Chapter 30

There were three graduate departments in most of the universities--theology, law, and medicine. While physical scientists are usually not cognizant of it apparently, theology is a science, a department of knowledge developed scientifically, and most of these medieval universities did more for its scientific development than the schools of any other period. Quite as much may be said for philosophy, for there are many who hesitate to attribute any scientific quality to modern developments in the matter. As for law, this is the great period of the foundation of scientific law development; the English common law was formulated by Bracton, the deep foundations of basic French and Spanish law were laid, and canon law acquired a definite scientific character which it was always to retain. All this was accomplished almost entirely by the professors in the law departments of the universities.

It was in medicine, however, where most people would be quite sure without any more ado that nothing worth while talking about was being done, that the great triumphs of graduate teaching at the medieval universities were secured. Here more than anywhere else is there room for supreme surprise at the quite unheard-of anticipations of our modern medicine and, stranger still, as it may seem, of our modern surgery.

The law regulating the practice of medicine in the Two Sicilies about the middle of the thirteenth century shows us the high standard of medical education. Students were required to have three years of preliminary study at the university, four years in the medical department, and then practise for a year with a physician before they were allowed to practise for themselves. If they wanted to practise surgery, an extra year in the study of anatomy was required. I published the text of this law, which was issued by the Emperor Frederick II about 1241, in the _Journal of the American Medical Association_ three years ago. It also regulated the practice of pharmacy. Drugs were manufactured under the inspection of the government and there was a heavy penalty for substitution, or for the sale of old inert drugs, or improperly prepared pharmaceutical materials. If the government inspector violated his obligations as to the oversight of drug preparations the penalty was death. Nor was this law of the Emperor Frederick an exception. We have the charters of a number of medical schools issued by the Popes during the next century, all of which require seven years or more of university study, four of them in the medical department, before the doctor's degree could be obtained. When new medical schools were founded they had to have professors from certain well-recognized schools on their staff at the beginning in order to assure proper standards of teaching, and all examinations were conducted under oath-bound secrecy and with the heaviest obligations on professors to be assured of the knowledge of students before allowing them to pass.

It might be easy to think, and many people are prone to do so, that in spite of the long years of study required there was really very little to study in medicine at that time. Those who think so should read Professor Clifford Allbutt's address on the "Historical Relations of Medicine and Surgery" delivered at the World's Fair at St. Louis in 1904. He has dwelt more on surgery than on medicine, but he makes it very clear that he considers that the thinking professors of medicine of the later Middle Ages were doing quite as serious work in their way as any that has been done since. They were carefully studying cases and writing case histories, they were teaching at the bedside, they were making valuable observations, and they were using the means at their command to the best advantage. Of course there are many absurdities in their therapeutics, but then we must not forget there have always been many absurdities in therapeutics and that we are not free from them in our day. Professor Richet, at the University of Paris, said not long ago: "The therapeutics of any generation is quite absurd to the second succeeding generation." We shall not blame the medieval generations for having accepted remedies that afterwards proved inert, for every generation has done that, even our own.

Their study of medicine was not without lasting accomplishment, however. They laid down the indications and the dosage for opium. They used iron with success, they tried out many of the bitter tonics among the herbal medicines, and they used laxatives and purgatives to good advantage. Down at Montpellier, Gilbert, the Englishman, suggested red light for smallpox because it shortened the fever, lessened the lesions, and made the disfigurement much less. Finsen was given the Nobel prize partly for re-discovery of this. They segregated erysipelas and so prevented its spread. They recognized the contagiousness of leprosy, and though it was probably as widespread as tuberculosis is at the present time, they succeeded not only in controlling but in eventually obliterating it throughout Europe.

It was in surgery, however, that the greatest triumphs of teaching of the medieval universities were secured. Most people are inclined to think that surgery developed only in our day. The great surgeons of the thirteenth and fourteenth centuries, however, anticipated most of our teaching. They investigated the causes of the failure of healing by first intention, recognized the danger of wounds of the neck, differentiated the venereal diseases, described rabies, and knew much of blood poisoning, and operated very skilfully. We have their text-books of surgery and they are a never-ending source of surprise. They operated on the brain, on the thorax, on the abdominal cavity, and did not hesitate to do most of the operations that modern surgeons do. They operated for hernia by the radical cure, though Mondeville suggested that more people were operated on for hernia for the benefit of the doctor's pocket than for the benefit of the patient. Guy de Chauliac declared that in wounds of the intestines patients would die unless the intestinal lacerations were sewed up, and he described the method of suture and invented a needle holder. We have many wonderful instruments from these early days preserved in pictures at least, that show us how much modern advance is merely re-invention.

They understood the principles of aseptic surgery very well. They declared that it was not necessary "that pus should be generated in wounds." Professor Clifford Allbutt says:

They washed the wound with wine, scrupulously removing every foreign particle; then they brought the edges together, not allowing wine or anything else to remain within--dry adhesive surfaces were their desire. Nature, they said, produces the means of union in a viscous exudation, or natural balm, as it was afterwards called by Paracelsus, Pare, and Wurtz. In older wounds they did their best to obtain union by cleansing, desiccation, and refreshing of the edges. Upon the outer surface they laid only lint steeped in wine. Powders they regarded as too desiccating, for powder shuts in decomposing matters; wine after washing, purifying, and drying the raw surfaces evaporates.

Almost needless to say these are exactly the principles of aseptic surgery. The wine was the best antiseptic that they could use and we still use alcohol in certain cases. It would seem to many quite impossible that such operations as are described could have been done without anaesthetics, but they were not done without anaesthetics. There were two or three different forms of anaesthesia used during the thirteenth and fourteenth centuries. One method employed by Ugo da Lucca consisted of the use of an inhalant. We do not know what the material employed was. There are definite records, however, of its rather frequent employment.

What a different picture of science at the medieval universities all this makes from what we have been accustomed to hear and read with regard to them. It is difficult to understand where the old false impressions came from. The picture of university work that recent historical research has given us shows us professors and students busy with science in every department, making magnificent advances, many of which were afterwards forgotten, or at least allowed to lapse into desuetude.

The positive assertions with regard to old-time ignorance were all made in the course of religious controversy. In English-speaking countries particularly it became a definite purpose to represent the old Church as very much opposed to education of all kinds and above all to scientific education. There is not a trace of that to be found anywhere, but there were many documents that were appealed to to confirm the protestant view. There was a Papal bull, for instance, said to forbid dissection. When read it proves to forbid the cutting up of bodies to carry them to a distance for burial, an abuse which caused the spread of disease, and was properly prohibited. The Church prohibition was international and therefore effective. At the time the bull was issued there were twenty medical schools doing dissection in Italy and they continued to practise it quite undisturbed during succeeding centuries. The Papal physicians were among the greatest dissectors. Dissections were done at Rome and the cardinals attended them. Bologna at the height of its fame was in the Papal States. All this has been ignored and the supposed bull against anatomy emphasized as representing the keynote of medical and surgical history. Then there was a Papal decree forbidding the making of gold and silver. This was said to forbid chemistry or alchemy and so prevent scientific progress. The history of the medical schools of the time shows that it did no such thing. The great alchemists of the time doing really scientific work were all clergymen, many of them very prominent ecclesiastics.

Just in the same way there were said to be decrees of the Church councils forbidding the practice of surgery. President White says in his "Warfare of Science with Theology in Christendom," that, as a consequence of these, surgery was in dishonor until the Emperor Wenceslaus, at the beginning of the fifteenth century, ordered that it should be restored to estimation. As a matter of fact, during the two centuries immediately preceding the first years of the fifteenth century, surgery developed very wonderfully, and we have probably the most successful period in all the history of surgery except possibly our own. The decrees forbade monks to practise surgery because it led to certain abuses. Those who found these decrees and wanted to believe that they prevented all surgical development simply quoted them and assumed there was no surgery. The history of surgery at this time is one of the most wonderful chapters in human progress.

The more we know of the Middle Ages the more do we realize how much they accomplished in every department of intellectual effort. Their development of the arts and crafts has never been equalled in the modern time. They made very great literature, marvellous architecture, sculpture that rivals the Greeks', painting that is still the model for our artists, surpassing illuminations; everything that they touched became so beautiful as to be a model for all the after time. They accomplished as much in education as they did in all the other arts, their universities had more students than any that have existed down to our own time, and they were enthusiastic students and their professors were ardent teachers, writers, observers, investigators. While we have been accustomed to think of them as neglecting science, their minds were occupied entirely with science. They succeeded in anticipating much more of our modern thought, and even scientific progress, than we have had any idea until comparatively recent years. The work of the later Middle Ages in mathematics is particularly strong, and was the incentive for many succeeding generations. Roger Bacon insisted that, without mathematics, there was no possibility of real advance in physical science. They had the right ideas in every way. While they were occupied more with the philosophical and ethical sciences than we are, these were never pursued to the neglect of the physical sciences in the strictest sense of that term.

Is it not time that we should drop the foolish notions that are very commonly held because we know nothing about the Middle Ages--and, therefore, the more easily assume great knowledge--and get back to appreciate the really marvellous details of educational and scientific development which are so interesting and of so much significance at this time?

APPENDIX III

MEDIEVAL POPULARIZATION OF SCIENCE

The idea of collecting general information from many sources, of bringing it together into an easily available form, so as to save others labor, of writing it out in compendious fashion, so that it could readily pass from hand to hand, is likely to be considered typically modern. As a matter of fact, the Middle Ages furnish us with many examples of the popularization of science, of the writing of compendia of various kinds, of the gathering of information to save others the trouble, and, above all, of the making of what, in the modern time, we would call encyclopedias. Handbooks of various kinds were issued, manuals for students and specialists, and many men of broad scholarship in their time devoted themselves to the task of making the acquisition of knowledge easy for others. This was true not only for history and philosophy and literature, but also for science. It is not hard to find in each century of the Middle Ages some distinguished writer who devoted himself to this purpose, and for the sake of the light that it throws on these scholars, and the desire for information that must have existed very commonly since they were tempted to do the work, it seems worth while to mention here their names, and those of the books they wrote, with something of their significance, though the space will not permit us to give here much more than a brief _catalogue raisonne_ of such works.

Very probably the first who should be mentioned in the list is Boethius, who flourished in the early part of the sixth century. He owed much of his education to his adoptive father, afterwards his father-in-law, Symmachus, who, with Festus, represented scholarship at the court of the Gothic King, Theodoric of Verona. These three--Festus, Symmachus, and Boethius--brought such a reputation for knowledge to the court that they are responsible for many of the wonderful legends of Dietrich of Bern, as Theodoric came to be called in the poems of the medieval German poets. The three distinguished and devoted scholars did much to save Greek culture at a time when its extinction was threatened, and Boethius particularly left a series of writings that are truly encyclopedic in character. There are five books on music, two on arithmetic, one on geometry, translations of Aristotle's treatises on logic, with commentaries; of Porphyry's "Isagoge," with commentaries, and a commentary on Cicero's "Topica." Besides, he wrote several treatises in logic and rhetoric himself, one on the use of the syllogism, and one on topics, and in addition a series of theological works. His great "Consolations of Philosophy" was probably the most read book in the early Middle Ages. It was translated into Anglo-Saxon by King Alfred, into old German by Notker Teutonicus, the German monk of St. Gall, and its influence may be traced in Beowulf, in Chaucer, in High German poetry, in Anglo-Norman and Provencal popular poetry, and also in early Italian verse. Above all, the "Divine Comedy" has many references to it, while the "Convito" would seem to show that it was probably the book that most influenced Dante. Though it is impossible to confirm by documentary evidence the generally accepted idea that Boethius died a martyr for Christianity, the tradition can be traced so far back, and it has been so generally accepted that this seems surely to have been the case. The fact is interesting, as showing the attitude of scholars towards the Church and of the Church towards scholarship thus early.

The next great name in the tradition should probably be that of Cassiodorus, the Roman writer and statesman, prime minister of Theodoric, who, after a busy political life, retired to his estate at Vivarium, and, in imitation of St. Benedict, who had recently established a monastery at Monte Cassino, founded a monastery there. He is said to have lived to the age of ninety-three. His retirement favored this long life, for, after the death of Theodoric, troublous times came, and civil war, and only his monastic privileges saved him from the storm and stress of the times. He had been interested in literature and the collection of information of many kinds before his retirement, and it is not unlikely that his recognition of the fact that the monastic life offered opportunities for the pursuit of this, under favorable circumstances, led him to take it up.

While still a statesman he wrote a series of works relating to history and politics and public affairs generally. These consisted mainly of chronicles and panegyrics, and twelve books of miscellanies called Variae. After his retirement to the monastery, a period of ardent devotion to writing begins, and a great number of books were issued. He evidently gathered round him a number of men whom he inspired with his spirit, or, perhaps, selected, because he found that, while they had a taste for a quiet, peaceful spiritual life, they were also devoted to the accumulation and diffusion of knowledge. A series of commentaries on portions of the Scriptures was written, the Jewish antiquities of Josephus translated, and the ecclesiastical histories of Theodoric, Sozomen, and Socrates made available in Latin. Cassiodorus himself is said to have made a compendium of these, called the "Historia Tripartita," which was much used as a manual of history during succeeding centuries. Then there were treatises on grammar, on orthography, and a series of works on mathematics. In all of his writings Cassiodorus shows a special fondness for the symbolism of numbers.

There is a well-grounded tradition that he insisted on the study of the Greek classics of medical literature, especially Hippocrates and Galen, and awakened the interest of the monks in the necessity for making copies of these fathers of medicine. The tradition that he established at Vivarium is also found to have existed at Monte Cassino among the Benedictines, and, doubtless, to this is to be attributed the foundation of the medical school of Salerno, where Benedictine influence was so strong. It is probable, therefore, that to Cassiodorus must be attributed the preservation in as perfect a state as we have them of the old Greek medical writers.

His main idea was, of course, the study of Scriptures, but with just as many helps as possible. He thought that commentators, and historians, not alone Christian, but also Hebrew and Pagan, should be studied to illustrate it, and then the commentaries of the Latin fathers, so that a thoroughly rounded knowledge of it should be obtained. He thus began an "Encyclopedia Biblica," and set a host of workers at its accomplishment.

Every country in Europe shared this movement for the diffusion of information during the early Middle Ages, and the works of men from each of these countries in succeeding centuries has come down to us, preserved in spite of all the vicissitudes to which they were so liable during the centuries before the invention of printing and the easy multiplication of books. To many people it will seem surprising to learn that the next evidence of deep broad interest in knowledge is to be found in the next century in the distant west of Europe, in the Spanish Peninsula. It is a long step from the semi-barbaric splendor of the Gothic court at Verona, to the bishop's palace in Seville in Andalusia. The two cities are separated by what is no inconsiderable distance in our day. In the seventh century they must have seemed almost at the other end of the world from each other. Those who recall what we have insisted on in several portions of the body of this work with regard to the high place Spanish genius won for itself in the Roman Empire, and how much of culture among the Spaniards of that time the occurrence of so many important writers of that nationality must imply, will not be surprised at the distinguished work of a great Christian Spanish writer of the seventh century.

Indeed, it would be only what might be expected for evidences of early awakening of the broadest culture to be found in Spain. The important name in the popularization of science in the seventh century is St. Isidore of Seville. He made a compendium of all the scattered scientific traditions and information of his time with regard to natural phenomena in a sort of encyclopedia of science. This consisted of twenty books--chapters we would call them now--treating almost _de omni re scibili et quibusdam aliis_ (everything knowable and a few other things besides). It is possible that the work may have been written by a number of collaborators under the patronage of the bishop, though there is no sure indication of this to be found either in the volume itself or even contemporary history. All the ordinary scientific subjects are treated. Astronomy, geography, mineralogy, botany, and even man and the animals have each a special chapter. Pouchet, in his "History of the Natural Sciences During the Middle Ages," calls attention to the fact that, in grouping the animals for collective treatment in the different chapters, sometimes the most heterogeneous creatures are brought under a common heading. Among the fishes, for instance, are classed all living things that are found in water. The whale and the dolphin, as well as sponges, and oysters, and crocodiles, and sea serpents, and lobsters, and hippopotamuses, all find a place together, because of the common watery habitation. The early Spanish Churchman would seem to have had an enthusiastic zeal for complete classification that would surely have made him a strenuous modern zooelogist.

The next link in the tradition of encyclopedic work is the Venerable Bede, whose character was more fully honored by the decree on November 13, 1899, by Pope Leo XIII declaring him a Doctor of the Church. Bede was the fruit of that ardent scholarship which had risen in England as a consequence of the introduction of Christianity. It had been fostered by the coming of scholar saints from Ireland, but was, unfortunately, disturbed by the incursions of the Danes. While Bede is known for his greatest work, the "Ecclesiastical History of the English People," which gives an account of Christianity in England from its beginning until his own day, he wrote many other works. His history is the foundation of all our knowledge of early British history, secular as well as religious, and has been praised by historical writers of all ages, who turned to it for help with confidence. He wrote a number of other historical works. Besides, he wrote books on grammar, orthography, the metrical art, on rhetoric, on the nature of things, the seasons, and on the calculation of the seasons. These latter books are distinctly scientific. His contributions to Gregorian Music are now of great value.