Part 3

The use of public baths and hydrotherapy lasted until the sixteenth century. At this epoch, and without any known reason, the public suddenly discontinued all balneary practices, and this was noticeable among the aristocratic class as among the common people. A contrary evil was developed. “Honest women,” says Vernille, “took a pride in claiming that they never permitted themselves certain ablutions.” Nevertheless, Marie de Romien, (_Instruction pour les Jeunes Dames_) in her classical work for the instruction of young women, remarks: “They should keep clean, if it be only for the satisfaction of their husbands; it is not necessary to do as some women of my acquaintance, who have no care to wash until they be foul under their linen. But to be a beautiful _damoyselle_ one may wash reasonably often in water which has been previously boiled and scented with fragrants, for nothing is more certain than that beauty flourishes best in that young woman who not only looks but smells clean.”

In an opuscle published in 1530, by one called De Drusæ, we observe that “notwithstanding the natural laws of propriety, women use scents more than clean water; and they thus only increase the bad smells they endeavor to disguise. Some use greasy perfumed ointments, others sponges saturated in fragrants”

“Entre leur cuisses et dessoubz les aisselles, Pour ne sentir l’espaulle de mouton.”

This horror of water did not last long, however, and at the commencement of the seventeenth century the false modesty of women ended with the creation of river baths, such as exist to-day along the banks of the Seine.

Was this restoration of cleanly habits due to medical advice? This question cannot be answered, but it may not be out of place to cite that remarkable passage from the “Essays of Montaigne” on the hygiene of bathing, which he recommends in certain maladies:

“It is good to bathe in warm water, it softens and relaxes in ports where it stagnates over sands and stones. Such application of external heat, however, makes the kidneys leathery and hard and petrifies the matter within. To those who bathe: it is best to eat little at night to the end that the waters drank the next morning operate more easily, meeting with an empty stomach. On the other hand, it is best to eat a little dinner, in order not to trouble the action of the water, which is not in perfect accord; nor should the stomach be filled too suddenly after its other labor; leave the work of digestion to the night, which is better than the day, when the body and mind are in perpetual movement and activity.

“I have noted, on the occasion of my voyages, all the famous baths of Christendom, and for some years past have made use of waters, for as a general rule I consider bathing healthy and deem it no risk to one’s physical condition. The custom of ablution, so generally observed at times past in all nations, is now only practiced in a few as a daily habit. I cannot imagine why civilized people ever allow their bodies to become encrusted with dirt and their pores filled with filth.”[9]

If Montaigne made great use of mineral waters, he had in revenge a formidable dread of physicians and their medicines, a sentiment he inherited from his father, “who died,” says he, “at the age of seventy-four years,” and his “grandfather and great-grandfather died at eighty years without tasting a drop of physic.”

Montaigne has justly criticized medicine in several essays on the healing art. He knew well the _intividia medicorum_, and it was for this reason that he remarked that a physician should always treat a case without a consultant. “There never was a doctor,” says Montaigne, “who, on accepting the services of a consultant, did not discontinue or readjust something.” Is not the same criticism deserved at the present day? How absurd are our medical consultations. The examples Montaigne gives of disagreements of doctors in consultation as to doctrines are equally applicable to modern times. The differences of Herophilus, Erasistratus, and the Æsclepiadæ as to the original causation of disease were no greater than those of the schools of Broussais and Pasteur, which have both acquired a universal celebrity in less than half a century.

Montaigne insisted that medicine owed its existence only to mankind’s fear of death and pain, an impatience at poor health and a furious and indiscreet thirst for a speedy cure, but the author of the “Essays” adds in concluding: “I honor physicians, not following the feeling of necessity, but for the love of themselves, having seen many honest doctors who were honorable and well worthy of being loved.”

The reputation for disagreement among doctors so much insisted on by Montaigne has served as a well-worn text for many other critics.

In _Les Serres_ of Guillaume Bouchet, a contemporary of the author, we find the same shaft of sarcasm directed at physicians. Where will you find men in any other profession save that of medicine who envy and hate each other so heartily? What other profession on earth is given over to such bitter disagreements? How can common people be expected to honor and respect experts and savants so-called when the professors call each other ignoramusses and asses? Call these doctors into a case and one after the other they will disagree as to the diagnosis as well as to the method of cure. As Pellisson wrote:

“When an enemy you wish to kill Don’t call assasins full of vice, But call two doctors of great skill To give contrary advice.”

Or in the verses of the original:

“D’un ennemi voulez vous defaire? Ne cherchez pas d’assasins Donnez lui deux medecins, Et qui’ils soient d’avis contrarie.”

This professional jealousy is always more apparent than real. Aside from the rivalry for public patronage physicians are a very social class of men, as witness their many festive meetings. We banquet in honor of St. Luke the physician, and St. Come, after each thesis, at anniversaries, at the election of the Dean, and on many other occasions. It is these co-fraternal meetings at which are reinagurated the old feelings of good-fellowship; our little quarrels only serve to discipline the medical body and to increase the grandeur of the Faculty. It is the constant rubbing of surfaces that makes the true professional metal glitter.

When we hear new doctors, young graduates, swear the Hippocratic oath, we do not forget that the principal articles of the statute prescribe the cultivation of friendships, respect for the older members of the profession, benevolence to the young beginners, and the preservation of professional decency and kindness. It may be insisted that banquets are not to be considered as medical assemblages, for there they laugh long and loud, and drink many a bumper of rich Burgundy; making joyous discourse; holding to the famous compliment of Moliere:

Salus, honor et argentum Atque bonum appetitum.

We know to-day many of the truthful precepts of the School of Salerno and their bearing on the medical records of the middle ages. Then as now the doctor had the ever increasing ingratitude of the patient (_ad proccarendam oegrorum ingratitudinem_).

“The disciple of Hippocrates meeteth often treatment rude, The payment of his trouble is base ingratitude. When the patient is in grievous pain the time is opportune For a keen, sharp-witted doctor to make a good fortune. Let him profit by the sufferer’s aches and gather in the money, For the ant gets winter provender and the summer bee its honey.”

Our ancient friends had no pity for charlatans, however. They rightfully abused all medical impostors, as we read in the precepts of Salerno’s school:

“Il n’est par d’ignorant, de chartatan stupide, D’histron imposteur, ou de Juif fourbe avide, De sorciere crasseuse ou de barbier bavard, De faussiare inpudent, ou de moine cafard, De marchand de savon, ou de avengle oculiste, De baigneur imbecile, ou d’absurde alchimiste, Pas d’heretique impur qui ne se targue, enfin, Du beau titre, du nom sacre de medecin.”

The investigation of medical science was far from being an honor to the middle ages. The best of the profession was hidden in the doctoral sanctuary, enveloped in those mysteries which are never penetrated by the profane and only known to the initiated.

The recommendations as to the secrets of our art are addressed to all young doctors in that famous epilogue commencing:

“Gardez surtout, gardez qui’un profane vulgaire De votre art respecte ne perce le mystere; Son eclat devoile perdrait sa dignite D’un mystere connu decroit la majeste,”

Let us invoke God, the Supreme physician, let us demand the professional banishment of every doctor who reveals a professional secret.

“Exsul sit medicus physicius secreta revelans.”—Amen!

THE GREAT EPIDEMICS OF THE MIDDLE AGES.

THE PLAGUE

Several great epidemics of the Plague had already devastated the world; the plague of Athens in the fifth century, B. C.; the plague of the second century, in the reign of Marcus Aurelius; the plague of the third century, in the reign of Gallus; then came that most terrible epidemic of the sixth century, known by the name of the inguinal pestilence, which, after ravaging Constantinople spread into Liguria, then into France and Spain. It was in 542, according to Procopius, that an epidemic struck the world and consumed almost all the human species.[10]

“It attacked the entire earth,” says our author, “striking every race of people, sparing neither age nor sex; differences in habitation, diet, temperament or occupation of any nature did not stop its ravages; it prevailed in summer and in winter, in fact, at every season of the year.

“It commenced at the town of Pelusa in Egypt, from whence it spread by two routes, one through Alexandria and the rest of Egypt, the other through Palestine. After this it covered the whole world, progressing always by regular intervals of time and force. In the springtime of 543 it broke out in Constantinople and announced itself in the following manner:

“Many victims believed they saw the spirits of the departed rehabilitated in human form. It appeared as though these spirits appeared before the subject about to be attacked and struck him on certain portions of the body. These apparitions heralded the onset of the malady. It is but fair to say that the commencement of the disease was not the same in all cases. Some victims did not see the apparitions, but only dreamed of them, but all believed they heard a ghostly voice announcing their inscription on the list of those who were going to die. Some claim that the greater number of victims were not haunted either sleeping or waking by these ghosts and the mysterious voice that made sinister predictions.

“The fever at the onset of the attack came on suddenly,—some while sleeping, some while waking, some while at work. Their bodies exhibited no change of color, and the temperature was not very high. Some indications of fever were perceptible, but no signs of acute inflammation. In the morning and at night the fever was slight, and indicated nothing severe either to the patient or to the physician who counted the pulse. Most of those who presented such symptoms showed no indications of approaching dissolution; but the first day among some, the second day in others, and after several days in many cases, a bubo was observed on the lower portion of the abdomen, in the groin, or in the folds of the axilla, and sometimes back of the ears or on the thighs.

“The principal symptoms of the disease on its invasion were as I have pointed out; for the remainder, nothing can be precisely indicated of the variations of the type of the disease following temperament; these other symptoms were only such as were imprinted by the Supreme Being at his divine will.

“Some patients were plunged into a condition of profound drowsiness; others were victims to furious delirium. Those who were drowsy remained in a passive state, seeming to have lost all memory of the things of ordinary life. If they had any one to nurse them they took food when offered from time to time, and if they had no care soon died of inanition. The delirious patients, deprived of sleep, were eternally pursued by their hallucinations; they imagined themselves haunted by men ready to slay them, and they sought flight from such fancied foes, uttering dreadful screams. Persons who were attacked while nursing the sick were in the most pitiable condition—not that they were more liable to contract the disease by contact, however, for nurses and doctors did not get the disease from actual contact with the sufferers, for some who washed and laid out the dead never contracted the malady, but enjoyed perfect health throughout the epidemic; some, however, died suddenly without apparent cause. Many of the nurses were overworked keeping patients from rolling out of bed and preventing the delirious from jumping from high windows. Some patients endeavored to throw themselves in running water, not to quench their thirst, but because they had lost all reason. It was necessary to struggle with many of the sick in order to make them swallow any nourishment, which they would not accept without more or less resistance. The buboes enfeebled certain patients who were neither drowsy nor delirious, but who finally succumbed to their atrocious sufferings.

“As nothing was known of this strange disease, certain physicians thought its origin was due to some source of evil hidden in the buboes, and they accordingly opened these glandular bodies. The dissection of the bubo showed sub-adjacent carbuncles, whose rapid malignity brought on sudden death or an illness of but few days’ duration. In some instances the entire body was covered by black spots the size of a bean. Such unfortunates rarely lived a day, and generally expired in an hour. Many cases died suddenly, vomiting blood. One thing I can solemnly affirm, that is, that the wisest physicians gave up all hope in the case of many patients who afterwards recovered; on the contrary, many persons perished at the very time their health was almost re-established. For all these causes, the malady passed the confines of human reasoning, and the outcome always deceived the most natural predictions.

“As to treatment, the effects were variable, following the condition of the victim. I may state that, as a fact, no efficacious remedies were discovered that could either prevent the onset of the disease or shorten its duration. The victims could not tell why they were attacked, nor how they were cured.

“Pregnant women attacked inevitably aborted at death, some succumbing while miscarrying; some going on to the end of gestation, dying in labor along with their infants. Only three cases are known where women recovered of plague after aborting; while only one instance is on record where a newly-born child survived its mother in this epidemic. Those in whom the buboes increased most rapidly in size, maturated and suppurated, most often recovered, for the reason, no doubt, that the malignant properties of the bubonic carbuncle were weakened or destroyed.

“Experience proved that such symptoms were an almost sure presage of a return to health. Those, on the contrary, in whom the tumor did not change its aspect from the time of its eruption, were attacked with all the symptoms I have before described. In some cases the skin dried and seemed thus to prevent the tumor, although it might be well developed, from suppurating. Some were cured at the price of a loss of power in the tongue, which reduced the victims to stammer and articulate words in a confused and unintelligible manner for the rest of their days.

“The epidemic at Constantinople lasted four months, three months of which time it raged with great violence. As the epidemic progressed the mortality-rate increased from day to day, until it reached the point of 5,000 deaths per day, and on several occasions ran up to as high as 10,000 deaths in the twenty four hours.”

Let us pass over this very important description that Procopius gives of the moral effect of this epidemic on the people, of the scenes of wild and heart-rending terror, of curious examples of egotism and sublime devotion, of instances of blind superstition developed in a great city under the influence of fear and the dread of a very problematical contagion.

Evagre, the scholastic, another Greek historian of the sixth century, recounts in his works the story of the plague at Constantinople. He states that he frequently observed that persons recovering from a first and second attack subsequently died on a third attack; also that persons flying from an infected locality were often taken sick after many days of an incubating period, falling ill in their places of refuge in the midst of populations free, up to that time, from the pestilence.

In following the progress of this epidemic from the Orient to the Occident, it was noticed that it always commenced at the sea-ports and then traveled inland. The disease was carried much more easily by ships than it could be at the present time, inasmuch as there were no quarantines and no pest-houses for isolating patients. It entered France by the Mediterranean Sea. It was in 549 that the plague struck Gaul. “During this time,” says Gregory of Tours, “the malady known as the _inguinal disease_ ravaged many sections and the province of Arles was cruelly depopulated.”[11]

This illustrious historian wrote in another passage: “We learned this year that the town of Narbonne was devastated by the _groin disease_, of so deadly a type that when one was attacked he generally succumbed. Felix, the Bishop of Nantes, was stricken down and appeared to be desperately ill. The fever having ceased, the humor broke out on his limbs, which were covered with pustules. It was after the application of a plaster covered with cantharides that his limbs rotted off, and he ceased to live in the seventieth year of his age.

“Before the plague reached Auvergne it had involved most all the rest of the country. Here the epidemic attacked the people in 567, and so great was the mortality that it is utterly impossible to give even the approximate number of deaths. Populations perished _en masse_. On a single Sunday morning three hundred bodies were counted in St. Peter’s chapel at Clermont awaiting funeral service. Death came suddenly; it struck the axilla or groin, forming a sore like a serpent that bit so cruelly that men rendered up their souls to God on the second or third day of the attack, many being so violent as to lose their senses. At this time Lyons, Bourges, Chalons, and Dijon were almost depopulated by the pestilence.”

In 590 the towns of Avignon and Viviers were cruelly ravaged by the _inguinal disease_.

The plague reached Marseilles, however, in 587, being carried there by a merchant vessel from Spain which entered the port as a center of an infection. Several persons who bought goods from this trading vessel, all of whom lived in one house nevertheless, were carried off by the plague to the number of eight. The spark of the epidemic did not burn very rapidly at first, but after a certain time the baleful fire of the pest, after smouldering slowly, burst out in a blaze that almost consumed Marseilles.

Bishop Theodorus isolated himself in a wing of the cloister Saint Victor, with a small number of persons who remained with him during the plague, and in the midst of their general desolation continued to implore Almighty God for mercy, with fasting and prayer until the end of the epidemic. After two months of calm the population of the city commenced to drift back, but the plague reappeared anew and most of those who returned died. The plague has devastated Marseilles many times since the epoch just mentioned.

Anglada[12] who, like the writer, derives most of his citations from Gregory of Tours, thinks that the plague that devastated Strasbourg in 591 was only the same _inguinal disease_ that ravaged Christendom. He cites, in support of his assertion, that passage from the historian poet Kleinlande translated by Dr. Boersch: “In 591 there was a great mortality throughout our country, so that men fell down dying in the streets, expiring suddenly in their houses, or even at business. When a person sneezed his soul was apt to fly the body; hence the expression on sneezing, ‘God bless you!’ And when a person yawned they made the sign of the cross before their mouths.”

Such are the documents we possess on the great epidemic of inguinal plague of the fourth century, documents furnished by historians, to whom medical history is indebted, and not from medical authors, who left no marks at that period.

THE BLACK PLAGUE.

The Black Plague of the fourteenth century was more destructive even than the bubonic pest of the sixth century, and all other epidemics observed up to the present day. In the space of four years more than twenty five millions of human beings perished—one-half the population of the world. Like all other pestilences, it came from the Orient—from India, and perhaps from China. Europe was invaded from east to west, from south to north. After Constantinople, all the islands and shores of the Mediterranean were attacked, and successively became so many foci of disease from which the pestilence radiated inland. Constantinople lost two-thirds of its population. Cyprus and Cairo counted 15,000 deaths. Florence paid an awful tribute to the disease, so great being the mortality that the epidemic has often been called _Peste de Florence_; “100,000 persons perished,” says Boccaccio. Venice lost 20,000 victims, Naples 60,000, Sicily 53,000, and Genoa 40,000, while in Rome the dead were innumerable.

In Spain, Germany, England, Poland, and Russia the malady was as fatal as in Italy. At London they buried 100,000 persons in the cemeteries. It was the same in France. Avignon lost 150,000 citizens in seven months, among whom was the beautiful Laura de Noves, immortalized by Petrarch, who expired from the plague in 1348, aged forty-one years. At Marseilles 56,000 people died in one month; at Montpellier three quarters of the population, including all the physicians, went down in the epidemic. Narbonne had 30,000 deaths and Strasbourg 16,000 in the first year of the outbreak. Paris was not spared; the _Chronique de Saint Denis_ informs us that “in the year of Grace 1348, commenced the aforesaid mortality in the Realms of France, the same lasting about a year and a half, increasing more and more until Paris lost each day 800 inhabitants; so that the number who died there amounted to more than 500,000 people, while in the town of Saint Denis the number reached 16,000.[13]

Among the victims were Jeanne de Bourgogne, wife of Philip VI.; Jeanne II., Queen of Navarre, grandchild of Philip the Beautiful. In Spain, died Alphonse XI. of Castille. “Happily,” says the _Chronicle_, “during the years following the plague the fecundity of women was prodigious—as though nature desired to repair the ravages wrought by death.” The symptoms and history of this plague have been described by several ocular witnesses, among others Guy de Chauliac, the celebrated surgeon and professor at Montpellier, who has left the following recital in quaint old French:

“The disease was such that one never before saw a like mortality. It appeared in Avignon in the year of our Saviour 1348, in the sixth year of the Pontificate of Clement VI., in whose service I entered, thanks to his Grace.

“Not to displease you, I shall briefly narrate for your edification the advent of the disease.

“It commenced—the aforesaid mortality—in January and lasted for the space of seven months.

“The disease was of two kinds. The first type lasted two months, with a continued fever and spitting of blood. This variety killed in three days, however.