Part 58

The Roman empire dismembered, Persia became an asylum for fugitive philosophy, and the Nestorians founded a medical school at Edessa in Mesopotamia, while other sectarians equally oppressed by ostensible orthodoxy, sought a refuge in the city of Dschondi-Sabour, where numbers of Persian and Arabian students flocked to learn their doctrines, and thus we have the origin of the celebrated school of Bagdad under the protection of their caliphs.

This regeneration of science was soon communicated to the shores of Europe, and the Caliph Alhakam founded a school at Cordova possessing upwards of 300,000 volumes, and Seville, Toledo, Saragossa, and Coimbra followed the bright example. Thus was a science, banished from Europe by bigoted and misguided Christians, restored to its former seat by Mohammedans.

The progress of the science of medicine under the Moorish government was so rapid in Spain, that we find one hundred and fifty medical writers in the schools of Cordova, and sixty-two in Murcia. While the Moors thus encouraged these important studies, the priests in the western states kept the nations under their control in a state of dense ignorance, and the practice of medicine such as it was, was confined within the cloisters of monasteries and nunneries. There does still exist a treatise of medicine written by Hildegarde, Abbess of a convent at Rupertsberg. Monks opened medical schools in several cathedrals, and we find Gregory I. sending one of these medical propagators to Canterbury, where Theodore, one of its archbishops, practised the healing art.

While the study of medicine had become a privilege of ignorant friars, it was destined to assume a semblance of learning in Italy, where some intelligent Benedictines founded a school at Salerno. Here the works of the Greeks, and Romans, and Arabian physicians were once more brought to light, and in the eighth century we find Salerno crowded with students, pilgrims, and invalids. In the eleventh century, this school had obtained a pre-eminence over every other medical institution, and at the period of the crusades its fame was universal--not that the ignorant and barbarous crusaders were capable of shedding any light on the improvement of their several countries from what they might have learned in Holy Land, but many of them who had happily returned to Europe, and been landed in the kingdom of Naples, were cured of their wounds and infirmities by these Benedictine doctors, who themselves owed much of their erudition to an African of the name of Constantine, who had studied at the school of Bagdad, and translated for the monks, who had offered him an asylum, Greek, Latin, and Arabian works, which to them were sealed volumes. Amongst the celebrated adventurers of rank who had escaped from the holy wars, was Robert, son of William the Conqueror, who was cured at Salerno of a supposed incurable wound in the arm. In this manner was the fame of the Salernian school spread far and nigh, and soon Ferdinand II. founded universities at Naples and Messina.

The course of studies in the school of Salerno was three years of logic, and five years of medicine and surgery. At the expiration of these sessions, the student was admitted to examination, and after having passed, was still obliged to practise for another year under the immediate eye of an experienced physician. It was only upon his certificate as to his professional capacities, that a licence to practise was granted, upon his engaging himself by oaths, to observe the laws of the college, to attend the poor gratuitously, and to report to the magistracy all apothecaries that adulterated their drugs or neglected the proper preparation of medicines prescribed.

The custom of granting academic dignities may be traced to the Nestorians and the Jewish professors in the East, where it was carried into the Moorish possessions in Spain. The school of Salerno was the first collegiate body that adopted it in the western Christian institutions. The degree they conferred was that of _Magister_. Previous to the granting of this distinction seven years study were required, and the candidate was to be upwards of one-and-twenty years of age. He had to explain in a public meeting the _Articella_ of Galen--a passage of the _Aphorisms_ of Hippocrates, and of the first book of Avicenna, after which he was examined in the works of Aristotle, he then received the degree of _Magister Artium et Physices_. It was only the professors who bore the title of Doctors.

In this manner did the science of medicine struggle for several centuries with obstacles that appeared insurmountable--in turn practised and persecuted--anathematized by the clergy, and soon after becoming a lucrative privilege of the church--prejudice, superstition, and ignorance had closed anatomical theatres, and from the days when flourished the school of Herophilus until the fourteenth century, the dissection of animals was alone permitted, and it was only by stealth that the student sought some knowledge of the human structure, from mouldering bones purloined from the cemetery. A brighter era arose in the year 1315, when Mondini de Luzzi, Professor of Anatomy at Bologna, ventured to dissect human bodies--a bold attempt, as seventeen centuries had elapsed since this investigation of the book of nature, the only record where errors can be detected and truth sought for, had been prohibited. The example of Mondini, who had written a practical anatomical manual was followed in various other schools, but a barber was the person charged with the opening of the subjects, and with no other instrument then his razor he endeavoured to demonstrate the parts which Mondini's work described.

From this period we may date the revival of medicine, although in the following century it made but little progress, still clogged by astrological absurdities and Arabic errors--and a Florentine physician, Marcillo Ficin, obtained a high repute by promulgating the doctrine that the vital spirits of man were similar to the ether which filled space and directed the planets; concluding that if man could obtain this ethereal principle he might prolong his days beyond human conception, he recommended the use of preparations of gold to obtain longevity and even advised the aged to drink youthful blood to prolong their precarious life. These absurdities were refuted by Chancellor Gerson, and the faculty of Paris condemned the Florentine's visions as diabolical and perilous--but what could have been the facilities offered at that time for the study of anatomy when we find Professor Montagnana, of Padua, boasting of having examined _fourteen_ subjects.

However the fifteenth century was destined to witness a remarkable event in the annals of medical learning, Emmanuel Chrysolore, embassador of Emmanuel Paleologus, arrived in Italy, to solicit means from the Christian powers against the inroads of the Turks. Chrysolore, during a protracted residence at Venice, employed the leisure which his diplomatic occupations left him to deliver lectures on various branches of science, and not only did he encourage the study of the Greek language, but corrected the many errors that teamed in the Arabic translation of classic works. It was to this learned man that the succeeding century were indebted for their knowledge of the works of Hippocrates, and we find that his doctrine formed the groundwork of medical studies over Europe.

But the study of the phenomena of nature founded on experience and observation was not sufficiently visionary and mystic, and soon we see cabalistic calculation and judicial astrology again subverting all doctrines that might lead to sound conclusions. Cornelius Agrippa of Cologne traversed the fairest cities of Europe, to expound the philosophy of Zamolxis and Abaris; maintaining that every Hebrew character had a natural signification, the Hebrew being, according to his ideas, not only the most ancient but a sacred language. He asserted that the language of demons was the Hebraic, and that all Hebrew letters being either favourable or hostile to these evil spirits, they might be conjured by a proper knowledge of their powers.

This visionary not only fancied that letters possessed this influence, but that it was shared by numbers. Thus to cure a tertian fever he directs the use of Verbena, to be cut at the third articulation of the plant; but in the treatment of a quartern, the disease would only yield to the fourth joints. He added that every man was under the influence of three demons--a sacred demon (a divine gift)--an innate demon--and a professional demon, sent us by the constellations and the celestial intelligences.

These reveries, however, were interrupted by the still greater absurdities of Paracelsus, a man whose ignorance could only be equalled by his vanity, since he maintained that as the genius of Greece had produced Hippocrates, the genius of Germany had created him for the salvation of mankind. He further assured his disciples that all the universities in the world had less knowledge than his beard, and that every hair of his head was more learned than all their writers.

Paracelsus was perhaps one of the most singular enthusiasts that ever swayed the schools of medicine, or assumed a despotic stand in science. To superstition, credulity, and disreputable living, he certainly did add a certain degree of genius, but more particularly a _tact_ which established such a reputation, that, without much presumption, he might have claimed the title which he assumed, of "_Prince of Medicine_," to which he added the pompous appellation of _Aureolus, Philippus, Paracelsus Theophrastus Bombastus ab Hoppenheim_.

This strange personage was born in 1493, at Einsidlen, a village near Zurich; he studied under Fugger Schwartz, a celebrated professor of what was then called the _Spagyristic_ school, or _Hermetic Medicine_, founded on a visionary doctrine that I shall shortly notice. He subsequently travelled over the greater part of Europe, chiefly courting a motley society of physicians, philosophers, old women, and barbers, culling all that he could from pretended science or unblushing ignorance. After having visited the German mines, where he became tainted with the superstition of the credulous workmen, he repaired to Russia, when he was made prisoner by a party of Tartars, who conducted him to their Cham. Taken into favour by their chief, he accompanied his son to Constantinople, where he pretended to have discovered the philosopher's stone. On his return to his native country, the magistrates of Bale appointed him to the chair of medicine; and in 1527 we find him delivering a course of lectures in the German tongue, being but an indifferent scholar. This sedentary life did not suit his roving habits; and being, moreover, likely to bring his ignorance into its proper light, he set out for Alsace with another enthusiast of the name of Oporinus, with whom however he shortly quarrelled. He continued to wander from town to town, scarcely ever sleeping, or changing his linen, clad in the most slovenly manner, and generally in a state of intoxication, until at Saltzburg in 1541 he was taken ill at a miserable inn and died in the 48th year of his busy life.

He no doubt had obtained during his adventurous career much experience, having for a long time followed armies and attended at sieges, and during epidemic maladies; but he sought to disguise his want of a proper education by the assumption of a supernatural influence. One of his wildest flights of fancy was, perhaps, his receipt to make a man without conjunction.

His doctrines were founded upon Judicial Astrology, Alchymy, Cabal, and Chemistry. Grossly ignorant in the last science, he pretended that all our diseases depended upon its combinations,--the combustion of sulphur, the effervescence of saline particles, and the coagulation and stagnation of mercury in our humours: all under the influence of the _Ens Astrorum_, the _Ens Deale_, the _Ens Spirituale_, the _Ens Veneni_, and the _Ens Naturale_. _Mercury_ was evacuated through the pores of the skin; _sulphur_ emanated from the nostrils; _deliquescent sulphur_ was discharged by the intestines; a _watery solution of sulphur_ arose from the eyes, while _arsenic_ oozed out of the ears. When these evacuations did not take place, the humour became putrid, and putrescency was _Localiter_ or _Emunctor labiter_--as the humours were either retained or excreted.

This humoral doctrine of Paracelsus, strange to say, obtained for upwards of a century, and many were the learned men who distracted their brains and that of their disciples to multiply his errors, since we find Sanctorius calculates 90,000 morbid alterations in these peccant humours.

In another part of this work, I have related the absurdities of Van Helmont, another visionary of the seventeenth century. Endless would be the task of recording the many systems and doctrines that have in turn ruled the schools of medicine, and been supported both by professors and disciples with a degree of virulent hostility as implacable as religious controversies; and still, while we read with contempt the absurd doctrines of our forefathers, and smile at the folly of their visions, we ourselves are advocating systems which, after a lapse of some few years, will appear just as ridiculous and preposterous to our successors in the doubtful career.

One question naturally arises from all this controversial discrepance--has society benefited by the successive revolutions which have overthrown schools and doctrines, chairs and professors? have the advocates of Sangradian phlebotomy, and those who considered that the lancet has committed greater havoc than the sword--have the employers of antimony, and those who would have sent to the scaffold opponents who gave an antimonial preparation--have either of these enthusiasts diminished, in any sensible manner, the scale of mortality, or have they influenced the prevalence of disease? This is a most important question, and, however ungracious may be the task, I shall endeavour to consider it.

It is but too true, that, with the exception of the introduction of inoculation and the cowpox, the bills of mortality do not appear, at any period, to have been influenced by the prevalence of any one medical system. This circumstance, however, cannot be admitted as invalidating the claims of medical men to a due consideration of their respective merits. I have endeavoured to show, in a preceding article, that the laws of nature appear to have regulated the equilibrium of life and death and the progress of disease with such harmony, indeed, that we might say that our existence was regulated with arithmetical accuracy. If this is admitted, it might be alleged, that if such be our fated tenure of life, recourse to medical aid becomes useless, and the efforts of physicians must prove effete. Such a deduction would be fatalism in its most absurd form; for, admitting that our days are thus numbered, the human frame may be assailed by many ailments, that may not prove fatal, but admit of relief, if they cannot be cured. It is, therefore, obvious, that the services of a physician are of great value, if he merely can alleviate our sufferings, and render a painful existence tolerable. Daily facts corroborate this assertion, and the most cruel pangs are constantly relieved by professional aid, although it is not equally evident that the same skill can prolong the patient's life, if "his hour is come;" but, as we know not when that fatal moment may strike, we must clearly seek to wind up the marvellous machinery, and keep it "going" as long as we can. We constantly behold individuals whose existence is most precarious, and yet who linger on for years, frequently to the disappointment of expectant heirs; for there is much truth in the old saying concerning those invalids who are considered to "have one foot in the grave," they find _that foot_ so very uncomfortable, that they hesitate for a long time ere they thrust in its fellow.

There is little doubt but that much mischief has been done by ignorant men, yet, perhaps, if the truth were known, more vital injury has been inflicted on mankind by enthusiastic science--ignorance gropes its way, so long, at least, as modesty allows to doubt; but, so soon as presumption leads the way, then ignorance assumes dogmatic assurance, and places the hardy practitioner on the same line as presumptive science--or, at least, what is considered such. It is then that enthusiasm, combined with interested motives, seeks to maintain an acquired influence by experimental proofs of supremacy; and, as it has been truly said, "There is no writ of error in the grave," mother earth shrouds the fallacies, and every disease that the eminent practitioner cannot cure is deemed incurable.

On the other hand, the Creator has gifted mankind with an innate and latent power of resisting noxious influence--a power called by the schools the _vis medicatrix naturæ_, and which is generally sufficient to throw off morbid attacks, when this principle is not exhausted, and the functions not impeded by organic derangement which involves the healthy equilibrium of life; then it is, that the prudent and experienced physician will carefully watch this precious faculty, and instead of counteracting the efforts of nature, assist her bounteous labours. This watchful practice, which may, however, be sometimes too inert, has been called _expectant medicine_--a slow and tardy process for the energetic practitioner, who, assuming the reins of life in his bold hands endeavours to goad and drive on nature in spite of herself; this practice has obtained the name of _active medicine_, of which our British practitioners are accused, by the _expectant_ continental physicians, who, to use a French expression, "_voient venir_," and the French themselves are so well aware of the imprudence of this hesitation in assisting nature, that they say "_Your physicians kill their patients, whereas ours let them die_." There is more truth in this remark than we perhaps are willing to believe.

The power of nature in the cure of diseases has been acknowledged by the most experienced and wise physicians. Stahl, in his dissertation, "_De Medicina sine Medico_," perhaps exaggerated the influence of this faculty. Bordeu maintains that out of ten patients, two-thirds are cured without assistance, and come within the circle of all those minor ailments to which flesh is the constant heir. The illustrious Boerhaave doubted whether the successful practice of the small number of able physicians was a compensation for the evils that arose from the errors of the ignorant; and, in this sad calculation, he seems disposed to think that it would have been better for mankind that the science of medicine had never existed.

All these deductions are both unjust and unwise; for, as I have already said, if physicians only possessed the means of affording relief, their mission upon earth is of the utmost importance. At the same time, while we watch the efforts of nature, it is our duty to rouse her energies when they become torpid, or to check inordinate action which would soon exhaust her power. Asclepiades very truly called the expectant practice of medicine "_a contemplation of death_." The powers of nature may be, and not inaptly, compared to those of the swimmer; however skilled in the art of natation, and able under ordinary circumstances to baffle an adverse tide, are we not to hasten to his succour, when we find that he is borne away by an inevitable current, or deprived by a cramp, of the power of stemming the stream?

We are also willing to forget, that the turbulence of passions, the "wear and tear" of life, by excesses or irregularities, gradually tend to render the "medicinal power" of nature of little or no avail; and it has been truly said, that had we no cooks, we perhaps might not have needed physicians. Man in fact, in a high state of civilization, seems determined to counteract all the efforts both of nature and of art to relieve him from the manifold curses of intemperance; and it is fortunate that his own feelings of gradual decay prompt him more energetically to a reform in his habits, than the most persuasive language his physician could employ.

In this illiberal view of the profession, how often do we lose sight of hereditary transmissions--heir-looms of disease--ingrafting misery on the variegated woof of our destinies--germs of fatal maladies which we bring into the world--a scourge on our posterity!--and yet, strange to say, our vain self-estimation blinds us in the contemplation of this doom--for the gratification of our desires, we bring forth a fearful generation--scrofulous, insane! Nay, we glory in the smiling offspring blooming around us--heedless, that the very roses we admire on their transparent cheeks, the coral hue that tinges their lips, are typical of flowers scattered on a grave, and the joyful beams of their bright yet languid looks are but the harbingers of the smile of death--the last kind look on earthly things.--And the physician is expected to arrest the hand of Providence--to eradicate germs struck before birth!

It must also be observed, that many of our maladies are, in fact, reactions of nature, endeavouring to overcome other affections--a struggle for harmonious unity--for healthy equilibrium. Thus do we see a burning fever, tending to cast upon the surface exanthematic eruptions--a febrile reaction which we call critical, and which too often, like a political crisis, destroys in fruitless endeavours to save. "_Si natura non moveat, move, tu, motu ejus_" was an ancient axiom; but how often, in seeking to trim the expiring lamp of life, do we not extinguish the last vital spark!

In regard to the influence of medicine on population, can it be expected, that when the most fatal pestilences do not thin it, the most erroneous medical practice can be more destructive? And, if nine-tenths of cholera, or pestiferated patients perish, on the other hand, nine-tenths of other cases of a less serious character are cured without medical intervention; and possibly, the chief study of a physician should be not to produce a more obstinate disease by the means he employs to cure an affection less formidable. Late years have proved that the effects of mercury were far more dreadful than the disease it was supposed to eradicate.

In the animadversions that are accumulated upon the physician, an insidious comparison to his disadvantage, has been made with the utility of the surgeon--a utility which man is compelled, however reluctantly, to acknowledge, since it is evident to his most gross senses--an amputated limb--a reduced luxation--are before his eyes, while the favourable changes operated on a morbid condition of the body are not self-evident, and can only be recognised by sound and unbiassed judgment. In this illiberal view, it is forgotten that the mere operative surgeon is nothing more than a mechanical agent--a butcher could perform the same operation with his rude knives and saws as the chirurgeon with his refined and improved instruments; it is the judgment that we look to, and the skill in attending to the general health of the patient, to bring him to a perfect cure; in these functions, of much more importance than the dexterity of the hand, the surgeon clearly assumes the duties of the physician; and it is not possible for a man to excel in one part of the profession without being conversant with the other; a surgeon must be a sound anatomist, and an observant physiologist--without the knowledge of these fundamental sciences, a surgeon and a physician might be compared to the bungler who attempted to repair a watch, without a previous acquaintance with its intricate machinery.