so many gaps in the series still remain unfilled that it is
not possible to furnish more than a disconnected and very imperfect
account. Archaeological investigations, however, are being conducted
with vigor and new discoveries are reported almost every month. There
are therefore good reasons for hoping that, in the course of the next
few years, much additional light will be shed on the mode of life and
accomplishments of these pioneers of civilization, who, before they
passed out of history, succeeded in attaining the highest degree of
cultivation in the science and art of medicine that had up to that
time been attained by any other nation. One thing is certain, says
Neuburger, they exerted a powerful influence upon the beginning of
medicine in Greece and upon the social hygiene of the Jewish people,
and therefore upon the human race at large.




                              CHAPTER III

                     ORIENTAL MEDICINE (Continued)


_The Medicine of the Ancient Persians._--After Cyrus the Great had
put an end to Babylon as a power among the nations the Persians became
the leaders in all the affairs not merely of Asia Minor but also of
the entire country from India to the shores of the Mediterranean; in
fact, they eventually also gained control of the land of the Pharaohs.
Notwithstanding the completeness of the political power which they
possessed over these conquered races, they permitted them to retain
their respective religions and even their individual languages;
as evidence of the correctness of which last statement the modern
discovery of inscriptions written in the three principal tongues may be
mentioned. The remarkable degree of general culture which existed at
Babylon at the time of the Persian conquest, and which the Sumerians
and Semites had originally introduced, was left undisturbed by the
political change.

So far as we possess any knowledge regarding the medicine of the
ancient Persians, this information has been derived, according to
Neuburger, from the Zend-Avesta--one of the ancient religious writings
preserved by the Parsees. It furnishes comparatively few facts of
special interest to physicians. In the main, the practice of medicine
must have differed very little from that employed by the earliest
Babylonian physicians, and briefly described on pages 11–16. There are
one or two additional matters, however, which deserve to be mentioned
here. It was maintained, for example, that the touching of a corpse
produced a special contamination, a belief which interfered most
seriously with the study of anatomy, and therefore prevented any
real advance in medical knowledge. Then, again, the ancient Persians
appear to have taken comparatively little interest in surgery, for it
is said that King Darius I. was obliged, when he needed treatment for
a badly sprained ankle, to send for a Greek physician. Finally, there
may be found in Herodotus the following statement, which shows that the
Persians had learned something of value, in practical hygiene, from
their neighbors, the Egyptians:--

   The Great King (Cyrus), when he goes to the wars, is always
   supplied with provisions carefully prepared at home, and with
   cattle of his own. Water, too, from the river Choaspes, which
   flows by Susa, is taken with him for his drink, as that is the
   only water which the kings of Persia taste. Wherever he travels,
   he is attended by a number of four-wheeled cars drawn by mules,
   in which the Choaspes water, ready boiled for use, and stored in
   flagons of silver, is moved with him from place to place.[10]

Neuburger makes the remark that the ancient Persians are entitled to
the gratitude of later generations for the valuable service which they
rendered the science of medicine, inasmuch as, during the dynasty of
the Sassanide princes (fifth century A. D.) and at a time when European
culture was hastening to its destruction, they gave shelter both to
classical culture in general and to the medical knowledge of the
Greeks, and then afterward handed it over to the conquering Arabs, who
passed it on to our forefathers.

_The Medicine of the Old Testament._--There are no medical
writings which give any information concerning the science and art of
medicine as possessed by the ancient Israelites, but the Bible contains
a number of passages that refer to matters which belong in the domain
of medicine, and more particularly in that of social hygiene. The
mosaic laws were framed with a view to the good of the Jewish people
as a whole, and were directed to such matters as the prevention and
suppression of epidemic diseases, the combating venereal affections
and prostitution, the care of the skin, the systematizing of work,
the regulation of sexual life, the intellectual cultivation of the
race, the provision of suitable clothing, dwellings and food, the use
of baths, etc. Many of these laws--like those, for example, which
prescribe rest on the Sabbath day, circumcision, abstinence from eating
the flesh of the pig, the isolation of persons affected with leprosy,
the observation of hygienic rules in camp life, etc.--testify to a
remarkably high degree of the power to reason correctly; and, when
considered in the light of modern science, they seem to justify the
prediction made in Deuteronomy iv., 6. A similar prediction (supposed
to be spoken by God from Mount Sinai) is made in Exodus xix., 6: “And
ye shall be unto me a kingdom of priests, and an holy nation.” That a
large part of the credit given to Moses for the wisdom displayed in
these sanitary laws really belongs to the Egyptians is shown by the
text of Acts vii., 22: “And Moses was learned in all the wisdom of the
Egyptians, and was mighty in words and in deeds.”

As regards the manner in which the Israelites treated the diseases
which afflicted them the Bible furnishes ample proof of the fact
that they placed their chief reliance upon prayers, sacrifices, and
offerings at their temples, and made comparatively small use of
medicinal agents, dietetic measures, and external applications. The
favorable effect of David’s harp-playing upon the melancholia of King
Saul furnishes the only instance, to be found in the Bible, of the
curative value of music in certain mental disorders.

The story of Naaman (2 Kings v.) deserves to be mentioned briefly here.
He was captain of the host of the King of Syria (about 894 B. C.) and
a man of valor, highly esteemed by his master, but he was--according
to the Bible statement--a leper. Learning casually that there was
in Samaria a prophet who might be able to cure his disease, he put
a large sum of money into his sack and departed for that country.
“So Naaman came with his horses and with his chariot, and stood at
the door of the house of Elisha. And Elisha sent a messenger unto
him, saying, Go and wash in Jordan seven times, and thy flesh shall
come again to thee, and thou shalt be clean.” Naaman, at first much
displeased with the advice given to him by Elisha, and especially by
the very informal manner in which it had been communicated to him,
finally decided to follow the prophet’s instructions. “Then went he
down, and dipped himself seven times in Jordan, ... and his flesh came
again like unto the flesh of a little child, and he was clean. And he
returned to the man of God, ... and came, and stood before him; and
he said, Behold, now I know that there is no God in all the earth,
but in Israel: now therefore, I pray thee, take a blessing of thy
servant.” Elisha, however, refused persistently to accept any reward
for the advice which he had given. He simply said to Naaman: “Go in
peace.” Before he departed, however, Naaman expressed to Elisha the
hope that he would be pardoned if he yielded to the necessity of bowing
down to the god Rimmon on certain occasions--as, for example, when he
accompanied his master, the king, on his visits to the temple of that
god for the purposes of worship. From the evidence furnished by this
account, as given in the Old Testament, it is fair to assume that both
Naaman and the writer of the book of Kings believed that the cure had
been effected by supernatural means. The modern physician, however,
is not ready to accept such an interpretation of the manner in which
Naaman’s cure was effected, but prefers to believe that the supposed
leprosy was in reality some curable form of skin disease which to
the unprofessional eye appeared like the other malady. It might, for
example, have been an aggravated general eczema, dependent upon such
excesses of eating and drinking as a wealthy captain of the king’s host
would be likely to indulge in. And if this supposition is correct, one
cannot but admire the great practical wisdom of Elisha in advising
Naaman to take seven baths--one a day presumably--in the river Jordan,
a spot so far removed from his home that it would scarcely be possible
for him to obtain any but the simplest kind of diet during this
comparatively long period of time.

An interesting case of snake-bite is briefly related in Acts xxviii.,
3–6. It is stated that “when Paul (after being shipwrecked on the
Island of Melita) had gathered a bundle of sticks, and laid them on the
fire, there came a viper out of the heat, and fastened on his hand. And
when the barbarians saw the venomous beast hang on his hand, they said
among themselves, No doubt this man is a murderer, whom, though he hath
escaped the sea, yet vengeance suffereth not to live. And he shook off
the beast into the fire, and felt no harm. Howbeit they looked when he
should have swollen, or fallen down dead suddenly: but after they had
looked a great while, and saw no harm come to him, they changed their
minds, and said that he was a god.” This narrative is interesting in
several respects, but there is one feature that deserves to receive
special mention, viz., the fact that Paul experienced no harm from the
bite of a poisonous serpent--a wound which frequently proves fatal.
Inasmuch as the account distinctly states that the reptile “fastened on
his hand” and that “the barbarians saw the venomous beast hang on his
hand,” the conclusion is warranted that one or both of the creature’s
fangs had entered the hand by a curving route, and probably in such
a manner that the free end of each fang, from which the poison is
ejected, passed completely through the skin from within outward. When
the bite of a poisonous snake is of a character such as I have just
described,--and not a few of them have this character,--only a very
small quantity of the venom is lodged in the subcutaneous tissues,
where the larger blood- and lymph-channels lie, and as a consequence the
person bitten escapes serious harm. On the other hand, when the fangs
enter the flesh in a less decidedly curving direction, thus permitting
a greater quantity of the venom to reach and remain in the deep-lying
tissues, serious or even fatal results may be anticipated. The point,
then, which I desire to make is simply this: Paul’s escape from death
in this instance may perfectly well be ascribed to natural causes.

The Israelites, at a certain stage of their history, appear to have
completely divorced the practice of medicine from the priestly
function. In one place, for example, it is stated that King Asa sought
relief from his ailment, not from Jehovah, but from the physicians.
Jeremiah expresses astonishment that not a single physician is to
be found in Gilead. May this not be interpreted as signifying that
regularly established physicians were at that time (595 B. C.) to be
found in some parts of Palestine? And, at a much earlier period (1500
B. C.), Job calls his friends “physicians of no value” (Job xiii.,
iv.). From these and a number of other statements in the Bible it seems
permissible to believe that, at a very early period of history, the
Jewish physicians occupied an entirely independent position.

It would doubtless appear strange to most readers of this brief sketch
of the history of medicine if some reference were not made in this
place to Luke, the author of the gospel which bears his name and of
the Acts of the Apostles, and who was also the companion of Paul on
his journey to Rome and during a portion of the latter’s stay in that
city. Luke was a native of Antioch, in Syria, and not a Jew. He was
a physician and tradition says that he was also a painter. It is not
known where he received his medical training, but it is not at all
unlikely that he studied at Alexandria, in Egypt, where the greatest
facilities for such training, obtainable at that period, were to
be found. His style of writing shows plainly that he was a man of
considerable cultivation and endowed with a clear and logical mind; and
if he had not possessed a genial personality he would hardly have been
known as “the beloved physician”; nor could any other motive but those
of loyal, self-sacrificing friendship for his friend, and a desire to
promote the cause of Christianity, have led him to share with Paul the
dangers and discomforts of the journey to Rome.

_The Medicine of India, China and Japan._--It would be too much
of a departure from the plan which is being followed in the writing of
this history to attempt to describe, even in the briefest manner, the
mode of development of the science and art of medicine in India, China
and Japan. Unquestionably the earlier physicians of these countries
made many valuable contributions to medical knowledge, but they were
made at such a period of time, or under such conditions, that they
could not have exerted an appreciable influence upon the development
of medicine in ancient Greece,--certainly no such influence as was
exerted by Assyria and Persia, and especially by Egypt. It therefore
seems permissible to speak of the medicine of these more remote
countries only incidentally, and not as an integral part of the series
of centres of learning which made the medicine of ancient Greece the
direct ancestor--if I may use such a term--of European medicine.[11]
In conformity with this idea it will be well to mention here briefly
a few of the more important facts relating to the achievements of the
physicians of the three countries named.

The most celebrated medical authors in India were Caraka, Súsruta and
Vagbhata--“The ancient trinity,” as they were called. Caraka probably
lived during the early part of the Christian era, Súsruta during the
fifth century, and Vagbhata not later than during the seventh century
A. D. It is apparent, therefore, that none of the treatises written
by these authors could have exerted the slightest influence upon the
growth of medical knowledge in ancient Greece.

The crudeness of many of the conceptions held by these Hindu physicians
concerning pathology is revealed in the following definition:
“Health is the expression of the normal composition of the three
elementary substances (air, mucus and bile) which play a vital
part in the machinery of the human body, and it is also dependent
upon the existence of normal quantitative relations between these
three substances; and when the latter are damaged, or when they are
abnormally increased or diminished, then disease of one kind or another
makes its appearance.”[12]

Great stress was laid by the physicians as well as by the priests of
ancient India upon the observance of very elaborate rules respecting
the care of the person while in health and, very naturally, when a
patient became ill the physician in charge paid quite as much attention
to the employment of hygienic and dietetic measures in effecting the
desired cure as to the administering of drugs.

The list of the commonly employed hygienic measures is too long for
reproduction in its entirety in this brief sketch, but an enumeration
of some of the more important items may prove interesting. In
estimating the value of these rules the reader should bear in mind
that they were intended for people living in a hot climate. Daily
bathing heads the list. Then follow: regulation of the bowels; rubbing
the teeth with fresh twigs of certain trees which possess astringent
properties, and also brushing them twice a day; rinsing the mouth with
appropriate washes; rubbing the eyes with salves; anointing the body
with perfumed oils; cutting the nails every five days, etc. Two meals
a day were prescribed--the first one between nine in the morning and
noon, and the second between seven and ten in the evening. “Only a
moderate amount of water should be drunk during the meal; drinking
water at the beginning of a meal delays digestion, while a copious
draught at the end produces obesity. After the meal the mouth should
be carefully cleansed and a short walk should be taken.” Among the
more important articles of food the following deserve to be mentioned:
rice, ripe fruit, the ordinary vegetables, ginger, garlic, salt, milk,
oil, melted butter, honey and sugar cane. If meat is eaten, preference
should be given to venison, wild fowl and the flesh of the buffalo.
The meat of the pig, and beef, as well as fish, are less conducive
to health. Gymnastic exercises in moderation are beneficial. Sleep
should be indulged in during the day only after some specially severe
exercise; at night it should not be extended beyond one hour before
sunrise. Bathing immediately after eating is harmful, and it is not to
be indulged in when one is affected with a cold, with a high fever,
with diarrhoea, or with some disease of the eyes or ears. A hot bath
or washing with warm water may be beneficial for the lower half of the
body, but for the upper half it is harmful. Sea bathing and cold baths
(preferably in the river Ganges) are beneficial. The clothing worn
should be clean; soiled garments are likely to produce skin diseases.
It is advisable to wear shoes, and an umbrella or a staff should be
carried. The wearing of garlands, finery, and jewels increases the
vital powers and keeps away evil spirits. The following are good
measures to adopt for the preservation of health: an emetic once a
week; a laxative once a month; and a bloodletting twice a year. All
the measures enumerated above were subject to modification according
to changes in the season, the locality, the weather, and various other
circumstances.

In harmony with the extraordinary fruitfulness of the land the
pharmacopoeia of India is very rich. It is a remarkable fact that not
one of the numerous drugs mentioned in the official list is of European
origin. The great majority of them belong to the vegetable kingdom;
Caraka stating that he knew of 500 plants that possessed remedial
virtues, while Súsruta placed the number at 760. Then, too, the list
contains a goodly number of drugs which belong, some to the animal and
others to the mineral kingdom. It appears that the physicians of India
began using mineral substances, both externally and internally, at a
very early period of their history. Among such substances the following
may be mentioned: sulphate of copper, sulphate of iron, sulphate of
lead, oxide of lead, sulphur, arsenic, borax, alum, potash, chloride
of ammonium, gold, precious stones of different kinds, etc. The people
of India were skilled in chemical and pharmaceutical work. The drugs
were prepared by them in a great variety of ways--as, for instance,
extracts of the juices of plants, infusions, decoctions, electuaries,
mixtures, syrups, pills, pastes, powders, suppositories, collyria,
salves, etc. Practicing physicians carried with them a sort of portable
medicine chest, and they often collected, themselves, the medicinal
plants which they required. Súsruta gives instructions as to the spots
where certain plants are most likely to be found, and as to the seasons
when they should be gathered. Charlatanry and mysticism often played a
part in this business. Thus, it was maintained that drugs collected and
prepared by persons other than physicians did not produce the desired
effects. The fact that cosmetics (especially hair dyes), “elixirs of
life,” aphrodisiacs, poisons and antidotes for poisons, occupy the most
prominent place in the list of pharmaceutic preparations sold, casts
a glaring ray of light, as Neuburger states, on the degree of culture
among the people of ancient India.

The list of separate maladies recognized by the physicians of the
latter country is inordinately long. There were 26 kinds of fevers, 13
species of swellings of the lower abdomen, 20 different diseases due to
worms, 20 kinds of urinary diseases, 8 varieties of strangury, 5 kinds
of jaundice, 5 varieties of cough or asthma, 18 kinds of “leprosy,” 6
kinds of abscesses, 76 different eye diseases, 28 affections of the
ear, 65 disorders of the mouth, 31 nasal affections, 18 diseases of
the throat, a large number of mental disorders, etc. It seems scarcely
necessary to remark that these so-called diseases were in reality
only groups of certain types of loosely related symptoms. The term
“leprosy,” for example, included, besides the disease which modern
physicians call by that name, a number of different affections of the
skin. It is worth noting here that diabetes mellitus, which is one
of the twenty different kinds of urinary diseases enumerated in the
classified list mentioned above, was first described by the physicians
of India, whose attention was directed to the disorder by observing
that flies and other insects were attracted to the urine of these
patients by reason of its sweetness. It is also an interesting fact
that occasionally these physicians, who, beyond a doubt, were keen
observers of symptoms, paid some attention to the anatomical features
of the individual cases. Thus, it is stated that the particular form of
swelling of the lower abdomen, to which they applied the name “splenic
belly,” is dependent upon “an enlarged spleen which distends the left
side, is as hard as a stone, and is arched like the back of a turtle”;
whereas they spoke of “an enlargement of the liver” when very much the
same conditions were observed on the right side of the abdomen. The
accuracy of their clinical observations is particularly noticeable in
their accounts of cases of consumption, apoplexy, epilepsy, hemicrania,
tetanus, rheumatism, venereal diseases, some affections of the skin,
and insanity. It was in their surgical technique, however, that
the physicians of ancient India were distinguished above all their
brethren of the neighboring oriental countries, and this superiority
they maintained for a very long time. Among the operations which they
performed the following may be mentioned: they removed tumors by
excising them, they opened abscesses by the use of the knife, they
employed scarifications (in inflammations of the throat) and made
punctures (in hydrocele and ascites), they passed probes into fistulae,
they extracted foreign bodies, and they employed needles armed with
hairs taken from the horsed tail or with thread composed of flax or
hemp. According to Súsruta their stock of instruments was composed of
101 blunt and 20 cutting instruments. Among those which were blunt
there were forceps of different sizes and forms, hooks, tubes, probes
or sounds, catheters, bougies, etc. They made use of the magnet
for drawing out foreign bodies of iron, and they applied cups for
therapeutic purposes. Their cutting instruments consisted of knives,
bistouris, lancets, scissors, trochars, needles, etc. Steel was the
metal of which they were made; for the people of India learned at a
very early period how to make steel. In suitable cases cauterization,
either with the actual cautery or with caustic potash, was a favorite
method of treatment with the surgeons of ancient India. “Burning with
the heated iron,” they taught, “is more effective than cauterization
with potash, inasmuch as it permanently cures diseases which may not be
cured by either drugs, surgical instruments, or chemical cauterizing
agents.” In cases of enlargement of the spleen they plunged red-hot
needles into the parenchyma of the organ, presumably through the
skin and other overlying tissues. There were fourteen different
kinds of surgical dressings; cotton, woolen, linen and silk being
the materials used for bandages, and strips of bamboo or some other
wood for splints. When the conditions permitted such a proceeding,
it was customary to sew up wounds of the head, face and windpipe.
Furthermore, it was the rule to perform all surgical operations at a
time when the constellations were favorable. Religious ceremonies were
performed both before the operation and after it was completed, and
it was also considered necessary that the operator should face the
west and the patient the east. Intoxication was employed as a means
of securing narcosis. Owing to their scrupulous cleanliness and the
minute attention which they paid to details, the surgeons of ancient
India obtained for a long time a much higher degree of success than
did the surgeons of other oriental nations. At the same time they were
not lacking in that degree of boldness which enables an operator--in
critical cases which probably without such prompt and radical action
would terminate fatally--to save life. For example, they did not
hesitate to open the abdominal cavity and to sew up a wound in the
intestines; they cut for stone in the bladder, employing for this
purpose the lateral method of operating; and they performed a great
variety of plastic operations.

Some of their hygienic rules concerning pregnant and nursing women
are eminently practical; others would hardly be approved by modern
accoucheurs. Here are a few of these rules: During the period of a
woman’s pregnancy close attention should be paid to her diet, and
special care should be exercised by her to avoid excesses or errors
of any kind. When the ninth month is reached she should take up her
abode in the small cottage in which she is eventually to be confined--a
building erected with special religious ceremonies and thoroughly
fitted with everything that is likely to conduce to her comfort. At
the time of the actual confinement she should have with her four
female assistants, and all those measures, of either a religious or a
practical character, which have in view the hastening of the birth of
the infant, should be scrupulously carried out. If any delay in the
delivery of the after-birth occurs, the removal of the mass may be
promoted by the employment of well-directed pressure over the lower
part of the abdomen, by shaking the body, and also, if necessary, by
giving an emetic. The woman in childbed should not be allowed to get
up before the tenth day after her confinement, and for a period of
six weeks her diet should be most carefully watched. On the third day
the child should be put to the mother’s breast; up to that time it
should be given only honey and butter. If the mother, for any reason,
is not able to suckle the infant, a wet-nurse should be employed for
the purpose, but not until the physician shall have subjected her to
a most thorough examination and shall have instructed her minutely in
regard to her own diet. The subsequent care of the child was provided
for in the most particular manner: It was restricted to a carefully
planned diet; it was not allowed to sit or to lie except in certain
prescribed positions; its times for sleeping were strictly ordered;
it was permitted to amuse itself only in certain ways;--in brief,
everything was done according to strict rules, even special precautions
being taken to guard the child, during the first years of life, against
dangerous demons. Weaning began after the sixth month, and for a
certain length of time the child was fed largely on rice. In cases of
difficult labor and in their gynaecological practice the physicians of
ancient India did not manifest any special knowledge or skill.

One of the instructions given to young physicians in India when they
were about to enter upon the practice of their profession, may be
of interest to the reader. It is worded as follows: “Let thy hair
and finger-nails be cut short, keep thy body clean, put on white
garments, wear shoes on thy feet, and carry a staff or umbrella in thy
hand. Thy demeanor should be humble, and thy heart pure and free from
deceitfulness.” The following proverb, although it originated in India,
is well worthy of acceptance in every part of the world: “When you are
ill the physician will be to you a father; when you have recovered from
your illness you will find him a friend; and when your health is fully
re-established he will act as your protector.”

On a previous page the statement has been made that the science and
art of medicine developed in ancient Greece quite independently of
any influence that might have been exerted by the teachings of the
physicians of India. This statement should be somewhat modified, for it
is reasonable to suppose, although directly confirmatory evidence has
not yet been discovered, that, through the channels of trade between
the two countries, some knowledge of the doings of the physicians
of India must have reached the ears of their Greek brethren. On the
other hand, at a later period of history (after Alexander the Great
had invaded India), the relations between the two countries became
quite close and were kept up without a break for several hundred
years. During the earlier part of this later period, as appears from
the writings of Hippocrates, Dioscorides and Galen, various drugs and
methods of treatment employed by the physicians of India were adopted
by the practitioners of Greece.

_Medicine of the Chinese and Japanese._--The isolation of China
with respect to those countries which were within comparatively easy
reach and in which there was a civilization that, already several
thousand years before the Christian era, had attained a remarkable
degree of development (India, Babylonia and Egypt, for example); her
blind belief in authority; her unwillingness to tolerate any influences
that seemed to emanate from foreigners; and her complete satisfaction
with her own methods of doing things, with her own beliefs, and with
her own natural and manufactured products,--these, it is generally
believed, were the most important factors in keeping this remarkable
nation in a state of immobility as regards at least some departments
of human knowledge and accomplishment. This is particularly true in
respect of the science and art of medicine. But China is at last
waking up from this lethargic state. A wonderful change has come over
her during the past twenty or thirty years, and she is now beginning
to realize that, with her millions of population and wonderful
natural resources, she has an important part to play in advancing the
civilization of the world.

The preceding remarks must not be interpreted as signifying that,
during the long ages of the past, China has not been developing and
is not able at the present time to show a record of very creditable
work accomplished in many departments of human activity. In her early
history, many centuries ago, she accomplished great things, and all--so
far as we now know--without aid from neighboring nations; but there
came a time when all this creative activity ceased, and then, for long
periods of years, she appeared to rest satisfied with the advances
which she had already made, and to have no further ambition to add to
the stock of her possessions.

Among the valuable things which should be credited to the Chinese
are the following: the discovery of the compass (about 1100 B. C.),
the making of porcelain, the invention of printing, the raising of
silkworms, the manufacture of glass and of paper, the successful dyeing
with purple, embroidering with gold, working in metals, the artistic
cutting of precious stones, enameling, the making of “India ink,” etc.
Furthermore, it is a fact most creditable to the Chinese that in no
other country in the world have scholars been held in such high esteem,
or assigned so high a rank, as they have been and still are in China.

Chinese medicine possesses a very rich literature. The first medical
treatise, which deals with plants that possess medicinal virtues, is
ascribed to the Emperor Schin-Nung, who flourished about 2800 B. C.
This is the monarch who taught his people from which springs they
should drink, and who tested all the plants of his vast empire with
reference to their healing properties. According to the legend the
wall of his stomach was so thin that he could look through it and see
everything that was going on in the interior of that organ. In this way
he was able to carry on a large series of experiments upon himself in
regard to the action of different poisons and their antidotes. It is
also related that medical knowledge was still further advanced by the
yellow Emperor Hoang-Ti who lived about 2650 B. C., and who is credited
by the Chinese with having invented arithmetic and music. The treatise
called “Noi-King,” which deals with the subject of internal diseases
and gives a systematic account of human anatomy, is also credited
by the Chinese to this monarch; but Neuburger maintains that this
book, which is still in common use in China, is of much more recent
origin. There are several other medical treatises which deserve to be
mentioned. Such, for example, are the following: the celebrated book on
the pulse, written by Wang-Schu-Scho in the third century B. C.; two
very important books written by Cho-Chiyu-Kei--one bearing the title
“Schang-Han-Lun” (On Fevers) and the other that of “Kin-Kwéi” (Golden
Casket);--the different treatises written by Tschang-Ki (tenth century
A. D.) and published in the collection called “The Golden Mirror of
the Forefathers in Medicine” (I-Tsung-Kin-Kien); and, finally, the
very popular modern work (in forty volumes) entitled “The Trustworthy
Guide in the Science and Art of Medicine” (“Ching-Che-Chun-Ching”). Of
these forty volumes, seven are devoted to nosology, eight to pharmacy,
five to pathology, six to surgery, and the remainder to children’s and
women’s diseases.

Anatomy, it appears, has never played other than a very insignificant
part in the Chinese system of medicine. This is not to be wondered
at when we remember that their religion makes the dissection of a
human body a sin worthy of punishment. No mutilated person, the
Chinese believed, would be permitted, upon reaching the domain of
the dead, to rejoin his ancestors. About the year 1700 A. D. the
Emperor Kang-Hi made the attempt to incorporate anatomy as a part
of the regular study of medicine in the Chinese Empire; his first
step being the authorization of P. Perennin, a Jesuit Father, to
translate Dionis’ work on anatomy into the Chinese. His efforts were,
however, unsuccessful, owing to the strong opposition offered by the
native physicians. And the attempts made during more recent times
to accomplish the desired reform by introducing copies of European
anatomical illustrations do not appear, as yet, to have produced any
appreciable impression. In very recent years, however, the medical
missionaries, sent out, if I am rightly informed, from the United
States, are giving excellent instruction in anatomy.

Physiology, as taught by the Chinese, is something beyond the
comprehension of modern Europeans. Neuburger explains their views
in the following manner: “The cosmos is the product of the combined
action of two dissimilar forces--the male (Yâng) and the female (Yin).
When these forces work in harmony a state of equilibrium results....
Matter consists of five elements, viz., wood, fire, earth, metal, and
water; and all things are composed of these elements. In sympathetic
relationship with these five elements stand the five planets (Jupiter,
Mars, Saturn, Venus, Mercury), the five different kinds of air (wind,
heat, moisture, dryness, cold), the five quarters of the globe (east,
south, west, north and the equator), the five periods of the year (in
addition to the four which we recognize, the Chinese make a fifth
period out of the last eighteen days of spring, summer, autumn and
winter), the five times of day, the five colors (green or blue, red,
yellow, white and black), the five musical tones, etc.... As in the
cosmos, so in man the two primeval forces--Yâng and Yin--underlie all
his vital processes. Thus, his body is made up of the five elements of
which all matter is composed, and health depends upon the maintenance
of a state of equilibrium between the male and the female forces,
etc.” After this brief exposition it seems unnecessary to devote any
further space to the consideration of the physiological doctrines of
the Chinese.

With respect to the questions of diagnosis and prognosis it may be
stated that the Chinese attach great importance to the necessity of
making a most careful objective examination of the entire body; but,
when one investigates the precise manner in which this examination is
to be carried out, it soon appears that most of the details relate to
matters of a purely fanciful or mystical nature. The only steps of real
importance, according to them, are the examination of the patient’s
pulse and the inspection of his eyesight and his tongue. From the
examination of the pulse alone they believe it possible to diagnose
the nature and seat of the disease. To examine the pulse properly
is a complicated affair and can scarcely be carried out in actual
practice in less time than ten minutes; indeed, in certain cases the
physician may find it necessary to devote two or three hours to the
business. According to the Chinese scheme there are many different
kinds of pulse, and there are no less than thirty-seven different types
of condition presented by the tongue, each bearing its own special
pathological significance.

Disease, so reads the Chinese doctrine, is a discord, a disturbance
of equilibrium, caused by the preponderance of one or the other of
the primeval forces (the male or the female). It manifests itself
in some disorder of the circulation of the vital air and the blood,
and eventually involves the organs of the body. Wind, cold, dryness,
moisture, the emotions and passions, poisons, and also evil spirits and
imaginary beasts are the causes of disease.

No other nation, says Neuburger, has at its command such a large number
of remedial drugs; and it is also a fact, he adds, that the department
of therapeutics is that in which Chinese medicine has reached its
highest development. The steadfast belief that in nature there exists
a remedy for every human ill led the physicians of that country to
search diligently in all possible directions for vegetable and animal
and also, to some extent, mineral substances which might possess
remedial virtues. Although this search necessarily brought to notice
a lot of useless drugs, it cannot be denied that eventually it added a
considerable number of remedies which have proved useful to the medical
profession of the entire world. In this category belong the following:
rhubarb, pomegranate root as a cure for worms, camphor, aconite,
cannabis, iron (for the relief of anaemia), arsenic (for malarial and
skin diseases), sulphur and mercury (both of these for affections of
the skin), sodium sulphate, copper sulphate (as an emetic), alum,
sal ammoniac and musk (for nervous affections). Toward the middle
of the sixteenth century A. D. there was published, under the title
“Pen-Tsao-Kang-Mu,” a monumental work (fifty-two volumes) in which are
very fully described no fewer than 1800 remedies, mostly of a vegetable
nature. Prophylactic Inoculation with the pus from a small-pox pustule
was practised by the Chinese as long ago as during the eleventh century
A. D., “thus constituting a forerunner of our modern serum therapy.”
(Neuburger.) Vaccination was not introduced into China until during the
nineteenth century of the present era. It is a curious fact that, in
the choice of a remedy, the Chinese physicians attach a certain degree
of importance to the form and color of the drug, as symbols indicative
of the effect which they may be expected to produce. Thus, the red
blossoms of the hibiscus plant are believed to be more efficacious
than the white as an emmenagogue; saffron, being of a yellow color,
possesses the power to relieve jaundice; beans that have the shape of
a kidney should be prescribed in cases of renal disease; glow-worms
should form a part of all eye-washes, etc.

The doses prescribed are very large, and the medicines are often put up
in an attractive form, with labels on which such descriptive titles as
these are written: “Powders of the Three very wise Men,” or “Powders
recommended by Five Distinguished Physicians”--titles which are
calculated to work upon the imagination of the patient.

There are two methods of treatment which the Chinese physicians
are very fond of employing for the relief of a great variety of
diseases--viz., acupuncture and cauterization of the skin over the
seat of the malady by means of what are termed “moxae”--moxibustion.
Moxae are prepared by kneading together into a cone-shaped, tinder-like
mass the leaves of the artemisia vulgaris, then drying it thoroughly.
Such a mass is attached to the skin at the affected spot by simply
moistening the base of the cone, after which the apex is ignited. Some
physicians prefer to interpose a thin sheet of metal between the skin
and the base of the moxa. The manner in which these contrivances should
be used in the different diseases and the proper number to employ are
matters subject to fixed rules. In a strong individual, for example,
as many as fifty moxae may be used at a time. In affections of the
chest they were applied to the patient’s back, in diseases of the
stomach to the shoulders, and in venereal affections over the spinal
column. In acupuncture, which is a procedure invented by the Chinese,
slender needles of gold, silver or highly tempered steel, from 5 to 22
centimetres (2 in.-8¼ in.) in length, were forced through the stretched
skin to different depths (1¼ in.-1½ in.) and then driven farther inward
in a rotary direction by means of a small hammer. The needles, after
being allowed to remain in situ for a few minutes, were withdrawn, and
pressure was made with the hand over the small wounds, or a moxa was
burned over the spot. There are in all 388 places where acupuncture may
be performed, and a chart of the body, showing where these places are
located, has been prepared for the guidance of the Chinese physicians.
Neuburger calls attention to the fact that the latter dislike the sight
of blood, and that this is one of the reasons why acupuncture and the
use of moxae have grown to be such popular remedies. Bloodletting
is rarely employed by them; but dry cupping, on the contrary, is a
favorite procedure in certain maladies. Massage is generally performed
by old or blind women, and much attention is devoted to the “movement
cure,” which is said to have been invented about 2500 B. C.

As may readily be imagined, the Chinese--owing to their dislike for the
sight of blood and also by reason of their ignorance of anatomy--have
not advanced, in surgery, beyond the most primitive state of that art.

The science of public health is quite unknown in China. In a Chinese
treatise entitled “Long Life,” the following advice is given: “Always
rise early in the morning, take some breakfast before you leave your
residence, drink a little tea before eating, at the mid-day meal
partake of well-cooked but not too highly salted food, eat slowly, take
a nap of two hours after the meal, eat lightly at night, and, before
going to bed, rinse your mouth with tea and have the soles of your feet
rubbed until they are warm.” (Neuburger.)

Up to the latter part of the nineteenth century of the present era,
Japan, so far as medical matters are concerned, differed in no
material respect from China. During the last fifty or sixty years,
however,--that is, since the visit of Commodore Perry, of the United
States Navy, to that country,--wonderful changes have taken place; and
now Japan, as a result of her determination to adopt the methods of
education, of utilizing steam and electric power, etc., has already
taken a leading place in the council of nations. The physicians, many
of whom received their training in the best schools of Europe and
the United States, are contributing to-day their full share toward
advancing the science of medicine. That China is following in the
footsteps of Japan is already plainly evident, and no intelligent
observer entertains the slightest doubt of her ultimately--probably at
no distant day--possessing a corps of medical men as well educated,
as efficient in the treatment of disease, and as practical in public
hygiene as their European and American confrères. During thousands
of years China has suffered severely from the blighting tyranny of
superstition, priestcraft and selfish bureaucracy, and, now that the
sunlight of truth and genuine liberty is beginning to search every nook
and cranny of that great country, we who have had the advantage of this
beneficent influence for so many scores of years truly rejoice over the
change that is taking place in China.




                              CHAPTER IV

                 GREEK MEDICINE AT THE DAWN OF HISTORY


It is from Greece and from Greece alone, says Daremberg, that our
modern medicine derives its origin.

   It has come down to us, in a direct line, through the sheer
   force of its inherent excellence, and with little or no aid from
   outside sources. Harvey, Bichat and Broussais are as much the
   legitimate heirs of Hippocrates, Herophilus, Galen, Berenger de
   Carpi and Vesalius, as Hippocrates is the heir of Homer, and
   as this divine singer of the anger of Achilles is himself the
   product of a civilization that existed before his day and that
   was in all probability the creation of Hindu influences.

It is to the development of medical knowledge in Greece, therefore,
that our attention should next be directed, and more particularly to
that period which belongs to the dawn of history--the pre-Homeric
period.

_The pre-Homeric Period of Medicine in Greece._--The poems of
Homer, the Iliad and the Odyssey, furnish us with the earliest and
almost the only written evidence of the state of medicine in Greece
during that period of time. They were probably written, according
to the authority of the Earl of Derby, somewhere about 800 B. C.,
and modern investigations show that the siege of Troy, the theme
of the Iliad, occurred between the years 1194 and 1184 B. C. These
investigations also show that in this region, and especially in the
Island of Crete and in Mycenae on the neighboring mainland of Asia
Minor, at this time and probably several hundred years earlier, there
existed a high degree of civilization. Specimens of a written language,
for example, were found among the objects recovered from the ruins
of the palace of King Minos at Cnossus in Crete, but hitherto no
interpreter of this unknown language has been found. It is reasonable
to expect, however, that in due time these Minoan records will be
translated, that still other records belonging to this remote age
will be discovered, and that much valuable information regarding the
condition of medical knowledge in Greece during this long period
will then be revealed to us. Strange as it may appear, the classical
Greek writers seem to have possessed very little knowledge concerning
this highly developed civilization at Cnossus. And yet, if we stop
to consider the matter, their silence will appear less strange for
the following reasons. Some great calamity (war, an earthquake, or a
conflagration) must have destroyed many of the evidences of Minoan
civilization besides those which are now being brought to light; then,
also, several hundred years elapsed between the occurrence of this
disaster and the classical period of Greek culture; and, finally, there
is the fact that the knowledge of past historical events, when kept
alive simply by tradition, slowly vanishes, until finally it becomes
so vague as to possess very little value. The discoveries made in the
Island of Crete and at Mycenae were not known to Daremberg when he
wrote the lines quoted above, but he felt perfectly sure, from his
knowledge of the laws of development in general, that a product so
highly cultured as Homer could not have suddenly sprung into existence
out of the apparent darkness and ignorance of the centuries immediately
preceding his time.

_The State of Medical Knowledge at the Time of the Siege of
Troy._--It is from Homer’s Iliad and Odyssey that our authoritative
knowledge of the most ancient Greek medicine is derived. In the former
work mention is made of Aesculapius and his two sons, Machaon and
Podalirius, both of whom accompanied Agamemnon and the Greek host in
their expedition against Troy. According to this author’s account they
served in the double capacity of surgeons to the army and valiant
leaders of troops. In order that the reader may judge for himself just
what is the nature of the evidence furnished by Homer with regard to
the medical knowledge of that period, it seems desirable to introduce
here a few of the more characteristic references which the poet makes
to spear, javelin and arrow wounds, to the injuries caused by fragments
of rocks hurled by the assailants, and to various remedial measures,
both surgical and medical, employed for the relief of the wounded or
sick warriors. There are at least one hundred such passages in the
Iliad alone, but the few which are here cited will serve as adequate
examples of Homer’s familiarity with anatomy and with some of the
methods of treating spear and arrow wounds,--a familiarity which
indicates that the poet must have had some medical training.

    Thus he; and not unmoved Machaon heard:
    They through the crowd, and through the widespread host,
    Together took their way; but when they came
    Where fair-hair’d Menelaüs, wounded, stood,
    Around him in a ring the best of Greece,
    And in the midst the godlike chief himself,
    From the close-fitting belt the shaft he drew,
    With sharp return of pain; the sparkling belt
    He loosen’d, and the doublet underneath,
    And coat of mail, the work of Arm’rer’s hand.
    But when the wound appeared in sight, where struck
    The stinging arrow, from the clotted blood
    He cleans’d it, and applied with skilful hand
    The healing ointments, which, in friendly guise,
    The learned Chiron to his father gave.
                             (Book IV. of the Iliad, Lines 221–259.)

       *       *       *       *       *

    He said: the spear, by Pallas guided, struck
    Beside the nostril, underneath the eye;
    Crashed through the teeth, and cutting through the tongue
    Beneath the angle of the jaw came forth:
    Down from the car he fell; and loudly rang
    His glittering arms: aside the startled steeds
    Sprang devious: from his limbs the spirit fled.
    Down leaped Aeneas, spear and shield in hand,
    Against the Greeks to guard the valiant dead;
    And like a lion, fearless in his strength,
    Around the corpse he stalk’d, this way and that,
    His spear and buckler round before him held,
    To all who dar’d approach him threatening death,
    With fearful shouts; a rocky fragment then
    Tydides lifted up, a mighty mass,
    Which scarce two men could raise, as men are now:
    But he, unaided, lifted it with ease.
    With this he smote Aeneas near the groin,
    Where the thigh bone, inserted in the hip,
    Turns in the socket joint; the rugged mass
    The socket crushed, and both the tendons broke,
    And tore away the flesh: down on his knees,
    Yet resting on his hand, the hero fell;
    And o’er his eyes the shades of darkness spread.
                                (The Iliad, Book V., Lines 333–356.)

       *       *       *       *       *

    He said, and passing his supporting hand
    Beneath his [Eurypylus’] breast, the wounded warrior led
    Within the tent; th’ attendant saw, and spread
    The ox-hide couch; then as he lay reclined,
    Patroclus, with his dagger, from the thigh
    Cut out the biting shaft; and from the wound
    With tepid water cleans’d the clotted blood;
    Then, pounded in his hands, a root applied
    Astringent, anodyne, which all his pain
    Allayed; the wound was dried, and stanch’d the blood.
                               (The Iliad, Book XI., Lines 958–967.)

       *       *       *       *       *

    But Jove-born Helen otherwise, meantime,
    Employed, into the wine of which they drank
    A drug infused, antidote to the pains
    Of grief and anger, a most potent charm
    For ills of every name.[13] Whoe’er his wine
    So medicated drinks, he shall not pour
    All day the tears down his wan cheeks, although
    His father and his mother both were dead,
    Nor even though his brother or his son
    Had fallen in battle, and before his eyes.
                           (Book IV. of the Odyssey, Lines 275–284.)

In former years and down almost to the present time, it was the custom
among English medical writers to speak of Aesculapius only as the
“God of Medicine,” thus conveying to the minds of many readers that
he was a mythological character, not a real personage. To-day, and
especially since Schliemann has demonstrated, by his excavations at
the site of ancient Troy, that Homer’s Iliad is not merely a beautiful
creation of his poetic fancy, but a narration of events that actually
occurred about 1200 B. C., it is quite generally acknowledged that
Aesculapius[14] is an historical character, an individual whose memory
should receive due honor from the physicians of modern times. Neither
Homer nor Pindar speaks of him as a god. In Athens he was publicly
deified in 420 B. C.

When Daremberg, as quoted above, expressed the belief that Hippocrates
was the product of an earlier civilization, he undoubtedly gave due
weight to other circumstances beside those which are narrated in
Homer’s poems--circumstances, for example, which are referred to
casually by several of the classical Greek authors, and to which fresh
importance has been given by a number of recent discoveries. Thus,
there is an abundance of evidence showing that the Greeks, both before
and after Homer’s time, held the memory of Aesculapius in the very
highest honor. So great, as they believed, was his power over disease,
so wonderful were the cures which he accomplished, and so noble and
pure was his character, that they made him a god and erected temples
in his honor--not mere places where a barren worship might be carried
on, but veritable sanatoria--termed Asclepieia--where the extraordinary
healing powers of him whom they had made a god might be perpetuated
for the benefit of succeeding generations. While, on the one hand,
the ancient Greeks may have been full of superstitious beliefs, they
were at the same time as kindly disposed toward their fellow men, as
generous in their spending of money for this purpose, and as practical
in their selection of suitable methods as are the benefactors of to-day
all over the world. In course of time these so-called temples became
the prototypes of our hospitals, sanatoria and schools of medicine,
and it therefore seems only proper that they should here be described
somewhat in detail.

_The so-called Aesculapian Temples and their Chief Purpose._--The
first of these temples, or Asclepieia, were established at Trikka, in
Thessaly; at Cnidus, on the coast of Caria in Asia Minor, opposite
Cos; at Epidaurus, in Argolis, Greece; at Cyrene on the northern
coast of Lybia, Africa, opposite the Island of Crete; at Crotona,
on the southeastern coast of Italy; and, finally, at Athens. It is
said that traces of as many as eighty of these Asclepieia have been
found in different parts of the ancient world. One of them, for
example, is known to have existed on the small island (Isola San
Bartolommeo) in the Tiber, at Rome. Their management was intrusted, in
the earlier years of their existence, to men who were descendants of
Aesculapius--i.e., the sons and grandsons of Machaon and Podalirius.
They were both priests and physicians, and are mentioned in history as
the Asclepiadae. With the progress of time it became necessary, as one
may readily understand, to intrust the temple service to individuals
who were not members of the family of Aesculapius. The original
Asclepiadae guarded as valuable secrets the methods of treatment and
the pharmaceutic formulae which had been handed down to them by the
head of the family. It was therefore natural, when these newly adopted
members were installed in office, that they should be made to promise,
under oath, not to “divulge these secrets to any but their own sons,
the sons of their teachers, or the pupils who were preparing themselves
to become regular physicians.” (Neuburger.)

The divulging of these secrets, it may be assumed, would gradually
entail upon the organization of priest-physicians a serious money
loss. As will be seen further on, the oath known as “the Hippocratic
Oath” omits these mercenary features, and thus places the vocation of
physician upon a much higher level.

It is an interesting fact, as noted by Hollaender, of Berlin, that
Homer does not make the slightest mention of temples dedicated to
Aesculapius; from which circumstance it may be inferred that a long
time--perhaps several hundred years--elapsed, after his death, before
his countrymen realized fully his greatness and the value of the
services which he had rendered in his rôle of physician. Of the temples
which were then built in his honor, all have long since fallen into
ruins, but in recent years excavations have been made at some of the
more important of these sites and under the guidance of competent
scholars, and as a result our knowledge of the state of medicine in
Greece between the time of Homer and the appearance of the Hippocratic
writings has been greatly enlarged. The facts revealed by these
excavations and the statements which are to be found in classical Greek
literature, but which previously did not receive all the consideration
that they deserved, have now been pieced together and we have thus
been furnished with a fairly satisfactory picture of the relations of
the different chambers and spaces in these temples, and with a more or
less complete account of the manner in which affairs were conducted by
those in charge. The following short description which is based on the
account recently published by Professor Meyer-Steineg of Jena, Germany,
will put the reader in possession of all the more important facts.[15]

  [Illustration: FIG. 1. VIEW OF THE TEMPLE OF AESCULAPIUS ON THE
  ISLAND OF COS.

  As it must have appeared to the traveler, in the third century
  B. C., on his approach by sea to the port of that island.

  Reconstitution based upon recent photographs and upon surveys by
  Herzog (_Koische Forschungen_, 1904).

  (Courtesy of Prof. Dr. Meyer-Steineg, of Jena, Germany.)]

There were two principal types of Asclepieia--one, like that of
Epidaurus, in Argolis, which occupied an inland situation, that had
clearly been chosen from religious motives alone, viz., because it was
believed, in accordance with an ancient tradition, that at this spot
Aesculapius had been born--and a second, like that of Cos, on the
island of the same name in the Aegean Sea, which situation without
doubt had been chosen chiefly because the locality was exceptionally
healthful. Of the first of these two types of temples, the sites of
both of which have been most carefully studied, very little need
be said in this brief sketch. The purely medical aspects of this
Asclepieion, to which at the height of its celebrity crowds flocked
from all parts of Greece, are of minor interest. The temple and its
accessory buildings, which appear to have been very extensive, were
located in a narrow valley, not far distant from the seaside village
which still to-day bears the name of Epidaurus. Then, also, the
locality is deficient in one important respect--it has an insufficient
supply of good drinking water; and, finally, it is only slightly
elevated above the sea-level. Dr. Meyer-Steineg remarks that the
patients who visited this temple must have owed whatever benefit they
derived from the visit to other influences than those of a purely
medical or hygienic character. Doubtless suggestion played an important
part in any relief which they may have obtained, and the so-called
temple-sleep was also doubtless a very effective factor in this
direction. The Asclepieion at Cos, on the other hand, occupied a most
healthful position on the northern slope of the ridge of mountains
which extends throughout the entire length of the island and attains a
maximum height of about 3000 feet. (See Fig. 1.)

It now remains for me to describe, as best I may within the limited
space which is at my command, the results of the excavations and
surveys that have been made in recent years on the Island of Cos.
Professor Meyer-Steineg’s article on this subject[16] is the source
from which I have derived the information contained in the following
account.

The temple and its associated buildings stood at an elevation of
three hundred feet above the sea-level and at a distance of a little
more than two miles from the city of Cos. The heights behind the
temple were in former times covered with forests and afforded ample
protection against the debilitating and much-dreaded south wind. A
brook of considerable size and of very pure water passed through the
temple grounds; the spring (Burinna) from which it took its origin
being located about 300 feet higher up on the side of the mountain.
Not far off, in the same neighborhood, is a mineral spring, the water
from which contains both iron and sulphur. All the physical conditions
of this site were, therefore, very favorable to the restoration of
both mental and bodily health. Professor Meyer-Steineg declares that
it is scarcely possible to determine accurately the age of the Cos
Asclepieion,--_i.e._, of the structures which the present ruins
represent,--but he believes that some of them date no farther back than
the third century B. C., at which time extensive structural alterations
were made.[17] Then, at a still later date (first century A. D.), in
consequence of the damage done by an earthquake, C. Stertinius Xenophon
(at the instigation of the Roman Emperor Claudius, whose private
physician he was) carried out some very radical changes. Not only were
the separate buildings well supplied with running water, but even many
of the individual rooms (of which there were a large number) were
equipped with the same conveniences. Hydropathy evidently formed an
important part of the treatment in the reconstructed temple. (See Fig.
2.)

As has been shown above, the climate, the freedom from disturbing
factors of all kinds, the existence at that spot of a plentiful supply
of pure water, the character of the structures composing the temple
group, and the widespread belief among the people that the Asclepiadae
were able, with the assistance of the god Aesculapius, to effect cures
which were obtainable nowhere else--all contributed to make the temple
at Cos one of the greatest sanatoria of ancient times.

  [Illustration: FIG. 2. BIRD’S-EYE VIEW OF THE TEMPLE OF AESCULAPIUS
  AND ASSOCIATED BUILDINGS ON THE ISLAND OF COS.

  As they appeared in the third century B. C.

  (Copied by permission from a model made by Prof. Dr.
  Meyer-Steineg for the Medico-historical Museum of the University
  of Jena, Germany.)]

  [Illustration: FIG. 3. GROUND PLAN OF THE ASCLEPIEION ON THE ISLAND
  OF COS.

  As Ascertained by the Researches of Dr. Herzog.

  The different structures are arranged as nearly as possible in
  the same positions which they occupied in the third century, B.
  C.

  _A_, main entrance to Asclepieion; _B_, _B_,
  _B_, gallery, 6 metres broad, with colonnade on one side;
  _C_, open space or court, on the southern side of which is
  a structure composed of recesses provided each with a bathing
  basin (_D_); _H_, staircase leading to intermediate
  terrace; _a_, massive series of steps leading to the upper
  terrace; _b_, _b_, _b_, broad gallery similar to
  that shown on the lower terrace; _d_, the temple proper.

  (From Prof. Dr. Meyer-Steineg’s _Medizinisch-historische
  Beiträge_.)]

The buildings which constituted what is commonly termed the “Temple
of Aesculapius” at Cos were located on three artificially prepared
terraces. The principal entrance to the group, as the excavations
conducted quite recently by Herzog show, was on the lower terrace,
and faced north--that is, toward the sea. From this lower level a
broad staircase led to the second or intermediate terrace, which, in
turn, was connected with the upper one by means of a very broad and
massive series of steps. The southern limit of this upper terrace
ended abruptly at the slope of the mountain. The arrangement of the
buildings on the three different terraces may, in harmony with the
account given by Professor Meyer-Steineg, be briefly described as
follows: That which stood on the lower terrace occupied three sides
of a parallelogram (Fig. 3), the open part of which faced south. The
longer side of the building measured about 120 metres (390 feet) in
length, and the two shorter sides each 55 metres (180 feet). The
supply of running water in every part of this great building, which
appears to have been devoted mainly, if not entirely, to therapeutic
purposes, must have been most abundant. The source from which the
water came was the Burinna spring, situated higher up on the mountain
at a spot far beyond all possibility of contamination. It is not yet
clear, says Dr. Meyer-Steineg, whether or not there were any buildings
devoted to therapeutic purposes on the intermediate terrace. (Figs.
2 and 3.) On the other hand, the great halls, contained in the large
building which surrounded the temple on the upper terrace, appear to
correspond very closely to the rooms that constituted the main portion
of the building on the lower terrace, and it is therefore probable that
this upper building also served some useful purpose in the general
scheme of the Asclepieion. It is Herzog’s opinion--according to
Meyer-Steineg--that the central idea around which everything in this
assemblage of fine buildings revolved, was a clinic conducted by the
Asclepiadae. The means chiefly employed at first for the restoration
of health were such simple agents as sunlight, pure air, pure drinking
water, dietetic measures, massage, physical exercise, etc., and yet,
when the patient’s condition seemed to require their use, there was no
hesitation in resorting to the rational employment of drugs, and even
surgical operations were performed. The numerous instruments which Dr.
Meyer-Steineg collected at the site of the ruins when he visited Cos in
1910, furnish ample corroborative evidence of the correctness of this
last statement.

Not the least important part which this famous Asclepieion played in
the history of medicine was the splendid opportunity which it afforded
to those who were preparing themselves to engage in the practice of
the healing art, for acquiring the necessary familiarity with the
different diseases and for learning how they should be treated.

The manner of conducting the preliminary treatment was probably not
the same in every particular in all the different Asclepieia, and yet
in the main the plan of procedure followed in Epidaurus, in Cos and in
Athens undoubtedly resembled closely that which Pagel furnishes in his
_Geschichte der Medizin_. It may be briefly described as follows:--

In the first place, moribund persons, the unclean, and women about to
be confined were not admitted into the temple enclosure. The management
of the latter class of patients was left entirely to women nurses, and,
when it became evident that a person was likely to die, the individual
was thereafter cared for outside the enclosure.[18] In short,
everything possible was done to keep out of sight all such objects as
might produce an unpleasant impression upon applicants for treatment.
After preliminary bathing and dieting, the patient was conducted into
the temple enclosure and encouraged to make offerings and to pray to
the god Aesculapius, an imposing statue of whom in marble was one of
the first things that confronted him. As he was led about by the priest
or an attendant, his imagination was wrought upon by the sight of
numerous votive offerings exposed to view on the walls or columns of
the buildings, by the singing of hymns in adoration of the god, and by
the reading of the records of earlier cases inscribed on tablets or on
the columns. After his mind had thus been worked upon, he was asked to
furnish to the priest a detailed history of his own case and to submit
to some sort of physical examination. As a final and most important
step in this first stage of the treatment he was subjected to what was
termed “the temple-sleep,” during which the suggestion of the proper
remedies to be employed was supposed to be communicated to him by the
god himself.

In our day it is difficult to understand how persons of a fair degree
of intelligence could for so long a period have continued to believe
in the efficacious interference of the deified Aesculapius in their
behalf. But that this belief really did exist is well known, and it was
only after the lapse of many centuries that the faith of the public
began to weaken, doubtless through the influence of several factors.
Perhaps the most important of these was the discovery of an increasing
number of instances of humbuggery or trickery, of which the officiating
priests, in some of the temples, had been guilty. The satirical writer,
Aristophanes, who flourished in Athens about 400 B. C., describes an
incident of this nature in his play entitled “Ploutos.” The following
extracts furnish an account of the doings observed by the slave Karion
on the occasion of his passing a night in the temple enclosure at
Athens:--

    The Scene throughout is laid at Athens, in front of the
    house of Chremulos.

          *       *       *       *       *

   _Blepsidemos_: Ought n’t we then to bring in some doctor?

   _Chremulos_: Prythee, what doctor is there now in the city?
   For their pay is no longer anything worth, nor their art.

   _Blep._: Let us cast about.

   _Chrem._: Nay, there is not one.

   _Blep._: I believe there is not.

   _Chrem._: Nay, by Zeus, the best plan is to do what I have
   been long preparing--(to conduct him [Ploutos]) to the temple of
   Asklepios [and] make him lie down [there].

          *       *       *       *       *

   _Chrem._: Karion, my man, you must bring out the bedclothes
   and lead Ploutos himself in the usual way, and carry everything
   else that is ready within.

    (_Exeunt omnes._)

       *       *       *       *       *

   _Chorus of Farmers._ What is the matter, Oh thou best
   friend of--thyself? For you seem to have come as a messenger of
   some good news.

   _Karion._[19] My master has fared most prosperously, or
   rather Ploutos himself. For, instead of being a blind man, he
   has been made to see again, and his pupils are clear-sighted, as
   he has met with a kindly friend in Asklepios the Healer.

   _Chorus._ You give me reason for joy, reason for shouts of
   triumph.

   _Karion._ Ye have reason to rejoice whether ye wish it or
   not.

   _Chorus._ I will shout aloud for Asklepios of the goodly
   children, the great light to mortals.

          *       *       *       *       *

   _Karion._ Well, as soon as ever we came to the god,
   leading a man then, indeed, most miserable, but now blessed and
   fortunate, if any other is so, first we led him to the sea, and
   then we bathed him.

   _Wife of Chremulos._ By Zeus, then the old man was
   fortunate, bathing in the cold sea.

   _Karion._ Then we went to the sacred enclosure of the god.
   And when on the altar the cakes and offerings were dedicated
   by the flame of murky Hephaistos, we laid down Ploutos, as was
   proper; and each of us made up from little odds and ends a bed
   for himself.

   _Wife._ Then were there certain others beside yourselves
   wanting the god?

   _Karion._ Yes, Neokleides, for one, and he is blind; but
   in stealing has far overshot those who can see; and there were
   many others with all sorts of ailments. But when the minister of
   the deity put out the lights and told us to go to sleep and said
   that we were to keep silent, if any of us perceived a noise, we
   all lay down in an orderly manner. And I was unable to sleep,
   for my attention was arrested by a certain pitcher of porridge
   a little way off from the head of a certain old woman, and I
   strangely desired to creep over to that pitcher. Then I looked
   up and saw the priest making a clean sweep of the cakes and
   dried figs from the sacred table. After this he went round all
   the altars in a circle to see if any cakes were left anywhere.
   Then he consecrated them into a certain wallet; and I, believing
   that there was great holiness in this proceeding, rise up to go
   to the pitcher of porridge.

   _Wife._ Oh you most miserable of men, were you not afraid
   of the god?

   _Karion._ Yes; by the gods I was afraid lest he with his
   fillets should reach the pitcher before me; for the priest
   had already given me a lesson. But, as soon as ever the old
   woman perceived the noise I made, she lifted up her hand over
   the pitcher (to protect it). Then I hissed and seized (her
   hand) by the teeth as if I were a reddish-brown snake. But
   she at once drew back her hand again and lay down peacefully,
   rolling herself up. And then I at once gulped down a lot of the
   porridge; and then, when I was full, I jumped up again.

   _Wife._ And didn’t the god come up to you?

   _Karion._ Not up to that time. After this I at once
   covered myself up, being afraid; but he made a complete circuit
   examining all the ailments in a most orderly fashion; and then a
   slave set by him a little mortar and box of stone.

   _Wife._ Of stone?

   _Karion._ No, by Zeus, certainly not,--at least, not the
   box.

   _Wife._ To the deuce with you, how did you see since you
   say you were covered up?

   _Karion._ Through my old cloak; for, by Zeus, it had holes
   not a few. First of all, he took in hand to pound a plaster
   for Neokleides, and he threw in three cloves of Tenian garlic.
   Then he bruised them in the mortar, mixing therewith the acid
   juice of the fig-tree and squill; then, having diluted it with
   Sphettian vinegar, he turned his eyelids inside out that he
   might feel more pain, and then applied the mixture. But he,
   squalling and bawling, jumped up and was running away, when the
   god said with a laugh:--“Sit down there now, smeared with thy
   plaster, that I may stop thee from going to the Assembly, having
   for once a real excuse.”

   _Wife._ What a patriot and sage the god is!

   _Karion._ After that he sat down by the side of Ploutos,
   and first he touched his head, and then, taking a clean towel,
   he wiped his eyelids all round, and Panakeia covered his head
   and all his face with a cloth of purple dye; and the god then
   whistled. Thereupon two snakes of monstrous size darted forth
   from the temple.

   _Wife._ Dear Gods!

   _Karion._ And these two (snakes) having quietly glided
   under the crimson cloth, licked his eyelids all around,
   methought. And before you could drink ten cups of wine, my
   mistress, Ploutos stood up and was able to see: and I clapped
   my hands with delight and awoke my master. And the god suddenly
   took himself off from our view with the snakes into the temple.

If one examines carefully the facts connected with the Aesculapian
temple treatment, so far as they are known to us, one cannot fail
to be impressed with their strong resemblance to what has been the
experience of similar semi-religious movements in more recent times,
not only in European countries but also in the United States. In all
of them there may be found a kernel of true religious belief, and no
candid observer can deny the fact that many persons have been benefited
thereby both in body and in mind. But, sooner or later, the method
has fallen into disrepute, either because it was employed in the vain
hope that it might accomplish a cure which surgical means alone could
effect, or else because unscrupulous persons, taking advantage of the
credulousness of those associated with the movement, utilized it for
their own selfish advantage.




                               CHAPTER V

       THE SIGNIFICANCE OF THE SERPENT IN THE STATUES AND VOTIVE
         OFFERINGS EXPOSED TO VIEW IN THE AESCULAPIAN TEMPLES


Almost every important gallery of sculpture in Europe possesses at
least one marble statue of Aesculapius, and in the majority of these
the god is represented as a middle-aged or elderly man of powerful
frame, having a full head of hair and full beard, and clothed only
with the pallium or mantle, which is so placed as to leave the right
shoulder and a large part of the chest uncovered. He holds in his
right hand a knotted staff around which, in many of the statues, is
coiled a serpent whose head approaches very closely to the hand. The
expression of the god’s countenance is strikingly peaceful and serene,
yet without any evidence of weakness. In not a few instances other
animals are represented alongside the statue, usually at the god’s
feet--as, for example, the cock, the owl, the eagle, the hawk or the
ram--and occasionally his daughter Hygieia is shown at his side feeding
the serpent. The cock is the symbol of watchfulness--a physician should
be vigilant; the owl symbolizes his need of clear-sightedness and of
readiness to care for his patients in the night as well as during the
day; the eagle has a penetrating eye and it is the emblem of long
life--a benefit which the healing art is capable of procuring; the hawk
was the bird consecrated to Isis, Queen of Egypt, who was believed by
the Egyptians to have been highly skilled in medicine; and the ram
is the symbol of dreams and divination. Pliny says that the patients
who were brought to the temple of Aesculapius were made to lie down
at night wrapped in the skin of a ram, in order that they might
have divine dreams. The presence of the serpent in nearly all of the
statues of Aesculapius is explained in a variety of ways. Some say
that this reptile, which sheds his skin once a year, is emblematic of
the sick person’s need to acquire a new body, or at least cast off
his old skin in the same manner as does the snake. Others consider
the serpent as merely the symbol of wisdom, as it is admittedly the
shrewdest and most cunning of all animals. In a few instances it is
represented as drinking from a receptacle held in the hand of Hygieia.
Perhaps the sculptor’s intention here was to show that the serpent,
although the wisest of all animals, believed that he might add to
his stock of wisdom by drinking from the fountain under the control
of Aesculapius, thus conveying the impression that the wisdom of the
latter was greater than his own. But all these interpretations are too
subtle for the uneducated mind to appreciate at a glance. They fail
also to satisfy our preconceived ideas of what such a statue should
be--viz., a memorial of the godlike character of Aesculapius and of
the priceless benefits which he conferred upon his fellow men, and,
at the same time, an object which, when first contemplated by one
who is ill, would at once evoke in that person feelings of perfect
confidence in the ability and the willingness of the god represented
by the statue to effect a cure. Some, perhaps even a majority, of the
statues thus far recovered from the ruins of the different Aesculapian
temples certainly fail to arouse any such sentiments in the minds of
ordinary observers; but there are others which do in some measure
accomplish this, and among the number the statue which may be seen in
the Berlin Museum and of which a photographic copy (Fig. 4) is here
reproduced, should certainly be included. The head of the god is less
imposing and the expression less kindly than are these features in
some of the other statues (see, for example, Fig. 5), but, to offset
this, the serpent represented in the latter is of the non-poisonous
variety.[20] The addition of such a harmless creature to the figure
representing the god contributes nothing to the power of the statue
as a whole to impress the people--_i.e._, the uneducated masses,
as, for example, the peasants, etc. On the other hand, the significance
of the poisonous snake in a statue of this character will be readily
appreciated if one considers the fact that in ancient times, as it is
even to-day in India, the loss of life caused by the bites of poisonous
snakes was enormous. In the presence of such a fact, therefore, it
would be difficult for a sculptor who was desirous of emphasizing
the extraordinary healing powers of his hero to accomplish this
more effectively than by embodying in his statue, along with other
impressive features, such characters as would show him to have gained
the mastery over that terribly fatal malady--the bite of the viper
and of the still more deadly serpents of India and parts of Africa.
Although we possess no facts which would warrant the statement that
Aesculapius had been particularly successful in the treatment of this
form of poisoning, these temple statues furnish indirect proof of a
strong character that his healing power in this direction had been
very great,--so great, indeed, as to have been largely instrumental
in winning for him the appellation of a god. Such a striking object,
especially when its more important features were commented upon by
the priest who accompanied the patient on his or her first tour of
inspection of temple wonders, could scarcely have failed to produce a
very deep impression upon the imagination.

  [Illustration: FIG. 4. ANCIENT STATUE OF THE GOD AESCULAPIUS IN THE
  BERLIN MUSEUM.

  (From Holländer’s _Plastik und Medizin_, with the author’s
  permission.)]

  [Illustration: FIG. 5.

  HEAD OF THE MARBLE STATUE OF THE GOD AESCULAPIUS IN THE NAPLES
  MUSEUM.]

In the illustration which has here been reproduced (Fig. 4), a viper,
as clearly shown by the shape of his head and neck and by the unusual
length of the jaw, has twined himself about the staff and is close
to the god’s hand, so close that in an instant’s time the fatal bite
might readily be inflicted. But Aesculapius shows by his countenance,
by the unconcerned manner in which he allows his right hand to remain
near the serpent’s head, and by the easy pose of his whole body, that
he is not at all concerned about the danger which appears to threaten
his life. In the estimation of the ancient Greeks this fearlessness was
undoubtedly attributed to the supernatural power which they believed
Aesculapius to possess over dangerous serpents as well as over diseases
of all kinds.

So far as now appears, all the statues of the god that have been dug
up in Greece or its nearest colonies represent the serpent as of
the size commonly observed in that part of the world. Hollaender,
however, furnishes (on page 118 of his work) an illustration which
represents--as he believes--the god Aesculapius in the presence of
an enormous snake, evidently a python. (Fig. 6.) As this variety of
serpent is not to be found in Greece, or indeed at any point further
north than the Mediterranean coast of Africa, it is fair to assume
that the bas-relief which depicts this scene must have been made for
exhibition in an Asclepieion located at Cyrene or at the relatively
near city of Alexandria, where patients, who were more or less familiar
with this serpent and realized its power of crushing people to death,
would have occasion to witness this suggestive work of art. And,
furthermore, as if it were for the express purpose of emphasizing the
great protective power of the god, the sculptor has introduced, on one
side of the scene, the figures of three women, two young children and
a lamb. The women nearest to the monster have folded their arms and do
not manifest the least sign of fear. The children also appear to be
unaware of the presence of a deadly danger. In short, the proximity of
the god Aesculapius has instilled into the minds of these human beings
the most complete sense of fearlessness; he himself, as in the case
of the statue of Aesculapius shown in Fig. 4, exhibiting a complete
absence of fear in the presence of the dangerous monster. Neither death
by poisoning nor death by constriction has any terrors for him to whom
the patient is about to appeal for relief from disease.

That pythons were a terror in former times to the people who inhabited
the coast regions near Cyrene is evident from a statement which
Aristotle makes in his History of Animals (Book VIII., Chapter
xxviii.). It reads as follows:--

   In Libya (Africa) the serpents, as has been already remarked,
   are very large. For some persons say that, as they sailed along
   the coast, they saw the bones of many oxen, and that it was
   evident to them that they had been devoured by the serpents.
   And, as the ships passed on, the serpents attacked the triremes,
   and some of them threw themselves upon one of the triremes and
   overturned it.




                              CHAPTER VI

       THE BEGINNINGS OF A RATIONAL SYSTEM OF MEDICINE IN GREECE


With the lapse of time the religious and mystical features of the
treatment carried on at the Asclepieia gave place, more and more,
to rational methods, and eventually--it is scarcely possible to
mention a date, but probably not many years before the Hippocratic
period--these institutions became centres for the spread of medical
knowledge of the most practical kind. This is particularly true of the
Asclepieion at Cos, where Hippocrates is believed to have received
his medical training. It is interesting to note that the mystical
features of the temple treatment--features which certainly did not
originate with Aesculapius himself or with his sons, Machaon and
Podalirius--eventually proved powerless to stay the slow but sure
advance of sound medical knowledge. Even during the period when these
false elements seemed to be most strongly rooted in the temple methods,
there were forces at work which in due time deprived them of much of
their pernicious power. This result was inevitable, for an organization
which, in order to prosper in its work of doing good to humanity,
depended upon the natural superstitiousness of the people, could not
possibly thrive for an indefinite length of time. That the evil results
did not develop sooner than they did simply shows how powerful and
stubborn is the force of superstition. In the absence of trustworthy
historical evidence, hypothetical statements only can be brought
forward, but there can scarcely be any doubt but that a genuine belief
in the power of Aesculapius (deified) to cure disease and restore
health persisted for centuries.

The custom of recording the case histories on tablets or on the
columns of the temple,--for at this period writing was in general
use,--and also that of dedicating to the god images which represented
(sometimes with a remarkable degree of truthfulness) the pathological
condition for which the patient sought relief, contributed very greatly
to the substitution of sound learning for religious mysticism and
poorly concealed humbuggery.

Among the interesting objects which may be seen at the Museum of the
History of Medicine in Jena, Germany, there are several of these
terra-cotta images (votive offerings) representing pathological
conditions; and among them the writer noticed more particularly one
which reproduced faithfully, though in diminutive size, the appearances
presented by cancer of the female breast. (Fig. 7.) There were also a
very carefully modeled statuette of the trunk of a woman affected with
ascites, and an admirable representation of a case of facial paralysis.
(Fig. 8.) These objects were obtained by Professor Meyer-Steineg on the
occasion of a recent visit to the ruins of the temple of Cos and other
similar ruins in Greece and Asia Minor. The British Museum possesses
many objects of the same character.

  [Illustration: FIG. 6. BAS-RELIEF OF AESCULAPIUS, ACCOMPANIED BY
  WOMEN AND CHILDREN, IN THE PRESENCE OF AN ENORMOUS SERPENT.

  The original is in the National Museum at Athens.]

  [Illustration: FIG. 7. FEMALE BUST SHOWING CANCER OF ONE BREAST.

  (Courtesy of Prof. Dr. Meyer-Steineg, of Jena, Germany.)]

It is not known at what precise date the _iatreia_, or small
private hospitals, first made their appearance, but it was about the
time when the religious character of the therapeutic work done in
the Asclepieia gave place to treatment of a more distinctly medical
character. Then, in addition to these _iatreia_, there were
schools for gladiators and institutions in which gymnastic exercises
were zealously cultivated; and in these places there was a frequent
demand for advice in regard to questions of diet, and for surgical
aid in the setting of broken bones, the reducing of dislocations,
and the curing of bruises and sprains. As may readily be understood,
the Asclepieia could not furnish the sort of professional aid which
these institutions needed, and thus a further stimulus was given to
the complete separation of the two kinds of medical practice--that
connected with the temple and that conducted by outside physicians.

In Plato’s “Republic” (Book III., Chapter 15) mention is made of a
certain Herodicus (of Selymbria; about 450 B. C.) who effected many
cures by a method of treatment which combined athletic exercises
with dieting. He gained considerable celebrity in this way, and is
undoubtedly entitled to the credit of having been the first to call
serious attention to the value of this plan of treating certain
maladies. But, unfortunately, he made use of it in not a few instances
where it proved harmful rather than beneficial to the patient, and thus
brought discredit upon the method.

Already previous to the time at which the changes mentioned above
took place, there had occurred still other changes in the character
and practice of medicine. The business of cutting for stone in the
bladder, for example, had been left entirely in the hands of men who
made a specialty of this branch of medicine--men who might truthfully
be called medical artisans. Then there was another class of men who
devoted their energies to collecting medicinal roots and plants.
They were a necessity to physicians, and constituted the first
representatives of the modern apothecary. Still another change in the
status of the Greek physicians had been slowly developing throughout
this pre-Hippocratic period, a change which tended more and more to
make them men of self-reliance and of considerable importance in their
respective communities, and which indicated very clearly that they were
steadily growing in skill and breadth of knowledge. As evidence of the
correctness of this statement it is sufficient to mention the fact that
Greek physicians had established so good a reputation that they were
frequently called to see important cases at a great distance--in Egypt,
in Persia, etc. But before further consideration is given to this
subject of the development of the Greek physician during the period
immediately preceding the appearance of the Hippocratic writings,
it seems advisable to say a few words concerning the facilities for
medical instruction which were available at that time.

_Medical Instruction in Connection with the Asclepieia._--
It does not appear clearly in any of the published descriptions
of these ancient Greek sanatoria just what were the relations
between the priests and the men who utilized all this rich clinical
material--records of all sorts of diseases, and the means (other
than religious) employed in treating them, pictures or plastic
reproductions of the visible pathological lesions, etc.--for the
purpose of instructing the younger men who contemplated engaging in the
practice of medicine. The modern teachers of the art know very well how
difficult is the task of combining in a satisfactory manner these two
things--the safeguarding of the patient’s interests and the utilization
of their maladies as object lessons for men who are preparing to cure
or relieve the bodily ills of those who may at some future moment need
their professional services. To them, therefore, it would be a matter
of very great interest to learn how this difficult problem had been
solved nearly twenty-five hundred years ago. But, unfortunately, no
satisfactory data upon which a trustworthy account might be founded
are obtainable, and we are obliged to fall back upon such aid as our
imagination may furnish. From Puschmann’s work on medical teaching in
ancient times the following statement relating to the subject has been
taken:--

   The priests in the Aesculapian temples were not, as is generally
   assumed, physicians in the ordinary sense. They may have
   acquired some knowledge of the art, and they may even in some
   instances have been regularly trained physicians, but the
   important fact remains that they wished it to be understood that
   the treatment carried out in the temple was in accordance with
   revelations made to them by the god Aesculapius, and not the
   mere fruit of human knowledge. Consequently the intervention
   of regular physicians in the temple management of the sick
   must have appeared to them quite superfluous. For this reason,
   therefore, it is not likely that there existed, on the part of
   either the temple priests or the physicians, any feeling of
   animosity or opposition. It is more likely that the contrary
   was the case, for the evidence shows that the physicians--the
   Asclepiadae--paid most humble reverence to the sacred relics
   of Aesculapius, and placed the most implicit confidence in the
   opinions which he was supposed to give in desperate cases.

  [Illustration: FIG. 8. PARALYSIS OF THE LEFT FACIAL NERVE.

  (Courtesy of Prof. Dr. Meyer-Steineg, _Jenaer
  medizinisch-historische Beiträge_, Heft 2, 1912.)]

While Puschmann does not say to what period in the history of these
temples his statement applies, it is safe to assume that he had in
mind only the earlier stages. When the systematic teachings of medical
pupils began, those physicians who gave the instruction--viz., the
Asclepiadae who were not at the same time priests--took up their abode
somewhere in the neighborhood of the temple. Thus, medical schools were
formed at different places, those of Rhodes, Crotone, Cyrene, Cos and
Cnidus attaining the greatest celebrity. The pupil paid a fee for his
instruction, and when his training was believed to be completed he was
admitted into the association or brotherhood of the Asclepiadae upon
taking the following oath, which for ages past has been known as “The
Hippocratic Oath,” but which is now believed to have been formulated
long before the time of Hippocrates:--


                         THE HIPPOCRATIC OATH

   I swear by Apollo the Physician and Aesculapius, and Hygieia and
   Panacea and all the gods and all the goddesses--and I make them
   my judges--that this mine oath and this my written engagement I
   will fulfil as far as power and discernment shall be mine.

   Him who taught me this art I will esteem even as I do my
   parents; he shall partake of my livelihood, and, if in want,
   shall share my goods. I will regard his issue as my brothers and
   will teach them this art without fee or written engagement if
   they shall wish to learn it.

   I will give instruction by precept, by discourse, and in all
   other ways, to my own sons, to those of him who taught me, to
   disciples bound by written engagements and sworn according to
   medical law, and to no other person.

   So far as power and discernment shall be mine, I will carry out
   regimen for the benefit of the sick and will keep them from harm
   and wrong. To none will I give a deadly drug even if solicited,
   nor offer counsel to such an end; likewise to no woman will I
   give a destructive suppository; but guiltless and hallowed will
   I keep my life and mine art. I will cut no one whatever for the
   stone, but will give way to those who work at this practice.

   Into whatsoever houses I shall enter I will go for the benefit
   of the sick, holding aloof from all voluntary wrong and
   corruption, including venereal acts upon the bodies of females
   and males whether free or slaves. Whatsoever in my practice or
   not in my practice I shall see or hear amid the lives of men
   which ought not to be noised abroad--as to this I will keep
   silence, holding such things unfitting to be spoken.

   And now if I shall fulfil this oath and break it not, may the
   fruits of life and of art be mine, may I be honored of all men
   for all time; the opposite if I shall transgress and be forsworn.

   (Translated from the Greek by the late John G. Curtis, M.D., of
   New York.)

While at first, according to Puschmann, many physicians did not belong
to the Aesculapian Brotherhood, there came a time when all were known
as Asclepiadae.

_Influence of the Schools of Philosophy on the Growth of Medical
Knowledge._--About the beginning of the sixth century B. C. there
developed, in Greece and its colonies, schools of philosophy which
exerted a most excellent influence upon the growth of medicine. The
first of these was the one known as the Ionian School, whose founders
and chief representatives were Thales, of Miletus in Ionia (born in
640, died in 548 B. C.), and his pupils Anaximander and Anaximenes.
The guiding principle of these men was to study natural phenomena and
to learn, if possible, their causes and the laws of their action.
Physiology, therefore, became one of their special studies, and
thus they contributed to the laying of one of the most important
foundation-stones of medicine. Thanks to the good quality of the work
of instruction that had thus far been carried on at Cos, Cnidus, and
other Asclepieia, medicine had by this time reached a sufficient
degree of development for its devotees to derive a full measure of
benefit from the new teaching of the philosophers. Well grounded in the
observation of disease in its different forms and modes of behavior,
and also familiarized with the ordinary methods of treatment, these
physicians needed to be shown a new route along which they might
advance to greater heights of knowledge, and they also needed to be
stimulated to further endeavor. The introduction of the new school
accomplished both of these purposes. It taught the men of the older
organizations that they must make much greater use of their reasoning
powers than they had hitherto done, and at the same time, through
the creation of a group of rival physicians, it supplied them with
the required stimulus. Another important school of philosophy was
that known as the Eleatic School, which flourished at Elea, in Lower
Italy, its leaders being natives of that city. The most prominent men
connected with this school were Parmenides (born about 540 B. C.) and
Xenophanes of Colophon, in Asia Minor, whose contributions to mental
science formed the basis of Plato’s metaphysics.

The period roughly embraced between the years 500 and 300 B.
C. represents the most brilliant age of Greek intellectual and
artistic activity. During this time there came into prominence such
philosophers, historians, poets, physicians, artists and generals of
armies as had never before been marshaled in historic array in so
rapid succession. Even at this late day the names of these great men
are almost household words--such names, for example, as Pythagoras,
Alcmaeon, Anaxagoras, Aristotle, Plato, Socrates, Sophocles,
Aeschylus, Euripides, Aristophanes, Pindar, Xenophon, Demosthenes,
Democedes, Hippocrates the Great, Phidias, Praxiteles, Zeuxis,
Apelles, Darius I., Alexander the Great, and many others of almost
equal celebrity. During the centuries immediately preceding this
golden age of Greek history, there seem to have been very few men of
great merit in any of the branches of learning or in the fields of
war or art, but this impression is certainly false. It is doubtless
to be explained by the fact that large quantities of documentary
evidence relating to these years have been entirely lost. Daniel Le
Clerc, for instance, states[21] that, of the separate histories of
the descendants of Aesculapius which were written by Eratosthenes,
Pherecydes, Apollodorus, Arius of Tarsus and Polyanthus of Cyrene,
not one has come down to our time. If, then, in the single department
of medicine, the destruction of documentary evidence was as great as
is here represented, how enormous must have been the loss of precious
historical materials in all the departments of human activity taken
together. We may, therefore, safely assume that this golden age, which
lasted only about two hundred years, represents simply the culmination
of an even longer period of slow but steady development, a period of
creditable though perhaps less brilliant achievements.

Of the names mentioned above there are several that belong to men who
were in various ways connected with the early history of medicine.
Pythagoras, for example, is said to have been one of the first among
the Greek philosophers to exert a strong and double impression upon
the medical teaching of that period. He was born in the Island of
Samos, near the coast of Asia Minor, about the year 575 B. C. After
spending several years in Egypt for purposes of study, and probably
visiting Babylon, at that time a great centre of learning and of
artistic cultivation, he established at Crotona, in the south of Italy,
a school[22] where natural philosophy, mathematics, acoustics, etc.,
were taught. He also devoted some attention to anatomy, to embryology,
to physiology and to therapeutics. According to his views of what
constituted hygienic living a man should accustom himself to a diet
of the simplest character, without meat. Pythagoras was a believer in
the Chaldean doctrine that the uneven numbers possess a more important
significance than the even, and that the number seven in particular
has a special relationship to the phenomena of certain diseases; the
crisis frequently falling on the seventh, fourteenth, or twenty-first
day. Galen, it is said, expressed surprise that a man as sensible and
learned as Pythagoras should have paid any attention to such trifles.
Not a few of the disciples of Pythagoras were physicians, and when
the brotherhood (if such it may be called) broke up, as it did in the
fifth century B. C., these men traveled about from one Grecian city to
another; from which fact they were given the name of “periodeuts” or
ambulant physicians. Crotona was also celebrated as the birthplace of
Milo, the athlete.

Democedes, who was a contemporary of Pythagoras, but not one of his
disciples, was a native of Crotona. Dion Cassius, the author of a Roman
history, ranks him and Hippocrates as the two most eminent physicians
of antiquity. Daremberg, who derived his facts from the works of
Herodotus, gives the following account of the adventures of Democedes:--

   Being unable to bear any longer the frequent anger and harsh
   treatment of his father, Calliphon, Democedes left Crotona,
   and settled in practice at Aegina, on the Saronic Gulf, not
   far from Athens. Almost from the very start he attained marked
   success, and already in the second year of his residence in
   Aegina he was made the recipient of a pension of one talent
   (equal to about £240, or $1200,) out of the public treasury.
   During the following year he was induced, by the offer of a
   larger pension (100 minae, or about $3000,) to settle in Athens;
   and, a year later, he accepted a still larger remuneration from
   Polycrates, the tyrant of Samos. Having accompanied the latter
   on a trip to Sardis, the capital of Lydia, in Asia Minor, he
   fell a prisoner into the hands of the governor of that city,
   and was made by him a slave. Not long afterward Darius gained
   possession of this governor’s or satrap’s property, including
   all his slaves; and thus, despite all his efforts to conceal
   his profession through fear that a knowledge of it on the part
   of the king might prolong his bondage indefinitely, Democedes
   was unable to do so. The discovery came about in the following
   manner. During a hunting trip Darius broke his ankle. He called
   to his assistance the court physicians, who were esteemed the
   most skilful that could be found in all Egypt, but they failed
   to give him relief. By the violence of their manipulations
   they rather made matters worse. For seven days and nights his
   sufferings were so great that he was unable to obtain any sleep.
   Finally, on the eighth day, one of the court attendants having
   told Darius that there was a Greek physician among the slaves,
   Democedes was sent for, and he appeared before the king clad in
   rags and with chains on his ankles. When asked whether he knew
   anything about medicine he denied such knowledge, being fearful
   that the discovery of the truth about himself would stand in
   the way of his ever getting back to Greece. Darius, perceiving
   that he was dissimulating, ordered the attendants to fetch the
   whips and pinchers. Whereupon Democedes made up his mind that
   he had better confess the truth. He accordingly told the king
   that, while not possessing a thorough knowledge of the healing
   art, long association with a physician had familiarized him
   more or less with the subject. The king then asked him to take
   charge of the case. Democedes, following the treatment adopted
   by the Greek physicians in similar conditions, applied soothing
   remedies and soon succeeded in procuring sleep for the suffering
   king. Eventually he obtained a complete cure, and Darius, who
   had made up his mind that he would never again be able to use
   his limb, was naturally delighted with the result. He loaded
   Democedes with gifts, and, being charmed with his conversation,
   made him sit at the royal table and did everything possible to
   render court life attractive; but liberty was denied him, which
   was the one thing that Democedes most ardently desired. The only
   use which the latter made of the great influence which he had
   obtained over Darius was to save the Egyptian physicians from
   the death by crucifixion which the king had decided to inflict
   upon them for their lack of skill.

   The means of escape finally presented themselves to Democedes
   in a most unexpected manner. Atossa, who was the wife of Darius
   and also the daughter of Cyrus, was afflicted with a swelling of
   the breast which developed into an abscess and began to burrow
   into the neighboring tissues. After, for a time, concealing
   the trouble through a sense of false modesty, she made up her
   mind to consult Democedes. He had the good fortune to cure her
   of this malady in a relatively short time. As preparations
   were then being made to send a number of spies to Greece with
   instructions to examine the coast carefully for the purpose
   of determining at what points the defenses were sufficiently
   weak to render an attack by the Persians reasonably sure of
   success, Democedes asked permission of Darius to accompany these
   men as their guide. His request was granted; and, as soon as
   the expedition reached Tarentum in Calabria, he delivered the
   Persian spies into the hands of Aristophilides, the king of that
   country, and then fled in all haste to Crotona, his native city.
   Shortly afterward these Persians, having been set at liberty by
   Aristophilides, made the attempt to capture Democedes and carry
   him off by main force, but the citizens of Crotona thwarted
   the attempt and compelled the men to return to Asia. Democedes
   then married the daughter of Milo, the athlete, and history
   furnishes no information regarding the subsequent career of this
   extraordinary man.

Daremberg calls attention to certain excellent proverbs which may be
found in the writings of the Greek poets and which are of some interest
to physicians. The following may serve as examples of those most widely
known:--[23]

   Joy is the best physician for fatigue.
                                (Pindar, 522–442 B. C.)

   The good physician is he who knows how to employ the right
   remedies at the proper time; the poor one, he who, in the
   presence of a serious illness, loses his courage, becomes
   flustered, and is unable to devise any helpful method of
   treatment.
                                 (Aeschylus, 525–456 B. C.)

   Physician, heal thyself.
                        (Euripides, 400–406 B. C.)

Advice given to Phaedra by her nurse:--

   If thou hast some ailment which thou dost not care to reveal to
   men, here are women who are competent to treat the condition
   properly.
                                                    (Euripides.)

    Sleep is the physician of pain,
  and
    Death is the supreme healer of maladies.
                                      (Sophocles, 495–406 B. C.)

In Plato’s writings there are to be found a few passages in which this
philosopher gives his views in regard to certain matters that are not
without interest to modern physicians. The following extracts are of
this nature:--

   There is not then, my friend, any office among the whole
   inhabitants of the city peculiar to the woman, considered as a
   woman, nor to the man, considered as a man; but the geniuses
   are indiscriminately diffused through both: the woman is
   naturally fitted for sharing in all offices, and so is the man;
   but in all the woman is weaker than the man.

   Perfectly so.

   Shall we then commit everything to the care of the men, and
   nothing to the care of the women?

   How shall we do so?

   It is therefore, I imagine, as we say, that one woman, too, is
   fitted by natural genius for being a physician, and another is
   not; one is naturally a musician, and another is not.

    (From “The Republic” of Plato, translated by Spens.)

   But tell me with reference to him who, accurately speaking, is
   a physician, whom you now mentioned, whether he is a gainer of
   money or one who taketh care of the sick? and speak of him who
   is really a physician.

   One who taketh care, said he, of the sick.

          *       *       *       *       *

   Why then, said I, no physician as far as he is a physician,
   considers what is advantageous for the physician, nor enjoins
   it, but what is advantageous for the sick; for it hath been
   agreed that the accurate physician is one who taketh care of
   sick bodies, and not an amasser of wealth. Hath it not been
   agreed?

   He assented.
                     (Plato, 428–547 B. C., translated by Spens.)

But Plato’s knowledge of human anatomy and physiology was very crude
and in some instances decidedly fanciful. In corroboration of this
statement the following extract from the “Timaeus” may be quoted:--

   And on this account, fearing to defile the Divine nature more
   than was absolutely necessary, they [the junior gods] lodged
   man’s mortal portion separately from the Divine, in a different
   receptacle of the body; forming the head and breast and placing
   the neck between, as an isthmus and limit to separate the two
   extremes.

   In the breast, indeed, and what is called the thorax, they
   seated the mortal part of the soul. And as one part of it was
   naturally better, and another worse, they formed the cavity of
   the thorax into two divisions (resembling the separate dwellings
   of our men and women), placing the midriff as a partition
   between them. That part of the soul, therefore, which partakes
   of fortitude and spirit and loves contention they seated
   nearer the head between the midriff and the neck; as it is the
   business of the reason to unite with it in forcibly repressing
   the desires, whenever they will not obey the mandate and word
   issuing from the citadel above.

   The heart, which is the head and principle of the veins as well
   as the fountain of the blood that impetuously circulates through
   all the members, they placed in a kind of sentry-house, that, in
   case of any outburst of anger, being informed by the reason of
   any evil committed in its members, owing either to some foreign
   cause, or else internal passions, it (the heart) might transmit
   through all its channels the threatenings and exhortations of
   reason, so as once more to reduce the body to perfect obedience,
   and so permit what is the best within us to maintain supreme
   command.

   But as the gods foreknew, with respect to the palpitation of
   the heart under the dread of danger and the excitement of
   passion, that all such swellings of the inflamed spirit would
   be produced by fire, they formed the lungs to be a sort of
   protection thereto; first of all, soft and bloodless, and next
   internally provided with cavities perforated like a sponge, in
   order to cool the breath which they receive, and give the heart
   easy respiration and repose in its excessive heat. On this
   account, then, they led the channels of the windpipe into the
   lungs, which they placed like a soft cushion round the heart, in
   order that when anger rises in it to an extreme height it might
   fall on some yielding substance, and, so getting cool, yield
   cheerfully and with less trouble to the authority of reason.
                     (Plato’s “Timaeus,” translated by Henry Davis.)

Alcmaeon, Empedocles, Diogenes of Apollonia, Anaxagoras and Pausanias,
whose names are mentioned above in the list of eminent men who
flourished during the golden age of Greek history, are entitled to
further consideration. Alcmaeon of Crotona was a contemporary and
disciple of Pythagoras. He was specially devoted to the study of
anatomy and physiology, and is credited with the distinction of
having been the first person to dissect animals for the purpose of
learning the formation of the different parts of their bodies. With the
exception of a few fragments that are to be found scattered throughout
ancient medical literature, Alcmaeon’s writings have all been lost.
The discovery of the optic nerve is credited to him, and Neuburger
states that he deserves still greater credit for having been the first
to declare that the brain is the central organ of all intellectual
activity.

Of all the disciples of Pythagoras, Empedocles attained the greatest
celebrity. He flourished about 444 B. C., his residence being at
Agrigentum, in Sicily. Much of his reputation appears to have been
due to the mystery which surrounded many of his actions. He was even
reputed to have brought again to life persons who were believed to be
dead. His works were all in verse, but only fragments have come down
to us. He placed the seat of hearing in the labyrinth of the temporal
bone. His death occurred in Peloponnesus at the age of sixty, as the
result of an accident.

Anaxagoras was born at Clazomenae, in Ionia, 500 B. C. He was the
teacher of Euripides, the Athenian poet, and Pericles, the greatest of
Athenian statesmen. He and his contemporary, Diogenes of Apollonia, in
Crete, devoted a great deal of attention to the study of anatomy. They
dissected animals and made some genuine discoveries; Anaxagoras noting
the existence of the lateral ventricles of the brain, and Diogenes
furnishing a description--very erroneous, it is true--of the vascular
system of the body. Puschmann says that, according to Aristotle,
the philosophers of that period considered the study of man and his
diseases the most important one to which they could devote their time
and thoughts. Many of them indeed had been educated as physicians, and
not a few were actual practitioners of medicine.




                              CHAPTER VII

                         HIPPOCRATES THE GREAT


Hippocrates was born in 460 B. C. in the city of Cos, on the island of
the same name. Both his father and grandfather were eminent physicians,
descendants of Aesculapius. On his mother’s side he traced his descent
from Hercules. The famous painter, Apelles, also hailed from the city
of Cos. To distinguish Hippocrates from an earlier individual of the
same name he was called Hippocrates II., or the Great. He is said to
have received his first instruction in medicine at the school of the
Asclepiadae in his native city, but his frequently repeated and very
favorable comments on the teachings of the Cnidian school[24] have
led some to believe that he may have received a part of his medical
training at the latter institution. At a later period of his life his
popularity as a teacher of medicine, in the school of the Asclepiadae
at Cos, attracted many pupils to that city. In accordance with a custom
which prevailed among the physicians of ancient Greece, Hippocrates,
at the beginning of his career, spent quite a long time in Athens, and
then traveled about, from one city to another, in the character of a
periodeutic or itinerant physician. In this way, as he himself reports
in some of his writings, he visited Thessaly, Thrace, the Island of
Thasos, Scythia, the countries bordering on the Black Sea, and even
Northern Egypt. Owing largely to domestic troubles he left his home in
Cos, during the latter part of his career, and removed to Thessaly.
He died about 370 B. C. at Larissa, at an advanced age. Soranus of
Ephesus, the celebrated obstetrician, reported that in his time (second
century A. D.) the tomb of Hippocrates was still standing, and that
it had been taken possession of by a swarm of bees whose honey was
far-famed for its efficacy in curing ulcers of the mouth in children.

Among the pupils of Hippocrates were his two sons, Draco and Thessalus,
and his son-in-law, Polybus. Thessalus, in the capacity of a military
surgeon, accompanied Alcibiades on his expedition to Sicily, and
later in his career he served as private physician to Archelaus, King
of Macedonia. It is also believed that a number of the writings in
the Hippocratic collection are from his pen. On the other hand, it
is a well-established fact that Polybus is the author of a few of
these treatises. When Hippocrates gave up the work of teaching, his
son-in-law, who was at that time engaged in private practice in Cos,
was chosen his successor in the school.

Among the many anecdotes which are related of Hippocrates, there is one
which may with propriety be repeated here:--

   On the occasion of a visit to Abdera, in the northern part of
   Thrace, Hippocrates was requested to examine into the mental
   condition of the philosopher Democritus, who was thought by
   his narrow-minded countrymen to be insane. Hippocrates found
   him deeply engrossed in the study of natural philosophy and
   asked him what he was doing. Democritus replied that he was
   investigating the foolishness of men. Whereupon Hippocrates
   reported that he considered Democritus the wisest of men.
   (Pagel.)

No better evidence of the true greatness of a man can be furnished than
that which is afforded by the praise of his contemporaries in the same
rank or walk of life; and when the appreciation comes from such men as
Plato and Aristotle, it constitutes an absolute guarantee that it is
well and honestly earned. To Hippocrates belongs the singular honor
of having won unstinted praise from both of these great philosophers,
Aristotle giving him the title of “Hippocrates the Great,” and Plato
comparing him to those famous sculptors, Polyclytus and Phidias. His
writings and those of the members of his family who were associated
with him in the work of promoting a knowledge of medicine were most
carefully preserved by his successors. When the Ptolemies began to
establish libraries at Alexandria, Egypt (285 B. C.), and manifested
a decided readiness to purchase the works of the most celebrated
authors, copies of the Hippocratic writings were among those which
found their way to that city. This eagerness on the part of the Kings
of Egypt to purchase books or manuscripts stimulated unscrupulous
persons to attribute to celebrated authors not a few of these works
which they offered for sale. The librarians, whose duty it was to
guard against such frauds, were not sufficiently well informed to
prevent them; and thus there were accepted, as genuine productions,
a few books which could not possibly have been written by those to
whom they were attributed. The collection of Hippocratic writings
did not escape this fate, and the evil was also further aggravated
by the fact that copyists and incompetent editors made all sorts of
emendations and additions on their own responsibility. Thus, it is
not surprising that a collection which originally contained only the
writings of Hippocrates and his immediate family, should in course of
time have become expanded, not only by such alterations as have just
been described, but also by the addition of entire works that had
been written by others. At the beginning of the third century B. C.,
the Ptolemies appointed a committee of learned men in Alexandria to
examine carefully the treatises reputed to be the work of Hippocrates
and to make a collection of those which appeared to them to be
genuine. They performed this task to the best of their ability, but
the result showed that they lacked the necessary critical powers; and
consequently during the past 2000 years repeated attempts have been
made to do what they failed to accomplish, but these efforts have only
succeeded in part. The French edition prepared by Émile Littré, the
distinguished member of the French Academy of Medicine, and published
in the years 1839–1861, was, until quite recently, universally
accepted as embodying the best results of modern research and criticism
with regard to this difficult question. But since 1861 other scholars
have been busily engaged in perfecting the text of the Hippocratic
writings, and their criticisms and suggestions have made it possible to
publish a German version of this great work which is of more practical
value to physicians than that of Littré, which forms a series of ten
large volumes and is no longer easy to obtain. On the other hand, the
German version by Robert Fuchs (Munich, 1895–1900), in three volumes
of moderate size, while in no respect inferior to the famous French
translation, is superior to it in several particulars: it is better
adapted to the needs of the ordinary practitioner of medicine, it
embodies the results of the excellent critical work done since 1861
(e.g., by Ermerins of Utrecht, Daremberg of France, and Ilberg and
Kühlewein of Germany), and it costs very much less than its French
predecessor and rival.

As regards the question of authenticity of the treatises contained in
the work known as “The Hippocratic Writings” the most important thing
to be determined is, not whether this or that book or chapter in the
collection was really written by Hippocrates, but whether the work in
its totality gives a correct and fairly complete picture of the best
medical thought and practice of the period during which Hippocrates
lived; and to this question a decided answer in the affirmative may be
given. As to the broad question of authenticity, Max Neuburger, the
distinguished Viennese author of the latest and most authoritative
history of medicine, thus expresses himself:--

   Notwithstanding the extremely small quantity of evidence which
   the so-called “Hippocratic Writings” themselves furnish as to
   who were the writers of the individual treatises and as to what
   Hippocrates himself actually did or thought; and although it
   is true that portions of the collection often contradict one
   another both in regard to questions of theory and also in regard
   to methods of treatment, one fact stands out conspicuously,
   viz., that the peculiar character of these writings both as a
   collection and taken separately, not only gives them a unique
   position in medical literature, but reveals plainly that
   they owe their origin directly or indirectly to the powerful
   influence of a single commanding personality.

As to the manner of teaching medicine, the Hippocratic writings show
that, at the time which is here under consideration, the mystical
features had almost completely disappeared. The science was now taught
by regular instructors, who agreed for a stipulated fee to take charge
of the pupil’s entire training from the beginning to the end of the
course. Candidates who were in delicate health were discouraged from
entering upon the career of a physician, and those who had completed
the regular course of instruction were sent out into the world equipped
with certain general principles for their future guidance in actual
practice. Some of these bear a close resemblance to the principles of
a similar nature which had been established at a much earlier period
in India. For example, the importance of cleanliness of the person is
strongly emphasized. Reticence, as well as courtesy, is classed as one
of the virtues of a good physician.

   He who acts hastily and does not take sufficient time for
   consideration is sure to be criticised unfavorably. If he breaks
   out too readily into laughter he will be thought uncultivated.

In another of the Hippocratic writings the physician is urged not to
indulge in too much small talk, but to confine his conversation as much
as possible to matters relating to the treatment of the disorder.

   In his business dealings the physician, like a genuine
   philosopher, should not display a greed for money, he should
   assume a modest and dignified attitude, he should appear quiet
   and calm, and his speech should be simple and straightforward
   and free from all superstition.

For their knowledge of human anatomy the physicians of that period
were obliged to depend on the dissection of animals. Specimens of
human bones were of course easily accessible, and consequently the
descriptions which are given of these structures are quite accurate,
even as regards many of the finer details.

It would be a very difficult matter to furnish here, within a limited
space, a reasonably clear exposition of the views held by Hippocrates
with regard to human physiology and pathology. Empedocles, a Greek
physician and high priest of Agrigentum, in Sicily, who was born about
490 B. C., founded a system of philosophy on the theory that the
universe is made up of four elements--fire, air, earth and water; and
he maintained that fire is the essence of life, the other elements
forming the basis of matter. It was upon this system that Hippocrates
founded his own theories of life, death and disease, but he disagreed
with Empedocles in regard to the manner in which the four elements
are united, his own belief being that they form together a genuine
mixture, whereas Empedocles maintains that their union represents
merely a mechanical aggregation of separate atoms. He also held that
these original four elements, to which he gave the names of heat,
cold, dryness and moisture, were represented in the human body by the
following four cardinal fluids or “juices”: blood, mucus or phlegm,
black bile and yellow bile.[25] He maintained, further, that when these
elements are mingled harmoniously so as to produce a state of perfect
equilibrium, health resulted; but that when some deficiency of one or
more of them, or some lack of harmony between them in other respects,
occurs, disease is produced. At a later date, a fifth element--wind or
air (pneuma)--was added to the other four; and when Hippocrates was
unable to account satisfactorily for certain phenomena of disease, he
was wont to refer the phenomenon observed to divine interference.

This brief exposition of the physiological and pathological views
held by Hippocrates, incomplete and superficial as it is, will have
to suffice. Those who wish to acquire a more profound knowledge of
the subject should consult some of the larger treatises like those of
Daremberg, of Max Neuburger, and of Pagel, as well as the sections
devoted to these subjects in the French (Littré) and the German (Fuchs)
versions of the Hippocratic writings. At every step in such a study,
the modern physician will encounter ideas and individual terms which he
will have great difficulty in comprehending; and later on, as he reads
the sections which deal with the more practical matters of the medical
art, he will be astonished to find that Hippocrates was a most acute
and trustworthy observer of the phenomena of disease, a remarkably
clear writer, and a standard-bearer of very high aims.

In the examination and treatment of the sick the physicians of
ancient Greece were highly trained. They paid very close attention
to the patient’s account of his symptoms, but it was to the physical
examination of the diseased body that they attached the greatest
importance. They noted with extreme care the color and other
peculiarities of the skin and mucous membranes, the condition of the
abdomen, and the shape and movements of the thorax; they tested the
patient’s temperature by placing the hand upon the body; and all
the excretions were subjected to the closest scrutiny. By means of
palpation they were able to determine not only the size of the liver
and spleen, but also the changes which occur in the form of these
organs in the course of certain diseases. They utilized succussion
both as an aid to diagnosis and as a means of favoring the breaking
through of pus into the bronchial tubes. They were familiar with the
pleuritic friction sound and with the finest râles, which they compared
to the creaking of leather or “the noise of boiling vinegar.” In
their descriptions of these sounds it is distinctly stated that the
examiner’s ear was kept tightly pressed against the patient’s chest.

In speaking of the accounts of individual diseases which appear in the
Hippocratic writings, Puschmann says that they are evidently based
on cases actually observed in practice, and that they are admirably
written. It is in the laws which they have laid down with regard to
the treatment of disease, however, that the Hippocratic writers have
gained their chief distinction, a distinction which will belong to them
through all time.

   The physician should be the handy man of Nature, and he should
   strive to aid and to imitate her efforts to effect a cure.
   His first care should be to remove, so far as is possible,
   the causes of the disease; and then, in the conduct of the
   treatment, he should keep in view at all times the special
   circumstances of the case, giving closer attention to the
   patient than to the disease itself. In short, he should aim at
   being useful, or at least he should be careful not to do any
   harm.




                             CHAPTER VIII

         BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS


The statements which have thus far been made in these pages with regard
to Hippocrates are only of a general character, and it may therefore
be interesting for the reader to have placed before him a few selected
extracts from the writings which have formed the basis of these
statements. The English text here used is a translation of the German
version of Robert Fuchs, to which reference has already been made.
It would have been a pleasure to use for this purpose the admirable
English translation of Frederick Adams, published in 1849 under the
auspices of the Sydenham Society of Great Britain; but, unfortunately,
this version contains only a part of the Hippocratic writings, and,
besides, this writer did not at that time have the advantage of
consulting the French and German versions which have been published
since 1849.

It seems almost unnecessary to state here, by way of preface, that the
small amount of space which may properly be devoted to these extracts
renders it necessary to present many of them in a very fragmentary
and disconnected form, merely enough text being furnished to give the
reader some slight idea both of the manner in which Hippocrates and
those associated with him handled certain medical topics, and also of
the views which they entertained with regard to the same subjects.


         BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS

   _Aphorisms._--I.--1. Life is short, art is long, the right
   moment lasts but an instant,[26] experience is often deceptive,
   a correct judgment is hard to reach.

   6. For the most serious ills extreme measures cautiously
   employed are the best.

   8. When an illness has reached its acme the lightest diet must
   be prescribed.

   11. During the exacerbations nourishment should be withheld, for
   at these times the giving of food is harmful; and in illnesses
   which are characterized by periodic paroxysms it is also best
   not to give food during the paroxysms.

   13. Old people bear fasting very well, and the same is almost
   true of persons of mature age; but young individuals do not bear
   abstinence from food so well, and this is particularly the case
   with children, especially with those of a lively disposition.

   24. In acute illnesses laxative remedies should rarely be
   administered, and then only in the early stage of the malady and
   with great caution.

   II.--2. When sleep puts an end to delirium it is a good sign.

   3. When either sleep or wakefulness oversteps the proper limit
   it is harmful.

   5. Causeless depression is an indication of some disorder.

   19. In acute diseases the prognosis as regards either death or
   recovery, is very uncertain.

   44. Corpulent persons are more likely than those who are slender
   to die a quick death.

   V.--7. When epileptic attacks occur before the age of puberty,
   a change for the better may be looked for; but if the disease
   makes its first appearance when the individual has already
   reached his twenty-fifth year, he may be expected to carry the
   affliction with him to the time of his death.

   9. Consumption most commonly attacks persons who are between the
   ages of eighteen and thirty-five.

   14. When a consumptive person has attacks of diarrhoea, a fatal
   issue may be anticipated.

   VII.--1. If in the course of an acute illness the extremities
   grow cold, it is an unfavorable sign.

   14. If, after a blow upon the head, stupefaction or delirium
   manifests itself, the outlook is bad.

[The total number of the aphorisms is 422.]

   _The Book of Prognoses._--1. I believe that it is best
   for a physician to acquire a certain degree of practice in the
   power to predict how the disease is likely to terminate; for if,
   when he is in the presence of his patient, he is able to state,
   not only what is going to take place in the future course of
   the malady, but also certain other facts which relate to the
   past behavior of the attack, but which were omitted from the
   account given to him of the previous history of the case, he
   will impress the patient with the belief that he is thoroughly
   familiar with the disease from which the latter is suffering,
   and that consequently he is a physician in whose knowledge and
   skill he can place entire confidence. Then, besides, he will be
   the gainer in another respect: his knowledge of what is likely
   to be the subsequent course of any given disease will enable
   him to treat it in the most effective manner. The ability to
   restore all his patients to health would of course be a greater
   power than that of correctly predicting the future behavior
   of a malady in any particular case. This ability, however, is
   clearly unattainable. One patient dies by reason of the severity
   of the disease itself, even before the physician is called in;
   a second one, shortly after the latter’s visit; and a third
   lingers on for a day or two after the doctor’s arrival, dying
   before the latter’s art has had time to produce a beneficial
   effect in hindering the advance of the malady. The observation
   of these different events should enable the physician to become
   acquainted with the nature of the diseases observed, and--more
   particularly--to learn to what extent, in individual instances,
   they manifest a strength greater than the patient’s power of
   resistance. At the same time, he must not forget that in many
   cases divine interference plays a part in directing the course
   of the disease. And thus, if he pays heed to all these things,
   the physician will merit the confidence of his patients and will
   gain the reputation of being a clever and skilful practitioner.

   IV.--It is better when the physician, upon the occasion of his
   first visit, finds the patient lying upon one side, with his
   hands, neck and thighs slightly flexed, and the entire body
   placed in a perfectly natural position, like that which a man
   assumes in bed when he is in a state of health. It is not so
   well when the physician finds the patient lying upon his back,
   with his hands, neck and thighs extended. But if the latter
   is found curled up and sliding down toward the foot of the
   bed, this is an unfavorable sign. Finally, if he is found with
   rather cold feet projecting from under the bedclothes, and with
   his arms outstretched and his neck and thighs exposed, his
   condition may be considered dangerous, for this attitude of the
   body betokens an agitated state of the mind. If the patient
   sleeps with his mouth constantly open, lying upon his back and
   with his thighs strongly flexed and widely separated, it may be
   assumed that death is near at hand. If he lies upon his belly
   when it is known that he was not in the habit of sleeping in
   this manner before he was taken ill, the inference is warranted
   either that he is delirious or that he is suffering from pain in
   the lower part of his abdomen. Finally, if the patient shows an
   inclination to maintain a sitting posture while the malady is
   still in an active stage, this feature must be looked upon as a
   grave symptom and especially so in inflammation of the lungs.

   XIV.--Pus that has a whitish color and a uniform consistency,
   that is smooth and free from clumps, and the odor of which is
   only slightly unpleasant, is the least harmful. On the other
   hand, a pus which possesses the opposite characteristics is very
   dangerous.

   XL.--Severe pain in the ear, if associated with a persistent
   fever is dangerous, for the patient may become delirious and die.

[There are 47 chapters in the Book of Prognoses; in addition, there
are 740 separate sections in the Coan Prognoses (_Praenotiones
Coacae_).]

   _The Epidemic Diseases._--VI.--4. The wife of Agasis
   had already as a young girl been troubled with shortness of
   breath. After she had reached womanhood, and soon after she had
   given birth to a child, she lifted a heavy weight. Immediately
   she heard, as she believed, a noise in her chest, and on the
   following day she experienced some difficulty in breathing and a
   certain amount of pain in her right hip. These two symptoms were
   so related to each other that, whenever the pain in the hip made
   its appearance, she immediately became conscious that she was
   short of breath, and, vice versa, whenever the pain ceased, she
   found that her breathing became easier. Her expectoration was
   of a foamy character and of a rather bright color, but, after
   it had been allowed to stand for a short time, it looked like
   diluted biliary matter that had been vomited. The pain in the
   hip troubled her chiefly when she performed manual work. She was
   advised to abstain from eating garlic, pork, mutton, and beef,
   and not to call loudly or to get excited while she was engaged
   in work.

   VII.--7. The wife of Polycrates became feverish during the
   summer season, and about the time of the dog star. In the
   morning her breathing was somewhat embarrassed, but after
   mid-day it became more difficult and at the same time more
   rapid. From the very beginning of the illness she had a cough
   and expectorated purulent masses. In the throat and along the
   course of the trachea one could hear a hoarse whistling sound.
   The patient’s face had a healthy color, and over the two halves
   of the jaw there was some redness, not of a deep hue but rather
   fresh and bright. A little later her voice also became hoarse,
   she began to show some emaciation, raw spots developed over
   the fleshy parts of her hips, and the surface of the body grew
   more moist than it had been before. On the seventieth day the
   outward evidences of fever became much less noticeable, but the
   respiration grew more rapid; and from that day to the time of
   her death, five or six days later, she was obliged to remain in
   a sitting posture. Toward the end the tracheal râle grew louder,
   and dangerous sweats occurred, but the patient never lost her
   expression of intelligence.

   _Fractures._--II.--9. In the human body the foot, like the
   hand, is composed of a number of small bones. As they are not
   easily broken it may safely be assumed, when such a case of
   fracture comes under observation, that some pointed or unusually
   heavy object had caused the lesion, and that the surrounding
   soft parts must necessarily have been injured at the same time.
   (Injuries of this nature will be discussed in a later section.)
   But if any part of this bony framework is pushed out of its
   natural position--whether this take place in one of the toes,
   or in one of the tarsal bones, it makes no difference--the
   dislocated part should be forced back into position in the
   manner recommended in section XXIV. In its essential features
   the treatment consists in the employment of wax plaster,
   compresses, and bandages, exactly the same as is done in the
   treatment of fractures of the long bones, but without splints.
   The same rules hold good with regard to the degree of pressure
   to be applied, and every third day the dressings should be
   renewed. On each occasion of such renewal the patient should be
   questioned with regard to the sensations which he feels after
   the bandages have been applied, and if necessary they should be
   readjusted in accordance with the nature of the answers which
   he gives. The great majority of these injuries heal completely
   in twenty days. The exceptional cases are those in which the
   fracture] involves a bone that stands in immediate relation
   with the bones of the leg. It is advisable, however, that the
   patient should remain in bed during the period mentioned; for,
   in not a few instances, the persons thus affected, failing to
   appreciate the gravity of the injury, walk about before the
   parts have really healed; and then, for an indefinite period
   of time, they are frequently reminded in a painful manner of
   the injury which they received. There is nothing astonishing in
   this when the fact is recalled to mind that the feet support the
   entire weight of the body.

[Forty-eight chapters or sections, some of them of considerable length,
are devoted to the subject of fractures. The authorities are almost
unanimous in stating that this portion of the so-called Hippocratic
writings was written by Hippocrates himself. Malgaigne and Petrequin,
two of the most competent French writers on questions relating to
surgery, declare that the treatises written by Hippocrates on fractures
and dislocations (the two forming in reality one continuous treatise)
are the best and most complete books ever written by a physician.]

   _Wounds of the Head._--10. The physician should, first of
   all, before touching the patient’s head, inspect carefully the
   wound and surrounding parts. After noting whether the injury
   has been inflicted upon a strong or a weak portion of the head,
   he should ascertain whether the hair has been cut by the fall
   or the blow, and whether portions of it have penetrated into
   the wound. In the latter event he should express his fear that
   the skull at this point has been laid bare and has perhaps even
   received some material injury. He should make this statement
   before he has touched or probed the wound. Then afterward he
   should proceed to a physical examination of the injured parts,
   in order that he may learn positively whether the overlying soft
   tissues have or have not been separated from the bone. If simple
   inspection reveals the fact that the skull has been laid bare,
   well and good; but, if the real condition is not thus revealed,
   he should not hesitate to employ the probe. If he finds that the
   soft parts have been separated from the bone and that the latter
   has been more or less injured, he should continue this more
   minute exploration until he shall have ascertained to just what
   extent and in what manner the skull has been injured, and what
   measures are required to remedy the damage; in brief, he should
   make the diagnosis. At the same time, however, he should not
   neglect to question the patient very closely about the manner
   in which the wound was inflicted, for in this way he may be
   able to infer the existence of a contusion, or even a fracture
   of the skull, of which no material evidences are discoverable.
   Important information may also be gathered by passing the hand
   over the seat of injury in the bone,--information which the
   employment of the probe is not competent to convey.

[Twenty-one additional chapters are devoted to wounds of the head,
every possible phase of the subject being handled by Hippocrates in the
most careful and thorough manner.]




                              CHAPTER IX

          THE STATE OF GREEK MEDICINE AFTER THE EVENTS OF THE
    PELOPONNESIAN WAR; THE FOUNDING OF ALEXANDRIA IN EGYPT, AT THE
     MOUTH OF THE NILE; AND THE DEVELOPMENT OF DIFFERENT SECTS IN
                               MEDICINE


Up to the time when war broke out between Sparta and Athens (431 B.
C.), the latter city had for many years easily held the supremacy, not
merely in everything relating to the science and art of medicine, but
also in all other branches of learning and especially in the arts of
sculpture, painting and architecture. At the time named above came the
beginning of her downfall. For a period of about twenty-one years she
struggled against disasters of all sorts.

_The Plague at Athens, the first Recorded in History._--Shortly
after the war began--a war engendered by the bitter jealousy of Sparta
over the ever increasing ascendancy of her rival--the latter city was
visited by a devastating plague, the first European pestilence that
has been recorded in history. Thucydides, who wrote the history of the
Peloponnesian War, gives a most lucid description of this plague of
Athens, from which I shall copy certain portions.

   It first began, it is said, in the parts of Ethiopia above
   Egypt, and thence descended into Egypt and Libya and into most
   of the King’s country. Suddenly falling upon Athens, it first
   attacked the population in Piraeus,--which was the occasion
   of their saying that the Peloponnesians had poisoned the
   reservoirs, there being as yet no wells there,--and afterward
   appeared in the upper city, when the deaths became much more
   frequent. All speculation as to its origin and its causes, if
   causes can be found adequate to produce so great a disturbance,
   I leave to other writers, whether lay or professional; for
   myself, I shall simply set down its nature, and explain the
   symptoms by which perhaps it may be recognized by the student,
   if it should ever break out again. This I can the better do,
   as I had the disease myself, and watched its operation in
   the case of others.... People in good health were all of a
   sudden attacked by violent heats in the head and redness and
   inflammation in the eyes, the inward parts, such as the throat
   or tongue, becoming bloody and emitting an unnatural and fetid
   breath. These symptoms were followed by sneezing and hoarseness,
   after which the pain soon reached the chest, and produced a hard
   cough. When it fixed in the stomach, it upset it; and discharges
   of bile of every kind named by physicians ensued, accompanied
   by very great distress. In most cases, also, an ineffectual
   retching followed, producing violent spasms, which in some
   cases ceased soon after, in others much later. Externally the
   body was not very hot to the touch, nor pale in its appearance,
   but reddish, livid, and breaking out into small pustules and
   ulcers. But internally it burned so that the patient could not
   bear to have on him clothing or linen even of the very lightest
   description; or indeed to be otherwise than stark naked. What
   they would have liked best would have been to throw themselves
   into cold water; as indeed was done by some of the neglected
   sick, who plunged into the rain-tanks in their agonies of
   unquenchable thirst; though it made no difference whether they
   drank little or much. Besides this, the miserable feeling of not
   being able to rest or sleep never ceased to torment them. The
   body meanwhile did not waste away so long as the distemper was
   at its height, but held out to a marvel against its ravages;
   so that when they succumbed, as in most cases, on the seventh
   or eighth day to the internal inflammation, they had still
   some strength in them. But if they passed this stage, and the
   disease descended further into the bowels, inducing a violent
   ulceration there accompanied by severe diarrhoea, this brought
   on a weakness which was generally fatal. For the disorder first
   settled in the head, ran its course from thence through the
   whole of the body, and, even where it did not prove mortal, it
   still left its mark on the extremities; ... some, too, escaped
   with the loss of their eyes.... Some died in neglect, others in
   the midst of every attention. No remedy was found that could be
   used as a specific; for what did good in one case, did harm in
   another.... Such was the nature of the calamity, and heavily
   did it weigh on the Athenians; death raging within the city and
   devastation without.
              (Translation of Richard Crawley; Dent & Sons, London.)

_Athens Ceases to be the Centre of Medical Learning._--It is safe
to assume that one by one the more prominent of the physicians who
had survived the events which have just been narrated, must have left
Athens and taken up their abode in the various cities of Asia Minor
and the neighboring islands, in Sicily, in Italy, etc. Hippocrates,
who was thirty years old at the time when the plague broke out in
Athens, appears not to have witnessed it. He practiced his profession
and taught medicine in his native city; then he spent a certain number
of years in traveling about as a peripatetic physician; and finally
settled for the remainder of his life in Thessaly. But the length of
each of these periods of his professional life is not mentioned by any
of the authorities. About forty years after the death of Hippocrates,
Alexander the Great had already nearly completed his series of
brilliant conquests, and was taking steps to found a city, or rather, a
university, in which medicine was to take an organized shape as one of
the great departments of human learning.

It may be well at this point, however, to interrupt this narrative
of the regular course of events for the purpose of considering very
briefly how far the physicians of that period had advanced toward
gaining a permanent and honorable position in their respective
communities.

_The Degree of Esteem in which Physicians Were Held by Their Fellow
Citizens and by the Governing Authorities During the Centuries
Immediately Preceding the Christian Era._--We have at our command
very little direct evidence bearing upon the question of the esteem in
which physicians were held three hundred years B. C. by the communities
in which they practiced their profession. We know positively that
the kings and princes of that period fully appreciated the value of
the services which were rendered to them by the physicians (commonly
Greeks) whom they employed. In the event of war they took with them
men who were skilled both in surgery and in the treatment of the
ordinary ills of the body. One of the sons of Hippocrates, for example,
served for some time in this capacity, and he is credited with the
statement that “the physician who wishes to obtain the best training
in surgery should enter the service of the army.” There were eight
surgeons officially connected with the “ten thousand” whom Xenophon
led back to Greece after the famous campaign in Asia Minor. The
army of Alexander the Great was accompanied by the most celebrated
surgeons of that period. Upon a bronze tablet found at Idalium, on
the Island of Cyprus, there is an inscription which dates back to the
fifth century B. C., and which commemorates the merits of a physician
named Onasilos, who, aided by his pupils, rendered valuable services,
without any remuneration, during one of the wars of the Greeks; and in
recognition of these services, the Government had bestowed upon him a
stipend and had exempted him from taxation. It is further known that
the Athenians lavishly heaped honors upon Hippocrates, initiating him
at public expense into the mysteries of the Eleusinia, giving him a
crown of gold, and distinguishing him in still other ways. These facts
show how highly the rulers of that day appreciated the services of a
competent physician; but, up to a comparatively recent date, it has
not been so easy to demonstrate what was his position in the esteem
of the community at large. The discovery, not many years ago, of two
inscriptions in Greek throw a certain amount of light upon this very
point. One of these, which bears the date of 388 B. C., states that
its purpose is to commemorate the fact that the physician Euenor, who
had been intrusted by the people with the work of supervising the
preparation of all the drugs intended for use in the public hospital,
had not only fulfilled his duty but had in addition spent large sums of
his own money in the accomplishment of this work. Another inscription,
which was unearthed in the Island of Carpathus, between Crete and
Rhodes, and which is believed to date back to the end of the fourth
or the beginning of the third century B. C., reads (in a somewhat
abbreviated form) as follows: “In view of the fact that, for more
than twenty years, Menocritus, the son of Metrodorus of Samos, has
devoted himself with much zeal and self-sacrifice to the duties of his
position as parish physician, living all this time in rather narrow
circumstances and not asking any pay for his services, we, the citizens
of Brycontium, have resolved to erect in his honor, in the temple of
Neptune, a marble column bearing an inscription that shall set forth
these facts, to crown him with a wreath of gold, and to announce
publicly, at the Aesculapian games, this our decision.” As apropos
of this subject I may be permitted to quote the following words from
Plato’s “The Republic” (Book 1, Chap. 18): “Will you call the medicinal
the mercenary art, if, in performing a cure, one earns a reward? No,
said he.”

_The Founding of Alexandria._--Alexander the Great, after subduing
the Persians and the cities of Phoenicia, marched into Egypt and
founded (331 B. C.), at the mouth of the Nile, the city of Alexandria.
In October of the same year he crossed the Euphrates and the Tigris
and defeated, for the second time, the Persian hosts under Darius.
Alexander was now the conqueror of Asia. During the following eight
years he laid his plans most carefully for the consolidation of his
great empire, the capital of which was to have been Babylon; but,
while he was thus making provision for the welfare of his numerous
subjects, who were of widely different tastes and aspirations, he
succumbed (323 B. C.) to a severe attack of malarial fever, aggravated
by an excessive indulgence in wine on the occasion of some festivity.
In the meantime Alexandria was developing rapidly into a great centre
of learning in all the departments of human knowledge. The Ptolemies,
beginning with Ptolemy Soter, who reigned over Egypt from 323 to 285
B. C., contributed greatly to this result. For a period of about 250
years Alexandria remained the centre around which revolved all that was
best in the domains of medicine, philosophy, geometry, mathematics,
history, etc. Money was spent lavishly in collecting the writings of
all those authors who had distinguished themselves in these different
fields of learning, and no pains were spared to secure correct
versions of the different works; the septuagint version of the books of
the Old Testament of the Bible being a conspicuous example of what the
Ptolemies accomplished in this direction during the third century B.
C. Every possible facility was offered at the same time for the giving
and receiving of instruction; and thus, with the immense library as a
foundation of priceless value, the Museum at Alexandria became in every
material respect a great university, the first one of which history
gives us any fairly satisfactory information. Several years after
the Museum library was established a second one of somewhat smaller
proportions was organized in the Serapeum (Temple of Serapis). The
example set by the Ptolemies was followed by Attalus, King of Pergamum
in Mysia, Asia Minor (241 B. C.), and, before many years had elapsed,
the great library of that city almost rivaled those of the Museum and
Serapeum at Alexandria. It was the competition between these two royal
collectors of books that led to the issuing of a decree that no more
papyrus was to be exported from Egypt, and thus there was provided the
stimulus which led to the discovery or invention of a new and better
material on which books might be written--viz., Pergamentum (our
parchment), a word coined from the name of the city in which it was
invented.

_The Development of Different Sects or Schools of Medicine._--Up
to the time of the death of Hippocrates medicine maintained the
character of a single organized and harmonious body; but, when this
great physician had disappeared from the scene and was no longer
there to guide the further development of medical science and to keep
his followers working shoulder to shoulder with a single spirit and
purpose, this hitherto homogeneous body split up into sects or schools,
each of which had some favorite doctrine the promulgation of which
seemed to each group of adherents to be of great importance. There
were at first two such principal groups, viz., the Dogmatics and the
Empirics. The former was composed of those who laid great stress upon
speculation or theorizing,--that is, upon the use of the reasoning
power,--and the latter of men who maintained that actual experience was
the only thing of any serious value. The respective leaders of these
two groups or sects were Plato and Aristotle.

In Raphael’s celebrated painting, “The School of Athens,” these two
heroes of philosophy are represented standing side by side--Plato with
his right hand elevated and pointing toward heaven, while Aristotle is
looking distinctly at the earth. Pictorially, the tendencies of the two
schools of philosophy could not have been better represented. Plato’s
genius had taken its flight heavenward and was contemplating earthly
things from this point of vantage; his method being to ignore system
and to look at everything with the eyes of purest love. “Delightfully
poetic, but thoroughly unprofitable speculation as to what constitutes
scientific truth and perfected morality!” (Friedlaender.)

Aristotle, whose father was a physician and a descendant of
Aesculapius, was the hero and guiding spirit of those who based their
philosophy on experience, on ascertained facts. Like his celebrated
pupil, Alexander the Great, who brought whole nations under his sway,
he too was a conqueror in every field of human knowledge. His ideas
ruled supreme over the minds of men for thousands of years and to-day,
although many of them are no longer accepted as valid, Aristotle
himself is universally held to have been the greatest thinker and
investigator who has ever lived upon this earth. (In chapter XIII. I
shall have occasion to say something further regarding the Dogmatics
and the Empirics.)

Out of the teachings of Plato and Aristotle developed two schools of
philosophy that exerted, in course of time, a great influence upon
the minds of men and upon the growth of medical science. The schools
referred to are the Epicureans and the Stoics. Epicurus (242–270 B.
C.), who gave his name to the first of these, taught that the highest
good was happiness.

   The happiness he taught his followers to seek was not sensual
   enjoyment, but peace of mind as the result of the cultivation
   of all the virtues. According to the teaching of his school
   virtue should be practiced _because_ it leads to happiness;
   whereas the Stoics taught that virtue should be cultivated for
   her own sake, irrespective of the happiness it will ensure. Zeno
   (circa 370–260 B. C.), the founder of the Stoic philosophy,
   taught an ethical system according to which virtue consists in
   absolute judgment, absolute mastery of desire, absolute control
   of the soul over pain, and absolute justice. The keynote of the
   system is _duty_, as that of Epicureanism is pleasure. (Sir
   William Smith.)

In addition to the sects named above, there was still another known
as the Older Dogmatic School, which was composed of men who had
been the direct followers of the great master, but who, forgetting
altogether the practical teachings of Hippocrates with regard to
the importance of experience, gave themselves up to all sorts of
hypotheses and theories. Among the names of the earliest followers of
this school one is astonished to find those of Thessalus and Draco,
the sons of Hippocrates, as well as the name of Polybus, the latter’s
son-in-law. Diocles of Carystos and Praxagoras of Cos, two of the most
distinguished men of that period, were also among the earliest members
of this dogmatic school. Diocles, who was one of the Asclepiadae, owed
his celebrity in part to his contributions to our knowledge of anatomy
and in part to the work which he had done in other departments of
medicine. Unfortunately, all of these writings have been lost with the
exception of a few fragments which came to light toward the middle of
the nineteenth century. Praxagoras was also one of the Asclepiadae. He
was distinguished, as has already been stated on an earlier page, by
the fact that he--and not Aristotle, as is sometimes stated--was first
to recognize the difference between arteries and veins, and also by
the further fact that he called attention to the practical value of
the pulse as an indication, in certain diseases, of the tone of the
patient’s bodily condition or vitality.




                               CHAPTER X

    ERASISTRATUS AND HEROPHILUS, THE TWO GREAT LEADERS IN MEDICINE
               AT ALEXANDRIA; THE FOUNDING OF NEW SECTS


Two of the most celebrated physicians of that period (305–280 B. C.)
were Erasistratus and Herophilus, both of whom were distinguished
as the founders of schools or sects of medicine at Alexandria. They
had received their early training as physicians from Chrysippus, a
widely known Stoic philosopher, who, according to Albert von Haller,
had taught at the school of Cnidus and had also written on medical
topics; and, among the other teachers, it is stated that Anaxagoras
of Cos had instructed Herophilus, and that Metrodorus, the son-in-law
of Aristotle, had performed the same service for Erasistratus. So far
as fundamental principles are concerned, the schools founded by these
two physicians at Alexandria differed very little from each other, and
the men themselves also gained their distinction in very much the same
branches of medical knowledge, both of them having made a number of
original discoveries in anatomy and both of them having become eminent
practitioners.

Herophilus was born at Chalcedon, a Greek city on the Propontus,
nearly opposite to Byzantium. We possess no knowledge whatever
regarding the earlier years of his career, notwithstanding the fact
that no fewer than four different men devoted their energies to the
writing of his biography. The books themselves have been either lost
or destroyed. Herophilus showed a decided leaning toward the study
of anatomy, and his contributions to this branch of medicine are
among the earliest which we possess. Herophilus strove to supply one
of the most conspicuous deficiencies in the Hippocratic system of
medicine, viz., inadequate knowledge of the nervous system; and to
this end he conducted a series of the most careful investigations,
as a result of which he was successful in establishing several facts
previously unknown. He described the membranes of the brain, the
choroid plexus, the venous sinuses, the structure which bears his
name,--the torcular Herophili,--the cerebral ventricles, and the
calamus scriptorius; he traced the course of the nerve trunks for some
distance from their origin in the brain and spinal cord; and it was he
who established the fact that two different sets of nerves exist--one
for conveying sensations to the brain and the other for producing
motion. In addition, he investigated the corpus vitreum, the retina,
the optic nerve, etc. He also called attention to the peculiar mode
of construction of the duodenum, and to the fact that the walls of
the arteries are thicker than those of the veins. Some idea of the
accurate manner in which he carried on his anatomical researches may be
gained from the fact that he noted the circumstance that the left vena
spermatica occasionally originates in the vena renalis.

Herophilus also gained distinction in the practical branches of
medicine. According to Puschmann he laid the foundations for a
scientific sphygmography. Thus he distinguished several varieties
of pulse in accordance with the differences which he noted in its
strength, regularity, degree of fulness, and rate of speed. He also
must have had considerable experience in surgery, as is shown by his
remark that a dislocation of the thigh, owing to the tearing of the
ligamentum teres which necessarily accompanies such a dislocation, is
likely to occur again in the same individual. In his writings relating
to the practice of medicine, Herophilus upheld the principle that
experience alone should be our guide, as theoretical considerations are
not to be trusted. He is also credited with having said, in response to
the question, Whom do you consider the best physician? “Him who knows
how to distinguish what is attainable from what is unattainable.”

Erasistratus, the contemporary of Herophilus and his associate in the
work of establishing at Alexandria a great anatomical and clinical
medical school, was a native of Julis, in the Island of Ceos, not far
from the coast of Attica. In the earlier part of his professional
career he spent some time at the Court of Seleucus, the founder of the
Syrian monarchy (312–280 B. C.). This monarch, who had been one of
Alexander the Great’s distinguished generals, consigned the government
of the eastern part of his vast kingdom to his son Antiochus. The
latter fell ill about this time, and the most distinguished physicians
of the Court were then called in to determine what was the nature of
his malady and to decide upon the proper treatment. The patient grew
more and more languid, showed complete indifference to all that took
place about him, and steadily lost flesh. Erasistratus, who was one of
the physicians summoned, observed his behavior very closely and soon
noted the fact that, whenever Stratonice, his young and attractive
stepmother, entered the sick room, Antiochus became agitated; his face
being flushed, his voice subdued, his pulse more rapid, and his eyes
brighter, all of which signs of excitement disappeared when Stratonice
left the room. From these phenomena this shrewd observer drew the
inference that the patient was deeply but hopelessly in love with his
father’s second wife. Accordingly he informed Seleucus that his son’s
illness was simply the result of having lost his heart to one who was
unable to return his affection. Seleucus, who was much astonished,
asked with deep interest who was the lady. “My wife,” replied
Erasistratus, without an instant’s hesitation. “But tell me then,”
asked Seleucus, “would you be willing to cause the death of my son,
who is so very dear to me, by refusing to give up your wife to him?”
“Would you, yourself, my lord, under similar circumstances,” replied
the physician, “be willing to give up Stratonice to the Prince, if it
had been she with whom he had fallen in love?” Seleucus having already
vowed that he would not hesitate for a moment to do so, Erasistratus
declared the whole truth to him, and of course there was nothing left
for the King but to keep his word. History fails to state whether or
not the lady made any objection to the transfer. As Antiochus lived
to reign for many years after the murder of his father, it is safe to
assume that he recovered his health.

This brief tale, the truth of which is not disputed by any of the
authorities, reveals Erasistratus to have been a clever diagnostician,
to have possessed a profound knowledge of human nature, and to have
been a man of exceptional courage; in short, he was a physician
admirably fitted to act as the founder and leader of one of the two
great medical schools of Alexandria. The following account may suffice
to convey some idea of his career after he became established at the
latter city.

At the beginning of his residence in Alexandria, Erasistratus, like
his great rival Herophilus, devoted his energies to anatomical and
physiological researches. These two men evidently realized to the full
how important it was to medicine, if it were to make a substantial
advance beyond the point to which Hippocrates and his followers had
already carried it, that a more complete understanding of the structure
and working of the human body should be obtained; and their efforts
in this direction were greatly aided by the enlightened views of the
kings of Egypt, the Ptolemies, who did everything in their power to
furnish these two investigators with all the human dissecting material
they could use to advantage. They even went so far as to allow them
the privilege of utilizing, for scientific purposes, the living bodies
of imprisoned criminals, “in order that they might in this way learn
the location, color, shape, size, construction, hardness, softness,
smoothness, nature of external surface, protuberances and recesses of
the individual organs during life.” The defense which they offered for
permitting such vivisections was this: “It is permissible to sacrifice
the lives of a few criminals if many worthy persons may thereby be
permanently benefited in health, or have their lives prolonged.”
(Puschmann.) Those who were opposed to such examinations upon human
beings expressed their disapproval in the following terms: “This
practice is not only cruel, but useless, and at the same time it
derogates from the dignity of the healing art, which is intended to
be a blessing and not a source of pain to man; for those in whom the
abdominal cavity is first opened and then the diaphragm divided, die
before it is possible to make the scientific examination ‘during life’
which constitutes, as it is claimed, the justification for the entire
procedure.” (Puschmann.)

As regards the work done by Erasistratus in the departments of anatomy
and physiology, the following statement may be made: He threw a great
deal of additional light upon the structure of the lacteals, the valves
of the heart, the brain, the nerves, and several other portions of the
body; and he assigned to the pneuma, or breath,--of which he assumed
that two kinds exist,--the most important rôle in the mechanism of
life. According to the description given by Galen and reported by Le
Clerc, the phenomena to which Erasistratus refers take place somewhat
as follows: “When the thorax or chest expands, the lungs also undergo
dilatation and fill themselves with air. This air, entering first by
way of the trachea, ultimately reaches the anastomosing terminals of
the bronchial tubes, from which locality the heart, by the act of
dilatation, draws it into itself, and then, immediately afterward
contracting, sends it, by way of the great artery (the Aorta), to every
part of the body.” When it is considered that at this remote period
of time nothing was known about oxygen and carbon dioxide, nor about
the power of these elements to pass freely through a thin membrane
(exosmosis and endosmosis), no surprise will be felt that Erasistratus
carried the physiology of respiration no farther than he did. On the
contrary, it is remarkable that he was able to describe so correctly
this complicated process. In fact, none of his successors, up to the
time when Harvey’s great discovery was announced, was able to furnish
a better description. The physiology of gastric digestion was another
of the problems concerning which Erasistratus held views that were
different from those commonly accepted by the physicians of that time.
The stomach, he maintained, first retracts when portions of food are
introduced and then contracts in such a manner as to break them up into
smaller and smaller fragments; this process taking the place of that
of “coction,” as taught by Hippocrates. The resulting chyle passes
from the stomach into the liver and is deposited in those spots where
the finer branches of the vena cava and the terminal twigs of the
channels which lead into the gall-bladder come together. Here the chyle
breaks up into two portions, one of which--viz., that which contains
biliary elements--gains an entrance into the channels that lead to the
gall-bladder, while the other, which is composed of elements suitable
for making pure blood, finds its way into the ramifications of the
vena cava. While holding these views about the mode of transformation
of gastric chyle into the bile and pure blood, Erasistratus did not
hesitate to confess that he was unable to say whether bile was produced
within the body or whether it already existed in the food that was
taken into the stomach.

As regards the treatment of disease Erasistratus held certain views
which were decidedly at variance with those maintained by the majority
of his associates. Thus, for example, Straton, a distinguished disciple
of this master, praises him for having banished bloodletting from the
list of remedial measures, and adds that he can testify to the fact
that Erasistratus had, by other means, cured all the diseases in which
the ancients commonly employed bloodletting as the chief remedial
agent. His favorite substitutes for the latter procedure were fasting,
dieting, physical exercise, and--in cases of hemorrhage--placing
ligatures around the arms and legs. Caelius Aurelianus is authority for
the statement that, in certain very exceptional cases, Erasistratus did
resort to bloodletting. Another of the latter’s tenets was his strong
objection to the employment of purgatives and composite remedies. On
the other hand, he appears to have attached considerable importance
to the employment of chicory in the treatment of all disorders of the
abdominal organs. One of the evidences of his preference for this
drug is to be found in the care which he takes in describing how the
plant should be prepared for remedial purposes. “Boil a bunch of the
plant in water until the mass is thoroughly cooked; then cast it into
a fresh supply of boiling water (to drive out still more of its bitter
quality); and finally, upon removing it from the boiling water, place
it for conservation in a receptacle containing oil. When it is required
for use add a small quantity of weak vinegar.” Galen, in commenting
jocosely upon the stress which Erasistratus lays upon these details,
makes the remark: “As if our domestics did not know how to cook a bunch
of chicory!”

Speaking of the effects produced by venom when one is bitten by a
poisonous snake, Erasistratus remarks that “from the effects which the
poison introduced in this manner produces, we may derive a general
indication as to how a cure may be obtained. The poison, it will be
noted, destroys very quickly the parts with which it comes in contact,
and then, by spreading throughout the body, causes death. The thing to
do, therefore, is to draw it as quickly as possible out of the body
and thus arrest its further spread. To this end the wound should first
be enlarged and its sides scarified; then, after it has been sucked,
a cupping glass should be applied over it; and, finally, it should be
cauterized.”

Erasistratus cultivated surgery as well as the other branches of
medicine. He was a bold operator, as may be inferred from the fact
that, in cases of scirrhus or other variety of tumor of the liver, he
did not hesitate to incise the skin and overlying integuments, and
then, after the peritoneal cavity had been opened, to apply directly to
the seat of the disease such medicaments as seemed to him appropriate.
On the other hand, he did not approve of _paracentesis abdominis_
in cases of dropsical effusion, as a means of evacuating the fluid
accumulated in the peritoneal cavity.

It appears that the disciples and successors of Herophilus and
Erasistratus soon abandoned the exact methods which these two great
masters had inaugurated and which, in a comparatively short time, had
produced such admirable results, and then they fell back into the
less arduous, the easy-going ways of speculation. Only a very few had
sufficient strength of character to walk in the older pathway, and
among the number were some who left Alexandria and established schools
in the other cities--as, for example, Zeuxis, who organized a new
centre of medical teaching at Laodicea, in the interior of Asia Minor,
and Hikesios, who founded another school at Smyrna, on the seacoast of
Lydia. It is not strange, therefore, that before many years had elapsed
the two original schools at Alexandria died a natural death. As Pliny
aptly writes, “It was so much more comfortable to sit on the benches
of the schools and have learning poured into your ears than to wander
daily through the desert outside in search of other nourishing plants.”
As a further result of this deadness of the schools at Alexandria (that
is, of the sect of the Dogmatics) the more serious-minded physicians
espoused with eagerness the side of the Empirics--a sect which
developed about this time, but which did not, it must be confessed,
hold out much hope of solving the physiological and pathological
problems of the day, but which nevertheless satisfied in some measure
their needs as practitioners.

Philinus of Cos (286 B. C.) was looked upon as the founder of the
school of the Empirics, and among its most distinguished disciples
were: Serapion of Alexandria (279 B. C.), Glaucias, Apollonius
Biblas, and--perhaps the most celebrated of them all--Herakleides of
Tarentum (242 B. C.), who did such excellent work in the department
of pharmacology. It was he, for example, who defined more precisely
than had been done by any one of his predecessors the proper manner
of employing opium. In addition, he wrote a commentary on the
Hippocratic works and also separate treatises on medical, surgical
and pharmaceutical topics. In the latter category belongs his book
entitled “A Military Pharmacopoeia.” Last of all, Apollonius Mus, a
distinguished follower of Herophilus, deserves to be mentioned because
it was he who perfected the preparation of castor oil. At a still later
date (158 B. C.) Zopyrus proved himself to be a most worthy successor
to Herakleides. It was he who first classified drugs according to the
effects which they produce, and he also invented or discovered the
preparation named “ambrosia,” a general antidote for poisons of all
kinds. Kings and princes were, at that period, in constant fear of
being poisoned, and so it came about that those who were skilled in the
knowledge and preparation of drugs were greatly stimulated by their
royal patrons to find efficient antidotes. It is narrated that Attalus
Philometer, King of Pergamum, the native city of the famous physician
Galen, and Mithridates Eupator, King of Pontus, cultivated poisonous
plants in their gardens and tried the effects of the poisons distilled
from them on criminals. They also encouraged in every possible way
the preparation of antidotes; and thus was compounded a mixture which
even to-day is still known by the name of “_Mithridaticum_.” For
centuries it was a very popular remedy for poisoning by snake-bite. Le
Clerc states that one of the first things that the great Roman general
Pompey did, after conquering Mithridates and gaining possession of his
palace (about 64 B. C.), was to have a careful search made for the
recipe of this famous antidote. Upon finding it he was surprised to
learn what simple ingredients it was composed of--viz., “20 leaves of
rue, a pinch of salt, two nuts, and two dried figs.” The theriacum,
which one hundred years later was modeled after the Mithridaticum,
contained a great deal of honey and a large number of unimportant
drugs, introduced--as Pliny claims--“to magnify the importance of the
apothecary’s art, rather than to increase the curative effects of the
remedy.”

The scepticism which already at that period had begun to take
possession of many of the best minds manifested itself in the form of
a disbelief in the possibility of discovering full scientific truth,
and men therefore taught the doctrine that the human understanding
is not capable of attaining anything higher than probability. The
acceptance of such a doctrine naturally acted as a powerful hindrance
to all further original research. And so the Empirics neglected the
study of anatomy and physiology as something quite superfluous and
unprofitable. They gave no further thought to the causes of disease,
and were quite satisfied simply to observe its manifestations, to
investigate the factors which appeared to bring it into a state of
activity, and to search for the means of effecting a cure. In carrying
on work of this character, they of course derived help, not only from
their own experience, but also from that of others--which latter became
in time a matter of history. When they encountered new experiences
and were unable to supply a satisfactory explanation they resorted
to a third method--that of reasoning by analogy. Upon this triple
support--one’s own individual experience, the experience of others
stored up in the form of history, and reasoning by analogy--rested the
entire structure of empiricism.

Strange as it may at first appear, the science of medicine from this
time onward made no further conspicuous progress until the middle of
the seventeenth century of the present era. In certain branches of
practical medicine--as, for example, pharmacology, obstetrics and
general surgery, and also in certain special departments--the Empirics
made a number of material additions to our knowledge; but in all
essential particulars the medical science taught throughout this period
of about two thousand years varied but little from that taught at
Alexandria one hundred or two hundred years before the birth of Christ.
This extraordinary phenomenon of almost complete arrest of development
for so long a period of time should not excite surprise, for something
of a similar nature has certainly occurred in other departments of
human knowledge.

The further history of the medical sects which flourished under the
Ptolemies and for a short time afterward, when Alexandria became
a colony of the Roman Empire, need not detain us long. Daremberg
furnishes a chronological chart of the physicians who played a more
or less prominent part in the work of these sects, and from this
it appears that they numbered thirty-four in all--ten followers of
Herophilus, fourteen of Erasistratus, and ten Empirics. Callamachur
and Bacchius, who belonged to the first of these groups, deserve to be
mentioned because they were its most distinguished members and because
they were the first physicians who wrote commentaries on the writings
of Hippocrates. In the sect of the Empirics the next in importance
after Philinus of Cos is Serapion of Alexandria. Mantias, another
disciple of Herophilus, gained considerable reputation from the fact
that he was the first to collect together into a single treatise the
different pharmaceutical formulae that were then in general use. He was
also an authoritative writer on surgical topics.

_Certain Branches of Medical Work Begin to Assume more Distinctly
the Character of Specialties._--At the time of Hippocrates there
were no specialists, or at least none who received any sort of official
recognition from the general body of physicians; and yet, there were,
even then, a few practitioners who devoted themselves preferably to
the treatment of certain maladies, like the affections of the eye and
the teeth; and, beside these, there were undoubtedly, in the larger
communities, men who were ready and competent to undertake the more
serious surgical operations. But even these men, as appears from the
language of the so-called Hippocratic oath, could not honorably perform
an operation for stone in the bladder; this particular work having been
left from time immemorial entirely in the hands of the lithotomists, a
class of men who performed no other kind of surgery and who, in fact,
were considered outside the pale of the medical profession--merely
surgical artisans.

During the Alexandrian period the attitude of the best physicians with
reference to specialization in medical practice evidently underwent
a change,--not a very marked one, it is true, but yet sufficient
in degree to attract some attention. We read, for example, that a
certain Demetrius of Apamea, a follower of Herophilus, was skilled
as an obstetrician and was also a clever diagnostician; that Andreas
of Carystus, another disciple of Herophilus and the physician upon
whose authority the incredible story of the burning of the Cnidian
archives by Hippocrates was spread abroad, was considered at this
time an expert in the science of obstetrics; that, toward the end of
the period (first century B. C.), Alexander Philalethes, a disciple
of Herophilus and well known as an author of treatises on the pulse
and on the doctrines taught by different physicians of that period,
acquired widespread celebrity as a gynaecologist; that Straton, a
disciple of Erasistratus, had gained considerable distinction as a
gynaecologist; and, finally, that two physicians--Gaius of Naples and
Demosthenes of Marseilles (Massilia)--were widely celebrated for their
skilfulness in the treatment of eye diseases. The latter was also a
successful author, for his treatise on ophthalmology retained its
popularity down to the Middle Ages. All these men, it should be noted,
were directly and indirectly connected with the work at Alexandria, and
were physicians of some degree of prominence. It is fair to assume,
therefore, that specialization in medical practice had by this time
become an accepted fact and was certainly not frowned upon by those in
authority. The result is entirely in accord with what might be expected
from a body of physicians as enlightened as were the men gathered
together at Alexandria during the centuries immediately preceding and
that immediately following the birth of Christ; but many additional
centuries were yet to elapse before anything like the well-defined
specialism of modern times was to become an established fact.




                              CHAPTER XI

        ASCLEPIADES, THE INTRODUCER OF GREEK MEDICINE INTO ROME


The seventh Ptolemy, Ptolemy Euergetes or Physcon, whose reign lasted
from 146 to 117 B. C., drove all men of learning away from Alexandria
and closed the famous schools in that city. It was only a few years
after these events, and at a time when that city was fast losing its
supremacy as the great centre of medical learning,[27] that there
appeared at Rome a Greek philosopher and physician who was destined to
become the founder of a new set of medical ideas and of a new kind of
medical practice. Being a man of general cultivation and attractive
personality, and not afraid to encounter the prejudices and ill will
which almost always greet a foreigner when he first establishes himself
in a strange country and among a people of a different race, he soon
overcame those obstacles and was eventually successful in making Rome
the starting-point and centre of the best medical thought and practice
of that period of the world’s history. To understand clearly, however,
the character of the work which Asclepiades accomplished in the city
which was soon to be the capital of the world as then known, it is
desirable that a brief account should be given of the condition of
medical affairs in Rome at the time of his arrival.

_The Practice of Medicine at Rome During the Century Immediately
Preceding the Christian Era._--Foreigners were not encouraged to
settle in Rome until toward the latter part of the second century B.
C., and consequently the treatment of the sick in that city maintained
its distinctly Roman character for an unusually long time. In the
households of the better classes the head of the family commonly
prescribed for any illness which might befall its members. In not a few
instances one of the slaves--who was known as a _servus medicus_,
and who might perfectly well have been a regularly educated Greek
physician--took charge of the patient in place of the master of the
house. A book of domestic remedies was the usual source of information
from which the latter derived his knowledge of therapeutics. Marcus
Porcius Cato, the distinguished Roman censor (234–149 B. C.), was the
author of one of the most popular of these books of recipes. The text
of this work has come down to our time. There were, at this period,
no regularly established physicians and no such thing as a medical
practice. For several hundred years the Romans were almost constantly
at war with the neighboring tribes or nations, and this life of
outdoor exposure and active exercise kept them free from the numerous
and very varied bodily ills of the later generations. This state of
society alone was quite sufficient to prevent the thoroughly trained
physicians of Greece and Alexandria from settling in Rome. But there
were still other forces at work which greatly delayed their taking
such a step, viz., the unwillingness on the part of the authorities
to grant to foreigners the rights of citizenship, and the very strong
prejudice which the Roman aristocracy cherished with regard to the
Greek nation. Some idea of the strength of the latter feeling may
be gathered from the letter which Cato the Censor, perhaps the most
influential citizen of Rome at that time, wrote to his son Marcus.
Daremberg gives the following quotation from this epistle: “The Greeks
are a perverse and unteachable race. Believe that an oracle is speaking
to you when I say--Every time that the Greeks bring to us some branch
of knowledge they will not fail to corrupt our manners; and it will
be far worse for us if they should send us their physicians, for they
have bound themselves by an oath to kill all Barbarians by the aid of
medicine--and they have the insolence to reckon us also as Barbarians.
Remember that I have forbidden you to call in a physician.” Daremberg
adds: “The old man Cato must have been very simple-minded to believe
for a moment that physicians would be such egregious fools as willingly
to kill the patients from whom they derive their support.” But even
this strong prejudice on the part of the Roman aristocracy had to
give way in course of time to forces of a much stronger character.
During the second century B. C., the Romans, no longer fearing the
encroachments of their warlike neighbors and having overcome all danger
of an invasion on the part of their once powerful Carthaginian foe,
entered upon a career of conquest. The capture of an ever increasing
number of cities and towns in Greece, Asia Minor, Egypt and Africa
brought great wealth to Rome, and, with it, increasing luxury, an
increase in the prevalence and variety of diseases, and an increased
need of men who were competent to deal successfully with such diseases.
The physicians who first attempted to meet this need were men of an
inferior stamp, to whom the situation appeared simply to afford an
excellent opportunity for making money; and very naturally they failed
to gain the respect and confidence of the better citizens. At a later
date Julius Caesar, who was, at that time, Consul (about 90 B. C.),
extended the right of citizenship to all foreign physicians who were
practicing in Rome, and thus was removed one of the greatest obstacles
which prevented the better class of Greek medical men from settling in
that city.

More than a hundred years before the time of which I am speaking
(_i.e._, about 218 B. C.), a Greek physician named Archagathus had
the courage to take up his abode in Rome. He was the son of Lysanias,
a native of Peloponnesus. At first he appeared to gain the favor of
the community in which he practiced, for they bought and placed at his
disposal a shop, or office, in the cross-way of Acilius, and gave him
the name of _vulnerarius_--healer of wounds. Later, however, they
disliked his rather too free use of the knife and the actual cautery,
and thereafter he was spoken of as the _carnifex_, or executioner.
Medicine was thus brought into disrepute and we hear nothing further
about physicians in Rome for more than a century--that is, until about
90 B. C., when Asclepiades,[28] a native of the city of Prusa, Bithynia
(northwest part of Asia Minor), made his appearance in that city. At
first he taught rhetoric, but, finding this occupation unprofitable, he
began the practice of medicine. Pliny says that he acquired a knowledge
of this art through the studies which he carried on after his arrival
in the city of Rome, but Neuburger makes the statement that he began
the study of rhetoric, philosophy and medicine in his youth and then
spent some time in perfecting his knowledge at Parion, a city of Mysia
on the Hellespont, at Athens, and probably also at Alexandria.

As a practitioner Asclepiades appears to have met with unusual success.
He was well educated and possessed of agreeable manners, and was the
friend as well as the physician of Cicero, one of the most polished
men of whom history furnishes us any knowledge. He was also on terms
of intimacy with Atticus and other eminent citizens of Rome. The
possession of such friends was more than sufficient to render him one
of the favored and prosperous physicians of his day in that city. As
Meyer-Steineg aptly says, “he owed not a little of his success to the
happy manner in which the scientist, the clever physician, and--to
a slight degree--the charlatan were combined in his character.” The
following anecdote which is told of him by Lucius Apuleius shows, on
the one hand, that he possessed remarkably keen powers of observation,
and, on the other, that there were some grounds for the charge that his
behavior was at times somewhat theatrical in character:--

   One day, as Asclepiades was returning to the city, from his
   place in the country, he observed the approach of a long funeral
   procession. Desiring to learn whether the deceased was a person
   of his acquaintance, and also in the hope of perhaps gaining
   other information of a professional nature, he approached as
   nearly as possible to the bier. The face of the corpse was
   anointed with sweet-smelling ointments over which spices had
   been sprinkled; but, notwithstanding this, he was able to detect
   certain signs which led him to suspect that the man might not
   yet be dead; and accordingly he examined the body very closely
   and thus satisfied himself that such was indeed the fact.
   Whereupon he called aloud that the man was still alive, and
   told the bearers to extinguish the torches, to carry away the
   materials for the pyre, and to remove the funeral feast from
   the grave to a table. Some at once objected to the carrying
   out of these measures and made sarcastic remarks about the
   healing art--probably because they were already in possession
   of the man’s estate, and were afraid that they might have to
   give it up. The more influential ones, however, insisted that
   the physician’s words should be heeded. Then Asclepiades,
   notwithstanding the opposition which was made by the relatives,
   succeeded in securing a brief delay, during which he had the
   supposed corpse removed to his own house. Restorative measures
   were employed, respiration was re-established, and the man was
   brought back to life. At the succeeding festivities unlimited
   praise was bestowed upon the wise physician.

Whether this tale, which I have copied from Neuburger, is true or
not, it seems to fit in well with the bold and independent character
of Asclepiades as it is revealed to us by the different writers of
the history of medicine. In his comment upon this narrative the
distinguished Viennese historian makes the remark that Asclepiades
was very conceited, and--like most reformers--showed a disposition to
ignore the work accomplished by his predecessors. He also expresses the
belief that Asclepiades possessed a leaning toward the methods of the
charlatan; the episode just narrated revealing a love for theatrical
display in his professional activity. On the other hand, in the further
course of the chapter which he devotes to this famous Roman physician,
Neuburger gives fuller recognition to the value of the services which
he rendered to medicine, and thus, in the light of these services, one
is justified in overlooking any little weaknesses of character which he
may have displayed. Perhaps the most important of the services which
Asclepiades rendered was that of having introduced Greek medicine into
Rome--an important connecting link in the transmission of medical
knowledge from Greece to Modern Europe.

_The Views of Asclepiades with Regard to Physiology and
Pathology._--The human body, according to the philosophy of
Asclepiades, is composed of atoms--that is, small bodies which are
invisible, have no definable quality, are in continual motion, through
mutual pressure undergo modifications in form, and break up into
innumerable smaller fragments or particles that differ both in size
and in shape. The arrangement of these small bodies is such that
intercommunicating spaces or pores are left between them, and through
these channels flows a sap or juice containing larger and smaller
particles; the larger ones composed of blood, and the smaller of vapor
or heat. Health, according to Asclepiades, is that state in which the
primitive atoms are properly distributed or placed and the flow of the
juices in the pores takes place normally. When, however, the flow is
arrested and the primitive atoms are disordered in their relations to
each other and to the pores, or when the elements composing the fluid
contents of the latter become mixed, disease results. Alterations in
the pores themselves, as contradistinguished from the fluid contained
within them, may also cause disease. Farther on, when the proper time
arrives for considering the sect of the Methodists, I shall have
occasion to discuss this subject again, and particularly that part
of it which relates to pathology. In the meantime, however, I cannot
resist the impulse to say a few words about the remarkable insight
possessed by Asclepiades into the manner of construction of the human
body, as manifested by this very brief but very significant anatomical
and physiological description. Upon a first reading one might easily
get the impression that Asclepiades has reference to only one kind or
system of “pores” or channels--viz., such as serve for the circulation
of tissue juices alone. But, upon a closer scrutiny of the text, one
finds some warrant for suspecting that he had in mind more than one
system of such channels; for he states distinctly that the fluid
circulating in these pores contains larger particles composed of blood
and smaller ones which consist of vapor (_spiritus_) or heat. The
question suggests itself: Could a man who had no knowledge of Harvey’s
discovery, who did not possess a microscope, and who at the same time
believed--as did all the ancients--that air circulated in the arteries
and blood in the veins, come any nearer to the actual truth than did
Asclepiades? His description needs very few alterations and additions
to make it fit correctly the system of terminal arterio-venous channels
known to-day as arterioles and capillaries.

_Methods of Treatment Adopted by Asclepiades._--The prevailing
methods of treating diseases in Rome were not approved by Asclepiades,
and he lost no opportunity of giving expression to this disapproval.
In the first place, he protested vigorously against the practice
of prescribing on every possible occasion purgatives and remedies
capable of producing vomiting. He had a decided preference for gentler
measures, his idea being that a physician should cure his patients
_tuto, celeriter, et jucunde_--safely, quickly and agreeably. Le
Clerc adds that this is a fine sentiment, but that its realization
in actual practice is something which most physicians find it very
difficult to attain. Asclepiades condemned strongly the employment of
magical remedies, a practice which was still much in use at that time
in Rome, although it was already less common than it had previously
been. Cato’s collection of household remedies contains a short list
of some of these appeals to man’s superstition.[29] In addition to
the remedial measures mentioned above, Asclepiades placed his chief
dependence on the following: abstinence from meat; the employment of
wine under certain well-defined circumstances; massage and frictions;
baths of different kinds (it is said that he devised a great variety);
walking; driving and being carried about in the open air in a litter
or in a boat on a quiet river or in the protected harbor. One of his
remedies in the case of sleeplessness consisted in having the patient
placed in a suspended couch which could easily be rocked from side to
side. As all these measures were agreeable and could at the same time
easily be employed by almost everybody, they met with general favor,
and in consequence Asclepiades was looked upon by the Romans as “a
person sent from heaven.” As a rule, he recommended the drinking of
simple water, but in certain cases (to be mentioned farther on) he did
not hesitate to advise the taking of wine in moderation. He advocated
tracheotomy, in cases of inflammation of the throat, in preference to
the then prevailing practice--both very painful and quite difficult to
carry out--of introducing a tube of some kind as a means of opening a
passage for the entrance of air into the lungs.

Le Clerc quotes Galen as authority for the statement that Asclepiades,
who never hesitated for an instant to criticise the different
therapeutic procedures of his predecessors, did not go so far as to
condemn wholly the practice of bloodletting. Indeed, he was quite ready
to employ it in the treatment of painful affections because, as he
claimed, the pain was caused “by the retention of the larger particles
or atoms in the pores or channels of the tissues, and hence--as
these particles were composed of blood--bloodletting was the only
remedy capable of setting them free.” Thus, he resorted to bleeding
in pleurisy, because this affection is characterized by pain; but he
abstained from employing the remedy in “peripneumonia” or “inflammation
of the lung,” because in most cases it is not accompanied by pain;
and he also did not approve of its employment in inflammation of the
brain (_phrenitis_). On the other hand, he advocated bleeding
in epilepsy and all forms of disease in which convulsions occurred,
and he also advocated it in cases of hemorrhage of every description.
Quinsy sore throat was another malady in which he drew blood freely
from the veins of the arm, of the temple and even of the tongue; and
in addition, when the disease was severe, he scarified the skin at
suitable spots and applied cups to the part. In all these measures
his purpose was “to open the pores”; and when this treatment failed
he incised the tonsils or the uvula, and even, as a last resort,
performed laryngotomy or tracheotomy. In cases of dropsy he employed
_paracentesis abdominis_,--that is, he made a very small opening
in the abdominal wall to serve as an outlet for the fluid contained in
the peritoneal cavity. From these facts it is evident that Asclepiades
did not always abide by his rule not to use any but very gentle
remedies.

Asclepiades showed, in his manner of treating still other pathological
conditions, how different was his practice from that of his
predecessors. In the first place, he was very partial, as has already
been stated, to such extremely mild forms of physical exercise in
the open air as one can obtain from driving or from being carried
in a litter or a boat. He prescribed these measures, not merely for
convalescents but also for those, for example, who were still in the
midst of an active fever. His idea was, that by means of such very
gentle forms of exercise the pores would become less clogged and
would permit the juices of the body to flow more freely. In cases of
dropsy, also, he was in the habit of employing friction for precisely
the same purpose. He even used this remedy in cases of inflammation
of the brain, in the expectation that he might thereby induce sleep
for these patients. Indeed, this subject of frictions was one on which
Asclepiades wrote at greater length than on any other remedial agent.

It is a surprising fact that, in common with Erasistratus, he taught
the doctrine that physical exercise was not at all necessary to persons
in normal health. At the same time he approved of it, when carefully
graded, for those who were affected with bodily ills of a certain
nature.

Wine was another remedy which Asclepiades was fond of prescribing
in all sorts of maladies, but his rules in regard to the manner in
which it should be employed were quite different from those adopted
by his contemporaries. A few illustrations will suffice to show the
different conditions for which he was wont to advocate the taking of
wine: He gave it, for example,--though probably much diluted with
water--to patients affected with fever, but only after the stage of
greatest activity had been passed. Strange as it may appear to-day,
he was rather in favor of giving to patients ill with inflammation of
the brain (_phrenitis_) wine in sufficient quantity to produce
intoxication; his belief being that he could in this way induce
drowsiness and eventually sleep--a thing so desirable for those
affected with that disease. Further, he instructed sufferers from
catarrh to drink twice or three times as much wine as they usually
drank, in consequence of which instructions the patients found it
necessary to dilute their wine with water to a less degree than
usual--that is, to such a degree that the proportion would be one-half
of each; thus showing, as Le Clerc remarks, how sober the ancients
must have been when they were in perfect health. They probably--he
adds--drank their wine ordinarily in the proportion of five-sixths
water to one-sixth wine, or, at most, three-quarters water to
one-quarter wine.

In some cases Asclepiades prescribed the drinking of wine (particularly
the wine of Cos) to which sea-water had been added; his idea being
that the addition of salt would enable the wine to penetrate farther
into the tissues and thus open the pores more freely. This idea of
added salt was not original with him, for Pliny states that in certain
parts of Greece it was customary to place casks filled with new wine
in the sea and to leave them there for some time. The wine, it was
claimed, was rendered by this procedure mature and pleasanter to drink.
They called wine thus treated “Thalassite wine” (from the Greek word
“thalassa,” sea). In cases of jaundice he occasionally recommended the
drinking of plain sea-water, whereby the bowels were stimulated to act
more freely. Under ordinary circumstances he employed, for the relief
of constipation, clysters, but he was sparing in their use.

The remedial measures enumerated above, together with dieting, are
those upon which Asclepiades chiefly relied in his practice. In acute
diseases he made very little use of drugs that were to be taken
internally, but in maladies of a chronic character he employed them
quite freely. Gargles, poultices and inunctions are mentioned among the
external remedies which he often prescribed.

_Further Particulars Regarding the Life and Career of
Asclepiades._--Le Clerc furnishes a number of details which throw
additional light upon the career of Asclepiades. During the latter’s
lifetime his professional reputation was very great. Lucius Apuleius,
the famous Roman satirist and rhetorician, and a contemporary of
Asclepiades, calls him the Prince of Physicians, second only to
Hippocrates the Great; Scribonius Largus, a Roman physician and writer,
who flourished during the reigns of the Roman emperors Tiberius and
Claudius (37–54 A. D.), speaks of him as a great medical author; Sextus
Empiricus, a writer remarkable for his learning and acumen, who lived
in the first half of the third century A. D., calls him a physician of
unrivaled skill; and Celsus, who is termed the Cicero of physicians,
on account of the purity of his Latin, holds him in high esteem as a
medical authority. His fame as a physician had spread to Asia Minor,
for we are told that Mithridates, King of Pontus, who reigned from 120
B. C. to 63 B. C., and who was a man of great ability and great energy,
invited him to take up his residence at his court; but Asclepiades
refused. Perhaps a still stronger evidence of his real worth as a man
is to be found in the fact that he was the physician and personal
friend of Cicero.

Notwithstanding these strongly favorable estimates of the ability
of Asclepiades there were not a few men, and they too men of great
authority, who were indisposed to give him so conspicuous a place in
the temple of fame. Galen, for example, while admitting that he was a
very eloquent physician, maintained that he was a sophist, given to
quibbling, and disposed to contradict everybody. Caelius Aurelianus, a
contemporary of Galen and the author of the most important practical
treatise on Methodism that has come down to our time, appears to have
held the same opinion as Galen with regard to Asclepiades. The complete
disappearance of all the writings of the latter author makes it
impossible for us at the present time to form an independent judgment
as to the merits of these conflicting estimates of the man’s character.
Galen was a great admirer of Hippocrates and it is very likely that he
took offense at the failure of Asclepiades to accept all the teachings
and therapeutic methods of his hero. As to the reasons which led
Caelius Aurelianus to agree with the estimate made by Galen, we know
absolutely nothing.

Toward the middle of the seventeenth century there was discovered at
Rome, not far from the Capena gate, a portrait bust in white marble
of Asclepiades. It was probably executed by a Greek sculptor residing
in Rome, for, if the work had been done in Greece, the face would
have been represented with a beard, as are the heads of Hippocrates,
Soranus and other celebrated physicians of antiquity. The absence of
the beard, furthermore, shows--according to the opinion of antiquarian
experts--that the bust must have been sculptured before the time of the
Emperor Claudius (41–54 A. D.), as he was the first of the Caesars to
wear a beard. This bust, which is a little larger than life-size, is
at present--if I am rightly informed--in the Capitoline Museum at Rome.

Asclepiades lived to a great age. In descending, one day, a flight of
steps he fell and received injuries from which he died.




                              CHAPTER XII

     THE STATE OF MEDICINE AT ROME AFTER THE DEATH OF ASCLEPIADES;
             THE FOUNDING OF THE SCHOOL OF THE METHODISTS


In summing up the effects which were produced by the teaching and
practice of Asclepiades upon the science and art of medicine, Dr.
Meyer-Steineg makes the remark that the wide and ready acceptance of
both depended largely upon the personal character of the man, upon the
manner in which he carried out the measures which he advocated, and
upon the fact that the Romans happened at that period of their history
to be ready to respond favorably to such new doctrines and therapeutic
methods; but that, as soon as his strong personality had ceased to
exert its influence, as it did after he had passed the active period
of his life, and also because Rome did not at that moment possess any
physicians who were sufficiently endowed with his medical gifts and
sagacity to perpetuate his art, both it and his doctrines began to lose
ground. Nevertheless, as this writer states, Asclepiades had already
succeeded admirably in preparing the way for a further development of
the healing art, and for this valuable service full credit should be
given him.

Not long after the death of Asclepiades, Antonius Musa,[30] the
personal physician of the Emperor Augustus, succeeded, by means of
hydrotherapy, in curing his royal patient of a protracted gouty or
rheumatic affection from which he had been a sufferer; and, as a mark
of gratitude for the cure which he had effected, the Emperor raised
him to the rank of a noble (about the year 10 A. D.), erected a statue
in his honor in the temple of Aesculapius, and at the same time issued
a decree that from that time forward the physicians who practiced in
Rome should be exempted from taxation and from certain other civic
burdens. These privileges, which were afterward confirmed by Vespasian
(70–79 A. D.) and also by Antoninus Pius (138–161 A. D.),[31] were of
great advantage to the medical profession as a whole. Julius Caesar
(100–44 B. C.), it will be remembered, had already (about half a
century earlier) bestowed Roman Citizenship upon the physicians who
practiced their profession in that city. Thus, at the time of which
we are now speaking, the medical men of Rome occupied the enviable
position of being on an equality with their fellow citizens of the
better class, a position which made it attractive for young men of
ability and of good social standing to enter the profession.

Among the numerous followers of Asclepiades the most distinguished
was undoubtedly Themison of Laodicea, a city of Phrygia, Asia Minor,
who flourished about the middle of the first century B. C. When he
was well advanced in years he wrote a medical treatise in which he
developed a system of pathology and therapeutics that was accepted as
the professional creed of the sect known as “Methodists.” Starting
from the doctrine of pores and primitive atoms taught by Asclepiades,
he laid great stress upon the idea that in disease all the alterations
which take place in the tissues may be classed in one or the other of
these two categories--a relaxation (_laxum_) or a contraction
(_strictum_) of the parts. To these two categories, which the
Methodists termed “communities,” and which were the only ones at first
accepted as a part of their creed, a third was soon added, viz., that
condition in which both relaxed and contracted states appear side by
side, although not necessarily both of them developed to the same
degree; and to this third category or “community” they applied the
term “_mixtum_.” The ideas which are here stated in a somewhat
crude and imperfect manner owing to my lack of knowledge of all the
facts, constitute the basis of the pathology of the “Methodists”--a
pathology which held its own in the domain of medicine during a period
of four hundred years, and which--in contradistinction to the humoral
pathology of Hippocrates--is justly entitled to the name of “solidist
pathology.” This doctrine, as might be expected, underwent certain
modifications during this long period of time, but they were not
serious enough to alter materially the fundamental form of the teaching
as it has here been described.

Themison and his followers, like their distinguished predecessor,
Asclepiades, possessed something more than a mere glimmering of the
truth in pathology as we know it to-day; and this idea suggests
the further thought that Morgagni, Rokitansky, Lebert, Virchow and
perhaps others whose names do not now occur to me, could scarcely have
developed a better pathology if they had lived during these first
centuries of the Christian era--a period of time when public sentiment
did not permit postmortem examinations, when Harvey’s discovery was not
even dreamed of, when the microscope was unknown, and when experimental
pathology was an impossibility. Many centuries had still to elapse
before medicine could gain that freedom of action, that rich equipment
of tools, and that stock of accumulated knowledge which enable her in
these days to make such giant strides forward as we have witnessed
during the past twenty or thirty years.

The question will naturally arise, How did the Methodists decide, in
the presence of an actual case of illness, which one of these abnormal
states (the laxum, the strictum, or the mixtum) was the condition
that called for medical treatment? The answer which they gave to this
question was, that the condition of the different secretions and the
dejections furnished the principal indication as to what particular
part or organ of the body was ailing, and also as to what was the
nature of the morbid change or process that produced the malady. When,
for example, the secretion from an organ or part was excessive, they
inferred that the pores of such a part were relaxed and distended,
thus permitting an increased flow; and when the secretion was less
than it should be, they decided that the pores were contracted. The
_status mixtus_ had reference to those cases in which a condition
of relaxation was observed in one part of the body, while that of
contraction was noted in another.

Neuburger mentions the fact that the Methodists were somewhat arbitrary
in their classification of the different diseases, most of the acute
maladies being placed by them under the heading _Status strictus_,
while they assigned the majority of the chronic affections to the
category of _Status laxus_.

The effect of the tendency of the Methodists to classify and simplify
all the departments of medicine was not wholly beneficial. It conveyed
to many the impression that medicine might readily be learned in the
course of a few months, and thus offered the temptation to inferior
men to choose the career of physician; and yet, on the other hand,
it infused into the art the essentially Roman characteristics of
orderliness, simplicity and efficiency. Anatomy, for example, was
studied only so far as a knowledge of this department of medicine was
necessary to render the physician familiar with the location, general
character and relations of the different organs. There was one field,
however, in which the adherents of this school displayed a high degree
of excellence, viz., in their descriptions of disease; and this is
especially true of those written by Caelius Aurelianus (fourth century
A. D.), whose manner of handling the subject of differential diagnosis
is far more thorough and satisfactory than that of any of the medical
authors who preceded him.

In their treatment of disease, the Methodists were largely guided by
the principle of _contraria contrariis_,--_i.e._, in those
cases in which, to the best of their belief, a _status laxus_
existed, they administered astringents, in the hope of thereby bringing
the parts back more nearly to a contracted condition; and, _vice
versa_, when the diagnosis of _status strictus_ was made, they
gave a relaxing medicine. The terms “laxatives” and “astringents,”
which are still applied to many drugs, were originated by the
Methodists. Bloodletting, for example, was one of the remedies which
they used for producing relaxation, and an astringent was employed
when a contrary effect was desired. In the list of relaxing remedial
agents (aside from bloodletting) were placed the following: warm
baths, poultices, inunctions with warm oil, vapor baths, fasting and a
restricted diet, diuretics (very carefully watched and employed only in
exceptional cases), emetics, diaphoretics and laxatives. The following
agents, on the other hand, were classed as contracting, astringent and
tonic remedies: washing with cold water, cold baths, the application of
cloths dipped in cold water, living in cold air, strengthening diet,
wine, vinegar, alum, narcotics, etc. Themison, it should be added, is
the first one among the ancient writers to mention the use of leeches
as a means of extracting blood. It does not follow from this, however,
that he was the discoverer of this method of local bloodletting; for it
is highly probable that this procedure had been in common use for many
years previous to his time.

Themison, as I have before stated, was an old man when he laid the
foundations for Methodism, and it is not probable that it attained
much importance as a sect until several years after his death. Then
Thessalus, a native of Tralles, a flourishing commercial city of Asia
Minor, and a man who had received his medical training in one of the
Greek schools, materially added to the body of doctrines held by this
sect, and at the same time rendered them more acceptable to physicians
generally. He was of humble birth, the son of a wool carder, and his
education had been rather neglected; but he nevertheless managed, by
his own efforts and in no small degree by the unlimited self-confidence
(Galen calls it impudence) which he possessed, to push his way to
the top of the ladder.[32] He acquired a large fortune during the
reign of Nero (54–68 A. D.) and apparently succeeded in persuading
this monarch that he was a great physician. Here are some facts which
appear to justify Galen’s dislike for Thessalus: In a letter to Nero
the latter writes: “I have founded a new medical sect, the only
genuine one in existence. I was forced to do so because the physicians
who preceded me had failed to discover anything that is likely to
promote health or to drive away disease; even Hippocrates himself
having laid down doctrines which are positively harmful.” His vanity,
according to Le Clerc, reached such a pitch that he called himself the
“conqueror of physicians.”[33] Pliny corroborates the latter statement
in the following words: “When he assumed the title of ‘conqueror of
physicians,’ a title which was engraved, according to his instructions,
on his tomb in the Appian Way.” Notwithstanding his unbounded conceit,
Thessalus appears to have made several important improvements in the
doctrines of the Methodists. He is also, as it appears, entitled to the
credit of having been the first to inaugurate the practice of giving
systematic instruction at the bedside; thus establishing for all time a
most valuable precedent for the guidance of his successors.

   “He was an excellent practitioner and an original thinker....
   He was also a prolific writer, as is shown by the number and
   variety of treatises which--as we are assured by Caelius
   Aurelianus--were composed by him.” The same authority speaks of
   him as “a leader among our chiefs,” thus affording good evidence
   of the degree of esteem in which he was held by the members
   of his own school. The fact that pupils came in throngs to be
   taught by him shows clearly how thoroughly he understood the
   needs of the physicians of Rome. (Meyer-Steineg.)

Thessalus, notwithstanding his declaration that medicine might readily
be taught in six months, wrote a larger number of treatises on
professional topics than any student of medicine could possibly read
and digest in the course of two or three years. They filled several
large volumes, but not one of them is known to exist to-day. He wrote
at great length, as we are assured, on the subject of surgery, a
subject in which he took an active interest. He taught that ulcers, no
matter in what part of the body they may be located, require the same
kind of treatment.

   If an ulcer is excavated, it is necessary to bring about a
   filling-up of the excavation; if its surface is on a level with
   the surrounding skin, the aim should be to make it cicatrize;
   if the growth of new tissue is excessive, the redundant portion
   should be destroyed by burning with caustic; and, finally, if
   the ulcer is of recent development and bleeds readily, the
   attempt should be made, by approximating the edges, to effect an
   immediate healing.

In the treatment of chronic ulcers which show little or no disposition
to heal, and which, when they do finally heal, are very prone to break
open afresh, Thessalus urges the great importance of ascertaining, if
possible, the cause or causes of this behavior. If it be found that
the trouble is due to some weakness or abnormal predisposition of
the part in which the ulcer is located, or that the condition of the
entire body is probably the real cause of the trouble, he recommends
the employment of “metasyncritic remedies”--that is, remedial measures
which effect a marked change in the individual’s vital processes
throughout the body, and also such as exert an alterative effect upon
the ulcer itself. Among the measures of the first class he enumerates
the following: Various forms of physical exercise; alternately
increasing and diminishing the amount of nourishment taken; and perhaps
the taking of an emetic at the very commencement of the treatment.
As to the second class of measures--those needed to bring about a
change in the ulcer itself--he makes the following recommendations:
Remove from the diseased tissues as much as will restore the parts,
as nearly as possible, to the condition of a healthy wound, and then
adopt the treatment suited for the latter condition. In cases in which
the ulcer heals and then subsequently breaks open again, it will
sometimes be found beneficial to apply in the neighborhood a plaster
containing an irritating substance like mustard, the effect of which
is often to change the disposition of the parts. In actual practice he
recommends that the local measures should be employed first, and then,
if they fail to accomplish the desired purpose, the physician should
have recourse to those enumerated in the first class--the strictly
metasyncritic remedies.

It is rather difficult to believe that a man so full of conceit and so
unjust in his criticisms of his predecessors as Thessalus clearly was,
could be capable of formulating such a concise statement of the nature
of chronic ulcers and such a practical rule for their proper treatment.
His development of the idea of “metasyncrisis”--or renovation of the
body (_recorporatio_), as Caelius Aurelianus translates the
word--seems to have been original with Thessalus.[34] The Methodists,
it should be added, deserve special credit for having been the first
to introduce and carry into effect the systematic treatment of chronic
diseases; and, as a general proposition, it may be said that their
treatment of all forms of disease was thoroughly practical, free from
all tendency to resort to magical methods, and based largely on the
employment of such hygienic measures as the use of baths of different
kinds (hydrotherapy), massage, moderate outdoor exercise, passive
movements, sea voyages, fasting, regulation of the diet, etc. One
of the favorite practices--of which Thessalus was said to have been
the originator--was to begin the treatment of almost all maladies by
prescribing an abstinence from all food for a period of three full
days. When I come to speak of Soranus and Caelius Aurelianus I shall
probably have occasion to give further details regarding the methods of
treatment employed by the Methodists.

As a system, says Neuburger, Methodism was not capable of inaugurating
any fundamental advances in medicine; the most that it was able
to accomplish was to broaden and otherwise improve the domain of
therapeutics, and some of its wiser members were diligent in collecting
and sifting critically a large number of valuable experiences, which
were then courteously registered by them to the credit of the sect.




                             CHAPTER XIII

     THE FURTHER HISTORY OF METHODISM AT ROME, AND THE DEVELOPMENT
     OF TWO NEW SECTS, VIZ., THE PNEUMATISTS AND THE ECLECTICS.--A
          GENERAL SURVEY OF THE SUBJECT OF SECTS IN MEDICINE


Among the Methodists there were many physicians who attained more
or less distinction during their professional career, but only two
of them, beside those whose contributions to medical knowledge have
already been mentioned in these pages, gained sufficient celebrity to
justify me in devoting some additional space to the description of the
work which they accomplished. Soranus, of Ephesus on the coast of Asia
Minor, and Caelius Aurelianus, of Sicca in the north of Africa, are the
physicians to whom I have reference.

It was Soranus, says Le Clerc, who gave the finishing touches to
the system of the Methodists, and the work which he did was of such
excellence that he may with justice be called the ablest and most
skilful of all the members of that school. Caelius calls him “a chief
among the leaders of our sect.” He received his medical training at
Alexandria and came to Rome about the year 100 A. D. His professional
career covered the period corresponding to the reigns of Trajan and
Hadrian (98–138 A. D.). He is known to posterity chiefly through
his two treatises--one on obstetrics and gynaecology and the other
on acute and chronic diseases. The first of these treatises, in the
original Greek, was rediscovered in 1838 by Reinhold Dietz, Professor
of Medicine in the University of Königsberg, Prussia, and a German
translation of the work (by Lüneberg and Huber) was published in Munich
in 1894. Moschion, who was probably a pupil of Soranus, wrote a popular
treatise on the same subject for the use of midwives, and in this book
he has reproduced much of the material which is to be found in the work
of his master. The treatise written by Caelius Aurelianus on acute and
chronic diseases is admitted by him to be founded on that which Soranus
wrote on the same subject. In fact, as Daremberg states, the work of
the former represents almost a translation (into Latin) of Soranus’
treatise. The sources just named are the principal ones from which our
knowledge of this author is derived.

Soranus was a prolific writer; the treatises which he wrote and which
deal with a great variety of subjects, number thirty in all. The
majority of these works, however, have been lost. He had many followers
and his influence upon medical science was very great, not simply
during his lifetime, but also for several centuries after his death.
He commanded the respect and confidence of the opponents of Methodism
as well as of the members of his own sect. One of his most pronounced
traits of character was his readiness to condemn, on every possible
occasion, superstitious practices, such as the employment of amulets,
magnets, etc. He was also a very persistent and earnest advocate of
the gentler and more rational obstetric methods. For example, he
disapproved of the reckless employment of remedies for hastening the
expulsion of the foetus, of the practice of succussion (which was
carried out by the aid of a ladder), of making the pregnant woman run
up and down stairs, of a resort to rough mechanical procedures for
extracting the placenta, etc. The following quotation from one of
Soranus’ treatises (Gynaeciorum, Lib. I., cap. 19) reveals clearly what
sort of a man and physician he was:--

   There is a disagreement; for some reject destructive practices,
   calling to witness Hippocrates, who says, “I will give nothing
   whatever destructive” and deeming it the special province of
   medicine to guard and preserve what nature generates. Another
   party maintains the same view, but makes this distinction,
   viz.: that the fruit of conception is not to be destroyed at
   will because of adultery or of care for beauty, but is to be
   destroyed to avert danger impending at parturition, if the
   uterus be small and cannot subserve the perfecting of the fruit,
   or have hard swellings and cracks at its mouth, or if some
   similar condition prevail. This party says the same thing about
   preventing conception, and with it I agree.

   (Translated from the Greek by the late John G. Curtis, M.D., of
   New York.)

Soranus was not only a great obstetrician,--admitted by all the
authorities to have been the greatest in ancient times,--he was also
in high repute for the work which he did in other departments of
medicine--in gynaecology, for example, in the instruction of midwives,
in the management of children’s diseases, in the diagnosis and
treatment of both acute and chronic diseases, in surgery, etc. While in
general he adhered to the fundamental teachings of the Methodists, he
did not hesitate to depart from the beaten pathway of that sect in his
explanations of certain pathological conditions; for he was more of a
clinical observer than a sectarian, and it was probably his independent
manner of thinking that gave the sect new vigor and thus enabled it to
live on through such a long period of time. Galen, who was not at all
disposed to speak favorably of the Methodists, says that he tried a
number of the remedies recommended by Soranus and found them good.

Caelius Aurelianus probably flourished during the third century A. D.
The different authorities, however, do not agree as to the limits of
the period during which he lived; some saying that his career antedated
that of Galen, while others claim that he came upon the scene after
the death of the latter, which occurred early in the third century A.
D. His chief merit appears to have been that, through his translation
of the writings of Soranus into Latin, he placed within reach of the
physicians of Rome the teachings of that admirable diagnostician and
therapeutist; for it must be remembered that the great majority of the
Roman medical men were not able to read Greek. On the other hand,
Caelius Aurelianus, who was himself a thoroughly practical physician,
deserves considerable credit for having enriched the text of his book
with many very appropriate examples (chiefly with regard to questions
of diagnosis) drawn from his own personal experience, which must
have been extensive. During the Middle Ages, as we are informed by
Friedlaender, this work furnished the chief source from which the monks
derived their knowledge about diseases and their proper treatment.
The Latin in which the book is written is described by nearly all the
authorities as barbaric.

_The Pneumatists._--Methodism had been established only a very
few years when Athenaeus of Attalia, a city on the coast of Pamphylia,
Asia Minor, founded (about 50 A. D.) a new sect--that of “Pneumatism.”
He was not the discoverer of the “pneuma” or “vital spirit,” for that
had already been admitted by the earlier schools of philosophy as a
fifth primary creative element, supplementary to the four well-known
substances--fire, air, earth and water. He believed that heat, cold,
moisture and dryness (the primary qualities of these four bodies)
were not the veritable elements of living beings. Heat and cold, he
maintained, were “efficient causes” and moisture and dryness “material
causes.” To these he added “spirit” as a fifth element; and he taught
that this spirit enters into the formation of all bodies and preserves
them in what may be termed their natural state. It was from the
Stoics, more particularly, that Athenaeus borrowed this belief, and
it was the latter fact, as Le Clerc says, which led Galen to speak of
Chrysippus--one of the most famous of the Stoics--as “the Father of the
Sect of the Pneumatists.”

In his application of the doctrine of Pneumatism to the science of
medicine, Athenaeus maintained that the majority of diseases owed their
origin to some disturbance or disorder of the spirit; but it is almost
impossible to understand, from the scanty data which have come down
to us, what Athenaeus really meant by the term “spirit,” and by the
expression “disorder of the spirit.”

   From the definition which he gives of the word “pulse” one
   is justified in drawing the conclusion that he considered
   the spirit to be an actual substance, capable of undergoing,
   to a greater or less degree, such changes as expansion and
   contraction. The same obscurity of meaning is encountered when
   one endeavors to discover how the new doctrine affected the
   practice of medicine. (Le Clerc.)

In view of all these circumstances it is not at all surprising that
Pneumatism was not very popular with the physicians of Rome, and
that, after a brief period had elapsed, many of the adherents of
this doctrine abandoned it and gave their preference to the more
practical teachings of the Methodists. Meyer-Steineg goes so far as to
remark that, to all intents and purposes, such a thing as a sect of
Pneumatists did not exist.

The most prominent of the disciples of Athenaeus were Theodorus,
Agathinus, Herodotus, Magnus and Archigenes.

Haller speaks of Theodorus as the inventor of a remedy which, as he
claimed, cures all cases of poisoning.

_The Eclectics._--Agathinus, a native of Sparta, was the teacher
of Herodotus and Archigenes. His chief distinction is to be found
in the fact that he gave to the offshoot from the school of the
Pneumatists the name of “Eclectics,”[35] his object being, as we are
assured by Neuburger, to bring the three sects (Pneumatists, Empirics
and Methodists) into closer union.

Herodotus--who, it is perhaps desirable to state, is a different person
from the famous historical writer of the same name--lived during the
latter part of the first century A. D., and was more closely allied to
the Methodists than to the Pneumatists. It appears from the text of a
fragment of one of his treatises that he wrote a description of the
disease now called small-pox and directed attention to its contagious
character.

Magnus, a native of Ephesus in Asia Minor, is reported to have been
the writer of a collection of letters on medical topics and also of a
history of the discoveries made in medicine subsequently to the time of
Themison.

Archigenes, the fifth member of this group of Pneumatists, was born
in Apamea, Syria, and lived in Rome under the reigns of Trajan
(98–117 A. D.) and Hadrian (117–138 A. D.). Le Clerc speaks of him as
belonging to the Eclectics rather than to the Pneumatists. This is
a matter, however, of small importance, as the sects were, at that
period, very much mixed. The poet Juvenal, who was a contemporary
of Archigenes, refers to him briefly as a physician who had a large
practice; and the historian Suidas says that he wrote a great deal
about physics as well as about medicine. That he was esteemed highly
as an authority in practical surgery is shown by the fact that Galen,
when he discusses surgical topics, makes frequent quotations from
the writings of Archigenes. Only fragments of the latter, however,
have come down to our time. His popularity as a practitioner was very
great; notwithstanding which he managed to write several treatises
on a variety of topics--on the pulse, on feverish diseases, on the
different types of fevers, on local affections, on the diagnosis and
treatment of acute and chronic maladies, on the right moment when
surgical operations should be performed, on drugs, and on therapeutic
procedures in general. He applied ligatures to blood-vessels and also
arrested further bleeding from them by passing needles through the
adjacent parts in such a manner as to exert pressure upon the vessel (a
procedure which is termed “acupressure”); he operated for the removal
of both mammary and uterine cancers; he employed the red-hot cautery
iron for the arrest of hemorrhage and also for the relief of coxalgia,
and he was familiar with the use of the vaginal speculum.

Antyllus, another prominent surgeon of that period, joined the
Methodists at a considerably later date. He was also the author
of an excellent treatise on surgery, the greater part of which,
unfortunately, has been lost or destroyed.

Aretaeus of Cappadocia, a district of Asia Minor, lived during the
second century A. D. He was a man of very broad culture. From the
fact that he assigned an important rôle to the pneuma, he is usually
classed among the Pneumatists. He does not appear, however, to have
taken a very active interest in the doctrines of that school, and both
Le Clerc and Daremberg seem disposed to call him an Eclectic, and we
may therefore rank him as one of the independent physicians of that
period. It is doubtful whether he ever practiced in Rome. His two
treatises--one on the causes and means of identifying acute and chronic
diseases, and the other on the treatment of these diseases--are written
in Greek, and are characterized by the clearness and simplicity of his
descriptions, which very closely resemble those of Hippocrates, and by
the soundness of the advice which he gives in regard to the methods
of treatment.[36] In his conceptions of what a physician should aim
to be, Aretaeus maintained a very high standard. Some of his views
regarding human physiology and pathology are given here very briefly:
Respiration serves the purpose of cooling the warmth of the heart, and
the lungs are therefore prompted by the latter organ to draw cool air
into their cavities; digestion takes place not only in the stomach
but also in the intestinal canal, and owes its origin to warmth; the
cerebral nerves, close to the spot from which they originate, cross
from one side to the other, and by the aid of this fact paralysis on
one side of the body may be explained. Aretaeus has gained considerable
fame, says Puschmann, from his description of the “Syriac ulcer,” the
picture of which he draws agreeing perfectly with what is known to-day
as pharyngeal diphtheria. In various places throughout his writings
he displays a thorough knowledge of normal anatomy--as, for example,
when he describes the ramifications of the vena portae and gall-ducts
of the liver. He was also well informed in matters belonging to the
domain of pathology, for he gives admirable descriptions of many of
the diseases--for example, pleurisy with empyema, pneumonia, pulmonary
consumption, cerebral apoplexy, paraplegia, tetanus, epilepsy, diabetes
mellitus, gout, etc. From the character of these descriptions one is
strongly tempted to believe that he must have made a certain number of
postmortem examinations.

According to Neuburger, Aretaeus enters very fully into details
when he discusses the subject of diagnosis; his statements in one
place warranting the belief that he even auscultated the heart. His
methods of treatment were based largely upon his own experience and
were generally of a simple character. He attached great importance,
for example, to a very careful regulation of the diet, muscular
exercise, massage, etc., and his employment of remedies was confined
to a very small number of such drugs as exert a mild action. When the
case, however, was of such a character as to call for more vigorous
interference, he did not hesitate to resort to the use of opium,
emetics, cathartics, venesection, blistering, the red-hot cautery iron,
etc.

Rufus, a native of Ephesus, a city of Asia Minor, about thirty-five
miles from Smyrna, is reckoned by most authorities among the Eclectics;
in other words, he was an independent, or one who adopted from the
teachings of the different sects such doctrines as met with his
approval, but who, at the same time, did not care to pose as the
disciple of any one of them. He received his medical training at
Alexandria, but it is not known where he practiced his profession.
Almost no details concerning his life or his professional career have
come down to our time. It is simply known that he flourished during
the reign of the Emperor Trajan (98–117 A. D.). Ebn Ali, an Arabian
physician and author, says that he was the leading medical authority
of his time and that his works were highly esteemed by Galen. His
treatise on anatomy (entitled “The Names of the Different Parts of the
Human Body”), which is one of the few that have escaped destruction,
is described as a treatise which was written for students, and which
possesses great value for the history of anatomical nomenclature. The
same authority says that Rufus was the first to describe the chiasma,
that he came very near establishing the existence of two different
kinds of nerves--motor and sensory--and that he attributed the control
of all bodily functions to the nervous system. He also states that he
was one of the first to furnish a description of the oriental bubonic
plague. Some idea of Rufus’ style of writing may be gathered from the
following quotations which have been taken from his short treatise
entitled “The Questioning of Patients”:--[37]

   It is necessary to question the patient, for by so doing one
   may gather more exact information concerning the nature of the
   malady, and will then be able to treat it more intelligently.
   In this way also one may learn whether the patient’s mind is
   in a normal or an excited state, and whether any change has
   taken place in his physical strength. Some idea regarding the
   nature and seat of the disease is usually obtained from such
   questioning. If, for example, the patient answers clearly and to
   the point, and does not hesitate; if his memory does not play
   him false; if his speech is not thick or indistinct; if, being a
   well-bred man, he gives his responses in a polite and cultivated
   manner; or if, in the case of a person who is naturally timid,
   the answers reflect this timidity, then you may feel confident
   that your patient’s mind is not affected. But if, on the other
   hand, you ask him about one thing and he gives you a reply about
   something entirely different; if, as he talks, he appears to
   forget what he was talking about; if he has a trembling tongue
   the movements of which are also uncertain; and, finally, if from
   a certain state of mind he passes rapidly to one of a totally
   different character,--all these changes are evidences that the
   brain is beginning to be affected.... If the patient speaks
   distinctly and with a fairly strong voice, and is able to tell
   his story without stopping from time to time in order to rest,
   the inference is warranted that his physical strength is not
   materially affected....

The following quotation is from his treatise on gout:--

   If the patient complains that one of his joints is painful, he
   should be asked whether or not the part has received a blow. If
   he replies that it has not, then (you may infer that the pain
   is due to gout and) you should forthwith put him on a suitable
   diet, order a clyster and bleed him at a spot not far (from the
   seat of the pain).... The withdrawal of nourishment is ordered
   for the purpose of arresting any further formation of new blood
   and thus preventing the joints from growing more sluggish in
   their movements. The clyster is ordered because we believe that
   it is beneficial (in this condition) to evacuate the bowels.
   The bleeding will be found useful, but to a less degree in
   the lower than in the upper limbs.... One must be careful not
   to assume that the patient is cured when he has been entirely
   relieved of his pain, because with the lapse of time fresh
   attacks are liable to occur; this disease, like certain other
   affections, possesses a periodic character.... Therefore it is
   well, immediately after the bloodletting, to employ friction, to
   get rid of the excess of moisture in the body by some laborious
   form of exercise, to take such articles of food as are easily
   digested,--in brief, to aim chiefly at reducing as much as
   possible the moisture of the body.

One cannot but feel a keen regret that so few of the writings of this
thoroughly practical and highly educated physician should have come
down to our time. So far as I am able to learn, Rufus wrote no fewer
than 102 treatises, all of which, with the exception of the seven
about to be mentioned (together with a number of fragments preserved
by different writers of antiquity) have either disappeared or been
destroyed. The titles of the treatises which have been preserved are as
follows: (1) Diseases of the Kidneys and Bladder; (2) On Satyriasis and
Gonorrhoea; (3) Purgatives; (4) The Names of the Different Parts of the
Human Body; (5) On the Questioning of Patients; (6) On the Pulse; (7)
On Gout.

_A General Survey of the Subject of Sects in Medicine._--During
the sixth century B. C.,--that is, about two hundred years before
the formation of the more distinctly medical sects of which mention
was made in Chapter IX.,--Pythagoras of Samos and his disciples put
forward certain beliefs or doctrines with regard to the mode of
action of some of the functions or vital processes of the human body,
and all those who accepted these teachings as affording a true and
satisfactory explanation of the phenomena in question constituted what
is generally termed a school or sect. Some of these individuals were
physicians--that is, men who undertook to cure or at least to relieve
those who were ill; but probably the majority were simply philosophers,
mere “lovers of wisdom,” who by studying problems of this nature sought
to satisfy their longing for a more perfect knowledge of the truth
respecting the various phenomena of life.

A few years later, Heraclitus of Ephesus, who, like Pythagoras, was
both a philosopher and a practicing physician, taught the doctrine that
all things owe their origin to fire. One is not at all surprised to
learn that he had relatively few followers, for history tells us that
he was both a misanthrope and a slanderer of the medical profession,
as shown by the following saying which is attributed to him: “Next to
physicians the grammarians are the biggest fools in the world.”

Hippocrates attached much importance to the value of experience and
to the necessity of studying disease at the bedside; at the same time
he upheld what is commonly known by the name of humoral pathology--a
doctrine which refers all maladies to some abnormal change in the
humors or fluid portions of the body. His writings also show that he
made full use of the reasoning power. The followers of this great
physician did not form a sect in the ordinary sense of the term; they
were his adherents simply because he was an able diagnostician, a
successful teacher, an excellent therapeutist, a skilful surgeon, a man
of very high moral character,--in short, a great physician. Every sect
which developed in the centuries following his death contained a goodly
proportion of Hippocratists.

Nearly two centuries after the active period of the professional life
of Hippocrates, Erasistratus and Herophilus gathered about themselves
in Alexandria (about 280 B. C.) large groups of followers, who held for
their respective teachers a degree of esteem which amounted, according
to Galen, almost to veneration. As there was little or no antagonism
or lack of harmony between the doctrines taught by these physicians,
the two groups cannot properly be classified among the sects. In
fact, it would be more correct to say that Erasistratus and Herophilus
contributed facts of permanent value to our stock of knowledge rather
than doctrines which might prove highly popular for a few scores of
years, but which would probably in due course of time be set aside as
no longer of value.

The four most characteristic types of sects in medicine were the
following: the Dogmatists--or Rationalists, as Daremberg calls them
in one place; their great rivals, the Empirics; the Methodists; and
the Eclectics. The oldest sect, the Dogmatists, did not come into
prominence until after the medical schools at Alexandria had already
been in operation for a long time. The development of the rival sect of
the Empirics at this late period brought with it endless discussions
regarding the merits of their respective teachings, and thus both of
them gained a degree of prominence which seems to us moderns to have
been out of all proportion to the importance of the subject-matters
discussed. The Dogmatists, says one writer, insisted that it is just as
necessary to be acquainted with the “hidden causes” of disease as with
those which are plainly recognizable, and that it is only by aid of the
reasoning power that we gain some knowledge of this class of causes.
They claimed that, while a knowledge of anatomy is of very great
service to the surgeon, it usually renders this service through the aid
of the reasoning power; as when, in the performance of a lithotomy, the
operator selects the fleshy (_i.e._, vascular) neck of the bladder
as the spot in which to make the opening with the knife, in preference
to the base of the organ, which is chiefly membranous in structure and
therefore less likely to heal solidly.

The plausible but rather shallow response made by the Empirics to
the arguments advanced by their rivals consisted in quoting certain
maxims, as, for example: “The farmer and the helmsman do not acquire
knowledge of their respective occupations from discussions, but from
actual practice”; “It is not of vital importance to know what are the
causes of the different diseases, but what remedies are competent to
cure them”; and “Diseases are not cured by eloquence, but by remedial
agents.”

Among the comments made by Celsus with regard to the differences which
distinguished the Dogmatists from the Empirics we find the following
statement: “The two sects employed the same remedies and pursued very
much the same course of treatment, but their reasonings about such
matters were different.”

Modern physicians will, at first thought, be disposed to wonder how men
as clever as many of these physicians were could have split up into
separate and more or less antagonistic sects because of such apparently
trivial differences of opinion. It must be remembered, however, that
these men were groping in comparative darkness whenever they tried to
advance their knowledge of pathology, and that in this imperfect light
many things seemed of much greater importance than they appeared to be
in the brighter light of later centuries. It is only fair, therefore,
to withhold criticism and to ask ourselves whether this strong desire
on the part of those men to advance their knowledge of pathology--a
desire which manifested itself in the formation of sects--was not in
reality an evidence of the great vitality of Greek medicine on Roman
soil in those early centuries.

The remarks made above with regard to the Dogmatists and the Empirics
apply in a general manner to the sects known as the Methodists and the
Eclectics, a sufficiently full account of which has been given in the
preceding chapter.[38]




                              CHAPTER XIV

           WELL-KNOWN MEDICAL AUTHORS OF THE EARLY CENTURIES
                         OF THE CHRISTIAN ERA


There were four men who were not especially identified with any of the
sects described in the preceding chapters, and yet who occupied, as
authors of medical treatises, very prominent places in the history of
medicine of the period or epoch which we have just been considering.
They are Celsus, Scribonius Largus, Pliny the Elder and Dioscorides.
These men lived during the first and second centuries A. D. and they
therefore all belong strictly to the period which is designated in our
scheme as the fourth epoch. I shall give here brief sketches of all of
these writers and of their works. While Caelius Aurelianus, another
important medical author, belonged to a much later period, I shall, for
reasons of convenience, describe in the same chapter with the others
the part which he played in the evolution of medicine.

Aulus Cornelius Celsus, called by some the Latin Hippocrates and by
others the Cicero of physicians because of the correctness and elegance
of his Latin and the clear manner in which he puts his thoughts into
words, flourished during the reign of the Emperor Augustus (27 B.
C.-14 A. D.). The date and place of his birth are not known, but it is
generally believed that he was born and received his education at Rome.
The great work which he wrote and upon which he must have been engaged
the larger part of his lifetime was a sort of cyclopaedia, which
bore the title “_Artium libri_,” and in which each department
of knowledge was represented by a separate treatise. It is said that
five books were devoted to agriculture, seven to rhetoric, eight to
medicine, etc.; but all of these treatises, excepting those relating
to the latter science, have been lost or destroyed. It is not certainly
known to which of the professions Celsus belonged, but the very skilful
and judicious manner in which he has culled all that is best from the
medical treatises published before his time, the remarkable knowledge
of technical details which he displays in every part of his own work,
and the fine tone of medical thought which pervades these eight
books, almost compel the conclusion that the author was a very clever
clinician, although probably not a physician who practiced for a money
reward. In no other published treatise is a more perfect picture of the
medical practice of antiquity to be found than that which Celsus gives
us in his work “_De arte medica libri octo_.”

It is not an easy matter to select, from a treatise of several hundred
pages in length, one or two passages of such a character that they may
be accepted as fairly representing the author’s manner of dealing with
medical and surgical questions of practical interest. The two given
below are translations from Védrènes’ version (Paris, 1876), and they
deal, the one with venesection and the other with the proper manner of
arresting hemorrhage from a wound. Both the passages quoted represent
only fragments, as sufficient space for more extensive extracts is not
available.

   _Book II., Chapter X._--_Bloodletting from a
   Vein._--Incising a vein for the purpose of drawing blood from
   it, is not a new procedure; but it is certainly a new thing to
   resort to bloodletting in almost all diseases. Again, it is an
   ancient custom to employ bloodletting in young subjects and in
   women who are not pregnant, but it is a new thing to perform
   this operation on infants and aged individuals, and on women
   approaching the period of confinement. It was the idea of the
   ancients that persons at the two extremes of life were not able
   to support this sort of treatment, and they were convinced that
   a pregnant woman, if subjected to the operation of bloodletting,
   would almost surely be confined before the completion of her
   time. Since then, however, experience has shown that there is
   no fixed rule about this matter, and that a physician should
   preferably regulate his course in accordance with observations
   of a different nature. The determining factor, for instance,
   is neither the age nor the pregnant state of the patient, but
   rather the degree of physical strength. In the case of a youth
   who is feeble, or of a delicate woman (aside from the question
   of pregnancy), it would be wrong to draw blood, for it would be
   robbing them of what little strength they possessed. But, in the
   case of a vigorous child, a robust old man, or a pregnant woman
   who is in good health, one need not hesitate to resort to this
   procedure. Nevertheless, there may arise, in connection with the
   operation of venesection, a number of questions which are quite
   likely to puzzle an inexperienced physician and perhaps lead him
   into error. For example, infants and old people possess as a
   rule diminished vigor, and the woman who is about to be confined
   needs all her strength for the period following delivery, both
   for herself and for the nourishing of the child. But the mere
   fact that one must give some thought to questions of this nature
   and must exercise prudence does not justify the immediate
   rejection of a method of treatment like that of venesection. For
   is it not the very essence of our art, not merely to consider
   the factors of age and the pregnant state, but also to form an
   estimate of that other and more important factor, viz., the
   patient’s strength,--be that patient an infant, an aged person,
   or a woman advanced in pregnancy,--and then to decide whether
   it is, or is not, great enough to bear the loss of blood?
   In deciding a question of this kind it will be necessary to
   distinguish between real vigor and obesity, between thinness and
   feebleness, etc.

          *       *       *       *       *

   Venesection is an easy operation for a physician who has already
   familiarized himself with the manner of performing it, but
   for one who is ignorant of these details it may prove very
   difficult. It is necessary, for example, to bear in mind that
   the artery and vein are united and that they are accompanied
   by nerves; and, further, that the injuring of the latter
   will induce spasms and violent pains. On the other hand, it
   must also not be forgotten that an artery once opened has no
   disposition to close, nor does it heal, and that sometimes the
   blood escapes in an impetuous manner. If, perchance, the vein
   is cut transversely, the edges of the opening contract and no
   more blood escapes. Again, if the scalpel is plunged into the
   parts timidly, the skin alone will be divided and the vein will
   not be opened. In some cases this vessel is so hidden from
   sight that the physician may experience difficulty in bringing
   it into view. Thus it will be seen that there are several
   circumstances which may render this operation difficult for an
   ignorant or inexperienced physician. The vein should be incised
   in a longitudinal direction, midway between its two sides. The
   moment the blood gushes from the opening its color and general
   appearance should be carefully noted, etc.

   _Book V., Chapter XXVI._--_The Proper Manner of Arresting
   Hemorrhage from a Wound._--If there is fear that there
   may be bleeding, one should fill the wound with dry lint,
   place over it a sponge wrung out of cold water, and press
   upon it with the hand. If the bleeding still continues, it is
   advisable to change the stuffing of lint somewhat frequently;
   and, if this step proves ineffective, then lint moistened with
   vinegar may be tried, for this liquid acts energetically in
   arresting hemorrhage. Some physicians, indeed, actually pour
   it into the wound. There is a strong objection, however, to
   the use of an agent which, like vinegar, arrests the bleeding
   too completely--viz., that it is apt to set up afterwards an
   intense inflammation of the parts. The same reasoning applies
   with even greater force to the employment of corrosives and
   caustics, which produce an eschar. Despite the effectiveness
   of most of these in arresting hemorrhage, their use should be
   discouraged.... Finally, if the bleeding continues it will be
   necessary to grasp the vessel from which the blood is escaping,
   to ligature it in two places close to the wound, and then to
   divide the vessel between the two ligatures, in order that
   it may retract (both of the new orifices having already been
   closed by the ligatures). If the circumstances are such that the
   plan just recommended cannot be carried out, it will then be
   advisable to apply the red-hot cautery to the bleeding vessel.
   When a rather free hemorrhage occurs at a part of the body where
   there are no nerve trunks and no muscles,--as on the forehead or
   at the top of the head,--the simplest plan is to apply a cup at
   some little distance from the source of the bleeding and thus
   divert the current of the blood from the spot affected.

And to these two longer extracts may be added a third:--

   From these considerations the inference is warranted that a
   physician cannot possibly give proper attention to a large
   number of patients. (Book III., Chapter IV.)

Celsus’ treatise was ignored by physicians for many centuries, but
it was considered by the monks, in the Middle Ages, a valuable
guide in the treatment of disease; and it was probably owing to
this circumstance, says Védrènes, that the book did not altogether
disappear. It was not until the year 1443 that Thomas de Sazanne,
afterward Pope Nicholas V., discovered a copy of the work in the church
of Saint Ambrosius, at Milan, but it was only in 1478 that the book was
printed for the first time (at Florence). Then, as if to make up for
the long neglect to which it had been subjected, no fewer than sixty
Latin editions were issued during the two succeeding centuries; and,
in addition, it was eventually translated into every modern European
language.

Scribonius Largus, a Roman physician who lived during the reigns
of Tiberius and Claudius (14–54 A. D.), owes his celebrity to the
fact that he wrote and published (in 47 A. D.) a book containing a
collection of the best medical formulae and popular recipes known at
that time. He appears to have had a large private practice and to have
spent a considerable portion of his professional life in the service
of the army. He accompanied the Emperor Claudius, for example, in his
campaign against Britain (43 A. D.), and the book which he wrote, and
which has just been mentioned, was dedicated by him to that emperor.
According to Neuburger, Scribonius is to be credited with having been
the first to describe correctly the proper manner of obtaining the drug
known as opium, and also the first to recommend, in the treatment of
severe headaches, the employment of electric shocks as communicated by
the fish called the “electric ray.”

Medical practice at that period, says Le Clerc, was divided among three
kinds of practitioners--those who treated their cases exclusively by
dietetic measures, those who effected cures by surgical means, and
those who took charge only of such patients as required chiefly the
employment of external remedies. But Scribonius Largus insists that
such a division was more theoretical than real, as no one of these
classes could get along without the cooperation of the others.

C. Plinius Secundus, commonly called Pliny the Elder, was born near the
beginning of the first century of the Christian era, either at Verona
or at Como in the north of Italy, and settled in Rome at an early
period of his life. At the beginning of his career he served for some
time in the army in Germany, and upon his return to Rome practiced as
a pleader. Subsequently he held various official positions which gave
him the opportunity of visiting other countries of Europe. He perished
at Stabiae (near the modern Castellamare, on the Gulf of Naples) in 79
A. D., at the age of fifty-six years, while watching the eruption of
Vesuvius, which overwhelmed Herculaneum and Pompeii. He was in command
of the Roman fleet at the time.

Pliny was indefatigable as a writer and as a gatherer of knowledge of
all sorts, and he and Celsus are well named the Encyclopaedists. He
is said to have written twenty books on the war with the Germans, an
unknown number on rhetoric and grammar, and thirty-seven on natural
history. The latter books alone have come down to our time. Pliny’s
nephew, who is known as Pliny the Younger, and who edited the great
work of his uncle on natural history, furnishes us, in a letter
addressed to the historian Tacitus, with some interesting details
regarding the elder Pliny’s manner of life. It appears from this
account, that the latter read almost incessantly. During his meals and
while he was taking his bath, an attendant read aloud to him. He also
took his books with him on his travels and was always accompanied by
a person who could write rapidly under dictation. He continued this
practice upon his return to Rome and dictated to his amanuensis even
while he was being carried about in a sedan chair. Books 20–27 of his
great work on natural history are devoted to the subject of remedial
agents belonging to the vegetable kingdom, books 28–32 deal with those
which belong to the animal kingdom, and books 33–37 treat of mineralogy
with special reference to medicine, painting and sculpture. Pliny was a
compiler and not an original investigator. Some idea of the popularity
of his treatise on natural history may be gathered from the fact that
it was the second book to be printed after the invention of printing,
the Bible being the first. Another interesting fact connected with
Pliny’s treatise is mentioned by Neuburger, viz., that the use of
hyoscyamus and belladonna as agents capable of dilating the pupils,
owed its origin to the discovery (by C. Himly, in 1800) of a place in
the text (Book XXV., 92) where it is stated that the juice of the plant
Anagallis was rubbed into the eyes before the operation for cataract
was undertaken.

According to Pliny (Book XXXI., Chapter VI.), the ancients employed
mineral waters extensively in the form of baths, and they also
occasionally used them as internal remedies. Galen, too, mentions the
fact that these waters were in demand in the spring or autumn for
purgative purposes.

In Book XXXIX., 8, 3, Pliny--as quoted by Védrènes--makes the following
remarks:--

   Very few Romans have shown an active interest in medical
   affairs, and those few speedily found it necessary to pass
   themselves off as Greeks. For it is a well-known fact that those
   physicians who, without being able to speak Greek, attempted to
   build up a practice in Rome, failed to gain the confidence of
   their patients, even of those who were not at all familiar with
   that language.... When one’s health is the question at issue the
   readiness to place confidence in a medical adviser is apt to
   diminish in proportion as one’s knowledge of the man increases.
   Indeed, medicine is the only art in which one is quite ready
   at first to put faith in almost anybody who calls himself a
   physician, and that too, despite the acknowledged fact that in
   no other circumstances of life is an imposture more fraught with
   danger.

English versions of Pliny’s Natural History and of Pliny the Younger’s
Letters have been published in what is known as Bohn’s Libraries.

Pedanius Dioscorides, a native of Anazarba, a small Greek town near
Tarsus in Cilicia, lived about the middle of the first century A. D.
(during the reigns of Nero and Vespasian). From his earliest youth he
took a great interest in botany, and, after reaching manhood, traveled
extensively in the wake of different Roman armies, for the sole purpose
of studying by direct observation the plants of different countries
and of verifying the medicinal virtues which each one was reputed to
possess. In this way he visited, in turn, Greece, Italy, Asia Minor
and perhaps also the southern portion of France (the Narbonaise). He
collected great quantities of specimens of every kind of drug--animal
and mineral substances as well as objects belonging to the vegetable
kingdom; and, wherever it was possible to do so, he wrote memoranda of
the traditions of the natives with regard to the uses and medicinal
effects of these different drugs. After he had completed all these
researches and had gathered together all this vast mass of materials,
he wrote his famous treatise on materia medica--“the most complete,
the best considered, and the most useful work of its kind to be found
anywhere to-day.” (Galen.) It is from this treatise, therefore, says
Dezeimeris, that one can derive the most satisfactory idea of the
early Greek materia medica; but at the same time, he adds, it is not
a book in which will be found a detailed account of the manner in
which the practitioners of that period employed the remedies which he
describes. The same authority calls attention to the great difficulty
which modern physicians often experience in their attempts to identify
the drugs which Dioscorides describes. Le Clerc calls attention to
the fact that the physicians who were contemporaries of Dioscorides
were not in the habit of employing either iron or antimony (called by
them _stibium_) internally. Apparently they had not yet learned
that these substances possess properties which exert a curative action
in certain diseases. On the other hand, he mentions the manner of
extracting quicksilver, by chemical means, from cinnabar [red sulphide
of mercury], the steps required for preparing acetate of lead, and the
proper way of making lime water.

The work to which reference has been made above was published by
Dioscorides about the year 77 A. D. It is the earliest pharmacological
treatise that has come down to our time, and for many succeeding
centuries it served as the authoritative guide in all questions
relating to drugs. The first printed edition of the Greek original
appeared in Venice in 1499, but a still earlier Latin version was
issued in 1478. According to Pagel the best edition (in Latin and
fully illustrated) is that of Pietro Andrea Mattioli, which was printed
in Venice in 1554. Neuburger commends highly the German version by J.
Berendes. (Stuttgart, 1902.)

Of Caelius Aurelianus we possess no biographical details beyond the
facts that he was a native of Sicca in Numidia, Africa, and that he
lived toward the end of the fourth or during the first part of the
fifth century of the present era. He was the author of several works,
all but one of which, however, have been lost. The single treatise
which has come down to our time treats of acute and chronic diseases,
and is spoken of by Daremberg as being virtually a translation of
one of the lost writings of Soranus. This book, says Haeser in his
History of Medicine, is the most important source from which our
knowledge of Methodism is derived; and Neuburger not only agrees with
this statement, but adds that the treatise of Caelius Aurelianus
played a most important part, toward the end of the Middle Ages, in
the evolution of medicine. Up to the present time no translation of
this work into any modern language has been published, but Neuburger
furnishes a very full analysis of its important parts. In two places,
as appears from this analysis, Caelius Aurelianus mentions--among
the signs and symptoms of certain affections of the respiratory
apparatus--phenomena which show beyond a doubt that he (or Soranus) was
familiar with auscultation of the chest. The words which he uses are
these:--

“_Stridor vel sonitus interius resonans aut sibilans in ea parte quae
patitur,” and “sibilatus vehemens atque asper in ultimo etiam pectoris
resonans stridor._”




                              CHAPTER XV

                            CLAUDIUS GALEN


During the centuries immediately preceding the Christian era, Greek
medicine was represented by a collection of treatises which had been
written by Hippocrates and his followers on anatomical, physiological,
pathological, therapeutical and ethical subjects, and which constituted
a fairly complete but not always easily intelligible system. As
time went on, however, and especially as new and useful facts were
constantly being added to the existing stock of medical knowledge,
the more thoughtful physicians began to feel that the system, which
up to that day had proved acceptable, needed to be perfected in a
number of respects; and accordingly, as a result of this feeling of
dissatisfaction, and also as an expression of the prevailing desire
for a more perfect knowledge of the truth, there developed, as has
been stated in the preceding chapters, a number of different medical
sects. When Galen first appeared in the field as a physician of unusual
promise, these various sects were all still in a thriving condition.
The Methodists, in particular, were very popular. Galen did not favor
any special sect, but in his writings he made it manifest that he
attached more importance to the teachings of Hippocrates than to those
of any other author. “It was Hippocrates,” he said, “who laid the real
foundations of the science of medicine.” It is therefore not surprising
that Galen should have devoted so much time to the writing of elaborate
commentaries on the works of Hippocrates. The service which he thus
rendered to medicine, says Daremberg, was of very great value. But
Galen, notwithstanding his great admiration for Hippocrates, did not
hesitate to criticise a number of his teachings, and especially those
which, as he believed, were not stated with sufficient clearness.
Valuable as was the service rendered to medicine by the writing of
these commentaries, there still remained an urgent need for a service
of a different and much more difficult kind, viz., that of welding
together into a single clearly written and easily intelligible system
of medicine, all that was good in the Hippocratic writings and in the
disconnected and at times antagonistic teachings of the sects. To
accomplish this successfully required the services of a man endowed
with mental gifts of a most exceptional character--complete knowledge
of medicine in all its departments, a mind thoroughly trained in
philosophy, the power to express his thoughts in simple language,
and an independence and fairness of judgment which would render him
indifferent to the petty interests of the sects. Claudius Galen, as
subsequent events showed, possessed these very gifts in a high degree,
and he devoted the better part of his reasonably long lifetime to the
accomplishment of this much-needed work. How greatly it was needed at
that particular period of time, nobody then knew or could even suspect.
It soon appeared, however, that all the vaunted civilization of the
Graeco-Roman world--much of it of the purest gold and a great deal
of the basest alloy--was to be swept so completely off the face of
the earth that, for thirteen hundred or more years, almost no thought
whatever could possibly be given to the science and art of medicine.
Fortunate, most fortunate it was, therefore, that, before this wave
of destruction reached Rome, all the best part of Greek medical
literature--for such it was in truth--had been gathered together and
carefully systematized by Galen and stowed away in the recesses and
chambers of remotely situated monasteries and churches by clear-sighted
monks for the benefit of later generations of physicians.

_Brief Biographical Sketch._--Claudius Galen was born in Pergamum,
an important Greek city of Asia Minor, about the year 131 A. D., under
the reign of the Emperor Hadrian. His father, whose name was Nicon,
was a man of ample means, well informed in philosophy, astronomy and
geometry, and most liberal in providing for the thorough education of
his son in every branch of useful knowledge. In two or three places
in his writings Galen speaks of his father in terms of affection. On
the other hand, he does not hesitate to state in the plainest language
possible that his mother was a veritable Xanthippe. In her moments of
bad temper she would not only shout and scream in a violent manner, but
would sometimes go so far as to bite her serving-maids. Pergamum, at
the time of which I am writing, offered unusually good opportunities
for studying disease. Its Asclepieion, which was built during Galen’s
boyhood, had already become one of the famous temples of Asia Minor,
and the sick and maimed flocked to it in large numbers. Then, in
addition, the city was well equipped with able physicians, who appear,
according to Neuburger, to have been on very friendly terms with the
priests of the temple. It was under the guidance of such men that
Galen--at the early age of seventeen, and after a careful training in
philosophy, mathematics, etc.--began the study of medicine. He speaks
with special interest and respect of one of his instructors, a certain
Quintus, who had the reputation of being an excellent anatomist and at
the same time one of the most distinguished practitioners of that day.
Another anatomist, Styrus, was also one of Galen’s teachers.

On the death of his father Galen left his home and devoted the
succeeding nine years to visiting all the different cities in which
he believed he might gain some additional knowledge in medicine and
surgery. A large part of this long period was spent in Alexandria,
which still retained much of its importance as a home of all the
sciences. On attaining his twenty-eighth year he left that city and
returned to Pergamum, evidently with the purpose of establishing
himself there in the regular practice of his profession. Through
the influence of the temple officials, and especially of the High
Priest, Galen received the appointment of physician to the gladiators,
a position which he held with credit for a period of four years,
and which afforded him excellent opportunities for cultivating his
knowledge of surgery. It was while he was serving in this capacity
that he devised and put into practice a method of saturating the
dressings (in cases of severe wounds) with red wine, for the purpose
of preventing the development of inflammation in the parts affected;
and the success which he thus obtained was so great that not one of the
gladiators intrusted to his care died from his wounds. History does
not state the precise manner in which Galen carried out his method of
utilizing wine in the dressing of wounds, and we are therefore unable
to determine just how much credit he was entitled to receive for this
crude but apparently effective means of securing local antisepsis.
It is clear, however, that Galen’s treatment could only have been a
modification of a much older method, for Jesus, in his answer to a
question put to him by a lawyer, said: “But a certain Samaritan, as he
journeyed, came where he (the injured man) was: and when he saw him,
he had compassion on him, and went to him, and bound up his wounds,
pouring in oil and wine, and set him on his own beast, ...” (St. Luke
x., 33, 34).

At the end of four years there broke out in Pergamum a riot which
rendered residence there, at least for a certain length of time,
undesirable. Accordingly Galen, who was now thirty-two years old,
and who was probably glad of an excuse for leaving a place where a
physician of his education and talents had so few opportunities for
gaining distinction, decided to visit Rome, and--if circumstances
appeared to favor the plan--to settle there. His first impressions
after arriving in that metropolis were favorable to the plan of
establishing himself there permanently, but at the end of a few years
he became conscious of the growing hostility of those practitioners
who had been for a longer time than he well established in that city.
This hostility increased as he rose in favor and esteem with people
of position and influence. He had treated skilfully and with success
Eudemus, a peripatetic philosopher of great celebrity, for a quartan
fever. He had also cured the wife of Boëthus (a patrician who belonged
to the consular class) of a serious illness and had received as an
expression of appreciation a gift of four hundred pieces of gold. He
had won the friendship and esteem of such men as Sergius Paulus, the
Praetor; of Barbaras, the uncle of the Emperor Lucius; and of Severus,
who was at that time Consul, but who later became Emperor. These very
influential men took an active interest in Galen’s scientific work,
having been invited by him on more than one occasion to witness his
dissections of apes,--dissections which he made for the particular
purpose of demonstrating the organs of respiration and of the voice.
All these facts soon became known to Galen’s rivals and probably helped
to fan the spark of their envy into a flame; but it is very doubtful
whether he was justified in saying that the ill feeling thus engendered
threatened to end in some act of personal violence, for which reason
he decided to leave Rome and return to Pergamum. His secret manner
of departure, without taking leave of anybody, and the fact that the
Plague was just at that time rapidly approaching Rome, justify the
belief, says Neuburger, that it was not fear of personal violence at
the hands of his jealous rivals that drove Galen away so mysteriously
from the city in which, in the short space of four or five years,
he had won so great professional success, but an unwillingness to
face his duty, which was, to remain and aid in the approaching fight
against the great destroyer--the Plague. If Galen had been a simple
physician, one of the great body of medical practitioners in Rome, no
one would be disposed to question the justice of the criticism which
the distinguished Viennese historian makes of his decision to abandon
that city at the moment of her distress and peril. But, as a matter
of fact, Galen was not a practitioner of medicine in the full sense
of that term. He treated cases of illness because in no other way
would it be possible for him to acquire the necessary familiarity with
disease; but, almost from the very beginning, he seems to have fully
realized that he was destined to devote his time and his energies to
a very different kind of professional work,--work which was urgently
needed, which promised to be of very great value to medical science,
and which probably no other physician then living was competent to do
effectively. Furthermore, he was himself profoundly conscious that the
work in question constituted the main object of his life. His own words
(see his statement with reference to Archigenes, on page 174) show
this plainly, and the huge mass of medical treatises which he wrote
reveal in the most unmistakable manner with what untiring persistency
he pursued the path which he believed it was his duty to follow. It
being assumed, then, that such were the motives which actuated Galen,
was it a mistake on his part to conclude that duty did not require him
to remain in Rome? The question is a difficult one to answer, and I do
not feel called upon to decide it. We do not, however, brand a general
in the army a coward because he endeavors to protect himself as much
as possible from danger during a battle, that he may be able, to the
very end, to direct the soldiers under his command. Similarly, was not
Galen justified in avoiding every risk which was likely to imperil the
performance of duties which were of far greater value to medicine and
to humanity at large than that of acting as a mere soldier in the ranks
of medical men?

It seems a great pity that one of the most inspiring figures in the
history of medicine should be represented to posterity with such a
blemish upon his character, and I have therefore ventured to suggest a
possible defense of Galen’s action.

Not very long after he had returned to Pergamum, Galen was summoned
by the Emperors Marcus Aurelius and Lucius Verus, who were then with
the army at Aquileia, a few miles north of the present Trieste, to
join them at that city; and he was, of course, obliged to obey. A
fresh outbreak of the Plague had occurred and there had already been
many fatal cases among the troops. It was therefore decided by the
emperors, almost immediately after Galen’s arrival, to return to Rome
with a part of the army. A start was accordingly made, and the company
had already advanced some distance on their way, when Lucius Verus
died. This unexpected event greatly increased the difficulties of
the return journey, as it was deemed necessary to carry the remains
of the deceased Emperor back to the imperial city. Thus Galen found
himself once more settled in Rome, this time in the capacity of private
physician to the Emperor Marcus Aurelius and his sons Commodus and
Sextus. The position was extremely well adapted to the needs of Galen,
who, from that time forward, for a period of several years, had at his
disposal ample time for writing and for conducting his experimental
work in anatomy and physiology, a privilege of which he appears to have
made excellent use. He lived to be seventy years of age, his death
occurring during the latter part of the reign of Severus, or at the
beginning of that of Caracalla (about 201 A. D.).

All Galen’s critics agree that he possessed his full share of
peculiarities,--not to call them by the harsher name of faults. He was
constantly ready, for example, to praise his own doings and sayings,
and he rarely lost an opportunity of holding up the physicians of Rome
to ridicule and contempt. He was specially bitter in his criticisms of
Methodism and its adherents--“the donkeys of Thessalus,” as he called
them. At the same time, no other physician of ancient or modern times
has manifested to an equal degree such extraordinary industry as a
writer and original investigator in a great variety of departments of
knowledge. Although many of his works have been lost,[39] those which
have come down to our time are still very numerous--“a sufficient
number,” says Neuburger, “to constitute a library by themselves.” I
give here a few of the titles of these works, in order that the reader
may get at least some idea of the great variety of medical topics which
Galen has discussed in his writings. The more complete list furnished
by Daniel Le Clerc contains nearly two hundred titles, and yet even
this is believed to fall short of the actual number.


            SELECTED LIST OF THE WORKS OF GALEN RELATING TO
                      MEDICINE. (FROM LE CLERC.)

   Explanation of some of the Ancient Terms Employed by Hippocrates.

   On the Establishment of the Art of Medicine.

   Definitions of Medical Terms.

   On the Different Sects in Medicine.

   Discourse against the Empirics.

   On the Importance, for a Physician, of a Thorough training in
   Philosophy.

   The Physician; or Introduction to Medicine.

   The Elements, as taught by Hippocrates. (2 books.)

   The Different Temperaments. (3 books.)

   On the Nature of Man; Commentaries on two Books of Hippocrates.
   (2 books.)

   The Humors.

   Do the Arteries Normally contain Blood?

   On Black Bile.

   On the Bones. (For Students in anatomy.)

   Dissection of the Vocal Organs.

   The Anatomy of the Eyes.

   Dissection of the Veins and Arteries.

   Dissection of the Nerves.

   On the Utility of the Different parts of the Body. (17 books.)

   On the Natural Faculties. (3 books.)

   The Sentiments of Hippocrates and of Plato. (9 books.)

   The Organ of Smell.

   The Movements of the Muscles. (2 books.)

   The Physiology of Respiration.

   On Obesity.

   On the Maintenance of Health. (6 books.)

   The Characteristics of Different Foods. (3 books.)

   Precepts regarding the Diet best suited to the Four Different
   Seasons and to Each of the Twelve Months of the Year.

   On the Manner of Living best suited to those who Wish to
   Preserve their Health. (3 books.)

   On Habit.

   On the Differences between Diseases.

   On the Causes of Diseases.

   On Marasmus or Consumption.

   On the Different Kinds of Fevers. (2 books.)

   On Thirst.

   On the Parts of the Body Affected. (6 books.)

   The Diseases of Women.

   The Different Kinds of Pulse. (16 books.)

   The Different Kinds of Urine.

   On Critical Days. (3 books.)

   Commentaries on the Treatises of Hippocrates. (39 books.)

   On the Manner of Treating Different Maladies. (17 books.)

   On Venesection. (3 books.)

   On the Use of Cups, Leeches and Scarifications.

   On Purgatives. (3 books.)

   On Colic.

   On Jaundice.

   On Gout.

   On Stone in the Bladder.

       Etc.

The numerous works of Galen, says Pagel, constitute a complete and
very satisfactory encyclopaedia of medicine. The most available
edition of his works in Greek is that of Karl Gottlob Kühn of Leipzig
(1821–1828; 22 Vols. of about 1000 pages each). There is scarcely a
department which this great physician has not treated quite fully. But,
unfortunately, the translations into modern languages are relatively
few, and they cover only small portions of the entire work. That
of Daremberg, entitled “_Oeuvres anatomiques, physiologiques et
médicales de Galien, etc._” (Paris, 1854–1857; 2 Vols.), is in every
way most satisfactory, and it is from this source that I have made a
few extracts--just sufficient to give the reader some idea of Galen’s
style of writing and of his competency to deal with such subjects as
human anatomy and physiology. To attempt anything like a complete
exposition of his views regarding pathology, therapeutics, hygiene,
etc., would necessitate my devoting more space to this part of the
history of medicine than I can afford to give. To those who desire to
obtain more ample information about Galen’s views regarding pathology
and therapeutics I would recommend a study of Daremberg’s admirable
work and a perusal of the careful analysis made by Neuburger of certain
portions of Galen’s text.

_Galen’s Contributions to Anatomy and Physiology._--At the
period of time about which I am now writing, and for many centuries
afterward, there existed among all classes of the community a very
strong prejudice against dissecting human corpses. And even Galen
himself appears to have shared this prejudice, for, in spite of his
intense eagerness to gain a more perfect knowledge of human anatomy, he
apparently did not dare to undertake any such investigation, even when
a favorable opportunity for so doing presented itself, as it did on the
occasion to which he refers in the following brief extract taken from
one of his treatises:--

   A carelessly constructed sepulchre on the banks of a river had
   been undermined during a season of flood, and the corpse thus
   set free had floated down stream a short distance, until it
   finally lodged on the shore of a small cove. Passing near by I
   had the opportunity of inspecting this corpse. The fleshy parts
   had already disappeared to a great extent through the process
   of decomposition, but the bones were still held together by
   their fibrous connections. The picture presented to the eye was
   that of a human skeleton specially prepared for the instruction
   of young physicians. On another occasion, a few steps from the
   main road, I came across the dead body of a robber who had been
   killed by the traveler whose money he had attempted to steal.
   The peasants of that neighborhood were not willing to bury the
   corpse of such a bad man, and they accordingly allowed it to
   remain at the spot where it was first discovered. In the course
   of the following two days, as might be expected, the vultures
   removed every particle of flesh from the bones, so that, when
   I saw what remained of the body, the only thing visible was a
   nicely cleaned skeleton.
                      (Le Clerc: _Histoire de la Médecine_, p. 711.)

Here were two excellent opportunities for gaining the additional
knowledge of human anatomy which Galen so much desired, but he
evidently was not at all disposed to avail himself of them--doubtless
because his mind was deeply imbued with the feeling that any such
interference on his part would be a sacrilegious act. Under the
circumstances, therefore, there was nothing left for him to do but
to utilize animals for purposes of dissection, and more particularly
apes, whose anatomy very closely resembles that of the human being.
Several of Galen’s books on anatomy have come down to our time, but
quite a number of others have been lost. From those which we possess,
and especially from the one entitled “Anatomical Administrations,”
it is permissible to conclude that he was a most skilful dissector
and an extremely close and careful observer, and that he was very
particular to set down the results of his observations in admirably
clear language. Indeed, Le Clerc assures us that Vesalius, the great
Flemish anatomist of the sixteenth century, bestowed high praise upon
Galen’s anatomical descriptions; and that, too, notwithstanding the
fact that the latter sometimes erred in his statements regarding the
similarity between certain parts observed in dissections of an animal
and the corresponding parts in man. In one of his treatises[40] Galen
states distinctly that the arteries contain blood. In another he gives
a remarkably full and accurate description of the nervous system,
including the brain, spinal cord, and many of the nerves.

   He describes the optic nerve, the oculo-motorius and
   trochlearis, the different ramifications of the trigeminus, the
   acusticus and facialis, the vagus and glossopharyngeus, the
   nerves of the pharynx and larynx, the sympatheticus (with the
   accompanying ganglia), and the radial, ulnar, median, crural and
   ischiatic nerves. (Puschmann.)

Although it is true that certain important anatomical and physiological
facts are found recorded for the first time in the works of Galen,
this must not be accepted as evidence that Galen himself is the real
discoverer of these facts. The most that can be claimed for him is that
he is the first writer to bring the facts in question to the knowledge
of us moderns. When the ancient books that have been lost are once
more brought to light, as they very well may be at any time, we shall
be able, perhaps, to give credit where credit is due. But there is one
department in which Galen did experimental work of an entirely original
character and for which he deserves unstinted praise. I refer to the
experiments which he made concerning the physiology of the brain and
spinal cord. They are related in the following extract, which has been
translated from the account given by Neuburger (_op. cit._, Vol.
I., p. 380):--

   The brain itself is not sensitive; it expands and contracts
   synchronously with the respiratory movements, the purpose of
   which action is to drive the pneuma from the cavities of that
   organ into the nerves. The function of the meninges is to hold
   the parts firmly together and to unite the blood-vessels.
   Pressure upon the brain causes stupor. An injury of the tissues
   surrounding the fourth ventricle or of those which constitute
   the beginning of the spinal cord produces death. The seat of
   the soul is in the substance of the brain, and not in its
   membranes. The spinal cord serves as a conductor of sensation
   and of motor impulses, and it also plays the part of a brain
   for those structures of the body which lie below the head.
   It gives off nerves like streamlets. Division of the spinal
   cord longitudinally in its median axis does not give rise to
   paralysis. Transverse division, on the other hand, causes
   symmetrical paralyses. If the cord is divided between the third
   and fourth cervical vertebrae, respiration is arrested, and
   if the division is made between the cervical and the thoracic
   portions of the spinal column, the animal breathes with the aid
   only of its diaphragm and of the upper muscles of the trunk of
   the body. Division of the recurrent nerves produces aphonia; if
   the fifth cervical nerve is divided, the scapular muscles on
   the corresponding side will be paralyzed. Galen considers the
   ganglia to be organs for reinforcing the energy of the nerves.
   The fact that both cerebral and spinal-cord nerve-filaments
   enter into the composition of the sympathetic nerve explains the
   extraordinary sensitiveness of the abdominal organs.

When we consider that these experiments are the first of their kind
of which history makes mention, that they were carried out nearly
seventeen hundred years ago, and that--so far as we know--they sprang
entirely from the brain of the experimenter, we may well express
unlimited admiration for Claudius Galen.

Daniel Le Clerc says that Galen’s principal treatise on human
physiology, entitled “Utility of the Different Parts of the Human
Body,” constitutes a _chef-d’oeuvre_ which has challenged the
admiration of physicians and philosophers in all ages. Christians,
however, he adds, are particularly gratified to learn from this work
that “Galen, although classed as a Pagan, unhesitatingly recognizes
that it was an all-wise, an all-powerful, an all-good God who created
man and all the other animals.” Further on, Le Clerc refers to another
statement which was made by Galen and which will be found on page 261
of Daremberg’s version. It reads as follows:--

   If I were to spend any more time in talking about such
   brutes--by which term he designates men who cannot appreciate
   the wisdom of God in distributing the different parts of the
   body in the manner in which He has done this--I should justly
   incur the blame of sensible persons. They would accuse me of
   desecrating the account which I am writing, an account which is
   intended as a hymn of sincere praise of the Creator of man. I
   believe that true piety consists, not in sacrificing numberless
   hecatombs nor in burning unlimited quantities of incense and a
   thousand perfumes, but in first searching out and then making
   known to my fellow men how great are the wisdom, the power, and
   the goodness of the Creator.

Galen’s work on “The Utility of the Different Parts of the Human Body”
is composed of seventeen books, all of which exist to-day in a complete
state. Taken together they form, as may be seen by the following list
of contents, a remarkably complete treatise on physiology. Books I. and
II. are devoted to the hand, forearm and arm (105 pages); Book III. to
the thigh, leg and foot (62 pages); Books IV. and V. to the alimentary
organs and their accessories (101 pages); Book VI. to the respiratory
organs (78 pages); Book VII. to the organs of the voice (67 pages);
Book VIII. to the head, the encephalon and the organs of special sense
(45 pages); Book IX. to the cranium, the encephalon and the cranial
nerves (38 pages); Book X. to the eyes and their accessories (45
pages); Book XI. to the face and more particularly the jaws (55 pages);
Book XII. to the neck and the rest of the spinal column (46 pages);
Book XIII. to the shoulder and the structure of the spinal column in
detail (40 pages); Books XIV. and XV. to the genital organs and the
parts in which the foetus develops (70 pages); Book XVI. to the nerves,
arteries and veins (43 pages); and Book XVII. Epilogue (11 pages).

There are very few modern text books in which the author treats the
subject in as exhaustive a manner as Galen has done in these seventeen
books. As may readily be imagined from the great number and length
of his writings, he often wanders off into side issues and thus lays
himself open to the charge of being a diffuse writer. At the same
time he cannot be accused of dullness, for in reading Daremberg’s
version one is seldom tempted to omit any of the text, and his style
is interesting. The following brief extracts, to which should be added
that given on a previous page, may be taken as fair samples of his
manner of treating questions in the department of physiology:--

   _Reasons why the Alae Nasi are Cartilaginous and why they may
   be Moved by Voluntary Muscular Action._--We have already
   explained in some measure the reasons why the alae nasi should
   be composed of cartilage and why it should be possible for the
   animal to move them at will.[41] It is an established fact that
   the movements of these parts are competent to aid in no small
   degree the somewhat forcible inspirations and expirations. This
   is the reason why the alae are constructed in such a manner as
   to be easily movable. They are made of cartilage because this
   substance is hard to fracture or to tear apart. The placing
   of these alar movements under the control of the will, and
   not under that of some other bodily force (like the arterial
   impulse, for example), is certainly an excellent arrangement;
   and, if one does not appreciate this without any further
   explanation, it must be because my previous reasonings about
   such matters have fallen upon inattentive ears.

   (Translated from Book XI., Chapter XVII., of Daremberg’s French
   version of Galen’s works.)

Another brief extract may be given here. It forms a part of the chapter
relating to the action of the sigmoid valves of the pulmonary artery,
etc., and merits special attention because it furnishes additional
evidence of the correctness of Daremberg’s statement that Galen was
the leader of the most advanced school of experimentation:--

   The more strongly the thorax, in its exertion of a compressing
   force, tends to drive the blood (out of the heart), the more
   tightly do these membranes (the sigmoid valves) close the
   opening. Invested in a circular manner from within outward,
   extending throughout the entire circumference of the interior
   of the vessel, these membranous valves are, each one of them,
   so accurately patterned and so perfectly fitted that when they
   are put upon the stretch by the column of blood, they constitute
   a single large membrane which closes (watertight) the orifice.
   Pushed back by the return flow of the blood, they fall back
   against the inner surface of the vein, and permit an easy
   passage of the blood through the amply dilated orifice (which
   they, an instant before, closed so perfectly).

   (Translated from Book VI., Chapter XI., of Daremberg’s French
   version of the works of Galen.)

In his comments upon the account of the sigmoid valves which I have
just quoted, Daremberg says that the description of these structures
given by Erasistratus at least four hundred years earlier is admitted
by Galen to be so correct that it would scarcely be possible to furnish
a better one.

_Galen’s Remarks upon the Subject of Diagnosis._--In the treatise
entitled “On the parts of the Body Affected” (Book II., Chapter X.)
Galen gives the following advice with regard to the method which it is
desirable to adopt when one wishes to ascertain which part or organ is
affected, what is the nature of the disease there located, and whether
it is primary in its nature or secondary to some affection of earlier
development:--

   It should have been the special duty of Archigenes, who
   appeared on the scene next in order after a series of the most
   illustrious physicians,[42] to infuse more light into medical
   teaching. Unfortunately, he did the very opposite; for we who
   have grown old in the exercise of the art (and should therefore
   find it easy to comprehend what is written about medicine), are
   at times unable to understand what he says. Such being the true
   state of affairs, I now propose to undertake what Archigenes
   failed to accomplish. I shall commence by indicating in a
   general way what is the proper method to adopt when one wishes
   to ascertain in what part or organ the disease is located and
   how one should proceed when it is proposed to teach the method
   to others. This method may be stated in the following terms:--

   In the first place, the part should be carefully examined in
   order that we may ascertain whether it presents any signs of
   special value as indicating the nature of the disease. In the
   next place, it is important in such an examination to know
   beforehand what are the particular signs which belong to each
   of the diseases that may affect the part or organ in question,
   and also whether these signs vary according to the particular
   section of the organ involved. In inflammation of the lung,
   for example, there are: difficulty in breathing (dyspnoea) and
   great general distress (malaise), the patient being obliged to
   remain in a sitting posture (orthopnoea)--all of which are signs
   indicating the possibility of suffocation. Furthermore, the
   air expired from the infected lung is sensibly hot, especially
   if the inflammation is of the erysipelatous variety, and, as
   a consequence, the patient shows a disposition to draw long
   breaths, knowing that the cold air which he thus draws into
   his lungs will afford him some measure of relief. The sputa
   expectorated when he coughs are differently colored; some
   being red, yellowish, or of a rusty appearance, while others
   are almost black, livid, or frothy. The patient also often
   experiences the sensation of a heavy weight in his chest,
   together with more or less pain, which seems to be located
   deep down in that region and which shoots backward into his
   spinal column or forward toward the sternum. Add to these
   manifestations a high fever and a pulse such as we have already
   described on another page, and you will have....

   (Translated from Daremberg’s French version of Galen’s works.)

It has been said that Galen possessed more than the ordinary share of
vanity with regard to his cleverness as a diagnostician; and certainly
some of the accounts which he gives, in his clinical and scientific
treatises, of his own experiences, seem to bear out this accusation.
One hesitates to expose the weak spots in the character of one of the
really great men of antiquity lest such exposure may convey a wrong
impression; at the same time it would be an error to represent him as
a man entirely free from the foibles common to humanity,--even to the
best and wisest of men. I therefore repeat here Galen’s own account of
a professional visit which he made to a brother physician whose malady
presented to himself and to his friends many obscure features.

   Upon the occasion of my first visit to Rome I completely won the
   admiration of the philosopher Glaucon by the diagnosis which I
   made in the case of one of his friends. Meeting me one day in
   the street he shook hands with me and said: “I have just come
   from the house of a sick man, and I wish that you would visit
   him with me. He is a Sicilian physician, the same person with
   whom I was walking when you met me the other day.” “What is the
   matter with him?” I asked. Then coming nearer to me he said,
   in the frankest manner possible: “Gorgias and Apelas told me
   yesterday that you had made some diagnoses and prognoses which
   looked to them more like acts of divination than products of the
   medical art pure and simple. I would therefore like very much to
   see some proof, not of your knowledge but of this extraordinary
   art which you are said to possess.” At this very moment we
   reached the entrance of the patient’s house, and so, to my
   regret, I was prevented from having any further conversation
   with him on the subject and from explaining to him how the
   element of good luck often renders it possible for a physician
   to give, as it were off-hand, diagnoses and prognoses of this
   exceptional character. Just as we were approaching the first
   door, after entering the house, we met a servant who had in his
   hand a basin which he had brought from the sick room and which
   he was on his way to empty upon the dung heap. As we passed
   him I appeared not to pay any attention to the contents of the
   basin, but at a mere glance I perceived that they consisted of a
   thin sanio-sanguinolent fluid, in which floated excrementitious
   masses that resembled shreds of flesh--an unmistakable evidence
   of disease of the liver. Glaucon and I, not a word having been
   spoken by either of us, passed on into the patient’s room. When
   I put out my hand to feel of the latter’s pulse, he called my
   attention to the fact that he had just had a stool, and that,
   owing to the circumstance of his having gotten out of bed, his
   pulse might be accelerated. It was in fact somewhat more rapid
   than it should be, but I attributed this to the existence of
   an inflammation. Then, observing upon the window sill a vessel
   containing a mixture of hyssop and honey and water, I made up
   my mind that the patient, who was himself a physician, believed
   that the malady from which he was suffering was a pleurisy; the
   pain which he experienced on the right side in the region of
   the false ribs (and which is also associated with inflammation
   of the liver) confirming him in this belief, and thus inducing
   him to order for the relief of the slight accompanying cough
   the mixture to which I have just called attention. It was then
   that the idea came into my mind that, as fortune had thrown the
   opportunity in my way, I would avail myself of it to enhance
   my reputation in Glaucon’s estimation. Accordingly, placing my
   hand on the patient’s right side over the false rib, I remarked:
   “This is the spot where the disease is located.” He, supposing
   that I must have gained this knowledge by simply feeling his
   pulse, replied with a look which plainly expressed admiration
   mingled with astonishment, that I was entirely right. “And”--I
   added simply to increase his astonishment--“you will doubtless
   admit that at long intervals you feel impelled to indulge in
   a shallow, dry cough, unaccompanied by any expectoration.” As
   luck would have it, he coughed in just this manner almost before
   I had got the words out of my mouth. At this Glaucon, who had
   hitherto not spoken a word, broke out into a volley of praises.
   “Do not imagine,” I replied, “that what you have observed
   represents the utmost of which medical art is capable in the
   matter of fathoming the mysteries of disease in a living person.
   There still remain one or two other symptoms to which I will
   direct your attention.” Turning then to the patient I remarked:
   “When you draw a longer breath you feel a more marked pain, do
   you not, in the region which I indicated; and with this pain
   there is associated a sense of weight in the hypochondrium?”
   At these words the patient expressed his astonishment and
   admiration in the strongest possible terms. I wanted to go a
   step farther and announce to my audience still another symptom
   which is sometimes observed in the more serious maladies of the
   liver (scirrhus, for example), but I was afraid that I might
   compromise the laudation which had been bestowed upon me. It
   then occurred to me that I might safely make the announcement
   if I put it somewhat in the form of a prognosis. So I remarked
   to the patient: “You will probably soon experience, if you have
   not already done so, a sensation of something pulling upon the
   right clavicle.” He admitted that he had already noticed this
   symptom. “Then I will give just one more evidence of this power
   of divination which you believe that I possess. You, yourself,
   before I arrived on the scene, had made up your mind that your
   ailment was an attack of pleurisy, etc.”

   Glaucon’s confidence in me and in the medical art, after this
   episode, was unbounded.

Thirty or forty years elapsed after Galen’s death before the Profession
began to realize how great an authority he had become in all matters
relating to medicine; not perhaps among the majority of physicians, but
among the better educated and those more given to reasoning about the
various problems in physiology and pathology. Then came the invasion
of Rome by the Barbarians, and with it the scattering of nearly all
those who were at the time practicing medicine in that great city.
This was the beginning of the long period known as the Middle Ages,
a period during which, so far as Italy and Gaul were concerned, the
science of medicine made no advance whatever. The physicians living
in a precarious manner in the towns, and the monks who practiced
medicine in the country districts, took very little interest, as may
readily be imagined, in the achievements of Galen. Through all those
years they clung to the doctrines of the Methodists, as revealed to
them in the work of Caelius Aurelianus, the favorite medical treatise
of that period. It was only during the latter part of the Middle Ages
that Galen’s teachings began once more to be appreciated at their true
value; and, as time went on, they gained a stronger and stronger hold
on the minds of medical men, until finally they held undisputed sway.
Friedlaender, speaking of medicine in those dark times, uses these
words: “Galen’s colossal personality loomed up throughout that long
night as a brilliant guiding star to light the intricate pathways of
medicine.”




                              CHAPTER XVI

     THE INFLUENCE OF CHRISTIANITY UPON THE EVOLUTION OF MEDICINE


The religion established by Jesus Christ in Judea during the early part
of the first century remained confined within the limits of that region
for a number of years, but already during the latter half of that
period groups of Christians were to be found in every part of the Roman
Empire, and in certain localities the membership of the new church had
increased so greatly in numbers as to excite the alarm and hostility
of the temple priests and of the governing officials. Persecutions,
especially in the city of Rome and at the instigation of Nero, became
more and more frequent and more and more pitiless, but they failed
utterly to destroy the new religion, so firmly was it rooted in the
followers of Jesus Christ. As a matter of fact its spread was checked
for only a few years, and then its adherents increased in numbers more
rapidly than ever. Neuburger, in his “History of Medicine,” makes the
following quotation from the account which Dionysius of Alexandria
gives of the great plague that occurred during the third century A. D.:

   The majority of our brethren in their love for their neighbors
   did not spare themselves, but acted as a unit in their efforts
   to assist. They visited the sick without the slightest fear and
   gave them the very best of care, for the sake of Christ....
   Among the non-Christians, however, the very opposite was true.
   As soon as any of their number fell ill they pushed them to one
   side, even those who were dearest to them, and, before they were
   more than half-dead, they threw them out into the street and
   took no care to bury the dead bodies.

Such an example of self-sacrifice and humanity--and there must have
been very many similar examples--could not possibly have failed to make
a profound impression upon the community at large. Daniel Le Clerc says
that three physicians suffered martyrdom for their Christian faith
during the reigns of the Emperors Marcus Aurelius, Lucius Verus and
Commodus. They were Papila (of Pergamum), Alexander (of Lyons) and
Sanctus (a contemporary of Galen), whose death was of a particularly
cruel character. Credit should also be given to Christianity, says
the same writer, for having established the rule that every community
should assume the expense and responsibility of caring for its own
poor and sick. This was a step of the greatest importance; and, at
a still later period, when Christianity became largely an affair of
the state, a complete hospital organization was effected, with the
bishop as the chief officer and, under him, deacons and deaconesses.
Such well-organized institutions proved to be of the greatest possible
benefit to the advance of medical science. They were the worthy
successors of those more ancient hospitals, the Aesculapian temples,
which were first established by the Greeks in the pre-Hippocratic age,
and they have continued in an unbroken chain from the institutions of
those primitive times to the thoroughly well-equipped hospitals of the
present day.

In 330 A. D. the new capital of the Roman Empire was established
in Byzantium, afterward called Constantinople, and Rome, which for
hundreds of years had been the metropolis of the world and the source
from which a large part of Roman history had emanated, was given a
subordinate position. Then followed, in 410 A. D., the conquest of the
latter city by the Visigoths, a horde of uneducated Barbarians who had
felt the might of Rome in previous years, and who now doubtless took
immense satisfaction in humiliating her and in destroying her valuable
possessions. There are good reasons for believing that, when the
Emperor Constantine established his residence in Byzantium, the leading
physicians of Rome followed him; and it is not likely that many of
those who, for one reason or another, preferred to remain in the old
capital, continued to do so after it became known that the Barbarians
were approaching the city. But the migration of these physicians to the
new capital did not mean a renewal there of the scientific activity
which had characterized the growth of Greek medicine in Rome during
the first two centuries of the Christian Era. It is probable that
the fugitives, being obliged to travel with the smallest amount of
baggage possible, left the major part of their books and papyrus rolls
behind, hoping, no doubt, that they might be able at some later date
to recover them. But the favorable occasion never arrived, and thus a
great deal of valuable medical literature entirely disappeared. The
loss, however, might have been even more serious than it was if the
Christian church had not already (during the third century) begun to
establish monasteries in secluded and inaccessible spots. It was to
these institutions that not only books of a religious character, but
also those relating to the science of medicine, were transported for
safe keeping during the early Middle Ages. Farther on, I shall have
occasion to refer to this subject again and to discuss more fully
certain other benefits which accrued to medical science from these
monastic institutions.

But while, on the one hand, the Christian church through the
instrumentality of the monasteries was lending its aid to the
preservation of the sources of medical knowledge, it was, on the other,
doing its best to arrest all further evolution of that branch of
science; not consciously, it must be admitted, but through a mistaken
sense of its duty to God. Thus it came about that the Emperor Justinian
I. (527–567 A. D.), acting under the narrow-minded advice of his
ecclesiastical counsellors, closed the medical schools at Athens and
Alexandria and at the same time withdrew the regular allowance of money
which up to that time had been paid to the state physicians and to
special scholars. A few years later, however (_i.e._, in the early
part of the seventh century A. D.), some of the more highly educated
physicians of Alexandria got together and made the attempt to organize
a school of medicine in that city. A course of lectures was planned
and sixteen of Galen’s works, carefully chosen for the purpose, were
made the basis of the new course of instruction. The books selected
were first carefully edited and simplified, and then commentaries
were added in order that in their final shape these treatises might
be better suited to the uses of students. The invasion of Alexandria
by the Arabs, however, soon put an effectual stop to this promising
attempt to revive Greek medicine.

In this brief sketch I have thus far mentioned only the more direct
effects produced by the new religion upon the evolution of medicine.
The indirect effects, however, were also in some cases of very great
importance. At the beginning of her history there developed in the
Christian church, among her chief men, a strong disposition to quarrel
over dogmas. To apply the term quarrelsomeness to this tendency may
easily convey a wrong impression. It was, more strictly speaking, a
highly developed conscientiousness on the part of men whose minds were
deeply imbued with the idea that they were rendering God a service by
keeping what they believed to be the true and only religion free from
errors of all kinds. It took many centuries to impress the leaders
of the church with the fact that the religion of Jesus Christ, like
the science of medicine or the natural sciences, was capable of
development to an almost indefinite extent; and it is owing to our
appreciation of this important fact that we moderns look with so much
more lenient eyes upon the distressing, not to say cruel, events
of mediaeval ecclesiastical history. At the time of which I am now
writing, however, it was considered highly unchristian--especially
for one holding authority in the church--to believe otherwise than
as her doctrines taught; and accordingly, in the early part of the
fifth century A. D., Nestorius, the Patriarch of Constantinople, was
deposed from his high office by a Council of the church and imprisoned
because he was unwilling to teach the doctrine of the miraculous birth
of Jesus Christ. Those who accepted the view held by Nestorius--and
they eventually became a very numerous and a very influential body of
Christians--were driven out of Constantinople and compelled to seek
homes in distant places. This affords, perhaps, an explanation of the
fact that, during the eighth century A. D., many Nestorian Christians
were found living in the eastern part of Syria and in Persia; and it
seems fair to assume that these Christian communities represented
to some extent the direct successors of those Nestorians who had
taken refuge in this remote corner of Asia Minor three hundred years
earlier. Furthermore, it is highly probable that there were Christian
communities in this region several centuries before the Nestorians
arrived, for it is believed that the Apostles James and Thomas visited
Persia and the northeastern part of Syria in the course of their work
as evangelists. It is not known, though, how many of the descendants of
these earlier Christians adopted the peculiar beliefs of the Nestorian
refugees.

And here it should be stated that the facts which have thus far
been mentioned are not the only ones that throw some light upon the
relationship subsisting between Christianity and the spread of medical
knowledge to Western Europe. Those which remain to be considered
are of two kinds, viz., facts relating to the origin of the Arabic
Renaissance, and facts which show that the Christian church, from the
fourth century onward, was contributing not a little, through the
establishment of the great monastic orders, such as the Benedictines,
the Dominicans, and the Franciscans, to the preservation if not to the
further evolution of Graeco-Roman medical knowledge. I shall reserve
for consideration in a later chapter this particular part of the
history of medicine; and in the meantime I shall endeavor to describe
the events which preceded and rendered possible the active study of
Greek medicine on the part of the followers of Mohammed.

So far as history furnishes us with any information on the subject, the
Nestorians who lived in Persia, Syria and Mesopotamia were Christians
of a remarkably liberal type. They appear to have been an unusually
peaceable people, for not only were they kindly disposed toward one
another, but they seem to have been on the best of terms with their
Jewish neighbors, who, like themselves, were eager after knowledge.
Already at a very early period there existed at Djondisabour--a
town which had been founded in the Province of Khorassan, in the
northeastern part of Persia, about the year 260 A. D., by Sapor II.,
King of that country--a school in which the medicine of Hippocrates
was taught. Freind, in his “History of Physick” (London, 1727),
says that about the year 272 A. D. the Emperor Aurelian (Lucius
Domitius Aurelianus), as a compliment to his daughter, who was the
wife of the King of Persia, sent to Djondisabour, the city in which
she resided, several Greek physicians; and Abulpharagius, the Arab
historian (thirteenth century), intimates that these were the men
who conducted the teaching in the newly established medical school.
Another possibility suggests itself. After the death of Alexander the
Great in Babylon (323 B. C.), from malarial fever, it is not unlikely
that some of the numerous Greek physicians who accompanied the army in
an official character, and who, we are warranted in believing, were
exceptionally well educated, decided not to remain in that unhealthy
district, but to settle in some of the neighboring towns (_e.g._,
Nisibis in the hill country to the north of Babylon, or Sura to the
east of the river Tigris); and that these men also contributed their
share toward the planting and perpetuation of Greek medicine in this
district of the Orient. However, the salient fact in this period of
the history of medicine is this: When Almansur, the Caliph of Bagdad
(712 to 775 A. D.), made up his mind to introduce Greek medicine into
his kingdom and looked around for the ways and means of accomplishing
this, he found at the city of Djondisabour men who were not only well
versed in Greek medicine, but who at the same time were so thoroughly
grounded in all departments of scholarship that they could at once
begin the work of translating the writings of Hippocrates and other
classical medical authors into Arabic, the language of the Mohammedans.
But at this stage of affairs the existence of a serious obstacle was
discovered. The writings which it was proposed to translate were not
immediately obtainable, and it therefore became necessary to institute
without delay a vigorous search for the books required. In order that
the reader may appreciate fully the difficulties which Almansur had to
overcome, in this matter of a scarcity of Greek originals, it seems
best to pause at this point, and to review briefly some of the facts
which bear upon the question at issue.

_The Wholesale Destruction of Medical Literature during the Early
Centuries of the Christian Era._--The invasion of Rome in 410 A. D.
was one of the first events which entailed a serious loss of the Greek
medical books that had been accumulating for several centuries in that
city. Fortunately, not a few of these works were rescued in time by
the church authorities and deposited for safe keeping in the various
monasteries scattered all over the Roman Empire. A still more serious
destruction of books occurred about the year 638 A. D., when Amrou, a
famous Arabian warrior, captured Alexandria and--under the instructions
of his master, Omar ben Khattab--destroyed the greater part of the
contents of the famous libraries located in that city. The narrative of
this event, as told by Lucien Le Clerc, is as follows:--

   John the Grammarian,[43] who was living at that time in
   Alexandria, held the following conversation with Amrou on a
   certain occasion: “You have inspected all the edifices of
   Alexandria, and have sequestrated all their contents. I have no
   objections to your appropriating everything that may be of use
   to you; there are certain things, however, which you may not
   wish to possess, but which are highly prized by us.”

   “What are those objects?” inquired Amrou.

   “The works on philosophy, which are contained in the public
   libraries,” John replied.

   “I can do nothing about them without a special order from the
   Prince of Believers, Omar ben Khattab,” was the answer given by
   Amrou.

   John’s wish having in the meantime been conveyed by the General
   to Omar, the latter sent this reply:--

   “As to the books of which you speak, I have this to say. If
   their contents agree with what is written in the word of God,
   the books are of no use to us, the Holy Writ being sufficient
   for our guidance. But if they are at variance with God’s word,
   then surely they should be destroyed.”

   Amrou therefore ordered all the books to be sent to the bathing
   establishments of Alexandria, to be used as fuel in heating
   the baths. So great was the number of books contained in the
   libraries that it took six months to consume them all. (Sismondi
   questions the correctness of this account.)

While the invasion of Rome by the Barbarians in the fifth century
and the capture of Alexandria by the Arabs in the early part of the
seventh gave rise to an enormous loss of valuable books relating to
medicine and philosophy in general, these were by no means the only
occasions when books were probably destroyed in great quantities. Wars
were frequent in those days and towns were constantly being sacked.
Everywhere throughout the East the modern traveler encounters the ruins
of large cities, and in those cities--the centres, as they were, of
wealth and culture--there must have been large collections of books. It
is not at all strange, therefore, that when the Caliph Almansur made
a serious beginning of the work which was to convert the Arabs into
rivals of the ancient Greeks, he should have found a great scarcity of
medical works which, after being translated, were to serve as manuals
of instruction. However, his ambition was very great, his wealth almost
inexhaustible, and his associates eager to aid him in realizing the
_renaissance_ which he had planned for his people; and, as will
appear later on, he and those who aided him eventually succeeded in
overcoming this apparently insurmountable obstacle.

Among the medical books which, upon the approach of the Goths,
were carried from Rome and other cities to different monasteries
for safe keeping there must have been very few that were written
in Latin, and yet these were the only ones from which the monks
individually could derive any benefit. Several centuries later, when
all the monasteries of Italy and the East were visited by those who
were searching eagerly for original manuscript copies of the Greek
medical writers,--Hippocrates, Soranus, Rufus of Ephesus, Aretaeus,
Dioscorides, Galen,--it was found that such copies existed in a number
of these institutions, thus showing that the monks had been actuated by
unselfish and far-seeing loyalty to the best interests of mankind when
they rescued these particular treasures from the hands of the enemy.
They themselves could make no use of them, being unable to read Greek,
but they knew their priceless value to medical science.

The Latin treatises which they had also rescued, and of which they made
excellent use during the succeeding centuries, were those of Celsus,
Scribonius Largus, Pliny the Elder (to a slight degree only) and
Caelius Aurelianus.




                                PART II

                          MEDIAEVAL MEDICINE




                             CHAPTER XVII

           THE CONDITION OF MEDICINE AT BYZANTIUM DURING THE
                     EARLY PART OF THE MIDDLE AGES


The Byzantine period of the history of medicine begins about the middle
of the fourth century A. D. and retains some degree of importance up to
or perhaps a little beyond the beginning of the eighth century. During
this period of nearly four centuries there appeared on the scene five
physicians whose writings form a very creditable part of the late Greek
medical literature. The names of these authors are: Oribasius, Aëtius,
Alexander of Tralles, Theodore Priscianus and Paulus Aegineta.

_Oribasius._--The first physician named in this list, Oribasius,
was born about the year 325 A. D. in Pergamum, an important city
of Asia Minor and the birthplace of Galen. He received his medical
training at Alexandria, settled in Constantinople (the new name given
to Byzantium), and soon afterward became the personal physician of
the Emperor Julian the Apostate, the nephew of Constantine the Great.
Subsequently he was appointed Quaestor of Constantinople, but, upon
the death of Julian (363 A. D.) and the accession of Valens and
Valentinianus to power, his property was confiscated and he himself was
obliged to take refuge among the Ostrogoths, who dwelt on the shores of
the Black Sea. These people received him with open arms, and he soon
acquired great influence among them. After a time, however, he was
recalled to Constantinople and all his former privileges were once more
granted to him. He died about the year 403 A. D.

Despite his duties as a practicing physician of the very highest
rank--duties which he could not wholly set aside when he accepted the
office of Quaestor of Constantinople--and despite the necessity of
devoting considerable time to the work which this non-medical official
position entailed, Oribasius, like Pliny, appears to have been a most
energetic contributor to medical literature. We possess to-day, for
example, a large part of the medical cyclopaedia (72 books) which he
prepared at the command of the Emperor Julian, and which--even in its
incomplete state--contains very full information regarding anatomy,
physiology, surgery, pathology and pharmacology. Although the work
is simply a compilation, its present value is great, for it contains
numerous extracts from earlier and contemporary treatises, many of
which have entirely disappeared,--treatises of which we should have had
no knowledge whatever if Oribasius had not introduced numerous extracts
from them into his cyclopaedia.

About the year 390 A. D., when Oribasius was already an old man, he
published (in nine books) a “Synopsis” of the larger work, chiefly
for the benefit of his son Eustathios, who was at that time studying
medicine. Surgery is omitted from this work, as that branch of medicine
was assumed to belong entirely to specialists. At a still later date
(about 395 A. D.), Oribasius published a third work (in four books)
entitled “Euporista,” which was intended chiefly for the use of
laymen. The subject-matter of this treatise consists of diet, hygiene
and general therapeutics. Neuburger speaks well of all three of the
published works of Oribasius, and furnishes a fairly full analysis of
the contents of each one.

Bussemaker and Daremberg have published, in six volumes (Paris,
1856–1876), an excellent French version of the works of Oribasius.

_Priscianus._--Theodorus Priscianus lived during the latter part
of the fourth and the first part of the fifth century of the present
era. Very little is known about his professional career beyond the
facts that he was a pupil of Vindicianus, a distinguished physician
who lived during the reign of the Emperor Valentinianus I. at
Constantinople (364–375 A. D.), and that subsequently he was chosen
the private physician of the Emperor Gratianus (375–383 A. D.). The
treatise which he composed, and which bore the title of “Euporiston,”
was originally written in Greek, but was afterward translated by
its author into Latin. An excellent German version of the work by
Meyer-Steineg was published in Jena in 1909. As the book was intended
by Priscianus to serve chiefly as a guide to practitioners of the
art, it contains practically nothing about anatomy and physiology.
In his pathology he follows closely the teachings of the Methodists;
his first question, in the presence of a case of illness, being: “Do
the symptoms point to a condition of _strictum_ rather than to
one of _laxum_, or _vice versa_?” “In his treatment,” says
Meyer-Steineg, “Priscianus follows very closely the rule that every
patient, no matter what may be the disease with which he is affected,
should first undergo a certain amount of general treatment.” In his
choice of remedies Priscianus invariably gives the preference to those
agents which are of a simple character and easy to obtain. On the other
hand, he does not hesitate to admit that he sometimes employs certain
magical remedies, as is shown by the following quotation taken from
Book IV., Chapter I., section 4:--

   If a person wears, during the waning of the moon, a wreath
   of polygonum on his head, he will obtain relief from his
   headache.... If one drinks of the water from which an ox has
   just drank, he will be relieved of the pain in his head.... If
   a loadstone be held upon the head it will draw out the hidden
   pain, and the same effect may be obtained by rubbing over the
   forehead a swallow’s nest thoroughly mixed with vinegar.

In Book I, paragraph 2, Priscianus draws a picture of the rude
and uncivilized behavior of the practitioners of his day in the
sick-room. The following are his words as translated from the German of
Meyer-Steineg:--

   As the patient lies on his bed prostrated by the severity of
   the disease, there quickly comes into the room a crowd of us
   physicians. No feeling of sympathy for the sick man have we,
   nor do we realize how impotent we all are in the presence of
   these forces of nature. Instead, we struggle to the utmost of
   our ability to obtain charge of the case; one depending for
   success on his powers of persuasion, a second on the strength
   of the arguments which he is able to bring forward, a third on
   his readiness to agree with everything that is said, and the
   fourth on his skill in contradicting the opinion of everybody
   else. And, as this quarrel goes on, the patient continues to lie
   there in a state of exhaustion. “For shame!” Nature seems to
   say, “you men are an ungrateful lot! You do not even permit the
   patient to die quietly; you simply kill him. And then, moreover,
   you accuse me of not furnishing sufficient means of effecting a
   cure. Illness is certainly a painful affair, but I have provided
   plenty of remedies. Poisons, I admit, are hidden in some of the
   plants, but the healing agents which may be extracted from them
   are much more numerous. Away, then, with your angry disputes and
   your self-glorifying chatter; for in these are not to be found
   the remedial agents which I have bestowed upon man, but rather
   in the powerful forces which reside in the seeds, fruits, plants
   and other objects which I have created in his interests.”

_Aëtius._--Aëtius was a native of Amida, in Mesopotamia, and
he lived during the early part of the sixth century A. D., under
the Emperor Justinian I. He studied medicine at Alexandria and then
settled in Constantinople, where he was appointed to the double office
of private physician to the emperor and commanding officer of his
body-guard (_Comes obsequii_),--an arrangement which made it
practicable for the emperor to have his physician near his person on
all possible occasions. Almost nothing is known about the subsequent
private life and professional career of Aëtius beyond the facts that
he was a Christian and that he wrote a treatise on medicine in sixteen
books, which together form a large volume. The work, says Le Clerc, is
almost entirely a compilation from the treatises of earlier writers
on medicine and surgery; the best parts of the book being those which
relate to the pathology and treatment of internal diseases, to materia
medica, and to ophthalmology. The Christianity of Aëtius, like that of
Alexander of Tralles, and other physicians of a later period, appears
to have permitted a belief in magical remedies. For example, Aëtius
gives formulae containing the names of the Saviour and the Holy Martyrs
for exorcising certain maladies, and he recommends the employment of
amulets. The subject of baths is treated by him quite thoroughly, and
he lays stress upon the importance of physical exercise as a means of
maintaining one’s health. Freind, the author of an English history of
medicine which was very popular in its day,[44] quotes the following
remedy for gout from the treatise of Aëtius:--

    In September to drink milk;
    in October to eat garlick;
    in November to abstain from bathing;
    in December not to eat cabbage;
    in January to take a glass of pure wine in the morning;
    in February to eat no beet;
    in March to mix sweet things both in eatables and drinkables;
    in April not to eat horseradish;
    nor in May the fish called Polypus;
    in June to drink cold water;--and so on through the remainder of
      the year.

At the end of the French version of “_Les Oeuvres de Rufus
d’Éphèse_” (translated from the Greek by Daremberg and Ruelle)
will be found fragments of some of the books of Aëtius; in 1899 J.
Hirschberg translated into German Book VII. (eye diseases) of the
same author; and, two years later (1901) Max Wegscheider published a
German version of Book XVI. (obstetrics and gynaecology). No other
translations of the writings of Aëtius into either French, German or
English are--so far as I am able to learn--available.

_Alexander of Tralles._--Alexander of Tralles, a city of Lydia,
in Asia Minor, was born about 525 A. D. His father Stephanus was
highly esteemed as a practicing physician, and his four brothers,
all of them older than himself, were men of distinction in their
several callings; Anthemius, the oldest, being one of the greatest
mathematicians and mechanicians of his day and the man to whom the
Emperor Justinian intrusted the rebuilding of the church of St.
Sophia in Constantinople;[45] Metrodorus, a celebrated grammarian and
the honored teacher of the youth belonging to the highest circles
of that metropolis; Olympius, a leading authority in jurisprudence;
and Dioscorus, a prominent physician in his native city. Alexander
received his first instruction in medicine from his father, but he
obtained his real training from a physician who was the father of his
most intimate friend Cosmas, and who, throughout Alexander’s entire
subsequent career, proved most helpful in advancing his interests. At
first he traveled extensively, visiting in succession--probably in
the capacity of a military surgeon--Italy, Northern Africa, Gaul and
Spain. Afterward, he settled permanently at Rome and practiced medicine
there during the remainder of a long life. Puschmann, the translator
of his writings, seems disposed to believe that he was both a teacher
and a practitioner of medicine during his residence in that city. When
he became too old to bear the heavy burdens of medical practice, he
wrote an account of his life,--a life which was rich in professional
experience,--and thus built for himself “a monument more striking and
more durable than the splendid temple erected by his eldest brother.”
(Meyer, quoted by Puschmann.)

Various circumstances justify the conclusion that Alexander of Tralles
was a Christian. His style of writing is simple and direct, and he
states his views with a degree of modesty which wins for him at once
the sympathy and confidence of his readers. He gives full and generous
recognition to the great physicians who lived and wrote before his
time, and more especially to Hippocrates. On the other hand, he does
not hesitate, when he believes that he is right, to put forward views
which are in direct antagonism with those of even so great an authority
as Galen. In the domain of therapeutics, says Puschmann, Alexander was
decidedly superior to Galen. His teachings are based on experience
gained in actual practice, whereas Galen was very often disposed to
trust to considerations of a theoretical nature; for he was chiefly
interested in establishing the pathology of the different diseases and
in opening up new territories in medicine in which the human mind might
display its activity.

The twelve books of which the treatise of Alexander of Tralles
consists, were printed in the original Greek for the first time in
1548, by Robert Étienne, the celebrated printer of Francis I., King of
France. The last and most perfect edition of the Greek text is that
of the late Dr. Theodore Puschmann, which was published in Vienna
in 1878 (two Vols.). It contains, in addition to the Greek version,
a careful analysis of the twelve individual books, and an admirable
German translation of the entire work. It is from the latter that the
following brief extracts (translated into English) are taken:--

   _Introduction to the writings of Alexander of
   Tralles._--Upon a certain occasion, my dearest Cosmas, thou
   didst urge me to publish my rich experiences in the domain of
   practical medicine, and I am now gladly complying with thy wish,
   for I feel under deep obligations to both thyself and thy father
   for the kindness which you have shown to me on every possible
   occasion in the past. Thy father was always a most helpful
   patron to me, not only in my practice, but also in all other
   relations of life. And thou also, even when thou wert living
   abroad, stood staunchly by me through all the trials which I
   experienced and the severe blows dealt me by Fate. For these
   reasons I will now in my old age, when it is no longer possible
   for me to endure the labor and worries of practice, do as thou
   desirest, and will write a book in which shall be set forth the
   experience which I have gained during my long service in the
   treatment of disease. I hope that many of those who read what
   is here written, with minds free from jealousy, will experience
   real pleasure in noting the well-founded and scientific
   character of the rules which I have laid down and the brevity
   and preciseness of my descriptions. For I have done my very best
   always to employ simple words, in order that everybody may find
   it easy to understand my book.

   _Some Magical Remedies or Amulets Recommended by Alexander
   of Tralles, as Effective in the Treatment of Colic._--The
   Thracians remove the heart from a lark while the bird is still
   alive, and wear it, prepared as an amulet, on the left thigh.

   Procure a little of the dung of a wolf, preferably some which
   contains small bits of bone, and pack it in a tube which the
   patient may easily wear as an amulet on his right arm, thigh, or
   hip during the attack. He must be very careful, however, not to
   allow the parts around the seat of the pain to come in contact
   with the earth or with the water of a bath. This amulet is, in
   my experience, an unfailing remedy, and almost all physicians of
   any celebrity have commended its virtues.

   Remove the nipple-like projection from the caecum of a young
   pig, mix myrrh with it, wrap it in the skin of a wolf or dog,
   and instruct the patient to wear it as an amulet during the
   waning of the moon. Striking effects may be looked for from this
   remedy.

   Let the design of Hercules throttling a lion be engraved upon a
   Median stone, and then instruct the patient to wear it on his
   finger after it has been properly set in a ring of gold.

   Take an iron ring and have the hoop made eight-sided. Then
   engrave upon the eighth side these words: “Flee, flee, oh
   Gaul! the lark has sought thee out.” On the under surface of
   the head or seal of the ring engrave the letters J. C., thus:
   [illustration] I have often made use of this amulet; and, while
   I should consider it wrong to keep silence about a remedial
   agent of such extraordinary efficacy in cases of colic, I
   feel bound to say that it should not be recommended to the
   first comer, but only to believers and to those individuals
   who know how to guard it carefully. The Great Hippocrates,
   with remarkable insight, gave the advice that things which are
   holy should be intrusted only to those who are of a religious
   character, and should be withheld from the profane. As regards
   the ring, however, the patient must be careful, before wearing
   it, to have a sketch made of it on either the seventeenth or the
   twenty-first day of the moon.

Alexander has been severely criticised for his advocacy of the
employment of amulets in the treatment of diseases; but he defends
himself against such criticism by saying that physicians owe it as a
duty to their patients to study carefully what he calls the hidden
forces of nature, and to pay unprejudiced attention to the effects
produced by amulets and other magical remedies. He reminds his critics
that Galen and other eminent medical authorities have insisted that
a place be given to this class of agents in the list of authorized
remedies; and he adds that Galen further emphasizes the duty of the
physician to employ them when other measures fail, or when the patients
themselves frankly confess that they have faith in their efficacy and
therefore wish them to be tried. Alexander also makes the statement
that Galen, after treating for a long time all reports about the
beneficial results obtained from the employment of magical measures
as old women’s tales, had finally decided that these benefits were at
times marvelous and should be accepted as genuine by physicians even if
they are unable to explain them.

How much Alexander of Tralles really believed in these supernatural
agents, or to what extent he relied upon their effect in influencing
the imagination, we may not know; but his was an age of superstition,
and the conditions governing society at that time were very different
from those which control the world at the present day.

_Paulus Aegineta._--Paulus Aegineta[46] was born in the Island of
Aegina, not far from Athens, in the early part of the seventh century
A. D., and practiced medicine in Alexandria, Egypt. He is known to us
as the author of a compend of medicine which was very popular during
a long period of time, especially among the Arabs, who, as early as
two hundred years after his death, translated his work from the Greek
into their own language. At a still later period it was also translated
into Latin, the two best versions in this language which we now possess
being those of Guintherus Andernacus (Paris, 1532) and of J. Cornarius
(Basel, 1556). There is also an English translation by F. Adams (“The
Seven Books of Paulus Aegineta,” London, 1845–1847), which is favorably
spoken of by Neuburger, and which is apparently at the present time
the only existing version of the work of Paulus of Aegina in a modern
European language; for the French translation by René Briau (“_La
Chirurgie de Paul d’Égine_,” Paris, 1855) comprises only Book VI.

The contents of the entire work are as follows: _Book
I._--Dietetics of Pregnant Women and of Children; Children’s
Diseases; Massage, Gymnastics, Sexual Hygiene, Bathing, etc.; _Book
II._--General Pathology, the Doctrine of Fevers, Semeiology; _Book
III._--Diseases of the Hair, Diseases of the Brain and Nerves,
Diseases of the Eyes, Ears, Nose, Mouth, Teeth and Face; _Book
IV._--Leprosy, Skin Diseases, Inflammations, Swellings, Tumors,
Wounds, Ulcers, Fistulae, Hemorrhage, Worms, Affections of the Joints,
etc.; _Book V._--Toxicology; _Book VI._--Surgery; _Book
VII._--Materia Medica.

To furnish even a very superficial analysis of the contents of this
treatise would call for more space than can well be given up here
to such a purpose. I shall therefore simply mention a few points of
special interest to which Neuburger calls attention in the course
of his very full analysis of the work. He states, for example, that
Paulus mentions several instances in which patients affected with lung
disease, coughed up calculi or small stone-like masses. He also states
that the same author was familiar with the fact that in the course of
“phthisis,” the pus may find its way into the bladder and there cause
ulceration [in other words, that pus containing tubercle baccilli
may flow down by way of the ureters and cause tuberculous ulceration
of the bladder]. Paulus’ theory regarding the origin of gout, adds
Neuburger, is quite remarkable for that early period. He maintains, for
example, that in persons who lead a rather inactive life and who are
often affected with digestive disorders, there is produced, through the
inadequate power of the tissues of the body to assimilate the excess
of nutriment brought to them, a _materies morbi_ which is drawn
first to the parts that are weakest or least capable of resistance (the
joints, for example) and then also to other structures, as the liver,
spleen, throat, ears and teeth. These ideas--let it be remembered--were
set down in writing in 650 A. D.

At the beginning of his analysis of Book VI., Neuburger makes this
remark: “Although the description given by Paulus of the surgery of
the ancients is based upon the writings of Hippocrates and Galen, as
well as upon those of Leonides, Soranus and Antyllus, one finds at
every step ample evidence that the writer possessed both independence
of judgment and the manual skill which belongs to a physician who is
familiar with surgical work.” He calls particular attention to the
section (No. 88) which deals with the manner of removing the heads of
arrows from wounds, and he gives special praise to Paulus for his most
instructive account of the diagnostic signs to be looked for in a case
of suspected wounding of a vital organ. He is extremely thorough, says
Neuburger, in his teachings about fractures and dislocations, and he
not infrequently differs from the views expressed by his predecessors.

In the section devoted to gynaecological operations Paulus makes it
perfectly clear that he was in the habit of using a speculum of a very
practical form. Here are his words:--

   ... and, while the operator is holding the instrument in
   position, an assistant turns the screw until the blades of the
   instrument have been separated to the distance desired.

In other chapters of Book VI., Paulus furnishes most interesting and
minute descriptions of a great variety of operations in general surgery
and also in obstetrics, ophthalmology, otology and rhinology. Those who
desire to learn further details about these surgical matters should
consult the English version mentioned on a previous page.

It is not at all unlikely that at some future day it will be found
desirable--by reason of the discovery of the treatises which they
are known to have written, but which have been lost--to add to this
short list of ancient medical authors the names of the following men
who are frequently quoted by them in their works: Antyllus, who made
some really valuable additions to our knowledge of the proper manner
of treating aneurysms, and who must have been a surgeon of great
resourcefulness; Leonides, the Alexandrian, who lived about the time of
Galen, and who appears to have been highly considered for his practical
common sense in the choice of surgical measures; Hesychios of Byzantium
and his distinguished son, Jacobus Psychrestus, who was highly spoken
of by his contemporaries (fifth century A. D.), in whose honor a
public statue was erected (Haller), and to whom is attributed the
saying: “A good physician should either decline at the start to take
charge of a patient, or else he should not leave him until he shall
have brought about some measure of improvement”; finally, Heliodorus,
and perhaps a few others who are less well known.




                             CHAPTER XVIII

     BEGINNING OF THE ARAB RENAISSANCE UNDER THE CALIPHS OF BAGDAD


Toward the end of the sixth century A. D. the prospects for the
perpetuation and further evolution of Greek medicine looked decidedly
dark. In Rome and in the larger Italian towns of the Roman Empire,
physicians were doubtless still to be found, but they must have led
very precarious lives and they certainly could not have had any leisure
or opportunity for scientific work. In these earlier years of the
Middle Ages the monks conducted the larger part of whatever medical
practice was required in the districts in which the monasteries were
located. In Byzantium, also, the outlook at this period of Roman
history was very unfavorable; and nowhere else, as a matter of fact,
would it have been possible for the casual observer to discover any
signs that indicated the approach of a revival in the study of the
sciences. And yet, even at that seemingly darkest moment in the history
of medicine, there were forces at work which would soon revive these
precious seeds of Greek knowledge, and, after transplanting them to
a richer soil, cause them to produce even better fruit and in larger
quantities than ever before.

The rulers under whose auspices the first steps in the great Arab
Renaissance were taken, belonged to what is known as the Abbaside
Dynasty, the founder of which was Abbas (566–652 A. D.), the uncle of
Mohammed. His descendants ruled as Caliphs of Bagdad, on the eastern
bank of the Tigris, for many centuries (from 750 A. D. onward).[47]
Almansur, the second Caliph of this dynasty, felt a very strong desire
that his people, the Arabs, should acquire knowledge of all the useful
branches of learning, and more especially of medicine and philosophy;
and accordingly, as the Greeks were then universally admitted to be
the only nation which possessed that knowledge, and as scarcely any
scientific books written in the Arabic language existed at that early
date, he directed all his efforts to the finding of Greek originals and
of the men qualified to translate them into Arabic. Already as early
as the sixth century A. D., Sergius, a Christian of Ras el Ain, had
translated a considerable number of Greek treatises into the Syrian
tongue, but his work was found to be of an inferior character, and for
this reason could not be utilized to any great extent in the present
undertaking. Honein (ninth century), one of the most eminent scholars
of the Arabic Renaissance, revised a few of these translations and
thus rendered them of some service; but by far the larger part of this
gigantic task of creating Arabic versions of the classical works of
Greek literature, was performed during the ninth century, a period
during which the reign of the Arabs extended from the Ganges on the
east to the Atlantic on the west. By the end of the eighth century
the work of translating had advanced only to the point of producing a
single treatise on medicine and a few relating to alchemy; but before
the ninth was completed, the Arabs had in their possession, in the form
of translations, nearly all the scientific literature of Greece, and,
more than this, they could boast that not a few men belonging to their
own nation had already become celebrated as scientists of the very
first rank.

The medical school at Djondisabour[48] at the time (765 A. D.) when
the Caliph Almansur decided to carry out the ambitious scheme which
he had been meditating, was practically under the control of a family
of Nestorian Christians. A large hospital formed the nucleus of the
institution and furnished all the material needed for familiarizing the
student with the different diseases and injuries commonly encountered
in that part of the world and with the methods of treatment which, as
long experience had shown, offered the best chances of affording relief
or effecting a cure. It was a clinical school of a most practical type,
and at the head of it was George Bakhtichou, who had been recommended
to Almansur as the physician best fitted to take responsible charge of
the new work which was then about to begin. George Bakhtichou was not
the organizer of the school at Djondisabour, but simply its head at
the time of which I am now speaking. Medicine had been taught there,
it appears, since the early part of the seventh century A. D. The
languages commonly spoken in that town were the Syrian, the Arabian
and the Persian, and probably only a few persons understood Greek. The
Caliph believed that, as the first and most important step in the new
work, medical text books, translations of the works of the best Greek
physicians, should be provided with as little loss of time as possible,
and George Bakhtichou agreed with this opinion entirely. The latter,
therefore, upon the urgent invitation of the Caliph, left the hospital
at Djondisabour in the charge of his son, Bakhtichou ben Djordis, and
went to Bagdad in company with two of his pupils, Ibrahim and Issa ben
Chalata. He was well received at Court, partly because he displayed a
readiness to further the Caliph’s educational plans, and partly also
because he was promptly successful in relieving him of a distressing
dyspepsia. Not long after he had arrived in Bagdad, however, he was
himself taken ill and was obliged to return to Djondisabour. Before
his departure the Caliph presented him with a gift of 10,000 pieces of
gold. Issa ben Chalata, one of the two pupils whom George Bakhtichou
had brought with him to Bagdad, was left behind to look after the
Caliph’s health. He proved faithless to his trust, however; and, as
soon as it was discovered that he was selling his supposed influence
with the Caliph, he was not only dismissed in disgrace but all his
property was confiscated. After this disagreeable experience the Caliph
did his best to induce George to return to Court, but the latter was
then unable to travel, owing to the injuries which he had received
from an accidental fall. His pupil Ibrahim went to Bagdad in his place.

It is known that George Bakhtichou personally took an active part in
the work of translating Greek medical treatises into Arabic, but it has
not yet been ascertained which books in particular were assigned to his
care in the distribution of the different tasks. Ossaibiah, the Arabian
historian, makes the statement that the work of translating Greek
medical treatises was entirely under the control and guidance of George
Bakhtichou; and in the “Continens” of Rhazes frequent mention is made
of the latter’s name. All of which confirms the belief that, at the
beginning of the Arabic Renaissance, George Bakhtichou was in reality
the head and front of the movement, so far at least as medicine was
concerned. When he became too old and infirm to continue his attendance
at the Djondisabour hospital, he intrusted the management of that
institution to Issa ben Thaherbakht, who was one of his best pupils. He
died in 771 A. D.

In 786 A. D., Haroun Alraschid succeeded to the caliphate; and not long
afterward, on the occasion of some temporary illness, he requested
Bakhtichou ben Djordis, the son of George and his successor in the work
of translating from the Greek, to consult with the regularly appointed
physicians of the Court in regard to the nature and proper treatment of
his malady. The consultation took place at the appointed time, and one
of the Caliph’s physicians, thinking that he might catch Bakhtichou in
a trap, submitted to him a specimen of urine which purported to come
from the Caliph, but which in reality had been obtained from a beast of
burden. Alraschid, who knew of the deception, asked:--

“What remedy would you administer to the person from whom this urine
came?”

Bakhtichou, who had been clever enough to recognize the true character
of the specimen, replied promptly: “Some oats, your Majesty.”

The Caliph laughed heartily over the episode, loaded George’s son
with presents, and appointed him the chief of all his physicians,--the
first instance among the Arabians, it is said, of the appointment of an
Archiater.

Bakhtichou ben Djordis was the author of a collection of short medical
treatises, and he also wrote, for the special use of his son Gabriel, a
medical “remembrancer.” He was as highly esteemed by the Arabs as his
father had been before him. The date of his death is not known.

Gabriel, the son of Bakhtichou and a grandson of the famous George
Bakhtichou, was the most distinguished member of this remarkable
family of physicians. In the year 792 A. D., five years after the
consultation mentioned above had taken place, Gabriel was sent by his
father to give medical advice to Jafar, the son of the Grand Vizier.
The treatment which he recommended proved to be entirely successful,
and, pleased with the result, Jafar soon afterward had an opportunity
to speak to Haroun Alraschid of Gabriel as the physician best fitted to
effect a cure in the case of his own favorite wife, who, in a fit of
yawning, had dislocated her shoulder. The Arabian physician had tried
friction, different sorts of ointments, and manipulations of every
imaginable kind, but all in vain. The dislocation still persisted.
When Gabriel arrived on the scene he told the Caliph that he could
bring the shoulder back into place provided no offense would be taken
at the means which he was about to employ. Alraschid gave the desired
promise and Gabriel made a movement as if he were about to lift up the
bedclothes. Instantly the patient, through a natural sense of modesty,
stretched out her dislocated arm to keep the bed-covering in place.
“There! she is cured!” exclaimed Gabriel, and such indeed was the
truth. The sudden movement of the limb had reduced the dislocation.--It
only remains for me to add that the sum of 500,000 drachmae[49] was
paid to Gabriel by Haroun Alraschid for his successful treatment.

Some surprise having been expressed by the Caliph’s relatives that
he should display such extravagant generosity toward a Christian, he
replied: “The fate of the empire is bound up in my fate, and my life is
in the hands of Gabriel.”

Gabriel Bakhtichou died in the early part of the ninth century, not
long after the Caliph El Mâmoun had started on his expedition against
the Greeks (828 A. D.). He was the author of several medical treatises,
and, like his famous grandfather, George Bakhtichou, he did everything
in his power to promote the work of translating from the Greek
into the Arabic. Gabriel’s brother, also named George, and his son
Bakhtichou ben Djabriel were both of them physicians of considerable
distinction. The latter accompanied El Mâmoun on his expedition against
the Greeks. It is a fact worth noting here, that throughout this war
the Caliph never for a moment lost sight of the great national scheme
of education which his predecessor Almansur had inaugurated and which
was still engaging the time and best efforts of many scholars and
copyists in Bagdad. Whenever he captured a city he insisted upon the
delivery to him of whatever copies of scientific treatises its citizens
might possess. But even these extraordinary methods of securing the
books which they needed did not satisfy the Arabs, their eagerness
to accumulate as many text books as possible being insatiable.
Accordingly, from time to time, one of the translators--some member
of the Bakhtichou family, for example--would be sent to the different
cities of Syria and Persia to search out and get possession of as
many Greek manuscripts as possible. Thus, Honein is reported to have
said: “I have not been able to procure a complete copy of Galen’s
‘Demonstration.’ Gabriel endeavored to find a copy, but did not
succeed; and I myself hunted through Irak, Syria, Palestine and Egypt,
but was at last only partially successful. I found one-half of the text
in Damascus.”

The work of translation was kept up with unremitting zeal until the
middle of the ninth century (reigns of El Ouatocq and of Moutaouakkel).

Among the physicians who received their training at the Djondisabour
medical school the Bakhtichous were not the only ones who attained
considerable distinction. John Mesué the Elder,[50] for example,
who was a Nestorian Christian and the son of an apothecary, became
more famous than any member of that family. He not only did his full
share of the translating, but he was also a prolific author and a
very faithful and efficient teacher, Galen’s writings furnishing the
basis of his lectures. He lived to be about eighty years of age, his
death occurring in 857 A. D. Most of his writings have been lost. Of
the twenty or more which have come down to our time those bearing the
following titles deserve to receive special mention:--

    Book of Fevers.
    On the Different kinds of Food and Drink.
    On Venesection and Scarifications.
    On Tubercular Leprosy.
    On Abnormal Prominence of the Abdomen.
    On Purgative Remedies.
    On Baths.
    On the Regulation of Diet.
    On Poisons and Poisoning.
    On Vertigo.
    On the Treatment of Sterility.
    On Dentifrices and Gargles.

Sabour ben Sahl, whose death occurred in 869 A. D., was also connected
with the hospital at Djondisabour. He was distinguished on account
of his special knowledge of the properties of simple drugs and their
combinations. He was also the author of the exhaustive formulary
known as _Acrabadin Kebir_--probably the first one of its kind,
says Le Clerc, of which history makes any mention. This formulary or
dispensatory--of which a large and a small edition existed--was in
general use in all the hospitals, physicians’ offices, etc., of that
time.

Still another most distinguished physician and author of medical
treatises received his training at the Djondisabour school--viz.,
John, son of Serapion (or Serapion the Elder, as he is commonly
called). He lived about the middle of the ninth century of the
Christian era and wrote entirely in the Syrian language, but at a later
date his works were all translated into Arabic. The smaller of his two
most important treatises, and at the same time the one which appears
to have attracted the most attention, was called the Kounnach. About
the middle of the twelfth century A. D. it was translated into Latin by
Gerard of Cremona, and named by him _Breviarium_; a still later
translation received the name of _Practica_. The first part of
this smaller treatise (the Breviarium or the Practica) is divided into
six books, the titles of which are as follows:--

    1. On Nodosities, Ophiasis, and Alopecia.
    2. On the Falling Out of the Eyelashes.
    3. On the Mild Form of Tinea, the form which resembles Favus.
    4. Scaly Affections of the Head and of Other Parts of the Skin.
    5. Lice of the Head and of the Body.
    6. Headache caused by Exposure to the Sun; and other forms of
         Cephalalgia.

Salmouïh ben Bayan, a Christian, was the last one of the pupils of the
Djondisabour school who attained considerable celebrity as a physician.
When the Caliph Motassem came to the throne in 833 A. D., he appointed
Salmouïh his personal physician and soon became very much attached
to him; leaning upon him more and more for advice in all sorts of
troubles. Salmouïh was the author of several medical treatises, but
they have all been lost, not even their titles are now known to us.
When dying (early in 840 A. D.), he sent word to the Caliph not to
put his entire trust in the medical judgment of Mesué if he should
find it necessary to call upon the latter for advice in the event of a
serious attack of illness. This celebrated physician was universally
admitted to be most learned in everything relating to medicine, but
there were many of his professional brethren--and Salmouïh was among
the number--who did not esteem him so highly as a practitioner. “The
most important thing in medicine,” said the latter, “is to appreciate
correctly the intensity of the disease, and that is something which
Mesué, with all his learning, is not able to do.” However, despite the
death-bed warning given by Salmouïh to Motassem, this ruler died less
than two years later from the effects of the treatment which Mesué
the Elder, who had been called in to prescribe for his Highness, had
ordered.

In addition to the pupils already mentioned there are a few others who,
according to the testimony of Le Clerc, reflected some credit upon the
institution in which they acquired their medical training. But enough
has already been said, I believe, to establish the fact that, in this
remote Persian province of Khorassan (to the west of the country known
to-day as Afghanistan), there existed during the eighth and ninth
centuries of the present era a most efficient medical school, which was
entirely managed by Nestorian Christians, and which sent out into the
world trained physicians of the very highest type.




                              CHAPTER XIX

     FURTHER ADVANCE OF THE ARAB RENAISSANCE DURING THE NINTH AND
               SUCCEEDING CENTURIES OF THE CHRISTIAN ERA


During the latter part of the eighth century the Arab Renaissance, so
far at least as the science of medicine was concerned, was controlled
and kept in vigorous life almost entirely by physicians who were
connected with the school at Djondisabour--one might almost say, by
physicians who were members of the Bakhtichou family. To this family,
therefore, belongs the chief credit for the admirable results attained
during this, the first stage of the Renaissance. But during the ninth
century A. D. men who had not received their professional training
at this famous school came to the fore and gave a fresh and a more
vigorous impulse to the work than their predecessors had given. Under
the Bakhtichous the translating had been well started, and in addition
a few original medical treatises had been written in the Arabic
language. During the period which followed, however, the translating
and copying became more active than before, and, in addition, several
really valuable treatises were produced by men who wrote in Arabic,
and who were--if not racially Arabs--at least the adopted sons of that
nation. Of these men none stands out more prominently than Honein, who,
according to Le Clerc, “accomplished a marvellous amount of work of
the most varied character and of a very high degree of excellence, and
that too despite many obstacles. While he was not the originator of the
Renaissance in the East, he took the most active part in keeping it up.”

Honein, who may rightly be considered as having at least inaugurated
the second stage of the Arab Renaissance, was born in 809 A. D. at
Hira, where his father Isaac, a Christian Arab, conducted a pharmacy.
The inhabitants of this town were known to be somewhat lacking in
cultivation, and it was therefore not surprising that, when Honein
went to Bagdad and presented himself to John, the son of Mesué, as one
who wished to become his pupil, his request was promptly declined on
the general ground that the people of Hira had not received sufficient
education to warrant any one of their number in undertaking the study
of medicine. This decision was of course a great disappointment to
Honein, but it disturbed him only for a short time. Soon afterward he
went to Greece where he worked hard to perfect himself in the knowledge
of the Greek language. Then, after a residence of two years in that
country, he returned to Bagdad, taking with him a considerable supply
of Greek books. His next step was directed toward gaining a better
knowledge of Arabic, and with this object in view he spent some time
in Bassora, a town which was situated not far to the south of Bagdad,
and which possessed good educational facilities. While residing there
he devoted a certain portion of his time to the translation of Galen’s
treatise on anatomy; and he was accordingly prepared, upon his return
to Bagdad, to submit to John, the son of Mesué, and to Gabriel, the son
of Bakhtichou (who by that time was well advanced in years), a specimen
of the work upon which he had been engaged. Both of these men were
greatly pleased with the excellence of the translation, and encouraged
Honein to go on with the work. El Mâmoun (the second son of Haroun
Alraschid), who was the then reigning Caliph, engaged his services both
as a translator of Greek writings (into Syriac as well as Arabic) and
as a reviser of the translations which had been made by others, and he
paid him most generously for these services. According to Le Clerc,
the amount of literary work done by Honein was simply prodigious.
He translated large portions of the treatises of Galen, Oribasius
and Paulus Aegineta, as well as several of the works of Aristotle
and of Plato, of the mathematicians and astronomers, and also of the
philosophers; and in addition he wrote a large number of original
treatises--such, for example, as a complete set of commentaries on the
writings of Hippocrates, a practical work on the diseases of the eyes,
etc.

The following account of Honein’s experience at the Court of the Caliph
Moutaouakkel (middle of the ninth century A. D.) furnishes some insight
into his character:--

   The Caliph, who had heard of the great learning, ability, and
   industry of Honein, but who had at the same time feared that he
   might be in secret communication with the Greeks, decided to
   subject him to a test that would reveal how far he was venal.
   Accordingly he sent for him, clothed him in robes of honor, gave
   him 50,000 drachmae, and then said:

   “I wish that thou wouldst prepare for me a secret combination of
   drugs which will enable me to get rid of one of my enemies.”

   Honein replied: “I have no knowledge of any but salutary
   remedies, and it never occurred to me that the Prince of
   Believers might ask me to furnish those of a different kind.
   However, if it be the wish of your Majesty, I will see what I
   can do; but I shall require plenty of time.”

   After waiting in vain for the desired preparation and finding
   that even threats failed to accomplish anything the Caliph put
   Honein in prison. Then, at the end of a year, which interval
   the latter had employed diligently in the work of translating,
   Moutaouakkel gave orders for the prisoner to be brought into
   his presence. Before this was done, however, a heap of objects
   of value was placed on one side of the room and instruments of
   torture on the other. When Honein was brought in, the Caliph
   said to him: “Time is passing, and my wishes have not yet been
   gratified. If thou art now ready to obey my behest, these
   treasures and many others in addition shall be thine. But, if
   thou continuest to refuse, I will subject thee to tortures and
   will finally put thee to death.”

   “I have already told the Prince of Believers,” replied Honein,
   “that my knowledge is limited to the preparation of salutary
   remedies.”

   Whereupon the Caliph said: “Have no fear! I simply wished to
   test thee! But tell me, what are the reasons upon which thy
   refusal is based?”

   “There are two reasons,” replied Honein: “my religion and my
   profession. The first teaches us to do good to our enemies;
   and the second, not to do any harm to the human race. Every
   physician has registered an oath that he will never administer a
   poison.”

   “Those are two excellent laws,” remarked the Caliph; and he
   proceeded to load Honein with presents.

Among those who were associated with Honein in his work of translating
Greek medical books into Arabic there are three whose names also
deserve to be remembered. They are: his son Isaac; his nephew Hobeïch;
and a Christian Greek named Costa ben Luca, whose residence was at
Baalbek. To men of the present time all these names of oriental
physicians are, as a rule, mere meaningless words, conveying no idea
of an important relationship to the evolution of medicine. During the
ninth and tenth centuries of the present era, however, and indeed
for many years subsequent to that time, they were accorded by the
physicians of that period almost as much honor for the part which they
took in furthering the revival of medicine among the Arabs as was given
to Honein himself. It seems therefore appropriate that at least a brief
account of the lives of these men and of the work which they did should
be given here.

Isaac received his education from his father Honein, and soon after
reaching manhood he was set to work translating from the Greek into
both Syrian and Arabic--two sister languages. He was a man of great
intelligence, and was thought by many to be the equal of his father
in the knowledge of Greek, Syriac and Arabic. He also had, like his
father, the good fortune to find favor with the rulers of that period.
He died in 912 A. D. as the result of a stroke of cerebral apoplexy.
In addition to his translations he wrote original treatises on the
following topics:--

    Simple Medicaments.
    Origins of Medicine.
    Correctives of Purgative Remedies.
    Treatment by Cutting Instruments.
    The means of Preserving the Health and the Memory.

Hobeïch was the son of Honein’s sister. The date of his birth is not
known. He received his training in the languages from his uncle, and
in the course of time became associated with the latter in the work
of translating. Eventually he reached his uncle’s high standard of
scholarship, and the text of his translations was from that time forth
accepted without any revision. The Caliph Moutaouakkel appointed him
Court Physician, and the immediate successors of this Caliph retained
him in the same position. His death occurred during the second half of
the ninth century of the Christian era.

Hobeïch translated the “Oath of Hippocrates” and a large number of the
more important of Galen’s treatises. In addition, he left to posterity
several original writings. Quotations from these are to be found in the
works of Rhazes, of Ebn el Beithar, and of Serapion the Younger, and
they reveal two important facts: first, that Hobeïch was an excellent
practicing physician; and, second, that the Arabs had already at this
comparatively early date begun to gather their medical information
from other sources than the Greek treatises. The following drugs, for
example, are described by Hobeïch in the quotations just mentioned, and
yet they do not appear to have been known to the Greek medical writers:
Turbith, Convolvulus of the Nile, Nux Vomica, Colocynth, Croton
Tiglium, Aloes and Myrobolans.

Costa, the son of Luca, was a Christian Greek from Baalbek, in Syria.
The dates of his birth and death are not known, but it is believed that
he lived during the first half of the tenth century of the present era.
He was an excellent Greek and Arabic scholar and was also familiar with
the Syriac language. His translations were esteemed equal to those
of Honein. After spending some time in Greece he settled in Irak, a
province of Persia, and devoted himself to the translation of the books
which he had brought with him from Greece. At a later period of his
life he removed to Armenia, a country which lies to the north of Irak,
between it and the Black Sea, and it was during his residence there
that he wrote a number of treatises. It was in Armenia, also, so far as
may be judged from the accounts which we possess, that his death took
place. As an evidence of the fact that he was highly esteemed by his
contemporaries, his biographer states that a cupola was built over his
tomb.

Among the medical works which he translated from the Greek the
following are the only ones of special importance: The Aphorisms of
Hippocrates, and Galen’s commentaries upon them.

The ninth century, the period during which the major portion of the
work described in the preceding part of this chapter was accomplished,
is considered by Lucien Le Clerc the most remarkable in the worlds
history. He speaks of it in the following terms:--

   Its greatness is emphasized by the fact that, except in this one
   corner of the globe, everything was in a state of decadence....
   Great as is the credit due the Abbaside Dynasty and its
   ministers, still greater is our admiration for the Arab nation
   on account of the eagerness with which it met the wishes of its
   rulers and also because it pursued resolutely, and despite all
   the obstacles (political and religious) which were placed in
   its way, the course laid down for it to follow.... The Arabs
   also knew how to choose men who were really eminent and to
   rescue them from lives which otherwise would probably have been
   sterile; they claimed the inheritance of Greek science; and they
   revealed to the world that they were worthy of this inheritance.

Some idea of the completeness of the list of Greek medical works which
the Arabs translated may be gained from the fact that Galen’s writings
are more complete in the Arabic than they are in the Greek, the
language in which they were originally composed.

With Costa the second stage in the Arab Renaissance came to an end.
All the work accomplished at Bagdad up to this period in our history
received its inspiration from the different Caliphs belonging to
the Abbaside Dynasty. But now the political conditions in the East
underwent a change, and other Arabian dynasties, each in its turn,
gained control of the power previously wielded by Almansur, Haroun
Alraschid and their successors. Fortunately, all of these new rulers
seem to have been favorably inclined toward the revival of literature,
and consequently the Arabs continued to take an active part in the
advance of medical knowledge during the tenth and eleventh centuries.
Bagdad, however, ceased to be the centre of all this intellectual
activity, and eventually Cordova in Spain almost rivaled the capital
of ancient Greece in the eagerness with which she sought to increase
her stores of books, and in her readiness to honor scholars. By this
time the Arabs controlled, not only Persia and Arabia, but also Egypt,
Palestine, Syria, Marseilles, the coast of Asia Minor, Greece, Sicily,
the northern part of Africa and Spain. Owing to the limited space at my
command I shall be obliged to confine my account to the more salient
features of the progress made during this later or third stage of the
Arab Renaissance.

Already as early as toward the end of the ninth century the number of
physicians in the East had increased so greatly, and the territory
where well-educated medical men were to be found had broadened to
such an extent, that I shall now be obliged, in order to maintain
some approach to chronological order in my account of the evolution
of medical science, to treat the subject according to countries. If
the men who stand out foremost in this third stage of the scientific
renaissance are not in every instance Arabs or Persians or Syrians, I
may at least claim that they are the product, directly or indirectly,
of the great Arab movement. The countries in which their best work was
done are the following: Persia (apart from Bagdad and its immediate
neighborhood), Egypt, Magreb (the modern Algiers and Tunis), Fez
and Spain. But, before I consider the progress of medicine in these
different parts of the Orient, I should say at least a few words about
the events which characterized the cessation of literary work at
Bagdad. As might be expected, that city, after the Greek medical and
scientific treatises had all been translated into Arabic, gradually
lost its pre-eminence as a centre of learning, and new centres
developed in other cities throughout the vast Musulman Empire. It must
not be inferred, however, that this change was wholly or even largely
due to the cessation of literary work. Other factors contributed to
this result, viz.: the decadence of the caliphate and the fact that
the caliphs themselves appeared to lose their interest in promoting
the sciences actively. It was not until during the tenth century that
any further interest in the advancement of medical science was taken
by those in authority at Bagdad. Then the Emir Adhad Eddoula built a
splendid hospital, and organized it on the basis of several separate
services--one for fever cases, another for accidental injuries, a third
for ophthalmic cases, and so on. Twenty-four physicians, who had been
selected because of their special aptitude for some particular class of
medical work, were appointed to take charge of the different services;
and it is interesting to note that nearly all of these men bear Arab
names. Nevertheless, for a still further period of many years, says Le
Clerc, there continued to be as many Christian as Mohammedan physicians
in Bagdad.

In the tenth century other hospitals were established in Bagdad. Thus,
in 914 A. D., the Vizir Ali ben Issa founded one which he endowed
in the most liberal manner. This Vizir must have been a most humane
person, for, when the physician-in-charge wrote to him for further
instructions regarding the course which he should pursue with respect
to people of different religions, the Vizir replied: “Use the fund for
the benefit of all classes alike, and be sure to remember the animals.”

_Persia._--Rhazes, whose full name is Abou Beer Mohammed ben
Zakarya, is generally admitted to have been the most illustrious of
Persia’s physicians, and probably the most distinguished representative
of Arab medical learning. He was born at Raj, in the Province of
Khorassan, about 850 A. D. After he had received his professional
training at Bagdad, he settled at Raj and was soon afterward appointed
director of the local hospital. At a later date he was placed in
charge of the hospital at Bagdad, but before many months had elapsed
he returned to Raj, his native town, and here he spent most of the
remaining years of his long life. The date of his death is stated by
Haeser as either 923 or 932 A. D., but Le Clerc mentions only the
latter date.

Rhazes was a very hard worker and was highly esteemed by his fellow
countrymen, who called him the Arabian Galen. The total number of
writings which he left behind him at the time of his death was
237, most of them dealing with medical subjects. A few of them,
however, were devoted to the discussion of chemical, anatomical and
philosophical questions. To-day we possess only 36 of the treatises
written by Rhazes, and of this number only six have been printed in
Latin. His greatest work, as all critics admit, is that which is
commonly known as the “Continens” (or “El Haouy”). In this work, which
is divided into twenty-two books, Rhazes gives in a condensed form the
views entertained by all his predecessors regarding the more important
questions in medical science, and then adds thereto the conclusions
which his own experience has led him to form.

He also wrote a second treatise (in ten books) which was esteemed
by the physicians of that and later periods almost as highly as
the Continens. It was called the “Mansoury,” and its contents are
distributed as follows: I., Anatomy; II., the Different Temperaments;
III., Alimentary Substances and Drugs; IV., Hygiene; V., Cosmetics;
VI., the Regimen to be adopted in Traveling; VII., Surgery; VIII.,
Poisons; IX., Maladies in General; X., Fevers.

A third treatise of considerable importance is that which is devoted
by Rhazes to the description and treatment of small-pox and measles.
So far as is known at the present time this is the first treatise that
has been written on these diseases, and its celebrity rests, not only
upon this circumstance, but also upon the facts that its author is
evidently familiar with the different types of small-pox and with the
characteristic features which distinguish this disease from measles.
Freind, in commenting upon this treatise, says that Rhazes assigned
for small-pox a cause “entirely new in physick, a sort of an _innate
contagion_. This is a _ferment_ in the blood, like that in
must, which purifies itself sooner or later by throwing off the peccant
matter at the glands of the skin; an hypothesis since applied, though
upon very slight grounds, to feavers in general by many moderns.” From
this account it is fair to conclude that Rhazes, in the tenth century
of the Christian era, as clearly suspected the germ origin of certain
febrile diseases as Liebermeister did toward the end of the nineteenth,
or as Fracastoro did in the sixteenth. And one cannot help exclaiming:
How many centuries had to elapse, and what an immense amount of other
facts had still to be discovered--facts in anatomy, in physiology, in
chemistry, in optics, etc.--before it became possible to convert this
suspicion, this simple product of the reasoning faculty, into an actual
demonstration of the truth in pathology!

Among the Arabian physicians of the eleventh century Avicenna is
certainly one who should be placed in the first rank. He was born in
980 A. D. at Afschena, a village in the Province of Khorassan, Persia,
and spent his youth in Bokhara, where his father held some high office
under the Government. His great intellectual capacity was revealed at
an early age. It is said, for example, that already before he was ten
years old he had committed the entire Koran to memory; and it is added,
further, that when he was only seventeen years old he had already
acquired such knowledge of medicine that he was invited to take part
in a consultation regarding some malady with which the Emir Nuch ben
Mansur was affected. The advice which he gave on this occasion was
followed, and in the sequel it proved so good that he was granted, as
a reward, unrestricted access to the royal library,--a privilege which
he utilized to the very best advantage. When his father died Avicenna
came into possession of a large fortune, which enabled him to indulge
in a great deal of traveling. In this way he visited one Persian Court
after another throughout a period of several years. Finally, during a
residence at Hamadan, the Prince Schems ed-Daula, whom Avicenna had
successfully treated for some malady, made him his Vizir. While he
held this office he managed, without neglecting his official duties,
to continue his scientific studies; but he was not able entirely to
keep out of political intrigues, and as a consequence his life was for
a short time in some danger. He was confined for several months in a
fortress, from which, however, he managed eventually to make his escape
to the Court of Ibn Kakujah, in Ispahan. He resided in that city during
the following fourteen years, and it was there that he wrote his two
principal works--the famous medical treatise known as the “Canon,” and
the equally celebrated cyclopaedic work on philosophy. Worn out by
his incessant and most exhausting literary labors and by his excesses
in other directions, Avicenna died in June, 1037 A. D., while he was
accompanying the Emir on his expedition to Hamadan. His tomb may still
be seen in the latter city.

Neuburger, from whose excellent History of Medicine the preceding
details have been gleaned, makes the statement that the treatise in
which Avicenna’s clinical experience was recorded has not come down to
our time, and that, consequently, we lack the means of estimating just
how great a physician--just how close a clinical observer and how wise
a practitioner--he really was. So far, however, as may be judged from
the evidence furnished by the Canon, Avicenna was not the equal, in all
practical matters relating to medicine, of Haly Abbas and of Rhazes.
He was perhaps too much inclined to “look at bedside phenomena through
the spectacles of preconceived theories.” In brief, he was, first and
foremost, a philosopher, and only in a subordinate degree a physician,
although a most excellent one. In Book III., where he discusses certain
surgical procedures, statements are made which justify the belief that
Avicenna was acquainted with intubation of the larynx.

Le Clerc mentions six other Persians who, during the tenth century of
the present era, gained more or less distinction as physicians. In the
following paragraphs brief notices are given of each of these men.

Eben el Khammar, born in 942 A. D., was a Christian and an excellent
practitioner. He was well versed in the science of medicine and a
writer of some importance. Date of death unknown.

Abou Sahl el Messihy, who was also a Christian, was a contemporary and
intimate friend of Avicenna. He died in 1000 A. D. He was the author
of a complete and very useful summary of medicine, entitled “Kitab el
Meya”; and the Arab historian Ossaibiah speaks in terms of admiration
of another treatise which he wrote and which bears the title,
“Exposition of God’s wisdom as Manifested in the Creation of Man.”

Abou Soleiman Essedjestany, commonly called “El Mantaky.” The dates
of his birth and death are not known. He wrote a number of treatises,
and--among others--one on “The Organization of the Human Faculties.”

Aboul Hassan Ahmed Etthabary, a native of Thabaristan, in the Province
of Khorassan. He was employed as a physician by the Emir Rokn eddoula
ben Bouïh, and is known as the author of a compendium of medicine
entitled: “Hippocratic Methods of Treatment.” He died in 970 A. D.

El Comry was one of the most eminent medical practitioners of his time,
and was in high favor with the royal household. He wrote a compendium
of medicine which bears the title “R’any ou Many,” and he was also
the author of a treatise on the causes of disease. His death occurred
toward the end of the tenth century of the Christian era.

Alfaraby, who is highly commended by Avicenna, should be classed among
the philosophers rather than among the physicians. He died in 950 A. D.

The sixth Persian physician of some distinction mentioned by Le Clerc
is Ali ben el Abbas--usually spoken of as Haly Abbas. The dates of his
birth and death are not stated by any of the authorities, but it is
known that he was a native of Ahouaz, a small town on the Karun river,
to the southeast of Bagdad, and that he was still living in 994 A. D.
Haly Abbas, it is claimed, was the first medical writer who ventured to
prepare a complete and systematically arranged Practice of Medicine.
He gave it the title of Al-Maleky--“The Royal Book,”--and dedicated
it to the Emir Adhad-ad-Daula, whose private physician he was. It is
a much smaller treatise than the “Continens” of Rhazes, and somewhat
more complete than the same author’s shorter work--the “Mansoury.” It
covers the entire field of medicine and is distinguished by its very
practical character. It was first translated into Latin in 1127 A. D.

Haly Abbas, in one of his treatises, speaks of Hippocrates in the
following terms: “Hippocrates, who is the prince of the medical art and
the first physician who ever wrote a book on this art, is the author of
many treatises on all sorts of medical topics.... But he writes in such
a very concise manner that much of what he says is obscure, and as a
consequence the reader, if he wishes to understand him, is obliged to
seek the aid of a commentary.”

_Egypt._--The dynasty of the Fatimides--the descendants of Fatima
(the daughter of Mohammed) and of Ismael, a great-grandson of Ali, the
fourth of Mohammed’s successors--reigned over Egypt for nearly two
centuries (10th to 12th of the present era), and they showed toward
the scientists the same spirit of generosity that had been manifested
toward them by the Abbasides in the earlier part of their reign. In 970
A. D. Moëz Eddoula drove out the reigning family, assumed the title of
Caliph, and founded the city of Cairo. In 972 he built the celebrated
mosque Al Azhar and constructed, as a sort of annex to it, a school, a
veritable university, where ultimately all the sciences were taught.
It throve vigorously, and students flocked to it in great numbers from
all quarters of the Moslem empire. During the eleventh and twelfth
centuries Egypt was once more, as it had been in the palmy days of
Alexandria, the home of many excellent and vigorous institutions of
learning. Among the physicians, however, who received their education
in medicine at Cairo during this long period, there was not one who
attained great eminence.

At the end of the eleventh century the Crusaders, under the leadership
of Godfrey de Bouillon and others, made their first serious attack
on Palestine and Syria, and from that time onward, for about two
centuries, they and the different armies sent out successively
from Europe carried on almost constant warfare, which Michaud the
distinguished French historian (about 1800 A. D.) calls the product
of a pious delirium. Wars of religion are the most savage and pitiless
of all wars, says Le Clerc, and this was emphatically true of those
waged by the Crusaders. On the other hand, says the same writer, “the
tolerance exhibited at that period by the Arabs in religious matters
is a well-attested fact, and it owes its origin to the circumstance
that their scientific education was conducted by Christians. Of
Saladin’s fifteen physicians two-thirds were either Jews or Christians.
Cultivation and good training were the characteristics of the Arabs
at that period of their history, whereas fanaticism and brute force
were the distinguishing features of the European soldiers. Several
hundred thousand adventurers first ravaged Europe and then pounced
upon Asia. At Antioch Godfrey de Bouillon committed all sorts of
excesses, and then, when he had taken Jerusalem, he massacred 70,000
of its inhabitants--Jews and Musulmans. Eighty years later, Saladin
retook Jerusalem; and, with the exception of a comparatively small
number, he allowed all of his captives to go free. His brother, Malek
el Adel, paid the ransom of 2000 of the prisoners. Contrast these
fruits of civilization with the barbarism of the European conquerors
under Godfrey de Bouillon. Another result of the Crusades was this:
The Franks lost a good deal of their savagery through contact with the
Arabs. At a still later period Western Europe drew a large part of her
supplies of knowledge from Spain--_i.e._, from the Musulmans.”

_Syria._--In the thirteenth century Damascus, the capital of
Syria, assumed considerable importance as a centre of medical activity.
Bagdad and Cairo had by this time lost the greater part of their
attractiveness for those who wished to perfect their knowledge of
the healing art, and the vandalism of the so-called Soldiers of the
Cross had put an end for many years to come to all hopes of making
Constantinople once more the home of scientific or artistic effort.
There was one branch of medical practice, however, in which the Cairo
physicians excelled all others--that, namely, of ophthalmology. This is
explained by the well-known fact that at all periods of her history
Egypt has been afflicted with ophthalmias to a much greater degree than
any of the other countries of the Mediterranean basin. The great wealth
accumulated in Damascus, the large number of hospitals which were
located in the city, and the attractiveness of the town as a place of
residence undoubtedly had much to do with the fact that it attained at
this period so great popularity as a centre of medical activity.

_Spain._--During the tenth century of the present era the Moslem
reign in Spain flourished greatly under the two enlightened rulers
of the Ommiade Dynasty--Abdurrahman Ennasser and Hakem, and medicine
shared fully in this prosperity. During Abdurrahman’s reign the Emperor
Romanus at Constantinople sent an embassy to Cordova in Spain, and
among the gifts which they took with them for the Prince, was a copy
of the treatise of Dioscorides in the original Greek, illustrated by
marvelously beautiful paintings of the different medicinal plants.
But there was nobody in Cordova at that time who could read Greek.
Accordingly, Abdurrahman begged the Emperor to send him a man who was
familiar with both the Greek and the Latin tongues, and it was in
answer to this request that the monk Nicholas was sent to Cordova (951
A. D.). Working in conjunction with several of the most distinguished
physicians of that city he succeeded in identifying nearly all of the
plants mentioned by Dioscorides.

Among the physicians of Arab, Persian or Jewish extraction who, during
the eleventh and twelfth centuries, practiced their profession in Spain
and attained considerable celebrity, the following deserve to receive
special mention here: Abulcasis, Avenzoar, Averroes and Maimonides.

_Abulcasis._--Abulcasis is universally credited with being the
greatest surgeon of whom the Arabs may rightfully boast. He was born
at Zahra near Cordova in 936 A. D., and his death occurred 1013 A.
D. Quite early in his professional career (before he had reached his
twenty-fifth year) he was appointed one of Abdurrahman’s private
physicians. Although he owes his reputation chiefly to the treatises
which he wrote on surgery Abulcasis was also the author of several
medical works. He published a collection of all his writings under the
title of “The Tesrif,” which is divided into thirty parts or books,
and which--according to Lucien Le Clerc--constitutes a veritable
encyclopaedia. During the course of the twelfth century Gerard of
Cremona translated into Latin the part relating to surgery; it is not
known at what time or by whom the remainder of the collection was
translated. The author’s name in the Latin edition is given, not as
Abulcasis, but as Alsaharavius.

During the lifetime of Abulcasis his writings, and especially his work
on surgery, were not very highly appreciated in Spain. This was largely
due to the fact that the Mohammedan inhabitants of that country did not
look upon surgery with any degree of favor. The Arabs of the East held
Abulcasis in much greater honor. Guy de Chauliac, the famous French
surgeon of the fourteenth century, in his treatise on surgery, quotes
Abulcasis no less than two hundred times. Le Clerc, in the course
of his remarks upon the value of the surgical treatise written by
Abulcasis, says: “This book will always be considered, in the history
of medicine, to represent the first formal and distinct scientific
treatise on surgery.” At the same time, the prevailing testimony makes
it appear that the book contains only a small portion of original
matter, a large part of its substance having been borrowed from the
work of the Greek author, Paulus Aegineta. Its chief merit consists in
the orderly and very clear manner in which the facts are presented, and
doubtless the popularity of the book was materially increased by the
fact that many of the instruments required for the different operations
were illustrated pictorially.

Lucien Le Clerc has published (Paris, 1861) a French translation of
Abulcasis’ Treatise on Surgery, and on page 71 of this version the
following statement will be found:--

   ... you may also introduce into the cannula a specially adapted
   piston in copper, or a stylet the end of which is armed with
   cotton. Then fill the cannula with oil or some other suitable
   fluid, introduce into one end the stylet armed with cotton, and
   push it onward until the liquid enters the ear.

Edouard Nicaise, commenting on these words in his version of Guy de
Chauliac’s _La Grande Chirurgie_ (page 690), says that they
constitute the first reference, thus far discovered in medical
literature, to the use of the instrument known as a syringe.

_Avenzoar._--Avenzoar was born in Seville, in the southern part
of Spain, during the latter part of the eleventh century. The exact
date is not known. His father was a physician of some distinction, and
his son also attained considerable eminence in the same profession.
According to Neuburger, Avenzoar died, at an advanced age, in 1162 A.
D., and was buried in Seville.

It is said that in actual practice Avenzoar, who was a man of some
wealth, confined himself to consultation work. He considered it beneath
the dignity of a physician to prepare drugs, to apply leeches, or
to perform certain surgical operations--as, for example, lithotomy;
but Le Clerc seems disposed to believe that Avenzoar did not adopt
this view until after he had become somewhat celebrated and had
accumulated a fortune. Neuburger ranks him next to Rhazes as a clinical
observer and a practitioner of sound common sense, and he speaks of
his great medical work, the Teïssir, as a treatise that abounds in
most interesting histories of cases of disease. Among these will be
found the account of an attack of mediastinitis which occurred in
his own person, and which ended in suppuration that found a vent for
its products by way of one of the bronchi.[51] As this disease is of
rare occurrence, and as Freind’s account of the attack is presumably
a translation of the original report in Arabic made by Avenzoar, its
reproduction here may be interesting. I shall take the liberty of
modernizing the text very slightly and of abbreviating it in one or two
places.

   I felt some pain in the region of the mediastinum (the membrane
   which divides the thorax in the middle) while I was on a
   journey. As it increased a cough developed, and I observed
   that my pulse was very hard and that I had an acute fever. On
   the fourth night I took away a pint of blood, but this gave me
   very little relief. Being obliged to travel all day I was much
   fatigued when I retired at night, and I fell asleep. During my
   sleep the bandage on the arm came off, and when I awoke I found
   the bed deluged with blood and my strength greatly exhausted.
   The next day I began to cough up a sanious matter, and my mind
   wandered at times. Gradually all the symptoms subsided and I
   recovered my health. Although I partook of large quantities of
   barley water, I believe that my recovery was not due to this,
   but rather to the great loss of blood which I had experienced.

Freind adds that “Avenzoar not only takes notice of an abscess in the
mediastinum, but in the pericardium likewise; which I don’t find had
been described or even observed by any of the Greeks or Arabians: and
there is no doubt but this membrane and the mediastinum to which it
is contiguous, are subject, as well as the pleura and lungs, to an
inflammation.”

It is one of the distinguishing features of Avenzoar’s character that,
in his writings, he does not hesitate to differ from his predecessors
whenever he believes that their views are erroneous.

_Averroes._--Averroes was one of Avenzoar’s most distinguished
pupils. Indeed, the latter’s famous work, the Teïssir, is dedicated to
Averroes. Thanks to the distinguished French historian and philosopher,
Ernest Renan, our knowledge of Averroes has been greatly expanded since
1852. Averroes was born at Cordova in 1126 A. D. His father and his
grandfather had both held the office of Cadhi (Alcalde, in Spanish),
and were therefore people of importance in that city. His studies were
confined at first largely to philosophy, and when he reached mature
age he gained a great reputation as the commentator and interpreter of
the writings of Aristotle. Still later in life much of his attention
was devoted to medicine, and he wrote a book which bears the title
“Kitab al-kullidschat” (General principles of Medicine). Among the
physicians of the later Middle Ages this work was commonly spoken of as
the “Colliget” (from kullidschat), and was almost as highly esteemed as
the Canon of Avicenna. The idea of writing a treatise on the individual
diseases was first entertained, among Arabian physicians, by Averroes;
but on reflection he abandoned the idea, and, instead, urged Avenzoar,
his friend and former instructor, to undertake the work in his place.
It was in this way that the Teïssir--the finest work on the practice of
medicine produced by an Arab writer--came to be written.

The topics treated in the “Colliget” are distributed throughout the
seven books in the following manner:--

    Book I.   Anatomy.
    Book II.  Health (Physiology).
    Book III. Diseases.
    Book IV.  Signs or Symptoms.
    Book V.   Remedial agents and Foods.
    Book VI.  The Preservation of Health.
    Book VII. The Treatment of Diseases.

Neuburger speaks of the “Colliget” as a fine piece of philosophical
writing, but adds that it is not at all suited to the needs of the
practical physician. Indeed, he doubts whether any person who has not
received a thorough training in natural philosophy--the philosophy of
Aristotle--would be able to follow the author intelligently.

_Maimonides._--Maimonides, who is ranked by Le Clerc as the
greatest Jew, after Moses, of whom the history of that nation makes
mention, was born at Cordova, Spain, in 1135 A. D. In early youth
his teachers were his father and a disciple of Ebn Badja. At the age
of thirteen, and from that time until he had reached his thirtieth
year, he was obliged under the pressure of circumstances, to profess,
at least outwardly, the faith of Islam. Death or banishment was
the only alternative. During the intervening period of seventeen
years he devoted himself exclusively to his studies. In 1160 A. D.
he accompanied his family to Fez, Morocco, and five years later he
settled at Fostath, near Cairo, Egypt. As a means of gaining his
livelihood he engaged in the business of trafficking in precious
stones, continuing his studies at the same time and carrying on a
certain amount of medical practice. Not long afterward he gained the
favor of the Vizir El Fadhl Beissâny, the friend of Saladin, Sultan of
Egypt and Syria, and was by him appointed one of the Court physicians.
This enabled him to give up entirely his commercial business. He
prospered in the practice of medicine and was very highly esteemed in
the community in which he lived. His death occurred in 1204 A. D.

Among the books which he wrote (generally in Arabic) on medical
subjects, the following deserve to receive special mention:--

   I. Commentary on the Aphorisms of Hippocrates.

   II. A work known as “Aphorisms of Maimonides” (borrowed partly
         from Hippocrates and partly from Galen).

   III. Résumé of the writings of Galen.

   IV. A letter relating to the subject of personal hygiene.

   V.-IX. Treatises on asthma; on hemorrhoids; on venoms and
         poisons in general; on drugs; and on forbidden articles
         of diet.

   X. A translation of one of Avicenna’s works.

Neuburger speaks in very favorable terms of the medical writings of
Maimonides, and adds that he also wrote a treatise which bears the
title: “Guide to Those in Perplexity”--a work which aims to reconcile
reason and faith. The book has been translated into French by Munk; and
the treatise on poisons has also been translated into the same language
by J. M. Rabbinowicz (Paris, 1867).

Speaking of the remarkable manner in which philosophy and medicine had
flourished in Spain during the tenth and eleventh centuries, under the
reigns of Haken II. and his successors, Ernest Renan says:

   The love of science and of things beautiful had established,
   in that privileged corner of the world, a degree of tolerance
   that can scarcely be matched in modern times. Christians, Jews,
   Musulmans all spoke the same language, sang the same poems, and
   took part in the same literary and scientific studies. All the
   barriers which commonly separate men were thrown down, and all
   worked with equal zeal in behalf of our common civilization.

With the death of Averroes (1198 A. D.), however, Arab philosophy lost
its last representative, and the Koran resumed its full authority over
freedom of thought. In the succeeding period of decadence (thirteenth
century of the Christian era) there were no physicians of first
importance, at least in Spain and Persia; and even in Egypt and Syria,
over which reigned at this time the enlightened family of Saladin,
the leading physicians were not of the same calibre as the men whose
names I have just mentioned. Bagdad and Cordova had by this time become
cities of less importance than Damascus, and botany and ophthalmology
were esteemed of greater value in the scheme of medical education
than at any previous time. It will not appear strange, however,
that medicine should have stood still during this later part of the
Middle Ages if we bear in mind the fact that warfare was then such a
frequently occurring event that nobody had either time or inclination
for scientific studies. The invasions of the Mongolians and the
Crusaders were most disturbing factors.

During the twelfth century of the present era there were--so we are
assured by Le Clerc--women physicians among the Arabs in Spain. It is
said, for example, that Abou Bekr, a distinguished medical practitioner
of that period, had a sister who was well trained in medicine, and that
it was she who acted as midwife at all the confinements of the wives of
the Caliph Almansur. After her death her niece officiated in the same
capacity in her place. There can scarcely be any reasonable doubt that,
almost from time immemorial, women as well as men have taken active
part in the practice of medicine.

According to Puschmann, Spain possessed, during the twelfth century of
the Christian era, seventy public libraries and seventeen institutions
for instruction in the higher branches of learning. Among the residents
of the city of Cordova there were, during the same period, no fewer
than one hundred and fifty authors; and the smaller cities of Almeria,
Murcia and Malaga could each claim proportionally an equally large
number, viz., fifty-two, sixty-one and fifty-three.

_The Effects of the Arab Renaissance as a Whole upon the Evolution of
Medicine._--Although the series of events which I have endeavored
to sketch here in brief outlines reveals an extraordinary degree of
zeal and persistence on the part of the Arab rulers and their subjects
to endow the nation with the knowledge and skill of their models,
the Greeks, the final results gained, at least so far as they relate
to the evolution of medicine as a whole, were not very great. The
movement lasted for five or six centuries, but nevertheless only a few
relatively unimportant facts were added by the Arabs to the stock of
knowledge which was possessed at the time of Galen’s death. Alhazen’s
brilliant researches in the eleventh century of our era in optics (more
particularly with reference to refraction) paved the way for a more
perfect knowledge, in modern times, of the physiology of vision; Geber,
who lived during the eighth century of the Christian era, and who is
spoken of by Le Clerc as “occupying the same place in the history of
chemistry that Hippocrates does in the history of medicine,” laid the
foundations of that important branch of science; Abulcasis discovered
the Medina worm (_dracunculus Medinensis_) and wrote an excellent
description of the pathological effects which it produces when it
lodges under the skin of a man’s leg; and, finally, our pharmacopoeia
was enriched, during these centuries, by the addition to it of a number
of new drugs and pharmaceutical preparations. These are among the more
important contributions which the Arabs made to the general stock of
medical knowledge. On the other hand, they contributed, in an indirect
manner, to the advance of the science of medicine. From the thirteenth
century onward, for a long period, the Latin language was destined to
serve as the vehicle by means of which all scientific knowledge was
to be spread abroad in the countries which are now known as Italy,
Spain, France, Switzerland, Germany, Belgium and Holland, and therefore
an immense amount of translating had to be done before the works of
Hippocrates, Galen and other Greek medical authors could be brought
within reach of the physicians of these different countries. At that
late date it was by no means always feasible to get possession of an
original copy of one of these classical treatises, and consequently in
such cases it became necessary to employ an Arabic version in the place
of the Greek original. It was in this indirect manner, therefore, that
the Mohammedan Renaissance contributed most effectively in advancing
the development of medical science in general.

One cannot dismiss the subject of Arabic medicine without calling
attention once more to the spectacle which this remarkable Renaissance
offers--that of an entire nation deliberately working to educate itself
up to the level of such intellectual and artistic giants as the ancient
Greeks; a work which continued with unabated zeal throughout several
centuries in spite of obstacles and discouragements, and which never
ceased for a moment. It is a spectacle without parallel in the world’s
history.




                              CHAPTER XX

             HOSPITALS AND MONASTERIES IN THE MIDDLE AGES


Long before the Christian era it was the practice among the Greeks
to make suitable provision for those who, by reason of poverty or
illness, were unable to provide for their own wants or to secure the
services of a physician. Their slaves, for example, were sent, when
overtaken with illness, or when they had become too feeble to work, to
what was termed _Xenodochia_--institutions where they received
kindly care and such medical treatment as was necessary. (Mommsen.) In
strong contrast with this humane practice stands the action of those
wealthy Roman property owners who, adopting the course recommended by
Cato, the famous censor (96–46 B. C.), “sold their slaves when they
became old and feeble or ill, as they would old iron, or oxen that
can no longer be utilized for work.” This cruel practice not only
continued throughout a period of nearly three centuries, but apparently
became more and more common, for we are told that the Emperor Claudius
(268–270 A. D.) was obliged, in order to mitigate the evil, to issue a
decree that, when a slave was driven out of the house by his owner, he
should be declared free.

_Hospitals and Other Kindred Institutions._--Toward the end of the
fourth century of the present era the first hospital was established in
Rome by the widow Fabiola, a member of the distinguished Fabian family,
and her example induced other wealthy Roman ladies to found similar
institutions. But already several years before this time the influence
of Christianity had made itself felt so strongly in the eastern branch
of the Roman Empire that the Emperor Julian, who had previously been
among its most bitter opponents, was forced to say, in one of his
letters:--

   Now we can see what it is that makes these Christians such
   powerful enemies of our gods; it is the brotherly love which
   they manifest toward strangers and toward the sick and the poor,
   the thoughtful manner in which they care for the dead, and the
   purity of their own lives.

Moved by these considerations, he decided forthwith to erect hospitals
in all the cities of the empire. We do not know whether he acted upon
this resolution or not, but it is a matter of record that St. Basil,
Bishop of Caesarea (370–379 A. D.), founded in that city, which is
about thirty miles distant from Jerusalem, a settlement composed of
numerous dwellings that were devoted to the use of the poor and the
sick. This institution was managed in an admirable manner, a special
corps of physicians and nurses being assigned to the duty of caring for
its inmates. At Edessa, the capital of Northern Mesopotamia, another
hospital was founded in 375 A. D. The date of the establishment of the
celebrated hospital at Djondisabour in Persia, of which mention is made
elsewhere (see page 204 _et seq._), is not known. About the middle
of the sixth century of the present era, Childebert I., King of the
Franks and son of Clovis, founded at Lyons, France, the Hôtel-Dieu, a
hospital which has afforded shelter and comfort to thousands of human
beings during the past fourteen hundred years, and which is in active
operation at the present time; a hospital, too, which has served as a
training school for a long line of distinguished physicians, surgeons
and gynaecologists. It is an interesting fact that Childebert intrusted
the management of this great institution to laymen (instead of the
ecclesiastical powers). Finally, toward the end of the sixth century,
Bishop Masona founded in Merida, Spain, a hospital in which Jews,
slaves and freemen were received and treated on the same footing; and
he laid down the rule that one-half of the moneys and other gifts
received by the church was to be devoted to the maintenance of this
institution. The list of hospitals and other charitable organizations
which were established in these early centuries is very long, and it
reveals the fact that in every known land there existed, throughout
these years, a strong wish to give aid and comfort to the poor, the
sick and the helpless. The Musulmans appear to have been as zealous
as the Christians in promoting works of this kind; for the records
show that in Bagdad, Cairo, Damascus, Cordova and many of the other
cities which were under their control, they provided ample hospital
accommodations. Indeed, one of the largest and most perfectly equipped
institutions of this character of which the history of the Middle
Ages furnishes any record, was that planned and constructed at Cairo,
Egypt, in 1283 A. D., by the Sultan El Mansur Gilavun. While it was
building, the workmen employed were not permitted to engage in any
undertaking for private citizens, and the Sultan himself never failed
to visit the spot every day during the progress of the work. The site
chosen was that of one of the royal palaces, and in tearing down this
structure, in order to make room for the new building, the workmen
brought to light a large chest filled with gold and precious stones,
the value of which was sufficient to pay the entire expense of erecting
the hospital. Upon the completion of the building and the equipment
of its spacious wards in the most perfect manner possible, the Sultan
expressed himself in the following terms:--

   I have founded this institution for people of my own class
   and for those who occupy an humbler station in life--for the
   king and for the servant, for the common soldier and for the
   Emir, for the rich man and for the poor, for the freeman and
   for the slave, for men and also for women. I have made ample
   provision for all the remedial agents that may be required, for
   physicians, and for everything else that may prove useful in any
   form of illness....

One of the characteristic features in the management of this hospital,
says Le Clerc, was the custom of giving to each of the poorer inmates,
when he left the institution, five pieces of gold, in order that he
might be spared the necessity of undertaking immediately work of an
exhausting character.

_Monasteries in Their Relation to Medicine._--While at first
these institutions were designed chiefly as places of refuge from
the turmoil of the world and from the violence of frequent warfare,
it became evident in the course of time that the evils incident to
such a secluded and self-centered life hindered rather than promoted
the development of those particular virtues which Jesus Christ urged
his followers to cultivate. This experience led to the adoption of
a different kind of cloister life; and so it came about, as stated
by Neuburger, that in 529 A. D. Benedictus of Nursia founded, at an
isolated spot high up on the slope of Monte Cassino, in Campania,
Italy, the now famous parent monastery of the Benedictine Order.
According to the original regulations of this order, the monks were
obliged to perform every day a certain amount of manual labor as well
as devotional exercises. Nine years later Cassiodorus, who had for
a long period been a sort of Secretary of State under Theodoric the
Great and his successors, became a monk, and, from that time to the
day of his death, “devoted all his energies to the service of God
and the advancement of science.” He secured a house not far from the
Benedictine monastery on Monte Cassino, gathered together there a
considerable library, and made it a rule of the place that the copying
of original codices (the majority of them theological) constituted
the most useful and honorable form of manual labor. A few years
later, this smaller establishment was made a part of the monastery at
Monte Cassino, and the rule just mentioned was thereafter adopted by
the enlarged institution. But the care of the sick, the feeble, and
children was the particular work which Benedictus, the founder of this
institution, had most at heart. Cassiodorus went even farther and urged
upon the brethren the desirability of studying the healing art and of
utilizing, for this purpose, the works of ancient medical authors.

   Learn all you can, he said, about the characteristics of
   different plants and about the methods of preparing medicinal
   mixtures, but set all your hopes upon the Lord who is the
   preserver of our lives. In your search for knowledge about
   drugs consult the herbarium of Dioscorides, who has described
   and pictured the different herbs with great accuracy. Afterward
   read Latin translations of the works written by Hippocrates and
   by Galen, particularly the latter’s treatise on therapeutics,
   the one which he addresses to the philosopher Glaucon; and, in
   addition, study the work of Caelius Aurelianus on the practice
   of medicine, that of Hippocrates on medicinal plants and methods
   of treatment, and some of the other writings on medicine which
   you will find in my library and which I have left behind me for
   the benefit of my brethren in this institution.

The advice given by Cassiodorus was heeded, not only by those to whom
it was addressed, but also by many succeeding generations of monks.
Even at the present time, says Neuburger, the books which Cassiodorus
recommended are still to be found, either in the form of original
manuscript copies or in that of translations, in the library of the
parent institution. Furthermore, when it is remembered how large a
number of affiliated Benedictine monasteries were established in
different parts of Europe, it will readily be appreciated that the good
accomplished by the advice which Cassiodorus gave must have been very
great.

Among the later abbots of Monte Cassino there were three who attained
considerable distinction as physicians. They were Bertharius, who wrote
two treatises on medical topics; Alphanus II., Archbishop of Salerno,
who was celebrated both as a physician and as a poet; and Desiderius
(1027–1087 A. D.), who was skilled, not only in medicine, but also in
jurisprudence, and who was elected Pope under the title of Victor III.
The monastery attained the height of its celebrity at the time when
Constantinus the African became one of its regular members. Although
Constantinus was a native Arab (born at Carthage about 1018 A. D.),
he became converted to Christianity quite early in life. It is said
that he was a great traveler as well as a great scholar, and that he
devoted several years to visiting foreign lands--Babylonia, India,
Egypt and Ethiopia. It was in this way that he became so well versed in
the languages of the East. Upon visiting Spain as a fugitive from his
native city, he took with him several of the works of Hippocrates and
Galen, and in course of time translated them into Latin. Finally, he
accepted the position of secretary to Robert Guiscard, the first Norman
Duke of Calabria and Apulia, who appears to have selected Salerno as
his place of residence. At the same time he became one of the teachers
at the medical school of that city, and served in this capacity for a
certain length of time; but, at the end of a few years, he was formally
accepted by the Abbot Desiderius as a member of the Monte Cassino
community, and it was here that he did the larger part of his literary
work. His death occurred in 1087 A. D., the same year in which the
Abbot Desiderius--or, rather, Pope Victor III.--died.

Constantinus was a prodigious worker, but it is doubtful whether he did
anything of an original character. Not a few of the treatises which
were, at that time, credited to him as original productions, are now
known--thanks largely to the researches of the great French historian
and linguist, Daremberg--to be simply translations from the Arabic.

It is believed by some authorities that at Monte Cassino medicine was
taught to laymen as well as to those who were preparing to become
members of the Benedictine Order of monks. It is not likely, however,
that this was done to any great extent, as much better facilities for
acquiring knowledge of medicine were available at Salerno in the near
neighborhood.

In some parts of Gaul, in the early Middle Ages, physicians received
very little consideration; indeed, to us moderns it seems strange
that any one should have possessed sufficient courage to accept
the responsibility of prescribing for a member of one of the royal
families. It is related by Neuburger, on the authority of Gregory of
Tours’ History of the Franks, that when Austrichildis, the wife of King
Guntram (sixth century A. D.), was ill with the plague and perceived
that her death was near at hand, she sent for her husband and extracted
from him a promise that he would behead the two physicians, Nicolaus
and Donatus, who had treated her and whose prescriptions had failed to
effect a cure. Her wish was carried out, in order--as the statement
reads--“that her Majesty might not enter the Realm of the Dead entirely
alone.” Many centuries later, however, when civilization had certainly
advanced far beyond the stage which it had reached in Gaul in the sixth
century of the present era, there were instances in which able and
conscientious physicians were subjected to equally cruel treatment for
their failure to effect a cure.

It was at about this same period, as is amply verified by the
statements made by Bishop Gregory of Tours, that faith in the power of
saintly relics to heal diseases became almost universal. So great was
the effect produced upon the minds of the people by the public display
of these objects--bones of saints, portions of their grave-stones,
etc.--that a large number of marvelous cures were reported as the
result of such displays; and doubtless--so great is the power of
suggestion over the human mind--many of these reports were true. A
century later (673–735 A. D.), the Venerable Bede, author of the famous
work entitled “Ecclesiastical History of the English Nation,” gave, in
the course of his narrative, an account of a case of aphasia in which
“a remarkable cure was effected”; and, although he mentions a course
of “systematic exercises in speaking” as the means used to effect that
cure, he attributes it to supernatural causes and not to the practical
treatment adopted. He also describes some of the epidemics of his time,
and gives most interesting though brief accounts of the methods of
treatment employed by the priests and the monks.

During the ninth and tenth centuries, as we learn from the very full
descriptions given by Neuburger in his History of Medicine, much zeal
was manifested by the monks at St. Gall in Switzerland, at Reichenau in
Saxony, and at Fulda, in Hesse Nassau, in the study of the different
branches of knowledge, medicine included. The following are the names
of those monks who attained the greatest distinction in this work:
Hrabanus Maurus, Abbot of the Fulda Monastery, afterward Archbishop
of Mayence, and the author of an encyclopaedia in which the science of
medicine receives quite full consideration; and Walahfrid Strabo, a
pupil of Maurus, Abbot of Reichenau, and the author of a treatise in
verse on medicinal plants.




                              CHAPTER XXI

       MEDICAL INSTRUCTION AT SALERNO, ITALY, IN THE MIDDLE AGES


The date of origin of the Medical School at Salerno is not known,
but such evidence as we possess shows without a doubt that already
in the earliest part of the Middle Ages some sort of facilities for
studying medicine were provided in that little town--the _Civitas
Hippocratica_, as it was called at a later period. It seems to
be the general impression, says Daremberg, that during those early
centuries only ignorance and superstition prevailed in Italy and Gaul;
in other words, that all desire for scientific research had vanished,
and that there no longer existed such a thing as the regular practice
of medicine. This impression, he adds, is erroneous. History shows
that schools modeled after those established by the Merovingian and
Carlovingian kings (448–639 A. D.), existed up to as recent a date as
the middle of the seventh century, and that subsequently the bishops
organized the teaching in such a manner that it should be entirely
under their control. As time went on, however, the schools assumed a
more public character, although the actual teaching was still carried
on in the cloisters and church edifices. It is well known, furthermore,
that the chief of the Ostrogoths, Visigoths and Lombards--the so-called
Barbarians, who at that time occupied these parts of Europe as
conquerors--showed themselves on many an occasion to be the enlightened
protectors of public instruction and the enthusiastic admirers of
classical literature and science.

   At Milan there is preserved a manuscript which furnishes
   satisfactory proof that the writings of Hippocrates and Galen
   were made the subject of public teaching at Ravenna toward
   the end of the eighth century of the present era.... And the
   transcribing of medical manuscripts was known to be carried
   on at the Monastery of St. Gall, in Switzerland, during the
   eighth century.... It is plain, therefore, that throughout
   those extensive regions which previously had formed a part of
   the Roman Empire, but which during the Middle Ages were under
   the dominion of Barbarian kings, there was never an entire lack
   of physicians, or of medical knowledge, or of facilities for
   teaching medicine. (Daremberg.)

In the light of these statements it is easy to believe that the
original development of the Medical School at Salerno was a perfectly
natural event like that of the founding of any of the medical
schools of a more recent date. The remarkably healthy and singularly
attractive character of the spot where the town of Salerno is located;
the proximity of mineral springs; the comparatively short distance
which separated it from such important centres of population as
Naples and the cities of the Island of Sicily, and from the famous
Benedictine Monasteries at La Cava, Beneventum and Monte Cassino; and
the circumstance that a Ducal Court was established there--all these
are facts which amply explain both why a medical school was founded
here rather than at some other spot, and why physicians of exceptional
ability were easily induced to make the place their home. At no time
in the history of the school, it is important to state, do the church
authorities appear to have been in control of its affairs. At most,
one or two of the monks seem to have taken part in the teaching for
limited periods of time; but in its main characteristics the school
may truthfully be described as an institution created and managed
by physicians for the advancement of medical science and the best
interests of the profession as a whole.[52]

The organization of hospitals and their utilization for purposes of
clinical instruction must have been the most important events which
followed next in order. It is only upon this assumption that we can
satisfactorily explain why, for many years in succession, physicians
traveled all the way from France, Germany and England to Salerno. They
were eager to gain additional knowledge of medicine, and clinical
instruction afforded the only sure way of obtaining it; but instruction
of this kind was nowhere else to be obtained at that remote period, and
consequently men of this earnest and ambitious stamp were compelled to
make the long journey and to incur the expense and the risk incident to
such a trip. As a further evidence of the value which the physicians of
the later Middle Ages set upon the writings of the teachers at Salerno,
the fact deserves to be mentioned that, toward the end of the twelfth
century and all through the thirteenth and fourteenth centuries, these
works were frequently quoted.

But the ability and learning of the Salerno physicians were highly
appreciated by the public at large as well as by their confrères in
other lands; for many people of wealth and of high social standing
visited Salerno for the purpose of consulting them. Among the number
were Adalberon, Bishop of Verdun, France, who journeyed thither in 984
A. D., but failed to obtain the relief which he required; Desiderius,
the Abbot of Monte Cassino; Bohemund, the son of Duke Robert Guiscard;
and William the Conqueror, afterward King of England. The two last
named remained for some time in Salerno, in order to secure needed
treatment for the wounds which they had received in battle.

Toward the end of the tenth, or at the beginning of the eleventh,
century the teaching of medicine at Salerno began to assume the
character of regularly organized work. The names of the men and women
who conducted it--for there were women as well as men in the corps of
teachers--are mentioned in various contemporaneous documents which have
come down to our time. They are as follows: Petroncellus, Gariopuntus,
Alphanus, Bartholomaeus, Cophon, Trotula, John and Matthew Platearius,
Abella, Mercuriade, Costanza Calenda, Rebecca Guarna, Afflacius,
Maurus, Musandinus and many others. According to Puschmann, the list
of physicians who, during the existence of the Medical School at
Salerno,--a period of nearly one thousand years,--acted as teachers
in the institution, comprised no less than 340 names. The presence
of several women among the instructors of this school, and the great
esteem in which they were held by the men of that time, both for their
ability as practitioners and for the excellence of the treatises which
they wrote, furnish strong confirmation of the statement which Plato
makes in his work entitled “The Republic,” and which I have already
quoted in one of the earlier chapters, viz.: “For women have as
pronounced an aptitude as men for the profession of medicine.” And, if
further evidence of the correctness of Plato’s opinion were needed, the
success attained by women physicians during the past thirty or forty
years in the United States of America might be cited.

To the general statement made above I may with advantage add a few
details regarding both the individual physicians at Salerno and the
books which they wrote. During recent years, thanks to the researches
of Henschel, de Renzi and Piero Giacosa, our knowledge of these matters
has been greatly enlarged. In 1837 Henschel found, in the library
at Breslau, Germany, a manuscript collection of Salerno medical
treatises (“Compendium Salernitanum”) dating back as far as the latter
part of the twelfth century of the present era. De Renzi, working
in association with Daremberg and Baudry de Balzac, succeeded in
collecting from the different libraries of Italy quite a large number
of additional Salerno treatises, all of which have since been published
under the title “_Collectio Salernitana, ossia documenti inediti e
trattati di medicina appartenenti alla scuola medica Salernitana_”
(5 vols., Naples, 1852–1859). Finally, Piero Giacosa has added to this
stock of Salerno writings by the publication (Turin, 1901) of a work
which bears the title “_Magistri Salernitani nondum editi etc._”
Beside the treatises to be found in these three collections there is
one other which, according to Neuburger, contributed more than all the
others combined to the fame of the Medical School of Salerno. The title
of this extraordinary work is: “_Regimen sanitatis Salernitanum_.”

The Salernian writings, it appears, may readily be divided into two
groups--those of the earlier and those of the later epoch of this
famous school. The treatises which belong to the older epoch are
written in the degraded Latin of the Middle Ages, and seem to have
been composed entirely for didactic purposes. In the main they are
compilations of still earlier Graeco-Latin works, but here and there,
especially in the parts which relate to therapeutics, evidences of a
certain measure of originality are discoverable. The pathology adopted
shows a hodge-podge of the humoral doctrine and that of the Methodists.

The chief representative of this early epoch is Gariopontus (first
half of the eleventh century), whose treatise on special pathology
and therapeutics--entitled “_Passionarius_”--was very popular
for a long period of years. Next in order comes Petroncellus, whose
“_Practica_” calls for no special comment. Of the works of
Alphanus, John Platearius (the elder) and Cophon (the elder), we
possess only fragments. Trotula, who lived about 1059 A. D. and was
believed to be the wife of John Platearius I., attained greater
celebrity than any of those just mentioned. She was related to Roger
I., Count of Sicily, and was therefore probably of Norman extraction,
and she was considered by her contemporaries to be very learned
(“_sapiens matrona_”).[53] Her writings, which are quite numerous,
are frequently quoted by later authors, this being especially true of
her work on diseases of women. The four other women who took an active
and creditable part in the work of the Salerno Medical School also
wrote treatises on various subjects: Abella, on “Black Bile”, (written
in verse); Mercuriade, on “Pestilential Fever,” and also on “The
Treatment of Wounds”; and Rebecca Guarna, on “Fevers.” In the case of
Costanza Calenda, the daughter of the Dean of the medical school and
a woman remarkable for her wisdom as well as for her great beauty, no
record of the treatises which she wrote appears to have been preserved.

The later epoch of the literature created by the Medical School of
Salerno begins about the year 1100 of the present era, after the Latin
translations and compilations made by Constantinus the African had
taught the physicians who were then at the head of affairs something
about the medicine of the Arabs, and had, at the same time, through
the latter medium, brought to their attention afresh the teachings
and practice of the ancient Greeks.[54] Among the works of the latter
character--works which in their Latin dress proved most valuable to the
Salerno physicians--are the following: “The Aphorisms of Hippocrates”;
“Galen’s _Ars Parva_” (_Mikrotechne_); and the same author’s
“Commentaries on the Hippocratic Writings.”

John Afflacius, a monk who lived during the latter half of the eleventh
century of the present era, was one of the pupils of Constantinus. His
treatise “On Fevers,” according to Neuburger, contains ample evidence
of the author’s ability as a clinical observer.

Something still remains to be said concerning Bartholomaeus, Cophon
the Younger, John Platearius the Younger and Archimathaeus. They
have already been mentioned in the list of authors whose writings
contributed materially to the celebrity of the Medical School of
Salerno, and it is now only necessary to furnish a few particulars
with regard to their lives and the nature of the work which they
accomplished.

Bartholomaeus wrote a treatise (entitled “_Practica_”) on the
practice of medicine as taught by Hippocrates, Galen, Constantinus and
the Greek physicians. Its enduring popularity is evidenced by the facts
that it was translated at an early period into several languages and
that portions of its text are often quoted by later authors. The book
contains ample evidence that its author was a very close observer and
a physician who strove to make accurate diagnoses.

Cophon the Younger (about 1100 A. D.) was the author of two works: a
treatise on anatomy which bore the title “_Anatomia Porci_,” and
one on the practice of medicine (“_Practica_”). The ancients, it
is stated, selected a pig for purposes of anatomical study “because its
internal organs present a very close resemblance to those of the human
being.” Both books are written in a clear and simple style.

John Platearius the Younger was the author of a work on internal
medicine (“_Practica Brevis_”) and also of one on the subject of
urine (“_Regulae Urinarum_”).

Archimathaeus wrote and published three treatises: one on “Urines,”
another on practical medicine (“_Practica_”), and the third
on “The Demeanor which a Physician should Observe when he Visits a
Sick Person” (“_De Aventu Medici_”). The latter treatise, says
Neuburger, is “a mixture of piety, artlessness, and slyness; but it
furnishes a capital picture of the carefully regulated behavior of the
mediaeval physician at the patient’s bedside, of the manner in which he
conducted his examination of the case, and of his intercourse with the
household as well as with the sick person.”

In addition to the treatises referred to above,--treatises which are
known to have been written by the authors to whom I have credited
them,--the _Collectio Salernitana_ contains several of which the
authorship is not known. One of these, which bears the title “_De
Aegritudinum Curatione_,” is reputed to furnish a better account
of the special pathology and therapeutics taught at the Medical
School of Salerno during the height of its celebrity than is to be
found in any of the other treatises. In one part of the book--that,
namely, in which local affections are discussed--the anonymous author
gives in succession the opinions held by the seven leading teachers
of the school (Platearius II., Cophon II., Petronius, Afflacius,
Bartholomaeus, Ferrarius and Trotula) with regard to each one of a
certain number of local diseases; thus enabling the reader to obtain a
very fair idea of what was the condition of medical science at Salerno
during the twelfth century of the present era.

The famous didactic poem known as the “School of Salerno” (_Schola
Salernitana_) and also as the “Code of Health of the School of
Salerno” (_Regimen Sanitatis Salernitanum_), was composed
originally about 1100 A. D. It was clearly intended in the first
instance for the guidance of laymen in matters relating to diet, the
conservation of health and the prevention of disease; but from time to
time, as the years rolled on, there were added to it several sections
which changed materially the character of the poem. From a mere code of
health it became eventually a fairly complete cyclopaedia of medicine
in versified form; the number of the verses having increased fully
tenfold during this long period. The poem, in its latest state, is
arranged in ten principal sections, as follows: Hygiene (8 chapters);
materia medica (4 chapters); anatomy (4 chapters); physiology (9
chapters); etiology (3 chapters); significance of different signs (24
chapters); pathology (8 chapters); therapeutics (22 chapters); nosology
(20 chapters); and the practice of medicine as actually experienced (5
chapters).

The work has been translated into nearly every modern language, and,
according to an estimate which was made in 1857, there are in existence
no fewer than 240 different editions. The most recent of these is the
French translation made by Meaux Saint-Marc and published by him (2d
edition) in Paris in 1880. There are two English versions--that by
A. Croke (Oxford, 1830), and the more recent one by John Ordronaux
(Philadelphia, 1871).

Some authorities make the statement that the poem was written
originally for the guidance of Robert, the son of William the
Conqueror; but Neuburger says that the dedication of the work to this
prince is lacking in many of the original manuscript copies and that
in some instances the word “Francorum” is to be found in the place
of “Anglorum”; for which reason he believes that the introduction
of a dedication was made long after the poem had been written. It
will probably appear strange to most readers that the author of the
“_Regimen Sanitatis_” (or “_Flos Medicinae_,” as it was
sometimes called) should have written his text in the form of verse
rather than in that of prose. He himself states briefly, at the end
of the poem,[55] some of the reasons why he preferred to adopt this
course. Rhythm, he maintains, makes it easy to say a great deal in a
few words; besides which, it facilitates by its novelty the memorizing
of new facts, and also enables one quickly to recall to mind those
which have been learned at some previous time. His judgment seems
to have been entirely correct, for the book proved to be immensely
popular, and retained its popularity throughout an extraordinarily long
period of time. Furthermore, as already stated, it accomplished a great
deal toward enhancing the reputation of the Salerno School of Medicine.
When we consider how difficult it must have been in those days for
students of medicine to memorize facts which were stored in books that
were very costly and oftentimes not obtainable at any price, we cease
to wonder at the great popularity of this miniature cyclopaedia in
leonine verse.[56] Here were to be found, at one-fourth or one-tenth
the price of any similar book written in prose, all the essentials
(anatomy, physiology, pathology, etc.) required by the candidate for
medical honors; and if, perchance, he possessed a good memory, he
might, without a very great mental effort, transfer the entire poem to
his own private storehouse of facts.

A few extracts from this remarkable piece of medical literature are
given below, in the belief that many of our readers will find them of
interest.

            ORIGINAL TEXT             DR. JOHN ORDRONAUX’S TRANSLATION

    Si vis incolumen, si vis te     If thou to health and vigor wouldst
      vivere sanum,                    attain,
    Curas tolle graves, irasci      Shun weighty cares--all anger deem
      crede profanum,                profane,
    Parce mero, coenato parum;      From heavy suppers and much sit
      non tibi vanum                  wine abstain.
    Surgere post epulas; somnum     Nor trivial count it, after pompous
      fuge meridianum;                 fare,
    Ne mictum retine, ne comprime   To rise from table and to take the
      fortiter anum.                   air.
    Haec bene si serves, tu longo   Shun idle, noonday slumber, nor
      tempore vives.                   delay
                                    The urgent calls of Nature to obey.

    _Conditiones Necessariae Medico._     _Demeanor Necessary For the
                                              Physician._

    Clemens accedat medicus cum     Let doctors call in clothing fine
      vesta polita;                   arrayed,
    Luceat in digitis splendida     With sparkling jewels on their
      gemma suis.                     hands displayed;
    Si fieri valeat, quadrupes      And, if their means allow, let
      sibi sit pretiosus;             there be had,
    Ejus et ornatus splendidus      To ride, a showy, rich-attired pad.
      atque decens.
    Ornatu nitido conabere carior   For when well dressed and looking
      esse,                           over-nice,
    Splendidus ornatus plurima      You may presume to charge a higher
      dona dabit                      price,
    Viliter inductus munus sibi     Since patients always pay those
      vile parabit,                   doctors best,
    Nam pauper medicus vilia        Who make their calls in finest
      dona capit.                     clothing dressed,
                                    While such as go about in simple
                                      frieze,
                                    Must put up with the meanest grade
                                      of fees;
                                    For thus it is, poor doctors
                                      everywhere
                                    Get but the smallest pittance for
                                      their share.

At Salerno the anatomical demonstration made, apparently only once a
year, for the benefit of the students, consisted in exposing to view
the abdominal viscera of the pig and commenting upon the features
which distinguish them from the same organs in the human body. In the
“_Regimen Sanitatis_” only eight lines of text are devoted to
anatomy.

In section IV., which relates to physiology, the text is more
instructive and entertaining, but still--as compared with the splendid
work accomplished by Galen--extremely incomplete and superficial.

In the early part of the twelfth century, Nicolaus Praepositus[57]
composed, at the request of his colleagues in the school of Salerno,
an “Antidotarium”--that is, a collection of formulae for combining
together, in a single pharmaceutical preparation, various drugs, both
those commonly employed in that part of Europe and others which were
then known only to the Arabian physicians. This book of formulae,
containing as it did descriptions of the effects which might be
expected from the different preparations, and furnishing instructions
with regard to the proper mode of employing them, served its purpose
admirably, not only in Salerno but throughout Europe, at least
during the Middle Ages. All the pharmacopoeias of a later date were
based upon his “Antidotarium,” and indirectly upon the still earlier
celebrated treatises written by Matthew Platearius and bearing the
titles “_Glossae_” and “_Circa instans_” (also that of “_De
simplici medicina_”). The most remarkable item, however, which
is to be found in the Antidotarium is that in which mention is made
of the use of soporific sponges (“_spongia soporifera_”), for
anaesthetizing purposes by means of inhalations, in certain surgical
procedures. (Neuburger.) They were made by impregnating the sponges
thoroughly with the juices of narcotic plants (opium, hyoscyamus,
mandragora, lactuca, cicuta, etc.), drying them, and putting them aside
until they were actually needed. Then the sponge was saturated for
about an hour with hot water or steamed, after which it was applied
over the patient’s nostrils and held there until the inhalation of the
fumes had induced sleep.

Another Salernian treatise worth mentioning is that written by Peter
Musandinus, under the title “On Foods and Beverages suitable for
Persons affected with a Fever.” This writer, who was one of the
teachers at the school of Salerno about the middle of the twelfth
century, says that great attention was paid in his time to the
preparation of foods in such a manner as to tempt the appetite of
people who were ill. He speaks of a meat extract which is prepared
from the flesh of the chicken, and also recommends that a soup
made by boiling a fowl in rose water be given to patients who are
affected with diarrhoea. He even goes so far as to lay stress upon
the importance of serving food to a sick person in dishes which are
pleasing to the eye. Apropos of the subject of foods that are easily
digestible and therefore suitable for invalids I may mention how Meaux
Saint-Marc translates or interprets the line in the “Regimen Sanitatis
Salernitanum” which reads _O fluvialis anas, quanta dulcedine
manas!_ His version may be rendered into English thus:

“Oh wood-duck, how gently doth thy soft flesh glide over the internal
surface of the stomach!”

Toward the end of the twelfth century (1180 A. D.) there was published
at Salerno a work on surgery--the oldest treatise on this subject
that is known to have been written in Italy during the Middle Ages.
It is now called “Roger’s Practice of Surgery,” but originally it was
spoken of (in accordance with a custom quite common in those days) as
“_Post mundi fabricam_,” which are the first three words of the
text. This book is of a very practical character and is written in a
simple, straightforward style. While it contains the usual amount of
traditional knowledge about surgical matters, it gives at the same time
the results of the personal experience of Roger, of his teachers, and
of his associates. As published in the “_Collectio Salernitana_”
the work represents, not the treatise as it was originally written,
but a revision made by Rolando of Parma. It is divided into four
parts or books, the topics treated in which comprise most of those
usually discussed in works on surgery. Under the heading “Wounds of
the Intestine,” in Book III., there occurs this most remarkable piece
of advice, viz., “to insert into the intestinal canal a small tubular
piece of elder and then to stitch the raw edges of the bowel together
over it.”

Another treatise on surgery, entitled “_Chirurgia Jamati_,”
was published at Salerno before the end of the twelfth century. Its
authorship is attributed to Jamerius, and in many respects it resembles
closely the treatise of Roger.

The “_Regimen Sanitatis_” was not, it appears, the only treatise
on medicine which was published at that period in the form of a poem.
Gilles de Corbeil (Petrus Aegidius Corboliensis), who had received
his professional training at the school of Salerno and was afterward
appointed the personal physician of King Philip Augustus in Paris
(1180–1223 A. D.), wrote versified treatises on these two groups of
topics--“The pulse, the urine, and the beneficial characteristics of
composite remedies,” and “The signs and symptoms of the different
maladies.” Both of these treatises were received everywhere throughout
Europe with great favor and they maintained their popularity for a
period of over four centuries. A French translation (by C. Vieillard)
of the treatise on urology was published in Paris in 1903. An edition
of the “_De signis et symptomatibus aegritudinum_” was printed in
Leipzig in 1907. The following five lines are quoted by Neuburger; and
they certainly display the remarkable gift possessed by Aegidius for
condensing a large amount of information into a very small space:--


                        DE CONDITIONIBUS URINAE

    _Quale, quid, aut quid in hoc, quantum, quotiens, ubi, quando,_
    _Aetas, natura, sexus, labor, ira, diaeta,_
    _Cura, fames, motus, lavacrum, cibus, unctio, potus,_
    _Debent artifici certa ratione notari,_
    _Si cupit urinae judex consultus haberi._

To translate this into easily comprehensible English prose would
certainly require the employment of at least five times as many words.

Another physician who received a part of his training at Salerno and
who is mentioned by Neuburger as “The greatest eye surgeon of the
Middle Ages,” is Benevenutus Grapheus (twelfth century), a native of
Jerusalem, and probably of Jewish parentage. He wrote a practical
treatise (“_Practica oculorum_”) which had a wide circulation, and
which has been translated into Provençal, French and English.

Toward the end of the thirteenth century the famous Medical School
of Salerno began to show signs of decadence. Various circumstances
were responsible for this change. In the first place, its career of
great usefulness had already covered a period of about seven hundred
years, and--according to the law affecting all things human--its
time of decrepitude was already more than due. Then, in the next
place, vigorous rivals were beginning to appear in different parts
of Europe,--at Bologna, at Montpellier and at Paris,--and these new
schools must have attracted large numbers of students who otherwise
would have frequented the University of Salerno for the educational
facilities which they required. Commercialism--if such a term may be
employed to characterize the action of those who were not willing
to undergo the entire course of training required for obtaining the
full privileges belonging to a physician--may perhaps also be named
as one of the influences which contributed to the slow breaking up of
the school. That this force had already begun to exert some effect
upon the management of the institution may be inferred from the fact
that in 1140 A. D., Roger, King of Sicily and Naples, promulgated
the law that nobody would be permitted to practice medicine in his
kingdom until he should have satisfied the royal authorities that he
was properly qualified to undertake such practice. The establishment
of such a law surely indicated that the number of those who were
incompetent to assume the responsibilities of a practitioner of
medicine was alarmingly on the increase; and, after it had gone into
effect, many must have been deterred from choosing a medical career,
and perhaps others have been diverted to schools which were located
in countries where the laws were more lax. In 1240 A. D. the Roman
Emperor Frederic II., who was also King of Sicily, made it a law that
the course of medical studies at Salerno should cover a period of
five years. All these factors taken together would seem to have been
sufficient slowly to diminish the popularity of this celebrated school.
But to these there were added, in the latter half of the thirteenth
century,--if we may believe Puschmann,--two new factors, which exerted
a powerful influence in destroying all hope of further regeneration,
viz., the establishment of a university at Naples, in 1258 A. D., by
Manfred, King of Sicily, and the narrow and illiberal spirit in which
the Church, by this time in almost full control of the education at
Salerno, managed the medical school.

During the following four centuries the University of Salerno--for
during the thirteenth century it became a university in fact, if not
in name--retrograded steadily, until finally the French Government, on
November 29, 1811, officially put an end to its existence. The traveler
who to-day visits Salerno, in the hope of seeing some remains of the
oldest medical school in Europe, will find there only a collection of
squalid buildings which serve as dwellings for the poorer classes, a
dirty and uncomfortable inn, and shops of nearly the same dimensions
as those which once lined the narrow streets of Pompeii. As he gazes,
however, at the superb view presented by the Gulf of Salerno he may
readily, by an effort of the imagination, reconstruct the picture of
the famous “Hippocratic City” as it was when William the Conqueror and
other distinguished persons visited it nearly a thousand years ago.

Neuburger, in his review of the career of the Salerno Medical School,
sums up its contributions to the science of medicine in about these
terms: Those who taught at Salerno were the first physicians in the
Christian part of Western Europe who procured for medicine a home in
which scientific considerations alone prevailed, where the Church
exercised no control whatever, and where all the different branches of
the science were favored to an equal degree. They devoted their best
energies, by oral teaching and by their writings, to the single object
of communicating practical knowledge of the healing art to all who
desired to obtain it; and, by the admirable example of their own lives,
they furnished a high standard for the guidance of those who wished to
reflect honor upon the name of physician.




                             CHAPTER XXII

     EARLY EVIDENCES OF THE INFLUENCE OF THE RENAISSANCE UPON THE
                PROGRESS OF MEDICINE IN WESTERN EUROPE


In previous chapters we have seen how the Arabs, inspired with an
extraordinary zeal for acquiring knowledge of the different sciences,
devoted time and money freely, throughout a period of several
centuries, to the accomplishment of this purpose. They were fired
with ambition to become a great nation, and their studies of the
world’s history taught them that the ancient Greeks had accumulated
in their literature vast stores of the very knowledge which they were
so anxious to acquire. Accordingly all their energies were directed
toward converting these stores from the Greek into their own language,
the Arabic. This widespread eagerness of the nation, at a given period
of its history, to improve itself intellectually is spoken of as the
Arabic Renaissance, and, at the time which I am now about to consider,
the movement had practically come to a standstill. A short time,
however, before this occurred, the physicians of Italy and of the more
northerly countries of Western Europe began to show a similar desire
to add to their medical literature; and their first step, like that
of the Arabs four or five centuries earlier, was directed to the work
of translating Arabic medical treatises into debased Latin, which was
the language commonly employed by the learned during the Middle Ages.
The knowledge which they desired to acquire could not at that time be
obtained in any other way, for nobody was acquainted with the Greek
language, and, besides, Greek originals had not yet been brought into
Western Europe. These first evidences of the Renaissance in that part
of the world were not confined to physicians; they were to be found
in every walk of life. The development of the movement reminds one of
what takes place near the sea coast, where a period of heat and calm is
suddenly broken by the appearance of a few gentle puffs of wind, which
are quickly succeeded by the full force of a steady and refreshing
sea-breeze. In like manner feeble indications of the coming movement
appeared in Italy, France, Germany and even England, and these were
soon followed by unmistakable evidences that a genuine Renaissance of
widespread proportions had begun. It was as if a great awakening had
taken place among the nations which had for centuries lain dormant;
an awakening which was followed by a desire to lay aside the trivial
pursuits in which they had so far been engaged, and to attain those
results which were, later on, to excite the wonder and admiration
of the world. Such were, for example, the development of the art of
printing with movable types; the discovery of America; the production
of such clever painters, sculptors, engravers, workers in metal,
etc., as Michael Angelo, Raphael, Albrecht Dürer, Benvenuto Cellini,
Rembrandt, and literally scores of others of nearly equal merit; the
development of a Shakespeare, a Milton and a Dante in the field of
literature; the production of a Luther, a man who had the courage to
protest against evil practices which had crept into the Christian
church. And medicine, as I have already stated, felt the influence
of the approaching Renaissance, and responded to it by efforts which
had for their object the acquisition of such knowledge as might be
furnished by translations from Arabic treatises. Constantinus, the
African, of whom mention has been made on a previous page, seems to
have been the first person (toward the end of the eleventh century) who
did any work of this kind; but his associates in Salerno do not appear
to have valued these translations very highly, or else, perhaps, they
were not yet prepared to give serious consideration to works which were
new to them. In the twelfth century, as will now be seen, the attitude
of the physicians of Western Europe underwent a change.

The city of Toledo, in Spain, was richly stocked with the manuscript
treasures of Arabic literature at the time (1085 A. D.) when it fell
into the hands of the Christians. One of the earliest scholars to
engage in the work of translating these treasures into Latin was
Gerard of Cremona, in Lombardy, who lived during the twelfth century
(1114–1187 A. D.). He spent most of his lifetime in Toledo, “learning
and teaching, reading and translating.” (Neuburger.) Among the medical
works which he translated from the Arabic the most important are the
following: Several of the writings of Hippocrates and Galen; the
Breviarium of Serapion; several of the writings of Rhazes and of Isaac
Judaeus; the treatise on surgery by Abulcasis; the Canon of Avicenna,
etc. This stimulated many others to follow in the footsteps of Gerard
of Cremona; and thus, during the thirteenth century, a number of works
of importance were translated in addition to those already mentioned.
Such, for example, were the “Colliget” of Averroes by Bonacosa, a Jew
(1255) of Padua; the “_Teïssir_” of Avenzoar, and the “Dietetics”
of Maimonides by John of Capua, a Jewish convert to Christianity
(1262–1278); the “_De veribus cordis_” of Avicenna by Arnaldus
of Villanova (about 1282); the treatise “_De simplicibus_” of
Serapion the Younger, and the “_Liber servitoris_” of Abulcasis,
by Simon Januensis; and many others. This wave of keen interest in
the writings of Arabic physicians and in the Arabic versions of Greek
medical authors soon reached Languedoc in France, and then passed over
from there into Italy. For a long time the Salerno physicians resisted
its influence, but they finally yielded to it, as the leaders in the
schools of Bologna, Naples, Montpellier and Paris had already done.
It was at Palermo, in Sicily, however, that the movement received its
greatest impetus. Frederick II., at that time King of Sicily, and a
ruler who was most tolerant in religious matters, had at his Court an
entire staff of Arabic physicians, philosophers, astrologers and poets;
and, in addition, he kept a number of learned Christians and Jews
constantly busy translating Arabic works into Latin. The most widely
known member of the latter group was Michael Scotus (or Scottus),
who at one time had been a teacher in the Medical School of Salerno.
Among the books which he translated while he was at Palermo there were
several of Aristotle’s treatises, more particularly those which dealt
with psychological topics and with natural history. Frederick not
only did everything in his power to promote the work of translating,
he also took pains to distribute copies of the Latin versions, when
completed, among the universities of Western Europe. His son, Manfred,
who succeeded him on the throne, seems to have been almost as much
interested in the work as his father had been. It was from him, for
example, that the University of Paris received a set of the Aristotle
volumes in Latin. When Charles I., King of Naples (1265–1285 A. D.),
conquered Sicily he manifested considerable interest in continuing the
work of his predecessors, particularly as regards treatises relating
to medicine. Among the translators whom he employed for this work
was Farragut (in Arabic, Faradsch ben Salem), from Girgenti, a small
town on the south coast of Sicily, about sixty miles from Palermo. In
addition to several treatises of minor importance he translated into
Latin the colossal work of Rhazes--the “Continens.” Charles I. kept at
his Court not only expert translators, but also skilled illuminators;
and it was by them that the celebrated manuscript copy of this work
which is to-day in the _Bibliothèque Nationale_ at Paris, was
illustrated with miniatures, three of which are portraits of Farragut.
This particular copy of the “Continens” was completed in 1282 A. D.
Not a few of the translations made during this period, it should be
stated, are now very difficult to understand. In the first, place, the
Latin in which they are written is of the barbaric type (neo-Latin),
something quite different from that employed by Cicero, Tacitus and
other Roman authors of the classical period; and, in the next, it is
not infrequently evident that the translator himself did not clearly
apprehend the meaning of the original Arabic text. Despite all these
drawbacks, however, the placing of Latin versions of Arabic writings
within the reach of European physicians accomplished much good. Even
the imperfections to which reference has just been made probably
served to increase the eagerness of these men to gain access to the
real sources of Arabic learning--viz., the writings in the original
Greek. To anticipate a little, I may say here that this object was
not attained until after the lapse of about two more centuries--that
is, not until the scholars of Western Europe had learned to read the
Greek, and had also brought out from their hiding places in churches
and monasteries of the East the needed originals. At that period of the
world’s history centuries corresponded to decades as modern events are
recorded.

One may gain some idea of the extent to which these Latin translations
of Arabic original treatises and of Arabic versions of Greek medical
works influenced the physicians of Western Europe, by consulting one
of the important medical treatises of the fourteenth century--that,
for example, of Guy de Chauliac (written 1363 A. D.). Edouard Nicaise,
the accomplished editor of this and several other mediaeval medical
treatises, has printed in his preface Joubert’s table showing just how
often Guy quotes each one of about four score earlier authors, and from
this analysis it appears that Abulcasis was quoted 175 times, Aristotle
62 times, Avicenna 661 times, Galen 890 times, Haly Abbas 149 times,
Mesué 61 times, Hippocrates 120 times, and Rhazes 161 times; or, to
state the facts somewhat differently, the quotations from treatises
introduced into Western Europe by the Arabs represent, in the present
instance, 70 per cent of all the quotations (2279 of a total of 3243)
made by this author. Another equally strong piece of evidence is that
afforded by Vincent de Beauvais’ encyclopaedia,--a work published
in Paris toward the middle of the thirteenth century,--in which the
parts relating to medicine appear to have been taken very largely from
treatises written by Arabic authors. (See statement on page 270.) There
can therefore be no reasonable doubt that the Arabs played a most
important part in the renaissance of medical learning which began a
century or two earlier, which already in the thirteenth century had
made great progress, and which very soon--as time is reckoned in the
calendar of all important world movements--was to culminate in that
still greater renaissance called “modern medicine.”

During the later portion of the Middle Ages (thirteenth and fourteenth
centuries) there were four universities which possessed medical schools
of considerable importance--viz., those of Bologna and Padua in Italy,
and those of Montpellier and Paris in France. All of these seats of
learning, like the famous school at Salerno, developed so gradually
and from such modest beginnings that it is scarcely possible to assign
to any of them a date of origin. Medicine was taught at several other
places--as, for instance, at Oxford, England; at Naples, Vicenza,
Siena, Rome, Florence, Ferrara, Pisa and Pavia, in Italy; at Salamanca
and Lerida, in Spain; at Prague, in Bohemia; at Cologne, in Germany;
at Vienna, in Austria, etc. But the part which these smaller schools
played in the work of advancing our knowledge of medicine was certainly
of far less importance than that which fell to the lot of the four
institutions just mentioned.

The University of Montpellier, if not the oldest of the four schools
mentioned, was apparently the first to attain some degree of
celebrity. It is known, for example, that the Archbishop of Lyons,
who was suffering at the time from some malady which the physicians
of that city were not able to cure, visited Montpellier 1153 A. D.
in the belief that he might there obtain the desired relief. John of
Salisbury, who lived during the latter half of the twelfth century and
who was considered one of the greatest scholars of his time, declared
that those who wished to acquire a satisfactory knowledge of medicine,
found that Salerno and Montpellier were the only places where the
desired instruction might be obtained. Gilles de Corbeil (mentioned
in the last chapter), Von der Aue, and other eminent men of the same
period spoke in equally favorable terms of the merits of Montpellier.
The celebrated monk, Caesarius of Heisterbach, calls the university of
that city “the headquarters of medical wisdom”; but at the same time
he expresses regret that the physicians of that school not only do not
believe in miraculous cures, but speak of them ironically. It was one
of the characteristics of the institution that the teachers, both the
medical and the philosophical, were, at a very early period, allowed
great freedom of thought and speech; but, as time went on, this liberty
became very much curtailed. During the thirteenth and fourteenth
centuries there were, it appears, many Jews among the students at
Montpellier, not merely in the department of medicine, but also in the
other departments of the university.

The medical schools of Salerno and Montpellier seemed, at this early
period (thirteenth century), to possess more individuality than did the
similar organizations at Bologna, Padua and Paris; for limited periods
of time each of them in turn enjoyed a certain amount of fame by
reason of the fact that some teacher or writer of special distinction
happened then to be officially connected with the school. In other
words, it was the fame of the man and not of the school, that induced
students to visit Bologna or Padua, or Paris, during the thirteenth
and fourteenth centuries. At a somewhat later period (fifteenth
and sixteenth centuries) all three of these institutions stood out
prominently before the world as celebrated medical schools, with
distinctive characteristics. To be invited to occupy a chair in one of
these institutions conferred honorable distinction upon the incumbent
selected, and when I reach that period, farther on in this history,
I shall describe each one of the more important schools separately.
In dealing with the earlier epoch, however, it seems best to devote
our attention more particularly to individual physicians than to the
schools with which they may happen to be connected.

Among the physicians belonging to the latter half of the thirteenth and
the first quarter of the fourteenth century there is one whose proper
place in the history of medicine is by no means easy to determine, and
who yet played a part of no small importance. This man was Pietro
d’Abano, or Petrus Aponensis, who was born at Abano, a small village
near Padua, 1250 A. D. Very little is known about his early youth,
but from this little we are warranted in drawing the conclusion that
his father, a notary, must have taken great pains to afford him every
possible educational advantage. He gave his son, for example, the
opportunity of studying Greek in Constantinople,--a thing of rare
occurrence in those early days,--and allowed him to remain there until
he had so far mastered the language that he was able to translate the
“_Problemata_” of Aristotle from the original text. Then, upon his
return home from Constantinople, he was sent to Paris for the purpose
of perfecting his knowledge of philosophy, mathematics and medicine.
After this thorough training for his life work, Pietro d’Abano began
teaching philosophy in Padua, and almost immediately he gained such
success that people spoke of him as “the great Lombard.” However, like
most of the men of that time who became conspicuous through their
intellectual attainments, Pietro d’Abano was soon accused by the
Dominicans of being a heretic and of cultivating the magician’s art. He
was able to parry this blow by making a journey to Rome and obtaining
from Pope Boniface VIII. a decree of absolution. About the same
time he began writing his two great works--the “_Conciliator_”
and the “Commentaries on Aristotle’s _Problemata_.” He did not
begin to teach medicine at the University of Padua until 1306, when
he was already fifty-six years of age. But his lectures, reflecting
as they did the depth and extent of his learning and the keenness of
his powers of analysis, were a source of great astonishment to his
contemporaries. It is reported by Neuburger, for example, that Gentile
da Foligno, one of the most distinguished professors in the Medical
School of Padua, happening to pass near the auditorium while Pietro
d’Abano was delivering his lecture, listened for a short time and then
exclaimed: “_Salve o santo tempio_”--“Hail to this time which has
brought forth such wonders!” With the increase of Pietro’s fame came
also a decided increase in the bitterness of the persecution carried
on against him by his ecclesiastical foes, largely due perhaps to his
open and courageous defense of the Averroism which they so much hated.
There is very little doubt that he would have been burned at the stake
about this time if the friendly disposition of the Popes and the mighty
influence possessed by the city of Padua had not shielded him from this
danger. In 1314 the newly founded school of Treviso invited Pietro
d’Abano to occupy the Chair of Medicine and Physics, and he accepted;
but he was taken ill and died during the following year. Shortly before
the occurrence of this event he was placed on trial for heresy by the
Inquisition, and the proceedings were continued even after his death.
Indeed, according to one account of this famous trial, not only was
the charge sustained, but the prescribed penalty was inflicted either
upon the disinterred corpse or upon an effigy of the condemned man. One
century later, the city of Padua erected a permanent memorial in Pietro
d’Abano’s honor.

The principal work of this remarkable physician--viz., the
“_Conciliator differentiarium philosophorum et praecipue
medicorum_”--was first printed at Venice in 1471. (It is said to
be one of the earliest printed books known.) It was a most popular
treatise, as is shown by the fact that between the year last mentioned
and 1621 it passed through a number of editions. Of the other treatises
which he wrote--some seven or eight in all--it will be sufficient
to mention here that one alone to which reference has already been
made in the preceding account, viz., the work entitled “_Expositio
problematum Aristotelis_” (Mantua, 1475, and Paris, 1520).

At this early period in the history of the Padua Medical School there
were one or two other men who attained a considerable degree of
celebrity for the excellence of the work which they did, either as
authors or as class-room teachers. A brief account of one of these,
Aegidius Corboliensis, has already been given on a preceding page, and
it seems only fair that I should furnish here similar brief accounts of
some of the others--Gentile da Foligno, Massilio and Galeazzo de St.
Sophia, Giacomo and Giovanni de’ Dondi, and Giacomo della Torre, from
Forli, all of whom contributed greatly to the steadily increasing fame
of the Padua School of Medicine; but, under the conditions which govern
the preparation of this brief history, I must reluctantly pass over
these names in silence.




                             CHAPTER XXIII

      FURTHER PROGRESS OF MEDICINE AND SURGERY IN WESTERN EUROPE
     DURING THE THIRTEENTH, FOURTEENTH AND A PART OF THE FIFTEENTH
                               CENTURIES


Among the men who, during the thirteenth century, exerted more or
less influence upon the growth of medical knowledge there are three
who deserve to receive some consideration at our hands. They were not
physicians, but yet some of their writings deal with topics which
are closely related to the science of medicine. They are: Albert von
Bollstädt, a German who is generally known as Albertus Magnus, one of
the greatest scholastic philosophers of the Middle Ages; Vincent of
Beauvais (Vincentius Bellovacensis), a French Dominican monk, who was
reader to Louis IX., and who compiled a general encyclopaedia which
brought him great fame at that period; and Roger Bacon, an Englishman
who, by reason of the extraordinary extent of his knowledge and his
remarkable powers of observation, was given the name of “Doctor
mirabilis.”

_Albertus Magnus._--Albertus Magnus was born at Lauingen, Swabia,
in 1193 A. D., obtained his education in Italy (at the University of
Padua, during the latter part of his stay), joined the Order of the
Dominicans on arriving at the age of thirty, and afterwards, throughout
his long life, devoted himself largely to teaching, particularly at
Paris and Cologne. He was a prolific writer and his works, particularly
those which treat of topics belonging to the domain of natural history,
were greatly appreciated. The effect, however, which they produced
upon a certain class of readers was to persuade them that he was a
great magician. The chief distinction of his writings lies in the
fact that they contain a large number of original observations which
he made during the course of his journeys afoot through Germany in
the character of Provincial of the Dominican Order. This habit of
exercising entire independence in the use of his reasoning powers
was something quite rare in those days. His observations were
directed chiefly to matters belonging to the domains of zoölogy,
botany, climatology, mineralogy, chemistry and physics. The following
significant advice, says Neuburger, is attributed to him: “As regards
the doctrines which relate to questions of belief and of morality, it
is the part of wisdom to attach greater authority to Saint Augustine
than to the philosophers; in matters belonging to the domain of
medicine put your chief trust in Galen and in Hippocrates; in natural
history, however, your best guide is Aristotle.” Neuburger adds that,
throughout the writings of Albertus Magnus, there appear interesting
statements relating to anatomy, physiology, psychology, and the plants
and minerals which may be used for remedial purposes.

An edition of the writings of Albertus Magnus (21 folio volumes) was
published in Lyons by Petrus Jamy in 1651. The work was republished in
Paris in 1892 and following years.

_Vincent of Beauvais._--Vincent of Beauvais, France, a Dominican
monk who lived during the first half of the thirteenth century and
was the tutor of Louis the Ninth’s children, devoted the major part
of his time to literary work. He wrote many theological treatises
and also edited a large encyclopaedia in which information is
furnished regarding everything that was known at that time. Several
hundred authors aided him in compiling this work, which is entitled
“_Speculum Majus_.” It is arranged in three parts, one of which
(“_Speculum Naturale_”) consists of 33 books that are divided
into 3740 chapters; and quite a number of the divisions are devoted
to topics relating to medicine. The authors, from whose writings this
medical information has been abstracted, are Hippocrates, Aristotle,
Dioscorides, Haly Abbas, Rhazes, Avicenna and several others--not to
mention the Church Fathers and other encyclopaedic writers connected
with the Church. The first printed edition of this great work appeared
toward the end of the fifteenth century (1473–1475 A. D.); the last,
or one of the last, in 1624. Lack of space will not permit me to give
any details concerning the works of a somewhat similar character
which were prepared, about the same time, by the English Franciscan
monk Bartholomaeus of Glanvilla (1260); by the Dominican, Thomas of
Cantimpré (1204–1280 A. D.), a pupil of Albertus Magnus; and by others.

_Roger Bacon._--Roger Bacon was born about 1210 A. D. in
Ilchester, Somersetshire, England, and received his early training at
Oxford. When he was thirty years of age he went to Paris and, after
devoting himself assiduously for seven years to the study of various
branches of learning, he received the Doctor’s degree (1247). The
wish to acquire a thorough knowledge of whatever subject he undertook
to study constituted a prominent feature of his character. He was
fond of languages, but he had an even greater love for mathematics,
particularly in connection with astronomy, and for experimental work
in the department of chemistry. It is said that he expended a large
sum of money (£2000) upon these chemical investigations. He left
Paris in 1250, returned to England, and not long afterward joined the
Order of the Franciscans. Robert Grossetête, Bishop of Lincoln, and
the Franciscan monk Adam of Marisco--two men whom Neuburger describes
as theologians of a very liberal type--exercised a strong influence
upon Bacon at this period of his life. They confirmed him in the
belief that familiarity with the learned languages was an acquisition
greatly to be prized, and at the same time they gave him every
encouragement to pursue his researches in mathematics and in natural
history. For a certain length of time he was an instructor at Oxford,
but his views with regard to ecclesiastic and moral questions and
the discoveries which he made in physics (especially in optics) were
beyond the comprehension of his contemporaries, who did not hesitate to
pronounce them works of the Devil and to subject Bacon to all sorts of
punishments and deprivations. Fortunately for him and for the cause of
science the newly elected Pope, Clement IV. (1266), came to his rescue
in those dark days and granted him--under the promise of absolute
secrecy--permission to continue his researches without hindrance and to
perfect the plans which he had in mind for reforms of different kinds.
I cannot follow this pioneer of scientific research work, this man who
was several centuries ahead of the time in which he lived, through all
the vicissitudes of his interesting and extraordinarily fruitful life;
I may simply add that his death occurred about the year 1294; that
he left behind him many important treatises, only a small portion of
which have thus far been published,[58] and that from these alone one
is justified in classing Roger Bacon as one of the greatest thinkers
whom history has recorded. So far as is now known, he wrote very little
concerning medicine, and--strange to say--he seems to have attached
considerable importance to astrology; indeed, he went so far as to
blame the physicians of his day for their ignorance regarding this
science, “as a result of which they neglect the best part of medicine.”
In strange contrast with these views, which to-day we characterize as
foolishness, is Bacon’s famous dictum: “Experiment is a firmer and more
trustworthy basis of knowledge than argument”--a maxim which is the
guiding principle of modern medicine.

The Medical School of Bologna.--The Medical School of Bologna first
began to assume a certain degree of prominence in the early part of
the thirteenth century, under the teaching of Thaddeus Alderotti--also
frequently called Thaddeus of Florence.

_Thaddeus Alderotti._--Thaddeus Alderotti, who was born at
Florence, Italy, 1223 A. D., of humble parentage, began the study
of philosophy and medicine at Bologna only after he had reached
manhood; but he was such an earnest student and made such good use of
his opportunities that in 1260 he was chosen to serve as one of the
teachers in the school. Throughout a period of many years he filled
the office so acceptably that his colleagues bestowed upon him the
name of “Master of Physicians.” Before this time arrived, however,
his lack of funds was sorely felt, for he was obliged, in order to
support himself, to offer consecrated wax candles for sale at the
entrance of the church. He is reported to have been not merely a most
learned physician, but also a very successful practitioner. He was
called into consultation from all parts of the country, so highly
was his opinion valued by other physicians; and thus in due time he
accumulated a large fortune. His charges were by no means small. It is
related, for example, that Pope Honorius IV. sent for him to come to
Rome, and, after the treatment was completed, paid him a fee of 10,000
gold pieces[59]--but not until after he had expressed surprise that
Thaddeus should have charged as much as 100 gold pieces per day for his
services. To this demurrer on the part of the Pope, Thaddeus replied
that the petty princes and even the simple nobles made no objection to
paying him 50 or more gold pieces per day. It is scarcely necessary to
add that the Holy Father did not wish to be outdone by his inferiors.

Alderotti died 1303 A. D.

Among the writings of Thaddeus Alderotti which have come down to our
time there are to be found a number of autobiographical references
which are not without interest. In one place, for example, he mentions
the fact that he occasionally walks in his sleep, and then proceeds
(in Latin) to discuss the phenomenon of sleep-walking as observed in
his own case. I give here a free translation of the text printed in
Neuburger’s History:--

   The fourth question which suggests itself is this: Can the
   senses during sleep come into active operation? Touching this
   fourth question I reason thus: It appears as if, when one
   is asleep, the senses must act, for a person may move about
   without incurring any harm when he is in that state, as is
   often observed in the case of those who, like myself, walk in
   their sleep.... Furthermore, it has been remarked that these
   people are able to harness a horse and then to ride the animal
   safely,--acts which it is not possible to perform without the
   aid of the senses. On the other hand, Aristotle maintains that
   a man, when asleep, is not capable of using his senses. To this
   I reply by conceding that during sleep a man certainly does not
   perceive what is going on about him. Wherefore, if you answer me
   by saying that the mere fact of a man’s ability to walk while
   he is asleep furnishes conclusive evidence that he possesses
   his senses, I reply that movements like that of walking are not
   the result of an impression made upon the mind (“_impressio
   imaginativa_”), but the product of a different mechanism, of
   a nature which permits it to operate during sleep.... As to the
   second point to which you call attention--that, namely, with
   regard to the power of bridling and riding a horse while one is
   asleep--I make this reply: These acts are performed as a result
   of an impression made upon the mind through the working of the
   imagination, and not as a direct consequence of any images
   created upon the eye; for, if the sleep-walker happens to be in
   a strange house when the impulse to walk seizes him, he will not
   go to the stable. The route which he is sure to take will be one
   with which he is familiar, as happened in the case of the blind
   teacher who, unaccompanied by any person, walked habitually
   through the streets of Bologna. And then, besides, I am able to
   speak from personal experience, for in one of my sleep walks I
   jumped down from an elevation about four feet above the ground
   without awaking from my sleep.... When, in the course of one
   of these walks, I am exposed to cold, or when I hear somebody
   speaking near me, I refer these phenomena entirely to something
   within myself, and I return to my bed.

Of the four medical schools to which a brief reference was made on a
preceding page, that of Bologna was probably the first to attain a
certain degree of celebrity; and it owed this distinction very largely
to the work done by men who were primarily surgeons, viz.: Hugo of
Lucca; Theodoric, Hugo’s son; William of Saliceto; and possibly, to
a very slight extent, Roland of Parma, who spent only a part of his
professional life in Bologna. But there was one other who, while he was
not a surgeon, yet contributed very greatly to the fame of the Bologna
school and at the same time to the real advance in surgical knowledge
which characterized the work of the men whose names have just been
mentioned--viz., Mondino. These men, especially Mondino, cultivated
the study of anatomy much more earnestly than their rivals at Salerno
had ever done, and the surgical methods which they adopted were of
a more scientific character than those practiced by Roger. In the
treatment of wounds, for example, instead of striving to bring about
healing by the application of remedies which stimulate suppuration,
they favored the dry method; in which practice they were justified
not only by their own experience but also by Galen’s teaching: “A dry
state of the wound approaches more nearly to what may be considered
the normal condition, whereas a moist state is surely unhealthy.”
(_Methodi medend._, IV., 5.) As an offset to the latter authority
the Salerno surgeons quoted that particular aphorism of Hippocrates
(V., 67) which reads: “_Laxa bona, cruda vero mala._”--almost the
very opposite of Galen’s doctrine. Then again, the Bologna surgeons
effected improvements in other directions: They materially restricted
the use of the red-hot cautery iron, and they cast aside as useless
many of the complicated apparatuses which had previously been employed
in the treatment of fractures and dislocations. It is evident from
these facts that the Bologna surgeons were not, as were most of the
physicians of the twelfth and thirteenth centuries (Thaddeus of
Florence perhaps excepted), slavish followers of the ancients or even
of the more modern Arabs, but men who thought independently and who
were not afraid to use their own powers of observation.

_Hugo of Lucca._--Hugo Borgognoni, more commonly called Hugo of
Lucca--was born in that city about the middle of the twelfth century,
served as municipal physician to the city of Bologna, accompanied
the Bolognese Crusaders on their expedition to Syria and Egypt, was
present at the siege of Damietta in 1219 A. D., and died a short time
before 1258, at the age of nearly one hundred. He acquired a great
reputation as a surgeon and brought up several sons who followed in
the same walk of life, among the number being Theodoric, who gained
even greater celebrity than his father in the domain of surgery. As
Hugo himself left no writings of any kind, we are largely dependent,
for a knowledge of his achievements, on the treatises which his son
Theodoric wrote. From this source we learn that Hugo recommended, for
use in surgical operations, the employment of narcotizing sponges like
those described on page 253, and was also an advocate of the plan of
treating wounds by the dry method (compresses soaked in wine over
which simple dressings were applied). In the treatment of empyema, of
abscesses, of penetrating wounds of the chest, and of both complicated
and simple wounds of the skull, he emphasized the wisdom of adopting
simple measures, of interfering with the parts as little as possible,
of abstaining from the use of the probe, and of observing strict
cleanliness. In cases of fracture of a rib it was his practice to
place the patient in a bath, and then, with fingers which had been
thoroughly oiled, to attempt the replacement of the separated ends of
the fractured bone. Neuburger regards Hugo of Lucca as the founder of
the Bologna School of Surgery.

_Theodoric of Lucca_, known also as Bishop Theodoric, was born
1206 A. D. While still quite a young man he joined the recently
established order of preachers, and not long afterward was appointed
Almoner (_Poenitentiarius_)[60] to Pope Innocent IV. Eventually
he became Bishop of Cervia, near Ravenna. By special permission of
the Pope, he was able to complete the surgical training which he had
received from his father, Hugo of Lucca; and thus, while he still held
the office of Bishop, he practiced surgery to some extent in Bologna.
In course of time his practice became very extensive and also very
lucrative; as a result of which he was able to leave a large fortune to
various charitable institutions. The first printed edition of his work
on surgery appeared in Venice in 1498, and was followed by numerous
later issues.

Theodoric, says Neuburger, was a most uncompromising advocate of the
dry method of treating wounds. His (Theodoric’s) words are these: “For
it is not necessary--as Roger and Roland have said, as most of their
disciples teach, and as almost all modern surgeons practice--to favor
the generation of pus in wounds. This doctrine is a very great error.
To follow such teaching is simply to put an obstacle in the way of
nature’s efforts, to prolong the diseased action, and to prohibit the
agglutination and final consolidation of the wound.”[61]

In his enumeration of the different means that may be employed for
arresting hemorrhage, Theodoric mentions cauterization, tamponading,
the application of a ligature, and the complete division of the injured
blood-vessel. He attached great importance to the proper feeding of the
patient. In Book III., chapter 49, of his treatise on surgery, he gives
minute instructions with regard to the proper manner of employing a
salve made with quicksilver, and at the same time he mentions the fact
that he observed a flow of saliva as one of the results of its use.

The expressions “healing by first intention” and “healing by second
intention” are encountered for the first time in the writings of
Brunus, a surgeon who practiced in the cities of Verona and Padua about
the middle of the thirteenth century, and who was a vigorous advocate
of the dry method of treating wounds. His two treatises (“_Chirurgia
magna_” and “_Chirurgia minor_”) were printed in Venice in
1546. Neuburger says that although a large part of the text in these
volumes consists of extracts from Galen, Avicenna, Hippocrates,
Abulcasis and other authorities, there are to be found at the same time
not a few observations of an original character.

_William of Saliceto._--William of Saliceto (_Guglielmo da
Saliceto_) is accorded by Neuburger the honor of being Bologna’s
greatest surgeon--if not, indeed, the greatest surgeon of that period.
He was born in the early part of the thirteenth century and spent a
large portion of his professional life in Bologna, where he not only
practiced medicine but also acted in the capacity of a teacher of this
science. During the latter part of his career he lived in Verona, where
he held the position of Municipal Physician and Attending Physician of
the City Hospital. He died about the year 1280.

Saliceto’s work on surgery is of a thoroughly practical character and
reveals the author to have been a born surgeon.[62] In addition to the
“_Cyrurgia_,” which was first printed in Piacenza 1476 A. D., he
wrote a treatise which bears the title “_Summa conservationis et
curationis_” (printed first in Piacenza in 1475). The “Surgery”
is divided into five books, preceded by a short chapter on general
methods, etc. Book I. is devoted to affections of the cranium,
eruptions on the head, eye diseases, ear diseases (snaring of ear
polypi), nasal polypi, abscesses in the axilla, affections of the
mammary gland, tumors in different parts of the body, venereal lesions
in the groin, and a long list of other surgical maladies. Book II.
describes wounds of all sorts, including those produced by arrows
(with reports of cases), penetrating wounds of the chest and abdomen
(with instructions about sewing both longitudinal and transverse
wounds of the intestine), etc. Under the head of penetrating wounds
of nerves (declared by the author to be very dangerous), Saliceto
recommends enlargement of the wound, the application of oil, and
the employment of opium or hyoscyamus to quiet the pain. Book III.
treats the subject of fractures and dislocations in a most thorough
manner. Mention is made of the crepitation noise heard in fractures
(_sonitus ossis fracti_) and a warning is given not to apply
the bandages too tightly and to be careful to change the dressings
every three or four days. The instructions given with regard to the
reduction of dislocations are said by Neuburger to be most sensible.
Book IV. contains such anatomical descriptions as may be helpful to
the practical surgeon. From these, however, it is evident that the
writer had never dissected the human cadaver. Book V. is devoted to
the subject of cauterizing and to the consideration of those remedial
agents which are commonly employed in surgery. The instruments used
for cauterizing purposes were made of different metals, gold or silver
being preferred for the more delicate ones, and brass and iron for the
others. Immediately after the cauterization it was customary to apply
butter, or the fat of some animal, or oil scented with roses, to the
burned part.

Saliceto’s other treatise--the _Summa conservationis etc._--is
also divided into five books, which contain chapters devoted to all
the more important branches of internal medicine and to questions
of diet, of the physician’s behavior in the presence of a patient,
etc. Especially interesting are his remarks about the importance of
considering the psychological effect produced upon the patient by
such matters as the physician’s manner of feeling the pulse, his
carefulness to inquire about the patient’s various symptoms (how the
night was passed, what food and drink had been taken, etc.)--an effect
which oftentimes is “greater than that produced by instruments and
medicines.” In discussing the subject of prognosis, Saliceto makes the
remark that it is always proper for the physician to hold out to the
patient hope of recovery, although he urges at the same time the wisdom
of telling the whole truth to the friends of the patient. He also lays
great stress upon the importance of “not holding any conversation with
the lady of the house upon confidential matters.” Neuburger gives a
number of other extracts from this most interesting work; but I must
abstain from devoting any more space to this one mediaeval author,
whose manner of writing makes it difficult to realize that the treatise
which he has written belongs to the thirteenth century and not to a
very recent period.

_Roland of Parma._--Roland, who was born in the city of Parma
and who spent a part of his life in Bologna, not only edited the work
of his teacher, Roger of Salerno, but also wrote a concise treatise
on surgery that is entitled “_Rolandina_.” Neuburger speaks
of this book as differing but little from Roger’s “_Practica
chirurgiae_.”[63] “It contains, however, the report of a case of
penetrating wound of the chest in which Roland showed not a little
courage by daring to cut off, flush with the skin, a portion of lung
tissue which happened to protrude from the wound, and then applying a
simple dressing.”

The treatise known by the title “_Glossulae quatuor magistrorum super
chirurgiam Rogerii et Rolandi_” was written by an unknown author or
perhaps by several authors. It represents a collection of commentaries
on the works of the two who are mentioned in the title of the book, and
should probably be classed as a part of the literature of the Salerno
School of Medicine.

_Mondino the Anatomist._--Mondino, who was the first physician,
after an interval of about fifteen hundred years, to revive the
practice of dissecting human bodies, was born at Bologna at about 1275
A. D. He received his professional training at the medical school of
his native city and was given the degree of Doctor in 1290, at the age
of fifteen(!). Not long afterward he began to teach anatomy in the same
institution and continued to serve in this capacity up to the time
of his death in 1326. The physicians who aided him in his anatomical
researches were Ottone Agenio Lustrulano, his prosector, and a woman
named Alessandra Gilliani, from Perriceto.

Mondino’s method of teaching anatomy was to deliver his lectures with
the dissected cadaver directly before him; that is, he demonstrated
the correctness of his statements as fast as he made them. (See Fig.
9.) Such a method was entirely new at the time and proved immensely
popular, attracting students to Bologna in large numbers. Partly in
this way and partly by means of the treatise on anatomy which he wrote
(“_Anatomia Mundini_”), he became the instructor of numerous
generations of physicians. His treatise remained the authoritative
guide in anatomy up to the middle of the sixteenth century.

  [Illustration: FIG. 9. THE OLDEST KNOWN PICTORIAL REPRESENTATION OF A
  FORMAL DISSECTION OF THE HUMAN BODY.

  The original, which is in the library of the University of
  Montpellier, France, appears in a manuscript copy of Guy de
  Chauliac’s _Chirurgia magna_ (fourteenth century). Eugen
  Holländer of Berlin, the author of _Die Medizin in der
  klassischen Malerei_, has courteously given permission to
  copy the reproduction. The many defects which appear in this
  picture are due to the fact that the reproduction was taken
  directly from the original miniature, now six hundred years old.
  Holländer gives the following description of this interesting
  scene:

  “In one of the rooms of the hospital a woman’s dead body is
  lying upon a table. Alongside the bed in which she died a nun
  is praying for her soul. Two physicians are busily engaged in
  the work of dissecting the body. An instructor is reading out
  of a book, for the benefit of the students who are crowding
  into the room, such portions of the text as apply to the case
  in hand, and at the same time he is directing their attention
  to the uterus which one of the dissectors is lifting out of the
  abdominal cavity. Owing to the defective state of the original
  miniature it is not possible to state positively what part the
  three women who stand near the head of the corpse are taking in
  the scene, but it is not unlikely that they too are physicians,
  especially as their presence on such an occasion would be quite
  in harmony with the customs of that period of time.”]

In one place in his “Anatomy” Mondino states explicitly that he
dissected two human cadavers in the month of January, 1315. This
statement renders it possible to fix the exact date when the
practice of making such dissections--which had been carried on for a
considerable period of time about 250 B. C.--was first resumed. If
one reflects upon the nature of the obstacles which in 1315 stood in
the way of a revival of this practice,--for example, the deep-seated
prejudice against it entertained by all classes of the community, and
the very strong opposition of the ecclesiastic authorities to what
they honestly believed to be a desecration of the human body,--one
will readily appreciate how great was the courage displayed by Mondino
when he almost openly undertook his first dissection. The subsequent
career of this famous teacher of anatomy justifies the belief that
his determination to take the course which he did was based upon
the profound conviction that the first step toward increasing the
scanty stock of knowledge possessed at that time with regard to the
structure of the human body in all its parts, must necessarily be one
in continuation of that which Erasistratus and his associates had taken
centuries earlier, but which had not been succeeded by a sufficient
number of other steps in the same direction. The series of discoveries
in anatomy, physiology and pathology which resulted from Mondino’s
courageous and intelligent act, form a part of the history of modern
medicine, and do not therefore call for consideration in this place. We
may simply add that much information of a very interesting character is
furnished by Neuburger (_op. cit._) with regard to the manner in
which Mondino and his immediate successors carried on their instruction
in anatomy from that time forward.

The Medical School at Bologna, as may well be imagined, gained great
fame from the possession of such distinguished teachers as those
whose careers I have briefly sketched--Hugo and Theodoric of Lucca,
William of Saliceto, and Mondino; and it retained a large part of this
celebrity throughout the fourteenth and fifteenth centuries, despite
the appearance on the scene, toward the end of this time, of several
formidable claimants for high honors in the domain of medical research
and education--viz., the schools at Montpellier and Paris, in France,
and that of Padua, in Italy.

_Lanfranchi and the Medical School of Paris._--According to
Edouard Nicaise[64] medicine was not taught publicly at Paris
previously to 1160 A. D. The teaching was carried on at that time
by associations of physicians, and it was only during the following
century (about 1250 A. D.) that something like a university was
established in that city. Up to the end of the sixteenth century (1595
A. D.), during the reign of Henry IV., this institution remained under
the control of the Church. Its functions--so far at least as medicine
was concerned--were limited to the bestowing of degrees, for it
possessed at that time no organization of instructors and no permanent
quarters in which the teaching might be carried on systematically; a
church (see Fig. 10) or the Dean’s residence serving as the locality in
which the lectures were commonly delivered.

During the middle part of the thirteenth century and for a long
time afterward, the practice of surgery, which was then of a rather
primitive type, was entirely in the hands of two classes of men--the
barbers and the so-called surgeons.[65] As time went on, the surgeons
began to feel the necessity of securing better protection for their
material interests, which were being more and more encroached upon by
the barbers--a class of men who were not privileged by the authorities
to include in their field of activities anything beyond hair-cutting,
shaving, cupping, the extraction of teeth, the application of
leeches, the incision of boils and perhaps one or two other simple
operations. For this reason, therefore, and also probably because
they too felt in some measure the effects of the Renaissance spirit
which was then abroad in the land, they organized themselves (1254
A. D.) into an association which bore the name of “College of Saint
Cosmas” (_Collège de St. Côme_).[66] One of the early acts of
this association was to establish the rule that all applicants for
membership should pass successfully an examination as to their fitness
before they could be admitted. Very little is known about the doings of
the organization during the early years of its existence. Later, as we
shall see, it played a very important part in the history of medicine
in France.

  [Illustration: FIG. 10. THE MANNER OF GIVING PUBLIC INSTRUCTION IN
  MEDICINE DURING THE MIDDLE AGES.

  (From Meaux Saint-Marc’s _L’École de Salerne_.)

  The present cut is evidently a modern copy of a much earlier
  original.]

From the account given by Nicaise it appears that no regular
instruction in anatomy was given in the University of Paris until after
the fourteenth century, and then only from three to five times a year,
when the body of a person who had been hung was publicly dissected.
“Such a dissection lasted seven days and was a veritable scientific
festival.” No official cliniques were held and the only way in which
the student of medicine could obtain some practical acquaintance with
disease and with the methods of treatment was by attaching himself to a
physician or a surgeon, or to a barber.

From the preceding brief and very incomplete account the reader will, I
trust, be able to form some idea of the condition of affairs, medical
and surgical, in Paris at the time when Lanfranchi arrived in that city.

Lanfranchi, says Neuburger, was born in Milan, Italy, and was
undoubtedly the most distinguished among the pupils of Saliceto at
Bologna. After leaving the medical school he practiced both medicine
and surgery for a certain length of time in his native city; but
finally, becoming involved in the quarrels between the Guelphs and
the Ghibellines, he--like many other Italian physicians--was obliged
to take refuge in France. In Lyons, which was his first place of
residence, he engaged for a short time in the practice of medicine and
also wrote his first treatise on surgery--“_Chirurgia Parva_.”
Then, after traveling from one place to another in the provinces, he
finally (1295 A. D.) settled permanently in Paris. In that city he very
soon acquired a large practice, and, at the same time, built up for
himself a great reputation as a teacher of medicine. The _Collège de
St. Côme_ elected him a member of that organization and profited
greatly from the fame which his teaching brought to the institution.
It is said that Jean Passavant, who was at that time the Dean of the
Medical Faculty of Paris, aided Lanfranchi in his work by every means
in his power. As a result Paris, during a considerable period of time,
was one of the few places in which genuine clinical instruction was
given to all those who desired to acquire a practical acquaintance
with disease. His larger treatise, the “_Chirurgia Magna_,” was
completed in 1296. It was dedicated to the King of France, Philip
IV., commonly called “_Phillippe le Bel_,” and its intrinsic
merits assured him a permanent reputation as a surgeon. This work,
which was translated years ago into English and has recently (1894)
been published by the “Early English Text Society,” under the title
“Lanfrank’s Science of Cirurgie,” consists of five separate fasciculi
or parts. A few extracts from the text of this celebrated work may
prove of interest to the reader. Not having access to the English
version just mentioned, I shall have to translate from the version
(partly Latin and partly German) supplied by Neuburger.

Part I. of the _Chirurgia Parva_ mentions some of the
characteristics which a surgeon should possess. He should, for example,
have well-formed hands, with fingers that are long and slender; his
body should be strong and firm in its movements; his hands and fingers
should respond quickly to the workings of the mind; his mind should
be of a subtle type; in character he should not be over-bold, but
self-reliant and yet modest; he should have a good supply of common
sense; he should be well-informed not only in medicine, but also in all
the branches of philosophy; he should be a good logician; he should be
familiar with the writings of medical authors; he should be virtuous
and ethical; he should be trustworthy; he should not be avaricious nor
envious; ... and, finally, he should be thoroughly familiar with all
the diseases to which the human body is liable. In one place Lanfranchi
refers to the fact that exposure to the air favors the production of
pus in a wound. Among the methods which may be employed for arresting
hemorrhage he mentions digital compression and ligaturing of the
bleeding vessels. He recommends that a wounded individual should
abstain from wine and from an over-nutritious diet. No attempt, he
says, should be made to extirpate, with the knife or by means of the
actual cautery, an ulcerated cancer, unless it appears probable that
by such means complete destruction of the tumor may be effected. In
traumatic tetanus dependent upon an injury of a tendon or nerve trunk
he recommends complete division of the wounded structure.

Part II. is devoted to the consideration of wounds of the different
parts of the body, taken in regular order from the head to the feet.
The descriptions, in each instance, are preceded by an adequate account
of the region affected. In his discussion of fractures of the skull he
speaks of the diagnostic value of the rough and jarring sound perceived
by the patient when the physician taps with a rod upon the injured
skull; and he also states that an aid to diagnosis may be derived from
the fact that a person whose skull is fractured experiences pain at the
seat of the injury when somebody passes the ends of his finger-nails
along a string which the patient holds suspended between his teeth.[67]
According to Neuburger the description which Lanfranchi gives of
the various symptoms observed in cases of fracture of the skull is
admirable. In the section relating to the treatment of such fractures
he warns against the tendency to resort too readily to the use of the
trephine, and expresses the belief that this instrument should be
employed only when the fractured bone is depressed or when there is
evidence of irritation of the dura mater.

Part III. deals with skin diseases and various forms of tumors,
including those of the thyroid gland; and with diseases of the eye,
the ear and the nasal cavities; with the various kinds of hernia; with
renal and cystic calculi; with hemorrhoids, varicose veins, etc.; with
abdominal dropsy; and with still other affections. In bloodletting he
recommends the practice of opening the vein longitudinally. He is very
emphatic in his manner of insisting that medicine and surgery should
not be divorced, and that the operation of drawing blood should not be
intrusted to barbers.

After the death or retirement of Lanfranchi during the first decade
of the fourteenth century, Paris appears to have played, at least for
a few years, a comparatively small part in the history of medical
teaching. Her rivals at Montpellier, in the south of France, and at
Bologna and Padua, in Italy, far outstripped her during this period.
There was one physician at Paris, however,--Henri de Mondeville,--who
would probably have proved a worthy successor of Lanfranchi if
circumstances had not seriously interfered with his acting the part of
a teacher.

_Henri de Mondeville._--Henri de Mondeville, says Edouard
Nicaise, was born about 1260 A. D. in Normandy. In his native
village--Mondeville or Mandeville, or Amondaville, all of which names
are found in the manuscripts--he was known simply as Henri, but in the
outside world and in medical literature he is mentioned, in accordance
with the prevailing custom of that period, as Henri de Mondeville.
After studying medicine for a certain length of time in Paris and
Montpellier, he went to Italy and became the pupil of Theodoric of
Bologna. He is said to have been passionately fond of surgery, which
at that period was, in France, a much despised branch of medicine. In
Italy, on the contrary, such men as William of Saliceto, Hugo of Lucca,
Theodoric and Lanfranchi had raised surgery to a position of great
honor, and Henri de Mondeville cherished the hope that he also might be
able to accomplish the same result in France. Upon his return to Paris
he was chosen one of the physicians (there were four in all) of the
royal household, and from that time onward he was frequently obliged to
set aside, for longer or shorter periods, all his personal interests
(private practice, lecturing to medical students, hospital service at
Hôtel-Dieu, etc.) in order to attend the King or the Comte de Valois
on some military expedition. This sort of service, however, was by no
means time lost, for it afforded him the opportunity to acquire great
experience in the treatment of wounds, an experience which reveals
itself on almost every page of his treatise on surgery. And yet there
came a time (1312) when de Mondeville complained bitterly of these
interruptions, for which he received no pay and which interfered
seriously with his literary work. Despite these hindrances, he appears
to have made a fair degree of progress in the writing of his book,
for at the date last named he gave a public reading of the first two
sections “before a large and noble assemblage of medical students and
other distinguished personages.” The portrait of de Mondeville which
is here reproduced is a copy of the miniature which appears in one of
the manuscripts of his treatise that was prepared 1314 A. D., and is
now preserved in the _Bibliothèque Nationale_ at Paris. Nicaise
furnishes the following details regarding the original miniature.

   Inasmuch as the MS. bears the date 1314 the portrait must have
   been painted while De Mondeville was still living. The master is
   represented wearing a violet-colored gown, red stockings, and a
   black skull-cap. He is thin, his beard is scanty and of a grey
   color like the hair of his head, his features are finely cut,
   and he appears to be a fairly tall man. So far as one may judge
   from this portrait De Mondeville’s age was then about fifty.

The date of his death is not known exactly, but it must have been
somewhere about 1320 A. D.

Nicaise sums up de Mondeville’s personal history and his contributions
to the science of medicine somewhat as follows: He was a man of
warm impulses, who loved the truth and despised all shams. He never
hesitated to speak his opinion about others, the King himself not being
excluded from his criticisms. He was also quite frank in his exposures
of the ignorance of both nobles and members of the clergy. He was not
in the least degree superstitious. He remained unmarried throughout
life and seems to have entertained a slight disposition to find fault
with women, for he attacks somewhat violently their mode of life and
their extravagance, especially in the case of the women of Montpellier.
Although he possessed a great reputation and a very large clientele of
patients, he did not acquire a fortune. He is quoted as saying: “I was
obliged from the very first to work hard for a living.” Suppuration,
according to the view of de Mondeville, was not a necessary phenomenon
in the healing of wounds.

  [Illustration: FIG. 11. HENRI DE MONDEVILLE.

  (From Nicaise’s Version, Paris, 1893.)

  From a miniature at the head of a manuscript which bears the
  date A. D. 1313, now preserved in the Bibliothèque Nationale at
  Paris.]

About the year 1316 the condition of de Mondeville’s health--he
probably had pulmonary tuberculosis--began to give him serious cause
for anxiety lest he might not live long enough to complete his book;
and, as a matter of fact, the treatise which we now possess shows
that his fears proved to be well grounded. The important subjects
of fractures, dislocations and hernia, for example, are mentioned
only casually. Those subjects, however, which he did discuss are
treated in a very clear and practical manner. Thus, for example, his
instructions with regard to the proper manner of treating wounds is
most satisfactory. Theodoric and he were the great champions of the
so-called dry treatment, which had been introduced at some remote
period of antiquity, but which apparently had not met with general
acceptance. Then, again, in his remarks on the subject of amputations,
he taught that the ligaturing of the severed arteries after the removal
of the amputated part, was universally recognized as the proper course
to adopt and should never be neglected.

In Chapter VII. of the first section of his treatise, de Mondeville
gives a description of the anatomy of the heart and related
blood-vessels, and at the same time furnishes an unusually clear
account of the physiology of the circulation which was universally
accepted by the physicians of that period, as it had already been
by those of earlier centuries. It seems desirable to reproduce this
account here in order that it may serve for purposes of comparison with
that which Harvey was to give three centuries later. It is only by
making such a comparison that the physicians of our time can appreciate
the vast importance which attaches to Harvey’s wonderful discovery. De
Mondeville’s account, abbreviated wherever it seemed practicable to do
this, reads as follows:--

   The heart is the most important of all the organs. It transmits
   to the other members of the body vitalizing blood, heat and
   spirit. Its muscular tissue, unlike ordinary muscle, is composed
   of three kinds of fibres, and it is not under the control of
   the will. It has the shape of a pineapple and is located in
   the centre of the chest, like a prince in the middle of his
   kingdom. Its lower extremity is directed somewhat to the left
   of the chest, as we are assured by the Philosopher (Aristotle)
   in his history of animals. There are two reasons why it points
   toward the left: 1., in order that it may not press upon the
   liver or be pressed upon by it; and 2., in order that it may not
   communicate its heat to the left side (the cool side) of that
   organ.

   It is important to note the fact that the heart is the only
   structure which contains blood in its substance; in all the
   other members of the body the blood is contained in the veins.
   The base of the heart is situated at its highest point and
   represents the broadest portion of the organ; it is attached to
   the posterior wall of the chest by a few ligaments, than which
   no stronger are to be found in any part of the body. These bands
   do not touch the heart at any point except at the top, where
   they take their origin; and their great strength is explained by
   the fact that it is their duty to hold the heart firmly in its
   proper position.

   The heart possesses two ventricles or cavities, of which the
   left one--by reason of the natural position of the organ as a
   whole--is a little higher than the right. Between these two
   cavities there is placed a partition which in its turn contains
   a small cavity--termed by some _the third ventricle_.
   Above each of the larger ventricles there is a sort of
   appendix--cartilaginous in structure, but flexible and at
   the same time strong,--which contains a cavity and has some
   resemblance to a cat’s ear. These structures, to which the
   common people have given the name _auricles_, alternately
   contract and dilate. The purpose for which they exist is to
   serve as reservoirs for the blood and air that are needed for
   the nourishment and cooling of the heart.

   To the right ventricle there comes a many-branched vein which
   conducts to the heart a coarse, thick and warm blood destined
   to nourish that organ. The portion of this abundant fluid which
   is not needed for this purpose is then rendered less coarse and
   thick by some subtle power possessed by the heart itself, after
   which it is driven into the cavity that is located within the
   partition wall which separates the ventricles the one from the
   other. From this smaller cavity, this so-called third ventricle,
   in which it receives additional heat and at the same time
   undergoes further thinning as well as some kind of digestion and
   purification, the blood passes on into the left ventricle and
   there undergoes a further change--one which is characterized by
   the development of that element which we call _spirit_,
   something clearer, more subtle, more pure, more glorious than
   any known substance in the human body, and therefore more nearly
   allied in its nature to celestial things. This new element
   forms a friendly and very appropriate link between the body and
   the soul; it is the direct agent or instrument of the latter,
   conveying to man the different faculties with which he may be
   endowed.

   From the left ventricle of the heart, alongside its auricle, two
   arteries are given off. One of them, which is only furnished
   with one tunic (as in the case of a vein) and which is called
   the _arteria venalis_ (pulmonary vein), carries to the
   lungs the blood which they require for their nourishment, and
   breaks up into many branches after entering these structures;
   the other artery is provided with two tunics and is called
   _the grand artery_ (the aorta). From the latter vessel
   are given off the numberless arteries which are distributed
   throughout the entire body--vessels which transport to every
   organ and structure both the blood which they need for their
   nourishment and the spirit required for their revivification.
   When this spirit passes into the ventricles of the brain it is
   subjected to a new species of digestion, which converts it into
   the _spirit of the soul_. Similarly, when it enters the
   liver it becomes _a nutritive spirit_; when it enters the
   testicles, _a generative spirit_, and so on through all the
   different organs.




                             CHAPTER XXIV

     DURING THE LATTER HALF OF THE MIDDLE AGES SURGERY ASSUMES THE
        MOST PROMINENT PLACE IN THE ADVANCE OF MEDICAL SCIENCE


During the first half of the fourteenth century, as has been shown
in the preceding chapter, Henri de Mondeville was largely successful
in rendering Paris the most prominent centre of medical activity in
France, if not in Western Europe generally. His life, however, was
short, and his position as one of the leading surgeons of the French
Army subjected him to many and prolonged interruptions, for which
reasons he was not able to complete his excellent treatise on surgery.
No physician of the same intellectual capacity and of equally strong
character appears to have been living in Paris at the time of De
Mondeville’s death, and consequently the importance of that city as a
centre of medical education diminished rapidly after that event. On
the other hand, the Medical School at Montpellier in the southern part
of France began at about this period, under the influence of Arnold of
Villanova (probably a small town in Catalonia, Spain, in the diocese of
Valencia), to acquire importance.

_Arnold of Villanova and the Medical School of
Montpellier._--Arnold of Villanova was born about 1240 A. D., of
humble parentage. He obtained his early education in a Dominican
cloister, and afterward devoted all his energies to the study of
languages (especially Hebrew), theology, philosophy, the natural
sciences (physics, alchemy), and medicine. Paris and Montpellier were
the principal cities in which he prosecuted those studies. Already as
early as the year 1270, Arnold had attained considerable celebrity
as a physician. Between the years 1289 and 1299 he appears to have
made his home in Montpellier, and to have been very actively engaged
both as a practicing physician and as a teacher of medicine. It was
in that city also that he wrote the more important of his numerous
medical treatises. At a later period of his life he appears largely
to have lost his interest in medicine, for in 1299 we find him acting
as an ambassador from the King of Aragon, whose private physician
he was, to the Court of Philippe le Bel, King of France, and deeply
entangled, during his stay in Paris, in disputes with the theologians
of that city respecting certain religious doctrines. He was also at
the same time busily engaged in championing various ecclesiastic
reforms which he was anxious to see inaugurated. His opponents haled
him before the tribunal of the Inquisition and succeeded in having him
cast into prison, where he remained until he expressed a willingness
to retract the obnoxious opinions which he had advanced. The same
tribunal pronounced his treatise “_De Adventu Antichristi_” to
be heretical. After these persecutions Arnold endeavored to procure
aid and comfort from Popes Boniface VIII. and Benedict XI. The former
was inclined in his favor, but Benedict manifested no disposition to
aid him. Boniface’s sentiments were doubtless influenced by the fact
that Arnold had treated him successfully for stone in the bladder; and
Neuburger incidentally states that, in the effecting of this cure,
not only medical and dietetic treatment had been employed, but also
two other measures--viz., the application of a bandage or truss which
encircled the loins snugly, and the wearing (by the patient) of a
magic seal ring upon which was engraved the effigy of a lion.[68] When
Pope Clement V. (1305–1315 A. D.) removed the papal seat from Rome
to Avignon, in France, Arnold was relieved from the charge of heresy
and reinstated in the respect of his contemporaries. He became the
trusted adviser of royalty, won the sympathy of Jayme II. and of his
brother, Frederic III., King of Sicily, for his broad-minded views
regarding religious matters, and was both hated and feared by his
enemies. According to trustworthy chronicles, Arnold of Villanova died
at sea in 1311, within sight of the coast of Genoa, while he was on a
voyage (probably from Sicily) to visit the Court of Clement V. In 1316
the Inquisition pronounced most of his philosophical and theological
writings heretical, and ordered them to be destroyed.

A complete collection of the medical writings of Arnold of Villanova,
so far at least as they were then known to exist, was printed at
Lyons, France, in 1586. It is said that many of the treatises which
this author wrote have been lost. Of those which have come down to our
time there are only three which call for any special comment--Arnold’s
“_Breviarium_,” a compendium of the practice of medicine; his
“_Commentary on the Regimen Salernitanum_,” the sales of which,
according to Neuburger, reached an enormous figure; and a work which
bears the title “_Parabolae medicationis secundum instinctum
veritatis aeternae, quae dicuntur a medicis regulae generales
curationis morborum_.” (Basel, 1560.) The latter treatise, which
might with propriety be given the simple title of “General Rules
regarding the Treatment of Diseases,” is dedicated (1300 A. D.) to
Philippe le Bel, King of France. It contains a number of chapters on
the principles of general pathology, and others on special pathology
and therapeutics, with relation both to internal diseases and to
those which particularly interest the surgeon. It also furnishes 345
aphorisms, many of which embody truths of the highest importance and
reveal the author to have been a man of independent judgment, of wide
experience, and of a philosophical type of mind.

In the “_Parabolae_” and the “_Breviarium_,” says Neuburger,
are to be found the most marked evidences of the knowledge and ability
which this great physician possessed. He then adds:--

   Arnold attached much importance to hygiene and the proper
   regulation of the diet as effective measures in preventing
   diseases, and he formulated an admirable set of rules for
   the ordering of one’s manner of living. In these he gives
   prominence to the value of baths, to the importance of taking
   a certain amount of physical exercise, and to the selection
   of the right kinds of food. He also describes in detail how
   wine may be utilized advantageously in cases of illness. As
   regards the choice of remedies to be employed he says that the
   physician should be guided by a very careful consideration
   of the patient’s age, temperament, habits of living, etc.;
   and, so long as there remains any doubt about the correctness
   of the diagnosis, he should employ only mild and indifferent
   remedies. The greatest care, he adds, should be exercised in the
   preparation of the drugs that are to be administered, and one
   should be very cautious about prescribing substances which have
   not been sufficiently tried.

Arnold’s writings are full of precepts which, like those quoted above,
show him to have been an excellent practitioner of medicine as well as
a man of sound common sense. And yet at the same time he appears to
have been more or less tainted with the prevailing belief in astrology,
in the efficacy of amulets (as in the case of Pope Boniface referred
to on a previous page), etc. His enemies gave him the reputation
of being a sorcerer upon whom the Devil had bestowed the power of
transmuting metals,--a reputation which undoubtedly was based upon the
fact that Arnold interested himself greatly in alchemistic processes,
often referring to them as closely resembling such organic phenomena
as generation, birth, growth, etc. But, in our judgment of the man,
we should be careful to remember that during the thirteenth century a
belief in alchemy, astrology, the efficacy of amulets, the influence
of supernatural agencies, etc., was almost universal. Even theologians
maintained that it was a sin for a practitioner of medicine to neglect
the influence of certain constellations. Indeed, there are even to-day,
not a few very sensible people in whose minds exists a lingering belief
in the interference of supernatural agencies in human affairs.

The importance of the influence which Arnold of Villanova exerted upon
the progress of medical science, and more especially upon the fame of
the Medical School of Montpellier, should not be estimated exclusively
from the value of his writings nor from the character of the work
which he performed as an instructor in that school. In the thirteenth
and fourteenth centuries physicians as a class did not hold so high
a position socially in Western Europe as they were probably entitled
to hold, and consequently Arnold’s later career, in which he showed
himself to be a wise, broad-minded, and very able statesman and as
an enthusiastic champion of greater liberty of thought in the domain
of religion, must be looked upon as having aided very materially in
raising the profession of medicine to a higher rank and in adding éclat
to the School of Montpellier.

_Contemporaries and Successors of Arnold of Villanova at
Montpellier._--During Arnold’s lifetime there does not appear to
have been another physician at Montpellier who could be compared with
him in professional ability or in general culture. There was one,
however, who attained considerable fame as a medical author, and who
certainly deserves at least a brief notice in this place--Bernard de
Gourdon, also known as Gordonius.

Bernard de Gourdon[69] began teaching medicine in Montpellier in 1285
A. D. He was the author of a treatise which bore the title “_Lilium
Medicinae_,” and which enjoyed an unusual degree of popularity for
a long period of time. The earliest printed edition appeared in Lyons
in 1474 and was followed by several others in 1491, 1550, 1559 and
1574. One of the latest editions is that of Frankfort, 1617. The book
was also translated into both French and Spanish. In his description
of the seven parts into which the book is divided, the author says, by
way of praising his own work: “In the lily there are many different
kinds of blossoms and in each one of these there are seven grains of a
golden character.” The book treats of fevers, poisonings, abscesses,
tumors, wounds and ulcers, of diseases of the liver, spleen, kidneys
and bladder, of affections of the eyes, and of numerous other topics.
The work as a whole, says Neuburger, lacks depth and thoroughness,
and reveals the author to be overfond of employing drugs, especially
in combination, and by no means free from a belief in the efficacy of
amulets and other supernatural remedies. It contains, however, one
or two references to matters of historical interest. For example, in
Chapter V., Part III., mention is made of spectacles. So far as now
appears, this is the first time that these useful contrivances are
referred to in medical literature; and the casual manner in which the
author speaks of them suggests the idea that they had already been
known for some time. Possibly Roger Bacon, who interested himself in
researches in the department of optics and who was a contemporary
of Gordonius, may have had something to do with the invention of
spectacles.

At the ceremony of the marriage of the Duchess Juta of Austria to
Count Louis of Oettingen, at Vienna in 1319, Pietro Buonaparte, the
Podesta of Padua, created considerable excitement by wearing a pair of
spectacles which he had received a short time previously from Salvino
degli Armati of Florence, the reputed inventor of these contrivances.
It is not generally known that the printing of books in very large
and bold type during the latter part of the fifteenth and the early
part of the sixteenth centuries was done expressly for the benefit of
far-sighted readers--this defect in vision characterizing a very large
percentage of the learned men of that period. The great number of books
which, during those early days of the art of printing, were published
in this style, emphasizes the fact that the usefulness of spectacles
was not generally appreciated until after the lapse of many scores of
years. Being very expensive they were within the reach of only persons
of wealth, and, in addition, they were extremely difficult to obtain.
As late as during the year 1572, Augustus, Elector of Saxony, moved by
a strong wish to possess a pair of spectacles, despatched a special
messenger first to Leipzig and then to Augsburg with instructions to
purchase them for him at the great annual fair. This agent, however,
was unsuccessful in the attempt, and, accordingly, in the summer of
1574, he was instructed to ride on as far as Venice. But, on arriving
there, he was informed that no glasses would be ground before the
month of October. He was consequently obliged to remain in that city
until the autumn, at which time he sent word to his master that the
optician’s charge for the instrument would be 50 thalers (equivalent to
$250 at the present value of money). The Elector, it appears, was only
too glad to pay this sum for the coveted article. The first spectacles
made were equipped with only convex glasses, for the use of far-sighted
persons. It was not until about two hundred years later that the art of
grinding concave glasses for the relief of short-sighted individuals
was discovered.

_Guy de Chauliac._--After the lapse of a few years there appeared
a man who was destined to add greatly to the fame of the Medical
School of Montpellier--not in the way in which Arnold of Villanova
had accomplished this result, but by the publication of the first
systematic treatise on surgery which was written in Western Europe
during the Middle Ages. This man was Guy de Chauliac, about whose early
life very little is known. He was born in the village of Chauliac, in
Auvergne, France, toward the end of the thirteenth century, his parents
being simple peasants; and during early boyhood he probably attended
the school connected with the village church. His medical studies were
begun at Toulouse and completed at Montpellier. But, at some time later
than 1326, he went to Bologna and perfected his knowledge of anatomy
under the guidance of Bertrucius, Mondino’s successor. After leaving
Bologna Guy visited Paris, arriving there subsequently to the deaths
of Lanfranchi, Pitard and Henri de Mondeville. Although he remained in
that great city only a short time, he appears to have formed a warm
friendship with several of the instructors in the medical school.

About the year 1330 he took up his residence in Lyons. His appointment
to the position of Canon of Saint-Just, a church which is located in
that city, doubtless made it necessary for him to adopt this course.
And yet it is most improbable that he spent much of his time in Lyons,
for his other duties--his attendance at the Papal Court in Avignon,
as private physician to three Popes in succession, and the numerous
calls made upon him for professional advice and especially for surgical
assistance by people living at a long distance from Lyons--compelled
him repeatedly to absent himself from his home, sometimes for several
days at a time. In 1348 the plague visited Avignon and carried off
large numbers of people, the poet Petrarch’s Laura being one of
the victims. During that terrible epidemic Guy was most faithful
in his devotion to Clement VI. and to many others who needed his
professional services. In 1357 he was promoted by Innocent VI. to the
office of Provost of Saint-Just. In 1363 when--according to, his own
declaration--he was an old man, he wrote the treatise on surgery which
has rendered his name famous in the history of medicine. His death
occurred about July 23, 1368.

Guy was not, as some writers have asserted, a professor of surgery in
the University of Montpellier; he was simply a physician who had won at
that institution the title of “Master in Medicine”--the highest grade
conferred by the university authorities, and one which necessarily
implied that the recipient had given a certain number of public
readings on medical topics. And yet in actual practice Guy manifested
a strong preference for the management of diseases which demanded
surgical treatment. His writings, furthermore, make it clear that he
had a strong affection for the institution in which he had been both a
student and in some measure an instructor.

The book which Guy de Chauliac wrote, and which bears the title
“_La Grande Chirurgie_,” is described by Malgaigne,[70] one of
the most distinguished French surgeons of the nineteenth century, in
the following terms: “I do not hesitate to say that, with the single
exception of the book written by Hippocrates, there is not a work on
surgery, no matter in what language written, which ranks higher than,
or is even equal to, the magnificent treatise of Guy de Chauliac.”
Although most surgeons of the present day will scarcely assent to
praise of such an extravagant nature, they will undoubtedly agree
in according to this admirable author of the fourteenth century a
high place of honor in the Temple of Fame. Nicaise, the editor of the
most recent version of Guy de Chauliac’s treatise, speaks of him as
the “founder of didactic surgery.” From 1363 A. D., the date of its
first publication in manuscript, to 1478, a period of more than one
hundred years, Guy’s book was universally regarded as the authoritative
treatise on surgery. But this branch of medicine, it must not be
forgotten, was, at that period of the Middle Ages, held in very small
esteem by physicians generally, and therefore it is almost certain that
Guy received no encouragement whatever from any outside source. All
the greater credit, therefore, is due him for the admirable manner in
which he carried on the task which he had set before himself during the
last years of his life. Extraordinary as it appears to us to-day, the
Montpellier School of Medicine, toward the end of the fifteenth century
(that is, only a comparatively short time after Guy’s death), issued a
decree that thereafter their pupils were not to study nor to practice
surgery. From this and other well-authenticated facts it appears that
the prejudice which existed at that period among physicians against
surgery, was strong enough to render them blind to the reality that
it was through the instrumentality of this very branch of medical
activity that the school at Montpellier had gained such an increase
in celebrity. They were unable to dispossess their minds of the idea
that operative and all other surgical procedures were derogatory to the
dignity of the educated physician.

Guy de Chauliac wrote his treatise originally in Latin--not the
Latin of the classical authors, but a Latin greatly deformed by the
introduction of French, Arabic and Provençal terms--barbaric Latin,
as it is often called. This language was commonly employed at the
University of Montpellier and at all other universities at that period;
but, as Nicaise states, the style of his writing is so concise, and at
the same time so intelligible, that it would scarcely be possible to
translate it into modern French without the loss of much of that which
constitutes the charm of the book. It was for the latter reason that
he decided to write his version of Guy’s treatise in old French--the
French of the thirteenth and fourteenth centuries. In order that our
readers, most of whom are doubtless more or less familiar with the
finished language of modern French literature, may see for themselves
to what extent the latter differs from its fourteenth century ancestor,
I shall introduce here a single paragraph of Nicaise’s text. I have
chosen it, more or less at random, from the admirable chapter which Guy
has written on wounds in general.

   Consequemment playes mortelles non necessairement, ains pour la
   pluspart, sont petites playes, et superficielles és susdites
   parties, et qui penetrent iusques à icelles et aux chefs
   des muscles. La raison est, parce que si elles ne sont bien
   traitées, il advient qu’on en meurt: et si sont bien traitées,
   on en guerit: ainsi que i’ay veu de la partie posterieure du
   cerveau, de laquelle sortit un peu de la substance du cerveau,
   ce qui fut reconnu par l’offense de la mémoire, laquelle il
   recouvra apres la curation. Ie ne dis pas toutesfois qu’on
   vesquit, s’il en sortoit toute une cellule, comme Theodore
   raconte d’un cellier. Aussi Galen ne dit pas, de deux blessez
   qu’il vit guerir en Smyrne du vivant de son maistre Pelope,
   qu’il en fust sorty de la substance de cerveau, ains seulement
   que le cerveau avoit esté blessé: Ne, de celuy qu’il vist guery
   en Smyrne (comme il recite au huitiesme de _l’Usage_), il
   ne dit pas qu’il en sortit de la substance du cerveau, ains
   qu’il fust blessé en l’un des ventricules gemeaux. Et avec ce
   on pensoit qu’il fust guery par le vouloir de Dieu. Car si tous
   deux eussent esté blessez, il n’eust gueres duré, comme il dit:
   et de ce il conclud l’utilite de la duplication de quelques
   instruments, ainsi qu’a esté dit cy dessus en l’anatomie. Et
   tant de cettui-cy, que de ceux-là, la guerison rare est fort
   rarement faite, comme il est dit au commentaire dessus allegué.

There are many places in Guy’s treatise where his description of a
surgical condition, or of the proper measures to adopt for the relief
or cure of such condition, would doubtless prove interesting to our
readers, and would in any event aid them materially in forming an
independent judgment as to the man’s character in general and also
with regard to his qualifications as a surgeon. But all of these
descriptions, when rendered in their entirety into English, occupy much
space, and for this reason I shall be obliged to furnish here merely a
few extracts from some of the more interesting portions of the text.

In the chapter which Guy devotes to wounds of nerves, cords and
ligaments--all of which structures were classed by him, as well as by
Galen, as belonging to the category of nerves--this author divides them
into punctured and incised wounds, bruises and concussions. As to the
first variety he says that they may be divided into closed punctured
and open punctured wounds.

   In the incised wounds two kinds may be distinguished: those in
   which the nerve is incised in the direction of its length and
   those in which the cut is made across the fibres. A further
   subdivision is practicable, viz., into wounds accompanied by
   more or less destruction of the substance of the nerve or its
   envelopes, and those in which such loss has not occurred. Among
   other differences worthy of mention are these: pain, spasmodic
   phenomena, and abscess formation are present in certain cases
   and absent in others. From all of which symptoms useful
   indications as to the treatment needed may be deduced.

In the section relating to the treatment of such traumatic affections
of nerves, Guy makes the remark that the measures called for are, for
the most part, the same as those required for wounds involving simply
the fleshy parts of the body.

   The element of pain, however, is one of the factors which
   distinguish wounds of a nerve from ordinary flesh wounds, and
   it may necessitate some slight modification of the treatment.
   Aside from this, one of the first things that should be done is
   to remove from the wound all foreign substances; after which
   the edges of the cavity should be brought together and held
   firmly in this position by appropriate means. Last of all, care
   should be taken to protect the parts. These are the general
   principles which are to guide the surgeon’s action. As to the
   special details, they must depend upon the different conditions
   presented by each individual case. Thus, for example, if we are
   dealing with a punctured wound of a nerve, there will be no
   edges of an excavation to bring together.

   If the object which produced the puncture is still lodged in the
   tissues, it must, as a matter of course, be withdrawn. After
   which, the further measures to be adopted may be enumerated
   under the following heads: careful regulation of the manner of
   living; removal from the system of all material which--attracted
   to the wounded part by the pain--might there cause irritation or
   inflammation; and protection of the body against any harm that
   might come to it through the occurrence of convulsions. These
   three measures are indicated for all wounds of nerves. But, in
   the case of a punctured wound, still other procedures should be
   employed, as will be discussed under a fourth head.

The four heads mentioned by Guy may be briefly stated in the following
terms: I. The patient should be put upon a light and very simple diet;
and, in addition, he should be given a bed that is soft and humid
(“_humidus et mollis_”). His surroundings should be kept quiet,
and nothing should be permitted to disturb his peace of mind. II. To
protect his tissues from the injurious influence of any superfluous
matters of an irritating nature that may be circulating in the blood
(_i.e._, cacochyme), a vein on the opposite side of the body
should be opened and a certain amount of this fluid withdrawn. In
certain cases, furthermore, it may be well, in addition, to administer
an aperient remedy. III. If convulsions develop, the head, neck and the
entire back should be anointed with well-warmed linseed oil or common
(? olive) oil, as recommended by Galen. IV. Special measures should be
adopted for providing a free outlet for any pus that may form in the
deeper parts of the wound; and here again Galen recommends for this
purpose the employment of one of several medicinal preparations which
he enumerates. “But the more certain course,” Guy adds, “is to make an
opening in the skin either with the razor or with the actual cautery
(which latter, according to Henri de Mondeville, is the better plan of
the two), and then to apply some subtle drying remedy which possesses
the power to penetrate into the deepest recesses of the injured
nerve--for example, savin oil.” (Guy has a good deal more to say on the
subject of wounds of nerves, but the few extracts given above should
suffice.)

It is now a well-known fact that Guy de Chauliac was in the habit of
treating fractures of the thigh by the employment of the weight and
pulley as means of keeping up a continuing extension of the damaged
limb. As his description of the method in question is very brief, it
may not seem out of place to reproduce it here. Translated into English
it reads as follows:--

   As to the plan which I employ, it is this: After making fast
   to the fractured thigh splints which extend down as far as the
   feet, I reinforce the support which they give, either by placing
   the limb in a box or by applying to its sides bundles of straw
   (_appuyements_). [These are shown in the left-hand lower
   corner of Fig. 12.] I then attach to the foot a mass of lead as
   a weight, taking care to pass the cord which supports the lead
   over a small pulley in such a manner that it shall pull upon the
   leg in a longitudinal direction. And if it then be found that
   there is not complete equality between the fractured limb and
   its fellow as regards length, the discrepancy may be corrected
   by gently pulling upon the former. Every nine days the limb
   should be cautiously handled; and at the end of about fifty days
   it will be found that firm union has taken place.

One more remark seems to be called for in reference to the fact that
Guy de Chauliac, although he was avowedly a surgeon, managed to win
as great a reputation and as high a social position as was possessed
by any physician of that period. The medical practitioner, it will be
remembered, held himself, during the Middle Ages, and was universally
held, to be a much higher type of man than the surgeon. The relative
standing of the two is well shown in the accompanying sketch (Fig.
13), in which all the details (attitude, head gear, gown, etc.) have
evidently been carefully studied by the artist. Guy, however, through
the sheer force of his character, and also probably because he was
known to have won the highest medical honor (the grade of “Master of
Medicine”) which it was in the power of the university to confer,
pushed his way to the top, and held, for a period of twenty years, the
position of private physician to three Popes in succession--Clement
VI., Innocent VI. and Urban V. In other words, the prevailing
prejudices and jealousies were not sufficiently powerful to block the
triumphant career of this man of solid merit and high character.

  [Illustration: FIG. 12. ONE OF THE WARDS IN THE HÔTEL-DIEU OF PARIS.

  As it appeared in the sixteenth century.

 (From _Chirurgie de Pierre Franco_, edited by E. Nicaise, Paris,
 1895.)]

_The State of Medicine and Surgery in Countries Other than Italy
and France During the Later Portion of the Middle Ages._--From the
account given by Neuburger it appears that the seeds planted by the
famous teachers of medicine and surgery in Italy and France during
the thirteenth and fourteenth centuries had begun to take root in
England and in the Low Countries to the north of France, and were
in fact already producing some good fruit in those lands. Thus, for
example, there have been handed down to our time the names of four
physicians who attained a certain degree of eminence in England during
the thirteenth and fourteenth centuries--Gilbertus Anglicus, John of
Gaddesden, John Mirfeld and John Arderne.

_Gilbertus Anglicus_, who was the first English medical writer
to secure a certain degree of celebrity among the physicians of
continental Europe, wrote a compendium of medicine that was commonly
called the “_Laurea anglica_.” The book contains, along with some
good original observations and the records of his own experience, not a
few wearisome theoretical discussions; and at the same time it reveals
the fact that the author was inclined to favor remedial measures
of a superstitious nature. In the last chapter of his compendium,
however, he makes the very practical suggestion that distillation may
be resorted to when one desires to purify water that is contaminated.
Gilbertus, after obtaining his preliminary training in England
in the early part of the thirteenth century, visited some of the
leading schools on the continent, among others those of Salerno and
Montpellier, in which latter city he appears to have practiced medicine
for a certain length of time.

_John of Gaddesden_, who is also spoken of as Johannes Anglicus,
was born about 1280 A. D. and died in 1361. He was therefore a
contemporary of Guy de Chauliac. He is said to have been a Fellow of
Merton College, Oxford, and to have held the positions of Prebendary
of St. Paul’s, London, and of private physician to the royal family.
He was also the author of a medical treatise which was generally known
by the title, “_Rosa Anglica_” (first printed in 1492). Neuburger
speaks of this book as being an imitation of Gourdon’s “_Lilium
Medicinae_,” but of a somewhat inferior grade, and he quotes two
or three passages which show that medicine was in a very low stage of
development in England at the beginning of the fourteenth century.
Gaddesden, for example, advises his confrères to adopt the rule of
always securing their honorarium before they undertake the treatment of
a sick person. In another part of the book he states that he treated
one of the sons of Edward II. for small-pox and secured excellent
results, not merely as regards the perfect restoration of his health,
but also as regards the complete prevention of any pitting of his face.
He attributes this success to the fact that he enveloped the patient in
a red cloth and took pains to have every object in the vicinity of the
bed draped in red.[71]

_John Mirfeld_, who lived during the second half of the fourteenth
century, completed his medical studies in Oxford, then entered
the Monastery of St. Bartholomew’s in London, and devoted himself
thenceforward to work in connection with the hospital belonging to that
institution. Among the books which he wrote there are a few that deal
with matters of interest to the physician. Such, for example, are a
glossary which bears the title “_Synonyma Bartholomaei_,” a work
called the “_Breviarium Bartholomaei_,” and a shorter treatise
on prognosis--the “_Speculum_.” None of these, however, possesses
any special importance.

  [Illustration: FIG. 13. THE PHYSICIAN, THE SURGEON AND THE
  PHARMACIST.

  Reproduction of a miniature at the head of Guy de Chauliac’s
  _La Grande Chirurgie_, edited by E. Nicaise, Paris, 1890.]

_John Arderne_ was born in England 1307 A. D., probably obtained
his medical training in Montpellier, accompanied the English Army to
France in the character of a “Sergeant-Surgion,” and was present at the
battle of Crécy (1346 A. D.). During the succeeding twenty-four years
he practiced medicine in Wiltshire and Newark, and then settled for
the remainder of his life in London. Although his practice included
both internal diseases and those which required surgical treatment, the
great reputation which he acquired was based chiefly upon his success
in the latter field. Most of his writings, it appears, are still in the
form of manuscript. They deal chiefly with surgery and are accompanied
by drawings of the instruments which he employed. They possess one
feature which distinguishes them from the majority of medical writings
of the Middle Ages, viz., they abound in reports of cases observed and
treated by the author; and, furthermore, the methods of treatment which
he recommends are in most instances rational and of a relatively simple
nature. The only one of Arderne’s treatises which has been printed
is that relating to _fistula in ano_. It bears the title, “John
Arderne--Treatises of Fistula in Ano, Haemorrhoids, and Clysters; from
an early fifteenth-century manuscript translation,” and is edited by
D’Arcy Power, Early English Text Society, Original Series, 139; London
and Oxford, 1910. Arderne, we are told by Neuburger, puts forward two
claims: 1, that he succeeded in curing a large number of cases of anal
fistula, in proof of which he gives the names of the persons upon whom
he operated successfully, many of whom are high up in the social scale;
and, 2, that no other surgeon of whom he has any knowledge, either in
England or on the continent of Europe, is able to cure the disease.

The three English physicians of whom I have here given very brief
accounts, can scarcely be said to compare favorably with those men
who, during the same period, brought fame to the medical schools of
Bologna, Padua, Montpellier and Paris; and this fact suggests the
question, Do these men really represent the best type of physicians who
lived in England during the fourteenth century? The great English poet
Chaucer, in his “Canterbury Tales” (written at about the same period
of time), furnishes us with a portrait of a man who appears to have
been well informed with regard to the earlier Greek and Arabian medical
authorities as well as with the leading physicians of his own time,
and who in addition was clever both in ascertaining the causes and
nature of his patients’ maladies and in prescribing for them the proper
remedies. As this physician’s name is not mentioned, we cannot be sure
that he was not one of the three to whom reference has just been made.
By the description given by the poet, who probably was personally
acquainted with the man whose portrait he draws, one is tempted to
believe that he was a physician of a higher type than any one of the
three named above. Chaucer’s account reads as follows:--

    There was also a Doctor of Phisik,
    In al this worlde was ther non him like
    To speke of phisik and of surgerye;
    For he was grounded in astronomye.
    He kepte his pacient wondrously and we
    In all houres by his magik natural.
    Well coude he gesse the ascending of the star
    Wherein his patientes fortunes settled were.
    He knew the cause of every maladye,
    Were it of cold, or hete, or moyst, or drye,
    And where they engendered, and of what humour;
    He was a very parfit practisour.
    The cause once knowen and his right mesúre,
    Anon he gaf the syke man his cure.
    Ful redy hadde he his apothecaries,
    To sende him drugges, and electuaries,
    For eche of them made the other for to wynne;
    Their friendshipe was not newe to begynne.
    Wel knew he the old Esculapius,
    And Discorides, and eek Rufus;
    Old Ypocras, Haly and Galien;
    Serapyon, Razis, and Avycen;
    Averrois, Damascen, and Constantyn;
    Bernard, and Gatisden, and Gilbertyn.
    Of his diete mesuráble was he,
    For it was of no superfluitee,
    But of gret norishing and digestible.

With the names of the three English physicians mentioned above, there
should be associated that of Jehan Yperman, who was born in Ypern,
Flanders, during the latter half of the thirteenth century, obtained
his professional training in Paris under Lanfranchi, and then, in
1303 or 1304, accepted the position of Physician to the Hospital of
Belle, a small Flemish town. In 1318 he settled permanently in Ypern,
his native city, and in a comparatively short time won completely the
confidence and esteem of his fellow townsmen through his attentiveness
to their wants when they were ill and through the great skill which he
manifested in his work as a surgeon. He died 1329 A. D.

Yperman’s writings deal with both medical and surgical topics. Of
those which have been translated from the Latin into French are: “La
chirurgie de maitre J. Yperman,” Anvers, 1863; “Traité de médecine
pratique de maitre J. Yperman,” Anvers, 1863; and “Traité de médecine
pratique de maitre J. Yperman,” Anvers, 1867. A perusal of these
works, says Neuburger, easily convinces one that Yperman was not only
a skilful and clever surgeon, but also a physician of independent
judgment and wide experience.

_Revival of the Practice of Dissecting Human Bodies._--It was in
Italy that dissecting was carried on during the fourteenth century more
vigorously than elsewhere in Europe. At first the only persons who made
such investigations for scientific purposes were individual physicians
or groups of physicians; and, in addition, they were obliged to carry
on the work in a secret manner--that is, by stealing from recently
dug graves the corpses which were necessary for such studies. It is
related, for example, that in 1319 one of the teachers in the Medical
School at Bologna and four of his pupils were brought before the Court
of Law under the charge of having clandestinely disinterred, for
purposes of dissection, the body of a man who had been hung for some
crime. At first the authorities merely winked at such transgressions,
but at the same time they made no attempts to have the law against
dissecting annulled or at least modified. Then, at a somewhat later
period, the conviction became general among the intelligent members
of the community that, unless work of this nature were officially
sanctioned, no real advance in the knowledge of human anatomy could
be made, and--what was probably of even greater importance in their
estimation--that Bologna might at the same time lose a good deal of its
superiority over its rivals as a centre of learning; and accordingly
it was found practicable to grant the desired sanction with many
modifying restrictions attached. Then, with the further lapse of time,
other medical schools fell into line and secured from the authorities
similar privileges for their teachers and pupils. Thus, in 1368, the
Senate of Venice authorized the medical school of that city to make a
public dissection of a human body once every year; and, eight years
later, the University of Montpellier acquired the same privilege. In
1391 John I. of Spain was equally generous in his treatment of the
Medical School at Lerida. After the opening of the fifteenth century
no further difficulties of a serious nature were experienced by the
teachers of anatomy in procuring at least some material for dissecting
purposes, and with each succeeding year such facilities steadily
increased. Unfortunately, however, there did not follow a corresponding
increase in the knowledge of human anatomy. As a matter of fact, it
was not until during the sixteenth century that any really valuable
work was accomplished in this branch of medicine. Guy de Chauliac,
in the first chapter of his treatise (“_La Grande Chirurgie_”),
gives the following description of the manner in which Bertrucius
taught anatomy in Bologna at the beginning of the fourteenth century,
and from this account it is easy to understand why the additions to
our stock of information in this department of medicine were so few
and so unimportant during this long period. The so-called dissecting,
it clearly appears, was in reality a not very profitable combination
of purely anatomical work of a primitive character and a search
for evidences of pathological changes. The clinical history of the
individual whose body was undergoing examination does not seem to have
played any part in the investigation. Here is De Chauliac’s account:--

   After placing the dead body on a bench, my master proceeded with
   his instructions, devoting thereto four separate sittings. At
   the first of these he passed in review those parts or organs
   which are concerned in nutrition; his reason for considering
   them first being that they are the earliest to undergo
   decomposition. At the second sitting he devoted himself to the
   spiritual organs of the body; at the third, to the animal parts;
   and at the fourth, to the extremities. Following the example
   furnished by Galen in his commentary on the book entitled “The
   Sects,” he maintained that there were nine things which should
   be taken into consideration when one examines the different
   parts of the body, to wit: their situation; their nature,
   color, bulk, number, and shape; their connections or relations;
   their actions and their utility; and the diseases which may
   affect them. Conducted in this manner the study of anatomy, he
   maintained, may prove helpful to the physician in recognizing
   diseases, in making prognoses, and in selecting a suitable plan
   for treatment.

Puschmann, quoting from Hyrtl, says that when Professor Galeazzo di
Santa Sofia, who had been called from Padua to Vienna to fill the
Chair of Anatomy in the medical school of that city, made his first
public dissection of a human body (1404 A. D.) in the Bürgerspital,
the sittings covered a period of eight days; at the end of which time
he collected as much money as he could from those who had attended
the course, and turned it over to the treasurer of the Faculty. Then
followed a period of twelve years during which not a single public
dissection of a human body was made in Vienna. In 1440 the Faculty were
greatly rejoiced over the prospect of receiving from the authorities
the body of a criminal who was to be hung on a certain day; but, when
the time arrived and the body had actually been delivered to them,
they were grievously disappointed by the sudden coming to life of the
supposed corpse. Instead of dissecting him for the benefit of science,
the doctors bestirred themselves in the man’s behalf, obtained a pardon
in due form, and sent him back to his home in Bavaria under the escort
of the college janitor. Not very long afterward, however, he committed
a fresh crime, and this time was effectively hung. History does not
state whether the dissection then came off, or not.

The Medical Faculty of the University of Tübingen established the rule
in 1497 that one human body should be publicly dissected every three
or four years; it being understood that during the progress of the
dissection the professor should read aloud to the class appropriate
portions of Mondino’s treatise on anatomy. The instruction in this
department of medical science was of the same general character in
all the other universities of Germany at that period. Anatomical
drawings, of a very crude type, were employed as substitutes for actual
dissection.

At Padua, in Northern Italy, the science of medicine had already before
the end of the first half of the fifteenth century made a decided
advance, in proof of which several circumstances may be mentioned. In
the first place, the importance of the study of anatomy had by this
time become so generally recognized that no special difficulty appears
to have been encountered in securing the erection, in 1446, of an
anatomical theatre; and during this same period several physicians
connected with the medical school acquired considerable celebrity by
their publication of important treatises on topics belonging to the
domain of general pathology and therapeutics, and by the wide influence
which they exerted as teachers. Among the number of those who helped
in these ways to spread the fame of the Medical School of Padua may
be mentioned Hugo Benzi, Antonio Cermisone, Giovanni Savonarola and
Bartolommeo Montagnana.

_Hugo Benzi_ (or Hugo of Siena) taught philosophy as well as
medicine in different institutions of learning--at Pavia, Piacenza,
Florence, Bologna, Parma, Padua and Perugia. His death probably
occurred at Ferrara about the year 1439. In addition to commentaries
on Hippocrates, Galen and Avicenna, he wrote several practical works
(“_Consilia_”) on such topics as periodical insanity, stomachic
vertigo, naso-pharyngeal polypi, epilepsy, lachrymal fistula, etc.

_Antonio Cermisone_ was a native of Padua, became a teacher of
medicine first in Pavia and afterward in Padua, wrote several useful
treatises about various diseases, and finally died about 1441.

_Giovanni Michele Savonarola_--the grandfather of the celebrated
Girolamo Savonarola, who was burned at the stake for heresy 1498 A.
D.--held the Chair of Medicine in Padua from about 1390 to 1462, and
also subsequently for a certain length of time in Ferrara. He was the
author of a number of treatises on practical medical topics--such,
for example, as fevers (first published in Venice in 1498), the art
of preparing simple and compound _aqua vitae_ (Basel, 1597), an
introduction to the practice of medicine (1553), the baths of Italy and
of the rest of the world (Venice, 1592), the different kinds of pulse,
etc. (Venice, 1497)--and he also wrote a large work covering the entire
field of medicine and modeled on the pattern of Avicenna’s “Canon.”
The book is divided into six parts, each of which is preceded by an
introduction that is devoted to the anatomico-physiological bearings
of that particular part; and here, in addition, there are to be found
scattered throughout the text references to surgical procedures.
Among the references of this character the following deserve to be
mentioned as worthy of some notice: the description of a speculum for
use in operations upon the interior of the nose; a reference to direct
laryngoscopy; the description of an instrument closely resembling the
well-known syringotome; the treatment of curvature of the spine by
mechanical means, etc. The book also reveals the fact that, already at
this period of the history of medicine (the middle of the fifteenth
century), physicians were beginning to take a more active part than
they had previously done in the management of confinement cases, which
as a rule were left entirely to the care of midwives. The records
also show that medical men were interesting themselves more and
more, as time went on, in sanitary science as applied to municipal
affairs. In most communities the need for such was indeed most urgent
at that time. The reforms of this nature were pushed with special
vigor in those parts of Italy which were governed by that enlightened
ruler of the Hohenstaufen family, Frederic II., King of Sicily and
Roman Emperor. The cultivation of personal hygiene was also pursued
very systematically during the later Middle Ages, the _Regimen
Salernitanum_ serving as the guide in such matters.

Taken all together the conditions in the physician’s world were in
anything but a promising state toward the end of the fifteenth century;
but the dawn of better times, of modern medicine, was near at hand,
and already signs of its approach were beginning to be recognizable in
different parts of Western Europe.




                              CHAPTER XXV

     BRIEF HISTORY OF THE ALLIED SCIENCES--PHARMACY, CHEMISTRY AND
                          BALNEOTHERAPEUTICS


During the excavations carried on at the site of Pompeii, there were
discovered three houses which bore every appearance of having been
occupied by apothecaries. Among the objects found in these buildings
were: A bronze box equipped with the apparatus required for mixing
ointments; a few surgical instruments; several glass receptacles
which had evidently at some earlier period contained fluid or
semi-fluid pharmaceutical preparations, but which, at the time when
the excavations were made, presented merely a deposit of some solid
but easily friable substance at the bottom of the vessel; and quite
a variety of drugs in the form of pills, tablets, powders, etc. At
first, the impression prevailed that these must have been the houses
of apothecaries, but subsequently the discovery, in each instance, of
the house sign representing a snake with a pine cone in its mouth (the
symbol of Aesculapius) satisfied the authorities that these particular
buildings had belonged to physicians. Indeed, as a matter of fact, no
good reasons have thus far been found for believing that apothecaries,
in the modern acceptation of the term, existed in even the largest
cities of Greece and Italy until a much later date.

_Pharmacy in Its Infancy._--All through the Hippocratic period and
during the years when Alexandria was at the height of its prosperity
as the great centre of medical activity, it was customary for the
physicians to prepare their own drugs. The same is true of the best
physicians belonging to the Augustan period; they were not willing to
put their trust in the drugs which had been prepared in the shops where
such things were usually sold.

In the second century of the present era Galen gave the definition
that a remedial drug, or “Pharmakon,” was something which, when taken
into the living body, produces an alteration in its component tissues
or organs, whereas foods or nutrient elements simply cause an increase
of the parts. He attached great importance to such characteristics as
purity, freshness, care in handling, etc. It was his custom to prepare
with his own hands the different combinations of simple remedial agents
which he administered to his patients, and he kept these combinations,
as well as the simple drugs of the more costly kinds, carefully stored
in locked wooden boxes in a room which was devoted to this special
purpose and which was termed the “Apotheke.” Originally, therefore,
the “apothecary” was simply the person who had charge of this room
in which the drugs and spices were carefully “placed to one side”
(ἀπό, τίθημι) for safe keeping. At a later period, when the
caretaker became also the compounder of drugs, another word of a more
comprehensive significance--that of “pharmacist”--gradually supplanted
the term apothecary.

There is another word, “antidote,” which has very materially changed
its significance during the lapse of centuries. Galen, for example,
employed this word as a synonym of pharmakon--a simple remedial agent,
and medical writers continued using the term in this sense during
the following thirteen or fourteen centuries. The word commonly
employed, by mediaeval physicians, to signify “pharmacopoeia,” was
“antidotarium.” In modern times the word “antidote” signifies only an
agent which neutralizes a poison.

Galen took a very great interest in everything relating to the
subject of drugs, and sometimes made long journeys for the purpose
of securing certain plants or roots which he was unable to procure
near home or which he was very anxious to obtain in a more perfect
condition than was possible when they were purchased from the regular
dealers. “Simple remedies,” he declared, “are pure and unadulterated,
and produce effects in only one direction. It is the business of
pharmacology to combine drugs in such a manner--according to their
elementary qualities of heat, cold, moistness and dryness--as shall
render them effective in combating or overcoming the conditions which
exist in the different diseases.” Galen’s interest in pharmacology
materially aided the advance of medical science in other ways. He
systematized the existing knowledge of materia medica and infused some
measure of orderliness into the therapeutics of his day. The success
of his efforts in this direction did not become manifest until after
he had been dead about fifty years; but, if his ideas were slow in
meeting with general acceptance, they took such deep root in the minds
of physicians that to-day in Persia Galen’s system of therapeutics is
the only one generally received as authoritative. Although the facts do
not warrant our making the same statement with regard to Western and
Southern Europe, it is nevertheless true that our dispensatories still
continue to honor the memory of this great physician by bestowing the
name of “Galenical Preparations” on a large group of pharmaceutical
combinations.

It is scarcely possible to state with any degree of positiveness at
what date pharmacists, in the modern sense of the term, came to be
recognized as constituting a separate and honorable class in every
well-organized community. It is known, however, that in Syria and
Persia, during the eighth and ninth centuries of the present era, not
a few of the leading physicians were the sons of apothecaries. Honein,
for example, of whose career I furnished a brief sketch in Chapter
XIX., was the son of an apothecary; and the careful manner in which he
was educated during his youth justifies the belief that his father must
have been a man of some cultivation and not at all like the general
average of that class of men of whom Galen speaks so disparagingly. But
even at that early period there certainly were individuals who were
skilled in the pharmaceutic art, for Berendes (_op. cit._) tells
us that Dioscorides (_circa_ 100 A. D.) describes minutely the
manner of preparing “Oisypum.” Oisypum is identical with the modern
“Lanolin” or “Lanolinum,” and is a pure fat of wool. Mention is made of
the preparation by four different authors of medical treatises during
the following sixteen centuries--viz., by Aëtius in the sixth, by
Paulus Aegineta in the seventh, by Nicolaus Myrepsus in the thirteenth,
and by Valerius Cordus in the seventeenth. Subsequently to the latter
date no further mention of the preparation is to be found in any of
the pharmacopoeias except the French Codex of the year 1758, in which
it is classed among the simple remedies under the title of “Oesipe.”
Finally Liebreich, toward the end of the nineteenth century, brought
the preparation once more into favor under the name of “lanolin.” The
fact that it remained in complete oblivion for such very long periods
of time is easily explained by the statement which Berendes makes:
“It was a troublesome ointment to manufacture, and consequently the
apothecaries disliked it and resorted to all sorts of falsifications.”

With the advance of the Arab Renaissance pharmacy gradually became a
regular established occupation in every fairly large city in the East.
It is known, for example, that the first public apothecary shop in the
city of Bagdad was established during the eighth century of the present
era under the caliphate of Almansur; and about the same time, probably
a little earlier, there existed at Djondisabour a similar pharmacy in
connection with the school and hospital of the Bakhtichou family. The
training of an apothecary in those days was probably the same as that
of the physician. Originally pharmacists were called “Szandalani,”
probably because they dealt largely in sandal wood.

The materia medica furnished by the Arab physician Rhazes in the
different works which he has written, is unusually rich in simple
elements, the majority of which are always drugs of a rather mild
action; Greece, Persia, Syria, East India and Egypt were the sources
from which they were derived. Beside the simple elements, Rhazes
mentions a number of composite preparations of drugs. As not a few
of the latter required very careful manipulation, it may safely be
inferred that the Arabian apothecaries of the ninth century had already
acquired considerable skill and experience in their special field of
work.

At Salerno, during the first half of the twelfth century, pharmacy
began to assume a position of considerable importance. The work
which was prepared by Nicolaus Praepositus, and which was known as
an “Antidotarium,” furnished quite full information with regard to
the characters and therapeutic uses of nearly 150 different drugs.
According to Berendes this work served for several centuries as the
basis of later pharmacopoeias. One of its notable features is the
importance which the author attaches to the duty of weighing very
carefully each of the drugs that enter into the composition of a given
preparation, of gathering certain vegetable products at the right
season, and of paying strict attention to their quality and to the
manner of preserving them.

In 1140 A. D., Roger, King of Naples and Sicily, promulgated a law
which defined what should be the proper relations between physicians
and apothecaries; and about one hundred years later (1241 A. D.)
Frederick II. amplified and gave greater precision to this law, thus
establishing what was practically an Institute of Apothecaries. The
following provisions constitute the essential features of the law:--

   1. The physician and the apothecary shall have no business
   interests in common.

   2. The physician shall not himself conduct an apothecary shop.

   3. In each department of the kingdom two respectable men,
   selected by the Faculty at Salerno, shall be assigned the duty
   of furnishing sworn statements to the effect that all the
   electuaries, syrups, and other preparations of drugs kept for
   sale in a given apothecary shop, have been made according to the
   established prescriptions and are offered for sale only in that
   state.

   4. In the case of those preparations which ordinarily do not
   keep for a longer time than one year without spoiling, the price
   at which they are to be sold shall be at the rate of 3 Tarreni
   (about 30 cents) per ounce; while those which ordinarily remain
   unchanged during a longer period, shall be valued at 6 Tarreni
   per ounce.

At the time which we are now considering, it was not the custom, owing
largely to the expensiveness of writing paper, to deliver to the
pharmacist a written prescription. Instead, the physician first gave
his instructions in person, and then, after he had seen the mixing and
other steps of the apothecary’s work properly performed, he carried the
preparation to the patient’s house.

Long before the middle of the fifteenth century apothecaries had become
thoroughly well established throughout Central and Western Europe.
Among the statutes of the Medical Faculty of Erfurt, Germany, there has
been found one which dates back to the year 1412 and which says:--

   The student of medicine, before he applies for the Bachelor’s
   Degree, should spend one month in the spring of the year, in an
   apothecary’s establishment, in order that he may familiarize
   himself with the proper manner of preparing clysters,
   suppositories, pessaries, syrups, electuaries and other things
   necessary for a physician to know.

The first work which was really worthy of being termed a treatise on
materia medica was published in 1447. It bore the title, “Compendium
Aromatariorum,” and was written by Saladin of Ascolo, the private
physician of Prince Antonio de Balza Ossino of Tarentum. Berendes says
that it was a work of much practical value.

_The First Indications of the Beginning of Chemistry._--Up to a
comparatively recent date it has been customary to speak of Geber as
the first practical chemist and the first writer among the ancients
who appreciated the important part which chemistry was likely to take
in medicine and philosophy at no distant period of time. But to-day,
as appears from the researches made by M. Berthelot about 1893, we are
compelled to abandon the belief that such a person as Geber existed,
and shall have to adopt the more commonplace view that the science
of chemistry represents a gradual development from the much older
alchemy. We may define the latter branch of knowledge as the science
of transforming copper and brass into gold and silver. During the first
two or three centuries of the Christian era there existed a firm belief
that such a transformation had actually been accomplished, and in
confirmation of the correctness of this statement it may be said that
Zosimos of Panopolis, one of the leading philosophers of Alexandria
during the fourth century of the present era, and a man who was
considered by his contemporaries, as well as by all later alchemists,
to be perhaps the greatest authority in this branch of knowledge,
speaks in unmistakable terms in his cyclopaedic work on alchemy (28
volumes), of a certain tincture which possesses the power of changing
silver into gold, and also of a “divine water” or fluid which is
capable of effecting many different transmutations. There can therefore
be no reasonable doubt that in the earlier centuries of the Middle Ages
the learned men of Alexandria accepted alchemy as a well-established
agency of great power. From the sixth century to the thirteenth this
science was cultivated with great assiduity by the Arabs in the
academies which they established in Cordova and other cities of Spain;
and it was from the latter region that the belief in alchemy spread to
all the countries of Western Europe, gradually gaining strength up to
perhaps the fifteenth century.

It was during the thirteenth century that the so-called “philosophers’
stone” came to be considered the most effective agent in transmuting
the baser metals into silver and gold, and there were not a few who
even believed that this as yet non-existent stone possessed the power
to increase longevity, to confer health, and to give a prosperous
issue to one’s undertakings. It was not the rabble, but the very
best and most highly educated men in the community who, during the
thirteenth century, took the most active interest in alchemy and the
philosophers’ stone. Arnold of Villanova, Raymund Lullus, Roger Bacon,
Albertus Magnus, and, to a lesser degree, the famous theologian Thomas
Aquinas were all believers in the art of the magician. And even more
extraordinary than this is the fact that in Germany men of this stamp
continued for two or three centuries longer to cherish a belief in the
reality of alchemistic processes. Even Martin Luther (1483–1546), the
great reformer, did not hesitate to express his approval of “the black
art,” as is shown by the following quotation from one of his writings:--

   The art of alchemy is commendable and belongs in truth to
   the philosophy of the ancient wise men, a fact which pleases
   me greatly, not merely because of the intrinsic merits and
   usefulness of the art in the matter of distillations of
   vegetables and oily fluids and sublimation of metals, but also
   because it serves as such a noble and beautiful symbol of the
   resurrection of the dead at the last day of judgment. (Berendes.)

Another celebrated character who dabbled in the black art was Johannes
Faust, who was born in 1485, obtained his degree of Bachelor of Arts at
the University of Heidelberg, and died in 1540 in Staufen in Breisgau.
Professor Scherer of Berlin says that “he was a great braggart, never
failed to create a sensation wherever he went, and had the conceit and
effrontery to pass himself off as a scientist among the learned men of
his day. He called himself the philosopher of philosophers, a second
Magus. He maintained that he was both a physician and an astrologer,
and claimed that he could restore the dead to life, and could predict
future events from a mere inspection of fire, air and water.”

But although the persistent and wonderfully energetic activities of
the alchemists failed to find the philosophers’ stone, or to transmute
the baser metals into silver and gold, they placed in the hands of man
the key to a knowledge of chemistry, that branch of science which was
destined in later years to play such an important part in pharmacy,
in agriculture and in other industries. Thus we owe to alchemists the
discovery of many processes and the invention of many apparatus which
serve as the groundwork of modern chemistry. Some of the more important
of these are the following: The use of the spirit lamp; the invention
of tubular retorts; the production of potash and soda by burning
the hard deposit which collects in wine casks as well as various
marine plants; the oxidizing of certain metals (iron, lead, copper,
quicksilver and antimony); the making of metallic arsenic, of wine of
antimony, of sulphate of iron, of chloride of silver, of acetic acid
and of many other chemical products; the purification of metals by the
use of lead, etc.

_Supplementary Data Relating to Balneotherapeutics._--I have
referred to this subject on several occasions in the course of the
earlier chapters of this history, but always without entering very much
into details. This policy was adopted, partly because the facts upon
which a satisfactory sketch of the growth of balneotherapeutics might
be based were not very numerous, and partly because of the necessity of
gaining space for more important matters.

The principal facts to which I made reference were: First, that before
the Christian era the employment of baths in a variety of different
ways for therapeutic purposes was universal in the East; and, second,
that in the city of Rome during the centuries immediately following the
birth of Christ, facilities for this kind of treatment were provided
on a most lavish scale--as in the baths of Agrippa (27 A. D.), of
Titus (79 A. D.), of Caracalla (211 A. D.), and of Diocletian (302 A.
D.). I may now add that the warm springs of Aachen (Aix-la-Chapelle),
Baden-Baden and Wiesbaden, in Central Europe, and Bath, in England,
were known to the ancient Romans, and were utilized by them to some
extent for therapeutic purposes; but it was not until a much later
period that they and the less well-known springs of Schwalbach,
Driburg, Warmbrunn, Goeppingen and Gastein began to be actively
frequented for remedial purposes. By the beginning of the sixteenth
century it had become a very popular thing for sufferers from all sorts
of ailments to resort to these and other European springs. The history
of the therapeutic employment of mineral waters belongs, however, to
the period of modern medicine rather than to that which I have been
considering in the present volume.




                               PART III

                    MEDICINE DURING THE RENAISSANCE




                             CHAPTER XXVI

    IMPORTANT EVENTS THAT PRECEDED THE RENAISSANCE--EARLY ATTEMPTS
                       TO DISSECT THE HUMAN BODY


_Important Events Immediately Preceding the Renaissance._--Three
hundred years before the Christian era Erasistratus and Herophilus
made, at Alexandria, Egypt, an attempt to develop a correct knowledge
of anatomy by means of dissections of human corpses, but the political
and religious conditions at that time were not favorable to scientific
work, and therefore the success attained was of a very restricted
character. Then, during the succeeding three or four centuries, this
early movement gradually died out, and no further contributions to
our knowledge of human anatomy were made until toward the end of the
second century of the present era, at which time Claudius Galen, a
man of giant intellect and tireless energy, did his best to supply
the anatomical knowledge so urgently needed. But the deeply rooted
prejudices of that age against dissections of the human body lay like
an insurmountable barrier across his path and forced him to confine his
efforts to the dissection of those animals whose bodily construction
resembled more or less closely that of man. Galen believed that the
anatomy which he thus evolved for the guidance of his professional
brethren would satisfy all their legitimate wants of this nature,
and he proceeded to build upon this faulty and unstable foundation
an equally faulty physiology. History records the extraordinary fact
that Galen’s belief in the sufficiency of his anatomy and physiology
for all the reasonable needs of physicians and surgeons was so well
grounded that during the following thirteen or fourteen centuries
nobody dared to cast the slightest suspicion upon the trustworthiness
of these foundations of the science of medicine. Then followed, during
the fourteenth and fifteenth centuries, an awakening which seemed to
affect all departments of human activity. This movement, which is
commonly termed the “Renaissance,” developed at first very slowly, and
reached a noteworthy degree of momentum only toward the middle of the
fifteenth century, about which time there occurred several events that
contributed greatly to strengthen and perpetuate the movement. Such
were, for example, the employment of gunpowder in the wars of Western
Europe; the invention of a method of manufacturing paper--a discovery
which led to the abandonment of the much more expensive parchment, and
prepared the way for the invention of printing in its different forms;
the taking of Constantinople by the Turks in 1453; the discovery of
America in 1492; and, finally, the Reformation inaugurated by Martin
Luther. Let us pass in review very briefly each of these events, in
order that we may the better appreciate how the science of medicine,
in the short space of time represented by a couple of centuries, made
a greater advance than it had previously made in the course of several
hundred years.

The employment of gunpowder in warfare robbed the knight of the
protection which he had previously enjoyed from the wearing of metal
armor, and thenceforward his life was as much imperiled in battle
as was that of the foot-soldier, who was not permitted to protect
his person in this manner. Thus were the two upper classes of the
community, the nobles and the bourgeois, in any conflict which might
arise between them, placed more nearly upon a footing of equality. The
ultimate result showed itself in an increased importance, an increased
prosperity, of the middle class or _bourgeoisie_, from which the
physicians chiefly came. Indeed, feudalism from this time forward
rapidly ceased to exist.

The discovery of paper, an excellent and relatively cheap substitute
for parchment, facilitated wonderfully the spread of knowledge.
Parchment, the material upon which books were written, was expensive
and was at times difficult to obtain; both of which circumstances
rendered books so costly that only a few physicians were able to
become the owners of the important standard medical works of that
period--such, for example, as the Hippocratic writings, Galen’s
treatises, the surgical manuals of de Mondeville and Guy de Chauliac,
the pharmacopoeia of Dioscorides, and still other books of lesser
value. And, if a satisfactory method of manufacturing paper had not
first been discovered, the benefits growing out of the invention of
printing in 1467 would have been far less than they actually proved to
be. Some idea of the magnitude of these benefits may be formed from the
following statement of facts. The demand for books, after the invention
of printing, became so great that the presses were kept almost
constantly busy. At first, according to the record furnished by Haeser,
Venice and Rome took the lead in supplying this great demand for books;
the former city printing 2978 and the latter 972 volumes between the
years 1467 and 1560; but, during a later period (1500–1536), Paris
outstripped Venice with a total of 3056 volumes, and Strassburg
advanced to the second place with a showing of 1021 volumes printed
during the same period of time. Thanks to the great diminution in the
market price of books that resulted from the two inventions named--the
manufacture of paper and the introduction of printing--almost every
physician in fairly prosperous circumstances was able at that period
to purchase the relatively few medical treatises which issued from the
presses; and, besides, new authors were thenceforth stimulated to put
their experiences into print.

Among the very first medical books printed the following deserve to be
mentioned:--

   (In Germany.) _Buch der Bündth-Erznei_, by Heinrich von
   Volsprundt, 1460.--_Das buch der wund Artzeny. Handwirckung
   der Cirurgia von Jyeronimo brunschwick_, 1508.--_Das
   Feldtbuch der Wundtartzney_, by Hans von Gerssdorff, 1517.

   (In Italy.) _Avicennae opera, arabice_, 1473.--_Guillelmi
   de Saliceto cyrurgia_, 1475. (A French translation was
   published at Lyons in 1492.)--_Celsi de medicina liber_,
   etc., 1478.--_Guidonis de Cauliaco cyrurgia_, 1490. (A
   French version was printed in Lyons in 1498.)

   (In France.) _Christophori de Barzizus de febribum cognitione
   et cura_, 1494.--_Bernard de Gourdon, traduction de son
   “Lilium medicinae,”_ 1495.

When Constantinople fell into the hands of the Turks in 1453, many of
its Greek inhabitants, and particularly those belonging to the more
highly educated classes, fled to Western Europe in order to escape from
the tyranny of the invaders. Not a few of these refugees brought with
them to Italy and France copies of the works of the classical Greek
authors, and on this account, as well as because of their willingness
to give instruction in their native tongue, they met with a cordial
welcome wherever they took up their new abodes. Their arrival in
Italy happened at a most propitious time, for the interest in Greek
literature was at that period just beginning to develop among Italian
scholars. Previously, Greek had been an almost unknown tongue in Italy.
Petrarch, for example, is reported to have said in 1360 that he did
not know of ten educated men in that country who understood Greek; and
there is no evidence to show that the number of such men increased
between 1360 and the time when the refugees from Constantinople
arrived. Many of the works of greatest importance to physicians--such,
for example, as the writings of Hippocrates, of Galen, of Rufus
of Ephesus, of Oribasius, of Alexander of Tralles, and of several
other classical medical authors of antiquity--were accessible (in
the original) only to those who were familiar with the Greek tongue.
Consequently the arrival of these refugees from Constantinople
constituted a most important event in the history of European medicine.

The discovery of America by Christopher Columbus in 1492 owed its
origin in part to the restless spirit of adventure which was abroad
in Spain and Italy at that time, and also, in perhaps still larger
measure, to the hope of gain which might be expected to follow the
discovery of a shorter and more direct route to India. As regards the
attainment of the latter object, the great explorer failed, but his
discovery of a new continent resulted eventually in bringing great
wealth to the rulers of Spain, in stimulating maritime commerce, and in
broadening men’s views with regard to every phase of human activity.
The addition of a few new drugs to the pharmacopoeia was a further
result of some importance. Luther’s efforts to reform the government
and doctrines of the Church undoubtedly gave a great impetus to the
Renaissance and therefore to the growth of the science of medicine.
Men learned to use their reasoning powers with greater freedom, and as
a result our knowledge of the structure of the human body (anatomy)
and of the working of its complicated machinery, both in health
(physiology) and in disease (pathology), made astounding advances. And
it is to the consideration of these fundamental branches of medical
knowledge that we must now turn our attention.

_Early Attempts to Dissect the Human Body._--Already as early as
during the first half of the fourteenth century physicians began to
appreciate the fact that further progress in the knowledge of medicine
was not to be attained otherwise than by a more profound study of human
anatomy than had been made up to that time; and they realized that it
was only by means of actual dissections that this more profound study
might be made. Various influences, however, co-operated to hinder such
study. In the first place, the people at large were thoroughly imbued
with the idea that dissecting a human corpse was an act of desecration,
and consequently it was by no means safe for a physician to do any
work of this character except in the most secret manner. Then, in
addition, it was commonly believed-and this belief persisted even up to
a comparatively recent date--that the bull which Pope Boniface VIII.
issued in 1300--and which declared that whoever dared to cut up a
human body or to boil it, would fall under the ban of the church--was
intended to cover dissections for purposes of anatomical study. The
recent investigations of Corradi, however, show (Haeser, p. 736 of the
third edition) that this bull was not intended to apply to dissections
for scientific purposes, but simply to put an end to the practice of
cutting up human corpses and boiling the separate sections in order to
obtain the bony framework in a condition suitable for transportation
from Palestine to Europe,--a practice which had grown to be very common
among the Crusaders.

Mondinus’ “Anatomy,” which was published in 1314, reveals the fact
that, during the early part of the fourteenth century, several private
dissections were made. As might be expected, from the primitive
character of the illustrations that accompany the text of Mondinus’
work, these dissections were carried out in a very imperfect manner,
for--to mention only a single example--this author admits that he made
no attempt to investigate the deeper structures of the ear, as such
an examination would necessitate the employment of violent measures,
“which would be a sinful act.”

The archives of the Bolognese School of Medicine contain an item which
reveals the active interest taken in anatomy by the students of that
day. It reads as follows: “At Bologna, in 1319, several of the Masters
stole from a grave the corpse of a woman who had been buried two days
before, and then turned it over to Master Albertus to dissect in the
presence of a large number of students.” At the Medical School of
Montpellier, in the south of France, the Faculty obtained permission
in 1376 to dissect the corpse of an executed criminal once every
year; and the records show that the school actually availed itself of
this privilege in the years 1377, 1396 and 1446. Felix Platter, who
afterward became one of the most distinguished physicians of Basel,
Switzerland, pursued his early medical studies at the latter university
during the years 1552–1557; and, in the diary which he faithfully
kept during this period, he reveals in an interesting manner what
difficulties as well as dangers he experienced, first, in reaching
Montpellier from his home in the eastern part of Switzerland, and,
second, in obtaining greater opportunities for acquiring a genuine
knowledge of anatomy than the school itself afforded in its official
course. Although, owing to lack of space, I shall not be able to quote
in full the appropriate portions of this most interesting narrative, I
will furnish an abridged English translation of the story as it appears
in Platter’s journal or diary. In all its more important details the
account reads as follows:--

   Our little party was composed of three persons, viz., Thomas
   Schoepfius, the schoolmaster of St. Pierre; a Parisian by
   the name of Robert who happened to be passing then through
   Basel on his way to Geneva; and myself, a lad of sixteen. We
   traveled on horseback and all three of us were armed with
   rapiers. My outfit, which was handed to me by my father shortly
   before our departure, consisted of two extra shirts and a few
   pocket-handkerchiefs, wrapped up in a piece of waxed cloth.
   In the matter of funds for the journey I received from my
   father three crowns in silver and four gold pieces which,
   for further security, he sewed into my vest. In addition,
   he presented me with a rare piece of silver money which had
   been issued by the Cardinal Mathieu Schiner, of the Canton de
   Valais, who personally commanded the Swiss soldiers in their
   successful combat with the troops of Louis the Twelfth, at
   Marignan. It was a coin, therefore, which possessed considerable
   historical value. My mother also bestowed upon me a gold coin (a
   _couronne_). As a last injunction my father begged me not
   to forget that, in order to procure the money which he had just
   placed in my hands, as well as that which he had already paid
   for my horse, he had been obliged to mortgage his property.

   We left the city at nine o’clock on the morning of Oct. 10th,
   1552, and at the same moment the news reached us that the Plague
   had made its appearance in Basel. This was a most depressing
   piece of intelligence, especially as we were already in great
   fear that the army of the Emperor Charles the Fifth, which was
   at that time on its way to the siege of Metz, would utterly
   destroy our city.

   We arrived at Berne early on the morning of Oct. 12th, and,
   after leaving our horses at the inn, The Falcon, lost no time
   in visiting the objects of interest in that ancient city, not
   forgetting the bear pit, in which there were at that time six
   of these creatures. In the afternoon we resumed our journey
   toward Fribourg, and very soon overtook a newly married couple.
   As they were traveling on horseback like ourselves, and were
   following the same route for a certain distance, we all agreed
   to keep together. While passing along a shady part of the road
   the bride’s dress became so firmly entangled in the branches of
   an apple tree that, failing to stop the horse, she was left
   suspended in the air by her skirts. I immediately dismounted and
   helped her to regain her feet, to adjust her disordered dress,
   and to resume her seat in the saddle. On arriving at Fribourg
   we put up at the inn called _La Croix Blanche_, and soon
   discovered that almost everybody in the town spoke French, a
   language with which Thomas and I, who were Germans, were not
   familiar; but, thanks to our companion Robert, the Parisian, we
   experienced no difficulty whatever in making all our wants known
   and in securing all the information that we desired.

   On the following day, Oct. 13th, it was raining hard when we
   left Fribourg, and we were soon wet to the skin. After passing
   through several small villages we stopped for refreshment at
   an inn in the picturesque town of Romont, and at the same time
   availed ourselves of the opportunity to have our clothes dried.
   Then, having satisfied our appetites, we resumed our journey
   in the direction of Lausanne; but we did not get very far on
   our way before we discovered that Thomas had disappeared. We
   were of course obliged to wait for him, and, by the time he had
   rejoined the party, darkness and a thick fog combined to render
   further progress very difficult, and we soon realized that we
   had lost our way. We wandered up and down for some time without
   encountering a barn or building of any kind in which we might
   find shelter from the rain and secure a measure of protection
   from the robbers who, according to common report, infested that
   part of the country. Finally, however, we discovered a small
   village; but, when we applied for a night’s lodging, not one
   of the householders was willing to receive us. So we engaged
   the services of a young peasant to act as our guide, and with
   his assistance we finally reached a mean-looking inn in a
   village called Mézières, which was composed of a few widely
   scattered houses. We entered the tavern and found several
   Savoyard peasants and some beggars seated at the long table of
   the bar-room; they were engaged in eating roasted chestnuts and
   black bread, which they washed down with copious draughts of a
   liquor called _piquette_. They unceremoniously examined
   our weapons and acted with great rudeness toward us in other
   respects. The woman who kept the house said she had no other
   room which she could place at our disposal, and our first
   impulse therefore was to resume our journey immediately after we
   had finished our meal of black bread and chestnuts; but, after
   careful reflection, we came to the conclusion that such a course
   might prove fraught with considerable danger. So we decided to
   remain awake and watch for an opportunity to make our escape.
   Very soon afterward these half-intoxicated men lay down on the
   floor before the fire in the adjoining hall-way or vestibule
   and fell into a sound sleep. Our guide then confessed to us
   that, while at work in the stable, he had heard them planning
   to waylay us on the highway at an early hour of the following
   day. As soon, therefore, as we heard them all snoring lustily
   we very quietly slipped out of the house. Our score having
   already been paid earlier in the evening, and our horses having
   been left saddled and bridled in the stable, we mounted and
   took our departure by a road which led at first in a direction
   different from that in which we were supposed to be traveling.
   We experienced no further trouble on this part of our journey
   and in due time reached Lausanne. When we told the people at the
   inn about our experience at Mézières they replied that we might
   consider ourselves most fortunate, as almost every day there
   occurred, in the forest through which we had passed (_la Forêt
   du Jorat_), a murder or some other deed of violence.[72] It
   was plain, therefore, that we had had a narrow escape from death.

   In the further course of our journey along the north shore
   of the lake we reached the city of Geneva on Oct. 15th. When
   I called upon John Calvin, to whom my father had given me a
   letter of introduction, he said to me: “My Felix, you arrive at
   the right moment, for I am now able to give you an excellent
   traveling companion for the remainder of your journey--_to
   wit_, Dr. Michel Heronard, a native of Montpellier.” This Dr.
   Heronard, as I learned subsequently, was a Protestant who played
   a prominent part in the religious disorders which, a few years
   later, greatly disturbed the peace of that city.

   On the 30th of October--just twenty days after we set out from
   Basel--we entered the city of Montpellier, and I lost no time
   in hunting up Laurent Catalan, the apothecary, at whose house I
   expected to reside during my stay in that city.

Platter had now, after a long and dangerous journey, reached one of the
three greatest medical schools of that period, and it was his hope
and expectation that he would here be able to acquire a correct and
intimate knowledge of human anatomy. He was already aware that this
knowledge could be satisfactorily obtained in only one way--that is,
by dissecting the human body; and accordingly he availed himself of
every possible opportunity, during the five years which he spent at
Montpellier, to accomplish this purpose. From the somewhat superficial
examination which I have made of the record furnished by the diary,
it appears that only five or six official lessons or demonstrations
were given by the professor of anatomy during the period of time
named; but--as every student of medicine knows--instruction of this
character is of relatively small value; and Platter himself seems to
have realized fully the truth of this statement, for during the second
year of his stay at Montpellier he joined a secret band of nocturnal
grave-robbers who were determined at all hazards to obtain the material
needed for self-instruction. The following brief description of one of
the raids made by this band of eager searchers after knowledge will
convey a good idea of the manner in which the work was conducted:--

   Our first excursion of this kind was made on Dec. 11th, 1554. As
   soon as it was really dark our fellow student Gallotus guided
   us, along the road that leads to Nîmes, to the Augustinian
   Monastery, which is situated about half-way between Castelnau
   and the Verdanson brook. Here we were received by a monk called
   Brother Bernard, a bold and determined fellow, who had disguised
   himself for the business in hand. At midnight, after we had
   partaken of food and drink, we started out, sword in hand, for
   the cemetery which is located close to the church of Saint
   Denis. Here we dug up with our hands a corpse which had been
   interred that very day; and, having lifted it out of the pit by
   means of ropes, and wrapped our cloaks around it, we carried the
   body on two canes as far as Montpellier. Then, having concealed
   our load close to the postern, alongside the city gateway, we
   summoned the keeper and begged him to get us some wine, as
   we were dying of thirst and very tired. While he was absent
   in search of the wine three of our party slipped in through
   the passage and carried the corpse safely to Gallotus’ house,
   which was only a short distance from the gate. The gate-keeper
   returned in due time with the wine, and did not appear to have
   the slightest suspicion of the trick that we had played upon
   him. It was now three o’clock in the morning.

The control exercised by the authorities over the practice of
dissecting human corpses differed very appreciably at different dates
in different parts of Europe. Thus, for example, orders were issued to
the Italian bishops during the latter part of the fourteenth century to
put a stop to further dissections, and for a period of over one hundred
years these orders accomplished the purpose desired. On the other
hand, the Emperor Charles the Fourth adopted a more liberal course:
from the year 1348 on he permitted dissections of human corpses to be
made without hindrance in Prague, Bohemia, but his liberality in this
particular appears to have been of little use, for there is no evidence
to show that the knowledge of anatomy made any appreciable advance
anywhere in Europe until after the beginning of the sixteenth century.

Gabriel Zerbi of Verona (1468–1505) published at Venice in 1502 the
first modern treatise on human anatomy that deserves to receive special
mention. Pagel speaks of it as containing fairly good descriptions of
different parts of the body. Zerbi held the Chair of Medicine, Logic
and Philosophy in the University of Padua, and lectured first in that
city, next at Bologna, and finally at Rome. One incident in his career
may prove of interest to the reader as showing the fearful risks to
which a practicing physician in those days was sometimes exposed. The
incident was of this nature:--

   A wealthy pacha in Constantinople, failing to obtain relief from
   his malady at the hands of the native Turkish doctors, summoned
   an Italian physician from Venice. Zerbi, whom the ruling
   Doge invited to accept the summons, sailed immediately for
   Constantinople in company with his two sons who were mere lads.
   The treatment which he inaugurated proved promptly successful,
   and Zerbi, having been handsomely remunerated for his services,
   was already on his way back to Venice when his ship was
   overhauled by a swift-sailing caique on board of which were
   the sons of his recent patient, who--as the story goes--had
   celebrated his recovery by eating and drinking to excess.
   This debauch promptly caused his death--probably by cerebral
   apoplexy; but the sons were convinced that it was the result of
   poison administered by Zerbi, and accordingly they lost no time
   in starting out to capture the supposed murderer. Their first
   act, on reaching the vessel which they were pursuing, was to
   kill the younger of the two sons, in the presence of the father,
   by sawing his body in two lengthwise. Then they killed Zerbi
   himself in the same manner.

Tiraboschi, the first historian of Italian literature (1731–1794), is
mentioned by Dezeimeris as his authority for this terrible tale. The
events here narrated occurred in 1505.

At the beginning of the sixteenth century--the period with which our
history now has to deal--the only available knowledge of anatomy
was that which had been supplied by Galen in the third century of
the Christian era, and which had been handed down through all the
intervening centuries as something absolutely correct and not to be
challenged. But the time had arrived when men were no longer willing
to accept as truth the teachings of any individual until they had
subjected them afresh to the most searching investigations; and thus
it came about that a group of remarkably able men devoted all their
energies, during the greater part of the sixteenth century, to a very
critical study of human anatomy. As the work accomplished by these
men constitutes a very important chapter--perhaps the most important
chapter--in the history of medicine, I may be pardoned if I devote a
disproportionately large amount of space to the consideration of the
careers of the more prominent of these founders of modern anatomy, and
to an enumeration of the details of the work which they accomplished,
and which furnished the most complete verification of the truth stated
by Francis Bacon, Lord Verulam (1561–1626), in the following words
(_translation_):--

   Man has no other means of getting at and revealing the truth
   than by induction coupled with a never-tiring, unprejudiced
   observation of nature and an imitation of her operations.
   Actual facts must first be collected, and not created by a
   process of speculation.

One of the earliest and most thorough students of human anatomy was
Marc Antonio della Torre (1473–1506), who belonged to an honorable
family of Verona, several members of which had attained distinction
as physicians. He planned to publish a treatise on anatomy, and, with
this object in view, secured the assistance of Leonardo da Vinci
(1452–1515), the celebrated painter, architect and civil engineer, to
make life-size pictures of the parts which he had dissected with such
care. But, after the latter had completed many of the drawings which
were intended to serve as illustrations for the projected treatise,
Della Torre unexpectedly died, and the book was never finished. Quite
a number of the drawings, however, found their way to England, and for
many years past they have been carefully treasured at Windsor Castle
and in certain private collections. If Della Torre’s life had been
spared it is highly probable that his treatise on anatomy, equipped
with illustrations copied from this great artist’s drawings, would have
constituted a formidable rival of Vesalius’ famous work.

Not long after this event it became the rule, among the leading
painters and sculptors of the Renaissance period, to pay a great deal
of attention to the study of human anatomy. The museums of Central and
Southern Italy contain quite a large number of anatomical drawings that
were made by Michael Angelo, by Raphael and by other great masters
of that period. Doubtless many of my readers recall seeing, in the
Cathedral of Milan, Marco Agrate’s (1562) extraordinary masterpiece,
in the form of a life-size black marble statue which represents Saint
Bartholomew standing erect, and carrying on one arm the folded skin of
his entire body. In this statue all the muscles and bony prominences
are modeled with perfect accuracy. It is a remarkable work of art.




                             CHAPTER XXVII

             THE FOUNDERS OF HUMAN ANATOMY AND PHYSIOLOGY


Among the earliest physicians of this period to inculcate the
importance of substituting a correct knowledge of anatomy for the
frequently incorrect descriptions that had been prepared by Galen and
handed down through the succeeding centuries, were the following:
Jacques DuBois of Paris (1478–1555), who was perhaps better known by
his latinized name of “Sylvius”; Guido Guidi (died in 1569), who was
also known as “Vidus Vidius”; and Winther of Andernach, a small city
on the Rhine. These three men, all of whom taught anatomy at Paris,
were commonly considered the best anatomists of that early period.
DuBois was further entitled to the credit of having been the first
physician to inject blood-vessels with a material that renders them
more easily visible, and also the first person in Paris to dissect a
human corpse. It was from these men that Vesalius, who afterward became
such a famous anatomist, received his first practical instruction in
this branch of medical science. Nothing further need be said here of
DuBois, but brief sketches of Guido Guidi and of Berengarius of Carpi,
another contemporary anatomist of considerable distinction, deserve to
find places in our history of this period. Vesalius’ facetious remark
that “Winther of Andernach never used a knife except for the purpose
of dissecting his food” absolves us from the duty of saying anything
further about his career as an anatomist.

In 1542 Francis the First, King of France, gave a great impulse to the
study of medicine by calling Guido Guidi from Florence, Italy, to teach
that science in the _Collége de France_, an institution which
he had founded at Paris in 1530. Guidi, upon his arrival in Paris,
was at once most cordially received, both by those who were to be his
colleagues and by the King. Francis bestowed upon him a suitable gift,
appointed him to the position of First Physician (Archiater) at his
Court, and assured him that he would receive an ample salary during
his residence in the French metropolis. In 1547, after the death of
Francis the First, Guidi returned to his home in Florence, where Cosimo
dei Medici, at that time the head of the Florentine Republic and a
little later Grand Duke of Tuscany (Cosimo III.), made him his First
Physician and gave him the appointment of Professor of Philosophy in
the University of Pisa. Not long afterward Guidi was transferred to the
Chair of Medicine. He retained this position almost up to the time of
his death (May 26, 1569), and during this long period Cosimo bestowed
upon him various ecclesiastic honors, which not only increased his
social rank but added materially to his financial resources.

Dezeimeris says that, while Guidi does not deserve to be placed, as
an anatomist, in the same rank with Vesalius and Fallopius,[73] he
merits full credit for the very important service which he rendered the
physicians of his day by placing within their reach translations of
certain Greek treatises relating to surgical topics--such treatises,
for example, as those of Hippocrates on ulcers, on wounds of the
head, on the joints and on fractures (with Galen’s comments), Galen’s
treatise on fasciae, and that of Oribasius on ligatures and other
surgical contrivances.

Apart from his merits as a worker in the field of medical science,
Guidi occupies a creditable place in the history of medicine as a
fine type of the well-educated and kindly disposed physician, as the
following testimony given by Benvenuto Cellini, the distinguished
Florentine sculptor, shows:--

   On the occasion of my visit to Paris I made the acquaintance
   of Messer Guidi, and I wish to state in what a very friendly
   manner I was received by that noble citizen of Florence and
   excellent physician, the most virtuous, the most lovable, and
   the most domestic man whom I have ever met.

Guidi’s treatise on anatomy was first published at Venice (under the
editorship of his nephew) in 1611--_i.e._, forty-two years after
his death. His translations from the Greek treatises of Hippocrates,
Galen and Oribasius will be found in the work which bears the title
“_Collectio Chirurgica Parisina_,” Paris, 1544.

Berengarius of Carpi (a small town in Northern Italy), who died in
1530, is pronounced by Kurt Sprengel a worthy predecessor of Vesalius.
He was Professor of Anatomy, first at Pavia and then at Bologna (from
1502 to 1527), and he is reported to have dissected more than one
hundred(!) cadavers during that period. Fallopius and Eustachius were
among his pupils, and it was their opinion that he did more than
anybody else to revive the interest in anatomical work. The famous
sculptor, Benvenuto Cellini (1500–1571), is authority for the statement
that Berengarius was not only an experienced anatomist and practicing
physician, but also a very skilful draughtsman; the three works which
he published being illustrated with a certain number of original
woodcuts that are not without interest both to the anatomist and to the
lover of art.

Andreas Vesalius (1514–1564) was born at Brussels, of German parents
whose home was located at Wessels on the Rhine,--whence the name
“Vesalius.” His father was the apothecary of the Princess Margaretha,
Charles the Fifth’s aunt, and several of his ancestors had been
physicians of considerable distinction. At Louvain he received, in
early youth, a thorough training in the Latin, Greek and Arabic
languages and also in mathematics. When he was about eighteen years
of age, he visited Montpellier and afterward Paris, at which latter
city he received practical instruction in anatomy from the three
men whose names I have mentioned in the preceding paragraph--viz.,
Guido Guidi, Jacques DuBois and Winther of Andernach. The instruction
in anatomy given in Paris at that period (about 1533) consisted
in interpretations of Galen’s teachings, in dissections of a few
animals, and in occasional demonstrations--which never lasted longer
than three days--of the easily accessible parts of a human cadaver.
Scanty as were these sources of information, Vesalius cultivated
them with the greatest zest. From time to time his teacher, DuBois,
noting the interest which his pupil took in anatomy, and recognizing
his fitness for imparting instruction, assigned to him the special
duty of rehearsing, in the auditorium, before his fellow students,
the essential facts of the day’s lecture. After war had been declared
between the Emperor Charles the Fifth and Francis the First, King of
France, Vesalius left Paris and returned to Louvain, where he began
lecturing on anatomy. These lectures constituted the very first attempt
at anything like systematic instruction in anatomy that is known
to have been made at that ancient university. It was while he was
engaged in this work that Vesalius, in order to become the possessor
of an entire human skeleton,--a thing of which he felt a very great
need,--ventured to remove from the gallows, outside the city, the
cadaver of a criminal. This, as Haeser declares, was an act of great
boldness and full of peril.

The life of a military surgeon attached to the army of Charles the
Fifth, which was the life that Vesalius led during the following year
or two, was not sufficiently attractive to divert his mind seriously
from his favorite study; and it is therefore not surprising that
we find him, at the age of twenty-three, accepting from the Senate
at Venice the appointment of the professorship of anatomy at the
University of Padua. When he entered upon this new work Vesalius felt
considerable uncertainty as to the correctness of the anatomy which
he was then teaching, and it is therefore easy to understand why his
first three lectures were based entirely upon the teachings of Galen;
but, before he had finished the third one of the series, he made up his
mind that he would cut loose from the anatomy of the ape and confine
himself to that of the human subject, as was then being revealed to
him more and more perfectly from his own dissections. The stock of
knowledge which he had thus begun to accumulate, increased steadily
until, after seven years of teaching at Padua, Bologna and Pisa, at
each of which schools of medicine he gave courses in anatomy of seven
weeks’ duration, and after conducting the most painstaking dissections
of a number of human cadavers, he finally declared that he was ready to
publish his great treatise on anatomy. Some of his friends, foreseeing
clearly what a storm of protest the new book would arouse among the
followers of Galen, urged him to postpone for a time its publication;
but a few others agreed with him that it should be issued without
further delay. Accordingly Vesalius sent the manuscript of his work at
once to the printers at Basel, and the book was finally published in
June, 1543, before its author had attained his twenty-ninth year. Its
title was “_De corporis humani fabrica_,” and it was provided with
exceptionally fine pictorial illustrations, most of which were drawn,
as is generally believed, by John de Calcar, one of Titian’s pupils. A
second edition, superior in every respect to the first, was published
in 1555. In comparison with this great work the few treatises written
by Vesalius in later years are of minor importance.

Vesalius may rightly be considered the founder of modern anatomy,
for he was the first to furnish correct information, based on actual
dissections of the human cadaver, respecting quite a large number of
the more important anatomical relations; and by this very act he won
the further credit of having dealt the first effective blow toward the
dethronement of Galen, the man who, next to Hippocrates,--probably even
more than Hippocrates,--had exercised, by his teachings in nearly every
department of medical science, almost despotic sway over physicians
for considerably more than one thousand years. At this distance of
time, it is hard to realize what a startling effect was produced by the
announcement of the discovery of so many errors in Galen’s scheme of
anatomy. Albert von Haller, the great authority on medical literature,
speaks of Vesalius’ book as an “immortal work”; and, although its title
would lead one to suppose that it deals only with the construction of
the human body, an examination of its contents reveals the fact that
it contains in addition quite full information regarding physiology and
pathological anatomy, as well as many details relating to comparative
anatomy. Perhaps the most marvelous thing about this book is the
fact that its author completed his work before he had reached his
twenty-eighth year. It may also interest the reader to learn that,
prior to 1914, the University of Louvain possessed a copy of Vesalius’
great work printed on vellum and illustrated with many drawings in
colors; but I am unable to say whether this beautiful volume did or did
not escape destruction at the hands of the ruthless men who invaded
Belgium during the summer of that memorable year.

  [Illustration: FIG. 14. ANDREAS VESALIUS.

  (After the portrait by Van Calcar in the Royal College of
  Surgeons, London.)

  Copied from the reproduction published in the _Nederlandsch
  Tijdschrift voor Geneeskunde_, Jan. 2, 1915.]

When the human mind has adjusted itself, in the course of years, to
consider certain beliefs and ideas as settled truths, it comes as a
painful shock to be told that these beliefs are erroneous and that
new ones must take their places. This is precisely what happened when
Vesalius’ book was first published. From one end of Europe to the
other there was a very great stir among the well-educated physicians;
the more liberal-minded being ready to accept at once the genuineness
of the new anatomy, whereas others,--and possibly they represented
the larger number,--acting under the influence of personal jealousy
or perhaps blinded by the belief that it was impious not to accept
without questioning the descriptions made by Galen, were scandalized
by the boldness of Vesalius in asserting that many of the statements
made by this great medical authority were incorrect. Jacques DuBois,
whose name has been mentioned by me on a previous page, was one of the
most bitter of Vesalius’ assailants. In a pamphlet which he published
in Paris in 1551 he even went so far as to speak of his late pupil as
“a crazy fool who is poisoning the air of Europe with his vaporings.”
On account of their former pleasant relations, and also because DuBois
was at that time an old man, Vesalius made no reply to these attacks;
but when Bartholomaeus Eustachius, Professor of Anatomy at Rome, one
of the most celebrated anatomists of that period, and a man of his own
age, entered the lists as the champion of Galen, Vesalius took up the
challenge, left the work upon which he was then engaged, and began a
tour of visits to the universities of Padua, Bologna and Pisa, for the
express purpose of disproving, by the aid of numerous dissections,
the statements made by his antagonists. Throughout this tour he was
received everywhere with enthusiasm, the older men among the teachers
of anatomy vying with the younger in manifesting the strength of their
approval. The entire journey, says Haeser, was from beginning to end
a series of the most brilliant triumphs. But, notwithstanding this
vindication, which most men would have accepted with the greatest
satisfaction, Vesalius returned to his home in Brussels only to find
that the bitter attacks made by his enemies had not ceased. This
depressed him greatly, for he was not philosophical enough to recognize
the facts that jealousy was at the bottom of this ill feeling toward
him, and also that sufficient time had not yet elapsed for the news
of his triumphant vindication to travel from Italy to Belgium. While
suffering from this fit of the blues he committed to the flames all his
books and manuscripts. These latter, it appears, contained not only
the fruits of many years of laborious anatomical and physiological
research, but also a large number of memoranda relating to pathological
anatomy.

In 1556, complaints having reached the ears of Charles the Fifth to
the effect that the sin of dissecting human corpses was greatly on the
increase, this monarch decided to refer the question to the Theological
Faculty of the University of Salamanca, in the northwestern part of
Spain, for an authoritative opinion. The reply which these broad-minded
theologians sent to the Emperor was most satisfactory. It is reported
to have been expressed in the following words: “The dissection of
human cadavers serves a useful purpose and is therefore permissible to
Christians of the Catholic Church.” This decision did not of course
put an immediate end to the harsh criticisms and petty persecutions of
the bigots; but, as the years went by, it was noted that the work of
scientific research in human anatomy and physiology acquired greater
freedom of action, and it is fair to assume that this result was
largely due to the famous decision to which I have just referred.

Shortly after Vesalius had retired, as stated above, from active
participation in anatomical research work, he was called by Charles the
Fifth to serve him in the capacity of private physician. During this
service, which lasted for several years, he visited, in company with
the Emperor, many of the principal cities of Europe; and then, when the
latter abdicated the throne of Spain,--for Charles was not only Emperor
of the Holy Roman Empire but also King of Spain,--Vesalius became the
private physician of Philip the Second, Charles’ son and successor on
the Spanish throne. This long period is largely a blank in the history
of Vesalius. Toward the end he got into trouble with the Inquisition
and was obliged, as a means of escaping the punishment of death, to
undertake a voyage to the Holy Sepulchre in Jerusalem. While he was
in that city he received an official invitation from the Senate at
Venice to fill the Chair of Anatomy at Padua. He then at once turned
his steps toward Italy, doubtless very happy over the prospect of once
more engaging in anatomical work; but he was shipwrecked on the coast
of the Island of Zante, October 2, 1564. Thirteen days later, before he
had completed his fiftieth year, he died from starvation and exposure.
A memorial tablet was placed in one of the neighboring churches on the
island, and in 1847 his Belgian compatriots erected a suitable monument
to his memory in the city of Brussels.

Admirable as was Vesalius’ treatise on human anatomy, it was soon
discovered that it was deficient in certain particulars. Not a few of
the descriptions, for example, were incomplete, and there were also a
number of parts or organs for which no descriptions whatever had been
provided. Many of these deficiencies were supplied by contemporary
anatomists, nearly all of whom were Italians. First and foremost among
this secondary but yet very important group of laborers in the field of
original research work, the names of Fallopius and Eustachius deserve
to be mentioned.

Gabriele Fallopius, who was born in Modena in 1523, was appointed to
the Chair of Anatomy at Ferrara when he was only twenty-four years
of age. Subsequently he taught at the University of Pisa. At the
time of his death in 1563 he was Professor of Anatomy, Surgery and
Botany at Padua. He made many important discoveries in anatomy, more
particularly in relation to foetal osteology and the distribution
of the blood-vessels. His work in the latter department is all the
more remarkable from the fact that it was accomplished at a time when
the art of injecting blood-vessels with some opaque material was
unknown in Italy. His name has been perpetuated in connection with
the Fallopian tube. As a man Fallopius was much liked because of his
kindly disposition and absence of conceit. The only treatise which he
published was that entitled “_Observationes anatomicae_,” Venice,
1561.

Bartholomaeus Eustachius, born at San Severino, in the Marches of
Ancona, in the early part of the sixteenth century, was one of the most
distinguished physicians of his day. He taught anatomy at the famous
University of Sapienza at Rome, and devoted a great deal of time and
thought to the preparation of a large work which was to bear the title
“On the Dissensions and Controversies Relating to Anatomy”; but death
overtook him before he had completed this undertaking. It appears,
however, that in 1564--that is, ten years before he died--he published
a smaller work containing separate chapters on the kidneys, the organ
of hearing, the movements of the head, the vena azygos, the vena
profunda of the arm, and on certain questions relating to osteology;
and he introduced, as illustrations for the text, eight plates of
octavo size. These plates and thirty-eight others, which were to have
served as illustrations for the great work, were all completed as early
as during the year 1552. The artist Pini, who made the drawings that
served as the originals from which the plates were made, was related in
some degree to Eustachius, and upon the latter’s death the metal plates
became his property by inheritance. But nothing further was heard of
them until they were discovered, early in the eighteenth century, by
Lancisi, the Pope’s attending physician, in the possession of Pini’s
descendants. They were published for the first time in 1714. Haeser
says that these pictures are true to nature, but that in artistic merit
they are not equal to those which belong to the treatise published by
Vesalius. The name Eustachius is permanently connected with the channel
which leads from the tympanum to the nasal cavities--the Eustachian
tube.

Only the briefest possible mention may here be made of those anatomists
who, following immediately in the footsteps of the three great leaders
mentioned above, played parts of greater or less importance in building
up the science of anatomy. Each one of them did creditable work in
correcting the errors made by their predecessors or in supplying
descriptions of structures or structural relations which these pioneers
had overlooked. Thus, long before the sixteenth century came to an end,
the gross anatomy of the human being had attained a large measure of
the completeness which it possesses to-day. The names of some of the
more prominent men among those to whom I have just referred are the
following: Giovanni Filippo Ingrassia, Matthaeus Realdus Columbus,
Julius Caesar Arantius, Constantius Varolius, Volcher Koyter and
Hieronymus Fabricius ab Acquapendente.

Ingrassia (1510–1580), a Sicilian physician, cultivated osteology
assiduously, and is entitled to special credit for having first
described the stapes, the third one of the ossicles of hearing, and
for having made valuable contributions to our knowledge of epidemic
diseases. He was a professor in the University of Naples, and, after
the year 1563, held the position of Archiater in Palermo, Sicily. His
descriptions of the different bones of the skeleton were made with such
care and thoroughness that later anatomists found very little for them
to discover or to alter.

Matthaeus Realdus Columbus (or simply Realdus Columbus), who died in
1559, was born in Cremona, Northern Italy. He served for some time as
Prosector to Vesalius at Padua, and then succeeded him in the Chair
of Anatomy, first at Padua and afterward at Pisa. The last teaching
position which he held was that of Professor of Anatomy in Rome, in
which city he counted Michael Angelo among his intimate friends.
The discoveries which he made in anatomy were quite numerous and of
considerable importance, and his descriptions were distinguished by
an unusual degree of accuracy and clearness. Unfortunately, he did
not hesitate, at the same time, to exalt the value of his own work by
disparaging that of his famous teacher.

Arantius, who also was one of the pupils of Vesalius, occupied the
Chair of Anatomy in his native city of Bologna during the latter half
of the century. His death occurred in 1589. The particular department
in which he gained considerable fame was that of the foetus, the
placenta, the uterus, etc. His descriptions of these structures are
written with very great care. Blumenbach gives him credit for having
been the first anatomist to furnish a description of the pregnant
uterus in its different stages. His earliest published work bears the
title “_De humano foetu opusculum_” Rome, 1564.

Constantinus Varolius, whose name is imperishably connected with that
part of the brain which is known as the “Pons Varolii,” was born in
Bologna in 1543. He was appointed Professor of Anatomy in the Academy
of his native city at an early age, and soon distinguished himself by
the careful studies which he made of the human brain and nervous system
in general. Before his untimely death at the age of thirty-two he was
chosen the attending physician of Pope Gregory the Thirteenth. His
earliest published work bears the title “_De nervis opticis, etc.,
epistola_,” Padua, 1573.

Volcher Koyter, who was born at Groningen, North Holland, in 1534,
studied under Fallopius and Guillaume Rondelet (1507–1566), to whom
the University of Montpellier was indebted for its anatomical theatre,
and to whom (rather than to Gaspard Bauhin of Basel) is due the honor
of discovering the ileo-caecal valve. Koyter was one of the earliest
workers in the field of comparative anatomy--a department of knowledge
to which Vesalius had already made some creditable additions; and
his two most important published treatises bear these titles: “_De
ossibus et cartilaginibus corporis humani tabulae_” (Bologna, 1566),
and “_Externarum et internarum principalium humani corporis partium
tabulae_” (Nuremberg, 1573). He died in 1600.

Hieronymus Fabricius was born in 1537 at Acquapendente, a small city
of Etruria, about fifty miles northwest of Rome. He studied anatomy
at Padua under Fallopius, and, after the latter’s death, was assigned
to the duty of making the necessary dissections and anatomical
demonstrations before the class. In 1565 he was appointed Professor
of Surgery, with the understanding that he was to continue giving his
demonstrations in anatomy. The salary which he received for this double
work was 100 ducats, but it was increased from time to time until
finally he was paid 1100 ducats yearly. At the end of thirty-six years
he was retired upon a pension of 1000 ducats for the remainder of his
life, and was allowed the privilege of appointing his successor in the
Chair of Surgery. He gave the place to Julius Casserius in 1609. To
distinguish him from another Fabricius, who gained great distinction in
the field of surgery, it has always been customary for later historical
writers to speak of him as “Fabricius ab Acquapendente.” His namesake
is known as “Fabricius Hildanus.”

As a teacher of anatomy, especially in its relations to physiology,
Fabricius was held in the highest esteem. Albert von Haller speaks of
him as being one of the glories of the Italian school of medicine.
Pupils came in flocks from all parts of Europe to attend his lectures,
and among them were some who, like William Harvey of England, afterward
attained great celebrity for the effective work which they did in
advancing the science of medicine. One of the attractive features of
Fabricius’ teaching was to be found in his practice--something quite
new at that period--of showing to the students, not only the particular
organ (human) upon which he happened then to be lecturing, but also
the corresponding organ in one or several of the animals; thus enabling
them to learn what were the features possessed in common by all the
species, and what were those in respect of which the species differed.
As time went on, the number of those who came to witness his anatomical
demonstrations increased so greatly that he felt impelled to build,
at his own expense, a new and larger amphitheatre. But even this, in
a short time, proved to be too small, and then the Senate at Venice,
which exercised a governing control over the University of Padua,
erected (in 1593) a much larger and more complete amphitheatre, upon
the walls of which there was placed an inscription stating that it had
been built in honor of Fabricius. Among the other distinctions which
were conferred upon him at this time he was raised to the rank of
Knight of the Order of Saint Mark and made an honorary citizen of Padua.

Fabricius ab Acquapendente added to our stock of anatomical knowledge
by his researches on the structure of the oesophagus, stomach and
intestines, the eye, ear, larynx and foetus. One of his chief claims to
distinction, however, rests upon the fact that he wrote an elaborate
monograph on the valves of the veins. Although these structures had
been seen and described at an earlier date by Charles Estienne,
Berengarius, Vesalius, Cannani and others (Fra Paolo Sarpi, for
example), nobody had yet offered a satisfactory explanation of their
probable use or had traced them through the venous system at large.
In 1574 Fabricius demonstrated their presence in all the veins of the
extremities.

But Fabricius ab Acquapendente was not merely a good anatomist and
physiologist; he was also a most distinguished surgeon and general
practitioner. From far and from near patients came to consult him
about their ailments, and he appears to have been immensely popular
among all classes of the community. His home, situated on the River
Brenta, just outside the city of Padua, was most attractive, and it was
there that he dispensed hospitality in a princely fashion. One of his
peculiarities was that in many cases he was unwilling to accept a fee
for his services. As a natural result, gifts of all sorts, many of them
of considerable value, were showered upon him. He devoted one of the
rooms of his residence to the purposes of a cabinet or museum, in which
all those gifts which were suited to such display might be properly
exposed to view, and over the doorway of the room he placed this
inscription, “_Lucri neglecti lucrum_,” which I venture to render
into English by the following, “Costly gifts representing unproductive
wealth.”[74]

Fabricius remained a bachelor all his life, and at the time of his
death (May 21, 1619, at the age of eighty-two) his fortune, which he
bequeathed to his brother’s daughter, amounted to 200,000 ducats--a
very large sum in those days.

The writings of Fabricius were published at Leipzig in a single volume
in 1687, but Johann Bohn, who edited the collection, omitted the
different prefaces which Fabricius had written. In the Leyden edition
of 1737 this defect has been remedied.

To furnish here even a much abbreviated account of the important
discoveries made in anatomy and physiology during the sixteenth century
would call for a much larger amount of space than can possibly be given
to these two branches of medical science. Our modern text books on the
subject of anatomy alone are, in a certain sense, catalogues of these
very discoveries, and every physician knows what a vast amount of space
they occupy. I have already made mention of a few of these discoveries,
and, when I come to consider the splendid work done by William Harvey
in the early part of the seventeenth century, I shall have occasion
to recapitulate briefly the more important discoveries made by his
predecessors in this particular field. In this way I shall be able to
supply information regarding several of the discoveries which I am now
obliged to pass over in silence, but which, under other circumstances,
would more properly receive consideration in the present chapter.




                            CHAPTER XXVIII

      FURTHER DETAILS CONCERNING THE ADVANCE IN OUR KNOWLEDGE OF
      ANATOMY--DISSECTING MADE A PART OF THE REGULAR TRAINING OF
       A MEDICAL STUDENT--IATROCHEMISTS AND IATROPHYSICISTS--THE
    EMPLOYMENT OF LATIN IN LECTURING AND WRITING ON MEDICAL TOPICS


_Further Details Concerning the Advance in Our Knowledge of Gross
Anatomy._--In the preceding chapter I have given some account of
the efforts made during the sixteenth century by certain physicians
to lay solidly the foundations of a gross anatomy of the human body.
The time was ripe for such a movement, and the right sort of men took
charge of it and pushed it forward to such a stage of successful
accomplishment that we physicians of to-day are able to continue in
the direction indicated, and under the impulse communicated, by these
master builders. These men, it should be remembered, did something more
than merely to lay solid and durable foundations in the form of an
accurate anatomy, they also taught the correct methods of procedure for
the erection of the superstructure of the science of medicine.

Up to the end of the sixteenth century almost all the work done in
anatomy was effected with the aid of the scalpel alone, the object
being to isolate and expose clearly to view the larger tissues and
organs, such as muscles, arteries, veins, nerves, etc. In a very few
instances more elaborate methods were devised, even as early as during
the fifteenth century, by men of exceptional cleverness. Thus, for
example, in 1490, Alexander Benedetti, Professor of Anatomy at Padua,
invented a method of preserving muscles, nerves and blood-vessels as
permanent dry specimens, and it is said that he sold such preparations
for large sums of money. As already stated on a previous page, the
injection of blood-vessels with certain fluids was also employed to a
very limited extent at this early period as a means of distinguishing
them more easily from the surrounding structures; but this practice
gave place, during the seventeenth century, to the better method of
employing, as an injecting material, a semi-fluid preparation which
became quite solid soon after it had penetrated well into the interior
of the vessels, and to which any desired opaque color might be given.
This method was invented by the Hollander, John Swammerdam (1627–1680)
and perfected by Van Horne. It was largely by the employment of this
procedure that Friedrich Ruysch of Amsterdam (1638–1731), Professor
of Anatomy and Botany in the university of his native city, gained
such celebrity throughout Europe for the great beauty of his permanent
anatomical preparations. Hyrtl mentions the fact that Peter the Great
of Russia, who resided for a certain length of time at Zaandam, near
Amsterdam, in order that he might familiarize himself with the art of
ship-building, was in the habit of visiting Ruysch from time to time
in his museum and laboratory; and finally (in 1717) bought from him,
for the sum of 30,000 florins, his entire collection of specimens,
together with the formula of the mixture which he employed in making
his injections. The collection itself, it should be stated, contained
not only specimens illustrative of normal human anatomy (_e.g._,
the various solid and hollow organs, the organs of special sense,
and objects belonging to the vascular, muscular, nervous and osseous
systems), but also many specimens illustrating pathological and
comparative anatomy, and a great variety of monstrosities.

Ruysch also attained remarkable success in restoring the rosy color
and soft flexibility of the skin and the natural facial expression
in certain dead bodies by the employment of a preservative fluid
widely known as “_Liquor balsamicus_.” Tradition says that in one
instance, that of a child whose corpse had been treated in this manner
by Ruysch, the face presented such a perfectly life-like appearance
that the Czar, as he passed near the object, thought he was looking
upon a sleeping child and gave it a kiss.

The aged professor lived to be ninety-three, and continued giving his
lectures on anatomy almost up to the day of his death, which resulted
from accidental injuries. When it became clear that these were of so
serious a nature that he could not possibly recover, he asked to be
carried on a stretcher into the assembly room in order that he might
say a farewell to the students who had been attending his lectures.

Although some critics have intimated that Ruysch should be ranked
merely as a very clever mechanic in the domain of anatomy, there are
certain well-established facts which show that this estimate of the man
is unfair. It is known, for example, that he was the first anatomist
to call attention to the features which distinguish the male from the
female skeleton (_e.g._, the differences in the form of the pelvis
and of the thorax). Ruysch also advanced our knowledge of the vascular
system by means of the improvements which he effected in the method of
injecting blood-vessels. His skill in this special work was so great
that people were wont to say of him that he possessed the fingers of
a fairy and the eyes of a lynx. It was Ruysch too who furnished the
first descriptions of the bronchial blood-vessels and of the vascular
plexuses of the heart. Finally, the term “_membrana Ruyschiana_,”
in connection with the choroid of the eye, bears testimony to the fact
that he was also an original worker in this very difficult corner of
the field of human anatomy.

The crowning event in the life of Ruysch--an event which shows
how wasteful many of us men are of our productive powers when we
deliberately retire from all participation in active work, physical or
mental, at the comparatively early age of sixty-five--occurred in 1717,
when he had attained the age of seventy-nine. Peter the Great had
hardly left the premises with the great collection of specimens for
which he had paid such a fabulous price, when Ruysch began the making
of a new collection; and at this task he worked so diligently that in
less than ten years he was able to deliver to John Sobieski, King of
Poland, the greater part of the new collection (for which he received
the sum of 20,000 florins). Then followed a period of about three years
during which he continued active work as a teacher of anatomy, death
alone seeming to possess the power to arrest his extraordinary energy.

Ruysch’s only published works are the following: Catalogue of the
Specimens contained in his Museum, Amsterdam, 1691; and a _Thesaurus
Anatomicus_, in 10 volumes, Amsterdam, 1701–1715.

In reading over the account which I have given of the discoveries
made in gross anatomy and in physiology during the sixteenth and
seventeenth centuries, I find that I have omitted some that may just as
appropriately be mentioned in this section as in that which I intend to
devote to work done in the domain of minute anatomy. I shall therefore
refer to them briefly now, and then pass on to the consideration of the
latter branch of my subject.

Eustachius, the famous Italian anatomist, deserves special credit
for the experimental methods which he devised and employed in his
efforts to gain a better knowledge of the anatomy and physiology of
the kidneys. Moritz Hofmann of Fürstenwald discovered in 1641, in the
turkey gobbler, the outlet duct of the pancreas, and a short time
afterward George Wirsung, a Bavarian, discovered the same structure in
the human being. Then, in 1651, Olaus Rudbeck, Professor of Anatomy
in the University of Upsala, Sweden, discovered the lymphatics of
the intestines, and established (at a later date) the fact that they
are a separate system from that of the chyle ducts. Francis Glisson
(1597–1677) of Cambridge University, England, one of Harvey’s pupils,
made two series of anatomical investigations of a most creditable
character--the first concerning the relationship which exists
between the intestinal lymphatics and the alimentary canal, and the
second regarding the internal construction of the liver (“capsule of
Glisson”). Thomas Wharton (1610–1673), a native of Yorkshire, England,
and a London practitioner of medicine, discovered the outlet channel
of the submaxillary salivary gland, now known as “Wharton’s duct,”
and he also published the first exhaustive treatise on the structure
of glands in general (thymus, pancreas, submaxillary, etc.). About
the middle of the seventeenth century Nathanael Highmore of Oxford,
England (1613–1685), discovered and adequately described the cavity
in the superior maxilla which bears his name (“antrum of Highmore”),
and which in comparatively recent years has assumed such importance
from the viewpoint of the practical surgeon. A Danish anatomist,
who is known to us English-speaking physicians as Nicholas Steno
(1638–1686), but to his own countrymen as Niels Stensen, discovered
the outlet duct of the parotid gland (“Steno’s duct”). Stephen
Blancaard (1650–1702), a practicing physician of Amsterdam, made the
first successful injections of capillary blood-vessels; and Domenico
de Marchettis (1626–1688), Professor in the University of Padua,
employing Blancaard’s technique, succeeded in proving that the finest
ramifications of both veins and arteries communicate the one with the
other. To Conrad Victor Schneider, a professor at the University of
Wittenberg, Germany (1614–1680), we are indebted for putting an end
forever to the erroneous doctrine that the nasal mucus is produced
in the brain. He did not, however, have the good fortune to discover
the glands from which this mucus actually comes; the credit for
this discovery being due to Niels Stensen. Among the host of other
successful discoverers in the domain of anatomy during the seventeenth
century the following men deserve at least to be mentioned by name:
Johann Conrad Peyer (1653–1712) of Schaffhausen, Switzerland; Johann
Conrad Brunner (1653–1727), also a native of Switzerland; Theodor
Kerckring (1640–1693) of Hamburg, Germany; Anton Nuck (1650–1692),
Professor of Anatomy at the University of Leyden, Holland; Reignier
de Graaf (1641–1673), a native of the Netherlands; and Thomas Willis
(1622–1675) and William Cowper (1666–1709), both of them Englishmen.

And, finally, it may be stated that all the leading anatomists of the
sixteenth century devoted a great deal of time to the study of the
manner in which the nerves are distributed throughout the body and
to ascertaining the arrangement of the intracranial and intraspinal
nervous structures. To give even the most superficial account of what
these men accomplished would occupy far more space than can well be
spared for this purpose. Kurt Sprengel is my authority for saying
that, of all the workers in this particular field during the period in
question, Fallopius is entitled to receive the greatest credit for what
he accomplished.

_The First Beginnings of Minute or Microscopic Anatomy._--The
anatomy of the tissues--microscopic anatomy--begins with Marcello
Malpighi (1628–1694), a native of Crevalcuore, near Bologna, Italy.
It is not positively known who was the inventor of the compound
microscope. First employed about the year 1620, the instruments of this
type came into fairly general use toward the middle of the seventeenth
century. But the early compound microscopes were not very satisfactory,
and consequently preference was given, for a long time, to those of
the simple type. Achromatic instruments were not purchasable until
1780, when the famous German physicist, Leonhard Euler, succeeded in
overcoming the obstacles which had up to that time stood in the way of
their successful manufacture.

In 1661 Malpighi, who was in the habit of manufacturing his own
microscopes, was able, by aid of one of these instruments, to exhibit
the blood, loaded with its corpuscular bodies, passing rapidly from
one capillary vessel to another in the frog’s lung. Then in 1683
Guillaume Molyneux, in 1690 Anton van Leeuwenhoek, and in 1697 William
Cowper, witnessed the same phenomenon in warm-blooded animals. Among
the other anatomists of this period who contributed in varying degrees
to our knowledge of the minute anatomy of the different tissues and
organs the following deserve to be mentioned: J. Riolan (1577–1657),
Boselli of Naples (1608–1679), Lower of Oxford, England (1631–1691),
Vesling of Minden, Germany (1598–1649), Regnier de Graaf of Delft,
Holland (1641–1673), who gained so great distinction by his accurate
description of the ovarian follicles (“Graafian follicles”); and
James Douglas (1676–1742), the English anatomist, who ascertained and
described the precise limits of the peritoneum.

Of all the men whom I have mentioned above, Malpighi and Leeuwenhoek
are probably the best known to our readers for the large number
and important character of the contributions which they made to
microscopic anatomy. The list of Malpighi’s achievements, for example,
includes the following, in addition to the demonstration of the blood
in actual circulation, as already mentioned: contributions to our
knowledge of the finer structure of plants; the demonstration of
the minute anatomy of the skin (“_rete mucosum_” or “_rete
Malpighi_”); the amplification of our knowledge of the structure
of the teeth; the discovery that the lungs are composed to a large
extent of terminal vesicles, the walls of which are richly supplied
with blood-channels.; the demonstration that certain glands possess
an acinous structure (_i.e._, an outlet channel springing from
numerous small sacs, the whole group resembling a cluster of grapes);
more complete details regarding the structure of the spleen and
the kidneys (“Malpighian bodies or corpuscles”); additions to our
knowledge of the structure of the white and the gray substances of
the brain and the demonstration that fibres from the spinal cord pass
on into the brain; the declaration that the papillae of the tongue
are organs of taste and the papillae of the skin are organs of the
sense of touch; and not a few other contributions of greater or less
importance. During his long life Anton Leeuwenhoek (1632–1723) of
Delft, Holland, made a great many additions to microscopic anatomy,
some of the more important of which are the following: he was the
first to discover and to describe the many varieties of Infusoria
(the animalcules found in stagnant collections of water); to him is
also due the credit of first observing the faceted arrangement in
the eyes of insects; he made original investigations into the origin
and mode of development of several species of the lower organisms; he
was the first to observe the canaliculated mode of construction in
bone, and he also noted the existence of the so-called bone-corpuscles
(afterward rediscovered and more accurately described by Purkinje); he
discovered the striated condition of the bundles of muscular fibres,
and was also the first person to teach the doctrine that the growth
of muscles is effected by an enlargement of the primitive bundles of
fibres and not by a multiplication of these structures; he taught
further that muscle-substance consists of numberless small spheres; he
was the first to describe the crystalline lens as a structure composed
of fibres which are arranged in layers or sheets; in association with
Guillaume Molyneux he studied, under the microscope, the speed with
which the blood-current travels in the blood-vessels; he made valuable
observations on the nature of the spermatozoa; and, finally, the very
first studies in bacteriology appear to have been made by Leeuwenhoek.
As a result of his discovery of “round, rod-shaped, thread-like and
corkscrew-shaped bacteria” between the teeth of a human being, the
theory was set forth that probably many diseases owe their origin to
such “little animals.”[75]

The same idea, as will be shown farther on, occurred to the
distinguished medical practitioner of Verona, Italy,--viz.,
Fracastoro,--one hundred years earlier (1546). Leeuwenhoek, it should
here be stated, possessed a very great advantage over his rivals in
the field of minute anatomy, for he was in the habit of using, in
his investigations, microscopes which he himself had made, and which
magnified from 160 to 270 diameters, whereas those utilized by the
others were capable of magnifying, at the maximum, only 143 diameters.
While a large part of the work which he performed shows plainly that
he was a skilful and careful anatomist and endowed with good mental
powers, Leeuwenhoek nevertheless manifested certain mean traits of
character. Daremberg says that these “consisted in his disposition
to conceal his technical methods from his associates, and in his
jealousy of others--as manifested, for example, toward Leibnitz, who
had established a similar laboratory for research work in minute
anatomy. These traits of character showed that fundamentally he was
not a true lover of science, but rather an artisan. And yet, with all
these faults, he does not appear to have placed an inordinately high
value upon his discoveries or to have been unreasonably sure of the
correctness of his conclusions.” The first monograph published by
Leeuwenhoek bears the date 1673. It is a study of the minute anatomy
of the bee’s sting. He was the first to declare that the blood is the
nutritive fluid _par excellence_, and that it is to be found in
the entire series of organisms belonging to the animal kingdom. He
divided blood into two parts--the red, or the solid portion, and the
serum. The corpuscles which float in the serum and give to the whole
fluid its red color, are called by him “particles,” in the case of
blood from birds, reptiles and fishes, and “globules” in that from
quadrupeds. He employed this term “globules” because he believed that
these bodies were exactly spherical in shape. According to Daremberg,
Leeuwenhoek’s studies cover the entire field of human histology, and
his findings are for the most part correct.

_The Founding of Organizations for the Advancement of Medical
Science._--During the seventeenth century there were formed a number
of associations which had for their object the promotion of scientific
knowledge, and these organizations contributed greatly to stimulate
original researches in anatomy and physiology and to secure accuracy in
the published results. Perhaps the most important institution of this
kind was the French _Académie des sciences_, which was founded in
1666, and which deserves the credit of having taken a very important
part in the perfecting of our knowledge of anatomy and physiology.
The Royal Society of London, founded in 1645, possesses a splendid
record of valuable work accomplished. The following organizations also
deserve to be honorably mentioned in this place: the _Accademia dei
Lincei_ at Rome, founded in 1603; the _Académie des Curieux de
la Nature_, 1652; and the _Accademia del Cimento_, founded at
Florence in 1657. New universities were also founded in Germany.

During the second half of the seventeenth century there were three
French physicians who deserve credit for the excellence of the work
which they did in the departments of anatomy and physiology, viz.,
Vieussens, du Verney and Dionis.

Raymond Vieussens (1641–1716), a native of Rovergue, was Professor of
Anatomy at the University of Montpellier, in Southern France. Some idea
of the extraordinary industry displayed by this anatomist may be gained
from the fact that he is credited with having dissected more than five
hundred bodies. His more important published works relate to the heart,
the nervous system and the structures of the organ of hearing. Pagel
speaks of him as being entitled to the name of founder of the pathology
of diseases of the heart.

Jean Guichard du Verney (1648–1730), who held the Chair of Anatomy
in the University of Paris, gained a large part of his fame as
an anatomist from the excellence of his investigations into the
complicated structures of the internal ear.

Pierre Dionis, who died in 1718, was Demonstrator of Anatomy and
Surgery at the Jardin du Roi in Paris during the latter part of the
seventeenth century and early part of the eighteenth. In 1690 he
published a treatise on anatomy which remained the standard book on
this subject for a number of years. In course of time it was translated
into the Latin, English, German and Chinese languages.

_Dissecting Made a Part of the Regular Training of a Medical
Student._--The opportunities for dissecting human bodies varied
greatly in different parts of Europe during the period of which I am
now treating. Vieussens, as we have just seen, dissected no fewer than
five hundred bodies during his long professorship at Montpellier;
and Joseph Lieutaud, Professor of Anatomy at Paris, dissected more
than twelve hundred bodies during the continuance of his connection
with that institution. So far as I have been able to learn from my
examination of the literature, the professors and their immediate
official assistants were the only persons who had, up to this time,
derived the principal benefits that flow from work of this nature; the
students merely listened to the instructor’s remarks upon the objects
which had previously been exposed to view by dissection. But toward
the end of the period--a little before or shortly after the beginning
of the eighteenth century--facilities were provided in some of the
medical schools, and before long in all of the leading ones, for the
students themselves to participate in this highly important part of a
physician’s education. The value of such training was emphasized by
the statement made by the English philosopher, John Locke (1632–1704),
toward the end of his life, viz., that all human understanding is based
upon experience. He wrote that at birth the human soul is like a clean
sheet of paper upon which all the objects perceived by the senses are
recorded as experiences, and there they remain until by the aid of
reflexion--_i.e._, by the aid of the understanding, which Locke
calls the inner sense--they are combined into conceptions or ideas.
Locke, it should be remembered, was educated as a physician, but he
never took his degree, nor did he ever practice medicine.

The first stimulating effects of the Renaissance upon the devotees
of the science of medicine were felt in Italy toward the end of the
fifteenth century, and these effects rapidly gained in intensity
during the following century. First France and afterward Switzerland,
Belgium, Holland and England were almost simultaneously brought under
the same influence; and in all these countries the students manifested
a remarkable eagerness to acquire all the knowledge they possibly
could. In Germany, however, the influence of the Renaissance did not
make itself felt until a much later date, and the thirst for knowledge
was very much slower in developing than was the case in any of the
other countries mentioned. Thus Puschmann, in his “History of Medical
Education,” makes the following statement which shows clearly that in
Germany the university students of that period must have been a very
rough set of men: “In 1625 the Senate of the University of Leipzig was
obliged to warn its students that they must cease disturbing wedding
festivals and handling the guests roughly, that they must no longer
make obscene remarks to married women and maidens, etc. And in 1631 a
physician named Lotichius, in writing to a friend, made the statement
that ‘in our German high schools the students seem to prefer strife to
the reading of books, daggers to copy-books, swords to pens, bloody
encounters to learned discussions, incessant boozing and noisy reveling
to the quiet pursuit of their studies, and public-houses and brothels
to students’ work-rooms and libraries.’” In 1660 the students at Jena,
on one occasion, carried on a regular battle with the police, and as
a result of this encounter several persons were killed. In the light
of this evidence, therefore, it is not surprising that the science of
medicine made comparatively little advance in Germany until after the
eighteenth century was reached.

_Iatrochemists and Iatrophysicists._--During the seventeenth
century there was a great deal of disputing among physiologists about
the nature of certain processes like assimilation and retrograde
metamorphosis, about the manner in which blood is formed, about
digestion, and about the rôle played by the lymph vessels. According to
Haeser a large proportion of the physicians of that day were confident
that chemistry was entirely competent to solve these riddles, and
yet, on the other hand, there were not a few who believed that the
science of physics, which was then much further advanced than that
of chemistry, was quite as competent to explain all the phenomena.
At first the split into these two factions was confined to men who
were interested in questions of a purely physiological nature, but in
a short time the practitioners of medicine were also drawn into the
controversy; and from that time onward it became customary to employ
the terms, “iatrochemists” and “iatrophysicists” in speaking of the
partisans of the two schools of medicine (the iatrochemical and
the iatrophysical or iatromechanical). The iatrochemists described
digestion as an act that is essentially chemical in character, a form
of fermentation; and by the latter term the more advanced members of
this school--François Deleboë Sylvius (1614–1672), who was born in
Hanau, Prussia, of Dutch parents, and who took his doctor’s degree in
Basel in 1637, and Thomas Willis of London (1622–1675)--understood
something quite different from our modern conception of fermentation.
Their interpretation was as follows: “An internal chemical movement
of matter which is set agoing and continued in action in the stomach
and intestinal canal through the agency of certain chemical reagents.”
(Haeser.) They attributed an important influence to the saliva, the
pancreatic juice and the bile in effecting the changes mentioned. The
iatrophysicists, on the other hand, and more particularly Archibald
Pitcairn of Edinburgh, Scotland (1652–1713), and Giorgio Baglivi of
Ragusa, Italy (1668–1707), described digestion as a purely mechanical
breaking up of the elements of the food partaken--a “trituration.” As
to the further fate of the resulting chyle (its mode of reaching the
blood, for example) the two schools were in perfect accord.

Sprengel mentions it as an actual fact that, during the seventeenth
century, there were several physicians who combined the two careers
of teacher of medicine and hydraulic engineer (iatrophysicists or
iatromathematicians).[76] Several events conduced to the formation,
in Italy and in Great Britain, of a distinct iatromathematical
school. Among them may be mentioned, first and foremost, Harvey’s
discovery of the circulation of the blood; second, the spread of the
doctrines taught by Descartes favored in a marked degree the union
of medicine and mathematics (physiology, the iatromathematicians
claimed, was only a branch of applied mathematics); and, third, the
formation at Florence, in the middle of the seventeenth century,
of an association of the pupils of Galileo. The objects of this
association were to cultivate their master’s philosophy, to carry on
the work of experimental physics, and to apply its principles in every
department of natural science. Alphonso Borelli (1608–1679), Professor
of Mathematics first at Messina and afterward at Pisa, the author of
the famous treatise on “The Movements of Animals,” and the founder
of the iatromathematical school, was a member of the association. In
this connection it is important to mention another zealous worker
in the field of iatromathematics, viz., Sanctorius Sanctorinus, of
Capo d’Istria (1561–1636). His work was done quite independently of
any general movement among scientific investigators and at a much
earlier period than that during which the school flourished. He was
quite successful, for example, in his attempts to measure the actual
amount of imperceptible evaporation, and to determine the influence
which this process exerts upon health and disease. In the course of
these investigations in what he called “static medicine,” Sanctorinus
invented a number of unusual instruments.

The phenomenon of the formation of schools or sects, the members of
which were keenly interested in the maintenance and promulgation
of certain physiological, pathological, or therapeutic doctrines,
manifested itself anew, as I have shown above, in the seventeenth
century. In the early years of the Christian era the partisans of
different medical doctrines formed schools of this nature which
flourished for a certain period of time and then died out completely.
Such, for example, were the sects of the Dogmatists, the Methodists,
the Pneumatists, etc. The mere fact of the existence of these different
schools or sects showed unmistakably that the science of medicine
was alive at that time and that its devotees were making vigorous
efforts to increase their stock of knowledge. Then followed the long
period of the Middle Ages, a series of many centuries, during which
medicine made only slight gains; but at last came the Renaissance,--the
fifteenth, sixteenth and seventeenth centuries,--and here again we have
a recurrence of the same phenomenon of sects in medicine; but note the
great difference between the earlier manifestations and those which
I have just outlined. The present group, it is proper to remark, is
merely the forerunner of several similar movements that are to occur
during the eighteenth and nineteenth centuries, movements that are all
based, in varying degrees, upon the truth.

_The Employment of Latin in Lecturing and Writing on Medical
Topics._--In all the countries of Europe, but more particularly
in Germany, there existed during the sixteenth and seventeenth
centuries--and for a long time subsequently--the practice of delivering
all the lectures on medical topics in the Latin tongue--_i.e._,
in a language which at best could not be easily understood by more
than a small proportion of the students. Even the lecturers themselves
must have been hampered in the full expression of their thoughts by
this rule, which was practically compulsory. Paracelsus (1493–1534),
the famous Swiss physician, tried--a full century earlier, as will be
shown farther on--to break up this seemingly harmless but in reality
objectionable custom; his example, however, was not followed, and the
practice was continued without interruption for at least two centuries
longer. The use of Latin as the language in which all medical knowledge
was to be taught was undoubtedly based upon the idea that it was
necessary for the educated physician to be reasonably familiar with
that particular tongue, for the simple reason that it was the only
one in which, in those early days in Western Europe, the writings of
Galen were accessible, for nobody but a few expert scholars had yet
acquired any useful knowledge of Greek, the language in which all of
Galen’s works were originally written. But it is quite likely that
with this motive, which certainly was intended to produce good and
useful fruit, there was coupled the further idea that the great mass
of irregular practitioners--the quacks, the early barber-surgeons
(_Wundaerzte_), and the peripatetic physicians--would in this
way be debarred from entering the ranks of the regularly trained
physicians. It was only after the custom of using the Latin for
lecturing and writing purposes had become thoroughly rooted in the
minds of medical men as something right and proper, that it began to
dawn upon the minds of some of the brighter men that this practice was
harmful to the advance of medicine beyond the standards established
by Galen. Vesalius, who was a contemporary of Paracelsus, fully
appreciated how serious an obstacle to further progress in anatomical
knowledge the teachings of Galen were, and it was he who made the first
really successful attack on this great hindrance to further progress;
but there is no evidence to show that he had the slightest idea that
lecturing and writing about medical topics in Latin played any part in
the perpetuation of the evil which he was fighting. To Paracelsus alone
belongs the credit, so far as I know, of endeavoring, through the force
of example and by spoken arguments, to break up the practice which we
are here considering. I may be mistaken in the view which I have here
expressed, but it is difficult for me not to believe that the habitual
use of Latin as the proper vehicle for the transmission of facts and
ideas belonging to the domain of medicine must have materially hindered
the advancement of that science; for such use certainly tended to keep
men’s minds moving in fixed ruts, and those ruts all led straight
toward the faulty teachings of Galen.




                             CHAPTER XXIX

    THE CONTRIBUTIONS MADE BY DIFFERENT MEN DURING THE RENAISSANCE,
      AND MORE PARTICULARLY BY WILLIAM HARVEY OF ENGLAND, TO OUR
      KNOWLEDGE OF THE CIRCULATION OF THE BLOOD, LYMPH AND CHYLE


Among the earliest known doctrines relating to the nature of the blood
and its mode of distribution throughout the body are those attributed
to Erasistratus and Galen; for the still more ancient ones, of which
Diogenes of Apollonia, Aristotle and the Hippocratic writers are
reputed to be the authors, are too incomplete to call for serious
consideration in this place.

_(a) The Doctrine Taught by Erasistratus._--Erasistratus, who
was born at Julis in the Island of Ceos (Aegean Sea) during the third
century before Christ, held the belief that the arteries contain
only air, which is drawn into the lungs by way of the trachea and
bronchi, whence it enters the pulmonary vein (called by him the “venous
artery”). In its further course this air passes from the pulmonary
vein into the left ventricle of the heart, and is then conveyed from
that organ through the arteries to the different tissues of the body.
Erasistratus further taught that the smallest subdivisions of both the
arteries and the veins lie side by side in the tissues, and that, in
certain abnormal bodily conditions, they communicate the one with the
other through anastomoses; but that, in a normal condition of the body,
no communication takes place between the two. In common with all other
physicians of that time, he believed that only the veins carry blood.
Here, then, we find the first glimmering of the truth with regard
to the nature of the circulating medium and also with regard to the
course which it pursues in one part of its circuit--that part, namely,
where the two kinds of vessels become capillary in character. His
substitution of air for blood in the arteries is plainly the principal
error in his scheme.

_(b) The Teaching of Galen and of Caesalpinus with Regard to the
Nature of the Blood and Its Mode of Distribution._--Galen, in the
second century of the present era, disputed the correctness of the
doctrine taught by Erasistratus. His objections are thus stated:
“Inasmuch as blood flows from an artery when it is wounded, one of two
things must be the truth. Either blood was already contained in the
vessel before it was wounded, or it must have found its way in from the
outside. But, if the blood comes from the outside into a vessel which
contains only air, then air must necessarily escape from that vessel
(when wounded) before blood does--which is contrary to the fact, as
blood alone flows out. Therefore arteries contain only blood.” As a
further proof of the correctness of his statement Galen carried out the
following experiment: In a living animal he placed two ligatures around
an artery at points situated not far apart, and then made an opening
in the vessel between the two ligatures. The intervening section of
the artery, it was thus found, contained only blood. This experiment,
it might reasonably be supposed, would have definitely settled the
question; but such was not the case. The followers of Erasistratus
immediately raised this objection: If the arteries contain blood, how
may the air which is drawn into the lungs find its way to all parts
of the body? Galen replied that the inhaled air does not pass through
the lungs, but is rejected by them after it has cooled the blood. This
refrigerating process, he claimed, constitutes the sole purpose of the
respiratory act.

Although Galen’s idea regarding the true function of respiration is
not in harmony with the doctrine taught by modern physiologists, it
nevertheless represents a marked advance over the belief previously
maintained. Even as recently as in the time of Albert von Haller
(approximately 1760–1780) physicians still continued to believe that
it was the function of respiration to cool the blood; and indeed it
was scarcely possible before 1800 to offer a more correct physiology
of the act of breathing, for it was not until after the lapse of many
centuries that the advance in our knowledge of chemistry reached a
point at which it became possible to find a satisfactory solution of so
complicated a problem.

As to the nature of the blood itself Galen believed, as I have already
stated more fully in Part I. (“Ancient Medicine”), that there are two
kinds--spirituous blood (or spirit) and venous blood. He gave the name
of spirituous blood to that which is found circulating in the arteries,
and which is appreciably brighter in color than that which fills the
veins. According to Flourens, the distinguished French physiologist
of the nineteenth century, Galen was the first among the ancient
anatomists to make this distinction of two different kinds of blood. To
the spirituous variety Galen ascribed the function of nourishing the
more delicately constructed organs like the lungs, while he claimed
that the venous blood is suited to nourish only the coarser ones, like
the liver, spleen, etc.

In his further development of a physiology of the circulation of the
blood Galen, who as a rule expresses his ideas with great clearness,
makes statements which I find it extremely difficult to comprehend.
I am therefore tempted to assume that the copyists, to whom we are
indebted for handing down his actual words from age to age, are the
persons upon whom should be cast the blame for the obscurity of which
I complain. However this may be, it is an unquestionable fact that
the ablest physiologists, were they to be confronted to-day with the
duty of solving this problem of the circulation under the conditions
of knowledge which existed during the third century of our era, would
surely not be able to provide a more correct solution than that which
is credited to Galen. The problem was attacked repeatedly by some
of the brightest and best-equipped minds of the Renaissance period,
but not one of these exceptionally clever men was able to offer an
entirely acceptable solution. Harvey alone, as will appear farther on
in this account, solved the riddle once and for all.

The “spirit”--the purest part of the blood--is lodged, according to
Galen, in the left ventricle; and, inasmuch as even the venous blood,
if it is to fulfil in some degree the function of a nourishing fluid,
must possess a certain proportion of “spirit,” it is clear that the
two ventricles should communicate the one with the other; for how
otherwise--thought Galen--is it possible for a certain amount of
“spirit” to commingle with the venous blood? The locality at which
this communication was assumed to exist was the interventricular
septum; and, as nobody was able to find anything like a foramen in this
membrane, it was asserted that the communication is effected through
an infinite number of pores. For over one thousand years physicians
accepted this porous character of the interventricular septum as an
established fact. In his commentaries on Mondino’s “Anatomy” (1521),
Berengarius of Carpi timidly ventured the statement that the openings
of communication are not distinctly visible, and this apparently was
the first feeble expression of doubt concerning the correctness of the
prevailing doctrine. Vesalius, on the other hand, boldly denied their
existence altogether.

According to Galen’s teaching the liver is the source of origin of all
the veins, just as the heart is the starting-point of all the arteries.
It is quite remarkable, says Flourens, that physicians who performed
almost daily the operation of venesection should, during a long series
of years, have failed to observe that this doctrine of blood flowing
through the veins from the liver to the different parts of the body,
could not possibly be true, inasmuch as at each such operation the
vein always became distended with blood _below_ (_i.e._, on
the distal side of) the ligature which they applied to the part (arm,
for example) before opening the vessel. This phenomenon, of course,
indicated clearly that the blood in the veins flowed _toward the
heart_, and not from any centrally located spot or organ _toward
the extremities_. And yet--he adds--even so bright and thoughtful
a man as Vesalius does not appear to have noticed this fact. Andreas
Caesalpinus (1519–1603), on the other hand, did observe and correctly
interpret the phenomenon; and he made the further observation that
physicians were habitually applying the ligature _above_ the
spot which they expected to bleed, regardless of the fact that in so
doing they were not acting in harmony with their belief concerning the
circulation of blood in the veins. Caesalpinus also states, in one part
of his writings, that “the blood, carried to the heart by the veins,
receives in that organ its last transformation toward perfection,
and is then--in this perfected state--transported by the arteries to
the remotest parts of the body.” So far as it relates to the general
movement of the blood this statement is correct, but it errs, as will
be shown presently, in mentioning the heart as the locality where the
perfecting process takes place. In his final remarks regarding the
anatomical relations which exist in the two chambers of the heart
Caesalpinus makes the following statement:--

   Each ventricle possesses two vessels--one through which the
   blood reaches that chamber, and a second one which serves to
   carry it out of the ventricle. The vessel through which the
   blood enters the right ventricle is called the _vena cava_,
   and that by which it leaves this same chamber is called the
   pulmonary artery. The vessel through which the blood arrives
   in the left ventricle is called the pulmonary vein, and that
   through which it leaves this left chamber of the heart is known
   as the aorta.

_The Circulation of the Blood as Elucidated by Michael
Servetus._--Michael Servetus, a native of Villanueva, Spain,
who in 1553 was burned alive at the stake near the city of Geneva,
Switzerland, because of his heretical teachings, is not infrequently
mentioned as the individual to whom credit is due for having furnished
the first description of the lesser or pulmonary circulation. There
is no question whatever regarding the justice of according to him
at least a part of this honor, but one should be careful to specify
that Servetus is entitled only to the credit of having been the first
to teach that the blood, in its journey from the right to the left
side of the heart, must pass entirely through the lungs. So far, his
doctrine is correct; but he also taught at the same time that the
fluid which enters the aorta from the left ventricle is not blood but
perfected “vital spirit” (Galen), and that it becomes genuine blood
only after it has tarried for a few brief instants in the ventricular
chamber and has there been subjected to some unknown influence
exerted by the heart itself. This second erroneous part of Servetus’
description seems to me to diminish very materially the credit to which
he is otherwise entitled; and I cannot help feeling that Dezeimeris is
right when he claims that Realdus Columbus, whose more perfect account
of the lesser circulation was written only a little later than that of
Servetus, is perhaps better entitled to the honor in question.

It is an interesting fact that Servetus introduces his disquisition
on the circulation of the blood in the very midst of a treatise which
bears the title “Restitution of Christianity,”--in other words, in a
treatise which would never, under ordinary circumstances, be consulted
by physicians in their search for information regarding an important
problem in physiology like that of the circulation of the blood. In
this physiologico-theological treatise Servetus, who--as I omitted to
state--was a theologian as well as a physiologist, used the following
expressions:--

   The soul, says Holy Writ, is in the blood; as a matter of fact,
   the soul is the blood. And since the soul is in the blood, one
   should--if one wishes to learn how the soul is formed--endeavor
   to learn how the blood is formed; and, in order to learn how
   the blood is formed, it is necessary to ascertain how it moves.
   (Flourens.)

I am unable to state whether it was this particular chapter, or
the work taken as a whole, which appeared to the ecclesiastical
authorities--first those of France and afterward those of Geneva--to
warrant the author’s condemnation as a heretic. And, when we are
disposed to blame severely those bigots who, in the fifteenth and
sixteenth centuries, manifested such a keen desire to destroy
“heretics,” let us remember, with a proper sense of shame, that
we still have in our midst, in this twentieth century and in this
“land of freedom,” men of high social standing who are as virulent
heresy-hunters as ever were the enemies of Servetus.

_Experiments of Realdus Columbus._--Matthaeus Realdus Columbus,
who was born at Cremona, Northern Italy, in the early part of the
sixteenth century, acted for some time as Vesalius’ prosector, and
must therefore have had ample opportunities for acquiring a thorough
knowledge of the experimental method of studying questions in
physiology. He wrote a description of the pulmonary circulation which
was more lucid and nearer to the truth than any which his predecessors
had furnished. This description, which will be found in his treatise
on anatomy (Venice, 1559), was based largely upon experiments that he
carried out upon living dogs. As rendered into English from the French
version supplied by Dezeimeris, it reads as follows:--

   When the heart dilates the blood passes from the vena cava into
   the right ventricle; from the latter chamber it is pushed into
   the arterial vein (the pulmonary artery), along which channel
   it is carried to the lung, there to be properly thinned and
   mixed with air. Ultimately the blood passes on into the venous
   artery (= the pulmonary vein), the function of which vessel is
   to carry this fluid, now charged with air through the action of
   the lung, into the left ventricle of the heart. Then follows
   the contraction (systole) of this organ, as a result of which
   action the tricuspid valves rise up into position and form a dam
   that prevents the return of the blood into the vena cava and
   the pulmonary veins. Simultaneously with this action the valves
   placed at the opening which represents the commencement of the
   aorta (left ventricle), and those placed at the opening which
   corresponds to the beginning of the pulmonary artery (right
   ventricle), yield and thus open the way for the distribution of
   the blood throughout the rest of the body.

The reader will, I believe, admit that this description, while perhaps
not faultless, is distinctly superior to that given by Servetus.

Columbus’ experimental studies threw considerable light upon other
matters relating to the physiology of the heart. He demonstrated,
for example, that the fluid which enters the left ventricle from the
lungs is genuine blood, and he also learned by the same method of
investigation the true nature of the systole and diastole of the heart
and the relations of these acts to the pulse and to the changes in the
position of the heart. The discovery of all these facts constituted
a material advance in our knowledge of the physiology of that organ;
but, from this time onward, for a period of nearly three-quarters of a
century, no further advance was made until William Harvey of England
appeared on the scene. The explanation of the failure of such able
investigators as Realdus Columbus, Vesalius, Servetus and others to
push their researches still further is to be found largely in the fact
that they were all still in bondage to the doctrines taught by Galen
centuries earlier, and probably more particularly to that dogma which
maintains that blood--if it is to be accepted as genuine or fully
formed blood--must first have been elaborated in the depths of the
liver. The impossibility of harmonizing such a dogma with the facts
which by that time were well established, is too plainly evident to
warrant further discussion in these pages.

_Discovery of Valves in the Larger Veins by Fabricius ab
Acquapendente._--The discovery of the presence of valves in the
interior of the larger veins is credited by some to Cannani (1546)
and by others to Fabricius ab Acquapendente (1574), but the best
authorities appear to favor the claim of Fabricius to this honor.
There are also a few authorities who maintain that Fra Sarpi, the
celebrated monk and scientist of Venice, is entitled to be considered
the discoverer of the valves in veins, but Tiraboschi, the historian of
Italian literature, makes it clear that this claim is unfounded.

Although it was known to Fabricius that these valves are inclined
toward the heart, he does not appear to have appreciated the fact that
this arrangement is entirely incompatible with Galen’s doctrine that
the flow of venous blood is from the liver toward the extremities; nor
did any other anatomist, so far as I am able to learn, discover this
incompatibility before it was pointed out by Harvey nearly fifty years
later.

_William Harvey, Who is Universally Acknowledged to be the Real
Discoverer of the Circulation of the Blood._--William Harvey was
born at Folkstone, England, in 1578, received his academic education at
Caius College, Cambridge, and became a doctor of medicine in 1602, at
the age of twenty-four. Four or five years before this event he went
to Padua, Italy, to study medicine under Fabricius ab Acquapendente,
who was considered at that period to be the ablest and most inspiring
teacher of anatomy and physiology in Europe. It was from him, it may
safely be assumed, that Harvey learned the importance of studying
Nature herself, rather than books, when one is desirous of learning her
secrets. Equipped with a thorough knowledge of the methods that may
best be employed in making studies of this character, Harvey returned
to England at the end of his long stay at Padua. He was soon afterward
made a member of the College of Physicians of London, and in 1615 was
elected to the Chair of Anatomy and Surgery in that institution. Later
still, he was appointed one of the physicians of St. Bartholomew’s
Hospital. He also held for several years the position of Court
Physician, first to James the First and then to Charles the First. It
was during this period of his professional career that he began working
in earnest upon the problem of the circulation of the blood, and he
kept steadily at this work throughout a period of several years. Among
the manuscripts preserved in the British Museum there is one bearing
the date of 1616 which shows that Harvey had already at this time
reached conclusions which, in all essential respects, agree with those
which appear in his final treatise published in 1628. The title of the
latter work is, “_Exercitatio anatomica de motu cordis et sanguinis
in animalibus_” (Frankfort, 1628).

Although, as I have shown above, several of the links in the chain
of proofs bearing upon this question of the circulation had already
been discovered before Harvey began his researches, he was not
willing to accept them as proven facts until he had himself tested
them thoroughly by the experimental method. Furthermore, they were
often disconnected, and this lack of continuity obliged him to supply
missing links at several points; in other words, nobody had as yet
demonstrated the important fact that the blood travels regularly in an
unbroken circuit, and it was to this great task that Harvey devoted
himself at the period which we are now considering. He carried out
all these investigations with the most painstaking care and made
public announcement of his discoveries only after the lapse of an
extraordinary length of time; his chief object being that ample
opportunity might thereby be afforded for complete verification. The
following are among the more important questions which he investigated
and to which he furnished satisfactory solutions. He learned, for
example, that the auricle and ventricle of each side of the heart do
not contract simultaneously but in succession. When the right auricle
contracts the blood which it then contains passes into the right
ventricle; and when the right ventricle contracts the blood is driven
into the pulmonary artery. From this vessel it passes ultimately into
the pulmonary vein, and from the latter into the left auricle, which
then contracts and drives the blood into the left ventricle. The
latter chamber next contracts and forces the blood into the aorta,
whence it is carried into all the arteries of the body. From these, in
turn, it passes into the veins and thence back to the right auricle
of the heart--the point from which it started. He corroborated the
finding--by other anatomists who had preceded him--of membranous valves
at the spots where the blood passes from one chamber to the other;
and he compared these valves to little doors which open to permit the
passage of the blood in one direction, but which close when there is
any tendency for it to pass in the opposite direction. The valves
of the right auricle, for example, allow the blood to pass into the
right ventricle, but prevent it from returning into the auricle. Then,
further, the valves of the right ventricle permit the blood to pass
into the pulmonary artery, but prevent it from returning into the
ventricle. The valves of the left auricle permit the blood to pass
into the left ventricle, but do not permit it to return into the left
auricle. Finally, the valves of the left ventricle allow the blood to
pass into the aorta, but prevent it from regurgitating into the same
ventricle. The valves with which the veins are equipped permit the
blood to travel onward toward the heart, but do not permit it to back
up into the arteries.

  [Illustration: FIG. 15. WILLIAM HARVEY.

  (After the portrait by Cornelius Jonson.)]

Galen taught that the arteries pulsated by reason of a “pulsific power”
which they derive in direct continuity from the tunics of the heart.
He tried to prove the correctness of his doctrine by experimental
methods, but in this he failed. Harvey was convinced that the arteries
do not pulsate by reason of their own inherent power, but by a force
of impulsion communicated to the blood at the heart. He refers to this
question in the following terms: “When an artery is opened the blood
escapes in jets of unequal force; the alternate jets being stronger
than the intermediate, and the stronger jets corresponding in time of
occurrence, not with the systoles but with the diastoles of the artery.
The artery, therefore, must be distended by impulsion, by the shock of
the blood. If the artery dilates by reason of its own inherent power,
the blood would not be expelled with the maximum force at the very
moment when this dilatation occurs.” As evidence of the non-existence
of Galen’s assumed “pulsific power,” Harvey mentions the fact that, in
the case of a patch-shaped calcification of the crural artery which
came under his observation, the pulsation took place as usual, but at a
point below (distal to) the edge of the patch. The intervening patch of
rigid calcareous matter was not able to prevent the traveling onward of
the propelling power.

Harvey next takes up the consideration of the veins, and, after
showing that they permit a flow of the contained blood in only one
direction,--viz., that from the extremities toward the heart,--he
calls attention to certain experiences which he has had: (1) When a
cord is tied lightly around a limb the flow of blood is arrested _only
in the veins_, because these vessels are located near the surface of
the skin; but, if the cord is tied more tightly, the flow of blood
is also arrested in the arteries, which lie at a relatively great
depth. (2) When a vein is tied the resulting distension manifests
itself _only below_ (_i.e._, on the distal side of) the ligature;
whereas, when an artery is similarly tied, the distension takes place
_above_ (_i.e._, on the proximal side of) the ligature. It is therefore
plain that in the veins the blood flows from the individual parts
toward the heart, but that in the arteries the flow is in the reverse
direction--_i.e._, from the heart toward the individual parts. “If one
reflects upon the nature of the movement of the blood,” says Flourens,
“one will promptly realize how speedy it is. Scarcely has the blood
entered the heart before it is hurried into the arteries; and then
from these vessels it passes in an instant into the veins, from which,
with almost equal speed, it finally travels back to the heart again.
It is this never-ending movement from one channel into another, and
then eventually back to the starting-point, which constitutes the
circulation of the blood.... Modern physiology dates from the discovery
of the circulation of the blood. Up to the time of this discovery
physiologists followed the ancients; they did not dare to walk alone.
Harvey had discovered the most beautiful phenomenon in the animal
economy.... From this time forward, instead of swearing by Galen and by
Aristotle, one had to swear by Harvey!”

Despite the great care which Harvey took to back up his scheme of the
circulation of the blood with unimpeachable proofs of its correctness,
he was obliged to pass through the same sort of experience as that to
which Vesalius and scores of other pioneers in the field of scientific
inquiry had been subjected. Two hostile forces stood constantly
ready, during that fruitful period of the Renaissance, to attack with
merciless bitterness all those who ventured to add new facts to our
stock of knowledge in the domain of medicine. On the one side were the
many men of small calibre, men filled with jealousy over the successes
gained by co-workers in the same field; and on the other was marshaled
the host of those who honestly believed that all medical wisdom ended
with Galen. Before his death, however (hardly thirty years later),
Harvey had the satisfaction of witnessing the almost unanimous
acceptance of his dogma concerning the circulation of the blood. Louis
the Fourteenth, King of France at this period, was so appreciative of
the importance of Harvey’s discoveries that he appointed Dionis, the
distinguished French anatomist, to demonstrate to the students of the
Medical School of the Jardin des Plantes at Paris the circulation of
the blood and other recent discoveries. Descartes (1596–1650), the
celebrated French philosopher, paid an even greater compliment to the
high character of the work accomplished by Harvey. His words, as quoted
by Flourens, are as follows:--

   If I am asked why the supply of venous blood does not become
   exhausted in flowing thus unceasingly into the heart, and why
   the arteries--since all the blood that passes through the
   heart must travel along these vessels--do not become filled to
   overflowing, I can see no good reason why I should not give
   to this question the very same answer that William Harvey, an
   English physician, to whom praise is due for having taught ...,
   has already given. [Then follows the text of Harvey’s reply.]

Our readers have doubtless noted the fact that, while Harvey, as I have
endeavored to show in the preceding account, has clearly established
his right to be considered the discoverer of the circulation of the
blood in all its most essential features, his scheme fails to furnish
any information concerning the composition of the blood and the manner
in which it is built up into a life-giving fluid. In the minds of some
this may seem to be an omission. A moment’s reflection, however, will
satisfy any reasonable person that questions of this nature do not form
a legitimate part of the problem which Harvey was engaged in solving,
and that they therefore should receive separate consideration. Thus,
for example, Harvey’s scheme fails to furnish satisfactory information
concerning those portions of the circuit where the blood is obliged
to travel through a system of communicating capillary channels, as
happens in the lungs and in the tissues generally throughout the body.
But Harvey had no means at his command for investigating a question
of this nature. Capillary blood-vessels are invisible to the naked
eye, and may be studied only with the aid of a microscope; but this
instrument was not available until long after the time (1605–1616)
when Harvey was engaged in carrying out his investigations into the
circulation of the blood.

_Other Discoveries Relating to the Vascular System._--To Vesalius
is due the credit of having discovered the fact that anastomoses exist
between the carotids and the vertebral arteries, thus explaining how a
man may continue to live even after both carotids have been severed or
ligated. His great rival, Fallopius, described these anastomoses in the
most detailed manner, and he noted the further fact that an anastomosis
with the basilar artery exists.

By the end of the sixteenth century a certain amount of progress had
been made toward a correct knowledge of the lymphatics. Bartholomaeus
Eustachius, for example, discovered the existence (in horses) of the
thoracic duct, but he supposed it to be a vein. His description of this
vessel reads as follows:--

   In these animals there is a large vessel which extends downward
   from the inner aspect of the clavicular vein (= left subclavian
   vein). At the point where it joins the vein it is closed by
   means of a semicircular valve. This vessel is of a whitish
   color and it contains a scanty watery fluid. Not far from its
   starting-point it divides into two branches which very soon,
   however, join together again, and then, as a single trunk from
   which no further branches are given off, it passes down along
   the left side of the spinal column, penetrates the diaphragm,
   spreads itself out over the aorta, and ends in a manner unknown
   to me.

About one hundred years later (1647), Jean Pecquet of Dieppe, France,
professor in the Medical School of Montpellier, rediscovered (in a
dog) this same duct, with its tributary chyle ducts and also its point
of entrance into the left subclavian vein; and, as he had rightly
interpreted its nature, anatomists by common agreement accorded him the
rights of discoverer.

At a still earlier date (1622) Caspar Aselli of Cremona, Northern
Italy, professor in the Medical School of Pavia, discovered the chyle
ducts. This discovery was made under the following circumstances, which
reveal the fact that good luck sometimes plays an important part in
the work of the searcher after truth in the departments of anatomy and
physiology:--

   Aselli was studying the distribution of the recurrent nerves and
   the movements of the diaphragm in a well-nourished living dog,
   when his attention was drawn to the presence of a large number
   of delicate white threads coursing as it were over the surface
   of the mesentery. Following the accidental injuring of one of
   these threads there escaped from the wounded structure quite
   a large quantity of chyle. Aselli, who instantly appreciated
   the full significance of what had happened, exclaimed, in the
   presence of the bystanders, “Eureka!” At the time he supposed
   that these chyle vessels terminated in the liver and contributed
   in some manner to the elaboration of the blood (in harmony with
   Galen’s universally accepted theory of sanguification); but
   later, after he had carried out a carefully conducted series
   of experiments, he was able to rectify this erroneous belief.
   (Haeser.)

Galen’s theory of sanguification may be stated as follows: The chyle is
received into the veins of the intestinal wall and carried thence to
the liver, in which organ they are all gathered together into a single
venous trunk which has received the name of “_vena portae_”--the
vein of the gateway. Everything that is destined to enter the liver
passes through this portal vein. In the organ itself the chyle
undergoes certain modifications, the result of which is, first, to
deprive it of its impurities and then, in addition, to effect other
changes that convert it into blood. Aselli’s glory, then, consists in
his having shown that chyle is taken up from the intestinal mucous
membrane by a set of its own vessels, and not by the veins, as taught
by Galen.

In 1651 Olaus Rudbeck of Arosen, Sweden, discovered the lymphatics of
the intestinal canal and followed their distribution into the lymph
nodes; he also established their relations with the thoracic duct and
with the venous system.

Thus, thanks to the series of brilliant discoveries made by William
Harvey, Realdus Columbus, Fabricius ab Acquapendente, Pecquet, Aselli
and a few others, the doctrine of the circulation of the blood and of
the part played by the accessory chyle and lymphatic vascular systems,
became firmly established before the end of the seventeenth century.




                              CHAPTER XXX

       ADVANCES MADE IN INTERNAL MEDICINE AND IN THE COLLATERAL
     BRANCHES OF BOTANY, PHARMACOLOGY, CHEMISTRY AND PATHOLOGICAL
                                ANATOMY


_General Remarks._--In the fundamental branches of medical
knowledge--anatomy and physiology--advances of a very decided character
were accomplished during the sixteenth and seventeenth centuries; and
in the preceding chapters I have endeavored to give my readers some
idea of the nature of these advances, of the men who were instrumental
in effecting them, and of the extent to which the way was made easy,
during this period, for the accomplishment of still further advances.
In carrying on the work of correcting the many errors which were found
to exist in the two departments mentioned, it was soon discovered that
the obstacles to be overcome were of a serious character, and that
the most formidable one of the group was what is universally known as
Galenism. If I now refer to this subject once more, perhaps for the
second or third time in the course of this history, it is because I
fear that my remarks with regard to the harmful influence exerted by
Galenism may not be rightly interpreted. For Galen’s personal character
I entertain, as I have already stated in the section relating to
Ancient and Mediaeval Medicine, the deepest respect, and I am filled
with great admiration for what he accomplished in advancing the science
of medicine; but at the same time I cannot overlook the fact that he
was hemmed in by insurmountable limitations. No single human being,
living at the beginning of the present era and surrounded, as Galen
was, by a herd of jealous rivals, could have successfully bid defiance
to those who considered it sacrilegious to dissect the dead body of a
fellow man; and yet, without the knowledge which may only in this way
be gained, how was it practicable for any individual, no matter how
clever he might be, to lay the foundations for a further advance in
medical knowledge? It seems to me therefore plain that Galen did all
that lay in his power to advance the science of medicine; and whatever
words of condemnation I may have employed in the text, when speaking
of the Galenists, refer solely to those physicians of later centuries
who were of such a narrow-minded type, so rigidly crystallized in the
belief that Galen’s teachings had reached the limit of all possible
knowledge in the science of medicine, that they did not hesitate to
class the efforts of men like Vesalius as acts of unpardonable impiety.
Galenism, then, refers to the very widely prevalent tendency among
physicians of the fifteenth, sixteenth and seventeenth centuries to
uphold the teachings of Galen as the _only_ trustworthy code upon
which they should depend for their guidance. In short, Galenism, at the
period named, meant for medicine a complete arrest of development.

I have now arrived at a point in the history of medicine where, owing
to the limited amount of space at my command, the difficulty of
deciding as to what subjects and what individual workers in the field
of medicine--a field now grown to very great proportions--shall receive
consideration in my sketch. Having decided from the very outset that my
best efforts shall be directed, consistently with a strict adherence
to historical truth, toward making my account readable, I now find it
absolutely necessary to jettison--if I may be permitted to use such a
nautical expression--much really valuable cargo, and to put ashore,
before continuing our voyage, many passengers of undoubted worth.
Nobody need bemoan the loss of all these valuable treasures, for the
great majority of them, I am confident, will be cared for properly by
those authors who are privileged to treat this whole subject with some
degree of thoroughness; and the reader, if he is familiar with German,
will even now find, in the excellent general treatises of Haeser, von
Gurlt, Pagel, Puschmann, Baas-Henderson and Neuburger, great stores
of the most satisfactory information concerning the thousand and one
details about which I am obliged to remain silent.

_Internal Pathology._--During the fifteenth century the
practitioners of medicine in Italy and France were still strongly
under the influence of the teachings of the Arabian medical authors.
One of the first writers in Italy to place the doctrines of internal
medicine upon a firmer footing was Antonius Benevienus, a native of
Florence (1440–1502). His treatise on some of the unusual causes of
disease, which was printed in Florence in 1506, is said to be written
in very clear language and to be based entirely upon cases which came
under his own observation. According to Haeser the first improvements
in the doctrines relating to pathological anatomy may be credited to
Benevienus, who also taught that pathological phenomena should be
studied by direct observation rather than from books.

Johannes Manardus of Ferrara (1462–1536) was a very sturdy opponent
of astrology, and, in general, did all in his power to weaken the
prevailing blind trust in the authority of the Arabian medical authors.
But the two physicians who, next to Fabricius ab Acquapendente, stand
out most conspicuously among their Italian contemporaries of the
sixteenth and seventeenth centuries, are Fracastoro and Lancisi--the
former a native of Northern and the latter of Southern Italy.

Hieronymus Fracastoro of Verona (1483–1553) ranks very high among the
physicians of the first half of the sixteenth century for his valuable
contributions to our knowledge of internal pathology. In the treatise
which he published in 1546 on contagious maladies, he states in plain
language his belief that the causes of diseases of this nature are to
be found in living germs that are endowed with the power of propagating
themselves. He divides these diseases into the following three groups:--

   1, Those which infect only by contact; 2, Those which not
   only infect by contact, but at the same time leave behind a
   centre or focus of infection--in which category he places
   tuberculosis, elephantiasis, and similar diseases; and 3, Those
   which infect not only by direct contact, or through the agency
   of a residuary centre or focus of infection, but also those
   which are capable of spreading their infective elements over
   wide areas--for instance, the pestilential fevers, certain
   ophthalmias, variola, etc. (From Viktor Fossel’s version of
   Fracastoro’s treatise published in Leipzig in 1910.)

Speaking of tuberculosis (called by him “phthisis”), Fracastoro says
that it is astonishing for how great a length of time the virus of this
disease retains its infective power. “It has been noted, for example,
that in quite a number of instances the clothes worn by a tuberculous
patient have communicated the disease to a healthy individual as late
as two years subsequently to the date at which they were removed from
the original tuberculous individual.” The same power of communicating
infection, he continues, may reside in such other objects as the bed,
the walls and the floor of the room in which a tuberculosis patient has
died. Under these circumstances, he adds, we are obliged to assume that
germs of this infective disease have remained attached to the different
objects mentioned.

Fracastoro was born in Verona, Italy, of parents who belonged to the
patrician class and were in easy circumstances. He studied mathematics
and philosophy at the University of Padua, and was quite prepared,
on reaching the age of twenty, to pass the examinations required of
candidates for the degree of Doctor of Medicine. Just at this time,
however, Padua was not a safe place of residence, owing to the war
that was threatened between the Emperor Maximilian the First and the
Republic of Venice. Accordingly Fracastoro took his degree at the
newly established Academy of Pordenone, in what is known to-day as the
Province of Udine (northeast of Venice); and shortly afterward, upon
the death of his father, he returned to Verona and began the practice
of medicine. As he quickly gained the confidence of the people, he
very soon found himself in a sufficiently prosperous condition to
warrant him in retaining possession of the family residence, which
was charmingly located at the foot of Monte Incaffi, midway between
the Adige River and the Lake of Garda. Here it was that Fracastoro
did a large part of his literary work, for he was a poet as well as
a physician. Pope Paul the Third appointed him to the position of
Physician-in-Ordinary to the Council of Trent, and it was by his advice
that, upon the appearance of the Plague in that city, the sittings
of the Council were thereafter held for a short season at Bologna.
Later, still other honors fell to his lot. He enjoyed the esteem of the
Emperor Charles the Fifth and of Francis the First, King of France; and
the latter’s highly cultivated sister, Margaret of Navarre, offered him
every inducement to settle at her Court, but the attractions of his own
home made it easy for him to decline all these offers. He died at his
villa on August 6, 1553, and six years later the city of Verona erected
in his honor a marble memorial tablet.

Fossel, in his biographical sketch of Fracastoro, says that the most
popular of his poetical writings was that entitled, “_Syphilis sive
morbus Gallicus_.” It was published in several successive editions,
and was translated into nearly all the languages of European countries.
I shall have occasion to refer to it again in a later chapter.

Giovanni Maria Lancisi was born at Rome on October 26, 1654. Like
Boerhaave he began his university studies under the service of the
Church, but, as time went on, his leaning toward the profession of
medicine became more and more pronounced, and he soon took up in
earnest the study of that science at the University of Sapienza,
devoting a large share of his time to dissecting and to clinical work
in the hospitals. In 1672, when he was only eighteen years old, he was
given the degree of Doctor of Medicine; and four years later, after a
competitive examination, he was appointed an assistant at the Hospital
of the Holy Ghost. In 1678 he was permitted, as a special honor, to
enrol himself as a student in the Collège de Saint-Sauveur. During
the following five years he enjoyed at this institution exceptional
facilities for studying medical literature, and was thus able to
accumulate an immense mass of useful extracts from the writings of the
best authors. In 1684 he was assigned to the duty of teaching anatomy
at the Sapienza, and for thirteen years he filled this post with great
credit to himself; Malpighi being one of those who took pleasure in
following his lectures. He had scarcely attained his thirtieth year
when he was honored by being appointed Physician-in-Chief and Privy
Councilor to Pope Innocent the Eleventh; and soon afterward he was made
a Canon of the Church of Saint Lawrence, the main purpose of which
appointment was to provide him with a suitable income. On the death
of the Pope in 1689 he resigned the latter office, in order that he
might have more leisure and freedom to pursue his professional duties.
Subsequently he became the regular medical attendant, first of Pope
Innocent the Twelfth and afterward of Pope Clement the Eleventh. He
died on January 21, 1720.

Von Haller speaks of Lancisi as “a physician who was most highly
esteemed by Pope Clement the Eleventh, who was very learned and very
philanthropic, and who loved to give aid to the afflicted and to
prevent litigation by wise counsels.” It was Lancisi also, as I have
stated on a previous page, who discovered at Rome, in the possession of
the heirs of the artist Pini who made the original drawings, the copper
plates which Eustachius had ordered nearly two hundred years earlier,
and which were to have been used by this celebrated anatomist in the
production of a most beautiful set of anatomical illustrations.[77]

The two most important original treatises published by Lancisi bear the
following titles: “_De motu cordis et aneurysmatibus_” (on the
movements of the heart and on aneurysms), Rome, 1728 (a later edition
in 1745); and “_De subitaneis mortibus Libri II_” (on sudden
deaths), Rome, 1707 (also later editions).

_Botany and Botanical Gardens._--The Egyptians, the Persians, the
inhabitants of India and China, and the ancient Greeks accumulated a
great mass of information relating to plants which might be utilized
in the treatment of different diseases. Then, in the early part of the
present era, Galen contributed not a little to our further knowledge
on this subject; but from that time forward, until the sixteenth
century, pharmacology practically remained unchanged. The beginnings of
a systematic study of all plants--in other words, modern botany--may
be traced to the establishment of botanical gardens, first in Italy
and afterward in Holland and France. According to Berendes the very
earliest attempt in relatively modern times to cultivate such a garden
was made at Salerno by Matthaeus Silvaticus. Then Master Gualterus, in
1333, was permitted by the Governing Council of Venice to make use of
a certain plot of ground for the cultivation of the plants in which he
was specially interested. So far as one may judge, however, both of
these were private undertakings. In 1545, at the request of Francesco
Buonafrede, Professor of Therapeutics at the University of Padua, the
Senate of that city laid out a garden for his uses in teaching. This
appears to be the earliest instance of the establishment of a botanical
garden in connection with a regularly organized medical school. Then,
in fairly quick succession, similar gardens were established at Pisa
(1547), Bologna (1567), Leyden, Holland (by Boerhaave in 1577), and
Heidelberg (1593). In France the University of Montpellier received
its first botanical garden in the year last named. Thus it appears
that about the middle of the sixteenth century botany began to receive
attention as a branch of knowledge which, as was then believed, it was
important for physicians to study; and from that time forward, for
more than two centuries, it formed a regular part of the curriculum in
all the leading medical schools. The two chairs of botany and anatomy
were not infrequently combined. Fallopius, for example, held the Chair
of Anatomy, Surgery and Botany in the University of Padua, and so
also did Vesling in the same university at a somewhat later date. The
first systematic works on botany were also published in the sixteenth
century. They were all written by German or Swiss authors, the most
noteworthy one of the collection being that of Conrad Gesner of Zürich
(1516–1565), who is spoken of by Haeser as “a man of noble birth, of
extraordinary industry, of extensive knowledge in every department
of natural history, and the author of a large number of treatises,
which, by reason of their intrinsic value, cannot fail to perpetuate
the memory of this distinguished scientist throughout all time.” He
had much to contend with throughout his short but eventful life. In
the first place, he was very poor--so poor that both he and his young
wife were obliged to support themselves during the early years of their
married life by teaching school. Then he studied medicine at Basel, and
afterward accepted the professorship of Greek, first at Lausanne and
then in turn at Basel and at Zürich. From the beginning to the end of
his career he was hampered by poverty and by frequent illnesses. But,
despite these obstacles and also notwithstanding the fact that he was
an indefatigable worker in matters relating to natural history, he is
reported to have played one of the most influential parts in the drama
of the Reformation. Only a man of exceptionally strong character and
of unusual ability would have found it possible to attain the success
which Gesner attained in these different undertakings and under such
unfavorable circumstances. Andreas Caesalpinus, whom I have already
mentioned as one of the earliest investigators of the question of
the circulation of the blood, also interested himself in the science
of botany. Puschmann speaks of him as the greatest botanist of the
sixteenth century. For several years he was Professor of Philosophy and
Medicine in the University of Pisa, but at a later date Pope Clement
the Eighth chose him to be his private physician and also appointed him
Professor of Medicine in the University of Sapienza at Rome. His death
occurred in the latter city in 1603.

Before dismissing all further consideration of the part played by
Italian and Spanish physicians during the sixteenth century in the
advancement of the science of medicine, I shall briefly mention a
few additional discoveries in botany and pharmacy that may serve to
render the present account more complete. In 1518 the monk Romano Pane
published the first account of the discovery of tobacco in America.
In 1560 Jean Nicot, a French diplomatist, brought back with him from
Portugal (to which country he had been sent as an ambassador) a small
supply of the seeds of the plant. To commemorate this service the
alkaloid found in the leaves of the tobacco plant was given the name of
_nicotine_. Capsicum was made known to the world by Dr. Chanca, a
companion of Christopher Columbus on the occasion of his second voyage
(1493) to America. Balsam of Copaiva was discovered by a Portuguese
monk in Brazil at some time between the years 1570 and 1600. It is
mentioned for the first time in the Amsterdam Pharmacopoeia of 1636.
Monardes described the Peruvian and Tolu balsams in 1565. Cacao was
first made known to Europeans by Fernando Cortez in 1519. About the
year 1550 coca was introduced as a drug that possesses the power of
allaying hunger and of enabling one to endure the fatigues attending
prolonged expeditions. Sarsaparilla came into use at about the same
date. Then followed jalap in 1556 and sassafras toward the end of the
century.

In Germany and in the Netherlands there were, during the sixteenth
century, very few physicians who manifested any marked degree of
learning in the science of medicine. The teachings of Paracelsus met
with a favorable reception in these parts of Europe and they continued
to hold supreme sway over the minds of men during a long period of
time. There were some physicians, however, who had received their early
professional training in Italy and France, and who for this reason
were less ready to accept unreservedly the doctrines of Paracelsus;
and, among these more independent spirits, Rembert Dodoens (Dodonaeus,
1517–1586) of Malines, near Antwerp, distinguished himself by making a
number of valuable contributions to the science of medicine. He held
the Chair of Medicine at the University of Leyden and was also the
personal physician of the Emperors Maximilian the Second and Rudolphus
the Second. He was a very accurate observer, and his writings are
particularly rich in matters relating to pathological anatomy; for
which reason not a few authorities are inclined to credit him with the
honor of being the founder of this department of medical science. Felix
Platter of Basel, Switzerland, of whose experiences as a student at the
University of Montpellier I have given a brief account on a previous
page, and who was at this time Professor of Medicine in his native
city, was also greatly interested in pathological anatomy. Haeser gives
him credit for publishing a number of valuable contributions to this
department of medical knowledge, and also for making the first attempt
at a classification of diseases.

Before I close this chapter it seems only fair that I should add a
few comments upon the careers of two physicians whose professional
attainments entitle them to some consideration. The men to whom I have
reference are Marcello Donato and Raymond Minderer.

Marcello Donato was a distinguished medical practitioner of the city of
Mantua, Northeastern Italy, who died about the year 1600. He was one of
the few who, at that early period, taught that it was very important to
study disease from nature--_i.e._, from direct observation--and
not from books. His description of the epidemic of small-pox of 1567
(published at Mantua in 1569) is worthy of commendation. His chief
work, however, is that which bears the title “_De medica historia
mirabili etc._” (Mantua, 1586.) It contains a remarkably large and
complete collection of rare and extraordinary cases belonging to every
department of medicine, and in his descriptions Donato pays particular
attention to the pathologico-anatomical aspects of each case. He
reports, for example, the instance of a Caesarian section performed on
a living woman in 1540 by Christopher Bain; the child being found dead.
Another interesting case reported by Donato is that of a child in whose
ear a cherry pit had been allowed to remain undisturbed until it began
to sprout; after which it was found easy to remove the impacted object.
In a somewhat similar case which Donato also reports, the sprouting
of the seed of Anagyris was hastened by the presence of a purulent
discharge from the ear. In both instances all attempts to extract the
foreign body had failed until the sprouting had caused the seed to
split. Finally, there is recorded the case of a young man into whose
nasal passage a leech had penetrated, while he was bathing, and had
then taken up its abode far back in the canal. Donato, by aid of direct
sunlight, “discovered the creature in that part where the nasal channel
merges into the oral cavity.” Presumably he succeeded in removing the
animal, but the text quoted by von Gurlt (Vol. II., p. 517) furnishes
no further particulars.




                             CHAPTER XXXI

                CHEMISTRY AND EXPERIMENTAL PHARMACOLOGY


The experiments which were carried out by Antonius Musa Brassavola, in
the early part of the sixteenth century, upon animals and criminals,
for the purpose of learning the effects produced by certain drugs when
administered internally, afford one of the earliest instances of a
genuine experimental pharmacology. The account of these experiments,
which was published at Rome, in 1536, under the title “_Examen omnium
simplicium, quorum usus est in publicis officinis_,” deserves
honorable mention. An even more remarkable evidence of the research
spirit which was abroad at that period is to be found in the work done
by Fortunatus Fedelis, a native of Palermo, Sicily, and an ardent
champion of the direct method of observation as applied to therapeutics.

Van Helmont, of whose life and contributions to the science of medicine
I now propose to furnish a sketch, represents in a certain sense
Paracelsus’ successor; and, as a matter of fact, he was even more
closely associated with the development of chemistry as an independent
science than was his predecessor.

Jean Baptiste Van Helmont was born at Brussels in 1577. His parents,
who belonged to the nobility, possessed ample financial means and
were therefore able to give their son every opportunity to secure a
liberal education. While still a lad he enrolled himself among the
students of the University of Louvain, and advanced so rapidly in his
studies that, already at the early age of seventeen, he had passed
all the examinations required of applicants for the degree of Master
of Philosophy. He was not willing, however, to receive this honor
at that time, feeling that he had not acquired sufficient knowledge
to justify such acceptance; and from that date forward he turned his
attention to the study of other branches of learning. Finally, in 1599,
he accepted from the same university the degree of Doctor of Medicine,
and soon afterward left Belgium with a large party of his friends to
make an extensive tour through the Alps of Switzerland and Savoy. After
his return home in 1602 he devoted his attention chiefly to chemical
researches; but in a very short time he started off again on a journey
to Spain and France, and eventually to England, where he spent nearly a
year in the city of London, returning to Belgium in 1605. He married,
about this time, a rich heiress of Wilworde, in the neighborhood of
Brussels, and resumed with great zest his labors in chemistry and
alchemy. He was thus enabled to manufacture many remarkable remedies
with which--as he himself declared--he succeeded in curing myriads
of patients who had failed to receive any benefit whatever from the
ordinary resources of medical science. He died on December 30, 1644.

I do not feel equal to the task of expounding Van Helmont’s often very
obscure theories regarding the physical and psychological processes
that take place in the human being; regarding the distinctions which he
makes between the “_archaeus influus_”--the regulating principle
which governs all the psychical and physiological processes in the
body--and the “_archaeus insitus_”--the subsidiary power which
resides in each individual part of the body, but which at the same time
is under the control of the “_archaeus influus_”; and regarding
the doctrine that disease is the result of an “_idea morbosa_” of
the “_archaeus influus_.” August Hirsch says that in developing
these theories Van Helmont puts forward many bright ideas, which
unfortunately lead one into a wilderness of fantastic, theosophic
concepts. If sufficient time and space were at my command it might
be interesting to separate some of these bright thoughts from the
extravagances in which they are buried, and thus demonstrate the truth
of the statements made by both Hirsch and Dezeimeris to the effect
that Van Helmont, in matters relating to physiology and pathology, was
unquestionably a precise and critical observer, a sound thinker, and a
correct interpreter; but the plan of the present work will not permit
me to enter into all these details. I can only quote a few of the
teachings or sayings to which Hirsch refers:--

   Digestion does not, as Galen maintains, depend upon heat, but
   upon a certain ferment existing in the gastric juice.

   Heat is not, as has hitherto been taught, the cause of life, but
   rather one of its products.

   The final cause of the sensory phenomena of life is the
   _archaeus influus_, which, while it is inseparably
   united with matter, nevertheless does not represent the soul
   itself, but rather the organ of the soul, and is seated in the
   “duumvirate” of the spleen and the stomach.

   Disease, in order to acquire sufficient power to antagonize
   life effectively, must unite its forces with the _archaeus
   influus_.

It is claimed that Van Helmont, more than any other teacher
of medicine, was instrumental in giving the deathblow to the
practice--which prevailed in all the medical schools of that day--of
teaching the obsolescent Galenic doctrines, and that for this valuable
service alone he deserves full recognition at the hands of the medical
profession of to-day. But, as we learn from Ernest von Meyer’s history
of chemistry, Van Helmont has a much stronger claim for recognition in
the fact that he made many important contributions to iatrochemistry
and also to fundamental or pure chemistry. Taking one thing with
another, says von Meyer, we may safely assert that Van Helmont’s
useful contributions to the medical and chemical sciences by far
outweigh those which are of a fantastic or useless nature. It was he,
for example, who materially increased our knowledge of the nature of
carbonic acid. He demonstrated how it may be extracted from limestone
or from potash by the aid of acids, from burning coal, and from wine
and beer while they are undergoing fermentation. He also showed that
it is present in the stomach, in various mineral waters, and in
hollows in the earth. He gave it the name of “_gas sylvestre_.”
He would doubtless have carried his discoveries much farther along if
he had possessed the apparatus which is required for such researches.
However, despite the lack of these facilities, he was able to describe
hydrogen and marsh gas as special varieties which do not possess the
same composition as ordinary air. Finally, in his treatise entitled
“_Pharmacopolium ac dispensatorium modernum_” will be found
a goodly number of useful instructions as to the proper manner of
preparing drugs.

A complete collection of his writings was published at Amsterdam by his
son, in 1648, under the title “_Ortus medicinae vel opera et opuscula
omnia_.”

Theophrast von Hohenheim--who is known everywhere throughout the
world as “Paracelsus”--was the son of Wilhelm Bombast von Hohenheim,
a physician who belonged to one of the noble families of the Duchy
of Württemberg. He was born in 1493 at a spot called “_Das Hohe
Nest_” (the lofty nest) in the Canton of Schwyz, about one hour’s
distance from the celebrated monastery or cloister of Einsiedeln, of
which institution his father was the official physician. Switzerland,
therefore, has a right to claim Paracelsus as one of her sons. In 1502
his father transferred his home to Villach, in Carinthia (to the east
of Tyrol), and continued to live there up to the time of his death in
1534. It is not known where the son obtained his degree of Doctor of
Medicine. It is a well-established fact, however, that he received the
first part of his training as a chemist from Johann Trietheim, the
Prior of Sponheim, and his subsequent education in the laboratory of
Sigmund Fugger, the cultivated owner of wines at Schwatz in the Tyrol.
He traveled all over Europe, going from one university to another and
making the acquaintance of people who were well informed in matters
relating to natural history, chemistry and metallurgy; and during all
this time he appears to have absorbed a great deal of information
relating to almost every department of human knowledge. Finally in
1526, soon after he had returned to Switzerland, he received, through
the aid of certain influential citizens, two important official
positions in Basel,--that of City Physician and that of Professor of
Medicine and Surgery in the University. To the surprise of all, and
contrary to long-established custom, he delivered his lectures in
German and not in Latin. This action on his part called forth bitter
criticism from the university authorities, but at first it met with the
approval of the students. During the following two years, however, he
gradually became unpopular with all classes of the community, and was
finally obliged to leave Basel. Haeser attributes this unpopularity
to Paracelsus’ rough manners, to his intolerance of the opinions of
his colleagues, and to his tirades against the apothecaries for their
excessive charges. It is very difficult to determine how far jealousy
was responsible for the state of affairs which I have just described.
Cabanès, the author of an admirable biography of Paracelsus (_Revue
Scientifique_, Paris, May 19, 1894), gives his own estimate of this
remarkable man’s character in the following terms: “Poor, miserable,
and persecuted during his lifetime, he was misunderstood even after
his death, and was calumniated by history.” Paracelsus evidently
believed it to be his bounden duty to destroy the then prevailing cult
of Aristotle, Galen and Avicenna as the great teachers in medicine;
and, filled with this idea, he prophesied the growth of a new science
of medicine on the ruins of their teachings. It is stated that the
students, after one of these excited lectures, made a bonfire and
burned a number of copies of the works of these famous authors, thus
showing that Paracelsus was sufficiently eloquent to infuse some of
his own reforming spirit into the minds of his auditors. He made
a great mistake, however, when he attacked in a similarly violent
manner the shortcomings of many of his contemporaries. “The medical
profession,” he said, “has become a mere money-making business.” As a
natural result of such tirades, Paracelsus was forced to leave Basel.
He fled first to Colmar in Alsace and at a later date took refuge in
St. Gall, Switzerland; and it was while he resided in that city that
he published three books of his “_Paramirum_.” Then in 1535 he
once more resumed his wandering life, in the course of which he visited
Poland, Lithuania, Illyria, etc. On reaching Salzburg, in Austria, he
fell ill and died on September 24, 1541, at the age of forty-eight.

Paracelsus was a prolific writer. To all the treatises which he
published he gave extravagant titles. To his principal work, for
example, he gave that of “_Paramirum_”--The Surprising Marvel;
to another, that of “_Paragranum_”--Grain of Superior Quality;
and to a third, that of “_Archidoxia_,”--Transcendental Science.
He wrote treatises on syphilis, on the plague, on epidemics, on the
diseases of grave-diggers, on ore-smelters, etc. It is admitted by all
his critics that he devoted altogether too much time and thought to
alchemy, demonology, necromancy, etc. Cabanès quotes Cruveilhier as
saying that Paracelsus believed in the reality of beings of a fantastic
nature, but attached little or no importance to them. Then Cabanès
himself adds: “The thing which more than anything else absorbed his
thoughts was the irresistible desire to overthrow the Galenic idol
and substitute for it the science of experience, of observation pure
and simple.” Bordes-Pagès, another distinguished French physician,
says of this extraordinary man: “The great glory of Paracelsus is to
be found in the facts that he cast off the yoke of a former epoch,
more speculative than practical; that he summoned physicians to resume
their allegiance to experience; and that he opened a long career
for the alchemists, upon whom he urged the duty thenceforward of
making new remedies the principal object of their researches.... He
simplified and spiritualized therapeutics.” Some of Paracelsus’ own
sayings are worth preserving: “Without air all living creatures would
perish from suffocation.” “Man is the supreme animal, the one last
created.” “_Alterius non sit, qui suus esse potest_” [He who is
able to be his own master should not allow himself to be led blindly by
another]. When he was accused of being coarse-grained and of deceiving
the people, he replied: “By nature and also owing to the kind of
people with whom I associated in my youth I am not of a finely-spun
texture.... We were not nourished with figs and white bread, but with
cheese, milk and black bread-food that does not make delicate lads....
They say of me that I lead the people astray, that I am possessed of a
devil, that I am a sorcerer, and that I am a magician. Whatever truth
there may be in these charges, one thing is certain: You are all of you
unworthy to unloose the latchets of my shoes.” (From _Paragranum_,
II., 120.)

Oporinus, who acted for a long time as Paracelsus’ assistant, made the
following statements with regard to some of the methods of his former
master:--

   He always kept several preparations stewing on his furnace--as,
   for example, a sublimate of oil or of arsenic, a mixture
   of saffron and iron, or his marvelous Opedeldoch. He never
   prescribed a special diet nor any hygienic measures. As a purge
   he gave a precipitate of theriaca or of mithridate, or simply
   the juice of cherries or grapes, in the form of granules (about
   the size of the droppings of mice), and he was careful always
   to give them in uneven numbers (1, 3, or 5). He was bitterly
   opposed to the polypharmacy which prevailed so widely in his day.

Cabanès says that we probably owe to Paracelsus an increased knowledge
of the virtues possessed by the different preparations of antimony,
mercury and iron, and by salines. It was he who created the distinction
between officinal and magistral preparations. To our list of
pharmaceutical preparations, he added tincture of hellebore, compound
tincture of aloes, digestive ointment, the tincture of metals (“Lilium”
of Paracelsus), the “Saffron of Mars,” etc. He was the inventor of the
precious preparation known as “_la mumie_,” a preparation which
was popularly believed to possess marvelous healing powers. Ambroise
Paré, toward the end of his career, was greatly blamed because he did
not employ this remedy, and he was finally compelled in self-defense to
write a pamphlet on the subject. (The text is reprinted in Malgaigne’s
“_Ambroise Paré_,” under the title of “_Traité de la mumie et de
la licorne_.”)

Adolphe Gubler of Paris credits Paracelsus with the distinction of
having been the first physician to give an impetus to the movement
which had for its object the application of chemistry to the perfection
of medicinal preparations. He also maintains that Paracelsus should be
looked upon as in a large degree the originator of specific remedies,
and that he is justly entitled to the distinction of having been the
first publicly to announce the “quintessences”--that is, the active
principles (vegetable alkaloids)--of drugs. According to this claim
it is understood that Paracelsus taught that each drug contained a
specially active elementary body which it was possible to extract
as a separate substance. Acting upon this belief Paracelsus did not
hesitate to give the preference to the pharmaceutical preparations
known as “tinctures”--that is, alcoholic extracts. Great credit is
also due to Paracelsus for his rejection of the doctrine that guaiac
is an efficient remedy against syphilis, and for his insistence that
mercury is the only useful agent in curing that disease. Tartar emetic
(potassium antimonyl tartrate) is one of the drugs the introduction of
which into our pharmacopoeia should be credited to Paracelsus.

One of the earliest references to genuine diphtheria is to be found in
the writings of Paracelsus, who speaks of the disease in the following
terms:--

   When this disease is located in an external wound it not
   infrequently spreads to the muscles of the larynx; and, _vice
   versa_, when a person has the disease in his throat, and at
   the same time happens to have an external wound, the malady is
   likely to spread to the wound.

Paracelsus’ idea of the existence of an “_archaeus_,” a power
which presides over all physiological actions as well as over all
the operations of medicinal drugs, resembles very closely the “vital
force,” or “animism” so strongly championed by Stahl in the seventeenth
century.

From all that I have said above regarding the excitable nature of
Paracelsus it seems almost a waste of time to tell our readers that his
contributions to the science of surgery were of very slight value. He
despised the study of anatomy, claiming that a knowledge of this branch
of medical science was not essential to a proper acquaintance with the
human body. “To dissect,” he once remarked, “was a peasant’s manner of
procedure.” (Cabanès.) His surgery, as one may imagine, showed clearly
the bad effects of such beliefs.

During the latter part of the nineteenth century there developed
among the leading men of the medical profession a sentiment in favor
of honoring the memory of Paracelsus by the erection of a suitable
monument at Basel, Switzerland, the city in which he made his first
public appearance. The project met with a favorable reception and the
statue is now an accomplished fact. This is a remarkable instance of
tardy justice being rendered to the memory of a physician who, for
three hundred years, was almost universally looked upon as a vain,
half-crazy man.

The next advances of any special importance in the department of
chemistry were made in Great Britain by Robert Boyle, who was born
at Lismore, County of Cork, Ireland, on January 25, 1626. He was the
fourteenth child of the Earl of Cork. His early training was obtained
at Eton, and then afterward he spent two years at Geneva, Switzerland,
in prosecuting his scientific studies. In 1654 he entered Oxford
University and became intimately acquainted with some of the most
learned men of that day. While he was a student at the university he
became a member of what was known as “The Invisible College,” a society
which was influential in bringing about the founding of “The Royal
Society,” of which organization he was president from the year 1680 to
the time of his death in 1691.

Boyle was endowed with a noble character--modest, religious and
generous. He gained distinction as a chemist in several departments.
Applied chemistry is indebted to him for a number of important
contributions; he added to our knowledge of chemical combinations and
to the methods of analyzing them; he enriched the chemistry of gases
and also pharmacology; and he gave a clear and easily intelligible
definition of what a “chemical element” is. He laid stress upon the
doctrine that a chemical combination represents the union of two
component elements, and that this combination possesses characteristics
quite different from those possessed by either of the two component
elements. Before his day there was practically no such thing as
analytical chemistry, and it is to Boyle that we owe the establishment
of a clear conception of what the terms “chemical reaction” and
“chemical analysis” signify. The part played by atmospheric air in
combustion was made by him the subject of numerous experiments which
proved later to be of great assistance in the final solution of the
problem.

In one of his writings Boyle says in substance that if men would devote
their energies to carrying out experiments and collecting observations,
rather than to the constructing of theories without having previously
tested with thoroughness the grounds upon which they believe them to
be based, the world would be greatly the gainer. The promulgation
and insistence upon the importance of this doctrine for the growth
of the science of chemistry constitute--so those competent to judge
claim--Boyle’s greatest merit in scientific work and his most important
contribution to chemistry.

Among the chemical treatises which Boyle wrote and published the
following deserve to receive special mention: “Sceptical Chymist,”
1661; “_Tentamina quaedam physiologica_,” 1661; “_Experimenta
et considerationes de coloribus_,” 1663; and “Medical Experiments,”
1692–1698. Although Boyle was not an avowed follower of Bacon, he
carried out thoroughly the principles which the latter taught.

Raymond Minderer, a practicing physician in Augsburg, Germany
(1570–1621), deserves the credit of having added to our stock of
remedies the acetate of ammonia (_liquor ammonii acetatis_).
Diluted with an equal quantity of water it is still employed to-day as
a remedy under the name of “Spirit of Mindererus.” He was the compiler,
in 1613, of the Augsburg Pharmacopoeia.

_General Therapeutics.--Transfusion.--The Discovery of Cinchona
and Ipecacuanha._--In the department of general therapeutics, as
we learn from Berendes, several important new measures were brought
forward during the seventeenth century; and among these the following
deserve to receive brief mention in this place: the operation of
transfusing blood from a healthy individual to one who is ill; the
introduction of cinchona into the European pharmacopoeia as an
efficient remedy in the treatment of certain fevers; the similar
introduction of another South American drug--viz., ipecacuanha; and
the invention of many medico-chemical products and the improvement of
others that were already in common use.

As regards the operation of transfusion, from which great things were
expected, Sir Christopher Wren (1632–1723), the famous architect and
astronomer of London, is reported to have been the first person to
urge a trial of this procedure. On the other hand, Robert Boyle, the
chemist, actually performed the operation on animals. He followed the
method suggested by Richard Lower (1631–1691) of England, viz., by
allowing the blood to flow from the carotid artery of one animal into
the jugular vein of a second animal; while Edmund King adopted the
plan of allowing the blood to pass from the jugular vein of one animal
into the corresponding vein of a second animal. Upon a human being the
operation was probably performed for the first time (in 1666) by Denys,
Professor of Philosophy and Mathematics in Paris. Repetitions of the
operation were made, two or three years later, in London and in Rome,
but they produced no good effects and in some instances they terminated
in the death of the individual for whose benefit the operation had
been performed. In 1668 the French Parliament and the Papal Government
forbade a repetition of the operation.

In 1638--so the story runs--the wife of Count Cinchon, Viceroy of Peru,
was cured of a stubborn intermittent fever by the native physicians,
who employed, in their treatment of the malady, the bark of the tree
now universally known by the name of “Cinchona.” In 1640 Juan del
Vego, the regular medical attendant of Count Cinchon, introduced
the new remedy into Spain, but it was not until after the lapse of
about fourteen years that the drug found its way into England and
Central Europe. The price at which it could be purchased was at first
very high; it was almost literally “worth its weight in gold.” Even
as late as 1680 the bark sold in England for £8 sterling per pound.
Notwithstanding the generally recognized value of the drug in the
treatment of certain fevers there were not a few men who continued
for many years to oppose its use. Thus, Johann Kanold, a practitioner
of medicine in Breslau, Germany, is reported to have said, on his
death-bed in 1729, that he would rather die than be cured by a remedy
the action of which was so opposed to all the principles which he
considered right in therapeutics.

Ipecacuanha, another very important drug, was added to our stock of
remedial agents toward the end of the seventeenth century. It was
brought into France from Brazil, in 1672, by a French physician named
Le Gras, but its value as a remedy for the cure of dysentery did not
begin to be appreciated until after Helvetius, a semi-quack, had sold
to Louis the Fourteenth, for one thousand louis-d’or (about $4000),
the formula for the preparation which he (Helvetius) had been using
with great success during the recent epidemic of that disease, and
which moreover had effected a remarkably rapid cure in the case of
the King’s own son--the Dauphin. After the purchase had been made by
Louis the Fourteenth, in the interest of the French people in general,
it was ascertained that the only active reagent among the ingredients
of the formula was ipecac, a drug with which the Paris physicians had
long been more or less familiar. Ipecac, it will also doubtless be
remembered, constitutes the important element in what is known as the
East Indian treatment of dysentery.

Probably the earliest modern treatise on matters connected
with pharmacy is that which bears the title “_Onomasticon
Latino-Germanico-Polonicum rerum ad artem pharmaceuticam
pertinentium_.” It was published about the year 1600, and its author
was Paul Guldinus.

One of the most important iatrochemical authorities of the seventeenth
century was Johann Rudolf Glauber (1604–1668), to whom we are indebted
for the invention or improvement of a large number of medico-chemical
products. The well-known “Glauber’s salt” may be named as one of these
products, and chloride of iron as another.




                             CHAPTER XXXII

     SOME OF THE LEADERS IN MEDICINE IN ITALY, FRANCE AND ENGLAND
            DURING THE SIXTEENTH AND SEVENTEENTH CENTURIES


_Eminent French Physicians._--Among the physicians of France who
attained a widespread and well-grounded celebrity throughout Europe
during the sixteenth century, Pierre Brissot deserves to be given
the first place. He was born in 1478 at Fontenay-le-Comte, not far
from Rochelle, and was a professor of medicine at Paris. He attained
considerable distinction, during the sixteenth century, by his advocacy
of the superiority of the Hippocratic method of bloodletting over that
introduced--or, rather, perpetuated--by the practitioners of that day
in Central Europe. The rule which was laid down by Hippocrates was
to the effect that, in venesection, the blood should be drawn from
the vein lying nearest to the part inflamed. The Greek physicians
of a later period forgot all about this rule and adopted in its
place one that was based on the doctrine that venesection practiced
in the vicinity of a focus of inflammation favors a determination
of blood to that part and therefore does only harm; and they
accordingly--especially in cases of pleuritis--abstracted blood from
the arm on the side opposite to that on which the disease was located,
or from one of the veins of the foot. This new rule was subsequently
adopted by the Arabian physicians, and it remained in full force up to
the end of the sixteenth century. A wide experience in the treatment of
the epidemic pleuritis which raged in Paris in 1514 confirmed Brissot
in the belief that the Hippocratic method is the one to be preferred;
but, despite his pleadings, the Parisian physicians refused to adopt
the method which he advocated and used their influence in securing from
the French Parliament an order forbidding him to continue employing it
in Paris. Discouraged by the treatment which he experienced in that
city, Brissot removed to Lisbon in Portugal, and soon had occasion
(in the epidemic which raged at Evora in 1516) further to satisfy
himself that the Hippocratic rule is the correct one. But here too he
encountered bitter opposition on the part of the Portuguese physicians;
his most active opponent being Dionysius, the Physician-in-Ordinary
to the King. Brissot then wrote an elaborate defense of the method
which he advocated, and this treatise was submitted to the judgment of
the Medical Faculty of the University of Salamanca. When the decision
of this learned body was given in Brissot’s favor, his opponents,
dissatisfied with the result, made still another effort to gain
their point, viz., by appealing to the Emperor Charles the Fifth.
They assured his Majesty that the Brissot Heresy, as they termed it,
was fully as dangerous to the cause of humanity as that championed
by Luther. But here again they failed. This final victory, however,
brought no satisfaction to Brissot, who died of dysentery in 1522,
just before the decision was rendered. Haeser speaks of this unusually
bitter dispute as one of the last of the violent battles which occurred
between the adherents of the Arabian physicians and the supporters of
the teachings of Hippocrates, and which terminated in “a most brilliant
victory of experience over Arabian dogmatism.”

  [Illustration: FIG. 16. “THE LOVESICK MAIDEN.”

  (After the painting by Jan Steen, 1626–1679.)

  One of this famous Dutch artist’s objects, in painting the scene
  here represented, was to satirize the practice, which was very
  prevalent among certain physicians of that period, of pretending
  to diagnose all sorts of maladies from the mere naked-eye
  inspection of his patient’s urine.

  (Courtesy of Dr. Eugen Hollander, author of _Die Medizin in
  der klassischen Malerei_, Stuttgart, 1903.)]

During the first half of the sixteenth century there developed a
belief, among the more ignorant physicians, that, in many cases of
illness, important information may be derived from a simple naked-eye
inspection of the patent’s urine as exposed to view in a flask-shaped
glass vessel. In the Hippocratic writings no adequate grounds for
such a belief are discoverable, but in one of Galen’s treatises there
have been found statements which appear(?) to give some sanction to
this new idea. However this may be, it is an established fact that
uroscopy was taken up at the time named with great zeal by all the
quacks in the land and by large numbers of practitioners of medicine
who saw in this procedure an easy and safe method of bettering their
fortunes. The public at large were greatly impressed with this new and
wonderful manner of detecting disease, and for a long period--indeed,
for more than half a century--this piece of clap-trap charlatanry
continued to thrive, and to reflect only discredit upon the medical
profession. There came a time, however, when people generally began
to suspect that uroscopy was not all that the charlatans claimed it
to be, and these suspicions were voiced in the popular saying, “The
pulse is good, the urine is normal, and yet the patient dies.” The
writers who were the most active in showing up the hollowness of
the claims of the uroscopists were Scribonius of Marburg, Germany,
Peter Foreest (1522–1597) of Alkmaar, Holland, and Leonardo Botallo
of Asti, in Piedmont (born in 1530). The latter authority, it may be
recalled, owes his chief distinction to the fact that he rediscovered
what has been erroneously named in his honor the “_foramen
Botalli_”--_i.e._, the _ductus arteriosus_ in the foetus.
He also attained some distinction in another direction. He revived
the violent disputes about venesection by recommending a resort to
this therapeutic procedure in nearly all illnesses. He went so far
as to advocate four or five bloodlettings in the course of an acute
attack, in each one of which operations from three to four pounds
of blood should, as he believed, be abstracted. Indeed, he claimed
that in an extreme case it might be perfectly proper to abstract as
much as _seventeen pounds_(!). Inasmuch as Botallo’s practice
was largely confined to the strong soldiers of Northern Italy it is
easier to understand how such extravagant bloodletting did not more
often prove fatal than it did. When, soon afterward, the Paris Faculty
condemned the practice in the strongest possible terms, Botallo’s
followers characterized sarcastically the French physicians as “pigmy
bloodletters” (_petits saigneurs_).

But the efforts of Scribonius, Botallo and others to put an end to the
uroscopy scandal were--I fully believe--not the only or perhaps even
the most potent factors in bringing about the suppression of the evil.
As many of our readers will remember, the art collections of European
capitals contain admirably painted specimens of Dutch and Flemish
genre pictures representing every phase of this uroscopic fraud, and
these striking masterpieces, revealing, as they undoubtedly did to the
community at large, the ridiculous character of the claims made by the
charlatans, could scarcely have failed to give a deadly blow to the
fraud. (See Fig. 17.)

In the early part of the sixteenth century Jean Fernel of Amiens
(1497–1558) was one of the leading medical authorities of France.
After receiving his degree of Doctor of Medicine at Paris, in 1530,
he settled in that city and soon acquired considerable reputation,
not only as a practitioner but also as a lecturer. In 1545 he was
called upon to take charge, professionally, of Diane de Poitiers, the
mistress of Henry, the son of Francis the First, King of France. About
the same time he was asked to serve as First Physician to the Dauphin,
but he was not disposed to accept the latter position, as he disliked
the duties of the office and also because he feared that they would
interfere with his favorite studies. He pleaded poor health, and his
excuse was accepted as valid. That Fernel was held in very high esteem
by the royal family is evident from the events which succeeded this
refusal. In the first place, it was insisted that he should accept
the stipend (600 livres) attached to the office, as a mark of the
royal favor; and then, in 1547, when Henry was crowned king (Henry the
Second), Fernel was urged to become his First Physician; but again he
declined the honor, this time on the ground that Louis de Bourges,
who had held the position with great credit under Francis the First
(Henry’s father), was entitled to be retained in office. The King
yielded to Fernel’s generous intervention in behalf of de Bourges.
But in 1556, when the latter died, Fernel felt obliged to accept the
position which had then become vacant; and from that time forward,
until the time of his death on April 26, 1558, he accompanied the
King on all his military expeditions. As he did not possess a robust
constitution, his health suffered not a little from the frequent
exposures to hardships of all sorts to which he was subjected; and, in
addition, during this long period he saw very little of his wife to
whom he was devotedly attached.

Fernel is universally admitted by French physicians to have been one
of the most cultivated teachers and practitioners of medicine of his
day. He was a very clear writer, and would doubtless have made a number
of valuable additions to the science if he had not been carried off by
illness at a comparatively early age.

Of his published writings the following are reckoned the most
important: “_Universa medicina_,” Paris, 1567; “_De abditis
rerum causis_,” Paris, 1548, and “_Therapeutices universalis seu
medendi rationis libri VII._,” Paris, 1554. (Many editions of each
of these works were published.)

In his discussion of various questions relating to physiology Fernel
maintains that the component elements of the body are vivified by means
of heat, and he elaborates this idea very much in the same manner as
Hippocrates does that of the “_callidum innatum_.” The spiritual
life, he says, is presided over by the soul (“_anima_”). When he
comes, however, to consider the individual powers of the soul, Fernel
treats the subject exactly as does Galen. He gives expression to one
rather bright idea: “The specific functions of each of the different
organs may be inferred in large measure from the character of the
structural elements of which they are composed.”

In his scheme of pathology Fernel divides diseases into _simple_
(“_similares_”)--diseases of the tissues; _compound_
(“_organici_”)--diseases involving entire organs; and
_complicated_ (“_communes_”)--diseases in which the normal
relations between the different parts are broken up.

In the chapter which Fernel devotes to the subject of therapeutics,
there is a section relating to venesection which, according to Haeser,
is well worth reading, as it reveals the power of the writer to grasp
the leading points and to reason correctly from them.

_Two English Physicians Who Became Famous During the Sixteenth
Century._--In the early part of the sixteenth century the medical
profession of Great Britain was in a most unsatisfactory state.
Humbuggery, ignorance and superstition were at that period of time
the most prominent characteristics of the majority of physicians
upon whom the people at large had to depend for the relief or
cure of their bodily ailments, and there were very few and very
untrustworthy measures in force for the production of a better class of
practitioners. Just at this juncture there appeared on the scene a man
who was eminently well equipped to rescue England from this lamentable
state of affairs and to put her on the high road to the acquisition of
an honorable body of medical men and of a corps of apothecaries who
could be trusted to dispense pure drugs properly compounded. I refer
to Thomas Linacre, who was born at Canterbury in 1461 or 1462, was a
Fellow of All Souls College, Oxford, and a graduate of the University
of Padua, and whose biography is sketched by John Freind (1675–1728) in
such an admirably clear, concise and appreciative manner that I cannot
do better--in view of the great importance of this event in the history
of medicine in England--than to reproduce it here in considerable
fulness of detail.

   Thomas Linacre was a man of a bright genius and a clear
   understanding, as well as unusual knowledge in different parts
   of learning: ... and, being very desirous to make further
   improvements by travelling, he thought he could no where succeed
   in his designs so well as by going to Italy, which began then
   to be famous for reviving the ancient Greek and Roman learning.
   There he was treated with extraordinary kindness by Lorenzo
   de Medicis, one of the politest men in his age and a great
   patron of letters; who favoured him so far in his studies as
   to give him the privilege of having the same preceptors with
   his own sons. Linacre knew how to make all his advantages of
   so lucky an opportunity; and accordingly, by the instructions
   of Demetrius Chalcondylas, a native of Greece, he acquired a
   perfect knowledge of the Greek tongue; and so far improved under
   his Latin master Politian, as to arrive to a greater correctness
   of style than even Politian himself....

   Having laid in such an uncommon stock of learning, he applied
   himself to the study of natural philosophy and physick;
   particularly he made it his business, and was the first
   Englishman who ever did so, to be well acquainted with the
   original works of Aristotle and Galen. He translated and
   published several tracts of the latter....

   In his own Faculty he distinguished himself so much that, soon
   after his return, he was pitched upon by that wise king, Henry
   the Seventh, as the fittest person to be placed about Prince
   Arthur, and to take care both of his health and his education.
   He was afterward made successively Physician to that king, to
   his successor Henry the Eighth, and to the Princess Mary....
   And indeed, as he was perfectly skilled himself in his own art,
   so he always shewed a remarkable kindness for all those who
   bent their studies that way; and wherever he found, in young
   students, any ingenuity, learning, modesty, good manners, and a
   desire to excel, he assisted them with his advice, his interest,
   and his purse. And to give a still stronger proof, how much he
   had the good of his own Profession and that of the Publick at
   heart, he founded two _Lectures of Physick_ in Oxford, and
   one at Cambridge....

   But he had still further views for the advantage of our
   Profession: he saw in how low a condition the practice of
   Physick then was, that it was mostly engrossed by illiterate
   monks and empiricks, who in an infamous manner imposed on the
   Publick; the Bishop of London or the Dean of St. Paul’s for the
   time being, having the chief power in approving and admitting
   the practitioners in London, and the rest of the bishops in
   their several dioceses. And he found that there was no way
   left of redressing this grievance, but by giving encouragement
   to men of reputation and learning, and placing this power of
   licensing in more proper hands. Upon these motives he projected
   the foundations of our College [of Physicians]; and using
   his interest at Court, particularly with that great patriot
   and munificent promoter of all learning, Cardinal Wolsey, he
   procured Letters Patent from the King, which were confirmed
   by Parliament, to establish a corporate Society of Physicians
   in this city, by virtue of which authority the College, as a
   corporation, now enjoys the sole privilege of admitting all
   persons whatever to the practice of physick, as well as that
   of supervising all prescriptions. And it is expressly declared
   that no one shall be admitted to exercise physick in any of
   the dioceses in England, out of London, till such time that he
   be examined by the President and three of the Elects, and have
   letters testimonial from them, unless he be a graduate in either
   University, who, as such, by his very Degree, has a right to
   practice all over England, except within seven miles of London,
   without being obliged to take any license from the Bishop....

   By other Acts another weighty affair is committed to the care of
   the College, [viz.,] the visiting of shops and the inspection of
   medicines; a thing surely of as much consequence at least to the
   patient as to the prescriber....

   Linacre was the first president of his new-erected college, and
   held that office for the seven years he lived after.... And
   perhaps no Founder ever had the good fortune to have his designs
   succeed more to his wish; this society has constantly produced
   one set of men after another, who have done both credit and
   service to their country by their practice and their writings.

If further evidence be needed to show what was the type of mind
possessed by this remarkable English physician, I may be permitted to
quote here a single brief statement made by his friend Erasmus, the
famous Dutch scholar and theologian, in a letter addressed to John
Fisher, Chancellor of Cambridge University: “Linacre is as deep and
acute a thinker as I have ever met with.”

In England, during the seventeenth century, there appeared on the scene
only one practicing physician of such conspicuous ability and of so
marked personal traits of character as to place his name, after the
lapse of a few years from the time of his death, and by the almost
unanimous assent of his associates, high up on the roll of honor. I
refer to the famous physician Sydenham.

  [Illustration: FIG. 17. THOMAS SYDENHAM.

  (After the portrait in the hall of All Souls’ College, Oxford.)]

Thomas Sydenham was born at Wynford Eagle, Dorsetshire, England, in
1624. At the age of eighteen he entered Magdalen College, Oxford,
and remained there until 1644, when he enlisted in the Parliamentary
Army. After a brief military service, he resumed his studies at the
university and received his Bachelor’s degree in 1648. It was only at
a much later date (1676), however, that he was given (after he had
pursued the prescribed course of studies) the degree of Doctor of
Medicine,--and then not by Oxford, but by Cambridge. After leaving
the university he first spent a few months at the Medical School of
Montpellier, France, and then settled (1666) in London as a practicing
physician, the necessary license having been granted him by the
College of Physicians. His first medical treatise, which bore the title
“_Methodus Curandi Febres_” [Method of Treating Fevers], was
published in 1666. The third edition of this work was issued ten years
later, but with the title changed to “_Observationes Medicae_
etc.” Between 1666 and 1683 he published several other treatises,
the more important of which deal with epidemic diseases--syphilis,
small-pox, hysteria and gout.

During the later period of Sydenham’s career he attained great
celebrity as a physician; but this celebrity would have been
short-lived if it had rested on nothing more substantial than mere
cleverness and professional success. As a matter of fact he had brought
about, by his teaching and also by his example, a most important
revolution in medicine, and it was the appreciation of this fact which
led the physicians of England to bestow upon him, after his death, the
appellation of “The English Hippocrates,” and which ultimately gave him
so highly honorable a position in the history of medicine in general. A
brief review of the state of medicine in England during the seventeenth
century will enable the reader to understand the full importance of the
change which Sydenham was instrumental in bringing about.

The physicians of that period were split up into three sects: the
followers of Galen, with whom should be classed the Graeco-Arabists;
the iatrochemists; and the iatrophysicists.

The Galenists were largely intent upon the strictest interpretation of
the teachings of Hippocrates, Galen and some of the Arabian authors.
Instead of studying disease itself they devoted their time and thoughts
largely to the interpretation of the words used by these fathers in
medicine--_i.e._, to philology. Real progress in the science
of medicine was not possible along this route. Accepting without
dispute the dogma of the four humoral qualities, together with the
different temperaments which result from the predominance of any one
of them, they combated these different temperaments or constitutions
by prescribing drugs in a very great variety of combinations
(polypharmacy).

The iatrochemists, attaching small importance to simple dietetic
measures, prescribed without stint all the most active substances
belonging to the mineral kingdom and all the new remedies which the
chemists had evolved from their furnaces.

Finally, the iatrophysicists directed their efforts to the removal or
diminution of all bodily conditions that appeared to act as mechanical
hindrances to health.

Sydenham, who possessed a rare degree of common sense, cast aside
all these hypotheses, disregarded the prevailing routine methods of
treatment, and refused to accept the therapeutic novelties of the day.
“Nature is to be my guide,” he declared, and from that time forward he
studied disease at the bedside, and watched carefully, and with a mind
free from prejudice, the effects of the remedies which he employed.
Thus, pursuing the methods advocated by the great master Hippocrates,
he was able to place his medical brethren once more on the pathway
which leads to an increase in knowledge of the healing art. Practical
medicine, which had previously been falling into an almost moribund
condition, was by his efforts made again a living and growing science.
That Sydenham had a perfectly clear conception of what was needed at
that time to renew the vitality of the medical profession of England
is plainly shown by the following statement which he makes in the
dedication of one of his writings to Dr. Mapletoft:--[78]

   After studying medicine for a few years at the University of
   Oxford, I returned to London and entered upon the practice of
   my profession. As I devoted myself with all possible zeal to
   the work in hand it was not long before I realized thoroughly
   that the best way of increasing one’s knowledge of medicine is
   to begin applying, in actual practice, such principles as one
   may already have acquired; and thus I became convinced that
   the physician who earnestly studies, with his own eyes,--and
   not through the medium of books,--the natural phenomena of
   the different diseases, must necessarily excel in the art of
   discovering what, in any given case, are the true indications as
   to the remedial measures that should be employed. This was the
   method in which I placed my entire faith, being fully persuaded
   that if I took Nature for my guide, I should never stray far
   from the right road, even if from time to time I might find
   myself traversing ground that was wholly new to me.

In the brief account which I have thus far given of the part played by
Sydenham in advancing the science of medicine, I have called attention
only to the general character of the services which he rendered. It
may now be interesting to furnish here a few details that will aid
in completing the picture of this great English physician,--details
relating to his life and personal character, to his views regarding
certain diseases and the remedies which he was in the habit of
employing for their relief or cure, and to his later writings.

Throughout the greater part of his professional career Sydenham was
a frequent sufferer from gout, some of the attacks being of a severe
type and occasionally of long duration. During the winter of 1676, for
example, he was seriously ill from renal calculus, haematuria being
brought on by the slightest movements of his body. All through the year
1677 he continued to experience frequent attacks of pain, and on one
occasion he was unable to leave the house for a period of three months.

Speaking of the epidemic of the Plague in 1665, during the progress of
which he left London, Sydenham says: “When I saw that the danger was
in my immediate neighborhood I listened to the advice of my friends
and joined the crowd of those who were fleeing to the country. A
little later, when the epidemic had further increased in severity,
and before any of my neighbors had returned, I yielded to the calls
of those who had need of my services, and went back to London.” It is
worthy of remark, says Laboulbène, who fully appreciated the heroism
which prompted this last decision, that we should never have known
of Sydenham’s weakness in regard to facing his duty, if he himself
had not stated the facts. This famous epidemic, as is well known, was
accompanied by an appalling mortality.

Andrew Browne, a Scotch physician of good standing, entertained serious
objections to some of the advice given by Sydenham in the treatise
entitled “_Schedula monitoria de novae febris ingressu_,”[79]
and, in order to learn more precisely what the author’s views on the
subject really were, he decided to run down to London for a day or two.
Sydenham gave him such a cordial reception and made his stay in the
metropolis so pleasant that he remained there several months--instead
of a day or two. “And when I returned to Scotland I felt contented and
joyful as if I were carrying back with me a valuable treasure.”

As an instance of his thoughtful kindness, it is related that Sydenham
had occasion to treat a poor man who lived in his neighborhood for an
obstinate bilious colic, but his employment of narcotics did not effect
very much in the way of relief. “I felt moved by pity for this poor
man in his misery; and accordingly I loaned one of my horses to him in
order that he might take long excursions on horseback.”

Sydenham had no eagerness for professional honors, although he
appreciated highly those which came to him spontaneously. As already
stated at the beginning of this sketch, the degree of Doctor of
Medicine was not conferred upon him by Cambridge as a mere honorary
affair, but was won by him after he had passed through the regular
course of training required of all candidates for this degree. His
case, however, was peculiar in one respect: he waited until after he
had been in active practice several years before he decided to pass
through the course of training required. He was not a member of the
College of Physicians of London, and he held no official position at
Court.

The following summary may serve to convey some idea of Sydenham’s views
regarding pathology and treatment. He defines an acute disease as “a
helpful effort made by Nature to drive out of the body or system, in
every way possible, the morbific material.” As regards the latter he
makes the following remarks:--

   Certain diseases are caused by particles which are disseminated
   throughout the atmosphere, which possess qualities that are
   antagonistic to the humors of the body, and which--when once
   they gain an entrance into the system--become mingled with the
   blood and thus are distributed throughout the entire organism.
   Certain other diseases owe their origin to fermentations or
   putrefactions of the humors, which fermentations vary in their
   nature--in some cases the humors being excessive in quantity,
   while in others they are bad in quality; and in either event the
   body finds itself incapable of first assimilating them and then
   excreting them--a state of affairs which cannot continue beyond
   a certain length of time without producing further harmful
   effects.

According to Sydenham the fever, in the acute diseases, assists
Nature by separating from the general (total) mass of the blood those
particles which have undergone putrefaction or have been rendered
unassimilable. Then they are driven out of the body by the route of the
sweat-glands, by diarrhoea, by eruptions upon the skin, etc. On the
other hand, in chronic diseases the morbific material is not of such a
nature as to produce fever, which is a mechanism for securing complete
purification. It is therefore deposited in one part or another of the
body where no force exists which is capable of ejecting it; or its
final transformation is not completed until after the lapse of a long
period of time.

In some of Sydenham’s writings one is occasionally surprised to find
teachings which seem to be strongly at variance with the advice which
he was so fond of giving--namely, that physicians should be careful
not to set up hypotheses which are not based upon observed facts. A
conspicuous instance of such a disregard of his own rule may be found
in his setting up of a pathological process to which he gives the name
of “inflammation of the blood.” This process, he maintains, is the
active cause of quite a large number of diseases, especially those
of an epidemic nature--such, for example, as pleurisy, pneumonia,
rheumatism, erysipelas, scarlet fever, etc. It is well-nigh impossible
for us moderns to comprehend how so practical and clear-headed a man as
Sydenham could have formulated such a purely hypothetical pathology, a
doctrine so completely lacking in anything like a solid foundation of
fact.

Sydenham excelled in the description of the clinical manifestations of
certain diseases, as, for example, small-pox, hysterical affections,
the encystment of a renal calculus, and the gout--a disease from which,
as already stated, he was a very frequent sufferer throughout a large
portion of his life. All his published works are in the Latin language,
but translations have been made into English, French, German, Flemish
and Italian. At All Souls College, Oxford, where Sydenham spent eight
years of his life, it was a fixed rule that all its members should
habitually converse and write in Latin.

Sydenham’s remarks upon liquid laudanum are worth recording:--

   Of all the remedies which a kind Providence has bestowed upon
   mankind for the purpose of lightening its miseries there is not
   one which equals opium in its power to moderate the violence
   of so many maladies and even to cure some of them.... Medicine
   would be a one-arm man if it did not possess this remedy....
   Laudanum is the best of all the cordials; indeed, it is the only
   genuine cordial that we possess to-day. [This was written in the
   middle of the seventeenth century.]

The laudanum employed by Sydenham was made according to the following
formula: Spanish wine, 400 grammes; Opium, 62 grammes; Saffron, 31
grammes; Powder of Canella and Powder of Clove, of each 4 grammes.

After much suffering and extreme weakness, Sydenham died on December
31, 1689.

Andrew Browne, the Scotch physician of whom mention has already been
made on an earlier page, makes the following comments on the closing
days of Sydenham’s career: “It is a difficult matter to believe,
and yet it is the truth: This great physician, who throughout his
life gave the clearest proof of nobility of soul, generosity and
clear-sightedness, died with the accusation hanging over his head that
he was ‘an impostor and an assassin of humanity.’” Laboulbène adds:
“After years of self-sacrifice in behalf of his fellow men Sydenham
received as his final earthly reward calumny and ignominy, and the
jealousy of many professional brethren.”




                            CHAPTER XXXIII

    THE THREE LEADING PHYSICIANS OF GERMANY DURING THE LATTER HALF
    OF THE SEVENTEENTH CENTURY: FRANZ DE LE BOË SYLVIUS, FRIEDRICH
                    HOFFMANN AND GEORG ERNST STAHL


The seventeenth century, says Berendes, was one of the saddest periods
in the history of Germany; but, during the greater part of this time,
the neighboring countries--Holland, France, England and Italy--still
continued to enjoy many of the blessings of the Renaissance,--such,
for example, as an uninterrupted activity of artistic efforts, of
scientific work, and of commerce;--but in Germany everything seemed to
be in a state of confusion. A bloody religious war was at this period
devastating the land, and the best powers of the people were being
wasted. Instead of increasing cultivation of manners and sentiments,
there was a steady growth of savagery. The Protestants, although they
probably were numerically superior, were split up into factions. The
Catholics, on the other hand, were united, and their power steadily
increased. In 1618 the disturbances, which previously had been
scattered in character, took on the form of what in time came to be
known as “The Thirty Years’ War,” a struggle which proved to be most
sanguinary, costing Germany a great deal in every respect. Finally,
the war was brought to an end by the signing of the Westphalian Treaty
of Peace at Lützen, in 1648. Some idea of the terribly destructive
nature of this long war may be gathered from the fact that the
population of Germany, which previously had been estimated at twenty
millions, was found to have been reduced to about six millions. Whole
towns and villages were laid in ashes, and as a consequence those
who had survived the disaster lost confidence in themselves and were
not able, at least for several years, to undertake anything in art,
literature or science; and this depressing atmosphere affected in some
degree the people of the Netherlands. Toward the end of the century,
however, there came a marked awakening among the younger generation of
physicians, and in the course of twenty or thirty years four men, only
three of whom, however, were of German birth, succeeded in attaining
a decided leadership in this department of science. The names of the
Germans are Franz de le Boë (commonly spoken of as Sylvius), Friedrich
Hoffmann and Georg Ernst Stahl. I shall now attempt to furnish, as
nearly as possible in proper chronological order, very brief sketches
of the lives of these distinguished physicians, together with an
account of the contributions which they made to the science of medicine.

_Franz de le Boë (Sylvius)._--Franz de le Boë (Sylvius) was born
at Hanau, Prussia, in 1614, of parents who belonged to the nobility
and were wealthy, and who consequently were able to give their son
every opportunity for acquiring an excellent education. Thus Franz
first received a thorough training in philosophy and the classics and
afterward visited in turn all the leading universities of Holland,
France and Germany before he finally took his degree of Doctor of
Medicine at Basel, Switzerland, in 1637. From this time forward, for a
period of twenty-three years, he devoted himself to the practice of his
profession, first in his native city and then in Leyden and Amsterdam.
In 1660 he accepted an invitation to occupy the Chair of Medicine
in the University of Leyden, and this position he held during the
remainder of his life. He died in 1672.

As a teacher Sylvius was very popular, Boerhaave alone, at a later
period, finding greater favor among the crowds of medical students and
physicians who frequented this university. Haeser and Haller both
attribute some portion of this popularity to the fact that Sylvius
combined genuine eloquence with a wonderful charm of manner and a
profound knowledge of chemistry, pharmacy and pathological anatomy.
In the practice of medicine he followed Van Helmont very closely,
but he was not willing to accept his teachings about an “_archaeus
insitus_” and an “_archaeus influus_.” The system which he
advocated was of a very simple character, and this fact undoubtedly
contributed much to his popularity among the students. His therapeutic
methods were also of a thoroughly practical nature.

Of the works which Sylvius published the following deserve to receive
special mention: “_Disputationes medicae_,” a book in which are
set forth his views regarding the fundamental principles of the science
of medicine--physiology in particular; “_De methodo medendi_,” a
treatise on therapeutics; and “_Praxeos medicae idea nova_,” a new
idea concerning the practice of medicine.

Sylvius was one of the earliest defenders of Harvey’s great discovery,
and he was also one of the first to call attention to the part played
by chemistry in elucidating some of the problems in physiology and
pathology. At the same time he was always ready to acknowledge the
importance of the part played by mechanics in respiration, in the
circulation of the blood, in the movements of the intestines, etc., in
which respects he was in entire agreement with the iatrophysicists or
iatromathematicians.[80]

Finally, there is one more respect in which Sylvius is entitled to
great credit: he paid most careful attention to the work of giving
clinical instruction. Recognizing, as I do, the importance of this
branch of medicine, I shall not hesitate to devote here a page or two
to a brief review of the manner in which it came to hold the honorable
position which it occupies to-day in all the best schemes for medical
education.

During the sixteenth century, as Puschmann assures us, an attempt was
made at Padua, Italy, to render clinical instruction an essential
part of the physician’s education, but the difficulties which were
encountered proved so much greater than was anticipated that it was
soon found necessary to abandon the plan; and then for many years no
further effort was made, either at Padua or at any of the other Italian
medical schools, to introduce clinical teaching. After the lapse of
nearly a century, Johannes Heurnius (1543–1601), Professor of Medicine
at the University of Leyden, made an effort to introduce the plan of
teaching medicine at the bedside; and a few years later (1630) two
other professors of the same university--viz., Otho Heurnius, son of
Johannes, and E. Schrevelius--formally introduced clinical instruction
at the city hospital. The plan which they adopted was the following:
The students in turn were permitted first to question the patient about
his ailment and then afterward to make whatever physical examination
appeared to be necessary; next, each one of them stated briefly what
he believed to be the nature of the malady, and also gave his views as
to the prognosis, symptoms and treatment; after which the professor
commented on these different reports, pointing out both the correct and
the incorrect features in each case. After a short trial of the plan
it became clear that it would have to be abandoned, for the students
did not like to have attention called in such a public manner to their
mistakes. Then, a few years later, Sylvius, who at that time was the
Professor of Medicine, introduced a system of clinical teaching which
is thus briefly described by his colleague, Lucas Schacht:--

   When, followed by his pupils, he approached the bedside of a
   patient, he assumed the air of one who is entirely ignorant
   of the nature of that person’s malady, of the accompanying
   symptoms, and of the treatment which was being carried out.
   Then he began to ask first one and then another of the students
   a great variety of questions respecting the case that was
   under consideration,--questions which at first seemed to have
   been propounded in a haphazard fashion, but which in reality
   were so cleverly formulated as to elicit from the class all
   the information needed for the making of a correct diagnosis,
   while leaving on the minds of the students the impression that
   they, and not the professor, had worked out the problem to a
   successful result.

This system, if such it may be termed, proved extremely successful, and
the knowledge of this success spread rapidly from one end of Europe
to the other, causing students and physicians to flock to Leyden from
Russia, Poland, Hungary, Germany, Denmark, Sweden, France, Italy and
England. So long as this particular university continued to possess, as
a member of its faculty, a professor of medicine who was clever enough
to carry on clinical instruction with the same profound knowledge
of human nature as had been displayed by Sylvius, just so long did
this institution remain without a rival in this part of the field of
medical education. Then Sylvius was followed, in the work of clinical
teaching, by Boerhaave, a man admirably fitted, both by nature and by
the training which he had received, to keep the University of Leyden
in the first rank of medical schools as regards this most useful
form of discipline. After 1738, the year in which Boerhaave died,
other universities besides that of Leyden began to provide fairly
satisfactory facilities for clinical study, and among the number of
such institutions those of Utrecht, Rome, Edinburgh, Paris and Halle
deserve to be mentioned. The lack of funds and doubtless also the lack
of the right sort of teachers were the principal reasons why these
schools were not able to vie with Leyden in furnishing the facilities
needed for clinical instruction. That the fault--at least in the case
of the University of Halle--was not to be attributed to a failure
on the part of the Medical Faculty to appreciate the value of such
instruction is clearly shown by the saying attributed to Friedrich
Hoffmann, who at that period was the Professor of Medicine:--

   By a mere attendance upon medical lectures no man will ever
   succeed in becoming a properly equipped practitioner of that
   art; it is indispensable, in addition, that he should receive
   clinical instruction.

The fairly permanent establishment of this fundamental branch of
medical teaching was not effected until about the middle of the
eighteenth century, when Van Swieten, one of Boerhaave’s most
distinguished pupils, was given full authority by the Empress Maria
Theresa to furnish, at the University of Vienna, all the facilities
required for successfully carrying on such instruction. From that
time onward, to a quite recent date, Vienna has been the Mecca of all
the younger physicians who aspired to become fully equipped in the
practical branches of the science of medicine.

_Georg Ernst Stahl._--Georg Ernst Stahl was born at Anspach,
Germany, in 1660. Little is known about his early life beyond the
fact that he pursued his studies at the University of Jena, received
the degree of Doctor of Medicine from that institution in 1684, and
shortly afterward began giving private courses in medicine which proved
to be very popular and soon brought him into public notice. In 1687
he was given the position of Court Physician at Weimar. In 1694, upon
the recommendation of Friedrich Hoffmann, who was at that time the
incumbent of the regular Chair, he was appointed Associate Professor of
Medicine in the recently founded University of Halle, Prussian Saxony;
the understanding being that he was to devote his attention more
particularly to the physiological, pathological, chemical and botanical
aspects of the subject. He held this position up to the year 1716, when
he was appointed one of the attending physicians of Frederick William
the First, King of Prussia, and thereafter was obliged to reside in
Berlin, in which city he died in 1734.

Stahl was a tireless worker, and wrote a large number of treatises
(two hundred and forty-four in all) on physiological and pathological
topics--all of them in Latin. Albert Lemoine, who has written an
elaborate monograph on one of these treatises (that relating to
animism), says that, despite the obscure style in which this and most
of his other treatises are written, one may, upon careful study,
satisfy himself that Stahl is a very close reasoner and possesses a
clear mind. His most conspicuous faults, Lemoine adds, are these: he
is opinionated and vain, and objects strongly to any criticisms that
his opponents make; and yet he is careful to take up these criticisms
one by one and subject them to a close analysis. His vanity led him to
maintain that he was the only person then living who was capable of
lifting medicine out of the rut in which it was at that time rigidly
held. He manifested a sovereign contempt, not only for the men whose
opinions differed from his, but also for those who complained of the
difficulty of comprehending the Latin in which his treatises are
written. Finally, Lemoine states that Stahl is addicted to mysticism,
as is shown by the invocations of all sorts with which he begins and
ends most of his writings. Haeser adds that Stahl possessed a gloomy,
reticent and overbearing spirit, in striking contrast with the charming
sweetness of temper of his colleague Hoffmann.

Among Stahl’s numerous contributions to medical literature there
is only one in which our readers are likely to take any particular
interest; I refer to the treatise which bears the title “_Theoria
medica vera_”--the true theory upon which the science of medicine
is based. It is in this work more particularly that Stahl expounds
the doctrine of animism. As I have tried in vain to obtain a really
satisfactory conception of this doctrine, which occupied so great a
place in the thoughts of the physicians of the period between 1650 and
1750, I have decided to rest satisfied with merely reproducing here
the interpretation which William Cullen of Edinburgh, one of Stahl’s
contemporaries and also one of the greatest English physicians of
that period, gives in his celebrated “First Lines of the Practice of
Physic”:--

   What is frequently spoken of as the power of nature--the “_vis
   conservatrix et medicatrix naturae_”--resides entirely in
   the rational soul. Stahl supposes that upon many occasions the
   soul acts independently of the body, and that, without any
   physical necessity arising from that state, the soul, purely
   in consequence of its intelligence, perceiving the tendency of
   noxious powers threatening, or of disorders any ways arising in
   the system, immediately excites such motions in the body as are
   suited to obviate the hurtful or pernicious consequences which
   might otherwise take place.

Barthélemy St. Hilaire of Paris (1805–1895) in one of his writings
says: “I am convinced that the central idea in Stahl’s physiology was
suggested to him by the reading of Aristotle’s ‘_De anima_,’ in
which this great philosopher states that the soul nourishes the body,
and also that nutrition is one of the four ways in which the soul
manifests itself.”

Speaking of the effect of Stahl’s doctrines upon the actual practice
of medicine as a whole, Cullen says that it was of a controlling
character, leading physicians to propose the “art of curing by
expectation”; the natural result of which was that they advocated for
the most part the employment of only very inert and frivolous remedies.
On the other hand, they zealously opposed the use of some of the most
efficacious drugs, such as opium and the Peruvian bark, and resorted
to bleeding and to the administration of emetics only in exceptional
cases. Cullen adds that:--

   The Stahlian system has often had a very baneful influence on
   the practice of physic, as either leading physicians into, or
   continuing them in, a weak and feeble practice, and at the same
   time superseding or discouraging all the attempts of art....
   The opposition to chemical medicines in the sixteenth and
   seventeenth centuries, and the noted condemnation of antimony by
   the Medical Faculty of Paris, are to be attributed chiefly to
   those prejudices which the physicians of France did not entirely
   get the better of for near a hundred years after. We may take
   notice of the reserve it produced in Boerhaave with respect to
   the use of the Peruvian bark.

Stahl, after taking up his residence in Berlin, devoted himself
energetically to the increase and spread of the knowledge of chemistry.
The thing which brought him the greatest celebrity, both in his own
lifetime and also during the years following his death, was his
propounding of the “phlogiston” theory. This theory was to the effect
that all combustible materials or substances contain (as he assumed)
an element to which he gave the name of _phlogiston_. He was not
able, however, to demonstrate the actual existence of this element;
he simply assumed that it existed. At the same time the fact should
here be stated that the terms “oxidation” and “reduction,” which came
into use during the following century, developed out of this theory of
phlogiston.

_Friedrich Hoffmann._--Friedrich Hoffmann was born at Halle,
Prussian Saxony, February 19, 1660, and received his medical education
in his native city, largely under the direction of his father, who was
himself a physician. In 1678 he attended lectures at the University
of Jena, and in the following year visited Erfurt in order to
benefit from the instruction of Caspar Cramer, who was at that time
a distinguished authority in chemistry. At the end of two years he
returned to Jena, took his degree of Doctor of Medicine, and acquired
the right to deliver public lectures. Then, during the following three
years, he visited Holland and England, and, upon his return in 1685,
settled at Minden, Westphalia, as a general practitioner of medicine.
In 1686 he was appointed District Physician of the Principality of
Minden and also Court Physician of the Prince Elector; and two years
later he accepted the position of District Physician at Halberstadt.
After the inauguration of the new university at Halle, July 12, 1694,
Hoffmann appears as one of the earliest professors chosen to serve the
institution. In 1701, when Frederick the Third, Electoral Prince of
Prussia, assumed the crown under the title of Frederick the First, King
of Prussia, he extended to Hoffmann an invitation to come to Berlin and
accept the position of Private Physician to His Majesty. Hoffmann was
not at first willing to accept the invitation, but in 1708, when the
King, who had then become seriously ill, renewed his request, Hoffmann
accepted, on condition that he might retain his professorship. In 1712
he returned to Halle and remained there until he died in 1742.

Before Hoffmann’s time very little was known concerning the nature of
carbonous (or carbonic) oxide and concerning the fatal effects which
may be produced by inhalation of this gas. It was a common belief,
for example, that the gas was given off by freshly plastered walls;
and--as an even worse error--the theological authorities showed an
inclination, in many of the fatal instances which probably were due
to inhalation of carbonous oxide, but in which no recognizable cause
of death had been discovered, to explain the event as due to the
malign interference of the Devil. In our time it is well understood
in the community that the fumes of carbonous oxide constitute the
most dangerous gas that one is liable to encounter, but in Hoffmann’s
day the people appear to have been less well informed concerning this
danger than they were in ancient times. In the treatise on this subject
which Hoffmann published in 1716,[81] several of the earliest known
instances of such poisoning are narrated, the first one being that
mentioned very briefly by Aristotle (384–322 B. C.). Then follow two
very short references to this subject in the “_De rerum natura_”
of the Roman poet Titus Lucretius Carus (95–52 B. C.). They read as
follows: (1) “The fumes of burning charcoal easily affect the brain if
thou hast not first taken a drink of water.” (Book VI., verse 803.) (1)
“If the fumes of the night lamp,[82] after it has been extinguished,
are inhaled rather deeply the effect experienced will be the same as if
one had been struck down by a blow on the head.” (Book VI., verse 792.)
The idea that the previous drinking of water is competent to prevent
the effects of poisoning by charcoal fumes is declared by Neuburger,
the translator of Hoffmann’s treatise, to be erroneous.

The earliest really satisfactory description of an instance of
non-fatal poisoning by the fumes of burning charcoal is credited by
Hoffmann to the Roman Emperor, Julian the Apostate, who reigned from
361 A. D. to 363 A. D. Before he was made Emperor, Julian was intrusted
by Constantius II., in 355 A. D., with the government of the Province
of Gaul, and in 357 he won a great battle against the Alamanni at
Strassburg; after which he took up his residence in the little city of
Lutetia, the present Paris. It was undoubtedly soon after this event
that he wrote the Greek satire which bears the title “Misopogon,” and
from which Hoffmann quotes the following account of Julian’s narrow
escape from death through the poisonous effects of carbonous oxide:--

   The little city which the Celts call Lutetia is built upon a
   small island in the midst of a river, and access to it from
   both sides is gained by means of wooden bridges. Ordinarily the
   winter climate in this region is mild, owing--as the people
   of the place claim--to the proximity of the Ocean. Good wine
   is produced there, and even fig-trees flourish provided care
   be taken to wrap them well in wheat straw or some similar
   protective material during the winter season. But my visit
   happened to have been made during an exceptionally severe
   winter, and as a result things which looked like slabs of
   Phrygian marble, closely packed together, were constantly
   floating down the river with the current, and, soon becoming
   jammed, they formed a sort of natural bridge. Although most of
   the houses--the one I occupied among the number--were provided
   with fireplaces and chimney-flues, and might therefore readily
   be heated, I was not willing that a fire should be kindled in my
   bedroom. I was very little sensitive to cold, and, in addition,
   I was desirous of becoming more and more hardened to its
   influence.... As the severity of the weather, however, showed no
   signs of letting up, I permitted the attendants to bring into
   the room a few glowing coals, just enough to render the air of
   the chamber less chilly. But, notwithstanding the very small
   degree of heat which these few burning coals supplied, it proved
   to be sufficient to draw out from the damp walls exhalations
   that caused my head to feel as if it were tightly held in a
   vice and also produced a sensation as if I were choking. I was
   immediately removed from the room, and the physicians who were
   promptly summoned administered an emetic which enabled me to
   get rid of the food which I had eaten a short time before. Soon
   afterward I had a refreshing sleep and was able on the following
   day to resume my work as usual. [Translated from the German
   version printed in Neuburger’s monograph.]

As will be seen from the reports which I have just quoted, there
existed among the Germans, early in the eighteenth century, no fixed
belief as to the real cause of death in many of these unexplained fatal
cases; and it was therefore no small public service which Hoffmann
rendered when he, in whose judgment about such matters the people at
large placed the greatest confidence, published such a clear and simple
explanation of the real cause of these deaths as that which is given in
this interesting monograph.

Hoffmann also added not a little to his fame by the invention of
a remedy which was first known as “Hoffmann’s drops,” but which
to-day appears in the United States Pharmacopoeia under the name
of “Hoffmann’s anodyne” or “_spiritus aetheris compositus_”
(sulphuric ether, 325; alcohol, 650; ethereal oil, 25).




                             CHAPTER XXXIV

         HERMANN BOERHAAVE OF LEYDEN, HOLLAND, ONE OF THE MOST
          DISTINGUISHED PHYSICIANS OF THE SEVENTEENTH CENTURY


Hermann Boerhaave, who was born at Voorhont, near Leyden, Holland, on
December 31, 1668, was the son of a poor but highly educated clergyman;
and it was owing to this circumstance that he received in early youth
a most careful training in Latin and Greek and in belles-lettres. At
the age of fourteen he entered the public school of Leyden, and made
such rapid progress in his studies--history, mathematics, the different
branches of natural philosophy, Hebrew and Chaldean languages, and
metaphysics--that he was soon able to follow regularly the lectures
given at the university. He was only fifteen at the time when his
father died, leaving him absolutely penniless; but Van Alphen, the
Burgomaster of Leyden, befriended him and furnished all the funds
needed for a continuance of his studies at the university. But young
Boerhaave, who was not willing to be entirely dependent on the aid thus
provided, contributed to his own support not a little by giving private
instruction to young students of the wealthy class. In 1690 he received
the degree of Doctor of Philosophy, the subject of his dissertation
being a refutal of the doctrines of Epicurus, Hobbes and Spinosa.
His original intention had been to prepare himself for the ministry,
but, after continuing his studies in theology for a short time, he
determined that the better course for him would be to choose the career
of physician. Accordingly he began, at the age of twenty-two, to study
the anatomical treatises of Vesalius, Fallopius and Bartholinus, and at
the same time he followed a course of instruction in dissecting, under
the guidance of the anatomist Nuck, and also occasionally attended the
lectures given by Drelincourt, who at that time was Professor of the
Theory of Medicine. In his reading of medical literature he showed a
decided preference for the writings of Hippocrates and Sydenham; and
he devoted a large portion of his time to the study of botany and
chemistry, two branches of the science of medicine in which he took a
very strong interest all through life. In 1693 he received the degree
of Doctor of Medicine from the University of Harderwyk.[83] In 1701
he was appointed Associate Professor of the Theory of Medicine in
the University of Leyden, and it was in this capacity that he began
building up that great reputation which in a very few years brought
crowds of students from all parts of the world to Leyden. As already
stated on a previous page, he owed a large part of his fame to the
admirable manner in which he conducted his clinical teaching. To show
how widely he was known throughout Europe the story is told that a
letter which had been sent to him from a mandarin living in China and
which bore the address, “To the illustrious Boerhaave, Physician in
Europe,” reached him in due course.

Soon after his first appointment at Leyden, he received other most
flattering offers, such as that of William the Third, Hereditary Prince
of the Netherlands, to accept the position of Court Physician at The
Hague, and a call from the University of Groningen (1703) to occupy
the Chair of Medicine. He declined these offers as he preferred to
remain at Leyden; but, a few years later, in 1709, he accepted the
full professorship of the Practice of Medicine in the institution
with which he was already connected. From the vantage ground of this
more responsible position he was able most successfully to teach the
students the best methods of observing, identifying and treating the
different diseases; and as a further result of this promotion in rank
his private practice grew rapidly, monarchs and princes coming from
every country in Europe to consult him about their maladies. Boerhaave
was also most popular among his fellow townsmen. It is related of
him, for example, that on one occasion, after he had been confined to
the house for about six months by an illness of a gouty nature, the
citizens of Leyden manifested their joy at his recovery by inaugurating
a general illumination of the town during the evening of the day on
which he made his first appearance on the street. He had two relapses
of the gouty affection, one in 1727 and another in 1729, and he finally
died from disease of the heart on September 23, 1738. The monument
raised in his honor by the city of Leyden bears the inscription:
“_Salutifero Boerhaavii genio sacrum_” (Sacred to the memory of
the health-giving genius of Boerhaave).

Some idea of the lucrative character of Boerhaave’s private practice
may be gained from the fact that he left to his only child, a daughter,
the sum of about four million francs. And yet he was noted for the
generous gifts which he made during his lifetime to all sorts of
scientific and benevolent objects.

Boerhaave, says Dezeimeris, exercised during his career, and also for a
long time after his death, an immense influence upon medical thought.
He is justly ranked, he adds, among the iatromathematicians, and it
is correct to say that he was largely instrumental in overthrowing
the chemical system which de le Boë (Sylvius) had developed. His own
treatise on this branch of knowledge (“Elementa Chemiae”), which was
published toward the end of his life, soon became the standard work
on this subject, and it retained its popularity for many years. “It
is to be regretted that, possessing as Boerhaave unquestionably did,
remarkable powers of observation, he should have allowed himself, in
opposition to the very principles which he advocated so strongly,
to indulge in the making of systems and hypotheses. He commenced by
advocating with enthusiasm the method of Hippocrates, and ended by
following the brilliant but not very trustworthy example of Galen.”
(Dezeimeris.)

The number of treatises which Boerhaave published is quite large,
the most important among them being the following: “_Oratio de
commendando studio Hippocratico_,” 1701; “_Institutiones medicae
in usus annuae exercitationis domesticos_,” 1708; “_Aphorismi
de cognoscendis et curandis morbis in usum doctrinae medicae_,”
1709 (English version printed in London in 1742); and “_Elementa
chemiae_,” 1732 (English translation by Peter Shaw, London, 1741).

Of the “Aphorisms,” one of the most widely known of Boerhaave’s
published treatises, I shall take the liberty of saying a few words.
This work is in reality a very concise statement of the author’s views
regarding pathology, pathological anatomy and therapeutics, and I
believe that the following paragraphs, although few in number, will
suffice to give our readers a fair idea of the general character of the
book. At the same time I must confess that I have not found it an easy
matter to understand and satisfactorily digest many of the individual
aphorisms, the text of which has been compressed into such a small
space. It therefore does seem surprising to learn from one critic that,
if one wishes to ascertain what Boerhaave’s views are with regard to
the science of medicine, one should read by preference the Commentaries
of Van Swieten, who was Boerhaave’s favorite pupil and assistant.

The following four or five aphorisms are typical specimens belonging to
the earlier sections of the book:--[84]

   (7.) A disease when present in a body, must needs be the bodily
   effect of a particular cause directed to that body.

   (8.) Which effect being entirely removed, health is recovered.

   (9.) It may be removed by correcting the illness itself in
   particular, _viz._, by the applications of medicines
   to the particular diseased part, or by some remedies which
   operate equally upon the whole: the first we’ll call a
   _particular_, the latter a _general_ cure.

   (10.) The way to both is discovered either _by
   observation_, or _by comparing_ one case with another,
   or _by a true reasoning_ from them both.

   (13.) He who doth, with the greatest exactness imaginable, weigh
   every individual thing that shall happen or hath happened to
   his patient and may be known from the observations of his own
   or of others, and who afterward compareth all these with one
   another, and puts them in an opposite view to such things as
   happen in an healthy state; and lastly, from all this, with the
   nicest and severest bridle upon his reasoning faculty, riseth
   to the knowledge of the very first cause of the disease, and of
   the remedies fit to remove them; _he_, and _only he_,
   deserveth the name of _a true physician_.

Then Boerhaave proceeds to make a classification of diseases, and among
the very first groups which one finds in this classified list are the
following: “Distempers of a lax and weak fibre”; “Distempers of the
stiff and elastic fibre”; “Distempers of the less and larger vessels”;
“Distempers of weak and lax entrails”; “Distempers of the too strong
and stiff entrails”; etc.--from which it is apparent that the old
doctrine of the _strictum_ and the _laxum_, which was taught
by the Methodists in the early centuries of our era, has here been
adopted by Boerhaave in all its essential characters; and also that the
treatment which he recommends for some of these classes of maladies
does not materially differ from that advocated by this ancient school
of medicine. The following extracts, I believe, will suffice to give
the reader a fairly clear understanding of what Boerhaave means by the
expressions “distempers of the solid simple fibre,” “distempers of a
lax and weak fibre,” and “distempers of the stiff and elastic fibre,”
and will at the same time show what methods he employed for overcoming
these distempers. At the time when Boerhaave made use of the term
“fibre” (_fibra_) in the very uncertain sense in which he here
employs it, Leeuwenhoek and Malpighi were demonstrating, by aid of the
newly perfected microscope, that the so-called simple tissues were in
reality quite complex structures; and one’s first impulse, therefore,
is to express surprise that a physician of such high standing as our
author should have used the term. But we moderns must not forget that,
in those early days, it took decades for knowledge of this nature
to spread even a very short distance, as from Delft to Leyden, and
then to exert its legitimate influence upon medical thought--that
is, to be digested and afterward permanently appropriated. There can
be scarcely any doubt that, at the time (1709) when Boerhaave wrote
these aphorisms, he had already heard about the existence and the
capabilities of the recently perfected microscope, but it is not at all
likely that he had as yet digested the gains in anatomical knowledge
which had been acquired through the assistance of this instrument. The
extracts referred to above are the following:--

                 DISTEMPERS OF THE SOLID SIMPLE FIBRE

   (21) Those parts (which, being separated from the fluid
   contained in the vessels, are applied and sticking to each other
   by the strength of the living body, and make the least fibre)
   are the least, the simplest, earthy, and hardly changeable from
   or by virtue of any cause, which are found in our living bodies.

                  DISTEMPERS OF A LAX AND WEAK FIBRE

   (24) The weakness of the fibre is that cohesion of the minutest
   parts described (21), which is so loosely linked that it may be
   pulled asunder even by that degree of motion which is requisite
   in healthy bodies, or not much exceeding it.

   (26) The weakness produceth easily a stretching and a breaking
   of the small vessels made up of those weak fibres (24), and
   consequently abates of their power over the fluids therein
   contained; from which distensions arise tumors, from the
   stagnating or extravasated liquids putrefactions, and, farther,
   all such innumerable ills as are the consequences of them both.

   (28) [In distempers of a lax and weak fibre] the cure must
   be obtained, 1. By aliments that abound in such matter as
   is described in section 21, and which [should] be almost so
   prepared beforehand as they are in a strong and healthy body;
   such are milk, eggs, flesh-broths, panadoes[85] rightly prepared
   of well-fermented bread; and rough wines. All which must be
   given in small quantities, but often. 2. By increasing and
   invigorating the motion of the solids and fluids by means of
   frictions with a flesh-brush, or with flannel; by riding on
   horseback, and in a coach, or by being carried in a boat; and
   lastly by walking, running and other bodily exercises. 3. By a
   gentle pressure or a bandage upon the vessels, and a moderate
   repelling of the liquids therein contained. 4. By medicines
   both acid and austere, or such as are spirituous and well
   fermented, but applied with great caution and gentleness. 5. By
   any means that will remove and remedy the too great pulling of
   them.

[That Boerhaave belonged to the iatrophysical or iatromechanical school
appears very clearly throughout these quotations.]

               DISTEMPERS OF THE STIFF AND ELASTIC FIBRE

   (35) [In distempers of this group] the cure is effected, 1.
   By such meat and drink as is thin and watery, without any
   roughness, chiefly by the continued use of milk-whey, of
   the softest herbs and salads, barley-water, thin gruel, and
   unfermented liquors. 2. By avoiding of exercise, and dwelling in
   a moist, coolish air, and taking long sleeps. 3. By the taking
   or outwardly applying watery, lukewarm, tasteless medicines, and
   such as contain the lightest and softest oils.

In the second half of the volume I find abundant evidence of
Boerhaave’s ability to treat efficiently some of the acute and chronic
maladies; and, after a perusal of the text which deals with these
affections, I have no difficulty in understanding how he came to be
looked upon as one of the leading medical practitioners of the period
during which he lived. I should be glad to reproduce here such portions
of the aphorisms as would corroborate the statement that I have just
made, but unfortunately the small amount of space that I can command
does not permit me to do this. At every step, as I advance, I am warned
against the danger of exceeding the limits permitted, and I shall,
therefore, in the present instance, have to rest satisfied with quoting
the larger part of a single paragraph in which is given an account of
the treatment employed in a case of acute pleurisy.

   (890) ... If the same pleurisy be recent before the end of the
   third day, yet violent from the many and strong symptoms, and
   dry, in a strong, exercised, dry body, without the hopes of
   the presence of (887 and 888) [a resolution or a concoction
   and excretion of the cause], then let the patient immediately
   be blooded largely, with a quick running stream out of a
   great vessel, and a large orifice, keeping his body quiet and
   leaning backwards, enforcing his breathing all the while with
   coughing or panting, fomenting the side at the same time, and
   gently rubbing it; which bleeding ought to be continued till the
   pain seems to abate pretty considerably, unless a fainting fit
   forces you to leave off sooner; at whose approach the vein must
   immediately be stopped. Bleeding ought to be repeated according
   as these symptoms do return upon whose account it was done the
   first time; and when that skin doth not any longer appear upon
   the surface of the blood, it is time to forbear more bleeding.

   From the beginning ought to be used fomentations, bathings, warm
   streams, liniments, plaisters, and the like; which may be of use
   as they loosen, resolve, mitigate, and avert....

As only extracts of considerable length would suffice to give our
readers a satisfactory idea of the attractive manner in which Boerhaave
deals with the subject of chemistry, I prefer to omit them altogether,
and to recommend to those who are specially interested in this
branch of science, that they consult Peter Shaw’s excellent English
translation of the “_Elementa Chemiae_.”

Albert von Haller, the celebrated Swiss physiologist and historian of
medical literature, speaks of Boerhaave as “my beloved preceptor, a man
of refined taste and a speaker or lecturer so logical and charming that
one more gifted can hardly be imagined.”




                             CHAPTER XXXV

    GENERAL REMARKS ON THE DEVELOPMENT OF SURGERY IN EUROPE DURING
                 THE FIFTEENTH AND SIXTEENTH CENTURIES


In the early period of the Renaissance surgery was apparently the
first of the practical branches of medicine to spring forward into
active life. Anatomy,--that is, human anatomy,--the foundation that is
absolutely necessary to the solid growth of surgery, scarcely existed
before the beginning of the sixteenth century; and it is therefore
not surprising that the records of the past reveal to us so very few
instances of men who attained any eminence as surgeons. When this
fact is taken into consideration I cannot help feeling that, in the
sketches which I drew, on earlier pages, of Theodoric of Cervia,
William of Saliceto, Lanfranchi of Milan (and later of France), Henri
de Mondeville and Guy de Chauliac, I gave to these men only a small
fraction of the credit to which they were justly entitled. Indeed,
the excellence of the work done by them and recorded in the treatises
which they published, is so great as to arouse the suspicion that they
had clandestinely acquired more knowledge of human anatomy than they
dared to admit. The life of a dissector of human bodies, it should be
remembered, was by no means safe in those days.

But the lack of a trustworthy knowledge of anatomy was not the only
hindrance to a healthy development of the art of surgery. There were
other obstacles which, up to a comparatively late period in the
sixteenth century, continued to block the advance of this art. Of
these, the principal one was perhaps the custom--not by any means
considered at that period professionally dishonorable--of keeping
secret the technique of certain operative procedures like that of
cutting for stone in the bladder or that of the radical cure of hernia.
Such knowledge was treated as private property, and was very carefully
handed down from father to son, or was sold for a large sum of money to
certain surgeons who engaged, under oath, not to reveal the details to
others. Thus we are assured by Haeser that two such eminent surgeons as
Ambroise Paré and Fabricius of Hilden were obliged to pay handsomely
for the information which they received from certain specialists
concerning their particular methods of procedure. It is from such
scraps of information which come to our knowledge casually that we
often learn the actual truth concerning the advance made at a given
period of time by a certain department of medical science. Although it
is not possible to fix the date when the custom to which I have just
referred was definitely abandoned, it may be stated as a fact that
after the seventeenth century very few instances of such ownership of
surgical secrets are discoverable in the records.

Inasmuch as at the very beginning of the Renaissance surgery was looked
upon, in the southern and central parts of Europe, as an occupation of
a somewhat menial character, the regularly organized medical schools
made very inadequate provision for the proper education and training of
those young men who were disposed to adopt a surgical career. During
the fourteenth and fifteenth centuries surgery was still tolerated at
Montpellier, but after the papal seat had been removed from Avignon
to Rome--that is, after 1479,--the pupils of that university were
forbidden to do any surgical work. In 1490, however, a course in
surgery was provided for the exclusive use of barbers. At first the
instruction was given in Latin, but, as these men did not understand
this language, the professor was soon compelled to employ a barbaric
Latin (half French and half Latin) in making his comments upon the
text of the lecture. This state of affairs lasted for more than a
century. In fact, it was not until after Paré, Franco and Wuertz had
demonstrated by their remarkable careers how honorable was this branch
of the science of medicine, that provision was made at Montpellier (in
1597) for regular instruction in surgery. But even then, for a period
of several years, it was found to be a very difficult matter to keep
the peace between the two groups of students--the medical and the
surgical; the governing authorities being finally obliged, in order
to prevent the encounters which frequently took place between the
rival bodies, to appoint four a.m. as the hour when the instruction in
surgery was to be given. Those students who were pursuing the course in
medicine looked upon the surgical pupils as intruders, as men unworthy
to associate with them, and they availed themselves of every possible
opportunity for making their connection with the university unpleasant.

In Paris, during the twelfth and thirteenth centuries the surgeons
formed themselves into corporations. Minor surgery was left entirely
in the hands of the barbers (a word which is derived from the Latin
“_barbarus_,” uncultivated) and barber-surgeons. They were
largely itinerant practitioners and army surgeons. As they traveled
from one city to another, the more enterprising ones announced their
approach by means of a sort of herald who proclaimed loudly the cures
which his chief was able to accomplish. In the course of time the
surgeons who lived in Paris formed themselves into the so-called
“College of Surgeons.” At a later date (1255) there was established
in that city by Jehan Pitard, the surgeon of Louis the Ninth (“Saint
Louis,” 1215–1270), a more perfect organization under the name of
the “College of Saint Cosmas,” which was placed under the protection
of Saints Cosmas and Damian. The members of this Brotherhood were
known as “Surgeons of the Long Robe,” to distinguish them from the
Barber-Surgeons or “Surgeons of the Short Robe”; and they were also
known as “_Maitres Chirurgiens Jurés_.” Through the influence of
Pitard this organization received from the King a set of governing
rules or constitution.

It may prove interesting to learn who Cosmas and Damian were, how they
came to be canonized, and for what reasons the organizers of the new
brotherhood preferred them to all others, as guardian saints. Cosmas
and Damian were the youngest of five brothers who belonged to a family
of some distinction in Arabia. They chose the career of peripatetic
physicians, and gave their services free to those who might have need
of them. They spent some time in the Province of Cilicia, Asia Minor,
and while in that country they met the death of martyrs, somewhere
about 287 A. D., during the persecutions of the Christians which
occurred in the reign of Diocletian. In the church pictures they are
represented as physicians, each one of whom holds in his hand either
a vessel containing a remedial preparation, or a staff around which
the emblematic serpent is twined, or (less frequently) a surgical
instrument of some kind. During the time of the Crusades there existed
an Order of Knights of Saint Cosmas and Saint Damian, who devoted
themselves specially to the care of sick pilgrims and to the freeing of
those who were held as prisoners.

In all the large cities of France there existed, during the fourteenth
and fifteenth centuries, corporations of surgeons, the great majority
of whom belonged to the class or grade of barbers. These men were not
permitted by their rules to use the knife, and, as a result, great
jealousy existed between them and the few who, having passed the
required examination, were authorized to perform cutting operations
and to assume the title of “Masters in Surgery.” In 1493, as the
result of an effort made by the barbers of Paris as a body, to gain
some knowledge of medical science, they obtained from the university
permission to purchase a corpse which had not yet been removed from the
gallows. They had, it appears, engaged a doctor of medicine to give
them instruction in anatomy, and it was upon a dissection of this body
that the teaching was to be based. In 1494 the Faculty made provision
for giving the barbers a regular course of lectures on surgery; and,
eleven years later (1505), additional privileges having in the meantime
been granted them by the university, they organized the “Corporation
of Barber Surgeons, or Surgeons of the Short Robe.” In the oath
which the members of this organization were obliged to take, it is
expressly stated, among other things, that “they will give due honor
and reverence to the Faculty, and will not administer any laxative or
alterative drug.”

From 1601 to 1731, when the _Académie de Chirurgie_ was founded,
there was an almost continuous series of squabbles between the surgeons
and the barbers, on the one hand, and the Medical Faculty of the
University, on the other. At a still earlier period, dating back even
to the fourteenth century, the quarrels were between the surgeons
(École de St. Côme) and the barbers, but, during the seventeenth
century and the early part of the eighteenth, the surgeons and the
barbers seem to have harmonized their interests and to have made common
cause against the Faculty. An edict was issued by Louis the Twelfth
in 1613 to the effect that the two corporations (the surgeons and
the barbers) should be fused into a single organization; and, even
before this, it had become customary to employ the words “surgeon” and
“barber” as synonymous terms. Finally, in the years 1644, 1645 and
1656, further agreements were entered into by the two bodies. After the
founding of the Academy of Surgery in 1731 nothing further is heard of
barber-surgeons.

In the account which I have thus far given of the agencies that were
available during the Renaissance for the perpetuation and increase of
medical knowledge, I make reference only to the established medical
schools and to the less pretentious but much more practical teaching
organizations furnished by the guilds or brotherhoods. In my remarks
I have said little or nothing about hospitals, which--potentially, at
least,--have a great deal to do with the advance of medical knowledge,
especially in the department of surgery. Unfortunately, my efforts to
procure information relating to this subject have not been rewarded
with much success and I shall therefore not be able to furnish more
than a few disconnected and very imperfect details.

At the beginning of the sixteenth century the city of Lyons possessed
(and it still possesses) the oldest hospital in France--viz., the
Hôtel-Dieu,--which was founded by Childebert the First in 542 A. D.
The city itself was at that period second in importance only to
Paris, and in some respects it was the equal of the metropolis in
celebrity. The art of printing was introduced there in 1472, and the
presses of that city were soon reckoned the best in Europe. Many
medical books were published at Lyons. François Rabelais (1483–1553),
the celebrated author of the humorous and satirical works “Gargantua”
and “Pantagruel,” was a regularly educated physician, and during his
residence at Lyons he edited various works of Hippocrates and Galen.
Michael Servetus, who displayed such marked ability by his researches
in regard to the circulation of the blood, was also a resident of Lyons
from 1530 to 1543. Some idea of the way in which a large hospital was
managed in those early days may be gained from the following statement
of facts: In 1619 as many as five patients were permitted to occupy
one bed in Hôtel-Dieu at Lyons. Although the hospital possessed
accommodations for a total of five hundred and forty-nine patients
(including pilgrims and poor people), there was only one medical man
whose duty it was to look after the surgical cases, and he resided
outside the building. At a somewhat later date there was provided a
“_chirurgien principal_,” whose duty it was to give the needed
surgical care to this class of patients, and who was obliged to
reside in the hospital. When this chief surgeon required assistance
in the dressing of wounds, etc., he was authorized to make use of
the “apothecary’s boy.” The stock of surgical instruments possessed
by the hospital in 1543 comprised the following items: One uterine
speculum; one trephine, which was composed of thirteen separate
parts; one mouth-plug, for use in keeping the jaws separated; one
ear speculum; and one elevatorium. All these facts, taken together,
furnish strongly corroborative evidence of the statement made by von
Gurlt in his _Geschichte der Chirurgie_, viz., that in France,
during the sixteenth century, the occupation of surgeon was considered
by the community but little better than that of a hair-cutter. It
is therefore not surprising that the great hospital of Lyons should
have been managed at that time in accordance with such a low sanitary
standard and with an almost total disregard of the purposes for which
a hospital exists. So far as I am able to learn, the conditions just
described were not peculiar to the city of Lyons. “During the reign of
Francis the First (1515–1547) there were in the main room (thirty-six
feet wide) of the Infirmary of Hôtel-Dieu at Paris,” says Boisseau,
“six rows of beds (three feet wide), each one of which accommodated
ordinarily three (at times even four) sick persons, who necessarily
were very uncomfortable. This is not all; for there were also in this
same infirmary seven or eight beds which were designed to accommodate
from twenty-five to thirty infants or young children, the great
majority of whom died from the poor quality of air which they had to
breathe in that institution.” I do not need to furnish additional
proofs in corroboration of the truth of the statement that during the
Renaissance the French civil hospitals contributed practically nothing
to the advance of medical science. It is possible that in Italy these
institutions may have been better managed, for, in the account which he
gives of his trip to Rome, Luther speaks of having visited a hospital
which particularly attracted his notice by reason of its orderliness
and the conspicuous cleanliness of every part of the building. As an
offset, however, to this favorable testimony I should state that in
some documents discovered in comparatively recent times there are
memoranda relating to the duties of the medical staff in the civil
hospital of Padua (1569)--a city in which was located the most famous
medical school to be found anywhere in Europe during the sixteenth
century. These memoranda read as follows: “There shall be a doctor of
physic upon whom rests the duty of visiting all the poor patients in
the building, females as well as males; a doctor of surgery whose duty
it is to apply ointments to all the poor people in the hospital who
have wounds of any kind; and a barber who is competent to do, for the
women as well as for the men, all the other things that a good surgeon
usually does.” (The word “surgeon” is evidently employed here in the
sense of barber-surgeon, and not in the modern sense of the word.) This
testimony and that furnished on a preceding page with regard to the
management at the two leading civil hospitals in France amply justify
the statement that during the sixteenth century medicine received no
aid whatever from these institutions in its efforts to advance.

For the sake of orderliness I shall, from this point onward, arrange
the information which I may find it desirable to furnish, under the
headings of the different countries of Europe; and in carrying out
this plan I shall begin with Germany, as it was there that the oldest
fifteenth-century treatises on practical surgery were first printed.




                             CHAPTER XXXVI

      SURGERY IN GERMANY AND SWITZERLAND DURING THE FIFTEENTH AND
                          SIXTEENTH CENTURIES


There were five men in Germany and German Switzerland who, during the
Renaissance, attained distinction as surgeons, and who at the same
time contributed, by their published writings as well as by the force
of example, to the advancement of medical science. The names of these
five surgeons are: Pfolspeundt, Brunschwig, von Gerssdorff, Fabricius
of Hilden and Felix Wuertz. The first three mentioned were born in the
early part of the fifteenth century, and all five of them derived their
practical knowledge of surgery in large measure from their experience
in warfare. Individual sketches of these men will be furnished farther
on, but I believe that these will be better understood if a brief
account of the state of medical education in general throughout
Germany, at the period which I am now considering, be first supplied.

_State of Medical Education in General Throughout Germany
(1400–1600)._--The University of Heidelberg was founded in 1386,
but it was not until about 1550 that the first beginnings of medical
teaching made their appearance in that institution. Equally feeble
attempts were made, twenty years later, to organize the teaching of
medicine at the University of Wuertzburg; but very little appears to
have been accomplished during the immediately following years, as may
be judged from the official announcement, in 1587, of what things
the Professor of Surgery would teach in the three-years’ course.
“_First year_: Lectures on the subject of tumors, in accordance
with the teachings of Galen; _Second year_: Lectures on the
subjects of wounds and ulcers, in accordance with the teachings of
Galen and Hippocrates and the Arabian medical writers; _Third
year_: Lectures on fractures and dislocations, in accordance with
the teachings of Galen and Hippocrates. Then, if sufficient time
is available during this last year of the course, a certain amount
of anatomy is to be taught (during the winter season) from Galen’s
writings on this subject. In the summer time the subject of simple
remedies may be taken up advantageously, and botanical demonstrations
may also be given.” Von Gurlt quotes Koelliker as his authority for
the statement that throughout the seventeenth century the medical and
surgical teaching at the University of Wuertzburg was very defective,
“almost nothing worthy of mention being accomplished during that long
period in the departments of anatomy and physiology.” In the University
of Basel, Switzerland, which was founded in 1460, medical teaching
was as barren as it was in all the German universities at that early
period. It was only in 1542 that the first public dissection of a
human body took place there. Vesalius was visiting the city at that
time for the purpose of superintending the printing of his great work
on anatomy, and the university authorities availed themselves of the
opportunity to secure from him not only this single demonstration, but
also in addition a course of lectures on anatomy. Fifteen years later,
Felix Platter, a native of Basel and a man of exceptional ability
(see sketch on pp. 332 _et seq._), made the first postmortem
examination known to have been made in that city. Two years later
still (1559), following in the footsteps of Vesalius, he made a public
dissection of a criminal’s corpse in the Church of St. Elizabeth.
From 1581 onward, with occasional omissions, a public dissection of
the corpse of a criminal was made by the professor of anatomy once
every year. In 1590 the question was discussed by the Faculty whether
it “might not also be practicable to secure from the hospital, for
dissection, an occasional corpse.” The first body obtained from this
source was dissected in 1604, but it was not until 1669 that a second
one was available. There was no museum of anatomy and the medical
school owned only two human skeletons--one male, that had been set
up by Vesalius, and one female which had been prepared by Platter.
During the first two hundred years of the existence of this university,
only twenty-three copies of the different writings of Hippocrates, of
Galen, of Dioscorides and of Paulus Aegineta were available for the
instruction of the medical students. “These books should be diligently
read aloud to the young men if their contents are to furnish the
maximum of useful information.” As for clinical instruction, each
student was expected to secure for himself, by private arrangement
with some active practitioner, the position of assistant, or to obtain
from the Archiater or City Physician an occasional opportunity of
seeing patients at the hospital. According to the rules established by
the Faculty the students were permitted to take private courses with
different physicians. Another and very valuable source of information
that was within the reach of these young men, was supplied by the
public disputations which were held quite frequently.

The preceding brief account, which I have compiled from von Gurlt’s
work, will serve, as I believe, to convey a fairly clear idea of the
primitive and very limited opportunities of acquiring a knowledge of
medicine and surgery which were afforded the student in Germany during
the fifteenth and sixteenth centuries. (It should be borne in mind that
Basel, although located in Switzerland, was in nearly all respects a
German city.) It was not until a much later period that the schools of
that country, in nearly every department of human knowledge, caught
up with and eventually surpassed--at least for a number of years--the
similar institutions in Italy and France.

  [Illustration: FIG. 18. CONSULTATION BY THREE PHYSICIANS UPON A CASE
  OF WOUND IN THE CHEST.

  (From a woodcut in the _Surgery of Hieronymus Brunschwig_,
  Strassburg, 1508.)

  This treatise, which was written by the author in 1497, passed
  through nine successive editions, the last one in 1539. Probably
  no woodcuts of a higher order of merit than those represented in
  this and the two following illustrations (Figs. XIX and XX) are
  to be found in medical literature.]

_Hieronymus Brunschwig._--Hieronymus Brunschwig was born at
Strassburg during the early part of the fifteenth century, the exact
date not being known. It is believed that he attained a great age, some
even claiming that he was one hundred and ten years old at the time of
his death. His treatise on surgery, bearing the simple title “_Das
buchler Wund Artzeny_,” was first published in 1497,
when he was already an old man, and it passed through nine editions
during the following forty-two years. It was also twice translated
into English. Up to the time of the discovery of Pfolspeundt’s work
it was believed to be the oldest German treatise on surgery known. It
was very freely illustrated with original woodcuts, not a few of which
possess considerable artistic merit. (See accompanying reproduction.)
The following headings of some of the more important chapters will
convey at least a fair idea of the character of the book: “Definition
of the Word ‘Surgeon’”; “Anatomy”; “Fatality of Wounds in Different
Parts of the Body”; “Different Kinds of Wounds”; “Different Kinds of
Surgical Instruments”; “Different Modes of Ligating Blood-Vessels”;
“Wounds of Blood-Vessels and Nerves”; “Methods of Arresting Bleeding”;
“Foreign Bodies in Wounds”; “Treatment of Wounds Inflicted by Poisoned
Arrows”; “Bruised or Crushed Wounds”; “Stab Wounds”; “Bites and
Stings”; “Wounds of the Head”; “Operations for Hare-Lip”; and several
other chapters on wounds and pathological conditions of other parts of
the body. Syphilis is not once mentioned in the book; and from this
circumstance von Gurlt infers that a knowledge of the existence of
this disease had not yet, at that early date (1497), reached Germany.
In Brunschwig’s _Liber pestilentialis, etc._, however, which was
printed three years later, syphilis is incidentally mentioned as the
“_malefrancose_” or “_malum mortuum_.” That Brunschwig was
well informed in the earlier surgical literature is shown by the fact
that he quotes from the writings of Theodoric, Guillaume de Saliceto,
Guy de Chauliac, Henri de Mondeville, and many others. A hasty and
necessarily very superficial perusal of the text of a few of the more
important chapters of this remarkable book satisfies me that Brunschwig
deserves to be classed among the really great surgeons of the fifteenth
and sixteenth centuries. A copy of this rare book may be seen in the
Surgeon-General’s Library at Washington, D. C.

_Heinrich von Pfolspeundt._--The earliest German treatise
relating to surgery is that which bears the title “_Buch der
Bündth-Ertznei_,” by Heinrich von Pfolspeundt, “_Bruder des
deutschen Ordens_.” It was written in 1460, and was first published
in printed form in 1868 by H. Haeser and A. Middeldorpf, Berlin.
The text of this very early German work on the practice of surgery
furnishes ample evidence to show that the author was worthy to be
ranked among the leading surgeons of the fifteenth century. At page
fifty-seven, says von Gurlt, may be read the remarkable statement that,
in the case of a wound of the intestinal canal, one may cut through
that organ at the point of injury and then introduce into the opposite
ends of the divided bowel a silver tube the margins of which have been
carefully bent so as not to offer at any point a cutting edge. The
tube may then be tied in place with thread of green silk. (Von Gurlt
speaks of this as the forerunner of Murphy’s button.) Speaking of
wounds caused by arrows, Pfolspeundt says that, to insure the patient’s
recovery, the planet under which he happens at that time to be, should
be in favorable conjunction. In one case which came under Pfolspeundt’s
care he was obliged to pay an astrologer the sum of fifty gulden in
order to ascertain whether the planet in question was or was not in a
favorable conjunction.

There is only one place in the entire book, says von Gurlt, where a
gunshot wound is mentioned, and then only incidentally; but this is
positively the first reference (about the middle of the fifteenth
century) to such wounds discoverable in medical literature.

Among the topics which are treated quite fully and in such a manner as
to show clearly that the author was well versed in at least this part
of operative surgery, those relating to rhinoplasty deserve to receive
special mention. From the viewpoint of history, this part of the book
is of very great importance. In no other treatise, says von Gurlt, do
we find an equally detailed and satisfactory account of the operative
method employed by the Two Brancas (father and son, from Catania,
Italy), who were contemporaries of Pfolspeundt. The latter learned this
method from an Italian surgeon, whose name he does not mention, and
he was particularly careful not to divulge the essential details to
anybody except two of his brethren in the Order to which he belonged.

For anaesthetic purposes in operative cases, Pfolspeundt was in the
habit of employing sponges saturated with the juices of opium, Atropa
mandragora, Conium maculatum, Hedera helix or arborosa, Lactuca and
Daphne mezereum; his technique resembling very closely that employed by
Guy de Chauliac, Theodoric and others. (See the appropriate chapters in
the earlier part of this volume.)

In his remarks upon the manner of bringing about the healing of an open
wound, Pfolspeundt says that “in all cases he tries to dispense with
stitches, but that, when he finds such support necessary, he first
spreads a thick layer of adhesive material over both margins of the
wound and afterward introduces the threaded needle through the mass
into the skin. Then, in order to bring the edges of the wound together,
he draws the thread taut and makes it fast by means of a very small
knot.... Whether the sharp fever which sometimes sets in afterward as
a complication, is due to simple inflammation or to erysipelas, is a
question which cannot always be decided; and it is still more difficult
to determine whether the thin watery secretion which sometimes develops
in a wound may not signify--as some writers maintain--the beginning of
suppuration in a joint.”

Were it not for the difficulty which one experiences in translating
correctly the ancient provincial German of Pfolspeundt’s text, I might
readily furnish further examples of his surgical pathology and methods
of treatment. The few, however, which I have already given will have to
suffice.

  [Illustration: FIG. 19. BARBER-SURGEON (_WUNDARZT_) EXTRACTING
  AN ARROW FROM A WOUNDED SOLDIER’S CHEST WHILE THE BATTLE IS STILL IN
  PROGRESS.

  (From the _Feldbuch der Wundarznei_ of Hans von Gerssdorff, first
  published in 1517; many later editions followed.)]

_Hans von Gerssdorff._--Hans von Gerssdorff, who was also called
“Schielhans” (squint-eyed Hans), was born in Strassburg about the
middle of the fifteenth century. He was a bold and skilful surgeon,
and acquired a wide experience and great self-confidence from his long
service in connection with the army. He was present, for example, at
the famous battles of Grandson (1476, in Switzerland) and Nancy (1477,
in France), in both of which the slaughter was very great, and in both
also Charles the Bold, Duke of Burgundy, was badly beaten. In 1517 von
Gerssdorff published at Strassburg a treatise on military surgery,
under the title: “_Feldbuch der Wundartzney_.” This book, which
is illustrated with exceptionally good woodcuts, two specimens of
which are here reproduced (Figs. 19 and 20), contains the earliest
discussion of gunshot wounds; and, in his remarks on the proper manner
of treating such wounds, von Gerssdorff leads one to infer that he
shared, although somewhat hesitatingly, the at that time prevailing
belief that these wounds are poisoned. He was a pronounced advocate of
the use of the red-hot cautery in cases of serious hemorrhage from a
wound. When it was found that the ball had penetrated the flesh to some
depth, he recommended that it be cut out; and if, after the removal
of the missile, the patient complained of much pain in the wound, hot
oil was to be poured into it freely. Before the employment of firearms
in warfare, amputation of a limb was rarely performed--that is, only
in cases where gangrene had developed in the corresponding hand or
foot. But von Gerssdorff assures us that, up to the time of writing
his “_Feldbuch_,” he had personally performed “nearly two hundred
amputations.” This great increase in the frequency of performing this
operation is clearly to be attributed to the increased use of the new
agent--gunpowder--in warfare. In this operation, according to his own
declaration, von Gerssdorff was not in the habit of suturing the flaps.
Instead, he brought the opposing edges together and then covered the
stump thus formed with the bladder of some animal. There are a number
of other interesting details relating to von Gerssdorff’s manner of
conducting this important operation, but it is not practicable to give
up the space that would be required for a satisfactory description of
them. There is one point, however, to which I may be permitted to refer
very briefly in this place, viz., the manner in which the surgeons of
this and even much earlier periods secured a fairly satisfactory degree
of local anaesthesia when they had occasion to perform an amputation.
They produced insensibility of the part by tying a band tightly around
the limb a short distance above the spot at which the amputation was
to be performed. At a somewhat later period, as in the middle of the
seventeenth century, artificial anaesthesia was also effected through
the application of snow or ice to the part.

The date of von Gerssdorff’s death is not known.

  [Illustration: FIG. 20. AMPUTATION OF THE LEG.

  (From Hans von Gerssdorff’s _Feldbuch der Wundarznei_.)

  Von Gurlt says that this is the earliest known pictorial
  illustration of the amputation of a limb.]

_Fabricius of Hilden._--Fabricius Hildanus--or Fabricius of
Hilden, near Düsseldorf--was born in 1560 and received his early
training in surgery from Cosmas Slotanus, a pupil of Vesalius and the
first barber-surgeon of Duke Wilhelm of Guelich-Cleve-Berg (eighteen
miles northeast of Aix-la-Chapelle). In 1585 he visited Geneva,
Switzerland, and continued his studies in that city under the guidance
of Jean Griffon, one of the most distinguished surgeons of that period.
After leaving Geneva he practiced medicine at Cologne, and during that
period (1591–1596) steadily increased his reputation as a skilful
surgeon, particularly well versed in anatomy. But he appears to have
acquired a strong liking for Switzerland and for the professional
friends whom he had gained in that country; and consequently it is not
surprising to learn that, during the later years of his life, he spent
long periods of time in Geneva, Lausanne and Berne, in the last of
which cities he filled the office of City Physician. He died in 1634,
at the age of seventy-four, full of honors and greatly beloved by all
who knew him.

Fabricius of Hilden laid great stress upon the importance, to the
surgeon, of a thorough grounding in anatomy. He had been profoundly
impressed by the fact that his instructor at Geneva, Jean Griffon,
never undertook an important operation until after he had refreshed
his memory by a dissection of the region involved. He was also much
interested in pathological anatomy, and always availed himself of every
possible opportunity for making a postmortem examination. As evidence
of the slowness with which news of important scientific discoveries,
particularly in the domain of medicine, traveled in those days I may
mention here the fact that, up to the time of his death in 1634,
Fabricius had not heard of Harvey’s great discovery of the circulation
of the blood (1628). Although he gained distinction in more than one
field of medicine his greatest reputation was unquestionably gained in
that of surgery; and his success in this field was to be ascribed to
his profound knowledge of anatomy, to his inventive genius, and to his
great technical skill. He insisted very strongly upon the importance,
for the surgeon, of possessing good instruments and well-constructed
apparatus.

If we compare Fabricius of Hilden with Ambroise Paré we are obliged
to admit that the latter, although decidedly inferior to his rival in
scientific training, was the greater surgeon of the two. It is perhaps
worth recording that Paracelsus and Wuertz were Fabricius’ bitter
opponents.

Of his published contributions to surgical literature, the most
important are to be found in the work entitled: “_Observationum et
curationum chirurgicarum centuriae VII._,” published at Lyons in
1641.

_Felix Wuertz._--Felix Wuertz was born at Zurich, Switzerland,
between the years 1500 and 1510 (the exact date is not known). As to
his early life and surroundings I am only able to say that his father
was a painter, that he himself took service under a barber, and that
at the end of two or three years, after he had learned the details of
this branch of work, he started out on his travels over Europe in the
character of a barber’s apprentice, as was, in those days, the regular
custom with apprentices of all trades or occupations. In this way he
visited such cities as Bamberg, Pforzheim, Nuernberg, Padua and Rome,
in each of which he spent a certain length of time as an aid to those
surgeons who were willing to employ him. It is not unlikely that it was
during this wandering period of his life that he gained some experience
in the treatment of gunshot wounds. In 1536, after an absence of
four or five years, he returned to his native city and was regularly
enrolled as a member of the barbers’ guild. During the following twenty
years he carried on the practice of medicine and surgery, but more
particularly the latter, with ever-increasing success. In 1559, for
reasons which are not mentioned by any of his biographers, he left
Zurich and established himself in Strassburg; and then, at the end of
another ten or twelve years, he again changed his residence, this time
giving the preference to Basel, a Swiss city located at the boundary
line between Germany and Switzerland. The exact date of Wuertz’s
death is not known, but--from various facts which he mentions in his
book--it may be inferred that it occurred in 1576, and that he was
residing at the time in the house of his son, who had the same name
as himself and was also a surgeon. The title of the treatise which he
wrote and which passed through a number of editions between the years
1563 and 1651,--not to mention translations into the French and Dutch
languages--was: “_Practica der Wundarznei_” (The Treatment of
Surgical Affections).

Malgaigne--says von Gurlt, in his History of Surgery--does not hesitate
to speak of Wuertz as one of the three greatest surgeons of the
sixteenth century (Franco and Ambroise Paré being the other two); and
von Gurlt adds that Wuertz’s “_Practica_” is rich in facts which
he had gathered from his own experience in everyday practice, and upon
which he makes comments that really represent his own views and not
those of various other authors. The leading principles which guided
Wuertz in his treatment of wounds of all kinds are thus formulated by
him:--

   Keep them as neat and clean as possible, and disturb them as
   little as you can; so far as may be practicable, exclude the
   air; favor healing under a scab; and do not give the patient a
   lowering diet, but feed him as you would a woman recovering from
   her confinement.

According to von Gurlt, Wuertz attached relatively small importance
to healing by first intention, and only in rare cases did he make
special efforts to secure this result. On the other hand, he availed
himself of every opportunity to enter his protest against some of
the bad tendencies which had somewhat suddenly made their appearance
in the practice of surgery in his day, and more especially “against
the almost universal employment of caustics and the red-hot iron for
arresting bleeding; against the uncalled-for and positively harmful
habit of repeatedly probing a wound; against the unreasonable practice
of inserting tents into wounds; against the uncontrolled application
of mushy poultices to wounds; and against the excessive employment of
bloodletting in the treatment of wounds.” He exhibited his conservatism
in still other ways. Thus, for example, he was very slow in reaching a
decision to amputate a limb or to remove splinters or larger portions
of loose bone from a wound, for he put greater trust in the reparative
powers of Nature than did most of the surgeons of that day. Wuertz was
also slower than were most of them in resorting to the operation of
trephining the skull. His ideas with regard to the nature of gunshot
wounds were not very clear, for he still believed that the projectile
caused some burning and a certain degree of poisoning of the wound;
but he condemned all unnecessary efforts at extraction, especially by
means of complicated instruments. It was better, he said, to wait until
the bullet or other missile manifested its presence at some easily
accessible spot in the body.

The statements made above bring out some of the good features
of Wuertz’s treatise. This work, however, says von Gurlt, also
contains not a few bad features, and among them he mentions the fact
that it abounds in repetitions and in evidences of the author’s
superstitiousness.

Some of Wuertz’s comments on the symptoms which occasionally develop in
cases of injury to the head, and the suggestions which he makes as to
the treatment that should be adopted, throw considerable light upon his
mode of procedure in the presence of certain surgical phenomena. The
following clinical lesson is based upon three hypothetical developments
in a case of cranial injuries:--

   (1) The patient’s wound in the head, let us suppose, has to
   all appearances healed, when it unexpectedly becomes swollen
   and painful and begins to discharge again. What measures are
   indicated under these circumstances? The wound should at once
   be freely reopened, for it may confidently be assumed that such
   a lighting up of the local symptoms is due either to a loose
   splinter of bone that is trying to escape or to the presence of
   a small area of bone caries. If, under these circumstances, you
   should not establish a free opening a large abscess will surely
   collect in that region and will soon make for itself a new
   outlet.

   (2) If the patient complains that he has constant pain in his
   head on the same side as that on which the injury was originally
   inflicted, that the pain is steadily increasing in severity,
   and that in addition he feels a sensation of pulsation in his
   head; and if, furthermore, you inspect closely the site of
   the original wound, and pass your finger cautiously over the
   spot, but fail to discover any appreciable external swelling,
   you may feel almost certain that a splinter or a spicule of
   bone projects from the inner table of the skull cap into the
   substance of the brain. Then, when the surgeon believes that
   the condition as just described truly represents the existing
   intracranial lesions, he should not hesitate to make an opening
   in the calvarium over the affected spot and remove the offending
   splinter.

   (3) If the patient, after the external wound has healed,
   complains of a throbbing and roaring in his head, not merely in
   the region of the actual injury but involving the entire head,
   and if the symptoms tend rather to increase than to diminish,
   and eventually become so severe that the patient is almost
   beside himself with the pain, then is the surgeon justified in
   believing that a clot of blood is imprisoned somewhere beneath
   the cranium and is gradually being converted into an abscess or
   a condition of ulceration. And if at the same time some swelling
   appears in the vicinity of the eyes, or if a bloody and purulent
   discharge begins to flow from the nose or the ears, he may not
   merely entertain a belief that his diagnosis is correct, but
   may assert with positiveness that the lesions just named really
   exist. And then the proper treatment for him to adopt is [in
   essentials] the following: The head having first been shaved
   over the site of the original wound, make a crucial incision
   through the scalp and pericranium, turn the flaps back, apply
   a strong, sharp-edged chisel to the surface of the bone, and
   remove enough of the cranium to afford a satisfactory view
   of the underlying parts. [Among the effects first observed]
   probably pus will well up into the opening, and the patient will
   then experience relief; and if a spicule of bone comes into
   view, remove it forthwith. The plan of treatment here suggested
   is the only one which can be trusted to effect a cure in a
   case like that which is now being considered.... If a boring
   instrument is employed for making an opening in the bone, be
   careful not to allow any of the chips made by the borer to enter
   or remain in the cranial cavity. Some surgeons teach that, if
   pus be not found at the first opening, a second one should be
   made at the distance of a finger’s breadth from the first, and
   that the intervening bone should be broken down with a strong
   and sharp knife so as to convert the two into a single opening.
   [Wuertz adds that he had never found it necessary to act in
   accordance with this advice.] After the pus or clot of blood
   has been removed, one may as a rule readily discover the true
   cause of the pain and other symptoms. As a final step, suitable
   dressings should be applied to the wound.

Another important department of practical surgery, in which Wuertz
appears to have gained special distinction, is that which relates to
wounds and certain diseases of the abdomen. Owing to lack of space it
will not be practicable to reproduce here any histories of the cases of
this nature which came under his observation, but I believe that the
following brief extracts from his remarks upon the best way of treating
them may in some measure answer the same purpose:--

   Penetrating wounds of the abdomen are universally admitted to
   be very dangerous, no matter what organs (stomach, intestines,
   liver, gall-bladder, spleen or kidneys) be involved in the
   injury. In the case of a wound of the liver or spleen it is not
   advisable to employ sutures; instead, one may use some kind of
   sticking plaster for bringing the edges of the wound together.
   Proper regulation of the diet plays an important part in the
   treatment of these conditions, and so also may venesection. When
   an intestine is the organ wounded I adopt the plan of treatment
   recommended by most authorities; that is, I stitch together the
   opposite edges of the wound and I cleanse the surface of the
   bowel carefully with milk that has been well saturated with the
   juice of anise seeds.

In his remarks about the treatment of suppurative processes involving
the thigh in the vicinity of the knee, Wuertz gives the following
advice:--

   Do not allow the knee to remain quiet, but stretch the
   surrounding parts and manipulate them as much as you can, in
   order that the joint may not become permanently rigid; for if
   you wait until the healing is completed before you resort to
   these measures you will often find that it is already too late.

Separate chapters are devoted to such topics as would to-day receive
the designations “pyaemia,” “hospital gangrene,” and “septicaemia”;
and in a separate short treatise which deals with the various ailments
of young children, Wuertz mentions the fact that he once suffered
greatly for ten days from an attack of migraine (hemicrania) and that
he experienced marked and permanent relief only after the operation
of arteriotomy had been performed upon his left temporal artery. In
another part of the volume he expresses himself in terms which justify
the belief that he must have performed amputation of the thigh on
one or more occasions. He does not, it is true, furnish any details
regarding the indications that point to the necessity of resorting
to this operation, nor does he state how it should be carried out;
he simply makes the remark, while speaking of the employment of the
red-hot cautery iron in arresting hemorrhage, that “it is useful in
amputation of a limb, particularly in the thicker part of the thigh,
and occasionally in other places, as in the removal of a tumor by the
use of the knife.” So far as I am aware, Celsus was the first among
ancient writers on surgery to say anything about amputations, and what
he does say on this subject consists simply of quotations from still
earlier writers--from Archigenes, Leonides and Heliodorus, surgeons
whose writings no longer exist except in the form of detached extracts
that appear in more modern treatises. The portions of text which Celsus
quotes show clearly that the surgeons whom I have just named were in
the habit of making flap operations in cases of amputation above the
elbow and above the knee; and Archigenes even taught the advisability
of first ligating the larger supply blood-vessels before one proceeds
to the amputation of a limb.

From the remarks which Wuertz makes in one or two places it is easy
to see that he was often not a little annoyed by the criticisms which
his professional brethren made with regard to some of his methods of
procedure. Thus, for example, he boldly declares that one’s experience
is of much greater value than any rule that may have been laid down by
the ancients.

   There can be no doubt, he says, that the ancients occasionally
   displayed great ignorance and great want of judgment, just as
   happens in our own time.... How much do you suppose I care
   whether Galen’s, or Avicenna’s, or Guy de Chauliac’s opinion
   does or does not agree with mine? Every such opinion--it should
   be remembered--was, at one time or another in their day, a new
   [and therefore unproved] opinion.... In practical surgery much
   more importance attaches to the manner in which one carries out
   one’s manipulations, and to the amount of experience which one
   may have acquired, than to the length of time which one devotes
   to windy consultations.

Fortune conferred very few favors upon Wuertz in the course of his
career; the aid granted by kings and princes played no part in the
moulding of his character; his greatness was entirely due to his
own unaided efforts. Paré, on the other hand, was certainly one of
Fortune’s favorites. He, too, like Franco and Wuertz, began his
professional life as a barber’s apprentice, but, as he was made of
a much finer clay, the ultimate product of his development was a
princely surgeon, perhaps no more efficient or skilful than his two
distinguished contemporaries, but unquestionably more many-sided,
more lovable than either of them. On the other hand, Wuertz rendered
a most valuable service to the science of surgery by his close and
patient study of certain symptoms which his confrères had overlooked
or incorrectly interpreted (such, for example, as pyaemia, hospital
gangrene and septicaemia); and he thus established the fact that these
were in reality independent diseases.




                            CHAPTER XXXVII

      THE DEVELOPMENT OF SURGERY IN ITALY DURING THE RENAISSANCE


During the latter part of the fifteenth, all of the sixteenth and the
early part of the seventeenth centuries quite a large number of Italian
surgeons attained honorable distinction by the contributions which they
made to the science of medicine; and even in the neighboring Latin
countries of Spain and Portugal,--countries in which the force of the
revival of all departments of learning had made itself felt to a much
feebler degree, and in which at the same time the opposition to such
revival was much more active,--several surgeons succeeded in winning
creditable places for themselves in the history of their art. The names
of the Italian surgeons are as follows: Giovanni da Vigo, Bartolommeo
Maggi, Marianus Sanctus, Fallopius, Carcano Leone, Fabricius ab
Acquapendente, Aranzi and Tagliacozzi. I will now add brief notices of
the careers of all these men, in order to convey at least some idea of
the grounds upon which their claim to honorable distinction rests.

Giovanni da Vigo--perhaps more frequently referred to in literature
by the French form of his name, “Jean de Vigo”--was born at Rapallo,
near Genoa, Italy, about the year 1460. He was the son of Bernardo di
Rapallo, who was also a surgeon; and he himself was the founder of a
school which sent out quite a number of practical surgeons. In 1485 he
began the practice of his profession at Saluzzo, a small town about
forty miles south of Turin; and ten years later he settled at Savona,
which is located on the Mediterranean, a short distance to the west
of Genoa. In 1503 he was chosen the personal physician of Cardinal
Giuliano della Rovere, who resided at Savona, and he continued to hold
this position after the cardinal was elected to the papal office under
the name of Julius the Second.

Da Vigo’s great treatise on surgery (“_Practica in arte chirurgica
copiosa continens novem libros_,” Rome, 1514) owed its celebrity,
during the early part of the sixteenth century, chiefly to the fact
that he was the first author to write somewhat thoroughly upon syphilis
and upon gunshot wounds--two surgical disorders of great importance
at that time. As to gunshot wounds, da Vigo was one of the first to
maintain that they were poisoned wounds; and for a long time afterward
this was the generally accepted opinion. Like all his contemporaries,
da Vigo was not willing to undertake such operations as those for the
cure of stone in the bladder, for the relief of cataract, and for the
cure of hernia. He left these, says Haeser, to the itinerant surgeons.
But he gained well-merited credit by his employment of ligatures for
the arrest of bleeding in a variety of conditions--not, however,
in amputations, as he appears to have avoided cutting operations.
According to the same authority, the circular pattern of trephine (the
kind which the surgeons of the present day prefer) was first introduced
by da Vigo. The following passage copied from his “_Practica_”
shows that he was familiar with the use of the ear speculum: “...
_si ad solem speculo instrumento aure ampliata_.” Da Vigo died
soon after 1517.

Bartolommeo Maggi, who was born at Bologna either in 1477 (Haeser)
or in 1516 (von Gurlt), held the Chair of Anatomy and Surgery in the
medical school of his native city, and then at a later date accepted
the position of private physician to Pope Julius the Third (1550–1555).
He held this position, however, only for a short time, as he found that
the climate of Rome did not agree with him. His posthumous fame rests
largely on the treatise which he wrote on gunshot wounds and which
was published by his brother a short time after the former’s death.
His treatise, says von Gurlt, is one of the best of those which were
published on this subject during the sixteenth century. Henry the
Second, King of France, expressed his gratitude to Maggi for the care
which he took of the wounded French soldiers who fell into the hands of
the papal troops at the sieges of Parma and Mirandola. Maggi maintained
firmly the belief that gunshot wounds are either poisoned or burned.
His death occurred in 1552. The title of his treatise on gunshot wounds
is: “_De vulnerum bombardarum etc._,” Bologna, 1552.

Marianus Sanctus of Barletta near Naples (born in 1489, died at some
unknown date after 1550) is credited with having been the first to
publish a description of the so-called “_apparatus magnus_”--the
name given in those early days to the method of extracting a calculus
from the urinary bladder through an incision in the perineum after a
grooved sound or director had first been passed into this organ by
way of the urethra. The title of the book in which this description
is given is the following: “_De lapide renum liber et de lapide ex
vesica per incisionem extrahendo_,” Venice, 1535. Marianus, however,
does not claim to have been the inventor of this method. Some writers
give the credit for this to Jean da Vigo’s father, Bernardo di Rapallo,
who communicated a knowledge of the method to Giovanni de Romanis,
who in turn instructed Marianus Sanctus. It is believed, furthermore,
by some writers that Giovanni de Romanis was the inventor of
lithontripsy[86]--the operation of crushing a stone in the bladder or
urethra. Laurent Colot, the famous French lithotomist of the eighteenth
century, obtained his knowledge from a certain Octavianus de Villa, a
friend of Marianus Sanctus, and then kept the matter secret for many
years.

Fallopius, the famous anatomist of the early part of the sixteenth
century, does not appear to have attained equal distinction in the
field of surgery. So far as one may judge from the portions of the
text selected from his writings by von Gurlt, Fallopius was a very
conservative if not a very timid surgeon, in this respect being not
unlike Fabricius ab Acquapendente. In the text to which reference has
just been made, I find a brief mention of a case which passed under
Fallopius’ observation and which, perhaps, is of sufficient interest
to be recorded here. The patient’s--a German student’s--finger had
been nearly severed by some cutting instrument, and the greater part
of the member remained attached to the hand only by a narrow strip of
flesh. “I stitched together the separated edges, and at the end of
three or four days I was astonished to find that firm union between the
separated parts had already taken place. This result seemed to me like
something miraculous.”

Carcano Leone was born at Milan in 1536, his parents being people of
good social standing. After receiving a thorough classical education,
he began his medical studies in his native city, under the guidance
of Pietro Martire, a pupil of Vesalius. He next continued his studies
at the University of Pavia, but eventually went to Padua, where he
enrolled himself among the pupils of Fallopius. After a residence of
two years in that city, he returned to Milan and opened a medical
school of his own. Upon the occasion of the death of the Cardinal and
Archbishop Carlo Borromeo, whose remains now rest in the cathedral of
Milan, it was Carcano Leone who was invited to make the postmortem
examination. He carried on the practice of his profession during a
period of about twenty-eight years, his death occurring--so far as may
now be learned--in 1606.

Carcano Leone’s reputation as a surgeon rests mainly on the treatise
which he wrote on the wounds of the head, and which was published at
Milan in 1583. From among the numerous cases of this character which
came under his observation, and of which a certain number are reported
by von Gurlt, I have selected the very brief histories of three that
seem to me well adapted to serve as examples of Leone’s knowledge of
surgery and also of his ability to cope with problems of so serious
a character. They reveal the fact that he was a surgeon of excellent
judgment, most persevering, and very resourceful. Briefly told, the
accounts of the three cases to which I have referred read as follows:--

   Case I.--A small boy was hit on the right temple by a stone
   that had been thrown by one of his companions. Unconsciousness
   resulted and lasted for six days. On the seventh day signs of
   returning consciousness manifested themselves, but inability to
   speak persisted. By the end of another week the boy had already
   made some efforts to speak, but his speech was incomprehensible.
   After the twentieth day it was possible to understand a little
   of what the boy was trying to say; and from this time onward
   steady improvement in this respect was recognizable from day
   to day; but the boy’s speech did not become quite normal until
   after the lapse of about a year.

   When Carcano Leone was called to see the patient he found that
   the entire temporal muscle had been crushed and that almost the
   entire right side of the head was occupied by a fluctuating
   swelling. By making a free incision in the swelling Leone gave
   exit to a large quantity of black coagulated blood. On the
   following day, when he made an examination with the probe, he
   found that the entire squamous portion of the temporal bone was
   in a fractured state, one part of it overriding the rest. By the
   aid of elevators he succeeded in lifting up the depressed part
   of the bone, but the accomplishment of this result left a large
   gap between the opposite edges of the fragments, and through
   this opening one could see the movements of the dura mater.
   Complete healing took place only after the lapse of twelve
   months.

   When Leone reported the case to his former teacher, Fallopius,
   the latter replied that he would not have had the courage to
   adopt the course which his former pupil had pursued.

   Case II.--In another case the patient, a full-grown man, was
   struck on the right temple by a highwayman with a heavy cane
   which broke in two in the middle under the great force which
   the assailant had employed. He was left lying on the roadside
   in a state of unconsciousness until some passers-by discovered
   him and carried him to his home. He remained unconscious for
   several days. Before the physician was summoned all sorts of
   measures had been resorted to for the purpose of dissipating the
   swelling in the temporal region, but without success. Leone, on
   arriving upon the scene, made a free incision which afforded
   escape to a large quantity of decomposing blood that appeared to
   be collected, not between the muscle and the skin, but between
   the muscle and the bone. The latter was found to be fractured
   transversely and depressed; and, in order to lift it back to
   its proper level, it became necessary first to incise the
   muscle transversely. At the end of three months the wound had
   completely healed and the patient had regained his health.

Speaking of the cases just narrated and of others of a similar nature,
Leone remarks that he has never had any experience that would justify
the fear expressed by Hippocrates that convulsions are likely to result
from dividing the temporal muscle.

With reference to the value of trephining the skull in cases of injury
to the head, Leone narrates the following experience:--

   Case III.--A man was struck by a heavy stone on the upper part
   of the forehead close to where the hair grows, and was thrown
   to the ground by the force of the blow. Here he lay as if dead.
   When Leone was called, a short time afterward, to see the
   patient he found the skin unbroken except at one small spot,
   and from this point he made an incision of such length that he
   was thereby enabled to explore the surface of the skull. In
   this way he discovered that there was a fracture which appeared
   to extend through the entire thickness of the skull. He then,
   without further delay, trephined the cranium over the line
   of the fracture. This was followed by such a copious flow of
   blood that Leone was obliged to adopt measures for arresting
   any further hemorrhage. During the following fourteen days (the
   summer season then being at its height) large quantities of
   decomposed and evil-smelling blood escaped from the wound; but
   the dura mater gradually assumed a more natural appearance, many
   splinters of bone were ejected, and finally--at the end of forty
   days--the wound healed. (As no further details are given in the
   text, it is fair to assume that there were no sequelae of an
   unfavorable nature.)

The whole subject of injuries to the skull is treated in a most
thorough manner by Leone, and the book is pronounced by Scarpa
(1752–1832), the famous anatomist, the best that, up to his time, had
been written on the subject. The three histories of cases which I have
here reproduced and which furnish such striking proof of what surgery
may accomplish when practiced by a man of good courage as well as of
good judgment, certainly justify the favorable opinion expressed by
Scarpa upon Leone’s work.

Fabricius ab Acquapendente, of whom I have already given some account
on a previous page, was distinguished not only as an anatomist and as a
physiologist, but also--which was true of his instructor, Fallopius--as
a surgeon. From his published writings, however, it appears very
clearly that, like Fallopius, he had a decided aversion to the use
of the knife; his activities as a surgeon being restricted largely
to the improvement of certain of the more bloodless operations (for
example, tracheotomy and thoracentesis and operations for the relief
of stricture of the urethra). He also invented several new surgical
instruments and devised a number of machines for use in orthopaedic
practice. He attached great value to the teachings of Celsus and Paulus
Aegineta, his writings containing frequent and copious references
to these authorities and relatively few data based upon his own
experience. In the section which he devotes to the subject of wounds of
the abdomen, Fabricius confirms the opinion very generally held by the
ancients, viz., that a wound of the small intestine is invariably fatal.

Gaspare Tagliacozzi was born at Bologna in 1546. He studied medicine
under Girolamo Cardano, Professor of Medicine, first at Pavia and
afterward at Bologna, and received his degree (“Doctor of Philosophy
and Medicine”) in 1570. Very soon afterward he began teaching surgery,
and a little later he also taught anatomy and the theoretical part of
medicine. In this work he was so successful that in 1576 he was made
a member of the Faculty. He died on November 7, 1599, at the age of
fifty-three.

The Italian method of performing plastic operations, says von Gurlt,
had already flourished for about one hundred and fifty years before
Tagliacozzi took up the subject in serious earnest and attained results
of decided scientific value. There are some doubts, however, as to the
precise degree of credit that should be awarded Tagliacozzi for his
share in the development of the operation which bears his name. The
facts which throw some light upon this question may be stated in the
following paragraphs:--

   (1.) Tagliacozzi’s Latin is not easy to understand, and he
   certainly does not furnish satisfactory information as to the
   manner in which he learned the details of the operation which we
   are here considering. Vesalius, Paré and other surgical authors
   of that period throw no light upon that question and furnish
   erroneous descriptions of the steps of the operation. Apparently
   they had never witnessed one of that character. (Von Gurlt.)

   (2.) The records seem to warrant the statement that, about
   the middle of the fifteenth century a surgeon by the name of
   Branca, who lived in the city of Catania on the southeast coast
   of Sicily, devoted himself largely to the reconstruction of
   damaged or defective noses. At first he transplanted a flap from
   the forehead or cheek; but afterward his son sought to improve
   the method by utilizing a flap of skin taken from the arm. By
   this plan the disfiguring of the patient’s face was avoided.
   The son employed the same method in repairing the lips and the
   ears. Pupils of the latter carried a knowledge of the method to
   the Bojano (Vianea or Vieneo) family in Tropea, Calabria, and
   from them it was transmitted, about the middle of the sixteenth
   century, to Tagliacozzi and eventually to the medical profession
   in every part of the world.

   (3.) In 1581 there was published at Cracow, Galicia (formerly
   Poland), a book which bore the title “Przymiot” and which gave
   a most complete account of the disease syphilis in all its
   manifestations and complications. This book, in its original
   form, is to-day one of the greatest bibliographical rarities;
   but a reprint of the work was published in 1881 by the Warsaw
   Surgical Society. In this volume Wojciech Oczko, the personal
   physician and secretary of the Polish kings Stephan Bathory and
   Sigismund the Third, discusses other surgical topics beside
   syphilis. He states, for example, that Aranzio (or Arantius),
   who was Professor of Surgery at Bologna at the time (1569) when
   he frequented that medical school, was successful in making a
   new nose by transplanting a flap of skin from the patient’s
   arm; and that he performed this operation without injuring the
   muscles of the arm, and also with perfect success as regards
   the creation of a straight and shapely nose. “This statement,”
   says von Gurlt, “coming as it does from an eye-witness who was
   at Bologna several years before Tagliacozzi’s time, furnishes
   satisfactory proof that rhinoplasty was successfully performed
   in that city several years before the date of publication
   (1586) of Tagliacozzi’s earliest comments on the subject,
   and that the credit for first bringing the operation to the
   knowledge of European surgeons is due to Aranzio rather than
   to Tagliacozzi.” The latter’s famous treatise on rhinoplasty
   (“_De chirurgia curtorum per insitionem_”) was published at
   Venice in 1597.

  [Illustration: FIG. 21. THE MANNER IN WHICH THE SO-CALLED
  TAGLIACOTIAN OPERATION FOR REPAIRING A DEFECTIVE NOSE SHOULD BE
  CARRIED OUT.

  (From the treatise published by Tagliacozzi, Venice, 1597.)]

   (4.) Fabricius of Hilden, the distinguished German surgeon
   of the sixteenth century, assures us that his teacher, Jean
   Griffon, at that time the leading surgeon of Lausanne (but, at
   an earlier period, of Geneva), performed the same operation in
   1592. The patient was a young Genevese woman whose nose had been
   cut off by some soldiers belonging to the army of the Duke of
   Savoy who were enraged at the resistance which she offered to
   their familiarities; and the operation proved most successful,
   “the new nose eliciting the admiration of all who saw it.”
   Fabricius adds that during the winter seasons, up to the year
   1613, the tip of this nose presented a somewhat purplish hue.
   The woman married in 1603.

   (5.) During the short lifetime of Tagliacozzi several tablets,
   on which laudatory inscriptions were engraved, were erected in
   the high school (_archiginasio_) of Bologna, and after his
   death a bust that represented him holding a nose in his hand was
   erected in the same building. Corradi, the medical historian
   (1833–1892), writes that in his time both bust and tablets had
   disappeared. Tagliacozzi’s remains were temporarily lodged in
   the cloisters of the church of San Giovanni Battista, and the
   report was circulated that, a few weeks after his death, a
   voice was heard saying that he was among the damned. Thereupon
   the remains were removed to the walls of the city, and the
   Tagliacotian method was soon forgotten, to be revived only after
   the lapse of many years.

All the data which I have reproduced in the preceding paragraphs
seem to point to the conclusion suggested by von Gurlt, viz., that
Tagliacozzi was willing to accept for himself a credit which belonged
in reality to another, and that there would be more justice in calling
the famous rhinoplastic method of procedure “the Arantian operation”
than the Tagliacotian; especially as our knowledge of the method
adopted by the younger Branca is entirely too vague to justify us in
bestowing this honor upon him.

Giulio Cesare Aranzio (or Arantius) was born at Bologna about the year
1530. He studied medicine first in his native city, under the guidance
of his uncle, Bartolommeo Maggi, and then afterward went to Padua,
where he may possibly have been one of Vesalius’ pupils. In 1548 he
made, at Padua, his first anatomical discovery--that of the _musculus
levator palpebrae superioris_. Before he was twenty-seven years
old he was chosen Professor of Medicine, Surgery and Anatomy in the
University of Bologna, and he filled the position with distinction up
to the time of his death on April 7, 1589--_i.e._, during a period
of thirty-three years.

The part taken by Aranzio in the advancement of surgery was apparently
of small importance. He succeeded, it is true (see remarks on page
479), in reviving the interest of contemporary surgeons in the
possibility of restoring damaged parts of the human face by means
of flaps taken from the patient’s arm. But I have not been able
to discover that he made any other material contributions to this
department of the science of medicine. It is possible, however, that
his plan of illuminating the interior of the nose and of operating upon
nasal polypi may possess some measure of originality; but I do not
feel competent to decide this question. As regards the procedure just
referred to, it may be stated briefly that Aranzio was in the habit,
when operating within the nasal cavity, of using by preference, for
illuminating purposes, the direct rays of the sun, which were allowed
to enter the room through a slit or hole in the wooden window blind;
and, when sunlight was not available, he used as a source of light
the rays emanating from a lighted wax candle. In the latter case he
increased the brilliancy of the illumination by interposing between the
flame of the candle and the illuminated field, a glass globe filled
with water,--an idea which probably originated with the goldsmiths or
the shoemakers. The employment of light reflected from a concave mirror
supplanted this method somewhere about the year 1866.

In Italy, during the sixteenth century, there were several
surgeons--uneducated empirics--who contributed not a little to our
knowledge of the radical cure of hernia; and of this number the
members of the Norsa family (from Norsa, a small town in the district
of Naples) were undoubtedly the best known and most experienced
operators. Horazio Norsa, for example, is reputed to have performed the
radical operation (in combination with castration) no less than two
hundred times. It was this same Horazio Norsa who, in the latter part
of his career, complained to Fabricius ab Acquapendente that, since the
wearing of trusses had become so common a custom as it then was, the
number of operations for the cure of hernia had greatly diminished.




                            CHAPTER XXXVIII

THE DEVELOPMENT OF SURGERY IN SPAIN AND PORTUGAL DURING THE RENAISSANCE


According to the authority of Morejon, who published (1842–1852) an
elaborate history of medicine in Spain and Portugal, these countries
almost rivaled Italy, during the sixteenth century, in the number and
excellence of their physicians. But, so far as I am able to judge
from the record, very few of these men appear to have taken a strong
interest in surgery, and of these few there are only three--Daza
Chacon, Francisco Arceo and Amatus Lusitanus--who left behind them
treatises which seem to call for a brief notice.

Dionisio Daza Chacon, who was born in 1503 at Valladolid, about one
hundred miles north of Madrid, received his early training partly in
his native city and partly at the University of Salamanca. After being
engaged for some time in private practice he joined the imperial army
(Charles the Fifth) in the capacity of a field surgeon in charge of a
corps of three thousand men. In addition to these troops there were
six thousand English archers, in the pay of the Emperor. At the two
sieges in which these men participated--the siege of Landrecy in 1543
and that of Saint Dizier in 1544--Daza Chacon acquired an extensive
experience in the treatment of both arrow and gunshot wounds, for the
number of those injured on those occasions was very great. In 1545,
after he had been chosen personal physician of Charles the Fifth, he
returned home by way of Madrid, and distinguished himself greatly in
1547 by his self-sacrificing attendance upon the victims of the Plague
in his native city. In 1557 he offered himself as a candidate for the
position of Surgeon-in-Chief of the hospital at Valladolid, and, after
passing with great credit the competitive examination, he was given the
appointment. During the following six years he served that institution
with conspicuous ability, and then accepted the position of private
physician to Prince Don Carlos, the son of Philip the Second, King of
Spain. Four years later he entered the service of Don Juan of Austria
(the natural brother of Philip the Second), and accompanied this prince
on his sea voyages to various parts of the Mediterranean; being with
him, for example, on the occasion of the bloody sea fight in the Gulf
of Lepanto in 1571. On reaching the age of seventy, Daza Chacon retired
from active practice and devoted himself to the writing of his great
work on surgery--“_Practica y teorica de cirujia, en Romance y en
Latin_,” Valladolid, 1600; and several later editions. The date
of Chacon’s death is not known, but it certainly occurred before the
publication of his book.

Von Gurlt says that Chacon’s treatise is distinguished by the
systematic and clear manner in which the author treats the subjects
with which he deals, and it shows him to be well versed in the
teachings of other writers on surgery, that he is ready at all times
to give them full credit for any contributions which they may have
made to this branch of medicine, and that he is remarkably free from
the superstitiousness which was so prevalent in his day. Of all the
treatises on surgery which have been written by Spaniards, either
during the sixteenth century or at a more recent date, this work, says
von Gurlt, is unquestionably the best.

The edition of the treatise published at Madrid in 1626 contains 922
pages--a large work. Among the reports of cases published in Part II.,
there are several which possess features of considerable interest, but
I shall be able to reproduce only one of them here:--

   The young prince, Don Carlos, aged seventeen, while residing
   temporarily at Alcalá de Henares, plunged head foremost, in
   the dark, down a steep staircase and struck his head against a
   closed door. When the lad was picked up it was found that, at
   the back of his head, there was an open wound about the size of
   a man’s thumbnail, that the surrounding scalp showed evidences
   of being bruised, and that the pericranium in this region
   had been laid bare. During the first three days following the
   accident the patient manifested only a moderate degree of fever,
   but on the fourth day the fever became more pronounced. The
   wound, which by this time was discharging actively, presented at
   first a healthy appearance, but it soon acquired an unhealthy
   aspect, and the patient began to complain of numbness in the
   right leg. Vesalius, the private physician of Charles the Fifth,
   the boy’s grandfather, was one of the many physicians who were
   called in to consult about the treatment of this case; he was
   sent for on the eleventh day following the accident. On the
   seventeenth day the wound was enlarged and the bone carefully
   examined, but no evidence of a fracture or a fissure was
   discovered. On the following day erysipelas manifested itself on
   the head and neck and extended downward until it had involved
   both arms. At the same time the fever increased very markedly,
   and for five days the patient was delirious. As by this time
   there was ample reason for suspecting that some intracranial
   injury had occurred, it was decided to trephine the skull. The
   operation was performed on the twenty-first day, but nothing of
   importance was discovered. The patient’s life was now evidently
   in great peril, and an unfavorable prognosis was pronounced.
   Four days later, however, complete consciousness returned.
   On the twenty-ninth day a quantity of pus was evacuated from
   the very much swollen eyelids; and, three days later still,
   the patient was found to be quite free from fever. On the
   forty-sixth day he left his bed for the first time, and at the
   end of ninety-three days the wound was found to have firmly
   cicatrized.

   [Some interesting details concerning the subsequent life of Don
   Carlos will be found in Motley’s “Rise of the Dutch Republic.”
   They suggest the possibility that his attacks of violent temper
   may have resulted from the lesions produced by the accident
   narrated above.]

Francisco Arceo was born, about the year 1493, at Fregenal in the
Province of Badajoz, Spain. It is not known at what university or other
educational institution he received his early training in the science
of medicine. It is a well-established fact, however, that at quite an
early stage of his professional career he acquired great celebrity for
his skill in treating both surgical and internal maladies, and that,
as a consequence, patients flocked in large numbers from all parts of
Spain to consult him. Rather late in life he wrote two treatises--one
on the treatment of wounds, as well as on ulcers and syphilis, and
another on the management of fevers. These two works were published at
Antwerp, in the year 1574, as a single volume, the author being at that
time, despite his advanced age (eighty), still in vigorous health and
able to practice with skill both branches of the science of medicine.
In 1658 a second edition of Arceo’s two treatises was published
at Amsterdam; and even at an earlier date there were published an
English translation (1588) and a German version (1614). A perusal of
the chapter which he devotes to the treatment of clubfoot gives the
impression that Arceo was an excellent surgeon--eminently practical
in his choice of means for securing certain results, and thoroughly
familiar with the extent to which he might depend upon the powers of
Nature to aid his efforts. The date of his death is not known.

Amatus Lusitanus is the name by which the Portuguese medical writer,
Juan Rodriguez de Castel Bianco, is commonly known. He was born in the
Province of Beira, Portugal, in 1511, of Jewish parents, and studied
medicine at the University of Salamanca. After doing duty as a surgeon
in two of the hospitals of that city, he took up his residence, for
short periods of time, first in Antwerp and then in Ragusa, Dalmatia,
on the eastern coast of the Adriatic. At this period of our history
the Inquisition was extremely active throughout the domains that were
under the rule of Charles the Fifth, and as a result Amatus soon
found himself obliged to abandon all his books, instruments, etc.,
and flee for his life to Northern Greece. As the Turks, who were in
possession of that country, were perfectly indifferent with regard to
the religious beliefs of the Jews, Amatus was allowed to settle down
quietly for the rest of his life at Thessalonica, in Macedonia.

During the later years of his career he published several books on
topics relating to the science of medicine--two of them on materia
medica and two on the cases of special interest which had come under
his personal observation during the course of his practice. The
latter work, which is entitled “_Curationum medicinalium centuriae
VII._,”[87] was printed in its entirety in Venice, in 1556 (2
vols.). Von Gurlt speaks of Amatus as a cultivated scholar and an
excellent observer. Of the seven hundred cases reported in this work
only a very few are of interest to the surgeon. Von Gurlt calls
attention to the fact that, during the earlier years of his practice,
Amatus devoted a fair share of his attention to surgery, but that
subsequently he performed no operations whatever; it being his rule to
intrust this work entirely to a regular surgeon or to a specialist.

In my search among the dozen or more histories of cases selected by
von Gurlt from the seven “Centuries” (700) of the complete treatise
as suitably illustrating Amatus’ manner of reporting the cases which
he had seen in practice, the various methods of treatment which he
adopted in his efforts to relieve the diseases or injuries that came
under his observation, and the demeanor of the man in the presence of
the ever-changing problems presented to the physician, I have succeeded
in finding only four that seem to furnish in even a slight degree the
information which I have just outlined. Unsatisfactory as these four
reports are in certain respects,--especially in their failure to reveal
to us the more strictly surgical capabilities of Amatus,--they at least
show that he was an able and conscientious practitioner, and to this
extent they possess value.

   The first case reported in Century I. is that of a peasant girl,
   aged thirteen, who, while walking barefooted in a field was
   bitten by a viper. Amatus did not see the patient until three
   hours later, but already at this early stage he observed many
   blue and red patches, scattered over the leg and thigh of the
   side on which the bite had been inflicted. Near the base of
   the foot there were two quite black spots corresponding to the
   bites of the reptile; and from the fact that there were only two
   such spots Amatus inferred that the snake must have been a male
   viper, which has only two poison fangs and is therefore less
   dangerous than the female which has four. The symptoms which
   the girl experienced were faintness, trembling and dizziness.
   As regards the treatment adopted, the skin in the immediate
   neighborhood of the bites was scarified and suction by the means
   of cupping glasses was employed; afterward a plaster, which was
   composed in part of theriaca, was applied to this region. The
   patient made a complete recovery.

   In Century V., Amatus gives an account of a fatal case of ear
   disease. The patient, a sickly-looking boy of eight who had
   been affected for a long time with a discharge from one ear,
   presented a non-sensitive lump on the side of the head. “As he
   began to show signs of feverishness it was decided to incise the
   lump; and when the incision had been made, it was found that a
   large part of the skull in this region had been destroyed by
   caries, as a result of which there was left a cavity in the side
   of the head, and this cavity was filled with a foul-smelling
   pus, débris, and granulation tissue that apparently rested on
   the dura mater. Three days later the surgeon[88] succeeded in
   removing from the cavity only a small quantity of the sanious
   material. On the fourth day, after an attack of convulsions, the
   patient died.”

   In Century VII. there is given an account of a man of the
   wealthy class who had been exposed to an excessive degree of
   cold for so long a time that he was literally almost half
   frozen. “As he was being carried into the village he gave orders
   that an ox should be slaughtered and that he himself should be
   snugly stowed away inside the carcass of the animal as soon
   as its interior furnishings had been removed. Thus he escaped
   freezing to death.”

   In the same century Amatus speaks of having seen a rather
   interesting case of _Filaria Medinensis_ (called by the
   Arabs “_vena medena_”) in a negro boy, eighteen years old,
   who had come to Thessalonica from Memphis, Egypt. “The worm
   had caused the production of an ulcer close to the boy’s heel,
   and in this the creature’s head, which looked very much like a
   vein, was recognizable. After the Turks had correctly diagnosed
   the nature of the trouble an Arabian physician, who had managed
   to secure a purchase on the worm, began rolling it up on a
   small stick. Gradually, after the lapse of several days, he
   succeeded in uncoiling the animal in its entire length (three
   cubits), as shown by the construction of the end of the tail,
   and thus permanently freed the boy from his trouble. The ancient
   authors express doubts as to the true nature of the object found
   in these ulcers, but I, Amatus, having examined the slender
   white creature and having witnessed its curved outlines as it
   projected itself outside the opening, do vouch for the fact that
   it possesses all the characteristics of a true worm.”




                             CHAPTER XXXIX

 THE DEVELOPMENT OF SURGERY IN FRANCE DURING THE RENAISSANCE.--PIERRE
                                FRANCO


Von Gurlt speaks of Pierre Franco as “one of the most skilful surgeons
and at the same time one of the most original medical writers of the
sixteenth century.” He and his contemporary, Ambroise Paré, were
of French birth, and to France therefore belongs the conspicuous
distinction of having contributed to medical science during the
Renaissance two of its most illuminating and efficient laborers. These
men, who were the leading operative surgeons in France during the
first half of the sixteenth century, did not owe their education as
physicians to the official training provided by the Medical Faculty,
but partly to the men who were classed as barbers and surgeons, or
barber-surgeons (_Collège de St. Côme_), and still more to
their own efforts. They gathered practical knowledge wherever they
might--largely from their official connection with armies during the
progress of different wars. Further details with regard to their
personal characters and the principal events of their professional
careers will be furnished in the following brief sketches.

_Pierre Franco._--Pierre Franco was born in the village of
Turriers, in Provence (now the Department of Basses-Alpes), about
the year 1500. He received his instruction in surgery from itinerant
lithotomists, operators for cataract, hernia-healers and men of
that class; and it is quite likely that, in the early days of his
professional career in Provence, he was himself a practitioner of this
humble type. At a somewhat later date he left the southern part of
France and took up his residence in Switzerland, first at Berne and
then at Lausanne. He probably left Provence because, in the early
part of the sixteenth century, the Protestants of that region were
being subjected to every form of persecution; and it is almost certain
that Franco belonged then to the Reformed Church, for he accepted the
salaried office of City Surgeon at Berne, the authorities of which city
were bitterly opposed to everybody and everything connected with the
Roman Catholic Church. Franco held the office named during a period
of ten years, the first part of the time at Berne, and afterward at
Lausanne, which latter city was then under the control of the Bernese
Government. He was a very close observer, a most enthusiastic student
of his art, and a man of intensely religious nature. Malgaigne, the
distinguished editor of the modern edition of Paré’s writings, speaks
thus of Franco: “I have no intention of writing here the history of
this man who was endowed with such a fine surgical genius; I may say,
however, that his was a life devoted entirely to the advancement of
surgery as a science.”

As an operative surgeon, says Edouard Nicaise, Franco ranked higher
than any of his contemporaries. Strange as it may appear, Ambroise Paré
frequently refused to take charge of cases in which an operation for
stone in the bladder, for hernia, or for cataract was required, whereas
Franco owed much of his reputation to the success which he had in
operating upon these three classes of cases. The latter, furthermore,
did most of his work on patients who belonged to the middle class, and
consequently his operations were characterized by very little of the
éclat which marked a large part of the work done by Paré, who from the
very beginning was befriended by Royalty and the Court circle. At the
same time, says Nicaise, Franco did more than any other man of that
period to enrich surgery with new discoveries.

Franco has written only two treatises. The first one, which was
published in Lyons, France, in 1556, bears the title: “A Small
Treatise on the Operative Treatment of Hernia”--one of the most
important departments of surgery (a book of 144 pages, 8vo). The second
work, which was issued in 1561, also at Lyons but by a different
publisher, bears the title: “_Traité des hernies contenant une
ample déclaration de toutes leurs espèces, etc._” (a book of 554
pages, 8vo). This work goes very thoroughly into the subject of hernia
in all its bearings, and also deals with several other important
surgical topics, such as genito-urinary diseases (in both the male
and the female), affections of the eyes, hare-lip, tumors, wounds in
general, dislocations, fractures, amputations, etc.; in short, it is
a fairly complete and decidedly original treatise on general surgery.
When Franco wrote the smaller work (that of 1556), he was settled at
Lausanne; but in 1561 he was living in Orange, which at that time was
the capital of a Principality that belonged to the House of Nassau.[89]
A few brief citations from the larger of the two treatises will suffice
to give our readers some idea of the manner in which Franco deals with
the subject-matter of the book.

Franco, says von Gurlt, was one of the first surgeons--perhaps the
very first--to perform the operation required for the relief of
strangulated hernia and at the same time to furnish a description of
the manner in which it should be performed. After mentioning the fact
that the strangulation of a portion of the intestine is attended with
considerable danger to the patient’s life, Franco proceeds to consider
the subject in greater detail:--

   Owing to the large amount of the fecal matter and gas contained
   within the portion of the intestine that is imprisoned in
   the scrotum, and also owing to the inflamed condition of
   the parts, it is frequently not possible to push the bowel
   back through the narrow aperture in the peritoneum; and this
   condition of things is apt to be aggravated by the constipation
   or by the efforts at vomiting that frequently accompany such
   strangulation. The vomiting, it is true, may in certain cases
   facilitate the desired reduction, but in others it does harm,
   especially by forcing more fecal matter into the scrotum. If
   the conditions described are permitted to continue unrelieved,
   death may certainly be expected to result. In a few cases the
   timely administration of medicine internally may overcome the
   difficulty, but, if this measure fail to produce the desired
   result, recourse must be had to surgery--not, however, if
   already the scrotum and neighboring genital parts have changed
   their color to a black, livid, bluish or some other unnatural
   hue, or if the hernial tumor manifest a round rather than an
   elongated shape, for all these signs are harbingers of death;
   and, as further unfavorable signs, should be reckoned a livid
   or black mucous membrane of the patient’s mouth, contracted
   nostrils, and an appreciably sunken condition of the eyes. But
   if, on the other hand, the scrotum possess a natural color and
   if it have not a spherical form but rather an oval shape, then
   it is proper, after a failure to secure the desired reduction by
   the internal use of medicine, to resort to a surgical operation.

   For the proper performance of this operation the surgeon
   should be provided with a nicely rounded metal staff, flat on
   one side, and a little larger than a goose’s quill. [Paré’s
   grooved sound or director, says von Gurlt, had not yet at that
   time been invented, and this staff was intended to serve, in
   a crude fashion, the same purpose.] The first step is to make
   an incision in the upper part of the scrotum, the direction in
   which it is to be carried being toward the symphysis pubis. When
   the hernial sac is reached the staff is introduced into the slit
   and pushed upward between the wall of the sac and the fleshy
   part of the penis, the flat side of the instrument being kept
   uppermost, as it is upon this surface that the cutting with the
   scalpel or the razor is to be done. After the end of the staff
   has been pushed well upward the flesh of the scrotum is to be
   divided upon the flat surface of this instrument; all danger
   of injuring the intestine being thus avoided. Then the attempt
   should cautiously be made to reduce or replace the intestinal
   folds. But if these efforts fail,--owing to the excessive
   distension of the bowel or because the constricting band has
   not yet been sufficiently relaxed,--then the following steps
   should be taken:--Grasp the spermatic cord (“_didymis_”),
   lift up its enveloping membranes one by one with hooks, and
   divide each one of them completely upon one’s finger nail, up
   to the point where the intestine is encountered. Then, having
   established, between the intestinal wall and the membranous
   coverings of the cord, an aperture large enough to admit the end
   of the metal staff, push the instrument onward and upward while
   at the same time it is held as it were balanced in the air, so
   that early warning may be communicated to the holding fingers in
   case the instrument, as it travels onward, should become caught
   in the folds of the intestine--an accident, however, which the
   slippery nature of the outer surface of the intestine renders
   improbable, but which nevertheless may occur if at any point
   there happen to be a break in the continuity of the tissues. As
   the next step in the operation the cord should be completely
   divided high up (the incision being made upon the staff) close
   to the opening in the peritoneum through which the folds of the
   intestine forced their way, in the first instance, into the
   scrotum; but the surgeon must, without fear of doing harm, and
   remembering that he is dealing with conditions of a desperate
   nature, see to it that the opening made in the peritoneum is
   amply large. Finally, with the aid of a soft piece of linen
   he should return the folds of the intestine to the peritoneal
   cavity, etc. [The remaining portions of the description are of
   minor importance and may well be omitted here.]

Franco, speaking of those cases in which a portion of the omentum is
found projecting into the hernial sac, lays great stress upon the
importance of “not doing what many a surgeon has done in the past
and what not a few are still doing in our time, viz., simply cutting
off the imprisoned distal portion of this membrane and returning
the remainder to the peritoneal cavity without first ligating the
divided blood-vessels and then cauterizing the cut surface; the
danger being that a failure to take these steps frequently leads to
a fatal hemorrhage into the peritoneal cavity--an occurrence which
actually happened to one of our most experienced surgeons in a case of
enterepiplocele.”

There were certain operative procedures in which Franco took a greater
interest than in others. Thus, for example, he was particularly fond of
operating for the relief of cataract, and the results which he obtained
were exceptionally favorable (180 cures out of a total of 200 cases
subjected to operation). Von Gurlt quotes him as saying:--

   If I had to choose between operations for the cure of cataract
   and abandoning all the rest of my surgical practice, I should
   prefer to adopt the latter course, so highly do I estimate the
   amount of good which I can do in this line of work, so very
   important does it appear to me, and so small is the amount of
   labor and worry which it entails.

Franco was also greatly interested in the cure of stone in the bladder,
and it was while treating cases of this character that he invented the
very important surgical procedure known in France as the “Franconian
operation for stone in the bladder” (hypogastric cystotomy, suprapubic
lithotomy). Here is the account which he gives of the circumstances
under which he was led to devise this method of removing a stone from
the bladder:--

   I will mention here an experience which I had on one occasion
   when I tried to remove a calculus from the bladder of a boy
   about ten years of age. The stone was about as large as a
   hen’s egg and resisted all my efforts to extract it by way of
   the incision made in the perinaeum. Being in a quandary as to
   how I should proceed next, and the parents and friends being
   greatly demoralized by the suffering to which I was unavoidably
   subjecting their child,--they maintained, I should add, that
   they would rather have him die than be subjected to such awful
   suffering;--and being influenced also by the thought that I
   could not afford to have it charged against me that I was not
   able to extract the calculus, I deliberately decided that I
   would make an opening above the pubic bone, and would remove
   the stone in this manner. Accordingly I incised the skin above
   the pubes, a little to one side of the base of the penis, and
   carried the knife through the soft tissues down to the calculus,
   which I had simultaneously pushed upward by pressing the fingers
   of my left hand against the perinaeum, while at the same time
   my assistant made counter-pressure against the stone by firmly
   compressing the abdominal wall above the object. This method of
   extraction proved successful.

   In due time the wounds healed firmly and the patient was
   relieved of his trouble, but only after a long and most serious
   illness.

Franco does not appear to have performed the suprapubic operation
for the extraction of a cystic calculus more than once (the case
just narrated), and he carefully refrains from recommending it to
other physicians. Most surgical authors, says Edouard Nicaise, blame
Franco very strongly for not having dared to recommend his suprapubic
operation. “But I do not agree with this judgment; Franco should rather
be praised for his prudence in not immediately announcing to the world
his invention of an important surgical operation.”[90]

The subsequent history of suprapubic lithotomy shows that Franco was
laboring under an exaggerated idea of the dangers attending this
operation. The comments of Pascal Baseilhac--a nephew of “Brother
Cosmas” (the famous French lithotomist of the early part of the
eighteenth century) and himself a skilled lithotomist--are worthy
of being repeated here. He says (p. 318 of his “_Traité sur la
lithotomie_,” Paris, 1804): “Franco based his unwillingness to
recommend the operation of suprapubic lithotomy on the belief which
was then widely prevalent, and which still persists even in our time
(middle of the eighteenth century), that the making of an incision into
the main body of the urinary bladder is sure to prove fatal, a belief
which experience and observation have now shown to be unwarranted.”

The Franconian operation, the great value of which was not sufficiently
appreciated by its inventor nor by contemporary surgeons, was revived
in 1719 by an Englishman, John Douglas, the distinguished surgeon of
Westminster Hospital, London, and the brother of James Douglas--the
anatomist who in 1730 described so minutely the relations of the
peritonaeum to the bladder (Douglas’ cul-de-sac).

In the case the history of which has just been narrated, the
circumstances attending the invention of the operation known to-day as
suprapubic cystotomy[91] or “suprapubic lithotomy,” were certainly of
such an unfavorable character as to call for the display of an unusual
degree of courage, wisdom, patience and manual skill on the part of
the surgeon in charge; and it was through a careful consideration of
these facts that Edouard Nicaise was led to award such high praise to
Franco for the work which he had done. Scarcely less remarkable is
the talent which the latter displayed in the invention of a forceps
(Fig. 22) strong enough to crush all but the hardest calculi and
yet so cleverly planned that it is practicable, while the crushing
end of the instrument is lying inside the bladder, to separate the
blades sufficiently far apart to render possible the grasping of the
stone between the jaws of the instrument without at the same moment
injuriously crushing the soft parts in the narrow channel of the wound
or opening.[92]

  [Illustration: FIG. 22. PIERRE FRANCO’S FORCEPS FOR CRUSHING CALCULI
  IN THE URINARY BLADDER.

  (From Edouard Nicaise’s _Pierre Franco_, Paris, 1895.)

  _a_, closed; _b_, open.]

In Franco’s day the belief was widely prevalent that there were
remedies which possessed the power of dissolving a cystic calculus.
His own opinion in regard to this matter is expressed in the following
words: “I am astonished that there should be many men who do not
hesitate to undertake the disintegration and pulverization of a stone
in the bladder by the employment of remedies which are either to be
administered by the mouth or to be injected _per urethram_ into
that organ.” He adds that a remedy strong enough to dissolve even the
softer stones would become so changed and weakened in passing through
the various organs which it must traverse on its journey from the
mouth to the bladder that it could not possibly produce the desired
effect; nor could a chemical solution strong enough to dissolve such
a calculus be injected into the bladder by way of the urethra without
either causing inflammation and ulceration of the walls of that organ
or promptly exciting muscular contraction that would effectively expel
the solution.

This seems to be an appropriate place in which to state that lithotrity
was practiced at an earlier date by Antonio Beniveni (1440–1502), a
Florentine physician whose writings reveal him to have been a man of
a very practical and unprejudiced type of mind, a very clear writer,
and a practitioner of wide experience. He also deserves credit for
having been the first surgeon to revive the operation of tracheotomy, a
procedure which was carried out by Antyllus fourteen centuries earlier,
but which appears to have been forgotten during this long interval. He
saved a patient’s life by means of the operation.

The date of Franco’s death is not known.




                              CHAPTER XL

   THE DEVELOPMENT OF SURGERY IN FRANCE (Continued).--AMBROISE PARÉ


Ambroise Paré was born, about the year 1517, at Laval, a small town in
the Department of Mayenne, France. His father was probably the valet
and barber of the Count of Laval. He went to Paris in early manhood
and spent three years, at this period, in fitting himself for the
career of a surgeon. He attended lectures on anatomy and surgery, did a
certain amount of dissecting, served for over two years as a surgeon’s
assistant in the great hospital of Hôtel-Dieu, made notes of some of
the cases which he saw, and was occasionally permitted to prescribe
for patients and even to perform some minor operations. From 1536
onward, nearly up to the time of his death, he was almost continuously
engaged, in the capacity of a surgeon, in accompanying different
French armies on their military expeditions. His professional title
at first was that of “barber,” but he doubtless very soon discovered
that, if he wished to advance, it would be absolutely necessary for
him to secure a higher title. Accordingly, in 1541, he and his friend
Thierry de Héry presented themselves for, and passed successfully,
the required examination and were accepted as “master-barbers.” It is
an interesting fact that, during his long professional career, Paré
was Chief Surgeon to four Kings of France in succession--first to
Henry the Second (1547–1559), next to Francis the Second (1559–1560),
then to Charles the Ninth (1560–1574), and finally to Henry the Third
(1574–1589). The last-named King bestowed upon him the additional
honor of “Councilor to his Majesty.” He also served, during a certain
period of his career, as an attending surgeon at Hôtel-Dieu. The three
large volumes of Paré’s writings (Malgaigne’s edition) are filled with
the rich experience which this great surgeon gained in the course
of a large private practice and in the field expeditions and sieges
conducted during the reigns of these Kings. Interspersed among the
reports of cases and descriptions of operations are to be found not a
few comments of a more general character and some biographic details
which add greatly to the charm of the work as a whole, and which at
the same time make it possible to form a general idea of Paré’s traits
of character. On almost every page one finds statements which reveal
the fact that he weighed almost all the duties of his daily life in a
profoundly religious manner. He showed himself warmly sympathetic for
all those whose ailments he was called upon to treat, and he was always
as ready to bestow his best services upon the Roman Catholics as upon
the Huguenots--to which latter denomination (if we may so call it) he
himself is commonly reported to have belonged. It seems to me more
probable, however, that he was a liberal-minded Roman Catholic rather
than a Protestant, for there is trustworthy evidence showing that all
his ten children were baptized in that faith and that he himself,
nineteen years before the night of Saint Bartholomew (August 24, 1572),
held the office of “_Pathe_” in the church of the parish in which
he lived. Another prominent trait of Paré’s character was the modest
estimate which he placed upon his own professional achievements. One of
his sayings, which occurs a number of times in his writings and which
has since become famous, is this:--

    _Je le pansay, et Dieu le guarist._
    [I dressed his wound and God caused it to heal.]

Some of the other sayings attributed to his pen and printed under
the heading “Surgical Canons and Rules,” at the end of Book XXVI.,
are characterized by a homely type of wisdom which seems to have
secured for them a permanent place in French literature. I give here
in the form of English translations six or seven of the more striking
specimens:--

   Mere knowledge without experience does not give the surgeon much
   self-confidence.

   Small will be the influence exerted by him who chooses surgery
   as a career simply for what he may make out of it.

   The frequent changing of physicians is not likely to bring
   comfort to the patient.

   The facts already discovered are few in comparison with those
   which are yet to be brought to light. We must not allow
   ourselves to lie down or fall asleep under the impression
   that the ancients knew all or have divulged all that is worth
   knowing. What they have accomplished should be utilized by us as
   a sort of scaffolding from which a more extensive view may be
   obtained.

In another place Paré expresses the same sentiment in a somewhat
different form, as follows:--

   My professional brethren must not expect to find any new and
   startling facts [Paré is speaking here of his treatise on
   surgery], but simply here and there some little addition to
   our previous stock of knowledge; for the good Guy de Chauliac
   has taught us that we are like the child who sits astride the
   giant’s neck; that is, we can see all that he sees and just a
   little more--or, in other words, we are able, through the aid
   afforded by the writings of our predecessors, to learn all that
   they have learned, and may at the same time acquire a little
   further knowledge through our own observations.

   A remedy that has been thoroughly tested is better than one
   recently invented.

   An injury which opens a large blood-vessel is likely to lead the
   victim of such a wound to the tomb.

   It is always wise to hold out hope to the patient, even if the
   symptoms point strongly to a fatal issue.

All through his professional career, but more especially during the
later years, Paré was repeatedly annoyed by the efforts which the
Medical Faculty made to bring him into disrepute. These men were
bitterly jealous of him on account of the great favor which he enjoyed
at Court, and so they adopted every possible means to injure his
reputation. When the complete collection of his writings was published
in 1575, they petitioned the authorities not to allow these “works of
a very impudent and ignorant man” to be sold until they should have
received the official sanction of the Faculty. One of Paré’s chief
offenses, as it appears, was that of not writing his treatises in
Latin, and among the twenty-nine specifications of his shortcomings was
that of plagiarism. (See remarks on this subject further on.)

In his efforts to extend his knowledge of the science of medicine, and
in particular to learn what the ancients had written on the subject,
Paré soon discovered that many obstacles stood in his way. He did not
allow himself, however, to be discouraged by this fact, but set to
work, without delay and in his usual resolute fashion, to remove them.
He found, in the first place, that all the available treatises of the
ancient medical authors were written in Latin, a language of which he
possessed scarcely any knowledge. So he was obliged to hire men to
translate for his own use large portions of these books. Then, at a
later date, after he had begun to accumulate notes for the treatises
in which he proposed to publish his own experiences and his own views
about the surgical topics in which he was interested, he saw clearly
that suitable pictorial illustrations would add materially to the
value of the written text, and he therefore did not hesitate to spend
a considerable sum of money--Malgaigne says three thousand livres--in
having the needed drawings made. Paré was also in no small degree
a public benefactor, for he purchased the formulae of some of the
more valuable of the remedies employed by the leading charlatans, in
order that he might print them and so place them within the reach of
everybody.

Paré gives the following picturesque account of his first experiences
as an army surgeon in actual warfare:--

   In 1536, he says, I accompanied the large army sent to Turin by
   Francis the First, King of France, to retake certain castles and
   fortifications which were held at that time by the troops of
   the Emperor Charles the Fifth. My official position was that of
   surgeon to the foot soldiers; and when our men took possession
   of Susa, after the enemy had been defeated, I was among the
   first to enter the city. Our horses rode rough-shod over the
   dead bodies lying on the roadway, and over the bodies of many
   who were simply wounded. It excited my compassion strongly
   to hear the cries of those who were thus subjected to great
   additional suffering, and I could not help wishing that I had
   never left Paris. Once actually in the city, I began to look
   around for a stable in which the horses of myself and my orderly
   might find shelter. The one I entered contained the corpses of
   four soldiers who had presumably died there, and three badly
   wounded men who were still alive, but whose faces were greatly
   disfigured by the wounds which they had received, and who--as we
   soon learned--were unable to see, hear or speak. An old soldier
   who entered the stable at that moment, and whose pity was
   excited by what he saw, asked me if it would be possible to save
   the lives of the men who were so badly injured. I replied “No.”
   He thereupon proceeded, without the least excitement and with
   due gentleness, to cut the throats of all three. At the sight of
   this act, of what seemed to me to be great cruelty, I exclaimed,
   “You are a wicked man!” His reply was: “I pray God that, if it
   should ever be my fate to be situated as these three men were
   when I entered the stable, there may be somebody at hand who
   will do to me what I have just done to these men, and will save
   me from a lingering and painful death.”

   When the fighting was entirely over, we surgeons had much work
   to do. I had not yet had any personal experience with the
   treatment of gunshot wounds, but I had read in Giovanni da
   Vigo’s work that such injuries should be considered poisoned
   wounds, by reason of their contact with gunpowder, and that the
   correct way of treating such wounds was to cauterize them with
   oil of sambucus (elder flowers) that was actually boiling and
   to which a little theriaca had been added. At first I hesitated
   somewhat about carrying out this practice, but after watching
   the other surgeons, in order to learn exactly how they applied
   the boiling oil, I plucked up my courage and did exactly what
   they did. My supply of oil, however, soon gave out, and I then
   decided to use as a substitute a healing preparation composed of
   yolk of egg, oil of roses, and turpentine. I slept badly that
   night, as I greatly feared that, when I came to examine the
   wounded on the following morning, I should find that those whose
   wounds I had failed to treat with boiling oil had died from
   poisoning. I arose at a very early hour, and was much surprised
   to discover that the wounds to which I had applied the egg and
   turpentine mixture were doing well; they were quite free from
   swelling and from all evidence of inflammatory action; and the
   patients themselves, who showed no signs of feverishness, said
   that they had experienced little or no pain and had slept quite
   well.

   On the other hand the men to whose wounds I had applied the
   boiling oil said that they had experienced during the night, and
   were still suffering from, much pain at the seat of the injury;
   and I found that they were feverish and that their wounds were
   inflamed and swollen. After thinking the matter over carefully,
   I made up my mind that thenceforward I should abstain wholly
   from the painful practice of treating gunshot wounds with
   boiling oil.

In 1545, when he was about twenty-eight years of age, Paré was sent as
a military surgeon to Boulogne-sur-Mer, which at that moment was being
besieged by the French. In 1544 the city had been captured by the army
of Henry the Eighth of England, and fighting of a desultory character
was in progress between the besiegers and the besieged at the time of
Paré’s arrival. He had not been there a long time when he was asked to
see professionally Francis of Lorraine, Duke of Guise, who had been
seriously wounded by a lance in a recent encounter with the enemy. The
metal head of the weapon, under the impulse of a glancing blow, had
penetrated the skin just above the right eye, had then traveled toward
the left side and in a slightly downward direction, along the surface
of the skull, and had finally come to rest at a point behind and below
the left ear, near the nape of the neck. When the lance had penetrated
thus far the wooden shaft broke in two, leaving the metal head in its
entirety and a part of the shaft so firmly lodged in the wound that
great force had to be employed before it was found possible, with the
aid of strong pincers, to extract it from its bed. An examination of
the injured parts then showed that there had been some fracturing of
the bony structures and extensive laceration of the arteries, veins,
nerves, etc., but that the left eye had apparently not been seriously
damaged. The onlookers were naturally impressed with the belief that
the Duke could not possibly recover from such a slashing of the face
and head; and Paré himself was careful at first not to commit himself
to a prognosis of too favorable a nature. However, he treated the
wound with the greatest care and in the course of a few weeks had the
satisfaction of seeing his patient restored to perfect health, but with
a deeply scarred face.

As can readily be imagined, this experience proved a splendid triumph
for Paré, and speedily brought him into great favor at Court and among
the nobility throughout France.

For several years subsequent to these events, Paré continued to serve
actively as a surgeon in the frequent wars which took place between
the royal troops of France and the armies of other European monarchs.
In 1552, when he was thirty-five years of age, his rank in the army
was raised to that of “Surgeon to the King,” the entire medical staff
of that period consisting of twelve surgeons of this rank. In 1554 he
was admitted to the _Collège de Saint Côme_ in Paris, the highest
professional honor to which a barber-surgeon might aspire; and in 1563,
after the siege of Rouen, he received the appointment of “First Surgeon
to Charles the Ninth.” After the latter’s death, Henry the Third also
appointed Paré to the same position in his Court. Thus, from almost the
very beginning of his professional career to the time of his death,
Paré was honored in every possible way by four successive Kings of
France. It was Charles the Ninth, however, who appears to have taken
a greater interest in Paré’s prosperity than did either of the other
three Kings. It was at Charles the Ninth’s request, for example, that
the brother-in-law of the Duke of Ascot, the Marquis of Auret, sent
for Paré to undertake the treatment of a wound which he had received
from a harquebus ball seven months previously. Paré gives the following
account of this interesting case which foreshadows--for example, in the
changing of the patient’s bed and linen and keeping him entertained
during convalescence--the best modern hospital nursing:--

   On arriving at the Chateau of Auret, writes Paré, which is
   located not far from Mons in Belgium, I learned that the
   harquebus ball had entered the thigh near the knee, had done
   considerable damage to the soft parts, and had fractured the
   femur. When I was ushered into his bedchamber, I found the
   Marquis very much emaciated, his eyes deeply sunken in their
   sockets, his skin hot and of a yellowish hue, and his voice
   feeble like that of man very near to death.... The leg was drawn
   up against the wall of the abdomen, and two large bedsores
   were visible posteriorly--one near the root of the spine and
   the other somewhat higher up. Thus it was impossible for the
   patient to assume any posture in which he would be free from
   suffering.... All things considered, it did not seem to me that
   the Marquis could possibly recover from such a combination of
   bodily ills. Nevertheless, to give him some encouragement,--for
   he was very low in spirits,--I told him that, with the aid of
   God and the assistance of his regular medical attendants, I
   would soon have him on his feet again....

   After dinner, in the presence of the Duke of Ascot, a few
   friends of the family, and the assembled physicians and
   surgeons, I expressed considerable surprise that free openings
   had not been made in the Marquis’s wounded thigh, in which bone
   caries and decomposition of the resulting discharge were already
   well established. The medical attendants replied that the
   patient was unwilling to submit to any such measures, and that
   he had even forbidden them to substitute clean linen bedclothes
   for those which were soiled and which had not been changed
   during the previous two months....

   When the consultation had come to an end and the local medical
   attendants had given their full approval of the different
   measures which I recommended, ... I proceeded to carry them out
   without further delay.

   Two or three hours after the completion of this operative work I
   instructed the house servants who were in immediate attendance
   upon the Marquis to place alongside his bed a second one
   equipped with a soft mattress, over which a fresh linen sheet,
   etc., had been spread. The transfer from one bed to the other
   was easily effected by a strong attendant, and when the change
   had been made the Marquis manifested great contentment. Two
   feather pillows were so placed under his back and loins that no
   pressure whatever would be made upon his bedsores. A refreshing
   sleep of four hours’ duration followed the adoption of these
   different measures, and there was much rejoicing in the entire
   household.

After a course of treatment lasting several weeks, Paré says:--

   Under this treatment the fever steadily diminished, the pain
   grew less and less, and the patient’s strength increased. When
   the proper moment arrived, I advised the Marquis to engage the
   services of some musicians (players on stringed instruments)
   and one or two comedians, in order that his spirits might be
   cheered by occasional entertainments of this character. Already
   at the end of one month we found it practicable to carry him
   in a chair into the garden and as far as the entrance gate,
   where he could watch the passers-by. When it became known among
   the peasants that he was in the habit of sitting close to the
   highway, they came from far and near to sing and dance in groups
   for his entertainment. He was greatly loved by both the common
   people and the nobility.

   At the end of six weeks the Marquis was able to get about on
   crutches, and two weeks later still I bade him good bye and
   returned to Paris. Before I left he presented me with a gift of
   great value, and the Duchess of Ascot insisted on my accepting
   a beautiful diamond ring as a mark of her appreciation of the
   services which I had rendered her brother.

Among the varied experiences which fell to the lot of Paré during
his association with Charles the Ninth, there is one which throws a
little additional light upon the man’s manner of promptly dealing with
an event which, without such promptness of action, might have led to
serious consequences.

He was passing through Montpellier one day in company with the King,
when he stopped for a few minutes at the shop of an apothecary for the
purpose of ascertaining how he preserved alive the vipers which he used
in compounding the remedy which is called “theriaca,” and which has
been used from time immemorial as an antidote to the poison of venomous
serpents. The apothecary placed before him a glass jar in which were
kept a number of these reptiles; and, when Paré took one of them up in
his fingers in order to obtain a better view of his fangs, the reptile
bit him near the tip of his index finger, between the nail and the
flesh. The pain which immediately followed was severe, partly, as Paré
explains, because the tip of the finger is a very sensitive part, and
probably also on account of the irritating effect of the venom. Then,
to quote Paré’s own words, “after making firm pressure upon the soft
parts above the wound, to prevent the poison from traveling upward, I
crowded the skin downward in the hope of forcing as much of the venom
as possible out of the finger. While doing these things I instructed
the apothecary’s assistant to mix some old theriaca with brandy, and
then to apply a pledget of cotton, saturated with the mixture, over
the wound. In the course of a few days, and with no other treatment,
all effects of the bite disappeared.”

In 1536, two years after his first experience with actual warfare in
the vicinity of Susa, Italy, and while he was still very young to
assume so great a responsibility, Paré--as we learn from the text of
Chapter 28, Book X., of Malgaigne’s edition--performed the operation
of exarticulation of the elbow-joint (the first recorded instance of
this operation, says von Gurlt). The case was that of a common soldier
who had been shot through the forearm, a little above the wrist, who
had been treated unsuccessfully by other surgeons, and who, at the
time when he came under Paré’s care, was suffering from a variety of
complications--viz., gangrene extending as high up as the shoulders,
extensive inflammation of the integuments on the adjacent side of
the thorax, and other symptoms that pointed toward a fatal issue. To
complicate matters, it was winter and the only approximately warm
shelter available was a cow-stable. At this early date, in the history
of surgery, the practice of ligating the blood-vessels which had been
divided in the course of an amputation had not yet been adopted, and
consequently the red-hot cautery had to be employed for arresting
the bleeding which followed the operation. (See also page 512.) In
addition to the amputation it was found necessary to make a number of
long and deep incisions into the inflamed tissues and to apply the
actual cautery freely “for the purpose of drying up and destroying
the virulent matters that had penetrated these parts.” Then, fourteen
days later, the patient, who had been lying all this time, exposed to
draughts of air, upon a receptacle intended for the storage of grain,
and who was protected from the cold by only the scantiest coverings,
developed trismus (lockjaw). When this new complication appeared Paré,
already at his wits’ end to find means with which to overcome the
difficulties which surrounded the case, decided first to have the man
removed to an adjacent stall in which there were several cows, the
presence of which in such a confined space might be counted upon to
increase appreciably the warmth of the surrounding air. Next, he gave
orders to rub briskly the back of the patient’s neck, as well as the
shoulders, the uninjured arm and the legs, with heated cloths which
were immediately afterward to be wrapped around him; and then, for
an outside covering, he utilized the straw and cows’ dung which were
plentifully within reach. In addition, two braziers which had been
procured from a neighboring dwelling, were charged with coals and kept
burning close to him. During three successive days and nights these
measures were kept up faithfully, and from time to time a mixture of
milk and soft egg was introduced into the patient’s mouth through a
suitable tube, after the jaws had first been pried open by a bit of
willow wood. The effect of these measures was to make the patient
perspire copiously and to induce a gentle action of the bowels; and,
as a further effect, the trismus was also overcome. For some time
afterward, in addition to the ordinary dressing of the healing wounds,
it was thought best to apply the red-hot cautery regularly at certain
intervals to the end of the bone of the upper arm. (This practice was
abandoned by Paré at a later date.) Final and perfect healing took
place after several large splinters of bone had been exfoliated.

At the end of his account of what one is tempted to call the wonderful
victory of a surgeon over the death that threatened to carry off this
gravely wounded soldier, Paré adds one of his characteristic appeals to
the oncoming younger generation of physicians:--

   Both God and Nature constantly remind the surgeon that, no
   matter how poor, in a given case, the prospect of a cure may
   seem, he should not for one moment cease doing his full duty;
   for Nature often accomplishes what the surgeon believes to be
   impossible. Cornelius Celsus [about the time of Jesus Christ]
   says: “_Contingunt in morbis monstra, sicut et in natura_.”
   [Marvels are observed in diseases, very much in the same manner
   as they are frequently encountered in nature.]

In the two preceding histories of actual cases treated,--one of these
patients being a wealthy officer of high rank and birth, and the other
a common soldier of the peasant class,--we obtain the best of evidence
that Paré was not influenced by the wealth, rank or social position of
his patients. Upon both classes he bestowed freely the fruits of his
knowledge, experience and skill.

The first mention, in medical literature, of a fracture through the
neck of the femur close to the joint, is to be found in Chapter 21,
Book XIII., of Paré’s treatise (page 753, Vol. II., of Malgaigne’s
edition). Furthermore, the first published account of a case of
diaphragmatic hernia is that given by Paré. (Von Gurlt.)

In 1538, during a visit to Turin in the capacity of surgeon to the
Mareschal de Montjean, Paré was asked by the latter to take charge of
one of his pages who had been wounded by a stone which struck him on
the right side of the head, causing a fracture of the parietal bone,
with escape of a portion of the brain substance from the external
wound. The subsequent history of this case is given by Paré in the
following words:--

   As soon as I fully realized the true nature of the injury and
   had examined the mass of tissue (about the size of a small nut)
   which had been expelled from the wound, I predicted that the
   patient would probably not recover. A young surgeon who happened
   to come into the room at this moment, examined the mass of
   tissue which had escaped from the wound and at once pronounced
   it to be fat. I assured him that, if he would wait until I had
   finished dressing the patient’s wound, I would prove to him that
   the mass was in reality cerebral tissue and not fat.... If this
   substance, I said, is fat, it will float on the water; but, if
   it is brain tissue, it will sink at once to the bottom of the
   dish. And, again, if it is fat it will promptly melt on exposure
   to heat, whereas brain substance will simply become desiccated.
   These tests were applied and it was shown that the tissue
   consisted, as I had declared, of brain substance.

   Notwithstanding the apparently serious damage which had been
   inflicted upon his brain the page made a good recovery, but
   remained permanently deaf in the right ear.

Among Paré’s numerous reports of cases there is one which possesses,
as I believe, sufficient interest--as well from the viewpoint of the
pathologist as from that of the surgeon--to justify me in reproducing
it, in a somewhat condensed form, in the present chapter.

Henry the Second, King of France, while tilting (June 30, 1559)
with Gabriel, Count of Montgomery, an officer of that sovereign’s
Scottish Lifeguard, received injuries which soon afterward proved
fatal. Montgomery’s lance--so Paré’s account states--struck the King’s
vizor and, breaking off at the spot where the metal tip or head is
attached to the wooden shaft, carried away this part of the helmet.
Then, impelled by the force which had originally been communicated
to the lance, the splintered end of its shaft struck the King’s now
unprotected head with great violence just above the right eyebrow,
tore up the skin and underlying muscular tissue of the forehead as
far as the outer angle of the left orbit, and finally destroyed the
adjacent eye. Five or six of the most experienced surgeons of France
were immediately summoned, and Philip the Second, King of Spain, sent
Vesalius from Brussels to aid them in their efforts to save the injured
King’s life. But all the measures adopted proved of no avail. Henry the
Second died on the eleventh day following the injury. Although in the
published account no statement is made to the effect that Paré was one
of the surgeons who attended the King during his illness, Malgaigne
expresses the opinion that he was probably present in the capacity of
a consultant; and the interesting comments which he (Paré) makes on
the nature and extent of the injury inflicted certainly justify this
opinion. No evidence of fracture of the skull was discovered either
before death or at the postmortem examination, and the most conspicuous
symptoms appear to have been fever and a comatose condition. At
the autopsy there was found, on the left side posteriorly, in the
occipital region, a clot of blood lying between the pia and the dura
mater. The brain substance in the immediate vicinity of the clot was
of a yellowish tinge and showed evidences of having already begun to
undergo decomposition. Paré’s diagnosis, in this case, was that of
violent concussion of the brain with rupture of meningeal vessels by
_contre-coup_ at a point opposite to that at which the blow
was originally inflicted by the lance. He did not believe that the
immediate damage done to the frontal portion of the cranium and to the
left eye had anything to do with the fatal issue.

  [Illustration: FIGS. 23 AND 24.

  FORCEPS DEVISED IN 1552 BY AMBROISE PARÉ FOR DRAWING OUT THE CUT
  ENDS OF ARTERIES AFTER THE AMPUTATION OF A LIMB, AND HOLDING
  THEM WHILE THE LIGATURE IS BEING APPLIED.

  (From von Gurlt’s _Geschichte der Chirurgie_, Berlin, 1898.)

  FIG. 23 represents the earlier; FIG. 24 the
  later pattern (see text.)]

One of the greatest discoveries made by Paré in the domain of surgery
is his method of promptly, effectively and safely arresting the
bleeding from the divided vessels of the stump after the amputation of
a limb. This discovery was made between the years 1552 and 1564, before
which period it had been customary to arrest the bleeding by applying
the red-hot cautery iron to the exposed ends of the divided vessels.
The new method consisted in tying a ligature (preferably doubled)
around the free or cut end of the blood-vessel, and allowing it to
remain undisturbed _in situ_ until, as the result of a localized
suppuration, it should be cast off. The accompanying cuts (Figs. 23 and
24) which have been copied from an earlier edition (1585) of Paré’s
work, represent the kind of forceps which he employed in separating
the free end of the artery or vein from the soft tissues in which it
was imbedded--a preliminary procedure which enabled him to tie the
ligature firmly around the vessel. The earlier pattern of forceps (Fig.
23) was not equipped with a spring, the purpose of which was to keep
the opposing blades separated, but the later pattern (Fig. 24) has
this useful addition. Another instrument which owes its origin to the
inventive genius of Paré is the grooved director--an instrument that
is of great value to the surgeon, particularly in operations for the
relief of strangulated hernia.

Besides the two inventions to which a brief reference has just been
made, Paré describes and pictures in his great treatise scores of
instruments and apparatus of all sorts, many of them doubtless products
of his own inventive genius. But to assign to these contrivances their
true value calls for a degree of expert knowledge which I do not
possess. Rather than to attempt any such appraisal, I prefer to furnish
here a summary of the more important of Paré’s achievements in surgery;
for such an enumeration--although it may prove to be in some measure
a recapitulation of things that have already been mentioned in the
preceding account--may be found useful for purposes of reference:--

   The discovery of improved methods of caring for the wounded
   on the battle-field and of transporting them to a hospital or
   other refuge; the introduction of better methods of treating
   wounds inflicted in warfare--especially gunshot wounds; the
   correction of the idea, universally accepted at the beginning
   of the sixteenth century, that bullets are sufficiently hot,
   upon penetration of the skin, to affect injuriously the wounds
   which they inflict;[93] the substitution of ligation of bleeding
   vessels (of an amputation stump) for the prevailing practice of
   applying to them the red-hot cautery iron; the abandonment of
   the practice of applying the heated cautery iron to the surface
   of section of a sawed bone; the performance, for the first
   time, of exarticulation of the elbow-joint; the demonstration
   of the usefulness of more frequently employing orthopaedic
   apparatus and prosthetic contrivances; and the introduction of
   improvements in the operation of trephining the skull.

It was a very common practice among the medical authors of the
sixteenth century--and, indeed, among authors generally--to utilize
the writings of their predecessors without giving them proper credit
for their work; and Paré, it appears, was not entirely free from this
fault. Von Gurlt mentions a few of the more glaring instances of such
sinning, and among them the following: Paré’s two chapters on tumors
are taken from the “_De institutione chirurgica_” of Jean Tagault
(Paris, 1543), who in turn is charged with having borrowed the data
from Guy de Chauliac’s treatise; in his chapter on wounds in general,
Paré has also borrowed largely from the same work; and the chapter
which he devotes to the subject of special wounds is taken from the
writings of Hippocrates; and, finally, he has transferred almost
bodily Philippe de Flesselle’s “_Introduction pour parvenir à la
vraie cognoissance de la chirurgie rationelle_.” Before we condemn
Paré for plagiarism, and although the facts as stated by von Gurlt are
undeniable, we should take several things into careful consideration.
It is fitting, for example, that we should make some sort of an
estimate of the value of the text thus appropriated, in order that we
may be able to measure the seriousness of Paré’s sinning; and, if we do
this, we cannot fail to be struck with its insignificance in comparison
with the admittedly valuable character of all the remaining text of
these three huge volumes--text which bears every mark of being the
product of Paré’s brain. Paré himself, in speaking of his borrowings
from other authors, says that his acts of this nature are “as harmless
as the lighting of one candle from the flame of another.” Then, again,
there are several of these borrowings which are evidently the handiwork
of a rather dull person, and this fact alone makes one bold to assert
that Paré, who was certainly not lacking in brains or in a desire
to follow the golden rule in his treatment of the property of such
writers, could scarcely have been guilty of such clumsily contrived
interpolations. Inasmuch, however, as many important facts bearing
upon the question at issue are not within my reach, I am obliged, in
my attempt to defend the memory of Paré, to fall back upon speculative
reasoning. The medical profession at large has long since heard this
charge of plagiarism and it refuses to attach any importance to it as
affecting the personal character of Paré. It prefers to believe that
he is guiltless and that somebody else--at a time, perhaps, when Paré,
being well advanced in years, was too ill to revise the manuscript of
the “Collection of his Writings” edited by Guillemeau--thoughtlessly
yielded to the impulse to remedy, by borrowing from other sources,
the trivial defects or omissions noted in the text. In any case,
whatever the actual truth may be, I am, I believe, justified in
maintaining that Paré is not rightly chargeable with the guilt of
plagiarism.

  [Illustration: FIG. 25. AMBROISE PARÉ, THE FAMOUS FRENCH SURGEON
  OF THE SIXTEENTH CENTURY.

  (From von Gurlt’s reproduction of the portrait published by Le
  Paulmier, Paris, 1885.)]

Strange as it might appear, if history did not furnish many examples
of the same character, Paré’s merits as a man and as a surgeon were
not as fully appreciated as they deserved to be until after the
lapse of nearly two centuries. In 1812 the _Société de Médecine de
Bordeaux_ offered a prize for the best eulogy of Ambroise Paré,
and it was awarded to Vimont. Finally, in 1840, a fine bust of the
distinguished surgeon was completed by the sculptor David of Angers,
and set up in bronze in Laval, Paré’s birthplace. The portrait here
reproduced from the engraving in von Gurlt’s work represents the bust
in question (Fig. 25).

A complete collection of the writings of Paré has been prepared by
J. F. Malgaigne, the distinguished French surgeon, and published in
three very large volumes (Paris, 1840–1841). This collection is based
on a careful comparison and collation of all the previously published
editions. The contents of these volumes cover very nearly the entire
range of surgery.




                              CHAPTER XLI

SURGERY IN GREAT BRITAIN DURING THE SIXTEENTH AND SEVENTEENTH CENTURIES


In Great Britain the cultivation of the science of medicine began at
a much later date than it did on the continent of Europe, and, so far
as may be judged from the facts within our reach, there were, in the
early part of the sixteenth century, very few Englishmen who could
justly lay claim to the possession of more than the rudiments of
the art of surgery. Two centuries earlier, as I have already stated
in a previous chapter, there were three men in England who gained
considerable fame in this department of medicine. They were Gilbert
“the Englishman” (1210), John of Gaddesden (1320), the author of the
famous book entitled “Rosa Anglica,” and John of Ardern (_circa_
1350); but afterward, for a period of nearly two hundred years, the
records fail to reveal to us a single surgeon of any note. Then during
the sixteenth century the only English surgeons whose names deserve to
be perpetuated are Gale, Clowes and Woodall, of whom I shall presently
give brief accounts. They were all at one time or another, as in the
case of the leading continental surgeons of that period, officially
connected with the army. Some idea of the unsatisfactory state of the
medical service in the English army of that period may be gathered from
the statements made by Gale regarding this matter. From his account it
appears that in 1544 the army was accompanied by a miscellaneous crowd
of men who were supposed to be in some measure physicians, but who in
reality were uneducated quacks, vendors of all sorts of dressings and
washes for wounds, of infallible cures for gunshot injuries, etc. The
mortality in the English camp was, as might readily be expected, very
heavy. The same state of things existed, at a somewhat later date, in
the fleet sent against the Spanish Armada. It is not to be wondered
at, therefore, that very few of the educated surgeons were willing to
accept service in the English army or the English fleet, especially as
the pay which they received was no greater than that of the drummers
and trumpeters. Toward the end of the century much greater attention
was paid to the care of the wounded and crippled, and, in corroboration
of this, it may be stated that Henry the Fourth, King of France,--who,
it may safely be assumed, was influenced to take this step by the
enlightened advice of Ambroise Paré,--ordered the establishment of
military hospitals for the use of the army which was at that time
besieging Amiens. And again, at a later date (1603), there was
established at Paris a retreat for old and infirm or mutilated officers
and soldiers.

It is an interesting fact that during the year 1544, while Henry the
Eighth of England, in alliance with the German Emperor Charles the
Fifth, was carrying on the war against Francis the First, King of
France, there were present, on the soil of the latter country, all the
leading European surgeons of that period--viz., Ambroise Paré, with
the French army which was laying siege to Boulogne-sur-Mer (captured
a few months earlier by the English troops); Thomas Gale, the most
famous surgeon of that day in England, with the army of the besieged;
and Vesalius and Daza Chacon with the troops of Charles the Fifth
at Landrecy (near the Belgian boundary, south of Brussels) and at
St. Didier (in the northeastern part of France). I have already, in
preceding chapters, given brief accounts of the lives and professional
accomplishments of all these surgeons with the exception of Gale, and
it only remains now to supply such information as may be obtainable
concerning the latter and also concerning his contemporaries, the
English surgeons Clowes and Woodall.

_Thomas Gale._--Thomas Gale was born in London in 1507, practiced
medicine for some years in that city, and then, in the capacity of
a surgeon, entered the service of the army under Henry the Eighth.
At a later date he joined the army of Philip the Second of Spain. In
1544 he was present at the battle of Montreuil in France, and he was
also present at the siege of St. Quentin, in 1557. Two years later he
returned to London and became a member of the Barber-Surgeons’ Company.
His death occurred in 1587.

Gale was the author of several books on surgical subjects, the most
important of these works being that which deals with gunshot wounds.
His views regarding wounds of this nature agree in the main with the
teachings of Ambroise Paré; and yet, according to von Gurlt, he appears
to have formed his opinions independently, for he does not once mention
that surgeon’s name. He was not only a skilful surgeon, but also a man
of scientific and literary tastes, as shown by his translations of some
of Galen’s writings and of Giovanni da Vigo’s treatise on surgery, and
also by his own published works. His book on gunshot wounds, to which
reference has already been made, is the one which reflects the greatest
credit upon the author. One of its chief merits is to be found in the
fact that it enabled the physicians of England to keep in some measure
abreast of their brethren on the continent, at least in the matter of
treatment by surgical means. In one part of the work he makes reference
to the belief, which was held at that time by many surgeons, that the
bullet not only scorched the flesh of the wound which it inflicted but
also introduced into it a poisonous element. I quote here one or two
extracts from the comments to which I have just referred:--

   The usuall Gonnepouder is not venemous, nother the shotte
   of such hoteness as is able to warme the fleshe, much lesse
   to make an ascar.... Hange a bagge ful of Gonnepouder on a
   place convenient: and then stand so far of as your peece wil
   shote leavell, and shote at the same, and you shall see the
   Gonnepouder to bee no more set on fyer with the heat of the
   stone [used as a bullet] than if you caste a cold stone at it.

An English translation of Paré’s book, says von Haller, was not
published until 1577. It is therefore not strange that Gale, whose book
was printed fourteen years earlier (_i.e._, in 1563), should
have made no mention of that author’s method of applying ligatures
to the bleeding vessels of an amputation stump. The first reference
(in English) to this plan of preventing hemorrhage from the divided
blood-vessels in an amputation stump occurs--so far as I have been able
to discover--in the treatise published in London by William Clowes, in
1588, under the title “A prooved practise for all young chirurgians
etc.” Clowes, however, erroneously gives the credit for this important
procedure to Guillemeau, one of Paré’s pupils.

In one of his writings Gale states, after witnessing the surgical
practice at the Royal hospitals of St. Bartholomew and St. Thomas in
1562, “that it was saide that Carpinters, women, weuvers, coblers and
tinkers did cure more people than the chirurgians.” (South.)

_William Clowes._--William Clowes was born, about the year 1540,
at Kingsbury, in Warwickshire, and received his early training in
surgery under George Keble of London. In 1563 he accepted the position
of surgeon in the army which was under the command of Earl Ambrose
of Warwick and was stationed at that time in France. Six years later
he settled in London, and was made a member of the Barber-Surgeons’
Company. In 1575 he received an appointment on the Surgical Staff of
St. Bartholomew’s Hospital and six years later still he was promoted to
the rank of full surgeon, a position which he already held in Christ’s
Hospital. In 1585 he resigned his appointment at St. Bartholomew’s and
accepted an invitation to serve in the Earl of Leicester’s army, which
was at that time in the Netherlands. During this war Clowes acquired
a rich and varied experience in the treatment of wounds. Soon after
his return to London in 1588 he joined the fleet which vanquished the
Spanish Armada. Later, he was given the appointment of Surgeon to the
Queen. His death took place at Plaistow, County of Essex, in August,
1604. Von Gurlt does not hesitate to qualify him as one of the most
distinguished English surgeons of his day.

Of the four surgical treatises which were written by Clowes, and of
which several editions were published between the years 1575 and 1637,
there is only one to which I shall refer in this brief account, viz.,
that which, in the edition of 1637, bears the title: “A profitable and
necessarie Book of Observations, for all those that are burned with the
flame of Gun-Powder.” This book is full of brief histories of cases
which came under the author’s personal observation, and it therefore
furnishes an excellent and truthful picture of the kind of wounds which
the highwaymen and soldiers of that day inflicted, and of the treatment
which was employed by the best English surgeons. The following may
serve as sufficient examples:--

(1) A clothier, who had been assailed by robbers, received a dangerous
wound in the left thigh. It was about four inches long and of such a
depth that “the rotula or round bone of the knee did hang downe very
much.” Clowes first removed a clot of blood from the wound and then,
“with a sharp and square-pointed needle, armed with a strong, even and
smooth silke thred, well waxed, introduced five stitches, one good
inch distant betweene every stitch, leaving a decent place for the
wound to purge at.” He then applied a suitable bandage. The patient’s
friends were not at all pleased that Clowes, having pronounced the
wound dangerous, should not have been willing to state how much time
would elapse before it would be healed. So they called in a charlatan,
who on the following day removed the dressings and cut through all
the stitches. Seven days later, Clowes was once more asked to see
the case. He found the wound gaping widely and in a bad state. After
adopting such measures as were most urgently required, he brought
the edges of the wound together by the application of three strips
of sticking-plaster. In due time healing took place, “but the motion
perished: for the patient had the imperfection of a stiff knee, which
constrained him to use a leather strap, fastened unto the toe of his
shooe, and again made fast unto his body; and so he remaineth unto this
day.”

(2) The history of the second case may be given here in the following
brief outlines. The patient, a ship’s gunner, was wounded in the lower
part of the abdomen by what was probably a partially spent ball. The
wound made by the missile was of such a nature that it permitted a
large portion of the “zirbus” (omentum), together with some of the
intestinal canal, to protrude from the opening. After making a careful
examination of the parts, Clowes was satisfied that the intestine was
still uninjured.

   Then with a strong double thread I did tie fast the zirbus as
   close unto the wound as possible wel I might, and within a
   finger bredth or thereabouts I did cut off that part of the
   zirb that hanged out of the wound, and so I cauterized it with
   a hot iron almost to the knot; all this being done, I put again
   into the body that part of the zirb which I had fast tied, and
   I left the peece of thred hanging out of the wound: which,
   within four or five days after, nature cast forth, the thred
   as I say being fast tied; then presently I did take a needle
   with a double strong silke thred waxed, wherewith I did thrust
   thorow both mirach [skin, adipose layer and muscular tissue]
   and ziphach [peritoneum] on the right side of the wound, but
   on the left side of the wound I did put the needle but thorow
   mirach only, and so tied these three fast together with a very
   strong knot, and presently I did cut of the thred.... All which
   is according to Weckers[94] and other learned men’s opinions
   and practices, who also say that the stitches of the one side
   must be higher than on the other side. [The usual dressings were
   afterward applied and were renewed three days later. At the end
   of twenty-one days the wound was found to be completely healed.]

In chapter 27 of the same work there is given a list of the medicaments
and instruments with which a field-or ship’s-surgeon should be equipped
before he engages in active service. From this list I select the
following items as showing--at least in some measure--in what respect
the tools employed by surgeons four hundred years ago differ from
the modern ones of a similar character: “Small and long waxe candles
to search the hollownesse or depth of a wound.” “Small buttons or
cauterizing irons meete to stay the flux of an artery or veine.” “A
trepan.” “Needles two or three, some eight inches, some ten or twelve
inches in length, having a decent eye in it guttered like a Spanish
needle, and point or end blunt or round, that it offend not in the
going in of it, made fit to draw a Flammula, or a pece of fine lawne
or linnen cloth through the body or member that is wounded.” “As for
stitching quils and other instruments, that a Surgeon ought always to
carry about him, I leave unspoken of.”

In praise of one of the plasters enumerated in the list, Clowes
narrates the following incident which occurred near Arnheim in the
Netherlands: “A horseman was wounded with a pike neere the middle of
his right thigh; the weapon so passing upwards that by good fortune it
rested upon the os pubis, otherwise he had been slaine.” As the first
step in the treatment, the copious bleeding was arrested; after which
warm _oleum hyperici_ [oil of St. John’s wort] was injected into
the wound, then a short tent was introduced, and the sticking plaster
was applied on the outside. “Thus he was cured in fourteene days, and
so was ready to serve in the field again.”

_John Woodall._--John Woodall or Woodhall was born in England
about 1569, and was sent as a military surgeon to France by Queen
Elizabeth with the troops which Her Majesty placed at the disposal
of the French King, Henry the Fourth. After his return to England,
Woodall was made a surgeon of St. Bartholomew’s Hospital and also
Surgeon-General of the East India Company. He was already at that time
a member of the Company of Barber-Surgeons of London. Woodall must have
had a very extensive experience in the practice of surgery, for he
states that he had performed the operation of amputation of a limb more
than one hundred times. The date of his death is not known.

Von Gurlt calls attention to the fact that the first notice printed
in English of Ambroise Paré’s method of ligating blood-vessels after
an amputation is to be found in the treatise written by John Woodall
and published in London in 1639, under the title: “The Surgeon’s Mate,
or Military and Domestic Surgery.” As the first edition of this book,
which was published in 1617, says nothing about Paré’s method, it seems
permissible to infer that the news of this improvement, one of the
most important made in surgery (1552), reached England from France only
after the lapse of eighty-seven years! There can be scarcely any doubt,
however, that individual English surgeons had already learned about
Paré’s improved method at a much earlier date.

_State of Surgery in England During the Seventeenth
Century._--Before I pass on to the consideration of the state of
surgery in England during the seventeenth century it seems desirable
that I should say a few words with regard to the relative standing of
the two branches of the medical profession--the physicians and the
surgeons--in the esteem of their fellow Englishmen at this period
of history. In France, it will be remembered, a surgeon was looked
upon, even as recently as during the first half of the sixteenth
century, as a man of inferior social standing, perhaps a shade better
than an apothecary, but certainly far below his more highly educated
associate--the physician. The favors extended by French Royalty to
Ambroise Paré and the very high esteem in which he was held by French
society in general effected a great change in the relative status of
the two classes of practitioners in France; and, as a result of this
change in public opinion, medical practitioners, subsequent to 1560 or
1570, were led to realize that a surgeon, if sufficiently educated,
if earnestly devoted to his professional work, and if intent upon
helping his fellow men rather than upon accumulating a fortune, might
confidently aspire to a position of equality with the best physicians
of the community in which he lived. In England a similar change of
opinion in regard to the honorableness of the career of surgeon
took place about this time, probably in consequence of the great
reputation gained by Gale, Clowes and Woodall. In both countries the
change occurred slowly, and in France what was gained during Paré’s
lifetime seemed afterward to be lost for a period of several years.
But eventually the prevailing opinion again became favorable to the
surgeons, and from that time to the present they have enjoyed an
ever-increasing esteem in public opinion. But there was a brief period,
early in the seventeenth century, when it must have been very galling
to the pride of an honorable and experienced surgeon to be placed as
it were under the tutelage of the physicians who were his official
associates in certain hospitals--as, for example, in St. Bartholomew’s,
London. The following extracts[95] from the “Orders” or “Articles” of
that institution (1633) explain more precisely what is meant by the use
of the word “tutelage”:--

   9. That no surgeon or his man do trepan the head, pierce the
   body, dismember or do any great operation on the body of any but
   with the approbation and by the direction of the Doctor (when
   conveniently it may be had) and the surgeons shall think it
   needful to require.

   13. That every surgeon shall follow the directions of the Doctor
   in outward operations for inward causes, for recovery of every
   patient under their several cures, and to this end shall once in
   the week attend the Doctor, at the set hour he sitteth to give
   directions for the poor.

    (From St. Bartholomew’s Hospital Reports, Vol. XXII., 1886.)

Among the English surgeons of the seventeenth century there appears to
have been only one who attained some degree of eminence, viz., Richard
Wiseman, who is often spoken of as the Ambroise Paré of England.
Haeser mentions 1625 as the date of his birth, and at the same time
states that he was in the service of the Stuart Kings from Charles
the First to James the Second. It seems to me highly probable that
this statement regarding the date of Wiseman’s birth is erroneous; for
if it be accepted as correct, then he (Wiseman) must have been only
fifteen years of age when he first started out with the prince (in
1640) on the latter’s wanderings through France and the Low Countries.
On the other hand, if Wiseman was really born in 1625, then we shall be
justified in assuming that he traveled with the prince at first simply
as his companion and not in a professional capacity; and we shall be
further justified in assuming that he acquired his medical and surgical
training during his residence on the continent.

In 1650 Wiseman returned with the prince to Scotland. At the battle
of Worcester he was taken prisoner by the Parliamentary army under
Cromwell and did not regain his liberty until 1652, at which time he
settled permanently in London. After the Restoration in 1660, his
practice increased very greatly and, so far as one may judge from the
large number of cases which he reports in his work on surgery that
was first published in 1676, it must have been very extensive and of
a most varied character. I have read many of these reports of cases
that occurred in Wiseman’s practice, and have been much impressed with
the thoroughly practical character of the treatment which he adopted
in the majority of instances, and also with the very clear and concise
manner in which he narrates the attendant circumstances--the nature of
the malady or of the injuries received, the treatment which he adopted,
and the final results attained. In the belief that they may furnish
corroborative evidence of the statements which I have just made, I now
take the liberty of reproducing here two of these reports of cases:--

   (1) Whilst I was a prisoner at Chester (1651), after the battel
   of Worcester, I was carried by Colonel Duckinfield’s order to a
   man that out of much zeal to the Cause, pursuing our scattered
   forces, was shot through the joint of the elbow; the bullet
   entering in at the external part of the _os humeri_, and
   passing out between the _ulna_ and _radius_. He had
   been afflicted with great pain the space of six weeks. I found
   the wound undigested,[96] and full of a loose, soft, white
   flesh, the bones fractured, and not likely to unite, many
   shivers lying included within the joints, and incapable of
   being drawn out. The lower part of the arm was oedematous to
   the fingers’ ends as full as the skin could well contain, and
   the upper part was inflamed; also about the _os humeri_
   and _axilla_ a perfect phlegmon was formed. The patient
   thus tired with pain, desired to be cured or have his arm cut
   off. To which purpose he had procured the Governor’s leave for
   my staying with him. But, while that phlegmon was upon the
   upper parts, there was no hope of a prosperous amputation, nor
   of cure while those shivers of bone lay pricking the nervous
   parts within the joint. The phlegmon was too forward for
   repercussion,[97] and yet not likely to suppurate in less than
   a week’s time. Wherefore I endeavored by emollients and some
   discutients to succour the grieved shoulder and parts thereabout
   by hindering the increase of the phlegmon, and to give some
   perspiration to the part. Then with good fomentations I
   corroborated the weak and oedematous member below; in which end
   I also raised his hand nearer to his breast. Also by detergents
   and bandage I disposed the wounds and fractured part to a better
   condition, made way for discharge of matter, and endeavored to
   extract the shivers of bones; then applied medicaments to remove
   the _caries_. After some days the abscess suppurated in
   the upper part of the shoulder and in the armpit; and while the
   matter discharged from thence, the tumour discussed, and that
   upper orifice cured soon after. But the continual pain in the
   fractured joint kept that opening in the axilla from healing.
   The patient growing weaker, and without hopes of cure, I was
   necessitated to proceed to amputation. To which purpose I sent
   to Chester to Mr. Murry, a knowing chirurgeon (since Mayor of
   that city), to come with instruments and other necessaries,
   whereby I might the better do the work. He accordingly came, and
   we prepared dressings ready; which were stupes or pledgits of
   fine short tow well worked, some like _splenia_ [bandages],
   others were round, and bigger or less. We wetted them all in
   oxycrate [water and vinegar], and dried them; et cetera....

   The apparatus thus made, and the patient some while before
   refreshed with a good draught of caudle [a hot drink made of
   spiced and sugared wine], his friends took him out of his bed,
   and placed him in a chair toward the light. One of his servants
   held his arm; another of his friends held his other hand. Then
   Mr. Murry drew up the skin and museulous flesh of the arm
   towards the shoulder, whilst I made a strong bandage, some three
   or four fingers’ breadth, above the affected part. Then with a
   good knife I cut off the flesh by a quick turn of my hand, Mr.
   M. pulling up the flesh, whilst I bared the bones.[98] After
   which, with as few motions of my saw [as possible], I separated
   the bone[s], the patient not so much as whimpering the while.
   After this Mr. Murry thrusting his hands downwards with the
   museulous flesh and skin which he had drawn upwards, I passed
   a strong needle and thread through the middle of the flesh and
   skin on both sides, within half an inch of the edges, and
   brought the lips close within a narrow compass; and having tied
   that ligature fast, and cut off the string, I passed the needle
   again through the two contrary sides, which I tied as close;
   then loosened the ligature above, and applied the little round
   stupes of tow spread with a quantity of Galen’s powder mixed
   with egg albumen. The long pledgits were applied from the middle
   of the stump each way upwards along the arm, over which I put on
   a bladder and a cross cloth, then rowled up the stump, and made
   the bandage [pass] under his other arm and over his neck.... He
   being thus dressed up, we put him into his bed. The third day
   we took off his dressings, and found the stump well digested,
   and at least two spoonfuls of matter discharged.... During which
   the bone exfoliated, and the stump soon after cicatrized. Then
   having procured a pass to come to London, I hastened away.

   (2) A lady coming to town with a swelling in her left breast,
   consulted some of our Profession, and at last me. She said she
   had some years since kernels in her breast, which were judged
   the “King’s Evil”; upon consideration of which she was presented
   to His Majesty, and touched. In progress of time they swelled,
   and her breast being extremely painful, she desired my judgment
   of it. The swelling was large and round, and greatly inflamed,
   under which it was soft and seemed to have matter in it. The
   parts more distant were hard, and several tubercles lying
   under the skin made it unequal; yet the breast was not fixed.
   She urged me instantly to deliver my thoughts of it; which to
   decline I turned from her, and told her friend it was a cancer,
   and that I saw no hopes to save her life but by cutting it off.
   He wished me to consider how I delivered such judgment of it,
   two chirurgeons having lately assured her the contrary, they
   taking it for a phlegmon. But I, not being used to guide my
   judgment by what others delivered, confirmed to him what I had
   before said by a sad prediction, which befel her in few weeks
   after. And indeed there was no way then to deal with it but by
   cutting off her breast.

One is not a little startled, after reading a number of case-histories
like the two which I have just reproduced, to discover other portions
of text (Vol. I., pp. 384 and 385) which show clearly that Wiseman,
although a surgeon of the most practical character and a man equipped
with excellent reasoning powers when he was placed in the presence
of most of the problems which are constantly being submitted to
physicians for solution, was nevertheless the victim of a belief that
supernatural powers may reside in certain human beings. Speaking
of the cure of the “King’s Evil”--also called by him “struma” and
“scrofula”--Wiseman, in the chapter which he devotes to this subject,
makes the following statement:--

   But when upon trial he (the chirurgeon) shall find the
   contumaciousness of the disease, which frequently deluded his
   best care and industry, he will find reason of acknowledging the
   goodness of God; who hath dealt so bountifully with this Nation
   in giving the Kings of it, at least from Edward the Confessor
   downwards (if not for a longer time), an extraordinary power in
   the miraculous cure thereof.... I myself have been a frequent
   eye-witness of many hundreds of cures performed by his Majesty’s
   touch alone, without any assistance of chirurgery; and those,
   many of them, such as had tired out the endeavors of able
   chirurgeons before they came thither.

Some years before his death, which occurred in 1686, Wiseman was given
the title of Serjeant-Chirurgeon to King Charles the Second.




                             CHAPTER XLII

        REFORMS INSTITUTED BY THE ITALIAN SURGEON MAGATI IN THE
      TREATMENT OF WOUNDS.--FINAL ENDING OF THE FEUD BETWEEN THE
     SURGEONS AND THE PHYSICIANS OF PARIS.--REVIVAL OF INTEREST IN
                       THE SCIENCE OF OBSTETRICS


_Reforms Instituted by Magati._--Cesare Magati, who was born in
1579 at Scandiano, in the Duchy of Règgio, studied medicine at the
University of Bologna and received the degree of Doctor of Medicine
from that institution in 1597. Immediately afterward he went to Rome
and devoted himself particularly to the study of anatomy and surgery.
Then, upon his return to his native land, he quickly acquired so great
a reputation as a surgeon that the Duke of Bentivoglio, who was a man
of enlightened views and ambitious to promote in every possible way the
best interests of the University of Ferrara, offered Magati the Chair
of Surgery in that institution. The offer was accepted in 1612, and
Magati continued to hold the position for several years, his services
being highly appreciated both by the authorities of the university and
by the students. But, when his health began to break down,--he was
affected with stone in the bladder,--he decided that his best course
was to resign his professorship, retire from active practice, and
become a Capuchin monk. When he took this step he obtained permission
from the head of the Chapter to which he belonged, to resume in a
limited measure the surgical work which he was so well fitted to do.
But in the year 1647 his sufferings became so acute that he was obliged
to visit Bologna in the hope of obtaining relief through operative
interference. The operation, however, did not prove successful, and
death occurred shortly afterward.

Magati effected, in a quiet and unostentatious manner, a number of
desirable reforms in surgical procedures. Thus, for example, he pointed
out how undesirable it is, in most cases, to change the dressings of
a wound so frequently as was, at that period, the common practice.
The process of cicatrization, he insisted, is not effected by the
efforts of the surgeon, but is fundamentally the work of Nature. Then,
in addition, he protested against the practice of introducing wicks
and pledgets of lint into wounds. These criticisms and this advice,
says von Gurlt, had been given many times before by different ancient
authors, but they undoubtedly had to be repeated from time to time.

The treatise in which Magati has written these things bears the
following title: “_De rara medicatione vulnerum, seu de vulneribus
raro tractandis, libri duo_,” Venice, 1616 and 1676; also Nuremberg,
1733.

_Final Extinguishment of the Long-standing Feud between the Surgeons
and the Physicians in Paris._--At several points in the course of
this sketch of the history of medicine, I have called attention to the
fact that, during the centuries preceding those which are reckoned by
certain authors as belonging to modern times, surgeons as a class were
generally looked upon, especially in the larger cities of France, as
decidedly inferior to physicians. The first attempt at something like
systematic instruction in surgery was made by the Brotherhood of Saint
Cosmas and Saint Damian at Paris. This organization, which was founded
by Jean Pitard about the middle of the thirteenth century, was composed
of a group of barbers who felt a strong desire to secure for themselves
a better training than was obtainable by the generality of barbers in
those days. The latter were known as “surgeons of the short gown,”
while the more ambitious men, who belonged to the group mentioned
above, were known as “surgeons of the long gown.” With the progress of
time this smaller group of barbers really succeeded in making better
surgeons of themselves, but in accomplishing this they intensified
at the same time the jealousy which the physicians as a class felt
toward them, a jealousy which repeatedly manifested itself in the form
of downright persecution. The data for a complete account of this
persecution, that persisted through centuries, are lacking, and even
if I possessed them I should not care to devote the time that would
be required for a proper presentation of the subject. It is pleasant,
however, to be able to record the fact that these plucky barbers
never entirely lost courage, but fought on, year after year, until
they eventually succeeded--with the help of a strongly sympathetic
public--in making the St. Côme Medical School the nursery of some
of the best surgeons in France during the sixteenth and seventeenth
centuries. It was here, for example, that Paré, Guillemeau, Thierry
de Héry and other men of distinction obtained their early training,
and it was doubtless through their influence that some of the wealthy
patients whom they had treated successfully, were induced to contribute
liberally to the support of the school. The final event in the history
of this institution was the complete overthrow of the opposing
physicians and the merging of the two surgical schools--that of the
regular Faculty and the St. Côme School--into one, under the direction
of de Lapeyronie, of whom I shall now furnish a brief sketch.

_François de Lapeyronie._--François de Lapeyronie was born at
Montpellier on January 15, 1678, and he enjoyed the privilege of
receiving a most careful preliminary education. He was only seventeen
years of age when the academic degree which corresponds to our Master
of Arts was bestowed upon him. As the next step he visited Paris for
the purpose of perfecting his knowledge of surgery, the branch of
science in which he was specially interested; and upon his return
to Montpellier he began giving instruction in anatomy and surgery.
In a short time he was chosen Surgeon-in-Chief of the Montpellier
Hôtel-Dieu. In 1714 he was called to Paris to take charge of the Duc
de Chaulnes, whose malady had not yielded to the treatment adopted
by the surgeons of that city; and in this case the measures which he
employed proved so efficacious that de Lapeyronie decided to settle
permanently in the metropolis. He taught anatomy in the Collège de
Saint-Côme, and in a short time was chosen Head Surgeon of the Charité,
one of the largest hospitals of Paris. In 1731 he became one of the
founders of the Royal Academy of Surgery, and he took a most prominent
part in the struggle which was then actively going on between the
physicians and surgeons of Paris,--one of the last and most serious
of the attempts made by the former to render the surgeons subordinate
to the physicians. The surgeons won the battle (April 23, 1743), and
Dezeimeris says that the part taken by de Lapeyronie in this struggle
may be looked upon as one of the most honorable achievements recorded
in the history of medicine. De Lapeyronie died on April 25, 1747, after
a long and painful illness. In his will he made most liberal provision
for the promotion of medical science; establishing funds for the giving
of annual prizes, for the founding of a medical library, for the
building of an anatomical amphitheatre, etc. In his treatise on anatomy
Hyrtl, the distinguished professor at the University of Vienna, makes
the following brief statement with reference to a certain dissecting
room in Paris, but he does not state in what part of the city the
room in question is located, nor does he mention any other facts that
might enable his readers to fix its location. In the absence of more
precise information concerning this matter, I shall take the liberty of
suggesting that Hyrtl’s discovery was made in the Anatomical Institute
which de Lapeyronie founded. Hyrtl’s statement reads as follows:--

   Over the entrance doorway of a dissecting room in Paris I read
   this inscription: _Hic locus est ubi mors gaudet succurrere
   vitae._ [Here is the spot where Death rejoices to render
   assistance to Life.] No more beautiful or fitting words could
   be employed for inspiring the student, upon his first entrance
   into the room, with respect for the work in which he is about to
   engage.

And yet, a few pages beyond that on which the above statement is
printed, Hyrtl quotes Vicq d’Azyr as saying: “Among all the sciences
anatomy is perhaps the one the usefulness of which has been most
highly lauded, but at the same time the one for which the least has
been done to favor its advancement.”

_The Revival of Interest in Obstetrics._--With Soranus, the
early Greek writer on obstetrics, this science seemed to come to
a standstill, and during all the intervening centuries, up to the
sixteenth, not a single work of any special value was published on
this subject; for it is safe to say that nobody would claim for the
one or two obstetrical treatises that were written by teachers in
the Medical School of Salerno during the ninth or tenth century,
that they contributed materially to advance our knowledge in regard
to this branch of medicine. It therefore seems fitting, as suggested
by Haeser, that during the century which gave birth to such immortal
works as those of Vesalius and Paré, there should appear somebody who
possessed the inclination to stir once more into life the dying embers
of the science of midwifery; and such a man was found in the person of
Eucharius Roesslin, the elder, more commonly known--says Dezeimeris--by
the Greek name of “Rhodion.” He lived during the first half of the
sixteenth century, his death occurring about the year 1526, and his
was the first modern treatise especially devoted to obstetrics. He
began the practice of medicine in the city of Worms, in the central
part of Germany, and then moved to Frankfort-on-the-Main, where he
filled the salaried office of City Physician. Midwifery, at that time,
was left entirely in the hands of ignorant old women; and it was only
in response to the wishes of Catherine, the Duchess of Brunswick and
Lüneberg, that Rhodion undertook to prepare a manual from which these
ignorant and careless women might learn to conduct their midwifery work
in a more efficient, safe and acceptable manner. This little treatise,
which was first published at Worms in 1513, passed through a number
of editions and was translated into Latin, French, Dutch and English.
Von Siebold says that Rhodion compiled its text from various ancient
sources, and added practically nothing from his own experience. The
woodcuts, which are supposed to represent the different positions of
the foetus in the uterus, are not at all in accordance with the truth,
and show the most marvelous products of the artist’s fancy. Von Siebold
states, however, that the prejudices which at that time existed in the
minds of the people against the slightest participation of males in the
operations of midwifery were so strong that Rhodion would not have been
permitted to do anything toward learning the truth by the employment of
direct observation and careful examination--the only possible way in
which the actual facts might have been learned.

Rhodion’s book, notwithstanding the defects to which I have just
referred, accomplished much good. It also restored the operation of
podalic version to the position which it deserved, and it improved
the service of the midwives,--which was what the Duchess chiefly
desired,--and it undoubtedly emphasized the fact that the time had
arrived when obstetrics should receive the same degree of scientific
study that was being bestowed on all the other departments of medicine.

The title of Rhodion’s (or Roesslin’s) little book reveals the fact
that he possessed no small degree of humor. It reads: “Garden of Roses
for Pregnant Women and for Midwives,” Worms, 1513.

_The Operation Known as Caesarian Section._--The following
statements relating to the operation known as “Caesarian section”
have been compiled from Haeser’s _Geschichte der Medizin_:--This
operation, which owes its name to the erroneous idea that Caesar
was brought into the world by its aid, is commonly believed to have
been practiced on different occasions throughout antiquity, but
there has not yet been found in the records of history any account
which shows clearly that the operation was performed upon a living
woman, and also that the incision extended not merely through the
abdominal integuments, but also through the actual uterine wall. At
Siegershausen, in Switzerland,--according to the report of Caspar
Bauhin in the treatise (“_Gynaecia_”) which he published at Basel
in 1586,--a man named Jacob Nufer performed (about 1500) what was
believed to be a Caesarian section on his own wife, and delivered a
living child. Both mother and child did well; the child growing up
to the age of seventy-seven and the mother giving birth to living
children, _per vias naturales_, several times afterward. In this
instance it is generally believed that the case was one of abdominal
pregnancy and that the wall of the uterus had not been incised.

The first separate treatise on Caesarian section was written by
François Rousset, and in it are reported several cases in which the
operation was said to have been performed successfully. But both von
Siebold and Kurt Sprengel do not seem willing to accept these reports
as genuine, and we are therefore compelled to assume that the first
trustworthy account of a Caesarian section successfully performed by
a Dr. Trautmann of Wittenberg (in 1610) is that given by Sennert in a
communication which was printed early in the seventeenth century.

_Invention of the Obstetrical Forceps._--After the publication of
Roesslin’s “Garden of Roses,” the book of which I gave a brief sketch
on a previous page, nothing worthy of special note was done for a
period of several years to advance the existing knowledge of midwifery
or even to systematize that which had already accumulated. Then there
began to appear evidences of an awakening among those physicians who
recognized the importance of this department of medical science, and as
a result there were soon placed upon record accounts of two or three
advances of real and permanent value. One of the first of these gains,
for example, was the revival and general acceptance of the practice of
podalic version, or version by internal manipulations,--that is, the
operation of changing the faulty position of the foetus _in utero_
in such a manner that the feet shall be the parts which protrude into
the vagina. Podalic version--as it appears from the account given by
von Siebold--was known to the ancients, both Celsus and Aëtius having
described it in their treatises, but it was afterward forgotten or
neglected until Ambroise Paré, in 1550, again recommended it in one of
his writings. At the same time Paré states, at the very beginning of
his monograph on this subject, that his colleagues, Thierry de Héry
and Nicole Lambert, had both of them already carried out the method in
certain cases. This fact, however, does not detract from the credit due
Paré for having been the first, after the lapse of several centuries,
to bring the operation to the knowledge of the medical profession; and
from that day to the present it has held a fixed place in the science
of obstetrics. As will be readily understood, this is not the proper
place in which to furnish details with regard to the operation itself.
When Paré was asked whether it would be permissible for the midwives
to undertake this operation of podalic version, he replied that it
would be, provided the individual who assumed this responsibility
felt convinced that she possessed the requisite degree of skill
and experience in work of this nature, and provided also that--as
soon as she began to suspect her inability to finish the operation
successfully--she would promptly call to her aid a skilful surgeon, one
who had acquired considerable experience in obstetrical operations.
Paré’s favorite pupil, Jacques Guillemeau (1550–1630), a native of
Orleans, France, made several important additions to our knowledge of
the operation of podalic version, and he was also in other respects an
important promoter of the science of operative obstetrics. His treatise
on this branch of practical medicine, which was originally written in
French and published at Paris in 1609, was soon translated into English
(“Childbirth, the Happy Deliverance of Women,” London, 1612). In the
opinion of von Siebold, podalic version may justly be considered the
most important contribution that was made to obstetrical science during
the sixteenth century.

One of the French midwives of this period, Louise Bourgeois (or
Boursier), attained considerable celebrity by the excellence of the
treatise which she wrote on obstetrics. She was born at Paris about
the year 1564. In 1588 she began to fit herself for the career of
midwife, and in the course of a few years, after passing successfully
the required examinations, she was admitted by the authorities as a
“sworn midwife” of the city of Paris. She gained steadily in experience
and public favor, and the record states that already as early as 1601
she had the good fortune to officiate at the delivery of Henry the
Fourth’s wife (Marie de Medicis) of a son--the Dauphin (later, Louis
the Thirteenth). Her royal patrons were much pleased with the services
which she rendered on this occasion, and, as a further evidence of
the confidence which she inspired, they asked her--as each of these
occasions approached--to preside at the births of five other children.

One of the meritorious features of the treatise which Louise Bourgeois
wrote,[99] says von Siebold, is to be found in the fact that she
championed most earnestly podalic version. The book was translated into
both German (1644) and Dutch (1658).

François Mauriceau (1637–1709), who was indisputably the most
distinguished writer on obstetrics of the seventeenth century, was
born in Paris. During the early part of his career he was simply a
general surgeon, but, after the lapse of a few years, he gave up all
his other work and confined himself strictly to midwifery. For quite a
long period he held the position of Chief Obstetrician at Hôtel-Dieu,
and at the same time he conducted an extensive private practice in
cases of confinement. Worn out by the excessive amount of work which he
performed during the most active period of his career, he was finally
obliged to retire from practice several years before his death.

Mauriceau did not invent any remarkable obstetric instruments or
procedures, but he was the first to set forth in clear and precise
terms the principles of this science and art and to expound the rules
required for putting them into practice. The titles of his two most
celebrated treatises are the following: “_Traité des maladies des
femmes grosses_,” Paris, 1668; and “_Observations sur la grossesse
et l’accouchement_,” Paris, 1695. In 1706, three years before his
death, he also published “_Dernières observations sur les maladies
des femmes grosses_.”

The first of the three books mentioned passed through five editions
during Mauriceau’s lifetime, and there were two reprintings after his
death. A noticeable feature of the work, says von Siebold, is the care
which the author takes to preface all his lectures with a detailed
exposition of the anatomical relations of the region concerning which
he is about to speak; and this custom, which he was the first to
introduce, has since then been followed by the great majority of those
who have written on the subject of midwifery.

In the book which hears the title “_Observations sur la grossesse,
etc._,” Mauriceau gives an account of his first and only interview
with the English obstetrician, Hugh Chamberlen, to whom is commonly
accorded the credit of having invented the first pattern of the
obstetric forceps. From this account it appears that on August 19,
1670, Mauriceau was called to see a primiparous woman, thirty-eight
years old, who had already been in labor for several days, but
who had not yet been able, owing to the extreme narrowness of her
pelvis, to give birth to her child. (The case was one of head
presentation.) As Mauriceau was not at all willing to perform a
Caesarian section,--which alone, as he believed, promised a way out
of the difficulty,--Chamberlen, who happened to be in Paris at that
moment, was asked to see the patient. He came at once, made a hasty
examination, and declared that he needed only six or seven minutes for
effecting, by means of the method which he had invented, the delivery.
The patient was placed under his charge and he proceeded to apply his
method. Instead of a few minutes, he spent three hours in the attempt
to accomplish this purpose, but without success; and then admitted
that it was impossible, in this particular case, to effect delivery.
At the end of twenty-four hours the woman was dead. A postmortem
examination revealed the fact that the uterus was torn in several
places and perforated at one spot, all of which lesions had evidently
been produced by the instrument or instruments employed by Chamberlen.
“To complete this story,” adds Mauriceau, “it should be remembered
that, six months before the occurrence of the events just narrated,
this physician had come to Paris from England, and boasted that he
possessed a secret method by means of which he could, even in the most
desperate cases of labor, promptly effect the delivery of the child,
and had told the King’s Physician-in-Ordinary that he would sell the
knowledge of this secret for the sum of 10,000 Thalers (about $7500).”

One naturally hesitates about giving any measure of credit to a
physician whose professional conduct, as revealed in his relations to
Mauriceau’s patient, is clearly that of a charlatan. At the same time
we are obliged to bear in mind that in 1670 it was still possible for
a physician or surgeon to own a secret method of treatment and yet not
forfeit all consideration on the part of his professional brethren.
But at no time in the history of medicine has such conduct as that
attributed to Hugh Chamberlen (apart from the question of ownership
of a secret process) been considered otherwise than reprehensible.
However, as there does not appear to have been an earlier claimant for
the honor of having invented the obstetric forceps,--crude as it must
have been in its first form,--it seems only fair that Chamberlen should
be granted undisputed possession of this honor. During the eighteenth
century--a period with which the present volume has no concern--the
obstetric forceps underwent many alterations, and finally was given, by
Levret and Baudelocque in France, by Smellie in England, and possibly
also by Palfyn in Holland, practically the form which it possesses
to-day.

Before I finally dismiss the allied topics of obstetrics and
gynaecology, it seems desirable that I should add a few remarks
concerning two French surgeons who attained considerable eminence in
this special field, viz., Portal and Dionis.

_Paul Portal._--Paul Portal, a native of Montpellier, France, was
a contemporary of Mauriceau and an excellent obstetrician. He received
his training under the best teachers at Paris, and more particularly
under the guidance of René Moreau, Dean of the Paris Faculty of
Medicine (1630 and 1631) and Royal Professor of Medicine and Surgery.
He died in 1703. In the treatise which he published at Paris in 1685
(“_La pratique des accouchements, etc._”) he lays down very
strongly the maxim that the surgeon or the midwife who has charge of
a case of labor should make no attempt to accelerate the efforts of
Nature until it becomes plainly evident that artificial assistance is
absolutely necessary. Portal cultivated the art of digital exploration
to a very high degree of excellence. In Chapter VI., according to von
Siebold, he expounds with great clearness the dangers which result from
a prolapse of the umbilical cord. When this condition is discovered, no
time should be lost in delivering the child. “In narrating some of his
most remarkable cases Portal uses very simple and clear language, and
he puts on record many things which in later years have been published
as entirely new discoveries. But, unfortunately, his immediate
successors were not disposed to profit from Portal’s admirable
teachings.” (Von Siebold.) The only translations of his treatise into
foreign languages that have been published are one in Dutch (1690) and
another in Swedish by Van Hoorn (1723).

_Pierre Dionis._--Pierre Dionis, who was born at Paris in the
early part of the seventeenth century, was in some degree related to
Mauriceau, the famous Parisian accoucheur. In 1673 he was appointed
Royal Demonstrator of Anatomy and Surgery at the institution known
as the “_Jardin-du-Roi_,” and from this date onward, up to
the year 1680, he gave instruction regularly in these branches of
medical knowledge to large classes of students. He was particularly
distinguished for the clear and methodical manner in which he handled
the subjects upon which he lectured. In the year last mentioned he was
called to Vienna to fill the position of Physician-in-Ordinary to Maria
Theresa, Empress of Austria, but von Siebold, who is my authority for
the present sketch, does not say for what length of time he continued
to hold this position. His death occurred in 1718.

The earliest work published by Dionis bears the title: “_Histoire
anatomique d’une matrice extraordinaire_,” Paris, 1685. (Description
of a case of extra-uterine pregnancy.) Five years later he published
the treatise on human anatomy (“_L’anatomie de l’homme, etc._,”
Paris, 1690) upon which his celebrity largely rests. This book passed
through numerous editions and was translated into Latin, Dutch and
English (1723), and also Chinese; this last piece of work being
done by the Jesuit missionary, Father Parrenin, at the request of
Cam-Hi, Emperor of China, who died in 1723. Another treatise, which
perhaps contributed, even more than did his Anatomy, to render Dionis
celebrated, is that which bears the title: “_Cours d’opérations de
chirurgie démontrées au Jardin-du-Roi_,” Paris, 1707; and later
translations into German, Dutch and English. This book covers the
entire field of operative surgery, and its subject-matter is most
methodically arranged. It contains a large number of precepts which
are as sound to-day as they were two hundred years ago. From the
frequent mention which Dionis makes of the diseases to which the teeth
are liable, and from his descriptions of the operations that may be
performed for the cure or relief of these disorders, one is justified
in drawing the conclusion that, at that early period, this branch of
surgery was not, as many suppose, abandoned entirely to charlatans.




                             CHAPTER XLIII

       THE FIRST APPEARANCE OF SYPHILIS IN EUROPE AS AN EPIDEMIC
       DISEASE.--MEDICAL JOURNALISM.--THE BEGINNINGS OF A MODERN
                PHARMACOPOEIA.--ITINERANT LITHOTOMISTS


Toward the end of the fifteenth and during the early part of the
sixteenth centuries accounts concerning syphilis began to be published
in the medical literature of Spain, Italy and France. The word
“syphilis,” it is true, does not appear in any of these records, for
it had not yet been coined; but the accounts themselves leave no room
for doubt that this was the disease to which the authors of these
records referred. The prevailing views with regard to the origin and
nature of syphilis differed somewhat in the three countries named. In
Spain, for example, it was a common belief that the disease originated
in an unfavorable conjunction of the stars[100] and yet at the same
time it was generally admitted that it was a disease which belonged
in the category of luxuries and might be avoided if one were careful
not to have intercourse with dissolute women. For a brief period of
time there were physicians in all three of the Latin countries who
maintained that syphilis had been imported, in the first instance,
from America by the men who made the voyage with Columbus and by the
earliest Spanish explorers of South America; but it was soon shown
that this theory was not compatible with certain known facts--such,
for example, as the published reports made by the Spanish physicians
Pintor and Torrella,[101] who describe cases of syphilis which they had
treated prior to 1493 (the year in which the first discoverers returned
from America). In Italy, according to Giovanni da Vigo, the author
of an excellent treatise on surgery (“_Practica in arte chirurgica
copiosa_,” Rome, 1514), the disease was first observed in Europe in
December, 1494, soon after the arrival of Charles the Eighth’s (France)
army at Naples; and only a short time elapsed before there developed,
as a result of this great accession of French soldiers, a veritable
epidemic of what then began to be known quite generally as “_morbus
gallicus_” or “the French disease.” The King himself, it is stated,
was among the number of those who contracted the infection.

So far as I am able to discover, the term “syphilis” was first
introduced into medical literature by Fracastoro, the distinguished
physician of Verona, who published in 1530 a Latin poem bearing the
title: “_Syphilis sive morbus gallicus_.” These verses were
received everywhere with great favor, were translated into several
modern languages, and speedily put an end forever to the employment of
the insulting term “_morbus gallicus_.”

A few more words with reference to the origin and distribution of
syphilis throughout the world may not seem inappropriate in this
place. J. K. Proksch, the author of the most recent history of this
disease,[102] says it has been fully proved that syphilis existed among
the inhabitants of India as long ago as during the Middle Ages, and he
adds that the evidence thus far collected justifies the further belief
that it was not an uncommon malady among the ancient Greeks and Romans,
and even among the Babylonians and Assyrians. Doubtless a good deal
of what was called “leprosy” in early times was in reality syphilis.
Another syphilographer--Raphael Finckenstein--makes the following
sensible remarks about the efforts that have been made to ascertain
the precise date when this disease first appeared in Europe:--[103]

   It is just as foolish to suppose that the date of the first
   appearance of syphilis may be discovered as it is to hope
   that the disease will ever entirely disappear. As long as
   wealth and idleness continue to exist, as long as there are
   men who remain unmarried and women whose moral character is of
   a yielding nature, and as long as it is not possible for the
   police to creep into every nook and corner, just so long will
   licentiousness and indulgence in fleshly lusts continue to
   disturb the peace of the community. These are the conditions
   necessary to the development and spread of syphilis.

Some account of the treatment of this form of venereal disease comes
next in order. It is commonly believed, says the author just quoted,
that it was from the Spanish physicians of the sixteenth century
that we learned how to treat syphilis by the methodical employment
of mercurial preparations. (See footnote at the bottom of page 542.)
He adds that there was published by Juan Almenar at Venice, in 1502,
a book which bears the title: “A treatise on the Morbus Gallicus,
in which it is demonstrated how the patient may be treated in such
a successful manner that the disease will never return, nor will
any objectionable lesions develop in the mouth; and yet, during the
progress of the treatment, the patient is not required to remain
in bed.” The author of this book, who was a resident of Valencia,
Spain, was a man of noble birth. His treatise passed through eight
successive editions, the last of which was printed at Basel in 1536.
Almenar’s plan of treatment was to employ mercurial inunctions in such
moderate doses as not to induce salivation. If, at the end of a few
days, he saw evidences of an approach of this symptom, he substituted
baths and evacuant remedies (rhubarb and senna) for a short time,
and also prescribed a more nourishing diet and the taking of various
internal remedies. Then, later, the inunctions were resumed. The
exact duration of such a course of treatment is not stated. So far as
I am able to judge from the account given by Finckenstein, Almenar
found it necessary in some cases to repeat the series of mercurial
inunctions as many as four times. His aim, in other words, was to
accomplish a radical cure of the disease, whereas his contemporaries,
who were mainly ignorant and uneducated physicians, were satisfied to
carry out a purely symptomatic treatment. Morejon, the historian of
Spanish medicine, expresses the belief that Almenar was the first to
use steam baths in the treatment of syphilis. Both Hensler and Simon,
the best modern authorities with regard to the history of syphilis,
agree that Almenar’s inunction method of treating this disease forms,
notwithstanding its crudeness in certain respects, the basis of all
modern methods of the same general character. Unfortunately, the
physicians of a later period did not follow the relatively mild and
safe inunction method advocated by Almenar, but so modified it for the
worse that it became a common thing for men to say that the cure was
worse than the disease.

_A Few Special Advances Worthy of Note._--The beginnings of
medical journalism belong to the second half of the seventeenth
century. In 1665, for example, there appeared for the first time,
a medical article in the “_Journal des Scavans_,” and during
the same year similar articles were printed in the “Philosophical
Transactions of the Royal Society of London.” According to August
Hirsch the earliest periodical that was devoted entirely to the
interests of the medical profession was the “_Journal des découvertes
en médecine_,” which was first published in 1679 and continued,
in 1680, under the title of “_Le Temple d’Esculape_.” Then
followed soon afterward: “_Le Journal des Nouvelles Découvertes en
Médecine_” (1681–1683); “_Le Mercure Savant_” (1684); “_Le
Zodiacus Medico-Gallicus_” (1680–1685), which was published in Latin
in Geneva, by Bonet; etc.

In addition to the more important advances in anatomy and physiology
that have already been mentioned on previous pages, the following
deserve to receive at least a passing notice: In the department
of anatomy and physiology, William Briggs (1642–1704), one of the
physicians of St. Thomas’ Hospital, London, published at Cambridge in
1676, under the title of “_Ophthalmographia_,” a most important
contribution to the anatomy and physiology of the eye; and there were
four other English anatomists who, during the seventeenth century,
gained well-merited credit by the original work which they did in the
fields of anatomy and physiology--viz., Thomas Willis (1622–1675),
Francis Glisson (1597–1677), Thomas Wharton (1610–1673), and Nathaniel
Highmore (1613–1684). The part played by Germany in these gains in
anatomy and physiology, during the period now under consideration, was
chiefly that of a sympathetic recipient; for the political conditions
at that time were entirely unfavorable to any active participation on
the part of the physicians of that country. Early in the eighteenth
century, however, they began in earnest to do their share of work in
advancing the science of medicine.

The relationship of the physical sciences to the theory and practice
of medicine is not of an intimate nature, and it will therefore not
be necessary for me to do more than briefly to enumerate the more
important of the discoveries of this character which occurred during
the sixteenth and seventeenth centuries.

Galileo (1564–1642), a native of Pisa, Italy, was the creator of the
science of motion, and he gave the first satisfactory demonstration
of equilibrium on an inclined plane. He devised an imperfect
species of thermometer, a proportional compass, and the refracting
telescope, by means of which latter instrument he made a number of
other important discoveries in the domain of astronomy. His pupil,
Evangelista Torricelli (1608–1647), also a native of Italy, discovered
the barometer, and in addition arrived at many fundamental truths
in mechanics and hydrostatics. Otto von Guericke (1602–1686), a
native of Magdeburg, Germany, invented the air pump. Sir Isaac Newton
(1642–1727), born at Woolsthorpe, Lincolnshire, one of the world’s
greatest authorities in natural philosophy, was the first to formulate
clearly the law of gravitation. Edme Mariotte (1620–1684), a native
of Burgundy, France, was the discoverer of what is commonly known as
“Mariotte’s law”--_i.e._, a law of elastic fluids, according to
which the elastic force is exactly in the inverse proportion of the
space which the mass of fluid occupies. He also discovered that the
part of the retina at which it meets the optic nerve is not capable of
conveying the impression of sight. Finally, Denis Papin (1647–1710),
a Frenchman, invented the first steam engine, of an embryonic and not
very practical type; for in this apparatus the piston floated on the
water in a separate cylinder.

The inventions which I have here briefly enumerated represent the more
important discoveries that were made in physical science during the
sixteenth and seventeenth centuries.

_The Beginnings of a Modern Pharmacopoeia, and One of the Last
Attempts of the Disciples of Galen to Maintain Their Ascendancy in
Therapeutics._--In the domain of pharmacology the first attempt in
modern times to organize this department of practical medicine was
made by an apothecary in Barcelona in 1497, and was published by him
in printed form in 1521. (Von Gurlt.) This pharmacopoeia was doubtless
wholly unknown beyond the borders of Spain. Not far from one hundred
years later,--_i.e._, in the early part of the seventeenth
century,--Theodore Turquet de Mayerne, who was born in 1573, in a
small village near the city of Geneva, made the second attempt in
modern times to organize the pharmacological department of practical
medicine. After showing quite early in life a fondness for the study
of chemistry, he devoted himself particularly to the investigation
of the remedies that are produced in the chemist’s laboratory; the
preparations of antimony attracting his especial interest. A little
before this time the physicians of Paris were split up into two
strongly antagonistic parties as regards the propriety of administering
this metal in any form as a remedy; but those who opposed its
therapeutic employment finally managed to secure from Parliament, in
1566, a decree prohibiting its use. While this quarrel was in progress,
de Mayerne visited Paris (1602) and established himself in that city
as an independent lecturer on chemistry. As the regular faculty still
held the belief that the teachings of Galen were the only safe guide
for physicians to follow, de Mayerne’s action must have appeared to
them like an impudent challenge. In one of his writings he strongly
recommended the employment of antimonial preparations,--remedies
introduced originally by the much-hated Paracelsus,--and he even
went so far as to offer some for sale. This was too much for the
disciples of Galen to bear without a protest, and consequently in
1603 the Parliament issued a new decree, in accordance with which de
Mayerne was prohibited from practicing medicine in Paris. This measure
appears to have proved successful in putting a stop effectively to
his obnoxious teachings, for we learn that shortly afterward he was
known to be living in London, where, in 1611, he was appointed the
Physician-in-Ordinary to King James the First, and later to Charles the
First. He died in 1655.

Jean Astruc, the distinguished French medical author of the eighteenth
century, speaks rather disparagingly of de Mayerne’s attempt to
organize a pharmacopoeia. An earlier, more successful, and much
more creditable attempt of this nature was made by Valerius Cordus,
whose “_Dispensatorium pharmacorum omnium_” was first published
at Nürnberg in 1535. This work, which subsequently bore the title
“_Pharmacopoeia Augustana_,” up to the year 1627 passed through
at least seven editions and was utilized to a greater or less extent
by the authors or editors of nearly all later pharmacopoeias. To
go still further back, the most ancient pharmacopoeia of which we
have any knowledge is that which bears the title of “_Antidotarium
Nicolai_,” the author of which work was Nicolaus, the President or
Dean of the Medical School at Salerno. The book was written originally
during the first half of the twelfth century, but it did not appear in
print, at Venice, until the year 1471, and then only in an incomplete
form. Quite recently a French translation of the book has been
made and published (1896) by Paul Dorveaux, of the Paris School of
Pharmacy. Most of the preparations there described have long since been
abandoned, but a few of them--such, for example, as citrine ointment,
honey of roses, oxymel, and oil of roses--are still to be found in the
pharmacopoeias of some nations.

_Itinerant Lithotomists._--For an unknown number of years
preceding the sixteenth century it had been a well-established custom
for members of the medical profession in France, and also, doubtless,
in neighboring countries, to intrust--as the Hippocratic oath
enjoined--all cases of stone in the bladder to expert lithotomists.
Such special knowledge and skill were not easily acquired, and so it
came about that there were very few individuals who were acknowledged
to be experts and who were really capable of teaching the art, and
these few guarded most carefully the knowledge which they had gained.
During the period of time which we are now considering, certain
members of the Collot and Pineau families were the most distinguished
lithotomists in France, and the records show that in the year 1600
Jehan Paradis and Nicolas Serre petitioned the Government for official
recognition of their special rights to enjoy a monopoly of operative
work of this character. “We ask that you give orders that all poor
patients who may apply to Hôtel-Dieu (the great city hospital of Paris)
or to the Bureau-of-the-Poor for relief from stone in the bladder, be
turned over to our care for proper treatment. The poor will receive
this treatment gratis, and those who can afford to pay will be charged
a very reasonable fee. And you will do well if you prohibit all other
persons from meddling with such cases in any manner.” In a document
bearing the date 1646 mention is made of four lithotomists--Philippe
and Charles Collot, Jacques Girault and Antoine Ruffin--who had erected
in the Faubourg Saint-Antoine, Paris, a building which was intended
to serve as a hospital “in which, at any time during the entire year,
those who are afflicted with stone in the bladder may be lodged, fed,
nursed and subjected to proper treatment,--the poor without charge of
any kind, and the well-to-do at a proper rate of remuneration.”

In Franco’s time (middle of the sixteenth century) cutting for stone
in the bladder was by no means an uncommon operation, and was almost
always performed by itinerant lithotomists (“_inciseurs_”). The
Collots had, for many years, possessed almost a monopoly of this
business. Laurent Collot, who was the first one of the family to engage
in the work, was Royal Lithotomist in 1556, and handed down to his son
all the knowledge on this subject which he had acquired through long
experience. François Tolet was another of these popular lithotomists
who flourished in Paris during the sixteenth and seventeenth centuries.
He died in 1724 at the age of seventy-seven. His treatise on lithotomy,
which was published in Paris in 1681, and subsequently passed through
several editions, is said by Dezeimeris to contain the records of a
large number of his own cases and to show clearly that he was a surgeon
of sound judgment. No better treatise on this subject, he adds, was
published during that period of the history of medicine.

In addition to those whom I have just mentioned there were two French
monks who gained wide celebrity as operators for stone in the bladder,
viz., Frère Jacques de Beaulieu and Frère Côme. The last-named belongs
to the early part of the eighteenth century, and should therefore--in
accordance with the plan which I have been following--not receive
consideration in the present account; but, in view of the fact that
these are the only two monks who, during the Renaissance and the period
immediately following, gained conspicuous credit for the honorable and
efficient service which they rendered, not merely to the science of
medicine but also to the cause of humanity, I believe that I cannot do
better than to place the two sketches together as if they both belonged
strictly to one and the same period of time.

  [Illustration: FIG. 26. FRÈRE JACQUES DE BEAULIEU.

  Born in 1651 in the village of Létendonne, Franche-Comté, France.

  (From the steel engraving in the treatise _De la Taille
  Latérale par le Périnée_, etc., by Pascal Baseilhac, nephew
  of Frère Côme, Paris, 1804.)]

(_a_) Frère Jacques--or Brother James, who was born in 1561 at the
village of Létendonne, near Lons-le-Saulnier, Central France,--learned
the art of operating for stone in the bladder from an Italian surgeon
named Paulony, and acted as his assistant or associate up to the time
when he became a monk of the Order of Saint Francis--that is, of that
branch of the Order which had its chapter house at Feuillants in
Languedoc. He traveled about the country offering to treat gratuitously
all persons affected with stone in the bladder who were willing to
trust him, and he made it a rule, whenever such a thing was possible,
always to operate in the presence of one or more physicians or
surgeons. He was also ready at all times to give instruction to those
who wished to learn his method of procedure. He never asked to be
remunerated, but was always pleased to receive from his patients a
written testimonial of what he had done for them. Out of the moneys
which he received from the rich he retained only that which he required
for his own support and for the purchase of such instruments as he from
time to time required; the balance he distributed among the poor. He
was very faithful in performing his religious duties, and he succeeded
in gaining the good will and esteem of everybody with whom he had any
dealings.

For a long time it was customary in France to credit Frère Jacques
(Fig. 26) with the invention of the lateral method of operating for
stone in the bladder. This, however, was an error, for Franco, on page
95 of E. Nicaise’s reproduction of the 1561 edition, describes this
operation clearly. It must therefore have been invented a long time
before Frère Jacques was born. The text (rendered into English) reads
as follows: “... the incision should be made between the anus and the
testicles, two or three finger-breadths to one side of the commissure
or perinaeum [median line of the perinaeum].” This is said to be the
earliest clear description of the first step of the lateral operation
of which we have any knowledge.

In 1697, when Frère Jacques visited Paris, he had already attained
wide celebrity as a lithotomist; the number of his successful
operations--all of which had been performed according to the lateral
method of procedure--having reached a grand total of several thousand.
He therefore had a right to suppose that his visit would prove
acceptable to the physicians of that metropolis; but the published
account of this visit reveals plainly the fact that the surgeons of
that city were not at all pleased that an itinerant lithotomist from
one of the provinces should have the effrontery to request permission
of the authorities to exhibit his method before the Medical Faculty of
Paris. His request, however, was granted, and he was allowed to operate
on a man, forty years old, at Hôtel-Dieu. He performed the operation
before a large assembly of physicians, and, after the stone had been
successfully extracted, the patient made a prompt recovery. A short
time afterward he operated upon another patient at Fontainebleau in the
presence of several physicians, one of whom was Monsieur Félix, the
First Surgeon of the King, Louis the Fourteenth. In this case also, as
well as in several later cases, Frère Jacques was entirely successful,
and he now began to be treated by the public with marked consideration.
But, in a short time, owing to the jealousy exhibited by a large clique
of Paris surgeons, who were encouraged to pursue this course by Mery,
the Head Surgeon of Hôtel-Dieu, Frère Jacques was finally forced to
leave Paris. I cannot follow him on his further wanderings throughout
Europe, from the leading cities of Holland, Belgium and Switzerland to
Vienna and Rome. In 1716 he retired to Besançon and lived there quietly
up to the time of his death in 1719. But even then his enemies--men to
whom he had never done the slightest harm--did their best to destroy
the last traces of his existence. A visit made to Besançon by one of
his acquaintances not long after our Franciscan monk’s death, revealed
the fact that his name had been erased from the church registry of
deaths. The lateral method of operating for stone, which had been
revived and thoroughly developed by him, still finds favor among the
best surgeons of our own day; and the names of those mean-spirited men
who tried so hard to injure him have long since passed into complete
oblivion.

  [Illustration: FIG. 27. JEAN BASEILHAC, COMMONLY KNOWN IN FRANCE AS
  FRÈRE CÔME.

  (From the steel engraving in Pascal Baseilhac’s treatise.)]

  [Illustration: FIG. 28. CONCEALED LITHOTOME INVENTED BY FRÈRE CÔME IN
  1748.

  (From the steel engraving in Pascal Baseilhac’s treatise.)]

(_b_) Frère Jean de Saint-Côme,--or Brother John of Saint
Cosmas,--whose real name was Jean Baseilhac, was born in 1703 at
Poyestruc, Department of Hautes-Pyrenées, France. He received his
instruction in the principles of medicine from his father and his
grandfather, both of whom were regularly enrolled Masters in Surgery.
In 1722, when there could no longer be any doubt about young
Baseilhac’s settled purpose to fit himself for the practice of
medicine, his father sent him to Lyons, where his uncle, who was
himself a surgeon, would be able to superintend the boy’s further
training. Through the latter’s influence, young Baseilhac was allowed
to enter the Hôtel-Dieu of that city as one of its regular pupils.
At the end of two years--_i.e._, in 1724--he left Lyons and
went to Paris, where he hoped to add materially to his stock of
professional knowledge. His first step, after reaching the metropolis,
was to enter the service of a surgeon in active practice; and then,
aided by the latter’s influence, he succeeded (in 1726) in entering
the Paris Hôtel-Dieu as one of the regular pupils. Soon after he
had completed his term of service at the hospital, he was appointed
Physician-in-Ordinary to the Prince-Bishop of Bayeux, in Normandy. The
death of the latter in 1728, less than two years after Baseilhac had
entered his service, came as a great blow to the young surgeon, for he
had learned to esteem him very highly. In his will the Bishop left a
small legacy to Baseilhac--that is, a sum of money sufficient to pay
for the regular course of instruction at the Medical School of Saint
Cosmas in Paris, and also to procure a complete outfit of surgical
instruments. In 1740 he became a member of the Feuillants Branch of
the Franciscan monks, it being understood, however, that he was to be
allowed the special privilege of practicing surgery among the poorer
classes. Through accidental circumstances he was led gradually to drop
general surgery and to confine his work to operations for stone. His
official name at this time was “Frère Jean de Saint-Côme,” or simply
“Frère Côme.” (Fig. 27.) As he gained in experience as a lithotomist,
he became convinced that the method which his predecessor, Frère
Jacques, had practiced with such great success, was preferable to the
more complicated and more dangerous plan commonly pursued by surgeons
at that time, and thereafter he adopted it in all his cases. But he
modified the procedure to a certain extent; that is, he invented an
instrument by means of which the actual cutting of the perinaeum was
accomplished with a concealed knife (see Fig. 28). The chief advantage
to be gained by the employment of this instrument consisted--as was
claimed by Frère Jean and his nephew, Pascal Baseilhac,--in the fact
that in this way the danger of making the incision in the wrong place,
or of too great length, was materially diminished.

The first patient upon whom the new instrument was tried (October 8,
1748), was a dealer in lime, sixty years of age and in rather delicate
health. In less than three weeks after the operation, he was entirely
cured. Subsequently the instrument was employed in a large number of
instances, and the method was found to be most satisfactory; successful
results being obtained--on the average--in twelve out of thirteen
cases, whereas the best results previously obtained by the method
commonly employed at that period was 50 per cent of cures. At a still
later date the statistics showed even better results--viz., 96 cures in
one group of 100 cases, and 316 cures in a second group of 330 cases.

Owing to the rapidly increasing number of patients affected with stone
in the bladder who wished to be operated upon by Frère Jean himself, he
established in Paris in 1753, near the Saint Honoré gateway, a special
hospital for lithotomy cases, and kept it in active service up to the
time of his death. The laboring classes, and the poor in general, were
not expected to pay any fees, and indeed money was often bestowed
upon these people when they left the hospital, to enable them to
return comfortably to their villages; those in moderate circumstances
were asked to pay only the expenses that had been incurred in their
behalf; and the well-to-do made such voluntary contributions as they
thought proper toward the support of the hospital. The registers of the
institution showed that, first and last, over one thousand operations
had been performed there, either by Frère Jean or by his nephew, Pascal
Baseilhac. Our monk’s death occurred on July 8, 1781.


                                THE END




           LIST OF THE MORE IMPORTANT AUTHORITIES CONSULTED


   ARISTOTLE: HISTORY OF ANIMALS, translated by Richard Cresswell,
   London, 1902.

   ASCHOFF, L.: KURZE UEBERSICHTSTABELLE ZUR GESCHICHTE DER
   MEDIZIN; forms the second part of Schwalbe’s treatise (_q.v._).

   BAAS-HANDERSON: HISTORY OF MEDICINE, New York, 1910.

   BASEILHAC, PASCAL: DE LA TAILLE LATÉRALE PAR LA PÉRINÉE, ET
   CELLE DE L’HYPOGASTRE, OU HAUT APPAREIL, Paris, 1804. (Includes
   an account of the career of Frère Côme.)

   BERENDES, J.: DAS APOTHEKENWESEN, Stuttgart, 1907.

   BOERHAAVE: A NEW METHOD OF CHEMISTRY, translated by Peter Shaw,
   M.D., London, 1741; APHORISMS, etc., English translation,
   London, 1742.

   BOTTEY, F.: TRAITÉ THÉORIQUE ET PRATIQUE D’HYDROTHÉRAPIE
   MÉDICALE, Paris, 1895.

   BROUSSAIS, F. J. V.: EXAMEN DES DOCTRINES MÉDICALES,
   troisième edition (4 vols.), Paris, 1829–1834.

   CABANÈS: PARACELSE--L’HOMME ET L’ŒUVRE, article in _La Revue
   Scientifique_, Paris, May 19, 1894.

   CASALIS: DE PROFANIS ROMANORUM RITIBUS; Chapter VII., DE
   AESCULAPIO, Rome, 1644.

   CELSE, A. C.: TRAITÉ DE MÉDECINE; traduction par le Dr. A.
   Védrènes, Paris, 1876.

   CHEREAU: LES ANCIENNES ÉCOLES DE MÉDECINE DE LA RUE DE LA
   BUCHERIE, Paris, 1866.

   CULLEN, WILLIAM: FIRST LINES OF THE PRACTICE OF MEDICINE,
   Edinburgh, 1802. (2 vols.)

   DAREMBERG, CHARLES: ŒUVRES ANATOMIQUES, PHYSIOLOGIQUES ET
   MÉDICALES DE GALIEN, 2 vols., Paris, 1854–1856; ÉTAT DE LA
   MÉDECINE ENTRE HOMÈRE ET HIPPOCRATE, Paris, 1869; HISTOIRE DES
   SCIENCES MÉDICALES, 2 vols., Paris, 1870.

   DEZEIMERIS, OLLIVIER ET RAIGE-DELORME: DICTIONNAIRE HIST. DE LA
   MÉD. ANC. ET MOD., 3 vols., Paris, 1828–1837.

   DIOSKURIDES, PEDANIOS: ARZNEIMITTELLEHRE, Uebersetzung von Dr.
   J. Berendes, Stuttgart, 1902.

   DORVEAUX, PAUL: L’ANTIDOTAIRE NICOLAI (NICOLAUS PRAEPOSITUS),
   Paris, 1896.

   FALK: GALEN’S LEHRE VOM GESUNDEN UND KRANKEN NERVENSYSTEME,
   Leipzig, 1871.

   FINCKENSTEIN: ZUR GESCHICHTE DER SYPHILIS, Breslau, 1870.

   FOSSEL, VIKTOR: HIERONYMUS FRACASTORO; DREI BUECHER VON DEN
   CONTAGIEN, DEN KONTAGIOESEN KRANKHEITEN UND DEREN BEHANDLUNG
   (1546), Leipzig, 1910.

   FRANCO, PIERRE: CHIRURGIE, Nouvelle édition par E. Nicaise,
   Paris, 1895.

   FREIND, J.: THE HISTORY OF PHYSICK, 2d edition, London, 1727. (2
   vols.)

   FRIEDLAENDER, L. H.: VORLESUNGEN UEBER DIE GESCHICHTE DER
   HEILKUNDE, Leipzig, 1839.

   FROELICH, H.: GALEN UEBER KRANKHEITSVORTAEUSCHUNGEN, in
   Friedrich’s Blaetter fuer Gerichtliche Medicin, I. Heft,
   vierzigster Jahrgang, Nuernberg, 1889.

   GERMAIN, A.: L’ÉCOLE DE MÉDECINE DE MONTPELLIER, Montpellier,
   1880.

   GUERINI: A HISTORY OF DENTISTRY, etc., Philadelphia and New
   York, 1909.

   VON GURLT: GESCHICHTE DER CHIRURGIE, Berlin, 1898. (3 vols.)

   GUY DE CHAULIAC: LA GRANDE CHIRURGIE, edited by Edouard Nicaise,
   Paris, 1890.

   HAESER, H.: LEHRBUCH DER GESCHICHTE DER MEDICIN, zweite Ausgabe,
   Jena, 1868. (3d edition, 1875.)

   VON HALLER, ALBERT: BIBLIOTHECA MEDICINAE PRACTICAE, Basel,
   1776. (4 vols.)

   HERODOTUS: HISTORY, translated by George Rawlinson, M.A. (2
   vols.)

   HIPPOCRATES: SAEMMTLICHE WERKE, translated into German by Dr.
   Robert Fuchs (3 vols.), Munich, 1895–1900.

   HIRSCH, AUGUST: GESCHICHTE DER MED. WISSENSCHAFTEN IN
   DEUTSCHLAND, Muenchen und Leipzig, 1893.

   HOLLAENDER, EUGEN: DIE MEDIZIN IN DER KLASSISCHEN MALEREI,
   Stuttgart, 1903; PLASTIK UND MEDIZIN, Stuttgart, 1912.

   HOMER: THE ILIAD AND THE ODYSSEY, published by Dent & Sons,
   London. (2 vols.)

   HYRTL, JOSEPH: LEHRBUCH DER ANATOMIE DES MENSCHEN, Vienna, 1846.

   JUSSERAND, J. J.: ENGLISH WAYFARING LIFE IN THE MIDDLE AGES
   (14th century), G. P. Putnam’s Sons, New York and London, 1889.

   LABOULBÈNE, M. A.: SYNDENHAM ET SON OEUVRE, article in the
   _Revue Scientifique_, Tome XLVIII, November 28, 1891.

   LE CLERC, DANIEL: HISTOIRE DE LA MÉDECINE, Amsterdam, 1723.

   LE CLERC, LUCIEN: HISTOIRE DE LA MÉDECINE ARABE (2 vols.),
   Paris, 1876.

   LEMOINE, ALBERT: LE VITALISME ET L’ANIMISME DE STAHL, Paris,
   1864.

   MALGAIGNE: OEUVRES COMPLÈTES D’AMBROISE PARÉ, 1840–1841, (3
   vols.)

   MEYER-STEINEG: CORNELIUS CELSUS UEBER GRUNDFRAGEN DER MEDIZIN,
   Leipzig, 1912; KRANKEN-ANSTALTEN IM GRIECHISCHROEMISCHEN
   ALTERTUM, Jena, 1912.

   VON MEYER, E.: GESCHICHTE DER CHEMIE, 3d edition, Leipzig, 1905.

   MOMMSEN, THEODORE: THE HISTORY OF ROME, translated from the
   German by W. P. Dickson and published by Dent & Sons, London.

   MUENZ, ISAAC: UEBER DIE JUEDISCHEN AERZTE IM MITTELALTER,
   Berlin, 1887.

   NEUBURGER, ALBERT: FRIEDRICH HOFFMANN UEBER DAS KOHLENOXYDGAS,
   Leipzig, 1912.

   NEUBURGER, MAX: GESCHICHTE DER MEDIZIN, Vol. I. and Vol. II.,
   zweiter Theil, 1906–1911.

   OPITZ, KARL: DIE MEDIZIN IM KORAN, Stuttgart, 1906.

   ORDRONAUX, JOHN: _Regimen sanitatis Salernitanum_, translated
   into English verse, Philadelphia, 1871.

   PAGEL, JULIUS: EINFUEHRUNG IN DIE GESCHICHTE DER MEDICIN,
   Berlin, 1898.

   PESSINA VON CECHOROD, W. M.: HEILIGE AERZTE UND PFLEGER DER
   KRANKEN, Prag, 1859.

   PETERSEN, JULIUS: HAUPTMOMENTE IN DER GESCHICHTLICHEN
   ENTWICKELUNG DER MEDICINISCHEN THERAPIE, Copenhagen, 1877.

   PLATO: THE REPUBLIC, TIMAEUS, AND CRITIAS, translated by Henry
   Davis, London, 1911.

   PLATTER, FELIX ET THOMAS, à Montpellier (1552–1557; 1595–1599),
   Montpellier, 1892.

   PRISCIANUS, THEODORUS: uebersetzt von Dr. Meyer-Steineg, Jena,
   1909.

   PUSCHMANN, THEODOR: THE ORIGINAL GREEK TEXT AND A GERMAN
   TRANSLATION OF ALEXANDER OF TRALLES, Vienna, 1878; and
   GESCHICHTE DES MEDICINISCHEN UNTERRICHTS, Leipzig, 1889.

   RUFUS D’EPHÉSE: OEUVRES, traduites par Daremberg et Ruelle,
   Paris, 1879.

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   1861.

   SALICET, GUILLAUME DE: CHIRURGIE, traduction par Paul Pifteau,
   Toulouse, 1898.

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   ARZNEIKUNDE (5 vols.), Halle, 1821–1828.

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   London.

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   WISEMAN, RICHARD: EIGHT SURGICAL TREATISES, 5th edition, London,
   1719.




                             GENERAL INDEX


                                   A

    ABDOMEN, penetrating wounds of, 469

    ABELLA, teacher of medicine at Salerno, 245

    ABOU BEKR, distinguished Arab physician in Spain, 232

    ABOU SAHL EL MESSIHY, distinguished Persian physician, 223

    ABSCESS, mediastinal, 229

    ABULCASIS, famous Arab surgeon, 226

    ABULPHARAGIUS, 184

    ACADÉMIE DE CHIRURGIE, Paris (1731), 450

    ACADÉMIE DES CURIEUX DA LA NATURE, 364

    ACADÉMIE DES SCIENCES, 363

    ACCADEMIA DEI LINCEI, Rome, 364

    ACCADEMIA DEL CIMENTO, Florence, 364

    ACRABADIN KEBIR, 209

    ACUPRESSURE, 143

    ADAMS, FREDERICK, 89

    AEGIDIUS CORBOLIENSIS, 255

    AENEAS, wounded in groin, 49

    AESCULAPIUS, 47, 49
      symbol of, 315
      temple of, at Cos, 514

    AËTIUS, 194, 318

    AFFLACIUS, JOHN, 245, 248

    AGATHINUS, 142

    AGRATE, MARCO, 339

    AIGLE, daughter of Aesculapius, 50

    ALAE NASI, Galen’s comments on movements of, 173

    ALBERT VON BOLLSTEDT (Albertus Magnus), 269

    ALCMAEON, 73, 79

    ALDEROTTI, THADDEUS, 272

    ALEXANDER OF TRALLES, 195

    ALEXANDER PHILALETHES, 115

    ALEXANDER THE GREAT, 100

    ALEXANDRIA, EGYPT, 100, 116

    ALHAZEN, researches in optics, 233

    ALKALOIDS (quintessences of Paracelsus), 405

    ALMANSUR, Caliph of Bagdad, 184, 203

    ALMENAR, JUAN, 544

    ALPHANUS II., Abbot of Monte Cassino, 239

    ALSAHARAVIUS, 227

    ALU, 13

    AMATUS LUSITANUS, 484, 487

    AMBROSIA, antidote for poisons, 112

    AMPUTATION OF LEG (Fig.), 463

    AMROU, 116, 185

    AMULETS and other magical remedies, 197

    ANAESTHESIA, SURGICAL, from employment of soporific sponges, 253,
      462

    ANATOMICAL DEMONSTRATIONS at Salerno, 253

    ANATOMICAL SPECIMENS, preservation of, 356

    ANATOMY AND PHYSIOLOGY, important discoveries during 16th century,
      353

    ANATOMY, importance of study of, 312

    ANATOMY, MICROSCOPIC, 360

    ANAXIMANDER, 72

    ANAXIMENES, 72

    ANDREAS OF CARYSTUS, 114

    ANIMISM, 405, 432

    ANTIDOTARIUM, early name for pharmacopoeia, 319

    ANTIDOTARIUM NICOLAI, 548

    ANTIMONY, curative action of, 158, 548

    ANTIOCHUS, cured by Erasistratus, 106

    ANTONINUS PIUS, 57

    ANTRUM OF HIGHMORE, 359

    ANTYLLUS, 143, 201

    APES, dissection of, 164

    APOLLO, the god of medicine, 18, 50

    APOLLONIUS MUS, 111

    APOTHECARY, 316, 319

    APPARATUS MAGNUS (operation for stone in the bladder), 474

    APULEIUS, LUCIUS, 120, 126

    AQUA VITAE, how prepared, 313

    ARABIAN PHYSICIANS, dogmatism of, 412

    ARAB RENAISSANCE, 203, 217, 233, 259

    ARANTIAN OPERATION, a substitute for Tagliacotian operation, 481

    ARANZIO or ARANTIUS, 349, 481

    ARCEO, FRANCISCO, 484, 486

    ARCHAEUS INFLUUS and ARCHAEUS INSITUS, 399

    ARCHAGATHUS, 119

    ARCHIGENES, 142, 174
      on ligation of larger blood-vessels before amputation of a limb,
        470

    ARCHIMATHAEUS, 248

    ARDERNE, JOHN, 307

    ARETAEUS, 144

    ARISTOPHANES, 58

    ARISTOTLE, 73, 102, 433
      commentary by Averroes, 229

    ARNOLD, of Villanova, 292–296

    ARROW, EXTRACTION OF, from chest during battle (Fig.), 461

    ARS PARVA, of Galen, 248

    ARTERIES, ligaturing of divided, after an amputation, 289

    ARTERIOTOMY, for relief of hemicrania, 470

    ARTERY FORCEPS devised by Ambroise Paré, 512

    ASAKKU, the demon who produces fever in the head, 13

    ASCLEPIADES, founder of a new sect at Rome, 116, 119, 122

    ASCLEPIEIA, 50, 52, 57

    ASCLEPIEION at Cos (Figs.), 53
      at Epidaurus, 52

    ASELLI, CASPAR, 385

    ASSYRIAN MEDICINE, 11

    ASTRINGENTS, 133

    ASTROLOGER, a typical, 12

    ASTROLOGERS in Babylonia, 14

    ASTRUC, JEAN, 548

    ATHENAEUS, founder of sect of Pneumatists, 141

    ATHENS, a great medical centre, 96
      epidemic of the Plague at, 96

    ATHLETIC EXERCISES as a therapeutic measure, 69

    ATHOTIS, 17

    AUGUSTUS, Roman Emperor, cured of gout by hydrotherapy, 129

    AURICLES OF THE HEART, comments on, by H. de Mondeville, 290

    AUSCULTATION of the chest, 20, 159

    AUSTRICHILDIS, King Guntram’s wife, 240, 241

    AUTHORS, numerous in Cordova in 12th century, 232

    AVERROES, pupil of Avenzoar, 229

    AVERROISM, 267

    AVENZOAR, 228

    AVICENNA, 221


                                   B

    BABYLONIA, genuine remedial agents employed in, 13

    BABYLONIAN ASTROLOGERS, 14

    BABYLONIANS, strange beliefs held by, in regard to human anatomy
      and physiology, 13

    BACON, FRANCIS, 338

    BACON, ROGER, 271

    BACTERIOLOGY, first studies in, 362

    BAGDAD, a second great hospital founded at, in A. D. 914, 219

    BAIN, CHRISTOPHER, 396

    BAKHTICHOU BEN DJORDIS, 205, 207

    BAKHTICHOU, GEORGE, 205

    BARBARIC LATIN, 262

    BARBERS, the earliest surgeons in France, 530

    BARBERS AND BARBER-SURGEONS, 282, 369, 449, 464

    BARBER-SURGEONS’ COMPANY, of London, 519

    BARTHOLOMAEUS, 245

    BASEILHAC, JEAN, 552

    BASEILHAC, PASCAL, 496

    BASEL, public dissection of human body at, 455
      visited by Vesalius in 1542, 455

    BATHS extensively used by ancients, 157, 323

    BAUDELOCQUE, 539

    BEDE, THE VENERABLE, believed in cures by supernatural means, 241

    BELLADONNA, when first used for dilating the pupils, 157

    BENEDICTINE MONASTERY on Monte Cassino, 238

    BENIVENI, ANTONIO, 389, 498

    BENVENUTO CELLINI, 341

    BERENDES, 159, 317, 322, 426

    BERENGARIUS OF CARPI, 342, 374

    BERNARDO DI RAPALLO, 472

    BERTHARIUS, abbot of Monte Cassino, 239

    BERTHELOT, on Geber, 320

    BERTRUCIUS, 310

    BILE, black and yellow, 86
      manner of production, 109

    BLADDER, tuberculous ulceration of, 200

    BLANCAARD, STEPHEN, 359

    BLOOD, inflammation of (Sydenham), 423
      production of, according to Erasistratus, 109
      spirituous, 373
      transfusion of, 408

    BLOODLETTING, comments on, by Celsus, 152
      from a vein, technique, 152
      how practice first originated, 6
      rule of Hippocrates regarding, 411
      under what circumstances advisable, 133

    BLOOD-VESSELS, CAPILLARY, circulation in, 383
      when first injected artificially, 356, 359

    BOERHAAVE, HERMANN, 144, 438, 441
      gives clinical instruction at Leyden, 430
      treatise on chemistry the standard for many years, 440

    BOILING OF DRINKING WATER practiced by ancient Persians, 26

    BOLOGNA MEDICAL SCHOOL, 272, 281, 332

    BONIFACE VIII., POPE, successfully treated for stone in the
      bladder, 293

    BOOKS, great demand for, in 15th century, 329

    BORELLI, ALPHONSO, 368

    BOTALLO, LEONARDO, 413

    BOTANICAL GARDENS, 17, 392, 393

    BOUGIES, URETHRAL, 495

    BOURGEOIS, LOUISE, 536

    BOYLE, ROBERT, a distinguished chemist, 406

    BRANCA, father and son, skilled in rhinoplasty, 459

    BRASSAVOLA, experimental pharmacologist, 398

    BREVIARIUM, ARNOLD’S, 294

    BRIGGS, WILLIAM, 545

    BRISSOT, PIERRE, 411

    BRONZE SURGICAL KNIVES, 16

    BROWNE, ANDREW, the friend of Sydenham, 422, 424

    BRUNNER, JOHANN CONRAD, 359

    BRUNSCHWIG, HIERONYMUS, 456

    BRUNUS, 277

    BULLETS not hot when they enter the flesh, 513

    BURINNA, name of spring on the Island of Cos, 54

    BYZANTIUM, the new capital of the Roman Empire, 180


                                   C

    CABANÈS, 402

    CACAO, 395

    CAELIUS AURELIANUS, 132, 159

    CAESAR, JULIUS, liberality of, toward foreign physicians settled
      in Rome, 119

    CAESALPINUS, ANDREAS, 372, 375, 394

    CAESARIAN SECTION, 396, 534

    CAIRO PHYSICIANS distinguished ophthalmologists, 225

    CALCAR, Vesalius’ draughtsman, 344

    CALCULUS in the bladder may not be dissolved by internal remedies,
      498

    CALLIDUM INNATUM of Hippocrates, 415

    CALVIN, JOHN, visited by Felix Platter, 335

    CANCER OF BREAST, sculptured in marble (Fig.), 68

    CANCER, ULCERATED, not to be cauterized, 285

    CANNANI, 378

    CANON, THE, of Avicenna, 222

    CAPSICUM, 395

    CARAKA, East Indian medical author, 31

    CARBONIC ACID, nature of, expounded by Van Helmont, 400

    CARBONOUS OXIDE, 434

    CARCANO LEONE, 475, 476

    CASE HISTORIES recorded on tablets, 67

    CASSIODORUS, 238

    CASTOR OIL, perfected by Apollonius Mus, 111

    CATARACT OPERATIONS of Pierre Franco, 494

    CATO, MARCUS PORCIUS, 117, 235

    CAUSTICS, too freely used as haemostatics, 466

    CAUTERIZATION of ulcerated cancer not approved by Lanfranchi, 285

    CAUTERIZING INSTRUMENTS, 279

    CELSUS, AULUS CORNELIUS, 150, 151, 155

    CEREBRAL NERVES, crossing of, in relation to paralysis of one side
      of the body, 144

    CERMISONE, ANTONIO, 313

    CHAMBERLEN, HUGH, 538

    CHALDEAN DOCTRINE OF NUMBERS, 74

    CHARCOAL, fumes of burning, 435

    CHAUCER’S ACCOUNT of a clever physician, 308

    CHEMICAL ELEMENT defined, 407

    CHEMISTRY in ancient Egypt, 17
      modern, developed gradually from alchemy, 320

    CHICORY an effective remedy in abdominal diseases, 109

    CHINESE CONCEPTIONS concerning human physiology, 41

    CHINESE MEDICINE, 38, 39

    CHIRON, 48

    CHRISTIANITY, influence of, upon evolution of medicine, 179

    CHRYSIPPUS, 141

    CHYLE, distribution of, after it leaves the stomach, 109

    CHYLE DUCTS, discovery of, 385

    CICERO’S INTERPRETATION of the expression “gods” as employed by
      the ancients, 18

    CINCHONA, discovery of, 408

    CIRCA INSTANS, the title commonly given to treatise of Matthew
      Platearius, 253

    CIRCULATION OF BLOOD, Galen’s physiology of, 373
      de Mondeville’s comments, 289

    CITIZENSHIP, rights of, bestowed by Julius Caesar on all foreign
      physicians practicing in Rome, 119, 130

    CIVITAS HIPPOCRATICA, 243

    CLAUDIUS, Roman Emperor, merciful action of, toward slaves, 235

    CLEMENS, of Alexandria, Egypt, 17

    CLEMENT IV., POPE, protects Roger Bacon, 272

    CLEMENT V., POPE, removes papal seat from Rome to Avignon, 293

    CLINICAL INSTRUCTION at Leyden Hospital, 429

    CLOWES, William, 519

    CNIDIAN SCHOOL OF MEDICINE, 81

    CNIDUS, in Caria, Asia Minor, 51

    COCA, 395

    COLD, exposure to, unusual treatment of, 489

    COLLEGE OF PHYSICIANS, London, 417

    COLLEGE OF SAINT COSMAS, Paris, 283, 284, 448

    COLLIGET, title of treatise written by Averroes, 229

    COLOT, LAURENT, famous French lithotomist, 474

    COLUMBUS, REALDUS, 349
      experiments relating to physiology of heart, 377

    CÔME, FRÈRE, 550

    COMMUNITIES, term employed by the Methodists for designating the
      two conditions “laxum” and “strictum,” 130

    COMPENDIUM AROMATARIORUM, the first modern treatise on materia
      medica, 320

    COMPENDIUM SALERNITANUM, 246

    CONCILIATOR, title of one of Pietro d’Abano’s great works, 266, 267

    CONSTANTINOPLE, taking of, by the Turks, an important aid to the
      advance of medicine, 328

    CONSTANTINUS THE AFRICAN, 239, 248, 260

    CONTAGION, INNATE, 220

    CONTAGIOUS DISEASES, Fracastoro’s classification of, 390

    CONTINENS, title of Rhazes’ great work, 220, 262

    CONTRARIA CONTRARIIS, principle of, in therapeutics, 132

    COSMAS AND DAMIAN, 282, 449

    COPAIVA, BALSAM OF, 395

    COPHON, teacher of medicine at Salerno, 245

    CORDOVA, SPAIN, centre of great intellectual activity, 218, 232

    CORPSE, the touching of a, believed by the Persians to produce a
      special contamination, 25

    COS, ISLAND OF (Figs.), 53

    COSTA BEN LUCA, 215, 216

    COSTANZA CALENDA, 245

    COWPER, WILLIAM, 360

    CROKE, A., 250

    CRONOS, 19

    CROTONA, ITALY, 51

    CULLEN, WILLIAM, 432

    CURTIS, JOHN G., 72, 140

    CYRENE, in Lybia, Africa, 51

    CYSTOTOMY, HYPOGASTRIC, 495


                                   D

    DAMASCUS, an active medical centre in the 13th century, 225, 232

    DAREMBERG, 50, 75, 240, 420

    DARIUS I., King of the Persians, 26, 75

    DAVID’S HARP-PLAYING, effect of, on King Saul’s melancholia, 27

    DA VINCI, LEONARDO, 339

    DAZA CHACON, 484

    DE LE BOË, FRANZ, 427

    DE MARCHETTIS, DOMENICO, 359

    DEMETRIUS, OF APAMEA, 114

    DEMOCEDES, 73, 75

    DEMOCRITUS, 82

    DEMOSTHENES, OF MARSEILLES, 115

    DENYS, OF PARIS, 408

    DESIDERIUS, Abbot of Monte Cassino, 239

    DEZEIMERIS, 341, 400

    DIETETICS OF PREGNANT WOMEN, 199

    DIETING AND ATHLETIC EXERCISES, 69

    DIETZ, REINHOLD, discoverer of an early Greek manuscript of
      Soranus, 138

    DIGESTION, physiology of, according to Erasistratus, 108
      according to Aretaeus, 144

    DIOCLES, of Carystos, 103

    DIONIS, PIERRE, distinguished French anatomist, 41, 364, 383, 540

    DIOSCORIDES, PEDANIUS, 157, 317

    DIPHTHERIA, GENUINE, recognized by Paracelsus, 405

    DIPHTHERIA, PHARYNGEAL, known in 2d century as Syriac ulcer, 144

    DISEASES mentioned in the papyrus Ebers, 20

    DISLOCATION OF SHOULDER, successfully reduced by Gabriel
      Bakhtichou, 207

    DISSECTING OF HUMAN BODIES, early attempts, 309, 327, 331
      practice approved by University of Salamanca, 346
      practice made obligatory in the medical schools early in 18th
        century, 364

    DISTEMPERS of the stiff and elastic fibres (Boerhaave), 442

    DIVINE WATER of the alchemists, 321

    DJONDISABOUR, early establishment of a medical school at, 184, 204

    DOCTOR, when first employed as a title, 280

    DODOENS, REMBERT (Dodonaeus), 395

    DOGMATISTS, sect of the, 101, 103, 149

    DONATO, MARCELLO, 396

    DON CARLOS, OF SPAIN, skull severely injured, 485

    DORVEAUX, PAUL, 548

    DOUGLAS, JAMES, 361

    DRACHMA, value of, 207

    DRACO, SON OF HIPPOCRATES, 82

    DRACUNCULUS MEDINENSIS, 233

    DRUGS, enumerated by Homer in the Odyssey, 18
      enumerated by Dioscorides, 18
      remedial effects of, 398

    DRY TREATMENT OF WOUNDS, 275, 285

    DUBOIS, JACQUES (Sylvius), the anatomist, 340, 345

    DYSENTERY, East Indian treatment of, 409


                                   E

    EAR, cherry pit in, 396
      fatal disease of, 489

    EAST INDIAN SURGEONS performed suprapubic cystotomy before the
      Christian era, 497

    EBEN EL KHAMMAR, a distinguished Persian physician, 222

    EBERS PAPYRUS, the, 20

    ECLECTICS, THE, 142, 149

    EGYPT, ANCIENT, practice of medicine in, 16, 17
      process of embalming in, 17
      temples were used as hospitals and as medical schools, as well as
        for purposes of worship, 19

    EGYPTIANS, THE ANCIENT, surgical instruments used by, 21
      surgical methods employed by, 21
      therapeutics of, 20
      they were good sanitarians, 23
      they were the originators of many of the Mosaic laws, 27

    ELEATIC SCHOOL OF PHILOSOPHY, 73

    ELBOW-JOINT, EXARTICULATION OF, 508

    ELECTRIC RAY, shocks communicated by, utilized in treatment of
      severe headache, 155

    ELISHA THE PROPHET cures Naaman’s so-called leprosy, 27

    EMBALMING, Egyptian process of, 17

    EMIR ADHAD EDDOULA founds a great hospital at Bagdad, 219

    EMPEDOCLES (444 B. C.) places the seat of the hearing in the
      labyrinth of the temporal bone, 80

    EMPIRICS, sect of the, 101, 111, 149

    ENCYCLOPAEDISTS, the, 156

    EPICUREANS, the, 102

    EPIDAURUS, in Argolis, Greece, 51

    EPIONE, wife of Aesculapius, 50

    ERASISTRATUS, 104, 106, 110
      teachings of, with regard to nature of the blood and the
        circulation, 371

    ERASMUS, on Linacre, 418

    ÉTIENNE, ROBERT, 197

    EUENOR, 99

    EULER, LEONHARD, 360

    EUPORISTA, title of Oribasius’ treatise, 192

    EUPORISTON, title of treatise by Priscianus, 193

    EUSTACHIUS, BARTHOLOMAEUS, 345, 348, 358, 384

    EVIL SPIRITS, part played by, in producing disease, 8

    EXERCISE, physical, not absolutely necessary to persons in normal
      health, 125

    EXPERIENCE, great value attached to, by Hippocrates, 148


                                   F

    FABIOLA, the widow, established the first hospital in Rome, 235

    FABRICIUS AB ACQUAPENDENTE, 349, 351, 378, 478

    FABRICIUS OF HILDEN, 464

    FACIAL HEMIPARESIS, sculptured in marble (Fig.), 68

    FALLOPIUS or FALLOPPIUS, GABRIELE, 341, 348, 360, 393, 474, 478

    FARRAGUT, of Girgenti, Sicily, 262

    FAUST, JOHANNES, 322

    FEDELES, FORTUNATUS, 398

    FEES, MEDICAL, in Babylonia, 15

    FEVER, NATURE OF, as taught by Sydenham, 423

    FELDBUCH DER WUNDARTZNEY, von Gerssdorff’s, 462

    FEMUR, FRACTURE OF, 510

    FERMENT IN BLOOD the cause of small-pox (Rhazes), 220

    FERNEL, JEAN, 414

    FILARIA MEDINENSIS, removal of, from boy’s leg, 489

    FINCKENSTEIN, 543

    FISTULA IN ANO, John Arderne’s treatise on, 307

    FLAMMULA, 522

    FLINT KNIVES, 9

    FLOS MEDICINAE, title of medical treatise, 251

    FLOURENS, 374

    FORAMEN BOTALLI, 413

    FORCEPS for crushing stone in the bladder (Fig.), 497

    FORCEPS, obstetrical, invention of, 535

    FOREEST, PETER, 413

    FORMULARY of Sabour ben Sahl, 209

    FOSSEL, 391

    FRA SARPI, 378

    FRACASTORO, HIERONYMUS, 221, 362, 389, 391

    FRANCO, PIERRE, 490, 494, 495, 497

    FRANCONIAN OPERATION, revived in 1719 by John Douglas of London,
      496

    FREDERICK II., King of Sicily, promotes work of translating from
      the Arabic, 261

    FREIND, JOHN, 184, 195, 416

    FRÈRE JACQUES DE BEAULIEU, 550

    FRIEDLAENDER, 3


                                   G

    GABRIEL, the most distinguished member of the Bakhtichou family,
      207

    GAIUS, OF NAPLES, a distinguished ophthalmologist, 115

    GALE, THOMAS, 517

    GALEAZZO DI SANTA SOFIA, Professor of Anatomy at Vienna, 311

    GALEN, CLAUDIUS, 74, 160, 316, 344
      on the nature of the blood, 372
      on the true function of respiration, 372
      on the treatment of wounds, 275
      treatises written by, 167

    GALENIC DOCTRINES, 400

    GALENICAL PREPARATIONS, 317

    GALENISM, meaning of the term, 388

    GALENISTS, ENGLISH, in 17th century, 419

    GALEN’S SYSTEM of therapeutics still used in Persia, 317

    GALILEO, 546

    GALLU, the demon who causes diseases of the hand, 13

    GARIOPONTUS, a teacher at Salerno, 245, 247

    GAS SYLVESTRE, 401

    GEBER, credited with being the founder of chemistry, 233
      now believed to be a mythical personage, 320

    GENTILE DA FOLIGNO, 266

    GERARD OF CREMONA, 227, 261

    GERM ORIGIN of certain febrile diseases suspected by Rhazes, 221

    GERMANY, devastated during the 17th century, 426
      medical education in (from 1400 to 1600), 454

    GERSSDORFF, HANS VON, 460

    GESNER, CONRAD, 394

    GILBERTUS ANGLICUS, 305, 516

    GILLES DE CORBEIL, on urology, 255

    GLADIATORS, SCHOOLS FOR, 68

    GLAUBER’S SALT, 410

    GLISSON, FRANCIS, 358, 546

    GLOSSULAE QUATUOR MAGISTRORUM, 280

    GORDONIUS, 296

    GOURDON, BERNARD DE (Gordonius), 296

    GOUT, remedy for, recommended by Aëtius, 195

    GRAAF, REIGNIER DE, 359, 361

    GRAPHEUS, BENEVENUTUS, celebrated eye surgeon of the 12th century,
      256

    GRAVES, ROBBING OF, for dissecting material, 309, 332, 336

    GREAT BRITAIN, condition of surgery in, during 16th and 17th
      centuries, 516

    GREEK PROVERBS relating to medicine, 77

    GREGORY, BISHOP OF TOURS, 241

    GRIFFON, JEAN, distinguished Genevese surgeon, 464

    GUAIAC, inefficient anti-syphilitic remedy, 405

    GUAINERIO, of Pavia, 496

    GUARNA, REBECCA, 245

    GUERICKE, OTTO VON, 546

    GUIDO GUIDI (Vidus Vidius), the anatomist, 340

    GUILLEMEAU, JACQUES, 536

    GUISCARD, ROBERT, a resident at Salerno, 240

    GULDINUS, PAUL, 409

    GUNPOWDER, first employment of, in European warfare, 328

    GUNSHOT WOUNDS, 467, 473

    GURLT, VON, 455

    GUY DE CHAULIAC, 227, 263, 298, 299, 310
      founder of didactic surgery, 300
      manner of treating injured nerves, 302
      manner of treating fractures of the thigh, 304

    GYMNASTIC EXERCISES, institutions for cultivating, 68

    GYNAECOLOGISTS, EARLY, 115

    GYNAECOLOGY successfully practiced by Soranus, 140


                                   H

    HALLER, ALBERT VON, 142, 344

    HALY, ABBAS, a Persian physician and the author of the famous
      treatise called “Al-Maleky”--“The Royal Book,” 223

    HAMMURABI’S LAW with reference to physicians’ fees in Babylonia, 15

    HARDERWYK, UNIVERSITY OF, 439

    HAROUN ALRASCHID, 206

    HARVEY, WILLIAM, discoverer of the circulation of the blood, 379

    HEAD, INJURIES OF (Wuertz), 467

    HEART, anatomy of, according to de Mondeville, 289
      physiology of, 377

    HEIDELBERG, UNIVERSITY OF, 454

    HELIODORUS, 202

    HELVETIUS, 409

    HEMORRHAGE FROM A WOUND, different means of arresting, 154, 277

    HENRY THE SECOND’s manner of death, 511

    HENSCHEL, researches of, 246

    HERAKLEIDES, OF TARENTUM, 111

    HERCULES an ancestor of Hippocrates, 81

    HERMETIC BOOKS relating to medicine, 18

    HERNIA, RADICAL CURE OF, by members of the Norsa family, 482

    HERNIA-HEALERS, 490

    HERODICUS, of Selymbria, 69

    HERODOTUS, a different person from the famous historian, 26, 142

    HEROPHILUS, a distinguished physician of Chalcedon, 104

    HERZOG, excavations made by, at Cos, 55

    HESYCHIOS, 201

    HEURNIUS, JOHANNES, clinical teacher at Leyden, 429

    HIGH OPERATION for stone in the bladder (_le haut appareil_), 495,
      496

    HIGHMORE, NATHANIEL, 359, 546

    HINDU PHYSICIANS held very crude ideas about pathology, 31

    HIPPOCRATES THE GREAT, 81, 82, 98, 411

    HIPPOCRATIC OATH, 71

    HIPPOCRATIC WRITINGS, French version of Littré, 83
      German version of Fuchs, 84
      short extracts, 89

    HIRSCH, AUGUST, 399, 545

    HOBEÏCH, 215

    HOFMANN, MORITZ, 358

    HOFFMANN, FRIEDRICH, 431, 434

    HOFFMANN’S ANODYNE, 437

    HOMERIC POEMS probably written about B. C. 800, 46

    HOMER’S FAMILIARITY WITH ANATOMY, 48

    HONEIN, 208, 212, 214, 317

    HOSPITAL GANGRENE, Wuertz’s views regarding, 469

    HOSPITALS in the Middle Ages, 219, 235

    HÔTEL-DIEU AT LYONS founded in the 6th century, 236, 450

    HÔTEL-DIEU AT PARIS over-crowded in early part of 16th century
      (Fig.), 452

    HRABANUS MAURUS, Abbot of Fulda Monastery, 241

    HUGO BENZI (Hugo of Siena), 312

    HUGO OF LUCCA, 275

    HYDROTHERAPY at the Cos _Asclepieion_, 54
      in the treatment of gout, 129

    HYGIEIA, daughter of Aesculapius, 50

    HYOSCYAMUS, when first used for dilating the pupils, 157

    HYRTL, JOSEPH, 311, 356, 532


                                   I

    IATREIA, or small private hospitals, 68

    IATROCHEMISTS and IATROPHYSICISTS in 17th century, 366

    IBRAHIM, pupil of George Bakhtichou, 206

    IDEA MORBOSA (Van Helmont), 399

    ILEO-CAECAL VALVE, discovery of, 350

    ILIAD AND ODYSSEY, references in, to medicine, 47

    INDIA, ANCIENT, rich in skilful surgeons, 35

    INDIA, great mortality in, from bites of venomous serpents, 64
      the medicine of, 31

    INGRASSIA, 349

    INNOCENT XI., POPE, 392

    INOCULATION against small-pox practiced by the Chinese in the 11th
      century, 43

    INTENTION, healing by first, 277

    INTESTINE, wounds of, 255, 459

    IONIAN SCHOOL OF PHILOSOPHY, 72

    IPECACUANHA, discovery of, 408, 409

    ISAAC, SON OF HONEIN, 215

    ISIS, 19

    ISOLA SAN BARTOLOMMEO, 51

    ISRAELITES, medicine of the, 26, 27

    ISSA BEN CHALATA, 205

    ITINERANT LITHOTOMISTS, 549


                                   J

    JACOBUS PSYCHRESTOS, 201

    JALAP, 395

    JAMERIUS, author of “Chirurgia Jamati,” 255

    JANISCUS, son of Aesculapius, 50

    JAPANESE PHYSICIANS, modern, 45

    JARDIN-DU-ROI, 540

    JASO, daughter of Aesculapius, 50

    JEAN DE VIGO, 472, 473

    JEWISH MEDICAL STUDENTS, numerous at Montpellier, 265

    JOHN of Arderne, 516
      of Capua, 261
      of Gaddesden, 305, 516
      of Salisbury, 264
      the Grammarian, of Alexandria, 185

    JOURNALISM, MEDICAL, beginnings of, 545

    JULIAN THE APOSTATE, Roman Emperor, 236, 435

    JUSSERAND, 306


                                   K

    KERCKRING, THEODOR, 359

    KING, EDMUND, 408

    KITAB AL-KULLIDSCHAT (= “Colliget”), title of Averroes’ treatise,
      229

    KOELLIKER, 455


                                   L

    LABOULBÈNE, comments on Sydenham, 425

    LABYRINTH of temporal bone, 80

    LANCISI, GIOVANNI MARIA, 349, 391
      discovers copper plates intended for Eustachius’ “Anatomy,” 392

    LANFRANCHI, 282, 284

    LANGUAGES, LEARNED, importance of acquiring a knowledge of them,
      271

    LANOLIN, described by Dioscorides in A. D. 100, 318

    LAPEYRONIE, FRANÇOIS DE, 531

    LARYNGOSCOPY, DIRECT, mentioned by Savonarola, 313

    LATIN, barbaric, 262, 300
      commonly employed by teachers of medicine in 16th and 17th
        centuries, 369
      habitually spoken at Oxford and Cambridge in 17th century, 424

    LAUDANUM, SYDENHAM’S LIQUID, formula for, 424

    LAUREA ANGLICA, title of treatise written by Gilbertus Anglicus,
      305

    LAXATIVES, a term originated by the Methodists, 133

    LAXUM AND STRICTUM, 130

    LE CLERC, DANIEL, 73, 171

    LE CLERC, LUCIEN, 217

    LEECH lodged in the naso-pharynx, 397

    LEECHES, therapeutic employment of, first mentioned by Themison,
      133

    LEEUWENHOEK, ANTON VAN, 360

    LEG, AMPUTATION OF (Fig.), 463

    LEIBNITZ, 363

    LEONIDES, 201

    LEONINE VERSIFICATION, 251

    LEVRET, 539

    LIBRARIES, PUBLIC, seventy possessed by Spain during the 12th
      century, 232

    LIEBREICH, originator of the term “lanolin,” 318

    LIGATURES applied to blood-vessels by Archigenes in the early part
        of 2d century, 143
      employment of, by Jean de Vigo, in 1460, 473
      used on amputation stumps, 519

    LINACRE, THOMAS, 416
      founded two “lectures of physick” at Oxford, 417
      instrumental in securing the foundation of the College of
        Physicians at London, 417

    LIQUOR BALSAMICUS, 357

    LITHONTRIPSY, Giovanni de Romanis supposed to be the inventor of,
      474

    LITHOTOME OF FRÈRE CÔME (Fig.), 553

    LITHOTOMISTS, ITINERANT, 490, 549

    LITHOTOMY, SUPRAPUBIC, 495

    LITHOTRITY practiced first by Beniveni in the 15th century, 498

    LOUIS DE BOURGES, First Physician to Francis I., 414

    LOUVAIN, UNIVERSITY OF, 345

    LOWER, RICHARD, 408

    LUCIUS VERUS, ROMAN EMPEROR, 165

    LUCRUM NEGLECTUM, probable meaning of the expression, 353

    LUKE, “THE BELOVED PHYSICIAN,” 30

    LUTETIA, GAUL, the present city of Paris, 435

    LUTHER, MARTIN, a believer in the “black art,” 322

    LYMPHATICS, INTESTINAL, 385

    LYONS, FRANCE, founding of the Hôtel-Dieu in that city
      (6th century), 236


                                   M

    MACHAON AND PODALIRIUS, sons of Aesculapius, 47, 50

    MAGATI, CESARE, 529

    MAGGI, BARTOLOMMEO, 473
      discoverer of the fact that a bullet is not hot at moment of
        inflicting a wound, 513

    MAGICAL REMEDIES, 197

    MAGNUS, disciple of Athenaeus, 142

    MAGREB, 218

    MAIMONIDES, esteemed the greatest Jew after Moses, 230

    MALEVOLENT SPIRITS, capable of producing disease, 8

    MALPIGHI, 360, 361

    MANARDUS, JOHANNES, 389

    MANFRED, KING OF SICILY, 262
      founds a university at Naples in 1258 A. D., 257

    MANUSCRIPTS, MEDICAL, transcribing of, at Monastery of Saint Gall,
      244

    MARC ANTONIO DELLA TORRE, 339

    MARCUS AURELIUS, Roman Emperor, 165

    MARIANUS SANCTUS, 474

    MARIOTTE, EDME, 546

    MARTYRDOM OF CHRISTIAN PHYSICIANS, 180

    MASTER OF MEDICINE, grade of, 304

    MATERIA MEDICA, early Greek, 158
      first modern treatise on (1447), 320

    MAURICEAU, FRANÇOIS, 537

    MAURUS, teacher of medicine at Salerno, 245

    MAYERNE, TURQUET DE, 547

    MEAUX SAINT-MARC, translator of “Schola Salernitana” into French,
      250

    MEDIASTINITIS, case of, 228

    MEDICAL TEACHING in Ancient Greece, 70, 85
      in the Asclepieia, 69

    MEDICAL TREATISES, GREEK, destruction of, in Rome, during the 5th
      century, 185

    MEDICINE, beginnings of a rational system of, 67
      development of different sects, after the death of Hippocrates,
        101
      evolution of, as affected by the Arab Renaissance, 203, 233
      God of, 50
      influence of the Italian Renaissance upon, 260
      mediaeval, 191
      practice of, at Rome, in century preceding Christian era, 117
      pre-Homeric period of, in Greece, 46
      relation of monasteries to, 238
      slowness of development of, 3

    MEDICINE MAN of the Indian tribes the earliest type of the
      physician, 8

    MEDINA WORM discovered by Abulcasis, 233

    MEMBRANA RUYSCHIANA, 357

    MENELAÜS wounded at siege of Troy, 48

    MENOCRITUS, physician, honored by a marble column in Greece, 99

    MERCURIADE, teacher of medicine at Salerno, 245

    MESOPOTAMIA, medicine in, 11

    MESUÉ, JOHN, THE ELDER, 209

    METASYNCRISIS, a term originated by Thessalus, 136

    METHODISTS, school of the, 129, 138, 149

    MEYER, ERNEST VON, 400

    MEYER-STEINEG, of Jena, Germany, 16, 52, 53, 68, 120, 129, 134,
      142

    MICHAEL SCOTUS, 262

    MICROSCOPIC ANATOMY, first beginnings of, 360, 362

    MIGRAINE relieved by arteriotomy, 470

    MIKROTECHNE of Galen, 248

    MINDERER, RAYMOND, 407

    MINERAL WATERS employed extensively by the ancients in the form of
      baths, 157

    MIRACH, 521

    MIRFELD, JOHN, 306

    MISOPOGON, title of satire written by Julian the Apostate, 436

    MITHRIDATES, 127

    MITHRIDATICUM, composition of, 112

    MIXTUM, term employed by the Methodists, 131

    MOMMSEN, 235

    MONASTERIES in the Middle Ages, 181, 235
      relation of, to medicine, 238

    MONDEVILLE, HENRI DE (Fig.), 287, 288, 289, 291

    MONDINO, the anatomist, 274, 280, 312, 332

    MONKS obliged to practice medicine during the Middle Ages, 141, 154

    MONTE CASSINO, founding of Benedictine monastery on, 238, 239

    MONTPELLIER, Medical School of, 264, 292, 332

    MORBUS GALLICUS, 543

    MOSAIC LAWS, the, related particularly to social hygiene, 26

    MOSCHION, pupil of Soranus, 139

    MOTASSEM, CALIPH, 210

    MOXAE, MOXIBUSTION, 44

    MURPHY’S BUTTON, Pfolspeundt’s (15th century) prototype of, 459

    MUSA, ANTONIUS, physician of Emperor Augustus, 129

    MUSANDINUS, 245, 254

    MUSULMANS as zealous as the Christians in establishing hospitals,
      237


                                   N

    NAAMAN’S SO-CALLED LEPROSY cured by the prophet Elisha, 27

    NAMTAR, the special demon of the Plague, 13

    NAPLES, university established at, in 1258 A. D., 257

    NASAL CAVITY, illuminating the, 482

    NEO-LATIN, 262

    NEOLITHIC AGE, state of medical knowledge during the, 9

    NEPENTHES, 49

    NERVES, WOUNDS OF, comments of Guy de Chauliac upon, 302

    NEUBURGER, MAX, 24, 41, 51, 84, 132, 222, 228, 231, 249

    NEWTON, SIR ISAAC, 546

    NICAISE, EDOUARD, 228, 263, 282, 287, 300

    NICHOLAS, THE MONK, sent by the Emperor Romanus to Cordova as an
      interpreter of Dioscorides, 226

    NICOLAUS MYREPSUS, 318

    NICOLAUS PRAEPOSITUS, Antidotarium of, 253

    NICOTINE, the alkaloid found in tobacco, 395

    NORSA FAMILY, celebrated as operators for the radical cure of
      hernia, 482

    NUCK, ANTON, the anatomist, 359, 439

    NUFER, JACOB, 534


                                   O

    OATH, HIPPOCRATIC, 71

    OBSTETRIC METHODS, rational, of Soranus, 138, 139

    OBSTETRICAL FORCEPS, 535

    OBSTETRICS, practice of, in ancient Egypt, 17

    ODYSSEY, reference to drugs in the, 18

    OIL OF ST. JOHN’S WORT, 522

    OISYPUM (LANOLIN), first described by Dioscorides (100 A. D.), 318

    OLD TESTAMENT, medicine of the, 26

    OLEUM HYPERICI, 522

    ONASILOS, a physician, bronze tablet in honor of (5th century
      B. C.), found in Island of Cyprus, 99

    OPEDELDOCH, 404

    OPHTHALMOLOGISTS, EARLY, 115

    OPHTHALMOLOGY, important contributions to, 546

    OPIUM, probably the drug referred to by term “nepenthes,” 49
      proper manner of obtaining, first described by Scribonius Largus,
        155
      Sydenham’s opinion with regard to the value of, 424

    OPORINUS, Paracelsus’ assistant, 404

    ORDRONAUX, JOHN, 250, 252

    ORIBASIUS, 191

    ORIENTAL MEDICINE, 11

    OSIRIS, or Serapis, 19

    OVER-EATING, according to the ancient Egyptians, is the cause of
      the majority of diseases, 22


                                   P

    PADUA MEDICAL SCHOOL, 267, 352

    PAGEL, 57

    PALERMO, SICILY, a great centre of literary activity, 261

    PANADOES, how prepared, 443

    PANAKEIA, daughter of Aesculapius, 50

    PANCREAS, outlet duct of, discovered in 1641, 358

    PAPER, INVENTION OF, 328

    PAPIN, DENIS, 547

    PARACELSUS, 369, 401, 405, 465
      monument in honor of, at Basel, 406
      pharmaceutical preparations of, 404
      sayings of, 403
      treatises published by, 403

    PARACENTESIS ABDOMINIS, 110, 124

    PARAMIRUM, title of Paracelsus’ principal treatise, 403

    PARCHMENT invented at Pergamum in 3d century B. C., 101

    PARÉ, AMBROISE (Figs.), 404, 499, 500, 502, 515
      abandons use of boiling oil, 503
      arrests bleeding from divided blood-vessels by use of ligatures,
        512
      bitter jealousy shown by his contemporaries, 501
      charge of plagiarism against him not sustained, 514
      devises artery forceps and other surgical apparatus, 512
      exarticulation of elbow-joint performed by him, 508
      some of his sayings, 500, 501
      summary of his more important achievements in surgery, 513
      treatise on surgery not published in English until 1577, 518

    PARIS MEDICAL SCHOOL, 282

    PARMENIDES, 73

    PARRENIN, FATHER, Jesuit missionary, 541

    PASON (= APOLLO), who invented the art of medicine, 18

    PASSAVANT, Dean of the Collège de St. Côme at Paris, 284

    PASSIONARIUS, title of Gariopontus’ treatise, 247

    PATHOLOGY, Fernel’s scheme of, 415
      views held by Hippocrates, 86

    PATHOLOGY, INTERNAL, 389

    PATROCLUS dresses the wound of Eurypylus, 49

    PAUL, THE APOSTLE, bitten by a poisonous snake on the Island of
      Melita, 29

    PAULUS AEGINETA, 199, 227, 318

    PECQUET, JEAN, rediscovers thoracic duct (in a dog), 384

    PERICARDIUM, ABSCESS IN THE, Avenzoar refers to its actual
      occurrence, 229

    PERIODEUTS or ambulant physicians, 75

    PERSIANS, THE ANCIENT, medicine of, 25
      took very little interest in surgery, 26

    PETER THE GREAT purchases Ruysch’s anatomical collection, 356

    PETRONCELLUS, a teacher of medicine at Salerno, 245

    PEYER, JOHANN CONRAD, 359

    PFOLSPEUNDT, HEINRICH VON, 458, 460

    PHARMACIST, early use of the term, 316

    PHARMACOLOGY, earliest treatise on, published by Dioscorides in
      77 A. D., 158

    PHARMACOPOEIA, modern term for antidotarium, 319
      Augsburg, compiled by Minderer, 407
      modern, beginnings of, 547
      of India, very rich, 33

    PHARMACY, in its infancy, 315
      first regularly established in the 8th century, 318

    PHARMAKON, term employed by Galen for a remedial drug, 316

    PHILINUS OF COS, 111

    PHILOSOPHERS’ STONE, 321

    PHILOSOPHY, SCHOOLS OF, in Greece and its colonies, 72

    PHYSICIANS, consultation of (Fig.), 457
      honored publicly in ancient Greece, 98, 99, 100
      more highly esteemed than surgeons in 14th century, 304
      suffered martyrdom for their Christian faith, 180

    PHYSIOLOGY, HUMAN, views held by Hippocrates, 86

    PIETRO D’ABANO, 266

    PINEAU FAMILY, lithotomists, 549

    PINI, anatomical draughtsman, 348, 392

    PITARD, JEHAN, Surgeon of Louis IX., 448, 530

    PITCAIRN, ARCHIBALD, 367

    PLAGUE AT ATHENS, history of, by Thucydides, 96

    PLAGUE, THE, avoidance of, by Galen, 164

    PLANTS, MEDICINAL VIRTUES OF, 157

    PLATEARIUS, John and Matthew, teachers of medicine at Salerno, 245

    PLATO, 73, 78
      views of, with regard to women physicians, 77

    PLATTER, FELIX, 336, 396, 455
      early experiences at Montpellier, 332

    PLEURISY, Boerhaave’s manner of treating it, 444

    PLINY THE ELDER, 155

    PNEUMA, or breath, plays the most important rôle in the mechanism
        of life, 108
      or vital spirit, 141

    PNEUMATISM not popular with the physicians of Rome, 142

    PNEUMATISTS, the, 141

    PODALIC VERSION, 535, 537

    PODALIRIUS, 47

    POISONOUS SNAKES, loss of life caused by the bites of, 64

    POLYBUS, son-in-law of Hippocrates, 82

    POMPEII, physicians’ houses disinterred at, 315

    PONS VAROLII, 350

    PORES, system of, for conveyance of tissue juices, 122

    PORTAL, PAUL, 539

    POULTICES, too free use of, condemned, 467

    POWER, D’ARCY, 307

    PRACTICA CHIRURGIAE of Roger, 254

    PRACTICA OCULORUM of Benevenutus Grapheus, 256

    PRACTICA of Bartholomaeus, 248

    PRACTICA of Cophon the Younger, 249

    PRACTITIONERS, improper behavior of, in the sick room, 193

    PRAEPOSITUS, meaning of the term, 253

    PRAXAGORAS OF COS, 103
      probably the first to distinguish the difference between arteries
        and veins, 103

    PRAYER FORMULAE employed by the Babylonians as protective remedies,
      13

    PREGNANT WOMEN, dietetics of, 199

    PREHISTORIC PERIOD of science of medicine, 4

    PRE-HOMERIC PERIOD of medicine in Greece, 46

    PRESCRIPTION WRITING first employed about A. D. 1400, 320

    PRINTING, INVENTION OF, favored advance of science of medicine, 328

    PRISCIANUS, THEODORUS, 192

    PROKSCH, 543

    PRZYMIOT, title of early Polish treatise on syphilis, 479

    PTOLEMIES, learning greatly prospered under their reign, 100

    PTOLEMY EUERGETES, OR PHYSCON, 116

    PULSE, meaning of, according to Athenaeus, 142

    PULSIFIC POWER OF ARTERIES (Galen), 381

    PURKINJE’S BONE-CORPUSCLES, 362

    PUSCHMANN, 70, 107, 196, 232, 257, 311, 365, 394

    PYAEMIA, Wuertz’s views regarding, 469

    PYTHAGORAS, 73, 74
      medical doctrines propounded by, 147

    PYTHON, Aesculapius represented in the presence of a, 65


                                   Q

    QUINTESSENCES OF PARACELSUS, 405

    QUINTUS, one of Galen’s teachers, 162


                                   R

    RABELAIS, FRANÇOIS, celebrated humorous writer, was a physician,
      451

    RABISU, the demon who causes diseases of the skin, 13

    RAPHAEL’S CELEBRATED PAINTING showing Plato and Aristotle, 102

    RATIONAL SYSTEM OF MEDICINE, beginnings of, in Greece, 67

    RECIPES, BOOKS OF, take the place of physicians in Rome, 117

    RED-HOT CAUTERY IRON too freely used for arresting bleeding, 466

    REFRACTION, researches of Alhazen in regard to, 233

    REGIMEN SANITATIS SALERNITANUM, 246
      Arnold’s commentary on, 294

    RELICS, SAINTLY, universal faith in their power to heal diseases,
      241

    REMEDIAL AGENTS, GENUINE, employed in Babylonia, 13

    REMEDIES, HOUSEHOLD, Cato’s collection of, 123

    RENAISSANCE, influence of, upon progress of medicine in Western
      Europe, 259

    RENAN, ERNEST, 229, 231

    RENZI, DE, on books written by physicians at Salerno, 246

    REPERCUSSION, 526

    RESPIRATION, physiology of, according to Erasistratus, 108
      according to Aretaeus, 144

    RETE MALPIGHI, 361

    RHAZES, illustrious Persian physician, 219, 318

    RHINOPLASTY in Italy in the 15th century, 459

    RHODION, 533

    RIOLAN, J., 360

    ROESSLIN, EUCHARIUS, 533

    ROGER’S PRACTICA, the oldest treatise on surgery written in Italy
      during the Middle Ages, 254

    ROKITANSKY, the famous Viennese pathologist, advice of, to those
      about to study medicine, 3

    ROLAND OF PARMA, 254, 279

    ROMAN PHYSICIANS, of foreign birth, awarded rights of citizenship
      by Julius Caesar, 130

    ROMANO PANE publishes first account of discovery of tobacco, 395

    ROME, state of medicine at, after the death of Asclepiades, 129

    ROSA ANGLICA, title of treatise written by John of Gaddesden, 306

    ROUSSET, FRANÇOIS, 535

    ROYAL SOCIETY OF LONDON, founding of, 363

    RUDBECK, OLAUS, 358, 385

    RUFUS OF EPHESUS, 145, 146

    RUYSCH, FRIEDRICH, the anatomist, 356, 358


                                   S

    SABOUR BEN SAHL, 209

    SAGE FEMME, possible origin of the term, 247

    SAINT BARTHOLOMEW’S HOSPITAL, London, 524

    SAINT BASIL, founder of a hospital at Caesarea, 236

    SAINT CÔME, COLLÈGE DE, 490

    SAINT COSMAS AND SAINT DAMIAN, Brotherhood of, 530

    SALADIN OF ASCOLO, author of first modern treatise on materia
      medica, 320

    SALADIN, SULTAN OF EGYPT, 225

    SALAMANCA, UNIVERSITY OF, 346

    SALERNO MEDICAL SCHOOL, 243, 244, 265
      women teachers at, 245

    SALICETO, WILLIAM OF, 277

    SALMOUÏH BEN BAYAN, a distinguished pupil of the Djondisabour
      school, 210

    SALVINO DEGLI ARMATI of Florence, reputed inventor of spectacles,
      297

    SANCTORIUS SANCTORINUS, 368

    SANDWITH, DR. F. M., concerning the most ancient surgical
      implements thus far discovered, 9

    SANGUIFICATION, Galen’s theory of, 385

    SANITARY SCIENCE in the 15th century, 314

    SAPIENZA, UNIVERSITY OF, at Rome, 391

    SARSAPARILLA, 395

    SAVONAROLA, GIOVANNI MICHELE, 313

    SCHIELHANS, nickname of Hans von Gerssdorff, 460

    SCHNEIDER, CONRAD VICTOR, 359

    SCHOOL OF SALERNO, title of poem, 250

    SCHOOLS, significance of the term, 74

    SCOTUS OR SCOTTUS, 262

    SCRIBONIUS LARGUS, 155, 413

    SECTS IN MEDICINE, 101, 147, 149

    SEPTICAEMIA, Wuertz’s views regarding, 470, 471

    SERAPION THE ELDER, 210

    SERAPIS OR OSIRIS, 19

    SERPENT, significance of the, in the statues and votive tablets
      exposed to view in the Aesculapian temples, 62

    SERVETUS, MICHAEL, 375
      on the circulation of the blood, 376

    SHOULDER, DISLOCATION OF, cured by Gabriel Bakhtichou, 207

    SIMON JANUENSIS, 261

    SISMONDI, THE HISTORIAN, 116

    SKULL, FRACTURES OF, 286, 476

    SLAVES SOLD BY ROMANS when they became old and feeble, 235

    SLEEP-WALKING, instance of, narrated by Alderotti, 273

    SMALL-POX described by Herodotus, 142
      earliest treatise upon, 220
      Gaddesden’s successful treatment of, 306
      prophylactic inoculation against, 43

    SMITH, SIR WILLIAM, 103

    SNAKE, POISONOUS, treatment of bite by, 110

    SNAKEROOT, an antidote for poisoning by the bite of a snake, 7

    SOBIESKI, KING OF POLAND, purchases Ruysch’s second anatomical
      collection, 358

    SOCIAL HYGIENE, the Mosaic laws relate particularly to, 26

    SOCRATES, 73

    SOPORIFIC SPONGES, 253

    SORANUS OF EPHESUS, 138, 139, 159
      rational obstetric methods of, 139

    SOUL, SPIRIT OF THE, 291

    SOUL, THE, is the blood, according to Servetus, 376

    SPAIN, medicine flourished in, during the 10th century, 226

    SPANISH SURGEONS of the 16th century, 484

    SPECIALIZATION in medicine, 114

    SPECTACLES, use of, first mentioned by Gordonius (A. D. 1285), 297

    SPECULUM, aural, employed by Jean de Vigo, 473
      majus, of Vincent Beauvais, 270
      vaginal, of Paulus Aegineta, 201

    SPINE, CURVATURE OF, 313

    SPIRIT, THE, 291, 374
      disorders of, 141
      of Mindererus, 407

    SPLENIA, 526

    SPLINTS made with bundles of straw, 304

    SPRENGEL, KURT, 342

    SPRINGS, EUROPEAN, in 16th century, 323

    STAHL, GEORG ERNST, 431
      doctrine of animism, 432
      his “phlogiston,” 433
      treatise on “theoria medica vera,” 432

    STENO, NICHOLAS (Niels Stensen), 359

    STIBIUM, 158

    STOICS, THE, 102

    STONE IN THE BLADDER, cutting for, 494
      Gaddesden’s peculiar method of treating, 306
      method of operating kept a secret by lithotomists, 447

    STRANGULATED HERNIA, Franco’s operation for, 492

    STRATON, a skilful gynaecologist, 115

    STRAW SPLINTS, for use in fractures, 304

    STRICTUM AND LAXUM, terms employed by the Methodists, 130
      Boerhaave adopts the doctrine, 442

    STYRUS, one of Galen’s teachers, 162

    SUGGESTION, power of, over the human mind, 241

    SUPERSTITIOUS BELIEFS constitute one of the most extraordinary
      characteristics of the human race, 10

    SURGEON, characteristics which he should possess, 285

    SURGEONS OF THE LONG ROBE, a name given to members of the Collège
      de St. Côme, 448

    SURGERY, considered a menial occupation during the Renaissance
        (Fig.), 306, 447
      early, in Great Britain, 516, 523
      strong prejudice against among French physicians of the 15th
        century, 300
      systematic instruction in, first given at Montpellier in 1597,
        448

    SURGICAL OPERATIONS in the age of primitive medicine, 8

    SUSRUTA, celebrated East Indian medical author, 31

    SWAMMERDAM, JOHN, 356

    SYDENHAM, THOMAS, 418
      a great sufferer from gout, 421
      describes an “inflammation of the blood,” 423
      experience with the great epidemic of the Plague, 421
      on the nature of fever, 423
      treatises published by, 419

    SYLVIUS (Franz de le Boë), 367, 427
      clinical instruction cultivated by him at Leyden, 428, 429
      treatises published by him, 428

    SYLVIUS, THE ANATOMIST, 340

    SYPHILIS, 473, 542
      poem relating to, 391

    SYRIAC ULCER (known to-day as pharyngeal diphtheria), 144

    SYRINGE, earliest reference to use of, to be found in Abulcasis’
      treatise on surgery, 227

    SYRINGOTOME, 313

    SZANDALANI, Arabic name for pharmacists, 318


                                   T

    TAGLIACOTIAN OPERATION, the so-called, 478, 480

    TAGLIACOZZI, GASPARE, 478

    TALISMANS, amulets, etc., as means of protection against evil
      spirits, 9, 13

    TEISSIR, THE, Avenzoar’s great medical work, 228, 230

    TELESPHORUS, son of, Aesculapius, 50

    TEMPLE PRIESTS in ancient Egypt, 17

    TEMPLE SLEEP at the Asclepieia, 57

    TEMPLES, AESCULAPIAN, their chief purpose, 51

    TENTS, PRACTICE OF EMPLOYING, in the treatment of wounds,
      condemned, 466

    TESRIF, THE, written by Abulcasis (= Alsaharavius), 227

    TETANUS, TRAUMATIC, Lanfranchi’s treatment of, 285

    THADDEUS ALDEROTTI, 272

    THALES, of Miletus, 72

    THEMISON, founder of the sect of the Methodists, 130
      the first to mention the employment of leaches, 133

    THEODORIC OF LUCCA, 276

    THEODORUS, a disciple of Athenaeus, 142

    THESSALUS, SON OF HIPPOCRATES, 82, 133

    THESSALUS, OF TRALLES, in Asia Minor, a prominent Methodist, 133

    THIERRY DE HÉRY, 499

    THIGH, amputation of, probably performed in early part of Christian
        era, 470
      fractures of, 304

    THIRTY YEARS’ WAR, THE, 426

    THOMAS AQUINAS, a believer in the art of the magician, 321

    THORACIC DUCT, 384

    THOT OR THOÜT (Hermes), the god, author of the hermetic books, 18,
      19

    THUCYDIDES, 96

    TIRABOSCHI, 338, 378

    TOBACCO, 395

    TOLEDO, SPAIN, richly stocked with manuscript treasures of Arabic
      literature, 261

    TOLET, FRANÇOIS, 550

    TOLU, BALSAM OF, 395

    TORCULAR HEROPHILI, 105

    TORRICELLA, 546

    TOSORTHOS, 17

    TOUCHING, for the “King’s evil,” 527, 528

    TRACHEOTOMY performed by Asclepiades (90 B. C.), 124
      revived by Antonio Beniveni in the 15th century, 498

    TRANSFUSION OF BLOOD, 408

    TRANSMUTATION OF BASER METALS INTO GOLD, 321

    TRAUTMANN, of Wittenberg, 535

    TREPHINE, circular pattern of, 473

    TREPHINING THE SKULL a very ancient surgical operation, 9
      Wuertz slow in resorting to the operation, 467

    TRIKKA, THESSALY, 51

    TROTULA, a teacher of medicine at Salerno, 245

    TUBERCULOSIS, virus of, long-lived, according to Fracastoro, 390

    TURQUET DE MAYERNE, 547

    TYDIDES, who smote Aeneas, 49


                                   U

    ULCERS, treatment of, according to the method of Thessalus, 135

    UROSCOPY eagerly adopted by charlatans in 16th century (Fig.), 412
      strongly denounced by Scribonius, Botallo and others, 413

    UTUKKU, the demon who causes diseases of the throat, 13


                                   V

    VAGBHATA, a celebrated East Indian medical author, 31

    VALERIUS CORDUS, 318

    VALVES, DISCOVERY OF, IN THE LARGER VEINS, 378

    VAN HELMONT, 398
      “archaeus influus” and “archaeus insitus,” 399
      characteristic sayings, 400
      remarkable remedies manufactured by him, 399

    VAN SWIETEN introduces clinical instruction at the University of
      Vienna, 431

    VAROLIUS, 349

    VEIN should be opened longitudinally in venesection, 286

    VENA PORTAE, 385

    VENESECTION, Celsus’ description of technical details, 152
      quantity of blood that may be withdrawn, 413
      spot from which blood should preferably be taken, 411

    VENOUS ARTERY (pulmonary vein), 371

    VENOUS BLOOD, FUNCTION OF, 373

    VERSIFICATION employed in medical treatises, 251

    VERSION, PODALIC, 535

    VESALIUS, 340, 342, 345, 347, 370, 374, 456

    VICQ D’AZYR, 532

    VICTOR III., POPE, 239

    VIDUS VIDIUS, 340

    VIEUSSENS, RAYMOND, 364

    VILLALOBOS, 542

    VINCENT OF BEAUVAIS, 270
      encyclopaedia of, 263

    VINDICIANUS, 192

    VIPER, cases of persons bitten by, 488, 507

    VIS CONSERVATRIX ET MEDICATRIX NATURAE (Stahl), 432

    VITAL FORCE, Stahl’s, 405

    VITAL SPIRIT, Galen’s, 376

    VIVISECTION OF CRIMINALS utilized at Alexandria, Egypt, for
      scientific purposes, 107

    VIZIR ALI BEN ISSA founds a great hospital at Bagdad in A. D. 914,
      219

    VOLCHER KOYTER, 349


                                   W

    WATER, CONTAMINATED, purification of, by distillation, 305
      of river Choaspes, ready boiled for use and stored in flagons of
        silver, carried by King Cyrus on his campaigns, 26

    WECKER, JOHANN JACOB, 521

    WEIGHT-AND-PULLEY TREATMENT of thigh fractures, Guy de Chauliac’s,
      304

    WHARTON, THOMAS, 359, 546

    WILLIAM OF SALICETO, 277

    WILLIAM THE CONQUEROR a patient at Salerno, 245

    WILLIS, THOMAS, 360, 367, 546

    WINE, Galen’s use of, in dressing wounds, 163
      proper employment of, according to Asclepiades, 125
      Thalassite, 126

    WINTER, OF ANDERNACH, 340

    WIRSUNG, GEORGE, discovers outlet duct of human pancreas, 358

    WISEMAN, RICHARD, 524

    WOMEN INSTRUCTORS IN MEDICINE highly esteemed at Salerno, 246

    WOMEN PHYSICIANS among the Arabs in Spain, during the 12th century,
      232

    WOODALL, JOHN, 522

    WOUNDS, DRY METHOD OF TREATING, 275, 285
      too frequent probing of, condemned, 466

    WREN, SIR CHRISTOPHER, 408

    WUERTZ, FELIX, 465
      condemns universal employment of chemical caustics and the
        red-hot iron for arresting bleeding, 466
      remarks on pyaemia, hospital gangrene and septicaemia, 469, 471
      remarks on treatment of penetrating wounds of abdomen, 469

    WUNDAERZTE, 369


                                   X

    XENODOCHIA, institutions for the care of slaves, 235

    XENOPHON, C. STERTINIUS, 54


                                   Y

    YPERMAN, JEHAN, a distinguished Flemish physician of 14th century,
      309


                                   Z

    ZEND-AVESTA, THE, 25

    ZENO, founder of the Stoic philosophy, 103

    ZERBI, GABRIEL, professional visit of, to Constantinople, cost him
      his life, 337

    ZEUXIS, organizer of a medical school at Laodicea, 111

    ZIRHACH, 521

    ZIRBUS, 521

    ZOPYRUS classified drugs according to the effects which they
      produce, 111

    ZOSIMOS, of Panopolis, 321


                              FOOTNOTES:

[1] A third volume is in course of preparation, but the probable date
of its publication has not been announced. An English translation of
the first volume (by Ernest Playfair) was published by Hodder and
Stoughton, of London, in 1910.

[2] Book I., section 197, of Rawlinson’s translation.

[3] From the statements just quoted it appears that a certain kind
of bronze (an alloy of copper and tin, with the addition perhaps of
a little zinc) was used in Assyria, in the manufacture of surgical
knives, as early as during the twenty-third century B. C. Dr.
Meyer-Steineg, Professor of the History of Medicine in the University
of Jena, Germany, assures the writer that knives made of this material
are susceptible of being given as keen a cutting edge as are those made
of the best of steel. At least one such bronze knife may be seen in the
collection of ancient surgical instruments, votive offerings, etc.,
which he is making for the benefit of the University.

[4] A Christian ecclesiastical writer who lived about the year 200 A. D.

[5] Lines 285–292 of Book IV. of the Earl of Derby’s translation, first
published in 1864.

[6] Pason is the same as Apollo, who was believed by the Greeks to have
been the inventor or discoverer of the art of medicine.

[7] See Le Clerc’s _Histoire de la Médecine_, Amsterdam, 1723.

[8] At bottom of p. 15 of his _Histoire de la Médecine_.

[9] Papyros Ebers, aus dem Aegyptischen zum ersten Male vollständig
ubersetzt von H. Joachim, Berlin, 1890.

[10] Book I., p. 96, of George Rawlinson’s translation.

[11] Neuburger speaks of the growth of medical knowledge in India as a
development that ran parallel with that of ancient Greece.

[12] _From Neuburger._--Equally crude are their ideas respecting
the causes of disease, as shown by the following items selected from
quite a long list of etiological factors: errors in diet and in the
habits of life, climatic influences, psychic factors, heredity, poison,
supernatural influences like the anger of the gods, the evil powers of
demons, etc. For purposes of diagnosis the earlier Indian physicians
utilized not only inspection, palpation and auscultation, but also the
senses of taste and smell. They noted the losses and increases in the
weight of the body, changes in the appearance of the skin, the tongue
and the excretions, alterations in the configuration of the body, the
form and other characteristics of swellings, etc. They also noted
changes in the patient’s voice, in the character of the breathing, in
the noises accompanying movements of the joints and the twistings of
the intestines. The crepitus caused by the rubbing together of the
roughened ends of a fractured bone did not escape their notice. At
a later period, doubtless through the influence of the teachings of
foreign physicians, they attached great importance to the examination
of the pulse.

[13] Nepenthes, believed to be opium, is the word employed in the
original.

[14] Aesculapius was held to be the son of Apollo, the god of medicine,
and to have been instructed in the art of healing by Chiron, one of the
centaurs. Beside his famous sons, Machaon and Podalirius, he had four
daughters whose names--Hygieia, Jaso, Panakeia and Aigle--have come
down to us through the ages. His wife’s name was Epione, and those of
his two younger sons were Telesphorus and Janiscus, but all three of
these names are rarely mentioned by the Greek writers.

[15] “Kranken-Anstalten im griechisch-römischen Altertum,” von Dr. med.
et jur. Theodor Meyer-Steineg, a. o. Professor an der Universität Jena;
Verlag von G. Fischer, 1912.

[16] “Kranken-Anstalten im griechisch-romischen Altertum,” in _Jenaer
medizin.-historische Beiträge_, Jena, 1912.

[17] All important traces of the earlier structures seem to have
disappeared.

[18] The Emperor Antoninus Pius, in order to provide properly for these
patients, erected at Epidaurus a special building in which confinement
cases and those likely to end fatally might be lodged.

[19] The slave of Chremulos.

[20] To save space the head of the god alone has been reproduced in
Fig. 5.

[21] _Histoire de la Médecine_, Amsterdam, 1723.

[22] The word “school,” when employed in the strictly modern sense of
that term, means an establishment regularly organized for the purpose
of giving instruction. Here, however, it is intended to signify simply
that certain places, like Cos, Crotona, Cnidus, etc., had become
the rendezvous of men who desired to cultivate--some as teachers,
others as disciples or pupils--certain branches of knowledge, or
certain doctrines. At a later period (third century B. C.) there was
established at Alexandria, Egypt, a well-organized school of medicine
closely resembling those of modern times.

[23] All of these are translations from the French.

[24] The city of Cnidus was situated very close to the Island of Cos,
on a peninsula that projects from the coast of Caria, Asia Minor.

[25] Black bile, it was believed, comes from the spleen, while the
yellow variety is a product of the liver.

[26] Daremberg (_Hist. de la Méd._) makes the following comments
on this sentence: “How many are the occasions when we physicians would
have it in our power to avert death, or at least to postpone it for a
few hours, if we would only engrave upon our memories these words of
the old man of Cos! ‘What a cruel responsibility rests upon those whose
duty it is to summon the doctor at the proper moment! And how great
must be the remorse if he fails to arrive in time!’ On the other hand,
how wise is the remark of Celsus: ‘The best practitioner is he who
never loses sight of his patients.’”

[27] After Alexandria first came under Roman rule (about 30 B. C.)
membership in the Museum was granted to athletes and other men of no
education, and it is said that even before that time Ptolemy Euergetes,
who had reopened the schools during the latter part of his reign,
bestowed some of the important positions upon men who were simply his
favorites. The library of the Museum was seriously damaged by fire at
the time when Julius Caesar was being besieged in Alexandria by the
inhabitants of that city, and was at last wholly destroyed by Amrou,
the Lieutenant of the Caliph Omar, in A. D. 651. The truth of this
extraordinary tale regarding the burning of books belonging to the
library at Alexandria in the seventh century is seriously doubted
by Sismondi (_Histoire de la Chute de l’Empire Romain_, Vol.
II., p. 57). “It was,” he says, “published for the first time, by
Abulpharagius, about six centuries after the event is supposed to have
occurred. And yet the contemporaneous national historians, Entychius
and Elmacin, make no mention of it whatever. An act of this nature,
furthermore, would be in direct conflict with the precepts of the
Koran and with the profound respect which the Mohammedans habitually
entertain for every scrap of paper on which the name of God happens to
be written.”

Under the later rule of the Romans, Alexandria regained a good deal of
its literary importance and also became a chief seat of Christianity
and theological learning; but as a centre of medical influence its
glory had long since departed.

[28] Asclepiades was not a descendant of Aesculapius, as one would
naturally infer from the name which he bore.

[29] It would not be easy to fix, even approximately, the date
when remedies of this character ceased to find acceptance in the
popular mind of Europeans, but there can be no doubt that they were
employed rather frequently even as late as during the eighteenth
century;--indeed, measures that strongly smack of superstition are now
and then looked upon with favor by the well-educated members of our
modern society. For many centuries, however, they have been abandoned
by all physicians excepting those who are unworthy to bear that honored
title.

[30] Neither Haller nor Dezeimeris furnishes any biographical
information with regard to Musa.

[31] Antoninus Pius, however, established the rule that these
privileges were not to be granted to all physicians indiscriminately,
but only to a limited number; and, later still, it was decided that
only the parish physicians were entitled to receive them.

[32] It seems almost unnecessary to call attention to the fact that the
subject of these remarks is not to be confounded with Thessalus, the
son of Hippocrates.

[33] Ἰατρονίκης is the word employed in the original Greek.

[34] The word “metasyncrisis,” as we are assured by Le Clerc, was
employed first by Cassius, one of the earlier disciples of Methodism,
and then, long after the time of Thessalus, by Galen, Oribasius, Aëtius
and Paulus Aegineta.

[35] Le Clerc calls attention to the incorrectness--etymologically
speaking--of the use of the word “Eclectics” in connection with a
school or sect. The members of such a body are not, he says, “the
chosen ones” as the term signifies, but “the choosers.”

[36] Boerhaave, the famous clinician of Leyden, Holland (eighteenth
century), was instrumental in having an excellent Latin translation
made of this work; and in 1858 a German translation by A. Mann was
published in Halle.

[37] Translated from _Oeuvres de Rufus d’Éphèse_; édition Grecque
et Française, par Daremberg et Ruelle, Paris, 1879.

[38] The term “dogmatists” is also employed by some authorities to
designate those physicians who laid great stress upon the importance of
following the teachings of Hippocrates and Galen.

[39] The majority of the writings of Galen are reported to have been
kept, for safe preservation, in the Temple of Peace, near the Forum;
and the destruction of this building by fire, during the latter half of
the second century, entailed the loss of all these valuable works.

[40] Book VI., Chapter XVII. (page 441 of Vol. I. of Daremberg’s
version).

[41] In his Commentaries on the works of Hippocrates (Epidemic
Diseases, III., t. XVII. B. § 4) Galen states that he has often
observed this to-and-fro movement of the alae nasi in certain cases of
illness and that he has interpreted it as indicating the existence of
some serious disorder of the respiratory tract. (Daremberg.)

[42] Hippocrates, Herophilus, Erasistratus, Asclepiades, Themison,
Celsus, Soranus and Athenaeus. Daremberg calls attention to the fact
that, although we possess to-day only a few fragments of the writings
of Archigenes, those few are of such a degree of excellence that we may
well ask ourselves whether Galen was not perfectly justified in placing
such a high estimate as he appears to have done upon the merits of this
writer,--and that, too, notwithstanding the unfavorable criticism which
he makes in the present paragraph about the author’s failure at times
to write with sufficient clearness on medical subjects.

[43] John the Grammarian, whose nativity is not stated by Le Clerc, was
at first a simple boatman who ferried back and forth those who attended
a school which was located on one of the islands at Alexandria. As a
result of his frequent talks with these men, he became enamored with
philosophy and decided, notwithstanding his age (forty years), to
devote himself entirely to the study of the subject. Accordingly, he
sold his boat and attended the lectures regularly, becoming at last
an expert in philosophy. He wrote several important treatises and
commentaries, some of them dealing with medical topics, and he also
made a number of translations from the Greek into Arabic.

[44] Third edition, London, 1726.

[45] Anthemius is also credited with being the inventor of the
principle of dome construction in architecture.

[46] Also written Paulus Aeginetes.

[47] The account which is given in this and the following chapters
is based largely on Dr. Lucien Le Clerc’s _Histoire de la Médecine
Arabe_, Paris, 1876.

[48] Le Clerc and Freind mention both Nishapur and Djondisabour as the
name of the capital of the Province of Khorassan in northeast Persia.

[49] The drachma was a silver coin worth about 9¾ pence English money.
The fee paid to Gabriel for his surgical services amounted, therefore,
to a little less than £2000 or $10,000.

[50] To distinguish him from Mesué the Younger, who lived at Cairo,
Egypt, about one hundred years later, and who attained considerable
celebrity on account of the treatises which he wrote on materia medica.

[51] For further remarks concerning the origin of the Teïssir see page
229.

[52] According to tradition the medical school at Salerno was founded
by four physicians--Adela, an Arab; Helinus, a Jew; Pontus, a Greek;
and Salernus, a Latin.

[53] Perhaps the French title “sage-femme” originated from this.

[54] There can be no question, says Neuburger (in agreement with
Daremberg), about the truth of the statement that Constantinus
allowed the authorship of several of the treatises issued at Salerno
under his name to be attributed to himself--as, for example, the
“_Liber Pantegni_” (_Pantechni_), which is in reality the
“_Liber Regalis_” of Haly Abbas; the “_Pieticum_,” which is
fundamentally the work of Ibn-al-Dschezzar; the “_De Oculis_,”
which is based upon Honein ben Ischak’s treatise on opthalmology; and
still other works which it is not necessary to specify.

[55] Under the heading “_Epilogus_” on pages 268 and 269 of Meaux
Saint-Marc’s version.

[56] Examples of leonine versification: “Contra vim _mortis_,
nulla est herba in _hortis_”; (p. 155 of Saint-Marc’s version) and
(from Shelley’s _Cloud_) “I am the _daughter_ of the earth
and _water_.”

[57] The term “praepositus” means the president or the dean of the
school with which the person named is connected.

[58] The Opus majus, ed. J. H. Bridges, Oxford, 1897 (2d edition,
1900); opera hactenus inedita, ed. B. Steele, Fasc. I., London.

[59] Aurei. The aureus is said to have been worth about 16 shillings,
English money.

[60] A church official to whom was intrusted the duty of granting
dispensations; “Almoner” is perhaps the equivalent term in English.

[61] “Non enim est necesse saniem--sicut Rogerius et Rolandus
scripserunt et plerique eorum discipuli docent, et fere omnes cururgici
moderni servant--in vulneribus generare. Iste enim error est major quam
potest esse. Non est enim aliud, nisi impedire naturam, prolongare
morbum, prohibere conglutinationem et consolidationem vulneris.” (II.,
cap. 27.)

[62] The most recent edition of this work is a French translation made
by P. Pifteau and published at Toulouse, in 1898.

[63] According to Daremberg (_Histoire des Sciences Médicales_,
Vol. I., p. 264) the title “Doctor” appears for the first time in the
Preface of Roger’s treatise (1180 A. D.).

[64] “_La Grande Chirurgie de Guy de Chauliac_,” Paris, 1890.

[65] The distinguishing sign of the barbers was the shaving dish, made
of _pewter_ and hung up at the door of the shop; that employed by
the surgeons was also a shaving dish, but made of polished brass. Those
surgeons who had received their training at the school of Saint Cosmas
and Saint Damian were permitted to display at the window a banner
bearing the coat of arms of this institution.

[66] The surgeons Cosmas and Damian were chosen patron saints of the
new organization. They were born in Arabia in the third century, and
are said to have been educated there. After having practiced medicine
for a certain length of time in Sicily, they were tortured and killed,
because of their Christian faith, by order of the Emperor Diocletian,
303 A. D. Hence the title “Saints.”

[67] Guy de Chauliac, who wrote a treatise on surgery in the latter
half of the fourteenth century, also speaks of the value of this
diagnostic sign.

[68] See remarks on the subject of amulets, etc., on pages 197, 198.

[69] A small town in the Department of Lot, France. The earliest Norman
ancestors of the Gurdon family in England are said to have derived
their name from that of this town.

[70] Introduction to the “Oeuvres d’Ambroise Paré,” Paris, 1840.

[71] “Gaddesden had for a long time been troubled how to cure stone:
‘At last,’ says he, in his _Rosa Anglica_, ‘I thought of
collecting a good quantity of those beetles which in summer are found
in the dung of oxen, also of the crickets which sing in the fields. I
cut off the heads and the wings of the crickets and put them with the
beetles and common oil into a pot; I covered it and left it afterwards
for a day and night in a bread oven. I drew out the pot and heated it
at a moderate fire, I pounded the whole and rubbed the sick parts;
in three days the pain had disappeared;’ under the influence of the
beetles and the crickets the stone was broken into bits. It was almost
always thus, by a sudden illumination, that this doctor discovered his
most efficacious remedies: Madame Trote [Trotula] of Salerno never
confided to her agents in various parts of the world the secret of more
marvelous and unexpected recipes.” (From Jusserand’s “English Wayfaring
Life in the Middle Ages.”)

[72] Some weeks later our fellow voyager, Thomas Schoepfius, wrote
to me that, on the return journey, he learned at Berne that “Long
Peter,” the leader of the Mézières robbers, had been apprehended by the
authorities and executed for his crimes; and that, when stretched on
the rack, he had confessed, among other things, that he had tried to
murder and rob some students who passed through Mézières on their way
to Lausanne.

[73] Also often spelled “Falloppius.”

[74] The meaning of this Latin inscription can best be appreciated by
those physicians who have, through a long period of years, practiced
their profession largely among the well-to-do classes of a metropolitan
city. They alone, I believe, would understand the significance of
“_lucrum neglectum_” as applied to a large proportion of the gifts
which a practitioner of medicine receives from grateful patients; and
it is not at all likely that a layman who is not familiar with this
aspect of a physician’s life would, under the circumstances mentioned,
have the slightest suspicion that the device quoted above could
possibly bear the meaning that I have given to it.

[75] See F. Loeffler: “Vorlesungen uber die geschichtliche Entwickelung
der Lehre von den Bakterien,” Leipzig, 1887, Th. 1; and also p. 310 of
Puschmann’s “Geschichte des Medicinischen Unterrichts,” Leipzig, 1889.

[76] The iatrophysicists and the iatromathematicians constituted
apparently two kindred branches of the same school.

[77] An edition of the completed set of these plates was published by
Lancisi at Rome in 1714.

[78] Translated from the French version printed by Daremberg in his
_Histoire de la Médecine_, Vol. II, p. 706. The originals of
Sydenham’s writings are all in Latin.

[79] Pronounced by Haeser to be a compilation, and not one of
Sydenham’s genuine writings.

[80] Physicians who maintain that all physiological and pathological
phenomena may be explained by the laws of physics.

[81] “Gründliches Bedenken und physicalische Anmerkungen von dem
tödtlichen Damff der Holzkohlen,” Halle, 1716.

[82] Probably this refers simply to a brazier containing burning
charcoal, the light emitted by which would doubtless be sufficient to
answer the purpose of a night lamp.

[83] A small seaport town located on the Zuider Zee, about thirty miles
northeast of Amsterdam. The university, which was founded there in
1648, was abandoned in 1818.

[84] Quoted from the English translation mentioned above.

[85] Bread boiled in water to the consistence of pulp.

[86] The modern operation known as litholapaxy.

[87] The word “_centuria_” is employed here in the sense of “a
group of one hundred.”

[88] Not Amatus, but a specialist. See remark near the top of page 488.

[89] Orange, which is only a short distance from Avignon and Turriers,
was ceded to France in 1713.

[90] In the absence of a more fitting place in which to speak of the
employment of urethral bougies, it seems permissible to state here that
the first mention (in medical literature) of these instruments occurs
in Chapter XV. of the treatise of Guainerio, Professor of Medicine at
the University of Pavia. This work, which was first published in 1439,
bears the title: “_Practica Antonii Guainerii_,” and a later
edition was issued at Venice in 1508. Speaking of a case of stone in
the bladder, Guainerius says: “And if the urine does not flow from the
bladder ... introduce a slender flexible rod of tin or silver into the
urethra.”

[91] Franco calls it the “high operation” or “hypogastric lithotomy.”

[92] After I had written the preceding description of Franco’s new
method of extracting a calculus from the urinary bladder, I learned,
from Haeser’s account of the surgical writings of Susrutas in the
Ayur-Veda (Sanscrit), that already before the Christian era (the
exact date is not known) the surgeons of East India had performed
this very operation. This fact, however, could not possibly have been
known to Franco, who--so far as modern surgeons are concerned--should
continue to be looked upon as the real inventor of suprapubic
cystotomy.--AUTHOR.

[93] The fact that bullets are not hot when they inflict a wound was
proven experimentally by Bartolommeo Maggi several years earlier, but
Paré makes no reference to this fact.

[94] Johann Jacob Wecker (1528–1586), born at Basel, Switzerland, and
author of a treatise entitled “_Practica medicinae generalis_”
(Basel, 1585).

[95] In this instance I have thought it best to modernize the spelling
of several of the words.

[96] Not healing in a healthy manner.

[97] Driving back.

[98] Haeser speaks of Wiseman as having gained considerable distinction
by the careful manner in which he made provision for the flaps in his
amputations.

[99] “_Observations diverses sur la stérilité, etc._,” Paris, 1609.

[100] For a confirmation of this statement see the poem on syphilis
(“_Enfermedad de las Bubas_”) written by the Spanish physician
Francesco Lopez de Villalobos and published by him in 1498 at
Salamanca. The employment of mercurial inunctions is also mentioned in
this poem.

[101] Physicians who had served at Rome as the regular medical
attendants of Pope Alexander the Sixth.

[102] “Die Geschichte der venerischen Krankheiten,” Bonn, 1895.

[103] “Zur Geschichte der Syphilis,” Breslau, 1870.


Transcriber’s Notes:

1. Obvious printers’, punctuation and spelling errors have been
corrected silently.

2. Some hyphenated and non-hyphenated versions of the same words have
been retained as in the original.

3. Italics are shown as _xxx_.