Part 14

The life of the Abbess Hildegarde is worthy of consideration, because it illustrates the period and makes it very clear that, in spite of the grievous misunderstanding of their life and work, so common in the modern time, these old-time religious had most of the interests of the modern time, and pursued them with even more than modern zeal and success, very often. Her career illustrates very well what the foundation of the Benedictines had done for women. When St. Benedict founded his order for men, his sister, Scholastica, wanted to do a similar work for women. We know that the Benedictine monks saved the old classics for us, kept burning the light of the intellectual life, and gave a refuge to men who wanted to devote themselves in leisure and peace to the things of the spirit, whether of this world or the other. We have known much less of the Benedictine nuns until now the study of their books shows that they provided exactly the same opportunities for women and furnished a vocation, a home, an occupation of mind, and a satisfaction of spirit for the women who, in every generation, do not feel themselves called to be wives and mothers, but who want to live their lives for others rather than for themselves and their kin, seeking such development of mind and of spirit as may come with the leisure and peace of celibacy.

Hildegarde was born of noble parents at Boeckelheim, in the county of Sponheim, about the end of the eleventh century (probably 1098). In her eighth year she went for her education to the Benedictine cloister of Disibodenberg. When her education was finished, she entered the cloister, of which, at the age of about fifty, she became abbess. Her writings, reputation for sanctity, and her wise saintly rule attracted so many new members to the community that the convent became overcrowded. Accordingly, with eighteen of her nuns, Hildegarde withdrew to a new convent at Rupertsberg, which English and American travellers will remember because it is not far from Bingen on the Rhine. Here she came to be a centre of attraction for most of the world of her time. She was in active correspondence with nearly every important man of her generation. She was an intimate friend of Bernard of Clairvaux, who was himself, perhaps, the most influential man in Europe in this century. She was in correspondence with four Popes, and with the Emperors Conrad and Frederick I, and with many distinguished archbishops, abbots, and abbesses, and teachers and teaching bodies of various kinds. These correspondences were usually begun by her correspondents, who consulted her because her advice in difficult problems was considered so valuable.

In spite of all this time-taking correspondence, she found leisure to write a series of books, most of them on mystical subjects, but two of them on medical subjects. The first is called "Liber Simplicis Medicinae," and the second "Liber Compositae Medicinae." These books were written in order to provide information mainly for the nuns who had charge of the infirmaries of the monasteries of the Benedictines. Almost constantly someone in the large communities, which always contained aged religious, was ailing, and then, besides, there were other calls on the time and the skill of the sister infirmarians. There were no hotels at that time, and no hospitals, except in the large cities. There were always guest houses in connection with monasteries and convents, in which travellers were permitted to pass the night, and given what they needed to eat. There are many people who have had experiences of monastic hospitality even in our own time. Sometimes travellers fell ill. Not infrequently the reason for travelling was to find health in some distant and fabulously health-giving resort, or at the hands of some wonder-working physician. Such high hopes are nearly always set at a distance. This of itself must have given not a little additional need for knowledge of medicine to the infirmarians of convents and monasteries. There were around many of the monasteries, moreover, large estates; often they had been cleared and made valuable by the work of preceding generations of monks, and on these estates peasants came to live. Workingmen and workingwomen from neighboring districts came to help at harvest time, and, after a chance meeting, were married and settled down on a little plot of ground provided for them near the monastery. As these communities grew up, they looked to the monasteries and convents for aid of all kinds, and turned to them particularly in times of illness. The need for definite instruction in medicine on the part of a great many of the monks and nuns can be readily understood, and it was this need that Hildegarde tried to meet in her books. The first of her books that we have mentioned, the "Liber Simplicis Medicinae," attracted attention rather early in the Renaissance, and was deemed worthy of print. It was edited at the beginning of the sixteenth century by Dr. Schott at Strasburg, under the title, "Physica S. Hildegardis." Another manuscript of this part was found in the library of Wolfenbuttel, in 1858, by Dr. Jessen. This gave him an interest in Hildegarde's contributions to medicine, and, in 1859, he noted in the library at Copenhagen a manuscript with the title "Hildegardi Curae et Causae." On examination, he was sure that it was the "Liber Compositae Medicinae" of the saint. The first work consists of nine books, treating of plants, elements, trees, stones, fishes, birds, quadrupeds, reptiles, and metals, and is printed in Migne's "Patrologia," under the title "Subtilitatum Diversarum Naturarum Libri Novem." The second, in five books, treats of the general diseases of created things, of the human body and its ailments, of the causes, symptoms, and treatment of diseases.

It would be very easy to think that these are small volumes and that they contain very little. We are so apt to think of old-fashioned so-called books as scarcely more than chapters, that it may be interesting to give some idea of the contents and extent of the first of these works. The first book on Plants has 230 chapters, the second on the Elements has 13 chapters, the third on Trees has 36 chapters, the fourth on various kinds of Minerals, including precious stones, has 226 chapters, the fifth on Fishes has 36 chapters, the sixth on Birds has 68 chapters, the seventh on Quadrupeds has 43 chapters, the eighth on Reptiles has 18 chapters, the ninth on Metals has 8 chapters. Each chapter begins with a description of the species in question, and then defines its value for man and its therapeutic significance. Modern scientists have not hesitated to declare that the descriptions abound in observations worthy of a scientific inquiring spirit. We are, of course, not absolutely sure that all the contents of the books come from Hildegarde. Subsequent students often made notes in these manuscript books, and then other copyists copied these into the texts. Unfortunately we have not a number of codices to collate and correct such errors. Most of what Hildegarde wrote comes to us in a single copy, of none are there more than four copies, showing how near we came to missing all knowledge of her entirely.

Dr. Melanie Lipinska, in her "Histoire des Femmes Medecins," a thesis presented for the doctorate in medicine at the University of Paris in 1900, subsequently awarded a special prize by the French Academy, reviews Hildegarde's work critically from the medical standpoint. She says that the saint distinguishes a double mode of action of different substances, one chemical, the other physical, or what we would very probably call magnetic. She discusses all the ailments of the various organs, the brain, the eyes, the teeth, the heart, the spleen, the stomach, the liver. She has special chapters on redness and paleness of the face, on asthma, on cough, on fetid breath, on bilious indigestion, on gout. Besides, she has other chapters on nervous affections, on icterus, on fevers, on intestinal worms, on infections due to swamp exhalations, on dysentery, and a number of forms of pulmonary diseases. Nearly all of our methods of diagnosis are to be found, hinted at at least, in her book. She discusses the redness of the blood as a sign of health, the characteristics of various excrementitious material as signs of disease, the degrees of fever, and the changes in the pulse. Of course, it was changes in the humors of the body that constituted the main causes for disease in her opinion, but it is well to remind ourselves that our frequent discussion of auto-intoxication in recent years is a distinct return to this.

Some of Hildegarde's anticipations of modern ideas are, indeed, surprising enough. For instance, in talking about the stars and describing their course through the firmament, she makes use of a comparison that is rather startling. She says: "Just as the blood moves in the veins which causes them to vibrate and pulsate, so the stars move in the firmament and send out sparks as it were of light like the vibrations of the veins." This is, of course, not an anticipation of the discovery of the circulation of the blood, but it shows how close were men's ideas to some such thought five centuries before Harvey's discovery. For Hildegarde the brain was the regulator of all the vital qualities, the centre of life. She connects the nerves in their passage from the brain and the spinal cord through the body with manifestations of life. She has a series of chapters with regard to psychology normal and morbid. She talks about frenzy, insanity, despair, dread, obsession, anger, idiocy, and innocency. She says very strongly in one place that "when headache and migraine and vertigo attack a patient simultaneously they render a man foolish and upset his reason. This makes many people think that he is possessed of a demon, but that is not true." These are the exact words of the saint as quoted in Mlle. Lipinska's thesis.

It is no wonder that Mlle. Lipinska thinks St. Hildegarde the most important medical writer of her time. Reuss, the editor of the edition of Hildegarde published in Migne's "Patrology," says: "Among all the saintly religious who have practised medicine or written about it in the Middle Ages, the most important is without any doubt St. Hildegarde...." With regard to her book he says: "All those who wish to write the history of the medical and natural sciences must read this work in which this religious woman, evidently well grounded in all that was known at that time in the secrets of nature, discusses and examines carefully all the knowledge of the time." He adds, "It is certain that St. Hildegarde knew many things that were unknown to the physicians of her time."

When such books were read and widely copied, it shows that there was an interest in practical and scientific medicine among women in Germany much greater than is usually thought to have existed at this time. Such writers, though geniuses, and standing above their contemporaries, usually represent the spirit of their times and make it clear that definite knowledge of things medical was considered of value. The convents and monasteries of this time are often thought of by those who know least about them as little interested in anything except their own ease and certain superstitious practices. As a matter of fact, they cared for their estates, and especially for the peasantry on them, they provided lodging and food for travellers, they took care of the ailing of their neighborhood, and, besides, occupied themselves with many phases of the intellectual life. It was a well-known tradition that country people who lived in the neighborhood of convents and monasteries, and especially those who had monks and nuns for their landlords, were much happier and were much better taken care of than the tenantry of other estates. For this a cultivation of medical knowledge was necessary in certain, at least, of the members of the religious orders, and such books as Hildegarde's are the evidence that not only the knowledge existed, but that it was collected and written down, and widely disseminated.

Nicaise, in the introduction to his edition of Guy de Chauliac's "Grande Chirurgie," reviews briefly the history of women in medicine, and concludes:

"Women continued to practise medicine in Italy for centuries, and the names of some who attained great renown have been preserved for us. Their works are still quoted from in the fifteenth century.

"There was none of them in France who became distinguished, but women could practise medicine in certain towns at least on condition of passing an examination before regularly appointed masters. An edict of 1311, at the same time that it interdicts unauthorized women from practising surgery, recognizes their right to practise the art if they have undergone an examination before the regularly appointed master surgeons of the corporation of Paris. An edict of King John, April, 1352, contains the same expressions as the previous edict. Du Bouley, in his 'History of the University of Paris,' gives another edict by the same King, also published in the year 1352, as a result of the complaints of the faculties at Paris, in which there is also question of women physicians. This responded to the petition: 'Having heard the petition of the Dean and the Masters of the Faculty of Medicine at the University of Paris, who declare that there are very many of both sexes, some of the women with legal title to practise and some of them merely old pretenders to a knowledge of medicine, who come to Paris in order to practise, be it enacted,' etc. (The edict then proceeds to repeat the terms of previous legislation in this matter.)

"Guy de Chauliac speaks also of women who practised surgery. They formed the fifth and last class of operators in his time. He complains that they are accustomed to too great an extent to give over patients suffering from all kinds of maladies to the will of Heaven, founding their practice on the maxim 'The Lord has given as he has pleased; the Lord will take away when he pleases; may the name of the Lord be blessed.'

"In the sixteenth century, according to Pasquier, the practice of medicine by women almost entirely disappeared. The number of women physicians becomes more and more rare in the following centuries just in proportion as we approach our own time. Pasquier says that we find a certain number of them anxious for knowledge and with a special penchant for the study of the natural sciences and even of medicine, but very few of them take up practice."

Just how the lack of interest in medical education for women gradually deepened, until there was almost a negative phase of it, only a few women in Italy devoting themselves to medicine, is hard to say. It is one of the mysteries of the vicissitudes of human affairs that ups and downs of interest in things practical as well as intellectual keep constantly occurring. The number of discoveries and inventions in medicine and surgery that we have neglected until they were forgotten, and then had to make again, is so well illustrated in chapters of this book, that I need only recall them here in general. It may seem a little harder to understand that so important a manifestation of interest in human affairs as the education and licensure of women physicians should not only cease, but pass entirely out of men's memory, yet such apparently was the case. It would not be hard to illustrate, as I have shown in "Cycles of Feminine Education and Influence" in "Education, How Old the New" (Fordham University Press, 1910), that corresponding ups and downs of interest may be traced in the history of feminine education of every kind. In that chapter I have discussed the possible reasons for these vicissitudes, which have no place here, but I may refer those who are interested in the subject to that treatment of it.

IX

MONDINO AND THE MEDICAL SCHOOL OF BOLOGNA

The most important contributions to medical science made by the Medical School of Salerno at the height of its development were in surgery. The text-books written by men trained in her halls or inspired by her teachers were to influence many succeeding generations of surgeons for centuries. Salerno's greatest legacy to Bologna was the group of distinguished surgical teachers whose text-books we have reviewed in the chapter, "Great Surgeons of the Medieval Universities." Bologna herself was to win a place in medical history, however, mainly in connection with anatomy, and it was in this department that she was to provide incentive especially for her sister universities of north Italy, though also for Western Europe generally. The first manual of dissection, that is, the first handy volume giving explicit directions for the dissection of human cadavers, was written at Bologna. This was scattered in thousands of copies in manuscript all over the medical world of the fourteenth and early fifteenth centuries. Even after the invention of printing, many editions of it were printed. Down to the sixteenth century it continued to be the most used text-book of anatomy, as well as manual of dissection, which students of every university had in hand when they made their dissection, or wished to prepare for making it, or desired to review it after the body had been taken away, for with lack of proper preservative preparation, bodies had to be removed in a comparatively short time. Probably no man more influenced the medical teaching of the fourteenth and fifteen centuries than Mundinus, or, as he was called in the Italian fashion, Mondino, who wrote this manual of dissection.

_Mundinus quem omnis studentium universitas colit ut deum_ (Mundinus, whom all the world of students cultivated as a god), is the expression by which the German scholar who edited, about 1500, the Leipzig edition of Mundinus' well-known manual, the _Anathomia_, introduces it to his readers. The expression is well worth noting, because it shows what was still the reputation of Mundinus in the medical educational world nearly two centuries after his death.[12]

Until the time of Vesalius, whose influence was exerted about the middle of the sixteenth century, Mondino was looked up to by all teachers as the most important contributor to the science of anatomy in European medicine since the Greeks. He owed his reputation to two things: his book, of which we have already spoken, and then, the fact that he reintroduced dissection demonstrations as a regular practice in the medical schools. His book is really a manual of making anatomical preparations for demonstration purposes. These demonstrations had to be hurried, owing to the rapid decomposition of material consequent upon the lack of preservatives. The various chapters were prepared with the idea of supplying explicit directions and practical help during the anatomical demonstrations, so that these might be made as speedily as possible. The book does not comprise much that was new at that time, but it is a good compendium of previous knowledge, and contains some original observations. It was entirely owing to its form as a handy manual of anatomical knowledge and, besides, because it was an incentive to the practice of human dissection, that it attained and maintained its popularity.

Mondino followed Galen, of course, and so did every other teacher in medicine and its allied sciences, until Vesalius' time. Even Vesalius permitted himself to be influenced overmuch by Galen at points where we wonder that he did not make his observations for himself, since, apparently, they were so obvious. The more we know of Galen, however, the less surprised are we at his hold over the minds of men. Only those who are ignorant of Galen's immense knowledge, his practical common sense, and the frequent marvellous anticipations of what we think most modern, affect to despise him. His works have never been translated into any modern language except piecemeal, there is no complete translation, and one must be ready to delve into some large Latin, if not Greek, volumes to know what a marvel of medical knowledge he was, and how wise were the men who followed him closely, though, being human, there are times when necessarily he failed them.

For those who know even a little at first hand of Galen, it is only what might be expected, then, that Mondino, trying to break away from the anatomy of the pig, which had been before this the basis of all anatomical teaching in the medical schools (Copho's book, used at Salerno and Bologna before Mondino's was founded on dissections of the pig), should have clung somewhat too closely to this old Greek teacher and Greek master. The incentive furnished by Mondino's book helped to break the tradition of Galen's unquestioned authority. Besides this, the group of men around Mondino, his master, Taddeo Alderotti, with his disciples and assistants, form the initial chapter in the history of the medical school of Bologna, which gradually assumed the place of Salerno at this time. There is no better way of getting a definite idea of what was being done in medicine, and how it was being done, than by knowing some of the details of the life of this group of medical workers.

Mondino di Liucci, or Luzzi, is usually said to have been born about 1275. His first name is a diminutive for Raimondo. It used to be said of him that, like many of the great men of history, many cities claimed to be his birthplace. Five were particularly mentioned--Florence, Milan, Bologna, Forli, and Friuli. There is, however, another Mondino, a distinguished physician, who was born and lived at Friuli, and it is because of confusion with him that the claim for Friuli has been set up. Florence and Milan are considered out of the question. Mondino was probably born in or near Bologna. The fact that there should have been this multiple set of claims shows how much was thought of him. Indeed, his was the best known name in the medical schools of Europe for nearly two centuries and a half. He seems to have been a particularly brilliant student, for tradition records that he had obtained his degree of doctor of medicine when he was scarcely more than twenty. This seems quite out of the question for us at the present time, but we have taken to pushing back the time of graduation, and it is not sure whether this is, beyond peradventure, so beneficial as is usually thought.

That his early graduation did not hamper his intellectual development, the fact that, in 1306, when he was about thirty-one years of age, he was offered the professorial chair in anatomy, which he continued to occupy with such distinction for the next twenty years, would seem to prove. His public dissections of human bodies, probably the first thus regularly made, attracted widespread attention, and students came to him not only from all over Italy, but also from Europe generally. In this, after all, Mondino was only continuing the tradition of world teaching that Bologna had acquired under her great surgeons in the preceding century. (See "Great Surgeons of the Medieval Universities.")