Chapter 1

Produced by Suzanne Lybarger, Irma Spehar and the Online Distributed Proofreading Team at http://www.pgdp.net (This file was produced from images generously made available by The Internet Archive/Canadian Libraries)

Old-Time Makers of Medicine

THE STORY OF THE STUDENTS AND TEACHERS OF THE SCIENCES RELATED TO MEDICINE DURING THE MIDDLE AGES

BY

James J. Walsh, K.C.St.G., M.D. Ph.D., LL.D., Litt.D., Sc.D.

DEAN AND PROFESSOR OF NERVOUS DISEASES AND OF THE HISTORY OF MEDICINE AT FORDHAM UNIVERSITY SCHOOL OF MEDICINE; PROFESSOR OF PHYSIOLOGICAL PSYCHOLOGY AT THE CATHEDRAL COLLEGE, NEW YORK

NEW YORK

FORDHAM UNIVERSITY PRESS

1911 COPYRIGHT 1911

JAMES J. WALSH

THE QUINN & GODEN CO. PRESS RAHWAY, N.J.

TO

REVEREND DANIEL J. QUINN, S.J.

The historical material here presented was gathered for my classes at Fordham University School of Medicine during your term as president of the University. It seems only fitting then, that when put into more permanent form it should appear under the patronage of your name and tell of my cordial appreciation of more than a quarter of a century of valued friendship.

"When we have thoroughly mastered contemporary science it is time to turn to past science; nothing fortifies the judgment more than this comparative study; impartiality of mind is developed thereby, the uncertainties of any system become manifest. The authority of facts is there confirmed, and we discover in the whole picture a philosophic teaching which is in itself a lesson; in other words, we learn to know, to understand, and to judge."--LITTRE: _OEuvres d'Hippocrate_, T. I, p. 477.

"There is not a single development, even the most advanced of contemporary medicine, which is not to be found in embryo in the medicine of the olden time."--LITTRE: Introduction to the Works of Hippocrates.

"How true it is that in reading this history one finds modern discoveries that are anything but discoveries, unless one supposes that they have been made twice."--DUJARDIN: _Histoire de la Chirurgie_, Paris, 1774 (quoted by Gurlt on the post title-page of his _Geschichte der Chirurgie_, Berlin, 1898).

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 documents. 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 anticipated 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 constitute, 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.

CONTENTS

CHAPTER PAGE

I. INTRODUCTION 1

II. GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 23

III. GREAT JEWISH PHYSICIANS 61

IV. MAIMONIDES 90

V. GREAT ARABIAN PHYSICIANS 109

VI. THE MEDICAL SCHOOL AT SALERNO 141

VII. CONSTANTINE AFRICANUS 163

VIII. MEDIEVAL WOMEN PHYSICIANS 177

IX. MONDINO AND THE MEDICAL SCHOOL OF BOLOGNA 202

X. GREAT SURGEONS OF THE MEDIEVAL UNIVERSITIES 234

XI. GUY DE CHAULIAC 282

XII. MEDIEVAL DENTISTRY--GIOVANNI OF ARCOLI 313

XIII. CUSANUS AND THE FIRST SUGGESTION OF LABORATORY METHODS IN MEDICINE 336

XIV. BASIL VALENTINE, LAST OF THE ALCHEMISTS, FIRST OF THE CHEMISTS 349

APPENDICES

I. ST. LUKE THE PHYSICIAN 381

II. SCIENCE AT THE MEDIEVAL UNIVERSITIES 400

III. MEDIEVAL POPULARIZATION OF SCIENCE 427

"Of making many books there is no end."--_Eccles._ xii, 12 (circa 1000 B.C.).

"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.

"Augescunt 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 space 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 prone 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 assumption 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 circumstances, 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 circumstances 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 assured 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 classes 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 masses 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 documents 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 passes 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 passed 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 institution. 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 classes of institutions, 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 institutions 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 institutions 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 illustration 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 passage 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 mass 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.