Full text of "An introduction to the history of medicine with medical chronology, suggestions for study and bibliographic data"

COLONEL WALTER D. McCAW, U.S. ARMY

LIBRARIAN OF THE SURGEON GENERAl's OFFICE (1903-1913)

IN ACKNOWLEDGMENT

OF HIS KIND ENCOURAGEMENT . .;

AND

HIS MANY COURTESIES

IN AID OF THE COMPLETION OF THIS BOOK

PREFACE TO THE SECOND EDITION

The reception of the first edition of this l)ook by the medical
profession has been most kind. The present edition, revised and
enlarged, has be(ni prepared in compliance with the author's agree-
ment with the ])ul)lishers.

Following the appearance of the first edition, necessarily a
hazardous venture, the author felt much cheered by the kind and
encouraging letters of Sir William Osier, the late Dr. S. Weir
Mitchell, Dr. A. Jacol)i, the late Dr. James G. Mumford, Dr.
Harvey Gushing, and many other friends. Professor Max Neu-
Ijurger, of Vienna, in a review all the more generous as written
amid the turmoil of war, opines that the author deliberately breaks
with many viewpoints standardized in the past or current on the
continent, which he regards as associated with the fact that the
writer "sees things through English spectacles." This is, alas!
(jne of the many delusions createtl in the human mind by the con-
flicting emotions of wartime. To view everything with "the
equal eye of Nature" cannot be claimed for the contents of any
single human calvarium. Professor Karl Sudhoff, of Leipzig, in
his reviews, has defined the author's procedure as "clear-sighted,
open-hearted, impartial," and concedes that "in the modern
period, he stands quite upon his own ground." A reader un-
influenced by emotion will perhaps recognize that, in this book,
an honest attempt has at least been made to be fair-minded,
to present the merits of English medicine as English medicine, of
German medicine qua (lerman medicine, of Frenchmen as French-
men, Russians as Russians, Americans as Americans. Whatever
intelligence and perspicacity the present writer possesses are of
French complexion. Even so, it would be difficult to affirm that
these pages contain anything unfair to German medicine, or to
the modern German organization of science. The author's main
endeavor, as a formal, impersonal historian, has been to arrive
at the engineer's "mean condensation ratio," to save his reader's
time by presenting things as briefly and concisely as possible.

Of the different criticisms offered, I value most highly that of
Professor William H. Welch, who said fi-ankly, "You have not

written a history of medicine as an inductive science." When the

8 PUKFACK TO TIIK SKC(»NI> KDITION

Uv\. KdwanI Irviiiii phiytully asked I'hoinas ( "arl\ !<• if lie would
marry a virgin of certain siiinm(>rs and uncertain cliainis. the
testy sa^t' of Kcclefechan replied: "Not lor a pure and iH>rfeet
rhrysolite tlie size of this t(>rra(iueous ti;lol>e!" 'Pli(>se aic pr(>eis(>ly
my si'Utinients in r(>jj;ard to the jirohlein ol accounting;- for the
<lul»iows progress (»f ine(Hcin(> as an inihictive science. Medicine
lias !ia«l Si) many ui)s and <lo\\ns in the past that to trace the slen-
der almost invisible threads connect int; the ai)i)urent breaks in
continuity in the dilTerent ])eriods is far beyond our ])resent ranj>;e
of com])reluMision. There are whole ]K'ri()ds in medical history
whicli si'em. in the phrase of La Fontaine, "an enormous solution
of contimiity." or. at least, we are too frequently confronted by
iiard -surfaces of discontinuity." We shall never be able to trace
the eonnectinfj; threads in the i)a.st until all the manuscript sources
of ancient and nu'dieval medicine have ])een exhumed and inter-
preted, nor can we sunnnarize "trial and error" in the later peri-
ods until proper source-books, accounting for the development of
knowletlge in the fundamental disciplines and specialties, have
l)eon made by comi^etent hands. I have endeavored to trace the
missinfi links of jirogress accoidins to my lights, l)ut I defer to the
ojnnion of Professor Welch and that of Dr. Charles Singer (Ox-
ford), who says (in a private letter): "The history of medicine
is a history of ideas and ])iography is only of value in so far as it
bears on ideas. The history of medicine is not concerned with
tattle about the lives of the great, nor with the absurdities of
ancient error, nor with the cjuaintness of antique expression. I
feel that we owe Sudhoff a gi'cat debt in that he has really sought to
elicit pi-inciples and demon.strate continuity, and that these are
much more important than any discovery he may make."

As stated in the preface of the first edition, this volume was
written with a definite literary intention, that of stimulating the
physician and student to do his own thinking and research by in-
teresting him in the subject at the start. The author has never
regarded his work as anything but a primer or guide-book to a
territory of vast dimensions; he has made no extravagant claims,
yet he may at least claim that his arrangement and interpretation
of the material, and his mode of presenting it, are his very own.
The insurance of accuracy in the facts, dates, footnotes and bib-
liographical appendices has taken more time and trouble than the
simple task of writing. In this regard, the author has been much
pleased that English physicians have cited his facts and findings
rather than his opinions. Opinions may be wrong: facts, if ac-
curately stated, can never be. Those who are acquainted with
what Augustus De Morgan calls "the masonic signs of learning"
will easily discover how far the present writer has been "original."

PREFACE TO THE SECOND EDITION 9

In the face of his veiy modest claims, and acting perhaps upon
the assumption that this is merely a work of com]iilation, cer-
tain persons have lil)erally pilfered, without acknowledoment, the
author's arrangements of things, and even his mode of expression,
in a way that seems small and ignoble as attempting to belittle
the results of an enormous amount of hard work. The publishers
of the volume have gone to very considerable expense to produce
it properly, and I mention this contretemps to explain the necessity
of the caveat "All rights reserved." I do not know any of these
people, but from such acquaintance with their procedure as I have,
I can only repeat the laconic utterance of my old chief, Dr. J. S.
Billings, in similar relations — "Can't say that I have appreciated
it nuich."

In the present edition, many investigations not hitherto ac-
cessible to me have been considered, in particular, the researches
of Erwin Rohde, Max Holier and Max Wellmann in ancient medi-
cine, of Sudhoff, Neulnn-ger, Husemann, Wickersheimer and
Singer in medieval medicine, of Georg Sticker in epidemiology, of
Tschirch and Schelenz in the history of pharmacy, of Erich El)-
stein in the histoiy of diseases antl diagnosis, and the valuable
American studies of W. A. Heidel on Greek corpuscular theories,
of John G. Curtis on Harvey, and of Edward C. Streeter on the
Florentine artist-anatomists of the Quattrocento. The inter-
pretation of medieval medicine in Professor Neuburger's splendid
history surpasses all other contemporary efforts, and since the
Oxford translation is still unpublished, I have not hesitated to fol-
low him closely in the fine print, in order to make his views better
known to those who do not read German. Some of the most
interesting finds in medical history of recent date, such as those of
Elliot Smith and Wood Jones in Egyptian, and of Morris Jastrow
in Babylonian medicine, have been literally dug up out of the
ground. The excavations of Sir Arthur Evans in Crete, the
Minoia regna of Virgil (et Cnosia regna petamus), have shed much
light on the unique post-neolithic culture and wonderful sanitary
appliances of Knossos, and while little is yet known of Minoan
medicine, it is likely that much remains to be uncovered or de-
ciphered. The last year has witnessed some encouraging advances
in medical history in this country. Dr. Mortimer Frank, of Chi-
cago, has completed a translation of Choulant's History of Ana-
tomical Illustration (with many additions), which I have read in
the ^IS., and which will undouljtedly be of great use to anatomists,
artists and art schools. Dr. Arnold C. Klebs has catalogued the
medical incunabula in America, and this, when supplemented by
the European material, will prove a valuable addition to medical
bibUography. Dr. William S. Dislirow, of Newark, N. J., has

Ill I'UKKACK TO IIIK SKCONI) KDllIOX

startr»| a miiscimi of medical liisloiN in liis rhy, llic sccoiid Aiiicri-
caii ftniiidalioii (if this kiiul, Inllowiiiii the cdllcct ions of Rear Ad-
miral .laiiics M. I'"liiil. r.S. N. (rc'tiicd). in the National Mus(Him
at W asliin;j;l()n. Dr. ( !(>(>r<2;(> Salt on (Harvard rnivorsity) is
\vi»rkin^ to cslahlisli an institutr of llic histoiN of sciiMice and
medicine in iliis count r>-. and it will be a sad mistake if this emi-
nent scholar does not i-ecei\c the cordial sU])]K)rt wliich his jjioject
deserves. .\ combined miMlical library and hi.storical institute
has already been planned b\ the membcM's of the .Johns Hopkins
Medical Faculty. Lastly, the Biillitin of the Mcdiail JJislory
Siicivhi of Chiauii) has been nuich improved in format and contents
by its present editor. Dr. Mortimer Fraiik, and a new journal, the
Annals of Mnlical Histonj, edited by Dr. Francis R. Packard
(rhiladelphia). has recently been started tin-ougli tlu^ zeal and
enterpri.se of Mr. Paul H. Ho(>ber (New York).

hi preparing this work, 1 have ))een mainly indebted to the
resources of the Surgeon General's Libiary, without which it could
not ha\e been written; and I desire to express my sincere grati-
tude to its successive Librarians. Colonel Walter D. McCaw and
Colonel Champe C. McCulloch, for the loan of special literature
for my private use. Professor Sudhoff (Leipzig) has very kindly
extended me the special privik^ge of copying some of his inter-
esting pictures relating to horoscopic medicine and the traditional
asjjects of anatomic illustration. Similar courtesies have been
granted by the Boston Medical Library, The Library of the New
York Academy of Aledicine, Dr. Arnold C. Klebs, Professor
William Stirling (Manchester, England), Professor William Bate-
son (London), Dr. Eugen Hollander (Berlin), Dr. Robert Miiller-
heim (Berlin), and others. In the correction of errors of omission
and commission in the first edition, and for other suggestions, I
gratefully acknowledge the assistance rendered by the late Dr.
S. Weir Mitchell, Sir WiUiam Osier (Oxford), Dr. A. Jacobi (New
York), Dr. John W. Farlow (Boston), Dr. Mortimer Frank (Chi-
cago), Dr. W^alter A. Jayne (Denver), Mr. Alfred Ela (Boston),
and many others. In presenting a revised account of the theories
of Freud, whose view of things I do not profess entirely to under-
stand or appreciate, I have been much indebted to my friend Dr.
William A. White (Washington) and to Dr. A. A. Brill (New
York), who has made the writings of Freud accessible to English
readers by his very accurate translations. In the sections on
medical bibliography and incunal)ula in the appendices, I have
drawn liberally on the valuable collections made in the Surgeon
General's Library by Mr. Felix Neumann, to whom I am in-
debted for helpful suggestions. I cheerfully acknowledge the
generous encouragement and helpful criticism of Dr. Arnold

PREFACE TO THE SECOND EDITION 11

Klebs in the past. Whatever excellences this volume may possess
in typograjohy and illustration are due the pu])lishers. Without
their generous and fri(Mully partiality, the first edition would never
have seen the liglit. The book has been entirely reset and re-
indexed in the new edition, and once more I render cordial thanks
to my friends. Dr. Albert AUemann and Dr. Frank J. Stockman,
of the Surgeon (leneral's Library, who have very generously given
u]i much of their private leisure to the correction of the proofs.

F. H. G.

Washington, D. C, June, 1917.

CONTENTS

PAGE

I. The Identity of all Forms of Ancient and Primitive Medicine 17
II. Egyptian Medicine 44

III. SrMERIAN AND ORIENTAL MeDICINE 52

IV. Greek Medicine:

I. Before Hippocrates •. 66

II. The Classic Period (460-146 B. C.) 80

III. The Gra-co-Roman Period (146 B. C.-47fi A. D.) 90

V. The Byzantine Period (476-732 A. D.) 104

\I. The Mohammedan and Jewish Periods (732-1096 A. D.) 110

Cultural Aspects of Mohammedan Medicine 118

VTI. The Medieval Period (1096-1438) 124

Cultural and Social Aspects of Medieval Medicine 152

\'III. The Period of the Renaissance, the Revival of Learning,

and the Reformation (1453-1600) 178

Cultural and Social Aspects of Renaissance Medicine 220

IX. The Seventeenth Century: The Age of Individual Scientific

Ende.wor 232

Cultural and Social Aspects of Seventeenth Century Medicine 270
X. The Eighteenth Century: The Age of Theories and Systems 303
Cultural and Social Aspects of Eighteenth Century Medicine . 384
XI. The Nineteenth Century: The Beginnings of Organized Ad-
vancement of Science 413

XII. The Twentieth Century: The Beginnings of Organized Pre-
ventive Medicine 704

Cultural and Social Aspects of Modern Medicine 749

Appendices:

I. Medical Chronology 793

II. Hints on the Study of Medical History 835

III. Bibliographic Notes for Collateral Reading 840

A. Histories of Meflicine 840

B. Medical Biography 841

C. Histories of Special Subjects 856

Index of Personal Names 869

Index of Subjects 891

"C'iviliziitioii iii it.s liiglier fonn today, tliough higlily complex, forms
essentially a unitary mass. It has no longer to be sought out in separate
luminous centers, shining like planets through the surrounding night. Still
less is it the jn-operty of one ])rivileged countiy or p(>ople. Many as are the
tongues of mortal man, its votaries, like th(> Immortals, sjjeak a single lan-
guage. Throughout the whole vast area illumined by its quickening rays its
workers are interdepcMident and pledged to a common cause." — Sm Arthur
Evans.

" For indeed it is one of the lessons of the history of science that each age
steps on the shoulders of the ages which have gone before. The value of each
age is not its own, but is in part, in large part, a debt to its forerunners. And
this age of ours, if, like its predecessors, it can boast of something of which
it is i)rou<l, would, could it read the future, doubtless find much also of which
it would be ashamed." — Sir Michael Foster.

"Take from the air every aeroplane; from the roads every automobile;
from the country every train; from the cities every electric light; from ships
every wireless apparatus; from oceans all cables; from the land all wires;
from shops all motors; from office buildings every elevator, telephone and
typewriter; let epidemics spread at will; let major surgery be impossible —
all this and vastly more, the bondage of ignorance, where knowledge now makes
us free, would be the terrible catastrophe if the tide of time should but ebb
to the childhood days of men still living! . . . Therefore, whoever desires
progress and prosperity, whoe\-er would advance humanity to a higher- plane
of civilization, must further the work of the scientist in every way he possibly
can." — William J. Humphreys.

"The development of human thought and achievement, as a whole, has
not been, as commonly supposed, a continual upward i)rogression, nor even
the equivalent of a continuous series of ascertained results. Thoughts and
inventions, which seemed on the verge of practical fruition, have often been
reduced to nothingness, even at the most decisive moment, through some
combination of untoward circumstances; yes, even the very memory of a
pathway broken into the Lanrl of Promise is often obliterated and what seemed
accomplished fact has had to be recreated by laljorious work covering years,
decades and even centuries. Just the simplest, most natural and, in the end,
almost self evident facts are the hardest to evolve and elucidate, just what
was most decisive and potent of result has been time and again overlooked
l)y the seeker after truth. . . . The gold of historic thought, indeed, is as
little to be found in the street as the gold of actual daily strife, and it is by no
means the task of the historian of broad general scope to give the initial clew
to its discovery. He, indeed, can only reproduce the past with fidelity and
exactitude. The intuition of the true investigator and pathfinder of today and
tomorrow must find its own way to new guiding principles from the work of
yesterday, before yesterday, and the distant past." — Karl Sudhoff.

"Doctrinaire formula-worship — that is our real enemy." — Max Neu-
burger.

"It is hardly an exaggeration to summarize the history of four hundred
3'ears by saying that the leading idea of a conquering nation in relation to the
conquered was, in 1600, to change their religion; in 1700, to change their trade;
in ISOO, to change their laws, and in 1900 to change their drainage. May we
not, then say that on the prow of the conquering ship in these four centuries
first stood the priest, then the merchant, then the lawyer, and finally the
physician?" — A. Lawrence Lowell.

"Aims, methods, and persistency, are common to the medical profession
of all countries. On its flag is inscribed what should be the life rule of all
nations: Fraternitv and soliilaritv." — Abraham Jacobi.

AN INTRODUCTION
TO THE

HISTORY OF MEDICINE

THE IDENTITY OF ALL FORMS OF ANCIENT AND
PRIMITIVE MEDICINE

OxE of the best accredited doctrines of recent times is that of
the unity or solidarity of folk-lore. The collective investigations
of historians, ethnologists, archeologists, philologists, and sociolo-
gists reveal the singular fact that all phases of social anthropology
which have to do with instinctive actions inevitably converge to a
common point of similarity or identity. This is true of all myths,
superstitions, laws, and social customs of primitive peoples (as also
of the cruder ethnic aspects of religions) which are concerned with
the fundamental instincts of self-preservation and reproduction.
It is possible, as we shall see, that manj^ strange cultural practices,
such as mummification, circumcision, or the couvade, may have
been deliberately transported by migrations from one continent
or island and imposed upon another (Elliot Smith). But the fact
remains that, for those human actions which have been defined as
instinctive, as based upon the innate necessity which is the mother
of invention, "folklore is an essential unity."^ The mind of savage
man, in its pathetic efforts to form religious and ethical systems for
moral and spiritual guidance, or to beautify the commoner aspects
of life with romance and poetry, has unconsciously taken the same
line of least resistance, followed the same planes of cleavage. The
civilized mind differs from the savage mind only in respect of a
higher evolutionary development. Human races and racial cus-
toms have changed as they became more highl}- specialized. The
heart of man remains the same.

' For a good summary of the matter, see the presidential address of
Charlotte S. Burne in Folk-Lore, London, 1911, xxii, 14-41; also, her revision
of "The Handbook of Folklore" (Pub. Folk-Lore Soc, No. Ixxiii, London,
1914).

2 17

IS HISTOUY or MKIHCINE

h f(tll«>\vs thai, iiiidcr (litT(M(Mil asix'cts of s|)ac(' and lime, all
phast's of folk-iiMMliciiic and aiinciil inc<licinc have Iuhmi cssciil iaily
alike in Iciidcncy, dilVt'rin.u; cnl.N \i\ nnini|)<iiianl details. In the
liLdit of aiitliropoloiiy. this proposition may l)c taken as piovcd.
CiiniMfoirM. hicroiilyphic, tunic, hircli-haik, and pahii-leaf in-
scriptions all indicat»> lliat ihc folk-ways of oai'Iy medicine, whether
Aocadian or Scandinavian. Slavic or Celtic, Roman or Polynesian,
have heen the sam(> in each case an affair of charms and spells,
plant-lore and psychotherapy, to stave off ihe effects of super-
nal m"al airtMicies.

Of the ultimate orij^in of folk-ways ajid ideas we know little or
nothing. Innumerable hypotheses have been advanced, in each
case the atteinj)! of a civilized or educaled miml to interpret the
workings of the primitive mind from isolated instances, and. in
almost (n-ery case, tlie investigatoi- has become obsessed by his
jiarticular theory to the extent of becoming a hobby-horse rider.
But all anthropologists agree that the general origin of folk-ways
and mores (religious or other) is social, concerned with the great
question "how to live," which is different at different times, in
different places, among different peoples. Of the mind of primi-
tive man, we know that it differs from the civilized mind mainly in
respect of education and development, that is, in the power to per-
ceive and a.ssign the right causes for ])lienomena, which gave us
science, and in certain perceptions of "values," which gave us
our standards of morality and taste. But in each of these things
the primitive mind everywhere has its own natural standards,
which are worthy of deepest consideration.

Apart from any theories as to his origin or evolution, we may
assume that prehistoric man w^as not different from w^hat we often
find primitive man to be — a savage sunk in his animal instincts.
At this stage of his existence he killed his food and fought his ene-
mies with sticks and stones, raped his women, hid himself in caves,
and was probably not unaware of certain hygienic precautions
which are instinctive in lower animals. A dog licks its wounds,
hides in holes if sick or injured, limps on three legs if maimed,
tries to destroy parasites on its body, exercises, stretches, and
warms in the sun, assumes a definite posture in sleeping, and seeks
out certain herbs and grasses when sick.^ It is not unreasonable
to suppose that actions like these may have been as instinctive
in a grown-up prehistoric man as they are in a primitive child of
his race today. "Man has climbed up from some lower animal
form," sa^'s John Burroughs, "but he has, as it were, pulletl the

' Usually Triticum caninum, Cynosurus cristatus, and Agrostis canina for
emesis and purgation. Cats have a known fondness for Valeriana officinalis
and Nepeta cataria (catmint).

IDENTITY OF FORMS OF ANCIENT AND rRIMlTIVE MEDICINE 19

laddci' up al'lcr him." We do not know when or where, how or
why, this occurred, but we do know the first rung of the ladder.
In the Hall of Anthropology of the National Museum at Wash-
ington (or in any other good collection of this kind) there are to
be seen innumeral)le specimens of a small object in chipped flint
which is the symbol of prehistoric man's uplift, his first step in the
direction of civilization. With this leaf-shaped flint in hand, he
had a new means of protecting himself against enemies, procuring
and preparing food, and of manufacturing other weapons and im-
plements of the same kind or of more liighly specialized kinds.
Now the interesting point about these prehistoric flints is that they
are to be found wherever traces of the existence of man are found,
changing in shape during the successive interglacial and post-
glacial periods, l^ut following his migrations over the surface of the
earth. Here cropping up as spear or arrow-point, there as tool or
ceremonial object, these primitive "celts," as they are called, have
been excavated from the river-drifts of England, France, and
North America, in the caverns of Devonshire and the Dordogne, in
the plains of Egypt and Palestine, and the frozen tundra of Siberia
and Alaska, in each case bearing the same identical form. In
the Early Stone Age (Paleolithic Period), up to the Solutrean
period, the chipped celts were little more than the result of a neces-
sarily crude flaking of oval or ovoid stones. From the time of
arrival of the pre-Chellean flint workers in Europe during the
Second Interglacial Period, one hundred thousand years ago,
each successive race had its peculiar technic of flint-chipping, its
characteristic retouch, until the crude coups de poing of the
Chelleans become the exquisite laurel-leaf points of Solutrean
man. But in the Magdalenian period the forms are again crude,
and finally dwindle away into the faultier Azilian forms and the
strange trapeziform shapes of the Tardenoisian microliths.^ In
the Later Stone Age (Neolithic Period) they were brought to a high
point of specialization and polish, but in shape and intention they
have remained the same throughout geologic space and time.
Their employment in surgery by the ancient Egyptians, or in
ritual circumcision by the Hebrews in the desert, goes to show the
unusual veneration in which they were held by these peoples on
account of their great antiquity. In what is perhaps the most
interesting of American contributions to archeology,^ Professor
William H. Holmes has demonstrated inductively (by working out

' See H. F. Osborn: Men of tlic Old Stone Age, New York, 1916, passim.

2 W. H. Holmes: "Stone Iin])l('nients of the Potomac-Chesapeake Tide-
water Province," Rep. Bur. Ethnol., 1893-4. Wash., 1S97, xv, 1-152. Also:
Mem. Internal. Cong. Anthrop., Chicago, 1894, 120-139, 4 pi.

20 IllsroUV OK MKDICINE

the miti:il mrtliotls of (•liii)!)iiiir; :mtl Makiiifz; himself) that even
ainonn P'«'»'iit AiiH>ric;iii Iii<li,iiis. like Iho.so of (he Piiicy Rraiich
(|iiarru's in thr District of Coluiiihia. ihc piocess of shupiiip; unci
s|M'('iali/inn the leaf-shaped tliiils was pi-ol)al)ly not different from
that employed l>y PaleoHthie man or even in what seem to be the
rude artefacts of I\oIithie man. There is appai<Mi(ly no distinction
in space and tim(> in the llakint; of prehistoric and primitive im-
plements. Similarly, ethnolofjists, as we have said, find that the
folklore and other traditions and snperstitions of i)rimitive peojjles
have a stronij; family likeiu^ss at all times and pla('(>s.

The common point of convergence of al,l medical folk-lore is the
notion that spirits or other snpernatnral agencies are the efficient
causes of disease and dcaih. Primitive medicine is inseparable
from primitive modes of icligious belief. If we are to under-
stand the attitude of the piimitive mind toward the diagnosis and
treatment of di.sease we must recognize that medicine, in our sense,
was only one phase of a set of magic or mystic processes d(\signed
to promote human well-being, such as averting the w'rath of
angered gods or evil spirits, fire-making, making rain, purifying
streams or habitations, fertilizing soil, improving sexual potency
or fecundity, preventing or removing blight of crops and epidemic
diseases, and that these powers, originally united in one person,
were he god, hero, king, sorcerer, priest, prophet, or physician,
formed the savage's generic concept of "making medicine." A
true medicine-maker, in the i)iinn'tivc sense, was the analogue of
our .scientific experts, ])hilanthroi)ists, and "efficiency engineers,"
a general promoter of human prosperit3^

In his attempts to interpret the ways of nature, savage man,
untutored because inexperienced, first of all confused life with
motion. Like Mime in Wagner's "Siegfried," he was puzzled if
not awed by the rustling of leaves in the forest, the crash and
flash of thunder and lightning, the flicker and play of sunlight
and firelight, and he could see no causal relation between a natural
object and its moving shadow% a sound and its echo, flowing water
and the reflections on its surface. Winds, clouds, storms, earth-
fpiakes, and other sights and sounds in nature were to him the
outward and visible signs of malevolent gods, demons, spirits, or
other supernatm-al agencies. The natural was to him the super-
natural, as it still is to many of us. He therefore worshiped the
sun, the moon, the stars, trees, rivers, springs, fire, winds, and even
serpents, cats, dogs, apes, and oxen; and, as he came to set up
carved stocks and stones to represent these, he passed from nature-
worship to fetish-worship. Even in his artistic productions, the
savage is at first animistic and ideographic, tends to vitalize
inanimate objects, and aims at the portrayal of action and move-

IDENTITY OF FORMS OF ANCIENT AM) PKIMITIVE MEDICINE 21

nu'iit rather than perfection of form.' Disease, in particuhir, he was
prone to regard at first as an evil spirit or the woi'k of such a spirit,
to be placated or cajoled, as with other deities, by burnt offerings
and sacrifice. A further association of ideas led him to regard
disease as something produced by a human enemy possessing super-
natural powers, wliicli he aimed to ward off by appropi-iat(^ spells
and sorceiy, similar to those employed b}' the enemy himself.
Again, his own reflection in water, his shadow in the sunlight, what
he saw in dreams, or in an occasional nightmare from gluttony, sug-
gested the existence of a spirit-world apart from his daily life and
of a soul apart from his body, and in this way he hit upon a third
waj^ of looking at disease as the work of offended spirits of the
dead, whether of men, animals, or plants. These three views of
disease are common beliefs of the lowest grades of human life, for,
as Rivers says, the category of natural causes ''can hardly be said
to exist" among them. Savages, as a rule, cheerfully accept all
three, while a lingering belief in human sorcery and the displeasure
of the dead is always a trait of the peasant and sometimes of his
descendants in "civihzed" communities. The modern Koreans
are said to number their demons "by thousands of billions."
Among savages such beliefs usually go hand in hand with shaman-
ism, an intermediate stage between polytheism and monotheism,
which assumes a Supreme Being or Great Spirit, with lesser di-
vinities and demons subordinated. With the beginnings of sham-
anism we have everywhere the advent of the medicine man and
the bilbo or witch-doctor, who assumes a solemn supervisory rela-
tion to disease and its cure not unlike that of the priest to religion.
The shaman handles disease almost entirely by psychotherapeutic
manoeuvers, which serve to awaken a corresponsive state of auto-'
suggestion in his patients. Whether North American Indian or
Asiatic Samoyed, he does his best to fiighten away the demons of
disease bj^ assuming a terrifying aspect, covering himself with the
skins of animals so as to resemble an enormous beast walking on its
hind legs, resorting to such demonstrations as shouting, raving,
slapping his hands or shaking a rattle, and pretending (or en-
deavoring) to extract the active principle of the disease by sucking
it through a hollow tube. To prevent future attacks, in other
words to keep the demon away for the future, he provides his

^ That there is a strong re,sem])lance between some of the concepts of
savage and paranoiac art is strikingly sliown in the reniarkahic carvings of a
paranoiac collected by G. Marro, Ann. de freniat., Turin, 191.'^, xxiii, 157-192,
6 pi. W. H. Holmes has shown that, in the savage, perfection of pattern forms
and figures had to follow upon development of the metric and geometric arts,
such as the shaping of potterv, textiles, technics, and architecture. (Rep.
Bur. Ethnol., 1882-3, Wash., 1886, iv, 443-465.)

22 iii>ri>iiv (IK .\ii;i)iciN'K

pntu'iit with a spcciMl fetish or ;iiiiul('l to lu' worn or enrriod about
liis pcrsoii. l''urllit'riiiort>. any fantastic tliinj!; ho may cloct to do
or not to do. such as passing; in or oul of a door or stepping over an
object with iniciition, he considers in the hght of "making medi-
cine." W c may smile at th(>se phases of shamanistic procechu'C,
hut. except for the noi.se. they are not essentially different from the
mind-medicine or faith-healing of our own day. Jioth rely upon
p.-^ydiotherapy and suggestion, ami for a sick savage, the fantastic
ehunor made ai)out him might be conceivably as effective as the
quieter methoils of ( luistian Science to a modern nervous patient.

It is hipliiy i)nil);il>lc that in .ill primitive sorictios, tlic priest , tlic magician,
ami tlir iiicdiciiic-maii were one and tlio same, and that the powers ascril)ed to
those ranked witli courage and the sword as means of securing iead<'rship()r
kingship. As those functions tieeame more specialized and difTerentiated, relifrion
became the exelnsive belief in and worship of some imiversal i)ower greater
than man himself; m;igie, a special set of processes within the power of man,
whereby he sought to predict and control natural phenomena, usually to
wreak evil and in opposition to the will of the god or gods; and medicine, tlie
attempt to direct and control those natm-al phenomena wliieh produce disease
and death in man (liivers).' Thus religion, through the inliibitions which
man jnit upon himself to attain to the godlike, became the origin of law and
ethics: the secret practices of magic engendered alcliemy .and other branches
of chemical and jjliysical sciences; a.strology, astronomy; while primitive medi-
cine remained more or less stationary among all jx^oples, always following in
the wake of other sciences, until it could utilize the luivauces made by physics
or chemistry. Black magic was concerned with producing drought, famine,
disease, death, or other evils; white magic, in averting these or in such posi-
tive good as rain-making, fire-making, or promotion of vegetation. Primitive
therapy, tlierefore. b(Tame a mode of white magic.

Primitive pathology ascribed disease to .something projected into the body
of the victim, something taken from it, or to the efT(>ct of sorcery upon some
part of or some object connected with the body of the patient. The first
category corresponds with our infectious and toxic diseases, the second,
€. g., tlie predilection of the Australian savage for the .adrenal fat of his enemies,
with the diathetic (metabolic) and deficiency diseases. The third category
Frazer defines as sympathetic magic (action at a di.stance),- including liomeo-
pathic or mimetic magic (action by or upon similar objects for good or evil) and
contagious magic (magical effect of a thing which has once been in contact
with a person or thing or formed part of it). As part of this cult, the soul was
regarded as "the animal inside the animal, the man inside the man," a manni-
kin, counterpart or double, sometimes a shadow or reflection,' absent from the
body in sleep, sometimes a truant and a wanderer, (;apable of being extracted
from the body by an enemy, or of being deposited in some safe place to secure
immortalit}', or even existing as a second self or "external soul" in various
plants or animals, upon whose welfare the welfare of the individual de-
pended.* The "perils of the soul," in primitive medicine, were averted by
complex systems of totems and taboos. On Eddystone Lsland (Melanesia)
nearh' every disease is ascribed to eating the fruit of tabooed trees. In other

* See W. H. R. Rivers, Fitzpatrick Lectures, Lancet, 1916, i, 59; 117.

- Sir James G. Frazer: The Magic Art (The Golden Bough, pt. i), London,
1913, i. .52-219.

' Frazer: Taboo and the Perils of the Soul (Golden Bough, pt. ii), London,
1911.

* Frazer: Balder the Beautiful (Golden Bough, pt. 7), London, 1913, ii,
95-278.

IDENTITY OF FORMS OF ANCIENT AND PRIMITIVK MEDICINE 23

parts of Melanesia, disease follows upon :iny infraction of totemic ordinances,
such as killing or eatino; the totem (Rivers).

Thus primitive medicine, magic, and religion are inseparable, although, as
in ancient Egypt or some parts of modern Melanesia, leechcraft may become
specialized to the point of having a do(!tor for every disease.

Apart from shamanism, the actual medical knowledge of primi-
tive man, given his limitations, was far from contemj)tible. As the
folk-lorists point out, the function of the medicine man was a
limited one, and the art of healing never progressed very far so
long as it was under the sway of belief in the supernatural. As the
savage advanced a little further in the knowledge which is gained
from experience, it was natural that some special talent for herb-
doctoring, bone-setting, and rude surgery should be developed and
employed as a special means of livelihood by certain individuals.
Along with these natvu'e-healers there went, of course, the in-
evitable "wise-women," who followed herb-therapy and midwifery,
and such specialists soon perceived that a number of poisons are
also remedies under various conditions. Medicine, which. Huxley
has so truly styled the foster-mother of many sciences, really
began v.dth this crude plant- and poison-lore of primitive peoples.

Early man regarded the poisoner with the same horror and loathing that we
feel, because, as Thomas points out,' the use of poison involves the idea of death
without the possibility of motor resistance, without giving the victim a fighting
chance.

When Ulysses applied to Ilus at Ephyra for a deadly arrow-poison, Ilus
declined, ''for he had in awe the immortal gods" (Odyssey, i, 260). At the
ancient Greek festival of the Thargelia, given at Athens every May, two
public outcasts, set apart for the purpose, were flogged with squills, wild fig
branches or agnus castus, and possibly stoned to death or flung into the sea.
The scapegoat, in this case, was called the Pharmakos, which also means a
poisoner, sorcerer, or magician. Whether the verb from which the word drug
{tpapnaKou) is derived, meant originally "to give drugs or poisons" or "to drive
away evil spirits with blows" is a matter of dispute.- But it seems probable
that the original pharmacologist was eyed with suspicion.

Primitive man's knowledge of medicinal simples was exactly
like the drug phase of our modern therapeutics,— extensive, if not
intensive, — and where he made mistakes it was (as in our own case)
due to the cause which Kant assigns for all human error — the in-
veteracy of the post hoc, propter hoc tendency in the human mind.
Like many physicians today, he tried to treat the disease rather
than the patient, not realizing (as we are just beginning to realize)
that the dynamic effect of a drug upon the patient's body depends
as much upon the delicate chemical adjustments of that body as
upon the composition of the drug itself. Whenever many differ-
ent remedies are proposed for a disease, it usually means that we

1 W. I. Thomas: Sex and Society, Chicago, 1907, 16;5"167.

''See Morley Roberts: The Pharmakos, Folk-Lore, London, 1916, xxvii,
218-224.

24 HISTOKY OK Ml'.DK'IM'.

know \»'i\v liillf .-ilxml trc.-iliii!:; the disrasc, and the .same thinji; is
true of a dnij: which is vaunted as a panacea or cure-all for many
(lisoasrs. "Im listening: to the jxaises of these panaceas," said
IVter Ki-uk(>iil)erm. lh(> old 1 lallc clinician. " we seem to be actually
sfandin;; hcforc the hoolh of a niount(>l)ank."' We are not much
l)Otter olY than caily man in this I'espect. Thus, th(> hieratic writ-
ings of th(> I'lgyptian papyri rev(>al an mmsually extensive materia
medica. the excellence* of which is vouched for in the Homeric
poems, and which can today be duplicated, in extent at least, in
tlie materia mc^lica of old civilizations like China or Japan, or even
in our own bulky pharmacopeias. AJjeband Macht have shown
that the ancient l';uroi)ean belief in the venomous nature of the
toad and the power of its dried skin to cure dropsy is explained by
the two alkaloids, bufap;in and epinephrin, which they isolated
from the tropical liufo agua. Bufagin (C18H24O4) has a marked
diuretic action.'- We find that savages in widel}^ separated coun-
tries easily get to know the most fatal arrow-poisons — curare,
ouabain, veratrin, boundou — as well as the virtues of drugs, like
opium, hashish, hemp, cocoa, cinchona, eucalyptus, sarsaparilla,
acacia. kous.so, copaiba, guaiac, jalap, podophyllin, or quassia.
W. K. SafTord has shown that the various narcotic snuffs used by
the Indians of the A\est Indies and South America are all products
of Piptadenia peregrina.^ Not to go further than our own country,
we find the North American Indians aware that arbutus is ''good"
for rheumatism; lobeha for coughs and colds; wild sage tea, golden-
seal, flowering dogwood, and prickly ash berries for fevers; elder,
wild cherry, antl sumac for colds and quinsies; wdld ginger, ginseng,
and euphorbia for digestive disorders; inhalations of pennyroyal
for headache; sa.ssafras or violet leaves for wounds and felons;
and the roots of sassafras and sarsaparilla for "coohng and puri-
fying the blood." In 1535-36, the Iroquois around Quebec, as
Jacques Cartier relates, treated scurvy in his crew vcr\^ successfully
with an infusion of the bark and leaves of the hemlock spruce;
and the French at Onondaga in 1657 found the sassafras leaves
recommended by the same tribe, "marvellous" for closing wounds
of all kinds.^ The "Materia Medica Americana" (1780) of the
old Anspach-Bayreuth surgeon Schoepf, who came over with the

' Cited by Baas.

^Abel and Macht: J. Pharm. and Exper. Therap., Baltimore, 1911-12,
iii, 319-377.

^Safford: Jour. Wash. Acad. Sc, 1916, vi, 547-562.

*See Yager: "Medicine in the Forest," Oneonta, X. Y., 1910. Yager
notes the infrequencj' of panaceas and gunshot prescriptions among the North
Arnerican Indians; each remedy was administered by itself for a given con-
dition. For the theory and formulse of Cherokee medicine, see J. Mooney
Bur. Am. Ethnol. Rep., Wash., 1891, vii, 319-369.

IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 25

Hessian troops during the war of the Revohition, shows that the
Anglo-Saxon settlers in the New World had already learned many
wrinkles in herb-therapy from the red men, in addition to the very
rich medical folk-lore which they undoubtedly brought with them
-from Old England. The plant-lore of rural England included a
knowledge of the virtues of camomile-, sage-, and dandelion-tc^as
as laxatives; of marjoram and primrose root for headache; of
wormwood as a tonic; of valerian for the "nerves"; of agrimony
and parsley for jaundice; of meadow-saffron (colchicum) for gout;
of fennel, eye-bright (euphrasy), and rue for bad eye-sight; of
male fern antl j:)each-leaves for worms; of tansy as a vermifuge and
abortifacient; of horehound, marshmallow or candied elecampane
for coughs and colds'; of foxglove as "the opium of the heart";
and of such "vulnerary plants" as bryony, agrimony, hare's ears,
moonwort, alehoof, and goldenrod. English poetry and folk-lore
arc full of references to thyme and marjoram, rosemary and rue,
mistletoe and ash, as well as poisons like hemlock, leopard's bane
(aconite), the deadly nightshade (belladonna), "the juice of cursed
hebenon" (yew), and henbane (hyoscyamus), which Aretaeus re-
garded as a cause of insanity and to which Shakespeare refers in
the same spirit as

. . the insane root
That takes the reason prisoner.

Asphodel, or dittany, is often mentioned in the Homeric poems as
a balm against the pain of newly inflicted wounds, and the same
tradition is still current among the country folk of Lancashire,
Ireland, and the moors of Scotland. Kipling has summed up the
whole matter in a charming verse —

Alexanders and Marigold,

Eyebright, Orris and Elecampane,
Basil, Rocket, Valerian, Rue,

(Almost singing themselves they run),
Vervain, Dittany, Call-me-to-you —

Cowslip, Melilot, Rose of the Sun.
Anything green that grew out of the mould
Was an excellent herb to our fathers of old.

In the use of natural or physical means against disease we dis-
cover that primitive man, with his well-ventilated habitations and
his hardy life in the open air, has advantages which his civilized
brother often seeks or finds only on compulsion. The Indian^
knew, for example, the importance of keeping the skin, bowels, and
kidneys open, and, to this end, the geyser, the warm spring, and

* For a full account of the medicine of the twentieth century Indian, see
A. Hrdlicka, Bur. Am. Ethnol., Bull. No. 34, 1908, 220-253.

'2i\ HISTOHV oi' Mi:ni(I.\K

llic s\vt';it-o\«'n writ' Ins ii:il iiral siilisl it iilcs loi' ;i Tiiikisli bath.
J'jursis or cjitliarsis. folldwcd liy a \api)i- Watli and a toM |)lnn^(%
set olT l)V a tiosr (tf willow -liaik (iccociidii (saliciii), was the Xorlh
Aincricaii Indian's succi'sst'iil tlicrapcutic schcnic in the case of
intcrniittiMit and rcniiltcnt t'cvcis: a xapoi- i)atli and ciniicifujia
wore his mainstays ajjainst rheuniatisni. J>iko the ancient J5al)y-
lonians. ho had his fixed periods tor ritual emesis and catharsis
{€. (J., the jireen-corn feast), much as our forefathers used zodiacal
cal(>ndars for l)lood-lettin{]j. Massa{:;e was long known and jirac-
tist^l l)v th(^ Indians, .lapanese, Malays, and I''ast Indians. In the
opinion of Rivers.' massajio was imjiorted into Melanesia by Poly-
nesian castaways, since Polynesian massage is apparently a true
rational therapeutic measure, while Melanesiaii massage is some-
thinc supi'rimposed upon a magic rite. Hypnotism originated
among the Hindus; inoculation against smallpox among the
Hindus, Persians, and Chinese. Lady Mary Wortle}' Montagu
got her idea of variolation from the East, and it is still employed
among the North and Central African tribes and races (Arnold
Klebs).- The early Japanese employed the moxa as the Chinese
did acupunctm-e. The Chinese of the Mongol dynasty (1260)^
proliably learned of the u.se of spectacles from India via Turkestan.
Snow-spectacles have been employed by polar tribes.

Surgery became a science in recent times, not so much through
individual skill or specialization of instruments, as through the
introduction of two new factors — anesthesia and antisepsis. Prim-
itive surgery included all the rudiments of the art. The earliest
surgical instrument was in all prol)ability not the specialized leaf-
shaped flint or "celt," already referred to, but rather some frag-
ment unusually sharpened as to edge and poirit by accidental
flaking.^ as in the obsidian knives of Peru. By means of these
sharpened flints or of fishes' teeth, blood was let, abscesses emptied,
tissues scarified, skulls trephined, and, at a later period, ritual
operations like circumcision were performed, as we have seen, with
the primitive celts themselves. Trephining for epilepsy or other
cerebral disorders goes back to prehistoric times, the finds showing
that it was often done more than once upon the same person, the
bits of skull excised being used as amulets. It is said that tre-
phining is still practised among the Aymaras of Bolivia and the

' W. 11. II. Rivers: Massage in Melaiie.sia: Tr. xvii. Internat. Cong
Med., 1913, London, 1914, Sect, xxiii, 39-42.

= Klebs: Johns Hopkins Hosp. Bull., Baltimore, 1913, xxiv, 70.

' B. Laufer: Mitt. z. Gesch. d. Med., Leipzig, 1907, vi, 379-385.

■• The writer is indebted to Prof. William H. Holmes for this important
information.

IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 27

Quichuas of Peru,' and another evidence of it is the curious cross-
wise nuitilation along the hues of the coronal and sagittal sutures,
first noticed as a common practice among the Loyalty Islanders by
an English missionary, Rev. Samuel Ella, in 1874,- and which
Manouvi'icr found afterward in neolithic female crania from Scine-
et-Oise and called the "sincipital T" (1895). '^ Primitive man's
wounds were dressed with moss or fresh leaves, ashes or natural
balsams, and, when poisoned, treated by sucking or cauterization.
Cupping was performed by means of animals' horns. The revulsive
effects of some accidental wound or hemorrhage, or the natural
and periodic process of menstruation, suggested, no doubt, the
advantages of blood-letting, which was to become a sort of thera-
peutic sheet-anchor through the ages. For couching a cataract or
opening an abscess, even a sharp thorn sufficed. The Dayaks
of Borneo enijiloy a sharp root (pinjampo). In the more advanced
phases of cultural development, pieces of hard wood may have
been pointed and edged, like the flint knives. During the Bronze
and Iron Ages expert skill in metal work became accomplished
fact, and surgical instrumentation was correspondingly improved.
In the excavations of the Swiss Lake Dwellings, which were dis-
covered in 1853,* the different cultural objects were found in suc-
cessive layers, from the Stone Age up to the Bronze and Iron Ages,
and of these, the real beginnings of northern European culture are
now held to be the iron implements and objects found at La Tene.
The phrase "La Tene" symbohzes, for anthropologists, the start-
ing-point of the cultural periods following upon the three Ice Ages,
with their two interglacial periods, not because the Lake Dwelling
finds are necessarily the earliest iron objects known, but because
they are the most representative and characteristic. La Tene
was preceded by the Eolithic, Paleolithic, Neolithic, Bronze, and
Earlier Iron (Halstatt) Ages. The La Tene finds, dating from
about 500 B. C. to Roman times, entirely distinct from Egyptian,

^ A. Bandelier: Ueber Trepanicren unter den heutigen Indianern Bolivias
(Internat. Cong. Americanists, 1894). S. J. Mozans (Rev. J. A. Zahm), in his
"Along the Andes and Down the Amazon" (New York, 1911), pp. 206, 207,
is of opinion that the leaves of Erythroxylon coca, when chewed, have anesthetic
properties, of which he gives a remarkable instance. This would explain how
easily the Peruvians may have accomplished trephining with the aid of a sharp
piece of flint or obsidian.

2 Ella: Med. Times & Gazi, London, 1874, i, r^O.

' L. Manouvrier: Rev. mens, de I'Ecole d'anthrop. tie Paris, 1890, vi, HI;
1903, xiii, 431. Manouvrier thinks the sincipital T may have been identical
with the crucial cauterizations of the skull recommended by Avicenna and
others, if not a ritual mutilation. Gron regards it as a mode of judicial torture.
Sudhoff identifies it with a derivative procedure employed by the Alexandrian
surgeons for ocular catarrhs and mentioned by Celsus (vii, cap. xii, sect. 1.5).

* First investigated by Ferdinand Keller in 1853—4.

2S HISTORY OF MKDICINK

Iiuliaii Di- ( iirck culluii'. iiulutlc iidii kiii\<'s, needles, fil)ula\ swords
and lances, with bracelets, necklaces. ;iii(l ear-iin^s of J']truscaii
or West ("eliic pattern, .•iiid iiuieral inns conlaininfj; human re-
mains, showing! that cremati(»n was the rul(> anionji; the La Tene
people. Some time lal(M-. as, for exam!)le, amonji the Gallo-
Homaii liiids in France, we trace (he evolution of the jointed or
arliouhitod surjiical instruments, like scissors, in which cutting was
done l>y indinvt rtction.' With improved metal instruments, such
cosmetic operations as tattooing, infihulation, boring holes for
e;ir-rings and nose-rings, or the Mica operation (external urethrot-
omy), as well as amj)Utation and litlujtomy, could be essayed.
The ancient Himhis performed almost every major operation ex-
*cept ligation of the arteries; ovariotomy has been done by Indian
and Australian natives, and IVlkin witnessed a native Cesarean
section in Iganda in 1S7S. I^oth opeiations are said to have been
performed by Cierman sowgelders in the sixte(Mith century.

The use of a soporific i)otion as a substitute for anesthesia goes
back to remote antiquit}^ as symbolized in the twenty-first verse
of the second chapter of Genesis: "And the Lord God caused a
deep .sleep to fall upon Adam, and he slept: and he took one of his
ril)s, and closed up the flesh instead thereof." From the soothing
Egyptian nepenthe of the Odj'ssey, which Helen casts into the
wine for Ulysses, to the "samme de sliinta" of the Talmud, the
"bhang" of the Arabian Nights, or the "drowsy sjTups" of Shakes-
peare's time, the soporific virtues of opium, Indian hemp {Cannabis
i}}dica), the mandrake (Atropa tnandragora), henbane (Hyoscy-
amus), dewtry (Datura stramonium), hemlock (Conium), and lettuce
(Lactucarium) appear to have been well known to the Orientals
and the Greeks;- and, in the thirteenth and fourteenth centuries,

' See M. Baiiflouin: Ardi. prov. do cliir., Paris, 1910, xix, 228-238.

- Poppj' and Indian iicini) were probably known to the Egyptians and
con.sequently to the Greek.s; mandragora to the Egj^ptians, Babylonians, and
Hebrews. Theophrastus and Dioscorides were the first to mention the
aphrodisiac and soporific properties of Atropa mandragora. It is not clear
whether the mandrakes which Rachel sought of Leah (Genesis xxx, 14-16)
were for the former purpose or to ease the pangs of childbirth. Dioscorides
was the first to speak of the employment of mandragora wine for surgical
anesthesia, and his recipe was tried out with success by Sir Benjamin Ward
Richardson (Brit, and For. Med.-Chir. Rev., Lond., 1874, liii). The mandrake
is also mentioned by Celsus, Pliny, Apuleius, Paul of .Egina, and Avicenna,
and the legends about the human shape of the root of the plant, its frightful
shrieks when uprooted, and the necessity of employing a dog. hitched to it for
this purpose, are a common feature of early English and German folk-lore.
Drugging with Indian hemp or henbane ("tabannuj ") was common among the
ancient Hindus and the later Arabs, and Sir Richard Burton adds: "These
have been used in surgery throughout the East for centuries before ether and
chloroform became the fa.shion in the civilized West." (Arabian Nights,
Denver edition, vol. iv, footnote to p. 71.) Hua, a Chinese physician, is said
to^have used hashish in surgery about 200 B. C. According to S. J. Alozans

IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 29

a mixture of some of these ingredients (''oleum de lateribus") was
formally recommended for surgical anesthesia by the mecheval
masters, Nicolaus Salernitanus, Copho, Hugh of Lucca and his
son Theodoric, in the form of a "spongia sonmifcra" or "confectio
soporis" for inhalation. Again, the use of such natural anti-
septics as extreme dryness, smoke (creosote), honey, nitre, and
wine was long known to early man. In seeking an "artificial
paradise" by means of narcotics and intoxicants like alcohol,
opium, hashish, or mescal, priority certainly belongs to primitive
man, to whom we also owe such private luxuries as tea, coffee,
cocoa, and tobacco. Medicine is curiously indebted to the non-
medical man for many of its innovations. As Oliver Wendell
Holmes has said:

It learned from a monk how to use antimony, from a Jesuit how to cure
agues, from a friar how to cut for stone, from a soldier how to treat gout, from
a sailor how to keep off scurvy, from a postmaster how to sound the Eustachian
tube, from a dairy-maid how to prevent smallpox, and from an old market-
woman how to catch the itch-insect. It borrowed acupuncture and the moxa
from the Japanese heathen, and was taught the use of lobelia by the American
savage.^

In the field of obstetrics, we find the midwife to be one of the
most ancient of professional figures. Engelmann's careful ethnic
studies of posture in labor show the universal tendency of primi-
tive and frontier women to assume attitudes^ best adapted to aid
or hasten delivery. The obstetric chair, first mentioned in the
Bible and by the Greek writers, appears to be of great antiquity,
and is still used by some races of the far East.

We now come to a phase of primitive healing which is inti-
mately connected with even the most recent aspects of the sub-
ject, namely, the effect of therapeutic superstitions and the actual
cure of disease through the influence of the mind upon the body.
This is a matter which can be approached in no derisive spirit,
especialh^ in the light of modern quackery and its successes. The
closer we look into the ways of primitive man, the more liable it is
to take down our own conceit. The untutored savage, as we have

("Along the Andes and Down the Amazon," New York, 1911, pp. 206, 207),
the ancient Peruvian Incas probably utilized the anesthetic properties of the
active principle of Erythroxylon coca in trephining. He cites a modern in-
stance of a coquero (habitual chewer of coca leaves) who was run over by a
car and experienced no apparent pain, although his foot had been taken off
in the accident.

1 O. W. Holmes: Medical Essays, Boston, 1883, 289. For a more exten-
sive presentation of this interesting subject, see George M. Gould's essay on
"Medical Discoveries by the Non-Medical," in Jour. Amer. Med. Assoc,
Chicago, 1903, xl, 1477-1487.

2 George J. Engelmann: "Labor Among Primitive Peoples," St. Louis,
J. H. Chambers & Co., 1882.

:>() llI>l•^lH^ oi' \ii;i)i<i\K

soon. llioMiiliI tliat iii<»l ion <>t ;in\' kind is ('(|iii\nlciit to lite. WlKM'ciii
doos lie tlilTcr troni llic nil iM-nicdinnist ic physiolo^isl who I'c-
voi'sos tho ociuatioM? Siniplx in this, that th(^ mind of the savage
is. as l^lack says.' like a lookitii!;-;;iass. rcfh'ct inj; ov(M-vlhin<2; and
rcMainini; nothing. As soon as an ()l)j(>ct passed Iroin his ol)S('i'va-
lion its imago disap|)oarod from his miMilal vi.sion and he ccascMl
to hng tlir f.Mct ot' its existence, still less to i-eason ;il)oiil it. Tho
primitive mind is. as KowJand scornfully said of "tho ordinary
ciiltival(>d or legal mind," essentially "discontinuous." ^Pho scien-
tific mind at least aims, in its nuMhods, at continuity of thought.
Tho folk-mind, oven today, has this inoyitablo tondency to mix up
the post hoc with the projihr hoc and to confuse accidonlals with
essentials. .Mmost any one who has li$Ml in the country, for in-
stance, will $v familiar with various rural superstitions relating to
warts — that killing or handling a toad may cause them and that
they can ho removed by some one touching them with pebbles or
muttering diarms over them ; or with the notion that stump-water
is good for freckles, while bad eye-sight can be remedied by the
water into which tho blacksmith has dipped his I'od-hot iron.
In some parts of fiolland, if a i)oy carrying water-lilies in his hand
falls down, it is suppo.sed to render him liable to fits. Readers of
Longfellow's "Evangeline" may recall the line which refers to
malaria as

Cured bj' wearing a spider hung around one's neck in a nutshell.

In Norfolk, England, this spider was tied up in a piece of muslin
and pinned over the mantelpiece as a remedy for whooping-cough.
In Donegal, a beetle in a bottle was regarded as a cure for the latter
disease; in Suffolk, to dip the child, head downward, in a hole dug
in a meadow: in northeast Lincolnshire, fried mice; in Yorkshire,
owl-broth; in other parts of England, riding the child on a bear;
in Scotland, anj'-thing that might be suggested by a man riding
upon a piebald horse.- Compare these fallacies, inept as they
seem, with w'hat has happened so often in the history of thera-
peutics. A patient's cure follows seemingly upon the administra-
tion of some new-fangled remedy or drug. Immediately, a causal
relation is established and the discoverer rushes into print with
the glad tidings. Statistics begin to mount up, until presently the
correlation curve is perceived to have so insignificant a slope that
nothing positive can be affirmed of the remedy whatever. It is

1 W. G. Black: Folk-Medicine, London, 1883, p. 207.
-Black: Op. cit., passim.

IDENTITY OF FORMS OF ANCIENT AND rUlMITIVE MEDICINE 31

then speedily consigned to the hml)o of forgotten things.^ Not so
with folk-remedies. The superstition becomes, as the derivation
implies, something standing over; and for a very important rea-
son, namely, that in some cases "Nature cures the disease while
the remed}- anuises the patient"; in others a cure is, in all proba-
1 )ility , brought about by the effect of the mind upon the body.

Black, the leading English authority on medical folk-lore, has
made a careful and exhaustive classification of the different super-
stitions to which average suffering humanity is liable.- These
include ideas as to the possible transference of disease, sympathetic
relationships, the possibility of new-birth or regeneration, the effects
of such accidental specific factors as color, number, solar and lunar
influences, magic writings, rings, precious stones, parts of the
lower animals, and charms connected with the names of the saints,
the lore of plants, the evil eye, birth, death, and the grave. To
look into these is to see clearly that "wonder is of the soul." As
the savage "sees God in clouds, or hears him in the wind," so his
ancestors saw disease not as a quality or condition of the patient,
but as something material and positive inside his body — a view
held even by Paracelsus. From this idea arose a notion that
disease could be transferred from one body to another, as where
Pliny, in his Natural History, claims that abdominal pain can be
transferred to a dog or a duck. Touching warts with pebbles,
healing snake-bite by clapping the bleeding entrails of a bisected
fowl to the wound (natural absorption), and the negro supersti-
tion of pegging a hank of the patient's hair into a tree in order to
transfer chills and fever to the tree or its owner, are well-known
forms of this curious belief. Sir Kenelm Digby proposed the fol-
lowing remedy for fever and ague: "Pare the patient's nails; put
the parings in a little bag, and hang the bag around the neck of a
live eel, and place him in a tub of water. The eel will die, the
patient will recover. "■'*

In medical mythology the doctrine of transference of disease derives from
the idea of purification (catharsis) or lustration. The scapegoat was usually a
god, or his substitute in the shape of a person, animal, or inanimate object,
upon which the sins of the people might be unloaded. Among the Aztecs, a
human being was annuall}' sacrificed in place of Vitzliputzli or other gods.

1 J. C. Bateson cites a recorded case of a Turkish upholsterer who, during
the delirium of typhus fever, drank from a pail of pickled cabbage and re-
covered, whereupon the Turkish doctors declared cabbage juice a specific for
the disease. The next patient dying imder this regime, however, they modi-
fied the dogma by saying that cabbage-juice is good for typhus provided the
patient be an upholsterer. Dietet. & Hyg. Gaz., N. Y., 1911, xxvii, pp. 297, 298.

- Op. cit., pp. 34-177.

'Cited by O. W. Holmes, "Medical Essays," Boston and New York,
1883, p. 381.

V2 lUsroUV OK MKDICINK

At the fo.stiviil of Xipt\ tlu* Flayoil CicmI, tho Mexicans killni all prisoners taken
in war. wlio were flayi-il Ix-fon-liaiul, llu- skins Ix'infi worn hy tliosc consf^criited
to this oult. In llie Ivonian Saturnalia, Saturn was personal <m1 hy a luan-
seapcgoat, who was afterward juit to ticatli. In the (ircek 'I'liarfidia, as we
liave si-en, tliere were two scapegoats iv"apA"i'">t)' Aneient sacrilice was
sometimes honorific (hoslia hoiiornria), a gift to tlie p.<n\; soinctiiiies eatliartic
or piaeular (hostia piiirularis), to coneiHatc^ tlie wrath of the good or evil pow-
ers, in which case human sacrilici> was usually (leiuan<ied; sometimes mystical
or sacramental, in whicli tlie god was conceived to be slain or eaten hy his
worshipers iHohertson Smith,). In hoiiorilic sacrilice, tlie god an<l his wor-
shipers shanxl the sacrilice a.s conunensals or totem-comi)anions, of the same
totem-kin, and the victim was .sometimes an animal representing a hostile
totem, sometimes one .sacred to tht^ god. In piacnilar sacrifice, a totem ani-
n\al or plant could he substituted for the human victim, and, in mystic .sacri-
fice, the g(Hl was represented by a similar animal f)r plant to partake of which
was to enter into conun union with him.-' \\ illi ifiis obsciu'c set of cults, widely
different in different peoples, is connect etl the consecration of sacrificial
plants or parts of sacrificial animals as therapeutic agencies.^ The Kathar-
mata or rejects of sacrifice, e.aten by the worshipers, were literally "made
sacn^l" b}' the rite. To this day the custom of "eating the god" persists in
the belief of Euioiiean peasants tliat mediciixal herbs are materialized benevo-
lent spirits. In nearly all European countries the plants culled at Midsum-
mer (.St. Jolm's) Eve acquired transient magical or medicinal virtues.*

Closely coiiiu'ctcd with this idea of transference was the old
trailition of a sympathy existing between parts of bodies separated
in space (Frazer's "sjaiipathetic magic"), amtisingly illustrated
in Sir Kenelm Digby's weapon-salve, which was applied to the
weapon instead of tho wound, and in the .same worthy's

Strange hermetic powder

That wounds nine miles point blank would solder,

liy skilful chemist with great cost

Extracted from a rotten post.

The idea of material regeneration or new-birth is of Hindu
(Aryan) origin and sprang from the primitive worship of the genera-
tive power of nature, the cult of the lingam and the yoni, the Hel-
lenized form of which is so strikingly set forth in the fourth book
of Lucretius. A cleft or hole in a rock or tree was regarded as
sjTiibolic of the sacred yoni, and children (even adults) afflicted
with scrofula, spinal deformit}^, or other infirmities, were supposed
to be freed from these bodily ills when passed through it. Traces
of the Saxon form of this superstition stn-vive in the "holed stone"
near Lanyon, Cornwall, through wdiicli scrofulous children were

1 Frazer: The Scapegoat (Golden Bough, pt. 6), London, 1913, 252: 275:
306. > r , ,

= X.W. Thomas: Encycl. Britannica, 11 ed., Cambridge, 1911, xxiii, 980-
984.

^ M. Hofier: Wald- und Baumkult (Munich, 1892); Die volksmedizinische
Organotherapie, Stuttgart, 1908; .Janus, Amst., 1912, xvii, 3; 76; 190.

* Frazer: Balder the Beautiful (Golden Bough, pt. 7), London, 1913, ii,
45-75.

IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 33

passed naked three times, in the "Deil's Needle"^ in the bed of the
Kiver Dee (Aberdeenshire) which was held to make barren women
fertile if they crept through it, and in the Crick Stone in Morva,
Cornwall, passage through which was esteemed a cui-c for any one
with a "crick in the back." It was White of Selborne''^ who de-
scribed the most recent form of this folk-belief in sympathetic
magic, which consists in passing a child afflicted with hernia
through a cleft in an ash-tree. In 1804, there was such a tree at
the edge of Shirley Heath, on the road to Birmingham,^ As late
as 1895-6, such trees were descril)cd as existing for this purpose in
Suffolk and Richmond Park,"* and there was once a similar tree in
Burlington County, New Jersey. The Scotch custom of passing
a consumptive child through a wreath of woodbine, the Enghsh
trait of crawling under a bramble bush for rheumatism, and the
"eye of the needle tree" on the island of Innisfallen, Killarney,
scjueezing through which insures long life and safe delivery to
women with child, are mentioned by Black as variants of this
superstition. Frazer regards the practice as a phase of sympa-
thetic magic, associated with the idea that the "external soul,"
the life of a person, is bound up with the life of a tree or plant.*

Color is a factor of great moment in folk-healing; in particular,
red, which the Chinese and New Zealanders regard as hateful to
evil spirits, and other peoples as a heat-producer. Red silken
bands, necklaces of coral beads, red pills and red fire, as well as
the red coral ring and bells with which the baby cuts its teeth, have
all had their superstitious associations, and the virtues of the
familiar red flannel cloth worn around the neck for sore throat and
whooping-cough were supposed to reside "not in the flannel but
in the red color."^ Finsen's red-light treatment, to prevent pitting
in smallpox, was once an ancient folk-belief, known to the Japanese,
and employed successfully by Gilbertus Anglicus, Bernard de
Gordon and by John of Gaddesden in the case of the son of Ed-
ward II. According to Valescus of Taranta, the rationale of the
red-light treatment was the ancient "doctrine of signatures," in
virtue of which a remedy was applied on account of some fancied

iSee "The Stone in Scottish Folk-Medicine," by Dr. David Rorie, in
the Caledonian Medical Journal, Glasgow, 1911, viii, pp. 410-415, giving an
interesting photograph of the "Deil's Needle."

= Gilbert WTiite: Natural History of Selborne, 1789, p. 202 (cited by
Black).

3 Gentleman's Mag., London, 1S04, 909. Cited by Frazer.

' Folk-Lore, London, 1896, vii, p. 303; 1898, ix, p. 330, with photos.

5 Frazer: Balder the Beautiful (Golden Bough, pt. 7) London. 1913, ii.
1.59-19.5.

" Black: Folk-Medicine, London, 1883, 111.
3

IIISTOUV (»K Mi;i)l(I\K

ic red cloth
to lower his

rcsriiil>l:m('(\ in sluipc or color, to the (lisc:l^^(^ 1
linn^iii.us around flic sniall|)(>.\ patient wore supposcc
temperature l)y (Ira winp; tlic red hlood outw.iid.

The idea that certain numerals can iu' sacred or tnali^nanl is of
Accadian (»riuin and connected witli Chaldean and Balndonian
astrolt^fiy. Of mystic numluMs, usually odd. three or a nuiltii)le
of three is the most pojiular for luck, j^ood or had; seven or one of
its luultiples for supernatural |)o\vers. Ilesiod (Works and Days,
765-828) says that the hrst. fourth an<i seventh days of the month
are "holy days." the(Mt:hth (4 4-4) and the ninth (8 X 3) "specially
pood for the works of man "; the t\velfth-(3 X 4) is better than the
eleventh: the hfth 'unkindly and terrible/' beeaase on a fifth,
"the Mrinnyes assisted at the birth of Ilorcus" ; the tenth is favor-
able for a boy to be Ixun. I he fourth for a p;irl; the ninth of the first
month " is a fjood day on which to i)eset or be born, both for a male
and a f(Mnale: it is never an wholly evil day." It was not for
nothiufi; that there were three Fates, three Furies, nine Muses,
twelve months and twelve signs of the zodiac, seven days to the
week, twelve hours around the clock, and so on. Three handfuls
of earth are always dropped on the coffin at burial. Palmists,
fortune-tellers, and others of their kind work assiduously (as their
signs read) "from nine to nine," and gamblers usually bet on odd
numbers. In Scotland and Portugal, the seventh son of a seventh
son is often regarded with horror or veneration, as one possessed
of second sight and other uncanny attributes. Such folk-remedies
as the West Sussex recipe for ague — "eat fasting seven sage leaves
for seven mornings fasting" — are common enough, Valescus de
Taranta arranged his huge therapeutic Philonium in seven books
out of a serious veneration for the solemn number seven. In
Chinese medicine, five is the sacred number. A reasonable aspect
of number-lore in medical literature is the Hippocratic doctrine of
crises and critical days^ {dies nefasti) w'hicli probably derived from
the teaching of Pythagoras, w^ho had assimilated it from the Chal-
dean folk-traditions. Here the folk-lore of numbers has a germ
of scientific truth in that there is a certain periodicity in some of
the phenomena of disease. The curves of rape, murder, and
general "running amok" (including wars) rise in hot weather.
That certain infectious diseases recur at definite periods gave rise
to the doctrine of the genius epidemicus or epidemic constitutions.
The known periodicitj' of epidemic diseases from year to year justi-
fied the old Chaldaic superstition of the "evil year" (malus anmis),
which, in the ^Middle Ages was associated with a certain serpiginous

* For a historical studv of the doctrine of critical days through the ages,
see Sudhoff: Wien. med. Wochenschr., 1902, lii, 210, 272, 321, 371.

IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 35

or })iilloiis eruption in man and animals (Mahon rnnlannum)}
Another superstition wliicli came from Chaklean astrology was
the belief that the heavenly bodies had an influence upon disease.
The sun, moon, stars, and planets were regarded as sentient, ani-
mated beings, exerting a profound influence upon human weal and
woe, and, late into the seventeenth century, European mankind
resorted to horoscopes (the " judicia astroruin") before attempting
any enterprise of moment, and in particular to determine the proper
time for blood-letting, emesis, and purgation. Moonshine was
supposed to be potent alike in causing lunacy, conferring beauty,
or curing warts and diseases.- Health, strength and sexual power
were supposed to vary with the waxing and waning of the moon.
Menstruation was connected with the lunar cycles. The full-
moon was a libido symbol ( White). ^ To let blood when the moon
and tides were at full {dies .Egyptiaci) was adjudged bad practice
in the Middle Ages. The lunar influence is further seen in the
common superstition that death occurs, as in the case of Shakes-
peare's Falstaff or of Barkis in "David Copperfield," at the turn-
ing of the tide. Darwin thought that the tidal periodicity of
physiological phenomena in vertebrates might be explained by their
descent from "an animal allied to the existing tidal ascidians."'*
Arrhenius, in his study of the influences of cosmic phenomena upon
the organism, has compared the curves of nativit,y, mortality,
menstruation and epileptic attacks with the periodic maxima and
minima of the electrical condition of the air.^ Comparable with
the influence attributed to the stars is the idea, already mentioned,
that disease is a scourge or punishment inflicted by gods or demons
alike and remediable only through divine or diabolic intervention.
The mischievous powers, whose ideas of good and evil were ap-
parently so interchangeable, could be propitiated or conciliated
only by sacrifice, which, as Jakob Grimm pointed out, had the
double purpose (like the graft given to politicians) of keeping the
powers in a good humor or of restoring good humor when neces-
sary. "To coerce the spiritual powers, or to square them and get
them on our side," says William James, "was, during enormous
tracts of time, the one great object in our dealings with the natural
world. "^ The Greek myth of the arrows of far-darting Apollo,
Bhowani, the cholera goddess of the Hindus, the many medical

1 Hoefler: Janus, Amst., 1909, xiv, 512-526.

2 Frazer: Adonis (Golden Bcjiigh, pt. iv), London, 1914, ii, 140-150.

3 W. A. White: Psychoanalyt. Rev., N. Y., 1913-14, i, 241-256.
^ Darwin: Descent of Man, London, 1871, i, 212, footnote.

5 Arrhenius: Skandin. Arch. f. Physiol., Leipzig, 1898, i, 367-416.
« W. James: Gifford Lectures, New York, 1902. Cited by Osborn.

'M\ HisToin oi' \ii:i)i(i\K

divinities of tin* Koiiians, the Indian and SaniovcMl lore of "inasic
bullets"' (a niiif if in "' Der T'lciscliiilz' ' ), the i)assafj;(' in the Book of
•lol) in wliicli the pal riareli attributes liis sulTerinjis to ''the arrows
of the AIniiuhty," Martin Lulhei's (•oiuict ion that "pestilence,
fever and other severe diseases are nau^ld else than the devil's
work." Cotton Mather's definition of sickness as "Flapelhun Dei
pro i)eciatis nnmdi," th(> medieval figurations of death as a reaper,
(the "Schnitter Tod '■ of (l(>rnian folk-sonp;), the folk-sui)(M-stition
that erysipelas (or "wild (ire") orifj;inates from fairy malice, all
illustrate the si rentriii of this (le(>p-root(>(l belief, which survived
in the many sermons and prayers delivc^-ed in time of pestilence
throughout the seventeenth and eighteenth centuries and even
erops up in our day imder various guises. Of a piece with this
theory of disease was the malignant or benignant power which
was supposed to attach to certain personalities. A child born on
Easter Eve could cure tertian or quartan fever. Persons born
"with a caul" were supposed to be clairvoyant. The power to
heal scrofula l)y royal touch was part and parcel of the divine right
of kings. In the West of Ireland, the blood of the Walshes,
Keoghs, and Cahills is held to be an infallible remedy for erysipelas
or toothache.^ The medical lore of hoi}' men, their special days,
the diseases they presided over and the holy wells and other things
blessed l)y them, form a special field in itself. The saints were
supposed, as usual, to have the power both of inflicting and healing
diseases, most of which were, however, associated with the names
of several saints. Thus the names of St. Guy, St. Vitus, and St.
With are ejionymic for chorea; St. Avertin, St. John, and St. Valen-
tine stood sponsors for epilepsy, St. Hubert of Ardennes, the patron
of huntsmen, cared for hydrophobia, while St. Anthony, St. Bene-
dict, St. Martial, and St. Genevieve presided over ergotism.
Kerler- has compiled a l)ulky volume made up of indices of these
patron saints of medicine alone. Sacred bits of pastry (Heil-
brote), derived, as Hofler shows, from the ancient sacrificial cakes,
were dedicated to these saints and eaten to ward off the particular
diseases.^

A remarkable example of belief in the malevolence of person-
ality is the superstition of the evil eye which causes Orientals to
wear a crescent of horns over the forehead as a safeguard, and
Levantines to cross their fingers or protrude the thumb between
the index and middle finger (manofica).

' Black: "Folk-Lore," London, 188.3, p. 140.

= D. H. Kerler: "Die Patronate der Heiligen," Ulm, 1905.

' M. Hofler: Janus, Amst., 1902, vii, 189; 23.3; 301.

IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 37

This belief, as Seligmann has shown, has existed from the earliest times
and is common to all human races. Mentioned in the Assyro-Babylonian
incantations, declared a capital crime in the tables of the Roman Decemvirs
(450 B. C), this power of inflicting evil has been ascribed variously to whole
races or religious sects, to dogs, wolves, and animals of the cat family, to rep-
tiles and mythical creatures, like the basilisk, to statues and inanimate objects,
to gods, demons, si)irits and all supernatural beings. In the Purana legend,
Siva destroys a whole town with one withering glance, as Wotan destroys
Hunding in "Die Walkiire." Lord Byron, Napoleon III, Queen Maria
Amelia of Portugal, the Popes Pius IX and Leo XIII and the composer
Offenbach were all feared for this hypnotic power. According to the Roman
writers, the evil eye was nystagmic, strabismic, dicoric or otherwise abnormal
or diseased. Ovid (Amores. viii, 15-16), attributes a double pupil to the
sorceress Dipea:

"Oculis quoque pupilla duplex
Fulminat, et geminum lumen in orbe manet,"

and says that eyes which gaze upon the diseased will suffer themselves —

"Dum spectant oculi laesos, laeduntvu- et ipsi."

Persius (ii, 34) attributes evil power to inflamed or reddened ey&s (urenies
oculi). ^

There is a strong human prejudice against disconcerting, in-
tensive, or forbidding appearances of the eye, as, indeed, for any
abnormity, whether it be the fascinatio of the ancient Romans,
the stral)ismic regard louche of the French writers, the jettatura of
the Corsican, the mal-occhio of the Itahan, the fihiiy glance of some
gypsies, the "steady, ambiguous look" which Arthur Symons
ascribes to Orientals, or the stony stare of the blue-eyed northern
races which a line of Tennyson's likens to the effect of the Gorgon's
head. We dislike a stare. The phrase, Sie fixieren mich, niein
Herr! has caused many a duel in Germany. We have a natural
aversion for a person having but one eye, because, as Charles
Dickens neatly said, "popular prejudice is in favor of two." Parti-
colored eyes or eyes each of a different color are nowise reassuring.
The blind are sometimes known to develop dubious tendencies
along sexual and other lines. It is easy to see from facts of this
kind how the notion of the "evil eye" came to be ingrained in the
beliefs of the Eastern and Levantine races, the Celts and the Afri-
can Negro, and, in some cases, not without reason.

An essential part of the theory of divine or personal influence
is the doctrine of amulets and talismans and, of course, th(> ap-
propriate charms and spells that go with them. The amulet
(from the Arabic "hamalet," a pendant) was an object usually
hung or worn about the patient's body as a safeguard against
disease or other misfortune. Amulets include a motlev array of

1 For an exhaustive study of this fascinating subject, see S. Seligmann,
Der bose BUck, 2 v., Berlin, 1910.

msrouY oi" Mi;i)i(iNi'.

on Ivistcr Sunday, and the ikons
dijiiiil.'iiics of the church. Tylor

straiim' and iiicorijiiuous olijccts. such ;is llic liils ol ci;iiiia excised
ill pr(>histt)ri<' trephininti, oljjccts of ncpluiic, Ki:,y|)(i;ui scarabs,
the jiri^ris of African sa\a.urs, ilic xnodoo fciislics of Ihiyli and
Louisiana, teeth from t he uiout lis of corpses, l)oiu's .-iiid ol licr parts
ui th(> lower animals, t he

I'iiilicr (if liiilli-str.-iiiLilril li.-iho,
Ditcli-iU'livcrcil I)}- a tlral)

of the \\'eird Sisters in Maclx'lh. riniis made of coffin-nails, widows'
weddintr-rinirs. I'iiiiis made fiom pennies collected hy l)efi;ji;ai"s at a
church |)orch and chanjicd for ;i silver {'oin from the ol'fei'tory,
"sacrament shillinfjjs" collect (m
and scapuhiries blessed by tlu
has shown that the brass objects on harness were originally Ro-
man amulets. Tn th(^ interestinji; exhibit of folk-medicine in the
Xatitjnal Museum at \\'ashinj;ton' a buckeye or horse-chestnut
{^■Esculus flavus), an Irish potato, a rabbit's foot, a leather strap
previously worn by a horse, and a carbon from an arc light are
shown as sovereign charms against rheumatism, and as Dr. Oliver
Wendell Holmes used to point out. in his (juizzical way, a belief
in the elHcacy of .some of these anti-rheumatics is by no means
confined to the European peasant and the negro. Other amulets
in the Washington exhibit are the patella of a sheep and a ring
made out of a coffin-nail (dug up out of a graveyard) for cramps
and epilep.sy, a peony root to be carried in the pocket against in-
sanity, and rare and precious stones for all and sundry diseases.

The folk-lore of stones is of great antiquity, and the oldest pre-
scription in existence, — that discovered in Egypt by W. Max
Miiller. — displayed in the Museum of Natural History in New
York, calls for the exhibition of a green stone as a fumigation
against hysteria. Dr. Robert Fletcher has shown- that ''scopel-
ism," the ancient Arabic custom of piling up stones in a field, either
to prevent its tillage or as a menace of death to the owner, is to be
found everywhere as a symbol of the hatred of Cain for Abel, of
the outlaw for the worker, of the barbarian for civilization. The
lore relating to mad-stones, snake-stones, eye-stones, and wart-
stones is considerable. Bezoars (enteroliths or other concretions
from the bodies of animals) were supposed to prevent melancholia
and all kinds of poisoning, including snake-bite. In England and
Scotland, holed stones (fairy mill-stones, pixy's grindstones) and

' Vi-sitors in Washington who are interested in folk-medicine and the
cultural a.spects of medical history will do well to see this unique collection,
which was prepared bj' Rcar-Admiral James M. Flint, Surgeon, U.S.N, (re-
tired).

-American Anthropologist, Washington, 1897, x, pp. 201-21.3.

IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 39

elf-bolts (flint arrow-hcads) were sometimes handsomely mounted
and woin al:)()ut the person for protection. Hildburgh's extensive
studies of Spanish amulets indicate a highly developed folk-cult
against the evil eye and other malevolent influences. L]very
horse, mule or donkey is belled, as also infants' toys, and horns;
claws, beads, and other objects are usually mounted in silver and
lielp out the quaint Spanish and gypsy scheme of personal orna-
mentation.^ Precious stones came to be esteemed, in the first
instance, no doubt, for their rarity, but equally for their supposed
potency against disease. From the engraved stones in the High-
Priest's breast-plate, representing the Twelve Tribes of Israel,
to the birth-stones and month-stones of our own day, there is a
continuity of belief in the power of these precious objects. Many
women dread to wear an opal; there is a supposed fatality about
pearls, and the diamond now, as of yore, will "preserve peace"
and "prevent storms" in a household. M. Josse, in Moliere's
"L'Amour Medecin," archly opines that nothing is so well calcu-
lated to restore a drooping young lady to health as "a handsome
set of diamonds, rubies or emeralds."

Talismans (from the Arabic "talasim") were amulets or other
charms that were carefully guarded but not necessarily worn about
the person. It is highly probable that the magical authority
attaching to the ownership of these precious objects gave them an
enlarged purchasing power and was thus the origin or (as in the
obolus given to Charon), at least, a symbol of money and wealth,
in the sense of stored up (potential) energy.- Talismans were
often written charms or "characts," such as the Hebrew phylac-
teries or verses from the Bible, Talmud, Koran, or Iliad. When
the Indians saw Catlin, the explorer, reading the New York Com-
mercial Advertiser, they thought it was "a medicine cloth for sore
eyes."^ In the category of spoken charms we must include all
prayers, incantations, conjurations and exorcisms used to drive
away disease, as well as mystic words like ABRACADABRA,
SICYCUMA, Erra Pater, Hax Pax Max, and the like.^ Thus
Cato the Censor, who hated Greek medicine, endeavored to treat
dislocations by repeating the following bit of gibberish: "Huat
hanat ista pista sista domiabo damnaustra et luxato." The charms
of the Byzantine period imposed a very heavy onus of responsi-
bility upon the several saints.

iW. L. Hildburgh: Folk-Lore, London, 1906, xvii, 454; 191.3, xxiv, 63;
1914, XXV, 206; 1916. xxvi, 404.

*M. Maviss: Compt. rend. Inst. fran^. d'anthrop., Paris, 1914, ii, 14-20.
A. Reinach: Ibid, 24-27.

» Black: Op. cit., p. 49. " Ibid., pp. 167, 168.

40 HISTORY OV MKOiriNE

In survcyiiiji {\\vsv dilTcrcut supcrstilioiis, (nic point liccoiucs of
esptH'ial inomcnt. It is highly iinpr()l);il)lo tlial any ol llic rcm-
rtlios miMitioiictl actually ciirmI disease. Imt tlicic is abundant evi-
dence of the iiiosl trust worthy kiml that there ha\'e heeii sick
ptM)p!«> who not well with the aid of nothiiiu; else. J low did they
get well? Short of accepting the existence of supernatural foices,
we can only fall hack upon such vagu(> explanations as "the heal-
ing power of natur(\" the tendency of nature to tln'ow off the
tnateriff! morhi or to bring unstahli^ cluMuical states to equilibrium,
the latter being th(^ most jilausible. But, in many cases of a
nervous nature or in neurotic individuals, there is indubitable
evidence of the effect of the mind upon the body, and in such cases
it is possible that a sensory impression may so influence the vaso-
motor centers or the internal secretions of the ductless glands as to
bring about definite chemical changes in the ])lood, glands, or other
tissues, which, in some cases, might constitute a " cure." We know
that the reverse is possible, for example, in such occurrences as the
whitening of the hair from intense grief or fear, or the production
of convulsions in a suckling infant whose mother has been exposed
to anger, fright, or other violent emotions Ix'fore nursing it. As
Loel) strongly puts it. "Since Pawlow and his pupils have succeeded
in causing the secretion of saliva in the dog l)y means of optic and
acoustic signals, it no longer seems strange to us that what the
philosoi)her terms an 'idea' is a process which can cause chemical
changes in the body."^ Billings compares the sensation o])tained
by placing the hand on a cold oljject in a dark room with the way
in which the blood "runs cold" when one realizes that this object
is a corpse.^ Crile's important studies of surgical shock show the
strong analogy existing between the phenomena produced by
shock, the extreme passion of fear, and the symptom-complex of
Graves' disease, particularly in regard to the pouring out of the
thyroid secretions and the destruction of the Puikinje cells in the
brain. W. B. Cannon shows that in fear, rage, or anger, the emo-
tions which prepare the animal for fight or flight, the digestive
and sexual functions are immediately inhibited, the adrenal secre-
tion is rapidly poured into the blood, mobilizing sugar from the
hepatic glycogen up to the point of glycosuria, counteracting the
effects of muscular fatigue, and hastening the coagulation time of
the blood, thus giving the organism wonderful capacity for offence,
defence, flight and repair of injured tissues. A man in a fighting
or frightened mood is a ductless gland phenomenon. The patho-
logical effect of ideas upon the sacral autonomic is seen in the

' J. Loeb: "The Mechanistic Conception of Life," Chicago, 1912, p. 62.
2 J. S. BiUings: Boston Med. & Surg. Jour., 1888, cxviii, p. 59.

IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 41

phenomena of sexual perversion.^ Extreme mental irritation or
depression can produce dyspepsia, jaundice, chlorosis, or general
decline; the outward manifestations of hysteria are innumerable;
and it is well known that it is bad for any person to go under a
surgical operation with the idea that he or she will not recover. A
number of cases are on record of persons mentally depressed but
not otherwise unwell who have realized the imminence of their
own death and predicted it with certainty. An impressive in-
stance was given from personal recollection by Dr. John S. Bill-
ings, in his Lowell Institute lectures on the history of medicine in
1887.2 An officer of unusually strong and active physique and in
the best of health had sustained a slight flesh wound at the battle
of Gettysburg. Becoming depressed in mind at the start, he de-
clared he would die, which he did on the fourth day. The post-
mortem showed that every oi'gan was healthy and normal and the
wound itself so trivial as to be a negligible factor. Crile's whole
philosophy of " anoci-association " in surgery turns upon these
mysterious mental influences, the combating of which constitutes
the essence of psychotherapy. People who have become dyspep-
tic, bilious, or melancholy from worry or hope deferred, green-sick
girls and women grown hysteric from disappointment in love,
usually brighten up on receipt of good news. Babinski's dismem-
berment of hysteria identifies its phenomena solely with those
capable of being produced in the hypnotic state. In treating the
different neuroses, Charcot was guided almost entirely by his favor-
ite maxim (from Coleridge) : "The best inspirer of hope is the best
physician," an aphorism which contains the germ of the Freud-
ian theory of psychoanalysis — to "minister to the mind diseased"
b}- removing the splinter of worry or misery from the brain, in order
to restore the patient to a cheerful state of mental equilibrium.
This fact has been utilized by all "nature healers" and faith-curists
with varying degrees of success, and it is the secret of all charla-
tans, from Apollonius of Tyana, Valentine Greatrakes, Caglios-
tro, "Spot" Ward, Joanna Stevens, Mesmer, James Graham, John
St. John Long, and the Zouave Jacob down to the days of Dowie-
ism and Eddy ism. It is also the secret of the influence of religion
upon mankind, and here the priest or pastor becomes, in the truest
sense, ein Arzt der Seek. In practical medicine, the principle now
has a definite footing as psychotherapy. Psychotherapy cannot
knit a fractured bone, antagonize the action of poisons, or heal a
specific infection, but in many bodily ills, especially of the nervous

1 W. B. Cannon: Bodily Changes in Pain, Hunger, Fear and Rage. New
York, 1915.

= J. S. Billings: Boston Med. & Surg. Jour., 1888, cxviii, p. o?.

\2 HISTOHY OF MKOICINK

syst(MM. its use is far more cHicicnt and i-csix'ctaMc lliaii I hat ol
many a drun which is claiincil to \>v a spciilic in an wniniaiiinaMc
niimlu'r of (hsordtM's.

In liiir. the l(\ssoii of the unity of piiniitive incMllcino, which is
only a corollary to tho ncncial proposition of the unity of folk-lore,
is that certain beliefs and supi-rsiitions have become infi;iained in
humanity through space and time, and can l)e eradicated only
thr<»ui:h the kimi of public enli^fhtonment which teaches that pre-
vention is better than cure. The tendency of humanity to seek
medical assistance in time of sickness or injury has been compared
with the emotional eliMuent in rc>lif!;ion, bgth l)ein}>; based upon "a
deep-lying instinct in hmnan nature that relief from suffering is an
obtainable goal."' As the supernal ural element in religion appeals
to humanity in its moinents of dependence and weakness, so for
the weary and heavy-laden, the down-trodden of the earth in the
past, medical superstitions were simph'a phase of what Stevenson
calls ''ancestral feelings."

Thus the history of medicine is also the historj'^ of human falli-
bility and error. The history of the advancement of medical
science, however, is the history of the discovery of a number of
important fundamental principles leading to new view's of disease,
to the invention of new instruments, procedures, and devices, and
to the formulation of pul)lic hygienic laws, all converging to the
great ideal of preventive or social medicine; and this was accom-
plished by the arduous labor of a few' devoted workers in science.
The development of science has never been continuous, nor even
progressive, but rather like that tangled, tortuous line w^hich Lau-
rence Sterne drew to represent the course of his whimsical narrative
of Tristram Shandy. Ideas of the greatest scientific moment have
been throttled at birth or veered into a blind alley through some
current theologic prepossessions, or deprived of their chance of
fruition through human indifference, narrow-mindedness, or other
accidental circumstances. It is no exaggeration to say that science
owes most to the shining individualism of a few chosen spirits.
Apart from this, "the success of a discovery depends upon the
time of its appearance."

Buckle maintained that ignorance and low-grade minds are the
cause of fanaticism and superstition, and, since his equation
is reversible, we may consider this proposition true if we apply it
to certain fanatical leaders of mankind, savage or civilized, who,
as "moulders of public opinion," have retarded human progress.
Chamfort said that there are centuries in which public opinion is
the most imbecile of all opinions, but this reproach cannot be en-

' B. M. Randolph: Washington Med. Ann., 1912, xi, p. 1.52.

IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 43

tirely saddled upon ''the complaininp; millions of men." History
teaches everywhere that permanent ignorance and superstition
are the results of the oppression of mankind by fanatical over-
men. In medicine, this is sometimes ludicrously true. "There is
notliing men will not do," says Holmes, "there is nothing they
have not done to recover their health and save their lives. They
have submitted to be half-drowned in water, and half-choked with
gases, to be buried up to their chins in earth, to be seared with hot
irons like galley-slaves, to be crimped with knives like codfish,
to have needles thrust into their flesh, and bonfires kindled on their
skin, to swallow all sorts of abominations, and to pay for all this,
as if to be singed and scalded were a costly privilege, as if blisters
were a blessing, and leeches a luxury. What more can be asked to
prove their honesty and sincerity?"^ Yet while the lack of public
enlightenment in certain periods produced the stationary or dis-
continuous mind, there are signs that the modern organized ad-
vancement of science may bring forth rich fruit for the medicine
of the future through the social cooperation of the mass of mankind
with the medical profession. As the ancient Greeks hung upon the
teachings of Empedocles and Hippocrates, as modern humanity
responded beautifully to the ideas of Jenner, Pasteur, and Lister,
so there has been at no time a greater interest in the advancement
of medicine and public health, as manifested in periodicals and
newspapers, than in our own. The awakening of the people to
looking after their own interests in regard to the organization and
administration of public hygiene is, no doubt, the hope of the pre-
ventive medicine of the distant future. Yet, even under the best
conditions, it is still possible and probable that many highly in-
telligent and highly educated persons will continue to hug their
whims and superstitions, consult quacks, and be otherwise amen-
able to psychotherapy, absent treatment and "action at a dis-
tance." "To folk-medicine," says Allbutt, "doubt is unknown;
it brings the peace of security."

1 O. W. Holmes: "Medical Essays," Boston, 1883, pp. 378, 379.

EGYPTIAN MEDICINE

^\'m•:TIlKH the huinaii race is doscoiulod from sovoral distinct
sp(>cics or from a single common ancestor, ''probably arboreal in
his habits." is lost in the dim and unattainable past. The dis-
coveries of the skekMal remains of human fossils at Neanderthal
(1856), Cro-Mafinon (1868), Spy (1887), krapina (1899), Heidel-
bert: (1907). Le Moustier (1908). La Chapelle-aux-Saints (1908),
and the recent Piltdown find (iM)anthropus Dawsoni, 1911) indi-
cate that, even in the paleolithic or chipped-flint period, there was
already considerable diversity in the cranial characters of mankind
;m(l that , in prehistoi'ic times, ihv human brain, developed at
the expense of a simian body, increases in volume as we go back-
ward, which would seem slightly in favor of the contention of
N'irchow and other (Jerman anthropologists that humanity is
diverse in origin. But whether the Pithecanthropus found at
Trinil River, Java, in 1891 be simian or human or, as its discoverer
Dubois claimed, a mixture of both, all craniologic evidence seems
to prove that prehistoric man was more closely akin to the higher
(anthropoid) apes in structure than they arc to the lower, a kinship
which is also borne out by the medico-legal or "precipitin" test
of blood-relationship. At the same time the gap between paleo-
lithic and neolithic man is much greater than that between the
people of the Later Stone Age and the civilizations of Egypt and
Mesopotamia. The prehistory of man began with the origins of
anthropoid life in the Oligoeene, the transformations of ape-men
into men in the Pleiocene, the extinction of the great mammals and
the dawn of the Old Stone Age Culture in the Pleistocene or Ice
Age (Osborn). There is no evidence of the existence of man before
the Ice Age, and whether flint implements were actually chipped
in the Eolithic period is not positively known; but the fact that
all subsequent remains are found embedded in successive layers of
strata points to a gradual and inevitable cultural development.

In the late Pleiocene or early Pleistocene (first interglacial stage) appeared
the Trinil raco ( Pithecanthropus); in the Middle Pleistocene (second intergla-
cial period), the Homo hcidclbergensis; in the late Pleistocene (third interglacial
period), the Piltdown and pre-Xeanderthaloid races; at the close of the glacial
period. Neanderthal man. With the disappearance of Neanderthal man came
the Cro-Magnon (Homo sapiens) with larger fore-brain and greater forethought.^

» H. F. Osborn: Men of the Old Stone Age, New York, 1916. Sir A.
Evans: Science, New York, 1916, n. s. xliv, 399-409.

EGYPTIAN MEDICINE 45

In the Mousterian period^ (tlie age of the Neanderthal skull),
man was probably more ape-like than the Australian savage; in
the Solutrian period, he was like the Bushmen and was already
skilful in chipping flints; in the Magdalcnian, he resembled the
Mongolians and the Esquimaux. The Solutrians and Magdalenians
were already mighty big-brained warriors and skilled artists, who
knew how to bridle horses, make specialized weapons, devise cloth-
ing, and execute most striking and life-like mural paintings and
line engravings on stone, bone, and ivory. That the Egyptian and
Sumerian civilizations were nearer to these people than had for-
merly been conceived is indicated by the results of modern cave
explorations and excavations. One of the most interesting facts
of recent development is that arthritis deformans or rheumatic
gout, a disease found in so many Egyptian mummies, is identical
with the "cave-gout" (Hohlcngicht) which Virchow found in bones
of prehistoric men and bears and which is also common in the skele-
tons of the inhabitants of the early German forests. The chipped
flint implements, of uncertain age, which are found near Fayum
and elsewhere, surpass all others in delicacy of form and flaking.
The fact that the neolithic chipped-flint knife was continually
used by the Egyptians in embalming the dead connects their al-
ready complex civilization with prehistoric man.

It is possible that many phases of Egyptian culture were spread,
even to the New World, by the mechanical process of convection.

Elliot Smith holds that between 2800 and 900 B. C. a curiously distinctive
cultui-e-complex was carried by trade and navigation from Egypt to the Medi-
terranean littoral, and after 900 B. C, by the Phoenician navigators to India;
thence to Malaysia, Indonesia, and Melanesia, ultimately reaching the shores
of the Americas, picking up, on the way, many modifications and additions
from the comi tries through which it passed. This so-called heliolithic culture
included sun-worship and its symbols; the l)uilding of megalithic monuments
and the rearing of gigantic stone images; the practice of mummification, or
embalming the dead, even among the North American Indians (H. C.
Yarrow), the practices of tattooing (Miss Buckland), piercing the ears (Park
Harrison), massage (W. H. R. Rivers), circumcision, etc.

This peculiar culture, the fantastic elements of which could never have
arisen si)ontaneously in so many distant localities, may have influenced the
early Minoan civilization of Crete after 2800 B. C. ; after 900 B. C, the Phoeni-
cian navigators may have been the middlemen, while the giant craft of Malay-
sia and Polynesia connected the maiidand of Asia with the Americas.-

1 The terms Acheulean, Mousterian, Solutrean, Magdalenian were intro-
duced by the French anthropologist Gabricd do Mortillet to indicate the suc-
cessive stages in the speciahzation of flint and other prehistoric implements
found at St. Acheul, Le Moustier, Solutre, and La Madeleine, to whi('h have
since been added the pre-Chellean (Mesvin), Chellean (Chelles-sur-Marne),
Aurignacian (Am-ignac), and Azihan (Mas d'Azil). They are now used in a
purely arbitrary way to indicate ci-anial and skeletal remains found in sites
corresponding, in order of geologic time, with these localities.

HI. EUiot Smith: The Migrations of Early Culture, Manchester, 1915.
Also, Bull. John Rylands Library, Manchester, 1916, iii, 48-77, 3 pi.

4(i HisroHY oi" Mi;mi INK

( )iir priiicipMl siuiri'cs of know Ictluc of 1 lie (•.•iilicst known jjIkiscs
of M^y|)li;in Miciliciiic :uv the l-ondon ( Wiczinski), Wcstcar (Lesser
Ht'Hiu). Hru^iscli (( ucMlcr l^ciimt. Illx'is ( Lcipzifi;), and Ihvirst
( I'hilailclpliiaV papyri, I'Ul cxtii anlcdalin^; (licse arc cortain pic-
tures (Miiira vet I oil the door-posts of a (oMiI) in the burial liround
near Menipliis and descrilu'd by their discoverer, W. Max Miiller.
as heinn the carhesi known i)ictiires of siirfj;ical operations (2r)()0
B. C.).' Althoiiirh we hav(> reasons for l)eHevins that the Kgyp-
tians ncNcr caiiic(| surgery to the extent of opening the body, yet
hero are clear ami unmistakable representations of circumcision
and jiossibly of sui'gery of tiie extiemit ies .tind n(M'k, tlie attitudes
and the hieroglyphic inscri|)t ions aflixed indicating that the pa-
tients are undergoing great pain. Apart from this, there is no
evitlence of surgcMy except in the splints found on the limbs of
mummies of all jjcriods. Egyptian anatomy and physiology were
of the most rudimentary character.

'I'he meilicine chest of an l"]gyptian (jueen of the eleventh
dynasty (2500 B. C.)^ containing vases, spoons, dried drugs and
roots is another imiwrtant find. There is also an inscription on a
tomlj near the pyramids of Sakarah which shows it to be the resting
place of a highly esteemed practitioner who served the fifth d^masty
of Pharaohs about 2700 B. C. I-em-hetep ("He who cometh in
peace") was a medical demigod, the .Esculapius of the Egyptians'^
of the third dynasty (4500 B. C.) who was afterward worshiped at
Menijihis and had a temple erected in his honor upon the island
of PhiUe. He was the earliest known physician. A papyric frag-
ment of the second centur}' A. D., recently published by the Egyp-
tian exploration fund, shows that he was worshiped even in the
time of Mycerinus.* A statue of the physician Iwte, of the nine-
teenth dynasty (1320-1180 B. C), is in the Imperial Museum at
Leyden.'

Besides the hierogh'phics, which were usually engraved or
painted on stone, like the picture-writing of American or Aus-
tralian savages, the Egj^ptian employed certain cursive scripts
(hieratic and demotic), usually inscribed upon thin sheets of the
papyrus plant. The oldest of these are the gynecological and
veterinarj^ scripts of the Petrie collection from Kahun (thirteenth

' \V. Max Miiller: Egyptological Researches, Washington, Carnegie Insti-
tution, 1900. See also J. J. Walsh: Jour. Am. Med. Assoc, Chicago, 1907,
xUx. pp. 1593-1595.

* For a picture of the same, see Jour. Am. Med. Assoc, 1905, xlv, 1932.

'KurtSethe: Imhotep, der Asklepios der Aegypter. Leipzig, 1902. Cited
by Sudhofif.

* Lancet, London, 1915, ii, 1204.

* A. P^onahn: Arch. f. Gesch. d. Med., Leipzig, 1908-9, ii, 375-378, pi. vi.

EGYPTIAN MEDICINE 47

dynasty). The most important of the medical papyri is that ob-
tained by Georg Ebers at Thebes in 1872, which dates back to
al)Out 1550 B. C. It consists of 110 pages of hieratic or cursive
script, the text in black letter, the rubrics in red. Ebers himself
supposed it to be one of the lost sacred or Hermetic Books of Thoth
(Hermes Trismegistus), the moon god, who, like Apollo in Greece,
was the special deity of medicine.^ This assumption has not stood
the test of time, and the Ebers Papyrus, with its marginal notes
and comments, is now regarded as a simple compilation.- It be-
gins with a number of incantations against disease and then
proceeds to list a large number of diseases in detail, with about 700
different remedies for the same. The most interesting parts are
the exteiisive sections on the eye and ear and the descriptions of
the AAA disease, the UHA disease and the Uhedu (painful swell-
ing), all three of which have been thought by Joachim to be identi-
cal with different stages of the hookworm infection (chlorosis
7Eg3'ptiaca).^ The large number of remedies and prescriptions
cited in the Papyrus points to a highly specialized therapeusis,
even in the sixteenth century B. C, but it cannot be claimed, as
many seem to contend, that these 700 odd remedies indicate any
special scientific advancement of the art of healing. We do not
find a few well-selected drugs, as opium, hellebore, hyoscyamus,
used, as the later Greek physicians employed them, with skill and
discrimination, but Egyptian therapy must have been, of neces-
sity, haphazard, because as we shall see, each Egyptian physician
was a narrow specialist, confining himself to one disease or to
diseases affecting one part of the body only. Many minerals and
vegetable simples are mentioned, from the salts of lead and copper
to squills, colchicum, gentian, castor oil and opium, and, as in
some pharmacopeias of even the seventeenth and eighteenth cen-
turies, these were compounded with such filthy ingredients as the

1 The first mention of Hermes Trismegistus was found by Karl Wessely in
a papn-us of the third centurv A. D. from Hermopohs (Mitt. a. d. Samml.
Erzii. Rainer, 1892, v, 133). Cited by Sudhoff.

"^ The hieratic writing of the Ebers Papyrus had first to be rendered into
hieroglyphics, l)y a method devised at the Orientalists' Congress in 1874, and
these were finally translated into German by Dr. H. Joachim of Berlin in 1890,
and into Enghsh by Carl H. von Klein. One of the first to attempt to decipher
the hieroglyphics on the Rosetta Stone (1799) was the Enghsh physician and
phvsicist, Thomas Young. The difficult task was finally accomplished bv
J. Y. ChampoUion (1818-28), and carried fm-ther by Richard Lepsius (1810-84)
Heinrich Brugsch (1827-94), who pubhshed a hieroglyphic demotic dictionary
(1867-82), Joseph Chabas (1817-82), Gaston Maspero and others.

' Joachim, PapjTos Ebers, Berlin, 1890. Edwin Pfister. however, thinks
that the aaa disease of the Ebers and Brugsch papyri was bilharziosis, since its
hieroglyph is a phallus. See Sudhoff's Arch., 1912-13, vi, pp. 12-20. Paul
Richter {Ibid., 1908-9, ii, 73-83) maintains that to the Egyptians "uhedu"
stood for a disease, while to moderns it only signifies a symptom (inflammation).

4S IIISI'OUV OK MKDU'INE

1>1o(m1. o\('i-('t;i, f;its and ^■is(•o^al iwi'ts of hifds, maininals and
rcptilt's. A favorite J'][iy|)tiaii |)oiiia(U' for haldnoss consisted of
('(lual parts of tlic fats of the lion, hippopotamus, crocodile, ^oose,
serpent ;ind ihox. Another consisteil sinii)ly of (Hjual i)arts of
writing; ink and (•ei-el)rospiiKil lluid. An oint tnent for the eye con-
sisted of a trituration of antimony in ^oose-fat. Another for con-
junctivitis employs a copper salt. A poultice for suppuration con-
sisted of equal parts of a meal of dates and wheat chaff, bicarbonate
of soda and seeds of endives. ,

llw most interesting i)art of the Ebers Papyrus is the last sec-
tion of all, which treats of tumors. ' II(Me, as in the description of
the AAA disease, we find some aj^proach to the accurate clinical
pictures of Hippocrates, and many have sui)posed, on this slender
evidence, that the Father of Medicine was indebted to Egypt for
much of his knowdedge. Some ethical precepts of the ancient
Egyptian physicians are very much like the Hippocratic Oath in
sentiment and expression, and this alone would point to the fact
that pre-Hippocratic medicine in (ireece had an origin closely con-
nected with l^gyptian medicine. There is, however, one marked
point of divergence, namely, that later Egyptian medicine was en-
tirely in the hands of priests, while Greek medicine, even at the
time of the Trojan War, would seem to be entirely free from
priestly domination, surgery in particular being often practised
by Homer's \varrior kings. Our principal authorities for the state
of Egyptian medicine during the fifth century B. C. are Herodotus
and Diodorus Siculus. From Herodotus we learn of the hygienic
customs of the Egyptians, the gods of their worship, their ideas
about medicine and their methods of embalming dead bodies.
"The art of medicine," saj's Herodotus, "is thus divided among

— them : Each physician applies himself to one disease only, and not
more. All places abound in physicians; some physicians are for
the eyes, others for the head, others for the teeth, others for the
intestines, and others for internal disorders."^ Medical practice
was rigidly prescribed by the Hermetic Books of Thoth, and if
a patient's death resulted from any deviation from this set line of

— treatment, it was regarded as a capital crime. Aristotle, writing
one century later, says, in his Politics, that physicians were al-
lowed to alter the treatment after the fourth day if the patient did
not improve.- The simple dress and frequent baths of the Egyp-
tians were what is suitable in a subtropical climate and not unlike
those of the Greeks. " They purge themselves every month, three
days in succession," says Herodotus, "seeking to preserve health
by emetics and clysters ; for they suppose that all diseases to which

1 Herodotus: ii, 84. * Aristotle: Politics, iii, 15.

EGYPTIAN MEDICINE , 49

nion are subject proceed from the food they use. And, indeed, in
other respects, the Egyptians, next to the Libyans, are the most
healthy people in the world, as I think, on account of the seasons,
because they are not liable to change."^ This view of the old his-
torian does not harmonize with the great frequency of rheumatoid
arthritis in the Egyptian mummies, which was probably due to
exposure to a moist climate during the inundations of the Nile.
The account of Egyptian embalming in Herodotus is, in the light
of all recent investigations, authentic and accurate^ and it shows
that the Egj'ptians already knew the antiseptic virtues of extreme
dryness and of certain chemicals, like nitre and common salt.
The brain \yas first drawn out through the nostrils by an iron hook
and the skull cleared of the rest by rinsing with drugs; the abdo-
men was then incised with a sharp flint knife, eviscerated, cleansed
with wine and aromatics, filled with myrrh, cassia and spices and
the wound sewed up. The bod}'^ was then steeped for seventy
days in sodium chloride or bicarbonate (natron) and afterward
washed and enveloped completely in linen bandages smeared to-
gether with gum. The relatives put it in a wooden coffin, shaped
like a man, which was deposited in the burial chamber along with
four Canopic jars containing the viscera. As with our North
American Indians, the departed spirit was furnished with food,
drink and other appointments and conveniences, and there was a
special ritual or Book of the Dead, which every Egyptian learned by
heart, as a sort of Baedeker to the other world. According to
Diodorus Siculus, the "paraschistes," who made the initial incision
with the flint knife, was held in such aversion that he was driven
away with curses, pelted with stones, and otherwise roughly handled,
if caught. On the other hand, the "taricheutes," who eviscer-
ated the body and prepared it for the tomb, was revered as belong-
ing to the priestly class. But this was probably only a per-
functory piece of ritualism. Sudhoff has recently published some
interesting plates^ representing the characteristic stone knives and
iron hooks used by the Egyptian embalmers, and Coinrie, in an
interesting paper in Sudhoff's Archiv,^ describes what are probably
the earliest known surgical instruments of the ancient Egyptians
(about 1500 B. C), consisting of three saber-shaped copper knives
with hooked or incurvated handles, found in a tomb near Thebes.
They are characteristic specimens of the Bronze Age. Elliot
Smith and Wood Jones have described the effects of splints of palm

' Herodotus: ii, 77. - Herodotus: ii, 86.

'Sudhoff: Arch. f. Gesch. d. Med., Leipz., 1911, v, pp. 161-171, 2 pi.
* Arch. f. Gesch. d. Med., Leipz., 1909, iii, pp. 269-272, 1 pi.
4

50 iiisrom OK mkdkmnio

filxM" (>mpl()y(>(l to iiuMid fi-;i('lur(^s, mihI \]\r r(>siilts of lic'iliiiti :vro
snrprisintily tiood, with little shortening;;.'

riif paleopathology of Kpypi was first invest i(>;iit((l liy P'oiKiurt in IKS').
In l',H)7, tlic l\^i\ piian fioxcrnnu iit insiituleil an arclicoiofiicai surscv of that
part of Nul>ia \\lii<'ii would lie s\ilis('([U(Milly lloodcii liy tlie raisinij; of tlic
Assuan dam. Tlie antliropoiofiica! and pathological i)hases of the in\'esli>!;atif)n
were entrusted to I'rofe.s.>^or G. Klliot Smith, with tiie ti.s.sistancc of F. Wood
Jones anil others.* The bulletins of tliis incjuiry, with line atlases of j^hites
eov(M"inj!; nnmnnics of all ])eriods. from the I're-Dynastic to the Hyzanliiic,
show that sy])hilis, caneei', and rickets wer(> md<nown, that riicumaloid
arthritis, e.ss(>ntially an en\ironm(>ntal and not a racial alTcction, was "par
ixctllcncc the hone disease of the ancient, l']fiyptiun and Xuhian," that the
teeth of the Pre-Dynastic people were uniformly good, as mi^ht he inferred
from the coarse, husky food found in the intestines, and that (lei)osifH of tartar
and caries, as also true Kout (yielding: uric acid icactions) became more com-
mon in the New l']mi)irc, when luxui'ious iiabits were formed. Thei-e was no
caries in the milk dentition of cliildren of the I're-Dynastic period, and when
caries did appear, it was follow(>d Ijy abscess formation spreading to the alveoli,
showhig that the P]gyptians had not the slightest rudiments of dentistry.
Evidenc(>s of mastoid disease, adhesions in ajjpendicitis, pleural adhesions,
fusion of the atlas to the occi])ut from s])ondylilis deformans, necrosis of hones,
cranial ulceration in females from carrying water-jars, and fatal sword-cuts
of the skidl were found. Of fractures, those in the cranium and forearm (at
a uniform site near the wrist) were most common, and probably caused by
fending l)lows aimed at the skull with the Naboot. Fractures of the femur were
more common than today, but no fractures of the patella were found, and few
below the knee-joint, the inmnmity ])rohal)ly resulting from locomotion with
bared feet and the absence of slipi)ery pavements and cm'bstones. Similarly,
the small number of fractures in the hand and wrist suggest freedom from vio-
lence by machinery.

Elliot Smith and RufTer, in a most int(>resting monograi)h, have described
a genuine case of Pott's di.sease in a mummy of tlu; twenty-first dynasty (circa
1000 B. C.).' Tlie histological examinations of Marc Armand Ruffer demon-
strated spondyhtis d(^formans, Bouchard's nodes, ague cake, biliary calculi,
calcification and atheroma of the arteries in various mummies, and an eruption
resemhhng variola in a mummy of the twentieth dynasty (1200-1100 B .C).^
Infantile paralysis is apparentlj^ represented in a stela of the eighteenth
dynasty in the CarLsberg Glyptothek at Copenhagen.* Many ancient Egyptian
statuettes in bronze or varnished earth, representing the gods Bes and Phtah,
are accurate figurations of achondroplasia (Charcot).^

1 Brit. Med. Jour., Lond., 1908, i, 732-737.
, * Egypt. Ministry of Finance. Survey DeparLmenl. The Archaeological
Survey of Nubia. Bulletins, Nos. 1-7, Cairo, 1907-11. Reports for 1907-8,
vol. II, on the human remains, by G. Elliot Smith and F. Wood Jones, with
Atlas, Cairo, 1910.

' G. Elliot Smith and M. A. Ruffer: "Pott'sche Krankheit an einer
agj'ptischen Mumie," Giessen, 1910.

^ RufTer: Histological stuflies on Egyptian Mummies, Cairo, 1911. Also,
Jour. Path, and Bact., London, 1910-11, xv, 1; 453, 4 pi.: 1911-12, xvi,
439, 9 pi.: 1913-14, xviii, 149, 6 pi.

* See O. Hamburger. Bull. Soc. fran^. d'hist. de med., Par., 1911, xi,
407-412.

« Charcot: Les difformes et les malades dans I'art. Paris, 1889, 12-26.
F. Ballod: Prolegomena zur Geschichte der zwerghaften Gotter in J<]gypten.
Munich dissertation (^Moscow, 1913j.

EGYPTIAN MEDICINE 51

The main interest of Egyptian medicine lies in its proximity and
relationsliip to Greek medicine. The references in Homer to the
skill of the Egyptian physicians in compounding drugs bring to
mind the fact that the word "chemistry" itself is derived from
chemi (the ''Black Land"), the ancient name of Egypt, whence
the science was called the "Black Art." Doubtless the ancient
(i reeks learned as much of medicine as of chemistry from these wise
elders across the sea, who told Solon that his people were "mere
ciiildren, talkative and vain, knowing nothing of the past"; who
were so skilled in metallurgy, dyeing, distillation, preparing leather,
making glass, soap, alloys and amalgams, and who, in Homer's
time, probably knew more anatomy and therapeutics than the
Hellenes. Yet, long before the Alexandrian period, Egyptian
civilization had become absolutely stationary in character, and,
in medicine, Egypt was going to school to Greece.^ As the Egyp-
tian gods — the dog or ibis-headed Thoth (the Egyptian Hermes),
the cat-headed Pacht, their deity of parturition, the beak-nosed
Horus, the horned Chnmn, the veiled Neith at Sais, remained for-
ever the same, while the Greek mythology was a continuous and
consistent evolution of deific figures of permanent beauty and
human interest, so Greek medicine was destined to go beyond.
Egyptian or Oriental medicine as surely as Greek poetry, sculpture
and architecture surpassed the efforts of these peoples in the same
kind.

1 See, for example, Sudhoff's studies of the Greek papyri of the Alexandrian
period (Studien z. Gesch. d. Med., Puschmann-Stiftung, Nos. 5, 6, Leipzig,
1909).

SUMERIAN AND ORIENTAL MEDICINE

I.\ THK hook of (liMK'sis wo road that Xiiiirod was "a mighty
luintor hoforo tlio Lord" and that "tho hofiinninfi; of hi.s kiiiji;doin
was Bal)ol and Kroch, and Accad and Cahioh in the land of Shinar."
Tho land of Shinar (Shunior or "Sumor") was the southern part
of Babylonia, ooni prising; the strip of country between the Vai-
phratos and tho Tigris down to tho Persian Gulf, and northern
Babylonia was called Aecad. The Babylonian sovereigns and
their Assyrian conquerors always styled themselves "kings of
Sumer and Accad." Before the advent of the Babylonians, it is
supposed that an original non-Semitic or Sumerian race existed,
about 4000-3000 B. C, who laid the foundations of modern civil-
ization by the invention of pictorial writing and the development
of astronomy. Others assume that the cursive script of the Su-
merians, \vhich, like Chinese writing, runs from right to left, was
in the first instance only a sort of cipher-code used by the dominant
Semitic race. In any case IMosopotamia was the starting-point of
Oriental civilization, of which the Babylonians were undoul)tedh'
the principal founders. They were skilled in matheniatics and
astronomy, originated the decimal system of notation, weights
and measures, made the divisions of time into tw^elve months in
the year, seven days in the week, sixty minutes and seconds in the
hour and minute respectively, and divided the circle, as w^e do, into
360 degrees. The}" invented the cuneiform inscriptions, reading
from left to right, they knew much about military tactics and the
art of war, and were variously skilled in music, architecture, pot-
tery, glass-blowing, weaving and carpet-making. Layard found
a planoconvex lens of rock-crystal in his explorations at Nineveh.

It is said that astronomj' is the oldest of the sciences, and in all
early civilizations we find it applied to the practical affairs of life
as astrolog}^ This trait is the essence of Sumerian or Accadian
medicine. Wars, epidemics, famines, successions of monarchs
and other affairs of public or private life, were closely studied in
relation to the prece.ssion of the equinoxes, eclipses, comets,
changes of the moon, and stars, and other meteorologic and as-
tronomic events, and from these fatalistic coincidences arose the
idea that certain numerals are lucky or unlucky. Thus astrology
and the interpretation of omens merged into prognosis and, as
with all early civilizations, the first Bab3'lonian physician was a

SUMERIAN AND ORIENTAL MEDICINE 53

priest or tlic first ])riest a physician. Inspection of tht; viscera, an
essential part of augury, led to inspection of the urine, and, among
the Babylonians, soothsaying was concentrated upon the liver,
terra-cotta models of which, about 3000 years old, have been
found, divided into squares and studded with prophetic inscrip-
tions. In Ezekiel (xxi, 21) we read: "For the king of Babylon
stood at the parting of the ways, at the head of the two ways to
use divination: he made his arrows bright, he consulted with
images, he looked in the liver." Neuburger points out how the
priestly interest in omens might have led to the collection and col-
location of clinical observations, such as facial expression, the ap-
pearances of the urine, the saliva, the blood drawn in blood-letting,
and other signs which were used as indices or tokens of recovery
or death; and he goes on to say that the next step in the direction
of scientific advancement would be the elimination of the super-
natural from the matter.^ This step, unfortunately, is and has
been the hardest one to take in medical reasoning. So we find the
Babylonian physicians regarding disease as the work of demons,
which swarmed in the earth, air and water, and against which long
litanies or incantations were recited.

In 1849, Sir Henry Layard, during his excavations of the Mound Kouyun-
jik, opposite Mosul, the site of Nineveh, discovered the great library of some
;«),000 clay tablets gathered by King Assurbanipal of Assyria (BGSHViG B. C),
which is now in the British Aluseum. From some 800 medical tablets in this
archival collection, which probably numbered 100,000, our knowledge of
Assyro-Babylonian medicine is mainly derived. In Morris Jastrow's reading ^
of these, shifting the blame for anything to demons (our disease-germs) was the
AssjTian concept of aetiology; diagnosis was probably based upon simple in-
spection of the patient, helped out by associative memory and terminology;
prognosis (iatromancy) was divination or augury from liver-inspection (hepatos-
copy), birth-omens, disease-omens and astrological signs antl portents;
therapy was exorcism by a special ritual, of which the exhibition of herbal
remedies was a part; incantation was prophylaxis. From hepatoscopy the
Babylonians learned the structure of the liver, and their clay models are Ijetter
specimens of anatomical illustration than the five-lobed medieval figurations.
Similar models of the liver have been founil on ancient Hittite sites in Asia
Minor, and Etruscan livers in bronze, dating from the third century B. C, have
been found near Piacenza. The liver, as the source of blood, was regarded as
the seat of the soul, and as the god identified himself with the sacrificial animal,
to inspiH't the liver was to see into the soul of the animal and the mind of the
god. The l)irth-omens, which have been specially studied l)y DennefekP and
Jastrow, led to the pseudo-sciences of physiognomy and palmistry and stimu-
lated the study of fcEtal and adult abnormities. All possible phases of par-
turition and abnormities of the foetus {Monstra) were regarded as signs and

^Neuburger: Gcschichte der Medizin, Stuttgart, 1906, i, 31.

- M. Jastrow: Proc. Boy. Soc. Med., Sect. Hist. Med., London, 1914,
vii, 109-176.

' L. Dennefeld: Babylonisch-assyri.sche Geburts-Omina, Leipzig, 1914.
Jastrow: Babyloiiian-.\ss>Tian Birth-Omens, Giessen, 191 :i. .VLso: Aspects of
Behef and Practice in Babylonia and Assyria, New York, 1911, ch. iii.

54 IllSl'dK'i (If MI'.DICINK

tdkcna of llu- iiidix iiiiuil's fuuirc fate, .-is hciiiji I lie attciid.iiit phcnoinona of a
now lif«' issuing; from aiiollicr. An almoriiially lar^ic oifiari {iiid/islniin per
ixcissuDi), or an alinormity on llic rinlil side, was a token of fulnrc power and
succoHs. An ahnonnally small or^an (niDiistnun jur (Icficlunn, or a deft cl. on
tlic left side, i>oint(>d to weakness, diseiuse and failnre. Tlie liirth omens in-
dieated wlietlier the individual was to bo superman or undorliiifi. The riles of
oxoroisni and the litanies to driv(> away diseases influei\eed I^jryptian, Hindu
and Chinese medicine and t hese wore carried o\'er into late Syiian medicine .and
thence to Islam and Medie\ al ( "hrist ianily. ( )ver a hundred drujis w<'re known,
and two jjeneral classes of these, shdiinnii, and (ihnii, represent, Jastrow be-
lieves, orjianie and inorganic substances respectively. The filtliier remedies
(Dreckapothcke) were probably designed to ilisgust the demon inside the body.
Rumination, acid stomach, rheumatism, neuralgia, and cardiac diseases are
described in the clay tai)lcts. Liver diseases and eye diseases form the centric
feature of Haby Ionian as of Arabic patiiology. SudliolT, interprets the (;once])ts
hiniiii and sibtu as epilepsy and contagion (seizure by denionsj, ami, in ihe
Middle Ages, epileptic seizure came to be regarded as a contagion.

The beginnings of the pfuctice of methcine among the Baby-
lonians have been desci'ibctl by Herodotus as follows: "They bring
out their sick to the market place, for they have no phj^sicians;
then those who pass by the sick person confer with him about the
disease, to discover whether they have themselves been afflicted
with the same disease as the sick person, or have seen others so
afflicted; thus the passers-by confer with him, and advise him to
have recourse to the same treatment as that by which they es-
caped a similar disease, or as they have known to cure others. And
they arc not alloweHl to pass by a sick pei-son in silence, without in-
quiring into the nature of his distemper."^ With the Babylonians,
as Montaigne quaintly observes, ''the whole people was the physi-
cian." They eventuallj' reached the stage at which, like the Egyp-
tians, they had a special doctor for every disease. Whether they
ever got beyond this stage we do not know, but we learn from the
Code Hannnin-abi (2250 B. C.) that the medical profession in
Babylon had advanced far enough in public esteem to be rewarded
with adequate fees, carefully prescribed and regulated by law.
Thus ten shekels in silver was the statutory fee for treating a
wound or opening an abscess of the eye with a bronze lancet, if
the patient happened to be a "gentleman"; if he were a poor man
or a servant, the fee was five or two shekels respectively. If the
doctor caused the patient to lose his life or his eye, he had his hands
cut off in the case of the gentleman or had to render value for value
in the case of a slave. It is clear from all this that the Babylonian
physicians owned slaves and sometimes operated for cataract.
Here as everywhere, it was sin-gery that made the first step in the
right direction. Internal medicine, among both the Persians and

i.SudhofT: Areh. f. Gesch. d. Med., Leipz., 1910-11, iv, 353; 1912-13,
vi, 4.5-1.

2 Herodotus: i, SO.

SUMERIAN AND ORIENTAL MEDICINE 55

the Babylonians, was occupied mainly in endeavoring; to cast out
the demons of disease. A votive object found at Susa (Persia)
bears a conjuration against mosquitos. A cylinder seal in Pier-
pont Morgan's collection bears the "Fly Symbol" emblematic of
Nergal, the Mesopotamian god of disease and death. ^ Some ad-
vance in public hygiene was made, for the excavations of the
huge Babylonian drains, of which models were recently exhibited
at the Dresden Exposition, show that they understood the proper
disposal of sewage.

Closely connected with Sumerian medicine in point of time is
the medicine of the Jewish people, in relation to the Assyrian
captivity (B. C. 722) and the Bal)ylonian captivity (B. C. 604).
The principal sources of our knowledge of Jewish medicine are the
Bible and the Talmud, the first throwing only such light upon the
subject as we should expect to find in the details of a legendary
historic narrative. In the Old Testament, disease is an expres-
sion of the wrath of God, to be removed only by moral reform,
prayers and sacrifice; and it is God who confers both health and
disease: " I will put none of these diseases upon thee, which I have
brought upon the Egyptians : for I am the Lord that healeth thee ' '
(Exodus XV, 26). The priests acted as hygienic police in relation
to contagious diseases, but there is not a single reference in the
Bible to priests acting as physicians. The latter were a class apart,
of whom we read, for example, that Joseph "commanded his ser-
vants the physicians to embalm his father" (Gen. l, 2), that King
Asa consulted physicians instead of the Lord and "slept with his
fathers" for his pains (II Chron. xvi, 12, 13), or that if two men
fight and one of them be injured to the extent of having to keep his
bed, the other "shall paj^ for the loss of his time, and shall cause
him to be thoroughlj^ healed" (Exodus xxi, 19). The Prophets,
on the other hand, frequently performed miracles, as where both
Elijah and Elisha raised children from the dead. The "healing"
of the waters of Jordan by Elisha (II Kings ii, 22) is a good ex-
ample of the ancient, primitive concept of "making medicine,"
as also the references to the use of hyssop as an agent of catharsis,
purification or lustration (Psalms li, 7; Exodus xi, 22; Leviticus
XIV, 4-7, 49-52), and the ritual of transferring leprosy to a bird
(Leviticus xiv, 1-8). A striking example of the relation between
the Divine wrath and the efficacy of prayer is to be found in the case
of Hezekiah, who, "sick unto death," and told by the Lord to set
his house in order, turned his face to the wall; his prayers were an-
swered by the Prophet Isaiah who, at the Divine instance, ordered
that a lump of figs be applied to the afflicted part, with the result

1 J. Offord: Sc. Progress, London, 1916, x, 572.

56 HlSToin (»K MKDICIMO

that Hc/ckiali rccoviMcd (11 Kiii.^s \\, 1 SV Besides th(> physi-
cians and the hiiih i)riests. wiio acted as piihhc hcallh oflicers, there
wiM-(> ])r()t"essi<)iial inidwives, who are iiienl ioniMl in the cas(^-^ of
Rachel, of Tainar, and |)ail iculaily in t he st rikini;- reference to t lie
ancient Oriental usa^e of the obstetric chair, in the hrst chapter of
the .second hook of I-Aodns. where Pharaoh conHnaiuls the mid-
wives to slay all Jewish infants of the male sex, "wluMi ye do the
office of a midwife to the Ilehn^w women, and ,s(>e them upon the
stools." Alatcrnal impressions form the subject of the second
half of the thirtieth chapter of (lenesis, in which .Jacob retaliates
upon Laban for the deception which the latter practised upon him
about Leah and Rachel by out wittinji' him in a method of raisinjj;
speckled and spotted livestock hardly explicable by Mendel's law.
Dreams are rijihtly regarded as "visions of the head," that is,
emanations of the brain (Daniel, iv, 5; 13: vii, i). The use of the
primitive chipped flint in ritual circumcision is referred to in the
second book of I']xodus (iv, 2.5) where Zipporah, the wife of Moses,
" took a sharp stone and cut off the foreskin of her son." In Joshua
(v, 2), God commanded Joshua, tlie successor of Moses, to make
sharp knives and circumcise the child r(>n of Israel l)orn aftei' the
Exodus from Egypt. This is the onl}^ surgical procedure men-
tioned in the Bible, but the use of the roller-bandage in fractures
is referred to in Ezekiel fxxx, 22) as follow;^: "Son of man, I have
broken the arm of Pharaoh king of Egypt; and, lo, it shall not be
bound up to be healed, to put a I'oller to bind it, to make it strong
to hold the sword." Wounds were dres.sed, as among all ancient
peoples, with oil, wine and balsams. Acromegaly, with super-
numerary digits, is described in the case of the son of Goliath of
Gath (II Samuel, xxi, 20; I Chronicles, xx, 6), epilepsy is men-
tioned (Numbers, xxiv, 4) and the effects of inebriety outlined
(Proverbs, xxiii, 20-35). Of the different diseases referred to in
the Bible, the most important are leprosy, the "issue," and the
several plagues visited upon Israel, notably the plague of Baal-
peor, in which twenty-four thousand perished (Numbers xxv, 9).
Yet these diseases are so vaguely alluded to that it is impossible
to identify them with any latter-day equivalents. Modern derma-
tologists contend, for instance, that Biblical leprosy (zaraath),i of
which Naaman was healed by dipping himself "seven times in
Jordan," and which was transferred (in the folk-lore sense), to
Gehazi, so that "he went out from his presence a leper as white as
snow," was, in reality, psoriasis. On the other hand, Iwan Bloch
and others maintain that the venereal plagues mentioned in the
Bible (Baal-peor and the rest) are not the same as present-day lues

^ Described in Leviticus, xiii, 1-46.

SUMERIAN AND OKlExXTAL MEDICINE 57

or gonorrhea.^ Plague after quail-eating is mentioned in Numbers
(xi, 31-33). Highly significant is the episode of Ahaziah (II
Kings, I, 2), who, when ill, sent to Beelzebub at Ekron to learn
if he might recover, for, according to Josephus, this god is to be
equated with the Greek Zeus Apomuios, the "averter of flies."
The fiery serpents mentioned in Numbers (xxi, 7) may have been
the dracunculus, and Castellani holds that the disease with
"emerods" in I Samuel (v, 6; vi, 4-5) was bubonic plague,
because the "mice died and marred the land."-

The principal interest in these Biblical diseases lies in the re-
markable efforts made to prevent them. The ancient Hebrews
were, in fact, the founders of prophylaxis and the high priests
were true medical police. The book of Leviticus contains the
sternest mandates in regard to touching unclean objects, the proper
food to be eaten, the purifying of women after child-birth, the
hygiene of the menstrual periods, the abomination of sexual perver-
sions and the prevention of contagious diseases. In the remark-
able chapters on the diagnosis and prevention of leprosy, gonorrhea
and leukorrhea (Leviticus xiii-xv), the most definite common-
sense directions are given in regard to segregation, disinfection
(even to the point of scraping the walls of the house or destroying
it completely), and the old Mosaic rite of incineration of the pa-
tient's garments and other foinites. In the Middle Ages, these
precepts from Leviticus were still in force against leprosy. Who
but does not admire the rigorous Hebrew regulation of sexual hy-
giene which, however severe, enforced exogamy, put a ban upon
perversions, and invested the figure of a good and virtuous woman
with that peculiar halo of respect which has been preserved b}' all
highly civilized nations down to the present time?^ The institution
of the Sabbath day gave tired workaday humanity a sort of per-

^ Medical scholars, who speculate about these uncertain details in such
dogmatic fashion, fail to consider the point, well known to mathematicians and
physicists, that the inherent probability of any occurrence tends the closer
to zero the further we get away from it, and that the effect of any event tends
to "die out asymptotically" in indefinite or infinite time. ^Esculapius was
very much of a reality to Homer, Hippocrates and Celsus. To us he is well-
nigh a myth. Bloch forgets that the logical opposite of the "morbus Ameri-
can us" theory of syphilis, which he advances with such fanatical zeal, is just
as likely to be true as the theory itself.

- The rodents appear in Poussin's painting "The Plague of the Philistines"
(.Janus, Amst., 189S, iii, 138). It is noticeable that the evidence of the asso-
ciation of mice with the plague is stronger in the Septuagint than in the Vul-
gate (see L. Aschoff, Janus, Amst., 1900, v, 611-613). In the Revised Ver-
sion the "nati sunt mures" is absent, but verse 8 of I Samuel, v suggests
the inguinal bubo of plague.

' It is worthy of note that the Mosaic mandates against bestiality, sexual
inversion, etc., in Exodus (xxi, xxii) and Leviticus (xviii) are the beginnings
of medical jurisprudence.

58 HIS'POHY OF MlsDKlXK

iiiaiitMil splint i(» rcsl updii. In slioil I lie cliicf liloiy of Uihlical
mctliciiu' lies, as Ncuhurficr I'itilit ly says, in t lie iiist it iit ion of social
li\iii(Mu> as a scicMicc. How lii,<ilil>' the physician was ('slcHMucd by
the Hchrcnvs of a later time may Ix' ^athci-cd fi-om the impi-cssive
languaj^o of Josus, son of Siiach (1<S() B. ('.):

1 . I lonour :i physician acconliiifi to t liy iiccil nf liiiii wit 1: I lie lidnniii'S

clue unto him:
For verily the l.oni hath created him.

2. For from the Most Ilijili comet h hcaliiifi;:

An<i from the l\in)i: he sliail receive a gift.
'A. The si<ill of tiie ])hysiciaii shall lift ^ip his head:

And ill liie siglit of great men lie .shall be admired.

The Tahimd is essentially a law hook, dating from the second
centmy A. D., and the information about Jewish medicine con-
veyed in it is, in consequence, of a more (k^finite and detailed char-
acter than we should expect to fintl in the half-legendary narrative
of the Bible. Its most interesting featm-e is the light it throws
upon later Jewish anatomy and surgery and upon the knowledge
of post-mortem appearances which the Hebrews gained through
the inspection of meat for food. Anatomy of any kind beffire the
time of \'esalius was a thing of shreds aiul patches and Jewish
anatomy was no exception to the rule. . Only a very few of the
parts of the body are mentioned in the Bible and these references
are as vague and general as those in the Iliad. In the Talmud, the
nimiber of bones in the skeleton is variously estimated at 248 or
252, and, of these, one, the bone Luz, which was supposed to lie
somewhere between the base of the skull and the coccyx, was re-
garded as the indestructible nucleus from which the body is to be
raised from the dead at the Resurrection. This myth, which
modern rabbinical authority holds to have originated from the
ancient Egj^ptian rite of "burying the spinal column of Osiris,"
was exploded by Vesalius in a striking passage in the "Fabrica."^
The Talmud displays considerable knowledge of the cesophagus,
larynx, trachea, the membranes of the brain and the generative
organs. The pancreas is called the "finger of the liver" and struc-
tures like the spleen, kidneys and spinal cord are frequently men-
tioned but not described. The blood is held to be the vital princi-
ple, identical with the soul, and the heart is essential to life. Res-
piration is likened to burning. The effect of the saliva upon food
and the churning movements of the stomach are noted, and the
liver is believed to elaborate the blood. Among the Hebrews, the
flesh of diseased or injured animals was always considered unfit for

1 See F. H. Garrison, "The Bone called 'Luz,'" New York Med. Jour.,
1911, xcii, pp. 149-1.51.

SUMERIAN AND ORIENTAL MEDICINE 59

food, and the autopsies, made upon slaughtered animals to de-
termine what was ''kosher" and "trepha," threw a light upon
pathologic appearances which the ancient Greeks never gained.
Hyperemia, caseous degeneration and tumors of the lungs were
noted, as also atrophy and abscess of the kidneys and cirrhosis and
necrosis of the liver. Talmudic surgery included the usual
"wound-surgery," with treatment by sutures and bandages, ap-
plications of wine and oil and the device of freshening the edges of
old wounds to secure more perfect union. Venesection, leeching
and cupping were common and, before attempting the major
operations, a sleeping draught ("samme de shinta") was admin-
istered. Cesarean section, excision of the spleen, amputations,
trephining, and the operation for imperforate anus in infants were
known, as also the use of the speculum and the uterine sound.
Fractures and dislocations were discussed, and crutches, artificial
limbs and artificial teeth employed.^ There is no evidence of
specialized medical education among the Jews until the Alexan-
drian period, and individual Hebrew physicians did not attain any
particular prominence until the Middle Ages and, more especially,
in the Modern Period.

As the Hebrews attained the highest eminence among Oriental
peoples in hygiene, so the ancient Hindus excelled all other nations
of their time in operative surgery. In the earliest Sanskrit docu-
ments, the Rig Veda (1500 B. C.) and the Atharva Veda, medicine
is entirely theurgic, and treatment consists of the usual spells
and incantations against the demons of disease or their human
agents, the witches and wizards. In the Brahminical period
(800 B. C.-IOOO A. D.), medicine was entirely in the hands of the
Brahmin priests and scholars, and the center of medical education
was at Benares. In an Indian rock inscription. King Asoka (circa
226 B. C.) records the erection of hospitals by him, and Cingalese
records indicate the existence of hospitals in Ceylon in 437 and 137
B. C. Indian and Ceylonese hospitals existed as late as 368 A. D.
The three leading texts of Brahminical medicine are the Charaka
Samhita, a compendium made by Charaka (second century A. D.)
from an earlier work of Agnivera, based upon the lectures of his mas-
ter Atreya (sixth century B. C.),-the Susruta (fifth century A. D.)
and the Vagbhata (seventh century A, D.). Of these the most
remarkable is Susruta, whose work, bearing the same name, is the
great storehouse of Aryan surgery. Indian medicine was particularly

^ P'or further information about Biblical and Talmudic medicine, see Julius
Prcuss, Bibliseh-Talmiidische Mediziii, Berlin, 1911, and the article by Dr.
Charles D. Spivak in the Jewish Encyclopedia, N. Y., 1904, viii, pp. 409-414.

- Charaka's text was completed by Dridhabala. See A. F. R. Hoernle:
Arch. f. Gosch. d. Med., Leipz., 1907-.S" i, 29-40.

()0 HlsroHV (tl- MKDUINE

weak in its niintoiuy. which coii.sistod of pui'cly fanciful numera-
tions of uniin;iiiinal)lc jjaits of t ho body, as 'M'){) hones, (S()() hj^a-
intMits. ")()() nuisclcs. i^OO veins, and so on. Hindu i)hysioIo<ry pre-
supposes that tlie vital |)rocesses ar(> actuale(| i)y means of the air
(hi'low the na\-el ), the bile (between t h(> na\-el and I he heart )and the
phlefrm (above the heait ), fi'om which ai'e deri\-ed the seven proxi-
mal principles, diyle, blood, flesh, fat, bone, marrow, and somen.
Health consists in a normal ciuantitativo relationship of th(\se
primary constituents, disease in a deranfiement of their ])ropei'
proportions. Diseases are ap;ain minutely subdivided, the Susruta
enumerating as many as 1 120, which are classed in the two grand
divisions of natural and supernatural diseases. Diagnosis was
cai-efiilly made and included inspection, palpation, auscultation
and the use of the special senses. Semeiology and prognosis com-
bined acute observation with the usual folk superstitions. As ex-
amples, witness the SuSruta's very recognizable description of
malarial fever, which is attributed to mosquitos, or the passage in
the Bhagavata Purana which warns people to desert their houses
"when ]-ats fall fi"om the roofs above, jump about and die," pre-
sumal)ly from plague. Essential diabetes mellitus was recog-
nized as Madhumeha or "honey-urine" (Jolly), and the symptoms
of thirst, foul breath, and languor were noted (W. Ebstein). In
therapeutics, a proper diet and regimen were carefully detailed,
and baths, enemata. emetics, inhalations, gargles, blood-letting
and urethral and vaginal injections emplo^'ed. The materia
medica of India was particular!}^ rich. Susruta mentions 760
medicinal plants, of which nard, cinnamon, pepper, cardamoms,
spices and sugar were native. Especial attention was paid to
aphrodisiacs and poisons, particularly antidotes for the bites of
venomous snakes and otlier animals. Jolh' mentions some 13
alcoholic drinks. The soporific effects of hyoscyamus and Canna-
bis indica were known, and their employment in surgical anesthesia
was, according to Burton, of great antiquity. The Bower MS.,
a valuable Sanscrit document on birch-bark (fifth centmy B. C),
found by a native in the ruins of ]\Iingai (Turkestan) and pur-
chased by Lieutenant Bower .in 1890 (edited by Hoernle), cor-
responds with the drug-lore of the Susruta and the Charaka in
many particulars. It contains a remarkable dithyramb in praise
of garlic (Allium sativwn)} The surgical arm of treatment in
India reached, as we have said, the highest point of development
attained in antiquity. The Susruta describes about 121 different
surgical instruments, including scalpels, lancets, saws, scissors,
needles, hooks, probes, directors, sounds, forceps, trocars, cathe-

1 L. Aschoff: Janus, Amst., 1900, v, 493-501.

SUMERIAN AND ORIENTAL MEDICINE 61

ters, syringes, bougies and a rectal speculum.^ These were
properly handled and jointed, the blade instruments sharp enough
to cut a hair and kept clean by wrapping in flannel in a box. The
Hindus apparently knew every important operative procedure
except the use of the ligature. They amputated limbs, checking
hemorrhage by cauterization, boiling oil or pressure. They
ti-eated fractures and dislocations by a special splint made of
withes of bamboo, which was subsequently adopted in the British
Army as the "patent rattan cane splint." They performed
lithotomy (without the staff), Cesarean section, excision of tumors,
and the removal of omental hernia through the scrotum. Their
mode of extracting cataract has survived to the present day and
they were especially strong in skin-grafting and other phases of
plastic surgery. Their method of rhinoplasty was probably
learned from them in the first instance by the itinerant Arabian
surgeons and so transmitted through private families, like the
Xorsini, from generation to generation even to the time of Tag-
liacozzi. The Hindus were especially clever in their method of
teaching surgery. Realizing the importance of rapid, dexterous
incision in operations without anesthesia, they had the student
practise at first upon plants. The hollow stalks of water
lilies or the veins of large leaves were punctured and lanced as
well as the blood-vessels of dead animals. Gourds, cucumbers
and other soft fruits, or leather bags filled with water were tapped
or incised in lieu of hydrocele or any other disorder of a hollow
cavity. Flexible models were used for bandaging, and amputa-
tions and the plastic operations were practised upon dead animals.
In so teaching the student to acquire ease and surety in operating
by "going through the motions," the Hindus were pioneers of
many recent wrinkles on the didactic side of experimental surgery.^
Whether the Hindus influenced Greek medicine before the time
of Alexander the Great or were themselves influenced by it is not
known; but it is certain that, at the time of Alexander's Indian
expedition (327 B. C.), their physicians and surgeons enjoyed a
well-deserved reputation for superior knowledge and skill. Some
writei-s even maintain that Aristotle, who lived about this time, got
many of his ideas from the East.

^ See "A Short History of Aryan Medical Science," by Sir Bhagvat Sinh
Jee, London, 1896, 176-186, with pictures of surgical instruments and other
apparatus, on plates 1-10.

- Readers of Captain Marryat's novels may recall how the apothecary,
Mr. Cophagus, taught venesection to the fatherless Japhet by making hiin,
"in the first instance, punctvu-e very scientifically all the larger veins of a
cabbage leaf, until, well satisfied with the delicacy of my hand and the pre-
cision of my hand, he wound up his instructions by permitting me to breathe
a vein in liis own arm." Marryal, Japhet in Search of a Father, ch. iv.

()2 lUSlOKV OK MKDICINE

Witli (lie .Moliaiumcthm coikiucsI . Imliaii incdiciiu^ j)ass('(l
uii(l(M" \\\c sway ot" (ho Aial)i(' (loiiiinahoii and vliiually ceased to
l>e. Its only sur\i\al in our own time consists appaivntly in tlie
^'edaIl(ic practices of the \arious Swaniis and Mahatnias who oc-
casionally visit this count i\- and whose stranfj;e cult has driven
many of its AnuMican adherents insane. It is interesting to note,
however, that the three I'Jiglishinen who did most to i)ut hyp-
notism upon a permanent basis in practical therapeutics — Bi'aid,
I"]sdaile and l^lliotson — undoulitcdiy got their ideas and some of
their experience from contact with India.

Chinese medicine is what our owli medicine might be, had we
been guided by medieval ideas down to the present time, that
is, absolutely stationary. Its literature consists of a lai'ge number
of works none of which are of the slightest scientific importance.
Their characteristics are reverence for authority, petrified formal-
ism and a pedantic excess of detail. Chinese anatomy accounts
for 3G5 bones in the human body, of which the cranium in some
sj'stems consists of only one bone, in others of eight in the male sex,
six in the female. The larynx opens into the heart, the spinal cord
into the testicles, the lung has eight lobes, the liver seven. The
spleen and the heart are the organs of reason. Each organ is re-
lated to a color, taste, season and time of the day, has a parent and
friends and enemies. The heart is the son of the liver, the son of
the heart is the stomach, its friend the spleen, its enemy the kid-
ney; red is its color, summer its season; it receives at mid-day
(Welch), With such inadequate knowledge of human structure
and function there could be very little surgery, particularly among
a people whose religious convictions were against the drawing of
blood or the mutilation of the body. Castration is in fact the only
operation they perform, and, while they use dry cupping and mas-
sage, they do not resort to venesection, but substitute the moxa
and acupuncture. The moxa, introduced into European practice
in the seventeenth centur}', consists of little combustible cones
which are applied all over the body and ignited. Acupuncture is
the insertion into the stretched skin of fine gold or silver needles,
which are twisted about. Both procedures are employed for pur-
poses of counter-irritation in gouty and rheumatic disordei's.
The Chinese were wonderfully clever at massage and were the first
to employ the blind as masseurs. They were earl}^ acquainted
with identification by finger-prints (dactyloscopy). Chinese
pathology is characterized by an excessive amount of detail; for
example, 10,000 varieties of fevers or 14 kinds of dysentery. In
diagnosis they attach great importance to the pulse, the varieties
of which are minutely subdivided and investigated by touching
different parts of the radial artery of either hand with the fingers.

SUMERIAN AND ORIENTAL MEDICINE 63

after the fashion of striking the keys of a piano. In this way, six
sets of pulse-data are eUcited, which are connected with the dif-
ferent organs and their diseases. Michael Boym, a Jesuit mis-
sionary in China, first wrote on Chinese pulse-lore (1666), giving
plates representing their peculiar mode of feeling the pulse. His
work was resurrected and published by the physician-botanist,
Andreas Cle3'er (1686). In his own compilation (1682), Cleyer
gives wood cuts illustrating the Chinese doctrine of the pulse and
the semeiology of the tongue, also thirty plates of Chinese anatomy,
and other phases of medical sinology. The Chinese materia
niedica is unusually extensive and includes such well-known drugs
as ginseng, rhubarb, pomegranate root, aconite, opium, arsenic,
sulphur, and mercury (for inunction and fumigation in syphilis),
and many disgusting remedies, such as the parts or excreta of
animals. The Hsi Yuan Lu, the official Chinese text-book of
forensic medicine for hundreds of years, contains many empirical
observations on poisons (Wu Lien-Teh). The ancient Chinese
knew of preventive inoculation against smallpox, which they
probably got from India. Annual statistical records of disease
were already established in the Chon Li (1105 B. C), good hygienic
precepts were advanced in another book of 700 B. C, and the
/ Chin Ching is a well-known manual of physical culture, with
illustrations. The plan of eating only cooked food, the sensible
costume of cotton and silk, the characteristic adaptation of their
architecture to climate, all show the good common sense of the
Chinese in these matters. But the infectious diseases are not yet
notifiable, so that scarlatina and smallpox sweep away thousands.
During the Manchurian epidemic of plague (1910-11), strategic
centres were established along the main railwa}^ lines in North
China and have availed to keep the disease out in the last five
years. This is also true of the systematic rat-proofing of houses
in Shanghai.^

The originator of medical missions in China was Dr. Peter
Parker [1804-88], a Yale graduate, who founded the Ophthalmic
Hospital at Canton (1835) and made the unique collection of
Chinese surgical paintings now in Yale.^ President Charles W.
Eliot in a tour of China stated that the most urgent need of its
millions was medical education. To him was mainly due the
foundation of the Harvard Medical School of China. China has
now an Army Medical College at Tientsin, the Peiyang Medical
College, established by Li Hung Chang, a school of medicine at
Peking, various schools connected with missionary establish-

1 Wu Lien-Teh: Nat. Med. Jour., China, Shanghai, 1916, ii, 32-36.
^C. J. Bartlett: Jour. Am. Med. Assoc, Chicago, 1916, Lxvii, 407-411.

64 iiisroKv oi' Mi;i)i(i\K

uuMits, Mild tuitluM' improvcinculs m:i\' he cxptM'tcd from \]\c
l{()('kofi'll(M' I'^oimdat ii>ii, wliicli sciil out two coiiiiuissions in
1914 If).

The {'onu'r-stoiic of tlic \:\\v Mculical School at ('huangslui
was laid in 191(). The National Medical Association of ( hina had
its first nuH>tin}:;s in ShanjiliiH <>n February 7-12, 191().

The Japanese are notiMl for tluMi- I'eniarkahle power of assiini-
latinij; tlu^ culture of othei' nations, and, liefore they came in con-
tact with luu'opean civilization, thcii' medicine was simply an ex-
tension of Chinese medicine. I p till 9(5 B. C the healing art in
Japan was passing through the mylhical phases common to all
forms of (>ai-ly nuvlicine.^ l')is(>ase was supposed to be caused by
divine inliuence (Kamino-no-ke), by devils and evil spirits or by
spirits of the dead. Two deities, with particularly long names,
presided over healing, which was further helped out l)y prayers
and incantations, and at a later period, by internal remedies,
venesection, and mineral baths. The period 96 B. C.-709 A. D.
marks the ascendancy of Chinese medicine, which was introduced
by way of Corea. The practitioners and teachers were priests.
Pupils were sent to China at government expense, and by 702
A. D. there were native medical schools, with seven-year courses
in internal medicine and shorter periods for the other branches.
The students were made ishi or doctors after passing a final ex-
amination in the presence of the Minister, and women were oc-
casionally trained as midwives. During the succeeding periods
(710-1333), called the "Nara," "Heian," and so on, after the
names of the different capitals of Japan, the influence of the
Chinese priest-healers was still dominant, with some advances in
surgical procedure, such as suturing intestinal wounds with mul-
berry fiber or couching a cataract with needles. In 758, a hospital
for the indigent sick was erected by Empress Komyo. The oldest
Japanese medical book, the Ishinho, written by Yasuhori Tambu
in 982, w'hich describes these surgical novelties, also records the
existence of lying-in hospitals and isolation houses for smallpox
patients. During the medieval period, personal observations of
clinical cases were recorded. The moxa, acupuncture, and many
of the Chinese herbal or mineral remedies were in vogue and mas-
sage was delegated to the blind as a suitable occupation. A strik-
ing contribution of the ancient Japanese to therapeutics was their
use of red hangings in the treatment of smallpox, the remedy
afterward employed by John of Gaddesden and Finsen. The first
Portuguese ship touched Japan in 1542, and with the arrival of

' Most of these details are taken from Y. Fujikawa's "Geschichte der
Medizin in Japan," Tokj-o, 1911.

SUMERIAN AND ORIENTAL MEDICINE 65

St. Francis Xavier in 1549 l)egins the rise of European influences.
The physicians who came with him and with the later mission-
aries — there was a Catholic church at Kyoto in 1568 — treated
the sick gratuitously, did surgical work, founded hospitals, and
planted lM)tanic gardens. After the expulsion of the missionaries,
two of their Japanese pupils settled at Sakai and founded a school.
The Dutch traders came in 1597 and their ship's surgeons also
exerted some influence. A translation of Ambroise Fare's works
was made in the seventeenth centurj^, but the importation of
European books was forbidden until the year 1700, after which
time translations of Boerhaave, Van Swieten, Heister, and other
writers began to appear. Vaccination was introduced by Moh-
nike in 1848. The medical school founded by the Dutch physi-
cians at Yeddo in 1857 passed into the hands of the government
in 1860 and became in time the present University of Tokyo. The
modern or Meiji period of Japanese medicine begins with the
year of revolution, 1868, and its distinctive feature is the rise of
German influences. The universities and medical academies, the
state examinations, the medical societies and medical journals,
are all copied after German models, and the ablest Japanese
medical men of today — Shiga, Kitasato, Noguchi, Hata — have
received their etlucation and training in Germany. This in-
fluence has persisted, even since the outbreak of the pan-Euz'opean
war. German is still the language of science in Japan, and reli-
gious ceremonies are still held at the little shinto shrine dedicated
to the memory of Koch.

To sum up what we owe to Oriental medicine, the Babylonians
specialized in the matter of medical fees, the Jews originated medi-
cal jurisprudence and pul)lic hygiene and ordained a weekly day of
rest, and the Hindus demonstrated that skill in operative surgery
which has been a permanent possession of the Aryan race ever
since.

GREEK MEDICINE

1. Before Hippocrates

The Greeks wcro a Sofntnelvolk, a composite people, and their
diverse elements — Ionian, 'Hicssaliaii, Arcadian, Achaian, .Eolian,
Dorian— gave them the self-willed Independence, the restless in-
dividuality, of a mountaineer and sea-farinp; race, traits which
were at once the secret of their greatness and their downfall. The
phj'sical geography of insular and peninsular Greece, with its deej)
coastwise indentations and abrupt mountain walls, isolated the
whole country and its separate states in a way that made at once
for inteni^e local i)atriotism, and at the same time gave the cultural
advantages of al)undant maritime intercourse with other nati(jns,
while such grandeur in external nature could only inspire the lofti-
est freedom of mind and spirit. Yet this very freedom of thought
prevented Greece from becoming a nation in the end, for her peo-
ple were too diverse in racial strain, pulled too many different
ways, to become permanently united. Greek history is the
history of several states, and these city-states "were too wilful to
combine."^

In the time of Grote, Greek history began with the first Olym-
piad (776 B. C.). Today, the origins of Greek civilization go back
to at least 3400 B. C, and are found outside the Greek peninsula.
Schliemann uncovered the plains of Troy in 1870-73, and unveiled
the ^Egean civilization of Mycenae and Tiryns (1600-1200 B. C.)
in 1876-84. The Minoan civilization of Crete, which goes back to
Neolithic man, was revealed in the excavations of Sir Arthur
Evans in 1894-1908. These investigations ^ go to show that Crete,
"a kind of half-way house between two continents," independent
of the Eurasian and Eurafrican cultures, was the starting point of
European civilization.

The early Minoan culture (3400-2000 B. C), contemporaneous with the
early dj-nasties of Egj^jt, the excavations lying over Neohthic strata which go
back to 9000 B. C, is characterized by pohshed stone axes, finely burnished
pottery, steatopygous female figures of clay, with pronounced breasts, like

1 Sir T. Clifford Allbutt : "Science and Mediaeval Thought," London, 1901,
p. 21.

2 See Sir A. Evans: Reports of Excavations, 1900-1908 in Ann. Brit.
School, Athens, 1900-1908, passim. Also his "Prehistoric Tombs of Knossos"
(1906), and Science, N. Y., 1916, n. s., xliv, 399; 448.

GREEK MEDICINE 67

those of Aurignacian man, with perhaps evidences of the worship of tlie
Magna Mater, or (ireat Mother of the Matriarchate, with the divine child-
husband. In the Middle Minoan Period (2()()()-1850 B. C), correspoiidinfi; with
the twelfth Egyptian dynasty, polychrome decorations, fine faiemce and
painted sherds abound, some specimens of which were found by Fhnders
Petrie among twelfth d>Tiasty remains at Kahun in the Fayum. The late Minoan
Period (1850-1400 B. C.), corresponding wdth the Hyksos period and the New
Enipir(> in I'^gyj^t, is best represented by the palaces excavated at Knossos and
Hagia Triada' The Knossian palace (the Cretan Labyrinth) is a stately, many-
storied structure, with winding corridors and subterranean passages, elaborate
domestic arrangements and the best sanitation, including ingenious devices for
ventilation, water-ways for drainage, cannon-shaped terra cotta piping, and
latrines wliich, in construction, excel anything of the kind before the nineteenth
century.' The corridors, landings and porticos are decorated with high reUefs
in gesso duro and animated wall-paintings, representing groups of court ladies
in curiously modern jackets, fashionable robes, with terraced flounces, and
gloves. The naturahstic faience images of the Mother Goddess and her female
votaries, represent her chthonic (earthly) aspect, with serpents, a tightly-
waisted figure, with the neolithic bell-shaped gown, of approved modern cut.

Gigantic, ornate amphor* for oil, fresco-paintings of bull-fights, with male
and female toreadors (whence the Athenian legend of the Minotavu-), a
gaming-board of gold-plated ivory, a shrine, with cult objects and offertory
vessels in place, a gypsum throne of Gothic aspect, evidence the highly special-
ized culture of Knossos.

In the ^Egean or Mycenaean culture revealed by Schliemann, there is the
same skill in ceramics and sculpture, fresco-painting and ornamentation, the
same massive architecture, as in the Lion's Gate at Mycenae. The aniconic
stage of worship of trees and pillars is succeeded by the cult of the Great
Mother, with the chthonic snakes or uranic doves. Shaft-burial of the dead
in cysts sunk in rock was followed by beehive tombs. The Mycenajan culture
is probably synclu-onous with the Pelasgian, and the post-Mycenaean culture
of the Homeric period shows Minoan influences. In place of the round shield
and armor of the Homeric Greeks, the Minoan and Mycenaean peoples used
shields covering the whole body, and their ornaments are of the Bronze Age.
The Homeric Greeks used iron weapons and cremated their dead. Their
Olympian Gods are not found in the Minoan and Mycenaean periods.

Of the early achievements of the historic Greeks, the Hellenes,
Thucj'dides himself says, at the beginning of his history, that
"they were no great things." He points out that ancient Hellas
had no settled population, wars and factions keeping the people
in a state of constant migration, so that "the richest soils were
always the most subject to change of masters." Under conditions
like these, a restless, athletic, warlike and sea-faring people were
developed whose chief interests were the active lives they led and
the influence exerted upon their affairs by the gods of their worship.

As Walter Pater has so charmingly set forth, in his studies of
Dionysus and "Hippolytus Veiled," it is a common error to sup-
pose that the ancient Greeks everywhere worshiped the same Pan-
theon of gods. In point of fact, as being a divided people, the
Hpllencs of the mountains, the coast, the valleys, farms and river-

'T. H. M. Clarke: Prehistoric Sanitation in Crete, Brit. Med. Jour.,
London, 1903, ii, 597-599.

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GREEK MEDICINE 09

sides had each a separate religion of their own, the whole forming,
of course, an essential polytheism, in that every little clan or village
community worshiped its special god, at the same time paying a
vague general reverence to the greater gods. Thus, Demeter was
the special divinity of those who lived on farms and among corn-
fields, Dionysus of those who cultivated vineyards, Poseidon of
those who dwelt by the sea, Pallas Athene of the Athenians,
while the lesser gods had each a particular locality where their
worship was a cult. "Like a network over the land of gracious
poetic tradition," says Pater, "the local religions had been never
wholly superseded by the worship of the great national temples."'
Thus we find, at the start, that there were many tutelary divini-
ties of medicine among the Greeks, with overlapping or inter-
changea})le functions in different places. The Greeks, as Pater
says, had not a religion, Init religions, "a theology with no central
authority, no link on historic time, liable from the first to an un-
observed transformation." Thus, Artemis (Diana), Demeter
(Ceres), Hermes (Mercury), Hera (Juno), Poseidon (Neptune),
Dionysus (Bacchus) were, all of them, patron gods and goddesses
of the healing art, and were able, at need, to produce disease
themselves. In the Hippocratic treatise "On the Sacred Disease,"
we read of epileptics that

••if they imitate a goat, or grind their teeth, or if their right side be con-
vulsed, they say that the mother of the gods (Cybele) is the cause. If they
speak in a sharper, shriller tone, they liken this state to a horse and say that
Poseidon is the cause. . . . But if foam be emitted by the mouth and the
patient kick with his feet, Ares (Mars) gets the blame. But terrors which
hapi)eii during the night, and fevers, and delirium, and jumpings out of hed,
and frightful apparitions, and fleeing away— all these they hold to be the plots
of He(!ate, and the invasions of th(> Heroes, and use purifications and incanta-
tions, and, as appears to me, make the divinity to be most wicked and impious."

Thus, as appears from the deprecating Hippocratic allusion to Hecate,
thi-re existed, apart from the cult of the Olympian gods, a darker, oljscurer cult,
naiiH'ly, the medical magic associated with the ritual of propitiating the so-
called chthonian deities of the earth and the imderworld. This was again not a
general lielief, but confined to distinct localities, vaguely including the cults of
the celestial gods in their ancient chthonic aspect, the cave gods, deified heroes,
heroized pliy.sicians (Heroi latroi) and the perturbed spirits of the dead. The
sacrificial rites were conducted in the witching hours before dawn and t:he
deities in\-oked were never addressed directly by name, but plcnn titulo, with
flattering appellations. The references to chthonic deities in the Greek authors
are therefore obscure. In the Greek Pantheon, the greater x^ouloi. are indenti-
cal with Frazer's "Spirits of the Corn and the Wild." Hades (Aidoneus,
Pluto), also styled "Zeus Katachthonius," Demeter chthonia (the Corn
Mother) and Persephone (Kore), goddess of death and the "poi)pied sleep."
Hermes Psychopompos, of the golden wand and sandals, the conductor of souls
lo Hades (Odyssey XXIV, 1), Cerberus, Hecate, the Erinnyes and all other
malevolent spirits, were associated with this cult, and coordinate with it

1 Pater: "Hippolytus Veiled," op. cit., p. KV.;

70 UISTOUV OF .Mi;i)I( l\IO

was lilt' ritual of |)ro|)itiatiii>!: or iiiNokiiiji llic (li'i)aii('(l spirits of tlic dead.'
Apart from tlu> purely rclijiious ritual of (lie xd6i>ioi and tlio cult of the dead,
tlioro arose an ("sotcric ritual tluTaiJy, derixcd from the circumstance that tlu^se
dark powers controlled not only fruit fulness of t lie cart h and in man, Itut could
indict or avert disease, insanity or death. Thus Plato (I'lia'drus, 2ti) sju-aks
of epidemic diseases as due to "ancient wrath," which Hohde interjjrets as the
anjier of dv|)arted souls. The chthonian animals an<l plants, sacred to these
deities, and employed in lieu of human sacrifice to ))ropitiate them, came to
have associative remedial functions, whether for ])urification from the stigma
of murder and crime ii'atharsis), or as coimectcd with the rite of comnumion
or "eating the god, " in the form of the i)arts of ;uiimals,2 sacrificial cakes or
incense plants dedicated to their worship. The ashes and reject.s of sacrifice
(katharmata) formed a kind of sacred jjliarmacopceia, sometimes distributed
among the worshipers and eaten by them, as in the Asclepieia. Of the in-
mmierable medicinal simjiles and animal remedies recommen(]ed by (5alen,
Dioscorides and Pliny, it is obvious that but few have any ))harma^'ologic
rationale in the laboratory sense. I'^acli chthonian remedy became an open
secret, justitietl by its mythologic associations. Some simples are even de-
scribed by Dioscorides and Pliny as the "blood" of different gods and chthonian
animals. But even as the drug (<t>aptxd.Kov) was sacred in a good and a bad
sense, through its relation to the clithonian idea of atonement or catharsis
by means of a sacrificial sctipegoat {(t>apnaK6s), so this empirical therapy
became detached from tlie priestly therapy of the temples, anfl its secret
practitioners were regarded as magicians. The careful study of Max Hofler
shows that the modern theory of animal remedies did not originate with the
(ireeks, hut with the doctrine of signatures (Similia similibus). From an analy-
sis and tabulation of 1254: ancient organotliera])eutic prescriptions, Hofler
shows that, except in the case of the liver, sjjleen and heart (all worthless),
parts of the animal body were never empk)yed exclusively to heal diseases of
the same parts, but in the most varied and cajjricious way, depending upon
the tenets of the chthonian cult.' Greek organotherapy was "homeopathic
magic" in the folklore sense, but by no means isotherapy, in the sense of "like
cures like."

The chief god of heahng in the Greek Pantheon was Apollo,
commonly called Alexikakos (the averter of ills), whose far-darting
arrows visited plagues and epidemics upon mankind and who could,
at need, avert them. He was also the god of purity and well-
being in youth, and, as Homer relates, the physician to the Olym-
pian gods, whose wounds or diseases he cured by means of the root
of the peony. Hence his name "Paean," and the epithet "sons of
Psean," as applied to physicians. Legend relates that a knowledge
of medicine was communicated by Apollo and his sister Artemis to
the Centaur Chiron, the son of Saturn. As one skilled in music
and surgery and especially versed in ancient lore, Chiron was en-
trusted with the rearing and education of the heroes Jason, Her-
cules, Achilles, and, in particular, .Esculapius, the son of Apollo
by the n3anph Coronis. As Pindar sings, in his fourth Isthmian

IE. Rohde: Psyche, 3. Aufl., Tubingen & Leipzig, 1903, i, 204 and 278,
passim.

2 Frazer: "The homeopathic magic of a flesh diet," Spirits of the Corn
and the Wild, 1912, ii, 138-168.

' M. Hofler: Die volksmedizinische Organotherapie und ihr Verhaltniss
zum Kultopfer, Stuttgart, 1908.

GREEK MEDICINE

ode, ^Esculapius ])ecame so proficient in the healing art that Pluto
accused him of (Uniinishins the number of shades in Hades, and he
was destroyed by a tlmndei'ljolt of Zeus. After his death he be-
came an object of worship, and the temples of his cult were the
famous Asclepieia, of which the most celebrated were those at Cos,
Epidaurus, Cnidus and Pergamus. These temples, commonly
situated on wooded hills or mountain sides, near mineral springs,
became popular sanitaria, managed by trained priests and, in
intention, not unlike the health-resorts of modern times. The
patients were received by the physician-priests, who stirred their
imaginations by recounting the deeds
of ^Esculapius, the success of the
temple treatment and the remedies
employed. After appropriate prayers
and sacrifice, the patient was further
purified by a bath from the mineral
spring, with massage, inunction and
other methods, and, after offering up
a cock or ram before the image of
the god, was inducted into the special
rite of "incubation" or the temple-
sleep. This consisted in lying down
to sleep in the sanctuary, and during
the night, the priest, in the guise of
the god, presented himself before the
patient to administer medical advice,
if he happened to be awake. If he
slept, as was usually the case, the
advice came in a dream, which was
interpreted afterward by the priests,
who then prescribed catharsis, emesis,
blood-letting or whatever remedies
seemed appropriate. If the treat-
ment was successful and the patient

cured, he then presented a thank-offering to the god, usually a
model of the diseased part in wax, silver or gold, while a votive
tablet giving the history of his case and its treatment was sus-
pended in the temple. The whole rite of incubation has been
facetiously described in the "Plutus" of Aristophanes, and in
more elevated and dignified style in the third chapter of Walter
Pater's romance of Roman antiquity, "Marius the Epicurean."
The votive tablets in the Asclepieia at Cos and Cnidus became
the permanent clinical records of the Coan and Cnidian Schools
of Medicine, of the first of which Hippocrates was himself a
pupil. The Greek traveler Pausanias noticed six of these votive

Colossal bust of iEscuIapius in
the British Museum.

72 lUSTOKV OK MEDICINE

colmiiiis wtitMi lie xisitcd llir (cmplc at l'",|)i(l:uiiiis ahout 150
A. I)., and two of lluMii were excavated in icccnl times by
Cavvadias. lMifj:rav(Ml upon tli(>sc last wvvv ahoiit thirty clin-
ical cases. tj;i\inii; the names of the patients, their bodily ills and
what was done foi- iluMn. The details of symptoms and treat-
ment an> very meaner. In most eases it suflieed if the ^od anointed
the patient in his sleep or if one of the sacred dogs or snakes in the
temple licked the diseased part. ( )ne patient came with fonr
fingers of his hand paralyzed, another was blind of one eye, an-
other had carried a spear-point in his jaw for six years, another had
an ulcer of the stomach, another empyema, another was infested
with vermin. All were reported as cured.' These fragmentary
case-histories, none of them conveying any medical information
of positive value, are sometimes supposed to have been the start-
ing-point of the ITi))pocratic descriptioils of disease.

Many anticjue images, in marble or terra cotta, exist, repre-
senting diffeient parts of the boch'. These may be ex voto objects,
for suspension in the temples, or simple plastic figurations of normal
anatomy. Those representing coils of intestines (in the Schlie-
mann collection, Athens or the Museo dei Termi, Rome), the chest,
with ribs (Vatican), or the situs viscerum (Vatican), are life-like
enough to be simple examples of anatomic illustration in three
dimensions, with or without didactic intention. ^

Among the legendary children of ^Esculapius, by his wife,
Epione. were his daughters Hj'gieia and Panacea, who assisted in
the temple rites and fed the sacred snakes. With the ancient
Greeks, as with the Egyptians, Cretans and Hindus, the serpent
was venerated as the companion of many gods or the favorite
chthonian shape in which they sometimes appeared, as in the cases
of the Minoan snake-goddess {Magna Mater) and Zeus Meilichios.
In his uranic aspect, .Esculapius is commonly represented as a
handsome Jove-like figure, always attended by the sacred snake
entwined around a rod, a minature Omphalos, like that of the temple
of Apollo at Delphi — a plastic expression of his iatromantic gift —
and a grotesque, childish figure (like a tiny-hooded monk or
.Miinchener Kindl) called Telesphorus, the god of convalescence.^

1 For further details, see E. T. Withington, "Medical History," London,
1894, Appendix ii (pp. 370-.397).

2 See E. Hollander: Plastik und Medizin, Stuttgart, 1912.

' Telesphorus appears in the statues of ^sculapius in the Villa Borghese
and Palazzo Massimo (Rome), in the ivory placque in the Liverpool Museum,
and in coins of Apamea and Nicaea. In certain Eastern coins he is transformed
into a cupping glass of mushroom shape. See L. Schenk: De Telesphoro deo
(Gottingen dissertation, 1888), and E. Hollander: Plastik und Medizin,
Stuttgart, 1912, 125-140.

GREEK MEDICINE 73

Of the sons of .Esculapius, two, Machaon and Podalirius, are men-
tioned in Homer's Catalogue of the Ships as leaders, commanding
thirt}' vessels and "good physicians both." ^sciilapius is him-
self referred to in the Iliad as a real chieftain of Thessaly who
learned medicine from the centaur Chiron, from whose teaching,
again, Achilles was able to impart his knowledge of the healing art
to his friend Patroclus. Machaon and Podalirius are often re-
ferred to in Homer's narrative as men skilled in extracting weapons,
l)iiiding up wounds and applying soothing drugs. In the fourth
Iliad, Machaon is summoned to remove an arrow which was driven
through the belt of Menelaus, King of Sparta. He arrives to
find a circle of warriors gathered about the hero, and "instantly
thereupon he extracted the arrow from the well-fitted belt. But
while it was being extracted the sharp barbs were broken. Then he
loosed the variegated l)elt and the girdle beneath, and the plated
belt which brass-workers had forged. But when he perceived the
wound, where the bitter shaft had fallen, having sucked out the
blood, he skilfully sprinkled on it soothing remedies, which benev-
olent Chiron had formerly given to his father." In the eleventh
Iliad, Idomeneus refers to Machaon as follows: "0 Neleian
Nestor, great glory of the Greeks, come, ascend thy chariot and
let Machaon mount beside thee; and direct thy solid-hoofed horses
with all speed towards the ships, for a medical man is the equal of
many others, both to cut out arrows, and to apply mild remedies."
At the end of the same l^ook, Eurypylus, wounded with an arrow
in the thigh, calls upon Patroclus to remove it. He is borne to a
tent, and there, Patroclus, "laying him at length, cut out with a
knife the bitter, sharp arrow from his thigh, and washed the black
blood from it with warm water. Then he applied a bitter, pain-
assuaging root, rubbing it between his hands, which checked all
his pains; the wound indeed dried up, and the bleeding ceased."
In the thirteenth Iliad, Helenus, son of Priam, is smitten through
the hand by the brass spear of Menelaus and we have a glimpse of
the "great-hearted Agenor" extracting it and binding the wounded
hand "sling-wise in well-twisted sheep's wool, which his attendant
carried for the shepherd of the people." Homeric scenes of this
kind are frequently depicted on antique vases (Daremberg) par-
ticularly on the "bowl of Sosias" (500 B. C), a specimen of Greek
ceramics in the Antiquarium of the Berlin Museum, representing
Achilles bandaging the wounded arm of Patroclus. In the eighth
Iliad (lines 81-86) there is a striking picture of the rotatory move-
nu^nts made l)y a horse which had been wounded in the bi-ain by an
arrow. The tenth Iliad (lines 25-31) contains, Cardamatis thinks,
a reference to autumnal malarial fevers (the epiala of Theognis),
which he attributes to the stagnant marshes and the destruction

74 HISTORY OK MKDICINE

of fdivsls ill the Hi()ii/.(> A.u;(\' 'I'linl women soinolinios rendered
niedieal aid we liatluM" from both Iliad and Odysse}', as in the refer-
ences in llie fiiinu'r to "yellow-haired Aj^aniede, who well under-
stood as many druj^s as the wide earth nonrishes," or, in the latter,
to the soporific which Helen casts into the wine, a dnip; "which
Polydamma, the wife of Thoii, liad iriven her, a woman of Egypt."
In the Odyssey, a healer of diseases is said to be as welcome at a
feast as a prophet, a builder of ships, or even a godlike minstrel.
From these specimens of the war-surgery of the Iliad it is plain
that the surgeon's art was held in high esteem by the ancient
Greeks, and that chieftains of high rank did not disdain to follow
it. It is said that over fort}' tiil'ferent wounds are described by
Homer (250 cases in all) but no details are given as to febrile or
other symptoms. The lesions were all the spear- and arrow-
wounds of primitive man, with no losses of limbs or crushing
injuries; the mortality was 75 per cent.^ The anatomic terms
used are, according to Alalgaigne and Daremberg, more or less
identical with those employed by Hippocrates. The scientific
disposal of the dead bj- cremation was a common practice in
Homeric Greece.^

There is no mention of the Asclepieia in the Homeric poems,
which date back to at least 1000 B. C, but we may assume that,
even then, laic physicians and surgeons were a distinct class from
priests, although perhaps associated with the latter in time of
peace. Apart from such "priests" and the medical men proper,
the healing art was studied by the philosophers, and practised in
some details by the "gymnasts," who bathed and anointed the
body and tried to treat wounds and injuries and even internal
diseases. Greek medicine, as Osier has said, "had a triple rela-
tionship with science, with gymnastics, and with theology," and
before the time of Hippocrates, it was regarded simply as a branch
of philosophy.

Greek philosophy before the age of Pericles was of Ionian origin
and was derived from Egypt and the East. Huxley regarded the
growth of the Ionian philosophy in the eighth to sixth centuries B. C.
as "only one of the several sporadic indications of some powerful
mental ferment over the whole of the area comprised between the
.Egean and Northern Hindustan." This ferment, in the view of
Zelia Nuttall and Elliot Smith,^ was the spread of a complex

'J. P. Cardamatis: Arch. f. Schiffs- u. Tropen-Hyg., Leipzig, 1915, xdx,
30.5, et seq.

-Hollander: Boil. kliu. Wochenschr., 1916, liii, 355.

» H. Frolich: Janus, Amst., 1897-8, ii, 248-251.

* Xuttall: Archseol. and Ethnol. Papers, Peabody Mus. Harvard Univ.,
Cambridge, 1901, ii, 526. Elliot Smith: Bull. John Rylands Library, Manches-
ter, 1916, iii, 61.

GREEK MEDICINE 75

Eurasian and Eurafrican culture by the Phoenician navigators.
The founder of the Ionic School was Thales of Miletus (639-544
B. C), who had studied under the Egyptian priests, and taught
that water is the primary element from which all else is derived.
He was followed by Anaximander of Miletus (611), who first
mapped the heavens and made a successful prediction of an eclipse,
Anaximenes of Miletus (570-500 B. C.) and Heraclitus of Ephesus
{circa 556-460 B. C), who, in succession, assumed that indivisible
matter (earth?), air, or fire respectively are the primordial elements.
These four elements, earth, air, fire, water, were assumed by
Anaxagoras of Clazomense (500-428 B. C.) to be made up of as
many parts or "seed" as there are varieties of sensible or per-
ceptible matter. These categories were thrown into striking relief
in the teaching of Empedocles of Agrigentum in Sicily (504-443
B. C), the picturesque hero of Matthew Arnold's poem, who as
philosopher, physician, poet, traveled through the Greek cities,
clad in a purple robe, gold-cinctured, laurel-crowned, long haired,
severe of mien, and on account of his medical skill, was held by the
people to be endowed with supernatural powers. One of his
poetic fragments shows the unusual reverence in which the Greek
physician was held at this time:

Ye friends, who in the mighty city dwell . .

Along the yellow Acragas, hard by

The Acropolis, ye stewards of good works,

The stranger's refuge venerable and kind,

All hail, O friends! But unto ye I walk

As god unmortal now, no more as man,

On all sides honored fittingly and well.

Crowned both with fillets, and with flowering wreaths.

When -^v-ith my throngs of men and women I come

To thriving cities I am sought by prayers,

And thousands follow me that they may ask

The path to weal and vantage, craving some

For oracles, whilst others seek to hear

A healing word 'gainst many a foul disease

That all too long hath pierced with grievous pains.'

Empedocles introduced into philosophy the doctrine of the ele-
ments, earth, air, fire, water, as "the four-fold root of all things."
The human body is supposed to be made up of these primordial
substances, health i-esulting from their balance, disease from im-
balance. He holds that nothing can be created or destroyed, and
that there is only transformation, which is the modern theory of
conservation of energy. Everything originates from the attrac-
tion of the foiu' elements and is destroyed by their repulsion, and he

1 From the interesting translations of the poetic fragments of Empedocles,
t>y \\iUiam Ellery Leonard in the Monist, Chicago, 1907, xvii, p. 468.

76 IllSlOliV (tl' MKOICINE

applies the saiiu^ i(l(>a. uikUm' the I'oi-ins of Ion'c and halo, lo the
moral world, ncvclopmciit is due to tlic union of dissimilar v,\v-
nuMits, d(M\iy to llic tcluin of like to like, air to air, fire to firo,
(\artli to earth. Mniprdoclcs is s.aid to \\:i\v raisiMJ Pantiicia Ironi
a t I'ancc, to ha \'(' checked an cpidciiiic of iiiaKarial fe\-ci- hy draining
swampy lands and to have improved the chmatie condition of his
native town by blocking ;i cleft in a moinitairi side. Legend re-
lates that he ended his life by thiowing himself into the crater of
jNIount Etna. Ilis pupil Pausanias i.s said by Plutarch to have
used fire in checking an epidemic.

Tiie Italian School of Philosophers was founded by Pythag-
oras of Samos (580 4S9 B. (\) at Crotona. Pythagoras was a
good geometer and discovc-red the pons asinorum (Euclid, I, 47).
He had studied in l^gypt, whence he probably acquired his doc-
trine of the mystic power of numbers. He held that unity being
perfection and representing God, the number twelve represents
the whole material universe, of which the factors three and four
represent the worlds, the spheres and the primordial elements.
As the monad (1) denotes the active or vital principle in nature,
so the dyad (2) represents the passive principle or mattei", the
triad (3), the world, formed by tlie union of the two former, and
the tetrad (4), the perfection of etei-nally flowing nature. Heaven
is made up of ten celestial spheres (nine of which are visible), the
fixed stars, the seven planets and the earth. The distances of the
celestial spheres from the earth correspond with the proportion of
sounds in the musical scale. Pythagoras was the first to investi-
gate the mathematical phj^sics of sound, and in the following way:
In passing a blacksmith's shop, one day, he noticed that, when the
smith's hammers were struck in rapid succession upon the anvil,
the chords elicited (the octave, thirds and fifths) were all har-
monious; the chord of the fourth was not. Going into the shop,
he found that this was due, not to the shapes of the hammers or the
force with which they w^ere struck, but to the differences in their
individual weights. Upon this hint, he went home and stretched
four strings of the same material, length and thickness, suspending
weights at the lower end of each, equal to the weights of the four
hammers respectively. Upon striking these strings, he got the
chords which he had heard in the smithy, and by subdividing the
strings with, other weights, he was able to construct the musical
scale. This w^as the earliest recorded experiment in physics, and
the scale was, after his death, engraved on brass, and set up in the
temple of Juno at Samos. Pythagoras reasoned that the celestial
spheres might produce sounds b}^ striking upon the surrounding
ether, and these sounds would vary with the velocity of impact and
the relative distance. The distances of the spheres from the earth

GREEK MEDICINE / /

correspond, as we have seen, to the proportion of sounds in the
scale, and as the heavenly bodies move accordinji; to fixed laws, the
sounds produced by them nnist be harmonious. This is the
docti'ine of the "harmony of the spheres." The number-lore of
Pythagoras is thought to have exerted a profound influence upon
the Hippocratic doctrine of crises and critical days, which assigned
fixed periods to the resolution of different diseases. More than to
anything else, the Greek physicians aspired to the scientific power
of prediction. In pathology, the plastic significance of the num-
ber four was combined, in the teaching of Plato and Aristotle, with
the doctrine of the four elements, as follows: Corresponding with
the elements of earth, air, fire and water were the fjualities dry,
cold, hot and moist, accoixling to the scheme:

hot +dry = fire; cold 4-dry = earth,
hot +moist = air ; cold +moist = water.

By reversing these equations, the four elements fire, air, earth and
water, which correspond with our hydrogen, oxygen, carbon,
nitrogen,^ could be resolved into their qualitative components.
Long before Aristotle, probably before Hippocrates, it was held
that, corresponding to these four elements, fire air, water, earth,
and the four qualities, hot, cold, moist, dry, are the four humors
of the body, viz., blood, phlegm, yellow bile, and black bile.
These three sets of elements, qualities and humors could then be
brought, by permutation and combination, into a complex system
of arrangements, based upon the following scheme:

hot +moi.st = blood; cold +moist = phlegm,

hot + dry = yellow bile; cold+dry =blackbile,

the different combinations giving the qualitative aspects of disease,
and, by the same token, of the physiologic action of drugs. The
whole arrangement made up the "humoral pathology" which
regarded health and disease as the proper adjustment or imbalance
respectively of the different components mentioned, and the
scheme was further elaborated by Galen and the Aral)ian physi-
cians, in that remedies and their compounds were classified in nu-
merical scales according to the "degrees" or relative proportions
of their several qualities. Thus the Arabian pharmacists held that
sugar is cold in the first degree, warm in the second degree, dry in
the second degree, and moist in the first degree; cardamoms are
warm in the first degree, cold by one-half a degree, dry in the fii'st
degree, and so on. In Galen's system, the Pythagorean doctrine
of numbers was applied to every aspect of medicine. For example,

• Pagel-Siidhoff, CA.

lis IIISTOKY OK MKDICINE

xhciv luv lUvvc facultii'S, naliirnl. si)iiil iial, aiiiiiial. 'I'licrc arc
throo spirits: tho natural, arisiiiii; iVom ihc Unci-: i1i(> vital, IVoiu
tlio lu>ai't, the aiiiiual, I'loiii llic l>iaiii. the iliicc Ix'iiiu; (jistrihutod
and (litTus(>(l tliiouu;!! I lie ImkIv liy the \ciiis, aiicrios and nerves.
There are tour ajies of man, adolesc(Mi('e (hot and moist) ; manhood
Oiot and dry); advaneed a^e (eold and dry); ok! age (cold and
moist V The eye has seven coats and ihrce liumors. There are
three kinds of drinks, pui'e. as watei'; coiilaining food, as wine;
or a mixture ot' hot 1 1. as syrups and me(liciiial (h'aughts. There are
thi'ee kinds ot fevers, the e|)h(Mneral, in the s])irit ; the ethic (hec-
tic?), in the solids; and the puti'id, in the humoi's; and the putrid
are of four varieties, the continued (synochal), in the blood; the
quotidian. \\\ the i)hlefiin; the tertian, in the yellow bile; the
quartan, in the black bile.' in short, everything in Oalenic and
Arabic nunlicine was mathematically subdivided, usually by the
sacred numcn'als of Pythagoias.

In Egypt, JVthagoras leariu^d the doctrine of transmigration of
souls or metempsychosis, and he is credited with being the first to
establish the fact that the brain is the central organ of the higher
activities, a proposition which was long afterward put to experi-
mental proof by Flourens and Ooltz.

After Pythagoras, the most important of the Greek philo.so-
phers, with the exception of Plato and Aristotle, was Democritus
of Abdera (460-360 B. C), who first stated the theory that every-
thing in nature, including the body and the soul, is made up of
atoms of different shapes and .sizes, the movements of which are
the cause of life and mental activity.

During the Heroic Age, and at the time of the Trojan war, the
dominant people in the Peloponnesus were the athletic, simple-
minded Achaians, whose high regard for surgery and the surgeons
was in stiiking contrast with the attitude of the ancient Romans.
In later times, Greek civilization was made up of two main ele-
ments, the Ionian or Attic, and the Doiic or Spartan. The com-
posite, imaginative, artistic peoples of Ionia and the islands were
interested in everything, and at once brave and warlike, keen and
business-like, serious and high-minded, or, at need, flippant and
ironical. As we see them in the comedies of Aristophanes, Lucian's
dialogues and the idyls of Theocritus, the city-bred Greeks were a
gay, quick-minded, supremely talkative people, adoring intelli-
gence for itself, fonder of speculation than of material facts, keen
at taking an advantage, and cheerfully complaisant as to their
neighbors' morals. Yet they were the same people who could

1 For further illustrations, see the very thoroughgoing account of Galen's
system by Johannitius in the "Medical History" of E. T. W'ithington (London,
1894), pp. 386-396.

GREEK MEDICINE 79

listen with reverent attention to the dramas of ^Eschylus and
Sophocles. In striking contrast were the Dorians or Spartans,
who were essentially robust, unimaginative warriors, severe in
such morals as they had, and like the Homeric Greeks and the
ancient Romans, cultivating the body rather than the mind, as an
essential pai-t of their scheme of military government. Under
the harsh laws of Lycurgus, eugenic procreation was compulsory.
Crippled and deformed infants were exposed or thrown into the
iMHotas. As with all military peoples, the Spartans were narrowly
jealous, suspicious or contemptuous of achievement or prosperity
in other nations. Both lonians and Spartans were extremely
curious about the future, and, like all people of early civilizations,
attached enormous importance to oracles, presages and omens,
so that prognosis was still the essential feature of Greek medicine
before Hippocrates. Among the Spartans, the surgeon was held
in the same high regard as among the Homeric heroes, and Lycurgus
classed them as non-combatant officials. Among the Attic or
Ionian Greeks, the medical profession, as we approach the Age of
Pericles, is found to be more highly specialized. In the first place,
general practitioners l)egan, toward the later period, to receive
stipulated fees for their services instead of the usual thank-offer-
ings of the temples, and, further, city and district or public phy-
sicians came to be appointed at an annual salary which, for the
times, was quite high — -in the case of Democedes at Athens (circa
525 B. C.) about $2000. These existed from Homer's time, are
mentioned by Herodotus, and Diodorus, and were well-known in
Athens from the Periclean Age down to the first century A. D., as
evidenced in Aristophanes, and manj^ Greek inscriptions. After
this time, they became known as apxtaTpoi. From the Greek
institution of the public physician, the Romans derived their
archiater, whence the German "Arzt." In Thessaly, the land of
horses, there was a public veterinarian (Hippiatros).^ There
were also militar}^ and naval surgeons among the Athenians, as
among the Spartans. Xenophon records that there were eight
army surgeons with the expedition of the Ten Thousand, at the
end of the fifth century, and mentions snow-blindness and gangrene
from frostbite. There were again midwives, professional lithoto-
mists, druggists and veterinarians, and finally a special class, the
"rhizotomi," or root gatherers, who wandered through the fields
and forests collecting vegetable simples. The physician's office
was called the latreion, and was used indifferently as a disj:)ensary,
consulting room and operating theatre. In the larger cities there
were public latreia, supported by special taxes.

^ R. Pohl: De Graecoruni niodicis publicis, Janus, Amst., 190.5, x, 491-494.

80 IIlsroHV OI- MKDICINE

MiHlii'al iiisi luct ion was iioi oiuaiiiztMl ;iii(l was, in cITcct. pri-
vate, eilluM' under sonic rcnowncil physician or rccciNCMl Ironi I he
atlherents of tli(> tlirfcrcnl schools. ( )n linishin<2; his coui'se, the
jrrachiato sinipl\' took the physician's oal h of I he i)art iculai' medical
chm or sect to whicli he heloniicd.

Such human anatomy as the Cireek physicians and suij;-eons
learned was. identical with the sculptor's knowled^o of the subject,
which the latter ac(|uircd tluouiili constant familiai-ity with the ap-
pearance of the nude body in action, either durinj>; the athletic con-
tests cele])i-ated by Pindar or in the pahrsti'a. '' If was here," sa3's
WaldsttMU, "with hundreds of nude youths, not onl.y wrestling,
jumpinjz; and ruiniins, but entleavorinp; by systematic practice to
remedy any defect oi- abnormality in aii}^ one liml) or orj^an, that
the artist, day by day, studied his anatomy of the human figure
without the need of enterin<i; the dissecting; I'oom."^ What Pater
calls "the age of athletic pi-izemen " was also the great age of ( Ireek
sculpture, and in nothing is the disci'iminating pow'er of Greek in-
telligence more beautifull}' and nobly shown than in the master-
pieces of the great artists of this period. In reference to their re-
markable capacity for close observation, Waldstein notes that the
pectineus muscle, hidden at the base of Scarpa's triangle, but
highly developed in the stress of Greek athletics, appears in some
of their statues, although it has escaped the attention of modern
artistic anatomists.^

In regard to education and personal hygiene, the Greeks cul-
tivated that ideal of a harmonious development of all the individual
faculties whicli was set aside or lost sight of during the Middle
Ages, but has been steadily coming more and more to the front in
later times. With such training, it is not strange that the Hellenes
of the fifth century attained a degree of civilization and a suprem-
acy in philosophy, Ij-rical and dramatic poetry, sculpture and
architecture, which has not been equaled by any people who came
after them. And this culminating period was also the Age of
Hippocrates.

II. The Classic Period (460-146 B. C.)

European medicine begins properly in the Age of Pericles anfl

its scientific advancement centers in the figure of Hippocrates

^(460-370 B. C.), who gave to Greek medicine its scientific spirit

and its ethical ideals. A contemporary of Sophocles and Eurip-

1 See Charles Waldstein: "The Argive Herajum," Boston, 1902, pp. 400,
401.

2 See Waldstein: Op. cit., 1S6, p. xxx and xxxiv; also editorial m Jour.
Am. Med. Assoc, Chicago, July 15, 1911, p. 222.

GREEK MEDICINE

ides, Aristophanes and Pindar, Socrates and Plato, Herodotus
and Thucydides, Phidias and Poly^notus, he Hved at a time when
the Atlienian democracy had attained its hifi;hest point of develop-
ment. Never, before or since, had so many men of genius appeared
in the same narrow Umits of space and time. Hippo(;rates was
born, according to Soranus, in the island of Cos, at the beginning
of the eightieth Ol^nnpiad, of an Asclepiad family. He received
his first medical instruction from his father, studied at Athens,
and acciuired extensive experience in travel and practic^e among
the cities of Thrace, Thessaly, and Macedonia. The date of his

Hippocrates (460-370 B. C). (Grofk iiiarlile bust in the British Museum.)

death is unknown, his age being variously given as anywhei-e from
85 to 109 years. The eminence of Hippocrates is three-fold: he
dissociated medicine from theurgy and philosophy,^ crystallized
the loose knowledge of the Coan and Cnidian Schools into syste-
matic science, and gave physicians the highest moral inspiration
they have. No future facts that may be dug up about cuneiform
or papyric medicine will ([uite impair the value of the great advance

' "Primus quidem ex omnibus memoria dignus, ab studio sapientia? dis-
ripliiiam hanc separavit." Celsus, Dc re medica, Proicmium.

82 HISTOID OF MioniciNio

lu' madi' in synthetic science. Hel'ore the Ai;(' of l'(Micles, tlie
Gfeek physici:ni was eithei' an associate of i)iiests in times of peace
or a sui'geon in lime of \\:ii\ As I he (Ireek nniid was essentially
plastic, so, in anatomy, his knowledii'e was mainly I lie sculptor's
knowl(Ml<!;e of visible oi" i)alpal)le paits, and, for this reason, his
clinical knowledgtyof intern.al diseases was conlined to externalities
also. l']ven as /

The (ircciaii gods woiT like tlic droeks,
A>k(>m-(\V('(J', colli and fair,

SO the early Hellenic iihf,-.sieian ivmained essentially a surf]::eoii
rather than a clinician in his attitude toward his patients, con-
sidering only the surface indications. In cold, dry enumeration
of symptoms, the Coan and Cnidian tablets and sentences, like
the Egyptian papyri, might have been scientific, if the physicians
of the time had known how to group and coordinate symptoms and
conseciuently to interpret them. All this was changed with the
advent of Hippocrates. All that a man of genius could do for in-
ternal medicine, with no other instrument of precision than his
own open mind and keen senses, he accomplished, and, with these
reservations, his best descriptions of disease are models of their
kind today. To him medicine owes the art of clinical inspection
and observation, and he is, above all, the exemplar of that flexible,
critical, well-poised attitude of mind, ever on the lookout for
sources of error, wdiich is the verj^ essence of the scientific spirit.
As Allbutt points out,^ Hippocrates taught the Coan physicians
that, in relation to an internal malady like empyema or malarial
fever, the basis of all real knowledge lies in the application of the
inductive method, that "grinding or rubbing in," which, better
than the mere haphazard notation of symptoms, consists in going
over them again and again, until the real values in the clinical
picture begin to stand out of themselves. Thus, instead of at-
tributing disease to the gods or other fantastic imaginations, like
his predecessors, Hippocrates virtually founded that bedside
method which was afterw^ard employed with such signal ability
by Sydenham, Heberden, Laennec, Bright and Addison, the Dub-
lin clinicians of the fifties, Frerichs, Duchenne of Boulogne, and
Charcot. Huchard says that the revival of the Hippocratic meth-
ods in the seventeenth century and their triumphant vindication
by the concerted scientific movement of the nineteenth, is the
whole history of internal medicine. The central Hippocratic
doctrine, the humoral pathology, which, as we have seen, attrib-

1 Sir T. C. Allbutt: "The Historibal Relations of Medicine and Surgery,"
London, 1905, pp. 6-13.

GREEK MEDICINE 83

utes all disease to disorders of the fluids of the body, has, in its
original form, long since been discarded, although some phases of
it still survive in the modern th(M)rv of serodiagnosis and sero-
therapy. It is the method of Hippocrates, the use of tlie mind and
senses as diagnostic instruments, together with his transparent
honesty and his elevated conception of the dignity of the physi-
cian's calling, his high seriousness and deep respect for his patients,
that make him, by common consent, the "Father of Medicine"
and the greatest of all physicians.

Claude Bernard said that observation is a passive science, ex-
perimentation an active science. Hippocrates was not acquainted
with experiment, but no physician ever profited more by experience.
Although Asclepiades called this observational method "a medita-
tion upon death," the work of Hippocrates must be judged by its
results. He described the "bilious, malarial, hemoglobinuric "
fevers of Thessaly and Thrace very much as the modern Greek
writers, Gardamatis, Kanellis, and the rest, have found them today,
and it has often been remarked that his clinical pictures of phthisis,
puerperal septicaemia, epilepsy, epidemic parotitis, the ciuotidian,
tertian, and quartan varieties of remittent fever, and some other
diseases might, with a few changes and additions, take their place
in any modern text-book. According to Paul Richter, Hippoc-
rates described anthrax as irvp aypiov {ignis agrestis),^ the "Per-
sian fire" of Avicenna, which Galen wrongly interpreted as ery-
sipelas.- Of the forty-two clinical cases in Hippocrates, — almost
the only records of the kind for the next 1700 years— twenty-five
are reported with characteristic sincerity as fatal, and, unlike
Galen, the author has nothing whatever to say about his own
clever diagnoses and remarkable cures, or of blunders on the part
of his fellow practitioners. "He seems," says Billings, "to have
written mainly for the purpose of telling what he himself knew, and
this motive — rare among all writers — is especially rare among
writers on medicine."^ Through Hippocrates, it was the chief
glory of Greek medicine to have introduced that spontaneous,
first-hand study of nature, with a definitely honest intention, which
is the motor power of modern science. After the Hippocratic
period, the practice of taking clinical case-histories died out, for
Galen's cases were written only to puff his own reputation, and
there was nothing of value up to the postmortems of Benivieni
and Vesalius.

The works attributed to Hippocrates are a Canon or scriptural

1 Epidem., vii, 20.

2 Richter: Arch. f. CJoscli. d. Med., Leipz., 1912-13, vi, 281-297.
U. S. BiUmg-s: "History of Surgery," New York, 1895, p. 24.

84 HISTOUV OK MKDICIN'K

Itoily of (loctrinc, usually divided into lour groups the ficnuinc,
the spui'ious. \\\v works of his picdcccssors. and ihoso of his coii-
icmpoi-ai'ics and followi'i's.' Wi'illcii in Ionic ( Ircck, the licninnc
writiiiijs include, at least, those icniaikaMc clinical jottinj^s, the
apliorisms (Books I-IIl), the ti-eatises on piounosis, on (>|)i(leinie
diseases (Hooks I and III), on diet in acute diseases, wounds of the
iu'ad. dislocations, ffactuivs and ulcefs, and the, excursus, "On
Ails, Waters and Places," which is ;ii once the first hook ever
written on medical <>;eoj»rai)h\-, clini.atolotiy, and anthrop()lo<i;y, if
we except the conteiu])orary narrative of Herodotus, with whom
Hipjiocrates is often in sucii strikinjj; accord. Tlie opKos, or
ph>-sician'.s oath, the earliest and most impressive document in
medical ethics, is not usually rej^arded as a genuine Hippocratic
w^riting, hut is thought to be an ancient temple oath of the Ascle-
l^iads. Yet both the Oath and the Law are so much in keeping
with what we know of the ethical s{)irit of the great Coan that they
are usually included in the liippocratic Canon. To a modern
reader, the best of the Aphorisms seem like the short-hand notes
of a keen mind at the bedside, intent on establishing a true rela-
tion between generals and particulars, accidentals and essentials.
While many of them go straight to the mark, others are strongly
suggestive of the kind of inade(iuate information that was probably
conve^-ed in the Coan and Cnidian sentences. The "Prognostics,"
the finished net result of the "Coan Prenotions " and " Prorrhetics "
of his predecessors, show that the dignity of the Greek physician
was based more upon his ability to predict clinical happenings
than his power to control them. To this end Hippocrates insti-
tuted, for the first time, a careful, .systematic, and thorough-
going examination of the patient's condition, including the facial
appearance, pulse, temperature, respiration, excreta, sputum,
localized pains, and movements of the body. He even notes the
ominous symptom of picking at the coverlid in fevers. He in-
troduced the doctrines of the four humors (humoral pathology),
coction of food in the stomach, healing by first intention, and di-
vided diseases into acute and chronic, endemic and epidemic.
The books on epidemic diseases contain the remarkable case
histories and clinical pictures to which w'e have referred. Not the
least among these is the famous "facies Hippocratica," that won-
derful thumb-nail sketch of the signs of approaching dissolution, -
some touches of which are given in Shakespeare's account of Fal-
staff's death. While there is nuich in the surgical writings of

1 For a chronologic schema of the Hippocratic writings (Petersen-Littre)
see Landsberg, .Tonus, Gotha, 1853, ii, 107-110. •

2 Prognosis, §2.

GREEK MEDICINE 85

Hippocrates that is faulty, incomplete, or not in accordance with
nuKlern practice, they are the only thing of value on the subject
l)efore the time of Celsus. The treatises on fractures, dislocations,
and wounds may be thought of as modern works in the same sense
in which Matthew Arnold regarded Thucydides as a modern
writer, illustrating the wonderful capacity of Greek intelligence
for separating essentials from accidentals, "the tendency to ob-
serve facts with a critical spirit; to search for their li^w, not to
wander among them at random; to judge by the rule of reason,
not by the impulse of prejudice or caprice. "^ Some of the greatest
medical scholars, Malgaigne, Littre, Petrequin, Allbutt, and the
rest, have pronounced the Hippocratic books on fractures, disloca-
tions, and wounds, given the limitations under which they were
written, to be the equal of any similar work of a more recent day.
Dislocations of the shoulder, Hippocrates says, are "rarely in-
wards or outwards, but frequently and chiefly downwards," and
his methods of reduction are practically those of modern times.
He was particularly strong in his account of congenital dislocations,
and in reducing and Ixandaging fractures. He was the first to
notice that- gibbous spine (Pott's disease) often coexists with
tubercle of the lungs, and was familiar with club-foot. In his
treatise on dislocations (§47), he describes the Calot treatment
of spinal deformity by redrei<i<ement force. He was acquainted
with fracture of the clavicle and dislocation of its acromial end, and
knew how to treat both conditions. In the treatment of wounds,
he says that they should never be irrigated except with clean water
or wine, the dry state being nearest to the healthy, the wet to the
(Useased, and the aseptic advantages of extreme dryness were
utilized in the avoidance of greasy dressings and the effort to bring
the fresh edges of the wound into close apposition, sometimes by
the use of astringents.^ Hippocrates recognizes that "rest and
immobilization are of capital importance," and to keep still is even
a better splint than bandaging. He describes the symptoms of
suppuration, and says that, in such cases, medicated dressings,
if applied at all, should be "not upon the wound itself, but around
it." If water was used for irrigation, it had either to be very pure
or else boiled, and the hands and nails of the operator were to be
cleansed. Hippocrates gives the first description of healing Ijy
first and second intention. In his description of the operating-

' Matthew Arnold: "Essays in Criticism," third series, Boston, 1910, p. 48.

- Dislocations, §41; Aphorisms, vi, 46.

' \Vhil(' the flry treatment of wounds was undoulitedly aseptic, as fai- as
it went, Sudhoff warns us against the erroneous tendency of Anagnostakis and
others to regard Hippocratic wound surgery as "antiseptic," in the niotlern
sense.

S() HISTOHY OF Mi;i)I(INE

I'lidiii, lie l;i\s st rcss ui>iiii uodd illiiiiHii;i t ion, poshii'c of I lie pal iciil ,
aiul ilic |)ri'sriicc of capaMc assistants, lie rcl'ci's to t rcpliiiiini;'
and para('(Milrsis, luil apparent ly knew not hini!; of anipiitat ion. In
Ills direct ions for t it'i)lnnin.u; in head injuries \\v notes (liat, a wound
of tlu' loft tenipoi-al icuion will caust^ convulsions on (he riji'hl side
and rice rrrs<t. 'Hic llii^poi'i-atic aphorism (hat diseases not curable
tiy iron ar(> curable by fire, which caused no end of surgical bungling
and malpractice down to the time of Pare, is really |)re-nippo-
cratic, being already mentioned in tli(> Agamemnon of /Eschylus.
It has been traced by Baas to the ancient Hindus. In clinical
diagnosis, Hippoci'ates was the first to note the ''succussion
sound," obtained by shaking the patient on a rigid seat, the ear
being ajiplied to the chest. Littr6 also comments on a "boiling
sound," and a sound like that made by new leather. Cheyne-
Stokes respiration ("like that of a i^ei'son recollecting himself")
is noted in the case of Philiscus.'

In therapeutics, Hippocrates believed simply in assisting na-
ture, and although he knew the use of many drugs, his scheme of
treatment was usually confined to such plain expedients as fresh
air, good diet, purgation, tisans of barley water, wine, massage,
and hydrotherapy. In Greek medicine, black hellebore {Ilelle-
horus niiier) was the universal purge, white hellebore {Veratrum
album), the universal emetic.

In lit(>rary style Hippocrates is hke the best Greek writers of
the classic period, clear, precise, and simple. The tract on ancient
medicine is the first script on medical history. The Law, the Oath,
antl the discourse "On the Sacred Disease" are the loftiest utter-
ances of Greek medicine, and, whether due to Hippocrates or not,
they represent the essence of his teaching. Behind the sensible
phenomena of nature he surmised the existence of some tremendous
power (enormon), which sets things going. The argument of the
"Sacred Disease," which deals with the supposed divine origin of
epilepsy, was the highest reach of free thought for centuries, and
had it been heeded, would have done away forever with the foolish
idea that human ills are caused by gods or demons.

The usual portraits of Hippocrates represent an old, bearded
man of venerable aspect. They are in no sense "counterfeit pre-
sentments," but only traditional. In the "Clouds" of Aristo-
phanes, there is a satirical reference to physicians as lazy, long-
haired foppish individuals with rings and carefully polished nails,
which is supposed to have been, incidentally, a slap at the Father of
INIedicine. It is highly probable that physicians of the Periclean
Age wore their hair and beards as much like the figures of Jove or

1 Epid. Dis., Bk. i. Sect. 3, § 13, Case 1. Cited by Finlayson.

GREEK MEDICINE 87

iEsculapius as possible, and were otherwise not lacking in the self-
sufficiency which characterized the (Ireeks of the period. We may
therefore infer that the supposed portraits of Hippocrates are only
variants of the bust of ^Esculapius, as rendered into marble by
Praxiteles (in the British Museum), or as seen in statuettes from
the shrine of Epidaurus or on the Greek coins of Cos, Pergamus,
and Ej)i(laurus, representing him enthroned. J

The most important editions of Hippocrates are:

1. The folio Latin text of the Opera Omnia, translated and edited by
Fahius Calvus, the friend and patron of Raphael, and pubhshed at Rome
under the auspices of Pope Clement VII in 1525. This was the first complete
edition of Hippocrates to be printed.

2. The folio editio princeps of the Greek text, published in the following
year (1526) by Aldus at Venice.

3. The Basel Opera Omnia, edited by Janus Cornarius and printed by
Froben (153S), highly prized on account of its textual and critical accuracy. _

4. The Greek text and Latin translation of Hieronymus Mercurialis,
printed bv the house of Giunta at Venice in 1538.

5. The Frankfurt edition of 1595, containing the valuable translation
and commentary of Anutius Foesius, the most learned, industrious and able
of the Hippocratic commentators before the time of Littre.

6. The magnificent ten-volume edition of Littre himself (Paris, 1839-61),
containing the Greek text, a French translation (all the readings known having
been carefully collated with critical notes), a biographic introduction and
special introductions to each separate treatise. It was the work of a hfetime
and is one of the triumphs of modern scholarship.

The first Greek text of the Aj^horisms was edited by Francois Rabelais,
and published at Lyons, in 1532. The parallel Greek and Latin texts of J. A.
van der Lintlen (Leyden, 16G5) and C. G. Kiihn (3 v., Leipzig, 1825-7) are
handy and highly esteemed. Of English translations, the most valuable is
that of the Scotch scholar, Francis Adams (London, 1849), which is limited to
the genuine works of Hippocrates. Next to this, the handiest for practical use
is the "CEuvres choisies" of Charles Daremberg (Paris, 1834); an excellent
German translation is that of R. Fuchs (3 v., Munich, 1895-1908). The surgi-
cal writings have been edited, with splendid commentaries, by J. E. Petrequin
(2 v., Paris, 1877-8). To understand the relation of Hippocrates to modern
medicine, the bilingual anthology of Theodor Beck (Hippocrates' Erkennt-
nisse, Jena, 1907) is highly recommended for beginners by Sudhoff.

Hippocrates voiced the spirit of an entire epoch, and after his
time there was a great gap in the continuity of Greek medicine.
In succeeding centuries, the open-minded, receptive spirit of his
teaching became merged into the case-hardened formalism of
dogmatists like Praxagoras,^ who cared more for rigid doctrine
than for investigation. The dogmatists divided medical science
into five branches: physiology, setiolog}^ (pathology), hygiene,
semeiology and therapeutics. Of these, the later Empirics retained
only the practical branches of semeiology and therapeutics, with

'The treatise called irepl rex''v^ in the corpus Hippocraticum has been
translated by Theodor Gomperz as "Die Apologie der Heilkunst" (Leipzig,
1910), and is attributed by him to a sophist of the fifth century, probably of
the school of Protagoras.

88 insTolO (11 MKOICINK

its sill)tli\isions ol' dictiiics. plinriuacolojiy, sur.^cn', and soiiict iiuos
hyjii(Mio.

The jin^Uost scientific name aflci- ITiiipocratcs is that of "tiic
master of those wlio know," ilie Asclepiad Aristotle (HSI ;V22
B. C.) of Stajiira. whntiaNc to niedicine llu> l)e<z;inninji;s of zo(")Iof^y.
comparative anat(ini\- and enihi yoloiry, and the use of formal lofjic
as an instrunicni of precision. Aristotle was a |)upil of Plato,
whose "Tinuieus" imposed some very fantastic theories ui)on medi-
cal teachinc; for centui'ies, but he ilnpl•()^•ed upon his master to the
extent, at least, of descrihin-i; about ")()() species of animals (some of
them fictitious), and studying their bodily structure. His most
important works are his Historin animalium and the treatises on
generation and motion.

He named the aorta, and noted a number of facts in embryology, such as
the punctuni salicns, the movements of the fetal lieart, and tlie possil)iIity of
superfelalion. He announced the doctrine of tlic primacy of the heart, as the
seat of the soul and the source of inn;ite heat, different from elemental fire, in
that it is life-giving. He held that life may originate si)ontaneously from foam
(pnemna, protoplasm) as Aphrodite sprang from the foam of the sea (Curtis).
In spontaneous generation, he believed that the soul is derived from the air and
tiie generative heat from the sun. In sexual generation, the semen is the vehicle
of the sold and the vital he.at, but "the cause of man is his father, the sun
and its motions." He was the first to use the term "anthropologist," but in
the sense of a vain, self-important person, the logical opposite of the "high-
minded man" of his "Ethics." His "entelechies," which he regarded as in-
ternu>diaries i)etween the soul and the body, have been revived, as a substitute
for "vital principles," bj' the morphologist Driesch.

Aristotle left his library and botanic garden to his friend and
pupil, Theophrastus of Eresos (370-286 B. C), who was also a
ph\'sician, and was called the "protol)otanist" because he did for
the vegetable kingdom what Hippocrates had previously done for
surgery and clinical medicine, in that he collated the loose plant-
lore of the woodmen and rhizotomists into a systematic treatise.
The "De HLstoria Plantarum" of Theophrastus contains descrip-
tions of some 500 different plants, and is a good example of the
power of the Greek mind to select what is important and reject
the superfluous. As Greene has shown, ^ he first divided plants
into flowering and flowerless, seed-plants into angiospermous and
gymnospermous, describing their external organs in sequence from
root to fruit. Before Goethe and Linnseus, he recognized the flower
as "a metamorphosed leafy branch." He differentiated aerial
roots from tendrils, and regarded fruit as "every form and phase
of seed encasement, seed included." He understood how the
annual rings on the stems and trunks of trees are formed, and
"without having seen a vegetable cell, yet distinguished clearly

IE. L. Greene: "Landmarks of Botanical History," Washington, Smith-
sonian Inst., 1909, pp. 52-142.

GREEK MEDICINE 89

between parenchymatous and proscnchj^matous tissues." The
most important editions of Thoo])hrastus are the two Aldines of
14!)7 ((Jreek) and 1504 (Latin), and Stapel's Greek and Latin text
of 1644.

Menon, another pupil of Aristotle, wrote the earliest contribu-
tion to medical history (latrika) after Hippocrates, a work which
was mentioned by Galen and discovered about 1895 in a London
papyrus edited l\v Diels (Anonymi Londinensis).

With the founding of Alexandria (331 B. C), Greek science and
culture was firmly implanted in the ancient civilization of Egypt.
Alexandria, with its great university and library, with such great
men as Ptolemy and Euclid, Hero and Strato, thus became the
means of preserving the Greek texts and of spreading Greek doc-
trine to the East.

The colonization of Greek medicine in Egypt led to brilliant
developments in anatomy and surgery, but our knowledge of the
two great Alexandrian anatomists, Herophilus and Erasistratus,
the originators of dissecting, is not based upon any textual record of
their writings, but was pieced together by the scholarship of
Marx and Hieronymus. Both Herophilus and Erasistratus made
important investigations of the nervous system, showing the rela-
tions of the larger nerves to the brain and spinal cord, and dis-
tinguishing sensory and motor nerves, with which they sometimes
confused the tendons. Both are credited with a vague reference
to the lacteal vessels. Herophilus in particular described the
torcular Herophili and the fourth ventricle of the brain, including
the calamus scriptorius. He also described the hyoid bone, the
duodenum, and the prostate gland, and, in the eye, the retina, vit-
reous and ciliary body. Erasistratus described the trachea, the
auricles and chordae tendineffi of the heart, but claimed that the
heart contains no blood. He devised the first crude respiration
calorimetei\, a jar in which he kept fowls, weighing them and their
Excreta, after feeding and completed digestion.^

Considerable light is thrown vipon the Hellenic medical culture grafted
upon Egypt in the Alexandrian period — the dietetics, materia mefiica, pathol-
ogy, wet-nursing, public baths, the surviving ''etiquette" of circumcision and
embalming, the temples of Serapis and Isis (Serapieia, Isieia, corresponding
to the Greek Asclepieia) — in Karl Sufihoff's splendid monograph, "Aerztliches
aus griechischen Papyrus-l'rkunden. Baustein zu einer medicinischen Kultur-
geschichte des Hellenismus," in Studien z. Gesch. d. Med. (Puschmann-Stift-
ung), Xos. 5, 6, Leipzig, 1909.

In the third century B. C, Alexandrian medicine was intro-
duced into Mesopotamia, and in this way Syria acquired the main

' Diels: Anonymi Londinensis, 33, 43. Cited by W. A. Heidel, Harvard
Stud. Cla,ss. Philol., 1911, xxii, 138.

90 HIsroHY (»K MKDICINK

body of Ilippoci'at ic doct liiic rid M^ypt, while nMiiiiiiiitj; inaiiy of
the astroloiiic f(>:itiir('s of Assyi'o-H:il)yIoiii;iii iiiciliciiic. This
dual sj'sttMu was stiuhod l)y Syrian physicians for o\'('r a thousand
years. An intci'cstin.u; Syi-iac [v\\. in (ividonce of this transit ion,
has be(Mi jiuhhshiMl hy W'alhs Hudiic.^ Syi'ia l)(M'ain(> the stepping-
stone or first station l)etAV(HMi Oriental, ( !rirco-Alexan(h'ian and
medieval nieilieine. In th(> Middle Ages, medical translations
from tlu^ (ii-eck texts \ver(> usuall\- made backwards, first into
Syriac, then into Arabic or Hebrew, then into Latin.

The tendencies of the school of i']mpirics, who s])rang from the
Alexaiulrian school in the second centuiy before Chi-ist, culminatcKl
in an actual development of (luasi-experi mental pharmacology
and toxicology at the hands of physicians and wary dilettante
rulers, of whom Mithridates, King of Pontus, achieved a reputation
in the art of giving and taking poisons. He is said to have im-
munizetl himself against poisoning by means of the blood of ducks
fed upon toxic principles, and he aspired to make a universal anti-
dote (alexipharmacy). These "mithridates" and "theriacs," as
they were called, engaged the talents of pharmacists up to the be-
ginning of the eighteenth century, and, in a manner, Mithridates
may be regarded as the originator of the idea of polyvalent drugs
and sera. The principal relics of this empirical poison-lore are the
treatise on poisonous animals by Apollodorus of Alexandria and
two hexameter poems of Nikander on poisonous animals (Theriaca),
and antidotes for poisons (Alexipharmaca), which have been pre-
served in the two Aldine editions of 1499 and 1523, and in the
French versification of these poems by Jacques Grevin (Plantin
imprint, Antwerp, 1568).

III. The Gr.eco-Roman Period (140 B. C.-476 A. D.)

In the early history of Rome, the primitive, dark, small
autochthonous peoples were mastered and overcome by warriors
from the North, the "close-fisted Umbrian" and the "sombre.
Puritanical Sabine." To this inmixture of races, yet another ele-
ment was added, the Etruscans, with their "fleshy bodies, almond
ej^es, big noses and gorgeous tastes," an Oriental race whose
ceremonies and divinations "may have been witnessed by Abra-
ham himself on his entry into Hebron." "The vast, dark back-
ground of Roman medicine," says Allbutt,^ "for us the soil on which
Roman medicine was to be cultivated, consisted of the original
small, dark race, reduced to formal or virtual servitude, degraded,

1 Syrian anatomy [etc] or "The Book of Medicines," ed. E. A. Wallis
Budge. ^ 2 v., Oxford; 1913.

2 Sir T. C. AUbutt: Brit. Med. .lour., London, 1909, ii, 1451.

GR^CO-ROMAN MEDICINE 91

but still vivacious and factious, and of an ascendant and irresisti-
ble aristocracy, mainly of northern invaders, but interpenetrated
by another ruling race of oriental hal)its." The Southern half of
Ital}' and Sicily were not conquered by the Northern invaders,
but remained "Magna Graecia" from the sixth century B. C. to the
tenth century A. D., and from Magna Graecia came one of the
streams of cultural influences which helped to form the School of
Salerno.

After the destruction of Corinth (146 B. C.), Greek medicine
may be said to have migrated to Rome. Before the Greek in-
vasion, the Romans, as the elder Pliny tells us, "got on for 600
years without doctors," relying mainly on medicinal herbs and
domestic simples, superstitious rites and religious observances.
To the Romans of the Empire, the Greek of any description was
the Grceculus esuriens of Juvenal. The proud Roman citizen, who
had a household god for nearly every disease or physiologic func-
tion known to him,^ a domestic herbal medicine of his own,"^ looked
askance upon the itinerant Greek physician, despising him as a
mercenary for accepting compensation for his services, and other-
wise distrusting him as a possilsle poisoner or assassin (Pliny,
XXIX, 7). Archagathus, who came to Rome in the year of the
city 535 (220 B. C.), the first Greek physician to practise there,
came to be known as "Carnifex" for his cruelty in surgery (Pliny,
XXIX, 6). It is further recorded that the intrigues of the physicians
Vettius Valens and Eudemus with Messalina and Livia, royal
ladies both, the non-existence of laws to punish malpractice,
poisoning and fraudulent manipulation of wills (by hired physicians) ,
and the enormous numbers of snakes kept in private houses in pur-
suance of the .Esculapian cult,-^ did little to make medicine respect-
able in the eyes of the austere Roman, who did not relish the intrusion
of foreign ideas (Pliny, xxix, 5-8, 22). Apart from the writings of
a private litterateur like Celsus, the principal Roman contribution
to medicine was the splendid sanitary engineering of the architect
Vitruvius. As Cos and Alexandria were the starting-points of
Greek medicine, early and late, so the most eminent physicians in
Rome came from Asia Minor, from the Schools of Pergamus,
Ephesus, Tralles and Miletus (Wellmann). Greek medicine was
finally established on a respectable footing in Rome through the

' Those Roman gods were worshiped utuier fajiciful liut appropriate names,
as Feljris, S(;abies, Angeronia, Fhionia, Uterina, Cloacina, Mcphitcs, Dea
Salus, and the like.

^ The favorite household remedy of the elder Cato was the cabbage.

' In 293 B. C, the cult of /}<"sculapius was introduced into Rome in the
form of a huge serpent from Epidaurus, representing the god in his chthonian
aspect (see Ovid, Metamorphoses, B., xv, 626-744).

92 IllSTOHY OK MlOniCINK

porsonalit y, tncl. ;iii(l suix'iior ;iluliiy of Asclepiades of I'itliyna
(124 B.C.). who stood ;i|);iit iVoiii I lie I )o<iiii;il ist s mid I lie I'Jiipirics,
and \vhos(> fraiiinciils arc picscnii 1 1 in ( liimpcii 's (ircc^k text
(W'tMinar. 17!)1). As('l('])iad('s was a I'oniial opponent of (he llip-
poci'atic idea that morbid conditions arc (hie to a (hstin-haiicc of the
humors of the l)ody (HumoraHsm). and attributed (Hsease to cou-
strictod or rolnxod eonthtions of its soHd partiel{>s (SoHdism).
This is tlie so-called docli-ine of lh(^ "sti'ietuin el laxuni," which
was derived from the atomic theory of Democritus and has been
revived at dilTereiit times unch'r such various {j;uis(>s as the liiai-
nouiau theory of sthenic and asthenic states, Frieth'ich Hoffmann's
idea of tonic and atonic conditions, Broussais' theory of irritation
as a cause of disease, and Kasori's doctrine of stimulus and contia-
stinmhis. As a logical cons(H]uence of his antagonism to Hippoc-
rates, Asclepiades founded his therapeutic scheme on the efficiency
of systematic intei-ference as opposed to the healing power of
nature; but in pi-actice he was a real Asclepiad, wisely falling back
upon the Coan regime of fresh air, light, appropriate diet, hydro-
therapy, massage, clj^sters, local applications, and sparing internal
medication. He was the first to mention tracheotomy. His in-
fluence for good was that of a superior personality but died witii
him. His pupils and adherents, Themison and others, exag-
gerated his doctrines into a formal '' Methodism, "^ while the fol-
lowers of the Stoic philosophers endeavored to found a system of
medicine based upon the physical action and status of the vital
air, or pneuma, which, taken in by the lungs, to cool the inner
heat engendered by the heart, is carried to the latter, while the
blood is derived from the liver. The Hellenic Renaissance in
Rome was thus characterized by three different ways of looking
at disease as disturbances of the liquid, solid or gaseous con-
stituents of the body, viz., HumoraHsm, Solidism, and Pneu-
matism. In all this welter of theorizing, six names stand out
above the rest — Celsus, Dioscorides, Rufus, Soranus, Galen, and
Antyllus, and most of these were in reality free-lances, that is,
"Eclectics." The Pneumatic School, founded by Athenseus of
Attalia, and continued by his pupil, Claudius Agathinus of Sparta,
the teacher of Archigenes and Leonidas, was the most important
departure. The Syrian Archigenes of Apamea (circa 54-117 A.
D.) has been shown by Max Wellmann to be the source of the text

' AUbutt says that the Methodists and the Empirics were, in some sort, a
continuation of the Coan and Cnidian schools, the former considering the whole
patient and his environment, the latter the locality of the disease and its local
treatment. The Cnidians and the Empirics merely hsted symptoms without
coordinating them and were, in consequence, only haphazard therapeutists.
See Allbutt's lectures on Greek medicine in Rome, Brit. Med. Jour., London,
1909, ii, 1449; 1515; 1598.

GR.ECO-ROMAN xMEDICINE 93

of Aretaeus and of much in Aetius.^ The medical literature of the
second century A. D. — Galen, Soranus, HeUodorus, Antyllus,
Aretseus, as also the great collective works of the Byzantines — •
was made up of excerpts and paraphrases; and this tendency re-
mained the custom in the Middle Ages up to the Renaissance.

Although Roman medicine was almost entirely in Greek hands,
the best account of it we have was the work of Aurelius Cornelius
Celsus, who lived in the reign of Tiberius Caesar. Celsus was,
infcrcntially, not a physician, but a private gentleman of the noble
family of the Cornehi, who, like Cato and Varro, compiled en-,
cyclopedic treatises on medicine, agriculture, and other subjects
for the' benefit of the Admirable Crichtons of his own station in
life. Celsus wrote on medicine in the same spirit in which Virgil
treated of veterinary matters in the third book of the Georgics,
and we are led to suppose that, in accordance with Roman usage,
he rendered medical assistance gratis, very much as the mistress
of an old English estate or Southern plantation played Lady
Bountiful among her friends and dependents. Classed by Pliny
among the men of letters (nuctores) rather than the medici, Celsus
was ignored by the Roman practitioners of his day, and slighted as
"mediocre" {mediocri vir ingenio) by Quintilian. His name is
mentioned only four times by the medieval commentators; but
with the Revival of Learning, he had his revenge, in that his work
("De Re Medicina") was one of the first medical books to be
printed (1478), afterward passing through more separate editions
than almost any other scientific treatise. This was due largely to
the purity and precision of his literary style, his elegant Latinity
assuring him the title of "Cicero medicorum." Celsus is the oldest
medical document after the Hippocratie writings, and, of the
sevent3^-two medical authors mentioned by him, only the work of
Hippocrates himself has come down to us relatively intact. The
"De re medicina'' consists of eight books, the first four of which deal
with diseases treated by diet and regimen, the last four describing
those amenable to drugs and surgery. The third book contains,
among other things, the first full account of heart disease (Cardia-
cus), which became the canon of subsequent knowledge in an-
tiquity.- The fifth book begins with a classified list of drugs, fol-
lowed by a chapter on weights and measures, pharmaceutic meth-
ods and prescriptions, ver}^ much like a modern hand-book of
therapeutics. Celsus was the first to recommend nutritive ene-

MVoUmann: Die pneumatische Schule l)is auf Archigenes. Berlin, 1895.
For- a detailed account of the doctrines of the Pneumatic School, see pages
i:jl^231.

- For a full account of the ancient conception of cardiac diseases, see
Landsberg: Janus, Breslau, 1847, ii, 53-124.

^•4 HISTOHV OF MKDICINE

luata. 'I'lic sixth l)i)()k tivats of skin' and vctuMxvil disoasos as woll
as those ol' the eye, car, nose, throat, and uu)iitli. Thcseveutli book
issur<2;ical, and contains one of the first accounts of the use of tlio
hfjiaturc, and a chissic description of lateral lithotomy. Under
the Konians, surf^ery (inchi(Hn^ ohsteliics and oi)litiKdniolof>;y)
attained to a (lefj;r(>e of i)eri'ection which it was not to reach a<;ain
before the time of Ambroise Pare. Surgical instrumentation,
in particuhir, was highly specialized. Over two hundred different
surgical instruments were found at Pompeii. Herniotomy and
plastic surgery were known, as well as the operations for cataract,
version, and Cesarean section. Sufficient reason for all this may
be found in the constant contact of the Romans with ghidiatoiial
and military surgery, and the fact that the dissection of executed
criminals was sometimes allowed. Hippocrates said that "war
is the only proper school for the surgeon." Celsus is also very full
on the different malarial fevers of Italy and their treatment, on
gout, and on the treatment of different kinds of insanity. He was
the first important writer on medical history, and, in his Pro-
oemium, establishes the status of Hippocrates, Herophilus, Era-
sistratus, and other great names of the past in the spirit of one who
might himself have said

I write as others wrote
On Sunium's height.

The close and careful investigation of the sources of Celsus by Max Well-
mann^ suggests, by confrontation and comparison of many parallel passages,
that this gi-eat text is probably a compilation, perhaps a translation, deriving
mainly from the genuine Hippocratic writings, from the fragment on fistula by
Asclepiades' pupil, the surgeon Meges, from the pharmacologic and therapeutic
writings of HeracUdes of Tarentum (including his exegesis of Hippocrates) and
from Asclepiades himself and his school. In Welknann's view, the presumable
Greek source of Celsus would then be some medical handbook for the laitj',
written before 26 A. D. by one Cassius P'ehx, a body-physician to Tiberius
Caesar. Of the 105 different editions of Celsus extant, the most interesting are
the Florentine cditio princeps (1478), the Milan imprint of 1481, the Venetian
imprint of 1524 (the rarest and costliest of all), the Aldine of 1525, and the
handsome Elzevir of 1657. The standard modern edition is that of Daremberg.
Viewed simply as a book, the best account of CeLsus in any language is un-
questionably the lucid and scholarly essay of Paul Broca.'

The three leading Greek surgeons of the period contemporary
with Celsus were the Pneumatists, Heliodorus, Archigenes (both
mentioned in Juvenal and the latter contemporaneous with Celsus),
Antyllus, contemporaneous with Galen, all of whom have come
down to us in the compilations of the Byzantine writers. Helio-

1 Of the forty skin diseases described by Celsus, alopecia areata is still
remembered as "area Celsi."

2 Wellmann: A. Cornelius Celsus : eine Quellenuntersuchung, Berhn, 1913.
^ "Conferences historiques de la Faculte de medecine," Paris, 1865, pp.

445-497.

GR^rO-ROMAN MEDICINE 95

dorus, w lio antedated Celsus, gave the first account of ligation and
torsion of blood-vessels, and was one of the first to treat stricture
by internal urethrotomy. He also described head injuries, the
operative treatment of hernia, circular and flap amputation. The
latter procedure was fully described by Archigenes of Apamea,
and both surgeons employed ligatures, which, in Galen's time, were
to be bought at a special shop in the Via Sacra. Antyllus, long
before Daviel, mentions the removal of cataract by extraction
and suction, but his name and fame are permanently associated
with his well-known method of treating aneurysms l^y applying
two ligatures and cutting down between them, which held the field
until the time of John Hunter.

Pedacius Dioscorides, the originator of the materia medica,
was a Greek army surgeon in the service of Nero (54-68 A. D.),
and utilized his opportunities of travel in the study of plants. His
work is the authoritative source on the materia medica of anti-
quity, of which he describes about 600 plants and plant-principles,
over a hundred more than Theophrastus. As Theophrastus was
the first scientific botanist, so Dioscorides was the first to write on
medical botany as an applied science. His first book deals with
aromatic, oily, gummy, or resinous plant products; the second with
animal products of dietetic and medicinal value and with cereals
and garden herbs; the third and fourth, with the other medicinal
plants. His classification was qualitative, as in a materia medica,
rather than botanical, but, like Theophrastus, he recognized natural
families of plants before Linnaeus, Adanson, and Jussieu. His
descriptions were followed, "word by word," for sixteen centuries,
and his book, says Greene,^ has been more attentively studied by
learned men than any other botanical work, with the possible ex-
ception of Bauhin's "Pinax" (1623). Up to the beginning of the
seventeenth century the best books on medical botany were still
simple commentaries on the treatise of Dioscorides, which is the
historic source of most of our herbal therapy, even of the famous
medieval substitutes for anesthesia. Mandragora wine (oivos
IJLavdpayopiT7]s) is prescribed internally by Dioscorides as a draught
for insonmia or pain, and in three places (iv, 76) he recommends
it explicitly in surgical operations or cauterization, whether per
OS, as a clyster, or as an inhalation (iv, 81).^

The most interesting editions of Dioscorides, are the Aldinc of 1-199 (Greek
text), the Stephanus of 1516 (Latin translation of RueUius), the rare bilingual
text of Cologne (1529), and the Italian commentary of Mattioli (Venice, 1544),

' E. L. Greene: "Landmarks of Botanical History," Washington, 1909
pp. 151-155.

2 For the citations, see Husemann's elaborate study in Deutsche Ztschr.
f. Chir., Leipz., 1895-6, xUi, 577-587.

96 msiOKY OK MKDUMNK

hIsi) I'XtiTiuely r;uv. TIk" Cinvro-Laliii text of Kurl Si)rciim'l (Leipzig, 1829-
30), (he dofiilitivo CJreek text of Max \\(llin;um (19()i>-7), ami tlio ('.(Minaii
translation, willi inarii'malia. l)y .1. Hciciidcs (Stuttfiart, \[H)'2) arc all vahiahle.
'I'ltc spiiritnis Latin MS. of " Dyascoridcs dc hcrhis fcniininis" in the llofhihlio-
tlu'k at Munich, with its ")()() iiiustral ions, as also the more c()nii)lct(! codex
(,9332) in the Hil)liothe(iiu> Nationale O'^'i-'^', which \\a.s executed about o-lO
A'. D., and was the source of liariopontus, Macer Floridus, the DiaetaTheodori,
and other medieval compilations, is now known to medical scholars as
"pseudo-Dioscorides."' The four authentic (ireek MS.S. are the codices of
Najiles. Constantinople tat Vienna), the illustrated Paris codex No. 2179. and
the MS. of Sir Thomas Phillips (^Chelteiduunj.

Aretaeus the Cajipadociaii, who also lived either under Domitian
or Hadrian (second to third eentiay A. D.), eonies nearer than any
other Greek to the spirit and method of Hippocrates, and is on this
account more readily appreciated l)v modern readers. As Max
Wellmann has shown, by careful comparison of texts, his work
really derives from the writings of Archigenes, and he is thus our
most important source for the teachings of the Pnetnnatic School.^
As a clinician, he ranks next to the Father of Medicine in the
graphic accuracy and fidelity of his pictures of disease, of which
he has given the classic accounts of pneumonia, pleurisy with
empj'ema, diabetes, tetanus, elephantiasis, diphtheria (ulcera
Sj'riaca), the aura in epilepsy, the first clear differentiation be-
tween cerebral and spinal paralysis, indicating the decussation of
the pyramids, and a very full account of the different kinds of
insanity. Althotigh not equal to the later Aetius in the accuracy
of his transcriptions from Archigenes, Aretaeus is easily the most
attractive medical author of his time. He was essentially a stylist,
and the character of his Ionic Greek is said to indicate a late period^
His work is preserved in the faulty Greek text of 1554, in Wigan's
valued Clarendon Press edition (Oxford, 1723), the Leipzig text
of C. G. Kiihn, and the Greek text with English translation by
Francis Adams (London, 1858).

Another great eclectic was Rufus of Ephesus, who lived in the
reign of Trajan (98-117 A. D.), and whose literary remains and
fragments have been preserved in the Paris text of 1554, and that
of Daremberg (Paris, 1879). He wrote a little work on anatomy
in which he described the capsule of the crystalline lens, the mem-
branes of the eye, the optic chiasm, and the oviduct in the sheep.
He also gave the first descriptions of traumatic erysipelas, epi-
thelioma, and bubonic plague (derived from Alexandrian sources).

1 H. Stadler: Janus, Amst., 1899, iv, 548-550.

2 See Wellmann: Die pneumatische Schule, Berlin, 1895, 22-64. The
relation between Aretaeus and Archigenes was first noted by Sprengel. C. W.
Klose (Janus, Gotha, 1851, i, 105; 217) maintained that Aretaeus preceded
Archigenes and was copied by him, but Wellmann's view seems the more
probable. For the many attempts to fix the Ufetime of Aretsus, see Klose,
p. 109.

GRiECO-ROMAN MEDICINE 97

He added many new compounds to the materia medica, of which
his "hiera," a purgative containinji; oolocynth, became celebrated.
Rufus was a good surgeon and described all the known methods of
hemostasis, "digital compression, styptics, the cautery, torsion
and the hgature" (Osier).

Soranus of Ephesus of the second century A. D., a follower
of the Methodist school of Asclepiades, is our leading authority on
the gynecology, obstetrics, and pediatrics of antiquity. His
treatise on midwifery and diseases of women, preserved in Dietz's
Greek text (Konigsberg, 1838), ^ was the original of such famous
works as Roslin's Rosengarten (1513), and Raynalde's "Byrthe of
Mankynde " (15-45) ; and most of the supposed innovations in these
books, such as the obstetric chair or podalic version, have been
traced back to Soranus. After Soranus, there were no real addi-
tions to obstetrics before the time of Pare, some fifteen hundred
years later.

The "Natural History" of Pliny the Elder (23-79 A. D.), of
which Books XX-XXXII deal exclusively with medicine, is a
vast compilation of all that was known in his time of geography,
meteorology, anthropology, botany, zoology, and mineralogy and is
interesting for its many curious facts about plants and drugs, its
sidelights on Roman medicine, and its author's many slaps at
physicians. After the invention of printing it passed through
more than eighty editions. It contains the original references to
many unique things, such as scurvy {stomacace) , Druidical medi-
cine, superfoetation and atavism {ipse avum regeneravit jEthiopum),
the case of Marcus Curius Dentatus, who was born with teeth,
the artificial iron hand of Marcus Sergius, the great-grandfather of
Catiline,- Mithridates' experiments with poisons, or Nero's use of
the monocle or lorgnette {Nero princeps gladiatorum pugnas spectabat
in smaragdo), which, some writers think, may have been an actual
eyeglass. The botanical errors of Pliny remained unchallenged
until the time of Nicholas Leonicenus (1492).

The ancient period closes with the name of the greatest Greek
physician after Hippocrates, Galen^ (131-201 A. D.), the founder
of experimental medicine. Born an architect's son at Pergamus,
Galen's youth and old age were those of a peripatetic. His life
was one long Wanderjahr. At Rome, where he commenced prac-
tice in 164 A. D., he soon attained the leadership of his profession,

1 Later editions by Ermerins (1869), Valentine Rose (1882), and one in
preparation by Joh. Illberg.

*Sec Sudhoff: Mitt. z. Gesch. d. Mod., Leipz., 1916, xv. No. 1.

'From the fifteenth century on, the erroneous form "Claudius Galen"
has been much employed. Edwin Klebs and others have shown it to be a
misreading of Cl[arissimus] Galen. (SudhofT.)

98 HISTOliV OF MEDICINE

l)Ul retinal vavIv to devote liiiiiself to .stu(l\', ti'nvel, ami teacliing.
Compared with Ilippoeratos, (iaieii seoins like llio versatile many-
sided man ol" talent as contrasted with the man of t iiie genius. He
was the most skilled jiractitioner of his time, hiil left no u;ood ac-
eoimts of elinieal cases, only miiaciilons cures. He usually sot his
patients well, and to this end instituted an elaborated systcnn of
polypharmacy,^ the memory of which survives in our language in
the term "galenicals," as applied to vegetable simples. Galen's
place in science is very high, but his roving disposition undoubtedly
did much to develo]) that cocksui'e attitude of mind which made
his writings the fountain-head of ready-made theory, or what
the Germans call "polypragmatism." He had an answ^er ready
for every problem, a reason to assign for every phenomenon. He
elaborated a s^^stem of pathology which combined the humoral
ideas of Hippocrates with the Pythagonnm theory of the four ele-
ments and his own conception of a spirit or "pneuma" penetrat-
ing all the parts. Referring all i)athologic phenomena back to
these postulates, Galen, with fatal facility and ingenuity, proceeded
to explain everything in the light of pure theor}^, thus substituting
a pragmatical system of medical philosophy for the plain notation
and interpretation of facts as taught l)y Hippocrates. The effect
of this dogmatism and infallibility upon after-time was appalling;
for while Galen's monotheism and piety appealed to the Moslems,
his assumption of omniscience was specially adapted to appease the
mental indolence and flatter the complacency of those who were
swayed entirely by reverence for authority. Up to the time of
Vesalius, Ein-opean medicine was one vast argumentimi ad hominem
in which everj-thing relating to anatomy and physiology, as well
as disease, w^as referred back to Galen as a final authority, from
whom there could be no appeal. After his death, European
medicine remained at a dead level for nearly fourteen centuries.

Galen was the most voluminous of all the ancient writers and
the greatest of the theorists and systematists. His works are a
gigantic encyclopedia of the knowledge of his time, including nine
books on anatomy, seventeen on physiology, six on pathology,
sixteen essays on the pulse, the Megatechne (Ars magna) or thera-
peutics (fourteen books), the Microtechne (Ars parva) or ''prac-
tice," and thirty books on pharmacy. He gave us the four classic
symptoms of inflammation, differentiated pneumonia from pleu-
risy, was the first to mention aneurysm,^ separating the traumatic
from the dilated form, described the different forms of phthisis,

1 A.sclepiades, Allbutt says, tended to dissipate the specific in the uni-
versal (physiologic therapeutics); Galen, proceeding from a theoretic mono-
theism, tended to lose the universal in the particular (polypharmacy).

2 "Alethodus Medendi," lib. v, f. 63 (Linacre's translation of 1519).

GR^CO-ROMAN MEDICINE 99

mentioning; its infectious nature antl proposing a full milk diet
and cliniatotherapy (sea voyages and dry elevated places) for the
disease; he understood the diathetic relation between calculus
and gout, and his prescriptions indicate a most intelligent use of
opium, hyoscyamus, hellebore and colocynth, hartshorn, turpen-
tine, alcohol (wine), sugar diet (honey), grape-juice, barley-water,
and cold compresses. He introduced the doctrine of the four
temperaments and set the pace for a fantastic pulse-lore or "ars
sphygmica," which was still in vogue in the eighteenth century.
He traveled far to learn all he could about the native remedies of
different regions, and even paid two special visits to the isle of
Lemnos in order to investigate the therapeutic value of its sacred
sealed earth (terra sigillata).^ As an anatomist, Galen gave many
excellent descriptions, especially of the motor and locomotor
systems, but his work was faulty and inaccurate, as being based
largely on the dissection of apes and swine. He studied osteology
in the ape (Macacus ecaudatus) and from stray human skeletons,
such as that of the robber he once found on a lonely mountainside.
His myology was based mainly upon the study of the musculature
of the Barbary ape (Macacus inuus), but he clearly understood the
difference between origin and insertion and knew most of the
muscles and their functions, although he had little nomenclature. ^
His splanchnology was defective and erroneous; his neurology is
the best feature of his anatomical work. From his dissections of
the brains of oxen, he distinguished the dura mater and pia mater,
the corpus callosum, the third and fourth ventricles with the iter
(Sylvian aqueduct), the fornix, corpora quadrigemina, vermi-
form process, calamus scriptorius, hypophysis and infundibulum.
Of the twelve cerel)i-al nerves, he knew seven pairs,'' also the sympa-
thetic ganglia, which he described as the reenforcers of the nerves.
His treatise on anatomical "administration" or method was the
first treatise on dissection, and authoritative through the centuries.
His contributions to the science were accepted as finalities up to
the time of Vesalius. But if Galen's anatomy failed in the long
run, through the fact that it was simian, canine, bovine, porcine,
rather than human, and because he subordinated accurate descrip-
tion of structures to speculation about their functions, he was the
first and only experimental physiologist before Harvey. He was
the first to describe the cranial nerves and the sympathetic system,
made the first experimental sections of the spinal cord, producing

iC. J. S. Thompson: Terra sigillata, Tr. XVII. Internat. Med. Cong.,
1913, London, 1914, sect, xxiii, 433-444.

2 J. S. Milno: Galen's knowledge of muscular anatomy, ibid., 389-400.

' For Galen's knowledge of the cerebral nerves, see Th. Beck, Arch. f.
Gesch. d. Med., Leipzig, 1909-10, iii, 110-114.

100 IllsroUV OF MKDICINE

luMuiplc^ia ; iJitxluccd ;ii)li(iiii;i liy culliiii:, the tcciiiiciil l.-irNiifical ;
and iiavc tlu' first \ali(l cxplaiiat ion of llic iiiccli.-iiiisiii of respira-
tion. He showed that the ailriics coiilaili Mood (l)y pcrt'onnlllfi;
tho Antylhis opciation), and (kMuoiisti-atcd the inotoi' power of the
hi\\v\ l»y sliowiii^- that th(> l)loo(l pulsates hetweeii the heart and a
lijiated arlei-y. hui not beyond it. He also showed that an ex-
cised heart will iieat outside tlie Ixxly, a eoinnioii incident at the
saerifieial rites, and ^ood cn idence that its heat do(>s not d(>pen(l
upon tlie nervous system. In tliese matters Galen fj;ave to medi-
cine that method of puttinu; (piestions to nature and of arran^in^
things so that nature may answer them, which we call e.xpei-i-
ment. Daremberg once repeated all of Galen's experiments in
the .laiihn des Plantes. In his i)hysiologic speculations about
his findings, Galen spoiled his work by his mania for teleology,
which he got from Aristotle's reading of nature. His bump of
r(>verence was inoi'dinately developed, and although he was right
in his primary assumi)tion that structure follows function, his en-
thusiasm led him into the strangest and most arbitrary hypotheses
based d priori upon his centric idea that every thing in nature
sho\vs an element of design and the goodness of the Creator.
Modern biologists see the living creature and its life-history as the
resultant of the parallelogram of two forces, the reaction of the
innate heredity against the outer environment. They reason that
differences in structure are the resultant of adaptation to the stress
and strain of environment. But Galen, as Neuburger puts it,
made his whole ph^'siological theory "a skilful and well-instructed
special pleading for the cause of design in nature," whereby he
lost himself in d priori speculations "to explain nature's execution
before even her mechanism had been demonstrated." His con-
tributions to the physiology of the nervous, respiratory, and cir-
culatory sj'stems, however faulty, were the only real knowledge for
seventeen centuries.^

There are three Galenic superstitions which, through their
plausible character, have had a great deal to do with preventing
the advancement of medical science. First, the doctrine of Vital-
ism, Avhich maintained that the blood is endued with "natural
spirits" in the liver, wdth "vital spirits" in the left ventricle of the
heart, and that the vital spirits are converted into "animal spirits"
in the brain, the w^hole organism being animated by a "pneuma."
Modifications of this theory, however attractive, have driven
physiology into many a delusive blind alley, even up to the time of
Driesch. Second, the notion that the blood, in its transit through

1 A possible exception to this statement would be the few physiologic
experiments made by VesaUus which, however, passed unnoticed in his time.

GR.ECO-ROMAN MKUICINE 101

the body, passes from the right to the left ventricle by means of
certain imaginary invisible pores in the interventriciilai" septum,
prevented theorists from having real insight into the circulation
until the time of Harvey.' Third, the idea that "coction" or
suppuration, is an essential part of the healing of wounds led to
those Arabist notions of "healing by second intention," setons and
laudable pus, which, although combated by Mondeville, Paracel-
sus and Pare, were not entirely overthrown before the advent of
Lister.

Of the many editions of Galen's works, the most important are the Aldine
Greek text of 1525 (five vohmies), the Basel edition of 1538, with the initial
letter by Holbein, and the nine different editions of the Latin text puljlished by
the house of Givmta at Venice between the years 1541 and 1625. Of Latin
translations, Conrad Gesner's (Basel, 1562), with the biographic illustrations
on the title page, and those of Linacre, are perhaps the most famous. Among
the modern editions, the best are the twenty-volume Greek and Latin text of
Kiilm (Leipzig, 1821-3.3)-, with a valuable index, and Daremberg's anthology
in two volumes (Paris, 1854-6). Galen's seven books of anatomy, an Arabic
MS. of the Ninth Century A. D., with German translation and commentary
by Max Simon (Leipzig, 1906) is very valuable. The most famous single
treatise of Galen is his monograph on the physiologic and teleologic aspects of
the different parts of the human body ("De Usu Partium"), the prototype of
all subsequent "Bridgewater treatises." The Corpus medicorum Graecorum
(Leipzig and Berhn), a series of Teubner texts published under the auspices of
the collective scientific academies of Europe, will include all the Greek writers.
The standard source for the minor Greek and Graeco-Latin writers is Valentin
Rose's Anecdota grseca et grseco latina (Berlin, 1864-70).

Of the condition of medicine under the Romans, considerable
is known but little need be said. Much of Roman medicine is
found in the secular writers, particularly the satirists and epi-
grammatists, and in the inscriptions. Before the second century
\. D., the Romans employed medical slaves (servi medici) , or relied
upon their special medical gods (Febris, Scabies, Uterina, and the
rest), with an occasional dilettante interest in healing on their own
account. How the early Roman citizens looked upon the Greek
physicians has been seen. But even after Asclepiades, Galen,
and Soranus had made the status of medicine respectable, the
Roman Quirites continued to regard the profession as beneath
them. Some Romans, early and late, practised or wrote upon
medicine, such as Scribonius Largus, author of Compositiones

' Galen regarded the arterial blood (charged with "vital" spirits) and the
venous blood (charged with "natural" spirits) as ebbing and flowing, back
and forth, through their respective channels, but having no connection with
each other except through the interventricular pores. In hke manner the
"animal (psychical) spirits" were supposed to course back and forth tkrough
the hollow nerves, which became solid after death. For a good account of this
|)hase of Galenic physiology, see Sir Michael Foster, "Lectures on the History
of Physiology," Cambridge, 1901, pp. 12, 13.

- For a valuable tabulation of Galen's citations from the older writers
(cd. Kiilm), see J. Zimmermann's Berhn dissertation (1902).

102 iiisiom oi' Mi:i)iciNK

Mttlicoruni (17 A. 1).), a coinpilalioii of diii^s and prescriptions,
wild also left an important oxpcctnraiit inixturo for phthisis
and lii'st suu'ii'cstcd ilic use of I he clcclric ra>'-lish in headaches;
CiPlius Aurelianus, the fifth centni\- nenroiofiisl , who ])araphrased
a lost work of Soranus of l']phesus on ])i'a('tice; C^uintus Serenus
Sanionicus, who wrote a di(hictic po(>in on popular medicine in
the third century A. D. (taken fi-oiu IMiny); S(>xtus Phicitus l'ap>-
riensis. who wrote a l)ook on animal iiKMlicine (fourth century);
\'in(Hciamis At'ei\ who wiote anatomic treatises and a foimulary
in the same period; C'assius Felix, the supposed oii<>;inal source of
(\^lsus. and Tlu^odorus Prisciamis, court physician to Cii'atian.
Besides the "medici" proper, there were the lieri) fi;athercrs
(rhizotomi). the druf>-ped(llers ipharniacopolw), the salve-dealers
(iingne7itarii), the army sinti'eons (medici cohortis, medici legionis),
and the archiatri or b()dy physicians to the emperors, some of
whom were also public or communal {archiatri pnpt(larci<). There
w(M'e also the less reputable iatroliptiv, or l)atli attendants, iiicdiccp
or female healers, sag(e or wise-women, ohstetricce, or midwives, the
professional poisoners (pharmacopoei) , and the depraved char-
acters who sold philtei's and abortifacients. A very dubious and
much satirized class were the eye specialists or oculists (medici
ocularii) who, each of them, sokl a special eye salve stamped with
his own private seal, usually compounded of salts of zinc and
other metals. Nearly two hundred of these seals have been
found. The house of the Vettii, excavated at Pompeii, has a
mural painting, representing cupids and psyches as "unguentarii"
in the act of expressing, heating, testing and selling olive oil
(Peters). Many evidences of Roman medicine have been found in
Britain.^

A special feature of Roman medioine was the cultivation of warm public
baths (thermw) and of mineral springs. General hydrotherapy was intro-
duced by A8cl(>piades, and no less than 1800 public baths had been founded
during the period 334 B. C.-180 A. D. (Haeser). The baths of Caracalla
and Diocletian had marble accommodations for 1600 and 3000 persons re-
spectively, the water being supphed from the great aqueducts. The estab-
lishments for cold bathing (frigidaria) often had a swimming-pool (piscina)
attached, l)ut it is not known whether the warm baths (lepidaria, caUdaria)
were heated as to the water or to the air of the room. The principal natural
springs were the thermae at Baise near Naples, Thermopylae in Greece (espe-
cially patronized by the Emperor Hadrian), and, in the Roman Colonies, Aix
les Bains (Aquce Gratince Allobrogum), Aix in Provence (Aqiue Sextice), Bag-
neres de Bigorre (Vicus Aquensia), Baden in Switzerland {Thermo polls), Baden
near Vienna {Aqum Pannonica), Baden Baden {Civitas Aquensis), Aix la
Chapelle (Aquisgranum), and Wiesbaden (Aquce Mattiacenses)} Military hos-

iSee H.Barnes: Proc. Roy. Soc. Aled. (Sect. Hist. Med.), London, 1913-
14, vii, 71-87.

2 Haeser: "Lehrb. d. Gesch. d. Med." 3. Aufl., Leipz., 187.5, i, 494.

GRiECO-ROMAN MEDICINE 103

pitals (valetudinnria) are mentioned by Hyftinus, and have been excavated at
Xeuss {('astruin Xova'sium) and Carnuntuiu (near Vieinia).

The Etruscans were wonderfully skillcHl in dentistry. Martial mentions
false teeth. Some remarkable specimens of Etruscan bridgework arc pre-
served in the museum of Corneto and have been described by Guerini and
Walsh.i

The special talent of the Romans was for miUtary science and
the making and administration of laws. Their hygienic achieve-
ments, such as cremation, the sensible, well-ventilated houses,
the great aqueducts, sewers, drains and public baths, were of far
greater consequence than their native literary contributions to
medicine. Yet even here, as Sudhoff says, they often produced hy-
gienic results without intention, things of hygienic value but of
non-medical origin.- Roman medicine, at best, can only be re-
garded as an offshoot or subvariety of Greek medicine.

1 Guerini: "History of Dentistry," New York, 1909,67-76, and J. J.
\Yalsh, "Modem Progress and History," Xew York, 1912, 79-103. For
ancient dental forceps, see Sudhoff: Arch. f. Gesch. d. Med., Leipz., 1908-9,
ii, 00-69, 3 pi.

-Karl SudhofT: "Hygienische Gedanken und ihre Manifestationen in
der Weltgeschichte," Deutsche Revue, Stuttgart, Oct., 1911, p. 43.

THE BYZANTINE PERIOD (476 732 A. D.)

Thk downfall of the Wcstcni Komaii lMni)ir(» was mainly duo
to the d(\u;(MU 'ration of the Honian slock tlirouj2;h mixture with
weaker and inferior races, niid the soldiers who had never known
defeat became an easy pic.x- to the invading l)arl)arians of the
North, infornieil with \hv. rugged and ]irimitive virtues which they
themselves had once ])ossessed. In the days of the Repul)lic, the
Roman had matched the Si)ai1an as a virile soldier and law giver,
essentially simj)le in mind and morals. In a state of society
"where wealth accumulates and men decay," he could not hold
his own with the flexible, wily Greek of later times, nor with the
subtle, fatalistic Oriental, both of them more agile in mind and
more dexterous in action than lie. Like the Normans in Sicily,
or those English colonists in Ireland, who became proverbially
"Hibernis ipsis Hiberniores," he fell under that strange law by
which the conqueror, in the end, assimilates himself to the con-
quered ])eople. By process of race-inmixture the Romans of the
fifth century A. D. had acquired the "serene impartiality" of
spirit which Professor Huxley attributes to the mongrel races, and
some think that the malarial fevers which had begun to devastate
the Italian peninsula had as much to do with weakening their
fiber as the luxuries and dissipations to which they were continually
exposed.^ Degeneration of mind and body, with consequent re-
laxation of morals, led to mysticism and that respect for the au-
thority of magic and the supernatural which was to pave the way
for the bigotry, dogmatism and mental inertia of the Middle Ages.
Under these conditions, the physician became more and more of a
mercenary, parasite and vendor of quack medicines. Long before
the downfall of Rome the magician, the thaumaturgist, the pro-
fessional poisoner, and the courtezan who peddled drugs —

Ambubaiaruin collegia, pharmocopolse,
Mendici, mimae, balatrones, hoc genus omne,

were familiar figures. In the Eastern Empire, the decomposition of
intelligence was even more pronounced, and today the adjective
"Byzantine" connotes little more than luxury, effemination and
sloth. Through the conflict of Pagan and Christian modes of
thought, almost all of the intellectual energy of the period was dissi-

1 In particular, W. H. S. Jones: Malaria and Greek history, Manchester,
1909. His view is vigorously opposed by J. P. Cardamatis (Arch. f. Schiffs- u.
Tropen-Hyg., Leipzig, 1915, xix, 273, 301).

104

THE BYZANTINE PERIOD 105

pated in religious controversy, while medicine had become an affair
of salves and poultices, talismans and pentagrams, with a mum-
bling of incantations and spoils very like the backwoods pranks of
Tom Sawyer and Hucklel)erry Finn, or some of the vagaries of
Christian Science. There were doubtless good people, then as
now, Init they did not come to the front, and there is pith in (lib-
bon's sarcasm about two pious characters of the period: "We
know his vices and are ignorant of her virtues." This supine cast
of mind and morals is well reflected in the Byzantine mysticism
of Wagner's Parsifal, and the figure of Kundry, the sorcerer's
minion, who brings nostrums from the far East to alleviate the
sufferings of Anfortas, may serve as a sort of type and symbol of
Byzantine medicine. In spite of all that has l^een written by
Curtis, Finlay, Zinkeisen, and others, little more can be claimed
for Byzantium than is contained in the sentence of Allbutt: "The
chief monuments of learning were stored in Byzantium until
Western Europe was fit to take care of them."^ The solitary thing
the Eastern Empire did for European medicine was to preserve
something of the language, culture and literary texts of Greece.
Concerning this point, Hirschljerg says conclusively that By-
zantium had no medieval period, but simpty went on "marking
time" in the past. This is borne out by the researches of other
historians, which show that the habit of compilation established
by the later Greek and Roman writers remained a set custom in
Eastern and Western Europe even beyond the Renaissance period.
Although the Byzantine power lasted over a thousand years (395-
1453 A. D.), medical history is concerned chiefly with the names of
four industrious compilers who were prominent physicians in the
first three centuries of its existence. Of these, the courtier Ori-
basius (325-403 A. D.), a friend and physician-in-ordinary to
Julian the Apostate and sometime quaestor of Constantinople, is
chiefly remarkable as a torch-bearer of knowledge rather than as
an original writer, but his compilations are highly valued by
scholars in that he always gives his authorities, and, so far as is
known, quotes them exactly. Medicine is indebted to him for a
remarkable anthology of the works of his predecessors, many of
whom (the surgeons Archigenes, Heliodorus, Antyllus, for instance)
might otherwise have })een lost to posterity. Galen in ])articular
he expounded with loving care and did much to establish him in
his central position of authority during the Dark Ages. Like
Galen, Oril)asius took all knowledge for his province. His great
encyclopedia of medicine comprised indeed over seventy volumes,

' Sir T. C. Allbutt: Science and Mediaeval Thought, London, 1901, 65.
See also his illuminating Finlayson lecture in Glasgow Med. Jour., 1913,
Ixxx, :321, 422.

1()() lllSTOKV i>I' Mi:i)Ul\K

(li-aliiiji witli all as|H'cts of tlir siiltjcct. Much of this has \)vvu
lost, hut its ant lior »>|)itomiz(>(l his kiiowlcdfiic in the lit lie "Syuo])-
sis" which he iiiaijc lor llic use of his son. His " iMipoi'ista," or
jiopular treatise on niciliciiie, had the I'arc merit of avoiding any
curnMit su])erstitions and inculcat iiiii sound therapeutic (loctrin(\
The stud(Mit of medical histoi-y will read Orihasius to best ad-
vantage in Daremherg's splendid six-volume edition, with the
pai'allel [""rencli translation (Paris, 1851-7G).

Aetiusof Ainida,\\ho lived in the sixth century, A. 1).. was also
a I'oyal physician [io Justinian 1, 527-(jr)) and cuincs obsequii
(lord high chaniherlain) at the court of Byzantium. He left an
cxtcMisive compilation, usually called the "'retrat)ii)lion," wiiieh is
a |)rincipal authoiitx' for what we know of the work of Rufus of
Ejihesus and Leonides in surgery, Soranus and Philumenus in
gynecology and t)l)st(^ti'ics. The first eiglit hooks wer(> j^uhlished
at \'enice in ir)l34, the hitherto unprinted hooks IX -XAT heing
now in prei)aration hy Max Wellmann. Aetius gives a tlescription
of epidemic dii)hthcria not unlike that of Aretaius, mentioning
paralysis of the palate as a sequel, and his work contains the best
account of diseases of the eye, ear, nose, throat and teeth in the
literature of antiquity. He has also interesting chapters on goitre
and hydrophobia. Aluch of Aetius, as Max W'eUmann has shown,
is taken from Archigenes through Philumenus. His accounts of
ele])hantiasis, ileus, the varieties of headache, pneumonia, pleurisy,
epilepsy, and the treatment of these conditions, are far more ac-
ciu'atc than those of Areta;us, whose work also derives from the
same common source. In surgery, he supplies many of the lost
passages in Oribasius, and describes modes of procedure (tonsillot-
omy, urethrotomy, treatment of hemorrhoids) not found else-
where. To him is due the first description of ligation of the
brachial artery above the sac for aneurism, which was later done
by Ciuillemeau (1594) and Anel (1710), to become in time the
Hunterian method (1786) (Osier). ^ Aetius recommended many
salves and plasters, and is supposed to have been a Christian by
reason of the charms and spells he proposes for their preparation.
Thus, in preparing a plaster, he says, one should intone repeatedly,
"The God of Abraham, the God of Isaac, the God of Jacob, give
virtue to this medicament." To remove a bone stuck in the throat,
one should cry out in a loud voice: "As Jesus Christ drew Lazarus
from the grave, and Jonah out of the whale, thus Blasius, the
martvr and servant of God, commands 'Bone come up or go
down.'"

1 Osier: Lancet, Lomlon, 1915, i, 950. Osier says that the original de-
scription of Aetius was wrongly attributed by Sprengel to Philagrius.

THE BYZANTINE PERIOD 107

Alexander of Tralles (525-605), a much traveled i)ractitioner
who finally settled in Rome, was the only one of the Byzantine
compilers who displayed any special originality. Although a
follower of Galen, his ''Practica" (first printed at Lyons in 1504)"^
contains some descriptions of disease and some prescriptions which
seem to 1)C his owni, notably those containing burnt substances.
His accounts of insanity, gout and the dysenteric and choleraic
disorders arc above the average. He has a highly original chapter
on intestinal worms and vermifuges, and he is said to have been the
first to mention rhu!)arb, and first recommended colchicum (her-
modactyl) in gout. Like Galen, he recommends a full milk diet,
change of air and sea voyages for phthisis, but his other prescrip-
tions are often disfigured by the obtrusion of the usual Byzantine
s]iells and charms.

Paul of ^gina (625-690), the last of the Greek eclectics and
compilers, was the author of an "Epitome" of medicine in seven
books, first printed by the Aldine press at Venice in 1528 and 1553,
later in tlie modern text (with French translation) of Rene Brian
(Paris, 1855), and Englished for the Sydenham Society by Francis
Adams (London, 1834-47).- Although he was a physician of high
repute, we may judge how low medicine had sunk in the seventh
century by his apologetic statements in regard to any lack of
originality on his part. He frankly admits that the ancients have
said all that could be said on the subject and that he is only a
humble scribe. Paul was, however, a very capable surgeon, and
the sixth book of his Epitome was the standard work on the sub-
ject up to the time of Albucasis, who indeed drew upon it for most
of his information. Paul gives original descriptions of lithotomy,
trephining, tonsillotomy, paracentesis and amputation of the
breast, but stopped short of opening the chest for empyema. In
describing herniotomy, he recommends removal of the testicles,
a mutilation which was perpetuated by the Arabians and continued
to be the vogue with the outcast medieval surgeons until far into
the sixteenth century. Paul gives the fullest account we have of
the eye surgery and military surgery of antiquity. He mentions
the frequency of naval physicians in his time. He omits all refer-
ence to podalic version, and as his authority was upheld by the
Arabians, the procedure disappears from literature until the time
of Roslin and Pare.

Among the minor writers' of the Byzantine period, we may men-

1 Modern readers may consult the admirable edition of Alexander Tralli-
anus by Thcodor Puschmaiin (2 vols.), Vienna, 1S78-9, with German transla-
tion and biographic introduction.

^ A valuable German translation, with commentary, by J. Berendes, was
published in Janus, Amst., 1908-13 passim, and at Leyden (E. .J. Brill, 1914).

lOS IllSIOKV OK MKDICINK

tioii I'ulilius \'(\m'tius l\(Mi;itus, a liorsc trader and lai'vicr dI' tlio
tit'th {•(Miturv, A. IX. whose "Ais \'eteriiiaria." i)ulilished at Basel
in l.")l2S, rontains the tir<t aiitlieiitic accoiinl of i^landei's; and
Thoophilus Pi-ot()s|iatliaiius, i)liysician and captain of the guard
to th(> lun])(M'or llerachus ((iO:^ (141), and a e()ntein|)()rary of Paul
of ,l]iiina. lie left an oiiiiinal deseri])! ion of the ])alniaris hrevis
muscle and the <.)lfactor\' ner\-e, and wrote a treatise on the urine'
which for conturios u])held the ( lalenic doctrine that the latter is a
tiltrat(> of the Mood, secreted in the poital \'ein and vena cava.
The same doctrine was maintained unchaniied in the thirtecMith
century hy .h)hainies Actuarius, tiie last of the Byzantine writers,
whose t'lahorate treatise on the urine made the notion authoritative
with th(> absurd "water-casters" of a later time. He is nu^morable
as the first to use a graduated glass for examining the urine, al-
though the markings upon it w(M'e not (piantitative but qualitative,
indicating the possil)l(> position of the different scums. ])reci])itates
antl sediuKMits.

During the Byzantine i)eriod, an interesting contribution to
clinical medicine was made by the Fathers of the Christian Church,
namely, the description of the earlier epidemics of smallpox.
Eusebius descril^ed a Syrian epidemic in 302 A. D., another Avas
described by Cregory of Tours in 581, and the term "variola" was
first emi)loyecl by Alarius, Bishop of Avenches, in 570. It is said
that the disease was also described in the Irish monastery records
of 675 A. D. as "Bolgagh" and "Galar Breac." The Chronicle
of St. Denis (580) mentions diphtheria as esquinancie. Baronius
described Roman epidemics of 856 and 1004, and Cedrenus records
a Byzantine epidemic of 1039 as cynaiiche (Hirsch).

In 1495, a valuable illustrated collection of surgical MS. made by the
Byzantine physician, Niketas, 900 A. D., was purchased in Crete by Janos
Laskaris for Lorenzo de' Medici, was subsequently acquired 'by Cardinal
Nicolas Rudolfi and is now one of the treasures of the Laurentian Library at
Florence (Codex Ixxiv, 7). This contains .30 full-sized plates illustrating the
commentary of Apollonius of Kitium on the Hippocratic treatise on disloca-
tions (Trept apdpwv) and 63 smaller cuts scattered through the pages of
Soranus' treatise on bandaging. The Apollonian pictures, which are also to be
found in Codex 3632 of the University Library at Bologna, are pen and brush
drawings in dark brown tone representing the various manipulations and ap-
paratus emploj^ed in reducing dislocations, the figures in each case being sur-
mounted by an archway of ornate Byzantine design. Their origins, SudhofT
thinks, go back to Alexandria or Cj-prus, where Apollonius wrote his commen-
tary during 81-.58 B. C. They were undoubtedly transmitted directly from an-
tiquity,^ and, therefore, represent the genuine Hippocratic traditions of sur-
gical practice as transmitted through later Greek channels to Byzantium.
The two sets of pictures were reproduced in freehand stj'le by the Renaissance

1 Edited by W. A. Greenhill (Oxford, 1S42).

2 Sudhoff : Beitrage zur Geschichte dor Chirurgie im Mittelalter, Leipzig,
1914, 4-7.

THE BYZANTINE PERIOD iUU

artists Jan Santorinos and Francesco Primaticcio and these reproductions were
used by Guido Guidi to illustrate his surgical collections (Paris, 1544).' The
treatise of ApoUonius has since been reprinted, w-ith the illustrations by Her-
mann Scluine (1896).'- The 200 designs used l)y Guido Guidi have been rejiro-
duced by H. Omont.^

' The pictures are to be found in Guido Guidi's "Chiurgia e greco in
latinum conversa" (Paris, 1544), in vol. iii of his "Ars Medicinahs," (Venice,
Kill), in his "Opera Omnia" (Frankfort, 1668), and in Conrad Gesner's
collection "Do chirurgia scriptores optimi," Ziirich, 1555, 321-358 (Sudhoff).

-ApoUonius von Kitium: lUustrierter Kommentar zur der Hippo-
kratischen Schrift irepl apOpuf, hrsg. von H. Schone, Leipzig, 1896.

^ Bibliotheque nationale. Departement des manuscrits. Collection de
chirurgiens grecs (M.S. latin, 6866). Ed. II. Omont, Paris [s. d.].

THE MOHAMMEDAN AND JEWISH PERIODS
(732 1096 A. D.)

]^\ the swords of Molianinu'd and his omirs, tlio wild outlaw
clans o( the Asian and Afrii-an deserts wer(> converted into nations
capable of acting as military and social units, but it was not until
long after his death, when the mighty empire w'hich he founded was
sulnlividcd into cali])hates, that the sciences and arts were per-
mitted to develop. During the ]ieriod of conciuest and conversion,
the fanatical, fatalistic zeal of the Moslems tended naturally
toward the destructioii and persecution of the things of the mind.
A\'hile the principal service of Islam to medicine was the preserva-
tion of Greek culture, yet the Saracens themselves were the origi-
nators not only of algebra, chemistry and gc^ology, but of many of
the so-called improvements or refinements of civilization, such as
street-lamps, window-panes, fireworks, stringed instruments, culti-
vated fruits, perfumes, spices, and that "often-changed and often-
washed undergarment of linen or cotton which still passes among
ladies under its old Arabic name."i In the intellectual sphere, the
monotheism and the dialectic tendencies of Galen and Aristotle
appealetl strongly to the Mohammedans. Galen's polypharmacy
in particular appealed to these natural chemists, and his haphazard
" polj'pragmatism " was molded by them into iron-clad dogma.
The Oriental idea that it is sinful to touch the human body with
the hands did little to advance anatomy or surgery. The general
trend of Oriental religious fatalism was toward contemplative
brooding and resigned submission to authority and such eager-
ness or free-plaj' of the mind as the Moslems possessed was ex-
pended in hair-splitting subtleties. Thus the intellectual tend-
encies of the ^Middle Ages were determined for them in advance,
and, if we may trust the statements of men so different as Sir
Henry Layard, Sir Henry Maine, and the ophthalmologist Hirsch-
berg, the great mass of the people in the East detest all reforms and
scientific inquiry to this day. We call the medical authors of the
Mohammedan period "Arabic" on account of the language in
w^hich they wrote, but, in reality, most of them were Persian or
Spanish-ljorn, and many of them were Jewish.

1 Draper: "History of the Intellectual Development of Europe," New
York, 1876, ii, pp. 33, 34. The Alharnbra, like the Cretan palace at Knossos,
contains a specimen of the sanitary invention known in Europe as W. C.

110

THE MOHAMMEDAN AND JEWISH PERIODS

111

The Mohammedan ])hysioians th(^mselvcs owed their mctUcal
knowledge, in the first instance, to a persecuted sect of Christians.
Nestorius, a j^-iest who had been made patriarch of Constantinople
in 428, taught the heretical doctrine that Mary should not be
styled the " :VIother of God " but the " Mother of Christ." In con-
sequence, he and his followers were driven into the desert and, like
the Jews after them, took up the study of medicine because of
religious and social ostracism. The Nestorian heretics gained

in^iy^-TS;^ r"^ ^^^ T'.r^tf -r^'T^if^ iny'^'m'VSv^-^ir'-^

Sclionia of the brain, crossing of the optic nerves and cross-section of the
e^-es, showing lens, vitreous, retina, conjunctiva, cornea and tunics. From
MS. 924 in the New Mosque at Constantinople (Pansier, Hirschberg, Sudhoff).

control of the school at Edessa in Mesopotamia, with its two large
hospitals, and made it a remarkable institution for teaching medi-
cine, but were driven out by th(^ orthodox Bishop Cyrus in 489.
Fleeing to Persia, where their theologic doctrines were welcome,
they estabhshed the famous school at Gondisapor, which was the
true starting-point of Mohammedan medicine.

The Eastern (or Bagdad) Caliphate (750-1258) was under the

1 12 HISTORY OK .Mi:i)l('lNl<;

s\\a\' of the Al)l)asi(li's, who wrvr tViciuls of U'ariiiii<>; and sciiMico
ami included such lihcral-niindcd rulers as i\w cali])lis Al-Mansur
(704-775), Ilarwii al-Hashid (7S()-8{)2) and Al-Mciannui (813-833).
These nionarchs eiicourau;ed the collection and copying of (h'cek
manuscripts, and the earli(>r ciMituries of the Alohanunedan ])erio(l
were occui)ied in translatinfz; the works of Hippocrates, (Jalen,
Dioscorieles and other (Ireek classics into Arabic. The j)rincii)al
Arabic translatoi-s in the eighth and ninth centuries were Johannes

.■■""'■- "■

'Mtj^^^t^

Wk ''-''-' '

^^^f ■•'■". • '

Wf '

^^M^ ■ '■

■ '

>• ' ■ ' ■■Jf •,"'■'•■ ■ ■ ' ■

-.-•>-i>^^, - -■ ■ ,..S.-_.i^ ..i_. ' ,. '..-.,0 aj- ■..>'■

■Arabic schema of tlie head, eyes, and "sight spirit," which proceeded from
the brain to envelop the object of vision and carry it back to the crystalline
humor. (From a Persian MS. of the Seventeenth Century.) Meyerhof and
Priifer (Sudhoff's Archiv., 1912, vi, 26).

Mesue the elder (777-837), called Janus Damascenus, a Christian
who became director of the hospital at Bagdad, and the Nestorian
teacher Honain ben Isaac (or Johannitius) (809-873), Avhom
Withington calls "The Erasmus of the Arabic Renaissance."
Johannitius had an adventurous career, translated Hippocrates,
Galen, Oribasius, and Paul of ^Egina, and was in his day the lead-
ing medical spirit of Bagdad. He wrote a commentary on Galen's
Microtechne (Isagoge in Artem parvam) and the oldest treatise

THE MOHAMMEDAN AND JEWISH PEKIODS 113

in Arabic on eye diseases (Hirsehbcrg).i The ten sections have
been translated by M. Meyerhof and C Priifer of Cairo, with an
interpretation of Honain's theory of vision, and interesting ])lates
representing tiie ''schematic eye" (Cairene MS.) and the (lalenic
''sight-spirit" (Sehgeist), which was supposed to proceed from
tiie brain via the nerves to envelop the object seen, proceeding
thence to the crystalline humor to complete the act of vision.

The greatest physicians of the Eastern Caliphate were the
three P(M-sians, Rhazes, Haly Abbas, and Avicenna.

Rhazes (800-932), a great clinician, ranks with Hippocrates,
Aretffius, and Sjalenham as one of the original portrayers of disease.'
His description of smallpox and measles is the first authentic ac-
count in literature, a classic text, preserved in the original Aralnc,
witli j)arallel Latin translation, in Channing's edition (London,
1766). Altliough smallpox had been vaguely described as early
as the sixth century by some of the church fathers and by the
seventh century chronicler, Aaron (cited in the Continent of
Rhazes), the account of Rhazes is so vivid and complete that it is
almost modern. His great encyclopedia of medicine, the El Hawi,
or "Continens," which Haller preferred to any other Arabic
treatise, is preserved in the Latin translation of Feragut (Brescia,
1486). ]\Iatle up of an enormous mass of extracts from many
sources, together with original clinical histories and experiments
in therapeutics, it reveals Rhazes as a Galenist in theory, although
he was a true follower of Hippocrates in the simplicity of his
practice. The ninth book of Rhazes, which was translated by
Vesalius and commentated by Gatinaria, was the source of thera-
peutic knowledge until long after the Renaissance.

Haly ben Abbas, a Persian mage, who died in 994, was the
autlior of the "Almaleki" ("Liber regius" or "Royal Book"), a
work which was the canonical treatise on medicine for a hundred
years, when it was superseded by the "Canon" of Avicenna. It
has never been printed in the original Arabic, l)ut was translated
into Latin in 1080 by Constantinus Africanus, who pul)lished it as
his own work.- This translation contains a description of small-

1 Arch. f. Gcsch. d. Med., Leipzig, 1910-11, iv, 163-190, 1 pi: 1912-13.
vi, 21-33. Thi.s work is not to be confused with the Moniloriujti. oculariorum
of Haly ben Isa (Jesu Hali), an eleventh century writing which became the
classic text-book on ophthalmology in later Islam and is still authoritative
(Hirschberg). The medieval Latin translation of this work is valueless and
uniutfUigible. The best moilern translation is that of Hirschberg and Lippert
(Leipzig, 1907).

^ The two principal Latin editions are the Venetian of 1492 and the Lyons
of 1.523.

1 14 msTOHV OF MKDKMNE

l)ox and " rri>iaii tiic" iiiiali^iiaiit aiilhrax), also the Latin Icrni
for smalli)()x (variola).'

Ibn Sina, or Avicenna (5)80-l()3()), called "the Prince of
Pliysicians," a coiivivuil Omarian s])irit, eniiiuMitly succossful in
jn-actico as court ])liysician and vizier to different caliphs, was one
wlio troil the primrose path at ease and cUed in the i)rinic of life
from the ("ITect of its ])leasuros. He was physician in chief to the
celebrated hospital at Baj^dad, and is said to lia\-e written over one
hundred works on different subjects, only a few of which have been
preserved. Ilis won(l(>rful descrij'jtion of the origin of mountains
(cited by Draper and W'ithinston) fully entitles him to be called
the "Fatlier of Geology," and it is interesting to note that two
l^hysicians, widely separated in space and time — Avicenna and
Fracastorius — are the only writers w^ho contributed anything of
value to this science for centuries. Avicemia is said to have been
the first to describe the preparation and ])roperties of sulphuric
acid and alcohol. His " Canon, "^ w'hich Haller styled a "methodic
inanity," is a huge, unwieldy storehouse of learning, in which the
author attempts to codify the w^hole medical knowledge of his
time and to square its facts with the systems of Cialen and Aristotle.
Written in clear and attra(;tive style, this gigantic tome became a
fountain-head of authority in the Middle Ages, for Avicenna's
elaborated train of reasoning, a miracle of syllogism in its way,
appealed particularly to the medieval mind, and indeed set the
pace for its movement in many directions. Arnold of Villanova
defined Avicenna as a professional scribbler who had stupefied
European physicians by his misinterpretation of Galen (Neuburger).
In fairness to Avicenna, it is proper to say that his clinical records,
which he intended as an appendix to the "Canon," were irrecover-
ably lost, and only the Arabic text of the latter, published at Rome
in 1593, and at Bulak in 1877, survives. That Avicenna must
have been a clever practitioner we should naturally infer from his
great reputation. For example, the striking plates in the Giunta
edition of 1595 show that he must have known and practised the
Hippocratic method of treating spinal deformities by forcible re-

1 The term "variola" was first employed in the Chronicle of Bishop
IMarius of Avenches, as follows: "Anno 570, Hoc anno morbus vahdus cum
profluvio ventris et variola Italiam Galliamque valde afflixit, et animalia
bubula per loca suprascripta ma.xime interierunt." Gregory of Tours, Historia
Francorum, in M. Bouquet, Recueil des historiens des Gaules, Paris, 1739,
ii. 18. Cited by Paul Richter, Arch. f. Gesch. d. Med., Leipz., 1911-12, v,
325.

^ The principal Latin editions of the Canon are the Milan imprint of
1473, the Paduan of 1476 and 1497, the Venetian of 1482, 1486, 1490, 1491,
1494 and 1500, the Giuntas of 1527, 1.544, 1555, 1582, 1595, and 1608. The
commentaries in toto were printed in five giant volumes by the Giunti at
Venice in 1523.

THE MOHAMMEDAN AND JEWISH PERIODS 115

duction which was reintroduced by Calot in 1896. His recom-
mendation of wine as the best dressing for wounds was very popular
in medieval practice. Avicenna also described the guinea-worm
(\'ena medinensis).^ He described anthrax as "Persian fire"
(Kanon, Bulak ed. 1294 (1877), III, 118) gave a good account
of diabetes, and is said to have noticed the sweetish taste of dia-
betic urine.- Yet, upon the whole, the influence of the "Canon"
upon medieval medicine was bad in that it confirmed physicians
in the pernicious idea that ratiocination is better than first-hand
investigation. It also set back the progress of surgery by in-
culcating the novel doctrine that the latter art is an inferior and
separate branch of medicine and by substituting the use of the
cautery for the knife.

Three treatises on anatomy by Rhazes, Haly Abbas, and Avi-
cenna have been edited by P. de Koning (1903).^

Oseibia (1203-69), of Damascus, the first historian of Arabic
medicine, wrote a series of biographies of ancient physicians, still
in manuscript, which was the main source of the histories of Wiis-
tenfeld and L. Leclerc.''

Other prominent medical figures of the Eastern Caliphate were
the Hebrew physician Isaac ben Solomon, called Isaac Judseus
(850-950), who wrote a treatise upon dietetics ("De Diseta,"
Padua, 1487), which became deservedly popular in Europe; and
the Arabian traveler Alxlollatif (1161-1231), who visited Egypt at
Saladin's instance, and while there had opportunities for studying
human skeletons which convinced him that Galen's osteology must
be wrong in many important respects.

The Western or Cordovan Caliphate (755-1236) attained
highest prosperity under the Spanish or Ommiade dynasty (755-
1036), and its leading medical authors were the surgeon Albucasis,
the philosopher Averroes, and the Jewish physicians Avenzoar
and Moses Maimonides.

Albukasim, called Albucasis, a native of Cordova, flourished in
the eleventh century, and was the author of a great medico-chirur-
gical treatise called the "Altasrif" (or "Collection"), of which
the surgical part survives in Channing's Arabic text and transla-

• Avicenna, Canon, sect. Ill, tract. II, cap. XXI.

^Dinquizzi: Bull. Acad, de med., Paris, 1913, Ixx, 631. Erich Ebstein
(Ztschr. f. Urol., Leipzig, 1915, ix, 243) shows that the Viaticum peregrinantes
of Ibii-el-Ischezzar ( -1004) contains a remarkable account of diabetes (De
passione diabetica) in which the thirst, polyuria, canine appetite, etc., are
noted but not the sweetish urine.

' Trois trait6s d'anatomie arabe, Leyden, 1903.

'' A Latin translation by J. J. Reiske is at Copenhagen, and the work was
partly translated into French by B. R. Sanguinette (Journal asiatique, Paris,
1854-6).

I lt> IllsroUV OK MKDICINE

tioii (Oxforil, ( "lartMiddn Tifss, 1778}. it cuiitaiiis illustrations of
surfvical ami (Iciital iiist i-iiiuciits (intorpohitiMl in the N'ciicliaii
sursit'al antliolof>;y of I.")!)!)) and was the Icadinj^ t('xt-l)ook on sur-
g(>rv in till" Middle^ A^cs up to the time of Salicoto. It consists
of tliri*(> hooks, found('(| upon tlic work of Paul of /l]^;ina. The
first book deals with the use of the aetual cautery, the special
feature of Arabian surgery, and gives descriptions and figurations
of till' iH'culiar instruments used; the second book contains full
descriptions of lithotomy, lithotrity, amijutations for gangrene
and the treatment of wounds; tlu> third l)ook deals with fractun^s
antl dislocations, including fracture of the pelvis and a mention of
paralysis in fracture of the spine. Albuoasis was apparently the
first to write on the treatment of deformities of the mouth and
dental arches, and he mentions the obstetric posture w-hich is now
known as the " WalcluM- jiosition."' In (iurlt's time, the illustra-
tions of surgical (including dental) instruments in Albucasis
counted as the earliest known, but many earlier have since been
discovered in medieval manuscripts by Sudhofl" and others. The
Oriental horror of touching the body wuth the hands or the knife
was the sufficient reason why these pictures from the antique were
not rej^roduced except occasionally in the maiuiscripts of the
Persian Mohammedans.

The greatest of the Jewish physicians of the Western Caliphate
was the Cordovan Avenzoar, who died in 1162. He was one of the
few^ men of his time who had courage enough to tilt against Galen-
ism, and by his description of the itch-mite (Acanis scabiei) he
may be accounted the first parasitologist after Alexander of
Tralles. He also described serous pericarditis, mediastinal ab-
scess, pharyngeal paralysis, and inflammation of the middle ear,
and he recommended the use of goat's milk in phthisis and trache-
otomy. His "Teisir" or "Rectification of Health" is preserved
in the Latin translation published at Venice in 1490.

His pupil, Averroes, also Cordovan-born (1126-1198), was more
noted as a philosopher and free thinker than as a physician. His
Kitab-al-KoUyat transliterated as "ColUgef^ ("Book of Uni-
versal "), an attempt to found a system of medicine upon Aris-
totle's philosophy, advanced the Pantheistic doctrine that the
soul or nature of man is absorbed into universal nature at death.
This denial of personal immortality caused Averroes to be perse-

' ''Turn decumbat mulier in coUum suum, pendeantque deorsum pedes,
ejus, ilia vero in lectum decumbat, etc.," cited by Dr. Herbert Spencer in
Lancet, London, 1912, i, p. 1.568. Mercurio, in La Comare (1596), also de-
scribed the hanging position of Walcher.

2 Published at Venice in 1482.

THE MOHAMMEDAN AND JEWISH I'KKlODiS 117

cuted in his own lifetime, and his followers to be anathematized
during the Middle Ages. His work is of interest only as a relic
of Arabic modes of thought. ^

The Kabbi Moses ben Maimon, called Moses Maimonides r
(1135-1204), was court-physician to Saladin, and his treatise on
personal hygiene ("Tractatus de Regimine Sanitatis") was written
for that sultan's private use. It contains some admirable pre-
cepts of diet and regimen, including a rhubarb and tamarind pill,
and its fir.st edition, the Florentine imprint of 1478, is esteemed as
one of the rarest of books. His tract on poisons was much cited
by medieval writers, and has been translated into French (1865)
and German (1873).

Such able chemists as the Arabians could not fail of being
good pharmacologists, and their descriptions of the materia med-
ica and of the preparation of drugs became standard authority
throughout the Middle Ages. Even to this day what Osier calls I
"the heavy hand of the Arabian" is sensed in the enormous bulk
of our own pharmacopeias. The principal storehouse of the Ara-
bian materia medica is the " Jami" of Ibn Baitar, a huge thirteenth
century compilation, describing some fourteen hundred drugs of
which about 300 are said to be new. The "Grabadin," or apothe-
cary's manual (" Antidotarium"), of the eponymous or pseud-
onymous Mesue junior, now called "pseudo-Mesue," a mys-
terious Latin compilation of the tenth or eleventh century,
of which the Arabic originals have never been found, was the most
popular com])endium of drugs in medieval Europe, and was used
everywhere in their preparation. The treatise on purgatives
divides the latter into laxative (tamarinds, figs, prunes, cassia),
mild (wormwood, senna, aloes, rhubarb) and drastic (jalap, scam-
mony, colocynth). The esteem in which these works were held
is shown by the fact that a Latin translation of both was one of the
first medical books to be printed (Venice, 1471). An important
work in the Persian language was the materia medica of Abu
Mansur/ containing descriptions of 585 drugs, of which 466 are
vegetable, 75 mineral and 44 animal. A Persian manuscript of
the eleventh century by Ismail of Jurjani contains probabh' the
most complete directions of the period for examining the urine.
There is much of value on climatology and medical geography in
the Arabic writers."

1 Epitomizod in Latin by R. Seligmann, Vienna, 1830-3.3, and translated
into German under the direction of Rudolf Robert (Histor. Stud. a. d. pharm.
Inst. d. Univ. Dorpat, 3. Heft, Halle, 1893 j.

2 See E. Wiedemann: Arch. f. Gesch. d. Xaturw., Leipzig, 1914-15, v,
56-68.

118 IllsroKV OK MKDICI.N'K

Cultural Aspects of Mohammedan Medicine. In Sir Hidianl
lUirton's translation of tlic Arabian Nights,' thero is a talc of :i
spomlthrift heir who has sciuandorcd all his substance except a
beautiful slave }j;irl of extraordiiuiry talents, wlio, realizinjj; her mas-
ter's ])lijiht. urf>;(\s him to brinjz; her before the ('alii)ii llarim al-
Rashid to be sold for a sum large enougii to cover his k)sses. On
seeing her. the ('alii)h tiecides to test the extent of her knowledge,
and lias specialists put her through a lengthy cross-examination
which, incidentally, furnishes us a good documentation of t he social
aspects of Aral)ian medicine. As the fair slave ex])loits lier
extensive knowledge of Mohammedan theology, law, ])hilosophy,
medicine, astronomy, astrology, music, chess-playing, and other
arts and sciences, we perceive that these accomplishments were also
an essential part of the Arabian physician's training, and at the
same time, that a certain acquaintance with the Galenical system
of medicine was a feature of the cultural equipment of any well-
educated Mohammedan of the period. The Aral)ians derived their
knowledge of Greek medicine from the Nestorian monks, many
practical details from the Jews, and their astrologic lore from
Egypt and the far East. So the slave girl follows the Talmud in
regard to the mmiber of the bones (249), gives an exact account of
the four humors, and details at length the effects of different con-
junctions of the planets. Diagnosis of internal disease is founded
upon six canons: (1) The patient's actions; (2) his excreta; (3)
the nature of the pain; (4) its site; (5) swelUng; (G) the effluvia of
tlie body; and further information is elicited by "the feel of the
hands," whether firm or flabl)y, hot or cool, moist or dry, or by
such indications as "yellowness of the whites of the eye" (jaundice)
or "bending of the back " (lung disease) . The symptoms of yellow
bile are a sallow complexion, dryness of the throat, a bitter taste,
loss of appetite, and rapid pulse; those of black bile, "false appetite
and great mental disquiet and cark and care," terminating in
melancholia.^ Medicinal draughts are best taken "when the sap
runs in the wood and the grape thickens in the cluster and the
two auspicious planets, Jupiter and Venus, are in the ascendant."
Cupping is most effective at the wane of the moon, with the
weather at set-fair, preferably the seventeenth of the month and
on a Tuesday. This, or something like it, was al)out the charac-
ter of Mohammedan practice toward the end of the fourteenth
century, the period assigned for the composition of the Arabian

1 Denver edition, 1899, vol. v, pp. 189-245 ("Abu al-Husn and his Slave-
girl Tawaddud"), the medical portion being on pp. 218-226.

2 Maurice Girardeau, in his Paris Dissertation (Xo. 107, 1910), points
out that the oholemic diathesis was perhaps the most prominent feature of
Arabic pathology.

THE MOHAMMEDAN AND JEWISH PERIODS 119

Nights, and we may reasonably infer that is also fairly representa-
tive of the best period of IMosk^n medicine as handed down by
tradition. According to Hirschberg's dictum, the peoples of Islam
have not attained to modernity, })ut rely upon the same medical
authorities which they employed in the Middle Ages.^ In the
past, the Arabian physician, whose professional importance was
gauged by the height of his turban and the richness and length
of his sleeves, was usually an astrologer and a magician, who re-
garded the heart as "the prince of the body," the lungs as the fan
of the heart, the liver as the guard of the heart and the seat of the
soul, the pit of the stomach as the seat of pleasure and the gall-
bladder as the seat of courage. From the Arabic medical texts, we
know that their authors upheld the Galenic pulse-lore, affected
to arrive at inaccessible data, such as the sex of the child in preg-
nancy by inspection of the urine (uroscopy), wrote charms in cups
with "purgative ink" to mystify their patients, indeed, resorted to
all manner of sensational trade-tricks and surprises in order to
impose their authority. Like some of our modern fakers, who con-
duct spiritualistic seances, the Arab physician hired confederates,
who found out about the patient's condition in advance or even
feigned to be patients themselves in order to puff his reputation.^
They abstained from dissecting out of religious conviction, left
operative surgerj^ and venesection to the wandering specialists,
and the care of women's diseases and obstetric cases to midwives;
were constantly squabbling among themselves, stipulated their
fees in advance and tried to collect at least half, if the case took an
unfavorable turn or did not improve. Some of the fees they re-
ceived were phenomenal. Galjriel Batischua, a favorite of Harun
al-Rashid, got about $1500 per annum "for bleeding and purging
the Commander of the Faithful," besides a regular monthly salary
of about $2500 and a New Year's purse of $6250. He estimated
his total fortune in fees at $10,000,000, and on being recalled from
banishment to heal Al-Meiamun, he received $125,000, which
Withington regards as the largest fee on record. Abu Nasr, ac-
cording to the same authority, received more than $60,000 for
curing one of the Caliphs of stone. Most all the prominent physi-
cians of the period aimed to curry favor with the reigning poten-
tates or to supplant rival colleagues in their good graces. The

1 J. Hirschberg: Geschichte der Augenheilkunde, 2. Aufl., Leipz., 1908, ii, 2,
footnote. He gives several examples, e. g., a Druse in Syria who in 1860 treated
eye diseases from tlie ten centuries older canon of Honain and Haly ben Isaac.
A Cairene book of eye-magic of 18.59 contains an illustration of 1296 A. D., etc.

^ The tricks of these people were legion, and formed t he sul)ject of a lucubra-
tion of Rhazes. See, in particular, M. Steinschneider: Wissenschaft und Char-
latanerie unter den Arabem im neunten Jahrhundert. Virchow's Arch.,
Berlin, 1866, xxxvi, .570; xxxvii, 560.

120 IllSTOUV OK MKDICINE

("'ali]">hs (hcinsclvi's, alter \\\c Mohamiiicdaii passion for coiKHicst
had IxHMi sated, hecaiiic loyal suijportcrs of science and were in-
strumental in foundinu; li(.)spitiils, lihruries, aiitl schools. I'A'en
private eoUcM-tions of hooks were sometiiiK^s of extraordinary ex-
tent, and all (Ireek, Efiyjitian. Indian, and .lewisli culture that did
not I'onllict with the creetl vi Islam was rai)idly assimilated. As
early as 707 A. D.. the Calipli El Welid had founded a hospital at
Damascus. Another was established at Cairo in 874, two at Bag-
dad in 018, another at Misr (Egypt) in 957, two others in the same
city in 925 and 977. In course of time dis])ensaries and infirmaries
exist (h1 in all the important cities of the Eastern Calii)hate and
about 1 1(10 a Jewish traveler found as many as sixty of these insti-
tutions in Bagdad alone. The largest and best appointed of the
Mohammedan hospitals were those founded at Damascus (1160)
and Cairo (1276). In the former of these, treatment was given
and drugs dispensed free of charge for three centuries. As late
as 1427 it was said its fires had never been ]iut out since its open-
ing. The great Al-Mansur hospital of Cairo (1283)^ was a huge
quadrangular structure with fountains playing in the four (court-
yards, separate wards for important diseases, wards for w^omen and
convalescents, lecture rooms, an extensive library, out-patient
clinics, diet kitchens, an orphan asylum, and a chapel. It employed
male and female nurses, had an income of about $100,000, and dis-
bursed a suitable sum to each convalescent on his departure, so
that he might not have to go to work at once. The patients were
nourished upon a rich and attractive diet, and the sleepless were
provided with soft music or, as in the Arabian Nights, with ac-
complished tellers of tales. The Cordovan Caliphate was equally
well off in the number, if not the extent, of its hospitals, while the
Bagdad Caliphate w'as especially noted for its ophthalmic dispen-
saries and lunatic asylums. The Aral:)ians were far ahead of their
European contemporaries in their kindly treatment of the insane.
Medical instruction was given either at the great hospitals at Bag-
dad, Damascus and Cairo, or as a special course at the academies
which existed in all the cities. Of these, the Hall of Wisdom at
Cairo was the most famous. The principal courses were clinical
medicine, pharmacology, and therapeutics. Anatomy and sur-
gery were neglected, but chemistry was held in special esteem.
Arabian medicine was, in fact, the parent of alchemy, the founder
of which was Geber (702-765), the discoverer of nitric acid and
aqua regia and the describer of distillation, filtration; sublimation,
water-baths, and other essentials of chemical procedure. Alchemy
was combined with astrology in this wdse. The ancient Chaldaic

iWustenfeld: Janus, Breslau, 1846, i, 28-39.

THE MOHAMMEDAN AND JEWISH PERIODS 121

Pantheism, the doctrine of an anima rmmdi, or "soul of the world,"
with indwelling spirits in all things, was applied to whatever could
be extracted from substances by fire, as "spirit" of wine, "spirit"
of nitre, or the various essences and quintessences; while to the
seven planets (the sun, the moon, Mars, Mercury, Jupiter, Saturn,
Venus) corresponded the seven days of the week and the seven
known metals (gold, silver, iron, quicksilver, tin, lead and copper).
As these metals were supposed to be "generated" in the bowels of
the earth, the special aim of alchemy was to find the fecundating
or germinal substance, under appropriate planetary influences.
Thus Geber's parable of a medicine which could heal any of six '.
lepers Avas regarded by Boerhaave as nothing more than allegory
of the philosopher's stone for transmuting the six baser planetary |
metals into gold. Hand in hand with this idea of transmutation
of metals went the notion of a polyvalent "elixir of life," which
could cure all diseases and confer immortal youth and which was
supposed to be of the nature of a "potable gold" {aurum potahile).
The search for potable gold led to the discovery of aqua regia and
the strong acids by Geber and Rhazes, and the quest of the elixir
became the foundation of chemical pharmaceutics. Even as late
as the sixteenth century, we find Paracelsus still upholding Geber's
idea that everything is made of mercury, sulphur and salt, and that
as "the sun rules the heart, the moon the brain, Jupiter the liver,
Saturn the spleen. Mercury the lungs, Mars the bile, Venus the
kidneys," so the seven planetary metals and their compounds were
specifics for the diseases of these organs under the will of the stars.
Arabian chemistry probably survived beyond the decadence of
Arabian medicine, for Leo Africanus, a traveler of the fifteenth
century, mentions a chemical society which existed at Fez at that
time. From their constant contact with strange lands and peoples,
the Arabian pharmacists or "sandalani" were the exploiters if not
the introducers of a vast number of new drugs; in particular, senna,
camphor, sandalwood, rhubarb, musk, myrrh, cassia, tamarind,
nutmeg, cloves, cubebs, aconite, ambergris and mercury; besides
being the originators of syrups, juleps, alcohol, aldehydes (all
Arabic terms), and the inventors of flavoring extracts made of rose-
water, orange and lemon peel, tragacanth, and other attractive
ingredients. The use of hashish {Cannabis indica) and bhang
(either Indian hemp or hyoscyamus) to produce drug-intoxication
{tabannuj) or deep sleep were well known, and the unseemly
behavior of addicts of those drugs is described in the Arabian
Nights. 1 King Omar casts the Princess Abrizah into a heavy
slumber with "a piece of concentrated bhang, if an elephant smelt

1 Burton's Arabian Nights (Denver edition), iii, 91-93, Suppl., iv, 19; 189.

122 HISTORY OV MKDIOINB

it \\v would sleep from yc^ir to yo;>r."' In anotluM- talc, the thief
Ahmad Kamakim diup;s the guards "with hemp fumes."" Thus
the possibilities of an(>sthesia by inhalation were known to ihe
Arabians, as well as to Dioseorides and the niediexal siu'geons, and
pri^sumably the orijjinai knowledge eunie from India, since the
I']gyptians did but little surgory. The Arabian a])i)thecary shops
were re|j;ularly ins]')ected by a syndic {Midtld-sib) who threatened
the merchants with humiliatinjj; corporal punishments if they
adulterated drugs ((luigues).'' The effect of Arabian chemistry
and jiharmacy upon European medicine last(Hl long after the Mo-
hammedan ]iow(T itself had waned and, with the simi)l(^s of Dios-
eorides and Pliny, their additions to the materia medica made up
the better part of the Eurojiean ])harmaco])eias for centuries.

Closely connected with Mohammedan medical culture is the
influence of the Jews upon European medicine. Under the Ara-
bian domination, Jewisli physicians were i)rominent figures at the
courts of the caliphs and a common belief in a stern monotheism
created a strong bond of sympathy betw^een Moslem and Hebrew.
Another point of contact w^as the fact that the Hebrew and
Mohammedan physicians, wdth their peculiar analytic cast of
mind, their intensive modes of thought and their appreciation of
"values," soon acquired a right materialistic way of looking at
concrete things. Thus Avhile medical men under Christianity
were still trifling with charms, amulets, saintly relics, the Cabala,
and other superstitions, many of the Jewish and Mohammedan
physicians w^ere beginning to look upon these things with a certain
secret contempt.

During the Middle Ages and long after, the lot of the Hebrew
physician in Europe was to be used and abused. In the tenth and
eleventh centuries, he was, as Billings says, "a sort of contraband
luxury,"'* resorted to by and protected by prince and prelate alike,
on account of his superior scientific knowledge, but hardly coun-
tenanced for any other reason. The Council of Vienna in 1267
forbade the Jews to practise among Christians. Under the Wes-
tern Caliphate, Jewish physicians were prominent figures in Spain
until they were banished the country in 1412, and the School of
Salerno utilized them as teachers until it had developed enough
home-grown talent to get along without them. The same thing
was true of ]\Iontpellier, which was closed to the Jews in 1301.

» Op. ciL, ii, 122-124. 2 Qp. dt.. iv, 71.

^ Guigues: Bull. d. sc. pharm., Paris, 1916, xxiii, 107-118. An interesting
list of the substances used to adulterate various standard drugs is given.

^ J. S. Billings: "The History and Literature of Surgery" (Dennis's
System of Surgery, New York, 1895, vol. i, p. 38).

THE MOHAMMEDAN AND JEWISH PERIODS " 123

There were many at Avignon up to the fifteenth century.^ The
interdictions put upon Jewish physicians by Popes Paul IV
(1555-9) and Pius V (1566-72) were hfted by Gregory XIII in
1584.- Although the different emperors continued to retain Jews
as their body physicians, yet, up to the time of the French Revolu-
tion, they were not allowed to study at the European universities
and, being moreover excluded from the liberal professions, played
little part in medicine during this period. At the outset of the
modern industrial movement, they were admitted to the rights of
citizenship all over Europe and given the freedom of the universi-
ties. The effect of this liberal policy was to bring forth a great
array of brilliant talent which contributed very materially to the
development of medicine in all its branches, as witness the work of
Henle, Cohnheim, Weigert, Traube, Strieker, and Pick in pathology,
Senator, Hayem and Boas in internal medicine, Romberg, Moll and
Freud in neurology, von Hebra, Kaposi, Neumann, von Zeissl and
Unna in dermatology, Caspar, Lesser, Ottolenghi and Lombroso
in forensic medicine, Hirsch, Marx, Pagel, Magnus and Neu-
l)urger in medical history, and, in the science of infection, Metchni-
koff, Frankel, Friedlander, Marmorek, Haffkine, Neisser, and Paul
Ehrlich,^ to mention only a few well-known names.

1 For a list of Jewish physicians at Avignon, see P. Pansier, Janus, Amst.,
1910, XV, 421-4.51.

2 A copy of this document is in the Surgeon General's Library.

' For a more complete list of modern Jewish physicians, see F. T. Hane-
man's paper in the Jewish Encyclopaedia, New York, 1904, viii, 421, 422.

THE MEDIEVAL PERIOD (1096 1438)

Thk MicUlle Ag(>s, tho jKM'iod of foiulalisin and ofclcsiasticisin,
arc commonly dccriiHl for .servile obeisance to authority, with its
attending evils of bigotry, i)edantry and cruelty. We regard any
one who seeks to suppress the truth by overbearing or underhanded
methods as "medieval-minded," and we think of .special privileges,
vested interests, unearned increments, Faustrecht, and other phases
of Rob Roy's "simple plan," as smacking of feudalism. Yet, in
the Middle Ages, there was true "con.sent of tlu^ governed."
The people aspired toward nationhood and solidarity rather than
toward personal independence and, under the.se conditions, were
willing to be led and directed rather than to think for themselves.
In the welter of race-inmixture and race-absorption that follow(^d
the downfall of the Roman Empire, it was found that Greek phi-
losophy (neo-Platonism) was a total failure as a moral force, and
the greatest need of European humanity was for a spiritual uplift,
for regeneration and renewal of character rather than for intellec-
tual development. Mental and moral activities were simply
paralyzed by that great cataclysm. To understand the impulses
which drove the hermits to the desert and founded the monas-
teries, one can read Gibbon, Lecky, Montalembert, Gregorovius,
Froude on the break-up of Roman society, Turgenieff's wonderful
evocation of a Csesarean triumph or Flaubert's miracle-play of
The Temptation of St. Anthony. Matthew Arnold, with his fine
historic sense, summed all this up in stirring verses:

On that hard Pagan world disgn.st

And secret loathing fell.
Deep weariness and sated lust

^Iade human Hfe a hell.

She veiled her eagles, snapp'd her sword,

And laid her sceptre downi;
Her stately purple she abhorr'd.

And her imperial crown.

She broke her flutes, she stopp'd her sports,

Her artists could not please;
She tore her books, she shut her courts,

She fled her palaces.

Thus, the Christian Church, with its spiritual appeal, its attractive
s}Tnbolism, its splendid organization and its consolidation with
Feudalism in protecting Europe from Moslem invasion, could not

124

THE MEDIEVAL PERIOD 125

but triumph. The Crusades aroused the fcehng of nationhood.
The organization of citizens against the rohl)er barons awakened
the civic consciousness. In the great struggle between collectivism
and individualism which began from that hour, intellectual inde-
pendence was bound to go to the wall if it came into conflict with
Church or State. In the Middle Ages there was immense concern
lest "the centrifugal forces of society overcome the centripetal."^
The gro^^i:h of the Christian virtue of compassion toward weakness
and suffering, and the more elevated and enlarged conception of the
l)osition and mission of women that grew out of it, led to new de-
partures in medicine along untried paths, particularly in nursing
the sick and in erecting hospitals everywhere for their care. Only
idle l)igotry could affirm that Pope and Emperor did not do a great
deal for medicine in the advancement of good medical legislation,
in the chartering and upljuilding of the medieval universities, in
the great hospital movement of the Middle Ages and in the en-
couragement of individual medical talent in many cases. Yet,
as Allbutt has shown, the strife of intellects during the Ages of
Faith was manifested in a way that tended to the absolute sup-
pression of experimental science or even of the actual verification
of premises. The Greek philosophers, as we have seen, held
opinions the most disparate without any special strife among them-
selves, and above all with a certain definite immunity from perse-
cution. To those who can appreciate the fine individualism of the
Greeks, the sentiment of the English poet will not seem exagger-
ated :

Greece, where only man whose manhood was as godhead ever trod,
Bears the bhud world witness yet of light wherewith her feet are shod:
Freedom, armed of Greece, was always very man and very God.

The medieval thinkers were all under the ban of authority, and
this for the strangest, yet most potent, of reasons. From the
earliest times, human ideas as to the meaning of life and the forces
behind the material world have usually progressed along two dis-
tinct, often parallel, lines, viz., a tendency to deify and worship
the objects or forces of external nature, culminating logically in
either Pantheism or Buddhistic Pessimism; and the rude fetish-
ism of the savage, which passed through the successive stages of
idolatry, hero-worship, ancestor-worship, polytheism, shamanism,
'finally merging into the pure monotheism of Israel, Christianity
and Islam. Christian Theism assumes that God is a spirit, omni-
present and immanent in nature, yet different from it, accessible

1 The phrase is used as a criterion of good and bad government in Roose-
velt's Romanes lecture on "Biological Analogies in History," Oxford, 1910,
p. 23. .>. . .

rj(> lllsroKV OK MIDK INE

to prayer, and capaljlc at need, of dixiiic iiilcrNciit ion in liiiinan
alVairs. l^antlicisin simply identifies (iod with nature and natural
forces. Now. in iurdi('\;il linics, till' op])osition hetween Theism
and Pantheism took the loini ol a dis))ute l)(>t\veen " lieaHsts" and
" XominaHsts." which. sa\s Alliiutt (paraphrasin<i; the laniiua<;-e
of John of Sahshury), "enf>;af;(Ml inoi'e of the time and jjassions of
men than for the house of ( 'ivsar to coiKiuer and f^overn the world."'
To the medie\al logician. " Realism" was just the o]i])o.sitc of our
nitidern concept of a kn()wl(Ml<>;e of material tliinjis. The Kealist
assununl, with Plato, that the idea is as actual as the thins itself
and creative of it, \\w form as real as the matter or substance and
anterior to it, wluMice it follows that all things jirococd from th(>
will of God. Tho Nomiiuilist, on the other hand, affirnuHl that
the form or idea is oidy a name or abstract conception, existing in
tho mind of tlic ob.scrvcr alone, and that Hod, therefore, exists im-
personally in each and every object of tiie material world. To
medieval theologians, such Pantheism as tliis could be no less than
infidelity and unbelief, since it tended to dissolve the dogmas of
faith and was subversive of the ideas of divine revelation and of
personal immortalitj^, the hope held out to the Christian. To
medieval physicians, such a manifesto of free-thought as the Hip-
pocratic treatise "On the sacred disease" would have been al)-
horrent, while Galen, with his devout monotheism and his careful
Bridgewater teleology, became an object of almost veneration.
Aristotl(>, in his Logic and Metaphysics, never made an absolutely
clear distinction between the supposed reality of idea and sub-
stance, and although proscribed under excommunication by the
Synod of Paris in 1209, was restored to favor by Gregory IX in
1231, and later regarded as an almost infallible authority. His
more scientific writings were never studied in the critical, inquiring
waj' in ^vhich the Greeks Avould have regarded these things.
Ptolemy said that ''He who would serve the cause of truth in
science must be, above all, a free thinker," yet his geocentric
system of astronomy came to be defended by the Church as if an
article of faith (Neuburger). The natural histories of Pliny and
Aristotle were accepted b\" medieval authorities as beyond cavil,
and imitated in the queer "Herbals" and "Bestiaries" (or Beast-
Books) of the time. All reasoning was formal and deductive.
Until the Renaissance, there was neither induction nor experiment.
Grown-up men accepted such a tissue of solemn nonsense as the
"Timseus" of Plato for sound physiologic doctrine. Nature her-
self was never questioned for her secrets, and, as Allbutt puts it,

1 For a full account of the .subject, see Sir Clifford Allhutt's splendid
Harveian oration, "Science and Mediaeval Thought" (,1901j, to which the
wTiter is very deeply indebted.

THE MEDIEVAL PERIOD 127

"Logic, which for us is but a cb'ill. and, hke all drills, a little out of
fashion, was for the Middle Ages a means of discovery, nay, the
very source of truth. . . . The dialectically irresistible was
the true."^ In the "Golden Legend" of Longfellow, medieval
physicians and medical students are represented as frittering away
their time in endless discussions about the nature of universals,
the relation between the idea and matter, and other dialectic
sulitleties. The Nominalist of advanced and dogmatic type was
even liable to persecution. Without going further into the lengthy
disputes between Nominalists and Realists, it may be said that
their adjustments of cause and effect have been traced through the
ages in the "pneuma" of Galen, the "archseus" of Paracelsus, the
"animism" of Van Helmont and Stahl, the "thought and exten-
sion" of Descartes and Spinoza, the "noumenon" and "phenom-
enon" of Kant, the "being ancLbe com ing^' of JEIegel^ the "will and
idea"--^f-Sehope»hatier^ and in such modern concepts as natural
law and natural phenomenon, tj^e and individual, force and mat-
ter, statics and dynamics, vital principles and "the fortuitous con-
currence of physico-chemical forces." In our own day, the con-
troversy has become merged into the opposition between Vitalism
and Materialism. In the Middle Ages, the enormous expenditure
of mental energy over this sterile, insoluble problem led the top-
heavy feudalized scholastic to entertain an ill-concealed contempt
for all manual arts and crafts, especially for anatomy and surgery.
Hence the surprising ignorance of Hippocrates in medieval times.
"Had Galen's works been lost," says Withington, "there can be
little doubt that the dark age of medicine would have been darker
and more prolonged than it was, for the medieval practitioner
could no more have appreciated the higher and freer teaching of
the phj'sician of Cos than he could have understood those grand
words, 'It seemed good to the Demos,' which Hippocrates saw in-
scribed at the head of every decree, and heard proclaimed in every
assem])ly."''^

The fundamental error of medieval medical science, as Guy de
("hauliac originally pointed out, and as Sir Clifford Allbutt, in a
masterly survey,^ has demonstrated, was in the divorce of medicine
from surgery. Greek intelligence, as personified in Hippocrates,
saw internal medicine in terms of surgery and saw surgery not only
as a mode of therapy, but as "the very right arm of internal medi-
cine," since, in diagnosis, the outward and visible signs of internal

1 Allbutt: Op. cit., pp. 50, 51.

nVithingtoii: Modical History, London, 1894, 104.

'Sir Clifford Alll)utt: "The Historical Relations of Medicine and Sur-
gery," London and New York, IflOo.

128 iii>>r()Kv oi" MF.niciNK

lu.-ihuly [\\\v only indices the (Irrck siirticon liad) wci-c nlso lli(>
niaiiist;iy of tlic clinician. lic;j;iniiiMi; with Axiccnna, nicdicxal
nuMlical authority iiuslu-d (lalcn's dictum that surj>;cry is only a
nio(l(> of tnvitnuMit to the oxtrcinc limit of trcalinj!; tlie sur^coii him-
sch" as a hu'k(\v and an inferior. The Arahian conunentators of
(ialen and the nie(Heval .Vrahists who co])ieil them were much
obsessed with the idea, peculiar to Oriental reli<2;i(Mis, that it is
unclean or unholy to touch the liumaii body with the hands under
certain conditions. As this tenet gained ground, scholastic and
monastic minds l)ecame, as we have said, gradually ]KMietrated
with the conviction that rcdecraft is sujx'rior to handcraft, cul-
minating in the famous edict of the Council of Tours, "Ecclesia
ahhorret a sanguine" (1103). 'The general practice of surgery,
inckuUng most of the major ojx'rations, was, in the end, relegated
to ])arl)ers, l)atii-keei)ers, sowgelders and wayfaring mountcl)anks,
and the surgeon came to be regarded in such a menial light that, even
in Prussia, up to the time of Frederick the ( Ireat, it was still one of
the duties of the army surgeon to shave the officers of the line. Again
the heresy imposed by the Arabist commentators of (^alen, that
"coction" (suppuration) and "laudable pus" are essential to the
healing of wounds, made operative surg(M\v a perilous and meddle-
some undertaking, all the more dangerous, indeed, in that the sur-
geon, whether scholar or mountebank, stood in jeopardy of life or
limb if he operated unsuccessfully on any of the feudal lords of earth.
The greatest surgeons of the time shrewdly advised their profes-
sional brethren to avoid the operative treatment of difficult or
incurable cases, and, when they attempted the major operations,
their custom was to require a guarantee that no harm should come
to them in the event of a fatal termination. To lift the surgical
art to its modern scientific (aseptic) status required the genius
and personal influence of the three greatest surgeons of all time —
Ambroise Pare, John Hunter and Lord Lister. The principal in-
terest of the medieval period, therefore, lies not in its internal medi-
cine, for there was precious little of it, but in the gradual develop-
ment of surgery from the ground up by faithful, sometimes ob-
scure, followers of the craft, who (in France at least) were kept
ostracized and short-coated by the edicts of the clerical bigots of
St. Come — the ''chirurgiens de longue robe." The continued
quarrels between St. Come, the Paris Faculty and the barbers re-
sulted in the admission of the latter to the practice of minor surgery
in 1372.

Xeuburger divides medieval medicine into foiu- periods, viz.,
the Monastic (fifth to tenth centuries), the Salernitan (eleventh
to twelfth centuries), the temporary enlightenment of the thir-
teenth century, in which the Arabist culture was grafted upon that

THE MEDIEVAL PERIOD 129

of the West, and th(> pre-Renaissance period (fourteenth century)
in which this cuhuro became dominant.

With the downfall of Rome came the Dark Ages durinsi; which
"Western Europe passed into a tedious period of material waste
and intellectual decadence.

The transition, as Neuburger shows, was not catastrojjliif, Ijut gradual.
The Germanic conquest entailed the loss of thousands of lives, the devastation
of gi-eat tracts of country, the desolation of many cities and the destruction of
innumeralile landmarks of art and cidturo, while the East still possessed a far-
flung netwoi-k of marts of commerce, co\-ering three-foiu'ths of the earth's sur-
face, and maintainetl its culture. In contrast with the imposing financial sys-
tem of the East, the West, through slackening of trade, the splitting up of
countries into small, separate states, and the falhng back of its peoples upon
agriculture as a last resort, acquired l>etty, parochial forms of economics, hole-
and-corner modes of finance, and a general peasant complexion, which atTorded
little incentive toward a finer contluct of life. Nations were gradually l)uilt up,
but, in the process, culture was inhibited. While the Moslem conquerors im-
posed the Arabic language ami culture upon the conquered, the Germanic
conquerors came under the sway of the Latinized culture of Christendom. In
western Europe, Latin became the official language of Church and State. Only
Latin translations of the Cireek authors were read. Science and learning sought
refuge in the bosom of the Church, and no less than Cassiodorus, "the last of
the Romans," pointed the way.

Thus began the period of Monastic medicine, in which, along
with a praiseworthy zeal for preserving the remains of ancient
literature and the traditions of a rational praxis, there grew up a
cult of faith-healing or theurgic therapy, an implicit l^elief in the
miraculous healing power of the saints and of holy relics. Super-
natural aid came to be more and more esteemed as the medical
art showed itself to be po^verless, particularly in the time of the
great e}:)idemics. Western medicine, imlike that of Byzantium
and Islam, went into eclipse, and its practice, as Neuburger says,
became as rudimentary and stereotyped as that of primitive man.

_ Under the beneficent reign of Theodoric tlie Great (493-526), there was
an inter-period of peace, with material prosperity and due regard for art ancl
science. The sole relic of this eai'ly Ostrogothic period is the dietetic epistle
of the Greek physician Anthimus, which is full of sound, sensible precepts,
throwing much hght upon the food-staples and kitchen practices of the time.
The trend of the Ostrogothic period, indeed the principal task then set for
medieval medicine, was in the way of translating, compiling and paraphrasing
from the ancients, a trend which had already been established by the later
Romans and the Byzantine writers. In this liiatter, Boethius [circa 480-524)
was the great exemplar. In the sixth century, the gradual passage of
science into the hands of the clergy was accomjilished, in the face of desolating
wars between the Ostrogoths and Byzantines, the incursion and estabhshment
of the Lombards in Italy (568-774), and devastating epidemics like the plague
of Justinian (543). Science and culture went to the wall, the schools of secular
learning crumbled and disappeannl, r(>ligious zeal and fanatical asceticism be-
came the order of the day. Crushed by the Lombards, left in the lurch by
Byzantium, the Latin population turjied" to the Church for protection. Glori-
fied by the nimbus of ancient Rome, the Church thus became a real territorial
power, able to practice genuine statecraft and to protect Western civilization.
"The Benedictines became the Nestorians of the West" (Neuburger). In the
9

130 HISTOHV OK Mi:i>I(INK

Koniin I'acis, wlinc ithysicians once Msscinlilnl .iml (l.ilcn (lw<'lt, rojx- l-'clix
I\' I r)2t)- AiU) ) set \i]> till- l<:isilic:i of SS. ("osiiiMs and Daiiiiaii, llic i)alron sainls
of iiu'diciiic. Ill (lie saiiic yoartliat .Iiistiiiiaii dosed tlic Scliool of I'liilosophy
at Atlions (")20), Benedict of Nursia (ISO-.'Jl.'i) founded, on the site of an aneient
temple of Ajiollo. the cloister of tlie liciiedicl iiie order al Monte Cassino; and
liere, after Cassiodorus ilSO ."i?")) iiad lunied 1 lie attention of I he monks to the
value of the t)lder wiitin^s, literary studies were assiduously culli\at('d and
vows to nurse the sick were taken as th(> prime iluty of tiie order, in accordance
with tlio exhortation of St. Benedict (1 njinnoruni cura ante omnia adhihcnda
est, lit sicut re vera Clirisfo, ita eis srn'iatiir). The cloister had a valuable col-
lection of nKuIical niainiscriiits. The Connnrtitariinn tiirdicinale of Bene(letto
Crespi, .\vclil)islioii of Milai\ ((iSl), a didactic h(>xameter poem dealinfi with the
lierhal treatment of 2(1 diseases, after the fashion of Serenus Samonicus,
is a relic of this period. Another consists of two treatises on diseases and their
remedies by Bertliarius (S57-8S4), the learned abbot of Monte Cassino. The
Lombard conquerors soon began to favor science and names of laic physicians
are pres(>rved in tlu^ Codex lombardus and elsewhere. In accordance with the
precepts of Cassiodorus, tlie aim of tlie time was to make a summation of all
medical knowledjrt* (siiinmn medicina'), gleaned from the Cire(>k antl ].atin
authors. Serenus Samonicus, i)seudo-Apuleius, p.seudo-riiny in therapeutics,
and in obstetrics, Canlius Aurelianus, and the pseudo-Soranic midwifery-book
of Muscio. were most favored in these comi)ilations. The best things of Ilijipoc-
rates, Galen, Kufus, Oribasius, Alexander Trallianus, and Dioscorides were
translated into Latin (fifth and eightli centuries), and, in the i)rocess of com-
pilation, a number of spurious writings attributed to pseudo-authors were
foisted off. The medical part of Pliny, mixed up and se;isoned with excerpts
from Cselius Aurelianus, Apuleius and Yindician, became our "pseudo-Pliny."
Many a smnnia medicinalis, masquerading under the names of Dioscoridcs or
Oribasius. was a mere liodge-podge from dilTerent soun-es. Of this character,
too, were the pseudonymous ei)istles attributed to Hippocrates, in particular
the Dynamidia {De idrtutibus herbarum), the de cibis, the epistle to Ptolemy
(De hotninis fabrica), and the capsula eburnea. This "ivory cajisule," a tract
on the prognosis of skin affections, alleged to have been found by Ca'sar in
the tomb of Hippocrates, was first printed in Wittwer's Archiv (1790), and
recently has been carefully studied in all the MS. readings by SudhofT (1916).^
It was first printed in Rhazes' Liber Almansoris. Under the Visigoths in
Spain (507-711), the activities of the medical profession were crushed by a
Draconic code of laws. With the conversion of the Visigoths to Christianitj'
(586), monastic medicine took its usual course. Cloisters and church founda-
tions even had their own physicians. A laparotomy for retained fetus in
ectopic pregnancy is attributed to Bishop Paul of Merida, where Bishop
Masona founded a large hospital about 580. The most learned man of his time
was Bishoj) Isidore of Seville {circa 570-636), author of an encyclopedia of
origins and etymologies, the fourth book of which contains a survey of medi-
cine, but with manj^ false and far-fetched derivations of medical terms.

Under the Merovingian monarchs {les rois faineants) in France (486-741),
Latin influences prevailed, but the dynasty has little to its credit save a string
of bloody civil wars, and physicians had a hard time of it. Gregory of Tours
(.538-593) records that the Prankish physicians had some skill in surgery and
were sometimes in request as forensic experts in trials, but even those in at-
tendance on royalty were humiliated or put to death if they failed to cure.
The people were given over to a belief in wonder-cures by strolling surgeons,
holy rehcs, exorcism and the Royal Touch. In time of epidemics, they came
in great crowds to pass nightly vigils in the churches, an analogue of the temple-
sleep. With such crude, bungling surgery as obtained, Httle wonder that Greg-
ory' counselled prayer and endurance of pain. With the advent of Charle-
magne (768-814) as Emperor of the West (800), medicine came into better times.
The cultural soil was prepared by the wandering Irish and Anglo-Saxon monks,
who travelled from Bangor and lona to the continent and founded the monas-

iSudhoff: Arch. f. Gesch. d. Med., Leipz., 1915-16, x, 79-116.

THE MEDIEVAL PERIOD 131

teries of Boljbio and St. Gall. Cloister schools were founded at Fulda by the
English Boniface, at Tours by the English Alcuin (735-804), at Chartres
by KuUiert (lOOti-lO'iS), and became famous centers of learning. Charlemagne
had a jihysic-garden. From the Ecc-lesiastical History of the Venerable Bede
(G74-73.5), we learn that medicine was not neglected by the English monks.
He tells of a cure of aphasia by met hodic exercises, and left a treatise in blood-
letting.

The encyclopedic "Physica" of the Abbot of Fulda and Archbishop of
Mainz, Hrabanus Maurus (776-856), Alcuin's favorite pupil and the "primus
pnrcei)tor (leinianiie," treats of medicine in the sixth, seventh, and eigh-
t(>(>nth books and gives a German-Latin glossary of anatomic terms. In the
ninth century, medicine was taught as part of "Physica," which included
arithmetic, astronomy, mechanics, geometry, and music, whence the physi-
cian was styled " physicus." The Hortulus of Walafrid Strabo of Suabia
(S07-849), the best pupil of Hraljanus, describes, in 444 pleasant hexameters,
tlie plants in the garden of the cloister at Reichenau, of which he was abbot.
Anglo-Saxon literature took its start in the reign of Alfred the Great (871-901),
and held its owni until the middle of the twelfth century. The principal medical
writings of the period are the Leech-Book of Bald, the Lacnuga, a book of
Anglo-Celtic magic and translations of Apuleius and Sextus Placitus. The
medieval penchant for allegory is exemplified in the Physiologus, a popular
{)urview of the virtues and \-ices in the form of twelve real or fantastic animals,
which was translated into all languages and although pure allegory in itself
became the original of "Beast-Books" or Bestiaries. LTnder the Carolingian
inonarchs, Jewish physicians were much favored in France. In upper Italy,
Sabbatai ben Abraham, callerl Donnolo (913-965) was a famous practitioner
and his Antulotarium,^ a formulary of some 120 remedies, is the oldest known
medical work in Hebrew. The oldest medical work in Spanish is a treatise on
fevers by Isaac, a Jewish physician of the eleventh century. '

Medicine in the eleventh and twelfth centuries was lifted to a
much higher level by the School of Salerno, which, as Neuburger
says, aroused the healing art from the decrepitude of half a cen-
turj', infused new life into things and guarded as a Palladium the
l)est traditions of ancient practice. Its origins are obscure. We
only know that it came into existence in "a most mysterious way."
That it was an ecclesiastical foundation is regarded by most his-
torians as an agreeable fable convenue, for the whole character of
the school was that of an isolated laical institution, a civitas Hip-
pocratica, in the midst of purely clerical foundations, and there is
significant silence about Salerno in the ecclesiastical chronicles.
Rut the city itself was a bishopric; after 974, an archbishopric;
\\here the Benedictines had a cloister and a hospital (820), and the
friendliest relations are said to have existed between the clergy and
the Salernitan physicians. The little seaside town of Salerno,
near Naples, was known even to the Romans as an ideal health
resort. The medical teachings and traditions of its famous school,
tlie first inde]5endent medical school of the time, came uj^on the
dreary .stagnation of the early Middle Ages, wdth something of the
invigorating freshness of the sea. Its anatomy was based upon
that of swine, its physiology and pathology were Galenic, its diag-

1 Edited by Steinschneider, Bei-lin, 1868.

l'.V2 iii>iiiK> di' mi;i)I('inp:

MDsis in;iiiil>' pulse jiiid ui'iiu' loi'c, Inil discasi^s wvvv .sIiuUchI lirst-
liaiul, in a si rai^lil toiwanl, s])(»iilaii(M)iis, cii^ai^ing inannor, therapy
was rational with an adnuraMe scheme of dietetit's, Salcrnitaii siir-
gory was new and original, ohslelrics iind nursing; were at)l> eulli-
vated 1>>- tal(>nt(Hl women. The Salcfnitan masters, sa>s Neu-
l)urfj;er, were the first medie\'al jihysieians to cultivate nuHlicinc
as an indojMMident hranch of science. Tliat tho Salernitan medi-
cal culture was Ilell(>nistic, that Salerno revived some of tlie best
traditions of ( ii'cek medicine, is du(> to tli(> fact that Sicily and
southernmost Italy were still ])art of Ma^na (iran'ia, and were
entirely unintluenc(>d )\v Roman cultun^ from the seventh century
B. C. to the tentli century A. 1). From Magna Grajcia, Byzantium
and Toledo came the three main streams of Greek culture, which
went to tiie formation of the Salernitan tradition. The oldest
docmnents of Sal(>rnitan mcHlicine are compilations in barbarous
Latin from the later Roman authors and pseudo-authors, and date
from the first half of the eleventh century.

Of these, the I'(if:si(Hiarins, a liandbook of special ])a(liology and thera-
peutics, associated with the name of daleii and attrilHited to the Lombard
Warimpotus or Gariopontus (died circa 1050) is, in the opinion of Sudhoff,
not a genuine Salernitan writing, but a compilation from liyzantine sources,
dating back to the eighth or ninth century. The writings of Alphonsus, Bishop
of Salerno {circa 10,50), the Practica of Petroncellus, an Anglo-Saxon version
of the same in Cockayne's Leechdoms, and the poem Spcculinn Jmminis (circa
1().")0) are the only other Salernitan reUcs before the time of Constantinus
Afrieanus.

Of httle efTect upofi Salerno, and nowise an outstanding personality,
Constantinus Afrieanus (circa 1020-1087) is yet an important landmark on
account of his strong influence upon the later Middle Ages. A native of Car-
thage, he gained a close knowledge of Oriental languages l)y extensive travel,
and, returning to his native city, is said to have been persecuted as a magician.
Fleeing to Italy, he lived for some time at Salerno, but whether he taught there
is uncertain. Steeped in Arabist culture as he was, he could have exerted little
influence upon the school and certainly left none. Islam was unpopular; for
before the Norman conquest of Sicily, the Saracen overlords of the island had
frequently menaced Salerno and on one occasion forty brave Normans saved
the Uttle town from their clutches (1016).

After 1070, we find Constantinus in the cloisters at IMonte Cassino, where
he ended his days in his hterary work. This consisted maiidy of Latin transla-
tions of Haly Abbas, Johannitius, Isaac Judseus, and the Arabized Galen and
Hippocrates. While these translations were httle noticed at Salerno, the influ-
(>nce of Constantine as a Latinizer of the Arabist culture ' was far-reaching, as
Sudhoff says, "a symptom of a great historic process," namely the fastening
of Mohammedan modes of thought upon Western Eurojiean medicine from
the twelfth century on. Johannes AfHacius {circa 1040-1100), a Saracen pupil
of Constantine, was the probable author of the Lihcr aureus, attributed to his
master, and of a Salernitan tract "de febribus et urinis," which contains a
device for cooling the sick-room by dripping water from a perforated vessel.
Taddeo Alderotti later bore witness that these translations of Constantine
were very faulty performances {nam ille insanus monacus in Iransjerrendo
peccamt quantifate et qualitate).

1 For the Arabic sources of Constantine, see M. Steinschneider: Virchow's
Arch., Berlin, 1866, xxvii, 3.51-410.

THE MEDIEVAL PERIOD 133

Iiuiepcudent treatises on practice of nie;licine, iiofable for clarity of con-
cei)tioii and concision of style were written se\erall\' l)y Majfister Jiartholo-
nuieus, Copho junior, Johannes Platearius junior, and l)y Archiniuthaeus, who
also wrote an important tract on hodegetics (De instructione medici) or the
etiquette of the physician's approach to the; bedside {De adeantu medici ad
(U'lirutum). The most remarkat)le contribution of the Salernitan school to in-
ternal medicine is the TracUdus de. (ugriliidittuni curatione, the first example of
an enc\'clopedic text-book of medicine, written by many authors, and no doubt
designed for posterity as the "^ Siunma tnedicinalis" of Salerno. It became the
standard school book of internal medicine in the first half of the twelfth cen-
tury.

.'\s in each "Practica" list(>d above, it treats of local di.seases seriaiiin, from
lirad to foot (d cdpitc ad cidceni}.

Among the earliest of the twelfth century contributions to natural history
was the compilation called Macer Floridus, a didactic hexameter poem on the
therapeutic virtues of 77 simjjles, attrii)uted to Odo of Meudon, which was
liiglily i)opular and frequently translated,' and was the original of the oldest
Scanihnavian medical writing, the Danish Ijegebog of Henrik HarjK'Streng.
The Lapidarius or stone-ljook of Bishop ^larbod of Reunes (died 1123) deals
with the medical and magic virtues of 60 precious stone.s.

These productions are contained in the "Breslau Codex,"
most of which has been reproduced in the collections of Salvatore
De Renzi (1853-6) and Piero Giacosa (1901). The Regimen
(Sanitatis) Salernitanum or Flos medicince, a poem in double
rhymed hexameters, was first printed in Latin in 1484.

Its date of origin is unknown, but Sudhoff holds that its probable proto-
type was a pseudo-AristoteUan epistle to Alexander the Great {De regimitie
satiitatis), Latinized by John of Toledo (Joannes Hispanus), a baptized Jew,
about 1130. This tract, dedicated to a Spanish princess, had a wide circulation
and was followed by a similar dietetic epistle, addressed to Frederick II him-
self by his court philosopher, Magister Theodorus. In Arnold of Villanova's
time, the Salernitan Regimen, which probably did not appear before 1250,
consisted of 362 verses, which the additions and interpolations of De Renzi
and others have expanded to 3,520. Thus the famous Salernitan Regimen owes
its origin to Toledan sources, was probably not knowm either to Frederick II
or GiUes de Corbeil, and consequently was circulated long after 1101, the usual
date assigned for its composition. -

The Regimen consists of a string of very sensible dietetic
and hygienic precepts, dedicated, in the several imprints, to the
King of England {Anglorum Regi), in most of the manuscripts to
the King of France (Francorum Regi) . It passed through some 240
separate editions, including Irish, Bohemian, Provencal and
Hebrew.^

Of the "Ladies of Salerno," Trotula, whom the thirteenth century trouv^re
Uutebd'uf styled "Dame Trot" {Madame Trolle de Salerne) is credited with
a gynecologic and cosmetic treatise De passionibus mulierum, while Abella

' Edited by Choulant, Leipzig, 1832.

2 See Sudhoff: Arch. f. Gesch. d. Med., Leipzig, 1914-15, viii, 377; 1915-
16, ix, 1; also, Pagel-Sudlioff, 173, and the Leipzig dissertation of Johannes
HrinkiTiann: "Die ai)okryphen Gesundhcitsregeln [etc.], 1915.

'An attractive Enghsli versification (bilingual text) is that of Dr. John
Ordronaux (Philadelphia, 1870).

134 I1IST()I{V OK Ml'.DKMNK

\vn»t(* />«• natiirn i^etnini!^ /i<>"'")''.s mikI Di utro hlh . hi I lie opinion of M.il^aifiiic
:\\u\ SudliolT. Trolula is not a piTsoii, iitil only (lie title of the hook itself.
Acconliiiv; to Dari'MiKeip; ami 1 )e l{en/i. it is the name of the authoress, whom
soiue suppose to lia\(> heen of the Hiititiiero family and the wife of the eldei-
IMatearius.

Tltr Antidotdfiiini of Nicolaus the Salcniitaii' was tlio first
formularx" and one of tlir first hooks to he priiitcil (in the sti])('rl)
tyiK)fi;raphy of Nicholas .Icnson, X'enicc, 1171j. It consists of
I'M) complex proscrijitions in ali)hal)ctic order, contains nian.\'
new Eastern drugs, also the original formula for the "anesthetic
sponge" {spang ia soinnif era) and a tal)le of weighls and measures.
The " Antidotarium" of Mattlueus Plat(>arius, known as "Circa
installs," was the original of the first French herbal (Le grant
hcrbier). In anatomy, Copho, one of the Jewish instructors at
Salerno, wrote a primer on the dissection of the ])ig, which was re-
printed in the little anatomic manual of Dryander (1537). The
Anatoniia of Ricardus Salernitanus and an anonymous Dvnion-
stratio anatcnnica arc also based upon porcine structure. There
were many treatises on uroscopy, in particular those of Joliannes
Aflflacius, Johannes Platearius, the younger Archimatheus, Maurus
and Urso. (lilles de Corbeil (^Egidius Corboliensis), Canon of
Paris and physician to Philippe Auguste of France (1165-1213),
wrote two poems on the pulse and the urine,- based upon the
I^yzantinc treatises of Theophilus Protos])atharius, also a poem
on the composition of medicines and a satire on the clergy {Hiera-
pigra ad purgandos prelatos). He laments the decline of Salerno
after it had been sacked by Henry VI (1194). After this terrible
event, according to .Egidius, the Salernitan professors degenerated
into l)eardless striplings who cared only for l;)ooks of prescriptions.
In the thirteenth century, the medical authority of Salerno was
gradually impinged upon by the great rival schools of Naples,
Palermo and Alontpellier, and its fame and influence became more
and more of a vanishing fraction, until the great school was finally
abolished by Napoleon on November 29, 1811.

The Physica of St. Hildegarde (1099-1179), Abbess of Rupertsberg, near
Bingen, describes the healing powers of the known plants, minerals and animals,
gi\-ing the German names by preference, contains precepts for the hygiene of
pregnancy and puerperiimi and rules for suppressing sexual desire. It is
interesting for its sidelights upon the medicine, botany, and gardening of
twelfth century Germany. The Httle tract on cUnical medicine {Causae et
curae), a medlej' containing many interpolations, has recently been edited by
P. Kaiser (Leipzig, 1903). St. Hildegarde's "Visions" {Scivias), containing

1 Sometimes called Nicolaus Prsepositus {i. e., Prseses of the faculty), but
now to be differentiated from Nicole Prevost. See Wickersheimer, BuU. Soc.
frang. d'hist. de med, Paris, 1911, x, 388-397.

- Printed at Parlua (1484), and Venice (1494). Edited by L. Choulant as
"Carmina medica," Leipzig, 1826.

THE MEDIEVAL PERIOD 135

wonderfully beautiful specimens of tlu; medieval art of illumination, not
unlike similar drawings by William Blai<e, are a revelation of h(>r relifiious life.
Charles Singer suggests that these visions may have harl a primary i)hysical
basis, in that the shimmering, radiating figures strongly resemble the stars,
colored spots, and fortification spectra associated with the scotoma scintillans
of migi'aine.i

The principal outcome of the School of Salerno was the work of |
two surgeons, Roger (Ruggiero) of Palermo and Roland (Rolando
Capelluti) of Parma, whose writings were independent of the in-
fluence of Constantinus Africanus or other Arabist sources ((lurlt).
Roger's Practica, written about 1180, re-edited by his pupil Roland
about 1250,'^ and commented upon by the "Four Masters" a little
later, was never separately printed but exists apart in manuscript,
although Daremberg pulilished a unique edition of the famous
commentary {Glossnke quatuor magistrorum) in 1854. Roger's
work became a standard text-book at Salerno, where he himself had
been a student and teacher. He knew of cancer and (possibly)
syphilis, described a case of hernia of the lungs, prescribed ashes
of sponge and sea-weed (iodides) for goiter or scrofula, employed
the significant mercurial salves for chronic dermal and parasitic
affections, introduced the seton and suture of the intestines over a
hollow tube,^ taught the use of styptics, sutures and ligatures in
hemorrhage and the healing of wounds by second intention (laud-
able pus). Roger, Roland and the Four Masters were succeeded
by the twelfth century surgeons, Jamerius^ and Hugh of Lucca
(Ugo Borgognoni), who left no record of his work behind him; by
Bruno of Longol)urg, an advocate of dry (aseptic) wound treat-
ment, whose "Chirurgia magna" completed at Padua in 1252, is
the first treatise of the time in which Arabic authors are drawn
upon; by Hugh's son or disciple, Teodorico Borgognoni (1205-
1296), Bishop of Cervia, whose treatise (completed in 1266) is
preserved in the surgical anthology ("Cyrurgia") of 1498 and 1499.
Theodoric was reviled by Guy de Chauliac as a copyist and plagiar-
ist, probably because, like Hugh before him, he contradicted the
pseudo-Galenist dogma of "coction" or "laudable pus" and stood
out in his day as a sturdy pioneer of a rational asepsis: "For it is
not necessary, as Roger and Roland have written, as many of their
disciples teach, and as all modern surgeons profess," he says,
"that pus should be generated in wounds. No error can be greater

1 C. Singer: Proc. Roy. Soc. Med. (Hist. Sect.), London, 1913-14. vii,
Xo. 2, 2.

2 Printed in the Venetian encyclopedic collections (entitled "Cyrurgia"),
of date 1498 and 1-199, in the Juntine of 154G, and in De Renzi's collections.

^ In the glosses of the Four Masters, a quill is used.

^ First printed from a Munich MS. by Pagel as "Chirurgia Jamati"
(BerUn, 1909). See also, the Berlin dissertation of Artur Saland (1895).

i;^() IIISI'OUV OK MK1>I('INE

tluiu tliis. Sucli ;i pr.-icticc is iiiilccd to liiiidcr iiatiirc, to |)i'oloii<;-
tho (lisoas(\ and to prmciit tlic coiiiilutinatioii and consolidation
of tlio wound." (Book II. rli. '27.) 'I'liis simple statcnient, as
Allhutt jioints ont, makes 'I'lieodoi-ic one of tlie most oi-i<>;inal sur-
fieons of all time, for only Mondexille, Paracelsus and List(M' u])held
these j)rincii)les after him. in the loiip; interref^num between
Mondeville and Lister, "the advocate.s of suppui-ation won all
along the lin(\" Hugh and Theodoric are also niemorahle for tho
inunction cure l)y the mercurial salve {uiujtictiiunt sdrrdcciiioan),
\\w sparing use of the cautery, and limitation of treatment with
ajiparatus in fractures and dislocations, 'i'lieir names an; also
associated with the medieval substitutes for anesthesia, tiie ori-
gins of which, however, go back to the icmote past, probably to
India.'

The earliest Salernitan reference to the "soporific sponge" occuns
ill tlie beautiful .Tcnson imprint of tlio Antulotarium of Nicliolas of Salerno
(,\'enice, 1471, fol. 32 verso), probably written in the eleventh century. The
sponge was steeped in a mixture of opium, hyoscyamus, nuilberry juice, lettuce,
hemlock, mandragora and ivy, dried, and, when moistened, inhaled by the
l)atient, who wa.s suljsequently awakened by applying fennel-juice to the nos-
trils. Tliis prescrii)tion, Husemann thinks, was (k-rived from older formula}
for anod.vne applications of similar ingredients to the tem])les for insomnia
{vigilm) or cataplasms for local ana^thesia, which are to be found in the
Antidoiarium of Nicholas (Oleum mandragoratum, fol. 22 verso), in the Prac-
tica of C^opho, in the Tractatus de aegritudinum curatione and even in Gaddesden
and Varignana. From Nicholas, the recipe of the spongia somnifera passed
on to Hugh and Theodoric (confectio somnifera) and thence to Gilbertus
Anglicus (1200), Pfolspeundt (1460), Guy de Chauliac, and the low German
Gothaer Arzneibuch. The old Dioscoridean sleeping potion was taken up by
Avicenna, Serapion, Jocelyn of Furness (1177-99), Isidore of Seville, Thomas
of Cantimpre, Conrad of Megenburg, Jerome Bock, .Jerome of Brunswick
(who sut)stituted belladonna), Matteo Silvatico, and Brassavola, while similar
narcotic potions are mentioned in Boccaccio (viii, 8; x, 4), Macchiavelli (II
Mandragola), Du Bartas, Marlowe, Middleton and Shakespeare (Romeo and
Juliet, iv, 1,3).

Through the Middle Ages, mandragora was the soporific par excellence,
preferable to opium and hemlock, because it was not liivc these "cold in the
fourth degree" but in the third. Its dangerous effects, when taken internally,
are indicated in Marlowe's Jew of Malta,

"I drank of poppy and cokl mandrake juice
And being asleep, belike they thought me dead,"

for which reason it was not used internally by the Salernitan surgeons.

The ablest Italian surgeon of the thirteenth century was Gug-
lielmo Salicetti, called Saliceto or Salicet (1201-1277), a man well
educated in hospital and on the battlefield, as also in respect of
university training. He was city physician at Bologna, later at
Verona, and, in 1275, completed his "Cyrurgia" (first printed at

1 Husemann: Deutsch. Ztschr. f. Chir., Leipzig, 1S9.5, xlii, 577-587.

THE MEDIEVAL PERIOD 137

Piacenza in 1476)' for the benefit of liis son, wlioni he brought uj)
to the profession of medicine. Although far shorter than his
treatise on internal medicine, his Surgery stands out as a great
landmark, or seamark in the history of the craft, and for the fol-
lowing reasons:- iSaliceto did not separate surgical diagnosis from |
internal medicine; and kept a good record of case histories, which
he held to be the foundation of his subject. He restored the use
of the knife, which Arabian practice had set aside in favor of the
cautery; lie showed how to suture; divided nerves and to diagnose :
l)leeding from an artery by the spurt of blood. He specifies con-
tralateral paralysis as a sequel of head injuries, for which he recom-
mends a thick compress to prevent the injurious admission of air;
crepitus {sonitus ossis fracti) is emphasized as a diagnostic sign of
fractures, arrow wounds are described in graphic fashion and a
furrier's suture is prescril^ed for intestinal wounds. He was the ;
first to assign venereal contagion as the real cause of chancre, bubo
and phagedenic ulcers, and even recommends a prophylactic ablutio
cum aqua frigida et roratio loci cum aceto (Neuburger). In his '
treatise on practice, he has left a classic description of dropsy due
to contracted kidney {"clurities in renibus"),^ a remarkable ac-
count of melancholia, and valuable contributions to gynecology.
The sound surgical principles of Saliceto were very ably upheld
by his pupil, Lanfranchi of Milan, who became involved in the
squabbles of the Guelphs and Ghibellines and was driven out of
his native town by the Visconti. At Lyons, he wrote his ''Chir-
urgia parva." Arriving in Paris in 1295, he fovmd himself, as a
married man, shut out of teaching at the university, where the
})rofessors were celibate clerics; and he therefore became associated
with the College de Saint Come, organized before 1260 by Jean
Pitard,* surgeon to Philip the Fair (1306-28). Here, by his
straightforward style of lecturing and his use of bedside instruc-
tion, he became the virtual founder of French surgery, and died in

' Translated into French, by Nicole Prevost (Lyons, 1492) and again with
commentaries, by Paul Pifteau (Toulouse, 1898). Saliceto's treatise on practice
(Sunmia conaervalionis et curationis) was first printed at Piacenza (circa 147.5-6),
and his Dc salute corporis at Leipzig (1495). His merits as a physician liave
i)een studied in the Berlin dissertations which Pagel set for his pupils, H.
Grunow (1895), E. Loewy (1897), W. Herkner (1897) and O. Basch (1898).

-See Gurlt, i, 754-765; Neuburger, ii, .380-.384, and Allbutt: "The His-
torical Relations of Medicine and Surgery," London, 1905, pp. '.i2, 33.

'Saliceto: "Liber . . . in scientia medicinah," Placentia^, 1476, ch. 140.
See also, Haeser, "Zur Geschichte der Bright'schen Krankheit," Janus, Bres-
lau, 1848, iii, 371, which gives interesting references to nephritis by the Arabic
^Titers Serapion and Rhazes.

^ A surgical manual by .lean Pitard, from MS. in Llineberg (Latin) and
Paris (old French) is printed by Sudhotf in Arch. f. Gesch. d. Med., Leipz.,
1908-9, ii, 189-278.

138 II IS ion V (»1- MKDU'INK

}'Mr>. In his " ( 'hii-iiriiia inaiiiia,"' coiuplcliMl in 112! 1(1 and dcdicalcil
to Philip th(> I'air i \'i'ni('(\ I I'.tO),' I .aiilVanc made a rcsohilc and
valiant stand atiainst the mcdicNal schism lictwccn snrnciy and
medicine which had existed since A\iceinia's time, staliniz; his con-
viction that t h(> suri;(M)n shonld also he an inlei'nisl in a neat
syllogism: [Oninis pnictirus < .s7 ///rr*r/c//.s; (imnis cj/rN/'diriis eM
prdcdcKs: crijo ooinis cyrnniicits est fhcoririis). He was the first to
doscriho concussion of the hrain, and his chapter on the symptoms
of fracture of the skull is account (m 1 a classic. Depressed fragments
and irritation of the dura are his oidy indications for trephining.
He also diifenMitiated het\v(HMi venous and arterial hemorrhage and
betwecMi cancer and hypertrophy of th(> female l)reast; and sucli
procedures as intubation of the esophagus, reunion of divided
nerves, and neurotomy for tetanus are among his innovations.
I'nlike Saliceto, Lanfranc was a cautcrist and averse to the knife.
He then^fore avoided tre]:)hining, cataract (extraction, or lithotomy,
treating hernia with trusses only, Init did not hesitate to operate for
empyema and wounds of the intestines, treating hemorrhage; by
styptics, digital compression, torsion, or even the ligature. He
gives careful directions for venesection, lamenting that this pro-
cedure should be the province of the barbers. His ethical advice
to the surgeon is quaint and characteristic, and although he looked
ui)on Paris as an earthly paradise he held the French surgery of iiis
day in sovereign contempt. The work of Saliceto and Lanfranc,
coincident with the development of the great medieval universities
—Paris (1110), Bologna (1113), Oxford (1167), Montpellier (1181),
Padua (1222), Naples (1224)— and the brilliant false dawn of
culture and liberalism in the thirteenth centui'y,'- did much to
further the growth of surgical talent in France, England and
Flanders. From the Italian families delle Preci and da Norsia
came the Preciani and the Norsini, whole generations of itinerant
surgeons who practised herniotomy, lithotomy, m-ethrotomy and
cataract extraction as a family secret.

Contemporary with Lanfranc was his loyal follower, Henri de
Mondeville (1260-1320), a hardy and original thinker, endowed
with great powers of wit and sarcasm, who made a valiant last

^ Also printed in the surgical anthologies of 1498-9. There was a French
translation by G. Yvoire (Lyons, 1490), an old English version, printed by the
Old English Text Society (1894), and another (Chirui^a parva) in black letter
by John Halle (London, 1565). A superb black letter translation of the
Chirurgia parva into Spanish was printed at Seville in 1495 by "tres alemanes
compaiieros." It was also translated into German bv Otho Brunfels (Strass-
burg, 1528).

^ For an interesting account of this Aufkldrung, which unfortunately did
not last long, see J. J. Walsh, "The Thirteenth Greatest of Centuries," New
York, 1912.

THE MEDIEVAL I'EllIOD 139

stand for the principle of avoiding suppuration by simple cleanli-
ness, as originally taught by Hi])pocrates and as reintroducc^d by
Hugh and Theodoric. Before 1301, he was one of the four body
surgeons of Philip tlie Fair, and in 1304 lu; delivered lecturers on
anatomy at the University of Montpellier.^ The surgical treatise
of Monde ville, begun in 1306 and left a torso (1316), was first edited
and printed from the several manuscripts by Pagel in 1892, and
later translated into French by Nicaise (Paris, 1893).- It abounds
in directions of the rarest common sense for the aseptic treatment of
wounds and in shrewd practical advice to the surgeon as to the
conduct of his professional life. In opposition to the salve surgery
of the Galenists, Monde ville advises simply to wash the wound
clean and put nothing whatever into it, since "wounds dry much
better before suppuration than after it." Wine and other " wound-
drinks" were given to strengthen the patient,Mn opposition to the
routine practice of cutting down his diet. For hemorrhage he
recommends styptics, digital compression, acupressure and torsion
of the isolated vessel by means of a sliding-noose ligature. His
biting wit is shown in such utterances as these: "(lod did not ex- -a
haust all His creative power in making Galen." "Many more / i
surgeons know how to cause suppuration than to heal a wound. "->^
"Keep up your patient's spirits by music of viols and ten-stringed
psaltery, or by forged letters describing the death of his enemies,
or by telling him that he has been elected to a bishopric, if a church-
man." "Never dine with a patient who is in your debt, but get .
your dinner at an inn, otherwise he will deduct his hospitality
from your fee." Henri's rapacity in the matter of fees shows how
hard they were to get in the Middle Ages,"* and what he says about
the subject suggests the type of surgeon who had to succeed by
dint of hard knocks. Like the heroes of Smollett, as described by
Sir Walter Scott, his cynical spirit seemed to delight in things
"attended with disgrace, mental pain, and bodily mischief to
others," yet it is hard to say offhand whether this was the fruit
of harsh experience or the expression of supreme irony.

A man of far different type was Guy de Chauliac (1300-70),

1 MondeviUe's anatomic treatise was reprinted from a Berlin MS. by
Pagel in 1889.

2 A fragmentary old French version of 1314 has been published bv A. Bos
(Paris, Societe des anciens textes frangais, 1897-9); another MS. of 1478 is
in the University Library of Upsala.

'See A. Raubach: Ueber die Wundtriinke in der mittelalterlichen Chi-
rurgie, Berlin dissertation, 1898.

* The Salernitan Dum. dolet, arxipe was the rule, as satirically indicated by
John of Salisbury. (Neuburger, ii, 32.5.) See also, C. Vieillard: Le pacte
medical au Moyen Age, Bull. Soc. frang. d'hist. de mod, Paris, 1904, iii, 482-
496.

lU)

HISTOUV OK Mi:i)l( 1\1

tlu' nu)st (listiiimiislicd authority on surj^cry in tlio rourtcciit li and
lit'totMith centui-ics. A country lioy from Auvci-^iic, ( !uy inana.ncd,
tln"ouj;h triiMids, to take holy orders and to net an excellent medical
etliication at 'roulous(>, MontpcUiiM- and Paris, with a special course
in anatomy at Holotiiia.' He thus became the most erudite sur-
Jieon of iiis time, and. in (hie course, settled down at Avi<>;non as
piiysician and "connnensal chaj)lain" to I'ope Clement VI and to
his successors, Innocent \'l and I'rhaii \ (1852-78). He was a
writer of rare learninii-, endowed with a fine critical and histoi'ic

Guy de Chauliac (1300-1370).

sense, and, indeed, the only medical historian of consequence be-
tween Celsus and Haller. As an operator, he set great store by
the study of human anatomy and was one of the first to take the
operations for hernia and cataract out of the hands of the strolling
mountebanks, although he hesitated to cut for stone. He believed
in cutting out cancer at an early stage with the knife, but employed
the actual cautery in the fungous variety as well as in caries, an-

1 Guy learned his anatomy from Mondino's pupil, Xiccolo Bertuccio, and
was also much influenced by the translation of Galen's De usu partium made
by Niccolo de Regio (1317-45).

THE MEDIEVAL PERIOD 141

thrax and similar Ic^sions. Ulcers he treated by means of an in-
vesting collar or guard of sheet lead, and he suspended fractures in
a sling bandage or (when in the thigh) l)y means of weight and pul-
ley. H(^ also gives an interesting summary of the dentistry of the
period.^ He throws a great light upon the operative procedure of
his time by his description of the narcotic or soporific inhalation,
originally attributed to Theodoric. This, the medieval substitute
for anesthesia, as above described, was in vogue up to the seven-
teenth century, and is frequently referred to by the Elizabethan
poets and dramatists, for instance, in the well-worn citation from
Thomas Middleton's tragedy of "Women Beware Women" (Act
IV, sc. 1):

I'll imitate the pities of old sin'o;eons

To this lost limb, who, ere they show their art,

Cast one asleep, then cut the diseased part.

Yet, in spite of his wide experience, (iuy de Chauliac was on the
whole a reactionary in the important matter of the treatment of
wounds and, by his great authority, threw back the progress of
surgery for some six centuries, giving his personal weight to the
doctrine that the healing of a wound must be accomplished by the |
surgeon's interference — salves, plasters and other meddling — •
rather than by the healing power of nature. As an ethical teacher,
Guy holds up a far nobler ideal to the surgeon than Henri, and his
mode of expression reveals the gentleman as well as the scholar.
During the epidemics of plague at Avignon in 1348 and 1360, he
stuck manfully to his post as a healer of the sick, while other
physicians fled the locality. His most important work is the
Inventariurn or "Chirurgia magna," written in 1363, and first
published in French translation at Lyons in 1478.- This book
passed through many editions, translations, and abridgments
(les fleurs du grand Guidon), and in the latter form it became the
vade mecum or "guidon" of surgical practice even beyond the six-
teenth century.

1 For which see V. Guerini's " History of Dentistry," Phila., 1909, pp. 142-
149, and J. J. Walsh's "Old-Time Makers of Medicine," New York, 1912,
pp. .319-.32.3.

^ La pratique en chirurgie du maistre CJuidon de Chauliac, Lyon, Barth-
elemy Buyer, 1478. The Latin text (Chirurgia) was first lorinted at Veni(!e
in 1490, a Venetian text in lingua franca in 14S0, a good Latin text by Laurent
Joubert, chancellor of Montpellier (Lyons, 1.57S); also a P>encli text dlouen,
161,5), and glossary by his sou (1.58.5). The l)est modern edition is that of
Edouard Xicaise (Paris, 1890). Many commentaries and al)ri(lgments were
made by .Symphorien Champier (1.537), Louis Verduc (1731) and others.
English, German, and Spanish versions exist. The black-letter " Questyonary "
of Robert Wyer (London, 1541) is a beautiful impression. A rare English MS.
owned by E.' C. Streeter is described bv him in Proc. Charaka Club, N. Y.,
1916, iv, 107-111, 2 pi.

142 lllslOKV OK MKDICINE

(iiiy's mcist (list iiimii>li('<l pupil was Pictro d'Argelata (died
142M). a ])i'ol'('ss()r at lioloiiiia. wliosc " ( 'iiufiiia " was pfiiitcd at
\'(Miic(' ill 1480. The cliaptrr (ill the ciislody of the dead body tells
how lie cinlia lined t lie corpse of Alexander \'. Arj2;(data t auj^lit t lie
dry treatment of wounds, hut powdenMl tliein: was skilled in
dentistry, used sutures and drainaf2;(>-tul)es in wounds, trejiliined
tlu> skull, incised the linea all)a in jjost-niortcni Cesarean s(M'tion.
and sonietiines ()])eraled for heiiiia, stono, and fistula in aiio. 'I'lie
latter oiieralioii attained a lii,t;ii (l(>ji;ree of |)(>i'fection in the hands
of John of Arderne (i;-5(Hl 90 |".']), the earliest of th(> Kiif-lish
surjieons. Arderne was a W(>ll-educate(l man who j>;()t his trainiiifi;
l)y an adventurous career as army sur<i;e()ii in the IIundrcMl "i'ears
War. lie wrote treatises on intestinal obstruction {Pa.ssio ilidca)
and goiit ; and an essay on clysters (1370), advocating an instru-
ment of his own invention. He employed irrigation in renal and
intestinal colic, cystitis and gonorrhea. His well-illustrated
treatise on fistula in ano (137()), in the opinion of its editor, D'Arcy
Power, introduced a well-described surgical operation for a con-
dition which most of his predecessors had abandoned as incurable.
Getting his patient into the lithotomy position, Arderne boldly
incised the outer wall of the fistula in all its Ijranches instead of
fretting it by probes and ligatures; checking any hemorrhage with
sponges, and avoiding all corrosive or irritating after-treatment of
the wound. This asepsis, akin to Mondeville's, is a reflex of Ar-
derne's training as a Norman surgeon. The Saxon leech crops out
in his leaning towards astrology, charms and wort-cunning.
"Nothing pleased him more than a charm."

Ciiovanni Arcolani (died 1484), or Arculanus, a professor of
medicine and surgery at Bologna (1422-1427) and Padua, whose
treatise on surgery ("Practica") was published at Venice in 1483,
is memorable as one of the leading pioneers of dentistry and the
surgery of the mouth. The surgical sections contain figurations
of the instruments used,^ including aural syringes and flexible
catheters. He describes the filling of hollow teeth with gold-leaf
and gives a remarkable account of the mental symptoms of alco-
holism.

The Chirurgia of Leonardo da Bertapaglia (died 1460) is only
an arrangement of the fourth book of Avicenna's Canon, full of
Arabian polj^jharmacy, with strong leanings towards astrology.

The Flemish surgeon, Jean Yperman (1295-1351), whose
"Chirurgie" was printed from the Flemish manuscript by Carolus

1 Neuburger, op. cit., ii, .508. J. J. Walsh: "Old-Time Makers of Medicine,"
New York, 1911, and "Modern Progress and History," New York, 1912,
116-118.

THE MEDIEVAL PERIOD 143

(Ghent, 1854) and again l)y Broeckx (Antwerp, 1863),^ was a pupil
of Lanfranc's who worthily ii])liel(l his master's teaching, especially
in regard to ligation and torsion of arteries.

He gives good accounts of trephining, arrow-wounds (with a special
wound-drink), heahng of harelip by means of freshened edges and special
sutures, artificial feeding by a silver tube, and enlargement of the ojiening in
reposition of prolapsetl visc(>ra. In the chapter on leprosy, he mentions the
anesthesia and the possibility of infection by sexual intercourse. Of the Royal
Touch for scrofula, he slyly notes that curable cases will get well without it
(Neuburger).

In the fourteenth century, he was the great authority on surgery
ill the Low Countries.

Hand in hand with th(> metlieval tlevelopment of surgery, there
necessarily went some effort to improve the status of human anat-
omy. Dissecting, at first rigorously proscribed by law and senti-
ment, became more and more a matter of course, following the de-
cree of Emperor Frederick II in 1240. Payne has divided medi(^val
anatomic teaching into three periods: First, the Salernitan (800-
1200), in which instruction was based upon the dissection of ani-
mals as set forth in the "Anatomia Porci" of Copho, one of the
.Jewish instructors at Salerno; second, the Arabist period (thir-
t(>enth century), in which such dissections were superseded by
l)Ooks and lectures. The leading authorities of this time were
Richard, of Wendover, called Ricardus Angiicus (1252), physician
to Gregory IX, whose work is preserved in the text of Robert
Toply (Vienna, 1902); and Henri de Mondeville, who, long before
Ambroise Pare, prefixed an anatomic treatise to his surgery, and
who improved upon Wendover's teaching by the use of pictures,
diagrams and a model of the skeleton.

The 1.3 miniature paintings which Henri employed have been reproduced
and described by Sudhoff from a French M.S. of 1314, also a number of crude
I)en-drawings from MS. at Berlin and Erfurt.- These tiny pictures are, per-
haps, the earhest anatomic illustrations of the time, and estabhsh several
norms of traditional anatomy, e. g., the muscular and visceral schemata, which
were slavishly followed for a long time. Better executed are the 18 colored
figures from the "Anatomie" of (luido de Vigevano (134.5), which Wicker,s-
heimer has reproduced from MS. .569 in the Musce Conde (Chantilly).^ The
anatomy in these drawings, intended to illustrate the technic of dissecting, is
extremely diagrammatic. In most of these medieval MS., the skeleton has the
spectral aspect (LcmiircNf/cstnlt) familiar in the many figurations of the Dance
of Death, suggesting a dried disembowelled preparation with the bones shining
through the skin; the stomach is invei-ted, giving the visceral schema the
appearance of a bagpipe, while the spinal column looks like a Malay creese.

'A "Traite de medecine pratique du maitre .Jch.ui 'S'perman" was also
edited and pubhshed by Broeckx (.Vntwerj), l.S()7j.

- Sudhoff: Anatomie im Mittehdter (Stud. z. Gesch. d. Med., Leipz., lUOS,
Heft 4, 82-89, pi. xxiv).

3 Wickersheimer: Arch. f. Ccsch. d. Med., T.eipz., 191.3-14. vii, 1-2.5, .5 pi.

144 lllSl'OKV OK Mi;i)l(l\K

TUv iiitrn'st of the tliifd |H'riuil crntiTs in llic i('\i\:il of limnnii
(lissrctinu; li\- Momliiio dr'Iji/zi (rirai 127") *)()), calliMl Mundinus,
of l^oloii'iia. whose Aiiat hoiuia was coiiiplcUMl in lilKi and first
published al I'aihia in 1478, and later at Leipzig- in IWY.i hy Martin
Pollich von Mellerstadt. In intention, this work was r(>aliy a little
liorn-hook of dissect inu;.' rather than a formal treatise on gross
anatomy.

Mundinus' sclioino of dissection hcfjins witli die ahdoiiiinal caAity, as
containinfi the pc'rishablc \iscoru. In tills Kcction ho incidcnially describes
al)doininal paracentesis, radical cure of hernia and lithotomy, f!;i\'es the differ-
ential dia.unosis l)(>t\veen renal and intestinal colic, an<l records his jjosl^-nior-
tenis on two female cadavers (.January, Ahuch, llil'i) to ascertain the relative
size of the uterus in virfiins and nuiltii)ara). He next passes to the chest and
neck, givhig a lengtliy descrijjtion of the heart, and concludes with the open-
inn of the skull. In sjx'akinfj; of \hc ear, h(> says wv. mifilit understand tlu^ tem-
poral hone Ix'tterif it were cleaned l)y boiling, only this is sinful (ncd propltr
peccatum dimitlere consuevi) (Neuburger).

Although full of (lalenical errors in regard to the structure^ of
the hmnan frame, preserving the old fictive anatomy of the
Arabists, with the Arabic terms, this work was yet the sole text-
book on anatomy for over a hundred years in all the medieval
schools. It passed through 33 editions and translations (Frank).
After this time, dissecting gained a firmer foothold as a mode of in-
struction. IVIundinus' work at Bologna was continued by his pupil
Niccolo Bertuccio (died 1347), who taught Guy de Chauliac.
Centile da Foligno gave a public diss(>ction at Padua in 1341. In
thirteenth century Italy physicians began to open the botly here
and there in order to find out the cause of death in suspicious cases
or in epidemic diseases. The first judicial postmortem was con-
ducted on a case of suspected poisoning by Guglielmo da Varig-
nana at Bologna in 1302. In 1348, necropsies w^re conducted
at Siena and were authorized at Montpellier about 1376-7. Pub-
lic dissections were decreed at the University of Montpellier in
1366, at Venice in 1368, at Florence in 1388, at Lerida in 1391, at
Vienna in 1404, at Bologna in 1405, at Padua in 1429, at Prague in
1460, at Paris in 1478, and at Tubingen in 1485.- An anatomic
theater was erected at Padua in 1446, and, at the Paris Faculty,
four dissections annually had been reciuired from the latter half of
the fifteenth century on. Even before the advent of Vesalius we
find the great artists of the Renaissance making dissections in the
hospital of Santo Spirito at Florence, })ut with the exception of
these artists, whose paintings really advanced anatomy without
didactic intention, dissecting was, as Neuburger remarks, mainly a

1 Otherwise a general medical manual (quoddam. opus iji medicina).

2 See F. Baker: Johns Hopkins Hosp. Bull., Bait., 1909, xx, footnote to
p. 331.

THE MEDIEVAL PERIOD

showy, ornamental feature of medieval instruction. In regard to
the bull De sepulturis, issued by Pope Boniface VIII in 1300, which
many supi^ose to have ])ut a dam])(n" u]^on anatomic r(^scarcli, it
is shown by Neuburger and Walsli that it was, in intention at least,
a simple mandate to prevent the bodies of dead Crusaders from
being boiled and dismembered before returning them to their rela-
tives.^

Title-page of Mundimis: "Anathoniia," Leipzig, 1493.

In the thirteenth century the Arabist culture was securely
grafted upon European medicine })y means of Latin translations,
and internal medicine in this period was essentially scholastic
and monastic, that is, its votaries were either monks or schoolmen
of the type of the foremost intellectual leaders of the thirteenth

1 Neuburger: op. cit., ii, 432. Walsh gives the Latin text in his "Popes
and Science" (New York, 1908, 413), and translates it in Med. Library and
Histor. Jour., 190G, iv, 265.
10

I 1(> Illsi'oKV ol- MKDICIME

cciitury HoiitT Uacon. 'riionias .\(|uiii;is, I)utis Scot lis and Al-
luTlus Masiims. 'I'tic ni('(lic\al lawyers and loiiiciaiis did <>;()()(|
service in sliarpcninu incn's luiiids and tcarliinn- them how to use
dialectics as an instrument or wea])on, l)ut science ils(>ll' could not
advance so h)nu; as the ])it falls oi" syllofiiisni were j)ref(M-i'ed to in-
duct ivi> demonstration of fact. We call the medieval writers on
practice of nic^licine Arabists on account of tluMr unswerving
fidelity to (ialenic dogma as transnuited Ihi-ough Mohammedan
sources. The great center of this translating movement was Toledo,
which. aft(M' falling into the hands of the Christians in lOS."), was
sought hy all and sundry for its rich stores of Arabic manuscripts,
while most of the Hebrew translations from the Arabic came from
Provence.

Gerhard of Cremona (,1114-87), who tran.slated Rhazos, Scrapion, Isaac
Judaeiis, Albucasis, and the Canon of Avicenna, was the principal interpreter
of tliis Toledan treasure-hoard; Marcus of Toledo translated much of (ialen
and the Isajioge of .Johannitius; the Salernitan Ferrafjut l)en ^alein translated
Rhazes in Sicily (1279) and .John of Toledo (.Joaiuios Ilispainis) j)i-ofoundly
influenced Salerno lij' his Latin version of the hygienic e]jistle of pseudo-
Aristotle. In this work of transplantation of Arabist doctrine, the .Jews, the
natural intermediaries between East and West, played a considerable part,
mainly in their own Hebrew versions of the Arabic. Otherwise, the Toledan
influences did not entirely make for good, .since the .so-called "translators,"
ignorant of Arabic, usually had some learned Jew or Saracen turn the text
orally into colloquial Spanish, to be rendered into barbarous Latin currente
calamo. Through medical, as well as linguistic, ignorance, the technical terms
were simply transferred without translation, the sense of the text was fre-
quently distorted, and the many contractions made it otherwise imintelHgible.'
This great mass of .\rabist doctrine was now attacked by the scholastic physi-
cians, who were either commentators in the orthodox sense, "aggregators,"
that is, compilers of the best things in their authors, "conciliators," that is,
those who sought to settle and reconcile the contradictions in Hellenist and
Arabist doctrine by dialectics, and "concorders," i. e., arrangers and harmon-
izers of the outstanding ideas and sentences of an author in regular order.-
The chief merit in all these medieval compilers was in their feehng for orderly
arrangement. There was httle independent thought. The influence of the
Arabic authors imported by Constantinus Africanus was already noticeable in
such early thirteenth century physicians as Ricardus Anglicus, Gualtherus
Agulinus, Petrus Hispanus, Gilbertus Anglicus and Jean de St. Amand, canon
of Tournay, who WTOte a commentary on the Antidotarium of Nicholas the
Salernitan, and a Revocatimim viemoriw, a labor-saving compend, designed to
save students sleepless nights over their Galen and Avicenna, and consisting of
a Concordance of these authors arranged by catchwords, an abbreviated key
to the contents of the Hippocratic and Galenic writings, and the Areolcp, a
condensed materia medica which enjoyed gi-eat popularity in the schools.
The founder of medical dialectics was Taddeo Alderotti (1223-130.3), called
Thaddeus Florentinus, a ^\Titer of dry scholia and good consilia, who began to
teach logical or scholastic medicine at Bologna in 1260, and was a thrifty,
much-envied practitioner. Thaddeus mtroduced the practice of swamping a
text in a veritable inundation of commentary. He early noted the faulty tran.s-
lations made by Constantine, and clung to the original Greek sources, but his

' M. Steinschneider: Die hebraischen Uebersetzungen des Mittelalters und
die Juden aLs Dolmetscher, Berlin, 1893. Also, Xeuburger, op. cit., 329-337.

= Pagel-Sudhoff (Berlin, 1915), 181.

THE MEDIEVAL PERIOD 147

own skill in logic-chopping suggests his training in the Canon of Avicenna.
The scholastic method attained its highest development at once in Bologna,
which was then the great center of legal casuistry and forensic trium[)hs.^

TYio "Conciliator di^ff'erentiarum'^ (Venice, 1471) of the heretic
Peter of Abano (1250-1315), tlie great ''Lombard," who as the title
of his work implies, tried to reconcile the views of the Arabists and
Grecians, marks the rise of the rival school of Padua as a center of
medical dialectics, of which Thaddeus and Peter were the; patterns
for a century.- The "Liber Pandect* Medicinje" of Matthaeus
Sylvaticus (died 1342), of Mantua, one of the first incunabula to
be printed (Strassburg, 1470 [?]) illustrates the same tendency.
The most prominent of the Arabists, however, were associated with
the rise of the medical school at Montpellier. Founded about 738,
this famous school, like that of Salerno, was charmingly situated
near the sea and not far from mineral baths. As early as 1137,
Bishop Adelbert of Mainz visited the school to listen to its medical
lecturers. St. Bernard refers to the visit of the Archbishop of Lyons
in his letters (1153), and its influence in France has survived to
this day. A prominent early representative of the Arabist teach-
ings of Montpellier was the alchemist Raymond Lully (1235-1315),
a native of Majorca, who, in addition to the philosopher's stone,
sought the "aurum potabile" or liciuid gold, as a sovereign elixir
against disease. Having entered the order of the Minorites, he
k^arned Arabic through his desire to convert the Moslems of North
Africa and, in this way, became acquainted with Aral)ian chemistry
and brought some of its ideas into Europe. A man of similar type
was the Catalan, Arnold of Villanova (1235-1312), who was a
doctor of theology, law, philosophy and mecUcine, and counsellor
or consultant to Peter III of Aragon. A follower of the Arabian
chemists, he also sought an universal elixir of life, and his alche-
mistic tendencies, taken together with his theologic heresies,
caused him to be anathematized after his death. He is credited
with the introduction of tinctures ami of brandy {aurum potabile)
into the pharmacopeia, and in many ways he was a sort of refined
Parac(>lsus, a man full of strange contradictions. He was a ])ioneer
in the classification of diseases and op])osed the abuse of dialectics,
the tendency of the Parisian scholastics to lose themselves in uni-
versals and ignore particulars, as well as the footless therapeutic
empiricism, which lost itself in particulars and ignored general
principles.

' Neuburger, op. cit., 375.

-Peter's "Conciliator" consists of 210 moot-points to be resolved by
dispute, e. g., "Utrum nervi oriantur a cerebro necne?" "Utrum medicina sit
scientia, necne," "An ossa sentiant," etc., which became the fashion for stu-
dents' dissertations and disputations even beyond the seventeenth century.

I IS IIlsi()i;\ ()|- Mi;i)i(i\K

I \v WAS a ct)!)!!!!!."*, ('U'fiiiiil , micrii ical w ritcr, w ho, acconliii^i to SNinplioiicii
Cliaiupicr, (Icclincil tn rcxisc any copy, once lie liail |)('iiiic(l it . His •' l^ics iar\-
u( rracticc" (Milan. lls;5l, one of tlic best ol' tlic incilicval iiandhooivs, con-
tnins unicli iiitlciicndcnt <)l)S(>rvati()ii, and many citations from now nnknown
physicians. .\rnoId's greatest work is the I'nniliola, a set of '.Wrt jyitliy ai)lior-
isnis. dedicated to I'liili]) t lie l-'air i I ;{()()), and containinji much ori^rinal tlioufj;lit.
Mis connncnlary on ihc Hc^iimcn Sanitatis, is not to he confnstMl witli llic
Ixcfiimcn itsch', sometimes a.scril>e(l to iiim, nor witli the otlier commenttuy
altril)ntablo to Ma^nino of Milan.' The hest modern si udies of .Arnold of \'il-
lanova are those of llanre.an on tlie textual side, and I'.aul l)iei)Kcn, on the
medical siile.'-

Otiier prominent pupils of Mont jjelliei' were t lie surj^eons ( iuy de ( "hauliac,
.\rderne and Monde\ill<'; \ alescus de 'J'aranta ( K5.S2-14 17), i)hysi(ian to
Charles \'l of France, whose "Tractatus de i)est(>" was one of th(^ earUost in-
(HHialiula (.1470 [?]); .Johannes de Tornamira, physician to Popes Gregory IX
and Clement \'1I, for many years chancellor of Alontpellier and remembered
liy liis " Introductoiium " i Lyons. 14!)()), a pojjular text-book on piaclice in the
fourteenth and fifteenlh centuries; i'eter of Spain (r277), calleil I'elrus llis-
panus, ))hysician to Pope ( Iregory X and afterward himself Po|)e .John X.XI,
who.sc "Thesaurus Pau])erunr' was ihc most popular of the medieval formu-
laries; and the leading rei)rosentatives of Anglo-Norman medicine, Bernard de
Gordon, Richard of \\'endover (the anatomist), Gilbertus Anglicus and .lohn
of (iaddesden.

Before the advent of the Xoniuiii eoiuiiierors, English medicine
was entirely in the hands of the Saxon leeches, whose i)ra('tice was
made uj) of charms, spells and herb-doctoring, and whose folk-
medicine is preserved in the "Leech-Book" of Bald and other
Anolo-Saxt)n "leechdoms."^ The Normans raised the social and
intellectual status of tlnnr physicians by having them educated
abroad as clerics.

Bernard de Gordon, presumably a Scotchman, did not practise in
England, })Ut was a teacher at MontpeUier from 1285 to 1307. His Lilium
Medicinie, which exists in several rare manuscripts and was first published at
Venice in 1490, is a characteristic Arabist text-book of the practice of medicine,
nowise classic, and typical of the Middle Ages in scholastic subtlety and rigid
adherence to dogma. The subject matter is well arranged; acute fever (l)u-
bonic plague), phthisis, ej^ilepsy, scabies, ignis sacer, anthrax, trachoma, and
leprosy are described as contagious, and the book is notable as containing the
first description of a modern truss and the first mention of spectacles as " oculus
berellinus." The "Compendium medicinse" (London, L510) of Gilbertus
Anglicus (died 1250), the leading exponent of Anglo-Norman medicine, is
very much like Gordon's Lily in style, arrangement of contents and modes of
thought. The author avows his preference for the simple expectant treatment
of Hippocrates, but hesitates to employ it for fear of seeming an oddfish.''
The most important feature of his work is an original account of leprosy which
became the basis of medieval information upon the subject. Gilbert was the
first to refer to smallpox as a contagious disease, a view afterward contradicted

' Xeuburger (ii, 391) attributes Arnold's commentary to Magninus Medi-
olanensis.

^Haureau, in "Histoire htteraire de France," LSSl, xxviii, 26-126, 4S7.
Diepgen: Arch. f. Gesch. d. Med., Leipzig, 1909-10, iii, 115; 188; 369;
1911-12, V, 88; 1912-13, vi, 380.

' See Oswald Cockayne, Leechdoms, wortcunning and starcraft of early
England. 3 vols. London, 1864-6.

* Neuburger, ii, 369.

THE MEDIEVAL PERIOD 149

even by Sydenham. The hook concludes with hygienic iHrections for (i':ivel(>rs
and seafarers, a literary specie's, which, hke the hygienic regimina written for
great overlords and ladies, was to become fashionable in time.' John of
Gaddesden (12S0 [?]-1361), a prebendary of St. Paul's, whom some think the
original of Chaucer's Doctor of Physic, was physician to King Ivlward II
of iMigland and a fellow and professor at Merton College, O.xford. His Ro^ii
Auyliai, compiled in 1314, and printed at Pavia in 1492,- contains an early
reference to the red light^ or Finsen treatment of smallpox, which was already
known to Gilbertus Anglicus and Bernard de Gordon; l)ut it is otherwise mainly
a farrago of Arabist (juackeries and couTitryside superstitions, (iuy de Chau-
liac called it "a vapid rose, devoid of fragrance," and Haller referred to its
author as "an empiric, full of superstition, obviously untrained, a lover and
eulogist of quack medicines, greedy of gain, an expert in kitchen-lore." John
Mirfeld, a monkish physician who worked in the cloisters of St. Bartholomew
in the second half of the fourteenth century, wrote a glossary and a l)reviary
to the treatis(> of Bartholomanis Anglicus. Among the popular writings of
the early fifteenth century may be mentioned the many herb-books and fornni-
laries in Middle-High and Middle-Low German, Middle English, Danish
and Icelandic, the Meinauer Naturlchre and the Welsh Mcddycjon Myddfai^
The Danske Laegebog'" of Henrik Harpestreng (died 1244), canon of Roeskilde,
consists of two herb books, deriving mainly from Macer Floridus, and a stone-
book, which derives from Marbod. A treatise on purgatives by Harpestreng
was edited by J. W. S. Johnsson in 1914.

The most eminent naturalist of the thirteenth century was the Dominican
monk, Albert von Bollstadt (119.3-1280), called Albertus Magnus, who was
successively a teacher at Paris anfl Cologne, Bishop of Ratislion (1260-1263),
ending his days in Cologne. He was the Aristotle of his period, and he declared
that the object of his Physica was to furnish the brethren of his order with
an Aristotelian Book of Nature. His descriptions of plants (De vegetahilihus)
were based upon his own observations and, according to Haller, contain the
beginnings of plant geography. His work on animals is of the same character,
and he assisted Frederick II in his work on falconry. The often reprinted
work on cosmetics (De secretis niulicrum), which usually goes by his name, was
in reality a huge compilation made by his pupil, Henry of Saxony. Albertus
Magnus did not WTite on medical practice, a subject forbidden to the Domini-
cans. His pupil, Thomas Aquinas, discussed physiologic questions in his
theologic writings and atlvanced the dubious animistic doctrine of qu<di tales
occulUt. Albertus Magnus was followed by such encyclopedists as the Domini-
can, Vincent de Beauvais (Speculum niajus, 1473-5), Bartholomew Glanvil,
properly Bartholoma^us Anglicus (De proprietatibus rerum), the Dominican.
Thomas de Cantipre (1204-80), whose De naturis rerum was the original of
the Fuch der naiur (1350) of Conrad von Megenberg (1309-74), and the
Temro of Dante's teacher, Brunetto Latini. All these tomes contain medical
matter.

The greatest ex])erimenter of the thirteenth century was the Enghsh
Franciscan Roger Bacon (1210-92), called Doctor mirabilis, who was a com-
parative philologist, mathematician, astronomer, physicist, physical geog-
rapher, chemist and physician. He reformed the calendar, did much for the
theory of lenses and vision, anticiptited spectacles, the telescope, gunpowder,

' See Sudhoff (Arch. f. Gesch. d. Med., Leipzig, 1910-11, iv, 263-281) on
the oldest kno\\7i (circa 1227) and Pagel-Sudhoif, p. 185.

- The later editions were those of Venice (1502), Pavia (1517), and Augs-
burg (1595). See G. Dock, Janus, Amst., 1907, xii, 425-435.

^ Ntniburger, ii, 369; 502. H. P. Cholmeley: John of Gaddesden and the
Rosa Medicina>, Oxford, 1912, 41. Compare Gilbei't's "Compendium Medi-
cinal," Lyons, 1510, fol. 348, verso, col. I, with (iaddesden (fol. 51 recto, col. 11).

■• Translated by John Pughe, edited by John ^^'illiams at Ithel, Llandovery,
1861.

5 Edited bv C. Moll)cch, 1861.

150 nisrouv ok mkdicin'k

(living lu'lls, l«>c<>in«)li\ I's and ll>iii;i iii.icliiiiis, :iiul \\;is a foKri inner dI inilurli\t'
and cNpcriiiifiilal sciciifc. Medicine lie regarded as a means of piolon^in^ life
tliniuuli alelieniy u'lieniistrv i and lie aijproxed of aslrolony and olliei- modes
of su|UTstition on account of liieir p>\ clioi iieiapeui ic cIToct.'

Thrc>c incdic'val writers on medical jilanls and simi)!('s deserve especial
mention, viz., (liacomo de' Dondi (Ti'tSl ;{")<)), wliose " Ajitiicfialor de inedi-
cinis siniplicii)ns," ininled at Strasslnnfi, cirm 1 170, l)y Adolf l^uscli i llie " !{"
l)rinteri,- is one of llie earliest known of medical incunahnla;' Sinione de Cordo
(diet! 1330), whose "Syn()nyma nicdicina'" (147;}) was the first dictionary of
druK^ and simples, under the (ireek, Latin and Arabic names, and the above-
nientioneil Matteo Silvatico, wliose I'diuUcts, also i)rinted by Uuscli at Stras,s-
burji. is a similar com|)ilation, tiiviiifi also botanic descriptions and thera-
peutic indications. These t hree books did for the Arabic botanic terms what.
Hyrtl later did for the anatomic, and, in a manner, they may be rejiarded as
the origin.s of our m(>dical dictionaries.

The pre-Renaissance medicine of llic fotirtoonth aiul early
fiftoontli cc'iitiiru's \var< ehai-actcri/cd by the attempt to cast tlio
Aral)ist tradition into a ri<i;icl mold by means of Aristotelian dia-
lectics and assimilation to tlie Aristotelian philosophy. The result
was that the (lalenic doctrine, after translation and re-translation
through the Arabic, Syrian and Hebrew glosses, was badly dis-
torte<l and wrenched away from its original mc^aning. Th(^ "spell
of Aristotle" was over all. The scholiast and tlie dialectician
ruled suj^reme, until more advanced spirits became frank sophists
or ske])tics, thus preparing the ground for the true R(n-i\al of
Learning. The medical literature of the fourteenth century was
entirely nn-eptive and ])assive, consisting of compilations, comm(Mi-
taries, glosses, glossaries, concordances, breviaries of i)ractice
(often called after the Lily and the Rose) and casuistic writings
or Consilia. In this period flourished Mimdinus, Guy, Monde-
ville, Arderne, Yperman and Argelata.

1 For a full account of Roger Bacon's work in science, see the "Commemo-
rative Essays," edited for his seventh centenary by A. G. Little (Oxford, 1914),
with an account of his work in medicine by E. T. Withington.

= The fact that the "R" printer was Adolf Rusch, and not his eniployer
Mentelin, was settled by the distinguished Gottingen philologist Karl Dziatzko,
in his essay "Der Drucker mit dem bizarren R" (Samml. bibliothekswi.ssensch.
Arbeiten, Halle, 1904, Heft 17, 13-24). Rusch, it seems, married Mentelin's
daughter, Salome, and eventually took over his business. The much disputed
"R" is in reality a monogram of the initial letters of Rusch's name, which he
was in the habit of inserting here and there in the books printed by him, as a
sign of his liandiwork during the days of his apprenticeship.

5 The question, "What is the earliest printed medical book of size?" is
still unsettled. The Gutenberg "Laxierkalender" of 14.57 of course antedates
evervthing else, but it is only a sheet of paper. Mile. Pellechet as.signs the date
14H7* to .Johann Gerson's three tracts on self-abuse, printed liy Ulrich Zell at
Cologne. The date " 146S" has been claimed for Roland of Parma's pest-tract
and 1469 for Giammateo Ferrari da Grado's Practica (Ft. 1). The question
cannot l)e finally decided until all the known medical incunabula have been
catalogued, collated aitd compared as to fonts of type, fihgranes (water-marks),
majuscules (initial letters) and the internal evidence of biographic and other
data. This important task has now been undertaken by Dr. Arnold C. Klobs,
who has already assigned dates and printers to many undated incunabula.

THK mp:dieval period 151

A striking feature of elinical mcilicine in the fourteenth and fifteenth cen-
tui-ies was the writing of "Consilia" or meiHcal case-hooks, consisting of
clinical records from the practice of well-known physicians anil lettei's of advice
written by them to imaginary patients or else to real pupils or country doctors,
who appeal(,>d to their superior knowledge as consultants. The earliest writer
in this gnirc was Taddeo degh Alderotti, whose Consilia still "slumber in the
nKuuisc-ripts" (Sudhoff). The practice was kept up by nearly all the scholastic
l^hysicians of the Bolognese and Paduan schools. The most important Con-
silia were those WTitten by the Paduan professors Gentile da Foligno, who was
a victim of the Black Death in 134S and was the first to observe gallstones;
Hugo Senensis (gastric vertigo, nasopharyngeal polyp, et(!.), Antonio Cermisone
(footbaths, turpentine in sciatica), Hav(M-ius de Baveriis (caries of the tempo-
ral bone, paralysis with aphasia, iron in chlorosis), Ferrari da (Irado, and Barto-
lonnneo Montagnana (1470), a descendant of a long line of physicians, an anato-
mist who had dissected as many as fourteen bodies, and a surgeon who described
strangulated hernia, operated for lacrimal fistula and extracted decayed teeth.
These Consiha, of which Montagnana gives some 305, usually run over the
patient's physical condition and disease, winding up with seasonable advice
as to what to eat, what drugs to take and what things to avoid. Being personal
histories, they have not the classic flavor of the cases described l)y Hippoc-
rates and Aretfeus, and are of interest chiefly for their many original oliserva-
tions and as showing that physicians had already begun to keep careful records
of their daily practice. The custom was kept up in the later i)eriods, e.g.,
by Johann Lange (1554), who described chlorosis, by Locke, who sent Consilia
to Sydenham, and in the interesting exchanges of medical cases in the corres-
pondence of Bretonneau with his ptipils, Velpeau and Trousseau.

Of the scholastic writers on internal medicine, Guglielmo Corvi of Brescia
(1250-1326) whose Pradicn was called Aggregator BrLviensiH:, Dino del Garbo
and his son Tommaso, Torrigiano di Torrigiani, Niccolo Bertuccio, the teacher
of Guy, and Pietro di Tussignano belonged to the Bolognese School, The
rival school of Padua, which followed the Averroistic leanings of Pietro
d'Abano, numbered among its masters Gentile da FoHgno (died 134S), famous
for his Consiha, Giacomo de' Dondi (129S-1359) and his son Giovanni, Marsilio
de Santa Sophia and his nephew Galeazzo, Giacome della Torre called Jacobus
Foroliviensis, Matteo Silvatico of Mantua, author of the famous PandedcB.
Francesco di Piedimonte, whose Suppkmentum Mesuce was one of the best
text-books of the time on special pathology and therapeutics, expressing the
final union of Salernitan and Arabic medicine, and Niccolo Falcucci (died circa
1412), called Nicolaus Florentinus, author of a vast repertory cafled Sermones
vxedicinales (1484), which summarizes the whole of medieval medicine, teeming
with original citations from all the known authorities.

Before the invention of printing there had accumulated a huge quantity
of medical literature in manuscript, the investigation of which has been mainly
the task of Professor Karl Sudhoff and the Institute of Medical History at
I.eipzig. This literature includes many hitherto unprinted texts and text-
books of the medieval physicians and surgeons, calendars and schemata for
blood-letting and purgation, "death-prognoses" setting forth the signs of dis-
solution {signa mortU), Le prase ha ubriefe or medico-legal expertises as to the
civil status of supposititious lepers, business announcements of vagrant physi-
cians, municipal ordinances against quackery, old German MS. on farriery
{Ross(irztieHmeher). consiha and even warnings against the abuse of alcohol.

The Montpellier School includes the names of Guy, Jean de Tourne-
mire, Johannes Jacobi, and many other famous chancellors and Papal physi-
cians. The principal medical writers of the early fifteenth century were Ugo
Benzi, called Hugo Senensis (died 1439), a great medical philosopher, connnen-
tator and consihary, who taught in all the famous Itahan schools, Antonio
Cermisone, Antonio Guainerio, Savonarola, Bartolommeo Montagnana, of
Padua, Arculano, Argelata, Marco Ciatinaria and Giammateo Ferrari da
fh-ado (died 1472), professor of medicine at Pavia, whose Practica (printed
146i)-7r) and Consilia, contain much original observation, e. g., of writer's
cramp, facial jniralysis, hemoptysis in dysmenorrhea, sterility from displace-

\')'2 HisToin' oi' Mi:i)i(i\io

iiiciU of till' ulcriis. ••iiid ilic ii>c <il' tlic pessary and ilic Iriiss in iilrriiic jjiolapso
and licriiia. In l-raiicc, llu' I'orlu.iiucsc X'alcsciis dc 'I'aranta, a leading; W'acluT
and piarlilioiuT at .Monlix-llirr, wrote a f;iinous tniet on pest (117Ii-4) and a
tliciajHnilic I'fiiloniiim (14!)()) wliicii w:us often rcprintod. Jmiciues Despars
(Jacolins de I'arlilms), at Paris, was coinineiitalor of Aviceniia, Mesne; and
Alexander 'rrallianns.

Cultural and Social Aspects of Medieval Medicine. 1 )iiiiii^ t he
Dark Aj!;rs I^ITC) 11)00), Wcslcni lMiro|K'aii cix ilizat ion was in a cha-
otic, fonnlcss !stat(\ the turbulent fernuMitat ion of barbaric or deca-
dent peoples resoh- in, u, t henisclves into new nations. Feudalism pnl
nationhood on its IVet, wliile the Cluirch was the oidy foster-mother
that science could find.^ In the Dark Aiies, th(> ckM-p;y were the
only class who had any ])retense to education and, before the time
of the School of Salerno, medicine was entirely in the hands of
Jewish and Arabian physicians.^ Tjie rest were simply vagrant
quacks or stationary humbugs whose ])ractice was discountenanced
by the Church on the ground that faith, prayers and fasting were
better than ])agan amulets, while the sick were advised to enuUate
the saints in their capacity for endurance of suffering (Gregory of
Tours) . With the rise of the School of Salerno, European medicine
began to look up a little, but, as soon as monks and clerics began to
practis(> medicine, it was found that the seeking of medical fees
to the detriment of r(>gular duties, the sight of many aspects of
the sick that might offend modesty, the possibility of being the
cause of a patient's death and other happenings were somewhat in-
consistent with the original intention of holy orders, and so we
find the Church instituting that long series of edicts which, in the
first instance, were aimed not so much at medicine as at its mal-
practice by monks.-'' These were the decrees of the councils of
Clermont (1130), Rheims (1131), the Second Lateran (1139),
IMontpellier (1162), Tours (1163), Paris (1212), the Fourth Lateran
(1215), and Le Mans (1247)," and their general effect was, un-
fortunately, not only to stop the monks from practising but to

1 How carefully tKe clergy collected medical literature is evidenced by the
remarkable bequest of medical books to the cathedral library at Hildesheim, as
listed in the will of Bishop Bruno (1161). See Neuburger, op. cit., ii, 321-322.

^ In spite of the Decretum Gratiani, excluding Jewish physicians from
practising among Christians, Archbishop Bruno of Treves (1102-24) was at-
tended by the learned Joshua, Moses of Liege was consulted by the clergy
in 1138, and medical practice at Prague was entirely in the hands of the Jews
in the twelfth century (Neuburger, ii, 325-33).

3 The earliest of these, that of Clermont (1130), refers specifically to the
"neglecta animarum cura," the "detestmida pecunia," and the "impudicus
oculus." Even in 877 the synod of Ratisbon had decreed that "Leges et physi-
cian 710)1 studeant sacerdotes" (Neuburger).

'' Sprengel gives the sources of these decrees, viz., O. D. Mansi: Sacrorum
consihorum nova et amphssima collectio, Florence, 1759-98, xxi, columns 459;
528; 1160: xxii, col. 1010: xxiii, col. 756.

THE MEDIEVAL PEUIOD 153

extend the special (xliuin of these decrees to the whole hkmUcuI
profession. As AUbutt says, "If Paj)al bulls conferred privileges,
they usually imj)lii'd or imposed restrictions." The famous
maxim of the Council of Tours ("Ecclesia abhorret a sanguine "),
for example, went wide of its supposed intention, since, in
casting discredit upon the sometimes murderous vagabond
surg(^on, the weight of its authority made the surgeon of l)est
ty]:)e still an inferior to the average practitioner, even in Protes-
tant Clermany to the end of the eighteenth century. Worse
still, the l)igots of tlie Paris Faculty went nmcli further than the
Papal See in widening the gap between surgery and medicine. The
Roman Pontiffs themselves were, some of them, liberal-minded
men of the world, who did not hesitate to employ talented Jewish
physicians at need and, in later times, did much to foster the arts
and sciences, in Italy at least. John XXI and Paul II were phy-
sicians. "Around the Papal Chair," says Allbutt, "the velvet
of the hand of the Church was thicker than the iron. In the air
of Rome or of Avignon the grim rigor of Paris was marvelously
softened." While great harm was done to medicine l)y the Papal
decrees which degraded the surgeon's status, we should not forget
that, up to the time of the crusades, all Europe outside of Italy was
in a state of barbarism antl that the status of surgery in these
countries was lower than it was among the Greeks at the time of
the Trojan War. A few shreds of technical knowledge may have
drifted over from far Byzantium, Init the evidence of the Niebe-
lungenlied, the Anglo-Saxon Leech-Books, and the X^orse Sagas
all point to the same conclusion, viz., that the care of the sick and
wounded was first in the hands of women and later intrusted to a
class of men who, in war-time, were in great recjuest but, in times of
peace, ranked on a level with menials.

Druidical medicine in Britain was entirely i)riestly.

The Druids were a forporation of magicians, and of these, the Seer (rates)
assumed iatromantic functions, with augury (insjiection of sacrificial entrails)
for prognosis, magic and wort-cunning for th(>rapy. Mistletoe (all-heal) was
the panacea, the six herbs, lycopodium, Pulsatilla, trifolium, primula, hyo-
scyamus and verbena were highly esteemed; artemisia, betonj', bryonia, cen-
tauria, belladonna, hellebore ancl mandragora were known. Druidesses were
also i)rominent in sorcery, second-sight and herb-therapy.' The Anglo-Saxon
Icechdoms tell the same story of charms, sjiells and simples. Blood-letting,
l)urging and (U-ugging were regulated by tlie moon's age. The Venerable Bede
reckoned the period April <S to May 2.5 as the best time, while certain days in
the interim, when the moon and tides were at full, were regardetl as unlucky
or Egyptian day.s (dies /Egypt iaci), a late Roman superstition, mentioned by
St. Augustine, and i)roba})ly of Babylonian origin.'- Ancient Irish medicine
has many signs of Oriental provenance, particularly in the austere regulations
of medical practice and quackery in the Brehon Laws, which suggest the Code

1 Neuburger, ii, 234-236.

-J. F. Payne: English medicine in the Anglo-Saxon limes, Oxford, 1904.

\7)l lIlsroKV OK MKDICINK

ll;uiiiinii;il)i. A straiific MS. of Ko^-r Hacoii'.-?;, wiittni citlKT in < luclif or
ciplicT, full of iviuarkahly iialunilistic miniiituro linurntioiis of prcfiiKiiicv,
siiutrcsts some kind of csolcrii- or incsiiicric in a trie, like that of the Ilimiu fakirs.'

Ill I'acitus ((uTinaiiiM, VII), it is said tluit the wouiidcd 'IVutons
soujiht tluMr wives and mothers, who. like the professional blood-
suckers of the eiij;hte(Mith century, a])])lied their lips to the wounds
((1(1 iiKilrcs, ad C(i)tjii(i(s riilncra J'cniitt, iicc illdc ntHNcrdri el cxigere
phujafi parent). The revenMU'O of the ancient Germans for the
intuit i\'e powers of woman was the oriu;iii of wcisc Frauen, who
practised hei-hal medicine.

Of these, the seeresse.s Veleda ami Aurinia, as Tacitus relates, were revered
as divinities. In the epic of "(Judrun" (1. 520) nienlion i.s also made of "wild
women" (loilde W'cihcr), who knew of healinji hcrlis. Demon-lore, magic,
charms and annilets made uj) the rest of early German medicine.- As among
tile (Jreeks, the wrath of the gods wa.s ai)i)cascd hy hioody .sacrifice, the demons
dispelled by exorcism, the therapeutic properties ascribed to certain plants,
parts of animals and the votive (usually heart-shaped) pastry used in sacrifice
were based upon theii' sacral associations with the gods in their chthonian or
earthly aspect. From this cull arose a sacred jiharmacopceia and a ''sacrificial
anatomy" [Opfiramitoinic), the technical terms of which were long a {)art of
the vocabulary of German huntsmen, and eventually made up the culinary
anatomy of the slaughter-pen and the kitchen (Hofler).^ The vernacular
names of diseases were derixed in the same way, directly from the ixxlily
eflfects or from demoniac etiology.^ I'o ward of! die demons of disease, the
gode or sacrificial jiriest was assisted by the aboriginal medicine-man, the
lekeis or Idhki, the equivalent of the Anglo-Saxon laeca (leech). Shejiherds,
herdsmen and smiths, as being natural veterinarians, also beame renowned
as healers, bonesetters anfl masseurs (Slreicher) in isolated localities.

In Russia, medicine was originally in the hands of the volkhava
or wolf-men, who, like the Druids and wise women, culled medicinal
herbs and resorted to charms and spells. The earliest relic of
Rtissian medicine is a vase of Clreek pattern excavated at Koul-
Oba, representing a Scythian chieftain in consultation with a
volkhava, a Scythian warrior examining another's teeth and a
surgeon bandaging an injured leg. This unique vase epitomizes
medieval medicine and surgery tip to the time of the School of
Salerno.^ After the introduction of Christianity in the tenth
century, Russian medicine passed into the hands of the priest-
hood, the wolf-men gave place to the monks of Mount Atlios, and
the Russian Church, like the Roman, put severe interdictions upon
sorcery and magic. Thus religion at the start tendetl to improve

1 In the possession of Mr. WiKred M. de Voynich.

2 Neuburger, op. ciL, ii, 236-240.

3M. Hofler: "Wald- und Baumkult," Munich, 1892; also "Die volks-
medizinische Organotherapie," Stuttgart, 190S.

* See Max Hofler's learned "Deutsches Krankheitsnamenbuch," Munich,
1899.

' P'or a photogi'aph of the Koul-Oba vase, see "Xouvelle Iconographie de
la Salpetriere," Paris, 1901, xiv, plate no. 72, opposite page 528.

THE MEDIEVAL PERIOD lo")

tli(' status of incdiciue, but speedily, if unintentionally, degraded
it, as soon as it found its own medical ministrants falling into evil
ways. Even the special nurses or " i)aral)olani,"i whom the Church
em])loyed to seek out the sick and convey them to places of shelter
and safety, were soon shorn of their powers as they Ijecame uppish,
c}uarrelsome antl overbearing. Even before this time, however,
the \'isigothic Code (fifth to seventh centuries) put the same severe
restrictions upon medical practice that we find in the Code
Hammurabi, iiefore taking up a case, the physician, under the
\'isigothic Code, had to make a contract and give pledges, and, if
his patient died, he got no fee. If he injured a nobleman in vene-
section he had to pay 100 solidi (about $225) ; if the nobleman died,
the ])hysician was turned over to the relatives of the deceased to
be tlealt with as they pleased. If he killed or injured a slave, he
had to replace him by one of equal value. He was forbidden to
l)leed a married woman in the absence of her relatives, for fear of
the commission of adultery, and he could not visit a prisoner lest
he defeat the ends of justice by furnishing him with poison. On
the other hand, it is stated that no one might cast a physician into
prison without a hearing, except in case of murder, and that the
statutory fee for instructing medical students should be twelve
solidi ($27) each. The other "Leges barbarorum" were equally
severe. Under the Bavarian Code (Lex Bajuvarum vii, 19), the
administration of an abortifacient entailed a fine of one sohdus
in the culprit's family, even unto the seventh generation.- From
these regulations, made by the secular arm of authority, and designed
to protect the public as well as the physician, it may be gathered
that, with medicine in such an unorganized condition, something
more than the guardianship of Church and State was necessary to
elevate the status of the healing art, and this was accomplished by
improved medical legislation, by the foundation of the great medie-
val universities and the subsequent formation of "guilds" by the
physicians themselves. Under the legal restrictions of meclieval
times, the surgeon worked daily and hourly in jeopardy of life or
limb.3 Marileif, Chilperic's body physician, was flogged, shorn

' First mentioned, A. D. 416, in the Codex (de legationibus) of Emperor
Theodosius (lib. xvi, tit. ii, 42-43), but ah-eady knowai as Parapemponti, in
St. Basil's account of his hospital at Ca^sarea (370-379). See C. F. Heusingor,
Janus, Brcslau, 1S47, ii, 500-525, wliich corrects the errors made by Sprengel.

- Neuburgor, 25(S.

2 For a careful study of this subject, see Sir John Tweedy on "The Deter-
rent Influence of Social and Legal Restrictions on Medical Thought and
Practice," Tr. Med. Leg. Soc, London, 1911, viii, pp. 1-S. Even among the
North American Indians of recent times, a medicine-man who has failed to
cure in a succession of cases is believed to have lost his curative powers, and
may be put to death. (See A. Hrdlicka: Bur. Am. Ethnol., Bull. No. 34,
Washington, 1908, 234.)

l.")() IllSIOin ol' Mi;i)l('lNlC

of his jiosscssions. and iiiadc a scii'. In ASO, (lunli-ain, Kin^ of
Iiurj2;un(ly, had two |)h>sicians executed n|)on tlie toinh of liis
qiioen, Austricliildcs, because- the laller died of |)hiu;ue in spite of
t heif t real men t . In I ',VA~ . a st roHint-; eye surjieon was t hrown into
tlie Oder lu'cause he failed to i-ure .h)hn of lioheiuia of his hhiuhu^ss,
and in WM, Matthias, Kina; of IIun,<i;arv, issued a prochunatioii
that whoevei- cured him of an arrow wound sliouid he richly re-
wai'ded, hut. faihiiii tliat, sliouM he ])ut to death. These barbari-
ties ]")oint theii' own moiai, h)i- the stroUiiifj; medieval mounte-
banks, ill couehinjj; a cataract, soiiietiiiies ])ut out an eye, inanji,led
the viscera in "cuttina;'" for ston(% and, in attein))tin,<2; to effect a
"ratlical cure" for hernia, as Baas says, not infrequently excised
"the radix of humanity itself. "^ AUbutt gives a striking picture
of a medieval incisor who. in ligating an artery, paralyzed his
l)atient's arm by ci'ushing the musculo-s])iral nerve and was after-
ward ]iursued with curses by his miserable victim whenever he
dared show himself in the street. If the Church "abhorred the
shedding of blood," therefore, it is fair to su))pose that, in the first
instance, its aversion had the same human significance as the well-
founded horror of hospitals and surgical operations which existed
in the minds of the laity u]) to the end of the nineteenth century.

A striking illustration of tlie neglect of surgery is to be found in the late
a])j)earan('e of ai'tificial liinhs, which were known to Herodotus and Pliny. In
the Middle Ages, there was an enormous loss of limbs, due to the imitiiating
effects of anesthetic leprosy and ergotism, to wounds from cannon-shot (in-
troduced at Crecy in 1346) and half-poimd gunshot (Perugia, 1364), and to
gi'uesome judicial pimishments. The stumps were commonly bound up in
splints, but crutches and wooden legs did not appear mitil much later. The
iron hand is first seen in a i)ictin-e of 1400. Goetz von Bcrlicliingen, after losing
his right hand l)y nuisket-shot at Landshut in 1.^04, had several hands made,
movable in the joints, with flexible fingers, capable of closure. One of these
still exists and was exhibited at Berlin in 1916.-

As the physicians looked down upon the surgeons, so the sur-
geons of higher education, who in the Middle Ages could be counted
on the fingers, looked down upon the barbers. The barbers were
originally trained for the purpose of Ijleeding and shaving the
monks. In the thirteenth century, the College de Saint Come
was organized at Paris (circa 1210), constituting a guild the mem-
bers of which were divided into the clerical barber-surgeons or
surgeons of the long robe, and the lay barbers or surgeons of the
short robe, and, in 1311, 1352 and 1364, royal decrees were issued

^ The strolling herniotomists believed castration to be necessary because
thej' thought the intestines and testicles were inclosed in the same sac, which
must be removed in its entirety to obviate relapses and faulty healing of the
peritoneum.

2 Hollander: Berl. khn. Wchnschr., 1916, hii, 355.

THE MEDIEVAL PERIOD 157

forbitkling the latter ta practise surgery without being duly ex-
amined by the formei'. In 1372, Charles V decrc^ed that the bar-
bers should be allowed to treat wounds and not be interfered with
by their long-rol)ed confreres. The same thing happened in Eng-
land, where the master-surgeons formed a separate guild in 1368,
recognized women physicians in 1389, combined with the physi-
cians about 1421,' while the l)arl)ers obtained a separate charter
from Edward l\ on February 24, 1462, which was enrolled l)y the
Court of Common Council in 1463. In this way, barber-surgery
(the surgery of the common people) became 'Svound-surgery,"
that is, was restricted to blood-letting and the healing of wounds.
The barliers (barbitonsores) themselves owed their business largely
to the fact that, after the monks were forbidden to wear beards in
1092, smooth chins and shaving became the fashion. In Ciermany
the barber was often a bath keeper {balneator) , who, in addition
to bleeding, cupping and leeching, gave enemas, picked lint and
extracted teeth, and his examination or " Meisterstiick " consisted
in sharpening a knife or in preparing certain salves and plasters.

Throughout the Middle Ages, there were some vague attempts to for-
mulate the principles of medical jurisprudence, the earliest of these being,
a^s Cumston })oints out, in tlH> laws of the (lei'manic and Slavic tribes, the SaUc
law. the Capitularies of Charlemagne (ninth century), the Assizes of the Cru-
saders, and, in the thirteenth century and after, the law of Emperor Frederick,
th(! Decretals of the Popes and general canon laws. The procedure in such
cases was often of the crudest kind, the tests being by ordeal, torture, de facto
verification of impotence, and "cruentation," or the spontaneous bleeding of a
corpse in the presence of the true murderer. The expert opinions given were
usually in the nature of hair-splitting casuistry, but Cousin and Cumston^
give a number of cases from French legal procedure of the fourteenth century
in which surgeons were commonly consulted in cases of wounds, homicide,
rape, and the like.

In the year 1140, Roger II of Sicily issued an edict forbidding
any one to practise medicine without proper examination, under
pain of imprisonment and the sale of his belongings at auction.
This important law was followed by an ordinance of larger scope
issued by Roger's grandson, the generous and liberal-minded Ho-
henstauffen Emperor, Frederick II in 1224.'*

Frederick's edict required that a candidate for license to practise must be
properly examined in public by the masters at Salerno, the license being issued

'■ South (Memorials of tlie Craft of Surgery in England, London, 1886, 53)
says that the date of this conjoint faculty of physicians and surgeons fell
somewhere between May, 1421, and May, 1423.

-Andre Cousin: "Essai sur les origines de la medecine legale," Paris,
di.ss. No. 252, 1905. C. G. Cumston: .Join-. Am. Inst. Trim. Law, Chicago,
1913, iii, 855-865.

3 Translated bv J. J. Walsh, in his "The Popes and Science," New York,
1908, 420-423.

158 iiisToin' oi' Mi:i)i('iNK

liy tlic EmiuMH)!' liiinscll' or liis rcprosoiilativc; railuic lo i'()iiii>ly willi ihc
slatnto lu'iiifi anain j)iiiiislial)l(' l)y a year's iiiii)ris()iiiiiciil and rorrciturc of
property. T1k> »"\amiiialion was l)as(>(l upon tlie ticnuiiu' liooks of I lipi)oci-al(\s,
(Jalcn and Aviccnna. and Ix'forc takiiifi it the candidalc nuisi li:i\c stuilicd
lo^ic for tlirco years, inediciiu* and sui-^iery for Cnc years, and liaxc i)raclised
for oi\e year under some experienced physician. 'I'lie candidalc in sur^erN' iiad
to fiive evidence that he had sludicd liie arl for at- ieasf a year, in i)articuiar,
huniaii anatomy, "without wiiicii no incision can he safely made nor any
fraeture treated." The physieian was re(]viired to treat the j^oor lor nothing;
to visit iiis patients twice a day and once a nifiht, if necessary; to avoid col-
hision willi ajiotiiecaries and to inform u])on them, if they achdterated or sul)-
stituted (h-Ufis. The medical fee was fixed at half a tarenus (about 'A'^ cents)
for ofKee practice or for i)atients residing;; in the city; four tar<Mii (.lii.OO) for
out-of-town visits, the jihysician paying his expenses, or three tareni (.f2.2;)),
if the patient paid them. For a successful operation for anal fistula, Jolm of
Arderne required 101) shillinjis at least, £40 from the well-to-do, C40 with robes
and a life annuity of lt)0 sliiliinfis aiuuially from the wealthy, \icliohis Colnet,
I)hysieian to Henry \' at Agincourt, was guaranteed twelvepence a day by
indentures. Thomas Morstede, the king's surgeon, got the same; with tJie usual
allowance of 100 marks {£66 13s. 4d.) a quarter (Power). The purclia.sing
power of money in this period is said to liave been fifteen or twenty times what
it is now. The ordinary laborer's pay in I'jigland was a penny a day as against
3 or 4 shillings now. Tlie sale of poisons, magic potions and aplu'odisiac philters
was punishable by death if any person lost his life therel)y; food, drugs and
apothecaries' mixtures were examined at stated intervals by inspectors; and
timely regulations were made in rnnnicii)al hygiene and rural hygiene, such as
for the proper depth of graves or the suitable disposal of r(>fuse.

■ Given the time at which it was issued, it would be hard to im-
prove upon the plain scope and intention of this law, which was
followed by similar ordinances for Spain in 1283 and Germany in
13-17, and was again confirmed by Joanna of Naples in 1365.'
Frederick's edict did much to elevate the status of the respectable
physician and correspondingly to diminish the number of quacks.
Another circumstance which brought physicians to the front as
medici publici was the fact that they were recjuired to determine
the possil)le existence of leprosy in suspected persons {Lepraschau)
in order to ascertain the civil status of the latter."' The improve-
ment of the medical profession was also furthered by the introduc-
tion of a new element — the rise and growth of the great medieval
universities, which usually Iwgan as a high-school or "studiuin
generale," I. e., migration or assemblage of students in some lo-
cality.

The earhest of these were at Paris (1110), Bologna (1158), Oxford (1167)
Montpellier (1181), and Valencia (1199); and the Italian universities at

' Sudhoff states that the alleged (ordinance for city physicians of U2ti,
attributed to Kaiser Sigmund (1410-37), is i)rol)aljly mythical, although lie has
discovered a citv ordinance of 1439, which he reproduces in Mitt. z. Gesch. d.
Med., Leipzig, 1912, xi, 126, 127.

- MS. forensic protocols on suspected lepers (Lepraschaubriefe) of dates,
13.57, 1380, 1397, and later have been discovered and published by Wickers-
heimer and Sudhoff (Arch. f. Ge.sch. d. Med., Leipz., 1908-9, ii, 434: 1910-11,
iv, 370).

THE MEDIEVAL PERIOD 159

Padua (1222), Messina (1224), and Naples (1224) were founded 1)V Fredc-rick
II himself. Tliose at Cambridge (1209), Salamanc-a (1243), Siena (1246-8),
Piaceiiza (1248), Seville (1254), Lisbon (1287), Perugia (1266), Lerida (1300),
(\)iinl)ra (12S8), Palermo (1312), Florence (1320), Crenoble (1339), Pisa (1343),
\'alladolid (1346) and Pavia (1361) followed, while the fourteenth and fifteenth
centuries witnessed also the rise of the principal (Jerman and Slavic universi-
ties, in particular, Prague (1348), Cracow (1364), Vierma (1365), Erfurt (1379),
Heidelberg (1386), Wiirzburg (1402), Leipzig (1409), Rostock (1419), Greifs-
wald (1456), Freiburg im Hreisgau (1457), Basel (1460), Budapest (1465),
Ingolstadt (1472) ami Tiit)ingen (1477); of the Scandinavian, Upsala (1477),
Copenhagen (1478), and, in Scotland, St. Andrew's (1411), Glasgow (1453)
and Aberdeen (1494). After the general dispersal of students over the Con-
tinent and England to form "studios," like Salerno (medicine), liologna (law),
and Paris (theology), three types of universities or privileged corporations
of students, as distinguished from the i)ul)lic higli-school (studium generale)
and {)rivate school (stJidiuin particulare) became established. The great law-
school of Bol(jgna became the type of civic university in which the rector was
electeil by the students, as at Padua and Siena. The University of Paris, the
center of medieval theology and philosophy (Abelard), was the type of the
ecclesiastical foundation, hke Montpellier, O.xford and Cambridge, in which
the students and masters combined as a closed corporation under a chancellor,
with the votes in the hands of the masters. The studium of Naples represented
the state Uni\'ersity, hke Salamanca or Lisbon, founded by a monarch with
papal recognition as "studia generalia respectu regni." The medical school at
Montpellier formed a separate corporation, apart from the schools of law and
the arts (Neul)urger). AH these were soon thronged with great concourses of
students, and it was through the influence of the medieval imiversities that the
physician came to be regarded in the end as a meml)er of a "learned profession."
The (ririum (grammar, rhetoric, dialectics) and quadrivium (arithmetic, geome-
try, astronomy, music), made up the "seven liberal arts," first introduced at
Bishop Fulbert's cathedral school at Chartres. Apart from these, medicine
was taught as a branch of philosophy {Fhysica), as set forth in Aristotle,
Averroes and other Arabic writers. Before the Revival of Learning and the
Invention of Printing, the Greek writers were seklom read in the original or
even in a straight translation, but "doubl.y disguised and half buried in glosses
which not only overlaid the text but often supplanted it."' The favorite text-
books were the Isagoge of Johannitius, Avicenna (i, iv), Rhazes' Liber medi-
cinalis (ix), Galen's Ars parva and the aphorisms, prognostics and dietetics of
Hippocrates. Most of these were contained in the well-known "Articella."
The curricuhun at Tiibingen in the fourteenth century, as given by Haeser,
comprised, in the first year, the first canon of Avicenna and the ninth book of
Rhazes, as expounded by Jacob of Forli and Arculanus; in the second year,
the Ars parva of Galen with the commentary of Torrigiani, and the fourth
canon of Avicenna; in the third year, the Aphorisms of Hippocrates and
(again) Avicenna, with suitable commentaries. The courses and text-books
were usually determined by papal bulls and the hbraries of the medieval
universities were small in extent, seldom exceeding a hundred or more volumes.
The house-inventory of Ugolino da Montecatino, who died at Florence in
1415, gives a catalogue of his medical library, whicli may be typical for medie-
val Italy.- The professors' salaries usually ranged from .$35 to $50 per annum.
The term "doctor of medicine" was first applied to the Salernitan graduates
by Gilles de Corbeil, in the twelfth century, and the graduation ceremonies
were commonly modeled after the Salernitan pattern. The candidate was first
required to defend four theses from Aristotle, Hippocrates, Galen and a modern
writer and to take an oath, the conditions of which corresponded, in the main,
with the decree of Emperor Frederick. He then received "a ring, a wreath of
laurel and ivy, a book first closed and then opened, the kiss of peace" and the

' Allbutt: Science and Medieval Thought, London, 1901, 69,

MV. Bombe and K. Sudhoff: Arch. f. Gesch. d. Med., Leipzig, 1911-12,
v, 225-239.

1()() HisToin i)i' Mi;ni(i\K

rank (if •■|)(ni()r in l'liilt)s<i|)liy and Mcilicinc."' .Idim Locke dcscrilx's very
iiiiicli tlio same tliiiifi al Mdiitprllicr iti ItiT"), ainl llic nistoiii of tlic nioilcni
(iiTinaii uiiivcrsitit's is almin similar line-;.

l'"roiii luoiiastit' itistitiilions caiiir ilic l'-iii(i])i'an lioiaiiic {fanlcii (//o/vw.s)
and i)liysic-i;ard('n iho-hiilfirls), such as llic ninth cciilury t^ardcn at St.
(lall, uliich was carefully i)laiuicd. 'I'hcsc ohlonji enclosures were oiiKinally
cultivated to protect pliysicians and apothecaries from the dru^-sellers, who
atli'nipteil to niono])oli/e the business liy eiicoui'afiinj^ popular superstitious
al)oul plants.

Medical ethics and medical etiquette were r(>nulate(l in detail by sets
of stereotyped rules, the (>arliest of wlii<'h is the Fdntiitld cninilis <irchi(dru-
riini of Theodorich diflh century A. D. ). Medical deontolofiy and hodenetics,
the snroir fiiiir of the practitioner, were little sciences in the .Middle Afies. In
the Salernitan treati.ses of Archimatluinis) the physician is instructed to ap-
proach the bedside lu(nii(i rultu, with the same luimble mien and wall-eyed
expression which we find in so many of the old miniature jiaintings.- His
remarks at table were to be iiimctuated by continued iufjuiries about the pa-
tient's condition, which he should always refjard as fj;rave, in order that either
a favorable or a fatal termination mifjht redound to his credit as woiider-
workinp; therapeutist or shnnvd prognostician. lie should not diminish his
professional credit by OKliftK the patient's wife, daughter or maid-servants.
Illusory treatment by harmless remedies was jiermissible, since otlu^rwise the
patient's mind might be ruffled In' not getting iiis money's worth, while a
normal recovery by the healing powers of luiture migiit injure the physician's
therapeutic reputation.' A later autliority suggests that if a convalescent show
signs of ingratitude in the matter of payment, he might be temporarily sick-
ened by some harmless dosing. Gaddesden says that he kept his best remedies
a secret apart from the vulgar, lest knowledge of the same elieapen the physi-
cian's status. Mondeville, Saliceto, Lanfranc and Arderne are all skeptical and
caustic about tlie ingratitude of the public in the payment of just dues.'' Guy
and Arnold of MUanova uphold the noblest ideals. Perhaps the best medieval
tract on medical etiquette; is the De cautelis mcdicorinn habendis of Alberto de
Zancariis, formerly attributed to Arnold.^

The chief glory of in('(Heval iiKMlieiiie was undoiil^tedly in the
organization of hospitals and sick nursing,^ which liad its origin in
the teachings of Christ. Yor while the germ of the hospital idea
may have existed in the ancient Babylonian custom of bringing the
sick into the market-place for consultation, as it were, and while
the latreia and Asclepieia of the Greeks and the Romans may have
served this pur]:)ose to some extent, the spirit of antiquity toward
sickness and misfortune was not one of compassion, and the credit
of ministering to human suffering on an extended scale belongs to

' Before 1592 the degree at Salerno was Master or Doctor of Arts and
Medicine. For three facsimile Salernitan diplomas of 1573, 1640 and 1665, see
P. Capparoni: Riv. di storia crit. di sc. med. e nat., 1916, vii, 65-74, 3 pi.

2 Neuburger: Geschichte der Medizin, ii, 448-455. ^ Ibid., 293-295.

* See D'Arcy Power's introduction to Arderne (Early English Text So-
ciety, No. 139), pp. xix-.xxvii.

* See the inaugural dissertation of Manuel Morris (from SudhofT's Insti-
tute), Leipzig, 1914.

* In the preparation of tliis section I have been much indebted to the
interesting article by Dr. James J. Walsh in the Catholic Encyclopaedia, sub
voce " Hospitals," and to SudhotT's "Aus der Geschichte des Krankenhaus-
wesens" (Jena, 1913).

THE MEDIEVAL PERIOD ^ IGl

Christianity. The Aral)iaii hos]iitals, lar^e and UlxM-al as were
their endowments and capacity, came long after the 1)egiiming of
the Christian era, and the Mohammedans probal^ly got tlie idea
from the Christians. The Asclei^ieia and other pagan temples were
closed by the decree of Constantine, A. D. 335, and, very soon after,
the movement of founding and Iniilding the Christian hospitals
went forward, in which Helena, the mother of Constantine, is said j
to have played an active part. These were, in all probability,
small at first, the wealthier Christians taking care of the sick in
Valetiidinaria, but by the accession of JuUan the Apostate in 361,
the movement was in full swing. In 369, the celebrated Basilias
at Ca3sarea in Cappadocia was founded by St. Basil, consisting of a
large number of buildings, with houses for physicians and nurses, I
workshops and industrial schools. It was followed by a charity
hospital of 300 beds for the plague-stricken at Edessa, which was
founded by St. Ephraim in 375. A hospital was founded at Alex-
andria by St. John the Almsgiver in 610, and, during the Byzantine
period, other large hospitals arose at Ephesus, Constantinople and
elsewhere. These eventually became specialized, according to
Christian ideas of the obligation of charity and hospitality, as
Nosocomia, or claustral hospitals for tlie reception and care of the
sick alone; Brephotrophia, for foundlings; Orphanotrophia, for
orphans; Ptochia, for the helpless poor; Gerontochia, for the
aged; and Xenodochia, for poor and infirm pilgrims. At the be-
ginning of the fifth century, hospitals began to spring up in the
Western Empire. The first nosocomium in Western Europe was
founded by Fabiola al)out 400, "to gather in the sick from the
streets and to nurse the wretched sufferers, wasted with poverty
and disease" (St. Jerome). Others were founded in Rome by
Belisarius, in the Via Lata, and by Pelagius; and, further west, by
Csesarius at Aries in 542, by Childe])ert I at Lyons in 542,^ and by
Bishop Masona at Merida in 580. The Hotel Dieu is said to have )
been founded between 641 and 691 by St. Landry, Bishop of Paris,
and was first mentioned in 829. A hospital was founded at Milan
in 777 and a foundling asylum in 787. St. Albans Hospital in i
England dates from the year 794. In the early Middle Ages,
infirmaries and hospices grew up alongside the cloisters. The
ideal ])lan of St. Call (820) included a hospital, with a room for
grave cases, dwelling-houses for physicians, bath-rooms for cupping
and bleeding and a pharmacy.- The mountain xenodochia or
hospices at Mont Cenis (825) and the Great St. Bernard (962) are

' Founded as a .xeiiodochium under laic authority ; given over to the clergy
in 1308.

2F. Keller: Bauviss des Klosters St. Gallcii, Zurich, 1844. Cited by
Neuburger.
11

102 5 II IS TO in (tl" Ml'.DIt l\K

still in existence. After the deatli of ( "liarleina.une, tii<' larj^er hos-
pitals hefran to decline tlirouiih sulxlivisioii or loss of re\-en\ie and,
at this i)eriod. we lind the monasteries, such as those of the Bene-
dictiiu" order at ( "luny. l-'ulda and els(>\vhere. ])r()vided with private'
infirmaries and "eleemosynary' hosi)i1als." Al)out this time, also,
arose the various Catholic hospital orders and fraternities for
looking after the sick, of which the earliest were the Parabolani
who. aceordin}:; to (iihhon. w(M-e first orfianized at Alexandria
durinii; the ])laj2;ne of ( lalliemis, A. D. 'ioii 2()S. Parabolani soufj;ht
out the sick, not.uidike the monks of St. liernard today, but s(jon
exceeded their authority and were gradually sui)])ressed. The
term ".sorority" probably comes from Soror, who founded the hos-
pital Santa Maria della Scala at Siena in 898. Other religious
orders which s])rang u]) about the time of the ('rusa(k>s were the
Alexians. the Antonines, the Beguins and the Hospitalku's, the
latter comi)rising the followers of St. Elizabeth of Hungary, who
founded two hospitals at Eisenach with a third on the Wartburg,
the Sisters of St. Catherine, the order of St. John of Jerusalem,
which was founded when the Crusaders reached the Holy City in
1099 and the Teutonic Order, which was started in a field hospital
outside the walls of Acre and was approved by Clement III in 1191.
The members of the latter order vowed themselves to care for the
sick and to build a hospital wherever their order was introduced,
and played a great part in Germany in medieval times, eventually
dying out from lack of funds in the fifteenth century. Similarly,
the Order of St. John of Jerusalem became merged into a purely
military order and declined in the thirteenth century. Parallel with
the specialization of nursing orders during the Crusades, however,
there went the great medieval hospital movement initiatefl by Pope
Innocent III in 1198, which has received the just encomium of
Mrchow. In 1145, Guy of Montpellier opened a hospital in honor
of the Holy Ghost, which was approved by the Pope in 1198, he
himself building the hospital in Rome called Santo Spirito in Sassia
in 1204. The example of the Pontiff was soon follow-ed all over
Europe, with the result that nearly every city had its Hospital of
the Holy Ghost, and it became the ambition of many a prince or
landgrave to found a "xenodochium pauperum, debilium et in-
firmorum." Virchow, in his essay on the hospitals of the Middle
Ages,^ gives a remarkable catalogue of these institutions in 155
German cities. Many of these were, of course, merely first aid and
nursing stations of the charitable order of Teutonic knights, but
Virchow's list shows the clefinite social character of the movement.

1 R. Virchow: " Krankenhauser und Hospitahveseii,'' in his Gcs. Abhandl.
a. d. Gebiete d. offentJichen Medicin u. d. Seuchenlehre, Berlin, 1879, ii, 1-130.

THE MEDIEVAL PERIOD 163

Til Eome. says Walsh, there wore four city hospitals in the eleventh
century, six in the twelfth, ten in the thirteenth. Another circum-
stance which vastly aided the city hospital movement was the
immense spread of leprosy in the Middle Ages. Already known
to tlu^ ancient Hebrews, Greeks and Romans, this disease began
to ai)pear in Northern Europe in the sixth and seventh centuries
A. D., and its spread in connection with the Crusades was appal-
ling, reaching its full height in the thirteenth century. The leper,
wandering abroad, an outcast from human society, condemned to
civil death by medical inspection (Lepraschmi), living apart in huts
in the open field, giving warning of his approach l)y horn or bell,
became a common figure, and the subject of frequent reference
in the chronicles and romances of the period, such as "Der arme
Heinrich" of Hartmann von Aue,^ the 'Trauendienst" of Ulrich
\on Lichtenstein,- the Grandes Chroniques de France,'' or the un-
forgetable passage in the Liineburger Chronik, which Heine para-
phrased :

Living corpses, they wandered to and fro, muffled from head to foot; a
hood drawni over the face, and carrying in the hand a bell, the Lazarus-bell,
as it was called, through which they were to give timely warning of their ap-
proach, so that every one could get out of the way in time.''

Leper hospitals were already mentioned by Gregory of Tours
{circa 560) and, as leprosy spread far and wide, the advantage of
these retreats for purposes of segregation became apparent and
they turned out to be a potent factor in the eventual stam]:)ing out
of the disease. The number of these lazar-houses (leprodochia or
leprosoria), as they were then called, was extraordinary. There
were some 220 in England and Scotland and 2000 in France alone.
\'irchow, in his wonderful study of leprosy in the Middle Ages, has
listed and described, with his usual patient fidelity, an amazing
number of these leper hospitals in all the Germanic cities of the
thirteenth and fourteenth centuries,^ and, while in all the medieval
hospitals care was confined to nursing and seclusion, with absolute
neglect of treatment, it is clear, from his thoroughgoing narrative,

1 In this poetical romance of the thirteenth century, "poor Henry," the
hero, journeys to Montpellier and Salerno to l)e cured of leprosy.

- The " Frauendienst " gives a ludicrous sidelight on the excesses of chiv-
alry, the leper episode representing the henpecked hero as consorting with
lepers to gratify the caprices of his exacting "lady."

'Swinburne's poem of "The Leper," filled with the fantastic "Frauen-
dienst " s])irit of the Middle Ages, is based upon an episode in this chronicle,
although the alleged citation in old French at the end of the poem was written
li\' the poet himself.

* Heinrich Heine: "Gestiindnisse" (Sanuntl. Werke, Cotta ed.,x, 241, 242).

^ R. Virchow: "Zur Geschichte (\ci< Au.ssatzes und der Spitiiler," Arch,
f. path. Anat. (etc.), Berlin, 1860, xviii, 138; 273; xix, 43; 1861, xx, 166.

104 IllsroUV (IK MKHICINK

that the ImiMiiiu; ol' the Icprosoiia icpicsciitiMl a tircal social and
hyjiicnir iini\i'iiu'iil . a \\a\t" ol ticiiuiiic pi'ophylaxis as well as ot
human charitN'. HiUiiiiis charactiM-i/cs the true spirit of tlic hos-
pital iiio\-ciuciit of the Middle Aj>;('s in the following; laii,u;uafi;(':

W lu'U tlio iiu'ilicval ]n-\rs{ (•st:il)lisli(Ml in each urcnt. city of l''rancc a
Hold Dicu, a place for (iod's liospitalily, it was in tlic interests of cliai'ily as
lie understood it, inciu<linn both the helping of llie sick poor and the alTordinj!;
to those who were neither sick nor poor an oi)|)(irtnnity anil a stimulus to help
their fellow men; and doulitless tiie cause of liunianity and religion was ad-
vanced more !>>■ the eiT<'ct on tlie fiixcrs than on the recei\-ci's.'

About the Ix'uiiiiiiiiii of the t hirtcciit li century, the liospitals
l)ejj;an to jkiss. without friction and \)\ nnitual a<;Tcement, from the
hands of the (a'closiastic authorities into those of the miuiici-
pality. J^y this time there \v(M-e many splendid city hos]~)itals, like
the Hotel Dieu or the Santo Spirito, and h()s])ital construction
attained its height in the fifteenth eentmy. Prominent English
hospitals of the medieval period were the Hospital St. (Jregory,
fotmded by Arehbishop Lanfranc in 1084; St. Bartholomew's,
founded in 1137 by Rahere, a jester, who joined a religious order
and obtained a grant of land from Henry I about 1123; the Holy
e'ross Hospital at Winchester, founded 1132; St. Mary's Hospital,
founded in London in 1197; and St. Thomas's Hospital, founded
by Peter, Bishop of Winchester, in 1215 and rebuilt in 1693.

Few reflect that the great struggles for commercial supremacy
and sea power, lieginning with the Mitldle Ages, and lasting for
nine centuries (during which time the centers of trade shifted
successively from Venice to Lisbon, Amsterdam and London),
were largely concerned with the enormous profits derived from the
drug-trade.

The rise of the naval power of the Venetian Republic (820-1517) besan
with the lucrative Mediterranean transport service necessitated by the Cru-
sades (109t)-r272). The influences of Arabic pharmacy, and actual contact
of the Crusaders with their Moslem foes, greatly enhanced the value of far
Eastern drugs. The records of the custom-house at the port of Acre (1191-
1291), and the later narrative of Marino Sanuto, show a lively traffic in aloes,
benzoin, camphor, cinnamon, cloves, cubebs, ginger, mace, musk, nard, nut-
megs, opium, pepper and rhutnxrb (Tschirch). Balsams, spices, dyes, resins,
rare woods and drugs had much to do with the struggles of the Venetians with
the Genoese and the Turks, culminating in the battle of Lepanto (1571). The
defeat of the Genoese in the sea-fight off Chioggia (1380) marks the height of
Venetian supremacy. The fall of Constantinople (145.3) marred much of the
Eastern and Egyptian trade and the high cost of pcpi)er and other condiments
gave an incenti\-e lo the Portuguese navigators, \\hen Vasco da Gama doubleii
the Cape and sailed into Calicut (May 20, 149S), the doom of Venetian com-
merce was sealed. Priuli, in his diary, records the gloom which fell upon the
Rialto when it became known that Portuguese carricks, laden with spices,

1 J. S. Billings: "Description of the Johns Hopkins Hospital," Baltimore,
1890, p. 48

THE MEDIEVAL PERIOD 165

wore in the harbor of Lisbon. For the next huiKh'cd years, the eoiitcr of (lie
drug trade was to be in the Portiifiuese capital.'

In studying tlie cultural phases of medicine, there is no docu-
mentation so effective or instructive as the oraphic, and for a period
so remote and well-nigh inaccessil)le to modern comprehension as
the Aliddle Ages, the great cathedrals, with their stained glass
windows, the liturgies. Books of Hours and illmninated missals,
the chansons and epics, the miracle plays and moralities furnish us
iho shortest path to such comprehension. Perhaps the best side-
lights upon (^u'licn- medieval medicine that we have are afforded
in the miniature paintings which illuminate certain manuscript
codices of the Salernitan masters, compiled and edited by Piero
( iiacosa in 1901.- One of these, an illustration to the Turin Codex
of Pliny's Natural History, represents an imposing interior, showing-
three physicians with features of unmistakal^ly Jewish cast,
clad in flowing Oriental robes and turl)ans, in professional atten-
dance upon some great personage. One of them is feeling the pa-
tient's pulse, the other two stand in grave consultation, while their
horses champ outside; and within, long-haired pages in doublet
and hose remain in waiting or converse among themselves. An-
other miniature on the same page shows a number of monks in a
magic circle, exorcising the devil. The theurgic therapy of medie-
val times, with its centric feature of a devil for each disease and a
particular saint to cast him out, was a crude form of the doctrine
of specificity. In the many pictures of exorcism collected by
Charcot and Richer^ from fifth century mosaics and miniatures
down to set paintings, engravings and frescoes by Giotto, Francesco
\\anni, Mezzasti, Rubens and other medieval and post-medieval
artists, the devil is always represented in full sight, in the act of
(^scaping from the mouth of the energimien. A cut from the
iiolognese Codex of the Canon of Avicenna show\s the medieval
physician, in gown and biretta, lecturing to his students, as on
the title page of the Mellerstadt Mundinus. A superb miniature
from the Turin Codex of the El Hawi of R hazes shows a Salernitan
master inspecting m'ine in a glass, while a humble looking patient
of rustic mien stands uncovered before him, holding the urine
basket in his hand. The contrast between the professional gravity
of the doctor's face and the pathetic solemnity of his mute, en-
during patient is one of the cleverest things in medieval art.
Uroscopy or water-casting was, in fact, a favorite theme of the

'■See Tschireh: Pharmakognosie, Leipzig, 1910, i, 695-702; and A. W.
Linton: Jour. Am. Pharm. As.soc., Phila., 1910, v, 2.50-25.5.

- Piero (iiacosa: "Alagistri Salernitani nonduin editi," one vol. and atlas,
Turin, fratelli Bocca, 1901.

^ J. M. Charrot and P. Kicher: Les deinoniaques dans I'art. Paris, 1S87.

l<')(i HISTOHV OF MIODICINE

paiiilcr and w o(nl-t'iip,ra\ ci' dow ii lo t lie licf^iiiiiiiijz; of I lie ('if>;lit(MMith
century, and tho accessories in tluvse ve])resentati()ns are iieail\-
always tlie same. The urinal liccanic Ihc cnitilciu of medical
l>ractice in the Midille Afi;es, and was e\t>ii used in some ])laces as
a sifjn-hoard device (Xeuhurti'er). Tlie urine was always contained
in a characteristic llask of Erli-nmcyer shape, sometimes graduated,
and this flask was carried in an osier basket with lid and handle,
lookinfj; v(>ry lik(> a modern cham])af^ne huckct. 'Vlw ])hysician,
of whatever period, is always rejiresented as inspecting the urine
in a most judicial way, often iioldinji; it up to the lip;ht in such wise
that there will he no reflection or refraction from the sun's rays.
Some medieval pictures represent the pliysician as disdaining to
touch the Erlenmeycr urinal with his hands. In the frontispiece
of Montagnana's treatise (1487), for instance, two Venetian pages
hold up the urine in glasses while the doctors, in gowns and skull-
caps, inspect it and comment u])on it. An effective miniature
from Avicenna, in CJiacosa's collection, shows a physician in office
consultation with a number of patients, each of whom stands with
his osier basket in his hands while the practitioner descants upon
the properties of each individual specimen of urine. Sometimes
the urine was carried to the ])hysician or wise-woman l^y a messen-
ger, the diagnosis being thus made at a distance. As may be
imagined, offhand diagnoses of this kind were a favorite imposture
of the strolling quacks, who reaped a rich harvest from the decep-
tion. Another miniature, in the Bolognese Codex of Avicenna,
shows us the front of an apothecary's shop, with the apprentices
braj-ing drugs in mortars, a physician riding by on horseback,
the medicine jars upon the shelves being labeled with Arabic in-
scriptions. The cuts around the border represent a cold bath in a
running torrent of water, another bath of a quasi-social character
taken by several persons together in one of the piscines or circular
bathing pools, with further representations of cupping, blood-
letting and the exploration of a chest wound. The most striking
cuts in Giacosa's collection, however, are the rude pen drawings
from the Coclex of Roland's Surgery in the Biblioteca Casanatense,
representing different episodes in the surgeon's experience, such as
the diagnosis of a fracture, the reduction of a dislocation, the inspec-
tion, widening, or suturing of a wound, the withdrawal of an arrow,
the setting of a fracture of the jaw and so on. These pictures,
crude as they are, will decidedly enhance any one's opinion of the
Salernitan surgeons and must be seen to be appreciated.

The splendid series of mamiseript pictures publislied by Sudhoff in his
recent study of medieval surgery (1914)^ afford us a unique visuaHzation of all

'K. Sudhoff: Beitriige zur Geschichte der Chirurgie im Mittelalter
(Studien, Heft 10), Leipzig, 1914.

THE MEDIEVAL PERIOD 167

phases of siirjiical practice in the eleventh to fifteenth centuries. In these,
chosen variously frcjui the Sloane and Harleian MS. (British Museum), tiie Ash-
mole and Rawliiison MS. (Oxford), the Marcian Codex (Venice), we see surgeons
cutting for hemorrhoids, fistula and stricture, removing nasal polyps, opening
abscesses. trei)hining, removing arrows, bandaging, cupping, letting blood and
applying the cautery, with iniunneral)le scenes of consultation, and schematic
manilcins for cauterization, cupping, venesection and zodiacal prognosis.
This is by far the most consideral)le contribution to the graphics of medieval
surgery which has yet been made.

Of the costume and personal appearance of the fourteenth cen- |
tury surgeon we get a fahit, far-away impression from the iUumi-
nated picture of John of Arderne in the Sloane MS., representing
the blond-bearded Saxon surgeon in gown, cloak and cap, seated
in a throne-Uke chair, in the act of demonstrating his mode of pro-
cedure in fistula; and from the miniature frontispiece in Nicaise's
edition of Mondeville (1314), representing that sharp-featured,
gray-haired master, tall and slim, in a purple gown of clerical cut,
black skull-cap, red stockings and slippered feet, reading lectures
with uplifted forefinger. Thirteenth century practice is well de-
picted in the Ashmole MS. 399 in the Bodleian (Singer). ^ Sud-
hoff has recently reproduced a number of consultation scenes from
the Sloane and other medieval MS. representing pulse-taking and
other features of diagnosis.- The Latin MS. codex of Galen at
Dresden (Db 92-93),'' which is assigned to the second half of the
fifteenth century, contains beautiful miniatures illustrating the
blue, ermine-bordered mantle of the medieval physician of rank, /
details of uroscopy, venesection, rectal irrigation, preparation of
drugs, bedside scenes, with clinical and anatomic demonstrations,
showing that the living nude body was sometimes boldly used for
didactic purposes in anatomic and obstetric teaching. These
are by far the best of the medical miniatures in point of artistic
m(M-it. Gilles de Corbeil satirized the fine raiment and outward I
(Hsplay of the medical celebrities in the twelfth century. Petrarch ,
richculed the fourteenth century physicians for their rings on the
fingers, tall horses, golden spurs, gorgeous clothes and pompous
airs, a far cry from a passage in Saxo Grammaticus (1,9), which de-
scribes King Gram (disguised as a Danish physician of the twelfth
century) as "dressed in the dirtiest rags he could find and sitting
. among the lowest menials in the hall." A curious obsequiousness,
the head cocked, in servile fashion, on one side, is noticeable in many
of the medieval pictures of physicians and surgeons. The faces

' C. Singer: Proc. Roy. Soc. Med. (Hist. Sect.), London, 1915, ix, 29-42.
^Sudhoff: Arch. f. (Icsch. d. Med., Lei])z., 1915-16, ix, 10-25, 3 pl.^
^ All the jMctures in the two-v()lum(> (-(xh^x have been handsomely rei)r()-
<luced l)y E. C. van Leersum and W. Martin in "Miniaturen der lateinisrheu
Galenos-Handschrift, Leyden, 1910. This uniciue MS. was first noticed by
Chouhuit.

16S

iiisi'oin oi' Mi:i)i('i\K

in :ill 1 licsc picl iircs li:i\c llic lacilr wnll-rycd expression which is
fduiid e\cn ill the p;iiiil iiitis of such musters as (".iotto, ('inial)ue
and l.ucas ( 'ranach. and which seem to suf>;fi;est that t liere was no
sell'-revi'latiun in the workiiiK^ot' the nuMlieval niincL The metliods
of tlie inedie\-al artists were uiHnistakal)l\' object i\-e, as in llol-
hein's ])ort raits, or the life-like r(>|)resenta( ions of tlie mule l)y Jan
\an l\vek (St. Baxo altar at (dient) and Pollajuolo. In this con-
nection we ma.\ ineiition t he memorable "Slultitia" of (iliotto in the
Cha])el of t he Madomia dellArena al Tadna, ( diirlaiidajo's ])ictun^

^•ffll

I The Human Foot as a Thermometer. (Painting by a Tyrolese artist in

the Ferdinandcum at Innsbruck.) From Dr. Robert MiiUerheim's "Die
Wochenstube in der Kunst" (Stuttgart, 1904).

of rhinophjTTia in the Louvre and another representation of the
same disease by the younger Holbein in the Prado. Turold, a
dwarf, is represented in the Bayeux Tapestry. A carved figure
of a woman, high up on one of the flying buttresses of the north
side of Rheims Cathedral (thirteenth century) is described as
' strikingly acromegalic (Leonard Mark). ^ Charcot found the facies
of glbsso-labial hemispasm in a mascaron of the Santa Maria
Formosa at Venice.

iL. Mark: Lancet, London, 1914, ii, 1413.

THE MEDIEVAL PEiilOD

109

In the fifteenth century, there were numbers of pictures painted
represent in ji; scenes in the lying-in cham])er. These, contrary to
modern custom and sentiment, are usually thronged with figures
])lying various avocations about the sick-room and some of them
frankly represent the act and moment of delivery. In the fore-
ground of each there is the inevitable nursemaid in the act of
washing the newborn infant, and, from some of these pictures, we
gather the curious fact that, in the Middle Ages, the sensitive
naked foot was used as a sort of clinical thermometer. In a fresco
of Luini's, in the Brera Gal-
lery at Milan, the nurse-
maid is dipping her hand
into the laasin to ascertain
if the water is too hot or
too cold for the infant.
In most of the pictures,
however, a wooden tub is
used, and in quite a num-
ber, notably in those rep-
resenting the "Birth of
the Virgin," by the elder
Holbein (Augsburg Gal-
lery), Bernhard Strigel
(Berlin (lallery), and Bar-
tholomiius Zeitblom
(Augsburg and Sigmar-
ingen Galleries), particu-
larly in a "Wochenstube"
of an unknown Tyrolcse
artist in the Ferdinandeum
at Innsbruck, the nurse-
maid is represented, Hke
the Highland laundresses
in "Waverley," with
"kilted kirtle," her bare
feet testing the tempera-
ture of the water in the tub. The different methods of investing
an infant in its swaddling clothes are strikingly shown in the bas-
relief figures in glazed clay by Andrea della Robbia in the loggia
of the Spedale degli Innocent! at Florence. ^

Another important fact which is brought out in the fifteenth

Bus-relief of Baml)ino in glazeti clay in
the r^oundling Asylum at Florence, by
Andrea della Robbia (1437-1.52.5), showing
method of swaddling infants. From Dr.
Robert Miillerheim's "Die Wochenstube in
der Kunst" (Stuttgart, 1904).

'Those who wish to study the relation of the fine arts to early obstetrics
will find all the pictures in Witkowski's "Histoire des accouchements," Paris,
1887, and in Robert Miillerheim's " Die ^^'ochenstube in der Kunst," Stuttgart,
1904.

170 IIISTOUY OK MKDICINE

(•oiitur>' pii't iiit's is iliat tlic use of spectacles li;iil by this time
l)('conu> (luitc cominoii.

Tlio disc(i\ cry of six'ctaclc-lcnscs h;i.s Ijccii \ari()iisly at I liljiilcd lo tlic
("liiiu'Sf, to tlH> Romans and to Uofi(>r Bacon. Tlic only authentic reference! is
riiny's statement, that Nero looked at the gladiators through an emerald
(smaragd), which Lessing discussed at great length in his " Anti(]uarian iict-
ters," and which, at best, can he construed only as a sort of lorgnette. It has
hevn inferred that s])ectacl(\s wei'c inxcntcd ahout I'iS") from the following
data: An inscription on a torn!) in the chapel adjoining the church of Santa
Maria Maggiore (Florenc(>) reads: " Here lies Salvino de'Armato degli Arinati,
of I''lorenc(>, the inventor of spectacles. May God forgive his sins. He died
A. D. 1317."' In the dictionary of the Florentine Academy (1729) we read,
sub voce "occhiali" (spectacl(>s), that (iiordaiio da Uivalto (loll), a monk
of Pisa, stated, in a sermon of February '2'.i, l.'iO."), that spectacles had been in-
vented le.ss than twenty years before and that lie him.self had seen and con-
versed with the inventor, who was either Salvino dc'Armati or the Dominican
monk, Alessandro della Sj)ina, who died in 1313. A manuscript of 1289, by
Sandro di I'ifozzo, published by Uedi in 1(')4S, mentif)ns spectacles as of recent
invention. Hernard de (iordon first referred to them, about 1305, as "oculus
l)ercllinus," because they were originally made from a smoky stone (berillus),
whence the (ierman "HrilhMi" (Parillen) and the French hesiclcs (bericles). Ar-
nold of Villanova terms them " vitrea vocata conspicilia," and (!uy de (,'hauliac,
in his C'hirurgia Magna (1363), recommends them, if collyria fail. During the
fourteenth and fifteenth centuries, spectacles consisted of convex lenses in
heavy unsightly frames which were sold at an uncommonly high price. They
figure as a d(>tail in Jan van Eyck's Madonna at Bruges in the hand of t he donor,
Georg van der Pale; in Ghirlandajo's Saint Jerome in the church of Ognissanti
at Florence, in a woodcut of the book-worm in Sebastian Brand's "Narren-
schiff" (1494); in Martin Schongauer's engraving of the Death of Mary; in
the decorations of the altar of St. Jacob's Church at Rothenburg an der Tauber;
and in a colored picture in a manuscri()t in the University Library at Prague,
representing the investiture of the Elector of Brandenburg (1417). In the
last, they give the wearer the appearance of a Chinese mandarin. The earliest
known pairs of spectacles, consisting of two large circular lenses connected by
a nose-l)ridge of pince nez pattern, one pair the property of the Renaissance
humanist, Willibald Pirkheimer (1470-1530), are now on exhibition in Nurem-
berg Museum and the Wartburg.^ The earliest books on spectacles were the
Uso de los antoios of Benito Daga de Valdes (Seville, 1623), a French version of
w'hich was printed by G. Albertotti in 1892, and L'occhiale aU'occhio by Carlo
Antonio Manzini (Bologna, 1660). The first is illustrated — -has tables for
sight-testing, and recommends spectacles in those operated for cataract.

During the Middle Ages, European humanity was plagued with
epidemic diseases as never before or since, and these were variously

* Through the courtesy of Hon. Leo J. Keena, U. S. Consul at Florence.
I am informed that the tombstone of Salvino degli Armati, which was origi-
nally over his remains in the cloister adjoining the church of Santa Maria
Maggiore in Florence, was removed, with a portrait-monument, from his
grave, and placed in the chapel of the Virgin Mary, on the right side of the
church, for preservation. The inscription, as verified, reads:

QUI DIACE SALVINO D'ARMATO DEGLI ARMATI
DI FIRENZE, INVENTOR DEGLI OCCHIALI
DIO GLI PERDONI LE PECCATA
ANNO D. MCCCXVII.

- See R. Greeff: "Die altesten uns erhaltenen Brillen," in Arch. f. Ophth.,
Wiesbaden, 1912, Ixxii, 44-51; also his articles in Ztschr. f. ophthal. Optik,
Berlin, 1913-14, i, ii, 46, 77.

THE MEDIEVAL PERIOD 171

attributed to comets and other astral influences, to storms, the
failure of crops, famines, the sinking of mountains, the effects of
drought or inundation, swarms of insects, poisoning of wells l)y the
Jews, antl other absurd causes. The real predisposing factors
were the crowded condition and bad sanitation of the walled
medieval towns, the squalor, misrule and gross immorality oc-
casioned by the many wars, by the fact that Europe was overrun
with wandering soldiers, students and other vagabond characters,
and by the general superstition, ignorance and uncleanliness of the
masses, who, even in their bath-houses, were crowded together in
one common compartment, sometimes with the sexes commingled.

In the Middle Ages, it was customary to regard eight diseases as con-
tagious, in accordance with the pseudo-Salernitan verse cited by Bernard de
Gordon (1307), the idea of which derives from Rhazes (Singer):

Febris acuta, ptisis, pedicon, scabies, sacer ignis,
Antrax, lippa, lepra nobis contagia praestant.

In an ordinance of the city of Basel (1350), in the Pest Regiment of Hans
Wircker (1450) and in the "Tractatulus de regimine sanitatis" of Siegmund
Abich of Prague (1484)^ these eight diseases, in Sudhoff's interpretation, cor-
respond with the above as bubonic plague, phthisis, epilepsy, scabies, erysipe-
las, anthrax, trachoma, leprosy, and those suffering from them were not per-
mitted to enter cities, or were isolated, if in cities, or driven from them, and
not permitted to sell articles of food and drink. Of these eight diseases,
scabies and lepra were ofttimes syphilis. The notion of epilepsy as contagious
sprang, Sudhoff thinks, from the ancient Assyro-Babylonian concept of seizure
by demons isibtu), the €7ra<^^ (contagiuw) of the Greek papyri of 77-350 A. D.,
as applied to the "sacred disease" ilepa voaos) of the Hippocratic canon.

The earhest of the great medieval pandemics were the leprosy, Saint
Anthony's fire or ergotism (857),^ scurvy (1218),' influenza, the "Dancing
Mania" (epidemic chorea), sweating sickness and pUca Polonica (1287); the
most formidable were the Black Death and syphiUs. Of the former, leprosy,
scurvy and influenza were either introduced or spread by the Crusades.
Chorea (dancing mania) was prol)ably the result of physical degeneracy plus '
fanatical religious enthusiasm, and acquired the name of St. Vitus's dance
from the processions of dancing patients in the Strassburg epidemic of 1418,
who proceeded in this wise to the chapel of St. Vitus in Zabern for treatment.
Plica Polonica, the unsightly disease of matted hair, was introduced into
Poland by the Mongol invasion (1287). In a passage in the Codex Lat. 25060
of the City Library of Munich (pp. 54-55), exhumed by Sudhoff, a diphtheria

' Peter Ochs: Geschichte der Stadt und Landschaft Basel, Basel, 1792,
pp. 452-453. Cited by Sudhoff (Wien. med. ^^'ochenschr., 1913, l.xiii, 3077-
3081, and Arch. f. Gesch. d. Med., Leipzig, 1912-13, vi, 454; 1914-15, viii,
188; 220). In a fourteenth century pest-tract of Magister Henricus of
Prague, unearthed by Sudhoff (Arch. f. Gesch. d. Med., Leipzig, 1913-14,
vii, 81-89), the eight diseases "cjui transeunt de hominibus in homines" are
reduced to five, viz., fevers, pest, leprosy, epilepsy and catarrhs (influenza or
phthisis). These "eight diseases" are liighly significant on account of the
prophylactic measures indicated.

2 Mezeray, in his history of France, describes the epidemic of 944 and 1090,
to the latter of which he gave the name St. Anthony's fire.

' First described by .laccjues de Vitry as ravaging the army (jf the Crusad-
ers before Damietta (CoUect. Guizot, liv, iii, § 351) and by Joinville in his
Histoire de St.-Lovs, Paris, 1617, 121.

I , •_' iiisroin <»i' Mi;i)iciNE

cpiilcMiiic of 1 Ht2 is dcscrilicd \)\ tla- Niiicmlx-if; fily pliysii-iaii, ll:irliii;um
Sclu'tlel.' lOrKotisin. variously known as ignis ti<ictr, ignis infcrnalis, or St.
Anllioiiy's fire,- was ofton as not erysipelas, hut usually a eliaracteristic dis-
ease of the Middle Ages, due to the formation of the fungus Cldpiccps purpurea
in spui'-shajjcd masses upon rye, tlu> common hread-slaple of the poorer classes.
The first allusion to it occurs in the .Vnuals of the ( 'oiivent. at Xanten, near the
Kliine, of date ahovit SoT, and, even in this hrief paragrapii, reference is already
made to its gangrenous character and the eventual dropi)ing ofT of the limbs
from morliticalion. Later French epidemics occurreii in 911, <).'')7, 10)59, 1089,
10',t(> and 1129, whi<'h were described, in the chronicles of the time, by Fro-
doard, Felibien and Siegebert. The tli.sease usually began with sensations of
extreme coldness in tiie affected part, followed by intense burning pains; or
else a crop of blisters broke out, the hmb becoming livid, foul and jjutrescent,
and eventually dropping ofT: in either case, after causing great sufTering in the
unfortunate victim. Keeovery commonly followed the loss of a limb and, by
some cruel sport of fate, patients sometimes survived after losing all four
limlis. When the gangrene at1acke(l the viscera, however, it was s])eeilily
fatal. In the dilTeri'nt chronicles, true wgotism was undoul)te(lly confused
with erysipelas, gangrene, and bubonic plague, and the so-called mal des ar-
(hnts was probably the latter disease. The convulsive form of ergotism did
not appear imtil a later period.

Diu-ing the ninth to the twelfth centuries, there were many i)rayers, con-
jurations, charms and anuilets against a strange periodic affect ion, which, from
its recurrence in "evil years," was called Malum Malannum. It was a ser-
piginous carbuncular or gangrenous eruption, often affecting the jaws of man
or animals, and po.ssibly glanders or anthrax.^

Tlu' BliH-k Death, wliich cuti.scd the unprecedentetl mortality
of one-fourth of the population of the earth (over sixty millions
of human beings), appeared in Europe about 1348, after devastat-
ing Asia and Africa. From a focus in the Crimea, it spread, via
Turkey, Greece and Italy, northward and westward over the whole
of Europe, again attacking it from a second focus by way of lower
Austria. It broke out anew, at intervals, up to the end of the
seventeenth century. Sweeping everything before it, this terrible
l>lague brought panic and confusion in its train and broke down
all restrictions of morality, decency and humanity. Parents,
children and lifelong friends forsook one another, every one striv-
ing to save only himself and to come off with a whole skin. Some
took to vessels in the open sea only to find that the pestilence was
hot upon them; some prayed and fasted in sanctuaries, others
gave themselves up to unbridled indulgence or, as in the Decameron
of Boccaccio, one of the most graphic accounts of the plague of
1348, fled the country to idle away their time in some safe retreat;

iSudhoff: Arch. f. Gesch. d. Med., Leipz., 1912-13, vi, 121-126.

2 The name St. Anthony's fire was first used by the French historian
Mezeray, in speaking of the' epidemic of 1090. The Order of St. Anthony
for the care of the sufferers was founded in 1093. St. Martial, St. Genevieve
and St. Benedict were also regarded as patron saints of ergotism, a fuller ac-
count of which maj' be found in the valuable historic monograph of Edvard
Ehlers. See, also, the paper of Dr. Robert Fletcher in Bristol Med.-Chir.
Journal, Dec, 1912, 29.5-315.

3 See M. Hofler: Janus, Amst., 1909, xix, .512-.526.

THE medip:val period 173

others la])so(l into sullen indifference and despair. The dead were
hurled ])ell-mell into huop pits, hastily dufj; for the ])urpose, and
putrefying bodies lay about everywhere in the houses and streets.
"Shrift there was none; churches and chapejs were open, but
neither ])riests nor penitents entered — all went to the charnel-
house. The sexton and the physician were cast into the same deep
and wide grave; the testator and his heirs and executors were
liurled from the same cart into the same hole together. "^ In short,
the Black Death, with its dark stains upon the skin, its hemorrhages
and gangrenous destruction of the lungs, its paralyzing effect upon
mind and body, was, in the grim phrase of the Italians, the mor-
tdlcfia (jrande ("the great mortality"), a veritable sign and symbol
of the King of Terrors. The axillary and inguinal, with the pul-
monary lesions, would make it identical with modern Oriental
l)lague. It was ably described by Guy de Chauliac (" transgressio
de tnortallfate") Boccaccio and Simon de Covino. The epidemic
of 1382 was described in close detail in the De peste of Chalin de
\'inario. The e])idemic had at least this good effect, that it led
the \'enetian Repul)lic to appoint three guardians of public health
(1348), to exclude infected and suspected ships (1374) , and to make
the first quarantine of infected areas (1403), so called because travel-
ers from the Levant were isolated in a detention hospital for forty
days (rjuaranta giorni). This forty days' quarantine was first prac-
tised by jNIarseilles (1383). Ragusa first practised detention for a
month (1377). The trentina gnxdually hecsLUie a quarantina. In
other cities, there were plague ordinances and private personal direc-
tion (Pestschriften) , pesthouses and other hygienic improvements.

One of the earliest of the pest-tracts was that of John of Burgimdy or
Johannes ad Barbani (1365), who was identical with Sir John Mandeville.
'riiis MS. of Bearded John, which was widely duplicated, translated and copied,
is astrologic in tendency. Plague is held to he the eftect of miasms or cor-
rupt vapors upon the humoral complexion of the patient, the pestilence enter-
ing as an evil emanation through the pores of the skin and traveling thence to
the heart, the hver and the brain. To combat this, bathing was interdicted,
lest the pores of the skin be opened, light diet, acid fruits and drinks, and
especially liberal potations of vinegar, were recommend(>d, the air of rooms
was purified by burning juniper branches or throwing powders on Uve coals
for the patients' inhalation; aromatic drugs were exhibited internally and car-
ried in the hand mixed with resin or amber (pomum ombre), and, if the disease
supervened, phlebotomy was the therapeutic sheet-anchor. Blood was let
from the superficial vein corresponding to the particular part affected and its
enumctory or excretory channel. As time went on, \-inegar acquired a promi-
nent status in the pest-tracts as an antiseptic measure.^

1 Cited from an okl writer of the period bv Dr. Robert J'letcher, in his
"Tragedy of the Great Plague of Milan," Jolnis Hopkins Hosp. Bull., 1S98,
ix, 176.

- D. W. Singer: Proc. Roy. Soc. Med., Sect. Hist. Med., London, 1916,
ix, 1.59-212. See also, Sudlioff: Pestschriften aus den ersten 150 Jahren nach
der Epidemie des "schwarzen Todes," 1.348 (Arch. f. Gesch. d. Med., Leipz.,
1910-16, iv-x, passim); and G. Sticker: Die Pest (Giessen, 1908-10).

174 HlSTOin Of MKOICINK

Tlie otluT ureal scoui'iic of tlic Middle Af^cs was syphilis,
whii'h was supposed to liaxc first appeared in epidemic form at tlu^
siep;(> of Na])les in 149.'), and to have heen coinmunicattMl to tlio
Kronc-h iiivadiM-s by the S])anish occupants, who ^o\ it (authorities
conjecture) from (\)luml)us's sailors, a visitation from the Now
World. Tliat si)ora(Uc syphilis existed in anticjuity and even in
prehistoric times is (]iiite within the rani^e of probability. The
supposed Nea])olitan epidemic of 11!).") <)(!, Sudhoff holds to have
b(>en an outl)r(>ak of tyi)hoid or ])araty))hoid infection.' If Col-
umbian in orifiin. malit^nant syphilis was ])erha])s the usual result
of the contact of civilized and primitive races, as in the "Black
Lion" of the Peninsular Wars, or the syphilis of Mexico, Japan,
and the South Seas. Syphilis is first mentioned in the following
works, recently printed in facsimile by Professor Karl Sudhoff. -

1. The Edict against Blasphemers (Gottesldsterer-Edikt) of Emperor Maxi-
iniHan I, issued August 7, 149.").

2. The X'aticiuium or "astrological vision" of the Frisian poet-physician
Tlicodoricus Ulsenius (Dietrich l^elzen), printed at Nuremlx'rg August 1,
149t), with a colored print of a syphilitic by Albrecht Diirer. (Reprinted at
Augsburg by .Joiiann Froscliauer, 1491).)

3. The "Eulogiuin," a j)oeni by Sebastian lirant, printed in September,
1496, by Joh. Berginaim von (Jlpe at Basel.

4. The "Tractatus de pestilentiali Scorra'' (Augsburg, Hans Schauer,
(Jctober 18, 1496), and "Ein hiibsclier Tractat von dem Ursprung des Bosen
Eranzos" (Augsburg, Hans Schauer, December 17, 1496), the first of these
reprinted three times at Nureinl)erg, Cologne, and Leipzig (1496), and the lat-
ter once at Nuremberg early in 1497.

5. The "Enarratio Satyrica," a poem of the Veronese patrician, Giorgio
Sommariva, printed at Venice in December, 1496.

6. The "Concihum breve contra malas pustulas" of Konrad Schellig
(Schelling), physician to the Elector Palatine (printed at Heidelberg in 1496).

7. Four prayers, one to St. Minus (Nuremberg, 1496), one to St. Dionysius
(Nureml)erg, 1496), one printed at Vienna, 1497, and one in low German of
uncertain date.

8. A letter from Barcelona (1495) by Nicolo Scillacio of Messina, printed
in his "Opuscula," March 9, 1496, at Pavia showing that, in June, 1495,
syphilis had broken out at Barcelona, simultaneously with the Naples epi-
demic, and was thought to have come from France (qui nuper e.x Gallia defluxit
in alias nationes).

All these tracts tend to show, Sudlioff thinks, that syphiUs was known in
Europe before the siege of Naples, since the name of the disease had already so
many diflferent synonyms and its general semeiology seems to have been defi-
nitely outlined as early as 1495.

' In confirmation of this, G. Sticker cites a camp epidemic of typlioid at
Louvain and Nymwegen in 1635, described by Diemerbroeck (Obs. et curat,
med., xxiv) as "vulgariter /e6ns gallica. a multis etiam morbus gallicus appcWa-
batur" (Mitt. z. Gesch. d. Med., Leipz., 1916, xv, 77).

- Karl Sudhoff: Graphische und typographische Erstlinge der Syphilis-
literatur, Leipzig, 1912. This work should be read by every one who wishes
to know the most recent views of the subject as controlled by first-hand in-
vestigation (with typographic and photographic reproduction) of the original
texts and documents. Sudhoff has continued these investigations in "Aus der
Frlihgeschichte der Syphilis" (Stud. z. Gesch. d. Med., Hft. 9), Leipzig, 1912.

THE MEDIEVAL PERIOD 175

It is also montionod Ijoforc the year 1501 in various tracts by Joseph
Griinpeck (149t)), \iccol6 LeuaiaMio (1497), Johannes Widmann (1497), Bar-
tolommeo Montagiiana (1498), Bartholoniaeus Steber (1498), Siinon Pistor
(1500), Martin Pollicli (1500), and Gasparo Torella (1500). '

The first reference to the sujjposed West Indian ori}iiu of syphihs is con-
tained in a woriv of Diaz de Isla (Trdctndo contni el ukiI xcrpcu'liiio-j, \\Titten
about 1510, and pubHslied in 15:59 and 1542, in whicii the disease is said to be
described as an absolutely new and unheartl-of affection in Barcelona, brought
from Hayti by Cohunbus' sailors in April, 1493. Isla is one of the rarest of
l)Ooks, and, if we may trust current accoimts, its author had treated sailors
in Columbus' fleet for sypliilis before they landed at Palos, also it is said that
both Monardes and Montejo speak of the disease as then prevalent in nearby
Seville, where a special hospital was built for syphilitics. The " Lucubratiun-
cula" of Leonhard Schmaus (1518) also refers to the West Indian origin of the
disease on the authority of sea-captains of the period. In favor of the West
Indian hypothesis, Hutchinson contended that, if transmissible syphihs existed
in Europe before 1492, it would have been mentioned in Chaucer and Boccac-
cio, while it was found in Hayti and San Domingo after Columbus' second
voyage. Virchow maintained that the caries sicca of prehistoric and pre-
Columbian skulls was not true syphilis but either identical with the arthritis
deformans (Hdhlengicht) of old cave-bears, or else caused by plants and insects,
which would eliminate the question of prehistoric syphihs in Europe. Medieval
syphilis was first known as mal franzoso, morbus GaUicus, mala ita poletana, after
the supposititious siege of Naples (1495), where it is supposed to have been
communicated to the French soldiers under Charles VIII by the Spanish
inhabitants. After it became epidemic, it was called the Spanish, Pohsh,
German, or Turkish "pocks," from the anxiety of the different nations to shift
the blame upon one another. Iwan Bloch has attempted to prove that the
evidences of mal franzoso in the cases of King Wenzel, the chorister of Mainz
(1473), and Peter Martyr's letter (1488) were either fabrications or forgeries.
On the other hand, the exhaustive studies recently made by Karl SudhofT show
that, in the "Gotteslastereredikt" of Emperor Maximihan (August 7, 1495),
mention is made of "malum franciciun," but nothing is said about syphilis in
relation to the siege of Naples. According to Guicciardini, there was no actual
siege at Naples, since Charles VIII passed through the city without opposition
on February 21, 1495. Furthermore, in moving homeward through Tuscany,
the troops were besieged at Novara early in July, and did not get away until
October 10th, two months after the date of Maximilian's Edict (August 7th);
yet the latter shows that the disease was well known in Germany in July,
while the actual march of events makes it clear that it could not have been
spread about by wandering soldiery until long after, as Sudhoff shows. Sud-
hoff also gives a large number of recipes for syphilis, indicating that, far from
being helpless in the treatment of the disease, physicians at the end of the four- ^
teenth century were already prescribing the mercurial inunctions which hafl '
been used as far back as the twelfth century for leprosy, chronic eczema, and
various skin eruptions. A special group of the latter, as yielding to mercury,
was, Sudhoff thinks, an endemic spirochetosis, in all probabihty syphilis.'
Mercury is first referred to in the Circa instans of Matthajus Platearius (1140).
Here, mercurial salves were recommended for dermal eruptions as by all
medieval surgeons from Roger down. Theodorich gives very expHcit clirec-

' For the texts of German tracts on syphilis between 1495 and 1510, see
C. H. Fuchs: Die iiltesten S(;hriftsteller liber die Lustseuche in Deutschland
(Gottingen, 1843). For bibliography down to 1899, see J. K. Proksch: Die
Litteratur liber die venerischen Krankheiten, 4 v., Bonn, 1889-1900.

2 For the text of Isla, see Janus, Amst., 1901, vi, 653: 1902, vii, 31.

' It is interesting to note that Sydenham thought that syf)hilis was irlenti-
cal with West African yaws; that Castellani's Treponema perlenue is hardly
distinguishable from Schaudinn's parasite, and that, for the former, "606"
is a true therapia sterilisans.

17(i ms'l'olO' OK Mi;i)I(INK

I tions for imiiu-i ion of mercury, w il li j in 'ran I ions ajiaiiist sali\ al ioii. I'lii' most
iiilcrcstinu of ilicsc recipes are two wliicii SiidliolT found in an old Italian
luanusci'ii)! al Copenhagen, dated 1 1(1"), llie handwriting of which has iieen
a-ssinnod by tlie directors of llic Stale Arcliives in tlic I'llizi al I'lorenee lo the
Hi-sl ciuart(>r of the (iftoenth {-(Mitury.' These recijies read {lU) ICUrtiuirio
opti)))!) <it imil franzitso ami (77) Per fare siro/ii ihi iikiIc franzoso, and contain
innri'dientsS ith'nli<'al with those enii)loyed in llie vep;elal)le electuaries ( h'rniihr-
Inliit rtji n ) of the early ( ierman and Italian wiiters on syphilis, 'i'hus, from the
internal evidence of liandw ritinj; in some of the llli/.i inannscrii)ts, .syphilis

• may have been endemic in Italy as early as 142',). SudholT also shows that tlio
alle<r(Ml iU) per cent mortality of French troops at Naples is a nursery tale
{Aminciiindrrhcn), that the Naples e])idemic itself was a typhoidal infection
like most of t he /(7)/v,>> pcslilculidlfs, and that the Nuremherji proliiiiition of
jtulilic hathinii in a common chamhei' oi' tank (Novemher 1(1, 14!J(1) wa,s similar
to tlK)se already issued years l)efore against leprosy and plague. At the end of
his interesting studies," he quotes a prognostication made by Paul von Middel-
hurg on the occasion of the conjunction of .lujiiter, Mars and Saturn in the sign
of the scorpion (November 2.'). 14S4). which annomices tlie ai)|)roach of a fear-
ful \-enereal di.sease, to reach its height ai)out 141)2-1.')()0, and gives, along with
a lurid purview of sexual debauchery, a series of resulting symjjtoms whicii are
strikingly like these of svphilis.

The end result of SudhofT's investigations is to the effect that from the

I twelfth century on, medieval physicians were richly supplied with mercurial

recii)es against an anomalous group of chronic skin affections, which, from t heir

very iiames — srcihics (p-ossri, rnrioUi (/ros.^n, (/rosse r&rolc, scahi.ru mala, bose

Bldltcrn, mill JriiNzoso — were most likely syphilitic.

Aside from the astrolo^ic view of it.s eaiisation, lue.s wa.s latterly
attributed to the rains and inundations of the same period (Leonid
cenus), intercourse of a leper with a prostitute (Monardi and Para-
celsus), poisoning of the wells by the Spanish viceroys of Naples
(Fallopius), or to disguised human flesh eaten by the French for
ordinary meat (Fioravanti). It is evident that the disease was
not clearly understood at first, but, after it became pandemic, its
sexual origin was recognized, and, as it spread northward and
southward from Italy, its different stages were more or less ac-
curately described between the years 1494 and 1550. In the six-
teenth century, the Chevalier Bayard called it "the disease of
him who has it" {le mal de celui qui Va). Mercury, which Galen
had interdicted as a "cold" poison, became the routine remedy.
The introduction of the inunction-cure and the sweating cure, was,
Sudhoff thinks, the starting-point of curative treatment' of dis-
eases in hospital, which had hitherto been neglected. There
were many sensible regulations of public stews, such as that of
Henry II (1161). Meanwhile humanity of high and low degree
had to learn the hard lesson that syphilis is "no respecter of per-
sons." Like the omnipresent grim skeleton in Holbein's "Dance
of Death," it laid hold of lords and commons, ju.st or unju.st, in

1 Sudhoff: Mal franzoso in Italien, Giessen, 1912.

2 Sudhoff: Aus der Friihgeschichte der Syphilis, Leipzig, 1912, pp. 159-
168.

THE MEDIEVAL PERIOD 177

tho same impartial spirit, and the illustrated l)ooks of a later time,
Blankaart's, for instance, teem with ]iictures representing the
miseries wrought by lues and the inconveniences of the clumsy,
if heroic, modes of treatment in vogue. Apart from wars and
famine, and even up to Ehrlich's time, syphilis has held its own
with tuberculosis and alcoholism, as a prime factor in l)ringing
about the degeneration of the human stock. ^■

THE PERIOD OF THE RENAISSANCE, THE REVIVAL OF
LEARNING, AND THE REFORMATION (1453 1600)

Tn the transition of civilized niaiikiiid from medieval to modern
conditions, many forces were operative, but imdouhtedly tlie most
l>otent for the <;To\vth of individualism and release from the ])an
of authority were the inventions of gunpowder, which gave the
coup (h' <iracc to feudalism, and of ])rinting,' the greatest agent
in uplifting mankind by self-education. With the discovery of
America, the discovery of the Xortliwest Passage by Vasco da
(iama, Magellan's circumnavigation of tlic globe, the ostaljlish-
ment of heliocentric astronomy by Copernicus, and the Reforma-
tion, freedom of thought and the critical spirit grew apace. I'he
effect of the revival of Greek culture by the Byzantine scholars
who poured into the Italian peninsula after the fall of Constanti-
nople (1453) was to substitute the spontaneous receptive attitude
of Plato and Hippocrates for the dialectics and logic-chopping
of Aristotle and the Galenists. Among the neo-Platonists, Leo-
nardo da Vinci and Nicholas Cusanus were eminent in physics.
The physician Fernelius made the first exact measurement of a
degree of the meridian, and Garcia Hernandez, a practitioner at
Palos, favored the project of Columbus, in opposition to the Uni-
versity of Salamanca. Natural perception in science (sentire
est scire) was the device of Campanella. Petrarch attacked
scholasticism, Pomponeo Pomponazzi, Giambattista della Porta,
]\Iarsilio Ficino, Johann Weyer, and Giovanni Pico rationalized
magic and astrology and opposed witchcraft, while Cornelius
Agrippa (Heinrich von Nettesheim) [1486-1535] progressed from
occultism (De occulta philosophia) to refined skepticism (De in-
certitudine et vanitate scientiarum, 1530). Prime movers in this
change for medicine were the great printers of the Renaissance
and the so-called "medical humanists." The sack of Mainz, by
Adolph of Nassau, in 1462, scattered the German printers over
Europe. The Gutenberg Bible was printed in 1454. Johann
^Mentelin at Strassburg (1460) and Albert Pfister at Bamberg
(1461) w^ere followed by Conrad Sweynheym and Arnold Pannarts,
who are credited with the first books printed in Italy, the Subiaco

1 The claims to the invention are divided between Laurens Janszoon
Coster, of Haarlem (1440), and Johan Gutenberg of Mainz (1450).

178

RENAISSANCE, REVIVAL OF LEARNING, AND REFORMATION 179

Cicero and Lactantius (1465). Johann Sp(\yer and Nicolas
Jenson began to print at Venice in 1409. Other Italian presses
were set up at Foligno and Trevi (1470), Bologna, Ferrara, Flor-
ence, Milan, Naples, Pavia and Treviso (1471). William Caxton
began to print in English about 1474-5, and later the i:)rinting-
houses of the Aldi and Giunti in Venice, Stephanus and Colinseus
in Paris, Herbst (Oporinus) and Froben in Basel, Wynkyn de
Worde and Wyer in London, Plantin at Antwerp, Elzevir in Ley-
den, vied with one another in the issue of stately folios and beauti-
ful texts, while such editors and translators as Niccolo Leoniceno
and Giovanni Manardi at Ferrara, Rabelais at Meudon, Giinther
of Andernach at Strassburg, Johann Hagenbut (Cornarus) at
^Marburg, Pietro Mattiolo at Rome, and Anutius Foesius at Metz,
did for Hippocrates wiiat Linacre and Caius in England did for
Galen. These Renaissance versions and editions are not only |
remarkable for unapproachable typography (those of Oporinus,
Colinseus, and the early German printers in Spain bearing away the
palm in this respect), but are usually furnished with good tables
of contents and oftentimes with subject and author indices at
the end, giving accurate paginations. Giovanni Malpeghino at
Ravenna awakened the sense of correct Latinity and accuracy of
expression. The philologic study of Greek medicine supplanted
the labors of the medieval "aggregators" and "conciliators," who
sought to compare and reconcile Hellenist and Arabist doctrine
(Neuburger). With the medical philologists came the critical, \
questioning spirit in medicine. ; -

Of the medical humanists, Niccolo Leoniceno (Leonicenus)
(1428-1524), professor of medicine at Padua, Bologna, and P'er-
rara, a friend of Politian and Linacre, and, like them, an elegant
Latinist, made a famous translation of the aphorisms of Hippoc-
rates, and, toward the close of his life, had even begun, by re-
quest, an accurate Latin trans,lation of the works of Galen. He
also wrote one of the earliest of the Renaissance tracts on syphilis
(1497),^ but his chief service to science lay in the difficult task of
correcting the botanical errors in the Natural History of Pliny.
In Leonicenus' day, this was a feat of the rarest intellectual
courage. Hermolaus Barbarus, an earlier commentator, had al-
ready corrected some 500 orthographic and grammatic bhuiders
perpetrated by the copyists of Pliny's manuscripts, l)ut to assert
that Pliny himself could be fallible in his statements of fact savored
of rankest heresy, for his writings, like those of Galen and Aristotle,

' "Libellus de epidcniia, quiini Itali morl)uni fjallicum vocaiit vulso l)r(is-
sulas," Venice, 1497 (Hain, 10019); another (nlition was published at Milan
in 1497 (Hain, 10020), and a third, printed in (lothic type, without place or
date (Hain, 10018), is the earliest and rarest of all.

ISO

iiisrouv OK Mi;i)i(iNi',

were lu-uiardcd as sacrosanct and uiiimpcaclialilc. A('('(.)r(liii}>;ly,
wlit'ii I .coiiiccmis, who was a ti'ood hotanist, puMislicd his littlo
tnu'ton thecrror.s of lMiii\ ' ( I 102), a xiolciit slorin oi' cuiitrovorsy
hrok(> loose ov(>r his head. His tVicnd I'oiiziano, CoHiiuccio, and
othiT non-hotanists, who cari'd nK)re lor the kHter titan for the
import of the old Honian's text, blazed away at the luckless com-
nientatoi' in iiiilx nuMliexal style for dariiifj; to challenge the ac-
curacy of "our Pliny." Leoniceinis stuck to his guns, however,
with this important seciuel, that all true botanists of later times —
Ruellius, Matthiolus. Cesalpinus, Cordus — accepted his emenda-
tions witliout cavil. In this respect Leonicenus may be said to

Thomas Linacre, M.D. (1460-1524).

have cleared the ground for the German ''Fathers of Botany."
Without the careful work of these botanist-commentators there
could have been no scientific description of the materia mecUca.

Thomas Linacre (1460-1524), physician to Henry VII and
Henry VIII, was educated at Oxford (1484) and in Italy, and
graduated at Padua. On account of his services to humanism
he was called by Fuller the "restorer of learning" in England. He
is remembered especially for his grammatic works (Payne thought

1 "De Plinii et alioruiii in medicina erroribus," Ferrara, 1492.

RENAISSANCE, REVIVAL OF LEARNING, AND REFORMATION 181

him the original of Robert Browning's "Grammarian"), for his
foundations of lectures on medicine at Oxford and Cambridge
(1524), and for his I^atin versions of Galen's treatises on hygiene
(1517),^ therapeutics (1519),- temperaments (1521),^ natural facul-
ties (1523),^ the pulse (1523),^ and semeiology (1524).« These faith-
ful and accurate translations had a wide circulation on the conti-
nent and made it clear to physicians of the day that for centuries
they had relied ujion garbled and second-hand versions of their
favorite author.

Francois Rabelais (1490-1553), who, like Linacre, was a priest
as well as a physician, made one of the first Latin translations of the
aphorisms of Hippocrates (Lyons, 1532), the original edition of
which is much prized by l)ibliophilesJ Rabelais is best known, of
course, l)y his immortal humorous works "Gargantua" and "Pan-
tagruel," which are not only filled with the strangest kind of med-
ical erudition, Init are exponents of Renaissance humanism in the
broadest sense. ^ Rabelais was the first to lecture on medicine at
Montpellier with the Greek text befor{> him.

Anutius Foesius, or Foes (1528-95), devoted forty years of a
laborious and useful life as city physician in his native town of
Metz, to the completion of a critical edition of the Greek text of
Hippocrates (1595), which is recognized by scholars everywhere as
unquestionably the best of its kind before the time of Littre.

In the group of medical philologists were also the botanist Leonhard
Fuchs who was the bitterest opponent of Arabism, the chnician Johann Lange,
John Kaye (1506-73), the Dr. Cains of the Merry Wives of Windsor and the
historian of the sweating sickness, his teacher, Giovainii liattista della Monte
(Montanus) (1498-1552), of Padua, Geroninio Mercin-iale (L530-160G), who
made a critical exegesis {Variae lectiones) of difficidt passages in the Greek
and Latin authors, the polygraphic Symphorien Champier (1472-1539), the
lexicographer .lean de Gorris (1505-77), the Spaniard P'rancisco Valles and
the Portuguese Luis de Lemos, who investigated the genuineness of the Hippo-
cratic writings.

Some time after the invention of printing Germany entered
the field of medicine with a remarkable array of semi-popular
treatises, most of them written, contrary to custom, in the vernac-
ular — ^the language of the people. According to Sudhoff, the

1 De sanitate tu(!nda, Paris, 1517. ^ Methodus medendi, Paris, L519.

^ De tempcramentis, Cambridge, Siberch, 1521.

'' De naturalibus facviltatibus, London, Pynson, 1523.

^ De pulsuuin usu, London, Pynson, 1523.

" De syniptoinatum differcntiis, London, Pynson, 1524.

' Earher Latin versions were published at Venice in 1495 (Hain, 8674) and
at Xureml)erg in 1496 (Hain, 8675).

* The old medieval custom of stuffing tiie youtlifui mind with b()()k4earn-
ing is keeidy ridiculed, and the Greek ideal of education as a drawing out of
all the faculties, including ilie physical and social, is upheld by Rabelais.

1S2 lllsTolfV OK MKOICINK

('arli(>st ptiiilcd (locniiicnl ichil iii.t; In incdiciiic is the iiiii(iiic " Piir-
fiation-Calciidar" (Ld.ricrkdlrndcr) ol' I l.")7, piiiitcd in the type of
( !uti'iil)(M'}i;'s ;it)-line Hilih".' and ((Hilaiiicd (;i slicct of |)ap('i" only)
in the Hiltliot liriiuc natioiialc at Paris. A uni(iU(' ('()i)y of u "Cal-
cndai- for Blood-L(>1tiii<j;" (AiJcrlassl:(if<'H(Jcr), ])riiit(>(l at Mainz
in 14()2.' is one of the treasures of the l^'iirstcnhcrf!; Jiihrary at
Donaues('hin<i;(Mi (leaden). Tlicsc ])o])ular almanacs, consisting
of loose leaves or liroadsides, pi-intcd on one side only, show the
liolil whicli judicial astroloj>;y (the Las.st(ifclki(iist) had taken ui)on
the i)eoi)le. In some of them a s])ecial figure, the "zo(Ha('-man ''
[Ticrkrciszcicheniiianii), indicates, as in (h'ug-storc almanacs of
more recent (hite, tlie parts of the l)ody influenced by the different
l)lanetar\- conjunctions, the proper times and places for ])lceding
and purgation under each sign of the zodiac, with gloomy prog-
nostications of the terrible diseases, wars, famines, and other ]X!sts
which were to befall humanity under different ascendencies and
conjunctions of the planets. Palmistry also attracted wide atten-
tion; the earliest publication on the subject was Johann Hartlieb's
illustrated block-l)ook, Die Kiinst Ciromantia (Augsburg, circa
1470). More scientific interest attaches to the Regiment der
jungen Kinder of Bartholoma?us Metlinger (Augsburg, 1473), a
little book on infant hygiene, which would be the first Renaissance
contribution to pediatrics had it not been preceded by Paolo
Bagellardo's De cegritudinibus infantum (Padua, 1472). A third
tract by Cornelius Roelants of Mechlin (Louvain, circa 1483-4)
has been found in an incunable in the University Library at Leipzig
and the Hunterian Museum at Glasgow (SudholT).-

The Artzneihuch of Ortollf of Bavaria (Nuremberg, 1477) was
an important German text of popular medicine in its day, followed,
about 1500, by Ortollf's quaint little Frauenbuchlein, or popular
handbook for lying-in women. A few years later (in 1513) there
appeared, at Worms, the Rosegarten of Eucharius Roslin, a work
which bears about the same relation to Renaissance obstetrics
that the "Anathomia" of Mundinus does to medieval anatomy.
Although mainly a compilation from Soranus of Ephesus, as
filtered through the manuscript codices of ]\Ioschion, it was still
the only text-book in the field after a lapse of fourteen centuries.
Three first editions were issued simultaneously, both extremely

1 For a facsimile of either, and a full account of all the calendar-incunabula,
see Sudhoff's interesting "Lasstafelkunst in Drucken des 15. Jahrhunderts,"
in his Arch. f. Gesch. d. Med., Leipzig, 1907-8, i, pp. 223 and 227, and p. 135
(opposite). The calendars of 1439 (Johann Nider von Gmiind) and 1448
contain nothing medical. /

- Sudhoff : Janus, Amst., 1909, xiv, 467-485 (with text). For the sources
of the work, see Sudhoff, Ibid., 1915, xx, 443-458.

RENAISSANCE, REVIVAL OF LEARNING, AND REFORMATION 183

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