The Evolution of Modern Medicine
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PETRUS APONUS PATAVINUS PHILOSOPHIAE MEDICINAEQUE
SCIENTISSIMUS, OB IDQUE, CONCILIATORIS NOMEN
ADEPTUS, ASTROLOGIAE VERO ADEO PERITUS,
UT IN MAGIAE SUSPICIONEM INCIDERIT,
FALSOQUE DE HAERESI POSTULATUS,
ABSOLUTUS FUERIT.(21)
(21) Naude: History of Magick, London, 1657, p. 182, or the
original: Apologie pour les grands hommes soupconnez de magic,
e.g., ed. Amst., 1719, p. 275.
It is said that Abano caused to be painted the astronomical figures in
the great hall of the palace at Padua.
One characteristic of mediaeval medicine is its union with theology,
which is not remarkable, as the learning of the time was chiefly in
the hands of the clergy. One of the most popular works, the "Thesaurus
Pauperum," was written by Petrus Hispanus, afterwards Pope John XXI.
We may judge of the pontifical practice from the page here reproduced,
which probably includes, under the term "iliac passion," all varieties
of appendicitis.
For our purpose two beacons illuminate the spirit of the thirteenth
century in its outlook on man and nature. Better than Abelard or St.
Thomas Aquinas, and much better than any physicians, Albertus Magnus and
Roger Bacon represent the men who were awake to greet the rising of the
sun of science. What a contrast in their lives and in their works! The
great Dominican's long life was an uninterrupted triumph of fruitful
accomplishment--the titanic task he set himself was not only completed
but was appreciated to the full by his own generation--a life not only
of study and teaching, but of practical piety. As head of the order in
Germany and Bishop of Regensburg, he had wide ecclesiastical influence;
and in death he left a memory equalled only by one or two of his
century, and excelled only by his great pupil, Thomas Aquinas. There are
many Alberts in history--the Good, the Just, the Faithful--but there is
only one we call "Magnus" and he richly deserved the name. What is his
record? Why do we hold his name in reverence today?
Albertus Magnus was an encyclopaedic student and author, who took all
knowledge for his province. His great work and his great ambition was to
interpret Aristotle to his generation. Before his day, the Stagirite was
known only in part, but he put within the reach of his contemporaries
the whole science of Aristotle, and imbibed no small part of his spirit.
He recognized the importance of the study of nature, even of testing
it by way of experiment, and in the long years that had elapsed since
Theophrastus no one else, except Dioscorides, had made so thorough
a study of botany. His paraphrases of the natural history books
of Aristotle were immensely popular, and served as a basis for all
subsequent studies. Some of his medical works had an extraordinary
vogue, particularly the "De Secretis Mulierum" and the "De Virtutibus
Herbarum," but there is some doubt as to the authorship of the first
named, although Jammy and Borgnet include it in the collected editions
of his works. So fabulous was his learning that he was suspected of
magic and comes in Naude's list of the wise men who have unjustly
been reputed magicians. Ferguson tells(22) that "there is in actual
circulation at the present time a chapbook . . . containing charms,
receipts, sympathetical and magicalcures for man and animals, . . .
which passes under the name of Albertus." But perhaps the greatest claim
of Albertus to immortality is that he was the teacher and inspirer
of Thomas Aquinas, the man who undertook the colossal task of fusing
Aristotelian philosophy with Christian theology, and with such success
that the "angelic doctor" remains today the supreme human authority of
the Roman Catholic Church.
(22) Bibliotheca Chemica, 1906, Vol. I, p. 15.
A man of much greater interest to us from the medical point of view is
Roger Bacon and for two reasons. More than any other mediaeval mind he
saw the need of the study of nature by a new method. The man who could
write such a sentence as this: "Experimental science has three great
prerogatives over other sciences; it verifies conclusions by direct
experiment; it discovers truth which they never otherwise would reach;
it investigates the course of nature and opens to us a knowledge of the
past and of the future," is mentally of our day and generation. Bacon
was born out of due time, and his contemporaries had little sympathy
with his philosophy, and still less with his mechanical schemes and
inventions. From the days of the Greeks, no one had had so keen an
appreciation of what experiment meant in the development of human
knowledge, and he was obsessed with the idea, so commonplace to us, that
knowledge should have its utility and its practical bearing. "His chief
merit is that he was one of the first to point the way to original
research--as opposed to the acceptance of an authority--though he
himself still lacked the means of pursuing this path consistently. His
inability to satisfy this impulse led to a sort of longing, which is
expressed in the numerous passages in his works where he anticipates
man's greater mastery over nature."(23)
(23) Dannemann: Die Naturwissenschaften in ihrer Entwicklung und
in ibrem Zusammenhange, Leipzig, 1910, Vol. I, pp. 278-279.
Bacon wrote a number of medical treatises, most of which remain in
manuscript. His treatise on the "Cure of Old Age and the Preservation of
Youth" was printed in English in 1683.(24) His authorities were largely
Arabian. One of his manuscripts is "On the Bad Practices of Physicians."
On June 10, 1914, the eve of his birth, the septencentenary of Roger
Bacon will be celebrated by Oxford, the university of which he is the
most distinguished ornament. His unpublished MSS. in the Bodleian will
be issued by the Clarendon Press (1915-1920), and it is hoped that his
unpublished medical writings will be included.
(24) It may be interesting to note the three causes to which he
attributes old age: "As the World waxeth old, Men grow old with
it: not by reason of the Age of the World, but because of the
great Increase of living Creatures, which infect the very Air,
that every way encompasseth us, and Through our Negligence in
ordering our Lives, and That great Ignorance of the Properties
which are in things conducing to Health, which might help a
disordered way of Living, and might supply the defect of due
Government."
What would have been its fate if the mind of Europe had been ready for
Roger Bacon's ferment, and if men had turned to the profitable studies
of physics, astronomy and chemistry instead of wasting centuries over
the scholastic philosophy and the subtleties of Duns Scotus, Abelard and
Thomas Aquinas? Who can say? Make no mistake about the quality of these
men--giants in intellect, who have had their place in the evolution of
the race; but from the standpoint of man struggling for the mastery of
this world they are like the members of Swift's famous college "busy
distilling sunshine from cucumbers." I speak, of course, from the
position of the natural man, who sees for his fellows more hope from the
experiments of Roger Bacon than from the disputations of philosophy on
the "Instants, Familiarities, Quiddities and Relations," which so roused
the scorn of Erasmus.
MEDIAEVAL MEDICAL STUDIES
IT will be of interest to know what studies were followed at a mediaeval
university. At Oxford, as at most of the continental universities, there
were three degrees, those of Bachelor, Licentiate and Doctor. The books
read were the "Tegni" of Galen, the "Aphorisms" of Hippocrates, the "De
Febribus" of Isaac and the "Antidotarium" of Nicolaus Salernitanus: if
a graduate in arts, six years' study in all was required, in other
faculties, eight. One gets very full information on such matters from
a most interesting book, "Une Chaire de Medecine au XVe Siecle," by Dr.
Ferrari (Paris, 1899). The University of Pavia was founded in 1361, and
like most of those in Italy was largely frequented by foreigners, who
were arranged, as usual, according to their nationalities; but the
students do not appear to have controlled the university quite so much
as at Bologna. The documents of the Ferrari family, on which the work is
based, tell the story of one of its members, who was professor at Pavia
from 1432 to 1472. One is surprised at the range of studies in certain
directions, and still more at the absence of other subjects. A list is
given of the teachers in medicine for the year 1433, twenty in all, and
there were special lectures for the morning, afternoon and evening. The
subjects are medicine, practical medicine, physics, metaphysics, logic,
astrology, surgery and rhetoric: very striking is the omission of
anatomy, which does not appear in the list even in 1467. The salaries
paid were not large, so that most of the teachers must have been in
practice: four hundred and five hundred florins was the maximum.
The dominance of the Arabians is striking. In 1467, special lectures
were given on the "Almansor" of Rhazes, and in the catalogue of
the Ferrari's library more than one half of the books are Arabian
commentaries on Greek medicine. Still more striking evidence of their
influence is found in the text-book of Ferrari, which was printed in
1471 and had been circulated earlier in MS. In it Avicenna is quoted
more than 3000 times, Rhazes and Galen 1000, Hippocrates only 140
times. Professor Ferrari was a man who played an important role in
the university, and had a large consultation practice. You will be
interested to know what sort of advice he gave in special cases. I have
the record of an elaborate consultation written in his own hand, from
which one may gather what a formidable thing it was to fall into the
hands of a mediaeval physician. Signor John de Calabria had a digestive
weakness of the stomach, and rheumatic cerebral disease, combined with
superfluous heat and dryness of the liver and multiplication of choler.
There is first an elaborate discussion on diet and general mode of life;
then he proceeds to draw up certain light medicines as a supplement,
but it must have taken an extensive apothecary's shop to turn out the
twenty-two prescriptions designed to meet every possible contingency.
One of the difficulties in the early days of the universities was to
procure good MSS. In the Paris Faculty, the records of which are the
most complete in Europe, there is an inventory for the year 1395 which
gives a list of twelve volumes, nearly all by Arabian authors.(25)
Franklin gives an interesting incident illustrating the rarity of
medical MSS. at this period. Louis XI, always worried about his health,
was anxious to have in his library the works of Rhazes. The only copy
available was in the library of the medical school. The manuscript was
lent, but on excellent security, and it is nice to know that it was
returned.
(25) Franklin: Recherches sur la Bibliotheque de la Faculte de
Medecine de Paris, 1864.
It is said that one of the special advantages that Montpellier had over
Paris was its possession of so many important MSS., particularly
those of the Arabian writers. Many "Compendia" were written containing
extracts from various writers, and no doubt these were extensively
copied and lent or sold to students. At Bologna and Padua, there were
regulations as to the price of these MSS. The university controlled the
production of them, and stationers were liable to fines for inaccurate
copies. The trade must have been extensive in those early days, as
Rashdall mentions that in 1323 there were twenty-eight sworn booksellers
in Paris, besides keepers of bookstalls in the open air.
MEDIAEVAL PRACTICE
THE Greek doctrine of the four humors colored all the conceptions of
disease; upon their harmony alone it was thought that health depended.
The four temperaments, sanguine, phlegmatic, bilious and melancholic,
corresponded with the prevalence of these humors. The body was composed
of certain so-called "naturals," seven in number--the elements,
the temperaments, the humors, the members or parts, the virtues
or faculties, the operations or functions and the spirits. Certain
"non-naturals," nine in number, preserved the health of the body, viz.
air, food and drink, movement and repose, sleeping and waking, excretion
and retention, and the passions. Disease was due usually to alterations
in the composition of the humors, and the indications for treatment were
in accordance with these doctrines. They were to be evacuated, tenuated,
cooled, heated, purged or strengthened. This humoral doctrine prevailed
throughout the Middle Ages, and reached far into modern times--indeed,
echoes of it are still to be heard in popular conversations on the
nature of disease.
The Arabians were famous for their vigor and resource in matters of
treatment. Bleeding was the first resort in a large majority of all
diseases. In the "Practice" of Ferrari there is scarcely a malady
for which it is not recommended. All remedies were directed to the
regulation of the six non-naturals, and they either preserved health,
cured the disease or did the opposite. The most popular medicines were
derived from the vegetable kingdom, and as they were chiefly those
recommended by Galen, they were, and still are, called by his name.
Many important mineral medicines were introduced by the Arabians,
particularly mercury, antimony, iron, etc. There were in addition scores
of substances, the parts or products of animals, some harmless, others
salutary, others again useless and disgusting. Minor surgery was in the
hands of the barbers, who performed all the minor operations, such as
bleeding; the more important operations, few in number, were performed
by surgeons.
ASTROLOGY AND DIVINATION
AT this period astrology, which included astronomy, was everywhere
taught. In the "Gouernaunce of Prynces, or Pryvete of Pryveties,"
translated by James Yonge, 1422,(26) there occurs the statement:
"As Galian the lull wies leche Saith and Isoder the Gode clerk, hit
witnessith that a man may not perfitely can the sciens and craft of
Medissin but yef he be an astronomoure."
(26) Early English Text Society, Extra Series, No. LXXIV, p. 195,
1898; Secreta Secretorum, Rawl. MS. B., 490.
We have seen how the practice of astrology spread from Babylonia and
Greece throughout the Roman Empire. It was carried on into the Middle
Ages as an active and aggressive cult, looked upon askance at times
by the Church, but countenanced by the courts, encouraged at the
universities, and always by the public. In the curriculum of the
mediaeval university, astronomy made up with music, arithmetic and
geometry the Quadrivium. In the early faculties, astronomy and astrology
were not separate, and at Bologna, in the early fourteenth century, we
meet with a professorship of astrology.(27) One of the duties of this
salaried professor, was to supply "judgements" gratis for the benefit of
enquiring students, a treacherous and delicate assignment, as that most
distinguished occupant of the chair at Bologna, Cecco d'Ascoli, found
when he was burned at the stake in 1357, a victim of the Florentine
Inquisition.(28)
(27) Rashdall: Universities of Europe in the Middle Ages, Vol.
I, p. 240.
(28) Rashdall, l.c., Vol. I, p. 244.--Rashdall also mentions that
in the sixteenth century at Oxford there is an instance of a
scholar admitted to practice astrology. l.c., Vol. II, p. 458.
Roger Bacon himself was a warm believer in judicial astrology and in the
influence of the planets, stars and comets on generation, disease and
death.
Many of the stronger minds of the Renaissance broke away from the
follies of the subject. Thus Cornelius Agrippa in reply to the request
of a friar to consult the stars on his behalf says:(29) "Judicial
astrology is nothing more than the fallacious guess of superstitious
men, who have founded a science on uncertain things and are deceived by
it: so think nearly all the wise; as such it is ridiculed by some most
noble philosophers; Christian theologians reject it, and it is condemned
by sacred councils of the Church. Yet you, whose office it is to
dissuade others from these vanities, oppressed, or rather blinded by I
know not what distress of mind, flee to this as to a sacred augur, and
as if there were no God in Israel, that you send to inquire of the god
of Ekron."
(29) H. Morley: The Life of Henry Cornelius Agrippa, London,
1856, Vol. II, p. 138.
In spite of the opposition of the Church astrology held its own; many of
the universities at the end of the fifteenth century published almanacs,
usually known as "Prognosticons," and the practice was continued far
into the sixteenth century. I show you here an illustration. Rabelais,
you may remember, when physician to the Hotel Dieu in Lyons, published
almanacs for the years 1533, 1535, 1541, 1546. In the title-page he
called himself "Doctor of Medicine and Professor of Astrology," and they
continued to be printed under his name until 1556. In the preparation
of these he must have had his tongue in his cheek, as in his famous
"Pantagrueline Prognostication," in which, to satisfy the curiosity of
all good companions, he had turned over all the archives of the heavens,
calculated the quadratures of the moon, hooked out all that has ever
been thought by all the Astrophils, Hypernephilists, Anemophylakes,
Uranopets and Ombrophori, and felt on every point with Empedocles.(30)
(30) Pantagrueline Prognostication, Rabelais, W. F. Smith's
translation, 1893, Vol. II, p. 460.
Even physicians of the most distinguished reputation practised judicial
astrology. Jerome Cardan was not above earning money by casting
horoscopes, and on this subject he wrote one of his most popular books
(De Supplemento Almanach, etc., 1543), in which astronomy and
astrology are mixed in the truly mediaeval fashion. He gives in it some
sixty-seven nativities, remarkable for the events they foretell, with an
exposition. One of the accusations brought against him was that he had
"attempted to subject to the stars the Lord of the stars and cast our
Saviour's horoscope."(31) Cardan professed to have abandoned a practice
looked upon with disfavor both by the Church and by the universities,
but he returned to it again and again. I show here his own horoscope.
That remarkable character, Michael Servetus, the discoverer of the
lesser circulation, when a fellow student with Vesalius at Paris, gave
lectures upon judicial astrology, which brought him into conflict with
the faculty; and the rarest of the Servetus works, rarer even than
the "Christianismi Restitutio," is the "Apologetica disceptatio pro
astrologia," one copy of which is in the Bibliotheque Nationale. Nor
could the new astronomy and the acceptance of the heliocentric views
dislocate the popular belief. The literature of the seventeenth century
is rich in astrological treatises dealing with medicine.
(31) De Thou, Lib. LXII, quoted by Morley in Life of Jerome
Cardan, Vol. II, p. 294.
No one has ever poured such satire upon the mantic arts as did Rabelais
in chapter twenty-five of the third book of "Pantagruel." Panurge goes
to consult Her Trippa--the famous Cornelius Agrippa, whose opinion
of astrology has already been quoted, but who nevertheless, as court
astrologer to Louise of Savoy, had a great contemporary reputation.
After looking Panurge in the face and making conclusions by metoposcopy
and physiognomy, he casts his horoscope secundum artem, then, taking a
branch of tamarisk, a favorite tree from which to get the divining
rod, he names some twenty-nine or thirty mantic arts, from pyromancy to
necromancy, by which he offers to predict his future. While full of rare
humor, this chapter throws an interesting light on the extraordinary
number of modes of divination that have been employed. Small wonder that
Panurge repented of his visit! I show here the title-page of a popular
book by one of the most famous of the English astrological physicians,
Nicholas Culpeper.
Never was the opinion of sensible men on this subject better expressed
than by Sir Thomas Browne:(32) "Nor do we hereby reject or condemn a
sober and regulated Astrology; we hold there is more truth therein than
in ASTROLOGERS; in some more than many allow, yet in none so much
as some pretend. We deny not the influence of the Starres, but often
suspect the due application thereof; for though we should affirm that
all things were in all things; that Heaven were but Earth Celestified,
and earth but Heaven terrestrified, or that each part above had an
influence upon its divided affinity below; yet how to single out these
relations, and duly to apply their actions, is a work ofttimes to be
effected by some revelation, and Cabala from above, rather than any
Philosophy, or speculation here below."
(32) Sir Thomas Browne: Pseudodoxia Epidemica, Bk. IV, Chap.
XIII. (Wilkin's ed., Vol. III, p. 84.)
As late as 1699, a thesis was discussed at the Paris Faculty, "Whether
comets were harbingers of disease," and in 1707 the Faculty negatived
the question propounded in a thesis, "Whether the moon had any sway on
the human body."
The eighteenth and nineteenth centuries saw, among intelligent men, a
progressive weakening of the belief in the subject; but not even the
satire of Swift, with his practical joke in predicting and announcing
the death of the famous almanac maker, nor contemptuous neglect of the
subject of late years sufficed to dispel the belief from the minds of
the public. Garth in the Dispensary (1699) satirizes the astrological
practitioners of his day:
The Sage in Velvet Chair, here lolls at Ease
To promise future Health for present Fees
Then as from Tripod solemn Sham reveals
And what the Stars know nothing of foretell. (Canto ii.)
The almanacs of Moore and Zadkiel continue to be published, and
remain popular. In London, sandwich men are to be met with carrying
advertisements of Chaldeans and Egyptians who offer to tell your fortune
by the stars. Even in this country, astrology is still practiced to
a surprising extent if one may judge from advertisements in certain
papers, and from publications which must have a considerable sale. Many
years ago, I had as a patient an estimable astrologer, whose lucrative
income was derived from giving people astral information as to the rise
and fall of stocks. It is a chapter in the vagaries of the human mind
that is worth careful study.(33) Let me commend to your reading the
sympathetic story called "A Doctor of Medicine" in the "Rewards and
Fairies" of Kipling. The hero is Nicholas Culpeper, Gent., whose picture
is here given. One stanza of the poem at the end of the story, "Our
Fathers of Old," may be quoted:
Wonderful tales had our fathers of old--
Wonderful tales of the herbs and the stars--
The Sun was Lord of the Marigold,
Basil and Rocket belonged to Mars.
Pat as a sum in division it goes--
(Every plant had a star bespoke)--
Who but Venus should govern the Rose?
Who but Jupiter own the Oak?
Simply and gravely the facts are told
In the wonderful books of our fathers of old.
(33) It is not generally known that Stonewall Jackson practiced
astrology. Col. J. W. Revere in "Keel and Saddle" (Boston, 1872)
tells of meeting Jackson in 1852 on a Mississippi steamer and
talking with him on the subject. Some months later, Revere
received a letter from Jackson enclosing his (Revere's)
horoscope. There was a "culmination of the malign aspect during
the first days of May, 1863--both will be exposed to a common
danger at the time indicated." At the battle of
Chancellorsville, May 9, 1863, Revere saw Jackson mortally
wounded!
James J. Walsh of New York has written a book of extraordinary interest
called "The Thirteenth, Greatest of Centuries." I have not the necessary
knowledge to say whether he has made out his case or not for art and for
literature. There was certainly a great awakening and, inspired by high
ideals, men turned with a true instinct to the belief that there was
more in life than could be got out of barren scholastic studies. With
many of the strong men of the period one feels the keenest mental
sympathy. Grosseteste, the great Clerk of Lincoln, as a scholar, a
teacher and a reformer, represents a type of mind that could grow
only in fruitful soil. Roger Bacon may be called the first of
the moderns--certainly the first to appreciate the extraordinary
possibilities which lay in a free and untrammelled study of nature.
A century which could produce men capable of building the Gothic
cathedrals may well be called one of the great epochs in history, and
the age that produced Dante is a golden one in literature. Humanity has
been the richer for St. Francis; and Abelard, Albertus and Aquinas form
a trio not easy to match, in their special departments, either before or
after. But in science, and particularly in medicine, and in the advance
of an outlook upon nature, the thirteenth century did not help man very
much. Roger Bacon was "a voice crying in the wilderness," and not one of
the men I have picked out as specially typical of the period instituted
any new departure either in practice or in science. They were servile
followers, when not of the Greeks, of the Arabians. This is attested by
the barrenness of the century and a half that followed. One would have
thought that the stimulus given by Mundinus to the study of anatomy
would have borne fruit, but little was done in science during the two
and a half centuries that followed the delivery of his lectures and
still less in the art. While William of Wykeham was building Winchester
Cathedral and Chaucer was writing the Canterbury Tales, John of
Gaddesden in practice was blindly following blind leaders whose
authority no one dared question.