Old-Time Makers of Medicine Part 1

Old-Time Makers of Medicine.

by James J. Walsh.

PREFACE

The material for this book was gathered partly for lectures on the history of medicine at Fordham University School of Medicine, and partly for articles on a number of subjects in the Catholic Encyclopedia. Some of it was developed for a series of addresses at commencements of medical schools and before medical societies, on the general topic how old the new is in surgery, medicine, dentistry, and pharmacy. The information thus presented aroused so much interest, the accomplishments of the physicians and surgeons of a period that is usually thought quite sterile in medical science proved, indeed, so astonishing, that I was tempted to connect the details for a volume in the Fordham University Press series. There is no pretence to any original investigation in the history of medicine, nor to any extended consultation of original doc.u.ments. I have had most of the great books that are mentioned in the course of this volume in my hands, and have given as much time to the study of them as could be afforded in the midst of a rather busy life, but I owe my information mainly to the distinguished German and French scholars who have in recent years made deep and serious studies of these Old Makers of Medicine, and I have made my acknowledgments to them in the text as opportunity presented itself.

There is just one feature of the book that may commend it to present-day readers, and that is that our medieval medical colleagues, when medicine embraced most of science, faced the problems of medicine and surgery and the allied sciences that are now interesting us, in very much the same temper of mind as we do, and very often antic.i.p.ated our solutions of them--much oftener, indeed, than most of us, unless we have paid special attention to history, have any idea of. The volume does not const.i.tute, then, a contribution to that theme that has interested the last few generations so much,--the supposed continuous progress of the race and its marvellous advance,--but rather emphasizes that puzzling question, how is it that men make important discoveries and inventions, and then, after a time, forget about them so that they have to be made over again? This is as true in medical science and in medical practice as in every other department of human effort. It does not seem possible that mankind should ever lose sight of the progress in medicine and surgery that has been made in recent years, yet the history of the past would seem to indicate that, in spite of its unlikelihood, it might well come about. Whether this is the lesson of the book or not, I shall leave readers to judge, for it was not intentionally put into it.

OUR LADY'S DAY IN HARVEST, 1911.

"The little by-play between Socrates and Euthydemus suggests an advanced condition of medical literature: 'Of course, you who have so many books are going in for being a doctor,' says Socrates, and then he adds, 'there are so many books on medicine, you know.' As Dyer remarks, whatever the quality of these books may have been, their number must have been great to give point to this chaff."--_Aequanimitas_, WILLIAM OSLER, M.D., F.R.S., Blakistons, Philadelphia, 1906.

"Augesc.u.n.t aliae gentes, aliae minuuntur; Inque brevi spatio mutantur saecla animantum, Et, quasi cursores vitai lampada tradunt."

--OVID.

One nation rises to supreme power in the world, while another declines, and, in a brief s.p.a.ce of time, the sovereign people change, transmitting, like racers, the lamp of life to some other that is to succeed them.

"There is one Science of Medicine which is concerned with the inspection of health equally in all times, present, past and future."

--PLATO.

I

INTRODUCTION

Under the term Old-Time Medicine most people probably think at once of Greek medicine, since that developed in what we have called ancient history, and is farthest away from us in date. As a matter of fact, however, much more is known about Greek medical writers than those of any other period except the last century or two. Our histories of medicine discuss Greek medicine at considerable length and practically all of the great makers of medicine in subsequent generations have been influenced by the Greeks. Greek physicians whose works have come down to us seem nearer to us than the medical writers of any but the last few centuries. As a consequence we know and appreciate very well as a rule how much Greek medicine accomplished, but in our admiration for the diligent observation and breadth of view of the Greeks, we are sometimes p.r.o.ne to think that most of the intervening generations down to comparatively recent times made very little progress and, indeed, scarcely retained what the Greeks had done. The Romans certainly justify this a.s.sumption of non-accomplishment in medicine, but then in everything intellectual Rome was never much better than a weak copy of Greek thought. In science the Romans did nothing at all worth while talking about. All their medicine they borrowed from the Greeks, adding nothing of their own. What food for thought there is in the fact, that in spite of all Rome's material greatness and wide empire, her world dominance and vaunted prosperity, we have not a single great original scientific thought from a Roman.

Though so much nearer in time medieval medicine seems much farther away from us than is Greek medicine. Most of us are quite sure that the impression of distance is due to its almost total lack of significance.

It is with the idea of showing that the medieval generations, as far as was possible in their conditions, not only preserved the old Greek medicine for us in spite of the most untoward circ.u.mstances, but also tried to do whatever they could for its development, and actually did much more than is usually thought, that this story of "Old-Time Makers of Medicine" is written. It represents a period--that of the Middle Ages--that is, or was until recently, probably more misunderstood than any other in human history. The purpose of the book is to show at least the important headlands that lie along the stream of medical thought during the somewhat more than a thousand years from the fall of the Roman Empire under Augustulus (476) until the discovery of America.

After that comes modern medicine, for with the sixteenth century the names and achievements of the workers in medicine are familiar--Paracelsus, Vesalius, Columbus, Servetus, Caesalpinus, Eustachius, Varolius, Sylvius are men whose names are attached to great discoveries with which even those who are without any pretence to knowledge of medical history are not unacquainted. In spite of nearly four centuries of distance in time these men seem very close to us.

Their lives will be reserved for a subsequent volume, "Our Forefathers in Medicine."

It is usually the custom to contemn the Middle Ages for their lack of interest in culture, in education, in literature, in a word, in intellectual accomplishment of any and every kind, but especially in science. There is no doubt about the occurrence of marked decadence in the intellectual life of the first half of this period. This has sometimes been attributed to what has been called the inhibitory effect of Christianity on worldly interests. Religion is said to have occupied people so much with thoughts of the other world that the beauties and wonders, as well as much of the significance, of the world around them were missed. Those who talk thus, however, forget entirely the circ.u.mstances which brought about the serious decadence of interest in culture and science at this time. The Roman Empire had been the guardian of letters and education and science. While the Romans were not original in themselves, at least they had shown intense interest in what was accomplished by the Greeks and their imitation had often risen to heights that made them worthy of consideration for themselves. They were liberal patrons of Greek art and of Greek literature, and did not neglect Greek science and Greek medicine. Galen's influence was due much more to the prominence secured by him as the result of his stay in Rome than would have been possible had he stayed in Asia. There are many other examples of Roman patronage of literature and science that might be mentioned. As we shall see, Rome drained Greece and Asia Minor of their best, and appropriated to herself the genius products of the Spanish Peninsula. Rome had a way of absorbing what was best in the provinces for herself.

Just as soon as Rome was cut off from intimate relations with the provinces by the inwandering of barbarians, intellectual decadence began. The imperial city itself had never been the source of great intellectual achievement, and the men whom we think of as important contributors to Rome's literature and philosophy were usually not born within the confines of the city. It is surprising to take a list of the names of the Latin writers whom we are accustomed to set down simply as Romans and note their birthplaces. Rome herself gave birth to but a very small percentage of them. Virgil was born at Mantua, Cicero at Arpinum, Horace out on the Sabine farm, the Plinys out of the city, Terence in Africa, Persius up in Central Italy somewhere, Livy at Padua, Martial, Quintilian, the Senecas, and Lucan in Spain. When the government of the city ceased to be such as a.s.sured opportunity for those from outside who wanted to make their way, decadence came to Roman literature. Large cities have never in history been the fruitful mothers of men who did great things. Genius, and even talent, has always been born out of the cities in which it did its work. It is easy to understand, then, the decadence of the intellectual life that took place as the Empire degenerated.

For the sake of all that it meant in the Roman Empire to look towards Rome at this time, however, it seemed better to the early Christians to establish the centre of their jurisdiction there. Necessarily, then, in all that related to the purely intellectual life, they came under the influences that were at work at Rome at this time. During the first centuries they suffered besides from the persecutions directed against them by the Emperors at various times, and these effectually prevented any external manifestations of the intellectual life on the part of Christians. It took much to overcome this serious handicap, but noteworthy progress was made in spite of obstacles, and by the time of Constantine many important officials of the Empire, the educated thinking cla.s.ses of Rome, had become Christians. After the conversion of the Emperor opportunities began to be afforded, but political disturbances consequent upon barbarian influences still further weakened the old civilization until much of the intellectual life of it almost disappeared.

Gradually the barbarians, finding the Roman Empire decadent, crept in on it, and though much more of the invasion was peaceful than we have been accustomed to think, the Romans simply disappearing because family life had been destroyed, children had become infrequent, and divorce had become extremely common, it was not long before they replaced the Romans almost entirely. These new peoples had no heritage of culture, no interest in the intellectual life, no traditions of literature or science, and they had to be gradually lifted up out of their barbarism.

This was the task that Christianity had to perform. That it succeeded in accomplishing it is one of the marvels of history.

The Church's first grave duty was the preservation of the old records of literature and of science. Fortunately the monasteries accomplished this task, which would have been extremely perilous for the precious treasures involved but for the favorable conditions thus afforded.

Libraries up to this time were situated mainly in cities, and were subject to all the vicissitudes of fire and war and other modes of destruction that came to cities in this disturbed period. Monasteries, however, were usually situated in the country, were built very substantially and very simply, and the life in them formed the best possible safeguard against fire, which worked so much havoc in cities.

As we shall see, however, not only were the old records preserved, but excerpts from them were collated and discussed and applied by means of direct observation. This led the generations to realize more and more the value of the old Greek medicine and made them take further precautions for its preservation.

The decadence of the early Middle Ages was due to the natural shifting of ma.s.ses of population of this time, while the salvation of scientific and literary traditions was due to the one stable element in all these centuries--the Church. Far from Christianity inhibiting culture, it was the most important factor for its preservation, and it provided the best stimulus and incentive for its renewed development just as soon as the barbarous peoples were brought to a state of mind to appreciate it.

Bearing this in mind, it is easier to understand the course of medical traditions through the Middle Ages, and especially in the earlier period, with regard to which our doc.u.ments are comparatively scanty, and during which the disturbed conditions made medical developments impossible, and anything more than the preservation of the old authors out of the question. The torch of medical illumination lighted at the great Greek fires pa.s.ses from people to people, never quenched, though often burning low because of unfavorable conditions, but sometimes with new fuel added to its flame by the contributions of genius. The early Christians took it up and kept it lighted, and, with the Jewish physicians, carried it through the troublous times of the end of the old order, and then pa.s.sed it on for a while to the Arabs. Then, when favorable conditions had developed again, Christian schools and scholars gave it the opportunity to burn brightly for several centuries at the end of the Middle Ages. This medieval age is probably the most difficult period of medical history to understand properly, but it is worth while taking the trouble to follow out the thread of medical tradition from the Greeks to the Renaissance medical writers, who practically begin modern medicine for us.

It is easy to understand that Christianity's influence on medicine, instead of hampering, was most favorable. The Founder of Christianity Himself had gone about healing the sick, and care for the ailing became a prominent feature of Christian work. One of the Evangelists, St. Luke, was a physician. It was the custom a generation ago, and even later, when the Higher Criticism became popular, to impugn the tradition as to St. Luke having been a physician, but this has all been undone, and Harnack's recent book, "Luke the Physician," makes it very clear that not only the Third Gospel, but also the Acts, could only have been written by a man thoroughly familiar with the Greek medical terms of his time, and who had surely had the advantage of a training in the medical sciences at Alexandria. This makes such an important link in medical traditions that a special chapter has been devoted to it in the Appendix.

Very early in Christianity care for the ailing poor was taken up, and hospitals in our modern sense of the term became common in Christian communities. There had been military hospitals before this, and places where those who could afford to pay for service were kept during illness. Our modern city hospital, however, is a Christian inst.i.tution.

Besides, deformed and ailing children were cared for and homes for foundlings were established. Before Christianity the power even of life and death of the parents over their children was recognized, and deformed or ailing children, or those that for some reason were not wanted, were exposed until they died. Christianity put an end to this, and in two cla.s.ses of inst.i.tutions, the hospitals and the asylums, abundant opportunity for observation of illness was afforded. Just as soon as Christianity came to be free to establish its inst.i.tutions publicly, hospitals became very common. The Emperor Julian, usually known as the Apostate, who hoped to re-establish the old Roman Olympian religion, wrote to Oribasius, one of the great physicians of this time, who was also an important official of his household, that these Christians had established everywhere hospitals in which not only their own people, but also those who were not Christians, were received and cared for, and that it would be idle to hope to counteract the influence of Christianity until corresponding inst.i.tutions could be erected by the government.

From the very beginning, or, at least, just as soon as reasonable freedom from persecution gave opportunity for study, Christian interest in the medical sciences began to manifest itself. Nemesius, for instance, a Bishop of Edessa in Syria, wrote toward the end of the fourth century a little work in Greek on the nature of man, which is a striking ill.u.s.tration of this. Nemesius was what in modern times would be called a philosopher, that is, a speculative thinker and writer, with regard to man's nature, rather than a physical scientist. He was convinced, however, that true philosophy ought to be based on a complete knowledge of man, body and soul, and that the anatomy of his body ought to be a fundamental principle. It is in this little volume that some enthusiastic students have found a description that is to them at least much more than a hint of knowledge of the circulation of the blood.

Hyrtl doubts that the pa.s.sage in question should be made to signify as much as has been suggested, but the occurrence of any even distant reference to such a subject at this time shows that, far from there being neglect of physical scientific questions, men were thinking seriously about them.

Just as soon as Christianity brought in a more peaceful state of affairs and had so influenced the ma.s.s of the people that its place in the intellectual life could be felt, there comes a period of cultural development represented in philosophy by the Fathers of the Church, and during which we have a series of important contributors to medical literature. The first of these was Aetius, whose career and works are treated more fully in the chapter on "Great Physicians in Early Christian Times." He was followed by Alexander of Tralles, probably a Christian, for his brother was the architect of Santa Sophia, and by Paul of aegina, with regard to whom we know only what is contained in his medical writings, but whose contemporaries were nearly all Christians.

Their books are valuable to us, partly because they contain quotations from great Greek writers on medicine, not always otherwise available, but also because they were men who evidently knew the subject of medicine broadly and thoroughly, made observations for themselves, and controlled what they learned from the Greek forefathers in medicine by their own experience. Just at the beginning of the Middle Ages, then, under the fostering care of Christianity there is a period of considerable importance in the history of medical literature. It is one of the best proofs that we have not only that Christianity did not hamper medical development, but that, directly and indirectly, by the place that it gave to the care of the ailing in life as well as the encouragement afforded to the intellectual life, it favored medical study and writing.

A very interesting chapter in the story of the early Christian physician is to be found in what we know of the existence of women physicians in the fourth and fifth centuries. Theodosia, the mother of St. Procopius the martyr, was, according to Carptzovius, looked upon as an excellent physician in Rome in the early part of the fourth century. She suffered martyrdom under Diocletian. There was also a Nicerata who practised at Constantinople under the Emperor Arcadius. It is said that to her St.

John Chrysostom owed the cure of a serious illness. From the very beginning Christian women acted as nurses, and deaconesses were put in charge of hospitals. Fabiola, at Rome, is the foundress of the first important hospital in that city. The story of these early Christian women physicians has been touched upon in the chapter on "Medieval Women Physicians," as an introduction to this interesting feature of Salernitan medical education.

During the early Christian centuries much was owed to the genius and the devotion to medicine of distinguished Jewish physicians. Their sacred and rabbinical writers always concerned themselves closely with medicine, and both the Old Testament and the Talmud must be considered as containing chapters important for the medical history of the periods in which they were written. At all times the Jews have been distinguished for their knowledge of medicine, and all during the Middle Ages they are to be found prominent as physicians. They were among the teachers of the Arabs in the East and of the Moors in Spain. They were probably among the first professors at Salerno as well as at Montpellier. Many prominent rulers and ecclesiastics selected Jewish physicians. Some of these made distinct contributions to medicine, and a number of them deserve a place in any account of medicine in the making during the Middle Ages. One of them, Maimonides, to whom a special chapter is devoted, deserves a place among the great makers of medicine of all time, because of the influence that he exerted on his own and succeeding generations. Any story of the preservation and development of medical teaching and medical practice during the Middle Ages would be decidedly incomplete without due consideration of the work of Jewish physicians.

Western medical literature followed Roman literature in other departments, and had only the Greek traditions at second hand. During the disturbance occasioned by the invasion of the barbarians there was little opportunity for such leisure as would enable men to devote themselves with tranquillity to medical study and writing. Medical traditions were mainly preserved in the monasteries. Ca.s.siodorus, who, after having been Imperial Prime Minister, became a monk, recommended particularly the study of medicine to the monastic brethren. With the foundation of the Benedictines, medicine became one of the favorite studies of the monks, partly for the sake of the health of the brethren themselves, and partly in order that they might be helpful to the villages that so often gathered round their monasteries. There is a well-grounded tradition that at Monte Ca.s.sino medical teaching was one of the features of the education provided there by the monks. It is generally conceded that the Benedictines had much to do with the foundation of Salerno. In the convents for women as well as the monasteries for men serious attention was given to medicine. Women studied medicine and were professors in the medical department of Salerno. Other Italian universities followed the example thus set, and so there is abundant material for the chapter on "Medieval Women Physicians."

The next phase of medical history in the medieval period brings us to the Arabs. Utterly uninterested in culture, education, or science before the time of Mohammed, with the growth of their political power and the foundation of their capitals, the Arab Caliphs took up the patronage of education. They were the rulers of the cities of Asia Minor in which Greek culture had taken so firm a hold, and captive Greece has always led its captors captive. With the leisure that came for study, Arabians took up the cultivation of the Greek philosophers, especially Aristotle, and soon turned their attention also to the Greek physicians Hippocrates and Galen. For some four hundred years then they were in the best position to carry on medical traditions. Their teachers were the Christian and Jewish physicians of the cities of Asia Minor, but soon they themselves became distinguished for their attainments, and for their medical writings. Interestingly enough, more of their distinguished men flourished in Spain than in Asia Minor. We have suggested an explanation for this in the fact that Spain had been one of the most cultured provinces of the Roman Empire, providing practically all the writers of the Silver Age of Latin literature, and evidently possessing a widely cultured people. It was into this province, not yet utterly decadent from the presence of the northern Goths, that the Moors came and readily built up a magnificent structure of culture and education on what had been the highest development of Roman civilization.

The influence of the Arabs on Western civilization, and especially on the development of science in Europe, has been much exaggerated by certain writers. Closely in touch with Greek thought and Greek literature during the eighth, ninth, and tenth centuries, it is easy to understand that the Arabian writers were far ahead of the Christian scholars of Europe of the same period, who were struggling up out of the practical chaos that had been created by the coming of the barbarians, and who, besides, had the chance for whatever Greek learning came to them only through the secondary channels of the Latin writers. Rome had been too occupied with politics and aggrandizement ever to become cultured. In spite of this heritage from the Greeks, decadence took place among the Arabs, and, as the centuries go on, what they do becomes more and more trivial, and their writing has less significance. Just the opposite happened in Europe. There, there was noteworthy progressive development until the magnificent climax of thirteenth century accomplishment was reached. It is often said that Europe owed much to the Arabs for this, but careful a.n.a.lysis of the factors in that progress shows that very little came from the Arabs that was good, while not a little that was unfortunate in its influence was borrowed from them with the translations of the Greek authors from that language, which const.i.tuted the main, indeed often the only, reason why Arabian writers were consulted.

With the foundation of the medical school of Salerno in the tenth century, the modern history of medical education may be said to begin, for it had many of the features that distinguish our modern university medical schools. Its professors often came from a distance and had travelled extensively for purposes of study; they attracted patients of high rank from nearly every part of Europe, and these were generous in their patronage of the school. Students came from all over, from Africa and Asia, as well as Europe, and when abuses of medical practice began to creep in, a series of laws were made creating a standard of medical education and regulating the practice of medicine, that are interesting antic.i.p.ations of modern movements of the same kind. Finally a law was pa.s.sed requiring three years of preliminary work in logic and philosophy before medicine might be taken up, and then four years at medicine, with a subsequent year of practice with a physician before a license to practise for one's self was issued. In addition to this there was a still more surprising feature in the handing over of the department of women's diseases to women professors, and the consequent opening up of licensure to practise medicine to a great many women in the southern part of Italy. The surprise that all this should have taken place in the south of Italy is lessened by recalling the fact that the lower end of the Italian peninsula had been early colonized by Greeks, that its name in later times was Magna Graecia, and that the stimulus of Greek tradition has always been especially favorable to the development of scientific medicine.

Salerno's influence on Bologna is not difficult to trace, and the precious tradition of surgery particularly, which was carried to the northern university, served to initiate a period of surgery lasting nearly two centuries, during which we have some of the greatest contributions to this branch of medical science that were ever made. The development of the medical school at Bologna antic.i.p.ated by but a short time that of a series of schools in the north Italian universities.

Padua, Piacenza, Pisa, and Vicenza had medical schools in the later Middle Ages, the works of some of whose professors have attracted attention. It was from these north Italian medical schools that the tradition of close observation in medicine and of thoroughly scientific surgery found its way to Paris. Lanfranc was the carrier of surgery, and many French students who went to Italy came back with Italian methods.

In the fourteenth century Guy de Chauliac made the grand tour in Italy, and then came back to write a text-book of surgery that is one of the monuments in this department of medical science. Before his time, Montpellier had attracted attention, but now it came to be looked upon as a recognized centre of great medical teaching. The absence of the Popes from Italy and the influence of their presence at Avignon made itself felt. While culture and education declined in Italy in the midst of political disturbances, they advanced materially at the south of France.

For our generation undoubtedly the most interesting chapter in the history of medieval medicine is that which tells of the marvellous development of surgery that took place in the thirteenth and fourteenth centuries. Considerable s.p.a.ce has been devoted to this, because it represents not only an important phase of the history of medicine, and recalls the names and careers of great makers of medicine, but also because it ill.u.s.trates exquisitely the possibility of important discoveries in medicine being made, applied successfully for years, and then being lost or completely forgotten, though contained in important medical books that were always available for study. The more we know of this great period in the history of surgery, the more is the surprise at how much was accomplished, and how many details of our modern surgery were antic.i.p.ated. Most of us have had some inkling of the fact that anaesthesia is not new, and that at various times in the world's history men have invented methods of producing states of sensibility in which more or less painless operations were possible. Very few of us have realized, however, the perfection to which anaesthesia was developed, and the possibility this provided for the great surgeons of the later medieval centuries to do operations in all the great cavities of the body, the skull, the thorax, and the abdomen, quite as they are done in our own time and apparently with no little degree of success.

Of course, any such extensive surgical intervention even for serious affections would have been worse than useless under the septic conditions that would surely have prevailed if certain principles of antisepsis were not applied. Until comparatively recent years we have been quite confident in our a.s.surance that antisepsis and asepsis were entirely modern developments of surgery. More knowledge, however, of the history of surgery has given a serious set-back to this self-complacency, and now we know that the later medieval surgeons understood practical antisepsis very well, and applied it successfully.

They used strong wine as a dressing for their wounds, insisted on keeping them clean, and not allowing any extraneous material of any kind, ointments or the like, to be used on them. As a consequence they were able to secure excellent results in the healing of wounds, and they were inclined to boast of the fact that their incisions healed by first intention and that, indeed, the scar left after them was scarcely noticeable. We know that wine would make a good antiseptic dressing, but until we actually read the reports of the results obtained by these old surgeons, we had no idea that it could be used to such excellent purpose. Antisepsis, like anaesthesia, was marvellously antic.i.p.ated by the surgical forefathers of the medieval period.

It has always seemed to me that the story of Medieval Dentistry presented an even better ill.u.s.tration of a great antic.i.p.atory development of surgery. This department represents only a small surgical specialty, but one which even at that period was given over to specialists, who were called dentatores. Guy de Chauliac's review of the dentistry of his time and the state of the specialty, as pictured by John of Arcoli, is likely to be particularly interesting, because if there is any department of medical practice that we are sure is comparatively recent in origin, it is dentistry. Here, however, we find that practically all our dental manipulations, the filling of teeth, artificial dentures, even orthodontia, were antic.i.p.ated by the dentists of the Middle Ages. We have only the compressed account of it which is to be found in text-books of general surgery, and while in this they give mainly a heritage from the past, yet even this suffices to give us a picture very surprising in its detailed antic.i.p.ation of much that we have been inclined to think of as quite modern in invention and discovery.

Medicine developed much more slowly than surgery, or, rather, lagged behind it, as it seems nearly always p.r.o.ne to do. Surgical problems are simple, and their solution belongs to a great extent to a handicraft.