Old-time makers of medicine; the story of the students and teachers of the sciences related to medicine during the middle ages

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Old -Time Makers of Medicine

BY THE SAME AUTHOR

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Old-Time

*r-

Makers of Medicine

THE STORY OF THE STUDENTS AND TEACHERS

OF THE SCIENCES RELATED TO MEDICINE

DURING THE MIDDLE AGES

o
James J. Walsh, K.C.St.G., M.D.

Ph.D., LL.D., LittD., Sc.D.

DEAN AND PROFESSOR OF NERVOUS DISEASES AND OF THE HISTORY OF MEDICINE AT

FORDHAM UNIVERSITY SCHOOL OF MEDICINE; PROFESSOR OF PHYSIOLOGICAL

PSYCHOLOGY AT THE CATHEDRAL COLLEGE, NEW YORK

R

VJ3

COPYRIGHT 1911
JAMES J. WALSH

THE OUINN 4 BOOEN CO. PRESS

REVEREND DANIEL J. QUINN, S.J.

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

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

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

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

PREFACE

The material for this book was gathered partly
for lectures on the history of medicine at Fordham
University School of Medicine, and partly for
articles on a number of subjects in the Catholic En-
cyclopedia. Some of it was developed for a series
of addresses at commencements of medical schools
and before medical societies, on the general topic
how old the new is in surgery, medicine, dentistry,
and pharmacy. The information thus presented
aroused so much interest, the accomplishments of
the physicians and surgeons of a period that is usu-
ally thought quite sterile in medical science proved,
indeed, so astonishing, that I was tempted to con-
nect the details for a volume in the Fordham Uni-
versity Press series. There is no pretence to any
original investigation in the history of medicine, nor
to any extended consultation of original documents.
I have had most of the great books that are men-
tioned in the course of this volume in my hands, and
have given as much time to the study of them as
could be afforded in the midst of a rather busy life,
but I owe my information mainly to the distin-
guished German and French scholars who have in
recent years made deep and serious studies of these
Old Makers of Medicine, and I have made my ac-
knowledgments to them in the text as opportunity
presented itself.

There is just one feature of the book that may

vi PREFACE

commend it to present-day readers, and that is that
our medieval medical colleagues, when medicine em-
braced most of science, faced the problems of medi-
cine and surgery and the allied sciences that are
now interesting us, in very much the same temper
of mind as we do, and very often anticipated our
solutions of them — much oftener, indeed, than most
of us, unless we have paid special attention to
history, have any idea of. The volume does not
constitute, then, a contribution to that theme that
has interested the last few generations so much,—
the supposed continuous progress of the race and
its marvellous advance, — but rather emphasizes that
puzzling question, how is it that men make im-
portant discoveries and inventions, and then, after
a time, forget about them so that they have to be
made over again? This is as true in medical science
and in medical practice as in every other depart-
ment of human effort. It does not seem possible
that mankind should ever lose sight of the progress
in medicine and surgery that has been made in re-
cent years, yet the history of the past would seem to
indicate that, in spite of its unlikelihood, it might
well come about. Whether this is the lesson of the
book or not, I shall leave readers to judge, for it was
not intentionally put into it.

OUR LADY'S DAY IN HARVEST, 1911.

CONTENTS

CHAPTER PAGE

I. INTRODUCTION ....... 1

II. GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 23

III. GREAT JEWISH PHYSICIANS . . . .61

IV. MAIMONIDES 90

V. GREAT ARABIAN PHYSICIANS . . .109

VI. THE MEDICAL SCHOOL AT SALERNO . „ 141

VII. CONST ANTINE AFRICANUS . . . .163

VIII. MEDIEVAL WOMEN PHYSICIANS . . .177

IX. MONDINO AND THE MEDICAL SCHOOL OF BOLOGNA 202

X. GREAT SURGEONS OP THE MEDIEVAL UNIVER-
SITIES ........ 234

XI. GUY DE CHAULIAC 282

XII. MEDIEVAL DENTISTRY — GIOVANNI OF ARCOLI 313

XIII. CUSANUS AND THE FlRST SUGGESTION OF LAB-

ORATORY METHODS IN MEDICINE . . 336

XIV. BASIL VALENTINE, LAST OF THE ALCHEMISTS,

FIRST OF THE CHEMISTS .... 349

APPENDICES

I. ST. LUKE THE PHYSICIAN .... 381

II. SCIENCE AT THE MEDIEVAL UNIVERSITIES . 400

III. MEDIEVAL POPULARIZATION OF SCIENCE , 427

" Of making many books there is no end."—
Eccles. xii, 12 (circa 1000 B.C.).

" The little by-play between Socrates and Euthy-
demus suggests an advanced condition of medical
literature : ' Of course, you who have so many books
are going in for being a doctor,' says Socrates, and
then he adds, ' there are so many books on medi-
cine, you know.' As Dyer remarks, whatever the
quality of these books may have been, their number
must have been great to give point to this chaff. ' '•
Aequanimitas, WILLIAM OSLER, M.D., F.E.S., Blakis-
tons, Philadelphia, 1906.

* ' Augescunt aliae gentes, aliae minuuntur ;

Inque brevi spatio mutantur saecla animantum,
Et, quasi cursores vitai lampada tradunt."

—OVID.

One nation rises to supreme power in the world,
while another declines, and, in a brief space of time,
the sovereign people change, transmitting, like
racers, the lamp of life to some other that is to suc-
ceed them.

" There is one Science of Medicine which is con-
cerned with the inspection of health equally in all
times, present, past and future."

— PLATO.

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INTRODUCTION

Under the term Old-Time Medicine most people
probably think at once of Greek medicine, since that
developed in what we have called ancient history,
and is farthest away from us in date. As a matter
of fact, however, much more is known about Greek
medical writers than those of any other period ex-
cept the last century or two. Our histories of medi-
cine discuss Greek medicine at considerable length
and practically all of the great makers of medicine
in subsequent generations have been influenced by
the Greeks. Greek physicians whose works have
come down to us seem nearer to us than the medical
writers of any but the last few centuries. As a con-
sequence we know and appreciate very well as a rule
how much Greek medicine accomplished, but in our
admiration for the diligent observation and breadth
of view of the Greeks, we are sometimes prone to
think that most of the intervening generations down
to comparatively recent times made very little
progress and, indeed, scarcely retained what the
Greeks had done. The Eomans certainly justify
this assumption of non-accomplishment in medicine,
but then in everything intellectual Borne was never
much better than a weak copy of Greek thought. In
science the Romans did nothing at all worth while
talking about. All their medicine they borrowed

2 OLD-TIME MAKERS OF MEDICINE

from the Greeks, adding nothing of their own. What
food for thought there is in the fact, that in spite
of all Rome's material greatness and wide empire,
her world dominance and vaunted prosperity, we
have not a single great original scientific thought
from a Roman.

Though so much nearer in time medieval medicine
seems much farther away from us than is Greek
medicine. Most of us are quite sure that the im-
pression of distance is due to its almost total lack
of significance. It is with the idea of showing that
the medieval generations, as far as was possible in
their conditions, not only preserved the old Greek
medicine for us in spite of the most untoward cir-
cumstances, but also tried to do whatever they could
for its development, and actually did much more
than is usually thought, that this story of " Old-
Time Makers of Medicine " is written. It repre-
sents a period — that of the Middle Ages — that is, or
was until recently, probably more misunderstood
than any other in human history. The purpose of
the book is to show at least the important head-
lands that lie along the stream of medical thought
during the somewhat more than a thousand years
from the fall of the Roman Empire under Augus-
tulus (476) until the discovery of America. After
that comes modern medicine, for with the sixteenth
century the names and achievements of the workers
in medicine are familiar — Paracelsus, Vesalius, Co-
lumbus, Servetus, Caesalpinus, Eustachius, Varolius,
Sylvius are men whose names are attached to great
discoveries with which even those who are without
any pretence to knowledge of medical history are

INTRODUCTION 3

not unacquainted. In spite of nearly four centuries
of distance in time these men seem very close to us.
Their lives will be reserved for a subsequent volume,
* ' Our Forefathers in Medicine. ' '

It is usually the custom to contemn the Middle
Ages for their lack of interest in culture, in educa-
tion, in literature, in a word, in intellectual accom-
plishment of any and every kind, but especially in
science. There is no doubt about the occurrence of
marked decadence in the intellectual life of the first
half of this period. This has sometimes been at-
tributed to what has been called the inhibitory effect
of Christianity on worldly interests. Religion is
said to have occupied people so much with thoughts
of the other world that the beauties and wonders, as
well as much of the significance, of the world around
them were missed. Those who talk thus, however,
forget entirely the circumstances which brought
about the serious decadence of interest in culture
and science at this time. The Roman Empire had
been the guardian of letters and education and
science. While the Romans were not original in
themselves, at least they had shown intense interest
in what was accomplished by the Greeks and their
imitation had often risen to heights that made them
worthy of consideration for themselves. They were
liberal patrons of Greek art and of Greek literature,
and did not neglect Greek science and Greek medi-
cine. Galen's influence was due much more to the
prominence secured by him as the result of his stay
in Rome than would have been possible had he
stayed in Asia. There are many other examples of
Roman patronage of literature and science that

4 OLD-TIME MAKEBS OF MEDICINE

might be mentioned. As we shall see, Rome drained
Greece and Asia Minor of their best, and appropri-
ated to herself the genius products of the Spanish
Peninsula. Rome had a way of absorbing what was
best in the provinces for herself.

Just as soon as Rome was cut off from intimate
relations with the provinces by the inwandering of
barbarians, intellectual decadence began. The im-
perial city itself had never been the source of great
intellectual achievement, and the men whom we think
of as important contributors to Rome's literature
and philosophy were usually not born within the
confines of the city. It is surprising to take a list
of the names of the Latin writers whom we are ac-
customed to set down simply as Romans and note
their birthplaces. Rome herself gave birth to but
a very small percentage of them. Virgil was born
at Mantua, Cicero at Arpinum, Horace out on the
Sabine farm, the Plinys out of the city, Terence in
Africa, Persius up in Central Italy somewhere, Livy
at Padua, Martial, Quintilian, the Senecas, and
Lucan in Spain. When the government of the city
ceased to be such as assured opportunity for those
from outside who wanted to make their way, deca-
dence came to Roman literature. Large cities have
never in history been the fruitful mothers of men
who did great things. Genius, and even talent, has
always been born out of the cities in which it did
its work. It is easy to understand, then, the deca-
dence of the intellectual life that took place as the
Empire degenerated.

For the sake of all that it meant in the Roman
Empire to look towards Rome at this time, however,

INTRODUCTION 5

it seemed better to the early Christians to establish
the centre of their jurisdiction there. Necessarily,
then, in all that related to the purely intellectual life,
they came under the influences that were at work at
Kome at this time. During the first centuries they
suffered besides from the persecutions directed
against them by the Emperors at various times, and
these effectually prevented any external manifesta-
tions of the intellectual life on the part of Christians.
It took much to overcome this serious handicap, but
noteworthy progress was made in spite of obstacles,
and by the time of Constantine many important of-
ficials of the Empire, the educated thinking classes
of Eome, had become Christians. After the conver-
sion of the Emperor opportunities began to be af-
forded, but political disturbances consequent upon
barbarian influences still further weakened the old
civilization until much of the intellectual life of it
almost disappeared.

Gradually the barbarians, finding the Eoman Em-
pire decadent, crept in on it, and though much more
of the invasion was peaceful than we have been ac-
customed to think, the Eomans simply disappearing
because family life had been destroyed, children had
become infrequent, and divorce had become ex-
tremely common, it was not long before they re-
placed the Romans almost entirely. These new peo-
ples had no heritage of culture, no interest in the
intellectual life, no traditions of literature or
science, and they had to be gradually lifted up out
of their barbarism. This was the task that Chris-
tianity had to perform. That it succeeded in ac-
complishing it is one of the marvels of history.

6 OLD-TIME MAKERS OF MEDICINE

The Church's first grave duty was the preserva-
tion of the old records of literature and of science.
Fortunately the monasteries accomplished this task,
which would have been extremely perilous for the
precious treasures involved but for the favorable
conditions thus afforded. Libraries up to this time
were situated mainly in cities, and were subject to
all the vicissitudes of fire and war and other modes
of destruction that came to cities in this disturbed
period. Monasteries, however, were usually situ-
ated in the country, were built very substantially
and very simply, and the life in them formed the
best possible safeguard against fire, which worked
so much havoc in cities. As we shall see, however,
not only were the old records preserved, but ex-
cerpts from them were collated and discussed and
applied by means of direct observation. This led
the generations to realize more and more the value
of the old Greek medicine and made them take
further precautions for its preservation.

The decadence of the early Middle Ages was due
to the natural shifting of masses of population of
this time, while the salvation of scientific and liter-
ary traditions was due to the one stable element in
all these centuries — the Church. Far from Chris-
tianity inhibiting culture, it was the most important
factor for its preservation, and it provided the best
stimulus and incentive for its renewed development
just as soon as the barbarous peoples were brought
to a state of mind to appreciate it.

Bearing this in mind, it is easier to understand
the course of medical traditions through the Middle
Ages, and especially in the earlier period, with re-

INTRODUCTION 7

gard to which our documents are comparatively
scanty, and during which the disturbed conditions
made medical developments impossible, and any-
thing more than the preservation of the old authors
out of the question. The torch of medical illumina-
tion lighted at the great Greek fires passes from
people to people, never quenched, though often burn-
ing low because of unfavorable conditions, but some-
times with new fuel added to its flame by the con-
tributions of genius. The early Christians took it
up and kept it lighted, and, with the Jewish physi-
cians, carried it through the troublous times of the
end of the old order, and then passed it on for a
while to the Arabs. Then, when favorable condi-
tions had developed again, Christian schools and
scholars gave it the opportunity to burn brightly
for several centuries at the end of the Middle Ages.
This medieval age is probably the most difficult
period of medical history to understand properly,
but it is worth while taking the trouble to follow
out the thread of medical tradition from the Greeks
to the Eenaissance medical writers, who practically
begin modern medicine for us.

It is easy to understand that Christianity's in-
fluence on medicine, instead of hampering, was most
favorable. The Founder of Christianity Himself
had gone about healing the sick, and care for the
ailing became a prominent feature of Christian
work. One of the Evangelists, St. Luke, was a
physician. It was the custom a generation ago, and
even later, when the Higher Criticism became pop-
ular, to impugn the tradition as to St. Luke having
been a physician, but this has all been undone, and

8 OLD-TIME MAKERS OF MEDICINE

Harnack's recent book, " Luke the Physician,"
makes it very clear that not only the Third Gospel,
but also the Acts, could only have been written by a
man thoroughly familiar with the Greek medical
terms of his time, and who had surely had the ad-
vantage of a training in the medical sciences at
Alexandria. This makes such an important link
in medical traditions that a special chapter has been
devoted to it in the Appendix.

Very early in Christianity care for the ailing poor
was taken up, and hospitals in our modern sense
of the term became common in Christian com-
munities. There had been military hospitals before
this, and places where those who could afford to
pay for service were kept during illness. Our mod-
ern city hospital, however, is a Christian institution.
Besides, deformed and ailing children were cared
for and homes for foundlings were established. Be-
fore Christianity the power even of life and death of
the parents over their children was recognized,
and deformed or ailing children, or those that for
some reason were not wanted, were exposed until
they died. Christianity put an end to this, and in
two classes of institutions, the hospitals and the
asylums, abundant opportunity for observation of
illness was afforded. Just as soon as Christianity
came to be free to establish its institutions publicly,
hospitals became very common. The Emperor
Julian, usually known as the Apostate, who hoped
to re-establish the old Roman Olympian religion,
wrote to Oribasius, one of the great physicians of
this time, who was also an important official of his
household, that these Christians had established

INTRODUCTION 9

everywhere hospitals in which not only their own
people, but also those who were not Christians, were
received and cared for, and that it would be idle to
hope to counteract the influence of Christianity until
corresponding institutions could be erected by the
government.

From the very beginning, or, at least, just as soon
as reasonable freedom from persecution gave op-
portunity for study, Christian interest in the med-
ical sciences began to manifest itself. Nemesius,
for instance, a Bishop of Edessa in Syria, wrote
toward the end of the fourth century a little work
in Greek on the nature of man, which is a striking
illustration of this. Nemesius was what in modern
times would be called a philosopher, that is, a spec-
ulative thinker and writer, with regard to man's
nature, rather than a physical scientist. He was
convinced, however, that true philosophy ought to
be based on a complete knowledge of man, body and
soul, and that the anatomy of his body ought to be a
fundamental principle. It is in this little volume
that some enthusiastic students have found a de-
scription that is to them at least much more than a
hint of knowledge of the circulation of the blood.
Hyrtl doubts that the passage in question should
be made to signify as much as has been suggested,
but the occurrence of any even distant reference to
such a subject at this time shows that, far from there
being neglect of physical scientific questions, men
were thinking seriously about them.

Just as soon as Christianity brought in a more
peaceful state of affairs and had so influenced the
mass of the people that its place in the intellectual

10 OLD-TIME MAKERS OF MEDICINE

life could be felt, there comes a period of cultural
development represented in philosophy by the
Fathers of the Church, and during which we have a
series of important contributors to medical litera-
ture. The first of these was Aetius, whose career
and works are treated more fully in the chapter on
" Great Physicians in Early Christian Times." He
was followed by Alexander of Tralles, probably a
Christian, for his brother was the architect of Santa
Sophia, and by Paul of ^Egina, with regard to whom
we know only what is contained in his medical
writings, but whose contemporaries were nearly all
Christians. Their books are valuable to us, partly
because they contain quotations from great Greek
writers on medicine, not always otherwise available,
but also because they were men who evidently knew
the subject of medicine broadly and thoroughly,
made observations for themselves, and controlled
what they learned from the Greek forefathers in
medicine by their own experience. Just at the be-
ginning of the Middle Ages, then, under the foster-
ing care of Christianity there is a period of consid-
erable importance in the history of medical litera-
ture. It is one of the best proofs that we have not
only that Christianity did not hamper medical de-
velopment, but that, directly and indirectly, by the
place that it gave to the care of the ailing in life as
well as the encouragement afforded to the intel-
lectual life, it favored medical study and writing.

A very interesting chapter in the story of the
early Christian physician is to be found in what we
know of the existence of women physicians in the
fourth and fifth centuries. Theodosia, the mother

INTRODUCTION 11

of St. Procopius the martyr, was, according to
Carptzovius, looked upon as an excellent physician
in Rome in the early part of the fourth century. She
suffered martyrdom under Diocletian. There was
also a Nicerata who practised at Constantinople un-
der the Emperor Arcadius. It is said that to her
St. John Chrysostom owed the cure of a serious ill-
ness. From the very beginning Christian women
acted as nurses, and deaconesses were put in charge
of hospitals. Fabiola, at Eome, is the foundress of
the first important hospital in that city. The story
of these early Christian women physicians has been
touched upon in the chapter on " Medieval Women
Physicians," as an introduction to this interesting
feature of Salernitan medical education.

During the early Christian centuries much was
owed to the genius and the devotion to medicine of
distinguished Jewish physicians. Their sacred and
rabbinical writers always concerned themselves
closely with medicine, and both the Old Testament
and the Talmud must be considered as containing
chapters important for the medical history of the
periods in which they were written. At all times
the Jews have been distinguished for their knowl-
edge of medicine, and all during the Middle Ages
they are to be found prominent as physicians. They
were among the teachers of the Arabs in the East
and of the Moors in Spain. They were probably
among the first professors at Salerno as well as at
Montpellier. Many prominent rulers and ecclesi-
astics selected Jewish physicians. Some of these
made distinct contributions to medicine, and a num-
ber of them deserve a place in any account of medi-

12 OLD-TIME MAKERS OF MEDICINE

cine in the making during the Middle Ages. One of
them, Maimonides, to whom a special chapter is de-
voted, deserves a place among the great makers of
medicine of all time, because of the influence that
he exerted on his own and succeeding generations.
Any story of the preservation and development of
medical teaching and medical practice during the
Middle Ages would be decidedly incomplete without
due consideration of the work of Jewish physicians.
Western medical literature followed Roman lit-
erature in other departments, and had only the
Greek traditions at second hand. During the dis-
turbance occasioned by the invasion of the barbari-
ans there was little opportunity for such leisure as
would enable men to devote themselves with tran-
quillity to medical study and writing. Medical tradi-
tions were mainly preserved in the monasteries.
Cassiodorus, who, after having been Imperial Prime
Minister, became a monk, recommended particularly
the study of medicine to the monastic brethren.
With the foundation of the Benedictines, medicine
became one of the favorite studies of the monks,
partly for the sake of the health of the brethren
themselves, and partly in order that they might be
helpful to the villages that so often gathered round
their monasteries. There is a well-grounded tradi-
tion that at Monte Cassino medical teaching was one
of the features of the education provided there by
the monks. It is generally conceded that the Bene-
dictines had much to do with the foundation of
Salerno. In the convents for women as well as the
monasteries for men serious attention was given to
medicine. Women studied medicine and were pro-

INTRODUCTION 13

fessors in the medical department of Salerno. Other
Italian universities followed the example thus set,
and so there is abundant material for the chapter on
" Medieval Women Physicians."

The next phase of medical history in the medieval
period brings us to the Arabs. Utterly uninterested
in culture, education, or science before the time of
Mohammed, with the growth of their political power
and the foundation of their capitals, the Arab
Caliphs took up the patronage of education. They
were the rulers of the cities of Asia Minor in which
Greek culture had taken so firm a hold, and captive
Greece has always led its captors captive. With
the leisure that came for study, Arabians took up
the cultivation of the Greek philosophers, especially
Aristotle, and soon turned their attention also to the
Greek physicians Hippocrates and Galen. For some
four hundred years then they were in the best posi-
tion to carry on medical traditions. Their teachers
were the Christian and Jewish physicians of the
cities of Asia Minor, but soon they themselves be-
came distinguished for their attainments, and for
their medical writings. Interestingly enough, more
of their distinguished men flourished in Spain than
in Asia Minor. We have suggested an explanation
for this in the fact that Spain had been one of the
most cultured provinces of the Eoman Empire, pro-
viding practically all the writers of the Silver Age
of Latin literature, and evidently possessing a
widely cultured people. It was into this province,
not yet utterly decadent from the presence of the
northern Goths, that the Moors came and readily
built up a magnificent structure of culture and edu-

14 OLD-TIME MAKERS OF MEDICINE

cation on what had been the highest development of
Roman civilization.

The influence of the Arabs on Western civiliza-
tion, and especially on the development of science
in Europe, has been much exaggerated by certain
writers. Closely in touch with Greek thought and
Greek literature during the eighth, ninth, and tenth
centuries, it is easy to understand that the Arabian
writers were far ahead of the Christian scholars of
Europe of the same period, who were struggling up
out of the practical chaos that had been created by
the coming of the barbarians, and who, besides, had
the chance for whatever Greek learning came to
them only through the secondary channels of the
Latin writers. Borne had been too occupied with
politics and aggrandizement ever to become cul-
tured. In spite of this heritage from the Greeks,
decadence took place among the Arabs, and, as the
centuries go on, what they do becomes more and
more trivial, and their writing has less significance.
Just the opposite happened in Europe. There, there
was noteworthy progressive development until the
magnificent climax of thirteenth century accomplish-
ment was reached. It is often said that Europe
owed much to the Arabs for this, but careful analysis
of the factors in that progress shows that very lit-
tle came from the Arabs that was good, while not
a little that was unfortunate in its influence was bor-
rowed from them with the translations of the Greek
authors from that language, which constituted the
main, indeed often the only, reason why Arabian
writers were consulted.

With the foundation of the medical school of

INTRODUCTION 15

Salerno in the tenth century, the modern history of
medical education may be said to begin, for it had
many of the features that distinguish our modern
university medical schools. Its professors often
came from a distance and had travelled extensively
for purposes of study; they attracted patients of
high rank from nearly every part of Europe, and
these were generous in their patronage of the school.
Students came from all over, from Africa and Asia,
as well as Europe, and when abuses of medical prac-
tice began to creep in, a series of laws were made
creating a standard of medical education and reg-
ulating the practice of medicine, that are interesting
anticipations of modern movements of the same
kind. Finally a law was passed requiring three years
of preliminary work in logic and philosophy before
medicine might be taken up, and then four years at
medicine, with a subsequent year of practice with a
physician before a license to practise for one's self
was issued. In addition to this there was a still
more surprising feature in the handing over of the
department of women's diseases to women pro-
fessors, and the consequent opening up of licensure
to practise medicine to a great many women in the
southern part of Italy. The surprise that all this
should have taken place in the south of Italy is
lessened by recalling the fact that the lower end
of the Italian peninsula had been early colonized by
Greeks, that its name in later times was Magna
Graecia, and that the stimulus of Greek tradition
has always been especially favorable to the develop-
ment of scientific medicine.

Salerno's influence on Bologna is not difficult to

16 OLD-TIME MAKERS OF MEDICINE

trace, and the precious tradition of surgery par-
ticularly, which was carried to the northern uni-
versity, served to initiate a period of surgery last-
ing nearly two centuries, during which we have some
of the greatest contributions to this branch of med-
ical science that were ever made. The development
of the medical school at Bologna anticipated by but
a short time that of a series of schools in the north
Italian universities. Padua, Piacenza, Pisa, and
Vicenza had medical schools in the later Middle
Ages, the works of some of whose professors have
attracted attention. It was from these north
Italian medical schools that the tradition of close
observation in medicine and of thoroughly scientific
surgery found its way to Paris. Lanfranc was the
carrier of surgery, and many French students who
went to Italy came back with Italian methods. In
the fourteenth century Guy de Chauliac made the
grand tour in Italy, and then came back to write a
text-book of surgery that is one of the monuments
in this department of medical science. Before his
time, Montpellier had attracted attention, but now it
came to be looked upon as a recognized centre of
great medical teaching. The absence of the Popes
from Italy and the influence of their presence at
Avignon made itself felt. While culture and edu-
cation declined in Italy in the midst of political dis-
turbances, they advanced materially at the south of
France.

For our generation undoubtedly the most interest-
ing chapter in the history of medieval medicine is
that which tells of the marvellous development of
surgery that took place in the thirteenth and four-

INTRODUCTION 17

teenth centuries. Considerable space has been de-
voted to this, because it represents not only
an important phase of the history of medicine,
and recalls the names and careers of great
makers of medicine, but also because it il-
lustrates exquisitely the possibility of important
discoveries in medicine being made, applied success-
fully for years, and then being lost or completely
forgotten, though contained in important medical
books that were always available for study. The
more we know of this great period in the history of
surgery, the more is the surprise at how much was
accomplished, and how many details of our modern
surgery were anticipated. Most of us have had
some inkling of the fact that anaesthesia is not new,
and that at various times in the world's history men
have invented methods of producing states of sensi-
bility in which more or less painless operations were
possible. Very few of us have realized, however,
the perfection to which anaesthesia was developed,
and the possibility this provided for the great
surgeons of the later medieval centuries to do opera-
tions in all the great cavities of the body, the skull,
the thorax, and the abdomen, quite as they are done
in our own time and apparently with no little degree
of success.

Of course, any such extensive surgical interven-
tion even for serious affections would have been
worse than useless under the septic conditions that
would surely have prevailed if certain principles of
antisepsis were not applied. Until comparatively
recent years we have been quite confident in our as-
surance that antisepsis and asepsis were entirely

18 OLD-TIME MAKERS OF MEDICINE

modern developments of surgery. More knowledge,
however, of the history of surgery has given a seri-
ous set-back to this self-complacency, and now we
know that the later medieval surgeons understood
practical antisepsis very well, and applied it success-
fully. They used strong wine as a dressing for
their wounds, insisted on keeping them clean, and
not allowing any extraneous material of any kind,
ointments or the like, to be used on them. As a con-
sequence they were able to secure excellent results
in the healing of wounds, and they were inclined to
boast of the fact that their incisions healed by first
intention and that, indeed, the scar left after them
was scarcely noticeable. We know that wine would
make a good antiseptic dressing, but until we actu-
ally read the reports of the results obtained by these
old surgeons, we had no idea that it could be used to
such excellent purpose. Antisepsis, like anaesthesia,
was marvellously anticipated by the surgical fore-
fathers of the medieval period.

It has always seemed to me that the story of
Medieval Dentistry presented an even better il-
lustration of a great anticipatory development of
surgery. This department represents only a small
surgical specialty, but one which even at that period
was given over to specialists, who were called denta-
tores. Guy de Chauliac's review of the dentistry of
his time and the state of the specialty, as pictured
by John of Arcoli, is likely to be particularly inter-
esting, because if there is any department of med-
ical practice that we are sure is comparatively re-
cent in origin, it is dentistry. Here, however, we
find that practically all our dental manipulations,

INTRODUCTION 19

the filling of teeth, artificial dentures, even ortho-
dontia, were anticipated by the dentists of the Mid-
dle Ages. We have only the compressed account of
it which is to be found in text-books of general
surgery, and while in this they give mainly a her-
itage from the past, yet even this suffices to
give us a picture very surprising in its detailed
anticipation of much that we have been inclined
to think of as quite modern in invention and dis-
covery.

Medicine developed much more slowly than
surgery, or, rather, lagged behind it, as it seems
nearly always prone to do. Surgical problems are
simple, and their solution belongs to a great extent
to a handicraft. That is, after all, what chirurgy,
the old form of our word surgery, means. Medical
problems are more complex and involve both art
and science, so that solutions of them are often
merely temporary and lack finality. During the
Middle Ages, however, and especially towards the
end of them, the most important branches of medi-
cine, diagnosis and therapeutics, took definite shape
on the foundations that lie at the basis of our mod-
ern medical science. We hear of percussion for ab-
dominal conditions, and of the most careful study
of the pulse and the respiration. There are charts
for the varying color of the urine, and of the tints
of the skin. With Nicholas of Cusa there came the
definite suggestion of the need of exact methods of
diagnosis. A mathematician himself, he wished to
introduce mathematical methods into medical
diagnosis, and suggested that the pulse should be
counted in connection with the water clock, the

20 OLD-TIME MAKERS OF MEDICINE

water that passed being weighed, in order to get
very definite comparative values for the pulse rate
under varying conditions, and also that the specific
gravity of fluids from the body should be ascer-
tained in order to get another definite datum in the
knowledge of disease. It was long before these sug-
gestions were to bear much fruit, but it is interest-
ing to find them so clearly expressed.

At the very end of the Middle Ages came the
father of modern pharmaceutical chemistry, Basil
Valentine. Already the spirit that was to mean so
much for scientific investigation in the Renaissance
period was abroad. Valentine, however, owes little
to anything except his own investigations, and they
were surprisingly successful, considering the cir-
cumstances of time and place. His practical sug-
gestions so far as drugs were concerned did not
prove to have enduring value, but then this has been
a fate shared by many of the masters of medicine.
There were many phases of medical practice, how-
ever, that he insisted on in his works. He believed
that the best agent for the cure of the disease was
nature, and that the physician's main business must
be to find out how nature worked, and then foster
her efforts or endeavor to imitate them. He in-
sisted, also that personal observation, both of pa-
tients and drugs, was more important than book
knowledge. Indeed, he has some rather strong ex-
pressions with regard to the utter valuelessness of
book information in subjects where actual experi-
ence and observation are necessary. It gives a con-
ceit of knowledge quite unjustified by what is really
known.

INTRODUCTION 21

What is interesting about all these men is that
they faced the same problems in medicine that we
have to, in much the same temper of mind that we
do ourselves, and that, indeed, they succeeded in
solving them almost as well as we have done, in spite
of all that might be looked for from the accumula-
tion of knowledge ever since.

It was very fortunate for the after time that in
the period now known as the Renaissance, after the
invention of printing, there were a number of seri-
ous, unselfish scholars who devoted themselves to
the publication in fine printed editions of the works
of these old-time makers of medicine. If the neglect
of them that characterized the eighteenth and early
nineteenth centuries had been the rule at the end
of the fifteenth and during the sixteenth century, we
would almost surely have been without the possibil-
ity of ever knowing that so many serious physicians
lived and studied and wrote large important tomes
during the Middle Ages. For our forefathers of a
few generations ago had very little knowledge, and
almost less interest, as to the Middle Ages, which
they dismissed simply as the Dark Ages, quite sure
that nothing worth while could possibly have come
out of the Nazareth of that time. What they knew
about the people who had lived during the thousand
years before 1500 only seemed to them to prove the
ignorance and the depths of superstition in which
they were sunk. That medieval scholars should
have written books not only well worth preservation,
but containing anticipations of modern knowledge,
and, though of course they could not have known
that, even significant advances over their own sci-

22 OLD-TIME MAKERS OF MEDICINE

entific conditions, would have seemed to them quite
absurd.

Fortunately for us, then, the editions of the early
printed books, so many of them monuments of learn-
ing and masterpieces of editorial work with regard
to medieval masters of medicine, were lying in
libraries waiting to be unearthed and restudied dur-
ing the nineteenth century. German and French
scholars, especially during the last generation, have
recovered the knowledge of this thousand years of
human activity, and we know now and can sym-
pathetically study how the men of these times faced
their problems, which were very much those of our
own time, in almost precisely the same spirit as we
do ours at the present time, and that their solutions
of them are always interesting, often thorough and
practical, and more frequently than we would like to
think possible, resemble our own in many ways.
For the possibility of this we are largely indebted
originally to the scholars of the Renaissance. With-
out their work that of our investigators would have
been quite unavailing. It is to be hoped, however,
that our recovery of this period will not be followed
by any further eclipse, though that seems to be
almost the rule of human history, but that we shall
continue to broaden our sympathetic knowledge of
this wonderful medieval period, the study of which
has had so many surprises in store for us.

n

GREAT PHYSICIANS IN EAELY CHRISTIAN

TIMES

What we know of the life of the Founder of
Christianity and how much He did for the ailing
poor would make us expect that the religion that He
established would foster the care and the cure of
suffering humanity. As we have outlined in the In-
troduction, the first of the works of Christian service
that was organized was the care of the sick. At first
a portion of the bishop's house was given over to
the shelter of the ailing, and a special order of as-
sistants to the clergy, the deaconesses, took care of
them. As Christians became more numerous, spe-
cial hospitals were founded, and these became pub-
lic institutions just as soon as freedom from perse-
cution allowed the Christians the liberty to give
overt expression to their feelings for the poor.
While hospitals of limited capacity for such special
purposes as the sheltering of slaves or of soldiers
and health establishments of various kinds for the
wealthy had been erected before Christianity, this
was the first time that anyone who was ill, no mat-
ter what the state of his pecuniary resources, could
be sure to find shelter and care. The expression of
the Emperor Julian the Apostate, that admission to
these hospitals was not limited to Christians, is the

23

24 OLD-TIME MAKERS OF MEDICINE

best possible evidence of the liberal charity that in-
spired them.

The ordinary passing student of the history of
medicine or of hospital foundation and organization,
can have no idea of the magnitude of some of these
institutions, and their importance in the life of the
time, unless it is especially pointed out. St. Basil,
about the middle of the fourth century, erected what
was spoken of as "a city for the sick," before the
gates of Caesarea. Gregory of Nazianzen, his
friend, says " that well built and furnished houses
stood on both sides of streets symmetrically laid out
about the church, and contained rooms for the sick,
and the infirm of every variety were intrusted to
the care of doctors and nurses." There were sep-
arate buildings for strangers, for the poor, and for
the ailing, and comfortable dwellings for the physi-
cians and nurses. An important portion of the in-
stitution was set apart for the care of lepers, which
constituted a prominent feature in Basil's work in
which he himself took a special interest. Earlier in
the same century Helena, the mother of the Em-
peror Constantine, had built similar institutions
around Jerusalem, and during this same century
nearly everywhere we have evidence of organi-
zation of hospitals and of care for the ailing
poor.

Not only were hospitals erected, but arrangements
were made for the care of the ailing poor in their
own homes and for the visitation of them, and for
the bringing to places adapted for their care and
treatment of such as were found on the street, or
neglected in their homes. The Church evidently

GEEAT PHYSICIANS IN EARLY CHRISTIAN TIMES 25

considered itself bound to care for men's bodies as
well as their souls, and many of the expressions in
common use among Christians referred to this fact.
Religion itself was spoken of as a medicine of the
soul and the body. Christianity was defined as the
religion of healing. The word salvation had a refer-
ence to both body and soul. Baptism was spoken
of as the bath of the soul, the- holy Eucharist as
the elixir of immortal life, and penance as the medi-
cine of the soul. It is not surprising to find, then,
that Harnack has found among the texts that il-
lustrate the history of early Christian literature this
one: " In every community there shall be at least
one widow appointed to assist women who are
stricken with illness, and this widow shall be
trained in her duties, neat and careful in her ways,
shall not be self-seeking, must not indulge too freely
in wine in order that she may be able to take up
her duties at night as well as by day, and shall con-
sider it her duty to keep the Church officials in-
formed of all that seems necessary."

The saving of deformed and ailing infants or
children whose parents did not care to have the
trouble of rearing them, required the establishment
by the Christians of another set of institutions,
Foundling Asylums and Hospitals for Children.
Until the coming of Christianity parents were sup-
posed to have the right of life and death over their
children, and no one questioned it. In every coun-
try in the world until the coming of Christianity this
had always been the case. Besides, there were in-
stitutions for the care of the old. These are the
classes of mankind who are especially liable to suf-

26 OLD-TIME MAKERS OF MEDICINE

fer from disease, and the opportunity to study
human ailments in such institutions could scarcely
help but provide facilities for clinical observa-
tion such as had not existed before. Unfor-
tunately the work of Christianity was hampered,
first by the Roman persecutions, and then later by
the invasion of the barbarians, who had to be edu-
cated and lifted up- to a higher plane of civilization
before they could be brought to appreciate the value
of medical science, much less contribute to its de-
velopment.

Harnack, whose writings in the higher criticism
of Scripture have attracted so much attention in re-
cent years, began his career in the study of Christian
antiquities with a monograph on Medical Features
of Early Christianity.1 He mentions altogether
some sixteen physicians who reached distinc-
tion in the earliest days of Christianity. Some
of these were priests, some of them bishops,
as Theodotos of Laodicea; Eusebius, Bishop of
Rome; Basilios, Bishop of Ancyra, and at least
one, Hierakas, was the founder of a religious order.
The first Christian physicians came mainly from
Syria, as might be expected, for here the old Greek
medical traditions were active. Among them must
be enumerated Cosmas and Damian, physicians who
were martyred in the persecution of Diocletian, and
who have been chosen as the patrons of the medical
profession. Justinian erected a famous church to
them. It became the scene of pilgrimages. Organi-
zations of various kinds since, as the College of St.

1 " Medicinisches aus der Aeltesten Kirchen Geschichte," Leipzig,
1892.

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 27

Come, and medical societies, have been named after
them.

Some idea of the interest of ecclesiastics in med-
ical affairs may be gathered from a letter of Bishop
Theodoret of Cyrus, directed to the prefect of the
city, when he was about to leave the place. He wrote
(see Puschmann, Vol. I., p. 494): "When I took
up the Bishopric of Cyrus I made every effort to
bring in from, all sides the arts that would be useful
to the people. I succeeded in persuading skilled
physicians to take up their residence here. Among
these is a very pious priest, Peter, who practises
medicine with great skill, and is well known for his
care for the people. Now that I am about to leave
the city, some of those who came at my invitation
are preparing also to go. Peter seems resolved to
do this. I appeal to your highness, therefore, in
order to commend him to your special care. He
handles patients with great skill and brings about
many cures."

Distinguished Christian writers and scholars, and
the Fathers of the Church in the early centuries, evi-
dently paid much attention to medicine. Tertullian
speaks of medical science as the sister of philosophy,
and has many references to the medical doctrines
discussed in his time. Lactantius, in his work, ' ' De
Opificio Dei," has much to say with regard to the
human body as representing the necessity for design
in creation. His teleological arguments have much
more force now than they would have had for peo-
ple generally twenty years ago. We have come back
to recognize the place of teleology. Clement of
Alexandria was an early Christian temperance ad-

28 OLD-TIME MAKERS OF MEDICINE

vocate, who argued that the use of wine was only
justified when it did good as a medicine. The prob-
lems of embryology and of diseases of childhood
interested him as they did many other of the early
Christian writers.

AETIUS

The first great Christian physician whose works
meant much for his own time, and whose writings
have become a classic in medicine, was Aetius Ami-
denus, that is, Aetius of Amida, who was born in the
town of that name in Mesopotamia, on the upper
Tigris (now Diarbekir), and who flourished about
the middle of the sixth century. His medical studies,
as he has told us himself, were made at Alexandria.
After having attracted attention by his medical
learning and skill, he became physician to one of
the emperors at Byzantium, very probably Justinian,
(527-565). He seems to have been succeeded in the
special post that was created for him at court by
Alexander of Tralles, the second of the great Chris-
tian physicians. There is no doubt that Aetius was
a Christian, for he mentions Christian mysteries,
and appeals to the name of the Saviour and the
martyrs. He was evidently a man of wide reading,
for he quotes from practically every important med-
ical writer before his time. Indeed, he is most
valuable for the history of medicine, because he gives
us some idea of the mode of treatment of various
subjects by predecessors whose fame we know, but
none of whose works have come to us. His official
career and the patronage of the Emperor, the

GREAT PHYSICIANS IN EAELY CHRISTIAN TIMES 29

breadth of his scholarship, and the thoroughly prac-
tical character of his teaching, show how medical
science and medical art were being developed and
encouraged at this time.

Aetius' work that is preserved for us is known in
medical literature as his sixteen books on medical
practice. In most of the manuscript it is divided
into four Tetrabibloi, or four book parts, each of
which consists of four sections called Logoi in
Greek, Sermones in Latin. This work embraces all
the departments of medicine, and has a considerable
portion devoted to surgery, but most of the im-
portant operations and the chapters on fractures
and dislocations are lacking. Aetius himself an-
nounces that he had prepared a special work on
surgery, but this is lost. Doubtless the important
chapters that we have noted as lacking in his work
would be found in this. He is much richer in
pathology than most of the older writers, at least
of the Christian era ; for instance, Gurlt says that he
treats this feature of the subject much more ex-
tensively even than Paulus ^ginetus, but most of
his work is devoted to therapeutics.

At times those who read these old books from cer-
tain modern standpoints are surprised to find such
noteworthy differences between writers on medicine,
who are separated sometimes only by a generation,
and sometimes by not more than a century, in what
regards the comparative amount of space given to
pathology, etiology, and therapeutics. Just exactly
the same differences exist in our own day, however.
We all know that for those who want pathology and
etiology the work of one of our great teachers is to

30 OLD-TIME MAKERS OF MEDICINE

be consulted, while for therapeutics it is better to
go to someone else. When we find such differences
among the men of the olden time we are not so
apt to look at them with sympathetic discrimina-
tion, as we do with regard to our contemporaries.
We may even set them down to ignorance rather
than specialization of interest. These differences
depend on the attitude of mind of the physician, and
are largely the result of his own personal equation.
They do not reflect in any way either on his judg-
ment or on the special knowledge of his time, but
are the index of his special receptivity and teaching
habit.

Aetius' first and second books are taken up en-
tirely with drugs. The first book contains a list of
drugs arranged according to the Greek alphabet. In
the third book other remedial measures, dietetic,
manipulative, and even operative, are suggested.
In these are included venesection, the opening of an
artery, cupping, leeches, and the like. The fourth
and fifth books take up hygiene, special dietetics, and
general pathology. In the sixth book what the
Germans call special pathology and therapy begins
with the diseases of the head. The first chapter
treats of hydrocephalus. In this same book rabies
is treated. What Aetius has consists mainly of
quotations from previous authors, many of whom he
had evidently read with great care.

Concerning those " bitten by a rabid dog or those
who fear water, ' ' Gurlt has quoted the following ex-
pression, with regard to which most people will be
quite ready to agree with him when he says that it
contains a great deal of truth, usually thought to be

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 31

of much later origin : 1 ' When, therefore, any one
has been bitten by a rabid dog the treatment of the
wound must be undertaken just as soon as possible,
even though the bite should be small and only super-
ficial. One thing is certain, that none of those who
are not rightly treated escape the fatal effect. The
first thing to do is to make the wound larger, the
mouth of it being divided and dilated by the scalpel.
Then every portion of it and the surrounding tissues
must be firmly pressed upon with the definite pur-
pose of causing a large efflux of blood from the part.
Then the wound should be deeply cauterized, etc. ' '

There are special chapters devoted to eye and ear
diseases, and to various affections of the face. Un-
der this the question of tattooing and its removal
comes in. It is surprising how much Aetius has
with regard to such nasal affections as polyps and
ulcers and bleedings from the nose. In this book,
however, he treats only of their medicinal treatment.
What he has to say about affections of the teeth is
so interesting that it deserves a paragraph or two
by itself.

He had much to say with regard to the nervous
supply of the mucous membranes of the gums,
tongue, and mouth, and taught that the teeth re-
ceived nerves through the small hole existing at the
end of every root. For children cutting teeth he
advised the chewing of hard objects, and thought
that the chewing of rather hard materials was good
also for the teeth of adults. For fistulas leading
to the roots of teeth he suggests various irritant
treatments, and, if they do not succeed, recommends
the removal of the teeth. He seems to have known

32 OLD-TIME MAKERS OF MEDICINE

much about affections of the gums and recognizes a
benignant and malignant epulis. He thought that
one form of epulis was due to inflammation of a
chronic character, and suggests that if remedies do
not succeed it should be removed. His work is of
interest mainly as showing that even at this time,
when the desire for information of this kind is usu-
ally supposed to have been in abeyance, physicians
were gathering information about all sorts even of
the minor ailments of mankind, gathering what had
been written about them, commenting on it, adding
their own observations, and in general trying to
solve the problems as well as they could.

Aetius seems to have had a pretty good idea of
diphtheria. He speaks of it in connection with
other throat manifestations under the heading of
" crusty and pestilent ulcers of the tonsils." He
divides the anginas generally into four kinds. The
first consists of inflammation of the fauces with the
classic symptoms, the second presents no inflamma-
tion of the mouth nor of the fauces, but is compli-
cated by a sense of suffocation — apparently our
croup. The third consists of external and internal
inflammation of the mouth and throat, extending
towards the chin. The fourth is an affection rather
of the neck, due to an inflammation of the vertebra
— retropharyngeal abscess — that may be followed
by luxation and is complicated by great difficulty of
respiration. All of these have as a common symp-
tom difficulty of swallowing. This is greater in one
variety than in another at different times. In cer-
tain affections even " drinks when taken are re-
turned through the nose."

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 33

Hypertrophy of the tonsils — Aetius speaks of
them as glands — is to be treated by various
astringent remedies, but if these fail the structures
should be excised. His description of the excision
is rather clear and detailed. The patient should be
put in a good full light, and the mouth should be
held open and each gland pulled forward by a hook
and excised. The operator should be careful, how-
ever, only to excise those portions that are beyond
the natural size, for if any of the natural substance
of the gland is cut into, or if the incision is made
beyond the projecting portion of the tonsil, there is
grave danger of serious hemorrhage. After ex-
cision a mixture of water and vinegar should be kept
in the mouth for some time. This should be admin-
istered cold in order to prevent the flow of blood.
After this very cold water should be taken.

In this same book, Chapter L, he treats of for-
eign bodies in the respiratory and upper digestive
tracts. If there is anything in the larynx or the
bronchial tubes the attempt must be made to secure
its ejection by the production of coughing or sneez-
ing. If the foreign body can be seen it should be
grasped with a pincers and removed. If it is in
the esophagus, Aetius suggests that the patient
should be made to swallow a sponge dipped in
grease, or a piece of fat meat, to either of which a
string has been attached, in order that the foreign
body may be caught and drawn out. If it seems
preferable to carry the body on into the stomach,
the swallowing of large mouthfuls of fresh bread
or other such material is recommended.

With regard to goitre, Aetius has some interest-

34 OLD-TIME MAKERS OF MEDICINE

ing details. He says that " all tumors occurring
in the throat region are called bronchoceles, for
every tumor among the ancients was called a cele,
and, though the name is common to them, they differ
very much from one another." Some of them are
fatty, some of them are pultaceous, some of them
are cancerous, and some of them he calls honey
tumors, because of a honey-like humor they contain.
* * Sometimes they are due to a local dilatation of the
blood vessels, and this is most frequently connected
with parturition, apparently being due to the draw-
ing of the breath being prevented or repressed dur-
ing the most violent pains of the patient. Such
local dilatation at this point of the veins is incurable,
but there are also hard tumors like scirrhus and
malignant tumors, and those of great size. With
the exception of these last, all the tumors of this
region are easily cured, yielding either to surgery
or to remedies. Surgery must be adapted to the
special tumor, whether it be honey-like or fatty, or
pultaceous." The prognosis of goitrous tumors is
much better than might be expected, but evidently
Ae'tius saw a number of the functional disturbances
and enlargements of the thyroid gland, which are
so variable in character as apparently to be quite
amenable to treatment.

Ae'tius' treatment of the subject of varicosities
is quite complete in its suggestions. " The term
varices," he says, " is applied to dilated veins,
which occur sometimes in connection with the testes
and sometimes in the limbs. Operations on
testicular varices patients do not readily consent to ;
those on the limbs may be cured in several ways.

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 35

First, simple section of the skin lying above the
dilated vessel is made, and with the hook it is sep-
arated from the neighboring tissues and tied. After
this the dilated portion is removed and pressure
applied by means of a bandage. The patient is
ordered to remain quiet, but with the legs higher
than the head. Some people prefer treatment by
means of the cautery." Gurlt, in his " History of
Surgery," calls attention to the fact that two of our
modern methods of treating varicose veins are thus
discussed in Aetius, that by ligation and that by
the cautery. The cautery was applied over a space
the breadth of a finger at several points along the
dilated veins.

Aetius' chapters on obstetrics and gynaecology
are of special interest, because, while we are prone
to think that gynaecology particularly is a compara-
tively modern development of surgery, this surgical
authority of the early Middle Ages treats it rather
exhaustively. His sixteenth book is for the most
part (one hundred and eleven chapters of it) de-
voted to these two subjects. He has a number of
interesting details in the first thirty-six chapters
with regard to conception, pregnancy, labor, and
lactation, which show how practical were the views
of the physicians of the time. Gurlt has given us
some details of his chapters on diseases of the
breast. Aetius differentiates phagedenic and rodent
ulcers and cancer. All the ordinary forms of
phagedenic ulcer yield to treatment, while malignant
growths are rendered worse by them. Where ulcers
are old, he suggests the removal of their thickened
edges by the cautery, for this hastens cure and

36 OLD-TIME MAKERS OF MEDICINE

prevents hemorrhage. With regard to cancer, he
quotes from Archigenes and Leonides. He says
that these tumors are very frequent in women, and
quite rare in men. Even at this time cancer had
been observed and recognized in the male breast.
He emphasizes the fact that cancerous nodules be-
come prominent and become attached to surround-
ing tissues. There are two forms, those with ulcer,
and those without. He describes the enlargement
of the veins that follows, the actual varicosities, and
the dusky or livid redness of the parts which seem
to be soft, but are really very hard. He says
that they are often complicated by very painful con-
ditions, and that they cause enlargement of the
glands and of the arms. The pain may spread to
the clavicle and the scapula, and he seems to think
that it is the pain that causes the enlargement of
the glands at a distance.

His description of ulcerative cancer of the breast
is very striking. He says that it erodes without
cause, penetrating ever deeper and deeper, and can-
not be stopped until it emits a secretion worse than
the poison of wild beasts, copious and abominable
to the smell. With these other symptoms pains are
present. This form of cancer is especially made
worse by drugs and by all manner of manipulation.
The paragraph from Leonides quoted by Aetius
gives a description of operation for cancer of the
breast, in which he insists particularly on the ex-
tensive removal of tissue and the free use of the
cautery. " The cautery is used at first in order to
prevent bleeding, but also because it helps to destroy
the remains of diseased tissues. When the burning

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 37

is deep, prognosis is much better. Even in cases
where indurated tumors of the breast occur that
might be removed without danger of bleeding, it is
better to use the cautery freely, though the amputa-
tion of such a portion down to the healthy parts may
suffice." Aetius quotes this with approval.

Others before Aetius had suggested the connec-
tion between hypertrophy of the clitoris and cer-
tain exaggerated manifestations of the sexual in-
stinct, and the development of vicious sexual habits.
As might be expected from this first great Christian
physician and surgeon, he emphasizes this etiology
for certain cases, and outlines an operation for it.
This operation had been suggested before, but Aetius
goes into it in detail and describes just how the
operation should be done, so as to secure complete
amputation of the enlarged organ, yet without in-
jury. He warns of the danger of removing more
than just the structure itself, because this may give
rise to ugly and bothersome scars. After the opera-
tion a sponge wet with astringent wine should be ap-
plied, or cold water, especially if there is much
tendency to bleeding, and afterwards a sponge with
manna or frankincense scattered over it should be
bound on. He treats of other pathological condi-
tions of the female genitalia, varicose veins, growths
of various kinds, hypertrophy of the portio vaginalis
uteri, an operation for which is described, and of
various tumors. He describes epithelioma very
clearly, enumerates its most frequent locations in
their order, lays down its bad prognosis, and hence
the necessity for early operation with entire re-
moval of the new growth whenever possible. He

38 OLD-TIME MAKERS OF MEDICINE

feared hemorrhage very much, however, and warns
with regard to it, and evidently had had some very
unfortunate experiences in the treatment of these
conditions.

Aetius seems to have had as thoroughly scientific
an interest in certain phases of chemistry apart
from medicine as any educated physician of the
modern time might have. Mr. A. P. Laurie, in his
" Materials of the Printer's Craft," l calls attention
to the fact that the earliest reference to the use of
drying oil for varnish is made by the physician
Aetius.

Aetius, or Aetios, to use for the nonce the Greek
spelling of his name, which sometimes occurs in
medical literature, and should be known, has been
the subject of very varied estimation at different
times. About the time of the Renaissance he was
one of the first of the early writers on medicine ac-
corded the honor of printing, and then was reprinted
many times, so that his estimation was very high.
With the reawakening of clinical medicine in the
seventeenth century his reputation waxed again, and
Boerhaave declared that the works of Aetius had
as much importance for physicians as had the Pan-
dects of Justinian for lawyers. This high estima-
tion had survived almost from the time of the
Renaissance, when Cornelius went so far as to say:
" Believe me, that whoever is deeply desirous of
studying things medical, if he would have the whole
of Galen abbreviated and the whole of Oribasius ex-
tended, and the whole of Paulus (of .^Egina) ampli-
fied, if he would have all the special remedies of the

'Foulis, London and Edinburgh, 1910.

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 39

old physicians as well in pharmacy as in surgery
boiled down to a summa for all affections, he will
find it in Aetius." Naturally enough, this exag-
gerated estimation was followed by a reaction, in
which Aetius came to be valued at much less than he
deserved. After all is taken into account in the
vicissitudes of his fame, it is clear, however, that he
is one of the most important links in the chain of
medical tradition, and himself worthy to be classed
among makers of medicine for his personal observa-
tions and efforts to pass on the teachings of the old
to succeeding generations.

ALEXANDER OF TBALLES

An even more striking example than the life and
work of Aetius as evidence for the encouragement
and patronage of medicine in early Christian times,
is to be found in the career of Alexander of Tralles,
whose writings have been the subject of most care-
ful attention in the Eenaissance period and in our
own, and who must be considered one of the great
independent thinkers in medicine. While it is usu-
ally assumed that whatever there was of medical
writing during the Middle Ages was mere copying
and compilation, here at least is a man who could
not only judiciously select, but who could critically
estimate the value of medical opinions and pro-
cedure, and weighing them by his own experience
and observation, turn out work that was valuable
for all succeeding generations. The modern Ger-
man school of medical historians have agreed in
declaring him an independent thinker and physician,

40 OLD-TIME MAKERS OF MEDICINE

who represents a distinct link in medical tradition.

He came of a distinguished family, in which the
following of medicine as a profession might be
looked upon as hereditary. His father was a physi-
cian, and it is probable that there were physicians
in preceding generations, and one of his brothers,
Dioscoros, was also a successful physician. Alto-
gether four of his brothers reached such distinction
in their life work that their names have come down
to us through nearly fifteen hundred years. The
eldest of them was Anthemios, the builder of the
great church of Santa Sophia in Constantinople.
As this is one of the world's great churches, and
still stands for the admiration of men a millennium
and a half after its completion, it is easy to under-
stand that Anthemios' reputation is well founded.
A second brother was Metrodoros, a distinguished
grammarian and teacher, especially of the youthful
nobility of Byzantium, as it was then called, or Con-
stantinople, as we have come to call it. A third
brother was a prominent jurist, also in Constan-
tinople. The fourth brother, Dioscoros, like Alex-
ander, a physician, remained in his birthplace,
Tralles, and acquired there a great practice.

It was with his father at Tralles that Alexander
received his early medical training. The father of
a friend and colleague, Cosmas, who later dedicated
a book to Alexander, was also his teacher, while he
was in his native city. As a young man, Alexander
undertook extensive travels, which led him into
Italy, Gaul, Spain, and Africa, everywhere gather-
ing medical knowledge and medical experience.
Then he settled down at Rome, probably in an official

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 41

position, and practised medicine successfully until
a very old age. He was probably eighty years of
age when, some time during the first decade of the
seventh century, he died.

Puschmann, who has made a special study of
Alexander's life and work, suggests that since some
of his books have the form of academic lectures he
was probably a teacher of medicine at Eome. As
might be expected from what we know of the rela-
tions of the rest of the family to the nobility of the
time, it is easy to understand, especially in connec-
tion with hints in Alexander's favorite modes of
therapeutics, that costliness of remedies made no
difference to his patients, that he must have had the
treatment of some of the wealthiest families in
Rome.

His principal work is a Treatise on the Pathology
and Therapeutics of Internal Diseases, in twelve
books. The first eleven books were evidently
material gathered for lectures or teaching of some
kind. The twelfth book, in which considerable use
of Aetius' writings is made, was written, according
to Puschmann, toward the end of Alexander's life,
and was meant to contain supplementary matter,
comprising especially his views gathered from ob-
servation as to the pathology of internal diseases.
A shorter treatise of Alexander is with regard to
intestinal parasites. There are many printed edi-
tions of these books, and many manuscript copies
are in existence. Alexander was often quoted dur-
ing the Middle Ages, and in recent years, with the
growth of our knowledge of medical history, he has
come to be a favorite subject of study.

42 OLD-TIME MAKERS OF MEDICINE

Alexander's first book of pathology and thera-
peutics treats of head and brain diseases. For bald-
ness, the first symptom of which is falling out of
the hair, he counsels cutting the hair short, washing
the scalp vigorously, and the rubbing in of sulphur
ointments. For grey hair he suggests certain hair
dyes, as nutgalls, red wine, and so forth. For
dandruff, which he described as the excessive forma-
tion of small flake-like scales, he recommends rub-
bing with wine, with certain salves, and washing with
salt water.

He gives a good deal of attention to diseases of
the nervous system. He has a rather interesting
chapter on headache. The affection occurs in con-
nection with fevers, after excess in drinking, and as
a consequence of injury to the skull. Besides, it
develops as a result of disturbances of the natural
processes in the head, the stomach, the liver, and
the spleen. Headache, as the first symptom of in-
flammation of the brain, is often the forerunner of
convulsions, delirium, and sudden death. Chronic
or recurrent headache occurs in connection with
plethora, diseases of the brain, biliousness, digestive
disturbances, insomnia, and continued worry.
Hemicrania has its origin in the brain, because of
the presence of toxic materials, and specially their
transformation into gaseous substances. It also
occurs in connection with abdominal affections. This
latter remark particularly is directed to the cases
which occur in women.

For apoplexy and the consequent paralysis, Alex-
ander considered venesection the best remedy.
Massage, rubbings, baths, and warm applications

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 43

are recommended for the paralytic conditions. He
had evidently had considerable experience with
epilepsy. It develops either from injuries of the
head or from disturbances of the stomach, or oc-
casionally other parts of the body. When it occurs
in nursing infants, nourishment is the best remedy,
and he gives detailed directions for the selection of
a wet nurse, and very careful directions as to her
mode of life. He emphasizes very much the neces-
sity for careful attention to the gastro-intestinal
tract in many cases of epilepsy. Planned diet and
regular bowels are very helpful. He rejects treat-
ment of the condition by surgery of the head, either
by trephining or by incisions, or cauterization. Reg-
ular exercise, baths, sexual abstinence are the
foundation of any successful treatment. It is prob-
able that we have returned to Alexander's treat-
ment of epilepsy much more nearly than is generally
thought. There are those who still think that rem-
edies of various kinds do good, but in the large
epileptic colonies regular exercise, bland diet, reg-
ulation of the bowels, and avoidance of excesses of
all kinds, with occupation of mind, constitute the
mainstay of their treatment.

Alexander has much to say with regard to phre-
nitis, a febrile condition complicated by delirium,
which, following Galen, he considers an affection of
the brain. It is evidently the brain fever of the
generations preceding the last, an important element
of which was made up of the infectious meningitises.
Alexander suggests its treatment by opiates after
preliminary venesection, rubbings, lukewarm baths,
and stimulating drinks. Every disturbance of the

44 OLD-TIME MAKERS OF MEDICINE

patient must be avoided, and visitors must be for-
bidden. The patient's room should rather be light
than dark. His teaching crops up constantly in the
centuries after his time, until the end of the nine-
teenth century, and while we now understand the
causes of the condition better, we can do little more
for it than he did.

Alexander divided mental diseases into two, the
maniacal and melancholic. Mania was, however,
really a further development of melancholia, and
represented a high grade of insanity. Under melan-
choly he groups not only what we denominate by
that term, but also all depressed conditions, and
the paranoias, as also many cases of imbecility.
The cause of mental diseases was to be found in the
blood. He counselled the use of venesection, of lax-
atives and purgatives, of baths and stimulant rem-
edies. He insisted very much, however, on mental
influence in the disease, on change of place and air,
visits to the theatre, and every possible form of
mental diversion, as among the best remedial
measures.

After his book on diseases of the head, his most
important section is on diseases of the respiratory
system. In this he treats first of angina, and recom-
mends as gargles at the beginning light astringents ;
later stronger astringents, as alum and soda dis-
solved in warm water, should be employed. Warm
compresses, venesection from the sublingual veins,
and from the jugular, and purgatives in severe
cases, are the further remedies. He treats of cough
as a symptom due to hot or cold, dry or wet dys-
crasias. Opium preparations carefully used are the

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 45

best remedies. The breathing in of steam impreg-
nated with various ethereal resins, was also recom-
mended.

He gives a rather interestingly modern treatment
of consumption. He recommends an abundance of
milk with a strong nutritious diet, as digestible as
possible. A good auxiliary to this treatment was
change of air, a sea voyage, and a stay at a water-
ing-place. Asses' and mares' milk are much better
for these patients than cows' and goats' milk. There
is not enough difference in the composition of these
various milks to make their special consumption of
import, but it is probable that the suggestive in-
fluence of the taking of an unusual milk had a very
favorable effect upon patients, and this effect was
renewed frequently, so that much good was
ultimately accomplished. For hemoptysis, espe-
cially when it was acute and due as Alexander
thought to the rupture of a blood vessel in the lungs,
he recommended the opening of a vein at the elbow
or the ankle — in order to divert the blood from the
place of rupture to the healthy parts of the circula-
tion. He insisted that the patients must rest, that
they should take acid and astringent drinks, that
cold compresses should be placed upon the chest
(our ice bags), and that they should take only a
liquid diet at most lukewarm, or, better, if agree-
able to them, cold. When the bleeding stopped, a
milk cure was very useful for the restoration of
these patients to strength.

It is not surprising, then, to find that Alexander
suggests a thoroughly rational treatment for
pleurisy. He recognizes this as an inflammation

46 OLD-TIME MAKERS OF MEDICINE

of the membrane covering the ribs, and its symp-
toms are severe pain, disturbance of breathing, and
coughing. In certain cases there is severe fever,
and Alexander knows of purulent pleurisy, and the
fact that when pus is present the side on which it
is is warmer than the other. Pleurisy can be, he
says, rather easily confounded with certain liver
affections, but there is a peculiar hardness of the
pulse characteristic of pleurisy, and there is no ex-
pectoration in liver cases, though it also may be ab-
sent in many cases of pleurisy. Sufferers from
liver disease usually have a paler color than
pleuritics. His treatment consists in venesection,
purgatives, and, when pus is formed, local incision.
He recommends the laying on of sponges dipped
in warm water, and the internal use of honey lem-
onade. Opium should not be used unless the patient
suffers from sleeplessness.

Some of the general principles of therapeutics
that Alexander lays down are very interesting, even
from our modern standpoint. Trust should not be
placed in any single method of treatment. Every
available means of bringing relief to the patient
should be tried. " The duty of the physician is to
cool what is hot, to warm what is cold, to dry what
is moist, and to moisten what is dry. He should
look upon the patient as a besieged city, and try to
rescue him with every means that art and science
places at his command. The physician should be an
inventor, and think out new ways and means by
which the cure of the patient's affection and the
relief of his symptoms may be brought about. ' ' The
most important factor in his therapeutics is diet.

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 47

Watering-places and various forms of mineral
waters, as well as warm baths and sea baths, are
constantly recommended by him. He took strong
ground against the use of many drugs, and the rage
for operating. The prophylaxis of disease is in
Alexander's opinion the important part of the
physician's duty. His treatment of fever shows the
application of his principle: cold baths, cold com-
presses, and a cooling diet, were his favorite rem-
edies. He encouraged diaphoresis nearly always,
and gave wine and stimulating drugs only when the
patient was very weak. He differentiates two kinds
of quartan fever. One of these he attributes to an
affection of the spleen, because he had noticed that
the spleen was enlarged during it, and that, after
purgation, the enlarged spleen decreased in size.

Alexander was a strong opponent of drastic rem-
edies of all kinds. He did not believe in strong
purgatives, nor in profuse and sudden blood-let-
tings. He opposed arteriotomy for this reason, and
refused to employ extensive cauterization. His
diagnosis is thorough and careful. He insisted par-
ticularly on inspection and palpation of the whole
body; on careful examination of the urine, of the
feces, and the sputum; on study of the pulse and
the breathing. He thought that a great deal might
be learned from the patient's history. The general
constitution is also of importance. His therapeutics
is, above all, individual. Kemedies must be admin-
istered with careful reference to the constitution,
the age, the sex, and the condition of the patient's
strength. Special attention must always be paid
to nature's efforts to cure, and these must be en-

48 OLD-TIME MAKERS OF MEDICINE

couraged as far as possible. Alexander had no
sympathy at all with the idea that remedies must
work against nature. His position in this matter
places him among the dozen men whose name and
writings have given them an enduring place in the
favor of the profession at all times, when we were
not being carried away by some therapeutic fad or
imagining that some new theory solved the whole
problem of the causation and cure of disease.

Gurlt, in his " History of Surgery," has ab-
stracted from Alexander particularly certain phases
of what the Germans call external pathology and
therapeutics. For instance, Alexander's treatment
of troubles connected with the ear is very interest-
ing. Gurlt declares that this chapter alone provides
striking evidence for Alexander's practical experi-
ence and power of observation, as well as for his
knowledge of the literature of medicine. He con-
siders that only a short abstract is needed to show
that.

For water that has found its way into the external
ear, Alexander suggests a mode of treatment that is
still popularly used. The patient should stand upon
the leg corresponding to the side on which there is
water in his ear, and then, with head leaning to that
side, should hop or kick out with the other leg. The
water may be drawn out by means of suction
through a reed. In order to get foreign bodies out
of the external auditory canal, an ear spoon or other
small instrument should be wrapped in wool and
dipped in turpentine, or some other sticky material.
Occasionally he has seen sneezing, especially if the
mouth and nose are covered with a cloth, and the

GREAT PHYSICIANS IN EAELY CHRISTIAN TIMES 49

head leant toward the affected side, bring about a
dislodgment of the foreign body. If these means do
not succeed, gentle injections of warm oil or wash-
ing out of the canal with honey water should be
tried. Foreign bodies may also be removed by
means of suction. Insects or worms that find their
way into the ear may be killed by injections of acid
and oil, or other substances.

Gurlt also calls attention to Alexander's careful
differentiation of certain very dangerous forms of
inflammation of the throat from others which are
rather readily treated. He says, " Inflammation of
the throat may, under certain circumstances, belong
to the severest diseases. The patients succumb to
it as a consequence of suffocation, just as if they
were choked or hanged. For this reason, perhaps,
the affection bears the name synanche, which means
constriction." He then points out various other
forms of inflammation of the throat, acute and
chronic, suggesting various names and the differ-
ential diagnostic signs.

One of the most surprising chapters of Alexan-
der's knowledge of pathology and therapeutics is
to be found in his treatment of the subject of in-
testinal worms, which is contained in a letter sent
by him to his friend, Theodore, whose child was suf-
fering from them. He describes the oxyuris ver-
micularis with knowledge manifestly derived from
personal observation. He dwells on the itching in
the region of the anus, caused by the oxyuris, and
the fact that they probably find their way into the
upper part of the digestive tract because of the
soiling of the hands. He knew that the tapeworms

50 OLD-TIME MAKERS OF MEDICINE

often reached great length, — he has seen one over
sixteen feet long, — and also that they had a life cycle,
so that they existed in two different forms. He de-
scribes the roundworms as existing in the intestines,
but occasionally wandering into the stomach to be
vomited. His vermifuges were the flowers and the
seeds of the pomegranate, the seeds of the helio-
trope, castor-oil, and certain herbs that are still
used, by country people, at least, as worm medicines.
For roundworms he recommended especially a de-
coction of artemisia maritima, coriander seeds, and
decoctions of thyme. Our return to thymol for in-
testinal parasites is interesting. For the oxyuris
he prescribed clysters of ethereal oils. We have
not advanced much in our treatment of intestinal
worms in the fifteen hundred years since Alexan-
der's time.

PAUL OF .EGINA

Another extremely important writer in these early
medieval times, whose opportunities for study in
medicine and for the practice of it, were afforded
him by Christian schools and Christian hospitals,
was Paul of ^Egina. He was born on the island of
^Egina, hence the name ^ginetus, by which he is
commonly known. There used to be considerable
doubt as to just when Paul lived, and dates for his
career were placed as widely apart as the fifth and
the seventh centuries. We know that he was edu-
cated at the University of Alexandria. As that in-
stitution was broken up at the time of the capture
of the city by the Arabs, he cannot have been there

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 51

later than during the first half of the seventh cen-
tury. An Arabian writer, Abul Farag, in " The
Story of the Reign of the Emperor Heraclius," who
died 641, says that " among the celebrated physi-
cians who flourished at this time was Paulus
^Eginetus." In his works Paul quotes from Alex-
ander of Tralles, so that there seems to be no doubt
now that his life must be placed in the seventh
century.

The most important portion of Paul's work for
the modern time is contained in his sixth book on
surgery. In this his personal observations are
especially accumulated. Gurlt has reviewed it at
considerable length, devoting altogether nearly
thirty pages to it, and it well deserves this lengthy
abstract. Paul quotes a great many of the writers
on surgery before his time, and then adds the re-
sults of his own observation and experience. In
it one finds careful detailed descriptions of many
operations that are usually supposed to be modern.
Very probably the description quoted by Gurlt of
the method of treating fishbones that have become
caught in the throat will give the best idea of how
thoroughly practical Paul is in his directions. He
says : * ' It will often happen in eating that fish-
bones or other objects may be swallowed and get
caught in some part of the throat. If they can be
seen they should be removed with the forceps de-
signed for that purpose. Where they are deeper,
some recommend that the patient should swallow
large mouthfuls of bread or other such food. Others
recommend that a clean soft sponge of small circum-
ference to which a string is attached be swallowed,

52 OLD-TIME MAKERS OF MEDICINE

and then drawn out by means of the string. This
should be repeated until the bone or other object
gets caught in the sponge and is drawn out. If the
patient is seen immediately after eating, and the
swallowed object is not visible, vomiting should be
brought on by means of a finger in the throat or
irritation with the feather, and then not infrequently
the swallowed object will be brought up with the
vomit. ' '

In the chapter immediately following this,
XXXIII, there is a description of the method of
opening the larynx or the trachea, with the indica-
tions for this operation. The surgeon will know
that he has opened the trachea when the air streams
out of the wound with some force, and the voice is
lost. As soon as the danger of suffocation is over,
the edges of the wound should be freshened and the
skin surfaces brought together with sutures. Only
the skin without the cartilage should be sutured,
and general treatment for encouraging union should
be employed. If the wound fails to heal immedi-
ately, a treatment calculated to encourage granula-
tions should be undertaken. This same method of
treatment will be of service whenever we happen to
have a patient who, in order to commit suicide, has
cut his throat. Paul's exact term is, perhaps, best
translated by the expression, slashed his larynx.

One of the features of Paul's " Treatise on Sur-
gery " is his description of a radical operation for
hernia. He describes scrotal hernia under the name
enterocele, and says that it is due either to a tearing
or a stretching of the peritoneum. It may be the
consequence either of injury or of violent efforts

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 53

made during crying. When the scrotum contains
only omentum, he calls the condition epiplocele;
when it also contains intestine, an epiplo-enterocele.
Hernia that does not descend into the scrotum he
calls bubonocele. For operation the patient should
be placed on the back, and, the skin of the inguinal
region being stretched by an assistant, an oblique
incision in the direction in which the blood vessels
run should be made. The incision should then be
stretched by means of retractors, until the contents
of the sac can be lifted out. All adhesions should
be broken up and the fat be removed, and the hernia
replaced within the abdomen. Care should be taken
that no loop of intestine is allowed to remain. Then
a large needle with double thread made of ten
strands should be run through the middle of the in-
cision in the end of the peritoneum, and tied firmly
in cross sutures. The outer structures should be
brought together with a second ligature, and the
lower end of the incision should have a wick placed in
it for drainage, and the site of operation should be
covered with an oil bandage.

The Arab writer, Abul Farag, to whose references
we owe the definite placing of the time when Paul
lived, said that " he had special experience in
women's diseases, and had devoted himself to them
with great industry and success. The midwives of
the time were accustomed to go to him and ask his
counsel with regard to accidents that happen during
and after parturition. He willingly imparted his
information, and told them what they should do.
For this reason he came to be known as the Ob-
stetrician. ' ' Perhaps the term should be translated

54 OLD-TIME MAKERS OF MEDICINE

the man-midwife, for it was rather unusual for men
to have much knowledge of this subject. His knowl-
edge of the phenomena of menstruation was as wide
and definite. He knew a great deal of how to treat
its disturbances. He seems to have been the first
one to suggest that in metrorrhagia, with severe
hemorrhage from the uterus, the bleeding might be
stopped by putting ligatures around the limbs. This
same method has been suggested for severe
hemorrhage from the lungs as well as from the
uterus in our own time. In hysteria he also sug-
gested ligature of the limbs, and it is easy to under-
stand that this might be a very strongly suggestive
treatment for the severer forms of hysteria. It is
possible, too, that the modification of the circulation
to the nervous system induced by the shutting off
of the circulation in large areas of the body might
very well have a favorable physical effect in this af-
fection. Paul's description of the use of the spec-
ulum is as complete as that in any modern text-
book of gynaecology.

FURTHER CHRISTIAN PHYSICIAN'S

Another distinguished Christian medical scientist
was Theophilus Protosbatharius, who belonged to
the court of the Greek Emperor Heraclius, in the
seventh century. He seems to have had a life very
full of interest and surprisingly varied duties. He
was a bishop, and, at the same time, commander of
the imperial bodyguard, and the author of a little
work on the fabric of the human body. The most
surprising chapter in the history of the book is

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 55

that for some two centuries, in quite modern times,
it was used as a text-book of anatomy at the Uni-
versity of Paris. It was printed in a number of
editions early in the history of printing, at least
one very probably before 1500, and several later.

There are very interesting phases of medicine de-
lightfully surprising in their modernity to be found
here and there in many of these early Christian
writers on medicine. For instance, in a compend
of medicine written by one Leo, who, under the Em-
peror Theophilus, seems to have been a prominent
physician of Byzantium (the compend was written
for a young physician just beginning practice), we
find the following classification of hydrops or ab-
dominal dilatation : " There are three kinds ; the first
is ascites, due to the presence of watery fluid, for
which we do paracentesis; second, tympany, when
the abdomen is swollen from the presence of air or
gas. This may be differentiated by percussion of
the belly. When air is present the sound given
forth is like that of a drum, while in the first form
ascites the sound is like that from a sack [the word
used is the same as for a wine sack] ; the third form
is called anasarca, when the whole body swells."

It has often been the subject of misunderstanding
as to why medicine should have developed among the
Latin Christian nations so much more slowly than
among the Arabs during the early Middle Ages.
Anyone who knows the conditions in which Chris-
tianity came into existence in Italy will not be sur-
prised at that. The Arabs in the East were in con-
tact with Greek thought, and that is eminently
prolific and inspiring. At the most, the Christians in

56 OLD-TIME MAKERS OF MEDICINE

Italy got their inspiration at second hand through
the Romans. The Romans themselves, in spite of in-
timate contact with Greek physicians, never made
any important contributions to medical science, nor
to science of any kind. Their successors, the Chris-
tians of Rome and Italy, then could scarcely be ex-
pected to do better, hampered especially, as they
were, by the trying social conditions created by the
invasion of the barbarians from the North. When-
ever the Christians were in contact with Greek
thought and Greek medicine, above all, as at Alex-
andria, or in certain of the cities of the near East,
we have distinguished contributions from them.

ARABIAN CHRISTIAN PHYSICIANS

That this is not a partial view suggested by the
desire to make out a better case for Christianity in
its relation to science will be very well understood,
besides, from the fact that a number of the original
physicians of Arab stock who attracted attention
during the first period of Arabian medicine, that is,
during the eighth and ninth centuries, were Chris-
tians. There are a series of physicians belonging
to the Christian family Bachtischua, a name which
is derived from Bocht Jesu, that is, servant of
Jesus, who, from the middle of the eighth to the
middle of the eleventh century, acquired great fame.
The first of them, George (Dschordschis), after ac-
quiring fame elsewhere, was called to Bagdad by
the Caliph El-Mansur, where, because of his med-
ical skill, he reached the highest honors. His son
became the body-physician of Harun al-Raschid.

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 57

In the third generation Gabriel (Dschibril) acquired
fame and did much, as had his father and grand-
father, for the medicine of the time, by translations
of the Greek physicians into Arabian.

These men may well be said to have introduced
Greek medicine to the Mohammedans. It was their
teaching that aroused Moslem scholars from the
apathy that had characterized the attitude of the
Arabian people toward science at the beginning of
Mohammedanism. As time went on, other great
Christian medical teachers distinguished them-
selves among the Arabs. Of these the most prom-
inent was Messui the elder, who is also known as
Janus Damascenus. Both he and his father prac-
tised medicine with great success in Bagdad, and his
son became the body-physician to Harun al-Easchid
either after or in conjunction with Gabriel Bach-
tischua. Like his colleague or predecessor in of-
ficial position, he, too, made translations from the
Greek into Arabic. Another distinguished Arabian
Christian physician was Serapion the elder. He
was born in Damascus, and flourished about the
middle of the ninth century. He wrote a book on
medicine called the " Aggregator," or " Brevi-
arium," or " Practica Medicinae," which appeared
in many printed editions within the century after
the invention of printing. During the ninth cen-
tury, also, we have an account of Honein Ben Ischak,
who is known in the West as Johannitius. After
travelling much, especially in Greece and Persia,
he settled in Bagdad, and, under the patronage of
the Caliph Mamum, made many translations. He
translated most of the old Greek medical writers,

58 OLD-TIME MAKERS OF MEDICINE

and also certain of the Greek philosophic and mathe-
matical works. The accuracy of his translations
became a proverb. His compendium of Galen was
the text-book of medicine in the West for many cen-
turies. It was known as the " Isagoge in Artem
Parvam Galeni." His son, Ishac Ben Honein, and
his nephew, Hobeisch, were also famous as medical
practitioners and translators.

Still another of these Arabian Christians, who
acquired a reputation as writers in medicine, was
Alkindus. He wrote with regard to nearly every-
thing, however, and so came to be called the philoso-
pher. He is said altogether to have written and
translated about two hundred works, of which
twenty-two treat of medicine. He was a contem-
porary of Honein Ben Ischak in the ninth century.
Another of the great ninth-century Christian physi-
cians and translators from the Greek was Kostaben
Luka. He was of Greek origin, but lived in
Armenia and made translations from Greek into
Arabic. Nearly all of these men took not alone
medical science, but the whole round of physical
science, for their special subject. A typical example
in the ninth century was Abuhassan Ben Korra,
many of whose family during succeeding genera-
tions attracted attention as scholars. He became
the astronomer and physician of the Caliph Mo-
tadhid. His translations in medical literature were
mainly excerpts from Hippocrates and Galen meant
for popular use. These Christian translators, thor-
oughly scientific as far as their times permitted
them to be, were wonderfully industrious in their
work as translators, great teachers in every sense

GEE AT PHYSICIANS IN EARLY CHRISTIAN TIMES 59

of the word, and they are the men who formed the
traditions on which the greater Arabian physicians
from Rhazes onward were educated.

It would be easy to think that these men, oc-
cupied so much with translations, and intent on the
re-introduction of Greek medicine, might have de-
pended very little on their own observations, and
been very impractical. All that is needed to coun-
teract any such false impression, however, is to
know something definite about their books. Gurlt,
in his " History of Surgery," has some quotations
from Serapion the elder, who is often quoted by
Rhazes. In the treatment of hemorrhoids Sera-
pion advises ligature and insists that they must be
tied with a silk thread or with some other strong
thread, and then relief will come. He says some
people burn them medicinis acutis (touching
with acids, as some do even yet), and some incise
them with a knife. He prefers the ligature, how-
ever. He calmly discusses the removal of stones
from the kidney by incision of the pelvis of the
kidney through an opening in the loin. He con-
siders the operation very dangerous, however, but
seems to think the removal of a stone from the
bladder a rather simple procedure. His descrip-
tion of the technique of the use of a catheter and
of a stylet with it, and apparently also of a guide
for it in difficult cases, is extremely interesting.
He suggests the opening of the bladder in the median
line, midway between the scrotum and the anus,
and the placing of a canula therein, so as to permit
drainage until healing occurs.

Even this brief review of the careers and the

60 OLD-TIME MAKERS OF MEDICINE

writings of the physicians of early Christian times
shows how well the tradition of old Greek medicine
was being carried on. There was much to hamper
the cultivation of science in the disturbances of the
time, the gradual breaking up of the Roman Empire,
and the replacement of the peoples of southern
Europe by the northern nations, who had come in,
yet in spite of all this, medical tradition was well
preserved. The most prominent of the con-
servators were themselves men whose opinions on
problems of practical medicine were often of value,
and whose powers of observation frequently cannot
but be admired. There is absolutely no trace of
anything like opposition to the development of med-
ical science or medical practice, but, on the contrary,
everywhere among political and ecclesiastical
authorities, we find encouragement and patronage.
The very fact that, in the storm and stress of the
succeeding centuries, manuscript copies of the writ-
ings of the physicians of this time were preserved
for us in spite of the many vicissitudes to which
they were subjected from fire, and war, and acci-
dents of various kinds for hundreds of years, until
the coming of printing, shows in what estimation
they were held. During this time they owed their
preservation to churchmen, for the libraries and
the copying-rooms were all under ecclesiastical
control.

ni

GREAT JEWISH PHYSICIANS *

Any account of Old-Time Makers of Medicine with-
out a chapter on the Jewish Physicians would indeed
be incomplete. They are among the most important
factors in medieval medicine, representing one of
the most significant elements of medical progress.
In spite of the disadvantages under which their race
labored because of the popular feeling against them
on the part of the Christians in the earlier centuries
and of the Mohammedans later, men of genius from
the race succeeded in making their influence felt not
only on their own times, but accomplished so much
in making and writing medicine as to influence many
subsequent generations. Living the segregated life
that as a rule they had to, from the earliest times

1My attention was called to the interesting story of the Jewish
physicians of the Middle Ages and their scientific accomplishment
while writing the article on Joseph Hyrtl for the Catholic En-
cyclopedia. His " Das Arabische und Hebraische in der Anatomic "
(Wien, 1879) has some interestingly suggestive material on these im-
portant chapters of the history of medicine. (I owe my opportunity
to consult it to the courtesy of the Surgeon-General's library.)
Biographic material has been obtained from Carmoly's " History of
the Jewish Physicians," translated by Dr. Dunbar for the Maryland
Medical and Surgical Journal, some extra copies of which were
printed by John Murphy and Co., Baltimore, about the middle of the
nineteenth century. Baas and Haeser's Histories of Medicine and
Puschmann and Pagel's " Handbook " provided additional material,
and I have found Landau's " Geschichte der Jiidischen Aerzte " (Ber-
lin, 1895) of great service.

61

62 OLD-TIME MAKERS OF MEDICINE

(the Ghettos have only disappeared in the nineteenth
century), it would seem almost impossible for
them to have done great intellectual work. It
is one of the very common illusions, however,
that great intellectual work is accomplished mainly
in the midst of comfortable circumstances and
as the result of encouraging conditions. Most
of our great makers of medicine at all times,
and never more so than during the past century,
have been the sons of the poor, who have had
to earn their own living, as a rule, before
they reached manhood, and who have always had the
spur of that necessity which has been so well called
the mother of invention. Their hard living condi-
tions probably rather favored than hampered their
intellectual accomplishments.

It is not unlikely that the difficult personal circum-
stances in which the Jews were placed had a good
deal to do at all times with stimulating their am-
bitions and making them accomplish all that was in
them. Certain it is that at all times we find a won-
derful power in the people to rise above their con-
ditions. With them, however, as with other peoples,
luxury, riches, comfort, bring a surfeit to initiative
and the race does not accomplish so much. At vari-
ous times in the early Middle Ages, particularly, we
find Jewish physicians doing great work and obtain-
ing precious acknowledgment for it in spite of the
most discouraging conditions. Later it is not un-
usual to find that there has been a degeneration into
mere money-making as the result of opportunity
and consequent ease and luxury. At a number of
times, however, both in Christian and in Moham-

GREAT JEWISH PHYSICIANS 63

medan countries, great Jewish physicians arose
whose names have come to us and with whom every
student of medicine who wants to know something
about the details of the course of medical history
must be familiar. There are men among them
who must be considered among the great lights
of medicine, significant makers always of the
art and also in nearly all cases of the science of
medicine.

A little consideration of the history of the Jewish
people and their great documents eliminates any sur-
prise there may be with regard to their interest in
medicine and successful pursuit of it during the
Middle Ages. The two great collections of Hebrew
documents, the Old Testament and the Talmud, con-
tain an immense amount of material with reference
to medical problems of many kinds. Both of these
works are especially interesting because of what they
have to say of preventive medicine and with regard
to the recognition of disease. Our prophylaxis
and diagnosis are important scientific departments
of medicine dependent on observation rather than
on theory. While therapeutics has wandered into
all sorts of absurdities, the advances made in pro-
phylaxis and in diagnosis have always remained
valuable, and though at times they have been for-
gotten, re-discovery only emphasizes the value of
preceding work. It is because of what they contain
with regard to these two important medical subjects
that the Old Testament and the Talmud are land-
marks in the history of medicine as well as of re-
ligion.

Baas, in his " Outlines of the History of Medi-

64 OLD-TIME MAKERS OF MEDICINE

cine," says: " It corresponds to the reality in both
the actual and chronological point of view to con-
sider the books of Moses as the foundation of sani-
tary science. The more we have learned about
sanitation in the prophylaxis of disease and in the
prevention of contagion in the modern time, the
more have we come to appreciate highly the teach-
ings of these old times on such subjects. Moses
made a masterly exposition of the knowledge neces-
sary to prevent contagious disease when he laid
down the rules with regard to leprosy, first as to
careful differentiation, then as to isolation, and
finally as to disinfection after it had come to be sure
that cure had taken place. The great lawgiver could
insist emphatically that the keeping of the laws of
God not only was good for a man's soul but also for
his body."

With this tradition familiarly known and deeply
studied by the mass of the Hebrew people, it is no
surprise to find that when the next great Hebrew
development of religious writing came in the Tal-
mud during the earlier Middle Ages, that also con-
tains much with regard to medicine, not a little of
which is so close to absolute truth as never to be
out of date. Friedenwald, in his " Jewish Phy-
sicians and the Contributions of the Jews to the
Science of Medicine," a lecture delivered before the
Gratz College of Philadelphia fifteen years ago,
summed up from Baas' " History of Medicine " the
instructions in the Talmud with regard to health and
disease. The summary represents so much more of
genuine knowledge of medicine and surgery than
might be expected at the early period at which it was

GREAT JEWISH PHYSICIANS 65

written, during the first and second century of our
era, that it seems well to quote it at some length.

" Fever was regarded as nature's effort to expel
morbific matter and restore health ; which is a much
safer interpretation of fever, from a practical point
of view, than most of the theories bearing on this
point that have been taught up to a very recent
period. They attributed the halting in the hind legs
of a lamb to a callosity formed around the spinal
cord. This was a great advance in the knowledge
of the physiology of the nervous system. An emetic
was recommended as the best remedy for nausea.
In many cases no better remedy is known to-day.
They taught that a sudden change in diet was injuri-
ous, even if the quality brought by the change was
better. That milk fresh from the udder was the best.
The Talmud describes jaundice and correctly
ascribes it to the retention of bile, and speaks of
dropsy as due to the retention of urine. It teaches
that atrophy or rupture of the kidneys is fatal. In-
duration of the lungs (tuberculosis) was regarded
as incurable. Suppuration of the spinal cord had
an early, grave meaning. Rabies was known. The
following is a description given of the dog's condi-
tion : * His mouth is open, the saliva issues from his
mouth; his ears drop; his tail hangs between his
legs; he runs sideways, and the dogs bark at him;
others say that he barks himself, and that his voice
is very weak. No man has appeared who could say
that he has seen a man live who was bitten by a
mad dog.' The description is good, and this prog-
nosis as to hydrophobia in man has remained un-
altered till in our day when Pasteur published his
startling revelation. The anatomical knowledge of
the Talmudists was derived chiefly from dissection
of the animals. As a very remarkable piece of prac-
tical anatomy for its very early date is the procuring

66 OLD-TIME MAKERS OF MEDICINE

of the skeleton from the body of a prostitute by the
process of boiling, by Rabbi Ishmael, a physician,
at the close of the first century. He gives the num-
ber of bones as 252 instead of 232. The Talmudists
knew the origin of the spinal cord at the foramen
magnum and its form of termination; they described
the oesophagus as being composed of two coats ; they
speak of the pleura as the double covering of the
lungs ; and mention the special coat of fat about the
kidneys. They had made progress in obstetrics ; de-
scribed monstrosities and congenital deformities;
practised version, evisceration, and Caesarian section
upon the dead and upon the living mother. A. H.
Israels has clearly shown in his ' Dissertatio His-
torico-Medica Inauguralis ' that Caesarian section, ac-
cording to the Talmud, was performed among the
Jews with safety to mother and child. The surgery
of the Talmud includes a knowledge of dislocation of
the thigh bone, contusions of the skull, perforation
of the lungs, oesophagus, stomach, small intestines,
and gall bladder; wounds of the spinal cord, wind-
pipe, of fractures of the ribs, etc. They described
imperforate anus and how it was to be relieved by
operation. Chanina Ben Chania inserted natural
and wooden teeth as early as the second century,
C. E."

There is a famous summing up of the possibilities
of life and happiness in the Talmud that has been
often quoted — its possible wanting in gallantry be-
ing set down to the times in which it was written.
" Life is compatible with any disease, provided the
bowels remain open; any kind of pain, provided the
heart remain unaffected ; any kind of uneasiness, pro-
vided the head is not attacked; all manner of evils,
except it be a bad woman. ' '

There are many other interesting suggestions in

GREAT JEWISH PHYSICIANS 67

the Talmud. Sometimes they have come to be gen-
erally accepted in the modern time, sometimes they
are only curious notions that have not, however, lost
all their interest. The crucial incision for carbuncle
is a typical example of the first class and the sug-
gestion of the removal of superfluous fat from within
the abdomen or in the abdominal wall itself by
operation is another. That they had some idea of
the danger of sepsis may be gathered from the fact
that they suspected iron surgical instruments and
advised the use of others of less enduring character.
The Talmud itself was indeed a sort of encyclo-
pedia in which was gathered knowledge of all kinds
from many sources. It was not particularly a book
of medicine, though it contains so many medical
ideas. In many parts of it the authors' regard for
science is emphatically expressed. Landau, in his
' ' History of Jewish Physicians, ' ' closes his account
of the Talmud with this paragraph:

11 I conclude this brief review of Talmudic medi-
cine with some reference to how high the worth of
science was valued in this much misunderstood work.
In one place we have the expression * occupation with
science means more than sacrifice.' In another
* science is more than priesthood and kingly dig-
nity.' "*

I0f course there are many absurd things 'recommended in the Tal-
mud. We cannot remind ourselves too often, however, that there have
been absurd things at all times in medicine, and especially in therapeu-
tics. It is curious how often some of these absurdities have repeated
themselves. We are liable to think it very queer that men should have
presumed, or somehow jumped to the conclusion, that portions of ani-
mals might possess wonderful virtue for the healing of diseases of the
corresponding special parts of man. We ourselves, however, within a

68 OLD-TIME MAKERS OF MEDICINE

After all this of national tradition in medicine be-
fore and after Christ, it is only what we might quite
naturally expect to find, that there is scarcely a cen-
tury of the Middle Ages which does not contain at
least one great Jewish physician and sometimes
there are more. Many of these men made distinct
contributions to medical science and their names
have been held in high estimation ever since. Per-
haps I should say that they were held in high estima-
tion until that neglect of historical studies which
characterized the eighteenth century developed, and
that there has been a reawakening of interest in our
time. We forget this curious decadence of the later
seventeenth and eighteenth centuries which did so
much to obscure history and especially the history
of the sciences. Fortunately the scholars of the six-
teenth and early seventeenth centuries accomplished
successfully the task of printing many of the books
of these old-time physicians and secured their pub-
lication in magnificent editions. These were bought
eagerly by scholars and libraries all over Europe

Httle more than a decade, had a phase of opotherapy— how much less
absurd It seems under that high-sounding Greek term— that was appar-
ently very learned in its scientific aspects yet quite as absurd as many
phases of old-time therapy, as we look at it. We administered cardin
for heart disease and nephrin for kidney trouble, cerebrin for insanity
(save the mark !), and even prostate tissue for prostatism— and with re-
ported good results ! How many of us realize now that in this we were
only repeating the absurdities, so often made fun of in old medicine,
with regard to animal tissue and excrement therapeutics? The Talmud
has many conclusions with regard to the symptoms of patients drawn
from dreams ; as, for instance, it is said to be a certain sign of sanguine-
ous plethora when one dreams of the comb of a cock. One phase of
our psycho-analysis in the modern time, however, has taken us back to
an interpretation of dreams different of course from this, yet analogous
enough to be quite striking.

GREAT JEWISH PHYSICIANS 69

in spite of the high price they commanded in that
era of slow, laborious printing. The Renaissance
exhibits some of its most admirable qualities in its
reverence for these old workers in science and above
all for the careful preparation by its scholars of the
text of these first editions of old-time physicians.
The works have often been thus literally preserved
for us, for some of them at least would have disap-
peared among the vicissitudes of the intervening
time, most of which was anything but favorable to
the preservation of old-time works, no matter what
their content or value.

During the second and third centuries of our era,
while the Talmudic writings were taking shape, three
great Jewish physicians came into prominence.
The first of them, Chanina, was a contemporary of
Galen. According to tradition, as we have said, he
inserted both natural and artificial teeth before the
close of the second century. The two others were
Bab or Eaw and Samuel. Bab has the distinction
of having studied his anatomy from the human body.
According to tradition he did not hesitate to spend
large sums of money in order to procure subjects
for dissection. At this time it is very doubtful
whether Galen, though only of the preceding gen-
eration, ever had the opportunity to study more than
animals or, at most, a few human bodies. Samuel,
the third of the group, was an intimate friend of
Bab's, perhaps a disciple, and his fame depends
rather on his practice of medicine than of research
in medical science. He was noted for his practical
development of two specialties that cannot but seem
to us rather distant from each other. His reputa-

70 OLD-TIME MAKERS OF MEDICINE

tion as a skilful obstetrician was only surpassed by
the estimation in which he was held as an oculist.
He seems to have turned to astronomy as a hobby,
and was highly honored for his knowledge of this
science. Probably there is nothing commoner in the
story of great Jewish physicians than their success-
ful pursuit of some scientific subject as a hobby and
reaching distinction in it. Their surplus intellectual
energy needed an outlet besides their vocation, and
they got a rest by turning to some other interest,
often accomplishing excellent results in it. Like
most great students with a hobby, the majority of
them were long-lived. Their lives are a lesson to a
generation that fears intellectual overwork.

During the fourth century we have a number of
very interesting traditions with regard to a great
Jewish physician, Abba Oumna, to whom patients
flocked from all over the world. He seems particu-
larly to have been anxious to make his services avail-
able to the scholars of his time. He looked upon
them as brothers in spirit, fellow-laborers whose in-
vestigations were as important as his own and whose
labors for mankind he hoped to extend by the helpful-
ness of his profession. In order that it might be easy
for them to come to him without feeling abashed by
their poverty, and yet so that they might pay him
anything that they thought they were able to, he
hung up a box in his anteroom in which each patient
might deposit whatever he felt able to give. His
kindliness towards men became the foundation for
many legends. Needless to say he was often im-
posed upon, but that seems to have made no differ-
ence to him, and he went on straightforwardly doing

GEEAT JEWISH PHYSICIANS 71

what he thought he ought to do, regardless of the
devious ways of men, even those whom he was gen-
erously assisting. While we do not know much of
his scientific medicine, we do know that he was a
fine example of a practitioner of medicine on the
highest professional lines.

With the foundation of the school at Djondisabour
in Arabistan or Khusistan by the Persian monarch
Chosroes, some Jewish physicians come into promi-
nence as teachers, and this is one of the first impor-
tant occasions in history when they teach side by
side with Christian colleagues. Djondisabour seems
distant from us now, lying as it does in the province
just above the head of the Persian Gulf, and it is a
little hard to understand its becoming a centre of
culture and education, yet according to well-
grounded historical traditions students flocked here
from all parts of the world, and its medical instruc-
tion particularly became famous. According to the
documents and traditions that we possess, clinical
teaching was the most significant feature of the
school work and made it famous. As a consequence
graduates from here were deemed fully qualified to
become professors in other institutions and were
eagerly sought by various medical schools in the
East.

With the rise of the strong political power of the
Mohammedans enough of peace came to the East at
least to permit the cultivation of arts and sciences
to some extent again, and then at once the eminence
of Jewish physicians, both as teachers and practi-
tioners of medicine, once more becomes manifest.
The first of the race who comes into prominence is

72 OLD-TIME MAKERS OF MEDICINE

Maser Djawah Ebn Djeldjal, of Basra. To him we
owe probably more than to anyone else the preserva-
tion of old scientific writings and the cultivation of
arts and sciences by the Mohammedans. He pre-
vailed on Caliph Moawia I, whose physician he had
become, to cause many foreign works, and especially
those written in Greek, to be translated into Arabic.
He seems to have taken a large share of the labor
of the translation on himself and prevailed upon
his pupil, the son of Moawia, to translate some works
on chemistry. The translation for which Maser
Djawah is best known is that of the Pandects of
Haroun, a physician of Alexandria. The transla-
tion of this work was made toward the end of the
seventh century. Unfortunately the " Pandects "
has not come down to us, either in original or trans-
lation, but we have fragments of the translation
preserved by Rhazes, the distinguished Arabian
medical writer and physician of the ninth century,
and there seems no doubt that it contained the first
good description of smallpox, a chapter in medicine
that is often — though incorrectly — attributed to
Rhazes himself. Rhazes quoted Maser Djawah
freely and evidently trusted his declarations im-
plicitly.

The succeeding Caliphs of the first Arabian dy-
nasty did not exhibit the same interest in education,
and above all in science, that characterized Moawia.
Political ambition and the desire for military glory
seem to have filled up their thoughts and perhaps
they had not the good fortune to fall under the in-
fluence of physicians so wise and learned as Maser
Djawah. More probably, however, they themselves

GREAT JEWISH PHYSICIANS 73

lacked interest. Toward the end of the seventh cen-
tury they were succeeded by the Abbassides. Al-
mansor, the second Caliph of this dynasty, was at-
tacked by a dangerous disease and sent for a
physician of the Nestorian school. After his res-
toration to health he became a liberal patron of
science and especially medical science. The new city
of Bagdad, which had become the capital of the realm
of the Abbassides, was enriched by him with a large
number of works on medicine, which he caused to be
translated from the Greek. He did not confine him-
self to medicine, however, but also brought about
translations of works with regard to other sciences.
One of these, astronomy, was a favorite. He made
it a particular point to search out and encourage the
translation of such books as had not previously been
translated from Greek into Arabic. While he pro-
vided a translation of Ptolemy he also had transla-
tions made of Aristotle and Galen.

It is not surprising, then, that the school of Bag-
dad became celebrated. Jewish physicians seem to
have been most prominent in its foundation, and the
most distinguished product of it is Isaac Ben Emran,
almost as celebrated as a philosopher as he is as a
physician. One of his expressions with regard to
the danger of a patient having two physicians whose
opinions disagree with regard to his illness has been
deservedly preserved for us. Zeid, an Emir of one
of the chief cities of the Arabs in Barbary, fell ill
of a tertian fever and called Isaac and another phy-
sician in consultation. Their opinions were so widely
in disaccord that Isaac refused to prescribe any-
thing, and when the Emir, who had great confidence

74 OLD-TIME MAKERS OF MEDICINE

in him, demanded the reason, he replied, ' * disagree-
ment of two physicians is more deadly than a tertian
fever." This Isaac, who is said to have died in 799,
is the great Jewish physician, one of the most im-
portant members of the profession in the eighth cen-
tury. His principal work was with regard to poisons
and the symptoms caused by them. This is often
quoted by medical writers in the after time.

The prominent Jewish physician of the ninth
century was Joshua Ben Nun. Haroun al-Raschid,
whose attempts to secure justice for his people are
the subject of so much legendary lore, and whose
place in history may be best recalled by the fact that
he is a contemporary of Charlemagne, was particu-
larly interested in medicine. He founded the city of
Tauris as a memorial of the cure of his wife. He
was a generous patron of the school of Djondisabour
and established a medical school also at Bagdad. He
provided good salaries for the professors, insisted on
careful examinations, and raised the standard of
medical education for a time to a noteworthy de-
gree. The greatest teacher of this school at Bagdad
was Joshua Ben Nun, sometimes known as the Rabbi
of Seleucia. His teaching attracted many students
to Bagdad and his fame as one of the great practi-
tioners of medicine of this time brought many pa-
tients. Among his disciples was John Masuee, whose
Arabian name is so different, Yahia Ben Masoviah,
that in order to avoid confusion in reading it is im-
portant to know both. Almost better known, per-
haps, at this time was Abu Joseph Jacob Ben Isaac
Kendi. Fortunately for the after time, these men
devoted themselves not only to their own observa-

GREAT JEWISH PHYSICIANS 75

tions and writings but made a series of valuable
translations. Joshua Ben Nun seems to have been
particularly zealous in this matter, following the
example of Maser Djawah of Basra.

Bagdad then became a centre for Arabian culture.
Mahmoud, one of Haroun's successors, provided in
Bagdad a refuge for the learned men of the East
who were disturbed by the wars and troubles of the
time. He became a liberal patron of literature and
education. When the Emperor Michael III of Con-
stantinople was conquered in battle, one of the obli-
gations imposed upon him was to send many camel
loads of books to Bagdad, and Aristotle and Plato
were studied devotedly and translated into Arabic.
The era of culture affected not only the capital but
all the cities, and everywhere throughout the Ara-
bian empire schools and academies sprang up. "We
have records of them at Basra, Samarcand, Is-
pahan. From here the thirst for education spread to
the other cities ruled by the Mohammedans, and each
town became affected by it. Alexandria, the cities
of the Barbary States, those of Sicily and Provence,
where Moorish influences were prominent, and of
distant Spain, Cordova, Seville, Toledo, Granada,
Saragossa, all took up the rivalry for culture which
made this a glorious period in the history of the
intellectual life.

Already, in the chapter on " Great Physicians in
Early Christian Times," I have pointed out that
many of the teachers of the Arabs were Christian
physicians. Here it is proper to emphasize the other
important factor in Arabian medicine, the Jewish
physicians, who influenced the great Arabian rulers,

76 OLD-TIME MAKERS OF MEDICINE

and were the teachers of the Arabs in medicine and
science generally. These Christian and Jewish phy-
sicians particularly encouraged the translation of
the works of the great Greek physicians and thus
kept the Greek medical tradition from dying out. It
is not until the end of the ninth, or even the begin-
ning of the tenth, century that we begin to have
important contributors to medicine from among the
Arabs themselves. Even at this time they have dis-
tinguished rivals among Jewish physicians. Indeed
these acquired such a reputation that they became
the physicians to monarchs and even high ecclesi-
astics, and we find them nearly everywhere through-
out Europe. Their success was so great that it is
not surprising that after a time the vogue of the
Jewish physicians should have led to jealousy of
them and to the passage of laws and decrees limiting
their sphere of activity.

The great Jewish physician of the ninth century
was Isaac Ben Soliman, better known as Isaac el
Israili, and who is sometimes spoken of as d 'Israeli.
He was a pupil of Isaac Ben Amram the younger,
probably a grandson of another Isaac Ben Amram,
who, after having become famous in Bagdad, went
to Cairo and became the physician of the Emir Zi-
jadeth III. The younger Isaac established a school,
and it was with him that Israeli obtained his intro-
duction to medicine. He practised first as an oculist
and then became body-physician to the Sultan of
Morocco. Because of the sympathy of his character
and his unselfishness he acquired great popularity.
Hyrtl refers to him respectfully as " that scholarly
son of Israel." Curiously enough, considering racial

GREAT JEWISH PHYSICIANS 77.

feeling in the matter, he never married, and when
asked why he had not, and whether he did not think
that he might regret it, he replied, * * I have written
four books through which my memory will be better
preserved than it would be by descendants." The
four books are his " Treatise on Fevers," his
" Treatise on Simple Medicines and Ailments," a
treatise on the i l Elements, ' ' and a treatise * * On the
Urine." Besides these, we have from him shorter
works, " On the Pulse," " On Melancholy," and
" On Dropsy." His hope with regard to his fame
from these works was fulfilled, for they were printed
as late as 1515 at Leyden, and Sprengel declared
them the best compendium of simple remedies and
diet that we have from the Arabian times. One of
his translators into Latin has called him the monarch
of physicians.

Some of his maxims are extremely interesting in
the light of modern notions on the same subjects. He
declared emphatically that " the most important
duty of the physician is to prevent illness. " " Most
patients get better without much help from the phy-
sician by the power of nature. ' ' He emphasized his
distrust of using many medicines at the same time
in the hope that some of them would do good. He
laid it down as a rule: " Employ only one medicine
at a time in all your cases and note its effects care-
fully. ' ' He was as wise with regard to medical ethics
as therapeutics. He advised a young physician,
" Never speak unfavorably of other physicians.
Every one of us has his lucky and unlucky hours."
It is pleasant to learn that the old gentleman lived
to fill out a full hundred years of life, and that in his

78 OLD-TIME MAKERS OF MEDICINE

declining years he was surrounded by the good will
and the affection of many who had learned to know
his precious qualities of heart and mind. More than
of any other class of physicians do we find the large
human sympathies of the Jewish physicians of the
Middle Ages praised by their contemporaries and
succeeding generations.

During the next centuries a number of Jewish phy-
sicians became prominent, though none of them until
Maimonides impressed themselves deeply upon the
medical life of their own and succeeding centuries.
Very frequently they were the physicians to royal
personages. Zedkias, for instance, was the physician
to Louis the Pious and later to his son Charles the
Bald. His reputation as a physician was great
enough to give him the popular estimation of a ma-
gician, but it did not save him from the accusation
of having poisoned Charles when that monarch died
suddenly. There seem to be no good grounds, how-
ever, for the accusation. There were a number of
schools of medicine, in Sicily and the southern part
of Italy, in which Jewish, Arabian, and Christian
physicians taught side by side. One of these teachers
wras Jude Sabatai Ben Abraham, usually known by
the name of Donolo, who was famous both as a writer
on medicine and on astronomy. Donolo studied and
probably taught at Tarentum, and there wrere similar
schools at Palermo, at Bari, and then later on the
mainland at Salerno. The foundation of Salerno,
in which Jewish physicians also took part, we shall
discuss later in the special chapter devoted to that
subject.

One of the great translators whose work meant

GREAT JEWISH PHYSICIANS 79

very much for the medical science of his own and
succeeding generations was the distinguished Jewish
physician, Faradj Ben Salim, sometimes spoken of
as Farachi Faragut or Ferrarius, who was born at
Girgenti in Sicily. He made his medical studies in
Salerno and did his work under the patronage of
Charles of Anjou towards the end of the thirteenth
century. His greatest work is the translation of the
whole of the " Continens " of Rhazes. The trans-
lation is praised as probably the best of its time
made in the Middle Ages. Faradj came at the end
of a great century, when the intellectual life of Eu-
rope had reached a high power of expression, and it
is not surprising that he should have proved equal to
his environment. This translation has also some ad-
ditions made by Faradj himself, notably a glossary
of Arabian names.

In Spain also Jewish physicians rose to distinc-
tion. The most distinguished in the tenth century
was Chasdai Ben Schaprut. Like many other of the
great physicians of this time, he had studied astron-
omy as well as the medical sciences. He became the
physician of the Caliph Abd-er-Eahman III of Cor-
dova. He seems also to have exercised some of
the functions of Prime Minister to the Caliph, and
took advantage of diplomatic relations between his
sovereign and the Byzantine Emperor to obtain some
works of Dioscorides. These he translated into
Arabian with the help of a Greek monk, whom he
seems also to have secured through the diplomatic
relations. Undoubtedly he did much to usher in that
enthusiasm for education and study which charac-
terized the next centuries, the eleventh and twelfth,

80 OLD-TIME MAKERS OF MEDICINE

at Cordova in Spain, when such men as Avenzoar,
Avicenna, and Averroes attracted the attention of
the educational world of the time. Jewish writers
have sometimes claimed one of the most distin-
guished of these, Avenzoar himself, as a Jew, but
Hyrtl and other good authorities consider him of
Arabic extraction and point to the fact that his an-
cestors bore the name of Mohammed. This is not
absolutely conclusive evidence, but because of it I
have preferred to class Avenzoar among the Arabian
physicians.

The one historical fact of importance for us is that
everywhere in Europe at that time Jews were being
accorded opportunities for the study and practice of
medicine. There are local incidents of persecution,
but we are not so far away from the feelings that
brought these about as to misunderstand them or to
think that they were anything more than local, pop-
ular manifestations. The more we know about the
details of the medical history of these times the
deeper is the impression of academic freedom and of
opportunities for liberal education.

Much has been said about the intolerance of ec-
clesiastical authorities toward the Jews, and of
Church decrees that either absolutely forbade their
practice of the medical profession and their devo-
tion to scientific study, or at least made these pur-
suits much more difficult for them than for others.
Of course it has to be conceded, even by those who
most insistently urge the existence of formal legis-
lation in the matter, that in spite of these decrees
and intolerance and opposition, Jews continued to
practise medicine and to be the chosen physicians of

GREAT JEWISH PHYSICIANS 81

kings and even of high ecclesiastical dignitaries, as
well indeed of the Popes themselves. This, it is
usually declared, must be attributed to the surpass-
ing skill of the Jewish physicians, causing men to
overcome their prejudices and override even their
own legal regulations. There is no doubt at all about
the skill of Jewish physicians at many times during
the Middle Ages. There is no doubt also of the sen-
timent of opposition that often developed between
the Christian peoples and the Jews. Any excuse is
good enough to justify men, to themselves at least,
in putting obstacles in the paths of those who are
more successful than they are themselves. Religion
often became a cloak for ill-will and persecution.

The state of affairs that has been presumed how-
ever, according to which laws and decrees were being
constantly issued forbidding the practice of medicine
to Jews by the ecclesiastical authorities, while at
the same time they themselves and those who were
nearest to them were employing Jewish physicians,
is an absurdity that on the face of it calls for investi-
gation of the conditions and from its very appear-
ance would indicate that the ordinary historical
assumption in the matter must be wrong.

I have been at some pains, then, to try to find out
just what were the conditions in Europe with
regard to the practice of medicine by the Jews.
There is no doubt that at Salerno, where the influ-
ence of the Benedictines was very strong and where
the influence of the Popes and the ecclesiastical au-
thorities was always dominant, full liberty of study-
ing and teaching was from the earliest days allowed
to the Jews. Down at Montpellier it seems clear that

82 OLD-TIME MAKERS OF MEDICINE

Jewish physicians had a large part in the foundation
of the medical school, and continued for several cen-
turies to be most important factors in the mainte-
nance of its reputation and the upbuilding of that
fame which draw students from even distant parts
of Europe to this medical school of the south of
France. During the ninth, tenth, eleventh, and
twelfth centuries Jewish physicians were frequently
in attendance on kings and the higher nobility, on
bishops and archbishops, cardinals, and even Popes.
Every now and then the spirit of intolerance among
the populace was aroused, and occasionally the death
of some distinguished patient while in a Jewish phy-
sician's hands was made the occasion for persecu-
tion. We must not forget, after all, that even as late
as Elizabeth's time, when Shakespeare wrote " The
Merchant of Venice," he was taking advantage of
the popular sentiment aroused by the execution of
Lopez, the Queen's physician, for a real or supposed
participation in a plot against her Majesty's life.
Shylock was presented the next season for the sake
of adventitious popularity that would thus accrue
to the piece. The character was played so as to
depict all the worst traits of the Jew, and was scorn-
fully laughed at at every representation. This is
an index of the popular feeling of the time. Bitter
intolerance of the Jew has continued. Down almost
to our own time the Ghettos have existed in Europe,
and popular tumults against them continue to occur.
Quite needless to say, these do not depend on Chris-
tianity, but on defective human nature.

During the Middle Ages the best possible criterion
of the attitude of the Church authorities towards the

GREAT JEWISH PHYSICIANS 83

Jews is to be found in the legislation of Pope Inno-
cent III. He is the greatest of the Popes of the
Middle Ages; he shaped the policy of the Church
more than any other ; his influence was felt for many
generations after his own time. His famous edict
with regard to them was well known : * ' Let no Chris-
tian by violence compel them to come dissenting or
unwilling to Baptism. Further, let no Christian ven-
ture maliciously to harm their persons without a
judgment of the civil power or to carry off their
property or change their good customs which they
have hitherto in that district which they inhabit."
Innocent himself and several of his predecessors and
successors are known to have had Jewish physicians.
Example speaks even louder than precept, and the
example of such men must have been a wonderful
advertisement for the Jewish physicians of the time.
Besides Innocent III, many of the Popes of the
twelfth and thirteenth centuries issued similar decrees
as to the Jews. It may be recalled that this was the
time when the Papacy was most powerful in Europe
and when its decrees had most weight in all coun-
tries. Alexander II, Gregory IX, and Innocent IV
all issued formal documents demanding the protec-
tion of the Jews, and especially insisting that they
must not be forced to receive Baptism nor disturbed
in the celebration of their festivals. Clement VI did
the same thing in the next century, and even offered
them a refuge from persecution throughout the rest
of France at Avignon. Distinguished Jewish schol-
ars, who know the whole story from careful study,
have given due credit to the Popes for all that they
did for their people. They have even declared that

84 OLD-TIME MAKERS OF MEDICINE

if the Jews were not exterminated in many of the
European countries it was because of the protection
afforded by the Church. We have come to realize in
recent years that persecution of the Jews is not at all
a religious matter, but is due to racial prejudice and
jealousy of their success by the peoples among whom
they settle. All sorts of pretexts are given for this
persecution at all times. Formal Church documents
and the personal activities of the responsible Church
officials show that during the Middle Ages the Church
was a protector and not a persecutor of the Jews.

There is abundant historical authority for the
statement that the Popes were uniformly beneficent
in their treatment of the Jews. In order to demon-
strate this there is no need to quote Catholic his-
torians, for non-Catholics have been rather emphatic
in bringing it out. Neander, the German Protestant
historian, for instance, said:

" It was a ruling principle with the Popes after
the example of their great predecessor, Gregory the
Great, to protect the Jews in the rights which had
been conceded to them. When the banished Popes
of the twelfth century returned to Rome, the Jews
went forth in their holiday garments to meet them,
bearing before them the 4 thora,' and Innocent II,
on an occasion of this sort, blessed them."

English non-Catholic historians can be quoted to
the same effect. The Anglican Dean Milman, for in-
stance, said: " Of all European sovereigns, the
Popes, with some exceptions, have pursued the most
humane policy towards the Jews. In Italy, and even
in Rome, they have been more rarely molested than
in the other countries."

GREAT JEWISH PHYSICIANS 85

Hallam has expressed himself to the same effect,
especially as regards the protection afforded to the
Jew by the laws of the Church from the injustice of
those around him. Laws sometimes fail of their
purpose and the persecuting spirit of the populace
is often hard to control, but everything that the cen-
tral authority could do to afford protection was done
and essential justice was enshrined in the Church
laws.

Prominent ecclesiastics would naturally follow the
lines laid down by their Papal superiors. The atti-
tude of those whose lives mark epochs in the history
of Christianity and who had more to do almost with
the shaping of the policy of the Church at many
times than the Popes themselves, can be quoted
readily to this same effect. Neander has called par-
ticular attention to St. Bernard's declarations with
regard to the evils that would follow any tolerance
of such an abuse as the persecution of the Jews.

' ' The most influential men of the Church protested
against such un- Christian fanaticism. When the
Abbot Bernard of Clairvaux was rousing up the
spirit of the nations to embark in the second crusade,
and issued for this purpose, in the year 1146, his let-
ters to the Germans (East Franks), he at the same
time warned them against the influence of those
enthusiasts who strove to inflame the fanaticism of
the people. He declaimed against the false zeal,
without knowledge, which impelled them to murder
the Jews, a people who ought to be allowed to
live in peace in the country."

But it has been said that there are decrees against
Jewish physicians, issued especially in the south of

86 OLD-TIME MAKERS OF MEDICINE

France, by various councils and synods of the
Church. Attention needs to be called at once to the
fact that these are entirely local regulations and
have nothing to do with the attitude of the Church
as a whole, but represent what the ecclesiastical au-
thorities of a particular part of the country deem
necessary for some special reason in order to meet
local conditions. Indeed at the end of the thirteenth
and the early fourteenth century, when these de-
crees were being issued in France, full liberty was
allowed in Italy, and there were no restrictions
either as to medical practice or education founded on
adhesion to Judaism.

What need to be realized in order to understand
the issuance of certain local ecclesiastical regula-
tions forbidding Jews to practise medicine are the
special conditions which developed in France at this
time. Many Jews had emigrated from Spain to
France, and the reputation acquired by Jewish phy-
sicians at Montpellier led to a number of the race
taking up the practice of medicine without any fur-
ther qualification than the fact that they were Jews.
That gave them a reputation for curative powers of
itself because of the fame of some Jewish doctors
and their employment by the nobility and the highest
ecclesiastics. It was hard to regulate these wander-
ing physicians. As a consequence of this, the fac-
ulty at Paris, always jealous of its own rights and
those of its students, at the beginning of the four-
teenth century absolutely forbade Jews from prac-
tising on Christian patients within its jurisdiction.
Of course the faculty of the University of Paris was
dominated by ecclesiastical authorities. The medical

GEEAT JEWISH PHYSICIANS 87

school was, however, almost entirely independent of
ecclesiastical influence, and was besides largely re-
sponsible for this decree. It was felt that something
had to be done to stop the evil that had arisen and
the charlatanry and quackery which was being prac-
tised. This was, however, rather an attempt to
regulate the practice of medicine and keep it in the
hands of medical school graduates than an example
of intolerance towards the Jews. Practically no
Jews had graduated at its university, Montpellier
being their favorite school, and Paris was not a little
jealous of its rights to provide for physicians from
the northern part of France. We have not got
away from manifestations of that spirit even
yet, as our non-reciprocating state medical laws
show.

During the next quarter of a century decrees not
unlike those of the University of Paris were issued
in the south of France, especially in Provence and
Avignon. Anyone who knows the conditions which
existed in the south of France at this time with re-
gard to medical practice will be aware that a number
of attempts were made by the ecclesiastical authori-
ties just at this time to regulate the practice of medi-
cine. Great abuses had crept in. Almost anyone
who wished could set up as a physician, and those
who were least fitted were often best able to secure
a large number of patients by their cleverness, their
knowledge of men, and their smooth tongues. The
bishops of various dioceses met, and issued decrees
forbidding anyone from practising medicine unless
he was a graduate of the medical school of the neigh-
boring University of Montpellier. After a time it was

88 OLD-TIME MAKERS OF MEDICINE

found that the greatest number of violators of these
decrees were Jews. Accordingly special regulations
were made against them. They happen to be ec-
clesiastical regulations, because no other authority at
that time claimed the right to regulate medical edu-
cation and the practice of medicine.

What is sure is that many Jewish physicians
reached distinction under Christian as well as Ara-
bian rulers at all times during the Middle Ages. It
would be quite impossible in the limited space at
command here to give any adequate mention of what
was accomplished by these Jewish physicians, whose
names we have scarcely been able to more than cata-
logue, nor of the place they hold in their times. As
the physicians of rulers, their influence for culture
and the cultivation of science was extensive, and as
a rule they stood for what was best and highest in
education. The story of one of them, who is gen-
erally known in the Christian world at least, Mai-
monides, given in some detail, may serve as a type
of these Jewish physicians of the Middle Ages. He
lived just before the flourishing period of university
life in the thirteenth century brought about that
wonderful development of medicine and surgery in
the west of Europe that meant so much for the final
centuries of the Middle Ages. His works influenced
not a little the great thinkers and teachers whose
own writings were to be the foundations of education
for several centuries after their time. Maimonides
was well known in the Western universities.
Though his life had been mainly spent in the East,
and he died there, there was scarcely a distinguished
scholar of Europe who was not acquainted directly

GEEAT JEWISH PHYSICIANS 89

or indirectly with his works, and the greater the
reputation of the scholar, as a rule, the more he
knew of Maimonides, Moses .ZEgyptaeus, as he was
called, and the more frequently he referred to his
writings.

IV

MAIMONIDES

The life of one of the great Jewish physicians,
who has come to be known in history as Maimonides,
is of such significance in medical biography that
he deserves to have a separate sketch. Born in
Spain, his life was lived in the East, where his con-
nection as royal physician with the great Sultan
Saladin of Crusades fame made his influence
widely felt. He is a type of the broadly educated
man, conversant with the culture of his time and of
the past, knowing much besides medicine, who has
so often impressed himself deeply on medical prac-
tice. While the narrow specialists in each genera-
tion, the men who are quite sure that they are cur-
ing the special ills of men to which they devote
themselves, have always felt that whatever of
progress there was in any given time was due to
them, they occupy but little space as a rule in the
history of medicine. The men who loom large were
the broad-minded, humanely sympathetic, deeply
educated physicians, who treated men and their ills
rather than their ills without due consideration of
the individual, and who not only relieved the dis-
comfort of their patients and greatly lessened
human suffering, and added to the sum of human
happiness in their time, but also left precious deeply
significant lessons for succeeding generations of

90

MA1MONIDES 91

their profession. Hippocrates, Galen, Sydenham,
Auenbrugger, Morgagni, these are representatives
of this great class, and Maimonides must be con-
sidered one of them.

Moses Ben Maimum, whose Arabic name was Abu
Amran Musa Ben Maimum Obaid Alia el-Cordovi,
who was called by his Jewish compatriots Ramban
or Rambam, was born at Cordova in Spain, on the
30th of March in 1135 or 1139, the year is in doubt.
It might not seem of much import now after nearly
eight centuries, but not a little ink is spilt over it
yet by devoted biographers.

We are rather prone to think in our time that the
conditions in which men were born and reared before
what we are pleased to call modern times, and, above
all, in the Middle Ages, must have made a distinct
handicap for their intellectual development. Most
of us are quite sure that the conditions in medieval
cities were eminently unsuited for the stimulation of
the intellect, for incentive to art impulse, for up-
lift in the intellectual life, or for any such broad
interest in what has been so well called the human-
ities— the humanizing things that lift us above ani-
mal necessities — as would make for genuinely lib-
eral education. We are likely to be set 'in the
opinion that the environment of the growing youth
of an old-time city, especially so early as the middle
of the twelfth century, was poor and sordid. The
cares of the citizens are presumed to have been
mainly for material concerns, and, indeed, mostly
for the wants of the body. They were only making
a start on the way from barbarism to something like
our glorious culmination of civilization. As " the

92 OLD-TIME MAKERS OF MEDICINE

heirs to all the ages in the foremost files of time "
we are necessarily far in advance of them, and we
are only sorry that they did not have the oppor-
tunity to live to see our day and enjoy the benefits
of the evolution of humanity that is taking place
during the eight centuries that have elapsed.

As a matter of fact, there was much more of abid-
ing profound interest in real civilization in many a
medieval city, much more general appreciation of
art, much more breadth of intelligence and sym-
pathy with what we call the humanities, than in most
of our large cities. The large city, as we know it, is
eminently a discourager of breadth of intelligence.
Specialism in the various phases of money-making
obscures culture. Maimonides, born in Cordova,
was brought up amid surroundings that teemed with
incentives of every kind to the development of in-
telligence, of artistic taste, and everything that
makes for cultivation of intellect rather than of in-
terest in merely material things.

It is well said that it is hard to judge the Cor-
dova of old by its tawdry ruins of to-day. The edu-
cated visitor still stands in awe and admiration
of the great mosque which expressed the high cul-
tivation of the Moors of this time. It is a never-
ending source of wonder to Americans. The city
itself has many reminders of that fine era of Moorish
culture and refinement of taste and of art ex-
pression, which made it in the best sense of the
word a city beautiful. The Arab invaders had
found a great prosperous country which had been
the most cultured province of the Roman Empire,
and on this foundation they made a marvellous de-

MAIMONIDES 93

velopment. " The banks of the Guadalquivir,"
says Mr. S. Lane-Poole in " The Moors in Spain r
(London, 1887), " were bright with marble houses,
mosques, and gardens, in which the rarest flowers
and trees of other countries were carefully culti-
vated, and the Arabs introduced their system of ir-
rigation which the Spaniards both before and since
have never equalled." The greatest beauty of the
city, of course, had come, and some of it had gone,
before Maimonides ' time. So much remains in spite
of time and war, and many unfortunate influences,
that we can have some idea how beautiful it must
have been in his youth seven centuries ago, and
how even more beautiful in the foretime. Of the
great mosque writers of travel can scarcely say
enough. Mr. Lane-Poole says: " Travellers stand
amazed among the forest of columns which open out
apparently endless vistas on all sides. The por-
phyry, jasper, and marbles are still in their places ;
the splendid glass mosaics, which artists from By-
zantium came to make, still sparkle like jewels in
the walls ; the daring architecture of the sanctuary,
with its fantastic crossed arches, is still as imposing
as ever; the courtyard is still leafy with the orange
trees that prolong the vistas of columns. As one
stands before the loveliness of the great mosque, the
thought goes back to the days of the glories of Cor-
dova, the palmy days of the Great Khalif, which
will never return."

Of all the countries in which the Jews all down
the centuries have lived there is probably none of
which they have been more loud in praise than
Spain. Their poets sang of it as if it were their

94 OLD-TIME MAKERS OF MEDICINE

own country; for centuries the people were happier
here than probably they have been anywhere else
for so long a period. Elsewhere in this book I have
called attention to all that Spain meant in Europe
during all the centuries from the beginning of the
Roman Empire down to the end of the Middle Ages.
Maimonides was fortunate in his birthplace, then,
and while circumstances compelled the family to
move away, this change did not come until a good
effect had been produced on the mind of the grow-
ing youth. Even when persecution came, Maimon-
ides clung to Spain with a tenacity born of deep
affection and emphasized by admiration for all
that she was and had been. Cordova was the jewel
of the Spain of this time, and though much less
than she had been in the long preceding time, when
she was the birthplace of Lucan and the two Senecas,
or even than what she had been in Abd-er-Rahman 's
days, or when she was the birthplace of Averroes,
still she remained wonderfully beautiful and at-
tractive, winning and holding the affections of men.
Maimonides' father, Maimum Ben Joseph, was a
member of the Rabbinical College of Cordova, and
famous for his knowledge of the Talmud. There
are some writings of his on mathematics and
astronomy extant. He directed the education of his
son, who, like many another distinguished scholar
in later life, seems to have exhibited very little
talent in his early years. There is no rule in the
matter. Precocity often disappoints. Genius is
often dull in childhood, but there are exceptions that
prove both rules. The basis of education in Spain
at that time among the Jews was the Bible, the

MAIMONIDES 95

Talmud, mathematics, and astronomy, a good
rounded education in literature, the basis of law,
and some exact physical science. After his prelim-
inary education at home Maimonides studied the
natural sciences and medicine with Moorish teach-
ers. Nature-study, in spite of frequent expressions
that declare it new in modern times, is as old as
man. He also received a grounding in philosophy
as a preparation for his scientific studies. At the
age of twenty- three he began the composition of a
commentary on the Talmud, which he continued to
work at on his journeys in Spain and in Egypt.
This is considered to be one of the most important
of this class of works extant, though, almost need-
less to say, similar writings are very numerous.

In the light of wanderings in philosophy during
the centuries since, it is rather interesting to quote
from that work the end of man as this Jewish
philosopher of the middle of the twelfth century
saw it. Recent teleological tendencies in biology
add to the interest of his views. According to
Maimonides, * ' Man is the end of the whole creation,
and we have only to look to him for the reason for
its existence. Every object shows the end for
which it was created. The palm-trees are there to
provide dates ; the spider to spin her webs. All the
properties of an animal or a plant are directed so
as to enable it to reach its purpose in life. What is
the purpose of man? It cannot lie alone in eating
and drinking or yielding to passion, nor in the
building of cities and the ruling of others, since
these objects lie outside of him, and do not touch his
essential being. Such material striving he has in

96 OLD-TIME MAKERS OF MEDICINE

common with the animal. A man is lifted from a
lower to a higher condition by his reason. Only
through his reason is he placed above the animals.
He is the only reasonable animal. His reason en-
ables him to understand all things, especially the
Unity of God, and all knowledge and science serve
only to direct man to the knowledge of God. Pas-
sions are to be subdued, since the man who yields
to passion subjects his spirit to his body, and does
not reveal in himself the divine power which in him
lies in his reason, but is swallowed up in the ocean
of matter."

Not long after Maimonides passed his twentieth
year the family, consisting of the father and his
two sons, Moses and David, and a daughter, moved
from Cordova to Fez, compelled by Jewish persecu-
tions. Here it is said that they had to submit to
wearing the mask of Islam in order to lead a peace-
ful existence. This has been doubted, however, and
his whole life is in flagrant contradiction with any
such even apparent apostasy from the faith of his
fathers. Father and son took advantage of the
opportunity of intercourse with Moorish physicians
and philosophers to increase their store of knowl-
edge, but could not be content in the political and
religious conditions in which they were compelled
to live. About 1155, then, they went to Jerusalem,
but found conditions even more intolerable there,
and turned back to Egypt, where they settled down
in Old Cairo. In 1166 the father died, and after
this we learn that the sons made a livelihood, and
even laid the foundation of a fortune, by carrying
on a jewelry trade. Moses still devoted most of his

MAIMONIDES 97

time to study, while his brother did most of the
business, but the brother was lost in the Indian
Ocean, and with him went not only a large sum of
his own money, but also much that had been en-
trusted to him by others. Maimonides undertook
to pay off these debts and at the same time had to
meet the necessities not only of himself and sister,
but also of the family of his dead brother. It was
then that he took up the practice of medicine and
succeeded in making a great name and reputation
for himself. He continued to write, however, and
completed his commentary on the Talmud.

About the age of fifty Maimonides, as seems to be
true of a good many men who live to old age, be-
came rather discouraged and despondent about him-
self. He refers to himself in his letters and
writings rather frequently as an old and ailing man.
He had nearly twenty years of active life ahead of
him, but he had the persuasion that comes to many
that he was probably destined to an early death.
His son was born shortly after this time, and that
seems to have had not a little to do with brightening
his life. While in Egypt Maimonides married the
sister of one of the royal secretaries, who, in turn,
wedded Maimonides' sister. Maimonides took on
himself the education of his son, who also became
a physician, though his father was not to have the
satisfaction of watching his success in the practice
of his chosen profession. This son, Abraham, be-
came the physician of Malie Alkamen, the brother
of Saladin, and, besides, was a physician to the hos-
pital at Cairo. His son, David, the grandson of
Maimonides, practised medicine also at Cairo till

98 OLD-TIME MAKERS OF MEDICINE

1300. He in turn left two sons, Abraham and Solo-
mon, who achieved reputation in the chosen pro-
fession of their great-grandfather.

Maimonides, after the birth of his son, became
one of the busiest of practising physicians. Indeed,
it is hard to understand how he had the time to do
any writing in his busy life. Still less can we un-
derstand his time for teaching. He was the physi-
cian to Saladin, whose relations with Richard Coeur
de Lion have made him known to English-speaking
people. Every morning, as the Court physician,
Maimonides went to the palace, situated half a mile
away from his dwelling, and if any of the many of-
ficials and dependents that then, as now, were at
Oriental courts, were ill, he stayed there for some
time. As a rule he could only get back to his own
home in the afternoon, and then he was, as he says
himself, " almost dying with hunger." Knowing
the scantiness of the Oriental breakfast, we are not
surprised. There he found his waiting-room full
of patients, " Jews and Mohammedans, prominent
and unimportant, friends and enemies, " he says
himself, " a varied crowd, who are looking for my
medical advice. There is scarcely time for me to
get down from my carriage and wash myself and
eat a little, and then until night I am constantly
occupied, so that, from sheer exhaustion, I must lie
down. Only on the Sabbath day have I the time to
occupy myself with my own people and my studies,
and so the day is away from me." What a picture
it is of the busy medical teacher at all times in the
world's history, yet it must not be forgotten that
it is from these busy men that we have derived our

MAIMONIDES 99

most precious lessons in caring for patients rather
than disease, in the art of medicine rather than med-
ical science — and their practical lessons have been
valuable long after the fine-spun theories of the
scientist that took so long to elaborate have been
placed definitely in the lumber room.

His reputation as a writer on medical topics is
not as great as that which has been accorded him
for his writings on philosophy and in Talmudic
literature, but he well deserves a place among the
great practical masters of medicine, as well as high
rank among the physicians of his time. There is
little that is original in his writing, but his thorough-
going common sense, his wide knowledge, and his
discriminating, eclectic faculty make his writings
of special value. As might have been expected, the
Aphorisms of Hippocrates attracted his attention,
and, besides, he wrote a series of aphorisms of his
own. The most interesting of his writings, how-
ever, is a series of letters on dietetics written for
the son of his patron Saladin. The young prince
seems to have suffered from one of the neurotic con-
ditions that so often develop in those who have their
lives all planned for them, and little incentive to do
things for themselves. The main portion of his
complaints centred, as in the case of many another
individual of leisure, in disturbances of digestion.
Besides, he suffered from constipation and feelings
of depression. Doubtless, like many a young per-
son of the modern time, he was quite sure that these
symptoms portended some insidious organic ail-
ment that would surely bring an early death. When
fathers, having done all that there is to do, just ex-

100 OLD-TIME MAKERS OF MEDICINE

pect their sons to enjoy the fruits of the paternal
accomplishments, conditions of this kind very often
develop, unless the young man proceeds to occupy
himself with even more dangerous distractions than
he finds in unending thought about his own feelings.
The rules of life and health that Maimonides laid
down in these letters have become part of our pop-
ular medical tradition. Probably more of the
ordinarily current maxims as to health have been
derived from them than would possibly be suspected
by anyone not familiar with them. In various
forms his rules have been published a number of
times. A good idea of them can be obtained from
the following compendium of them, which I ab-
breviate from a biographical sketch of Maimonides
by Dr. Oppler, which appeared in the " Deutsches
Archiv fiir Geschichte der Medizin und Medicinische
Geographic " (Bd. 2, Leipzig, 1879).

1. Man is bound to lead a life pleasing to God if
he wants to have a healthy body, and he must hold
himself far from everything that can hurt his health
and accustom himself to whatever renews his
strength. He should eat and drink only when hungry
and thirsty and should be particularly careful of the
regular evacuation of his bowels and of his bladder.
He must not delay either of these operations, but as
far as possible satisfy the inclination at once.

2. A man must not overload his stomach but
be content always with something less than is neces-
sary to make him feel quite satisfied. He should not
drink much during the meal and only of water and
wine mixed, taking somewhat more after digestion
has begun and after digestion is completed, in mod-
eration according to his needs. Before a man sits
down to table he should note whether he has any

MAIMONIDES 101

tendency to evacuation and should make the body
warm by movement and activity. After this exercise
he should rest a little before taking food. It is very
beneficial after work to take a bath and then the
meal.

3. Food should be taken always in the sitting
position. There should be no riding nor walking, nor
movements of the body until digestion is finished.
The man who takes a walk or any strenuous occu-
pation immediately after eating subjects himself to
serious dangers of disease.

4. Day and night should be divided into twenty-
four hours. Men should sleep for eight hours, and
so arrange their sleep that the end of it comes with
the dawn, so that from the beginning of sleep until
sunrise there should be an eight-hour interval. We
should all leave our beds about the time that the sun
rises.

5. During sleep a man should lie neither on his
face nor on his back but on his side, the beginning
of the night on his left and at the end on his right.
He should not go to sleep for three or four hours
after eating and should not sleep during the day.

6. Fruits that are laxative, as grapes, figs,
melons, gourds, should be taken only before meal
time and not mixed with other food. It would be
better to let these get into the abdominal organs
and then take other food.

7. Eat what is easily digestible before what is
difficult of digestion. The flesL of birds before beef
and the flesh of calves before that of cows and steers.
(Birds were then thought more digestible than other
flesh; we have reversed the ruling. The note shows
how light and digestible their flesh was considered
and the reason therefor.)

8. In summer eat cooling food, acids, and no
spices. In winter, on the contrary, eat warming
foods, rich in spices, mustard, and other heating sub-

102 OLD-TIME MAKERS OF MEDICINE

stances. In cold and warm climates one should eat
according to the climatic conditions.

9. There are certain harmful foods that should
be avoided. Large salt fish, old cheese, old pickled
meat, young new wine, evil-smelling and bitter foods
are often poisonous. There are also some which are
less harmful, but are not to be recommended as ordi-
nary nutritive materials. Large fish, cheese, milk
more than twenty-four hours after milking, the flesh
of old oxen, beans, peas, unleavened bread, sauer-
kraut, onions, radishes and the like. These are to be
taken only in small quantities and only in the winter
time and they should be avoided in the summer.
Beans and lentils are to be recommended neither in
winter nor summer.

10. As a rule one should avoid the eating of tree
fruits, or not eat much of them, especially when
they are dry and even less when they are green. If
they are unripe they may cause serious damage. Jo-
hannesbrod is very harmful at all times, as are also
all the sour fruits, and only small amounts of them
should be eaten in summer or in warm countries.

11. The fruits that are to be recommended dry
as well as fresh, are figs, grapes, and almonds.
These may be eaten as one has the appetite for them,
but one should not accustom himself to eat them
much, though they are healthier than all other fruits.

12. Honey and wine are not good for children,
though they are beneficial for older people, especially
in winter. In summer one-third less of them should
be eaten than in winter.

13. Special care should be taken to have regular
movements of the bowels that carry off the impuri-
ties of the body. It is an axiom in medicine, that
so long as evacuations are absent, or difficult, or re-
quire strong efforts, the individual is liable to seri-
ous disease. Every medical means should be taken
to overcome constipation in order to escape its dan-

MAIMONIDES 103

gers. For this purpose young people should be
given salty food, materials that have been soaked in
olive oil, salt itself, or certain vegetable soups with
olive oil and salt. Older people should take honey
mixed with warm water early in the morning and
four hours later should take their breakfast. This
proceeding should be followed up from one to four
days until the constipation is overcome.

14. Another axiom of medicine is that so long as
a man is able to be active and vigorous, does not
eat until he is over-full, and does not suffer from
constipation, he is not liable to disease. Even such
men, however, are much safer if they do not take
food .that may disagree with them.

15. Whoever gives himself up to inactivity, or
puts off evacuations of the bowels, or suffers from
constipation, will be sure to suffer from many dis-
eases and will see his strength disappear even should
he eat the best food in the world and make use of all
the remedies that physicians have. Immoderate eat-
ing is a poison for men and the cause of many dis-
eases which attack them. Most diseases come from
either eating too much or partaking of unsuitable
food. That was what Solomon meant with his
proverb : ' ' He who puts a guard over his mouth and
his tongue protects himself from many evils," that
is to say, whoever protects his mouth from the over-
indulgence in food and his tongue from unsuitable
speech protects himself from many evils.

16. Every week at least a man should take a
warm bath. One should not bathe when hungry, nor
after eating until the fo'od is digested, and bathe the
whole body in warm but not too hot water and the
head in hot water. Afterwards the body should be
washed in lukewarm and cool water until finally cold
water is used. One should pour neither cold nor
even lukewarm water on the head, nor bathe in cold
water in the winter time, nor when the body is

104 OLD-TIME MAKERS OF MEDICINE

tired and in perspiration. At such times the bath
should be put off for a while.

17. As soon as one leaves the bath one should
cover oneself, and especially cover the head, so that
no draught may strike it. Even in summer, care
must be taken to observe this rule. After this one
should rest for a while until the heat of the body
passes off and then should go to table. If one could
sleep a little just before a meal it is often very bene-
ficial. Neither during the bath nor immediately after
it should cold water be drunk, and if there is an
inappeasable thirst a little wine and water or water
and honey should be taken. In winter it is beneficial
to rub the body with oil after the bath.

18. Venesection should not be practised fre-
quently, for it is only meant for serious illness. It
should not be permitted in winter or summer, nor
during the months of April or September (the " r >:
months). After passing his fiftieth year an indi-
vidual should abstain from venesection. Venesec-
tion should not be practised on the day when one
takes a bath or goes on a journey or returns from it.
On the day when it is practised less than usual
should be eaten and drunk, and the patient should
give himself to rest, undertake no work nor bother-
some occupation, and take no walk.

19. Whoever observes these rules of life faith-
fully I guarantee him a long life without disease.
He shall reach a good old age, and when he comes
to die will not need a physician. His body will re-
main always strong and healthy, unless of course
he has been born with a weafc nature, or has had an
unfortunate bringing up, or should be attacked by
epidemic disease or by famine.

20. Only the healthy should keep these rules.
Whoever is ill or a sufferer from any injuries, or
has lost his health through bad habits, for him there
are special rules for each disease, only to be found

MAIHONIDES 105

in the medical books. Let it be remembered that
every change in a life habit is the beginning of an
ailment.

21. If no physician can be secured, then ailing
people may use these rules as well as the healthy.

These rules are, of course, full of the common
sense of medicine that endures at all times. For
the tropical climate of the Eastern countries they
probably represent as good advice as could be given
even at the present time. With them before us it is
not surprising to find that on other subjects Mai-
monides was just as sensible. Perhaps in nothing is
this more striking than in his complete rejection of
astrology. Considering how long astrology, in the
sense of the doctrine of the stars influencing human
health and destinies, had dominated men's minds,
and how universal was the acceptance of it, Mai-
monides ' strong expressions show how much genius
lifts itself above the popular persuasions of its
time, even among the educated, and how much it
anticipates subsequent knowledge.

It is well to remind ourselves that as late as the
middle of the eighteenth century Mesmer's thesis
on ' ' The Influence of the Stars on Human Constitu-
tions ' ' was accepted by the faculty of the University
of Vienna as a satisfactory evidence not only of his
knowledge of medicine, but of his power to reason
about it. At the end of the twelfth century Maimon-
ides was trying to argue it out of existence on the
best possible grounds. " Know, my masters," he
writes, " that no man should believe anything that
is not attested by one of these three sanctions : — ra-
tional proof as in mathematical science, the percep-

106 OLD-TIME MAKERS OF MEDICINE

tion of the senses, or traditions from the prophets
and learned men." His biographer in the mono-
graph " Maimonides," published by the Jewish
Publication Society of America,1 expresses his
further views on the subject in compendious form,
and then gives his final conclusion as follows :

" * Works on astrology are the product of fools,
who mistook vanity for wisdom. Men are inclined
to believe whatever is written in a book, especially
if the book be ancient; and in olden times disaster
befell Israel because men devoted themselves to such
idolatry instead of practising the arts of martial de-
fence and government.' He says, that he had him-
self studied every extant astrological treatise, and
had convinced himself that none deserved to be called
scientific. Maimonides then proceeds to distinguish
between astrology and astronomy, in the latter of
which lies true and necessary wisdom. He ridicules
the supposition that the fate of man could be de-
pendent on the constellations, and urges that such
a theory robs life of purpose, and makes man a
slave of destiny. ' It is true,' he concludes, ' that
you may find strange utterances in the Rabbinical
literature which imply a belief in the potency of the
stars at a man's nativity, but no one is justified in
surrendering his own rational opinions because this
or that sage erred, or because an allegorical remark
is expressed literally. A man must never cast his
own judgment behind him ; the eyes are set in front,
not in the back.'

While Maimonides could be so positive in his
opinions with regard to a subject on which he felt
competent to say something, he was extremely mod-

1 " Maimonides," by David Yellin and Israel Abrahams, Philadelphia,
1903.

MAIMONIDES 107

est with regard to many of the great problems of
medicine. He often uses the expression in his
writings, " I do not see how to explain this matter."
He quotes with approval from a Rabbi of old who
had counselled his students, " teach thy tongue to
say, I do not know. ' ' In this, of course, he has given
the best possible evidence of his largeness of mind
and his capacity for making advance in knowledge.
It is when men are ready to say, " I do not know,"
that progress becomes possible. It is very easy to
rest in a conscious or unconscious pretence of knowl-
edge that obscures the real question at issue. A great
thinker, who lived in the century in which Maiinon-
ides died, Eoger Bacon, set down as one of the
four principal obstacles to advance in knowledge
indeed, as the one of the four that hampered intel-
lectual progress the most, the fact that men feared
to say, " I do not know. ' '

One of the most interesting features of Maimon-
ides' career for the modern time is the influence that
his writings exerted over the rising intellectual life
of Europe within a half century after his death.
Most people would be rather inclined to think that
this Jewish author of the East would have very
little influence over the thinkers and teachers of
Europe within a generation after his death. He
died in 1204, just at the beginning of one of the
great productive centuries of humanity, perhaps
one of the greatest of them all. In literature, in
art, in architecture, in philosophy, and in educa-
tion, this century made wonderful strides. Two of
its greatest teachers, Albertus Magnus and his
pupil, Thomas Aquinas, quote from Moses JEgyp-

108 OLD-TIME MAKERS OF MEDICINE

taeus, the European name for Maimonides at that
time, and evidently knew his writings very well.
Maimonides was for them an important connecting
link with the world of old Greek thought. Others
of the writers and teachers of this time, as William
of Auvergne, and the two great Franciscans, Alex-
ander of Hales and Duns Scotus, were also in-
fluenced by Maimonides. In a word, the educa-
tional world of that time was much more closely
united than we might think, and it did not take
long for a great writer's thoughts to make them-
selves felt several thousand miles away. Maimon-
ides was, then, in his own time one of the world
teachers, and, in a certain sense, he must always re-
main that, as representing a special development of
what is best in human nature.

V

GREAT ARABIAN PHYSICIANS

In order to understand the place of the Arabs in
medicine and in science, a few words as to the rise
of this people to political power, and then to the cul-
tivation of literature and of science, are necessary.
We hear of the Arabs as hireling soldiers fighting
for others during the centuries just after Christ,
and especially in connection with the story of the
famous Queen Zenobia at Palmyra. After the de-
struction of this city we hear nothing more of them
until the time of Mohammed. During these six and
a half centuries there is little question of education
of any kind among them except that at the end of
the sixth century, the Persian King Chosroes I,
who was much interested in medicine, encouraged
the medical school in Djondisabour, in Arabistan,
founded at the end of the fifth century by the Nes-
torian Christians, who continued as the teachers
there until it became one of the most important
schools of the East. It was here that the first Arab
physicians were trained, and here that the Chris-
tian physicians who practised medicine among the
Arabs were educated.

Among the Arabs themselves, before the time of
Mohammed, there had been very little interest in
medicine. Grurlt notes that even the physician of
the Prophet himself was, according to tradition, a

109

110 OLD-TIME MAKERS OF MEDICINE

Christian. Mohammed's immediate successors were
not interested in education, and their people mainly
turned to Christian and Jewish physicians for
whatever medical treatment they needed. When
the Caliphs came to be rulers of the Mohammedan
Empire, they took special pains to encourage the
study of philosophy and medicine; though dissec-
tion was forbidden by the Koran, most of the other
medical sciences, and especially botany and all the
therapeutic arts, were seriously cultivated.

Until the coming of Mohammed, the Arabs had
been wandering tribes, getting some fame as hireling
soldiers, but now, under the influence of a feeling
of community in religion, and led by the military
genius of some of Mohammed's successors, whose
soldiers were inspired by the religious feelings of
the sect, they made great conquests. The Moham-
medan Empire extended from India to Spain within
a century after Mohammed's death. Carthage was
taken and destroyed, Constantinople was threat-
ened. In 661, scarcely forty years after the hegira
or flight of Mohammed, from which good Moham-
medans date their era, the capital was transferred
from Medina to Damascus, to be transferred from
here to Bagdad just about a century later, where it
remained until the Mongols made an end of the
Abbasside rulers about the middle of the thirteenth
century. At the beginning the followers of Mo-
hammed were opposed to knowledge and education
of all kinds. Mohammed himself had but little.
According to tradition, he could not read or write.
The story told with regard to the Caliph Omar and
the great library of Alexandria, seems to have a

GREAT ARABIAN PHYSICIANS HI

foundation in reality, though such legends usually
are not to be taken literally. Certainly it represents
the traditional view as to the attitude of the earlier
Moslem rulers to education. Omar was asked what
should be done with the more than two million vol-
umes. He said that the books in it either agreed
with the Koran, or they did not. If they agreed
with it they were quite useless. If they did not,
they were pernicious. In either case, they should
be done away with, because there was an element of
danger in them. Accordingly, the precious volumes
that had been accumulating for nearly ten centuries,
served, it is said, to heat the baths of Alexandria
for some six months — probably the most precious
fuel ever, used. Fortunately for posterity, the edict
was not quite as universal in its application as the
story would indicate, and exceptions were made for
books of science.

In the course of their conquests, however, the
Mohammedan Arabs captured the Greek cities of
Asia Minor. They were brought closely in contact
with Greek culture, Greek literature, and Greek
thought. As has always been the case, captive
Greece took its captors captive. What happened
to the Romans earlier came to pass also among the
Arabs. Inspired by Greek philosophy, science, and
literature, they became ardent devotees of science
and the arts. While not inventing or discovering
anything new, like the Romans they carried on the
old. Damascus, Basra, Bagdad, Bokhara, Samar-
cand all became centres of culture and of educa-
tion. Large sums were paid for Greek manu-
scripts, and for translations from them. Under the

112 OLD-TIME MAKERS OF MEDICINE

famous Harun al-Raschid, at the end of the eighth
century, whose name is better known to us than that
of any others, because of the stories of his wander-
ing by night among his people in order to see if
justice were done, three hundred scholars were sent
at the cost of the Caliph to the various parts of the
world in order to bring back treasures of science,
and especially of geography and medicine. It is an
interesting historical reflection that the Japanese
and Chinese are doing the same thing now.

The Arabs were very much taken by the philoso-
phy of Aristotle, and it became the foundation of all
their education. Greek thought, as always, inspired
its students to higher things. Soon everywhere in
the dominions of the Caliphs, philosophy, science,
art, literature, and education flourished. Medicine
was taken up with the other sciences and cultivated
assiduously. Freind, in his " Historia Medicinae,"
says that the writings of the old Greeks which
treated of medicine were saved from destruction
with the other books at Alexandria, for the desire
of health did not have less strength among the Arabs
than among other nations. Since these books
taught them how to preserve health, and were not
otherwise contrary to the laws of the Prophet, that
served to bring about their preservation. Freind
also calls attention to the fact that grammars and
books which treated of the science of language were
likewise saved from destruction. Besides the
library, the Arabs, after their conquest of Alex-
andria in the eighth century, came under the in-
fluence of the university still in existence there.

In the West, in Spain, the Arabs enjoyed the

GEEAT ARABIAN PHYSICIANS 113

same advantages as regards contact with culture
and education as their conquest of the Eastern
cities and Alexandria brought them in the East.
While it is not generally realized, Spain was, as we
have pointed out, the province of the Roman Em-
pire in the West that advanced most in culture be-
fore the breaking up of the Empire. The Silver
Age of Latin literature owes all of its geniuses to
Spain. Lucan, the Senecas, Martial, Quintilian,
are all Spaniards. Spain itself was a most flourish-
ing province, and under the Spanish Caesars, from
the end of the first to about the end of the second
century, increased rapidly in population. Spain
was the leader in these prosperous times, and the
tradition of culture maintained itself. When
Spain became Christian the first great Christian
poet, Prudentius, born about the middle of the
fourth century, came from there. He has been
called the Horace and Virgil of the Christians.

The coming down of the barbarians from the
North disturbed Spain's prosperity and the peace
and culture of her inhabitants, but it should not be
forgotten that the first medieval popularization of
science, a sort of encyclopedia of knowledge, the
first of its kind after that of Pliny in the classical
period, came from St. Isidore of Seville, a Spanish
bishop.

There has been considerable tendency to insist
that Spanish culture and intellectuality owe nearly
all to the presence of the Moors in Spain. This can
only be urged, however, by those who know nothing
at all of the Spanish Caesars, the place of Spain in
the history of the Roman Empire, and the continu-

114 OLD-TIME MAKERS OF MEDICINE

ance of the culture that then reached a climax of
expression during succeeding centuries. On the
contrary, the Moors who came to Spain owe most
of their tendency to devote themselves to culture
and education to the state of affairs existent in
Spain when they came. There is no doubt that
they raised standards of education and of culture
above the level to which they had sunk under the
weight of the invading barbarians from the North,
and Spain owes much to the wise ruling and devo-
tion to the intellectual life of her Moorish invaders.
All the factors, however, must be taken together in
order to appreciate properly the conditions which
developed under the Arabs in both the East and the
West. The Arabs invented little that was new in
science or philosophy; they merely carried on older
traditions. It is for that that the modern time
owes them a great debt of gratitude.

RHAZES

The most distinguished of the Arabian physicians
was the man whose rather lengthy Arabian name,
beginning with Abu Bekr Mohammed, finished with
el-Eazi, and who has hence been usually referred
to in the history of medicine as Rhazes. He was
born about 850 at Raj, in the Province of Chorasan
in Persia. He seems to have had a liberal early
education in philosophy and in philology and litera-
ture. He did not take up medicine until later in
life, and, according to tradition, supported himself
as a singer until he was thirty years of age. Then
he devoted himself to medical studies with the

GREAT ARABIAN PHYSICIANS 115

ardor and the success so often noted in those whose
opportunity to study medicine has been delayed.
His studies were made at Bagdad, where Ibn Zein
el-Taberi was his teacher. He returned to his na-
tive town and was for some time the head of the
hospital there. Later he was called by the Sultan to
Bagdad to take charge of the renovated and en-
larged hospital of the capital. His medical career,
then, is not unlike that of many another successful
physician, especially of the modern time. At
Bagdad he had abundant opportunities for study,
and the ambition to make medicine as well as to
make money and gain fame.

His studies in science were all founded on Aris-
totle. Though he was called the Galen of his time,
and looked up to the Greek physician as his master,
even the authority of Galen did not override that of
the Stagirite in his estimation. One of his apho-
risms is said to have been, * ' If Galen and Aristotle
are of one mind on a subject, then surely their
opinion is true. When they differ, however, it is
extremely difficult for the scholar to decide which
opinion should be accepted. ' ' He drew many pupils
to Bagdad, and, when one knows his teaching, this
is not surprising. Some of his aphorisms are very
practical. While the expressions just quoted with
regard to Galen and Aristotle might seem to in-
dicate that Rhazes was absolutely wedded to author-
ity, there is another well-known maxim of his which
shows how much he thought of the value of experi-
ence and observation. " Truth in medicine," he
said, " is a goal which cannot be absolutely reached,
and the art of healing, as it is described in books,

116 OLD-TIME MAKERS OF MEDICINE

is far beneath the practical experience of a skilful,
thoughtful physician." Some of his other medical
aphorisms are worth noting. " At the beginning of
a disease choose such remedies as will not lessen
the patient's strength." " When you can heal by
diet, prescribe no other remedy, and, where simple
remedies suffice, do not take complicated ones."

Rhazes knew well the value of the influence of
mind over body even in serious organic disease, and
even though death seemed impending. One of his
aphorisms is: " Physicians ought to console their
patients even if the signs of impending death seem
to be present. For the bodies of men are dependent
on their spirits." He considered that the most
valuable thing for the physician to do was to in-
crease the patient's natural vitality. Hence his ad-
vice: " In treating a patient, let your first thought
be to strengthen his natural vitality. If you
strengthen that, you remove ever so many ills with-
out more ado. If you weaken it, however, by the
remedies that you use you always work harm."
The simpler the means by which the patient's cure
can be brought about, the better in his opinion. He
insists again and again on diet rather than artificial
remedies. "It is good for the physician that he
should be able to cure disease by means of diet, if
possible, rather than by means of medicine." An-
other of his aphorisms seems worth while quoting:
" The patient who consults a great many physicians
is likely to have a very confused state of mind."

Some idea of Rhazes' strenuous activity as a
writer on medical subjects may be obtained from
the fact that thirty-six of his works are still extant,

GREAT ARABIAN PHYSICIANS 117

and there are nearly two hundred others of which
only the titles have been preserved. Some of these
are doubtless the works of pupils and students of
succeeding generations, published under his name
to attract attention. His principal work is " Con-
tinens," or " Comprehensor, " which owes its title
to the fact that it was meant to contain the whole
practice of medicine and surgery. It includes
references to the writings of all previous distin-
guished medical writers, from Hippocrates to
Honein Ben Ishac, also known as Johannitius, a
Christian Arabian physician, one of Rhazes' teach-
ers. The most frequently quoted of these authori-
ties are Galen, Oribasius, Aetius, and Paul of .ZEgina.
The work, however, is not made up entirely of quo-
tations, but contains many observations made by the
author himself. Gurlt says that the foundation of
the theoretic medicine of Rhazes is the system of
Galen, while in practice he seems to cling more to
the aphorisms of Hippocrates. He has many prac-
tical points which show that he thought for himself.
For instance, in wounds of the abdomen, if the in-
testines are extruded and cannot be replaced, he
suggests the suspension of the patient by his hands
and feet in a bath in order to facilitate their return.
If they do not go back readily, compresses dipped in
warm wine should be used. Cancer he declares to
be almost incurable. He has much to say about the
bites of animals and their tendency to be poisonous,
knew rabies very well, and knew also that the
bites of men might have similar serious conse-
quences.

It is impossible to give any adequate idea of the

118 OLD-TIME MAKERS OF MEDICINE

thoroughly practical character of Rhazes' medical
writing in a few lines, but it may suffice to say that
there is scarcely any feature of modern medicine
and surgery that he does not touch, and of tener than
not his touch is sure and rational and frequently
much better than the advice of successors long after
him in the same matters. An example or two will
suffice to illustrate this. In the treatment of nasal
polyps he says that whenever drug treatment of
these is not successful, they should be removed with
a snare made of hair. For fall of the uvula he sug-
gests gargles, but when these fail he advises re-
section and cauterization. Among the affections of
the tongue he numbers abscess, fissure, ulcer, can-
cer, ranula, shortening of the ligaments, hypertro-
phy, erythema of the mucous membrane, and in-
flammatory swelling. In general his treatment of
the upper respiratory tract is much farther ad-
vanced than we might think possible at this time.
He advises tracheotomy whenever there is great dif-
ficulty of respiration, and describes how it should
be done. After the dyspnea has passed the edges
of the wound should be brought together with
sutures. It is not surprising, then, to find that the
treatment of fractures and luxations is eminently
practical, and, indeed, on any subject that he touches
he throws practical light.

In the introduction to his edition of the works of
Ambroise Pare, Malgaigne says that the first refer-
ence to a metal band in connection with trusses is
to be found in Rhazes. Hernia was, of course, one
of the serious ailments that, because of its super-
ficial character, was rather well understood, and so

GREAT ARABIAN PHTSICIANS 119

it is not surprising to find that much of our modern
treatment of it was anticipated. The manipulations
for taxis, the use of a warm bath for the relaxation
of the patient by means of heat and by putting the
head and feet higher than the abdomen while in the
bath, and the employment of various kinds of trusses
to prevent strangulation of the hernia recur over
and over again, in the authors of the Middle Ages.
Many of the suggestions are to be found in the early
Greek authors, but subsequent writers give a cer-
tain personal expression to them which shows how
much they had learned by personal observation in
the employment of various methods.

Pagel, in Puschmann's " Handbook of the His-
tory of Medicine," declares that Ehazes' most im-
portant work for pure medicine is his monograph on
smallpox. Its principal value is due to the fact
that, though he has consulted old authorities care-
fully, his discussion of the disease is founded al-
most entirely on his own experience. His descrip-
tion of the various stages of the disease, of the forms
of the eruption, and of the differential diagnosis, is
very accurate. He compares the course of the fever
with that of other fevers, and brings out exactly
what constitutes the disease. His suggestions as
to prognosis are excellent. Those cases, he de-
clares, are particularly serious in which the erup-
tion takes on a dark, or greenish, or violet color.
The prognosis is also unfavorable for those cases
which, having considerable fever, have only a slight
amount of rash. His treatment of the disease in
young persons was by venesection and cool douches.
Cold water and acid drinks should be administered

120 OLD-TIME MAKERS OF MEDICINE

freely, so that sweat and other excretions may carry
off poisonous materials. Care must be taken to
watch the pulse, the breathing, the appearance of
the feet, the evacuations from the bowels, and to
modify therapy in accordance with these indications.
The eruption is to be encouraged by external warmth
and special care must be taken with regard to com-
plications in the eyes, the ears, the nose, the mouth,
and the pharynx.

A fact that will, perhaps, give the best idea to
modern readers of the place of Rhazes in the his-
tory of medicine is that Vesalius considered it worth
his while to make a translation of his principal work.
Unfortunately that translation has not come down
to us. When Vesalius, pestered by the con-
troversies that had come upon him because of his
venturing to make his observations for himself, ac-
cepted the post of physician to the Emperor Charles
V, he burnt a number of his manuscripts.
Among these were his translation of Rhazes and
some annotations on Galen, which, as he says him-
self, had grown into a huge volume. The Galenists
were bitterly decrying his refusal to accept Galen
on many points, and both of these works would have
added fuel to the flame of controversy. He deemed
it wiser, then, not to give any further opportunities
for rancorous criticism, and, feeling presumably
that in his new and important post it was not worth
while to bother further over the matter, he burnt
them. He tells the reason in his letters to Joachin
Roelant: " When I was about to leave Italy to go
to Court, since a number of the physicians whom
you know had made the worst kind of censure of

GREAT ARABIAN PHYSICIANS 121

my books, both to the Emperor himself, and to other
rulers, I burned all the manuscripts that were left,
although I had never suffered a moment under the
displeasure of the Emperor because of these com-
plaints, and in spite of the fact that a number of
friends who were present urged me not to destroy
them."

Vesalius' translation of Rhazes was probably un-
dertaken because he recognized in him a kindred
spirit of original investigation and inquiry, whose
work, because it was many centuries old, would
command the weight of an authority and at the same
time help in the controversy over Galenic questions.
This, of itself, would be quite enough to make the
reputation of Ehazes, even if we did not know from
the writings themselves and from the admiration of
many distinguished men as well as the incentive that
his works have so often proved to original ob-
servation, that he is an important link in the chain
of observers in medicine, who, though we would
naturally expect them to be so frequent, are really
so rare.

ALI ABBAS

Rhazes lived well on into the tenth century. His
successor in prestige, though not his serious rival,
was Ali Ben el- Abbas, usually spoken of in medical
literature as Ali Abbas, a distinguished Arabian
physician who died near the end of the tenth cen-
tury. He wrote a book on medicine which, because
of its dedication to the Sultan, to whom he was body-
physician, is known as the " Liber Regius," or

122 OLD-TIME MAKERS OF MEDICINE

" Royal Book of Medicine." This became the lead-
ing text-book of medicine for the Arabs until re-
placed by the ' ' Canon of Avicenna ' ' some two cen-
turies later. The " Liber Regius ' was an ex-
tremely practical work and, like most of the Arabian
books of the early times, is simple and direct, quite
without many of the objectionable features that de-
veloped later in Arabian medicine. It is valuable
mainly for its contributions to diet and the fact
that AH Abbas tested many of his medicines on ail-
ing animals before applying them to men. Of
course, it owes much to earlier writers on medicine,
and especially to Paul of ^Egina.

An example of its practical value is to be found
in his description of the treatment of a wound of
the brachial artery, when, as happened often in
venesection from the median basilic vein, it was in-
jured through carelessness or inadvertence. If
astringent or cauterizing methods do not stop the
bleeding, the artery should be exposed, carefully
isolated, tied in two places above and below the
wound, and then cut across between them. He has
many similar practical bits of technique. For in-
stance, in pulling a back tooth he recommends that
the gums be incised so as to loosen them around
the roots, and then the tooth itself may be drawn
with a special forceps which he calls a molar forceps.
In ascites he recommends that when other means
fail an opening should be made three finger-breadths
below the navel with a pointed phlebotomy knife,
and a portion of the fluid allowed to evacuate itself.
A tube should then be inserted, but closed. The
next day more of the fluid should be allowed to

GREAT AEABIAN PHYSICIANS 123

oome away, and then the tube removed and the ab-
domen wrapped with a firm bandage.

It is easy to understand that Ali Abbas' book
should have been popular, and the more we know
of it the easier it is to explain why Constantine
Africanus should have selected it for translation.
It contains ten theoretic and ten practical books, and
gives an excellent idea of the medical knowledge and
medical practice of the time. Probably the fact
that Constantine had translated it led to its early
printing, so that we have an edition of it published
at Venice in 1492, and another at Lyons in 1523.
During the Middle Ages the book was often spoken
of as " Eegalis Dispositio," the " Royal Disposi-
tion of Medicine. ' '

MOORISH PHYSICIANS

After Ehazes, the most important contributors to
medical literature from among the Arabs, with the
single exception of Avicenna, were born in Spain.
They are Albucasis or Abulcasis, the surgeon;
Avenzoar, the physician, and Averroes, the philo-
sophic theorist in medicine. Besides, it may be re-
called here that Maimonides, the great Jewish physi-
cian, was born and educated at Cordova, in Spain.
It might very well be a surprise that these distin-
guished men among the Arabs should have flour-
ished in Spain, so far from the original seat "of
Arabian and Mohammedan dominion in the East,
where, owing to conditions in the modern time, the
English-speaking world particularly is not likely to
assume that the environment was favorable for the

124 OLD-TIME MAKERS OF MEDICINE

development of science and philosophy. Anyone
who recalls, however, the history of Spanish in-
tellectual influence in the Roman Empire, as we
have traced it at the beginning of this chapter, will
appreciate how favorable conditions were in Spain
for the fostering of intellectual development. With
the disturbances that had come from political strife
and the invasion of the barbarians in Italy, Spain
had undoubtedly come to hold the primacy in the in-
tellectual life of Europe at the time when the Arabs
took possession of the peninsula.

ABULCASIS

The most important of the Arabian surgeons of
the Middle Ages is Albucasis or Abulcasis, also
Abulkasim, who was born near Cordova, in Spain.
The exact year of his birth is not known, but he
flourished in the second half of the tenth century.
He is said to have lived to the age of 101. The
name of his principal work, which embraces the
whole of medicine, is " Altasrif," or " Tesrif,"
which has been translated " The Miscellany." Most
of what he has to say about medical matters is
taken from Rhazes. His work on surgery, however,
in three books, represents his special contribution
to the medical sciences. It contains a number of il-
lustrations of instruments, and is the first illustrated
medical book that has come to us. It was translated
into Latin, and was studied very faithfully by all
the surgeons of the Middle Ages. Guy de Chauliac
has quoted Albucasis about two hundred times in
his " Chirurgia Magna." Even as late as the be-

GREAT ARABIAN PHYSICIANS 125

ginning of the sixteenth century Fabricius de Ac-
quapendente, the teacher of Harvey, confessed that
he owed most to three great medical writers, Celsus
(first century), Paul of .^Egina (seventh century),
and Abulcasis (tenth century).

Abulcasis insisted that for successful surgery a
detailed knowledge of anatomy was, above all, neces-
sary. He said that the reason why surgery had
declined in his day was that physicians did not
know their anatomy. The art of medicine, he added
further, required much time. Unfortunately, to
quote Hippocrates, there are many who are physi-
cians in name only, and not in fact, especially in
what regards surgery. He gives some examples of
surgical mistakes made by his professional brethren
that were particularly called to his attention. They
are the perennially familiar instances of ignorance
causing death because surgeons were tempted to
operate too extensively.

His description of the procedure necessary to
stop an artery from bleeding is an interesting ex-
ample of his method of teaching the practical tech-
nique of surgery. Apply the finger promptly upon
the opening of the vessel and press until the blood
is arrested. Having heated a cautery of the ap-
propriate size, take the finger away rapidly and
touch the cautery at once to the end of the artery
until the blood stops. If the spurting blood should
cool the cautery, take another. There should be
several ready for the purpose. Take care, he says,
not to cauterize the nerves in the neighborhood, for
this will add a new ailment to the patient's affec-
tion. There are only four ways of arresting arterial

126 OLD-TIME MAKERS OF MEDICINE

hemorrhage. First, by cautery ; second, by division
of the artery, when that is not complete — for then
the extremities contract and the blood clots — or by
a ligature, or by the application of substances which
arrest blood flow, aided by a compressive bandage.
Other means are inefficient, and seldom and, at most,
accidentally successful. His instruction for first
aid to the injured in case of hemorrhage in the ab-
sence of the physician, is to apply pressure directly
upon the wound itself.

The development of the surgical specialties among
the Arabs is particularly interesting. Abulcasis
has much to say about nasal polyps. He divided
them into three classes: (1) cancerous, (2) those
with a number of feet, and (3) those that are soft
and not living, — these latter, he says, are neither
malignant nor difficult to treat. He recommends
the use of a hook for their removal, or a snare for
those that cannot be removed with that instrument.
His instructions for the removal of objects from the
external ear are interestingly practical. He ad-
vises the use of bird lime on the end of a sound to
which objects will cling, or, where they are smaller,
suction through a silver or copper canula. Hooks
and pincettes are also suggested. Insects should be
removed with a hook, or with a canula, or, having
been killed by warm oil, removed by means of a
syringe. Some of his observations with regard to
genito-urinary surgery are quite as interesting. He
even treated congenital anomalies. He suggests cut-
ting of the meatus when narrowed, dilatation of
strictures with lead sounds, and even suggests plans
of operations to improve the condition in hypo-

GREAT ARABIAN PHYSICIANS 127

spadias. He gives the signs for differentiation be-
tween epitheliomata and condylomata, and distin-
guishes various forms of ulceration of the penis.

Abulcasis discusses varicose veins in very much
the same spirit as a modern surgeon does. They
occur particularly in people who work much on
their feet, and especially who have to carry heavy
burdens. They should not be operated on unless
they produce great discomfort, and make it impos-
sible for the sufferer to make his living. They may
be operated on by means of incision or extirpation.
Incision consists of cutting the veins at two or three
places when they have been made prominent by
means of tight bandages around the limb. The blood
should be allowed to flow freely out of the cut ends,
and then a bandage applied. For extirpation, the
skin having been shaved beforehand, the vein should
be made prominent, and then carefully laid bare.
"When freed from all adhesions, it should be lifted
out on a hook, and either completely extirpated or
several rather long pieces removed. He lays a good
deal of stress on the necessity for freeing the vein
thoroughly and lifting it well out of tissues before
incising it. In old cases special care must be taken
not to tear the vein.

Minute details of technique are often found in
these old authors. Abulcasis, for instance, treats of
adherent fingers with up-to-date completeness. They
can occur either congenitally or from injury, as, for
instance, burning. They should be separated, and
then separation maintained by means of bandages
or by the insertion between them of a thin lead plate,
which prevents their readhesion. Adhesions of the

128 OLD-TIME MAKERS OF MEDICINE

fingers with the palm of the hand, which Abulcasis
has also seen, should be treated the same way.

At times there is surprise at finding some rare
lesion treated with modern technique, and a hint
at least of our modern apparatus. Fracture of the
pubic arch, for instance, is described in Abulcasis
quite as if he had had definite experience with it.
When this occurs in a woman, the reposition of
the bone is often greatly facilitated by a cotton
tampon in the vagina. This tampon must be re-
moved at every urination. There is another way,
however, of better securing the same purpose of
counterpressure. One may take a sheep's bladder
into the orifice of which a tube is fastened. One
should introduce the bladder into the vagina, and
then blow strongly through the tube, until the blad-
der becomes swollen and fills up the vaginal cavity.
The fracture will, as a rule, then be readily re-
duced. Here is, of course, not alone the first hint
of the colpeurynter, but a very practical form of
the apparatus complete. Old-time physicians used
the bladders of animals very generally for nearly
all the medical purposes for which we now use rub-
ber bags.

AVICENNA

Undoubtedly the most important of Abulcasis'
contemporaries is the famous physician whose
Arabic name, Ibn Sina, was transformed into Avi-
cenna. He was born toward the end of the tenth
century in the Persian province of Chorasan, at the
height of Arabian influence, and is sometimes spoken

GREAT ARABIAN PHYSICIANS 129

of as the chief representative of Arabian medicine,
of as much importance for it as Galen for later
Greek medicine. His principal book is the so-called
" Canon." It replaced the compendium " Con-
tinens " of Rhazes, and, in the East, continued un-
til the end of the fifteenth century to be looked upon
as the most complete and best system of medicine.
Avicenna came to be better known in the West than
any of the other Arabian writers, and his name car-
ried great weight with it. There are very few sub-
jects in medicine that did not receive suggestive, if
not always adequate, treatment at the hands of this
great Arabian medical thinker of the eleventh cen-
tury. He copied freely from his predecessors, but
completed their work with his own observations and
conclusions. One of his chapters is devoted to
leprosy alone. He has definite information with re-
gard to bubonic plague and the filaria medinensis.
Here and there one finds striking anticipations of
what are supposed to be modern observations.
Nothing was too small for his notice. One portion
of the fourth book is on cosmetics, in which he
treats the affections of the hair and of the nails.
He has special chapters with regard to obesity,
emaciation, and general constitutional conditions.
His book, the " Antidotarium, " is the foundation of
our knowledge of the drug-giving of his time.

Some idea of the popularity and influence of Avi-
cenna, five centuries after his time, can be readily
derived from the number of commentaries on him
issued during the Renaissance period by the most
distinguished medical scholars and writers of that
time. Hyrtl, in his ' ' Das Arabische und Hebraische

130 OLD-TIME MAKERS OF MEDICINE

in der Anatomic," quotes some of them, — Bartholo-
maeus de Varignana, Gentilis de Fulgineis, Jacobus
de Partibus, Didacus Lopez, Jacobus de Forlivio,
Ugo Senesis, Dinus de Garbo, Matthaeus de Gradi-
bus, Nicolaus Leonicenus, Thaddaeus Florentinus,
Galeatus de Sancta Sophia. A more complete list,
with the titles of the books, may be found in Haller's
" Bibliotheca Anatomica." For over three cen-
turies after the foundation of medical schools in
Europe (and even after Mondino's book had been
widely distributed), Avicenna was still in the hands
of all those who had an enthusiasm for medical
science.

AVENZOAE

Another of the distinguished Arabian physicians
was Avenzoar — the transformation of his Arabic
family name, Ibn-Zohr. He was probably born in
Penaflor, not far from Seville. He died in Seville
in 1162 at the age, it is said, of ninety-two years.
He was the son of a physician descended from a
family of scholars, jurists, physicians, and officials.
He received the best education of the time not only
in internal medicine, but in all the specialties, and
must be counted among the greatest of the Spanish
Arabian physicians. He was the teacher of Aver-
roes, who always speaks of him with great respect.
He is interesting as probably being the first to sug-
gest nutrition per rectum. A few words of his
description show how well he knew the technique.
His apparatus for the purpose consisted of the
bladder of a goat or some similar animal structure,

GREAT ARABIAN PHYSICIANS 131

with a silver canula fastened into its neck, to be
used about as we use a fountain syringe. Having
first carefully washed out the rectum with cleansing
and purifying clysters, he injected the nutriment-
eggs, milk, and gruels — into the gut. His idea was
that the intestine would take this, and, as he said,
suck it up, carrying it back to the stomach, where it
would be digested. He was sure that he had seen
his patients benefited by it.

Some light on his studies of cases that would re-
quire such treatment may be obtained from what
he has to say about the handling of a case of
stricture of the esophagus. He says that this be-
gins with some discomfort, and then some difficulty
of swallowing, which is gradually and continuously
increased until finally there comes complete impos-
sibility of swallowing. It was in these cases that
he suggested rectal alimentation, but he went
farther than this, and treated the stricture of the
esophagus itself.

The first step in this treatment is that a canula
of silver or tin should be inserted through the mouth
and pushed down the throat till its head meets an
obstruction, always being withdrawn when there is
a vomiting movement, until it becomes engaged in
the stricture. Then freshly milked milk, or gruel
made from farina or barley, should be poured
through it. He says that in these cases the patient
might be put in a warm milk or gruel bath, since
there are some physicians who believe that through
the lower parts of the body, and also through the
pores of the whole body, nutrition might be taken
up. While he considers that this latter method

132 OLD-TIME MAKERS OF MEDICINE

should be tried in suitable cases, he has not very
much faith in it, and says that the reasons urged
for it are weak and rather frivolous. It is easy
to understand that a man who has reached the place
in medicine where he can recommend manipulative
treatments of this kind, and discuss nutritional
modes so rationally, knew his practical medicine
well, and wrote of it judiciously.

AVERROES

Among the distinguished contributors to medi-
cine at this time, though more a philosopher than a
physician, is the famous Averroes, whose full Arabic
name among his contemporaries was Abul-Welid
Mohammed Ben Ahmed Ibn Roschd el-Maliki. Like
Avenzoar, of whom he was the intimate persona]
friend, and Abulcasis and Maimonides, he was born
in the south of Spain. He was in high favor with
the King of Morocco and of Spain, El-Mansur Jacub,
often known as Almansor, who made him one of his
counsellors. His works are much more important
for philosophy than for medicine, and his philo-
sophical writings gave him a place only second to
that of Aristotle in the Western world during the
Middle Ages. Averroism is still a subject of at least
academic interest, and Renan's monograph on it
and its author was one of the popular books of the
latter half of the nineteenth century in philosophic
circles. In spite of his friendship with the Moorish
King and with Avenzoar, he fell under the suspi-
cion of free thinking and was brought to trial with
a number of personal friends, who occupied high

GREAT ARABIAN PHYSICIANS 133

positions in the Moorish government. He escaped
with his life, but only after great risks, and he was
banished to a suburb of Cordova, in which only Jews
were allowed to live. By personal influence he suc-
ceeded in securing the pardon of himself and
friends, and then was summoned to the court of the
son and successor of El-Mansur in Morocco. He
died, not long after, in 1198.

Altogether there are some thirty-three works of
Averroes on philosophy and science. Only three
of these are concerned with medicine. One is the
" Colliget," so-called, containing seven books, on
anatomy, physiology, pathology, diagnostics, ma-
teria medica, hygiene, and therapy. Then there is
a commentary on the ' ' Cantica of Avicenna, ' ' and a
tractate on the ' ' Theriac. ' ' Averroes ' idea in writ-
ing about medicine was to apply his particular sys-
tem of philosophy to medical science. His intimate
relations with other great physicians of the time,
and in particular his close friendship with Avenzoar,
enabled him to get abundant medical information in
faultless order so far as knowledge then went, but
his theoretic speculations, instead of helping medi-
cine, as he thought they would, and as philosophers
have always been inclined to think as regards their
theoretic contributions, were not only not of value,
but to some extent at least hindered human progress
by diverting men from the field of observation to
that of speculation. It is interesting to realize that
Averroes did in his time what Descartes did many
centuries later, and many another brilliant thinker
has done before and since.

134 OLD-TIME MAKERS OF MEDICINE

ARABIAN INFLUENCE

The fame of these great thinkers and writers in
philosophy and in medicine came to be known not
only through the distribution of their books long
after their death, but during their lifetime, and in
immediately subsequent generations, ardent seekers
after knowledge, who were themselves afterwards
to become famous by their teaching and writing,
found their way into the Arabian dominions in
order to take advantage of the educational oppor-
tunities afforded. These were better than they
could secure at home in Christian countries, be-
cause the process of bringing culture and devotion
to literature and science into the minds of the North-
ern nations, who had replaced the old Eomans in
Europe, was not yet completed. Bagdad and Cor-
dova were the two favorite places of educational
pilgrimage. The names that are most familiar
among the scholars in the Middle Ages in Europe
are those of whom it is recorded that they made
long journeys in order to get in touch with what
the Arabs had preserved of the old Greek civiliza-
tion and culture. Among them are such men as
Michael Scot or Scotus, Matthew Platearius, who
was afterwards a great teacher at Salerno; Daniel
Morley, Adelard of Bath, Egidius, otherwise known
as Gilles de Corbeil; Romoaldus, Gerbert of
Auvergne, who later became Pope under the name
of Sylvester II; Gerard of Cremona, and the best
known of them all, at least in medicine, Constantine
Africanus, whose wanderings, however, were prob-

GREAT ARABIAN PHYSICIANS 135

ably not limited to Arabian lands, but who seems
also to have been in Hindustan.

We are rather prone to think that this great spirit
of going far afield for knowledge's sake is recent,
or, at least, quite modern. As a matter of fact,
one finds it everywhere in history. Long before
Herodotus did his wanderings there were many vis-
itors who went to Egypt, and many more later who
went to Crete, and many more a few centuries later
who went to the shores of Asia Minor seeking for
the precious pearl of knowledge, and sometimes find-
ing it without finding the even more precious pearl
of wisdom, " whose worth is from the farthest
coasts.'*

To the Arabs we owe the foundation of a series
of institutions for the higher learning, like those
which had existed around them in Asia Minor and
in Egypt at the time they made their conquests.
Alexandria, Pergamos, Cos, Cnidos, Tarsus, and
many other Eastern cities had had what we would
call at least academies, and many of them deserved
the name of universities. The Arabs continued the
tradition in education that they found, and estab-
lished educational institutions which attracted wide
attention. As we have said, the two most famous
of these were at Bagdad and at Cordova. Mostan-
ser, the predecessor of the last Caliph of the family
of the Abbassides, built a handsome palace, in which
the academy of Bagdad was housed. It is still in
existence, and gives an excellent idea of the benefi-
cent interest of this monarch and of other of the
Abbasside rulers in education. Its fate at the pres-
ent time is typical of the attitude of the Moham-

136 OLD-TIME MAKERS OF MEDICINE

medans towards education. Though the building is
still standing, the institution of learning is no longer
there. As Hyrtl remarks, it is not ideas that are
exchanged in it now, but articles of commerce. It
has become the chief office of the Turkish customs
department in Bagdad.

These institutions of the higher learning, founded
by the Arabs, at first as rather strict imitations of
the museums or academies of Egypt and Asia
Minor, gradually changed their character under the
Arabs. Their courses became much more formal,
examinations became much more important. Schol-
arship was sought not so much for its own sake, as
because it led to positions in the civil service, to the
favor of princes, and, in general, to reputation and
pecuniary reward. Formal testimonials proclaim-
ing education, signed by the academic authorities,
were introduced and came to mean much. Lawyers
could not practise without a license, physicians also
required a license. These formalities were adopted
by the Western medieval universities to a consid-
erable degree and have been perpetuated in the mod-
ern time. Undoubtedly they did much to hamper
real education among the Arabs by setting in place
of the satisfaction of learning for its own sake
and the commendation of teachers the formal recog-
nition of a certain amount of work done as recog-
nized by the educational authorities. There was al-
ways a tendency among the Arabs to formulate and
formalize, to over-systematize what they were at;
to think that new knowledge could be obtained
simply by speculating over what was already ac-
quired, and developing it. There are a number of

GREAT ARABIAN PHYSICIANS 137

comparisons between this and later periods of edu-
cation that might be suggested if comparisons were
not odious.

The influence of Arabian medicine on modern
medicine can, perhaps, best be judged from the num-
ber of words in our modern nomenclature, which,
though bearing Latin forms, often with suggestion
of Greek origins, still are not derived from the old
Latin or Greek authors, but represent Arabic terms
translated into Latin during the Renaissance period.
Hyrtl, without pretence of quoting them all, gives
a list of these which is surprising in its compre-
hensiveness. For instance, the mediastinum, the
sutura sagittalis, the scrobiculus cordis, the mar-
supium cordis, the chambers of the heart, the velum
palati, the trochanter, the rima glottidis, the fon-
tanelles, the alae of the nose, all have their present
names, not from original Latin expressions, but
from the translation of Arabic terms. For all such
words the Greeks and Romans have quite other ex-
pressions, in which the sense of our modern terms
is not contained. This has given rise to many mis-
understandings, and to many attempts in the mod-
ern times to return to the classic terminology rather
than preserve what in many cases are the barba-
risms introduced through the Arabic, but it is doubt-
ful whether any comprehensive reform in the matter
can be effected, so strongly entrenched in medical
usage have these terms now become.

Freind, in his " History of Medicine," already
cited, calls attention to the fact that the Arabs had
an unfortunate tendency to change by addition or
subtraction of their own views the authors that they

138 OLD-TIME MAKERS OF MEDICINE

studied, and wished to translate to others. This
seems to have been true even of some of the most
distinguished of them. Of course, the idea of pre-
serving an author's text untouched, and making it
clear just where note and commentary came in,
had not yet come to men's view, but quite apart from
this the Arabs apparently often tried to gain ac-
ceptance for their own ideas by having them
masquerade as the supposed ideas of favorite classic
authors.

Another unfortunate tendency among the Arabs
was their liking for the discussion of many trivial
questions. Hyrtl, in his volume on " Arabian and
Hebrew Words in Anatomy,"1 declares that it is
almost incredible how earnestly some trivial ques-
tions in anatomy and physiology were discussed by
the Arabs. He gives some examples. Why does
no hair grow on the nose of men1? Why does the
stomach not lie behind the mouth? Why does the
windpipe not lie behind the esophagus? Why are
the breasts not on the abdomen? Why are not the
calves on the anterior portion of the legs? Even
such men as Ehazes and Avicenna discuss such
questions.

It was this tendency of the Arabs that passed
over to the Western Europeans with Arabian com-
mentaries on philosophy and science, and brought
so many similar discussions in the scholastic period.
These trivialities have usually been supposed to
originate with the scholastics themselves, for they
are not to be found in the Greek authors on whom

^'Das Arabische und Hebraische in der Anatomie," Dr. Joseph
Hyrtl, Wien, 1879.

GREAT ARABIAN PHYSICIANS 139

the scholastics were writing commentaries, but they
are typically Oriental in character, and it must be
remembered that during the twelfth and early thir-
teenth centuries, at least, Greek philosophy found
its way largely into Europe in Arab versions, and
these characteristically Arabian additions of the
discussion of curious trivial questions came with
them and produced an imitative tendency among the
Europeans.

As a rule the more careful has been the study of
Arabian writers in the modern time, particularly
by specialists, the clearer has it become that they
lacked nearly all originality. Especially were they
faulty in their observations; besides, they had a
definite tendency to replace observation by theory, a
fatal defect in medicine. The fine development of
surgery that came at the end of the Arabian period
of medicine in Europe could never have come from
the Arabs themselves. Gurlt has brought this out
particularly, but it will not be difficult to cite many
other good authorities in support of this opinion.

Hyrtl, in his " Thesis on the Earer Old Anato-
mists,"1 says that " the Arabs paid very little at-
tention to anatomy, and, of course, because of the
prohibition in the Koran, added nothing to it. What-
ever they knew they took from the Greeks, and espe-
cially Galen. Not only did they not add anything
new to this, but they even lost sight of much that
was important in the older authors. The Arabs
were much more interested in physiology; they
could study this by giving thought to it without soil-

1<( Anat. Antiq. Rariores," Vienna, 1835.

140 OLD-TIME MAKERS OF MEDICINE

ing their hands. They delighted in theory, rather
than in observation."

While we thus discuss the lack of originality and
the tendency to over-refinement among the Arabian
medical writers, it must not be thought that we
would make little of what they accomplished. They
not only preserved the old medical writers for us,
but they kept alive practical medicine with the prin-
ciples of the great Greek thinkers as its basis.
There are a large number of writers of Arabian
medicine whose names have secured deservedly a
high place in medical history. If this were a formal
history of Arabian medicine, their careers and works
would require discussion. For our purpose, how-
ever, it seems better to confine attention to a few
of the most prominent Arabian writers on medi-
cine, because they will serve to illustrate how thor-
oughly practical were the Arabian physicians and
how many medical problems that we are prone to
think of as modern they occupied themselves with,
solving them not infrequently nearly as we do in
the modern time.

VI

THE MEDICAL SCHOOL AT SALERNO

The Medical School at Salerno, probably organized
early in the tenth century, often spoken of as the
darkest of the centuries, and reaching its highest
point of influence at the end of the twelfth century,
is of great interest in modern times for a number of
reasons. First it brought about in the course of its
development an organization of medical education,
and an establishment of standards that were to be
maintained whenever and wherever there was a true
professional spirit down to our own time. They in-
sisted on a preliminary education of three years of
college work, on at least four years of medical train-
ing, on special study for specialist's work, as in
surgery, and on practical training with a physician
or in a hospital before the student was allowed to
practise for himself. At Salerno, too, the depart-
ment of women's diseases was given over to women
professors, and we have the text-books of some of
these women medical teachers. The license to prac-
tise given to women, however, seems to have been
general and did not confine them merely to the care
of women and children. We have records of a num-
ber of these licenses issued to women in the neigh-
borhood of Salerno. This subject of feminine med-
ical education at Salerno, because of its special inter-
est in our time, will have a chapter by itself.

141

142 OLD-TIME MAKERS OF MEDICINE

These are the special features of medical education
in our own time that we are rather prone to think
of as originating with ourselves and as being indices
of that evolution of humanity and progress in man-
kind which are culminating in our era. It is rather
interesting, then, to study just how these develop-
ments came about and what the genesis of this great
school was. The books of its professors were widely
read, not only in their own generation but for cen-
turies afterwards. With the invention of printing
at the time of the Renaissance most of them were
printed and exerted profound influence over the re-
vival of medicine which took place at that time.
Salerno became the first of the universities in the
modern sense of the word. Here there gathered
round the medical school, first a preparatory depart-
ment representing modern college work, and then
departments of theology and law, though this latter
department particularly was never quite successful.
The fact that the first university, that of Salerno,
should have been organized round a medical school,
the second, that of Bologna, around a law school, and
the third, that of Paris, around a school of theology
and philosophy, would seem to represent the ordi-
nary natural process of development in human inter-
ests. First man is interested in himself and in his
health, then in his property, and finally in his rela-
tions to his fellow-man and to God.

Though much work has been done on the subject
in recent years, it is not easy to trace the origin of
the medical school at Salerno. The difficulty is em-
phasized by the fact that even the earliest chron-
iclers whose accounts we have were not sure as to its

THE MEDICAL SCHOOL AT SALERNO 143

origin, and even had some doubt about the age of the
school. Alphanus, usually designated Alphanus I be-
cause there are several of the name, who is one of
the earliest professors whose name and fame have
come down to us, gives us the only definite detail as
to the age of the school. He was a Benedictine
monk, distinguished as a literary man, known both
as poet and physician, who was afterwards raised to
the Bishopric of Salerno. As a bishop he was one
of the beneficent patrons, to whom the school owed
much. He lived in the tenth century, and states that
medicine flourished in the town before the time of
Guimarus II, who reigned in the ninth century. In
the ancient chronicle of Salerno, re-discovered by De
Renzi and published in his " Collectio Salernitana, "
it is definitely recorded that the medical school was
founded by four doctors, — a Jewish Rabbi Elinus,
a Greek Pontus, a Saracen Adala, an Arab, and a
native of Salerno, each of whom lectured in his
native language. There are many elements in this
tradition, however, that would seem to indicate its
mythical origin and that it was probably invented
after the event to account for the presence of teach-
ers in all these languages and the coming of students
from all over the world. The names, for instance,
are apparently corruptions of real names, as can be
readily recognized. Elinus, the Jew, is probably
Elias or Eliseus, Adala is a corruption of Abdallah,
and Pontus, as pointed out by Puschmann in his
" History of Medical Education," should probably
be Gario-Pontus.

While we do not know exactly when the medical
school at Salerno was founded, we know that a hos-

144 OLD-TIME MAKERS OF MEDICINE

pital was established there as early as 820. It was
founded by the Archdeacon Adelmus, and was
placed under the control of the Benedictines after it
was realized that a religious order, by its organiza-
tion, was best fitted for carrying on such charitable
work continuously. Other infirmaries and charitable
institutions, mainly under control of the religious,
sprang up in Salerno. It was the presence of these
hospitals in a salubrious climate that seems first to
have attracted the attention of patients and then of
physicians from all over Europe and even adjacent
Africa and Asia. Puschmann says that it is uncer-
tain whether clinical instruction was imparted in
these institutions or not, but the whole tenor of what
we know about the practical character of the teach-
ing at Salerno and of the fine development of profes-
sional medicine there, would seem to argue that
probably those who came to study medicine here
were brought directly in contact with patients.

As early as the ninth century Salerno was famous
for its great physicians. We know the names of at
least two physicians, Joseph and Joshua, who prac-
tised there about the middle of the ninth century.
Eagenifrid, a Lombard by his name, was private
physician to Prince Wyamar of Salerno in the year
900. The fact that he was from North Italy indi-
cates that already foreigners were being attracted,
but more than this that they were obtaining oppor-
tunities unhampered by any Chauvinism. From
early in the tenth century physicians from Salerno
were frequently brought to foreign courts to become
the attending physicians to rulers. Patients of the
highest distinction from all over Europe began to

THE MEDICAL SCHOOL AT SALERNO 145

flock to Salerno, and we have the names of many of
them. In the tenth century Bishop Adalberon,
when ailing, went there, though he found no cure
for his ills. Abbot Desiderius, however, the great
Benedictine scholar of the time, who afterwards be-
came Pope Victor III, regained his health at Sa-
lerno under the care of the great Constantine Afri-
canus, who was so much impressed by the gentle
kindness and deep learning and the example of the
saintly life of his patient that not long after he went
to Monte Cassino to become a Benedictine under
Desiderius, who was abbot there. Duke Guiscard
sent his son Bohemund to Salerno for the cure of
a wound received in battle, which had refused to
heal under the ordinary surgical treatment of the
time. William the Conqueror, early in the eleventh
century and while still only the Duke of Normandy,
is said to have passed some time at Salerno for a
similar reason.

The most interesting feature of the medical life at
Salerno at this time is the relations between the
clergy and the physicians. In the sketch of the life
of Constantine Africanus, which follows this chap-
ter, there is some account of the friendship between
Abbot Desiderius of Monte Cassino and Constantine
Africanus, and the latter 's withdrawal from his pro-
fessorship to become a Benedictine. One of the phy-
sicians of the early tenth century who stood high in
favor with Prince Gisulf was raised to the Bishopric
of .Salerno. This was Alphanus, whom we have al-
ready mentioned as a chronicler, a monk, a poet, a
physician, and finally the Bishop of Salerno.

The best proof of how thorough was the medical

146 OLD-TIME MAKERS OF MEDICINE

education at Salerno and how much influence it ex-
erted even over public opinion is to be found in the
regulation of the practice of medicine, which soon
began, and the insistence upon proper training be-
fore permission to practise medicine was granted.
The medical school at Salerno early came to be a
recognized institution in the kingdom of the Two
Sicilies, representing a definite standard of medical
training. It is easy to understand that the attrac-
tion which Salerno possessed for patients soon also
brought to the neighborhood a number of irregular
physicians, travelling quacks, and charlatans.
Wealthy patients were coming from all over the
world to be treated at Salerno. Many of them doubt-
less were sufferers from incurable diseases and noth-
ing could be done for them. Often they would be
quite unable to return to their homes and would be
surely unwilling to give up all hope if anybody prom-
ised them anything of relief. There was a rich field
for the irregular, and of course, as always, he came.
Salerno had already shown what a good standard of
medical education should be, and it is not surprising,
then, that the legal authorities in this part of the
country proceeded to the enforcement of legal regu-
lations demanding the attainment of this standard,
in order that unfit and unworthy physicians might
not practise medicine to their own benefit but to the
detriment of the patients.

Accordingly, as early as the year 1140, King Rug-
giero (Roger) of the Two Sicilies promulgated the
law : ' * Whoever from this time forth desires to prac-
tise medicine must present himself before our of-
ficials and judges, and be subject to their decision.

TEE MEDICAL SCHOOL AT SALERNO 147

Anyone audacious enough to neglect this shall be
punished by imprisonment and confiscation of goods.
This decree has for its object the protection of the
subjects of our kingdom from the dangers arising
from the ignorance of practitioners."

Just about a century later the Emperor Frederick
II, the Hohenstaufen, in the year 1240, extended this
law, emphasized it, and brought it particularly into
connection with the great medical school of the Two
Sicilies, of which territory he was the ruler. This
law has often been proclaimed as due to his person-
ality rather than to his times, — as representing his
very modern spirit and his progressive way of look-
ing at things. There is no doubt that certain per-
sonal elements for which he should be given due
credit are contained in the law. To understand it
properly, however, one must know the law of King
Eoger of the preceding century; and then it is easy
to appreciate that Frederick's regulation is only
such a development of the governmental attitude to-
ward medical practice as might have been expected
during the century since Roger's time. It has some-
times been suggested that this law made by the Em-
peror Frederick, who was so constantly in bitter
opposition to the Papacy, was issued in despite of the
Church authorities and represents a policy very dif-
ferent from any which they would have encouraged.
The early history of Salerno, even briefly as we
have given it, completely contradicts any such idea.
The history of medical regulation at the beginning of
the next century down at Montpellier moreover,
where the civil authorities being weak the legal or-
dering of the practice of medicine was effectively

148 OLD-TIME MAKERS OF MEDICINE

taken up by the Church, and the authority for the
issuance of licenses to practise was in the hands of
the bishops of the neighborhood, shows clearly that
it is not because of any knowledge of the real medical
history of the times that such remarks are made, but
from a set purpose to discredit the Church.

The Emperor Frederick's law deserves profound
respect and consideration because of the place that
it holds in the legal regulation of the practice of
medicine. Anyone who thinks that evolution must
have brought us in seven centuries much farther in
this matter than were the people of the later Middle
Ages should read this law attentively. Everyone
who is interested in medical education should have
a copy of it near him, because it will have a chasten-
ing effect in demonstrating not only how little we
have done in the modern time rather than how much,
but above all how much of decadence there was dur-
ing many periods of the interval. The law may
be found in the original in " The Popes and
Science " (Fordham University Press, N. Y., 1908).
Three years of preliminary university education be-
fore the study of medicine might be taken up, four
years of medical studies proper before a degree was
given, a year of practice with a regularly licensed
physician before a license to practise could be ob-
tained, a special course in anatomy if surgery were
to be practised; all this represents an ideal we are
striving after at the present time in medical edu-
cation. Besides this, Frederick's law also regulates
medical fees, requires gratuitous attendance on the
poor for the privilege of practice accorded by the
license, though the general fees are of a thoroughly

THE MEDICAL SCHOOL AT SALERNO 149

professional character and represent for each visit
of the physician about the amount of daily wage that
the ordinary laborer of that time earned. Curiously
enough, this same ratio of emolument has maintained
itself. This law was also a pure drug law, regulat-
ing the practice of pharmacy, and the price as well
as the purity of drugs, and the relations of phy-
sicians,, druggists, and the royal drug inspectors
whose business it was to see that only proper drugs
were prepared and sold.

All this is so much more advanced than we could
possibly have imagined, only that the actual docu-
ments are in our possession, that most people refuse
to let themselves be persuaded in spite of the law
that it could have meant very much. Especially as
regards medical education are they dubious as to
conditions at this time. To them it seems that it
can make very little difference how much time was
required for medical study or for studies prelim-
inary to medicine, since there was so little to be
learned. The age was ignorant, men knew but little,
and so very little could be imparted no matter how
much time \vas taken.

This is, I fear, a common impression, but an ut-
terly false one. The preliminary training that is
the undergraduate work at the universities consisted
of the Seven Liberal Arts — the trivium and quad-
rivium, which embraced logic, rhetoric, grammar,
metaphysics, under which was included not a little
of physics, cosmology in which some biology was
studied, as well as psychology and mathematics, as-
tronomy, and music. This was a thoroughly
rounded course in intellectual training. No wonder

150 OLD-TIME MAKERS OF MEDICINE

that Professor Huxley said in his Inaugural Ad-
dress as Rector of Aberdeen, " I doubt if the cur-
riculum of any modern university shows so clear and
generous a comprehension of what is meant by cul-
ture as this old trivium and quadrivium does.'*
There is no doubt at all about the value of the under-
graduate training, nor of the scholarship of the men
who were turned out under the system, nor of their
ability to concentrate their minds on difficult sub-
jects— a faculty that we strive to cultivate in our
time and do not always congratulate ourselves on
securing to the degree, at least, that we would like.

As to the medical teaching, JEgidius, often called
Gilles of Corbeil, who was a graduate of Salerno
and afterward became the physician-in-ordinary to
Philip Augustus, King of France, thought that he
could not say too much for the training in medicine
that was given at this first of the medical schools.
One thing is sure, the professors were eminently
serious, the work taken up was in many ways thor-
oughly scientific, and some of the results of the
medical investigations of that early day are inter-
esting even now. The descriptions of diseases that
we have from the Salernitan school are true to na-
ture and are replete with many original observa-
tions. Puschmann says: " The accounts given of
intermittent fever, pneumonia, phthisis, psoriasis,
lupus, which they called the malum mortuum, of
ulcers on the sexual organs, among which it is easy
to recognize chancre, and of the disturbances of the
mental faculties, especially deserve mention." They
seem to have been quite expert in their knowledge of
phthisis. In the treatment of it they laid great

THE MEDICAL SCHOOL AT SALERNO 151

stress upon the giving up of a strenuous life, the
living a rather easy existence in the open air, and a
suitable diet. When the commencement of consump-
tion was suspected, the first prescription was a good
course of strengthening nourishment for the pa-
tient. On the other hand, they declared that the
cases in which diarrhea supervened during consump-
tion soon proved fatal. In general, with regard to
people who were liable to respiratory diseases, they
insisted upon life in an atmosphere of equable tem-
perature. Though the custom was almost unheard
of in the Salerno of that time, and indeed at the
present time there is very little heating during the
winter in southern Italy, they insisted that patients
who were liable to pulmonary affections should have
their rooms heated.

On the other hand, they suggested the cooling of
the air of the sick-room, as we have noted in the
chapter on Constantine Africanus, and Afflacius rec-
ommended the employment of an apparatus from
which water trickled continuously in drops to the
ground and then evaporated. Baths and bleeding
were employed according to definite indications and
diet was always a special feature. They had a num-
ber of drugs and simples, and the employment of
some of them is interesting. Iron was prescribed
for enlargement of the spleen. The internal use of
sea sponge, in which of course there is a noteworthy
proportion of iodine, was recommended for relief
from the symptoms of goitre by reducing its size.
Iodine has been used so much ever since in this af-
fection, even down to our own day, that this employ-
ment of one of its compounds is rather striking.

152 OLD-TIME MAKERS OF MEDICINE

Massage of the goitre was also recommended, and
this mode of treatment was commonly employed for
a number of ailments.

Probably the best idea that can be obtained in
brief space of the achievements of the University
of Salerno is to be found in Pagel's appreciation of
Salerno's place in the history of medicine in his
chapters on " Medicine in the Middle Ages " in
Puschmann's " Handbuch der Geschichte der Me-
dizin " (Berlin, 1902). He said : " If we take up now
the accomplishments of the school of Salerno in the
different departments there is one thing that is very
remarkable. It is the rich independent productivity
with which Salerno advanced the banners of medical
science for hundreds of years almost as the only au-
tochthonous centre of medical influence in the whole
West. One might almost say that it was like a
versprengten Keim — a displaced embryonic ele-
ment— which, as it unfolded, rescued from destruc-
tion the ruined remains of Greek and Roman medi-
cine. This productivity of Salerno, which may well
be compared in quality and quantity with that of
the best periods of our science, and in which no de-
partment of medicine was left without some ad-
vance, is one of the striking phenomena of the history
of medicine. While positive progress was not made,
there are many noteworthy original observations to
be chronicled. It must be acknowledged that pupils
and scholars set themselves faithfully to their tasks
to further as far as their strength allowed the sci-
ence and art of healing. In the medical writers of
the older period of Salerno who had not yet been
disturbed by Arabian culture or scholasticism, we

THE MEDICAL SCHOOL AT SALERNO 153

cannot but admire the clear, charmingly smooth,
light-flowing diction, the delicate and honest setting
forth of cases, the simplicity of their method of
treatment, which was to a great extent dietetic and
expectant, and while we admire the carefulness and
yet the copiousness of their therapy, we cannot but
envy them a certain austerity in their pharmaceutic
formulas and an avoidance of medicamental poly-
pragmasia. The work in internal medicine was espe-
cially developed. The contributions to it from a
theoretic and a literary standpoint, as well as from
practical applications, found ardent devotees."

Less than this could scarcely have been expected
from the medical school which brought such an up-
lift of professional dignity and advance in the stand-
ards of medical education that are to be noticed in
connection with Salerno. Eegistration, licensure,
preliminary education, adequate professional studies,
clinical experience under expert guidance, even spe-
cial training for surgical work, all came in connec-
tion with this great medical school. Such practical
progress in medical education could not have been
made but by men who faced the problems of the prac-
tice of medicine without self-deception and solved
them as far as possible by common-sense, natural,
and rational methods.

It is usually said that at Salerno surgery occupied
an inferior position. It is true that we have less
record of it in the earlier years of Salerno than we
would like to see. It was somewhat handicapped by
the absence of human dissection. This very impor-
tant defect was not due to any Church opposition to
anatomy, as has often been said, but to the objection

154 OLD-TIME MAKERS OF MEDICINE

that people have to seeing the bodies of their friends
or acquaintances used for anatomical purposes. In
the comparatively small towns of the Middle Ages
there were few strangers, and therefore very seldom
were there unclaimed bodies. The difficulty was in
the obtaining of dissecting material. We had the
same difficulty in this country until about two gen-
erations ago, and the only way that bodies could be
obtained regularly was by " resurrecting " them,
as it was called, from graveyards. In the ab-
sence of human subjects, anatomy was taught at
Salerno upon the pig. The principal portion of the
teaching in anatomy consisted of the demonstration
of the organs in the great cavities of the body and
their relations, with some investigations of their
form and the presumed functions of the correspond-
ing organs in man. Copho's well-known " Anatomy
of the Pig " was a text-book written for the students
of Salerno. In spite of its limitations, it shows the
beginnings of rather searching original inquiry and
even some observations in pathological anatomy. It
is simple and straightforward and does not profess
to be other than it is, though it must be set down as
the first reasonably complete contribution to com-
parative anatomy.

When their surgery came to be written down,
however, it gave abundant evidence of the thorough-
ness with which this department of medicine had
been cultivated by the Salernitan faculty. We have
the text-book of Roger, with the commentary of Ro-
lando, and then the so-called commentary of the
Four Masters. These writings were probably made
rather for the medical school at Bologna than that

THE MEDICAL SCHOOL AT SALERNO 155

of Salerno, though there is no doubt that at least
Roger and Rolando received their education at Sa-
lerno and embodied in their writings the surgical
traditions of that school. While I have preferred, in
order to have a connected story of surgical develop-
ment, to treat of their contributions to their specialty
under the head of the " Great Surgeons of the Me-
dieval Universities," it seems well to point out here
that they must be considered as representing espe-
cially the surgical teaching of the older medical
school of Salerno. There are many interesting fea-
tures of the old teaching that they have embodied
in their books. For instance, at Salerno both sutures
and ligatures were employed in order to prevent
bleeding. We are rather accustomed to think of such
uses of thread, and especially the ligature, as being
much later inventions. The fact of the matter is,
however, that ligatures and sutures were reinvented
over and over again and then allowed to go out of
use until someone who had no idea of their dangers
came to reinvent them once more.1

*It seems hard to understand how so useful an auxiliary to the
surgeon as the ligature, — it seems indispensable to us, — could pos-
sibly be allowed to go out of use and even be forgotten. It will not
be difficult, however, for anyone who recalls the conditions that
obtained in old-time surgery. The ligature is a most satisfying
immediate resource in stopping bleeding from an artery, but a septic
ligature inevitably causes suppuration and almost inevitably leads
to secondary hemorrhage. In the old days of septic surgery sec-
ondary hemorrhage was the surgeon's greatest and most dreaded
bane. Some time from the fifth to the ninth day a septic ligature
came away under conditions such that inflammatory disturbance had
prevented sealing of the vessel. If the vessel was large, then the
hemorrhage was fast and furious and the patient died in a few
minutes. After a surgeon had had a few deaths of this kind he

156 OLD-TIME MAKERS OF MEDICINE

Much is often said about the place of Arabian sur-
gery and medicine at this time, and the influence
that they had over the medical teaching and think-
ing of the period. To trust many of the shorter
histories of medicine the Arabs must be given credit
for more of the medical thought of this time than any
other medical writers or thinkers. It is forgotten,
however, apparently, that in the southern part of
Italy, where Salerno was situated, Greek influence
never died out. This had been a Greek colony in
the olden time and continued to be known for many
centuries after the Christian era as Magna Graecia.
Greek medicine, then, had more influence here than
anywhere else. As a matter of fact, the beginnings
of Salernitan teaching are all Greek and not at all
Arabian. This is as true in surgery as in medicine.
I have quoted Gurlt in the chapter on " Great Sur-
geons of the Medieval Universities," insisting that
the Salernitan school owed nothing at all to Arabian
surgery. Salernitan medicine was, during the
twelfth century, just as free from Arabian influence.
When Arabian medicine makes itself felt, as pointed
out by Pagel in his " Geschichte der Heilkunde im
Mittelalter," l far from exerting a beneficial influ-

dreaded the ligature. He abandoned its use and took kindly to such
methods as the actual cautery, red-hot knives for amputations, and
the like, that would sear the surfaces of tissues and the blood-
vessels, and not give rise to secondary hemorrhage. A little later,
however, someone not familiar with secondary risks would reinvent
the ligature. If he were cleanly in his methods and, above all, if
he were doing his work in a new hospital, the ligature worked very
well for a while. If not, it soon fell into innocuous desuetude again.
'Puschmann: " Handbuch der Geschichte der Medizin," Vol. I, page
652.

THE MEDICAL SCHOOL AT SALERNO 157

ence, it had a rather unfortunate effect. It led espe-
cially to an oversophistication of medicine from the
standpoint of drug therapeutics. The Arabian
physicians trusted nature very little. In this they
were like our forefathers of medicine one hundred
years ago, of whom Bush was the typical representa-
tive— so history repeats itself.

Before the introduction of Arabian medicine the
Salernitan school of medicine was noted for its
common-sense methods and its devotion to all the
natural modes of healing. It looked quite as much
to the prevention of disease as its treatment. Diet
and air and water were always looked upon as sig-
nificant therapeutic aids. With the coming of Ara-
bian influence there began, says Pagel, " as the lit-
erature of the times shows very well, that rule of
the apothecary in therapeutics which was an unfor-
tunate exaggeration. Now all the above-mentioned
complicated prescriptions came to be the order of
the day. Apparently the more complicated a pre-
scription the better. Dietetics especially was rele-
gated to the background. Salerno, at the end of the
twelfth century, had already reached its highest
point of advance in medicine and was beginning to
decline. Decadence was evident in so far as all the
medical works that we have from that time are either
borrowings or imitations from Arabian medicine
with which eventually Salernitan medical literature
became confounded. Only a few independent au-
thors are found after this time." This is so very
different from what is ordinarily presumed to have
been the case and openly proclaimed by many his-
torians of medicine because apparently they would

158 OLD-TIME MAKERS OF MEDICINE

prefer to attribute scientific advance to the Arabs
than to the Christian scholars of the time, that it is
worth while noting it particularly.

Salerno was particularly rich in its medical lit-
erary products. Very often we have not the names
of the writers. Apparently there is good reason to
think that a number of the professors consulted to-
gether in writing a book, and when it was issued it
was considered to be a text-book of the Salernitan
school of medicine rather than of any particular pro-
fessor. This represents a development of co-opera-
tion on the part of colleagues in medical teaching
that we are likely to think of as reserved for much
later times.

The most important medical writing that comes to
us from Salerno, in the sense at least of the work that
has had most effect on succeeding generations, has
been most frequently transcribed, most often trans-
lated and committed to memory by many generations
of physicians, is the celebrated Salernitan medical
poem on hygiene. The title of the original Latin
was " Regimen Sanitatis Salernitanum. " It was
probably written about the beginning of the twelfth
century. A century or so later it came to be the cus-
tom to call medical books after flowers, and so we
had the " Lilium Medicinae " and the " Flos Medi-
cinae " down at Montpellier, and this became the
" Flos Medicinae " of Salerno. Pagel calls it the
quintessence of Salernitan therapeutics.

For many centuries portions at least of this Latin
medical poem were as common in the mouths of
physicians all over Europe as the aphorisms of Hip-
pocrates or the sayings of Galen. Probably this en-

THE MEDICAL SCHOOL AT SALERNO 159

ables us to understand the great reputation that the
Salernitan school enjoyed and the influence that it
Avielded better than anything else. The poem is di-
vided into ten principal parts, containing altogether
about 3,500 lines. The first part on hygiene has 855
lines in eight chapters. The second part on materia
medica, though containing only four chapters, has
also about 800 lines. Anatomy and physiology
are crowded into about 200 lines, etiology has some-
thing over 200, semiotics has about 250, pathology
has but thirty lines more or less, and therapeutics
about 400; nosology has about 600 more, and finally
there is something about the physician himself, and
an epilogue. As Latin verses go, when written for
such purposes, these are not so bad, though some
of them would grate on a literary ear. The whole
work makes a rather interesting compendium of
medicine, with therapeutic indications and contra-
indications, and whatever the physician of the me-
dieval period needed to have ready to memory.
Some of its prescriptions, both in the sense of
formulas and of directions to the patient, have quite
a modern air.

One very interesting contribution to medical lit-
erature that comes to us from Salerno bears the title,
" The Coming of a Physician to His Patient, or An
Instruction for the Physician Himself." We have
had a number of such works published in recent
years, but it is a little surprising to have the subject
taken up thus early in the history of modern pro-
fessional life. It is an extremely valuable document,
as demonstrating how practical was the teaching at
Salerno. The work is usually ascribed to Archi-

160 OLD-TIME MAKERS OF MEDICINE

mattheas, and it certainly gives a vivid picture of
the medical customs of the time. The instruction for
the immediate coming of the physician to his patient
runs as follows : * ' When the doctor enters the dwell-
ing of his patient, he should not appear haughty,
nor covetous, but should greet with kindly, modest
demeanor those who are present, and then seating
himself near the sick man accept the drink which is
offered him (sic) and praise in a few words the
beauty of the neighborhood, the situation of the
house, and the well-known generosity of the family,—
if it should seem to him suitable to do so. The pa-
tient should be put at his ease before the examination
begins and the pulse should be felt deliberately and
carefully. The fingers should be kept on the pulse at
least until the hundredth beat in order to judge its
kind and character; the friends standing round will
be all the more impressed because of the delay and
the physician 's words will be received with just that
much more attention. ' '

The old physician evidently realized very well how
much influence on the patient's mind meant for the
course of the disease. For instance, he recommends
that the patient should be asked to confess and re-
ceive the sacraments of the Church before the doc-
tor sees him, for if mention is afterwards made of
this the patient may believe that it is because the
doctor thinks that there is no hope for him. For
the purpose of producing an effect upon the patient's
mind, the old physician does not hesitate even to
suggest the taking advantage of every possible
source of information, so as to seem to know all about
the case. " On the way to see the sick person he

THE MEDICAL SCHOOL AT SALERNO 161

[the physician] should question the messenger who
has summoned him upon the circumstances and the
conditions of the illness of the patient; then, if not
able to make any positive diagnosis after examining
the pulse and the urine, he will at least excite the
patient's astonishment by his accurate knowledge
of the symptoms of the disease and thus win his
confidence."

At the end of these preliminary instructions there
is a rather diplomatic — to say the least — bit of ad-
vice that might perhaps to a puritanic conscience
seem more politic than truthful. Since the old pro-
fessor insists so much on not disturbing the pa-
tient's mind by a bad prognosis or any hint of it,
and since even some exaggeration of what he might
think to be the serious outlook of the case to friends
would only lead to greater care of the patient, there
is probably much more justification for his sugges-
tion than might be thought at first glance. He says,
' ' When the doctor quits the patient he should prom-
ise him that he will get quite well again, but he
should inform his friends that he is very ill ; in this
way, if a cure is affected, the fame of the doctor
will be so much the greater, but if the patient dies
people will say that the doctor had foreseen the fatal
issue."

The story of the medical school of Salerno, even
thus briefly and fragmentarily told, illustrates very
well how old is the new in education, — even in medi-
cal education. There is scarcely a phase of modern
interest in medical education that may not be traced
very clearly at Salerno though the school began its
career a thousand years ago, and ceased to attract

162 OLD-TIME MAKERS OF MEDICINE

much attention over six hundred years ago. We owe
most of our knowledge of the details of its organiza-
tion and teaching to De Renzi. Without the devo-
tion of so ardent a scholar it would have been almost
impossible for us to have attained so complete a pic-
ture of Salernitan activities. As it is, as a conse-
quence of his work we are able to see this first of
modern medical schools developing very much as do
our most modern medical schools. There has been
an accumulation of medical information in the thou-
sand years, but the ways and modes of facing prob-
lems and many of the solutions of them do not differ
from what they were in the distant past. The more
we know about any particular period, the more is this
brought home to us. It is for this that study of par-
ticular periods and institutions of the olden time, as
of Salerno, grows increasingly interesting, because
each new detail helps to iill in sympathetically the
new-old picture of human activity as it may be seen
at all times.

VII
CONSTANTINE AFEICANUS

Probably the most important representative of
the medical school at Salerno, certainly the most
significant member of its faculty, if we consider the
wide influence for centuries after his time that his
writings had, was Constantine Africanus. He is in-
teresting, too, for many other reasons, for he is the
first representative, in modern times, that is, who,
after the incentive of antiquity had passed, devoted
himself to creating a medical literature by transla-
tions, by editions, and by the collation of his own
and others' observations on medical subjects. He
is the connecting link between Arabian medicine and
Western medical studies. The fact that he was first
a traveller over most of the educational world of his
time, then a professor at the University of Salerno
who attracted many students, and finally a Bene-
dictine monk in the great abbey at Monte Cassino,
shows how his life ran the gamut of the various
phases of interest in the intellectual world of his
time. It was his retirement to the famous mon-
astery that gave him the opportunity, the leisure,
the reference library for consultation that a writer
feels he must have near him, and probably also the
means necessary for the publication of his works.
Not only did the monks of Monte Cassino itself de-

163

164 OLD-TIME MAKERS OF MEDICINE

vote themselves to the copying of his many books,
but other Benedictine monasteries in various parts
of the world made it a point to give wide diffusion
to his writings.

As a study in successful publication, that is, in
the securing of wide attention to writings within a
short time, the career of Constantine and the story
of his books would be extremely interesting.
Medieval distribution of books is usually thought to
have been rather halting, but here was an exception.
It was largely because Benedictines all over the
world were deeply interested in what this brother
Benedictine was writing that wide distribution was
secured for his work within a very short time. His
superiors among the Benedictines had a profound
interest in what he was doing. The great Bene-
dictine Abbot Desiderius of Monte Cassino, who
afterwards became Pope, used all of his extensive
influence in both positions to secure an audience for
the books — hence the many manuscript copies of
his writings that we have. It is probable that Con-
stantine established a school of writers at Monte
Cassino, for he could scarcely have accomplished so
much by himself as has been attributed to him. Be-
sides, his works attracted so much attention that
writers of immediately succeeding generations who
wanted to secure attention for their works some-
times attributed them to him in order to take ad-
vantage of his popularity. It is rather difficult,
then, to determine with absolute assurance which
are Constantine 's genuine works. Some of those
attributed to him are undoubtedly spurious. What
we know with certainty, however, is that his

CONST ANT1NE AFRICANUS 165

authentic works meant much for his own and after
generations.

Constantine was born in the early part of the elev-
enth century, and died near its close, having lived
probably well beyond eighty years of age, his years
running nearly parallel with his century. His sur-
name, Africanus, is derived from his having been
born in Africa, his birthplace being Carthage. Early
in life he seems to have taken up with ardor the
study of medicine in his native town, devoting him-
self, however, at the same time to whatever of phys-
ical science was available. Like many another
young man since his time, not satisfied with the
knowledge he could secure at home, he made distant
journeys, gathering medical and scientific informa-
tion of all kinds wherever he went. According to
a tradition that seems to be well grounded, some of
these journeys took him even into the far East.
During his travels he became familiar with a num-
ber of Oriental languages, and especially studied
the Arabian literature of science very diligently.

At this time the Arabs, having the advantage of
more intimate contact with the Greek medical tradi-
tions in Asia Minor, were farther advanced in their
knowledge of the medical sciences than the scholars
in the West. They had better facilities for obtain-
ing the books that were the classics of medicine, and,
with any desire for knowledge, could scarcely fail
to secure it.

What was best in Arabian medicine was brought
to Salerno by Constantine and, above all, his trans-
lation of many well-known Arabian medical authors
proved eminently suggestive to seriously investigat-

166 OLD-TIME MAKERS OF MEDICINE

ing physicians all over the world in his time. Be-
fore he was to be allowed to settle down to his
literary work, however, Constantine was to have a
very varied experience. Some of this doubtless was
to be valuable in enabling him to set the old Arabian
teachers of medicine properly before his generation.
After his Oriental travels he returned to his native
Carthage in order to practise medicine. It was not
long, however, before his superior medical knowl-
edge, or, at least, the many novelties of medical
practice that he had derived from his contact with
the East, drew upon him the professional jealousy
of his colleagues. It is very probable that the repu-
tation of his extensive travels and wide knowledge
soon attracted a large clientele. This was followed
quite naturally by the envy at least of his pro-
fessional brethren. Feeling became so bitter, that
even the possibility of serious personal conse-
quences for him because of false accusations was
not out of the question. Whenever novelties are
introduced into medical science or medical practice,
their authors are likely to meet with this opposition
on the part of colleagues, and history is full of ex-
amples of it. Galvani was laughed at and called the
frogs' dancing-master; Auenbrugger was made fun
of for drumming on people; Harvey is said to have
lost half of his consulting practice ; — all because they
were advancing ideas that their contemporaries
were not ready to accept. We are rather likely to
think that this intolerant attitude of mind belongs
to the older times, but it is rather easy to trace it in
our own.
In Constantine 's day men had ready to hand a

CONSTANT1NE AFRICANUS 167

very serious weapon that might be used against in-
novators. By craftily circulated rumors the pop-
ulace was brought to accuse him of magical prac-
tices, that is, of producing his cures by association
with the devil. We are rather prone to think little
of a generation that could take such nonsense seri-
ously, but it would not be hard to find analogous
false notions prevalent at the present time, which
sometimes make life difficult, if not dangerous, for
well-meaning individuals.1 Life seems to have been
made very uncomfortable for Constantine in
Carthage. Just the extent to which persecution
went, however, we do not know. About this time
Constantine 's work attracted the attention of Duke
Robert of Salerno. He invited him to become his
physician. After he had filled the position for a time
a personal friendship developed, and, as has often
happened to the physicians of kings, he became a
royal counsellor and private secretary. When the
post of professor of medicine at Salerno fell vacant,
it is not surprising, then, that Constantine should
have been made professor, and from here his teach-
ing soon attracted the attention of all the men of
his time.

Constantine seems to have greatly enhanced the
reputation of the medical school, and added to the
medical prestige of Salerno. After teaching for some
ten years there, however, he gave up his professor-
ship— the highest position in the medical world of
the time — apparently with certain plans in mind.

1 The first dentist who filled teeth with amalgam in New York,
some eighty years ago, had to flee for his life, because of a hue and
cry set up that he was poisoning his patients with mercury.

168 OLD-TIME MAKERS OF MEDICINE

He wanted leisure for writing the many things in
medicine that he had learned in his travels in the
East, so as to pass his precious treasure of knowl-
edge on to succeeding generations ; and then, too, he
seems to have longed for that peace that would
enable him not only to do his writing undisturbed,
but to live his life quietly far away from the strife
of men and the strenuous existence of a court and of
a great school.

There was probably another and more intimate
personal reason for his retirement. Abbot Desi-
derius of the Benedictine Abbey of Monte Cassino,
not far away, had become a close and valued friend.
Before having been made abbot, Desiderius and
Constantine probably were fellow professors at
Salerno, for we know that Desiderius himself and
many of his fellow Benedictines taught in the under-
graduate department there. Desiderius enjoyed
the reputation of being one of the most learned men
of the time when his election to the abbacy at Monte
Cassino took him away from Salerno. His de-
parture was a blow to Constantine, who had learned
by years of friendship that to be near his intimate
friend, the pious scholarly Benedictine, was a solace
in life and a never failing incentive to his own in-
tellectual work. Desiderius seems, indeed, to have
been a large factor in influencing the great physi-
cian to write his books rather than devote himself to
oral teaching, since the circulation of his writing
would confer so much more of benefit on a greater
number of people. Perhaps another element in the
situation was that Desiderius was desirous of hav-
ing the learned physician, the travelled scholar, at

CONSTANTINE AFRICANUS 1G9

Monte Cassino, for the sake of his influence on the
scholarship of the abbey, and for the incentive that
he would be to the younger monks to apply them-
selves to the varied field of knowledge which the
Benedictines had chosen for themselves at this time.

Whatever hopes of mutual solace and helpfulness
and of the joys of intimate close friendship may
have been in the minds of these two most learned
men of their time, they were destined to be grievously
disappointed. Only a few years after Constantine's
entrance into the monastery at Monte Cassino Desi-
derius was elected Pope. The humble Benedictine
did not want to take the exalted position, but it was
plainly shown to him that it was his duty, and that
he must not shirk it. Accordingly, under the name
of Pope Victor III, he became one of the great
Popes of the eleventh century. One might think
that he could have summoned Constantine to Rome,
but perhaps he knew that his friend would prefer
the quietude of the cloister, and then, too, probably
he wanted to allow him the opportunity to accom-
plish that writing for which Constantine and him-
self had planned when the great physician entered
the monastery.

All that we know for sure is that some twenty
years of Constantine's life were spent as a monk in
Monte Cassino, where he devoted his time mainly
to the writing of his books. One bond of union there
was. Each of the works, as soon as completed,
was sent off to the Pope as long as he lived. On
the other hand, though busy with his Papal duties,
Pope Victor constantly stimulated Constantine, even
from distant Borne, to go on with his work. There

170 OLD-TIME MAKERS OF MEDICINE

were messages of brotherly interest and solicitude
just as in the old days. The great African physi-
cian's best known work, the so-called " Liber Pan-
tegni, ' ' which is really a translation of the * ' Khitaab
el Maleki ' ' of Ali Ben el- Abbas, is dedicated to Desi-
derius. Constantine wrote a number of other books,
most of them original, but it is difficult now to de-
cide just which of those that pass under his name
are genuine. Many were subsequently attributed to
him that are surely not his.

These translators of the Middle Ages proved to
be not only the channels through which informa-
tion came to their generations, but they were also
incentives to study and investigation. It is when
men can get a certain amount of information rather
easily that they are tempted to seek further in
order to solve the problems that present themselves.
There are three great translators whose work meant
much for the Middle Ages at this time. They were,
besides Constantine in the eleventh century, Gerard
of Cremona, in the twelfth, and the Jewish Faradj
Ben Salim, at Naples, in the thirteenth. Gerard did
in Spain for the greater Arabian writers what Con-
stantine had accomplished for those of lesser im-
port. Under the patronage of the Emperor Fred-
erick Barbarossa, he published translations of
Ehazes, Isaac Judaeus, Serapion, Abulcasis, and Avi-
cenna. His work was done in Toledo, the city in
which, during the twelfth and thirteenth centuries,
so many translators were at work making books for
the Western world.

Constantine did much more than merely bring out
his translations of Arabian works. He gave a zest to

CONSTANTINE AFEICANUS 171

the study of the old masters, issued editions of cer-
tain, at least, of the works of Hippocrates (" Apho-
risms ") and Galen (" Microtechnics "), and, in gen-
eral, called attention to the precious treasure of med-
ical lore that must be used to advantage if men were
to teach the rising generation out of the accumulated
knowledge of the past. Pagel, in Puschmann's
" Handbook," does not hesitate to say that " a
farther merit of Constantine must be recognized,
inasmuch as that not long after his career the sec-
ond epoch of the school of Salerno begins, marked
not only by a wealth of writers and writings on
medicine, but, above all, because from this time on
the study of Greek medicine received renewed en-
couragement through the Latin versions of the
Arabian literature. We may think as we will of
the worth of these works, but this much is sure, that
in many ways they brought about a broadening
and an improvement of Greek knowledge, especially
from the pharmacopeia standpoint."

Probably the best evidence that we have for Con-
stantine's influence on his generation is to be found
in what was accomplished by men who acknowledged
with pride that he was their master, and who
thought it a mark of distinction to be reckoned as
his disciples.

Among these especially noteworthy is Johannes
Afflacius, or Saracenus (whose surname of the Sara-
cen probably means that he, too, came from Africa,
as his master did). He was the author of two
treatises on " Fevers and Urines," and the so-
called " Cures of Afflacius." Some of these cures he
directly attributed to Constantine. Then there is a

172 OLD-TIME MAKERS OF MEDICINE

Bartholomew who wrote a " Practica," or " Manual
of the Practice of Medicine," with the sub-title,
11 Introductions to and Experiments in the Medical
Practice of Hippocrates, Constantine, and the Greek
Physicians." Bartholomew represents himself as a
disciple of Constantine. This " Practica " of
Bartholomew was one of the most commonly used
books of the twelfth and thirteenth centuries
throughout Europe. There are manuscript com-
mentaries and translations, and abstracts from it
not only in the Latin tongues, but especially in the
Teutonic languages. Pagel refers to manuscripts
in High and Low Dutch, and even in Danish. The
Middle High Dutch manuscripts of this ' ' Practica '
of Bartholomew come mainly from the thirteenth
century, and have not only a special interest be-
cause of their value in the history of philology, but
because they are the main sources of all the later
books on drugs which appeared in very large num-
bers in German. They have a very great historico-
literary interest, especially for pharmacology.

To Afflacius we owe a description of a method of
reducing fever that is not only ingenious, but, in
the light of our recently introduced bathing methods
for fever, is a little startling. In his book on
" Fevers and Urines," Afflacius suggests that when
the patient's fever makes him very restless, and
especially if it is warm weather, a sort of shower
bath should be given to him. He thought that rain
water was the best for this purpose, and he de-
scribes its best application as in rainy fashion, modo
pluviali. The water should be allowed to flow down
over the patient from a vessel with a number of

CONSTANTINE AFRICANUS 173

minute perforations in the bottom. A number of
the practical hints for treatment given by Afflacius
have been attributed to Constantine.

Constantine's reputation has, in the opinion of
some writers, been hurt by two features of his pub-
lished works, as they have come to us, that we find
it difficult to understand. One of these is that his
translations from the Arabic were made mainly
not of the books of the great leaders of Arabian
medicine, but from certain of the less important
writers. The other is that it does not seem always
to have been made clear in the manuscripts that
have come down to us, whether these writings were
translations or original writings. Some have even
gone so far as to suggest that Constantine himself
would have been quite willing to receive the credit
for these writings.

As to the first of these objections, it may be said
that very probably Constantine, in his travels, had
come to realize that the books of the great Arabian
physicians, Rhazes, Abulcasis, Avicenna, and others,
already received so much attention that the best
outlook for medicine was to call particular notice
to the writings of such lesser lights as Ali Abbas,
Isaac JudaBus, Abu Dschafer, and others of even
less note. Certainly we cannot but feel that his
judgment in the matter must have been directed
by reasons that we may not be able to understand at
present, but that must have existed, for all that
we know of the man proves his character as a prac-
tical, far-sighted scholar. Besides, it seems not un-
likely that but for his interest in them we would not
at the present time possess the translations of these

174 OLD-TIME MAKERS OF MEDICINE

minor Arabian writers, and that would be an un-
fortunate gap in medical history.

The other misunderstanding with regard to Con-
stantine refers to the fact that it is now almost im-
possible to decide which are his own and which are
the writings of others. It has been said that he
even tried to palm off some of the writings of others
as his own. This seems extremely unlikely, how-
ever, knowing all that we do about his life ; and the
suspicion is founded entirely on manuscripts as we
have them at the present time, about a thousand
years after he lived. What mutilations these manu-
scripts underwent in the course of various copyings
is hard now to estimate. Monastic copyists might
very well have left out Arabian names, because they
were mainly interested in the fact that they were
providing for their readers works that had received
the approval of Constantine, and the translation of
which at least had been made under his direction.
It is quite clear that he did not do all the translat-
ing himself, and that he probably must have organ-
ized a school of medical translators at Monte Cas-
sino. Then just how the various works would be
looked at is very dubious. Undoubtedly many of the
translations were done after his death, or certainly
finished after his time, and at last attributed to
him, because he was the moving spirit and had prob-
ably selected the books that should be translated, and
made suggestions with regard to them. For all of
his monks he was, as masters have ever been for
disciples, much more important, and rightly so, than
those writers to whom he referred them.

The whole question of plagiarism in these

CONSTANTINE AFEICANUS 175

medieval times, as I have pointed out elsewhere, is
entirely different from that of the present time.
Now a writer may consciously or unconsciously
claim another writing as his own. We have come
to a time when men think much of their individual
reputations. It was no uncommon thing, however,
in the Middle Ages, and even later in the Renais-
sance, for a writer to attribute what he had writ-
ten to some distinguished literary man of the pre-
ceding time, and sign that writer's name to his own
work. The idea of the later author was to secure
an audience for his thoughts. He seemed to be quite
indifferent whether people ever knew just who the
writer was, but he wanted to influence humanity by
his writings. He thought much more of this than
of any possible reputation that might come to him.
Of course, there was no question of money. There
never has been any question of money-making when-
ever the things written have been really worth while.
Literature that has deeply influenced mankind has
never paid. Publications that have paid are insig-
nificant works that have touched superficially a whole
lot of people. To think of Constantine as a pla-
giarist in our modern sense of the word, as trying
to take the credit for someone else's writings, is to
misunderstand entirely the times in which he lived,
and to ignore the real problem of plagiarism at that
time.

With the accumulation of information with re-
gard to the history of medicine in his time, Con-
stantine's reputation has been constantly enhanced.
It is not so long since he was considered scarcely
more than a monkish chronicler, who happened to

176 OLD-TIME MAKERS OF MEDICINE

have taken medicine rather than history for his
field of work. Gradually we have come to appre-
ciate all that he did for the medicine of his time.
Undoubtedly his extensive travels, his wide knowl-
edge, and then his years of effort to make Oriental
medicine available for the Western civilization that
was springing up again among the peoples who had
come to replace the Eomans, set him among the
great intellectual forces of the Middle Ages.
Salerno owed much to him, and it must not be for-
gotten that Salerno was the first university of mod-
ern times, and, above all, the first medical school
that raised the dignity of the medical profession,
established standards of medical education, edu-
cated the public mind and the rulers of the time to
the realization of the necessity for the regulation
of the practice of medicine, and in many ways an-
ticipated our modern professional life. That the
better part of his life work should have been done
as a Benedictine only serves to emphasize the place
that the religious had in the preservation and the
development of culture and of education during the
Middle Ages.

vm

MEDIEVAL WOMEN PHYSICIANS

Very probably the most interesting chapter for
us of the modern time in the history of the medical
school at Salerno is to be found in the opportunities
provided for the medical education of women and
the surrender to them of a whole department in the
medical school, that of Women's Diseases. While
it is probable that Salerno did not owe its origin
to the Benedictines, and it is even possible that there
was some medical teaching there for all the cen-
turies of the Middle Ages from the Greek times, for
it must not be forgotten that this part of Italy was
settled by Greeks, and was often called Magna
Gnecia, there is no doubt at all that the Bene-
dictines exercised great influence in the counsels
of the school, and that many of the teachers were
Benedictines, as were also the Archbishops, who
were its best patrons, and the great Pope Victor III,
who did much for it. For several centuries the
Benedictines represented the most potent influence
at Salerno.

For most people who are not intimately familiar
with monastic life, and, above all, with the story
of the Benedictines, their prestige at Salerno might
seem to be enough of itself to preclude all possibility
of the education of women in medicine at Salerno.
For those who know the Benedictines well, however,

177

178 OLD-TIME MAKERS OF MEDICINE

such a departure as the accordance of opportunities
for women to study medicine would seem eminently
in keeping with the practical wisdom of their rules
and the development of their work. From the be-
ginning the Benedictines recognized that a monastic
career should be open to women as well as to men,
and Benedict's sister, Scholastica, established con-
vents for them, as her brother did the Benedictine
monasteries, thus providing a vocation for women
who did not feel called upon to marry. That the
members of the order should recognize the advisabil-
ity of affording women the opportunity to study
medicine, and of handing over to them the depart-
ment of women's diseases in a medical school in
which they had a considerable amount of authority,
seems, then, indeed, only what might have been ex-
pected of them.

We are prone in the modern time to think that
our generation is the first to offer to women any
facilities or opportunities for education in medicine.
We are prone, however, just in the same way, to
consider that a number of things that we are doing
are now being done for the first time. As a matter
of fact, it is extremely difficult to find any im-
portant movement or occupation that is not merely
a repetition of a previous interest of mankind. The
whole question of feminine education we are apt to
think of as modern, forgetting that Plato insisted
in his " Republic," as absolutely as any modern fem-
inist, that women should have the same opportuni-
ties for education as men, and that at Rome, at the
end of the Republic and the beginning of the Em-
pire, the women occupied very much the same posi-

MEDIEVAL WOMEN PHYSICIANS 179

tion in social life as our own at the present time.
Their husbands supplied the funds, and they
patronized the artists, gave receptions to the poets,
lionized the musicians, and, in general, " went after
culture " in a way that is a startling reminder of
what we are familiar with in our own time. Just as
soon as Christianity began to influence education,
women were given abundant opportunities for
higher education in all forms. In Ireland, the
first nation completely converted to Christianity,
— where, therefore, the national policy in education
could be shaped by the Church without hindrance, —
St. Brigid's school at Kildare was scarcely less
famous than St. Patrick's at Armagh. It had sev-
eral thousand students, and, to a certain extent at
least, co-education existed. In Charlemagne's time,
with the revival of education on the Continent, the
women of the Imperial Court attended the Palace
School, as well as the men. In the thirteenth cen-
tury we find women professors in every branch at
Italian universities. Some of them were at least
assistants in anatomy. The Renaissance women
were, of course, profoundly educated. In a word,
we have many phases of feminine education, though
with intervals of absolutely negative interest, down
the centuries.

There had evidently been quite a considerable
amount of opportunity, if not of actual encourage-
ment, for women in medicine, both among the Greeks
and the Romans, in the early centuries of the Chris-
tian era. Galen, for instance, quotes certain pre-
scriptions from women physicians. One Cleopatra
is said to have written a book on cosmetics. This

180 OLD-TIME MAKERS OF MEDICINE

name came afterwards to be confounded with that
of Queen Cleopatra, giving new prestige to the book,
but neither Galen nor Aetius, the early Christian
physician, both of whom quote from her work, speak
of her as anything except a medical writer. Some
monuments to women physicians from these old
times have escaped the tooth of time. There was
the tomb of one Basila, and also of a Thecla, both of
whom are said to have been physicians. Two other
names of Greek women physicians we have, Origenia
and Aspasia, the former mentioned by Galen, the
latter by Aetius in his " Tetrabiblion." Darem-
berg, the medical historian, announced in 1851 that
he had found a Greek manuscript with the title, * ' On
Women's Diseases," written by one Metrodora, a
woman physician. He promised to publish it. It
was unpublished at the time of his death, but could
not be found among his papers. There is a manu-
script on medical subjects, bearing this name, men-
tioned in the catalogue of the Greek Codices of
the Laurentian Library at Florence, but this is said
to give no indication of the time when its author
lived. We have evidence enough, however, to show
that Greek women physicians were not very rare.

The Romans imitated the Greeks so faithfully-
one might almost say copied them so closely — that it
is not surprising to find a number of Roman women
physicians. The first mention of them comes from
Scribonius Largus, in the first century after Christ.
Octavius Horatianus, whom most of us know better
as Priscian, dedicated one of his books on medicine
to a woman physician named Victoria. The dedica-
tion leaves no doubt that she was a woman in active

MEDIEVAL WOMEN PHYSICIANS 181

practice, at least in women's diseases, and it is a
book on this subject that Priscian dedicates to her.
He mentions another woman physician, Leoparda.
The word medico, for a woman physician was very
commonly used at Rome. Martial, whose epigrams
have been a source of so much information in med-
ical history, especially on subjects with regard to
which information was scanty, mentions a medica
in an epigram. Apuleius also uses the word. There
are a number of inscriptions in which women physi-
cians are mentioned. Among the Christians we find
women physicians, and Theodosia, the mother of St.
Procopius, the martyr, is said to have been very
successful in the practice of both medicine and
surgery. She is numbered among the martyrs, and
occurs in the Roman Martyrology on the 29th of
May. Father Bzowski, the Polish Jesuit, who com-
piled " Nomenclatura Sanctorum Professione Medi-
corum " (Rome, 1621; the book is usually catalogued
under the Latin form of his name, Bzovius), has
among his list of saints who were physicians by
profession a woman, St. Nicerata, who lived at Con-
stantinople in the reign of the Emperor Arcadius,
and who is said to have cured St. John Chrysostom
of a serious disease.

The organization of the department of women's
diseases at Salerno, under the care of women pro-
fessors, and the granting of licenses to women to
practise medicine, is not so surprising in the light
of this tradition among Greeks and Romans, taken
up with some enthusiasm by the Christians. We
are not sure just when this development took place.
The first definite evidence with regard to it comes

182 OLD-TIME MAKERS OF MEDICINE

in the life of Trotula, who seems to have been the
head of the department. Some of her books are
well known, and often quoted from, and she con-
tributed to a symposium on the treatment of disease,
in which there are contributions, also, from men
professors of Salerno at the time. She seems to
have flourished about the middle of the eleventh
century. Ordericus Vitalis, a monk of Utica, who
wrote an ecclesiastical history, tells of one Rudolph
Malcorona, who, in 1059, came to Utica and re-
mained there for a long time with Father Robert,
his nephew. " This Rudolph had been a student
all his life, devoting himself with great zeal to
letters, and had become famous for his visits to the
schools of France and Italy, in order to gather there
the secrets of learning. As a consequence he was
well informed not only in grammar and dialectics,
but also in astronomy and in music. He also pos-
sessed such an extensive knowledge of the natural
sciences that in the town of Salerno, where, since
ancient times, the best schools of medicine had ex-
isted, there was no one to equal him with the ex-
ception of a very wise matron."

This wise matron has been identified with Tro-
tula, many of the details of whose life have been
brought to light by De Renzi, in his " Story of the
School of Salerno." 1 According to very old tradi-
tion, Trotula belonged to the family of Ruggiero.
This was a noble family of Salerno, many of the
members of which were distinguished in their native
town at least, but the name is not unusual in Italy,

J" Storia de la Scuola di Salerno."

MEDIEVAL WOMEN PHYSICIANS 183

as readers of Dante and Boccaccio are likely to
know. It was, indeed, as common as our own
Kogers, of which it is the Italian equivalent.

De Kenzi has made out a rather good case for the
tradition that Trotula was the wife of John
Platearius I — so called because there were probably
three professors of that name. Trotula was, ac-
cording to this, the mother of the second Platearius,
and the grandmother of the third, all of them dis-
tinguished members of the faculty at Salerno.

Her reputation extended far beyond her native
town, and even Italy itself, and, in later centuries,
her name was used to dignify any form of treat-
ment for women's diseases that was being exploited.
Eutebeuf, one of the trouveres, thirteenth-century
French poets, has a description of the scene in
which one of the old herbalist doctors who used to
go round and collect a crowd by means of songs
and music, and then talk medicine to them — just as
is done even yet in many of the smaller towns of
this country — is represented as saying to the crowd
when he wants to make them realize that he is no
ordinary quacksalver, that he is one of the disciples
of the great Madame Trot of Salerno. The old-
fashioned speech runs somewhat as follows:
" Charming people: I am not one of these poor
preachers, nor the poor herbalists, who carry little
boxes and sachets, and who spread out before them
a carpet. I am the disciple of a great lady, who
bears the name of Madame Trot of Salerno. And
I would have you know that she is the wisest woman
in all the four quarters of the world."

Two books are attributed to Trotula; one bears

184 OLD-TIME MAKERS OF MEDICINE

the title, " De Passionibus Mulierum," and the other
has been called " Trotula Minor," or " Summula
Secundum Trotulam," and is a compendium of what
she wrote. This is probably due to some disciple,
but seems to have existed almost in her own time.
Her most important work bears two sub-titles,
" Trotula 's Unique Book for the Curing of Diseases
of Women, Before, During, and After Labor," and
the other sub-title, " Trotula 's Wonderful Book of
Experience (experiment alis) in the Diseases of
Women, Before, During, and After Labor, with
Other Details Likewise Relating to Labor."

The book begins with a prologue on the nature
of man and of woman, and an explanation of how
the author, taking pity on the sufferings of women,
came to devote herself to the study of their diseases.
There are many interesting details in the book, all
the more interesting because in many ways they an-
ticipate modern solutions of difficult problems in
women's diseases, and the care of the mother and
child before, during, and after labor. For instance,
there are a series of rules on the choice of the nurse,
and on the diet and the regime which she should
follow if the child is to be properly nourished with-
out disturbance.

Probably the most striking passage in her book
is that with regard to a torn perineum and its re-
pair. This passage may be found in De Renzi or in
Gurlt. It runs as follows: " Certain patients, from
the severity of the labor, run into a rupture of the
genitalia. In some even the vulva and anus be-
come one foramen, having the same course. As a
consequence, prolapse of the uterus occurs, and

MEDIEVAL WOMEN PHYSICIANS 185

it becomes indurated. In order to relieve this con-
dition, we apply to the uterus warm wine in which
butter has been boiled, and these fomentations are
continued until the uterus becomes soft, and then it
is gently replaced. After this the tear between the
anus and vulva we sew in three or four places with
silk thread. The woman should then be placed in
bed, with the feet elevated, and must retain that
position, even for eating and drinking, and all the
necessities of life, for eight or nine days. During
this time, also, there must be no bathing, and care
must be taken to avoid everything that might cause
coughing, and all indigestible materials."

There is a passage, also, almost more interesting
with regard to prophylaxis of rupture of the
perineum. She says, " In order to avoid the afore-
said danger, careful provision should be made, and
precautions should be taken during labor somewhat
as follows: A cloth should be folded in somewhat
oblong shape, and placed on the anus, so that, during
every effort for the expulsion of the child, that
should be pressed firmly, in order that there may
not be any solution of the continuity of tissue."

Her book contains, also, some directions for vari-
ous cosmetics. How many of these are original,
however, is difficult to say. Trotula's name had be-
come a word to conjure with, and many a quack in
the after time tried to make capital for his remedies
in this line by attributing them to Trotula. As a
consequence, many of these remedies gradually
found their way into the manuscript copies of her
book, and subsequent copyists incorporated them
into the text, until it became practically impossible

186 OLD-TIME MAKERS OF MEDICINE

to determine which were original. There are manu-
scripts of Trotula's work in Florence, Vienna, and
Breslau. Some of these contain chapters not in
the others, undoubtedly added by subsequent hands.
In one of these, that at Florence, from which the edi-
tion of Strasburg was printed in 1544, and of Venice,
1547, one of the Aldine issues, there is a mention in
the last chapter of spectacles. We have no record
of these until the end of the thirteenth century,
when this passage was probably added. It was also
printed at Basle, 1566, and at Leipzig as late as
1778, which would serve to show how much atten-
tion it has attracted even in comparatively recent
times.

After Trotula we have a number of women physi-
cians of Salerno whose names have come down to us.
The best known of these bear the names Constanza,
Calendula, Abella, Mercuriade, Rebecca Guarna, who
belonged to the old Salernitan family of that name,
a member of which, in the twelfth century, was
Romuald, priest, physician, and historian, Louise
Trencapilli, and others. The titles of some of their
books, as those of Mercuriade, who occupied her-
self with surgery as well as medicine, and who is
said to have written on " Crises," on " Pestilent
Fever," on " The Cure of Wounds," and of Abella,
who acquired a great reputation with her work on
" Black Bile," and on the " Nature of Seminal
Fluid," have come down to us. Rebecca Guarna
wrote on " Fevers," on the " Urine," and on the
" Embryo." The school of Salernitan women
came to have a definite place in medical literature.

While, as teachers, they had charge of the depart-

MEDIEVAL WOMEN PHYSICIANS 187

ment of women's diseases, their writings would seem
to indicate that they studied all branches of medi-
cine. Besides, there are a number of licenses pre-
served in the archives of Naples in which women
are accorded the privilege of practising medicine.
Apparently these licenses were without limitation.
In many of these mention is made of the fact that
it seems especially fitting that women should be al-
lowed to practise in women's diseases, since they
are by constitution likely to know more and to
have more sympathy with feminine ills. The
formula employed as the preamble of this license
ran as follows : " Since, then, the law permits women
to exercise the profession of physicians, and since,
besides, due regard being had to purity of morals,
women are better suited for the treatment of
women's diseases, after having received the oath of
fidelity, we permit, etc."

Salerno continued to enjoy a reputation for train-
ing women physicians thoroughly, until well on in
the fifteenth century, for we have the record of Con-
stance Calenda, the daughter of Salvator Calenda,
who had been dean of the faculty of medicine at
Salerno about 1415, and afterwards dean of the
faculty at Naples. His daughter, under the diligent
instruction of her father, seems to have obtained
special honors for her medical examination. Not
long after this, Salerno itself lost all the prestige
that it had. The Kings of Naples endeavored to
create a great university in their city in the thir-
teenth century. They did not succeed to the extent
that they hoped, but the neighboring rival institution
hurt Salerno very much, and its downfall may be

188 OLD-TIME MAKERS OF MEDICINE

traced from this time. Gradually its reputation
waned, and we have practically no medical writer of
distinction there at the end of the fourteenth cen-
tury, though the old custom of opportunities for
women students of medicine was maintained.

This custom seems also to have been transferred
to Naples, and licenses to practise were issued to
woman graduates of Naples. This never achieved
anything like the reputation in this department that
had been attained at Salerno. Salerno influenced
Bologna and the north Italian universities pro-
foundly in all branches of medicine and medical edu-
cation, particularly in surgery, as can be seen in
the chapter on " Great Surgeons of the Medieval
Universities," and the practice of allowing such
women as wished to study medicine to enter the
university medical schools is exemplified in the case
of Mondino's assistant in anatomy, Alessandra
Giliani, though there are also others whose names
have come down to us.

The University of Salerno had developed round
a medical school. It was the first of the uni-
versities, and, in connection with its medical school,
feminine education obtained a strong foothold. It
is not surprising, then, that with the further de-
velopment of universities in Italy, feminine educa-
tion came to be the rule. This rule has maintained
itself all down the centuries in Italy, so that there
has not been a single century since the twelfth in
which there have not been one or more distinguished
women teachers at the Italian universities. Uni-
versity life gradually spread westward, and Paris
came into existence as an organized institution of

MEDIEVAL WOMEN PHYSICIANS 189

learning after Bologna, and, doubtless, with some
of the traditions of Salerno in the minds of its
founders. Feminine education, however, did not
spread to the West. This is a little bit difficult to
understand, considering the reverence that the Teu-
tonic peoples have always had for their women folk
and the privileges accorded them. A single un-
fortunate incident, that of Abelard and Heloise,
seems to have been sufficient to discourage efforts
in the direction of opportunities for feminine edu-
cation in connection with the Western universities.
Perhaps, in the less sophisticated countries of the
North and West of Europe, women did not so
ardently desire educational opportunities as in Italy,
for whenever they have really wanted them, as,
indeed, anything else, they have always obtained
them.

In spite of the absence of formal opportunities
for feminine education in medicine at the Western
universities, a certain amount of scientific knowl-
edge of diseases, as well as valuable practical train-
ing in the care of the ailing, was not wanting for
women outside of Italy. The medical knowledge of
the women of northern France and Germany and
England, however, though it did not receive the
stamp of a formal degree from the university and
the distinction of a license to practise, was none the
less thorough and extensive. It came in connection
with certain offices in their own communities, held
by members of religious orders. Genuine informa-
tion with regard to what the religious were doing
during the Middle Ages was so much obscured by
the tradition of laziness and immorality, created at

190 OLD-TIME MAKERS OF MEDICINE

the time of the so-called reformation in order to
justify the confiscation of their property by those
whose one object was to enrich themselves, that we
have only come to know the reality of their life and
accomplishments in comparatively recent years.
We now know that, besides being the home of most
.of the book knowledge of the earlier Middle Ages,
the monasteries were the constant patrons of such
practical subjects as architecture, agriculture in all
its phases, especially irrigation, draining, and the
improvement of land and crops; of art, and even
what we now know as physical science. Above all,
they preserved for us the old medical books and
carried on medical traditions of practice. The
greatest surprise has been to find that this was
true not only for the monks, but also for the
nuns.

One of the most important books on medicine that
has come to us from the twelfth century is that of a
Benedictine abbess, since known as St. Hildegarde,
whose life was spent in the Rhineland. Her works
serve to show very well that in the convents of the
tenth, eleventh, and twelfth centuries there was
much more of interest in things intellectual than we
have had any idea of until recent years, and that,
indeed, one of the important occupations of convent
life was the serious study of books of all kinds, some
of them even scientific, as well as the writing of
works in all departments. The century before St.
Hildegarde there is the record of Hroswitha, who
wrote a series of dramas in imitation of Terence,
that were meant to replace, for the monks and nuns
of that period, the reading of that rather too human

MEDIEVAL WOMEN PHYSICIANS 191

author. Hroswitha, like Hildegarde, was a German,
and we have the record, also, of another religious
writer, abbess of the Odilian Cloister, at Hohenberg,
who wrote a book called " Hortus Deliciarum, the
Garden of Delights," a book of information on
many subjects not unlike our popular encyclopedias
of the modern time, the title of which shows that
the place of information in life was considered to be
the giving of pleasure. While this work deals
mainly with Biblical and theological and mystical
questions, there are many purely scientific passages
and many subjects of strictly medical interest
treated.

The life of the Abbess Hildegarde is worthy of
consideration, because it illustrates the period and
makes it very clear that, in spite of the grievous
misunderstanding of their life and work, so com-
mon in the modern time, these old-time religious
had most of the interests of the modern time, and
pursued them with even more than modern zeal
and success, very often. Her career illustrates
very well what the foundation of the Benedictines
had done for women. When St. Benedict founded
his order for men, his sister, Scholastica, wanted
to do a similar work for women. We know that
the Benedictine monks saved the old classics for
us, kept burning the light of the intellectual life,
and gave a refuge to men who wanted to devote
themselves in leisure and peace to the things of
the spirit, whether of this world or the other. We
have known much less of the Benedictine nuns un-
til now the study of their books shows that they
provided exactly the same opportunities for women

192 OLD-TIME MAKERS OF MEDICINE

and furnished a vocation, a home, an occupation of
mind, and a satisfaction of spirit for the women
who, in every generation, do not feel themselves
called to be wives and mothers, but who want to
live their lives for others rather than for them-
selves and their kin, seeking such development of
mind and of spirit as may come with the leisure and
peace of celibacy.

Hildegarde was born of noble parents at Bockel-
heim, in the county of Sponheim, about the end of
the eleventh century (probably 1098). In her eighth
year she went for her education to the Benedictine
cloister of Disibodenberg. When her education was
finished, she entered the cloister, of which, at the age
of about fifty, she became abbess. Her writings,
reputation for sanctity, and her wise saintly rule
attracted so many new members to the community
that the convent became overcrowded. Accord-
ingly, with eighteen of her nuns, Hildegarde with-
drew to a new convent at Rupertsberg, which Eng-
lish and American travellers will remember because
it is not far from Bingen on the Ehine. Here she
came to be a centre of attraction for most of the
world of her time. She was in active correspond-
ence with nearly every important man of her gen-
eration. She was an intimate friend of Bernard of
Clairvaux, who was himself, perhaps, the most in-
fluential man in Europe in this century. She was in
correspondence with four Popes, and with the Em-
perors Conrad and Frederick I, and with many dis-
tinguished archbishops, abbots, and abbesses, and
teachers and teaching bodies of various kinds. These
correspondences were usually begun by her corre-

MEDIEVAL WOMEN PHYSICIANS 193

spondents, who consulted her because her advice
in difficult problems was considered so valu-
able.

In spite of all this time-taking correspondence,
she found leisure to write a series of books, most
of them on mystical subjects, but two of them on
medical subjects. The first is called " Liber Sim-
plicis Medicine," and the second " Liber Composite
Medicinae." These books were written in order to
provide information mainly for the nuns who had
charge of the infirmaries of the monasteries of the
Benedictines. Almost constantly someone in the
large communities, which always contained aged re-
ligious, was ailing, and then, besides, there were
other calls on the time and the skill of the sister
infirmarians. There were no hotels at that time,
and no hospitals, except in the large cities. There
were always guest houses in connection with
monasteries and convents, in which travellers were
permitted to pass the night, and given what they
needed to eat. There are many people who have
had experiences of monastic hospitality even in our
own time. Sometimes travellers fell ill. Not in-
frequently the reason for travelling was to find
health in some distant and fabulously health-giving
resort, or at the hands of some wonder-working
physician. Such high hopes are nearly always set
at a distance. This of itself must have given not
a little additional need for knowledge of medicine
to the infirmarians of convents and monasteries.
There were around many of the monasteries, more-
over, large estates; often they had been cleared and
made valuable by the work of preceding genera-

194 OLD-TIME MAKERS OF MEDICINE

tions of monks, and on these estates peasants came
to live. Workingmen and workingwomen from
neighboring districts came to help at harvest time,
and, after a chance meeting, were married and
settled down on a little plot of ground provided
for them near the monastery. As these communi-
ties grew up, they looked to the monasteries and
convents for aid of all kinds, and turned to them
particularly in times of illness. The need for
definite instruction in medicine on the part of a
great many of the monks and nuns can be readily
understood, and it was this need that Hildegarde
tried to meet in her books. The first of her books
that we have mentioned, the " Liber Simplicis
Medicinae," attracted attention rather early in the
Renaissance, and was deemed worthy of print. It
was edited at the beginning of the sixteenth century
by Dr. Schott at Strasburg, under the title,
" Physica S. Hildegardis." Another manuscript
of this part was found in the library of Wolfenbut-
tel, in 1858, by Dr. Jessen. This gave him an in-
terest in Hildegarde 's contributions to medicine,
and, in 1859, he noted in the library at Copenhagen
a manuscript with the title " Hildegardi Curae et
Causoa." On examination, he was sure that it was
the " Liber Composite Medicinae " of the saint.
The first work consists of nine books, treating of
plants, elements, trees, stones, fishes, birds,
quadrupeds, reptiles, and metals, and is printed in
Migne's " Patrologia," under the title " Subtilita-
tum Diversarum Naturarum Libri Novem." The
second, in five books, treats of the general diseases
of created things, of the human body and its ail-

MEDIEVAL WOMEN PHYSICIANS 195

ments, of the causes, symptoms, and treatment of
diseases.

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

Dr. Melanie Lipinska, in her " Histoire des
Femmes Medecins," a thesis presented for the doc-

196 OLD-TIME MAKERS OF MEDICINE

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

Some of Hildegarde's anticipations of modern
ideas are, indeed, surprising enough. For instance,
in talking about the stars and describing their
course through the firmament, she makes use of a
comparison that is rather startling. She says:
* * Just as the blood moves in the veins which causes

MEDIEVAL WOMEN PHYSICIANS 197

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

It is no wonder that Mile. Lipinska thinks St.
Hildegarde the most important medical writer of her
time. Reuss, the editor of the edition of Hilde-
garde published in Migne's " Patrology," says:
" Among all the saintly religious who have prac-
tised medicine or written about it in the Middle
Ages, the most important is without any doubt St.
Hildegarde. . . . " With regard to her book he
says : ' ' All those who wish to write the history of
the medical and natural sciences must read this work
in which this religious woman, evidently well
grounded in all that was known at that time in the

198 OLD-TIME MAKERS OF MEDICINE

secrets of nature, discusses and examines carefully
all the knowledge of the time." He adds, "It is
certain that St. Hildegarde knew many things that
were unknown to the physicians of her time. ' '

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

Nicaise, in the introduction to his edition of

MEDIEVAL WOMEN PHYSICIANS 199

Guy de Chauliac's " Grande Chirurgie," reviews
briefly the history of women in medicine, and con-
cludes :

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

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

" Guy de Chauliac speaks also of women who
practised surgery. They formed the fifth and last
class of operators in his time. He complains that
they are accustomed to too great an extent to give
over patients suffering from all kinds of maladies

200 OLD-TIME MAKERS OF MEDICINE

to the will of Heaven, founding their practice on
the maxim * The Lord has given as he has pleased;
the Lord will take away when he pleases; may the
name of the Lord be blessed.'

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

Just how the lack of interest in medical education
for women gradually deepened, until there was al-
most a negative phase of it, only a few women in
Italy devoting themselves to medicine, is hard to
say. It is one of the mysteries of the vicissitudes
of human affairs that ups and downs of interest in
things practical as well as intellectual keep con-
stantly occurring. The number of discoveries and
inventions in medicine and surgery that we have
neglected until they were forgotten, and then had
to make again, is so well illustrated in chapters of
this book, that I need only recall them here in gen-
eral. It may seem a little harder to understand
that so important a manifestation of interest in
human affairs as the education and licensure of
women physicians should not only cease, but pass
entirely out of men's memory, yet such apparently
was the case. It would not be hard to illustrate, as
I have shown in " Cycles of Feminine Education
and Influence " in " Education, How Old the New "
(Fordham University Press, 1910), that corre-

MEDIEVAL WOMEN PHYSICIANS 201

spending ups and downs of interest may be traced in
the history of feminine education of every kind.
In that chapter I have discussed the possible rea-
sons for these vicissitudes, which have no place here,
but I may refer those who are interested in the
subject to that treatment of it.

IX

MONDINO AND THE MEDICAL SCHOOL OF
BOLOGNA

The most important contributions to medical sci-
ence made by the Medical School of Salerno at the
height of its development were in surgery. The
text-books written by men trained in her halls or
inspired by her teachers were to influence many
succeeding generations of surgeons for centuries.
Salerno 's greatest legacy to Bologna was the group
of distinguished surgical teachers whose text-books
we have reviewed in the chapter, " Great Surgeons
of the Medieval Universities." Bologna herself was
to win a place in medical history, however, mainly in
connection with anatomy, and it was in this depart-
ment that she was to provide incentive especially
for her sister universities of north Italy, though
also for Western Europe generally. The first
manual of dissection, that is, the first handy volume
giving explicit directions for the dissection of human
cadavers, was written at Bologna. This was scat-
tered in thousands of copies in manuscript all over
the medical world of the fourteenth and early fif-
teenth centuries. Even after the invention of print-
ing, many editions of it were printed. Down to the
sixteenth century it continued to be the most used
text-book of anatomy, as well as manual of dissec-
tion, which students of every university had in hand

202

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 203

when they made their dissection, or wished to pre-
pare for making it, or desired to review it after the
body had been taken away, for with lack of proper
preservative preparation, bodies had to be removed
in a comparatively short time. Probably no man
more influenced the medical teaching of the four-
teenth and fifteen centuries than Mundinus, or, as
he was called in the Italian fashion, Mondino, who
wrote this manual of dissection.

Mundinus quern omnis studentium universitas
colit ut deum (Mundinus, whom all the world of stu-
dents cultivated as a god), is the expression by
which the German scholar who edited, about 1500,
the Leipzig edition of Mundinus' well-known
manual, the Anathomia, introduces it to his readers.
The expression is well worth noting, because it
shows what was still the reputation of Mundinus in
the medical educational world nearly two centuries
after his death.1

Until the time of Vesalius, whose influence was
exerted about the middle of the sixteenth century,
Mondino was looked up to by all teachers as
the most important contributor to the science of

1 It is probably interesting to note that the word universitas as used
here has no reference to our word university, but refers to the whole
world of students as it were. In the Middle Ages universities were
called studio, generalia, general studies — that is, places where everything
could be studied and where everyone from any part of the world could
study. Our use of the word university in the special modern sense
of the term comes from the formal mode of address to the faculty of a
university when Popes or rulers sent them authoritative documents.
Such documents began with the expression Universitas vestra, all of
you (in the old-time English, as preserved in the Irish expression, " the
whole of ye"), referring to all the members of the faculty. The transfer
to our term and signification university was not difficult.

204 OLD-TIME MAKERS OF MEDICINE

anatomy in European medicine since the Greeks.
He owed his reputation to two things: his book, of
which we have already spoken, and then, the fact
that he reintroduced dissection demonstrations as
a regular practice in the medical schools. His book
is really a manual of making anatomical prepara-
tions for demonstration purposes. These demon-
strations had to be hurried, owing to the rapid de-
composition of material consequent upon the lack
of preservatives. The various chapters were pre-
pared with the idea of supplying explicit directions
and practical help during the anatomical demonstra-
tions, so that these might be made as speedily as
possible. The book does not comprise much that
was new at that time, but it is a good compendium of
previous knowledge, and contains some original ob-
servations. It was entirely owing to its form as a
handy manual of anatomical knowledge and, besides,
because it was an incentive to the practice of human
dissection, that it attained and maintained its pop-
ularity.

Mondino followed Galen, of course, and so did
every other teacher in medicine and its allied sci-
ences, until Vesalius' time. Even Vesalius permit-
ted himself to be influenced overmuch by Galen at
points where we wonder that he did not make his
observations for himself, since, apparently, they
were so obvious. The more we know of Galen,
however, the less surprised are we at his hold over
the minds of men. Only those who are ignorant of
Galen's immense knowledge, his practical common
sense, and the frequent marvellous anticipations of
what we think most modern, affect to despise him.

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 205

His works have never been translated into any
modern language except piecemeal, there is no com-
plete translation, and one must be ready to delve
into some large Latin, if not Greek, volumes to
know what a marvel of medical knowledge he was,
and how wise were the men who followed him
closely, though, being human, there are times when
necessarily he failed them.

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

Mondino di Liucci, or Luzzi, is usually said to
have been born about 1275. His first name is a
diminutive for Baimondo. It used to be said of
him that, like many of the great men of history,
many cities claimed to be his birthplace. Five were

206 OLD-TIME MAKERS OF MEDICINE

particularly mentioned — Florence, Milan, Bologna,
Forli, and Friuli. There is, however, another Mon-
dino, a distinguished physician, who was born and
lived at Friuli, and it is because of confusion with
him that the claim for Friuli has been set up.
Florence and Milan are considered out of the ques-
tion. Mondino was probably born in or near Bo-
logna. The fact that there should have been this
multiple set of claims shows how much was thought
of him. Indeed, his was the best known name in the
medical schools of Europe for nearly two centuries
and a half. He seems to have been a particularly
brilliant student, for tradition records that he had
obtained his degree of doctor of medicine when he
was scarcely more than twenty. This seems quite
out of the question for us at the present time, but
we have taken to pushing back the time of gradua-
tion, and it is not sure whether this is, beyond
peradventure, so beneficial as is usually thought.

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

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 207

Mondino came from a family that had already dis-
tinguished itself in medicine at Bologna. His uncle
was a professor of physic at the university. His
father, Albizzo di Luzzi, seems to have come from
Florence not long after the middle of the thirteenth
century, for the records show that, about 1270, he
formed a partnership with one Bartolommeo Raineri
for the establishment of a pharmacy at Bologna.
Later this passed entirely under the control of the
Mondino family, and came to be known as the
Spezieria del Mondino. In it were sold, besides
Eastern perfumes, spices, condiments, probably all
sorts of toilet articles, and even rugs and silks and
feminine ornaments. The stricter pharmacy of the
earlier times developed into a sort of department
store, something like our own. The Mondini, how-
ever, insisted always on the pharmacy feature as a
specialty, and the fact was made patent to the gen-
eral public by a sign with the picture of a doctor on
it. This drug shop of the Mondini continued to be
maintained as such, according to Dr. Pilcher, until
the beginning of the nineteenth century.1

One of the fellow students of Mondino at the Uni-
versity of Bologna had been Mondeville. He came
from distant France to take a course in surgery with

1 Physicians wore a particular garb consisting of a cloak and often
a mask, supposed to protect them from infections at this time, so
that it was not difficult to make a characteristic picture as a sign for
a pharmacy. These symbolic signs were much commoner and very
necessary when people generally were not able to read. It is from
that period that we have the mortar and pestle as also the colored
lights in the windows of the drug stores, and the many-colored
barber-pole. Also the big boot, key, watch, hat, bonnet, and the
like, the last symbolic sign invention apparently being the wooden
Indian for the tobacco store.

208 OLD-TIME MAKERS OF MEDICINE

Theodoric, whose high reputation in the olden time,
vague with us half a century ago, is now amply
justified by what we know of him from such ardent
students and admirers as Pagel and Nicaise. Not
long after Mondino's death, Guy de Chauliac came
from France to reap similar opportunities to these,
which had proved so fruitful for Mondeville. The
more that we learn about this time the more do we
find to make it clear how deeply interested the gen-
eration was in education in every form, artistic,
philosophic, but, also, though this is often not
realized, scientific.

The long distances, so much longer in that time
than in ours, to which men were willing, and even
anxious, to go, in order to obtain opportunities for
research, and to get in touch with a special master,
the associations with stimulating fellow pupils of
other lands, the scientific correspondences, almost
necessarily initiated by such circumstances, all in-
dicate an enthusiasm for knowledge such as we have
not been accustomed to attribute to this period. On
the contrary, we have been rather inclined to think
them neglectful of all education, and have, above all,
listened acquiescently while men deprecated the
lack of interest in things scientific displayed by
these generations. Indeed, many writers have gone
out of their way to find a reason for the supposed
lack of interest in science at this time, and have
proclaimed the Church's opposition to scientific edu-
cation and study as the cause.

At this time Italy was the home of the graduate
teaching for all Europe. The Italian Peninsula con-
tinued to be the foster-mother of the higher educa-

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 209

tion in letters and art, but also, though this is less
generally known, in science, for the next five cen-
turies. Germany has come to be the place of pil-
grimage for those who want higher opportunities
in science than can be afforded in their own coun-
try only during the latter half of the nineteenth
century. France occupied it during the first half
of the nineteenth century. Except for short inter-
vals, when political troubles disturbed Italy, as
about the middle of the fourteenth century, when
the removal of the Popes to Avignon brought their
influence for education over to France and a short
period at the beginning of the eighteenth century,
when the Netherlands for a time came into educa-
tional prominence, Italy has always been the
European Mecca for advanced students. Prac-
tically all our great discoverers in medicine, until
the last century, were either Italians, or else had
studied in Italy. Mondino, Bertrucci, Salicet, Lan-
franc, Baverius, Berengarius, John De Vigo, who
first wrote on gun-shot wounds ; John of Arcoli, first
to mention gold filling and other anticipations of
modern dentistry; Varolius, Eustachius, Caesal-
pinus, Columbus, Malpighi, Lancisi, Morgagni, Spal-
lanzani, Galvani, Volta, were all Italians. Monde-
ville, Guy de Chauliac, Linacre, Vesalius, Harvey,
Steno, and many others who might be named, all
studied in Italy, and secured their best opportunities
to do their great work there.

It would be amusing, if it were not amazing, to
have serious writers of history in the light of this
plain story of graduate teaching of science in Italy
for over five centuries, write about the opposition of

210 OLD-TIME MAKERS OF MEDICINE

the Church to science during the Medieval and
Renaissance periods. It is particularly surprising
to have them talk of Church opposition to the med-
ical sciences. The universities of the world all had
their charters from the Popes at this time, and were
all ruled by ecclesiastics, and most of the students
and practically all of the professors down to the
end of the sixteenth century belonged to the clerical
order. The universities of Italy were all more di-
rectly under the control of ecclesiastical authority
than anywhere else, and nearly all of them were
dominated by papal influence. Bologna, while do-
ing much of the best graduate work in science, espe-
cially in medicine, was, in the Papal States, abso-
lutely under the rule of the Popes. The university
was, practically, a department of the Papal govern-
ment. The medical school at the University of
Rome itself was for several centuries, at the end of
the Middle Ages, the teaching-place where were as-
sembled the pick of the great medical investigators,
who, having reached distinction by their discoveries
elsewhere, were summoned to Rome in order to add
prestige to the Papal University. All of them be-
came special friends of the Popes, dedicated their
books to them, and evidently looked to them as
beneficent patrons and hearty encouragers of
original scientific research.

"While this is so strikingly true of medical science
as to make contrary declarations in the matter ut-
terly ridiculous, and to suggest at once that there
must be some motive for seeing things so different
to the reality, the same story can be told of graduate
science in other departments. It was to Italy that

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 211

men came for special higher studies in mathematics
and astronomy, in botany, in mineralogy, and in ap-
plied chemistry, so far as it related to the arts of
painting, illuminating, stained-glass making, and the
like. No student of science felt that he had quite
exhausted the opportunities for study that were pos-
sible for him until he had been down in Italy for
some time. To meet the great professors in Italy
was looked on as sure to be a source of special in-
centive in any department of science. This is com-
ing to be generally recognized just in proportion
as our own interest in the arts and crafts, and in
the history of science, leads us to go carefully into
the details of these subjects at first hand. The
editors of the " Cambridge Modern History," in
their preface, declared ten years ago that we can
no longer accept with confidence the declaration of
any secondary writer on history. This is par-
ticularly true of the medieval period. We must go
back to the writers of those times.

If it seems surprising that the University of Bo-
logna should have come into such great prominence
as an institute for higher education at this time, it
would be well to recall some of the great work that
is being done in this part of Italy in other depart-
ments at this time. Cimabue laid the foundation of
modern art towards the end of the thirteenth cen-
tury, and during Mondino's life Giotto, his pupil,
raised an artistic structure that is the admiration
of all generations of artists since. Dante's years
are almost exactly contemporary with those of
Giotto and of Mondino. If men were doing such
wondrous work in literature and in art, why should

212 OLD-TIME MAKERS OF MEDICINE

not the same generation produce a man who will ac-
complish for the practical science of medicine what
his friends and contemporaries had done in other
great intellectual departments.

In recent years we have come to think much more
of environment as an influence in human develop-
ment and accomplishment than was the custom some-
time ago. The broader general environment in
Italy, with genius at work in other departments, was
certainly enough to arouse in younger minds all
their powers of original work. The narrower en-
vironment at Bologna itself was quite as stimulat-
ing, for a great clinical teacher, Taddeo Alderotti,
had come, in 1260, from Florence to Bologna, to take
up there the practice and teaching of medicine. It
was under him that Mondino was to be trained for
his life work.

To understand the place of Mondino, and of the
medical school of Bologna, in his time, and the repu-
tation that came to them as world teachers of medi-
cine, we must know, first, this great teacher of Mon-
dino and the atmosphere of progressive medicine
that enveloped the university in the latter half of
the thirteenth century. In the chapter on " Great
Surgeons of the Medieval Universities ' ' we call par-
ticular attention to the series of distinguished men,
the first four of whom were educated at Salerno, and
who came to Bologna to teach surgery. They were
doing the best surgery in the world, much better
than was done in many centuries after their time;
indeed, probably better than at any period down to
our own day. Besides, they seem to have been mag-
netic teachers who attracted and inspired pupils.

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 213

We have the surgical contributions of a series of
men, written at Bologna, that serve to show what
fine work was accomplished. At this time, however,
the field of medicine was not neglected, though we
have but a single great historical name in it that has
lived. This was Taddeo Alderotti, a man who lifted
the medical profession as high in the estimation of
his fellow citizens at Florence as the great painters
and literary men of his time did their depart-
ments, and who then moved to Bologna, because of
the opportunity to teach afforded him by the uni-
versity.

It is sometimes a little difficult for casual students
of the time to understand the marvellous repu-
tation acquired by this medieval physician. It
should not be, however, when we recall the enthusi-
astic reception and procession of welcome accorded
to Cimabue's Madonna, and the almost universal
acclaim of the greatness of Dante's work, even in
his own time. In something of that same spirit Bo-
logna came to appreciate Taddeo, as he is familiarly
known, looked upon him as a benefactor of the com-
munity, and voted to relieve him of the burden of
paying taxes. He came to be considered as a pub-
lic institution, whose presence was a blessing to his
fellow citizens, and whose goodness to them should
be recognized in this public way. One is not sur-
prised to hear Villani, the well-known contemporary
historian, speak of him as the greatest physician hi
Christendom.

The feelings of the citizens of Bologna, it may
well be confessed, were not entirely unselfish, or
due solely to the desire to encourage a great sci-

214 OLD-TIME MAKEES OF MEDICINE

entific genius. Few men of his generation had done
more for the city in a material way quite apart from
whatever benefits he conferred upon the health of
its citizens than Dr. Taddeo. It was he who or-
ganized medical teaching in the city on such a plane
that it attracted students from all over the world.
Bologna had had a great law school before this,
founded by Irnerius, to which students had come
from all over the world. With the advent of Tad-
deo from Florence, and his success as a medical
practitioner, there began to flock to his lectures
many students who spread his fame far and wide.
The city council could scarcely do less than grant the
same privileges to the medical students and teachers
of Taddeo 's school as they had previously accorded
to the faculty of law and its students. The city
council recognized quite as clearly as any board of
aldermen in the modern time how much, even of
material benefit, a great university was to the build-
ing up of a city, though their motives were prob-
ably much higher than that, and their enlightened
policy had its reward in the rapid growth of Bo-
logna until, very probably at the end of the thir-
teenth century, it had more students than any uni-
versity of the modern time. The number was not
less than fifteen thousand, and may have been twenty
thousand.

To this great university success Taddeo and his
medical school contributed not a little. The espe-
cially attractive feature of his teaching seems to
have been its eminent practicalness. He himself
had made an immense success of the practice of
medicine, and accumulated a great fortune, so much

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 215

so that Dante, in his " Paradise," when he wishes to
find a figure that would represent exactly the op-
posite to what St. Dominic, the founder of the
Dominicans, did for the love of wisdom and hu-
manity, he takes that of Taddeo, who had accom-
plished so much for personal reputation and
wealth.

This might easily lead to the impression that
Taddeo 's teaching was unscientific, or merely em-
piric, or that he himself was a narrow-minded maker
of money, intent only on his immediate influence,
and hampered by exclusive devotion to practical
medicine. Nothing could be farther from the truth
than any such impression. Taddeo was not only the
head of a great medical school, a great teacher whom
his students almost worshipped, a physician to whom
patients flocked because of his marvellous success,
a fine citizen of a great city, whom his fellow citizens
honored, but he was a broad-minded scholar, a
philosopher, and even an author in branches apart
from medicine.

In that older time it was the custom to combine
the study of philosophy and medicine. For cen-
turies after that period in Italy it was the custom
for men to take both degrees, the doctorate in
philosophy and in medicine at the same time. In-
deed, most of those whose work has made them
famous, down to and including Galvani, did so.
Taddeo wrote commentaries on the works of Hip-
pocrates and Galen, but he also translated the
ethics of Aristotle, and did much to make the learn-
ing of the Arabs easily available for his students.
His was a broad, liberal scholarship. Dr. Lewis

216 OLD-TIME MAKERS OF MEDICINE

Pilcher, in his article on " The Mondino Myth,"1
does not hesitate to say that " to the spirit which,
from his professorial chair, Taddeo infused into the
teaching and study of medicine undoubtedly is due
the high position which for many generations there-
after the school of Bologna continued to maintain as
a centre of medical teaching. ' '

Of course, erudition had its revenge, and carried
Taddeo too far. The difficult thing in human
nature is to stay in the mean and avoid exaggera-
tion. His methods of illustrating medical truths
from many literary and philosophical sources often
caused the kernel of observation to be hidden be-
neath a blanket of speculation or, at least, to be
concealed to a great extent. Even the Germans,
who have insisted most on this unfortunate tendency
of Taddeo, have been compelled to confess that there
is much that is valuable in what he accomplished,
and that even his modes of expression were not
without a certain vivacity which attracted atten-
tion and doubtless added materially to his success
as a teacher. Pagel, in Puschmann's " Handbuch,"
says : * * It cannot be denied rthis is just after he has
quoted a passage of Taddeo with regard to dreams]
that Taddeo 's expressions have a certain liveliness
all their own that gives us some idea why he was
looked upon as so good a teacher, a teacher who, as
we know now, also gave instruction by the bedside
of patients. ' ' Pagel adds, * ' Taddeo 's greatest merit
and his highest significance in medical education
consist in the fact that a great many (zahlreiche)

1 The Medical Library and Historical Journal, Brooklyn, December,
1906.

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 217

physicians followed directly in his footsteps and
were counted as his pupils. They were all men, as
we know them, who as writers and practitioners of
medicine succeeded in going far beyond the level of
mediocrity in what they accomplished. ' '

This was the teacher who most influenced young
Mondino when he came to the University of Bo-
logna, for it seems not unlikely that as a medical
student he was actually the pupil of Taddeo, then
in a vigorous old age. If not, he was at least brought
under the direct influence of the teaching tradition
created during more than thirty years by that won-
derful old man. Knowing what we do of Taddeo it
is not surprising that his pupil should have accom-
plished work that was to influence succeeding gen-
erations more than any other of that wonderful
thirteenth century. Dr. Pilcher in the article on
11 The Mondino Myth," so often placed under contri-
bution in this sketch, says that " It needs no great
stretch of the imagination to picture somewhat of
the effect that contact with such a man as Taddeo di
Alderotto * might have, in molding the character of
his young neighbor and pupil, the chemist's son, who
a few years later, by his devotion to the study of
human anatomy, was to re-establish the practical

1 Taddeo, who was born in 1215, according to our usually accepted
traditions in the matter, would have been seventy-five years of age
when Mondino as a youth of scarcely more than fifteen went to
the University. It might seem that so old a man would have very
little influence over the young man. Taddeo, however, had, as we
have said, a very strenuous old age. Everything in life had come to
him late. He was well past thirty before he began to study philoso-
phy and medicine, having been a seller of candles from necessity be-
cause of poverty in his younger years. His great success in practice
came when he was past forty. He first began to teach when he was

218 OLD-TIME MAKERS OF MEDICINE

pursuit of study on the human cadaver as the com-
mon privilege of the skilled physician, and was to
engrave his own name deeply on the records of
medicine. ' '

Under this worthy compatriot and contemporary
of the great Florentines, Mondino was inspired to be
the teacher that did so much for Bologna. Until
recent years it has usually been the custom to give
too much significance to the work of the men whose
names stand out most prominently in the early his-
tory of departments of the intellectual life. Mon-
dino's reputation has shared in this exaggerative
tendency to some extent, hence the necessity for
realizing what was accomplished before his time and
the fact that he only stands as the culmination of a
progressive period. Carlyle spoke of Dante as the
man in whom " ten silent centuries found a voice."
The centuries, however, were only silent because the
moderns did not know how to listen to their mes-
sage. We know now that every country in Europe
had a great contributor to literature in the century
before Dante. The Cid, the Arthur Legends, the
Nibelungen, the Troubadours, naturally led up to
Dante. He was only the culmination of a great period

forty-five, and he was nearly fifty-five before he began to write.
According to tradition he married when he was nearly eighty — •
whether for the first or second time is not said — and while this might
be considered, and would in some cases be, an indication of weak-
ness of character (it would probably depend on whether he married
or was married), it seems in his case to have indicated a vigor of
body and character which shows very clearly how great was the pos-
sibility of his influence as a teacher having been maintained even
up to this late time of life, and thus influencing a pupil who is to
represent the most potent influence at the beginning of the next
century.

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 219

of literature. We know now that men had worked
in art before Cimabue and Giotto, and had done im-
pressive work that made for the progress of art.
These names, however, have come to represent in
many minds the sort of solitary phenomena that
Dante has seemed sometimes even to scholars.

Because Mondino did such good work in medical
teaching it is sometimes declared, even in rather seri-
ous histories, that he was the first to accomplish any-
thing in his department, and that before his time
there is a blank. Some historians, for instance, have
insisted that Mondino was the first to do human dis-
sections, and that he did at most but two or three.
Only those who are unacquainted with the magnifi-
cent development of surgery that took place during
the preceding century, the evidence for which is so
abundantly given in modern historians of medicine
and especially in Grurlt's great work on the history
of surgery, from which we have quoted enough to
give a good idea of the extent to which the move-
ment went, are likely to accept any such declaration.
There could not have been all that successful sur-
gery without much dissection not only of animals
but also of human bodies. The teaching of dissec-
tion was not regularly organized until Mondino 's
time, but it seems very clear that even he must have
dissected many more bodies than the number usually
attributed to him. Professor Lewis Stephen Pilcher
of Brooklyn, who made a special study of Mondino
traditions in Bologna itself, and collected some of the
early editions of his books, feels so acutely the ab-
surdity of the ordinarily accepted tradition in this
matter, that he has written a paper on the subject

220 OLD-TIME MAKEES OF MEDICINE

bearing the suggestive title, " The Mondino Myth."
He says : *

" We are accustomed to think cf the practice of
dissection as having been re-created by Mondino, and
at once fully developed, springing into acceptance.
The year 1315 is the generally accepted date for the
first public anatomical demonstration upon a human
body made by Mondino, and yet it is true that among
the laws promulgated by Frederick II, more than
seventy-five years before (A.D. 1231), was included
a decree that a human body should be dissected at
Salernum at least once in five years in the presence
of the assembled physicians and surgeons of the
kingdom, and that in the regulations established for
admission to the practice of medicine and surgery
in the kingdom it was decreed that no surgeon should
be admitted to practise unless he should bring testi-
monials from the masters teaching in the medical
faculty, that he was ' learned in the anatomy of
human bodies, and had become perfect in that part
of medicine without which neither incisions could
safely be made nor fractures cured.'

" Salernum was notable in its legalization of the
dissection of human bodies before the first public
work of Mondino, for, according to a document of
the Maggiore Consiglio of Venice of 1308, it appears
that there was a college of medicine at Venice which
was even then authorized to dissect a body every
year. Common experience tells us that the embodi-
ment of such regulations into formal law wrould
occur only after a considerable preceding period of
discussion, and in this particular field of clandestine
practice. It is too much to ask us to believe that
in all this period, from the date of the promulgation
of Frederick's decree of 1231 to the first public dem-
onstration by Mondino, at Bologna in 1315, the de-

1 Medical Library and Historical Journal, 1906.

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 221

cree had been a dead letter and no human body
had been anatomized. It is true there is not, as far
as I am aware, any record of an/ such work, and
commentators and historians of a later date have,
without exception, accepted the view that none was
done, and thereby heightened the halo assigned to
Mondino as the one who ushered in a new era. Such
a view seems to me to be incredible. Be that as it
may, it is undeniable that at the beginning of the
14th century the idea of dissecting the human
body was not a novel one; the importance of a
knowledge of the intimate structure of the body had
already been appreciated by divers ruling bodies,
and specific regulations prescribing its practice had
been enacted. It is more reasonable to believe that
in the era immediately preceding that of Mondino
human bodies were being opened and after a fash-
ion anatomized. All that we know of the work of
Mondino suggests that it was not a new enterprise
in which he was a pioneer, but rather that he brought
to an old practice a new enthusiasm and better meth-
ods, which, caught on the rising wave of interest in
medical teaching at Bologna, and preserved by his
own energy as a writer in the first original system-
atic treatise written since the time of Galen, created
for him in subsequent uncritical times the reputation
of being the Restorer of the practice of anatomizing
the human body, the first one to demonstrate and
teach such knowledge since the time of the Ptolemaic
anatomists, Erasistratus and Herophilus.

" The changes have been rung by medical his-
torians upon a casual reference in Mondino 's chapter
on the uterus to the bodies of two women and one
sow which he had dissected, as if these were the first
and the only cadavers dissected by him. The con-
text involves no such construction. He is enforcing
a statement that the size of the uterus may vary,
and to illustrate it remarks that 'a woman whom I

222 OLD-TIME MAKERS OF MEDICINE

anatomized in the month of January last year, viz.,
1315 Anno Christi, had a larger uterus than one
whom I anatomized in the month of March of the
same year.' And further, he says that ' the uterus
of a sow which I dissected in 1316 (the year in which
he was writing) was a hundred times greater than
any I have seen in the human female, for she was
pregnant and contained thirteen pigs.' These hap-
pen to be the only reference to specific bodies that
he makes in his treatise. But it is a far cry to wring
out of these references the conclusion that these are
the only dissections he made. It is quite true that
if we incline to enshroud his work in a cloud of mys-
tery and to figure it as an unprecedented awe-inspir-
ing feature to break down the prejudices of the ages,
it is easy to think of him as having timidly profaned
the human body by his anatomizing zeal in but one
or two instances. His own language, however,
throughout his book is that of a man who was fa-
miliar with the differing conditions of the organs
found in many different bodies; a man who was
habitually dissecting. ' '

(Quotations from the work of Mundinus showing
his familiarity with dissections. The leaf and line
references are to the Dryander edition, Marburg,
1541.)

" I do not consider separately the anatomy of
component parts, because their anatomy does not
appear clearly in the fresh subject, but rather in
those macerated in water." (Leaf 2, lines 8-13.)

" . . . these differences are more noticeable in the
cooked or perfectly dried body, and so you need not
be concerned about them, and perhaps I will make
an anatomy upon such a one at another time and
will write what I shall observe with my own senses,
as I have proposed from the beginning." (Leaf 60,
lines 14-17.)

11 What the members are to which these nerves

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 223

come cannot well be seen in such a dissection as this,
but it should be liquefied with rain water, and this is
not contemplated in the present body." (Leaf 60,
lines 31-33.)

" After the veins you will note many muscles and
many large and strong cords, the complete anatomy
of which you will not endeavor to find in such a body
but in a body dried in the sun for three years, as I
have demonstrated at another time; I also declared
completely their number, and wrote the anatomy of
the muscles of the arms, hands, and feet in a lecture
which I gave over the first, second, third, and fourth
subjects." (Leaf 61, lines 1-7.)

Very probably the best evidence that we have of
the comparative frequency at least of dissection at
this time is to be found in the records of a trial for
body-snatching that occurred in Bologna. The de-
tails would remind one very much of what we know
of the difficulties with regard to dissection in America
a couple of generations ago, when no bodies were
provided by law for dissection purposes. In the
course of some studies for the history of the New
York State Medical Society (New York, 1906) I
found that nearly every one of the first half dozen
presidents of the New York Academy of Medicine,
which is not much more than sixty years old, had
had body-snatching experiences when they were
younger. Dr. Samuel Francis, the medico-historical
writer, tells of a personal expedition across the ferry
in the winter time, bringing a body from a Long
Island graveyard. In order to avoid the constables
on the Long Island side and the police on the New
York side, because there had been a number of cases
of body-snatching recently and the authorities were

224 OLD-TIME MAKERS OF MEDICINE

on the lookout, the corpse was placed sitting beside
the physician who drove the wagon, with a cloak
wrapped around it, as if it were a living person
specially protected against the cold. Similar experi-
ences were not unusual. The lack of bodies for dis-
section is sometimes attributed to religious scruples,
but they have very little to do with it, as at all times
men have refused to allow the bodies of their friends
to be treated as anatomical material. This is the
natural feeling of abhorrence and not at all religious.
It is only when there are many unclaimed bodies of
strangers and the poor, as happens in large cities,
that there can be an abundance of anatomical
material.

The details of this body-snatching case are
strangely familiar to those who know the history of
similar cases before the middle of the nineteenth cen-
tury. The case occurred in 1319 in Bologna, just
four years after Mondino's public dissections. Four
students were involved in the charge of body-snatch-
ing, all of them from outside the city of Bologna it-
self, three from Milan and one from Piacenza. In
modern experience, too, as a rule, students from out-
side of the town where the medical college was situ-
ated, were always a little readier than natives to
violate graveyards. These four students were ac-
cused of having gone at night to the Cemetery of
St. Barnabas, outside the gate of San Felice,—
suburban graveyards were usually the scene of such
exploits, — and to have dug up the body of a certain
criminal named Pasino, who had been hanged a few
days before. They carried the body to the school in
the Parish of San Salvatore, where Alberto Zancari

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 225

was teaching. The resurrection had been accom-
plished without witnesses, but there were several
witnesses who testified that they recognized the body
of Pasino in the school and students occupied with
its dissection. If evidence for the zeal of the medi-
cal students of that time for dissection were needed,
surely we have it in the testimony at this trial. At
a time when body-snatching has become a criminal
offence usually there have been many repeated oc-
currences of it before the parties are brought to trial,
so that it seems not unlikely that a good many dis-
sections of illegally secured bodies were being done
at Bologna at this time.

We know of a regulation of the University in
force at this time, which required the teachers
at the University to do an anatomy or dissection for
students if they secured a body for that purpose.
The students seem to have used all sorts of influ-
ence, political, monetary, diplomatic, and ecclesiasti-
cal, in order to secure the bodies of criminals. Some-
times when they failed in their purpose they waited
until after burial and then took the body without
leave. When we recall the awfully deterrent condi-
tion in which bodies must have been that were thus
provided for dissecting purposes, it is easy to under-
stand that the enthusiasm of the students for dis-
section must have been at a very high pitch. Cer-
tainly it was far higher than at the present day,
when, in spite of the fact that our dissecting-rooms
have very few of the old-time dangers and unpleas-
antnesses, dissection is only practised with assiduity
if special care is exercised in requiring attendance
and superintending the work of the department.

226 OLD-TIME MAKERS OF MEDICINE

In my book on ' ' The Popes and Science ' ' I have
gathered the traditions relating to Mondino 's as-
sistants in the chair of anatomy at Bologna. They
furnish abundant evidence of the fact that dissec-
tions, far from being uncommon, must have been not
at all infrequent at the north Italian universities at
this time. Curiously enough, one of these assistants
was a young woman who, as was not infrequently the
custom at this time in the Italian universities, was
matriculated as a student at Bologna. She took up
first philosophy, and afterwards anatomy, under
Mondino. While it is not generally realized, co-educa-
tion was quite common at the Italian universities of
the thirteenth and fourteenth centuries, and at no
time since the foundation of the universities has a
century passed in Italy without distinguished women
occupying professors' chairs at some of the Italian
universities. This young woman, Alessandra Gili-
ani, of Persiceto, a country district not far from
Bologna, took up the study of anatomy with ardor
and, strange as it may appear, became especially
enthusiastic about dissection. She became so skilful
that she was made the prosector of anatomy, that is,
one who prepares bodies for demonstration by the
professors.

According to the " Cronaca Persicetana," quoted
by Medici in his ' * History of the Anatomical School
at Bologna ' ' :

" She became most valuable to Mondino because
she would cleanse most skilfully the smallest vein,
the arteries, all ramifications of the vessels, without
lacerating or dividing them, and to prepare them for

HONDINO AND MEDICAL SCHOOL OF BOLOGNA 227

demonstration she would fill them with various
colored liquids, which, after having been driven into
the vessels, would harden without destroying the ves-
sels. Again, she would paint these same vessels to
their minute branches so perfectly and color them so
naturally that, added to the wonderful explanations
and teachings of the master, they brought him great
fame and credit." The whole passage shows a won-
derful anticipation of our most modern methods-
injection, painting, hardening — of making anatom-
ical preparations for class and demonstration pur-
poses.

Some of the details of the story have been doubted,
but her memorial tablet, erected at the time of her
death in the Church of San Pietro e Marcellino of
the Hospital of Santa Maria de Mareto, gives all the
important facts, and tells the story of the grief of her
fiance, who was himself Mondino's other assistant.1
This was Otto Agenius, who had made for himself a
name as an assistant to the chair of anatomy in
Bologna, and of whom there were great hopes enter-
tained because he had already shown signs of genius
as an investigator in anatomy. These hopes were
destined to grievous disappointment, however, for
Otto died suddenly, before he had reached his thirti-
eth year. The fact that both these assistants of Mon-
dino died young and suddenly, would seem to point

'Pilcher (too. tit.) tells of her tomb. I venture to change his
translation of the inscription in certain unimportant particulars.
He says:

"We know the very place where she was buried in front of the
Madonna delle Lettre in the Church of San Pietro e Marcellino of the

228 OLD-TIME MAKERS OF MEDICINE

to the fact that probably dissection wounds in those
early days proved even more fatal than they occa-
sionally did a century or more ago, when the proper
precautions against them were not so well under-
stood. The death of Mondino's two prosectors in
early years would seem to hint at some such un-
fortunate occurrence.

As regards the evidence of what the young man
had accomplished before his untimely death, prob-
ably the following quotation, which Medici has taken

Hospital of Santa Maria de Mareto, where her associate, Agenio,
mourning and inconsolable, placed a tablet with this inscription:

D . O . M .
Vrceo . Content!

Alexandrae . Galinae . Pvellae . Persicetanae

Penicillo . Egregiae . Ad . Anatomen . Exhibendam

Et . Insignissimi . Medici . Mundini . Lucii

Faucis . Comparandae . Discipulae . Cineres

Carnis . Hie . Expectant . Resurrectionem

Vixit . Ann . XIX . Obiit . Studio . Absunta

Die XXVI Martii . A . S . MCCCXXVI

Otto . Agenius . Lustrulanus . Ob . Earn . Demptam

Sui . Potiori . Parte . Spoliatus . Sodali . Eximiae

Ac . De . Se . Optime . Meritae . Inconsolabilis . M . P .

This inscription may be translated as follows:

In this urn enclosed

The ashes of the body of

Alexandra Giliani, a maiden of Periceto;

Skilful with her brush in anatomical demonstrations

And a disciple equalled by few,
Of the most noted physician, Mundinus of Luzzi,

Await the resurrection.
She lived 19 years: she died consumed by her labors

March 26, in the year of grace 1326.

Otto Agenius Lustrulanus, by her taking away

Deprived of his better part, his excellent companion,

Deserving of the best,
Has erected this tablet."

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 229

from one of the old chroniclers, will give the best
idea:

* * What advantage indeed might not Bologna have
had from Otto Agenius Lustrulanus, whom Mon-
dino had used as an assiduous prosector, if he had
not beeen taken away by a swift and lamentable death
before he had completed the sixth lustrum of his
life! "

How well the tradition created by Mondino con-
tinued at the university will be best understood from
what we know of Guy de Chauliac's visit to the medi-
cal school here about the middle of the century. The
great French surgeon tells us that he came to Bo-
logna to study anatomy under the direction of Mon-
dino's successor, Bertruccius. When he wrote his
preface to his great surgery he recalled this teaching
of anatomy at Bologna and said, "It is necessary
and useful to every physician to know, first of all,
anatomy. For this purpose the study of books is
indeed useful, but it is not sufficient to explain those
things which can only be appreciated by the senses
and which need to be seen in the dead body itself."
He advises his students to consult Mundinus' treatise
but to demonstrate its details for themselves on the
dead body. He relates that he himself had often,
multitoties, done this, especially under the direction
of Bertruccius at Bologna. Curiously enough, as
pointed out by Professor Pilcher, Mondino had used
this same word multitotiens (the variant spelling
makes no difference in the meaning) in speaking
about his own work. In describing the hypogastric
lesion he mentions that he had demonstrated cer-
tain veins in it many times, multitotiens.

230 OLD-TIME MAKERS OF MEDICINE

Mondino was just past fifty when he finished his
little book and permitted copies of it to be made.
Though the book occurs so early in the history of
modern book-making the author offers his excuses to
the public for writing it, and quotes the authority
of Galen, to whom he turns in other difficult situ-
ations, for justification. As prefaces go, Mondino 's
is so like that of many an author of more recent
date that his words have a bibliographic, as well as
a personal, interest. He said:

* ' A work upon any science or art — as saith Galen
— is issued for three reasons: first, that one may
satisfy his friends. Second, that he may exercise
his best mental powers. Third, that he may be saved
from the oblivion ^incident to old age. Therefore,
moved by these three causes, I have proposed to my
pupils to compose a certain work on medicine.

" And because a knowledge of the parts to be
subjected to medicine (which is the human body,
and the names of its various divisions) is a part
of medical science, as saith Averrhoes in his first
chapter, in the section on the definition of medicine,
for this reason among others, I have set out to lay
before you the knowledge of the parts of the human
body which is derived from anatomy, not attempting
to use a lofty style, but the rather that which is
suitable to a manual of procedure. "

Some of the early editions of Mondinus' book are
said, according to old writers, to have contained illus-
trations. None of these copies have come down to
us, but the assertion is made so definitely that it
seems likely to have been the case. The editions
that we have contain wood engravings of the method
of making a dissection as frontispiece, so that it

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 231

would not be difficult to think of further such illus-
trations having been employed in the book itself. As
we note in the chapter on " Great Surgeons of the
Medieval Universities," Mondeville, according to
Guy de Chauliac, had pictures of anatomical prepara-
tions which he used for teaching purposes. It is
easy to understand that the value of such aids would
be recognized at a time when the difficulty of preserv-
ing bodies made it necessary to do dissections hur-
riedly so as to get the rapidly decomposing material
out of the way.

Beyond his book and certain circumstances con-
nected with it we know very little about Mondino.
What we know, however, enables us to conclude that,
like many another great teacher, he must have had
the special faculty of inspiring his students with an
ardent enthusiasm for the work that they were tak-
ing under him. Hence the body- snatching and other
stories. Mondino continued to be held in high esti-
mation by the Bolognese for centuries after his
death. Dr. Pilcher calls attention to the fact that
his sepulchral tablet, which is in the portico of the
Church of San Vitari in Bologna, and a replica of
which he was allowed to have made in order to bring
it to America, is the only one of the sepulchral tablets
in the great churches of Florence, San Domenico,
San Martino, the Cathedral and the Cloister of San
Giacomo degli Ermitani, which has not been removed
from its original location and placed in the halls of
the Civic Museum. Their removal he considers " a
kind of desecration which does violence to one's sense
of sanctity and propriety. " " Fortunately, thus far,
the Mondino Tablet has escaped the spoiler. ' ' Very

232 OLD-TIME MAKERS OF MEDICINE

probably Dr. Flicker 's replica of the tablet which he
was required to deposit in the Civic Museum at the
time when the copy was made to be brought to
America may save the tablet to be seen in its original
position for many generations.

Mondino's career is of special interest because it
foreshadows the life and accomplishment of many
another maker of medicine of the after time. He
did a great new thing in medicine in organizing
regular public dissections, and then in making a
manual that would facilitate the work. He waited
patiently for years before completing his book in
order that it might be the fruit of long experience,
and so be more helpful to others. He was so modest
as to require urging to secure the publication. He
had the reward of his patience in the popularity of
his little work for centuries after his time. The
glimpse that we get of his relations to his young
assistants, Agenius and Alessandra, seems to show
us a teacher of distinct personal magnetism. Un-
doubtedly the reputation of his book did much for
not only the medical school of the University of
Bologna, but also for the medical schools of other
north Italian universities, and helped to bring to
them the crowds of students that flocked there during
the fourteenth and fifteenth centuries.

Taddeo and Mondino turned the attention of the
medical students of their generations Bolognawards.
Before that time they had mainly gone to Salerno.
After their time most of the ardent students of medi-
cine felt that they must study for a time at least at
Bologna. Other important medical schools of Italian
universities at Padua, at Vicenza, at Piacenza, arose

MONDINO AND MEDICAL SCHOOL OF BOLOGNA 233

and prospered. During the time when the political
troubles of Italy reached a climax about the middle
of the fourteenth century, while the Popes were at
Avignon, there was a remission in the attendance at
all the Italian universities, but with the Popes' re-
turn to Eome and the coming of even comparative
peace to Italy, Bologna once more became the term
of medical pilgrimages for students from all over
the world. In the meantime Mondino's book went
forth to be the most used text-book of its kind until
Vesalius' great work came to replace it. To have
ruled in the world of anatomy for two centuries as
the best known of teachers is of itself a distinction
that shows us at once the teaching power and the
scientific ability of this professor of anatomy of
Bologna in the early fourteenth century.

Strange as it may appear to those who have not
watched the development of our knowledge of the
Middle Ages in recent years the most interesting
feature in the medical departments and, indeed, of
the post-graduate work generally of the medieval
universities, is that in surgery. There is a very gen-
eral impression that this department of medicine did
not develop until quite recent years, and that par-
ticularly it failed to develop to any extent in the
Middle Ages. A good many of the historians of this
period, indeed, though never the special historians
of medicine, have even gone far afield in order to
find some reason why surgery did not develop at this
time. They have insisted that the Church by its
prohibition of the shedding of blood, first to monks
and friars, and then to the secular clergy, prevented
the normal development of surgery. Besides they
add that Church opposition to anatomy completely
precluded all possibility of any genuine natural evo-
lution of surgery as a science.

There is probably no more amusing feature of
quite a number of supposedly respectable and pre-
sumably authoritative historical works written in
English than this assumption with regard to the ab-
sence of surgery during the later Middle Ages. Only

234

GREAT SUEGEONS OF MEDIEVAL UNIVERSITIES 235

the most complete ignorance of the actual history of
medicine and surgery can account for it. The writers
who make such assertions must never have opened an
authoritative medical history. Nothing illustrates so
well the expression of the editors of the " Cambridge
Modern History " referred to more than once in
these pages that " in view of changes and of gains
such as these [the printing of original documents]
it has become impossible for historical writers of the
present day to trust without reserve even to the most
respected secondary authority. The honest student
finds himself continually deserted, retarded, misled
by the classics of historical literature. ' ' Fortunately
for us this sweeping condemnation does not hold to
any great extent for the medical historical classics.
All of the classic historians of medicine tell us much
of the surgery of the thirteenth and fourteenth cen-
turies, and in recent years the republication of old
texts and the further study of manuscript documents
of various kinds have made it very clear that there
is almost no period in the history of the world when
surgery was so thoroughly and successfully culti-
vated as during the rise and development of the uni-
versities and their medical schools in the thirteenth
and fourteenth centuries.

It is interesting to trace the succession of great
contributors to surgery during these two centuries.
We know their teaching not from tradition, but from
their text-books so faithfully preserved for us by
their devoted students, who must have begrudged
no time and spared no labor in copying, for many of
the books are large, yet exist in many manuscript
copies.

236 OLD-TIME MAKERS OF MEDICINE

Modern surgery may be said to owe its origin to a
school of surgeons, the leaders of whom were edu-
cated at Salerno in the early part of the thirteenth
century, and who, teaching at various north Italian
universities, wrote out their surgical principles and
experiences in a series of important contributions to
that department of medical science. The fact that
the origin of the school was at Salerno, where, as is
well known, Arabian influence counted for much and
for which Constantine's translations of Arabian
works proved such a stimulus a century before,
makes most students conclude that this later medie-
val surgical development is simply a continuation of
the Arabian surgery that, as we have seen, developed
very interestingly during the earlier Middle Ages.
Any such idea, however, is not founded on the reali-
ties of the situation, but on an assumption with re-
gard to the extent of Arabian influence. Gurlt in his
" History of Surgery " (Vol. I, page 701) completely
contradicts this idea, and says with regard to the
first of the great Italian writers on surgery, Rogero,
that " though Arabian works on surgery had been
brought over to Italy by Constantine Africanus a
hundred years before Roger's time, these exercised
no influence over Italian surgery in the next century,
and there is scarcely a trace of the surgical knowl-
edge of the Arabs to be found in Roger's works."

It is in the history of medicine particularly that it
is possible to trace the true influence of the Arabs on
European thought in the later Middle Ages. We
have already seen in the chapter on Salerno that
Arabian influence did harm to Salernitan medical
teaching. The school of Salerno itself had developed

GEEAT SURGEONS OF MEDIEVAL UNIVERSITIES 237

simple, dietetic, hygienic, and general remedial meas-
ures that included the use of only a comparatively
small amount of drugs. Its teachers emphasized
nature's curative powers. With Arabian influence
came polypharmacy, distrust of nature, and attempts
to cure disease rather than help nature. In surgery,
which developed very wonderfully in the thirteenth
and fourteenth centuries, Salerno must be credited
with the incentive that led up to the marvellous de-
velopment that came. With this, however, Arabian
influence has nothing to do. Gurlt, besides calling
attention to the fact that the author of the first great
text-book on the subject not only did not draw his in-
spiration from Arab sources, insisted that " instead
of any Arabisms being found in his [Roger's] writ-
ings many Grsecisms occur." The Salernitan school
of surgery drank at the fountain-head of Greek sur-
gery. Apart from Greek sources Roger's book rests
entirely upon his own experiences, those of his teach-
ers and his colleagues, and the tradition in surgery
that had developed at Salerno. This tradition was
entirely from the Greek. Roger himself says in one
place, " We have resolved to write out deliberately
our methods of operation such as they have been
derived from our own experience and that of our
colleagues and illustrious men."

ROGER, ROLAND, AND THE FOUR MASTERS

Ruggero, or Rogero, who is also known as Rogerio
and Rogerus with the adjective Parrnensis, or Saler-
nitanus, of Parma or of Salerno, and often in Ger-
man and English history simply as Roger, lived at

238 OLD-TIME MAKERS OF MEDICINE

the end of the twelfth or the beginning of the thir-
teenth century and probably wrote his text-book
about 1180. This text-book was, according to tradi-
tion, originally drafted for his lessons in surgery at
Salerno. It attracted much attention and after being
commented on by his pupil Rolando, the work of
both of them being subsequently annotated by the
Four Masters, this combined work became the basis
of modern surgery. Roger was probably born either
in Palermo or Parma. There are traditions of his
having taught for a while at Paris and at the Uni-
versity of Montpellier, though these are not substan-
tiated. His book was printed at Venice in 1546, and
has been lately reprinted by De Renzi in his " Col-
lectio Salernitana."

Roland was a pupil of Roger's, and the two names
that often occur in medieval romance became asso-
ciated in a great historic reality as a consequence of
Roland's commentary on his master's work, which
was a favorite text-book in surgery for a good while
in the thirteenth century at Salerno. Some space will
be given to the consideration of their surgical teach-
ing after a few words with regard to some disciples
who made a second commentary, adding to the value
of the original work.

This is the well-known commentary of the Four
Masters, a text-book of surgery written somewhat in
the way that we now make text-books in various de-
partments of medicine, that is, by asking men who
have made specialties of certain subjects to write on
that subject and then bind them all together in a
single volume. It represents but another striking
reminder that most of our methods are old, not new

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 239

as we are likely to imagine them. The Four Masters
took the works of Roger and Rolando, acknowledged
their indebtedness much more completely than do our
modern writers on all occasions, I fear, and added
their commentaries.

Gurlt says (" Geschichte der Chirurgie," Vol. I, p.
703) that " in spite of the fact that there is some
doubt about the names of the authors, this volume
constitutes one of the most important sources for the
history of surgery of the later Middle Ages and
makes it very clear that these writers drew their
opinions from a rich experience." It is rather easy
to illustrate from the quotations given in Gurlt or
from the accounts of their teaching in Daremberg or
De Renzi some features of this experience that can
scarcely fail to be surprising to modern surgeons.
For instance, what is to be found in this old text-
book of surgery with regard to fractures of the skull
is likely to be very interesting to surgeons at all
times. One might be tempted to say that fewer men
would die every year in prison cells who ought to
be in hospitals, if the old-time teaching was taken to
heart. For there are rather emphatic directions not
to conclude because the scalp is unwoundedthat there
can be no fracture of the skull. Where nothing can
be felt care must be exercised in getting the history
of the case. For instance, if a man is hit by a metal
instrument shaped like the clapper of a bell or by a
heavy key, or by a rounded instrument made of lead
— this would remind one very much of the lead pipe
of the modern time, so fruitful of mistakes of diag-
nosis in head injuries — special care must be taken to
look for symptoms in spite of the lack of an external

240 OLD-TIME MAKERS OF MEDICINE

penetrating wound. Where there is good reason to
suspect a fracture because of the severity of the in-
jury, the scalp should be incised and a fracture of the
cranium looked for carefully. That is carrying the
exploratory incision pretty far. If a fracture is
found the surgeon should trephine so as to relieve the
brain of any pressure of blood that might be affect-
ing it.

There are many warnings, however, of the danger
of opening the skull and of the necessity for defi-
nitely deciding beforehand that there is good reason
for so doing. How carefully their observations had
been made and how well they had taken advantage
of their opportunities, which were, of course, very
frequent in those warlike times when firearms were
unknown, hand-to-hand conflict common, and blunt
weapons were often used, can be appreciated very
well from some of the directions. For instance, they
knew of the possibility of fracture by contrecoup.
They say that ' ' quite frequently though the percus-
sion com.es in the anterior part of the cranium, the
cranium is fractured on the opposite part." l They
even seem to have known of accidents such as we now
discuss in connection with the laceration of the mid-
dle meningeal artery. They warn surgeons of the
possibilities of these cases. They tell the story of
" a youth who had a very small wound made by a
thrown stone and there seemed no serious results or
bad signs. He died the next day, however. His
cranium was opened and a large amount of black

irThi3 is so striking that I quote their actual words from Gurlt, p.
704 : " Multoties fit percussio in anteriori parte cranei et craneum in
parte frangitur contraria"

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 241

blood was found coagulated about his dura
mater. ' '

There are many interesting things said with re-
gard to depressed fractures and the necessity for
elevating the bone. If the depressed portion is
wedged then an opening should be made with the
trephine and an elevating instrument called a spatu-
men used to relieve the pressure. Great care should
be taken, however, in carrying out this procedure
lest the bone of the cranium itself, in being lifted,
should injure the soft structures within. The dura
mater should be carefully protected from injury as
well as the pia. Care should especially be exercised
at the brow and the rear of the head and at the com-
missures (proram et pupim et commissuras] , since
at these points the dura mater is likely to be ad-
herent. Perhaps the most striking expression, the
word infect being italicized by Gurlt, is : "In ele-
vating the cranium be solicitous lest you should infect
or injure the dura mater. ' '

For wounds of the scalp sutures of silk are recom-
mended because this resists putrefaction and holds
the wound edges together. Interrupted sutures
about a finger-breadth apart are recommended.
" The lower part of the wound should be left open
so that the cure may proceed properly." Red pow-
der was strewed over the wound and the leaf of a
plant set above it. In the lower angle of the wound
a pledget of lint for drainage purposes was inlaid.
Hemorrhage was prevented by pressure, by the bind-
ing on of burnt wool firmly, and by the ligature of
veins and by the cautery.

There are rather interesting discussions of the

242 OLD-TIME MAKERS OF MEDICINE

prognosis of wounds of the head, especially such as
may be determined from general symptoms in this
commentary of the Four Masters on Roger's and
Rolando's treatises. If an acute febrile condition
develops, the wound is mortal. If the patient loses
the use of the hands and feet or if he loses his power
of direction, or his sensation, the wound is mortal.
If a universal paralysis comes on, the wound is mor-
tal. For the treatment of all these wounds careful
precautions are suggested. Cold was supposed to be
particularly noxious to them. Operations on the
head were not to be done in cold weather and, above
all, not in cold places. The air where such operations
were done must be warmed artificially. Hot plates
should surround the patient's head while the opera-
tion was being performed. If this were not possible
they were to be done by candlelight, the candle being
held as close as possible in a warm room. These
precautions are interesting as foreshadowing many
ideas of much more modern time and especially indi-
cating how old is the idea that cold may be taken in
wounds. In popular medicine this still has its place.
Whenever a wound does badly in the winter time pa-
tients are sure that they have taken cold. Such popu-
lar medical ideas are always derived from sup-
posedly scientific medicine, and until we learned
about microbes physicians used the same expressions.
We have not got entirely away from them yet.

These old surgeons must have had many experi-
ences with fractures at the base of the skull. Hemor-
rhages from the mouth and nose, for instance, and
from the ears were considered bad signs. They were
inclined to suggest that openings into the skull should

GEEAT SURGEONS OF MEDIEVAL UNIVERSITIES 243

be discovered by efforts to demonstrate a connection
between the mouth and nares and the brain cavity.
For instance, in their commentary the Four Masters
said : ' ' Let the patient hold his mouth and nostrils
tight shut and blow strongly." If there was any
lessening of the pressure or any appearance of air
in the wound in the scalp, then a connection between
the mouth and nose was diagnosticated. This is in-
genious but eminently dangerous because of the in-
fectious material contained in the nasal and oral
cavities, so likely to be forced by such pressure into
the skull. They were particularly anxious to detect
linear fractures. One of their methods of negative
diagnosis for fractures of the skull was that if the
patient were able to bring his teeth together strongly,
or to crack a nut without pain, then there was no
fracture present. One of the commentators, how-
ever, adds to this " sed hoc aliquando fallit — but this
sign sometimes fails." Split or crack fractures were
also diagnosticated by the method suggested by Hip-
pocrates of pouring some colored fluid over the skull
after the bone was exposed, when the linear fracture
would show by coloration. The Four Masters sug-
gest a sort of red ink for this purpose.

While they have so much to say about fractures
of the skull and insist, over and over again, that
though all depressed fractures need treatment and
many fissure fractures require trepanation, still
great care must be exercised in the selection of cases.
They say, for instance, that surgeons who in every
serious wound of the head have recourse to the
trephine must be looked upon as ' * fools and idiots ' '
(idioti et stolidi). In the light of what we now know

244 OLD-TIME MAKERS OF MEDICINE

about the necessity for absolute cleanliness, — asep-
sis as we have come to call it, — it is rather startling
to note the directions that are given to a surgeon to
be observed on the day when he is to do a trepana-
tion. For obvious reasons I prefer to quote it in the
Latin : " Et nota quod die ilia cavendum est medico a
coitu et malis cibis aero, corrumpentibus, ut sunt
allia, cepe, et hujusmodi, et colloquio mulieris men-
struosce, et manus ejus debent esse mundce, etc."
My quotation is from Gurlt, Vol. I, p. 707. The direc-
tions are most interesting. The surgeon 's hands must
be clean, he must avoid the taking of food that may
corrupt the air, such as onions, leeks, and the like;
must avoid menstruating and other women, and in
general must keep himself in a state of absolute
cleanliness.

To read a passage like this separated from its
context and without knowing anything about the
wonderful powers of observation of the men from
whom it comes, it would be very easy to think that
it is merely a set of general directions which they
had made on some general principle, perhaps quite
foolish in itself. We know, however, that these men
had by observation detected nearly every feature of
importance in fractures of the skull, their indications
and contra-indications for operation and their prog-
nosis. They had anticipated nearly everything of
importance that has come to be insisted on even in
our own time in the handling of these difficult cases.
It is not unlikely, therefore, that they had also ar-
rived at the recognition by observations on many
patients that the satisfactory after-course of these
cases which were operated on by the surgeon after

GEEAI SURGEONS OF MEDIEVAL UNIVERSITIES 245

due regard to such meticulous cleanliness as is sug-
gested in the paragraph I have quoted, made it very
clear that these aseptic precautions, as we would
call them, were extremely important for the outcome
of the case and, therefore, were well worth the sur-
geon's attention, though they must have required
very careful precautions and considerable self-denial.
Indeed this whole subject, the virtual anticipation of
our nineteenth-century principles of aseptic surgery
in the thirteenth century, is not a dream nor a far-
fetched explanation when one knows enough about
the directions that were laid down in the surgical
text-books of that time.

THE NOBTH ITALIAN SURGEONS

After Roger and Rolando and the Four Masters,
who owe the inspiration for their work to Salerno
and the south of Italy, comes a group of north
Italian surgeons: Bruno da Longoburgo, usually
called simply Bruno ; Theodoric and his father, Hugo
of Lucca, and William of Salicet. Immediately fol-
lowing them come two names that belong, one almost
feels, to a more modern period : Mondino, the author
of the first text-book on dissection, and Lanfranc (the
disciple of William of Salicet), who taught at Paris
and " gave that primacy to French surgery which it
maintained all the centuries down to the nineteenth "
(Pagel). It might very well be thought that /this
group of Italian surgeons had very little in their
writings that would be of any more than antiquarian
interest for the modern time. It needs but a little
knowledge of their writings as they have come down

246 OLD-TIME MAKERS OF MEDICINE

to us to show how utterly false any such opinion is.
To Hugo da Lucca and his son Theodoric we owe
the introduction and the gradual bringing into prac-
tical use of various methods of anaesthesia. They
used opium and mandragora for this purpose and
later employed an inhalant mixture, the composition
of which is not absolutely known. They seem, how-
ever, to have been very successful in producing in-
sensibility to pain for even rather serious and com-
plicated and somewhat lengthy operations. Indeed
it is to this that must be attributed most of their
surprising success as surgeons at this early date.

We are so accustomed to think that anaesthesia was
discovered about the middle of the nineteenth cen-
tury in America that we forget that literature is
full of references in Tom Middleton's (seventeenth
century) phrase to " the mercies of old surgeons who
put their patients to sleep before they cut them."
Anaesthetics were experimented with almost as zeal-
ously, during the latter half of the thirteenth century
at least, as during the latter half of the nineteenth
century. They were probably not as successful as we
are,but they did succeed in producing insensibility to
pain, otherwise they could never have operated to the
extent they did. Moreover the traditions show that
the Da Luccas particularly had invented a method
that left very little to be desired in this matter of
anaesthesia. A reference to the sketch of Guy de
Chauliac in this volume will show how practical the
method was in his time.

Nearly the same story as with regard to anaesthet-
ics has to be repeated for what are deemed so surely
modern developments, — asepsis and antisepsis. I

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 247

have already suggested that Roger seems to have
known how extremely important it was to approach
operations upon the skull with the most absolute
cleanliness. There are many hints of the same kind
in other writers which show that this was no mere
accidental remark, but was a definite conclusion de-
rived from experience and careful observation of
results. We find much more with regard to this same
subject in the writings of the group of northern Ital-
ian surgeons and especially in the group of those
associated with William of Salicet. Professor Clif-
ford Allbutt, Regius Professor of Medicine at the
University of Cambridge, England, in his address
before the St. Louis World's Fair Congress of Arts
and Science in 1904, did not hesitate to declare that
William discussed the causes for union by first in-
tention and the modes by which it might be obtained.
He, too, insisted on cleanliness as the most impor-
tant factor in having good surgical results, and all
of this group of men, in operating upon septic cases,
used stronger wine as a dressing. This exerted, as
will be readily understood, a very definite antiseptic
quality.

Evidently some details of the teaching of this
group of great surgeons in northern Italy in the
second half of the thirteenth century will make
clearer to us how much the rising universities of the
time were accomplishing in medicine and surgery as
well as in their other departments. The dates of
the origin of some of these universities should per-
haps be recalled so as to remind readers how closely
related they are to this great group of surgical teach-
ers. Salerno was founded very early, probably in

248 OLD-TIME MAKERS OF MEDICINE

the tenth century; Bologna, Reggio, and Modena
came into existence toward the end of the twelfth
century; Vicenza, Padua, Naples, Vercelli, and Pi-
acenza, as well as Arezzo, during the first half of the
thirteenth century; Rome, Perugia, Trevizo, Pisa,
Florence, Sienna, Lucca, Pavia, and Ferrara during
the next century. The thirteenth century was the
special flourishing period of the universities, and
the medical departments, far from being behind,
were leaders in accomplishment. (See my " The
Thirteenth Greatest of Centuries," N. Y., 1908.)

BRUNO DA LONGOBURGO

The first of this important group of north Italian
surgeons who taught at these universities was Bruno
of Longoburgo. While he was born in Calabria, and
probably studied in Salerno, his work was done at
Vicenza, Padua, and Verona. His text-book, the
" Chirurgia Magna," dedicated to his friend An-
drew of Piacenza, was completed at Padua in Jan-
uary, 1252. Gurlt notes that he is the first of the
Italian surgeons who quotes, besides the Greeks, the
Arabian writers on surgery. Eclecticism had defi-
nitely come into vogue to replace exclusive devotion
to the Greek authors, and men were taking what
was good wherever they found it. Gurlt tells us that
Bruno owed much of what he wrote to his own ex-
perience and observation. He begins his work by a
definition of surgery, cliirurgia, tracing it to the
Greek and emphasizing that it means handwork. He
then declares that it is the last instrument of medi-
cine to be used only when the other two instruments,

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 249

diet and potions, have failed. He insists that sur-
geons must learn by seeing surgical operations and
watching them long and diligently. They must be
neither rash nor over bold and should be extremely
cautious about operating. While he says that he
does not object to a surgeon taking a glass of wine,
the followers of this specialty must not drink to
such an extent as to disturb their command over
themselves, and they must not be habitual drinkers.
While all that is necessary for their art cannot be
learned out of books, they must not despise books
however, for many things can be learned readily
from books, even about the most difficult parts of
surgery. Three things the surgeon has to do : — * * to
bring together separated parts, to separate those
that have become abnormally united, and to extirpate
what is superfluous. ' '

In his second chapter on healing he talks about
healing by first and second intention. Wounds must
be more carefully looked to in summer than in win-
ter, because putrefactio est major in aestate quam
in hyeme, putrefaction is greater in summer than in
winter. For proper union care must be exercised to
bring the wound edges accurately together and not
allow hair, or oil, or dressings to come between
them. In large wounds he considers stitching indis-
pensable, and recommends for this a fine, square
needle. The preferable suture material in his experi-
ence was silk or linen.

The end of the wound was to remain open in order
that lint might be placed therein in order to draw
off any objectionable material. He is particularly
insistent on the necessity for drainage. In deep

250 OLD-TIME MAKERS OF MEDICINE

wounds special provision must be made, and in
wounds of extremities the limb must be so placed
as to encourage drainage. If drainage does not take
place, then either the wound must be thoroughly
opened, or if necessary a counter opening must be
made to provide drainage. All his treatment of
wounds is dry, however. Water, he considered, al-
ways did harm. We can readily understand that the
water generally available and especially as surgeons
saw it in camps and on the battlefield, was likely to
do much more harm than good. In penetrating
wounds of the belly cavity, if there was difficulty
in bringing about the reposition of the intestines,
they were first to be pressed back with a sponge
soaked in warm wine. Other manipulations are sug-
gested, and if necessary the wound must be enlarged.
If the oiuentum finds its way out of the wound, all
of it that is black or green must be cut off. In
cases where the intestines are wrounded they are to
be sewed with a small needle and a silk thread and
care is to be exercised in bringing about complete
closure of the wound. This much will give a good
idea of Bruno's thoroughness. Altogether, Gurlt,
in his " History of Surgery," gives about fifteen
large octavo pages of rather small type to a brief
compendium of Bruno's teachings.

One or two other remarks of Bruno are rather
interesting in the light of modern developments in
medicine. For instance, he suggests the possibility
of being able to feel a stone in the bladder by means
of bimanual palpation. He teaches that mothers
may often be able to cure hernias, both umbilical and
inguinal, in children by promptly taking up the treat-

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 251

ment of them as soon as noticed, bringing the edges
of the hernial opening together by bandages and
then preventing the reopening of the hernia by pro-
hibiting wrestling and loud crying and violent mo-
tion. He has seen overgrowth of the mamma in
men, and declares that it is due to nothing else but
fat, as a rule. He suggests if it should hang down
and be in the way on account of its size it should
be extirpated. He seems to have known considera-
ble about the lipomas and advises that they need
only be removed in case they become bothersomely
large. The removal is easy, and any bleeding that
takes place may be stopped by means of the cautery.
He divides rectal fistulas into penetrating and non-
penetrating, and suggests salves for the non-pene-
trating and the actual cautery for those that pene-
trate. He warns against the possibility of producing
incontinence by the incision of deep fistulae, for this
would leave the patient in a worse state than before.

HUGH OF LUCCA

Bruno brought up with him the methods and prin-
ciples of surgery from the south of Italy, but there
seems to have been already in the north at least one
distinguished surgeon who had made his mark. This
was Ugo da Lucca or Ugo Luccanus, sometimes
known in the modern times in German histories of
medicine as Hugo da Lucca and in English, Hugh of
Lucca. He flourished early in the thirteenth cen-
tury. In 1214 he was called to Bologna to become
the city physician, and joined the Bolognese volun-
teers in the crusade in 1218, being present at the

252 OLD-TIME MAKERS OF MEDICINE

siege of Damietta. He returned to Bologna in 1221
and was given the post of legal physician to the city.
The civic statutes of Bologna are, according to Gurlt,
the oldest monument of legal medicine in the Middle
Ages. Ugo died not long after the middle of the
century, and is said to have been nearly one hundred
years old. Of his five sons, three became physicians.
The most celebrated of these was Theodoric, who
wrote a text-book of surgery in which are set down
the traditions of surgery that had been practised in
his father's life. Theodoric is especially enthusiastic
in praise of his father, because he succeeded in bring-
ing about such perfect healing of wounds with only
wine and water and the ligature and without the
employment of any ointments.

Ugo seems to have occupied himself much with
chemistry. To him we owe a series of discoveries
with regard to anodyne and anaesthetizing drugs.
He is said to have been the first who taught the
sublimation of arsenic. Unfortunately he left no
writings after him, and all that we know of him we
owe to the filial devotion of his son Theodoric.

THEODORIO

This son, after having completed his medical
studies at the age of about twenty-three, en-
tered the Dominican Order, then only recently
established, but continued his practice of medi-
cine undisturbed. His ecclesiastical preferment
was rapid. He attracted the attention of the
Bishop of Valencia, and became his chaplain
in Rome. At the age of about fifty he was made

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 253

a bishop in South Italy and later transferred
to the Bishopric of Cervia, not far from Ravenna.
Most of his life seems to have been passed in Bo-
logna however, and he continued to practise medi-
cine, devoting his fees, however, entirely to charity.
His text-book of surgery was written about 1266
and is signed with his full name and title as Bishop
of Cervia. Even at this time however, he still re-
tained the custom of designating himself as a mem-
ber of the Dominican Order.

The most interesting thing in the first book of
his surgery is undoubtedly his declaration that all
wounds should be treated only with wine and ban-
daging. Wine he insists on as the best possible
dressing for wounds. It was the most readily availa-
ble antiseptic that they had at that time, and un-
doubtedly both his father's recommendation of it and
his own favorable experience with it were due to
this quality. It must have acted as an excellent in-
hibitive agent of many of the simple forms of pus
formation. At the conclusion of this first book he
emphasizes that it is extremely important for the
healing of wounds that the patient should have good
blood, and this can only be obtained from suitable
nutrition. It is essential therefore for the physician
to be familiar with the foods which produce good
blood in order that his wounded patients may be fed
appropriately. He suggests, then, a number of arti-
cles of diet which are particularly useful in produc-
ing such a favorable state of the tissues as will bring
about the rebirth of flesh and the adhesion of wound
surfaces. Shortly before he emphasizes the neces-
sity for not injuring nerves, though if nerves have

254 OLD-TIME MAKERS OF MEDICINE

been cut they should be brought together as carefully
as possible, the wound edges being then approxi-
mated.

Probably the most interesting feature for our gen-
eration of the great text-books of the surgeons of
the medieval universities is the occurrence in them
of definite directions for securing union in surgical
wounds, at least by first intention and their insist-
ence on keeping wounds clear. The expression
union by first intention comes to us from the olden
time. They even boasted that the scars left after
their incisions were often so small as to be scarcely
noticeable. Such expressions of course could only
have come from men who had succeeded in solving
some of the problems of antisepsis that were solved
once more in the generation preceding our own.
With regard to their treatment of wounds, Professor
Clifford Allbutt says : 1

11 They washed the wound with wine, scrupulously
removing every foreign particle; then they brought
the edges together, not allowing wine nor anything
else to remain within — dry adhesive surfaces were
their desire. Nature, they said, produces the means
of union in a viscous exudation, or natural balm, as
it was afterwards called by Paracelsus, Pare, and
Wurtz. In older wounds they did their best to ob-
tain union by cleansing, desiccation, and refreshing
of the edges. Upon the outer surface they laid only
lint steeped in wine. Powders they regarded as too
desiccating, for powder shuts in decomposing mat-
ters; wine after washing, purifying, and drying the
raw surfaces evaporates."

1 " Historical Relations of Medicine and Surgery Down to the Six-
teenth Century," London, 1904.

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 255

Theodoric comes nearest to us of all these old sur-
geons. The surgeon who in 1266 wrote: " For it
is not necessary, as Roger and Roland have written,
as many of their disciples teach, and as all modern
surgeons profess, that pus should be generated in
wounds. No error can be greater than this. Such
a practice is indeed to hinder nature, to prolong the
disease, and to prevent the conglutination and con-
solidation of the wound ' ' was more than half a mil-
lennium ahead of his time. The italics in the word
modern are mine, but might well have been used by
some early advocate of antisepsis or even by Lord
Lister himself. Just six centuries almost to the year
would separate the two declarations, yet they
would be just as true at one time as at another.
When we learn that Theodoric was proud of the
beautiful cicatrices which he obtained without the
use of any ointment, pulcherrimas cicatrices sine
unguento aliquo inducebat, then further that he im-
pugned the use of poultices and of oils on wounds,
while powders were too drying and besides had a
tendency to prevent drainage, the literal meaning of
the Latin words saniem incarcerare is to " in-
carcerate sanious material," it is easy to understand
that the claim that antiseptic surgery was antici-
pated six centuries ago is no exaggeration and no
far-fetched explanation with modern ideas in mind
of certain clever modes of dressing hit upon acci-
dentally by medieval surgeons.

Theodoric 's treatment of many practical problems
is interesting for the modern time. For instance, in
his discussion of cancer he says that there are two
forms of the affection. One of them is due to a

256 OLD-TIME MAKERS OF MEDICINE

melancholy humor, a constitutional tendency as it
were, and occurs especially in the breasts of women
or latent in the womb. This is difficult of treatment
and usually fatal. The other class consists of a
deep ulcer with undermined edges, occurring partic-
ularly on the legs, difficult to cure and ready of re-
lapse, but for which the outlook is not so bad. His
description of noli me tangere and of lupus is rather
practical. Lupus is " eating herpes," occurs mainly
on the nose, or around the mouth, slowly increases,
and either follows a preceding erysipelas or comes
from some internal cause. Noli me tangere is a cor-
roding ulcer, so called perhaps because irritation of
it causes it to spread more rapidly. He thinks that
deep cauterization of it is the best treatment. Since
these are in the department of skin diseases this
seems the place to mention that Theodoric describes
salivation as occurring after the use of mercury for
certain skin diseases. He has already shown that
he knows of certain genital ulcers and sores on the
genital regions and of distinctions between them.

WILLIAM OF SALICET

The third of the great surgeons in northern Italy
was William of Salicet. He was a pupil of Bruno's
and the master of Lanfranc. The first part of his
life was passed at Bologna and the latter part as the
municipal and hospital physician of Verona. He
probably died about 1280. He was a physician as
well as a surgeon and was one of those who insisted
that the two modes of practising medicine should not
be separated, or if they were both medicine and

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 257

surgery would suffer. He thought that the physician
learned much by seeing the interior of the body dur-
ing life, while the surgeon was more conservative
if he were a physician. It is curiously interesting
to find that the Regius Professors at both Oxford
and Cambridge in our time have expressed them-
selves somewhat similarly. Professor Clifford All-
butt is quite emphatic in this matter and Professor
Osier is on record to the same effect. Following
Theodoric, William of Salicet did much to get away
from the Arabic abuse of the cautery and brought
the knife back to its proper place again as the ideal
surgical instrument. Unlike those who had written
before him, William quoted very little from preced-
ing writers. Whenever he quotes his contemporaries
it is in order to criticise them. He depended on his
own experience and considered that it was only what
he had actually learned from experience that he
should publish for the benefit of others.

A very good idea of the sort of surgery that Wil-
liam of Salicet practised may be obtained even from
the beginning of the first chapter of his first book.
This is all with regard to surgery of the head. He
begins with the treatment of hydrocephalus or, as
he calls it, ' * water collected in the heads of children
newly born." He rejects opening of the head by an
incision because of the danger of it. In a number of
cases, however, he had had success by puncturing the
scalp and membranes with a cautery, though but a
very small opening was made and the fluid was al-
lowed to escape only drop by drop. He then takes up
eye diseases, a department of surgery rather well
developed at that time, as can be seen from our

258 OLD-TIME MAKERS OF MEDICINE

account of the work of Pope John XXI as an oph-
thalmologist during the thirteenth century. See
Ophthalmology (January, 1909), reprinted in
" Catholic Churchmen in Science," Philadelphia,
The Dolphin Press, 1909.

William devotes six chapters to the diseases of
the eyes and the eyelids. Then there are two chap-
ters on affections of the ears. Foreign bodies and
an accumulation of ear wax are removed by means
of instruments. A polyp is either cut off or its pedi-
cle bound with a ligature, and it is allowed to shrivel.
The next chapter is on the nose. Nasal polyps were
to be grasped with a sharp tenaculum, cum tenacillis
acutis, and either wholly or partially extracted.
Ranula was treated by being lifted well forward by
means of a sharp iron hook and then split with a
razor. It is evident that the tendency of these to fill
up again was recognized, and accordingly it was
recommended that vitriol powder, or alum with salt,
be placed in the cavity for a time after evacuation
in order to produce adhesive inflammation.

In the same chapter on the mouth one finds that
William did not hesitate to perform what cannot but
be considered rather extensive operations within
the oral cavity. For instance, he tells of removing
a large epulis and gives an account in detail of the
case. To quote his own words: " I cured a certain
woman from Piacenza who was suffering from fleshy
tumor on the gums of the upper jaw, the tumor hav-
ing grown to such a size above the teeth and the
gums that it was as large or perhaps larger than a
hen's egg. I removed it at four operations by
means of heated iron instruments. At the last

operation I removed the teeth that were loose with
certain parts of the jawbone."

In the next chapter there is an account of the treat-
ment of a remarkable case of abscess of the uvula.
In the following chapter the swelling of cervical
glands is taken up. In his experience expectant
treatment of these was best. He advises internal
medication with the building up of the general
health, or suggests allowing the inflamed glands to
empty themselves after pustulation. After much
meddlesome surgery we are almost back to his meth-
ods again. He did not hesitate to treat goitre sur-
gically, though he considered there were certain in-
ternal remedies that would benefit it. In obstinate
cases he suggests the complete extirpation of cystic
goitre, but if the sac is allowed to remain it should
be thoroughly rubbed over on the inside with green
ointment. He warns about the necessity for avoid-
ing the veins and arteries in this operation, and says
that * ' in this affection many large veins make their
appearance and they find their way everywhere
through the fleshy mass."

What I have given here is to be found in a little
more than half a page of G-urlt's abstract of the
first twenty chapters of Salicet's first book. Alto-
gether Gurlt has more than ten pages of rather small
print with regard to William ; most of it is as inter-
esting and as practical and as representative of an-
ticipations of what is done in the modern time as
what I have here quoted. William, as I have said,
depended much more upon his own experience than
upon what was to be found in text-books. He knew
the old text-books very well however, but as a rule

260 OLD-TIME MAKERS OF MEDICINE

did not quote from them unless he had tried the
recommendations for himself, or unless similar cases
to these mentioned had come under his own observa-
tion. He was evidently a thoroughly observant phy-
sician, a skilled surgeon who was practical enough to
see the simplest way to do things, and he proceeded
to do them. It is no wonder that he influenced suc-
ceeding generations so much, nor that his great
pupil, Lanfranc, continuing his tradition, founded a
school of surgery in Paris, the influence of which
was to endure almost down to our time, and give
France a primacy in surgery until the nineteenth
century.

LANFRANC

After Salicet's lifetime the focus of interest in
surgery changes from Italy to France, and what is
still more complimentary to William, it is through a
favorite disciple of his that the change takes place.
This was Lanfranchi, or Lanfranco, sometimes
spoken of as Alanfrancus, who practised as phy-
sician and surgeon in Milan until banished from
there by Matteo Visconti about 1290. He then went
to Lyons, where in the course of his practice he
attracted so much attention that he was offered the
opportunity to teach surgery in Paris. He attracted
what Gurlt calls an almost incredible number of
scholars to his lessons in Paris, and by hundreds
they accompanied him to the bedside of his patients
and attended his operations. The dean of the med-
ical faculty, Jean de Pas savant, urged him to write
a text-book of surgery, not only for the benefit of

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 261

his students at Paris but for the sake of the prestige
which this would confer on the medical school.
Deans still urge the same reasons for writing. Lan-
franc completed his surgery, called " Chirurgia
>Magna," in 1296, and dedicated it to Philippe le Bel,
the then reigning French King. Ten years later he
died, but in the meantime he had transferred Italian
prestige in surgery from Italy to France and laid
the foundations in Paris of a thoroughly scientific
as well as a practical surgery, though this depart-
ment of the medical school had been in a sadly
backward state when he came.

In the second chapter of this text-book, the first
containing the definition of surgery and general in-
troduction, Lanfranc describes the qualities that in
his opinion a surgeon should possess. He says, " It
is necessary that a surgeon should have a temperate
and moderate disposition. That he should have well-
formed hands, long slender fingers, a strong body,
not inclined to tremble and with all his members
trained to the capable fulfilment of the wishes of
his mind. He should be of deep intelligence and
of a simple, humble, brave, but not audacious dis-
position. He should be well grounded in natural
science, and should know not only medicine but every
part of philosophy; should know logic well, so as to
be able to understand what is written, to talk prop-
erly, and to support what he has to say by good rea-
sons." He suggests that it would be well for the
surgeon to have spent some time teaching grammar
and dialectics and rhetoric, especially if he is to
teach others in surgery, for this practice will add
greatly to his teaching power. Some of his expres-

262 OLD-TIME MAKERS OF MEDICINE

sions might well be repeated to young surgeons in
the modern time. " The surgeon should not love
difficult cases and should not allow himself to be
tempted to undertake those that are desperate. He
should help the poor as far as he can, but he
should not hesitate to ask for good fees from the
rich."

Many generations since Lanfranc's time have
used the word nerves for tendons. Lanfranc, how-
ever, made no such mistake. He says that the
wounds of nerves, since the nerve is an instrument
of sense and motion, are, on account of the greater
sensitiveness which these structures possess, likely
to involve much pain. Wounds along the length of
the nerves are less dangerous than those across
them. When a nerve is completely divided by a
cross wound Lanfranc is of the opinion, though
Theodoric and some others are opposed to it, that
the nerve ends should be stitched together. He says
that this suture insures the redintegration of the
nerve much better. After this operation the restora-
tion of the usefulness of the member is more com-
plete and assured.

His description of the treatment of the bite of a
rabid dog is interesting. A large cupping glass
should be applied over the wound so as to draw out
as much blood as possible. After this the wound
should be dilated and thoroughly cauterized to its
depths with a hot iron. It should then be covered
with various substances that were supposed to draw,
in order as far as possible to remove the poison.
His description of how one may recognize a rabid
animal is rather striking in the light of our present

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 263

knowledge, for he seems to have realized that the
main diagnostic element is a change in the disposi-
tion of the animal, but above all a definite tendency
to lack playfulness. Lanfranc had seen a number
of cases of true rabies, and describes and suggests
treatment for them, though evidently without very
much confidence in the success of the treat-
ment.

The treatment of snake bites and the bites of other
poisonous animals was supposed to follow the prin-
ciples laid down for the bite of a mad dog, especially
as regards the encouragement of free bleeding and
the use of the cautery.

Lanfranc has many other expressions that one is
tempted to quote, because they show a thinking sur-
geon of the old time, anticipating many supposedly
modern ideas and conclusions. He is a particular
favorite of Gurlt 's, who has more than twenty-five
large octavo, closely printed pages with regard to
him. There is scarcely any development in our mod-
ern surgery that Lanfranc has not at least a hint of,
certainly nothing in the surgery of a generation ago
that does not find a mention in his book. On most
subjects he has practical observations from his own
experience to add to what was in surgical literature
before his time. He quotes altogether more than
a score of writers on surgery who had preceded
him and evidently was thoroughly familiar with gen-
eral surgical literature. There is scarcely an impor-
tant surgical topic on which Gurlt does not find some
interesting and personal remarks made by Lanfranc.
All that we can do here is refer those who are inter-
ested in Lanfranc to his own works or Gurlt.

264 OLD-TIME MAKERS OF MEDICINE

MONDEVILLE

The next of the important surgeons who were to
bring such distinction to French surgery for five
centuries was Henri de Mondeville. Writers usu-
ally quote him as Henricus. His latter name is only
the place of his birth, which was probably not far
from Caen in Normandy. It is spelled in so many
different ways, however, by different writers that it
is well to realize that almost anything that looks
like Mondeville probably refers to him. Such vari-
ants as Mundeville, Hermondaville, Amondaville,
Amundaville, Amandaville, Mandeville, Armanda-
ville, Armendaville, Amandavilla occur. We owe
a large amount of our information with re-
gard to him to Professor Pagel, who issued the
first edition of his book ever published (Berlin,
1892). It may seem surprising that Mondeville 's
work should have been left thus long without publica-
tion, but unfortunately he did not live long enough to
finish it. He was one of the victims that tuberculosis
claimed among physicians in the midst of their work.
Though there are a great number of manuscript
copies of his book, somehow Eenaissance interest in
it in its incompleted state was never aroused suf-
ficiently to bring about a printed edition. Certainly
it was not because of any lack of interest on the part
of his contemporaries or any lack of significance in
the work itself, for its printing has been one of the
surprises afforded us in the modern time as showing
how thoroughly a great writer on surgery did his
work at the beginning of the fourteenth century.

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 265

Gurlt, in his " History of Surgery," has given over
forty pages, much of it small type, with regard to
Mondeville, because of the special interest there is
in his writing.1

His life is of particular interest for other reasons
besides his subsequent success as a surgeon. He was
another of the university men of this time who wan-
dered far for opportunities in education. Though
born in the north of France and receiving his pre-
liminary education there, he made his medical stud-
ies towards the end of the thirteenth century under
Theodoric in Italy. Afterwards he studied medicine
in Montpellier and surgery in Paris. Later he gave
at least one course of lectures at Montpellier himself
and a series of lectures in Paris, attracting to both
universities during his professorship a crowd of
students from every part of Europe. One of his
teachers at Paris had been his compatriot, Jean
Pitard, the surgeon of Philippe le Bel, of whom he
speaks as " most skilful and expert in the art of
surgery," and it was doubtless to Pitard 's friend-
ship that he owed his appointment as one of the four
surgeons and three physicians who accompanied the
King into Flanders.

Besides his lectures, Mondeville had a large con-
sultant practice and also had to accompany the King
on his campaigns. This made it extremely difficult

JOf course, for any extended knowledge of Mondeville, a modern
reader must turn to Nicaise's translation of his "Chirurgia," which,
with an introduction and a biography, was published at Paris in 1893.
Nicaise's publication of this and of Guy de Chauliac's treatise has
worked a revolution in medical history and, above all, has made
these old authors available for those who hesitate to take up a work
•written entirely in Latin.

266 OLD-TIME MAKERS OF MEDICINE

for him to keep continuously at the writing of his
book. It was delayed in spite of his good intentions,
and we have the picture that is so familiar in the
modern time of a busy man trying to steal or make
time for his writing. Unfortunately, in addition to
other obstacles, Mondeville showed probably before
he was forty the first symptoms of a serious
pulmonary disease, presumably tuberculosis. He
bravely fought it and went on with his work. As his
end approached he sketched in lightly what he had
hoped to treat much more formally, and then turned
to what was to have been the last chapter of his
book, the Antidotarium or suggestions of practical
remedies against diseases of various kinds because
his students and physician friends were urging him
to complete this portion for them. We of the modern
time are much less interested in that than we would
have been in some of the portions of the work that
Mondeville neglected in order to provide therapeutic
hints for his disciples. But then the students and
young physicians have always clamored for the
practical — which so far at least in medical history
has always proved of only passing interest.

It is often said that at this time surgery was
mainly in the hands of barbers and the ignorant.
Henri de Mondeville, however, is a striking example
in contradiction of this. He must have had a fine
preliminary education and his book shows very wide
reading. There is almost no one of any importance
who seriously touched upon medicine or surgery be-
fore his time whom Mondeville does not quote. Hip-
pocrates, Aristotle, Dioscorides, Pliny, Galen,
Rhazes, AH Abbas, Abulcasis, Avicenna, Constan-

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 267

tine Africanus, Averroes, Maimonides, Albertus
Magnus, Hugo of Lucca, Theodoric, William of Sa-
licet, Lanfranc are all quoted, and not once or twice
but many times. Besides lie has quotations from
the poets and philosophers, Cato, Diogenes, Horace,
Ovid, Plato, Seneca, and others. He was a learned
man, devoting himself to surgery.

It is no wonder, then, that he thought that a sur-
geon should be a scholar, and that he needed to
know much more than a physician. One of his char-
acteristic passages is that in which he declares " it
.is impossible that a surgeon should be expert who
does not know not only the principles, but every-
thing worth while knowing about medicine," and
then he added, " just as it is impossible for a man
to be a good physician who is entirely ignorant of
the art of surgery." He says further: " This our
art of surgery, which is the third part of medicine
(the other two parts were diet and drugs), is, with
all due reverence to physicians, considered by us
surgeons ourselves and by the non-medical as a
more certain, nobler, securer, more perfect, more
necessary, and more lucrative art than the other
parts of medicine." Surgeons have always been
prone to glory in their specialty.

Mondeville had a high idea of the training that
a surgeon should possess. He says: " A surgeon
who wishes to operate regularly ought first for a
long time to frequent places in which skilled sur-
geons operate often, and he ought to pay careful
attention to their operations and commit their tech-
nique to memory. Then he ought to associate him-
self with them in doing operations. A man cannot

268 OLD-TIME MAKERS OF MEDICINE

be a good surgeon unless he knows both the art and
science of medicine and especially anatomy. The
characteristics of a good surgeon are that he should
be moderately bold, not given to disputations before
those who do not know medicine, operate with fore-
sight and wisdom, not beginning dangerous opera-
tions until he has provided himself with everything
necessary for lessening the danger. He should have
well-shaped members, especially hands with long,
slender fingers, mobile and not tremulous, and with
all his members strong and healthy so that he may
perform all the good operations without disturb-
ance of mind. He must be highly moral, should care
for the poor for God's sake, see that he makes him-
self well paid by the rich, should comfort his pa-
tients by pleasant discourse, and should always ac-
cede to their requests if these do not interfere with
the cure of the disease." " It follows from this,"
he says, " that the perfect surgeon is more than the
perfect physician, and that while he must know medi-
cine he must in addition know his handicraft. ' '

Thinking thus, it is no wonder that he places his
book under as noble patronage as possible. He says
in the preface that he " began to write it for the
honor and praise of Christ Jesus, of the Virgin Mary,
of the Saints and Martyrs, Cosmas and Damian, and
of King Philip of France as well as his four chil-
dren, and on the proposal and request of Master
William of Briscia, distinguished professor in the
science of medicine and formerly physician to Pope
Boniface IV and Benedict and Clement, the present
Pope." His first book on anatomy he proposed to
found on that of Avicenna and ' * on his personal ex-

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 269

perience as he has seen it." The second tractate on
the treatments of wounds, contusions, and ulcers
was founded on the second book of Theodoric ' ' with
whatever by recent study has been newly acquired
and brought to light through the experience of mod-
ern physicians." He then confesses his obligations
to his great master, John Pitard, and adds that all
the experience that he has gained while operating,
studying, and lecturing for many years on surgery
will be made use of in order to enhance the value
of the work. He hopes, however, to accomplish all
this " briefly, quietly, and above all, charitably."
There are many things in the preface that show us
the reason for Mondeville's popularity, for they ex-
hibit him as very sympathetically human in his in-
terests.

While Mondeville is devoted to the principle that
authority is of great value, he said that there was
nothing perfect in things human, and successive gen-
erations of younger men often made important addi-
tions to what their ancestors had left them. While
his work is largely a compilation, nearly everywhere
it shows signs of the modification of his predecessors'
opinions by the results of his own experience. His
method of writing is, as Pagel declares, * * always in-
teresting, lively, and often full of meat. ' ' He had a
teacher's instinct, for in several of the earlier manu-
scripts his special teaching is put in larger letters
in order to attract students' attention. . . He seems
to have introduced or re-introduced into practice the
idea of the use of a large magnet in order to extract
portions of iron from the tissues. He made several
modifications in needles and thread holders and in-

270 OLD-TIME MAKERS OF MEDICINE

vented a kind of small derrick for the extraction of
arrows with barbs. Besides, he suggested the sur-
rounding of the barbs of the arrows with tubes, to
facilitate extraction. In his treatment of wounds,
Pagel considers that as a writer and teacher he is
far ahead of his predecessors and even of those who
came after him in immediately subsequent genera-
tions. One of his great merits undoubtedly is that
Guy de Chauliac, the father of modern surgery, in
his text-book turned to him with a confidence that
proclaims his admiration and how much he felt that
he had gained from him.

One of the most interesting features of Monde-
ville's work is his insistence on the influence of the
mind on the body and the importance of using this
influence to the best advantage. It is especially im-
portant in Mondeville's opinion to keep a surgical
patient from being moody. * * Let the surgeon, ' ' says
he, * * take care to regulate the whole regimen of the
patient's life for joy and happiness by promising
that he will soon be well, by allowing his relatives
and special friends to cheer him and by having some-
one to tell him jokes, and let him be solaced also by
music on the viol or psaltery. The surgeon must
forbid anger, hatred, and sadness in the patient, and
remind him that the body grows fat from joy and
thin from sadness. He must insist on the patient
obeying him faithfully in all things. He repeats with
approval the expression of Avicenna that " often the
confidence of the patient in his physician does more
for the cure of his disease than the physician with
all his remedies." Obstinate and conceited patients
prone to object to nearly everything that the sur-

GEEAT SURGEONS OF MEDIEVAL UNIVERSITIES 271

geon wants to do, and who often seem to think that
they surpass Galen and Hippocrates in science and
wisdom, are likely to delay their cure very much, and
they represent the cases with which the surgeon has
much difficulty.

Mondeville thought that nursing was extremely
important and that without it surgery often failed
of its purpose. He says, ' * For if the assistants are
not solicitous and faithful, and obedient to the sur-
geons in each and every thing which may make for
the cure of the disease, they put obstacles and diffi-
culties in the way of the surgeon." It is especially
important that the patient's nutrition should be
cared for and that the bandages should be managed
exactly as the surgeon directs. He has no use for
garrulous, talkative nurses, and does not hesitate to
say that sometimes near relatives are particularly
likely to disturb patients. ' ' Especially are they prone
to let drop some hint of bad news which the surgeon
may have revealed to them in secret, or even the
reports that they may hear from others, friends or
enemies, and this provokes the patient to anger or
anxiety and is likely to give him fever. If the as-
sistants quarrel among themselves, or are heard mur-
muring, or if they draw long faces, all of these
things will disturb the patients and produce worry
and anxiety or fear. The surgeon therefore must be
careful in the selection of his nurses, for some of
them obey very well while he is present, but do as
they like and often just exactly the opposite of what
he has directed when he is away. ' '

We do not know enough of the details of Monde-
ville's life to be sure whether he was married or not.

272 OLD-TIME MAKERS OF MEDICINE

It is probable that he was not, for all of these sur-
geons of the thirteenth century before Mondeville's
time, Theodoric, William of Salicet, Lanfranc, and
Guy de Chauliac, after him belonged to the clerical
order; Theodoric was a bishop; the others, how-
ever, seem only to have been in minor orders. It
is therefore from the standpoint of a man who views
married life from without that Mondeville makes his
remarks as to the difficulty often encountered when
wives nurse their husbands. He says that the sur-
geon has difficulty oftener when husbands or wives
care for their spouses than at other times. This is
much more likely to take place when the wives are
caring for the husbands. " In our days," he says,
" in this Gallican part of the world, wives rule their
husbands, and the men for the most part permit
themselves to be ruled. Whatever a surgeon may
order for the cure of a husband then will often seem
to the wives to be a waste of good material, though
the men seem to be quite willing to get anything that
may be ordered for the cure of their wives. The
whole cause of this seems to be that every woman
seems to think that her husband is not as good as
those of other women whom she sees around her."
It would be interesting to know how Mondeville was
brought to a conclusion so different from modern
experience in the matter.

For those who are particularly interested in med-
ical history one of the sections of Henry's book has
a special appeal, because he gives in it a sketch of
the history of surgery. We are little likely to think,
as a rule, that at this time, full two centuries before
the close of the Middle Ages, men were interested

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 273

enough in the doings of those who had gone before
them to try to trace the history of the development of
their specialty. It is characteristic of the way that
the scholarly Mondeville views his own life work
that he should have wanted to know something about
his predecessors and teach others with regard to
them. He begins with Galen, and as Galen divides
the famous physicians of the world into three sects,
the Methodists, the Empirics, and the Rationalists,
so Mondeville divides modern surgery into three
sects: first, that of the Salernitans, with Roger,
Roland, and the Four Masters ; second, that of Wil-
liam of Salicet and Lanfranc; and third, that of
Hugo de Lucca and his brother Theodoric and their
modern disciples. He states briefly the characteris-
tics of these three sects. The first limited patients'
diet, used no stimulants, dilated all wounds, and got
union only after pus formation. The second allowed
a liberal diet to weak patients, though not to the
strong, but generally interfered with wounds too
much. The third believed in a liberal diet, never di-
lated wounds, never inserted tents, and its members
were extremely careful not to complicate wounds of
the head by unwise interference. His critical dis-
cussion of the three schools is extremely interesting.
Another phase of Mondeville 's work that is sym-
pathetic to the moderns is his discussion of the ir-
regular practice of medicine and surgery as it existed
in his time. Most of our modern medicine and sur-
gery was anticipated in the olden time; but it may
be said that all of the modes of the quack are as old
as humanity. Galen's description of the travelling
charlatan who settled down in his front yard, not

274 OLD-TIME MAKERS OF MEDICINE

knowing that it belonged to a physician, shows this
very well. There were evidently as many of them
and as many different kinds in Mondeville's time as
in our own. In discussing the opposition that had
arisen between physicians and surgeons in his time
and their failure to realize that they were both mem-
bers of a great profession, he enumerates the many
different kinds of opponents that the medical profes-
sion had. There were " barbers, soothsayers, loan
agents, falsifiers, alchemists, meretrices, midwives,
old women, converted Jews, Saracens, and indeed
most of those who, having wasted their substance
foolishly, now proceed to make physicians or sur-
geons of themselves in order to make their living
under the cloak of healing. ' '

What surprises Mondeville however, as it has al-
ways surprised every physician who knows the sit-
uation, is that so many educated, or at least sup-
posedly well-informed people of the better classes,
indeed even of the so-called best classes, allow them-
selves to be influenced by these quacks. And it is
even more surprising to him that so many well-to-do,
intelligent people should, for no reason, though with-
out knowledge, presume to give advice in medical
matters and especially in even dangerous surgical
diseases, and in such delicate affections as diseases
of the eyes. " It thus often happens that diseases
in themselves curable grow to be simply incurable or
are made much worse than they were before." He
says that some of the clergymen of his time seemed
to think that a knowledge of medicine is infused into
them with the sacrament of Holy Orders. He was
himself probably a clergyman, and I have in the

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 275

modern time more than once known of teachers in
the clerical seminaries emphasizing this same idea
for the clerical students. It is very evident that the
world has not changed very much, and that to know
any time Reasonably well is to find in it comments
on the mdrning paper. We are in the midst of just
such a series of interferences with medicine on the
part of the clergy as this wise, common-sense sur-
geon of the thirteenth century deprecated.

In every way Mondeville had the instincts of a
teacher. He took advantage of every aid. He was
probably the first to use illustrations in teaching
anatomy. Guy de Chauliac, whose teacher in anat-
omy for some time Mondeville was, says in the first
chapter of his " Chirurgia Magna " that pictures
do not suffice for the teaching of anatomy and that
actual dissection is necessary. The passage runs
as follows : ' ' In the bodies of men, of apes, and of
pigs, and of many other animals, tissues should be
studied by dissections and not by pictures, as did
Henricus, who was seen to demonstrate anatomy
with thirteen pictures." x What Chauliac blames is
the attempt to replace dissections by pictorial de-
monstrations. Hyrtl, however, suggests that this in-
vention of Mondeville 's was probably very helpful,
and was brought about by the impossibility of pre-

1 In the very first book containing some account of human anatomy,
a German volume by Conradus Mengenberger, called " Puch der Na-
tur," the date of printing of which is about 1478, — that is, less than ten
years after the printing of the very first book, the " Biblia pauperum,"
which appeared in 1470,— there are, according to Haller in his "Biblio-
theca Anatomica," a series of illustrations. This is the first illustrated
medical work ever published.

276 OLD-TIME MAKERS OF MEDICINE

serving bodies for long periods as well as the dif-
ficulty of obtaining them.

YPEBMAN f

One of the maxims of the old Greek philosophers
was that good is diffusive of itself. As the scholas-
tics put it, bonum est diffusivum sui. This proved
to be eminently true of the old universities also, and
especially of their training in medicine and in sur-
gery. We have the accounts of men from many na-
tions who went to the universities and returned to
benefit their own people. Early in the thirteenth cen-
tury Richard the Englishman was in Italy, having
previously been in Paris and probably atMontpellier.
Bernard Gordon, probably also an Englishman, was
one of the great lights in medicine down at Mont-
pellier, and his book, * l Lilium De Medicina, ' ' is well
known. Two distinguished surgeons whose names
have come down to us, having studied in Paris after
Lanfranc had created the tradition of great surgical
teaching there, came to their homes to be centres of
beneficent influence among their people in this mat-
ter. One was Yperman, of the town of Ypres in
Belgium; the other Ardern of England. Ypermann
was sent by his fellow-townsmen to Paris in order
to study surgery, because they wanted to have a
good surgeon in their town and Paris seemed the
best school at that time. Ypres was at this period
one of the greatest commercial cities of Europe, and
probably had a couple of hundred thousand inhab-
itants. The great hall of the cloth gild, which has
been such an attraction for visitors ever since, was

GREAT SUEGEONS OF MEDIEVAL UNIVERSITIES 277

built shortly before the town determined upon the
very sensible procedure of securing good surgery
beyond all doubt by having a townsman specially
educated for that purpose.

Yperman's work was practically unknown to us
until Broeck, the Belgian historian, discovered man-
uscript copies of his book on surgery and gath-
ered some details of his life. After his return from
Paris, Yperman obtained great renown, which
maintained itself in the custom extant in that
part of the country even yet of calling an expert
surgeon an Yperman. He is the author of two
works in Flemish. One of these is a smaller com-
pendium of internal medicine, which is very inter-
esting, however, because it shows the many subjects
that were occupying physicians' minds at that time.
He treats of dropsy, rheumatism, under which occur
the terms coryza and catarrh (the flowing diseases),
icterus, phthisis (he calls the tuberculosis, tysiken),
apoplexy, epilepsy, frenzy, lethargy, fallen palate,
cough, shortness of breath, lung abscess, hemor-
rhage, blood-spitting, liver abscess, hardening of the
spleen, affections of the kidney, bloody urine, dia-
betes, incontinence of urine, dysuria, strangury,
gonorrhea, and involuntary seminal emissions — all
these terms are quoted directly from Pagel's ac-
count of his work; the original is not available in
this country.

JOHN ABDERN

In English-speaking countries of course we are in-
terested in what was done by Englishmen at this

278 OLD-TIME MAKERS OF MEDICINE

time. Fortunately we have the record of one great
English surgeon of the period worthy to be placed
beside even the writers already mentioned. This
is John Ardern, whose name is probably a modifica-
tion of the more familiar Arden, whose career well
deserves attention. I have given a sketch of his
work in " The Popes and Science." 1 He was edu-
cated at Montpellier, and practised surgery for a
time in France. About the middle of the century how-
ever, according to Pagel, he went back to his native
land and settled for some twenty years at Newark,
in Nottinghamshire, and then for nearly thirty years
longer, until about the end of the century, was in
London. He is the chief representative of English
surgery during the Middle Ages. His " Practica,"
as yet imprinted, contains, according to Pagel, a
short sketch of internal medicine, but is mainly de-
voted to surgery. Contrary to the usual impression
with regard to works in medicine and surgery at
this time, the book abounds in references to case his-
tories which Ardern had gathered, partly from his
own and partly from others' experience. The thera-
peutic measures that he suggests are usually very
simple, in the majority of cases quite rational,
though, of course, there are many superstitions
among them; but Ardern always furnished a num-
ber of suggestions from which to choose. He must
have been an expert operator, and had excellent suc-
cess in the treatment of diseases of the rectum. He
seems to have been the first operator who made
careful statistics of his cases, and was quite as proud

JFordham University Press, New York, 1908.

GEEAT SURGEONS OF MEDIEVAL UNIVERSITIES 279

as any modern surgeon of the large numbers that
he had operated on, which he gives very exactly.
He was the inventor of a new clyster apparatus.

Fortunately we possess here in America, in the
Surgeon General's Library at Washington, a very
interesting manuscript containing Ardern's surgical
writings, though it has not yet been published. Even
a little study of this and of the notes on it prepared
by an English bibliophile before its purchase by the
Surgeon General 's Library, serves to show how val-
uable the work is in the history of surgery. There
are illustrations scarcely less interesting than the
text. Some of these illustrations were inserted by
the original writer or copyist, and some of them later.
In general, however, they show a rather high devel-
opment of the mechanics of surgery at that time.
Some of the pages have spaces for illustrations left
unfilled, so that evidently the copyist did not com-
plete his work. The titles of certain of the chapters
are interesting, as illustrating the fact that our
medical and surgical problems were stated clearly
in the olden time, and thinking physicians, even six
centuries ago, met them quite rationally. There is,
for instance, a chapter headed " Against Colic and
the Iliac Passion," immediately followed by the sub-
heading, " Method of Administering Clysters."
The iliac passion, passio iliaca of the old Latin, is
usually taken to signify some obstruction of the in-
testines causing severe pain, vomiting, and eventu-
ally fecal vomiting. A good many different forms
of severe painful conditions, especially all those com-
plicated by peritonitis, were included under the term,
and the modern student of surgery is likely to won-

280 OLD-TIME MAKERS OF MEDICINE

der whether these old observers had not noted that
the right iliac region was particularly ppone to be
the source of fatal conditions. There is a chapter
entitled " Against Pain in the Loins and the Kid-
neys," followed by the chapter subheading,
" Against Stone in the Kidneys." There is a chap-
ter with the title, * ' Against Ulceration of the Blad-
der or the Kidneys." Another one, with the title
" Against Burning of the Urine and Excoriation of
the Lower Part of the Yard. ' ' Gonorrhea is frankly
treated under the name Shawdepisse, evidently an
English alliteration of the corresponding French
word. As to the instrumentation of such conditions
and for probing in general, Ardern suggests the use
of a lead probe, because it may readily be made to
bend any way and not injure the tissues.

MEDIEVAL SURGERY

Even this brief account of the surgeons who taught
and studied at the medieval universities demon-
strates what fine work they did. It is surely not too
much to say that the chapter on university educa-
tion mainly concerned with them is one of the most
interesting in the whole history of the universities.
Their story alone is quite enough to refute most of
the prevalent impressions and patronizing expres-
sions with regard to medieval education. Their
careers serve to show how interested were the men
of many nations in the development of an extremely
important application of science for the benefit of
suffering humanity. Their work utterly contradicts
the idea so frequently emphasized that the great

GREAT SURGEONS OF MEDIEVAL UNIVERSITIES 281

students of the Middle Ages were lacking in prac-
ticalness. Besides, they make very clear that we
have been prone to judge the Middle Ages too much
from its speculative philosophies. It has been the
custom to say that speculation ruled men's minds
and prevented them from making observations, de-
veloping science, or applying scientific principles.
There was much speculation during the Middle Ages,
but probably not any more in proportion than exists
at the present day. We were either not acquainted
with, or failed to appreciate properly, until com-
paratively recent years, the other side of medieval
accomplishment. Our ignorance led us into misun-
derstanding of what these generations really did. It
was our own fault, because during the Renaissance
practically all of these books were edited and printed
under the direction of the great scholars of the time
in fine editions, but during the eighteenth century
nearly all interest was lost in them, and we are only
now beginning to get back a certain amount of the
precious knowledge that they had in the Renaissance
period of this other side of medieval life. We have
learned so much about surgery because distinguished
scholars devoted themselves to this phase of the his-
tory of science. Doubtless there are many other
phases of the history of science which suffered the
same fate of neglect and with regard to which the
future will bring us equally startling revelations.
For this reason this marvellous chapter in the his-
tory of surgery is a warning as well as a startling
record of a marvellous epoch of human progress.

XI
GUY DE CHAULIAC

One of the most interesting characters in the his-
tory of medieval medicine, and undoubtedly the most
important and significant of these Old-Time Makers
of Medicine, is Guy de Chauliac. Most of the false no-
tions so commonly accepted with regard to the Mid-
dle Ages at once disappear after a careful study of
his career. The idea of the careful application of
scientific principles in a great practical way is far
removed from the ordinary notion of medieval pro-
cedure. Some observations we may concede that
they did make, but we are inclined to think that these
were not regularly ordered and the lessons of them
not drawn so as to make them valuable as experi-
ences. Great art men may have had, but science and,
above all, applied science, is a later development of
humanity. Particularly is this supposed to be true
with regard to the science and practice of surgery,
which is assumed to be of comparatively recent
origin. Nothing could well be less true, and if the
thoroughly practical development of surgery may be
taken as a symbol of how capable men were of apply-
ing science and scientific principles, then it is com-
paratively easy to show that the men of the later
Middle Ages were occupied very much as have been
our recent generations with science and its practical
applications.

282

GUT DE CHAULIAC 283

The immediate evidence of the value of old-time
surgery is to be found in the fact that Guy de
Chauliac, who is commonly spoken of in the history
of medicine as the Father of Modern Surgery, lived
his seventy-odd years of life during the fourteenth
century and accomplished the best of his work,
therefore, some five centuries before surgery in our
modern sense of the term is supposed to have de-
veloped. A glance at his career, however, will show
how old are most of the important developments
of surgery, as also in what a thoroughly scientific
temper of mind this subject was approached more
than a century before the close of the Middle Ages.
The life of this French surgeon, indeed, who was a
cleric and occupied the position of chamberlain and
physician-in-ordinary to three of the Avignon Popes,
is not only a contradiction of many of the tradi-
tions as to the backwardness of our medieval for-
bears in medicine, that are readily accepted by many
presumably educated people, but it is the best pos-
sible antidote for that insistent misunderstanding of
the Middle Ages which attributes profound igno-
rance of science, almost complete failure of observa-
tion, and an absolute lack of initiative in applica-
tions of science to the men of those times.

Guy de Chauliac 's life is modern in nearly every
phase. He was educated in a little town of the
south of France, made his medical studies at Mont-
pellier, and then went on a journey of hundreds of
miles into Italy, in order to make his post-graduate
studies. Italy occupied the place in science at that
time that Germany has taken during the nineteenth
century. A young man who wanted to get into touch

284 OLD-TIME MAKERS OF MEDICINE

with the great masters in medicine naturally went
down into the Peninsula. Traditions as to the atti-
tude of the Church to science notwithstanding, Italy
where education was more completely under the
influence of the Popes and ecclesiastics than in any
other country in Europe, continued to be the home
of post-graduate work in science for the next four
centuries. Almost needless to say, the journey to
Italy was more difficult of accomplishment and in-
volved more expense and time than would even the
voyage from America to Europe in our time. Chau-
liac realized, however, that both time and expense
would be well rewarded, and his ardor for the round-
ing out of his education was amply recompensed
by the event. Nor have we any reason for thinking
that what he did was very rare, much less unique,
in his time. Many a student from France, Germany,
and England made the long journey to Italy for
post-graduate opportunities during the later Middle
Ages.

Even this post-graduate experience in Italy did
not satisfy Chauliac, however, for, after having
studied several years with the most distinguished
Italian teachers of anatomy and surgery, he spent
some time in Paris, apparently so as to be sure that
he would be acquainted with the best that was being
done in his specialty in every part of the world. He
then settled down to his own life work, carrying his
Italian and French masters' teachings well beyond
the point where he received them, and after years
of personal experience he gathered together his
masters' ideas, tested by his own observations, into
his " Chirurgia Magna," a great text-book of sur-

GUY DE CHAULIAC 285

gery which sums up the whole subject succinctly,
yet completely, for succeeding generations. When
we talk about what he accomplished for surgery, we
are not dependent on traditions nor vague informa-
tion gleaned from contemporaries and successors,
who might perhaps have been so much impressed
by his personality as to be made over-enthusiastic
in their critical judgment of him. We know the man
in his surgical works, and they have continued to be
classics in surgery ever since. It is an honorable
distinction for the medicine of the later fourteenth,
the fifteenth, and sixteenth centuries that Guy de
Chauliac's book was the most read volume of the
time in medicine. Evidently the career of such a
man is of import, not alone to physicians, but to all
who are interested in the history of education.

Chauliac derives his name from the little town
of Chauliac in the diocese of Mende, almost in the
centre of what is now the department of Lozere.
The records of births and deaths were not consid-
ered so important in the fourteenth century as they
are now, and so we are not sure of either in the case
of Chauliac. It is usually considered that he was
born some time during the last decade of the thir-
teenth century, probably toward the end of it, and
that he died about 1370. Of his early education we
know nothing, but it must have been reasonably
efficient, since it gave him a good working knowledge
of Latin, which was the universal language of science
and especially of medicine at that time ; and though
his own style, as must be expected, is no better than
that of his contemporaries, he knew how to express
his thoughts clearly in straightforward Latin, with

286 OLD-TIME MAKERS OF MEDICINE

only such a mixture of foreign terms as his studies
suggested and the exigencies of a new development
of science almost required. Later in life he seems
to have known Arabic very well, for he is evidently
familiar with Arabian books and does not depend
merely on translations of them.

Pagel, in the first volume of Puschmann's " Hand-
book of the History of Medicine," says, on the
authority of Nicaise and others, that Chauliac re-
ceived his early education from the village clergy-
man. His parents were poor, and but for ecclesi-
astical interest in him it would have been difficult
for him to obtain his education. The Church sup-
plied at that time to a great extent for the founda-
tions and scholarships, home and travelling, of our
day, and Chauliac was amongst the favored ones.
How well he deserved the favor his subsequent
career shows, as it completely justifies the judg-
ment of his patrons. He went first to Toulouse, as
we know from his affectionate mention of one of his
teachers there. Toulouse was more famous for law,
however, than for medicine, and after a time Chau-
liac sought Montpellier to complete his medical
studies.

For English-speaking people an added interest in
Guy de Chauliac will be the fact that one of his
teachers at Montpellier was Bernard Gordon, very
probably a Scotchman, who taught for some thirty-
five years at this famous university in the south of
France, and died near the end of the first quarter
of the fourteenth century. One of Chauliac 's fellow-
students at Montpellier was John of Gaddesden, the
first English Eoyal Physician by official appoint-

GUY DE CHAULIAC 287

ment of whom we have any account. John is men-
tioned by Chaucer in his " Doctor of Physic," and
is usually looked upon as one of the fathers of Eng-
lish medicine. Chauliac did not think much of him,
though his reason for his dislike of him will prob-
ably be somewhat startling to those who assumejthat
the men of the Middle Ages always clung servilely
to authority. Chauliac 's objection to Gaddesden's
book is that he merely repeats his masters and does
not dare to think for himself. It is not hard to
understand that such an independent thinker as
Chauliac should have been utterly dissatisfied with
a book that did not go beyond the forefathers in
medicine that the author quotes. This is the ex-
planation of his well-known expression, " Last of all
arose the scentless rose of England [' Eosa An-
glias ' was the name of John of Gaddesden's book],
in which, on its being sent to me, I hoped to find the
odor of sweet originality, but instead of that I en-
countered only the fictions of Hispanus, of Gilbert,
and of Theodoric."

The presence of a Scotch professor and an Eng-
lish fellow-student, afterwards a royal physician, at
Montpellier, at the beginning of the fourteenth cen-
tury, shows how much more cosmopolitan was uni-
versity life in those times than we are prone to
think, and what attraction a great university medical
school possessed even for men from long distances.

After receiving his degree of Doctor of Medicine
at Montpellier Chauliac went, as we have said, to
Bologna. Here he attracted the attention and re-
ceived the special instruction of Bertruccio, who
was attracting students from all over Europe at

288 OLD-TIME MAKERS OF MEDICINE

this time and was making some excellent demonstra-
tions in anatomy, employing human dissections very
freely. Chauliac tells of the methods that Bertruc-
cio used in order that bodies might be in as good
condition as possible for demonstration purposes,
and mentions the fact that he saw him do many dis-
sections in different ways.

In Eoth's life of Vesalius, which is usually con-
sidered one of our most authoritative medical his-
torical works not only with regard to the details of
Vesalius' life, but also in all that concerns anatomy
about that time and for some centuries before, there
is a passage quoted from Chauliac himself which
shows how freely dissection was practised at the
Italian universities in the fourteenth century. This
passage deserves to be quoted at some length be-
cause there are even serious historians who still
cite a Bull of Pope Boniface VIII, issued in 1300,
forbidding the boiling and dismembering of bodies
in order to transport them to long distances for
burial in their own country, as being, either rightly
or wrongly, interpreted as a prohibition of dissec-
tion and, therefore, preventing the development of
anatomy. In the notes to his history of dissection
during this period in Bologna Roth says : ' ' Without
doubt the passage in Guy de Chauliac which tells
of having frequently seen dissections, must be con-
sidered as referring to Bologna. This passage runs
as follows : * My master Bertruccius conducted the
dissection very often after the following manner:
the dead body having been placed upon a bench, he
used to make four lessons on it. In the first the
nutritional portions were treated, because they are

GUY DE CHAULIAC 289

so likely to become putrefied. In the second, he
demonstrated the spiritual members; in the third,
the animate members; in the fourth, the extrem-
ities.' " (Both, " Andreas Vesalius." Basel, 1896.)
Bertruccio 's master, Mondino, is hailed in the his-
tory of medicine as the father of dissection. His
book on dissection was for the next three centuries
in the hands of nearly every medical scholar in
Europe who was trying to do good work in anatomy.
It was not displaced until Vesalius came, the father
of modern anatomy, who revolutionized the science
in the Eenaissance time. Mondino had devoted him-
self to the subject with unfailing ardor and enthusi-
asm, and from everywhere in Europe the students
came to receive inspiration in his dissecting-room.
Within a few years such was the enthusiasm for dis-
section aroused by him in Bologna that there were
many legal prosecutions for body-snatching, the con-
sequence doubtless of a regulation of the Medical
Department of the University of Bologna, that if
the students brought a body to any of their teachers
he was bound to dissect it for them. Bertruccio,
Mondino 's disciple and successor, continued this
great work, and now Chauliac, the third in the tradi-
tion, was to carry the Bolognese methods back to
France, and his position as chamberlain to the Pope
was to give them a wide vogue throughout the world.
The great French surgeon's attitude toward anat-
omy and dissection can be judged from his famous
expression that " the surgeon ignorant of anatomy
carves the human body as a blind man carves
wood." The whole subject of dissection at this time
has been fully discussed in the first three chapters

290 OLD-TIME MAKERS OF MEDICINE

of my " Popes and Science," where those who are
interested in the matter may follow it to their satis-
faction.1

After his Bologna experience Chauliac went to
Paris. Evidently his indefatigable desire to know
all that there was to be known would not be satisfied
until he had spent some time at the great French
university where Lanfranc, after having studied
under William of Salicet in Italy, had gone to estab-
lish that tradition of French surgery which, carried
on so well by Mondeville his great successor, was
to maintain Frenchmen as the leading surgeons of
the world until the nineteenth century (Pagel).
Lanfranc, himself an Italian, had been exiled from
his native country, apparently because of political
troubles, but was welcomed at Paris because the
faculty realized that they needed the inspiration of
the Italian medical movement in surgery for the es-
tablishment of a good school of surgery in connec-
tion with the university. The teaching so well begun
by Lanfranc was magnificently continued by Monde-
ville and Arnold of Villanova and their disciples.
Chauliac was fortunate enough to come under the
influence of Petrus de Argentaria, who was worthily
maintaining the tradition of practical teaching in
anatomy and surgery so well founded by his great
predecessors of the thirteenth century. After this
grand tour Chauliac was himself prepared to do
work of the highest order, for he had been in touch
with all that was best in the medicine and surgery
of his time.

'FordLam University Press, New York, 1908.

GUY DE CHAULIAC 291

Like many another distinguished member of his
profession, Chauliac did not settle down in the scene
of his ultimate labors at once, but was something of
a wanderer. His own words are, " Et per multa
tempora operatic fui in multis partibu^." Perhaps
out of gratitude to the clerical patrons of his native
town to whom he owed so much, or because of the
obligations he considered that he owed them for his
education, he practised first in his native diocese of
Mende ; thence he removed to Lyons, where we know
that he lived for several years, for in 1344 he took
part as a canon in a chapter that met in the Church
of St. Just in that city. Just when he was called
to Avignon we do not know, though when the black
death ravaged that city in 1348 he was the body-
physician of Pope Clement VI, for he is spoken of
in a Papal document as " venerabilis et circum-
spectus vir, dominus Guido de Cauliaco, canonicus et
prcepositus ecclesice Sancti Justi Lugduni, medi-
cusque domini Nostri Papa." All the rest of his
life was passed in the Papal capital, which Avignon
was for some seventy years of the fourteenth cen-
tury. He served as chamberlain-physician to three
Popes, Clement VI, Innocent VI, and Urban V. We
do not know the exact date of his death, but when
Pope Urban V went to Rome in 1367, Chauliac was
putting the finishing touches on his " Chirurgia
Magna," which, as he tells us, was undertaken as a
solatium senectutis — a solace in old age. When
Urban returned to Avignon for a time in 1370
Chauliac was dead. His life work is summed up for
us in this great treatise on surgery, full of anticipa-

292 OLD-TIME MAKERS OF MEDICINE

tions in surgical procedures that we are prone to
think much more modern.

Nicaise has emphasized the principles which
guided Guy de Chauliac in the choice and interpreta-
tion of his authorities by a quotation from Guy
himself, which is so different in its tone from what
is usually supposed to have been the attitude of mind
of the men of science of the time that it would be
well for all those who want to understand the Mid-
dle Ages better to have it near them. Speaking of
the surgeons of his own and immediately preceding
generations, Guy says: " One thing particularly is
a source of annoyance to me in what these surgeons
have written, and it is that they follow one another
like so many cranes. For one always says what the
other says. I do not know whether it is from fear
or from love that they do not deign to listen except
to such things as they are accustomed to and as
have been proved by authorities. They have to my
mind understood very badly Aristotle's second book
of metaphysics where he shows that these two
things, fear and love, are the greatest obstacles on
the road to the knowledge of the truth. Let them
give up such friendships and fears. * Because while
Socrates or Plato may be a friend, truth is a
greater friend.' Truth is a holy thing and worthy
to be honored above everything else. Let them fol-
low the doctrine of Galen, which is entirely made
up of experience and reason, and in which one in-
vestigates things and despises words."

After all, this is what great authorities in medi-
cine have always insisted on. Once every hundred
years or so one finds a really great observer who

GUY DE CHAULIAC 293

makes new observations and wakes the world up.
He is surprised that men should not have used their
powers of observation for themselves, but should
have been following old-time masters. His corn-
temporaries often refuse to listen to him at first.
His observations, however, eventually make their
way. We blame the Middle Ages for following au-
thority, but what have we been always doing but
following authority, except for the geniuses who
come and lift us out of the rut and illuminate a new
portion of the realm of medicine. After they have
come, however, and done their work, their disciples
proceed to see with their eyes and to think that they
are making observations for themselves when they
are merely following authority. When the next mas-
ter in medicine comes along his discovery is neg-
lected because men have not found it in the old
books, and usually he has to suffer for daring to
have opinions of his own. The fact of the matter
is that at any time there is only a very limited num-
ber of men who think for themselves. The rest think
other people's thoughts and think they are thinking
and doing things. As for observation, John Ruskin
once said, " Nothing is harder than to see something
and tell it simply as you saw it." This is as true in
science as in art, and only genius succeeds in doing
it well.

Chauliac's book is confessedly a compilation. He
has taken the good wherever he found it, though he
adds, modestly enough, that " his work also contains
whatever his own measure of intelligence enabled
him to find useful (qua juxta modicitatem mei in-
genii utilia reputavi). Indeed it is the critical judg-

294 OLD-TIME MAKERS OF MEDICINE

ment displayed by Chauliac in selecting from his
predecessors that best illustrates at once the prac-
tical character of his intellect and his discerning
spirit. What the men of his time are said to have
lacked is the critical faculty. They were encyclo-
pedic in intellect and gathered all kinds of informa-
tion without discrimination, is a very common criti-
cism of medieval writers. No one can say this of
Chauliac, however, and, above all, he was no re-
specter of authority, merely for the sake of author-
ity. His criticism of John of Gaddesden's book
shows that the blind following of those who had
gone before was his special bete noir. His bitterest
reproach for many of his predecessors was that
" they follow one another like cranes, whether for
love or fear, I cannot say."

Chauliac 's right to the title of father of surgery
will perhaps be best appreciated from the brief ac-
count of his recommendations as to the value of sur-
gical intervention for conditions in the three most
important cavities of the body, the skull, the thorax,
and the abdomen. These cavities have usually been
the dread of surgeons. Chauliac not only used the
trephine, but laid down very exact indications for its
application. Expectant treatment was to be the
rule in wounds of the head, yet when necessary, in-
terference was counselled as of great value. His
prognosis of brain injuries was much better than
that of his predecessors. He says that he had seen
injuries of the brain followed by some loss of brain
substance, yet with complete recovery of the patient.
In one case that he notes a considerable amount
of brain substance was lost, yet the patient recovered

GUY DE CHAULIAC 295

with only a slight defect of memory, and even this
disappeared after a time. He lays down exact indi-
cations for the opening of the thorax, that noli me
tangere of surgeons at all times, even our own, and
points out the relations of the ribs and the dia-
phragm, so as to show just where the opening should
be made in order to remove fluid of any kind.

In abdominal conditions, however, Chauliac's an-
ticipation of modern views is most surprising. He
recognized that wounds of the intestines were surely
fatal unless leakage could be prevented. Accord-
ingly he suggested the opening of the abdomen and
the sewing up of such intestinal wounds as could be
located. He describes a method of suture for these
cases and seems, like many another abdominal sur-
geon, even to have invented a special needleholder.

To most people it would seem absolutely out of the
question that such surgical procedures could be prac-
tised in the fourteenth century. We have the definite
record of them, however, in a text-book that was the
most read volume on the subject for several cen-
turies. Most of the surprise with regard to these
operations will vanish when it is recalled that in
Italy during the thirteenth century, as we have al-
ready seen, methods of anaesthesia by means of
opium and mandragora were in common use, having
been invented in the twelfth century and perfected
by Ugo da Lucca, and Chauliac must not only have
known but must have frequently employed various
methods of anaesthesia.

In discussing amputations he has described in
general certain methods of anaesthesia in use in his
time, and especially the method by means of inhala-

296 OLD-TIME MAKERS OF MEDICINE

tion. It would not seem to us in the modern time
that this method would be very successful, but there
is an enthusiastic accord of authorities attesting that
operations were done at this time with the help of
this inhalant without the infliction of pain. Chauliac
says:

1 i Some prescribe medicaments which send the pa-
tient to sleep, so that the incision may not be felt,
such as opium, the juice of the morel, hyoscyamus,
mandrake, ivy, hemlock, lettuce. A new sponge is
soaked by them in these juices and left to dry in the
sun; and when they have need of it they put this
sponge into warm water and then hold it under the
nostrils of the patient until he goes to sleep. Then
they perform the operation."

Many people might be prone to think that the
hospitals of Chauliac's time would not be suitable
for such surgical work as he describes. It is, how-
ever, only another amusing assumption of this self-
complacent age of ours to think that we were the
first who ever made hospitals worthy of the name
and of the great humanitarian purpose they sub-
serve. As a matter of fact, the old-time hospitals
were even better than ours or, as a rule, better than
any we had until the present generation. In " The
Popes and Science," in the chapter on " The Foun-
dation of City Hospitals," I call attention to the
fact that architects of the present day go back to
the hospitals of the Middle Ages in order to find
the models for hospitals for the modern times. Mr.
Arthur Dillon, a well-known New York architect,
writing of a hospital built at Tonnerre in France, to-
ward the end of the thirteenth century (1292), says:

GUY DE CHAULIAC 297

" It was an admirable hospital in every way, and
it is doubtful if we to-day surpass it. It was iso-
lated ; the ward was separated from the other build-
ings ; it had the advantage we so often lose of being
but one story high, and more space was given to
each patient than we can now afford.

11 The ventilation by the great windows and ven-
tilators in the ceiling was excellent ; it was cheerfully
lighted ; and the arrangement of the gallery shielded
the patients from dazzling light and from draughts
from the windows and afforded an easy means of
supervision, while the division by the roofless low
partitions isolated the sick and obviated the depres-
sion that comes from sight of others in pain.

" It was, moreover, in great contrast to the cheer-
less white wards of to-day. The vaulted ceiling was
very beautiful; the woodwork was richly carved,
and the great windows over the altars were filled
with colored glass. Altogether it was one of the
best examples of the best period of Gothic Archi-
tecture."1

The fine hospital thus described was but one of
many. Virchow, in his article on hospitals quoted in
the same chapter, called attention to the fact that in
the thirteenth and fourteenth centuries every town
of five thousand or more inhabitants had its hospital,
founded on the model of the great Santo Spirito
Hospital in Eome, and all of them did good work.
The surgeons of Guy de Chauliac's time would in-
deed find hospitals wherever they might be called in
consultation, even in small towns. They were more
numerous in proportion to population than our own

JSee picture of the hospital ward at Tonnerre, in " The Thirteenth
Greatest of Centuries," 3rd edit., New York, 1911.

298 OLD-TIME MAKERS OF MEDICINE

and, as a rule, at least as well organized as ours
were until the last few years.

It is no wonder that with such a good hospital
organization excellent surgery was accomplished.
Hernia was Chauliac's specialty, and in it his sur-
gical judgment is admirable Mondeville before his
time did not hesitate to say that many operations
for hernia were done not for the benefit of the pa-
tient, but for the benefit of the surgeon, — a very
striking anticipation of remarks that one sometimes
hears even at the present time. Chauliac discussed
operations for hernia very conservatively. His rule
was that a truss should be worn, and no operation
attempted unless the patient's life was endangered
by the hernia. It is to him that we owe the inven-
tion of a well-developed method of taxis, or manipu-
lation of a hernia, to bring about its reduction, which
was in use until the end of the nineteenth century.
He suggested that trusses could not be made accord-
ing to rule, but must be adapted to each individual
case. He invented several forms of truss himself,
and in general it may be said that his manipulative
skill and his power to apply his mechanical prin-
ciples to his work are the most characteristic of his
qualities. This is particularly noteworthy in his
chapters on fractures and dislocations, in which he
suggests various methods of reduction and realizes
very practically the mechanical difficulties that were
to be encountered in the correction of the deform-
ities due to these pathological conditions. In a word,
we have a picture of the skilled surgeon of the mod-
ern time in this treatise of a fourteenth-century
teacher of surgery.

GUY DE CHAULIAC 299

Chauliac discusses six different operations for the
radical cure of hernia. As Gurlt points out, he
criticises them from the same standpoint as that of
recent surgeons. The object of radical operations
for hernia is to produce a strong, firm tissue support
over the ring through which the cord passes, so that
the intestines cannot descend through it. It is
rather interesting to find that the surgeons of this
time tried to obliterate the canal by means of the
cautery, or inflammation producing agents, arsenic
and the like, a practice that recalls some methods
still used more or less irregularly. They also used
gold wire, which was to be left in the tissues and is
supposed to protect and strengthen the closure of
the ring. At this time all these operations for the
radical cure of hernia involved the sacrifice of the
testicle because the old surgeons wanted to obliterate
the ring completely, and thought this the easiest
way. Chauliac discusses the operation in this re-
spect and says that he has seen many cases in which
men possessed of but one testicle have procreated,
and this is a case where the lesser of two evils is to
be chosen.

Of course Guy de Chauliac would not have been
able to operate so freely on hernia and suggest, fol-
lowing his own experience, methods of treatment of
penetrating wounds of the abdomen only that he had
learned the lessons of antiseptic surgery which had
been gradually developed among the great surgeons
of Italy during the preceding century. The use of
the stronger wines as a dressing together with in-
sistence on the most absolute cleanliness of the sur-
geon before the operation, and careful details of

300 OLD-TIME MAKERS OF MEDICINE

cleanliness during the operation, made possible the
performance of many methods of surgical interven-
tion that would otherwise surely have been fatal.
Probably nothing is harder to understand than that
after these practical discoveries men should have
lost sight of their significance, and after having
carefully studied the viscous exudation which pro-
duces healthy natural union, should have come to the
thought of the necessity for the formation of laud-
able pus before union might be expected. The mys-
tery is really no greater than that of many another
similar incident in human history, but it strikes us
more forcibly because the discovery and gradual de-
velopment of antiseptic surgery in our own time has
meant so much for us. Already even in Chauliac's
practice, however, some of the finer elements of the
technique that made surgery antiseptic to a marked
degree, if not positively aseptic in many cases, were
not being emphasized as they were by his predeces-
sors, and there was a beginning of surgical meddle-
someness reasserting itself.

It must not be thought, however, that it was only
with the coarse applications of surgery that Chau-
liac concerned himself. He was very much inter-
ested in the surgical treatment of eye diseases and
wrote a monograph on cataract, in which he gathers
what was known before his time and discusses it in
the light of his own experience. The writing of
such a book is not so surprising at this time if we
recall that in the preceding century the famous Pope
John XXI, who had been a physician before he be-
came Pope, and under the name of Peter of Spain
was looked up to as one of the distinguished sci-

GUY DE CHAULIAC 301

enlists of his time, had written a book on eye dis-
eases that has recently been the subject of much
attention.

Pope John had much to say of cataract, dividing
it into traumatic and spontaneous, and suggesting
the needling of cataract, a gold needle being used
for the purpose. Chauliac's method of treating
cataract was by depression. His care in the selec-
tion of patients may be appreciated from his treat-
ment of John of Luxembourg, King of Bavaria,
blind from cataract, who consulted Chauliac in 1336
while on a visit to Avignon with the King of France.
Chauliac refused to operate, however, and put off
the King with dietary regulations.

In the chapter on John of Arcoli and Medieval
Dentistry we call attention to the fact that Chauliac
discussed dental surgery briefly, yet with such prac-
tical detail as to show very clearly how much more
was known about this specialty in his time than we
have had any idea of until recent years. He recog-
nized the dentists as specialists, calls them denta-
tores, but thinks that they should operate under the
direction of a physician — hence the physician should
know much about teeth and especially about their
preservation. He enumerates instruments that
dentists should have and shows very clearly that the
specialty had reached a high state of development.
A typical example of Chauliac's common sense and
dependence on observation and not tradition is to
be found in what he has to say with regard to
methods of removing the teeth without the use of
extracting instruments. It is characteristic of his
method of dealing with traditional remedies, even

302 OLD-TIME MAKERS OF MEDICINE

though of long standing, that he brushes them aside
with some impatience if they have not proved them-
selves in his experience.

" The ancients mention many medicaments, which
draw out the teeth without iron instruments or which
make them more easy to draw out; such as the milky
juice of the tithymal with pyrethrum, the roots of
the mulberry and caper, citrine arsenic, aqua fortis,
the fat of forest frogs. But these remedies promise
much and accomplish but little — mais Us donnent
beaucoup de promesses, et peu d' operations."

It is no wonder that Chauliac has been enthusi-
astically praised. Nicaise has devoutly gathered
many of these praises into a sheaf of eulogies at the
end of his biography of the great French surgeon.
He tells us that Fallopius compared him to Hippoc-
rates. John Calvo of Valencia, who translated the
' * Great Surgery ' ' into Spanish, looks upon him
as the first law-giver of surgery. Freind, the great
English physician, in 1725 called him the Prince
of Surgeons. Ackermann said that Guy de Chau-
liac's text-book will take the place of all that has
been written on the subject down to his time, so that
even if all the other works had been lost his would
replace them. Dezimeris, commenting on this, says
that " if one should take this appreciation literally,
this surgeon of the fourteenth century would be the
first and, up to the present time, the only author
who ever merited such an eulogy." " At least," he
adds, " we cannot refuse him the distinction of hav-
ing made a work infinitely superior to all those which
appeared up to this time and even for a long time
afterwards. Posterity rendered him this justice, for

GUT DE CHAULIAC 303

he was for three centuries the classic par excellence.
He rendered the study easy and profitable, and all
the foreign nations the tributaries of our country."
Peyrihle considered Guy's " Surgery " as the most
valuable and complete work of all those of the same
kind that had been published since Hippocrates and
added that the reading of it was still useful in his
time in 1784. Begin, in his work on Ambroise Pare,
says " that Guy has written an immortal book to
which are attached the destinies of French surgeons."
Malgaigne, in his " History of Surgery," does not
hesitate to say, " I do not fear to say that, Hip-
pocrates alone excepted, there is not a single treatise
on surgery, — Greek, Latin, or Arabic, — which I
place above, or even on the same level with, this
magnificent work, ' The Surgery of Guy de Chau-
liac.' " Daremberg said, " Guy seems to us a sur-
geon above all erudite, yet expert and without ever
being rash. He knows, above all, how to choose
what is best in everything. ' ' Verneuil, in his ' ' Con-
ference sur Les Chirurgiens Erudits," says, " The
services rendered by the * Great Surgery ' were im-
mense; by it there commenced for France an era
of splendor. It is with justice, then, that posterity
has decreed to Guy de Chauliac the title of Father
of French surgery."

The more one reads of Chauliac 's work the less
is one surprised at the estimation in which he has
been held wherever known. It would not be hard
to add a further sheaf of compliments to those col-
lected by Nicaise. Modern writers on the history
of medicine have all been enthusiastic in their ad-
miration of him, just in proportion to the thorough-

304 OLD-TIME MAKERS OF MEDICINE

ness of their acquaintance with him. Portal, in his
" History of Anatomy and Surgery," says,
" Finally, it may be averred that Guy de Chauliac
said nearly everything which modern surgeons say,
and that his work is of infinite price but unfortu-
nately too little read, too little pondered." Mal-
gaigne declares Chauliac's " Chirurgia Magna " to
be " a masterpiece of learned and luminous writ-
ing." Professor Clifford Allbutt, the Regius Pro-
fessor of Physic at the University of Cambridge,
says of Chauliac's treatise: " This great work I
have studied carefully and not without prejudice;
yet I cannot wonder that Fallopius compared the
author to Hippocrates or that John Freind calls
him the Prince of Surgeons. It is rich, aphoristic,
orderly, and precise." 1

If to this account of his professional career it be
added that Chauliac's personality is, if possible,
more interesting than his surgical accomplishment,
some idea of the significance of the life of the great
father of modern surgery will be realized. We have
already quoted the distinguished words of praise
accorded him by Pope Clement VI. That they were
well deserved, Chauliac's conduct during the black
death which ravaged Avignon in 1348, shortly after
his arrival in the Papal City, would have been suffi-
cient of itself to attest. The occurrence of the
plague in a city usually gave rise to an exhibition
of the most arrant cowardice, and all who could,
fled. In many of the European cities the physicians
joined the fugitives, and the ailing were left to care

1 "The Historical Relations of Medicine and Surgery," by T, Clifford
Allbutt, M.A., M.D. London; Macmillan & Co., Ltd., 1905.

GUY DE CHAULIAC 305

for themselves. With a few notable exceptions, this
was the case at Avignon, but Guy was among those
who remained faithful to his duty and took on him-
self the self-sacrificing labor of caring for the sick,
doubly harassing because so many of his brother
physicians were absent. He denounces their con-
duct as shameful, yet does not boast of his own
courage, but on the contrary says that he was in
constant fear of the disease. Toward the end of
the epidemic he was attacked by the plague and
for a time his life was despaired of. Fortunately
he recovered, to become the most influential among
his colleagues, the most highly admired of the physi-
cians of his generation, and the close personal friend
of all the high ecclesiastics, who had witnessed his
magnificent display of courage and of helpfulness
for the plague-stricken during the epidemic. He
wrote a very clear account of the epidemic,
which leaves no doubt that it was true bubonic
plague.

After this fine example, Chauliac's advice to
brother physicians in the specialty of surgery car-
ried added weight. In the Introductory chapter of
his ' ' Chirurgia Magna ' ' he said :

" The surgeon should be learned, skilled, in-
genious, and of good morals. Be bold in things that
are sure, cautious in dangers; avoid evil cures and
practices; be gracious to the sick, obliging to his
colleagues, wise in his predictions. Be chaste, sober,
pitiful, and merciful; not covetous nor extortionate
of money; but let the recompense be moderate, ac-
cording to the work, the means of the sick, the char-
acter of the issue or event, and its dignity."

306 OLD-TIME MAKERS OF MEDICINE

No wonder that Malgaigne says of him, " Never
since Hippocrates has medicine heard such language
filled with so much nobility and so full of matter
in so few words."

Chauliac was in every way worthy of his great
contemporaries and the period in which his lot was
cast. Ordinarily we are not apt to think of the
early fourteenth century as an especially productive
period in human history, but such it is. Dante's
Divine Comedy was entirely written during Chau-
liac's life. Petrarch was born within a few years
of Chauliac himself; Boccaccio in Italy, and Chaucer
in England, wrote while Chauliac was still alive.
Giotto did his great painting, and his pupils were
laying the deep, firm foundations of modern art.
Many of the great cathedrals were being finished.
Most of the universities were in the first flush of
their success as moulders of the human mind. There
are few centuries in history that can show the exist-
ence of so many men whose work was to have an
enduring influence for all the after time as this
upon which Chauliac 's career shed so bright a light.
The preceding century had seen the origin of the
universities and the rise of such supremely great
men as Albertus Magnus, Roger Bacon, Thomas
Aquinas, and the other famous scholars of the early
days of the mendicant orders, and had made the in-
tellectual mould of university training in which
men's minds for seven centuries were to be formed,
so that Chauliac, instead of being an unusual phe-
nomenon is only a fitting expression of the interest
of this time in everything, including the physical
sciences and, above all, medicine and surgery.

GUT DE CHAULIAC 307

For some people it may be a source of surprise
that Chauliac should have had the intellectual train-
ing to enable him to accomplish such judicious work
in his specialty. Many people will be apt to assume
that he accomplished what he did in spite of his
training, genius succeeding even in an unfavorable
environment, and notwithstanding educational dis-
advantages. Those who would be satisfied with any
such explanation, however, know nothing of the edu-
cational opportunities provided in the period of
which Chauliac was the fruit. He is a typical uni-
versity man of the beginning of the fourteenth cen-
tury, and the universities must be given due credit
for him. It is ordinarily assumed that the univer-
sities paid very little attention to science and that
scientists would find practically nothing to satisfy
in their curricula. Professor Huxley in his address
on " Universities, Actual and Ideal," delivered as
the Rectorial Address at Aberdeen University in
1874, declared that they were probably educating in
the real sense of the word better than we do now.
(See quotation in " The Medical School at
Salerno.")

In the light of Chauliac 's life it is indeed amusing
to read the excursions of certain historians into the
relationship of the Popes and the Church to science
during the Middle Ages. Chauliac is typically rep-
resentative of medieval science, a man who gave due
weight to authority, yet tried everything by his
own experience, and who sums up in himself such
wonderful advance in surgery that during the last
twenty years the students of the history of medicine

308 OLD-TIME MAKERS OF MEDICINE

have been more interested in him than in anyone
who comes during the intervening six centuries.
Chauliac, however, instead of meeting with any op-
position, encountered encouragement, liberal patron-
age, generous interest, and even enjoyed the inti-
mate friendship of the highest ecclesiastics and the
Popes of his time. In every way his life may be
taken as a type of what we have come to know about
the Middle Ages, when we know them as we should,
in the lives of the men who counted for most in
them, and do not accept merely the broad general-
izations which are always likely to be deceptive and
which in the past have led men into the most absurd
and ridiculous notions with regard to a wonderful
period in human history.

That Guy de Chauliac was no narrow specialist
is abundantly evident from his book, for while the
11 Great Surgery " treats of the science and art of
surgery as its principal subject, there are remarks
about nearly everything else relating to medicine,
and most of them show a deep interest, a thorough
familiarity, and an excellent judgment. Besides we
have certain expressions with regard to intellectual
matters generally which serve to show Guy as a pro-
found thinker, who thoroughly appreciated just how
accumulations of knowledge came to men and how
far each generation or member of a generation
should go and yet how limited must, after all, be
the knowledge obtained by any one person. With
regard to books, for instance, he said, " for every-
one cannot have all the books, and even if he did
have them it would be too tiresome to read them all

GUT DE CHAULIAC 309

and completely, and it would require a godlike
memory to retain them all." He realized, however,
that each generation, provided it took the oppor-
tunities offered it, was able to see a little bit farther
than its predecessor, and the figure that he employs
to express this is rather striking. " Sciences," he
said, " are made by additions. It is quite impossible
that the man who begins a science should finish it.
We are like infants, clinging to the neck of a giant ;
for we can see all the giant sees and a little more."

One of the most interesting features of the history
of Guy de Chauliac is the bibliography of his works
which has been written by Nicaise. This is ad-
mirably complete, labored over with the devotion
that characterized Nicaise 's attitude of unstinted
admiration for the subject. Altogether he has some
sixty pages of a quarto volume with regard to the
various editions of Guy's works.

The first manuscript edition of Guy de Chauliac
was issued in 1363, the first printed edition in 1478.
Even in the fourteenth century Guy's great work
was translated into all the languages generally used
in Europe. Nicaise succeeded in placing 34 com-
plete manuscripts of the ' ' Great Surgery " : 22 of
these are in Latin, 4 are in French, 3 are in English,
2 only in Provengal, though that was the language
spoken in the region where much of Chauliac 's life
was passed, and one each in Italian, in Low Dutch,
and in Hebrew. Of the English manuscripts, one is
number twenty-five English of the Bibliotheque
Nationale, Paris; a second is number 3666 English
of the Sloane collection in the British Museum, and

310 OLD-TIME MAKERS OF MEDICINE

a third is in the Library of the University of Cam-
bridge.1

Paulin Paris, probably one of the best of recent
authorities on the age and significance of old manu-
scripts, says in the third volume of his ' Manuscrits
Fran§ais," page 346, " This manuscript [of Guy
de Chauliac's " Great Surgery "] was made, if not
during the life, then certainly very shortly after the
death of the author. It is one of the oldest that can
be cited, and the fact that an English translation
was made so near to the time of the original com-
position of the book attests the great reputation
enjoyed by Guy de Chauliac at this time, and which
posterity has fully confirmed. ' '

The Sloane copy in the British Museum contains

1 The beginning of the manuscript copy in the ' ' BibliotMque Natio-
nale " is extremely interesting as an example of the English of the period,
and alongside of it it seems worth while to quote the closing sentence
as Nicaise reproduces them :

"In godes name here bygyneth the inventarie of gadryng to gedre
medecyne in the partye of cyrurgie compilede and fulfilled in the zero
(yere?) of our Loord 1363 by Guide de Cauliaco cirurgene and doctor
of physik in the f ulclere studye of Mountpylerz.

" On page 191, verso. — Here endeth the cyrurgie of Maistre Guyd' de
Cauliaco dottoure of phisik."

The University of Cambridge copy has the title in the colophon. It
runs as follows : " Ye inventorye of Guydo de Caulhiaco Doctor of
Phisyk and Cirurgien in Ye Universitie of Mount Pessulanee of Mont-
peleres." The fly-leaf contains the words, " Jesu Christ save ye soule
of mich.' It is rather interesting to note how much closer to modern
English is this copy, made probably not much more than half a century
later than the first one and, above all, how much more nearly the spell-
ing has come. At this time, however, and, indeed, for more than a
century later, spelling had no fixed rule, and a man might spell the
same word quite differently even on the same page. The difference
between doctor spelled thus in the early edition, and doctours in the
later one, probably means nothing more than personal peculiarities of
the original translator or copyist.

GUT DE CHAULIAC 311

some medical recipes at the end by Francis Verney.
It was probably written in the fifteenth century.
Its title is :

" The inventorie or the collectorie in cirurgicale
parte of medicine compiled and complete in the yere
of our Lord 1363, with some additions of other doc-
tours, necessary to the foresaid arte or crapte
(craftef)."1

What we find in the period of manuscripts, how-
ever, is as nothing compared to the prestige of Guy
de Chauliac's work, once the age of printing began.
Nicaise was able to find sixty different printed edi-
tions of the " Great Surgery." Nine others that are
mentioned by authors have disappeared and ap-
parently no copies of them are in existence. Besides
there are sixty editions of portions of the work, of
compendiums of it and commentaries on it. Alto-
gether 129 editions are extant. Of these there are
sixteen Latin editions, forty-three French, five
Italian, four Low Dutch, five Catalan, and one Eng-
lish. Fourteen appeared in the fifteenth century,
thirty-eight in the sixteenth century, and seventeen
in the seventeenth century. The fourteen editions
belonging to the incunabula of printing, issued, that
is, before the end of the fifteenth century, show what
lively interest there was in the French surgeon of
the preceding century, since printing presses at this
precious time were occupied only with the books that

1 In Nicaise this last word is written crapte. I have ventured to
suggest erafte, since a misreading between the two letters would be
so easy. In the same way I have suggested tentatively a changing
of the « in the title of the Bibliotheque Nationale copy to y, mak-
ing the word yere instead of sere.

312 OLD-TIME MAKERS OF MEDICINE

were considered indispensable for scholars. The
first edition of the " Great Surgery " was printed in
1478 at Lyons. Printing had only been introduced
there five years before. This first edition, primus
primarily or editio princeps, was a French transla-
tion by Nicholas Panis. In 1480 an Italian edition
was printed at Venice. The first Latin edition was
printed also in Venice in 1490.

It would be only natural to expect that the suc-
cessors of Guy de Chauliac, and especially those who
had come personally in contact with him, would take
advantage of his thorough work to make still fur-
ther advances in surgery. As matter of fact, de-
cadence in surgery is noted immediately after his
death. Three men taught at the University of
Montpellier at the end of the fourteenth and the be-
ginning of the fifteenth century, John de Tornamira,
Valesco de Taranta, and John Faucon. They can-
not be compared, Gurlt says, with Guy de Chauliac,
though they were physicians of reputation in their
time. Faucon made a compendium of Guy's work
for students. Somehow there seemed to be the im-
pression that surgery had now reached a point of
development beyond which it could not advance.
Unfortunate political conditions, wars, the with-
drawal of the Popes from Avignon to Rome, and
other disturbances, distracted men's minds, and
surgery deteriorated to a considerable extent, until
the new spirit at the time of the Renaissance came
to inject fresh life into it.

XII

MEDIEVAL DENTISTRY— GIOVANNI OF
AECOLI

If there is one phase of our present-day medicine
and surgery that most of us are likely to be quite
sure is of very recent development it is dentistry.
Probably most people would declare at once that
they had every reason to think that the science and
art of dentistry, as we have it now, developed for
the first time in the world's history during the last
generation or two. It is extremely interesting to
realize then, in the light of this almost universal
persuasion, founded to a great extent on the con-
viction that man is in process of evolution and that
as a consequence we must surely be doing things
now that men never did before, to find that dentistry,
both as an art and science, is old ; that it has devel-
oped at a number of times in the world's history,
and that as fortunately for history its work was
done mainly in indestructible materials, the teeth
themselves and metal prosthetic apparatus, we have
actual specimens of what was accomplished at a num-
ber of periods in the olden times. Surprising as it
will seem to those who hear of it for the first time,
dentistry reached high perfection even in what we
know as ancient history. It is rather easy to trace
scientific and craftsmanlike interest in it during the

813

314 OLD-TIME MAKERS OF MEDICINE

medieval period and in the magnificent development
of surgery that came just at the end of the Middle
Ages, dentistry shared to such degree that some of
the text-books of the writers on surgery of this time
furnish abundant evidence of anticipations of many
of the supposedly most modern developments of den-
tistry.

There are a number of historical traditions with
regard to dentistry and the treatment of the teeFh in
Egypt that can be traced back to good authorities
in Egyptology of a generation or more ago, but it is
rather hard to confirm the accounts we have by
actual specimens; either none were found or for
some reason those actually discovered are now not
readily available for study. Among the Phenicians
however, though we have good reasons to think that
they learned their arts and crafts from the Egyp-
tians, there is convincing evidence of a high develop-
ment of dentistry. M. Ernest Renan, during an ex-
ploring expedition in Phenicia, found in the old
necropolis at Sidon a set of teeth wired together, two
of which were artificial. It was a striking example
of bridgework, very well done, and may now be seen
in the Louvre. It would be more than a little surpris-
ing, from what we know of the lack of inventiveness
on the part of the Phenicians and their tendency
to acquire their arts by imitation, if they had reached
such a climax of invention by themselves. Since
they adapted and adopted most of their arts and
crafts from Egypt, with which they were in close
commercial relations, it has been argued with some
plausibility that the Egyptians may have had many
modes of dental prosthesis, but removed all artificial

MEDIEVAL DENTISTRY— GIOVANNI OF ARCOLI 315

teeth and dental appliances from the mouth of
corpses before embalming them, in preparation for
the next world, because there was some reli-
gious objection to such human handiwork being
left in place for the hereafter, as they hoped
for it.

There is a well-authenticated tradition of intimate
intercourse in a commercial way between the old
Etruscans who inhabited the Italian hill country and
the Phenicians, so that it is no surprise to find that
the oldest of Etruscan tombs contain some fine ex-
amples of bridgework. An improvement has come
over Phenician work however, and bands of gold
instead of wire are used for holding artificial teeth
in place. Guerini, whose " History of Dentistry "
is the standard work on the subject, on a commission
from the Italian government, carefully studied these
specimens of Etruscan dental work in the museums
of Italy, and has made some interesting observa-
tions on them. In one specimen, which is espe-
cially notable, two incisor teeth are replaced by a
single tooth from a calf. This was grooved in such
a way as to make it seem like two separate teeth.
Gruerini suggests a very interesting and quite unex-
pected source for this. While examining the speci-
men he wondered where the old Etruscan dentist
had obtained a calf's tooth without a trace of wear
on it. He came to the conclusion that he must have
cut into the gums of a young calf before the per-
manent tooth was erupted in order to get this struc-
ture absolutely unworn for his purpose. A number
of examples of bridgework have been found in the
old Etruscan tombs. The dates of their construe-

316 OLD-TIME MAKERS OF MEDICINE

tion are probably not later than 500 B.C., and some
of them are perhaps earlier than 700 B.C.

The Etruscans affected the old Romans in the mat-
ter of dentistry, so that it is easy to understand the
passage in the " Laws of the Twelve Tables," issued
about 450 B.C., which, while forbidding the burial of
gold with corpses, made a special exception for such
gold as was fastened to the teeth. Gold was rare
at Rome, and care was exercised not to allow any
unnecessary decrease of the visible supply almost in
the same way as governments now protect their gold
reserves. It may seem like comparing little things
with great, but the underlying principle is the same.
Hence this special law and its quite natural excep-
tion.

In Pope Julius' Museum in Rome there is a speci-
men of a gold cap made of two plates of gold riveted
together and also riveted to bands of metal which
were fastened around the neighboring teeth in order
to hold the cap in place. This is from later Repub-
lican times at Rome. At the end of the Republic
and the beginning of the Empire there appear to
have been many forms of dental appliances. Martial
says that the reason why one lady's teeth — whose
name he does not conceal — are white and another's
—name also given — were dark, was that the first
one bought hers and the second still had her
own. In another satiric poem he describes an elderly
woman as so much frightened that when she ran
away her teeth fell out, while her friends lost their
false hair. Fillings of many kinds were used, den-
trifices of nearly every kind were invented, and den-
tistry evidently reached a high stage of development,

MEDIEVAL DENTISTRY— GIOVANNI OF ARCOLI 317.

though we have nowhere a special name for dentist,
and the work seems to have been done by physicians,
who took this as a specialty.

While in the Middle Ages there was, owing to con-
ditions, a loss of much of this knowledge of antiquity
with regard to dentistry, or an obscuration of it, it
never disappeared completely, and whenever men
have written seriously about medicine, above all
about surgery in relation to the face and the mouth,
the teeth have come in for their share of scientific
and practical consideration. Aetius, the first impor-
tant Christian writer on medicine and surgery, dis-
cusses, as we have seen in the sketch of him, the
nutrition of the teeth, their nerves, " which came
from the third pair and entered the teeth by a small
hole existing at the end of the root," and other in-
teresting details of anatomy and physiology. He
knows much about the hygiene of the teeth, discusses
extraction and the cure of fistula and other details.
Paul of ^E'gina in the next century has much more,
and while they both quote mainly from older authors
there seems no doubt that they themselves had made
not a few observations and had practical experience.

It was from these men that the Arabian physicians
and surgeons obtained their traditions of medicine,
and so it is not surprising to find that they discuss
dental diseases and their treatment rationally and
in considerable detail. Abulcasis particularly has
much that is of significance and interest. We have
pictures of two score of dental instruments that were
used by them. The Arabs not only treated and filled
carious teeth and even replaced those that were
lost, but they also corrected deformities of the mouth

318 OLD-TIME MAKERS OF MEDICINE

and of the dental arches. Orthodontia is sometimes
said to be of much later origin and to begin many
centuries after Abulcasis' time, yet no one who
knows of his work can speak of Orthodontia as an
invention after him. In this, however, as in most of
the departments of medicine and surgery, the Arabs
were merely imitators, though probably they ex-
panded somewhat the practical knowledge that had
come to them.

When the great revival in surgery came in the
twelfth and thirteenth centuries it is not surprising
that there should also have been an important re-
newal of interest in dentistry. A detailed review
of this would take us too far afield, but at least
something may be said of two or three of the great
representative surgical writers who touched on this
specialty.

About the middle of the fourteenth century that
prince of surgeons, and model of surgical writers,
Guy de Chauliac, wrote his great text-book of sur-
gery, ' ' Le Grande Chirurgie. ' ' An extremely inter-
esting feature of this work is to be found in the
chapters that treat of diseases of the teeth. These
are not very comprehensive, and are evidently not
so much the result of his experience, as the fruit
of his reading, yet they contain many practical valua-
ble ideas that are supposed to be ever so much
later than the middle of the fourteenth century.
His anatomy and physiology at least are not without
many errors. His rules for the preservation of the
teeth show that the ordinary causes of dental decay
were well recognized even as early as this. Emphasis
was laid on not taking foods too hot or too cold, and

MEDIEVAL DENTISTRY— GIOVANNI OF ARCOLI 319

above all not to follow either hot or cold food by
something very different from it in temperature.
The breaking of hard things with the teeth was
recognized as one of the most frequent causes of
such deterioration of the enamel as gives oppor-
tunity for the development of decay. The eating
of sweets, and especially the sticky sweets — pre-
serves and the like — was recognized as an important
source of caries. The teeth were supposed to be
cleaned frequently, and not to be cleaned too roughly,
for this would do more harm than good. We find
these rules repeated by succeeding writers on gen-
eral surgery, who touch upon dentistry, or at least
the care of the teeth, and they were not original
with Guy de Chauliac, but part of the tradition of
surgery.

As noted by Guerini in his " History of Den-
tistry," the translation of which was published under
the auspices of the National Dental Association of
the United States of America,1 Chauliac recognized
the dentists as specialists. Besides, it should be
added, as is evident from his enumeration of the sur-
gical instruments which he declares necessary for
them, they were not as we might easily think in the
modern time mere tooth pullers, but at least the best
among them treated teeth as far as their limited
knowledge and means at command enabled them to
do so, and these means were much more elaborate
than we have been led to think, and much more de-

1<(A History of Dentistry from the Most Ancient Times Until the
End of the Eighteenth Century," by Dr. Vincenzo Guerini, editor of the
Italian Review L'Odonto-Stomatologia, Philadelphia and New York, Lea
and Febriger, 1909.

320 OLD-TIME MAKERS OF MEDICINE

tailed than we have reason to know that they were at
certain subsequent periods.

In fact, though Guy de Chauliac frankly confesses
that he touches on the subject of dentistry only in
order to complete his presentation of the subject of
surgery and not because he has anything of his own
to say with regard to the subject, there is much that
is of present-day interest in his brief paragraphs.
He observes that operations on the teeth are special
and belong to the dentatores, or dentists, to whom
doctors had given them over. He considers, how-
ever, that the operations in the mouth should be per-
formed under the direction of a physician. It is in
order to give physicians the general principles with
which they may be able to judge of the advisability
or necessity for dental operations that his short
chapters are written. If their advice is to be of
value, physicians should know the various methods
of treatment suitable for dental diseases, including
mouth washes, gargles, masticatories, anointments,
rubbings, fumigations, cauterizations, fillings, filings,
and the various manual operations. He says that
the dentator must be provided with the appropriate
instruments, among which he names scrapers, rasps,
straight and curved spatumina, elevators, simple and
with two branches, toothed tenacula, and many dif-
ferent forms of probes and canulas. He should also
have small scalpels, tooth trephines, and files.

Chauliac is particularly emphatic in his insistence
on not permitting alimentary materials to remain
in cavities, and suggests that if cavities between
the teeth tend to retain food material they should
even be filed in such a way as to prevent these

MEDIEVAL DENTISTRY— GIOVANNI OF ARCOLI 321

accumulations. His directions for cleansing the
teeth were rather detailed. His favorite treatment
for wounds was wine, and he knew that he suc-
ceeded by means of it in securing union by first
intention. It is not surprising, then, to find that he
recommends rinsing of the mouth with wine as a
precaution against dental decay. A vinous decoction
of wild mint and of pepper he considered particularly
beneficial, though he thought that dentifrices, either
powder or liquid, should also be used. He seems
to recommend the powder dentifrices as more effica-
cious. His favorite prescription for a tooth powder,
while more elaborate, resembles to such an extent,
at least some, if not indeed most of those, that
are used at the present time, that it seems worth
while giving his directions for it. He took equal
parts of cuttle bone, small white sea-shells, pumice
stone, burnt stag's horn, nitre, alum, rock salt, burnt
roots of iris, aristolochia, and reeds. All of these
substances should be carefully reduced to powder
and then mixed. His favorite liquid dentifrice con-
tained the following ingredients, — half a pound each
of sal ammoniac and rock salt, and a quarter of a
pound of sacharin alum. All these were to be re-
duced to powder and placed in a glass alembic and
dissolved. The teeth should be rubbed with it, using
a little scarlet cloth for the purpose. Just why this
particular color of cleansing cloth was recommended
is not quite clear.

He recognized, however, that cleansing of the teeth
properly often became impossible by any scrubbing
method, no matter what the dentifrice used, because
of the presence of what we call tartar and what he

322 OLD-TIME MAKERS OF MEDICINE

called hardened limosity or limyness (limosite en-
durcie). When that condition is present he suggests
the use of rasps and spatumina and other instru-
mental means of removing the tartar.

Evidently he did not believe in the removal of
the teeth unless this was absolutely necessary and
no other method of treatment would avail to save
the patient from continuous distress. He summar-
izes the authorities with regard to the extraction of
teeth and the removal of dental fragments and roots.
He evidently knew of the many methods suggested
before his time of removing teeth without recourse
to instrumental extraction. There were a number
of applications to the gums that were claimed by
older authors to remove the teeth without the need
of metal instruments. We might expect that Chau-
liac would detect the fallacy with regard to these
and expose it. He says that while much is claimed
for these methods he has never seen them work in
practice and he distrusts them entirely.

The most interesting phase of what Guy de Chau-
liac has to say with regard to dentistry is of course
to be found in his paragraphs on the artificial re-
placement of lost teeth and the subject of dental
prosthesis generally. When teeth become loose he
advises that they be fastened to the healthy ones
with a gold chain. Guerini suggests that he evi-
dently means a gold wire. If the teeth fall out they
may be replaced by the teeth of another person or
with artificial teeth made from oxbone, which may
be fixed in place by a fine metal ligature. He says
that such teeth may be serviceable for a long while.
This is a rather curt way of treating so large a

MEDIEVAL DENTISTRY— GIOVANNI OF ARCOLI 323

subject as dental prosthesis, but it contains a lot of
suggestive material. He was quoting mainly the
Arabian authors, and especially Abulcasis and Ali
Abbas and Rhazes, and these of course, as we have
said, mentioned many methods of artificially replac-
ing teeth as also of transplantation and of treat-
ment of the deformities of the dental arches.

On the whole, however, it must be confessed that
we have here in the middle of the fourteenth century
a rather surprising anticipation of the knowledge of
a special department of medicine which is usually
considered to be distinctly modern, and indeed as
having only attracted attention seriously in com-
paratively recent times.

After Guy de Chauliac the next important con-
tributor to dentistry is Giovanni of Arcoli, often
better known by his Latin name, Johannes Arcu-
lanus, who was a professor of medicine and surgery
at Bologna and afterwards at Padua, just before
and after the middle of the fifteenth century, and
who died in 1484. He is famous principally for be-
ing the first we know who mentions the filling of
teeth with gold.

It might possibly be suggested that coming at this
time Arculanus should rather be reckoned as a Maker
of Medicine in the Renaissance than as belonging to
the Middle Ages and its influences. His education,
however, was entirely completed before the earliest
date at which the Renaissance movement is usually
said to begin, that is with the fall of Constantinople
in 1452, and he was dead before the other date, that
of the discovery of America in 1492, which the
Germans have in recent years come to set down as

324 OLD-TIME MAKERS OF MEDICINE

the end of the Middle Ages. Besides, what he has
to say about dentistry occurs in typical medieval
form. It is found in a commentary on Rhazes,
written just about the middle of the fifteenth cen-
tury. In the later true Renaissance such a com-
mentary would have been on a Greek author. In his
commentary Arculanus touches on most of the
features of medicine and surgery from the stand-
point of his own experience as well as from what
he knows of the writings of his predecessors and
contemporaries. With the rest he has a series of
chapters on diseases of the teeth. Guerini in his
" History of Dentistry " says that " this subject
[dentistry] is treated rather fully, and with great
accuracy." Even some short references to it will,
I think, demonstrate this rather readily.1

Arculanus is particularly full in his directions
for the preservation of the teeth. We are rather
prone to think that prophylaxis is comparatively a
modern idea, and that most of the principles of
conservation of human tissues and the prevention
of deterioration and disease are distinctly modern.
It needs only a little consideration of Arculanus' in-
struction in the matter of the teeth, however, to
undo any such false impression. For obvious
reasons I prefer to quote Guerini 's summation of
this medieval student of dentistry's rules for dental
hygiene :

" For the preservation of teeth — considered by
him, quite rightly, a matter of great importance—

lThe first printed edition of Arculanus is that of Venice, 1542,
bearing the Latin title, " Joannis Arculani Conunentaria in Nonura
Librum Rasis," etc.

MEDIEVAL DENTISTRY— GIOVANNI OF ARCOLI 325

Giovanni of Arcoli repeats the various counsels
given on the subject by preceding writers, but he
gives them as ten distinct canons or rules, creating
in this way a kind of decalogue of dental hygiene.
These rules are : (1) It is necessary to guard against
the corruption of food and drink within the stom-
ach; therefore, easily corruptible food — milk, salt
fish, etc. — must not be partaken of, and after meals
all excessive movement, running exercises, bathing,
coitus, and other causes that impair the digestion,
must also be avoided. (2) Everything must be
avoided that may provoke vomiting. (3) Sweet and
viscous food — such as dried figs, preserves made
with honey, etc. — must not be partaken of . (4) Hard
things must not be broken with the teeth. (5) All
food, drink, and other substances that set the teeth
on edge must be avoided. (6) Food that is too hot
or too cold must be avoided, and especially the rapid
succession of hot and cold, and vice versa. (7) Leeks
must not be eaten, as such a food, by its own nature,
is injurious to the teeth. (8) The teeth must be
cleaned at once, after every meal, from the particles
of food left in them ; and for this purpose thin pieces
of wood should be used, somewhat broad at the ends,
but not sharp-pointed or edged; and preference
should be given to small cypress twigs, to the
wood of aloes, or pine, rosemary, or juniper and
similar sorts of wood which are rather bitter and
styptic; care must, however, be taken not to search
too long in the dental interstices and not to injure the
gums or shake the teeth. (9) After this it is neces-
sary to rinse the mouth by using by preference a
vinous decoction of sage, or one of cinnamon,
mastich, gallia, moschata, cubeb, juniper seeds, root
of cyperus, and rosemary leaves. (10) The teeth
must be rubbed with suitable dentrifices before going
to bed, or else in the morning before breakfast. Al-
though Avicenna recommended various oils for this

326 OLD-TIME MAKERS OF MEDICINE

purpose, Giovanni of Arcoli appears very hostile to
oleaginous frictions, because be considers them very
injurious to the stomach. He observes, besides, that
whilst moderate frictions of brief duration are help-
ful to the teeth, strengthen the gums, prevent the
formation of tartar, and sweeten the breath, too
rough or too prolonged rubbing is, on the contrary,
harmful to the teeth, and makes them liable to many
diseases."

All this is so modern in many ways that we might
expect a detailed exact knowledge of the anatomy
of the teeth and even something of their embryology
from Arculanus. It must not be forgotten, however,
that coming as he does before the Renaissance, the
medical sciences in the true sense of the word are
as yet unborn. Men are accumulating information
for practical purposes but not for the classification
and co-ordination that was to make possible the
scientific development of their knowledge.

Giovanni of Arcoli 'a acquaintance with the anat-
omy of the teeth was rather sadly lacking. He does
not know even with certainty the number of roots
that the teeth have. This has been attributed to
the fact that he obtained most of his information
from books, and had not the time to verify de-
scriptions that he had found. It has been argued
from this that he was himself probably not a prac-
tical dentist, and turned to that specialty only as a
portion of his work as a general surgeon, and that
consequently he was not sufficiently interested to
verify his statements. His chapters on dentistry
would seem to bear out this conclusion to some ex-
tent, though the very fact that one who was himself

MEDIEVAL DENTISTRY— GIOVANNI OF AECOLI 327

not specially interested in dental surgery should
have succeeded in gathering together so much that
anticipates modern ideas in dentistry, is of itself a
proof of how much knowledge of the subject there
was available for a serious student of that time.
The anatomy of the teeth continued to be rather
vague until about the middle of the next century
when Eustachius, whose investigations of the anat-
omy of the head have deservedly brought him fame
and the attachment of his name to the Eustachian
canal, wrote his " Libellus de Dentibus — Manual of
the Teeth," which is quite full, accurate, and de-
tailed. Very little has been added to the microscopic
anatomy of the teeth since Eustachius' time. He
had the advantage, of course, of being intimately
in contact with the great group of Renaissance anato-
mists,— Vesalius, Columbus, Varolius, Fallopius, and
the others, the great fathers of anatomy. Besides,
his position as Papal Physician and Professor of
Anatomy at the Papal Medical School at Rome gave
him opportunities for original investigation, such as
were not easily obtained elsewhere.

Arculanus can scarcely be blamed, therefore, for
not having anticipated the Renaissance, and we must
take him as merely the culmination of medieval
knowledge with regard to anatomy and surgery.
Medieval medical men did not have the time nor
apparently the incentive to make formal medical
science, though it must not be forgotten, as has been
said, that they did use the knowledge they obtained
by their own and others' observation to excellent
advantage for the practical benefit of ailing hu-
manity. The sciences related to medicine are con-

328 OLD-TIME MAKERS OF MEDICINE

scious developments that follow the evolution of
practical medicine, nor must it be forgotten that
far from always serving as an auxiliary to applied
medical science, often indeed in the history of medi-
cine scientific pursuits have led men away into side
issues from which they had to be brought back by
some genius medical observer. As might be ex-
pected, then, it is with regard to the practical treat-
ment and general consideration of ailments of the
teeth that Giovanni of Arcoli is most interesting.
In this some of his chapters contain a marvellous
series of surprises.

Arculanus was probably born towards the end of
the fourteenth century. The date of his death is
variously placed as either 1460 or 1484, with the
probability in favor of the former. From 1412 to
1427 he was professor at Bologna, where in accord-
ance with the non-specializing tendencies of the time
he did not occupy a single chair but several in suc-
cession. He seems first to have taught Logic, then
Moral Philosophy, and finally Medicine. His repu-
tation in medicine drew many students to the uni-
versity, and his fame spread all over Italy. The
rival University of Padua then secured him, and
he seems to have been for some twenty years there.
Later apparently he accepted a professor's chair
at Ferrara, where the D'Estes were trying to bring
their university into prominence. It was at Fer-
rara that he died. He was a man of wide reading,
of extensive experience, both of men and medicine,
and one of the scholars of his time. His works are,
as we have said, mainly excerpts from earlier writers
and particularly the Arabians, but they contain

MEDIEVAL DENTISTRY— GIOVANNI OF ARCOLI 329

enough of hints drawn from his own observation and
experience to make his work of great value.

While, as Gurlt remarks in his " History of Sur-
gery," Arculanus' name is one of those scarcely
known — he is usually considered just one of many
obscure writers of the end of the Middle Ages — his
writings deserve a better fate. They contain much
that is interesting and a great deal that must have
been of the highest practical value to his contempo-
raries. They attracted wide attention in his own
and immediately succeeding generations. The proof
of this is that they exist in a large number of manu-
script copies. Just as soon as printing was intro-
duced his books appeared in edition after edition.
His " Practica " was printed in no less than seven
editions in Venice. Three of them appeared before
the end of the fifteenth century, which places them
among the incunabula of printing.

Probably nothing in the history of human intel-
lectual interest is more striking than the excellent
judgment displayed by the editors who selected the
works to be printed at this time. Very few of them
were trivial or insignificant. Fewer still were idle
speculations, and most of them were almost of clas-
sical import for literature and science. Four edi-
tions of this work were printed in Venice in the
sixteenth century, one of them as late as 1560, when
the work done by such men as Vesalius, Columbus,
Eustachius, and Fallopius would seem to have made
Arculanus out of date. The dates of the various
editions are Venice, 1483, 1493, 1497, 1504, 1542, 1557,
and 1560. Besides there was an edition printed at
Basel in 1540.

330 OLD-TIME MAKERS OF MEDICINE

Arculanus is said to have re-introduced the use of
the seton, that is the method of producing intense
counter-irritation by the introduction of some foreign
body into an incision in the skin. We owe to him,
too, according to Pagel in the chapters on medieval
medicine in Puschmann's " Handbook of the History
of Medicine," an excellent description of alcoholic
insanity.

His directions for the treatment of conditions in
the mouth and nose apart from the teeth are quite
as explicit and practical, and in many ways quite
as great an anticipation of some of our modern no-
tions as what he has to say with regard to the teeth.
For instance, in the treatment of polyps he says that
they should be incised and cauterized. Soft polyps
should be drawn out with a toothed tenaculum as
far as can be without risk of breaking them off.
The incision should be made at the root so that
nothing or just as little as possible of the pathologi-
cal structure be allowed to remain. It should be
cut off with a fine scissors, or with a narrow file
just small enough to permit its ingress into the
nostrils, or with a scalpel without cutting edges on
the sides, but only at its extremity, and this cutting
edge should be broad and well sharpened. If there
is danger of hemorrhage, or if there is fear of it,
the instruments with which dissection is made should
be fired (igniantur), that is, heated at least to a dull
redness. Afterwards the stump, if any remains,
should be touched with a hot iron or else with
cauterizing agents so that as far as possible it should
be obliterated.

After the operation a pledget of cotton dipped in

MEDIEVAL DENTISTRY— GIOVANNI OF AECOLI 331

the green ointment described by Rhazes should be
placed in the nose. This pledget should have a
string fastened to it, hanging from the nose in order
that it may be easily removed. At times it may be
necessary to touch the root of the polyp with a stylet
on which cotton has been placed that has been dipped
in aqua fortis (nitric acid). It is important that
this cauterizing fluid should be rather strong so that
after a certain number of touches a rather firm
eschar is produced. In all these manipulations in
the nose Arculanus recommends that the nose should
be held well open by means of a nasal speculum.
Pictures of all these instruments occur in his "extant
works, and indeed this constitutes one of their most
interesting and valuable features. They are to be
seen in Gurlt's " History of Surgery."

In some cases he had seen the polyp was so
difficult to get at or was situated so far back in
the nose that it could not be reached by means of a
tenaculum or scissors, or even the special knife de-
vised for that purpose. For these patients Arcu-
lanus describes an operation that is to be found in
the older writers on surgery, Paul of ^Egina (^Egi-
netus), Avicenna, and some of the other Arabian
surgeons. For this three horse-tail hairs are twisted
together and knotted in three or four places, and one
end is passed through the nostrils and out through
the mouth. The ends of this are then pulled on
backward and forward after the fashion of a saw.
Arculanus remarks evidently with the air of a man
who has tried it and not been satisfied that this
operation is quite uncertain, and seems to depend
a great deal on chance, and much reliance must not

332 OLD-TIME MAKERS OF MEDICINE

be placed on it. Arculanus suggests a substitute
method by which latent polyps or occult polyps as
he calls them may be removed.

There is scarcely an important disease for which
Arculanus has not some interesting suggestions, and
the more one reads of him the more is one surprised
to find how many things that we might think of as
coming into the purview of medicine long after his
time or at least as having been neglected from the
time of the Greeks almost down to our own time
are here treated explicitly, definitely, and with ex-
cellent practical suggestions. He has a good deal
to say with regard to the treatment of angina, which
he calls synanche, or synanchia, or cynanche, or an-
gina. Parasynanche is a synonymous term, but
refers to a milder synanche. He distinguished four
forms of it. In one called canine angina, because
the patient's tongue hangs out of his mouth, some-
what the same as from an overheated dog in the
summer time, while at the same time the mouth is
held open and he draws his breath pantingly, Arcu-
lanus suggests an unfavorable prognosis, and would
seem to refer to those cases of Ludwig's angina in
which there is involvement of the tongue and in which
our prognosis continues to be of the very worst
even to our own day. At times the angina causes
such swelling in the throat that the breathing is
interfered with completely. For this Arculanus'
master, Rhazes, advised tracheotomy. Arculanus
himself, however, apparently hesitated about that.

It is not surprising, then, to find that Arculanus
is very explicit in his treatment of affections of the
uvula. He divides its affections into apostema,

MEDIEVAL DENTISTRY— GIOVANNI OF ARCOLI 333

ulcus, putredo sive corrosio, et casus. Apostema
was abscess, ulcus any rather deep erosion, putredo
a gangrenous condition, and casus the fall of the
uvula. This is the notorious falling of the soft
palate which has always been in popular medical
literature at least. Arculanus describes it as a pre-
ternatural elongation of the uvula which sometimes
goes to such an extent as to make it resemble the
tail of a mouse. For shorter elongations he sug-
gests the cautery; for longer, excision followed by
the cautery so that the greater portion of the ex-
tending part may be cut off. If people fear the
knife he suggests following Bhazes, the application
of an astringent powder directly to the part by
blowing through a tube. His directions for the
removal of the uvula are very definite. Seat the
patient upon a stool in a bright light while an
assistant holds the head; after the tongue has been
firmly depressed by means of a speculum let the
assistant hold this speculum in place. With the left
hand then insert an instrument, a stilus, by which the
uvula is pulled forward, and then remove the end
of it by means of a heated knife or some other
process of cauterization. The mouth should after-
wards be washed out with fresh milk.

The application of a cauterizing solution by means
of a cotton swab wrapped round the end of a sound
may be of service in patients who refuse the actual
cautery. To be successful the application must be
firmly made and must be frequently repeated.

After this it is not surprising to find that Arcu-
lanus has very practical chapters on all the other
ordinary surgical affections. Empyema is treated

334 OLD-TIME MAKERS OF MEDICINE

very thoroughly, liver abscess, ascites, which he
warns must be emptied slowly, ileus especially when
it reaches stercoraceous vomiting, and the various
difficulties of urination, he divides them into dysuria,
ischuria, and stranguria, are all discussed in quite
modern fashion. He gives seven causes for diffi-
culty of urination. One, some injury of the bladder ;
two, some lesion of the urethra ; three, some patho-
logical condition in the power to make the bladder
contract; four, some injury of the muscle of the
neck of the bladder ; five, some pathological condition
of the urine; six, some kidney trouble, and seven,
some pathological condition of the general system.
He takes up each one of these and discusses the vari-
ous phases, causes, disposition, and predispositions
that bring them about. One thing these men of the
Middle Ages could do, they reasoned logically, they
ordered what they had to say well, and they wrote it
out straightforwardly.

That Arculanus' work with regard to dentistry
was no mere chance and not solely theoretic can
be understood very well from his predecessors, and
that it formed a link in a continuous tradition which
was well preserved we may judge from what is to
be found in the writings of his great successor,
Giovanni or John de Vigo, who is considered one
of the great surgeons of the early Renaissance, and
to whom we owe what is probably the earliest treatise
on * * Gun-shot Wounds. ' ' John of Vigo was a Papal
physician and surgeon, generally considered one of
the most distinguished members of the medical pro-
fession of his time. Two features of his writing on
dental diseases deserve mention. He insists that

MEDIEVAL DENTISTRY— GIOVANNI OF ARCOLI 335

abscesses of the gums shall be treated as other ab-
scesses by being encouraged to come to maturity and
then being opened. If they do not close promptly,
an irritant Egyptian ointment containing verdigris
and alum among other things should be applied to
them. In the cure of old fistulous tracts near the
teeth he employs not only this Egyptian ointment
but also arsenic and corrosive sublimate. What he
has to say with regard to the filling of the teeth is,
however, most important. He says it with extreme
brevity, but with the manner of a man thoroughly
accustomed to doing it. " By means of a drill or
file the putrefied or corroded part of the tooth should
be completely removed. The cavity left should then
be filled with gold leaf." It is evident that the
members of the Papal court, the Cardinals and the
Pope himself, had the advantage of rather good den-
tistry at John de Vigo's hands even as early as the
beginning of the sixteenth century.

John de Vigo, however, is not medieval. He lived
on into the sixteenth century and was influenced
deeply by the Renaissance. He counts among the
makers of modern medicine and surgery, as his
authorship of the treatise on gun-shot wounds makes
clear. He comes in a period that will be treated of
in a later volume of this series on ' * Our Forefathers
in Medicine. ' '

XIII

CUSANUS AND THE FIRST SUGGESTION OF
LABORATORY METHODS IN MEDICINE

As illustrating how, as we know more about
the details of medical history, the beginnings of
medical science and medical practice are pushed
back farther and farther, a discussion in the Ber-
liner klinische Wochenschrift a dozen years ago is
of interest. Professor Ernest von Leyden, in sketch-
ing the history of the taking of the pulse as an impor-
tant aid in diagnostics, said that John Floyer was
usually referred to as the man who introduced the
practice of determining the pulse rate by means of
the watch. His work was done about the beginning of
the eighteenth century. Professor von Leyden sug-
gested, however, that William Harvey, the English
physiologist, to whom is usually attributed the dis-
covery of the circulation of the blood, had empha-
sized the value of the pulse in medical diagnosis,
and also suggested the use of the watch in counting
the pulse. Professor Carl Binz, of the University of
Bonn, commenting on these remarks of Professor
von Leyden, called attention to the fact that more
than a century before the birth of either of these men,
even the earlier, to whom the careful measurement
of the pulse rate is thus attributed as a discovery,
a distinguished German churchman, who died
shortly after the middle of the fifteenth century, had

336

FIRST SUGGESTION OF LABORATORY METHODS 337

suggested a method of accurate estimation of the
pulse that deserves a place in medical history.

This suggestion is so much in accord with modern
demands for greater accuracy in diagnosis that it
seems not inappropriate to talk of it as the first
definite attempt at laboratory methods in the de-
partment of medicine. The maker of the sugges-
tion, curiously enough, was not a practising physi-
cian, but a mathematician and scholar, Cardinal
Nicholas of Cusa, who is known in history as
Cusanus from the Latin name of the town Cues on
the Moselle River, some twenty-five miles south of
Treves, where he was born. His family name,
Nicholas Krebs, has been entirely lost sight of in
the name derived from his native town, which is the
only reason why most of the world knows anything
about that town. Cardinal Cusanus suggested that
in various forms of disease and at various times of
life, as in childhood, boyhood, manhood, and old
age, the pulse was very different. It would be ex-
tremely valuable to have some method of accurately
estimating, measuring, and recording these differ-
ences for medical purposes. At that time watches
had not yet been invented, and it would have been
very difficult to have estimated the time by the
clocks, for almost the only clocks in existence were
those in the towers of the cathedrals and of the pub-
lic buildings. The first watches, Nuremberg eggs,
as they were called, were not made by Peter Hen-
lein until well on into the next century. The only
method of measuring time with any accuracy in
private houses was the clepsydra or water-clock,
which measured the time intervals by the flow of a

338 OLD-TIME MAKEES OF MEDICINE

definite amount of water. Cardinal Cusanus sug-
gested then that the water-clock should be employed
for estimating the pulse frequency. His idea was
that the amount of water which flowed while a hun-
dred beats of the pulse were counted, should be
weighed, and this weight compared with that of
the average weight of water which flowed while a
hundred beats of the normal pulse of a number of
individuals of the same age and constitution were
being counted.

This was a very simple and a very ingenious sug-
gestion. We have no means of knowing now
whether it was adopted to any extent or not. It
may seem rather surprising that a cardinal should
have been the one to make such a suggestion.
Cusanus, however, was very much interested in
mathematics and in the natural sciences, and we
have many wonderful suggestions from his pen.
He was the first, for instance, to suggest, more than
a century before Copernicus, that the earth was not
the centre of the universe, and that it would not be
absolutely at rest or, as he said, devoid of all mo-
tion. His words are: " Terra igitur, qua centrum,
esse nequit, motu omni car ere non potest." He de-
scribed very clearly how the earth moved round its
own axis, and then he added, what cannot fail to be a
surprising declaration for those in the modern times
who think such an idea of much later origin, that he
considered that the earth itself cannot be fixed, but
moves as do the other stars in the heavens. The
expression is so astonishing at that time in the
world's history that it seems worth the while to
give it in its original form, so that it may be seen

FIRST SUGGESTION OF LABORATORY METHODS 339

clearly that it is not any subsequent far-fetched in-
terpretation of his opinion, but the actual words
themselves, that convey this idea. He said: " Con-
sideravi quod terra ista non potest esse fixa, sed
movetur ut alia stellce."

How clearly Cusanus anticipated another phase
of our modern views may be judged from what he
has to say in " De Docta Ignorantia ' ' with regard to
the constitution of the sun. It is all the more sur-
prising that he should by some form of intuition
reach such a conclusion, for the ordinary sources of
information with regard to the sun would not sug-
gest such an expression except to a genius, whose
intuition outran by far the knowledge of his time.
The Cardinal said: " To a spectator on the surface
of the sun the splendor which appears to us would
be invisible, since it contains, as it were, an earth
for its central mass, with a circumferential envelope
of light and heat, and between the two an atmos-
phere of water and clouds and of ambient air."
After reading that bit of precious astronomical sci-
ence announced nearly five centuries ago, it is easy
to understand how Copernicus could have an-
ticipated other phases of our knowledge, as he did
in his declarations that the figure of the earth is
not a sphere, but is somewhat irregular, and that
the orbit of the earth is not circular.

Cusanus was an extremely practical man, and was
constantly looking for and devising methods of ap-
plying practical principles of science to ordinary
life. As we shall see in discussing his suggestion
for the estimation of the pulse rate later on, he
made many other similar suggestions for diagnostic

340 OLD-TIME MAKERS OF MEDICINE

purposes in medicine, and set forth other applica-
tions of mathematics and mechanics to his genera-
tion.

Many of Cusanus' books have curiously modern
names. He wrote, for instance, a series of mathe-
matical treatises, in Latin of course, on " Geometric
Transmutations," on " Arithmetical Comple-
ments," on " Mathematical Complements," on
" Mathematical Perfection," and on " The Correc-
tion of the Calendar." In his time the calendar was
in error by more than nine days, and Cusanus was
one of those who aroused sufficient interest in the
subject, so that in the next century the correction
was actually made by the great Jesuit mathemati-
cian, Father Clavius. Perhaps the work of Cusanus
that is best known is that * * On Learned Ignorance—
De Docta Ignorantia," in which the Cardinal points
out how many things that educated people think they
know are entirely wrong. It reminds one very much
of Josh Billings 's remark that it is not so much the
ignorance of mankind that makes them ridiculous,
as the knowing so many things that ain't so. It is
from this work that the astronomical quotations
which we have made are taken. The book that is of
special interest to physicians is his dialogue " On
Static Experiments," which he wrote in 1450, and
which contains the following passages :

" Since the weight of the blood and the urine of
a healthy and of a diseased man, of a young man
and an old man, of a German and an African, is
different for each individual, why would it not be
a great benefit to the physician to have all of these
various differences classified? For I think that a

FIRST SUGGESTION OF LABORATOET METHODS 341

physician would make a truer judgment from the
weight of the urine viewed in connection with its
color than he could make from its color alone, which
might be fallacious. So, also, weight might be used
as a means of identifying the roots, the stems, the
leaves, the fruits, the seeds, and the juice of plants
if the various weights of all the plants were properly
noted, together with their variety, according to lo-
cality. In this way the physician would appreciate
their nature better by means of their weight than
if he judged them by their taste alone. He might
know, then, from a comparison of the weights of
the plants and their various parts when compared
with the weight of the blood and the urine, how to
make an application and a dosage of drugs from the
concordances and differences of the medicaments,
and even might be able to make an excellent prog-
nosis in the same way. Thus, from static experi-
ments, he would approach by a more precise knowl-
edge to every kind of information.

1 ' Do you not think if you would permit the water
from the narrow opening of a clepsydra [water-
clock] to flow into a basin for as long as was neces-
sary to count the pulse a hundred times in a healthy
young man, and then do the same thing for an ail-
ing young man, that there would be a noticeable dif-
ference between the weights of the water that would
flow during the period? From the weight of the
water, therefore, one would arrive at a better knowl-
edge of the differences in the pulse of the young and
the old, the healthy and the unhealthy, and so, also,
as to information with regard to various diseases,
since there would be one weight and, therefore, one
pulse in one disease, and another weight and another
pulse in another disease. In this way a better judg-
ment of the differences in the pulse could be ob-
tained than from the touch of the vein, just as more
can be known from the urine about its weight than
from its color alone.

342 OLD-TIME MAKERS OF MEDICINE

" Just in the same way would it not be possible
to make a more accurate judgment with regard to
the breathing, if the inspirations and expirations
were studied according to the weight of the water
that passed during a certain interval? If, while
water was flowing from a clepsydra, one were to
count a hundred expirations in a boy, and then in
an old man, of course, there would not be the same
amount of water at the end of the enumeration.
Then this same thing might be done for other ages
and states of the body. As a consequence, when
the physician once knew what the weight of water
that represented the number of expirations of a
healthy boy or youth, and then of an individual of
the same age ill of some infirmity or other, there is
no doubt that, by this observation, he will come to
a knowledge of the health or illness and something
about the case, and, perhaps, also with more cer-
tainty would be able to choose the remedy and the
dose required. If he found in a healthy young
man apparently the same weight as in an old and
decrepit individual, he might readily be brought to
the conclusion that the young man would surely die,
and in this way have some evidence for his prog-
nosis in the case. Besides, if in fevers, in the same
way, careful studies were made of the differences
in the weight of water for pulse and respiration in
the warm and the cold paroxysms, would it not be
possible thus to know the disease better and, per-
haps, also get a more efficacious remedy? '

As will be seen from this passage, Cusanus had
many more ideas than merely the accurate estima-
tion of the pulse frequency when he suggested the
use of the water-clock. Evidently the thought had
come to him that the specific gravity of the sub-
stances, that is, their weight in comparison to the
weight of water, might be valuable information.

FIRST SUGGESTION OF LABORATORY METHODS 343

Before his time, physicians had depended only on
the color and the taste of the urine for diagnostic
purposes. He proposed that they should weigh it,
and even suggested that they should weigh, also, the
blood, I suppose in case of venesection, for com-
parison's sake. He also thought that the compara-
tive weight of various roots, stems, leaves, juices of
plants might give hints for the therapeutic uses of
these substances. This is the sort of idea that we
are apt to think of as typically modern. Specific
gravities and atomic weights have been more than
once supposed to represent laws in therapeutics,
which so far, however, we have not succeeded in
finding, but it is interesting to realize that it is
nearly five hundred years since the first thought in
this line was clearly expressed by a distinguished
thinker and scientific writer.

There are many interesting expressions in
Cusanus' writings which contradict most of the im-
pressions commonly entertained with regard to the
scholars of the Middle Ages. It is usually assumed
that they did not think seriously, but speculatively,
that they feared to think for themselves, neglected
the study of nature around them, considered author-
ity the important source of knowledge, and were as
far as possible from the standpoint of modern sci-
entific students and investigators. Here is a
passage from Nicholas, on knowing and thinking,
that might well have been written by a great intel-
lectual man at any time in the world's history, and
that could only emanate from a profound scholar at
any time.

344 OLD-TIME MAKERS OF MEDICINE

11 To know and to think, to see the truth with the
eye of the mind, is always a joy. The older a man
grows the greater is the pleasure which it affords
him, and the more he devotes himself to the search
after truth, the stronger grows his desire of pos-
sessing it. As love is the life of the heart, so is the
endeavor after knowledge and truth the life of the
mind. In the midst of the movements of time, of
the daily work of life, of its perplexities and con-
tradictions, we should lift our gaze fearlessly to
the clear vault of heaven, and seek ever to obtain a
firmer grasp of and a keener insight into the origin
of all goodness and beauty, the capacities of our
own hearts and minds, the intellectual fruits of
mankind throughout the centuries, and the wondrous
works of nature around us; at the same time re-
membering always that in humility alone lies true
greatness, and that knowledge and wisdom are alone
profitable in so far as our lives are governed by
them."

The career of Nicholas of Cusa is interesting, be-
cause it sums up so many movements, and, above all,
educational currents in the fifteenth century. He
was born in the first year of the century, and lived
to be sixty-four. He was the son of a wine grower,
and attracted the attention of his teachers because
of his intellectual qualities. In spite of compara-
tively straitened circumstances, then, he was af-
forded the best opportunities of the time for educa-
tion. He went first to the school of the Brethren
of the Common Life at Deventer, the intellectual
cradle of so many of the scholars of this century.
Such men as Erasmus, Conrad Mutianus, Johann
Sintheim, Hermann von dem Busche, whom Strauss
calls " the missionary of human wisdom," and the

FIRST SUGGESTION OF LABORATORY METHODS 345

teacher of most of these, Alexander Hegius, who
has been termed the schoolmaster of Germany, with
Nicholas of Cusa and Rudolph Agricola and others,
who might readily be mentioned, are the fruits of
the teaching of these schools of the Brethren of the
Common Life, in one of which Thomas a Kempis,
the author of " The Imitation of Christ," was, for
seventy years out of his long life of ninety, a teacher.
Cusanus succeeded so well at school that he was
later sent to the University of Heidelberg, and sub-
sequently to Padua, where he took up the study of
Roman law, receiving his doctorate at the age of
twenty-three. This series of educational oppor-
tunities will be surprising only to those who do not
know educational realities at the beginning of the
fifteenth century. There has never been a time
when a serious seeker after knowledge could find
more inspiration. On his return to Germany,
Father Krebs became canon of the cathedral in
Coblenz. This gave him a modest income, and
leisure for intellectual work which was eagerly
employed. He was scarcely more than thirty when
he was chosen as a delegate to the Council at Basel.
After this he was made Archdeacon of the Cathedral
of Liittich, and from this time his rise in ecclesi-
astical preferment was rapid. He had attracted so
much attention at the Council of Basel that he was
chosen as a legate of the Pope for the bringing about
certain reforms in Germany. Subsequently he was
sent on ecclesiastical missions to the Netherlands,
and even to Constantinople. At the early age of
forty he was made a Cardinal. After this he was
always considered as one of the most important

346 OLD-TIME MAKERS OF MEDICINE

consultors of the Papacy in all matters relating to
Germany. During the last twenty-five years of his
life in all the relations of the Holy See to Ger-
many, appeal was constantly made to the wisdom,
the experience, and the thoroughly conservative,
yet foreseeing, judgment of this son of the people,
whose education had lifted him up to be one of the
leaders of men in Europe.

It was during this time that he wrote most of his
books on mathematics, which have earned for him
a prominent place in Cantor's " History of Mathe-
matics," about a score of pages being devoted to
his work. Much of his thinking was done while
riding on horseback or in the rude vehicles of the
day on the missions to which he was sent as Papal
Legate. He is said to have worked out the formula
for the cycloid curve while watching the path de-
scribed by flies that had lighted on the wheels of his
carriage, and were carried forward and around by
them. His scientific books, though they included
such startling anticipations of Copernicus' doc-
trines as we have already quoted (Copernicus did
not publish the first sketch of his theory for more
than a quarter of a century after Cusanus' death),
far from disturbing his ecclesiastical advancement
or injuring his career as a churchman, seem actu-
ally to have been considered as additional reasons
for considering him worthy of confidence and con-
sultation.

As the result of his careful studies of conditions
in Germany, he realized very clearly how much of
unfortunate influence the political status of the Ger-
man people, with their many petty rulers and the

FIRST SUGGESTION OF LABORATORY METHODS 347

hampering of development consequent upon the
trivial rivalries, the constant bickerings, and the
inordinate jealousies of these numerous princelings,
had upon his native country. Accordingly, towards
the end of his life he sketched what he thought
would be the ideal political status for the German
people. As in everything that he wrote, he went
straight to the heart of the matter and, without
mincing words, stated just exactly what he thought
ought to be done. Considering that this scheme of
Cusanus for the prosperity and right government of
the German people was not accomplished until more
than four centuries after his death, it is interesting,
indeed, to realize how this clergyman of the middle
of the fifteenth century should have come to any
such thought. Nothing, however, makes it clearer
than this, that it is not time that fosters thinking,
but that great men at any time come to great
thoughts. Cusanus wrote :

' * The law and the kingdom should be placed under
the protection of a single ruler or authority. The
small separate governments of princes and counts
consume a disproportionately large amount of rev-
enue without furnishing any real security. For this
reason we must have a single government, and for
its support we must have a definite amount of the
income from taxes and revenues yearly set aside by
a representative parliament and before this parlia-
ment (reichstag) must be given every year a definite
account of the money that was spent during the pre-
ceding year."

Cusanus' life and work stand, then, as a type of
the accomplishment, the opportunities, the power of
thought, the practical scholarship, the mathematical

348 OLD-TIME MAKERS OF MEDICINE

accuracy, the fine scientific foresight of a scholar of
the fifteenth century. For us, in medicine, it is in-
teresting indeed to realize that it is from a man of
this kind that a great new departure in medicine
with regard to the employment of exact methods of
diagnosis had its first suggestion in modern times.
The origin of that suggestion is typical. It has
practically always been true that it was not the
man who had exhausted, or thought that he had done
so, all previous medical knowledge, who made ad-
vances in medicine for us. It has nearly always
been a young man early in his career, and at a time
when, as yet, his mind was not overloaded with the
medical theories of his own time. Cusanus was
probably not more than thirty when he made the
suggestion which represents the first practical hint
for the use of laboratory methods in modern medi-
cine. It came out of his thoughtful consideration of
medical problems rather than from a store of gar-
nered information as to what others thought. It is
a lesson in the precious value of breadth of educa-
tion and serious training of mind for real progress
at all times.

XIV

BASIL VALENTINE, LAST OF THE ALCHE-
MISTS, FIRST OF THE CHEMISTS

" Fieri enim potest ut operator erret et a via
regia deflectat, sed ut erret natura quando recte
tractatur fieri non potest."

' * For it is quite possible that the physician should
err and be turned aside from the straight (royal)
road, but that nature when she is rightly treated
should err is quite impossible."

This is one of the preliminary maxims of a
treatise on medicine written by a physician born
not later than the first half of the fifteenth century,
and who may have lived even somewhat earlier. We
are so prone to think of the men of that time as
utterly dependent on authority, not daring to follow
their own observation, suspecting nature, and al-
most sure to be convinced that only by going counter
to her could success in the treatment of disease be
obtained, that it is a surprise to most people to find
how completely the attitude of mind, that is sup-
posed to be so typically modern in this regard, was
anticipated full four centuries ago. There are
other expressions of this same great physician and
medical writer, Basil Valentine, which serve to show
how faithfully he strove with the lights that he had
to work out the treatment of patients, just as we do
now, by trying to find out nature's way, so as to

349

350 OLD-TIME MAKERS OF MEDICINE

imitate her beneficent processes and purposes. It
is quite clear that he is but one of many faithful,
patient observers and experimenters — true sci-
entists in the best sense of the word — who lived in
all the centuries of the Middle Ages.

Speculations and experiments with regard to the
elixir of life, the philosopher's stone, and the trans-
mutation of metals, are presumed to have filled up
all the serious interests of the alchemists, supposed
to be almost the only scientists of those days. As
a matter of fact, however, men were making original
observations of profound significance, and these
were considered so valuable by their contemporaries
that, though printing had not yet been invented,
even the immense labor involved in the manifold
copying of large folio volumes by the slow hand
process did not suffice to deter them from multiply-
ing the writings of these men so numerously that
they were preserved in many copies for future gen-
erations, until the printing press came to perpetuate
them.

Of this there is abundant evidence in the preced-
ing pages as regards medicine, and, above all,
surgery, while a summary of accomplishments of
workers in other departments will be found in Ap-
pendix II, ' * Science at the Medieval Universities. ' '

At the beginning of the twentieth century, with
some of the supposed foundations of modern chem-
istry crumbling to pieces under the influence of the
peculiarly active light thrown upon our nineteenth
century chemical theories by the discovery of
radium, and our observations on radio-active ele-
ments generally, there is a reawakening of interest

BASIL VALENTINE 351

in some of the old-time chemical observers, whose
work used to be laughed at as so unscientific, or, at
most, but a caricature of real science, and whose
theory of the transmutation of elements into one
another was considered so absurd. It is interesting
in the light of this to recall that the idea that the
elementary substances were essentially distinct
from each other, and that it would be impossible un-
der any circumstances to convert one element into
another, belongs entirely to the nineteenth century.
Even so deeply scientific a mind as that of Newton,
in the preceding century, could not bring itself to
acknowledge the tradition, that came to be accepted
subsequent to his time, of the absurdity of metallic
transformation. On the contrary, he believed quite
formally in transmutation as a basic chemical prin-
ciple, and declared that it might be expected to occur
at any time. He had seen specimens of gold ores in
connection with metallic copper, and concluded that
this was a manifestation of the natural transforma-
tion of one of these yellow metals into the other.

"With the discovery that radium transforms itself
into helium, and that, indeed, all the so-called radio-
activities of the heavy metals are probably due to a
natural transmutation process constantly at work,
the ideas of the older chemists cease entirely to be a
subject for amusement. The physical chemists of
the present day are very ready to admit that the
old teaching of the absolute independence of some-
thing over seventy elements is no longer tenable,
except as a working hypothesis. The doctrine of
" matter and form," taught for so many centuries
by the scholastic philosophers, which proclaimed

352 OLD-TIME MAKERS OF MEDICINE

that all matter is composed of two principles, an
underlying material substratum, and a dynamic or
informing principle, has now more acknowledged
verisimilitude, or lies at least closer to the gener-
ally accepted ideas of the most progressive sci-
entists, than it has at any time for the last two or
three centuries. Not only the great physicists, but
also the great chemists, are speculating along lines
that suggest the existence of but one form of mat-
ter, modified according to the energies that it pos-
sesses under a varying physical and chemical en-
vironment. This is, after all, only a restatement in
modern times of the teaching of St. Thomas of
Aquin, in the thirteenth century.

It is not surprising, then, that there should be a
reawakening of interest in the lives of some of the
men, who, dominated by some of the earlier scho-
lastic ideas, by the tradition of the possibility of
finding the philosopher's stone, which would trans-
mute the baser metals into the precious metals, de-
voted themselves with quite as much zeal as any
modern chemist to the observation of chemical
phenomena. One of the most interesting of these—
indeed, he might well be said to be the greatest of
the alchemists — is the man whose only name that we
know is that which appears on a series of manu-
scripts written in the High German dialect of the
end of the fifteenth and the beginning of the six-
teenth century. That name is Basil Valentine, and
the writer, according to the best historical tradi-
tions, was a Benedictine monk. The name Basil
Valentine may only have been a pseudonym, for it
has been impossible to trace it among the records of

BASIL VALENTINE 353

the monasteries of the time. That the writer was
a monk, however, there seems to be no room for
doubt, for his writings give abundant evidence of it,
and, besides, in printed form they began to have
their vogue at a time when there was little likelihood
of their being attributed to a monastic source, un-
less an indubitable tradition connected them with
some monastery.

This Basil Valentine (to accept the only name we
have) did so much for the science of the composition
of substances that he eminently deserves the desig-
nation that has been given him of the last of the
alchemists and the first of the chemists. There is
practically a universal recognition of the fact now
that he deserves also the title of the Founder of
Pharmaceutical Chemistry, not only because of the
value of the observations contained in his writings,
but also because of the fact that they proved so sug-
gestive to certain scientific geniuses during the cen-
tury succeeding Valentine's life. Almost more than
to have added to the precious heritage of knowledge
for mankind, it is a boon for a scientific observer to
have awakened the spirit of observation in others,
and to be the founder of a new school of thought.
This Basil Valentine undoubtedly did, and, in the
Eenaissance, the incentive from his writings for
such men as Paracelsus is easy to appreciate.

Besides, his work furnishes evidence that the in-
vestigating spirit was abroad just when it is usually
supposed not to have been, for the Thuringian monk
surely did not do all his investigation alone, but
must have. owed, as well as given, many a suggestion
to his contemporaries.

354 OLD-TIME MAKERS OF MEDICINE

Some ten years ago, when Sir Michael Foster,
professor of physiology in the University of Cam-
bridge, England, was invited to deliver the Lane
Lectures at the Cooper Medical College in San Fran-
cisco, he took for his subject " The History of
Physiology." In the course of his lecture on " The
Rise of Chemical Physiology " he began with the
name of Basil Valentine, who first attracted men's
attention to the many chemical substances around
them that might be used in the treatment of disease,
and said of him :

" He was one of the alchemists, but in addition to
his inquiries into the properties of metals and his
search for the philosopher's stone, he busied himself
with the nature of drugs, vegetable and mineral, and
with their action as remedies for disease. He was
no anatomist, no physiologist, but rather what now-
adays we should call a pharmacologist. He did not
care for the problem of the body, all he sought to
understand was how the constituents of the soil and
of plants might be treated so as to be available for
healing the sick and how they produced their effects.
We apparently owe to him the introduction of many
chemical substances, for instance of hydrochloric
acid, which he prepared from oil and vitriol of salt,
and of many vegetable drugs. And he was appar-
ently the author of certain conceptions which, as we
shall see, played an important part in the develop-
ment of chemistry and of physiology. To him, it
seems, we owe the idea of the three ' elements,' as
they were and have been called, replacing the old
idea of the ancients of the four elements — earth, air,
fire, and water. It must be remembered, however,
that both in the ancient and the new idea the word
' element ' \vas not intended to mean that which it
means to us now, a fundamental unit of matter, but

BASIL VALENTINE 355

a general quality or property of matter. The three
elements of Valentine were: (1) sulphur, or that
which is combustible, which is changed or destroyed,
or which at all events disappears during burning or
combustion; (2) mercury, that which temporarily
disappears during burning or combustion, which is
dissociated in the burning from the body burnt, but
which may be recovered, that is to say, that which is
volatile, and (3) salt, that which is fixed, the residue
or ash which remains after burning. ' '

It is a little bit hard in our time for most people
to understand just how such a development of thor-
oughly scientific chemical notions, with investiga-
tions for their practical application, should have
come before the end of the Middle Ages. This diffi-
culty of understanding, however, we are coming to
realize in recent years, is entirely due to our ig-
norance of the period. We have known little or
nothing about the science of the Middle Ages, be-
cause it was hidden away in rare old books, in rather
difficult Latin, not easy to get at, and still less easy
to understand always, and we have been prone to
conclude that since we knew nothing about it, there
must have been nothing. Just inasmuch as we have
learned something definite about the medieval
scholars, our admiration has increased. Professor
Clifford Allbutt, the Eegius Professor of Medicine
at the University of Cambridge, in his Harveian
Oration, delivered before the Eoyal College of Phy-
sicians in 1900, on " Science and Medieval
Thought" (London, 1901), declared that "the
schoolmen, in digging for treasure, cultivated the
field of knowledge even for Galileo and Harvey, for
Newton and Darwin." He might have added that

356 OLD-TIME MAKERS OF MEDICINE

they had laid foundations in all our modern sciences,
in chemistry quite as well as in astronomy, physi-
ology, and the medical sciences, in mathematics and
botany.

In chemistry the advances made during the
thirteenth, fourteenth, and fifteenth centuries were,
perhaps, even more noteworthy than those in any
other department of science. Albertus Magnus, who
taught at Paris, wrote no less than sixteen treatises
on chemical subjects, and, notwithstanding the fact
that he was a theologian as well as a scientist, and
that his printed works fill some fifteen folio volumes,
he somehow found the time to make many observa-
tions for himself, and performed numberless ex-
periments in order to clear up doubts. The larger
histories of chemistry accord him his proper place,
and hail him as a great founder in chemistry, and a
pioneer in original investigation.

Even St. Thomas of Aquin, much as he was oc-
cupied with theology and philosophy, found some
time to devote to chemical questions. After all,
this is only what might have been expected of the
favorite pupil of Albertus Magnus. Three treatises
on chemical subjects from Aquinas' pen have been
preserved for us, and it is to him that we are said
to owe the use, in the Western world at least, of the
word amalgam, which he first employed in describ-
ing various chemical methods of metallic combina-
tion with mercury that were discovered in the search
for the genuine transmutation of metals.

Albertus Magnus' other great scientific pupil,
Roger Bacon, the English Franciscan friar, followed
more closely in the scientific ways of his great

BASIL VALENTINE 357

master, devoting himself almost entirely to the
physical sciences. Altogether he wrote some
eighteen treatises on chemical subjects. For a long
time it was considered that he was the inventor of
gunpowder, though this is now known to have been
introduced into Europe by the Arabs. Roger Ba-
con studied gunpowder and various other explosive
combinations in considerable detail, and it is for this
reason that he obtained the undeserved reputation
of being an original discoverer in this line. How
well he realized how much might be accomplished by
means of the energy stored up in explosives, can,
perhaps, be best appreciated from the fact that he
suggested that boats would go along the rivers and
across seas without either sails or oars, and that
carriages would go along the streets without horse
or man power. He considered that man would
eventually invent a method of harnessing these ex-
plosive mixtures, and of utilizing their energies for
his purposes without danger. It is curiously inter-
esting to find, as we begin the twentieth century, and
gasolene is so commonly used for the driving of
automobiles and motor boats, and is being introduced
even into heavier transportation as the most avail-
able source of energy for suburban traffic, at least,
that this generation should only be fulfilling the idea
of the old Franciscan friar of the thirteenth century,
who prophesied that in explosives there was the
secret of eventually manageable energy for trans-
portation purposes.

Succeeding centuries were not as fruitful in great
scientists as the thirteenth, and yet, in the second
half of the thirteenth, there was a Pope, John XXI,

358 OLD-TIME MAKERS OF MEDICINE

who had been a physician and professor of medicine
before his election to the Papacy, three of whose
scientific treatises — one on the transmutation of
metals, which he considers an impossibility, at least
as far as the manufacture of gold and silver was
concerned; a treatise on diseases of the eyes, to
which good authorities have not hesitated to give
lavish praise for its practical value, considering the
conditions in which it was written ; and, finally, his
treatise on the preservation of the health, written
when he was himself over eighty years of age-
are all considered by good authorities as worthy of
the best scientific spirit of the time.

During the fourteenth century, Arnold of Vil-
lanova, the inventor of nitric acid, and the two Hol-
landuses, kept up the tradition of original investiga-
tion in chemistry. Altogether there are some
dozen treatises from these three men on chemical
subjects. The Hollanduses particularly did their
work in a spirit of thoroughly frank, original in-
vestigation. They were more interested in min-
erals than in any other class of substances, but did
not waste much time on the question of transmuta-
tion of metals. Professor Thompson, the professor
of chemistry at Edinburgh, said, in his ' ' History of
Chemistry," many years ago, that the Hollanduses
give very clear descriptions of their processes of
treating minerals in investigating their composition,
and these serve to show that their knowledge was
by no means entirely theoretical, or acquired only
from books.

It is not surprising, then, to have a great in-
vestigating pharmacologist come along sometime

.BASIL VALENTINE 359

about the beginning of the fifteenth century, when,
according to the best authorities, Basil Valentine
was born. From traditions he seems to have had a
rather long life, and his years run nearly parallel
with his century. His career is a typical example
of the personally obscure and intellectually bril-
liant lives which the old monks lived. Probably
in nothing have recent generations been more de-
ceived in historical matters than in their estimation
of the intellectual attainments and accomplishment
of the old monks. The more that we know of them,
not from second-hand authorities, but from their
own books and from what they accomplished in art
and architecture, in agriculture, in science of all
kinds, the more do we realize what busy men they
were, and appreciate what genius they often brought
to the solution of great problems. We have had
much negative pseudo-information brought together
with the definite purpose of discrediting monasti-
cism, and now that positive information is gradu-
ally being accumulated, it is almost a shock to find
how different are the realities of the story of the
intellectual life during the Middle Ages from what
many writers had pictured them.

To those who may be surprised that a man who
did great things in medicine should have lived dur-
ing the fifteenth century, it may be well to recall
the names and a little of the accomplishment of the
men of this period, who were Basil Valentine's con-
temporaries, at least in the sense that some portion
of their lives and influence was coeval with his.
Before the end of this century Columbus had dis-
covered America, and by no happy accident, for

3GO OLD-TIME MAKERS OF MEDICINE

many men of his generation did correspondingly
great work. Cardinal Nicholas of Cusa had de-
veloped mathematics and applied mathematical
ideas to the heavens, so that he could announce the
conclusion that the earth was a star, like the other
stars, and moved in the heavens as they do. Con-
temporary with Cusanus was Begiomontanus, who
has been proclaimed the father of modern astron-
omy, and a distinguished mathematician. Tos-
canelli, the Florentine astronomer, whose years run
almost parallel with those of the fifteenth century,
did fine scholarly work, which deeply influenced Co-
lumbus and the great navigators of the time. The
universities in Italy were attracting students from
all over Europe, and such men as Linacre and Dr.
Caius went down there from England. Raphael
was but a young man at the end of the century, but
he had done some noteworthy painting before it
closed. Leonardo da Vinci was born just about
the middle of the century, and did some marvellous
work before the end of that century. Michael
Angelo was only twenty-five at the close of the
century, but he, too, did fine work, even at this
early age. Among the other great Italian painters
of this century are Fra Angelico, Perugino,
Raphael's master, Pinturicchio, Signorelli, the pupil
of his uncle, Vasari, almost as distinguished, Botti-
celli, Titian, and very many others, who would have
been famous leaders in art in any other but this
supremely great period.

It was not only in Italy, however, that there was
a wonderful outburst of genius at this time, for
Germany also saw the rise of a number of great

BASIL VALENTINE 361

men during this period. Jacob Wimpheling, the
" Schoolmaster of Germany," as he has been called,
whose educational work did much to determine the
character of German education for two centuries,
was born in 1450. Eudolph Agricola, who in-
fluenced the intellectual Europe of this time deeply,
was born in 1443. Erasmus, one of the greatest of
scholars, of teachers, and of controversialists, was
born in 1467. Johann Eeuchlin, the great linguist,
who, next to Erasmus, is the most important char-
acter in the German Renaissance, was born in 1455.
Then there was Sebastian Brant, the author of " The
Ship of Fools," and Alexander Hegius, both of this
same period. The most influential of them all,
Thomas a Kempis, who died in 1471, and whose
little book, " The Following of Christ," has in-
fluenced every generation deeply ever since, was
probably a close contemporary of Basil Valentine.
When one knows what European, and especially
German scholars, were accomplishing at this time,
no room is left for surprise that Basil Valentine
should have lived and done work in medicine at this
period that was to influence deeply the after history
of medicine.

Most of what Basil Valentine did was accom-
plished in the first half of the fifteenth century.
Coming, as he did, before the invention of printing,
when the spirit of tradition was more rife and dom-
inating than it has been since, it is almost needless to
say that there are many curious legends associated
with his name. Two centuries before his time,
Roger Bacon, doing his work in England, had suc-
ceeded in attracting so much attention even from

362 OLD-TIME MAKERS OF MEDICINE

the common people, because of his wonderful sci-
entific discoveries, that his name became a byword,
and many strange magical feats were attributed to
him. Friar Bacon was the great wizard, even in
the plays of the Elizabethan period. A number of
the same sort of myths attached themselves to the
Benedictine monk of the fifteenth century. He was
proclaimed in popular story to have been a won-
derful magician. Even his manuscript, it was said,
had not been published directly, but had been hid-
den in a pillar in the church attached to his
monastery, and had been discovered there after the
splitting open of the pillar by a bolt of lightning
from heaven. It is the extension of this tradition
that has sometimes led to the assumption that Val-
entine lived in an earlier century, some even going
so far as to say that he, too, like Roger Bacon, was
a product of the thirteenth century. It seems rea-
sonably possible, however, to separate the tradi-
tional from what is actual in his existence, and thus
to obtain some idea at least of his work, if not of
the details of his life. The internal evidence from
his works enables the historian of science to place his
writing within half a century of the discovery of
America.

One of the myths that have gathered around the
name of Basil Valentine, because it has become a
commonplace in philology, has probably made him
more generally known than any of his actual dis-
coveries. In one of the most popular of the old-
fashioned text-books of chemistry in use about half
a century ago, in the chapter on antimony, there
was a story that students, if I may judge from my

BASIL VALENTINE 363

own experience, never forgot. It was said that
Basil Valentine, a monk of the Middle Ages, was
the discoverer of this substance. After having ex-
perimented with it in a number of ways, he threw
some of it out of his laboratory one day when the
swine of the monastery, finding it, proceeded to gob-
ble it up, together with some other refuse. Just when
they were finishing it, the monk discovered what they
were doing. He feared the worst from it, but took
the occasion to observe the effect upon the swine
very carefully. He found that, after a preliminary
period of digestive disturbance, these swine de-
veloped an enormous appetite, and became fatter
than any of the others. This seemed a rather de-
sirable result, and Basil Valentine, ever on the
search for the practical, thought that he might use
the remedy to good purpose on the members of the
community. Some of the monks in the monastery
were of rather frail health and delicate constitution,
and most of them were rather thin, and he thought
that the putting on of a little fat, provided it could
be accomplished without infringement of the rule,
might be a good thing for them. Accordingly, he
administered, surreptitiously, some of the salts of
antimony, with which he was experimenting, in the
food served to these monks. The result, however,
was not so favorable as in the case of the hogs. In-
deed, according to one, though less authentic, ver-
sion of the story, some of the poor monks, the un-
conscious subjects of the experiment, perished as
the result of the ingestion of the antimonial com-
pounds. According to the better version, they suf-
fered only the usual unpleasant consequences of

364 OLD-TIME MAKERS OF MEDICINE

taking antimony, which are, however, quite enough
for a fitting climax to the story. Basil Valentine
called the new substance which he had discovered
antimony, that is, opposed to monks. It might be
good for hogs, but it was a form of monks' bane, as
it were.1

Unfortunately for most of the good stories of
history, modern criticism has nearly always failed
to find any authentic basis for them, and they have
had to go the way of the legends of Washington's
hatchet and Tell's apple. We are sorry to say that
that seems to be true also of this particular story.
Antimony, the word, is very probably derived from
certain dialectic forms of the Greek word for the
metal, and the name is no more derived from anti
and monachus than it is from anti and monos (op-
posed to single existence), another fictitious deriva-
tion that has been suggested, and one whose etymo-
logical value is supposed to consist in the fact that
antimony is practically never found alone in nature.

Notwithstanding the apparent cloud of unfounded
traditions that are associated with his name, there

JIt is curious to trace how old are the traditions on which some of
these old stories, that must now be rejected, are founded. I have come
upon the story with regard to Basil Valentine and the antimony and
the monks in an old French medical encyclopedia of biography, published
in the seventeenth century, and at that time there was no doubt at all
expressed as to its truth. How much older than this it may be I do not
know, though it is probable that it comes from the sixteenth century,
when the kakoetlies scribendi attacked many people because of the facil-
ity of printing, and when most of the good stories that have so worried
the modern dry-as-dust historian in his researches for their correction
became a part of the body of supposed historical tradition. It is prob-
ably French in origin because in that language antimoine is a tempting
bait for that pseudo-philology which has so often led to false derivations.

BASIL VALENTINE 365

can be no doubt at all of the fact that Valentinus —
to give him the Latin name by which he is commonly
designated in foreign literatures — was one of the
great geniuses, who, working in obscurity, make
precious steps into the unknown that enable human-
ity after them to see things more clearly than ever
before. There are definite historical grounds for
placing Basil Valentine as the first of the series of
careful observers who differentiated chemistry from
the old alchemy and applied its precious treasures
of information to the uses of medicine. It is said
to have been because of the study of Basil Valen-
tine's work that Paracelsus broke away from the
Galenic traditions, so supreme in medicine up to his
time, and began our modern pharmaceutics. Fol-
lowing Paracelsus came Van Helmont, the father
of modern medical chemistry, and these three did
more than any others to enlarge the scope of medica-
tion and to make observation rather than authority
the most important criterion of truth in medicine.
Indeed, the work of this trio of men of the fifteenth
and sixteenth centuries — the Renaissance in medi-
cine as in art — dominated medical treatment, or at
least the department of pharmaceutics, down almost
to our own day, and their influence is still felt in
drug-giving.

While WTC do not know the absolute data of either
the birth or the death of Basil Valentine and are
not sure of the exact period even in which he lived
and did his work, we are sure that a great original
observer about the time of the invention of printing
studied mercury and sulphur and various salts of
the metals, and above all introduced antimony to

366 OLD-TIME MAKERS OF MEDICINE

the notice of the scientific world, and especially to
the favor of practitioners of medicine. His book,
" The Triumphal Chariot of Antimony," is full of
conclusions not quite justified by his premises nor
by his observations. There is no doubt, however,
that the observational method which he employed
furnished an immense amount of knowledge, and
formed the basis of the method of investigation by
which the chemical side of medicine was to develop
during the next two or three centuries. Great harm
was done by the abuse of antimony, but then great
harm is done by the abuse of anything, no matter
how good it may be. For a time it came to be the
most important drug in medicine and was only re-
placed by venesection.

The fact of the matter is that doctors were looking
for effects from their drugs, and antimony is, above
all things, effective. Patients, too, wished to see the
effect of the medicines they took. They do so even
yet, and when antimony was administered there was
no doubt about its working.

The most interesting of Basil Valentine's books,
and the one which has had the most enduring in-
fluence, is undoubtedly " The Triumphal Chariot
of Antimony."1 It has been translated and has

1 There is in the New York Academy of Medicine a thick 24mo
volume in which three of the classics of older medicine are bound
together. They are Kerckringius's " Commentary on the Triumphal
Chariot of Antimony," published at Amsterdam, 1671; Steno's
" Dissertation on the Anatomy of the Brain," published in Leyden
in 1671, and Father Kircher's " Scrutinium Physico Contagiosae
Luis quae dicitur Pestis " (Physico-medical Discussions of the Con-
tagious Disease which is called Pest). This was published at Leipzig
in 1659. Just how the three works came to be bound together is hard

BASIL VALENTINE 367

had a wide vogue in every language of modern
Europe. Its recommendation of antimony had such
an effect upon medical practice that it continued
to be the most important drug in the pharmacopoeia
down almost to the middle of the nineteenth century.
If any proof were needed that Basil Valentine or
that the author of the books that go under the name
was a monk it would be found in the introduction
to this volume, which not only states that fact very
clearly, but also in doing so makes use of language
that shows the writer to have been deeply imbued
with the old monastic spirit. I quote the first para-
graph of this introduction because it emphasizes this.
The quotation is taken from the English translation
of the work as published in London in 1678. Curi-
ously enough, seeing the obscurity surrounding Val-
entine himself, we do not know for sure who made
the translation. The translator apologizes some-
what for the deeply religious spirit of the book,
but considers that he was not justified in eliminating

to say. Very probably they belonged to some old-time scholar, though
there is nothing about the books to tell anything of the story. The
fact that all three of the authors were ecclesiastics of the Catholic
Church, Valentine a Monk, Steno a Bishop, and Kircher a Jesuit,
would seem to be one common bond and perhaps a reason for the
binding of these rather disparate treatises together. In that case
it is probable that the book came from an old monastic library
dispersed after the suppression of the order by some government.
It seems not unlikely that the volume belonged at some time to an
old Jesuit library, for they have suffered the most in that way.
That these three classics of medicine should have been republished
in handy volume editions within practically ten years shows an
interest in medical literature that has not existed again until our
own time, for during the eighteenth and early nineteenth centuries
there was almost utter neglect of them.

368 OLD-TIME MAKERS OF MEDICINE

any of this. The paragraph is left in the quaint,
old-fashioned form so eminently suited to the
thoughts of the old master, and the spelling and
use of capitals is not changed.

" Basil Valentine: His Triumphant Chariot of
Antimony. — Since I, Basil Valentine, by Religious
Vows am bound to live according to the order of St.
Benedict and that requires another manner of Spirit
of Holiness than the common state of Mortals exer-
cised in the profane business of this World; I
thought it my duty before all things, in the beginning
of this little book, to declare what is necessary to be
known by the pious Spagyrist [old-time name for
medical chemist], inflamed with an ardent desire of
this Art, as wThat he ought to do, and whereunto to
direct his striving, that he may lay such foundations
of the whole matter as may be stable; lest his Build-
ing, shaken with the Winds, happen to fall, and the
whole Edifice to be involved in shameful Ruine
which otherwise being founded on more firm and
solid principles, might have continued for a long
series of time. Which Admonition I judged was,
is and always will be a necessary part of my re-
ligious Office; especially since we must all die, and
no one of us which are now, whether high or low,
shall long be seen among the number of men. For
it concerns me to recommend these Meditations of
Mortality to Posterity, leaving them behind me, not
only that honor may be given to the Divine Majesty,
but also that men may obey him sincerely in all
things.

" In this my meditation I found that there were
five principal heads, chiefly to be considered by the
wise and prudent spectators of our Wisdom and
Art. The first of which is Invocation of God. The
second, Contemplation of Nature. The third, True
Preparation. The fourth, the Way of Using. The

BASIL VALENTINE 369

fifth, Utility and Fruit. For lie who regards not
these, shall never obtain place among true Chymists,
or fill up the number of perfect Spagyrists. There-
fore, touching these five heads, we shall here follow-
ing treat and so far declare them, as that the general
Work may be brought to light and perfected by an
intent and studious Operator."

This book, though the title might seem to indicate
it, is not devoted entirely to the study of antimony,
but contains many important additions to the chem-
istry of the time. For instance, Basil Valentine ex-
plains in this work how what he calls the spirit of
salt might be obtained. He succeeded in manufac-
turing this material by treating common salt with
oil of vitriol and heat. From the description of
the uses to which he put the end product of his
chemical manipulation, it is evident that under the
name of spirit of salt he is describing what we now
know as hydrochloric acid. This is said to be the
first definite mention of it in the history of science,
and the method suggested for its preparation is not
very different from that employed even at the pres-
ent time. He also suggests in his volume how alco-
hol may be obtained in high strengths. He distilled
the spirit obtained from wine over carbonate of
potassium, and thus succeeded in depriving it of a
great proportion of its water. We have said that
he was deeply interested in the philosopher's stone.
Naturally this turned his attention to the study of
metals, and so it is not surprising to find that he
succeeded in formulating a method by which metallic
copper could be obtained. The material used for the
purpose was copper pyrites, which was changed to

370 OLD-TIME MAKERS OF MEDICINE

an impure sulphate of copper by the action of oil
of vitriol and moist air. The sulphate of copper
occurred in solution, and the copper could be pre-
cipitated from it by plunging an iron bar into it.
Basil Valentine recognized the presence of this
peculiar yellow metal, and studied some of its quali-
ties. He does not seem to have been quite sure,
however, whether the phenomenon that he witnessed
was not really a transmutation of at least some of
the iron into copper as a consequence of the other
chemicals present. There are some observations on
chemical physiology, and especially with regard to
respiration, in the book on antimony which show
their author to have anticipated the true explanation
of the theory of respiration. He states that animals
breathe because air is needed to support their life,
and that all the animals exhibit the phenomenon of
respiration. He even insists that the fishes, though
living in water, breathe air, and he adduces in sup-
port of this idea the fact that whenever a river is
entirely frozen the fishes die. The reason for this
being, according to this old-time physiological chem-
ist, not that the fishes are frozen to death, but that
they are not able to obtain air in the ice as they
did in the water, and consequently perish.

There are many testimonials to the practical char-
acter of all his knowledge and his desire to apply
it for the benefit of humanity. The old monk could
not repress the expression of his impatience with
physicians who gave to patients for " diseases of
which they knew little, remedies of which they knew
less." For him it was an unpardonable sin for a
physician not to have faithfully studied the various

BASIL VALENTINE 371

mixtures that he prescribed for his patients, and not
to know not only their appearance and taste and
effect, but also the limits of their application. Con-
sidering that at the present time it is a frequent
source of complaint that physicians often prescribe
remedies with even whose physical appearance they
are not familiar and whose composition is often quite
unknown to them, this complaint of the old-time
chemist alchemist will be all the more interesting
for the modern physician. It is evident that when
Basil Valentine allows his ire to get the better of
him it is because of his indignation over the quacks
who were abusing medicine and patients in his time,
as they have ever since. There is a curious bit of
aspersion on mere book learning in the passage that
has a distinctly modern ring, and one feels the truth
of Russell Lowell's expression that to read a classic,
no matter how antique, is like reading a commentary
on the morning paper, so up-to-date does genius ever
remain :

" And whensoever I shall have occasion to contend
in the School with such a Doctor, who knows not
how himself to prepare his own medicines, but com-
mits that business to another, I am sure I shall ob-
tain the Palm from him ; For indeed that good man
knows not what medicines he prescribes to the sick ;
whether the color of them be white, black, gray, or
blew (sic), he cannot tell; nor doth this wretched
man know whether the medicine he gives be dry or
hot, cold or humid ; but he only knows that he found
it so written in his books, and then pretends to
knowledge or as it were Possession by Prescription
of a very long time; yet he desires to further in-
formation. Here again let it be lawful to exclaim,
Good God, to what a state is the matter brought!

372 OLD-TIME MAKERS OF MEDICINE

what Goodness of Minde is in these men ! what care
do they take of the sick! Wo, wo to them! in the
day of Judgement they will find the fruit of their
Ignorance and Rashness, then they will see him
whom they pierced, when they neglected their Neigh-
bor, sought after money and nothing else; whereas
were they cordial in their profession, they would
spend Nights and Days in Labour that they might
become more learned in their Art, whence more cer-
tain health would accrew to the sick with their esti-
mation and greater glory to themselves. But since
Labour is tedious to them they commit the matter
to chance, and being secure of their Honour, and
content with their Fame, they (like Brawlers) de-
fend themselves with a certain garrulity, without
any respect had to Confidence or Truth."

Perhaps one of the reasons why Valentine's book
has been of such enduring interest is that it is
written in an eminently human vein and out of a
lively imagination. It is full of figures relating to
many other things besides chemistry, which serve to
show how deeply this investigating observer was
attentive to all the problems of life around him.
For instance, when he wants to describe the affinity
that exists between many substances in chemistry,
and which makes it impossible for them not to be
attracted to one another, he takes a figure from the
attractions that he sees exist among men and women.
It is curious to find affinities discussed in our modern
sense so long ago. There are some paragraphs with
regard to the influence of the passion of love that
one might think rather a quotation from an old-time
sermon than from a great ground-breaking book in
the science of chemistry.

BASIL VALENTINE 373

" Love leaves nothing entire or sound in man; it
impedes his sleep, he cannot rest either day or night ;
it takes off his appetite that he hath no disposition
either to meat or drink by reason of the continual
torments of his heart and mind. It deprives him of
all Providence, hence he neglects his aff,airs, voca-
tion, and business. He minds neither study, labor,
nor prayer ; casts away all thoughts of anything but
the body beloved; this is his study, this his most
vain occupation. If to lovers the success be not an-
swerable to their wish, or so soon and prosperously
as they desire, how many melancholies henceforth
arise, with griefs and sadness, with which they pine
away and wax so lean as they have scarcely any flesh
cleaving to the bones. Yea, at last they lose the life
itself, as may be proved by many examples ! for such
men (which is an horrible thing to think of) slight
and neglect all perils and detriments, both of the
body and life, and of the soul and eternal salvation."

It is evident that human nature is not different
in our sophisticated twentieth century from that
which this observant old monk saw around him in
the fifteenth. He continues :

' ' How many testimonies of this violence which is
in love, are daily found? for it not only inflames the
younger sort, but it so far exaggerates some persons
far gone in years as through the burning heat
thereof, they are almost mad. Natural diseases are
for the most part governed by the complexion of
man and therefore invade some more fiercely, others
more gently; but Love, without distinction of j»oor
or rich, young or old, seizeth all, and having seized
so blinds them as forgetting all rules of reason, they
neither see nor hear any snare."

But then the old monk thinks that he has said
enough about this rather foreign subject, and apolo-

374 OLD-TIME MAKERS OF MEDICINE

gizes for his digression in another paragraph that
should remove any lingering doubt there might be
with regard to the genuineness of his monastic char-
acter. At the end of the passage he makes the
application in a very few words. The personal ele-
ment in his confession is so naive and so simply
straightforward that instead of seeming to be the
result of conceit, which would surely have repelled
the reader, it rather attracts and enhances his kindly
feeling for its author. The paragraph would remind
one in certain ways of that personal element that
was to become more popular in literature after
Montaigne in the next century made it rather the
fashion.

" But of these enough; for it becomes not a re-
ligious man to insist too long upon these cogitations,
or to give place to such a flame in his heart. Hith-
erto (without boasting I speak it) I have throughout
the whole course of my life kept myself safe and free
from it, and I pray and invoke God to vouchsafe
me his Grace that I may keep holy and inviolate the
faith which I have sworn, and live contented with
my spiritual spouse, the Holy Catholick Church.
For no other reason have I alleged these than that
I might express the love with which all tinctures
ought to be moved towards metals, if ever they be
admitted by them into true friendship, and by love,
which permeates the inmost parts, be converted into
a better state."

The application of the figure at the end of his
long digression is characteristic of the period in
which he wrote, as also to a considerable extent
of the German literary methods of the time.

In this volume on the use of antimony there are

BASIL VALENTINE 375

in most of the editions certain biographical notes
which have sometimes been accepted as authentic,
but oftener rejected. According to these, Basil Val-
entine was born in a town in Alsace, on the southern
bank of the Rhine. As a consequence of this, there
are several towns that have laid claim to being his
birthplace. M. Jean Reynaud, the distinguished
French philosophical writer of the first half of the
nineteenth century, once said that Basil Valentine,
like Ossian and Homer, had many towns claim him
years after his death. He also suggested that, like
those old poets, it was possible that the writings
sometimes attributed to Basil Valentine were really
the work not of one man, but of several individuals.
There are, however, many objections to this theory,
the most forcible of which is the internal evidence
derived from the books themselves showing similari-
ties of style and method of treating subjects too great
for us to admit non-identity in the writers. M.
Reynaud lived at a time when it was all the fashion
to suggest that old works that had come down to
us, like the Iliad and the Odyssey, and even such
national epics as the Cid and the Arthur Legends
and the Nibelungenlied were to be attributed to
several writers rather than to one. We have passed
that period of criticism, however, and have reverted
to the idea of single authorship for these works, and
the same conclusion has been generally come to with
regard to the writings attributed to Basil Valentine.
Other biographic details contained in " The Tri-
umphal Chariot of Antimony " are undoubtedly
more correct. According to them Basil Valentine
travelled in England and Holland on missions for his

376 OLD-TIME MAKERS OF MEDICINE

order, and went through France and Spain on a
pilgrimage to St. James of Compostella.

Besides this work, there is a number of other
books of Basil Valentine's, printed during the first
half of the sixteenth century, that are well known
and copies of which may be found in most of the
important libraries. The United States Surgeon
General 's Library at Washington contains not a few
of the works on medical subjects, and the New York
Academy of Medicine Library has some valuable
editions of certain of his works. Some of his other
well-known books, each of which is a good-sized
octavo volume, bear the following descriptive titles
(I give them in English, though as they are usually
found, they are in Latin, sixteenth-century transla-
tions of the original German) : " The World in Mini-
ature : or, The Mystery of the World and of Human
Medical Science," published at Mayburg, 1609;
" The Chemical Apocalypse: or, The Manifestation
of Artificial Chemical Compounds," published in
Erfurt in 1624; " A Chemico-Philosophic Treatise
Concerning Things Natural and Preternatural, Es-
pecially Relating to the Metals and the Minerals,"
published at Frankfurt in 1676 ; * ' Haliography : or,
The Science of Salts : A Treatise on the Preparation,
Use, and Chemical Properties of All the Mineral,
Animal, and Vegetable Salts," published at Bologna
in 1644; " The Twelve Keys of Philosophy," Leipsic,
1630. These are of interest to the chemist and
physicist rather than to the physician, and it is as
a Maker of Medicine that we are concerned with
Valentine here.

The great attention aroused in Basil Valentine's

BASIL VALENTINE 377

work at the Renaissance period can be best realized
from the number of manuscript copies and their
wide distribution. His books were not all printed
at one place, but, on the contrary, in different por-
tions of Europe. The original edition of " The
Triumphal Chariot of Antimony " was published in
Leipsic in the early part of the sixteenth century.
The first editions of the other books, however, ap-
peared at places so distant from Leipsic as Am-
sterdam and Bologna, while various cities of Ger-
many, as Erfurt and Frankfurt, claim the original
editions of still other works. Many of the manu-
script copies still exist in various libraries in Eu-
rope; and while there is no doubt that some unim-
portant additions to the supposed works of Basil
Valentine have come from the attribution to him of
scientific treatises of other German writers, the style
and the method of the principal works mentioned is
entirely too similar not to have been the fruit of
a single mind and that possessed of a distinct in-
vestigating genius, setting it far above any of its
contemporaries in scientific speculation and observa-
tion.

The most interesting feature of all of Basil Valen-
tine's writings that are extant is the distinctive ten-
dency to make his observations of special practical
utility. His studies in antimony were made mainly
with the idea of showing how that substance might
be used in medicine. He did not neglect to point
out other possible uses, however, and knew the secret
of the employment of antimony in order to give
sharpness and definition to the impression produced
by metal types. It would seem as though he was

378 OLD-TIME MAKERS OF MEDICINE

the first scientist who discussed this subject, and
there is even some question of whether printers and
typefounders did not derive their ideas in this mat-
ter from our chemist.

Interested though he was in the transmutation of
metals, he never failed to try to find and suggest
some medicinal use for all of the substances that
he investigated. His was no greedy search for gold
and no cumulation of investigations with the idea
of benefiting only himself. Mankind was always in
his mind, and perhaps there is no better demonstra-
tion of his fulfilment of the character of the monk
than this constant solicitude to benefit others by
every bit of investigation that he carried out. For
him, with medieval nobleness of spirit, " the first
part of every work must be the invocation of God,
and the last, though no less important than the
first, must be the utility and fruit for mankind that
can be derived from it."

The career of the last of the Makers of Medicine
in the Middle Ages may be summed up briefly in
a few sentences that show how thoroughly this old
Benedictine was possessed of the spirit of modern
science. He believed in observation as the most
important source of medical knowledge. He valued
clinical experience far above book information. He
insisted on personal acquaintanceship on the part
of the physician with the drugs he used, and thought
nothing more unworthy of a practitioner of medicine,
—indeed he sets it down as almost criminal — than
to give remedies of whose composition he was not
well aware and whose effect he did not thoroughly
understand. He thought that nature was the most

BASIL VALENTINE 379

important aid to the physician, much more impor-
tant than drugs, though he was the first to realize
the significance of chemical affinities, and he seems
to have understood rather well how individual often
were the effects obtained from drugs. He was a
patient student, a faithful observer, a writer who
did not begrudge time and care to the composition
of large books on medicine, yet withal he was no
dry-as-dust scholar, but eminently human in his
sympathies with ailing humanity, and a strenuous
upholder of the dignity of the profession to which
he belonged. Scarcely more can be said of anyone
in the history of medicine, at least so far as good
intentions go ; though many accomplished more, none
deserve more honor than the Thuringian monk whom
we know as Basil Valentine.

There are many other of these old-time Makers of
Medicine of whom nearly the same thing can be said.
Basil Valentine is only one of a number of men
who worked faithfully and did much both for med-
ical science and professional life during the thou-
sand years from the fall of Rome to the fall of
Constantinople, when, according to what used to be
commonly accepted opinion, men were not animated
by the spirit of research and of fine incentive to
do good to men that we are so likely to think of
as belonging exclusively to more modern times. A
man whom he greatly influenced, Paracelsus, took
up the tradition of scientific investigation where
Basil Valentine had left it. His work, though more
successfully revolutionary, was not done in such a
fine spirit of sympathy with humanity nor with that
simplicity of life and purity of intention that char-

380 OLD-TIME MAKERS OF MEDICINE

acterized the old monk's work. Paracelsus' birth in
the year of the discovery of America places him
among the makers of the foundations of our modern
medicine, and he will be treated of in a volume on
" The Forefathers in Medicine."

APPENDIX I
ST. LUKE THE PHYSICIAN »

In the midst of what has been called the " higher
criticism " of the Bible in recent times, one of the
long accepted traditions that has been most strenu-
ously assailed and, indeed, in the minds of many
scholars, seemed, for a time at least, quite discred-
ited, was that St. Luke the Evangelist, the author
of the Third Gospel and the Acts of the Apostles,
was a physician. Distinguished authorities in early
Christian apologetics have declared that the pillars
of primitive Christian history are the genuine
Epistles of St. Paul, the writings of St. Luke, and
the history of Eusebius. It is quite easy to under-
stand, then, that the attack upon the authenticity of
the writings usually assigned to St. Luke, which in
many minds seemed successful, has been considered
of great importance. In the very recent time there
has been a decided reaction in this matter. This
has come, not so much from Roman Catholics, who
have always clung to the traditional view, and whose
great Biblical students have been foremost in the
support of the previously accepted opinion, but from
some of the most strenuous of the German higher
critics, who now appreciate that destructive, so-
called higher criticism went too far, and that the
traditional view not only can be maintained, but is
the only opinion that will adequately respond to all
the new facts that have been found, and all the re-
cently gathered information with regard to the re-
lations of events in the olden time.

1 Paper read before the first meeting of the American Guild of St.
Luke.

381

382 OLD-TIME MAKERS OF MEDICINE

By far the most important contribution to the dis-
cussion in recent years came not long since from the
pen of Professor Adolph Harnack, the professor of
church history in the University of Berlin. Pro-
fessor Harnack 's name is usually cited as that of
one of the most destructive of the higher critics.
His recent book, however, ''Luke the Physician,"1 is
an entire submission to the old-fashioned viewpoint
that the writer of the Third Gospel and of the Acts
of the Apostles was a Greek fellow-worker of St.
Paul, who had been in company for years with
Mark and Philip and James, and who had previ-
ously been a physician, and was evidently well
versed in all the medical lore of that time. Har-
nack does not merely concede the old position. As
might be expected, his rediscussion of the subject
clinches the arguments for the traditional view, and
makes it impossible ever to call it in question again.
It is easy to understand how important are such ad-
missions when we recall how much this traditional
view has been assailed, and how those who have held
it have been accused of old-fogyism and lack of
scholarship, and unwarranted clinging to antiquated
notions just because they thought they were of faith,
and how, lacking in true scholarship, seriously ham-
pering genuine investigation, such conservatism has
been declared to be.

The question of Luke's having been a physician is
an extremely valuable one, and no one in our time is
better fitted by early training and long years of
study to elucidate it than Professor Harnack. He be-
gan his excursions into historical writing years ago,
as I understand, as an historian of early Christian
medicine. Some of his works on medical conditions
just before and after Christ are quoted confidently
by the distinguished German medical historians.
From this department he graduated into the field

1 Published by Putnams, New York, 1909.

APPENDIX 383

of the higher criticism. He is eminently in a posi-
tion, therefore, to state the case with regard to St.
Luke fully, and to indicate absolutely the conclu-
sions that should be drawn from the premises of
fact, writings, and traditions that we have. He does
so in a very striking way. Perhaps no better ex-
ample of his thoroughly lucid and eminently logical
mode of argumentation is to be found than the para-
graph in which he states the question. It might well
be recommended as an example of terse forcefulness
and logical sequence that deserves the emulation of
all those who want to write on medical subjects. If
we had more of these characteristic qualities of Har-
nack's style, our medical literature, so called, would
not need to occupy so many pages of print as it
does — yet would say more. Here it is :

St. Luke, according to St. Paul, was a physician. When a physician
writes a historical work it does not necessarily follow that his profession
shows itself in his writing; yet it is only natural for one to look for traces
of the author's medical profession in such a work. These traces may be
of different kinds: 1, The whole character of the narrative may be deter-
mined by points of view, aims, and ideals which are more or less medical
(disease and its treatment); 2, marked preference may be shown for
stories concerning the healing of diseases, which stories may be given in
great number and detail; 3, the language may be colored by the lan-
guage of physicians (medical technical terms, metaphors of medical char-
acter, etc.). All these three groups of characteristic signs are found, as
we shall see, in the historical work which bears the name of St. Luke.
Here, however, it may be objected that the subject matter itself is
responsible for these traits, so that their evidence is not decisive for the
medical calling of the author. Jesus appeared as a great physician and
healer. All the evangelists say this of Him; hence it is not surprising
that one of them has set this phase of His ministry in the foreground, and
has regarded it as the most important. Our evangelist need not there-
fore have been a physician, especially if he were a Greek, seeing that in
those days Greeks with religious interests were disposed to regard
religion mainly under the category of healing and salvation. This is
true, yet such a combination of characteristic signs will compel us to
believe that the author was a physician if, 4, the description of the par-
ticular cases of disease shows distinct traces of medical diagnosis and
scientific knowledge; 5, if the language, even where questions of medi-
cine or of healing^are not touched upon, is colored by medical phrase-
ology; and, 6, if in those passages where the author speaks as an eye-
witness medical traits are especially and prominently apparent. These
three kinds of tokens are also found in the historical work of our
author. It is accordingly proved that it proceeds from the pen of a
physician.

384 OLD-TIME MAKERS OF MEDICINE

The importance of the concession that Luke was a
physician should be properly appreciated. His
whole gospel is written from that standpoint. For
him the Saviour was the healer, the good physician
who went about curing the ills of the body, while
ministering to people's souls. He has more ac-
counts of miracles of healing than any of the other
Evangelists. He has taken certain of the stories
of the other Evangelists who were eye-witnesses,
and when they were told in naive and popular lan-
guage that obscured the real condition that was
present, he has retold the story from the physician's
standpoint, and thus the miracle becomes clearer
than ever. In one case, where Mark has a slur on
physicians, Luke eliminates it. In a number of
cases the correction of Mark's popular language in
the description of ailments is made in terms that
could not have been used except by one thoroughly
versed in the Greek medical terminology of the
times. As a matter of fact, there seems to be no
doubt now that Luke had been, before he became an
Evangelist, a practising physician in Malta of con-
siderable experience. His testimony, then, to the
miracles is particularly valuable as almost a medical
eye-witness.

In medical science, St. Luke's time was by no
means barren of knowledge. The Alexandrian
school of medicine had done some fine work in its
time. It was the first university medical school in
the world's history, and there dissection was first
practised regularly and publicly for the sake of
anatomy, and even the vivisection of criminals who
were supplied by the Ptolemei for human physi-
ology, was a part of the school curriculum. A num-
ber of important discoveries in brain anatomy are
attributed to Herophilus, after whom the torcular
herophili within the skull is named, and who in-
vented the term calamus scriptorius for certain ap-

APPENDIX 385

pearances in the fourth ventricle. His colleague,
Erasistratus, the co-founder of this school at Alex-
andria, did work in pathological anatomy, and laid
the foundation for serious study there. For three
centuries there is some good worker, at or in con-
nection with Alexandria, whose name is preserved
for us in the history of medicine. Other Greek
schools of medicine in the East, as, for instance, that
of Pergamos, also did excellent work. Galen is the
great representative of this school, and he came in
the century after St. Luke. A physician educated
in Greek medicine at that time, then, would be in
an excellent position to judge critically of the
miracles of healing of the Christ, and it would seem
to have been providential that Luke was called for
this purpose.

The evidence for his membership of our pro-
fession will doubtless be interesting to all physi-
cians. Some of the distinctive passages in which
Luke's familiarity with medical terms to such an
extent that to express his meaning he found him-
self compelled to use them, will appeal at once to
these, for whom such terms are part of everyday
speech. The use of the word hydropikos, which is
not to be met with anywhere else in the New Testa-
ment, nor in the non-medical Greek literature of that
time, though the word is of frequent occurrence as a
designation for a person suffering from dropsy (and
always, as in Luke, the adjective for the substan-
tive), in Hippocrates, Dioscorides, and Galen is a
typical example.

Where such vague terms as paralyzed occur
Luke does not use the familiar word, but the med-
ical term that meant stricken with paralysis, in-
dicating not any inability to use the limbs, but such
a one as was due to a stroke of apoplexy. We who,
as physicians, have heard of so many cures of
paralysis from our friends, the Eddyites, are prone

386 OLD-TIME MAKERS OF MEDICINE

to ask, as the first question, what sort of a paralysis
it was. Luke made inquiries from men who were
eye-witnesses, and then has described the scene with
such details as convinced him as a physician of the
reality of the miracle, and his description was meant
to carry conviction to the minds of others.

Occasionally St. Luke uses words which only a
physician would be likely to know at all. That is
to say, even a man reasonably familiar with medical
terminology and medical literature would not be
likely to know them unless he had been technically
trained. One of these is the word sphndron, a word
which is only medical, and is not to be found even
in such large Greek lexicons of ordinary words as
that of Passow. Sphudron is the anatomical term
of the Graeco-Alexandrian school for the condyles
of the femur. Galen and other medical authors use
it, and Luke, in giving the details of the story of
the lame man cured, in the third chapter of the Acts,
seventh verse, selects it because it exactly expresses
the meaning he wished to convey. In this story
there are a number of added medical details. These
are all evidently arranged so as to give the full
medical significance to the miracle. For instance,
the man had been lame from birth, literally from
the womb of his mother. At this time he was forty
years of age, an age at which the spontaneous cure
of such an ailment or, indeed, any cure of it, could
scarcely be expected, if, during the preceding time,
there had been no improvement.

In the story of the cure of Saul's blindness Luke
says in the Acts that his blindness fell from him
like scales. The figure is a typically medical one.
The word for fall that is used is, as was pointed out
by Hobart (" Medical Language of St. Luke," Dub-
lin, 1882), exactly the term that is used for the fall-
ing of scales from the body. The term for scales is
the specific designation of the particles that fall

APPENDIX 387

from the body during certain skin diseases or after
certain of the infectious fevers, as in scarlet fever.
Hippocrates and Galen have used it in many places.
It is distinctively a medical word. In the story
of the vision of St. Peter, told also in the Acts, the
word ecsta-sis, from which we derive our word ec-
stasy, is used. This is the only word St. Luke uses
for vision and he alone uses it. This term is of
constant employment in a technical sense in the
medical writers of St. Luke's time and before it.
When the other evangelists talk of lame people they
use the popular term. This might mean anything
or nothing for a physician. Luke uses one of the
terms that is employed by physicians when they wish
to indicate that for some definite reason there is
inability to walk.

In the story of the Good Samaritan there are
some interesting details that indicate medical inter-
est on the part of the writer. It is Luke's character-
istic story and a typical medical instance. He em-
ploys certain words in it that are used only by
medical writers. The use of oil and wine in the
treatment of the wounds of the stranger traveller
was at one time said to indicate that it could not
have been a physician who wrote the story, since the
ancients used oil for external applications in such
cases but not wine. More careful search of the old
masters of medicine, however, has shown that they
used oil and wine not only internally but externally.
Hippocrates, for instance, has a number of recom-
mendations of this combination for wounds. It is
rather interesting to realize this, and especially the
wine in addition to the oil, because wine contains
enough alcohol to be rather satisfactorily antiseptic.
There seems no doubt that wounds that had been
bathed in wine and then had oil poured over them
would be likely to do better than those which were
treated in other ways. The wine would cleanse and

388 OLD-TIME MAKERS OF MEDICINE

at least inhibit bacterial growth. The subsequent
covering with oil would serve to protect the wound
to some degree from external contamination.

Sometimes there is an application of medical
terms to something extraneous from medicine that
makes the phrase employed quite amusing. For in-
stance, when Luke wants to explain how they
strengthened the vessel in which they were to sail he
describes the process by the term which was used in
medical Greek to mean the splinting of a part or at
least the binding of it up in such a way as to enable
it to be used. The word was quite a puzzle to the
commentators until it was pointed out that it was
the familiar medical term, and then it was easy to
understand. Occasionally this use of a medical
term gives a strikingly accurate significance to
Luke's diction. For instance, where other evangel-
ists talk of the Lord looking at a patient or turning
to them, Luke uses the expression that was techni-
cally employed for a physician's examination of his
patient, as if the Lord carefully looked over the ail-
ing people to see their physical needs, and then pro-
ceeded to cure them. Manifestly in Luke's mind the
most interesting phase of the Lord's life was His
exhibition of curative powers, and the Saviour was
for him the divine healer, the God physician of bodies
as well as of souls.

There are many little incidents which he relates
that emphasize this. For instance, where St. Mark
talks about the healing of the man with a
withered hand, St. Luke adds the characteristic
medical note that it was the right hand. When he
tells of the cutting off of the ear of the servant of
the high priest in the Garden of Olives St. Luke takes
the story from St. Mark, but adds the information
that would appeal to a physician th#t it was the
right ear. Moreover, though all four evangelists
record the cutting off of the ear, only St. Luke adds

APPENDIX 389

the information that the Lord healed it again. It
is as if he were defending the kindly feelings of the
Divine Physician and as if it would have been in-
excusable had He not exerted His miraculous powers
of healing on this occasion. It is St. Luke, too, who
has constantly distinguished between natural ill-
nesses and cases of possession. This careful dis-
tinction alone would point to the author of the third
gospel and the Acts as surely a physician. As it is
it confirms beyond all doubt the claim that the
writer of these portions of the New Testament was
a physician thoroughly familiar with all the medical
writings of the time and probably a physician who
had practised for a long time.

Certain miracles of healing are related only by
St. Luke as if he realized better than any of the
other evangelists the evidential value that such in-
stances would have for future generations as to the
divinity of the personage who worked them. The
beautiful story of the raising from death of the son
of the widow of Nain is probably one of the oftenest
quoted passages from St. Luke. It is a charming
bit of literature. While it suggests the writer physi-
cian it makes one almost sure that the other tradition
according to which St. Luke was also a painter must
be true. The scene is as picturesque as it can be.
The Lord and His Apostles and the multitudes com-
ing to the gate of the little city just as in the evening
sun the funeral cortege with the widow burying her
only son came out of it. The approach of the Lord
to the weeping mother, His command to the dead son
to arise, and the simple words, " and he gave him
back to his mother," constitute as charming a scene
as a painter ever tried to visualize. Besides this,
Luke alone has the story of the man suffering with
dropsy and the woman suffering from weakness.
The intensely picturesque quality of many of these
scenes that he describes so vividly would indeed seem

390 OLD-TIME MAKERS OF MEDICINE

to place beyond all doubt the old tradition that he
was an artist as well as a physician.

It is interesting to realize that it is to Luke alone
that we owe the account of the well-known message
sent by Christ Himself to John the Baptist when
John sent his disciples to inquire as to His mission.
After describing His ministry He said: " Go and
relate to John what you have heard and seen: the
blind see, the lame walk, the deaf hear, the lepers
are made clean, the dead rise again, to the poor
the Gospel is preached.'* To no one more than to
a physician would that description of His mission
appeal as surely divine.

To those who care to follow the subject still
further, and above all, to read opinions given before
the reversal of the verdict of the higher criticism
on the Lucan writings, indeed before ever that trial
was brought, there is much in " Horae Lucanas — A
Biography of St. Luke," by Henry Samuel Baynes
(Longmans, 1870), that will surely be of interest.
He has some interesting quotations which show how
thoroughly previous centuries realized all the force
of modern arguments. For instance, the following
paragraph from Dr. Nathaniel Robinson, a Scotch
physician of the eighteenth century, will illustrate
this. Dr. Robinson said:

It is manifest from his Gospel, that Luke was both an acute ob-
server, and had even given professional attention to all our Saviour's
miracles of healing. Originally, among the Egyptians, divinity and
physic were united in the same order of men, so that the priest had the
care of souls, and was also the physician. It was much the same under
the Jewish economy. But after physic came to be studied by the
Greeks, they separated the two professions. That a physician should
write the history of our Saviour's life was appropriate, as there were
divers mysterious things to be noticed, concerning which his education
enabled him to form a becoming judgment.

It is even interesting to realize that St. Luke's
tendency to use medical terms has been of definite
value in determining the question whether both the

APPENDIX 391

third gospel and the Acts of the Apostles are by the
same man. They have been attributed to St. Luke
traditionally, but in the higher criticism some doubt
has been thrown on this and an elaborate hypothe-
sis of dual authorship set up. It has been asserted
that it is very improbable on extrinsic grounds that
they were both written by one hand and certain in-
trinsic evidence, changes in the mode of narration,
especially the use of the first personal pronoun in
the plural in certain passages, has been pointed to
as making against single authorship. This tendency
to deny old-time traditions of authorship with re-
gard to many classical writings was a marked char-
acteristic of the early part of the nineteenth century,
but the close of the century saw practically all of
these denials discredited. The nineteenth century
ushered in studies of Homer, with the separatist
school perfectly confident in their assertion that the
Iliad and the Odyssey were not by the same person,
and even that the Iliad itself was the work of several
hands.

At the beginning of the twentieth century we are
quite as sure that both the Iliad and Odyssey were
written by the same person and that the separatists
were hurried into a contrary decision not a little by
the feeling of the sensation that such a contradiction
of previously accepted ideas would create. This is
a determining factor in many a supposed novel dis-
covery, that it is hard always to discount sufficiently.
A thing may be right even though it is old, and most
new discoveries, it must not be forgotten, that is,
most of those announced with a great blare of trum-
pets, do not maintain themselves. The simple argu-
ment that the separatists wrould have to find another
poet equal to Homer to write the other poem has
done more than anything else to bring their opinion
into disrepute. It is much easier to explain certain
discrepancies, differences of style, and of treatment

392 OLD-TIME MAKERS OF MEDICINE

of subjects, as well as other minor variants, than to
supply another great poet. Most of the works of
our older literatures have gone through a similar
trial during the over-hasty superficially critical nine-
teenth century. The Nibelungenlied has been at-
tributed to two or three writers instead of one. The
Cid, the national epic of Spain, and the Arthur
Legends, the first British epic, have been at least
supposed to be amenable to the same sort of criti-
cism. In every case, scholars have gone back to
the older traditional view of a single author. The
phases of literary and historic criticism with regard
to Luke's writings are, then, only a repetition of
what all our great national classics have gone
through from supercilious scholarship during the
past hundred years.

It is not surprising, then, that there should be dual
or even triple ascriptions of authorship for various
portions of the Scriptures, and Luke's writings have
on this score suffered as much or more even than
others, with the possible exception of Moses. It is
now definitely settled, however, that the similarities
of style between the Acts and the third gospel are
too great for them to have come from two different
minds. This is especially true, as pointed out by
Harnack, in all that regards the use of medical terms.
The writer of the Acts and the writer of the third
gospel knew Greek from the standpoint of the phy-
sician of that time. Each used terms that we find
nowhere else in Greek literature except among med-
ical writers. What is thus true for one critical at-
tack on Luke's reputation is also true in another
phase of recent higher criticism. It has been said
that certain portions of the Acts which are called
the " we " portions because the narration changes
in them from the third to the first person were to
be attributed to another writer than the one who
wrote the narrative portions. Here, once more, the

APPENDIX 393

test of the medical words employed has decided the
case for Luke's sole authorship. It is evidently an
excellent thing to be able to use medical terms prop-
erly if one wants to be recognized with certainty
later on in history for just what one's business was.
It has certainly saved the situation for St. Luke,
though there may be some doubt as to the real force
of objections thus easily overthrown.

It is rather interesting to realize that many schol-
ars of the present generation had allowed themselves
to be led away by the German higher criticism from
the old tradition with regard to Luke as a physician
and now will doubtless be led back to former views
by the leader of German biblical critics. It shows
how much more distant things may influence certain
people than those nearer home — how the hills are
green far away. Harnack confesses that the best
book ever written on the subject of Luke as a phy-
sician, the one that has proved of most value to
him, and that he still recommends everyone to read,
was originally written in English. It is Hobart's
11 Medical Language of St. Luke,"1 written more
than a quarter of a century before Harnack. The
Germans generally had rather despised what the
English were doing in the matter of biblical criti-
cism, and above all in philology. Yet now the ac-
knowledged coryphaeus of them all, Harnack, not only
admits the superiority of an old-time English book,
but confesses that it is the best statement of the sub-
ject up to the present time, including his own. He
constantly quotes from it, and it is evident that it
has been the foundation of all of his arguments. It
is not the first time that men have fetched from
afar what they might have got just as well or better
at home.

Harnack has made complete the demonstration,

, 1882.

394 OLD-TIME MAKERS OF MEDICINE

then, that the third gospel and the Acts were writ-
ten by St. Luke, who had been a practising phy-
sician. In spite of this, however, he finds many ob-
jections to the Luke narratives and considers that
they add very little that is valuable to the contem-
porary evidence that we have with regard to Christ.
He impairs with one hand the value of what he has
so lavishly yielded with the other. He finds incon-
sistencies and discrepancies in the narrative that for
him destroy their value as testimony. A lawyer
would probably say that this is that very human ele-
ment in the writings which demonstrates their au-
thenticity and adds to their value as evidence, be-
cause it shows clearly the lack of any attempt to do
anything more than tell a direct story as it had
come to the narrator. No special effort was made to
avoid critical objections founded on details. It was
the general impression that was looked for.

Sir William Ramsay, in his " Luke the Phy-
sician and Other Studies in the History of Re-
ligion " (New York: Armstrong and Sons, 1908),
has answered Harnack from the side of the profes-
sional critic with much force. He appreciates thor-
oughly the value of Professor Harnack 's book, and
above all the reactionary tendency away from ni-
hilistic so-called higher criticism which characterized
so much of German writing on biblical themes in
the nineteenth century. He says (p. 7): "This
[book of Harnack 's] alone carries Lukan criticism
a long step forwards, and sets it on a new and
higher plane. Never has the unity and character of
the book been demonstrated so convincingly and con-
clusively. The step is made and the plane is reached
by the method which is practised in other depart-
ments of literary criticism, viz., by dispassionate in-
vestigation of the work and by discarding fashion-
able a priori theories."

The distinguished English traveller and writer

APPENDIX 395

on biblical subjects points out, however, that
in detail many of Harnaek's objections to the
Lukan narratives are due to insufficient considera-
tion of the circumstances in which they were written
and the comparative significance of the details
criticised. He says, " Harnack lays much stress on
the fact that inconsistencies and inexactnesses occur
all through Acts. Some of these are undeniable;
and I have argued that they are to be regarded in
the same light as similar phenomena in the poem
of Lucretius and in other ancient classical writers,
viz., as proofs that the work never received the final
form which Luke intended to give it, but was still
incomplete when he died. The evident need for a
third book to complete the work, together with those
blemishes in expression, form the proof. "

Ramsay's placing of Harnack 's writing in general
is interesting in this connection. (P. 8) " Professor
Harnack stands on the border between the nineteenth
and twentieth century. His book shows that he is to
a certain degree sensitive of and obedient to the new
spirit; but he is only partially so. The nineteenth
century critical method was false, and is already
antiquated. . . .

' * The first century could find nothing real and true
that was not accompanied by the marvellous and the
' supernatural.' The nineteenth century could find
nothing real and true that was. Which view was
right and which was wrong? "Was either complete?
Of these two questions, the second alone is profitable
at the present. Both views were right — in a certain
way of contemplating; both views were wrong — in
a certain way. Neither was complete. At present,
as we are struggling to throw off the fetters which
impeded thought in the nineteenth century, it is
most important to free ourselves from its prejudices
and narrowness."

He adds (pp. 26 and 27) : " There are clear signs

396 OLD-TIME MAKERS OF MEDICINE

of the unfinished state in which this chapter was left
by Luke; but some of the German scholar's criti-
cisms show that he has not a right idea of the sim-
plicity of life and equipment that evidently char-
acterized the jailer's house and the prison. The
details which he blames as inexact and inconsistent
are sometimes most instructive about the circum-
stances of this provincial town and Roman colonia.

" But it is never safe to lay much stress on small
points of inexactness or inconsistency in any author.
One finds such faults even in the works of modern
scholarship if one examines them in the microscopic
fashion in which Luke is studied here. I think I can
find them in the author [Harnack] himself. His
point of view sometimes varies in a puzzling way."

As a matter of fact, Harnack, as pointed out by
Ramsay, was evidently working himself more and
more out of the old conclusion as to the lack of au-
thenticity of the Lucan writings into an opinion
ever more and more favorable to Luke. For instance,
in a notice of his own book, published in the The-
ologische Literaturzeitung , " he speaks far more
favorably about the trustworthiness and credibility
of Luke, as being generally in a position to acquire
and transmit reliable information, and as having
proved himself able to take advantage of his posi-
tion. Harnack was gradually working his way to
a new plane of thought. His later opinion is more
favorable. ' '

Ramsay also points out that Professor Giffert,
one of our American biblical critics, had felt com-
pelled by the geographical and historical evidence
to abandon in part the older unfavorable criticism
of Luke and to admit that the Acts is more trust-
worthy than previous critics allowed. Above all,
" he saw that it was a living piece of literature
written by one author." In a word, Luke is being
vindicated in every regard.

APPENDIX 397

Some of the supposed inaccuracies of Luke vanish
when careful investigation is made. Some of his
natural history details, for instance, have been im-
pugned and the story of the viper that * * fastened ' '
itself upon St. Paul in Malta has been cited as an
example of a story that would not have been told in
that way by a man who knew medicine and the re-
lated sciences in Luke's time. Because the passage
illustrates a number of phases of the discussion with
regard to Luke's language I make a rather long
quotation from Ramsay:

Take as a specimen with which to finish off this paper the passage
Acts xxviii, 9 et seq., which is very fully discussed by Harnack
twice. He argues that the true meaning of the passage was not
understood until medical language was compared, when it was shown
that the Greek word by which the act of the viper to Paul's hand is
described, implies " bit " and not merely " fastened upon." But it is
a well-assured fact that the viper, a poisonous snake, only strikes,
fixes the poison fangs on the flesh for a moment, and withdraws its
head instantly. Its action could never be what is attributed by
Luke the eye witness to this Maltese viper; that it hung from Paul's
hand and was shaken off into the fire by him. On the other hand,
constrictors, which have no poison fangs, cling in the way described,
but as a rule do not bite. Are we, then, to understand in spite
of the medical style and the authority of Professor Blass (who trans-
lates " momordit " in his edition), that the viper fastened upon the
apostle's hand? Then, the very name viper is a difficulty. Was
Luke mistaken about the kind of snake which he saw? A trained
medical man in ancient times was usually a good authority about
serpents, to which great respect was paid in ancient medicine and
custom.

Mere verbal study is here utterly at fault. We can make no
progress without turning to the realities and facts of Maltese natural
history. A correspondent obligingly informed me some years ago
that Mr. Bryan Hook, of Farnham, Surrey (who, my correspondent
assures me, is a thoroughly good naturalist), had found in Malta
a small snake, Coronella austriaca, which is rare in England, but
common in many parts of Europe. It is a constrictor, without
poison fangs, which would cling to the hand or arm as Luke de-
scribes. It is similar in size to the viper, and so like in markings
and general appearance that Mr. Hook, when he caught his specimen,
thought he was killing a viper.

My friend, Prof. J. W. H. Trail, of Aberdeen, whom I consulted,
replied that Coronella Icevis or austriaca, is known in Sicily and the
adjoining islands; but he can find no evidence of its existence in
Malta. It is known to be rather irritable, and to fix its small teeth
so firmly into the human skin as to need a little force to pull it off,

398 OLD-TIME MAKERS OF MEDICINE

though the teeth are too short to do any real injury to the skin.
Coronella is at a glance very much like a viper; and in the flames
it would not be closely examined. While it is not reported as found
in Malta except by Mr. Hook, two species are known there belong-
ing to the same family and having similar habits (leopardinus and
zamenis (or coluber) gcmonensis) . The coloring of Coronella leo-
pardinus would be the most likely to suggest a viper.

The observations justify Luke entirely. We have here a snake so
closely resembling a viper as to be taken for one by a good naturalist
until he had caught and examined a specimen. It clings, and yet it
also bites without doing harm. That the Maltese rustics should mis-
take this harmless snake for a venomous one is not strange. Many un-
educated people have the idea that all snakes are poisonous in varying
degrees, just as the vulgar often firmly believe that toads are poison-
ous. Every detail as related by Luke is natural, and in accordance
with the facts of the country.

In a word, then, the whole question as to Luke's
authority as a writer, as an eye-witness of many
things, and as the relator of many others with regard
to which he had obtained the testimony of eye-wit-
nesses is fully vindicated. Twenty years ago many
scholars were prone to doubt this whole question.
Ten years ago most of them were convinced that the
Luke traditions were not justified by recent investi-
gation. Now we have come back once more to the
complete acceptance of the old traditions.

Perhaps the most unfortunate characteristic of
much nineteenth-century criticism in all depart-
ments, even those strictly scientific, was the marked
tendency to reject previous opinions for new ones.
Somehow men felt themselves so far ahead of old-
time writers and thinkers that they concluded they
must hold opinions different from their ancestors.
In nearly every case the new ideas that they evolved
by supposedly newer methods are not standing the
test of time and further study. There had been a
continuous belief in men's minds, having its basis
very probably on a passage in one of St. Peter's
Epistles, that the earth would dissolve by fire. This
was openly contradicted all during the nineteenth
century and the time when the earth would freeze
up definitely calculated by our mathematicians.

APPENDIX 399

Now after having studied radioactivity and learned
from the physicist that the earth is heating up and
will eventually get too hot for life, we calmly go
back to the old Petrine declaration. Some of the
most distinguished of the German biologists of the
present day, such men as Driesch and others, calmly
tell us that the edifice erected by Darwin will have
to come down because of newly discovered evidence,
and indeed some of them go so far as to declare that
Darwinism was a crude hypothesis very superficial
in its philosophical aspects and therefore acceptable
to a great many people who, because it was easy to
understand and was very different from what our
fathers had believed, hastened to accept it. Nothing
shows the necessity for being conservative in the
matter of new views in science or ethics or religion
more than the curious transition state in which we
are with regard to many opinions at the present
time, with a distinct tendency toward reaction to
older views that a few years ago were thought quite
untenable. We are rather proud of the advance that
we are supposed to be making along many lines in
science and scholarship, and yet over and over again,
after years of work, we prove to have been following
a wrong lead and must come back to where we
started. This has been the way of man from the be-
ginning and doubtless will continue. The present
generation are having this curious regression that
follows supposed progress strongly emphasized for
them.

APPENDIX II

SCIENCE AT THE MEDIEVAL UNIVERSI-
TIES 1

With the growth of interest in science and in na-
ture study in our own day, one of the expressions
that is probably oftenest heard is surprise that the
men of preceding generations and especially uni-
versity men did not occupy themselves more with
the world around them and with the phenomena that
are so tempting to curiosity. Science is usually sup-
posed to be comparatively new and nature study only
a few generations old. Men are supposed to have
been so much interested in book knowledge and in
speculations and theories of many kinds, that they
neglected the realities of life around them while spin-
ning fine webs of theory. Previous generations, of
course, have indulged in theory, but then our own
generation is not entirely free from that amusing
occupation. Nothing could well be less true, however,
than that the men of preceding generations were not
interested in science even in the sense of physical
science, or that nature study is new, or that men
were not curious and did not try to find out all they
could about the phenomena of the world around
them.

The medieval universities and the school-men who
taught in them have been particularly blamed for
their failure to occupy themselves with realities in-

^he material for this chapter was gathered for a paper read before the
Medical Improvement Society of Boston in the spring of 1911. In
nearly its present form it was published in T/ie Popular Science Monthly
for May, 1911, and thanks are returned to the editor of that magazine
for permission to reprint it here. The additions that have been made
refer particularly to the estimation of Aristotle in the Middle Ages.

400

APPENDIX 401

stead of with speculation. We are coming to recog-
nize their wonderful zeal for education, the large
numbers of students they attracted, the enthusiasm
of their students, since they made so many hand-
written copies of the books of their masters, the de-
votion of the teachers themselves, who wrote at
much greater length than do our professors even
now and on the most abstruse subjects, so that it is
all the more surprising to think they should have
neglected science. The thought of our generation in
the matter, however, is founded entirely on an as-
sumption. Those who know anything about the
writers of the Middle Ages at first hand are not
likely to think of them as neglectful of science even
in our sense of the term. Those who know them
at second hand are, however, very sure in the matter.
The assumption is due to the neglect of history
that came in the seventeenth and eighteenth cen-
turies. We have many other similar assumptions
because of the neglect of many phases of mental de-
velopment and applied science at this time. For in-
stance, most of us are very proud of our modern
hospital development and think of this as a great
humanitarian evolution of applied medical science.
We are very likely to think that this is the first time
in the world's history that the building of hospitals
has been brought to such a climax of development,
and that the houses for the ailing in the olden time
were mere refuges, prone to become death traps and
at most makeshifts for the solution of the problem
of the care of the ailing poor. This is true for the
hospitals of the seventeenth and eighteenth centuries,
but it is not true at all for the hospitals of the thir-
teenth and fourteenth and fifteenth centuries. Miss
Nutting and Miss Dock in their " History of Nurs-
ing ' ' 1 have called attention to the fact that the
lowest period in hospital development is during the

*New York, Putnam, 1908.

402 OLD-TIME MAKERS OF MEDICINE

eighteenth and early nineteenth centuries. Hospi-
tals were little better than prisons, they had narrow
windows, were ill provided with light and air and
hygienic arrangements, and in general were all that
we should imagine old-time hospitals to be. The
hospitals of the earlier time, however, had fine high
ceilings, large windows, abundant light and air, ex-
cellent arrangements for the privacy of patients, and
in general were as worthy of the architects of the
earlier times as the municipal buildings, the cathe-
drals, the castles, the university buildings, and every
other form of construction that the late medieval
centuries devoted themselves to.

The trouble with those who assume that there was
no study of science and practically no attention to
nature study in the Middle Ages is that they know
nothing at all at first hand about the works of the
men who wrote in the medieval period. They have
accepted declarations with regard to the absolute de-
pendence of the scholastics on authority, their al-
most divine worship of Aristotle, their utter readi-
ness to accept authoritative assertions provided they
came with the stamp of a mighty name, and then
their complete lack of attention to observation and
above all to experiment. Nothing could well be more
ridiculous than this ignorant assumption of knowl-
edge with regard to the great teachers at the me-
dieval universities. Just as soon as there is definite
knowledge of what these great teachers wrote and
taught, not only does the previous mood of blame for
them for not paying much more attention to science
and nature at once disappear, but it gives place to
the heartiest admiration for the work of these great
thinkers. It is easy to appreciate, then, what Pro-
fessor Saintsbury said in a recent volume on the
thirteenth century :

And there have even been in these latter days some graceless onea
who have asked whether the science of the nineteenth century after an

APPENDIX 403

equal interval will be of any more positive value — whether it will
not have even less comparative interest than that which appertains to
the scholasticism of the thirteenth.

Three men were the great teachers in the medieval
universities at their prime. They have been read
and studied with interest ever since. They wrote
huge tomes, but men have pored over them in every
generation. They were Albertus Magnus, the
teacher of the other two, Thomas Aquinas and Roger
Bacon. All three of them were together at the Uni-
versity of Paris shortly after the middle of the thir-
teenth century. Anyone who wants to know any-
thing about the attitude of mind of the medieval
universities, their professors and students, and of all
the intellectual world of the time towards science
and observation and experiment, should read the
books of these men. Any other mode of getting at
any knowledge of the real significance of the science
of this time is mere pretence. These constitute the
documents behind any scientific history of the de-
velopment of science at this time.

It is extremely interesting to see the attitude of
these men with regard to authority. In Albert's
tenth book (of his " Summa "), in which he cata-
logues and describes all the trees, plants, and herbs
known in his time, he observes: " All that is here
set down is the result of our own experience, or has
been borrowed from authors whom we know to have
written what their personal experience has con-
firmed; for in these matters experience alone can
be of certainty." In his impressive Latin phrase
" experimentum solum certificat in talibus." With
regard to the study of nature in general he was quite
as emphatic. He was a theologian as well as a sci-
entist, yet in his treatise on " The Heavens and
the Earth " he declared that " in studying nature
we have not to inquire how God the Creator may, as
He freely wills, use His creatures to work miracles

404 OLD-TIME MAKERS OF MEDICINE

and thereby show forth His power. We have rather
to inquire what nature with its immanent causes can
naturally bring to pass." *

Just as striking quotations on this subject might
be made from Roger Bacon. Indeed, Bacon was
quite impatient with the scholars around him who
talked over-much, did not observe enough, depended
to excess on authority, and in general did as mediocre
scholars always do, made much fuss on second-hand
information — plus some filmy speculations of their
own. Friar Bacon, however, had one great pupil
whose work he thoroughly appreciated because it
exhibited the opposite qualities. This was Petrus—
we have come to know him as Peregrinus — whose
observations on magnetism have excited so much at-
tention in recent years with the republications of
his epistle on the subject. It is really a monograph
on magnetism written in the thirteenth century.
Roger Bacon's opinion of it and of its author fur-
nishes us the best possible index of his attitude of
mind towards observation and experiment in science.

I know of only one person who deserves praise for his work in ex-
perimental philosophy for he does not care for the discourses of men
and their wordy warfare, but quietly and diligently pursues the works
of wisdom. Therefore what others grope after blindly, as bats in the
evening twilight, this man contemplates in their brilliancy because
he is a master of experiment. Hence, he knows all of natural science
whether pertaining to medicine and alchemy, or to matters celestial
or terrestrial. He has worked diligently in the smelting of ores
as also in the working of minerals; he is thoroughly acquainted with
all sorts of arms and implements used in military service and in
hunting, besides which he is skilled in agriculture and in the meas-
urement of lands. It is impossible to write a useful or correct
treatise in experimental philosophy without mentioning this man's
name. Moreover, he pursues knowledge for its own sake; for if he
wished to obtain royal favor, he could easily find sovereigns who
would honor and enrich him.

Similar expressions might readily be quoted from
Thomas Aquinas, but his works are so easy to secure

* " De Coelo et Mundo," 1, tr. iv., x.

APPENDIX 405

and his whole attitude of mind so well known, that
it scarcely seems worth while taking space to do so.
Aquinas is still studied very faithfully in many uni-
versities, and within the last few years one of his
great text-books of philosophy has been replaced in
the curriculum of Oxford University, in which it
occupied a prominent position in the long ago, as
a work that may be offered for examination in the
department of philosophy. It is with regard to him
particularly that there has been the greatest revul-
sion of feeling in recent years and a recognition of
the fact that here was a great thinker familiar with
all that was known in the physical sciences, and who
had this knowledge constantly in his mind when he
drew his conclusions with regard to philosophical and
theological questions.

It used to be the fashion to make little of the
medieval scholars for the high estimation in which
they held Aristotle. Occasionally even yet one hears
narrowly educated men, I am sorry to say much
more frequently scientific specialists than others,
talk deprecatingly of this ardent devotion to Aris-
totle. No one who knows anything about Aristotle
ever indulges in such an exhibition of ignorance of
the realities of the history of philosophy and science.
To know Aristotle well is to think of him as proba-
bly possessed of the greatest human mind that ever
existed. We do not need to go back to the Middle
Ages to be confirmed in that opinion. Modern sci-
entists who know their science well, but who also
know Aristotle well, and who are ardent worship-
pers at his shrine, are not hard to find. Romanes,
the great English biologist of the end of the nine-
teenth century, said: " It appears to me that there
can be no question that Aristotle stands forth not
only as the greatest figure in antiquity but as the
greatest intellect that has ever appeared upon this
earth."

406 OLD-TIME MAKERS OF MEDICINE

Before Eomanes, George H. Lewes, in his inter-
esting monograph in the history of thought, * ' Aris-
totle, a Chapter in the History of Science," is quite
as complimentary to the great Greek thinker. We
may say that Lewes was by no means partial to
Aristotle. Anything but inclined to accept author-
ity as of value in philosophy, he had been rendered
impatient by the fact that so much of the history
of philosophy was dominated by Aristotle, and it
was only that the panegyric was forced from him
by careful study of all that the Stagirite wrote that
he said : * ' History gazed on him with wonder. His
intellect was piercing and comprehensive ; his attain-
ments surpassed those of every philosopher; his in-
fluence has been excelled only by the founders of
religion . . . his vast and active intelligence for
twenty centuries held the world in awe. ' '

Professor Osborn, whose scholarly study of the
theory of evolution down the ages * ' From the Greeks
to Darwin " rather startled the world of science
by showing not only how old was a theory of evolu-
tion, but how frequently it had been stated and how
many of them anticipated phases of our own thought
in the matter, pays a high compliment to the great
Greek scientist. He says : ' ' Aristotle clearly states
and rejects a theory of the origin of adaptive struc-
tures in animals altogether similar to that of Dar-
win." He then quotes certain passages from Aris-
totle's " Physics," and says: " These passages
seem to contain absolute evidence that Aristotle had
substantially the modern conception of the evolution
of life, from a primordial, soft mass of living matter
to the most perfect forms, and that even in these he
believed that evolution was incomplete for they
were progressing to higher forms. ' '

Modern French scientists are particularly lauda-
tory in their estimation of Aristotle. The group
of biologists, Buffon, Cuvier, St. Hilaire, and others

APPENDIX 407

who called world attention to French science and its
attainments about a century ago, are all of them on
record in highest praise of Aristotle. Cuvier said:
* ' I cannot read his work without being ravished with
astonishment. It is impossible to conceive how a
single man was able to collect and compare the multi-
tude of facts implied in the rules and aphorisms con-
tained in this book."

It is possible, however, to get opinions ardently
laudatory of Aristotle from the serious students of
any nation, provided only they know their Aristotle.
Sir William Hamilton, the Scotch philosopher, said :

" Aristotle's seal is upon all the sciences, his spec-
ulations have determined those of all subsequent
thinkers." Hegel, the German philosophic writer,
is not less outspoken in his praise: " Aristotle pene-
trated the whole universe of things and subjected
them to intelligence." Kant, who is often said to
have influenced our modern thinking more than any
other in recent generations, has his compliment for
Aristotle. It relates particularly to that branch of
philosophy with which Kant had most occupied him-
self. The Koenigsberg philosopher said: " Logic
since Aristotle, like Geometry since Euclid, is a fin-
ished science."

I do not want to tire you or I could quote many
other authorities who proclaim Aristotle the genius
of the race. They would include poets like Dante
and Goethe, scholars like Cicero and Anthon, literary
men like Lessing and Reich and many others. The
scholars of the Middle Ages, far from condemnation
for their devotion to Aristotle, deserve the highest
praise for it. If they had done nothing else but ap-
preciate Aristotle as our greatest modern scholars
have done, that of itself would proclaim their pro-
found scholarship.

The medieval writers are often said to have been
uncritical in their judgment, but in their lofty esti-

408 OLD-TIME MAKERS OF MEDICINE

mation of Aristotle they displayed the finest possible
critical judgment. On the contrary, the generations
who made much of the opportunity to minimize me-
dieval scholarship because of its worship at the
shrine of Aristotle, must themselves fall under the
suspicion at least of either not knowing Aristotle
or of not thinking deeply about the subjects with
regard to which he wrote. For in all the world's his-
tory the rule has been that whenever men have
thought deeply about a subject and know what Aris-
totle has written with regard to that subject, they
have the liveliest admiration for the great Greek
thinker. This is true for philosophy, logic, meta-
physics, politics, ethics, dramatics, but it is also
quite as true for physical science. He lacked our
knowledge, though not nearly to the degree that is
usually thought, and he had a marvellous accumula-
tion of information, but he had a breadth of view
and a thoroughness of appreciation with a power
of penetration that make his opinions worth while
knowing even on scientific subjects in our enlight-
ened age.

As for the supposed swearing by Aristotle, in the
sense of literally accepting his opinions without dar-
ing to examine them critically, which is so constantly
asserted to have been the habit of the medieval schol-
ars and teachers, it is extremely difficult in the light
of the expressions which we have from them, to
understand how this false impression arose. Aris-
totle they thoroughly respected. They constantly
referred to his works, but so has every thinking gen-
eration ever since. Whenever he had made a
declaration they would not accept the contradiction
of it without a good reason, but whenever they had
good reasons, Aristotle's opinion was at once re-
jected without compunction. Albertus Magnus, for
instance, said : ' * Whoever believes that Aristotle
was a God must also believe that he never erred,

APPENDIX 409

but if we believe that Aristotle was a man, then
doubtless he was liable to err just as we are." A
number of direct contradictions of Aristotle we have
from Albert. A well-known one is that with regard
to Aristotle's assertion that lunar rainbows ap-
peared only twice in fifty years. Albert declared
that he himself had seen two in a single year.

Indeed, it seems very clear that the whole trend
of thought among the great teachers of the time was
away from the acceptance of scientific conclusions
on authority unless there was good evidence for
them available. They were quite as impatient as the
scientists of our time with the constant putting for-
ward of Aristotle as if that settled a scientific ques-
tion. Koger Bacon wanted the Pope to forbid the
study of Aristotle because his works were leading
men astray from the study of science, his authority
being looked upon as so great that men did not think
for themselves but accepted his assertions. Smaller
men are always prone to do this, and indeed it con-
stitutes one of the difficulties in the way of advance
in scientific knowledge at all times, as Roger Bacon
himself pointed out.

These are the sort of expressions that are to be
expected from Friar Bacon from what we know of
other parts of his work. His * ' Opus Tertium ' ' was
written at the request of Pope Clement IV, because
the Pope had heard many interesting accounts of
what the great thirteenth-century teacher and experi-
menter was doing at the University of Oxford, and
wished to learn for himself the details of his work.
Bacon starts out with the principle that there are
four grounds of human ignorance. These are, ' ' first,
trust in inadequate authority; second, that force of
custom which leads men to accept without properly
questioning what has been accepted before their
time; third, the placing of confidence in the asser-
tions of the inexperienced; and fourth, the hiding of

410 OLD-TIME MAKERS OF MEDICINE

one 's own ignorance behind the parade of superficial
knowledge, so that we are afraid to say I do not
know." Professor Henry Morley, a careful student
of Bacon's writings, said with regard to these ex-
pressions of Bacon:

No part of that ground has yet been cut away from beneath the feet
of students, although six centuries have passed. We still make sheep-
walks of second, third and fourth, and fiftieth hand references to
authority; still we are the slaves of habit, still we are found fol-
lowing too frequently the untaught crowd, still we flinch from the
righteous and wholesome phrase " I do not know " and acquiesce
actively in the opinion of others that we know what we appear to
know.

In his 1 1 Opus Ma jus ' ' Bacon had previously given
abundant evidence of his respect for the experi-
mental method. There is a section of this work
which bears the title " Scientia Experimentalist'
In this Bacon affirms that " without experiment
nothing can be adequately known. An argument may
prove the correctness of a theory, but does not give
the certitude necessary to remove all doubt, nor will
the mind repose in the clear view of truth unless it
finds its way by means of experiment." To this he
later added in his * * Opus Tertium " : * * The strong-
est argument proves nothing so long as the conclu-
sions are not verified by experience. Experimental
science is the queen of sciences, and the goal of all
speculation. ' '

It is no wonder that Dr. Whewell, in his * ' History
of the Inductive Sciences," should have been un-
stinted in his praise of Roger Bacon's work and
writings. In a well-known passage he says of the
' * Opus Majus ' ' :

Roger Bacon's " Opus Majus " is the encyclopedia and " Novum
Organon " of the thirteenth century, a work equally wonderful with
regard to its wonderful scheme and to the special treatises by
which the outlines of the plans are filled up. The professed object
of the work is to urge the necessity of a reform in the mode of
philosophizing, to set forth the reasons why knowledge had not made
greater progress, to draw back attention to the sources of knowl-

APPENDIX 411

edge which had been unwisely neglected, to discover other sources
which were yet almost untouched, and to animate men in the
undertaking of a prospect of the vast advantages which it offered.
In the development of this plan all the leading portions of science
are expanded in the most complete shape which they had at that
time assumed; and improvements of a very wide and striking kind
are proposed in some of the principal branches of study. Even if the
work had no leading purposes it would have been highly valuable as
a treasure of the most solid knowledge and soundest speculations
of the time; even if it had contained no such details it would have
been a work most remarkable for its general views and scope.

As a matter of fact the universities of the Middle
Ages, far from neglecting science, were really scien-
tific universities. Because the universities of the
early nineteenth century occupied themselves almost
exclusively with languages and especially formed
students' minds by means of classical studies, men in
our time seem to be prone to think that such lin-
guistic studies formed the main portion of the cur-
riculum of the universities in all the old times and
particularly in the Middle Ages. The study of the
classic languages, however, came into university life
only after the Renaissance. Before that the under-
graduates of the universities had occupied them-
selves almost entirely with science. It was quite as
much trouble to introduce linguistic studies into the
old universities in the Renaissance time to replace
science, as it was to secure room for science by push-
ing out the classics in the modern time. Indeed the
two revolutions in education are strikingly similar
when studied in detail. Men who had been brought
up on science before the Renaissance were quite sure
that that formed the best possible means of develop-
ing the mind. In the early nineteenth century men
who had been formed on the classics were quite as
sure that science could not replace them with any
success.

There is no pretence that this view of the medieval
universities is a new idea in the history of educa-
tion. Those who have known the old universities at

412 OLD-TIME MAKERS OF MEDICINE

first hand by the study of the actual books of their
professors and by familiarity with their courses of
study, have not been inclined to make the mistake
of thinking that the medieval university neglected
science. Professor Huxley in his " Inaugural Ad-
dress as Rector of Aberdeen University ' ' some
thirty years ago stated very definitely his recognition
of medieval devotion to science. His words are well
worth remembering by all those who are accustomed
to think of our time as the first in which the study
of science was taken up seriously in our universities.
Professor Huxley said :

The scholars of the medieval universities seem to have studied
grammar, logic, and rhetoric; arithmetic and geometry; astronomy,
theology, and music. Thus their work, however imperfect and faulty,
judged by modern lights, it may have been, brought them face to
face with all the leading aspects of the many-sided mind of man.
For these studies did really contain, at any rate in embryo, some-
times it may be in caricature, what we now call philosophy, mathe-
matical and physical science, and art. And I doubt if the curriculum
of any modern university shows so clear and generous a comprehen-
sion of what is meant by culture, as this old Trivium and Quadrivium
does.

It would be entirely a mistake, however, to think
that these great writers and teachers who influenced
the medieval universities so deeply and whose works
were the text-books of the universities for centuries
after, only had the principles of physical and ex-
perimental science and did not practically apply
them. As a matter of fact their works are full of
observation. Once more, the presumption that they
wrote only nonsense with regard to science comes
from those who do not know their writings at all,
while great scientists who have taken the pains to
study their works are enthusiastic in praise. Hum-
boldt, for instance, says of Albertus Magnus, after
reading some of his works with care :

Albertus Magnus is equally active and influential in promoting the
study of natural science and of the Aristotelian philosophy. His
works contain some exceedingly acute remarks on the organic struc-

APPENDIX 413

ture and physiology of plants. One of his works bearing the title of
" Liber Cosmographicus De Natura Locorum " is a species of physical
geography. I have found in it considerations on the dependence of
temperature concurrently on latitude and elevation and on the effect
of different angles of the sun's rays in heating the ground which have
excited my surprise.

It is with regard to physical geography of
course that Humboldt is himself a distinguished
authority.

Humboldt 's expression that he found some exceed-
ingly acute remarks on the organic structure and
physiology of plants in Albert the Great's writings
will prove a great surprise to many people. Meyer,
the German historian of botany, however, has
re-echoed Humboldt 's praise with emphasis. The
extraordinary erudition and originality of Albert's
treatise on plants drew from Meyer the comment :

No botanist who lived before Albert can be compared with him
unless Theophrastus, with whom he was not acquainted; and after
him none has painted nature in such living colors or studied it so
profoundly until the time of Conrad Gessner and Caesalpino.

These men, it may be remarked, come three cen-
turies after Albert's time. A ready idea of Albert's
contributions to physical science can be obtained
from his life by Sighart, which has been translated
into English by Dixon and was published in London
in 1870. Pagel, in Puschmann's " History of Medi-
cine," already referred to, gives a list of the books
written by Albert on scientific matters with some
comments which are eminently suggestive, and fur-
nish solid basis for the remark that I have made,
that men's minds were occupied with nearly the same
problems in science in the thirteenth century as we
are now, while the conclusions they came to were
not very different from ours, though reached so long
before us.

This catalogue of Albertus Magnus' works shows
very well his own interest and that of his generation
in physical science of all kinds. There were eight

414 OLD-TIME MAKERS OF MEDICINE

treatises on Aristotle's physics and on the under-
lying principles of natural philosophy and of energy
and of movement; four treatises concerning the
heavens and the earth, one on physical geography
which also contains, according to Pagel, numerous
suggestions on ethnography and physiology. There
are two treatises on generation and corruption, six
books on meteors, five books on minerals, three books
on the soul, two books on the intellect, a treatise on
nutritives, and then a treatise on the senses and an-
other on the memory and on the imagination. All
the phases of the biological sciences were especially
favorite subjects of his study. There is a treatise on
the motion of animals, a treatise in six books on
vegetables and plants, a treatise on breathing things,
a treatise on sleep and waking, a treatise on youth
and old age, and a treatise on life and death. His
treatise on minerals contains, according to Pagel, a
description of ninety-five different kinds of precious
stones. Albert's volumes on plants were reproduced
with Meyer, the German botanist, as editor (Berlin,
1867). All of Albert's books are available in modern
editions.
Pagel says of Albertus that

His profound scholarship, his boundless industry, the almost incon-
trollable impulse of his mind after universality of knowledge, the
many-sidedness of his literary productivity, and finally the almost
universal recognition which he received from his contemporaries and
succeeding generations, stamp him as one of the most imposing char-
acters and one of the most wonderful phenomena of the Middle Ages.

In another passage Pagel has said :

While Albert was a Churchman and an ardent devotee of Aristotle,
in matters of natural phenomena he was relatively unprejudiced and
presented an open mind. He thought that he must follow Hippocrates
and Galen, rather than Aristotle and Augustine, in medicine and in
the natural sciences. We must concede it a special subject of praise
for Albert that he distinguished very strictly between natural and
supernatural phenomena. The former he considered as entirely the
object of the investigation of nature. The latter he handed over
to the realm of metaphysics.

APPENDIX 415

Eoger Bacon is, however, the one of these three
great teachers who shows us how thoroughly prac-
tical was the scientific knowledge of the universities
and how much it led to important useful discoveries
in applied science and to anticipations of what is
most novel even in our present-day sciences. Some
of these indeed are so startling, that only that we
know them not by tradition but from his works,
where they may be readily found without any doubt
of their authenticity, we should be sure to think that
they must be the result of later commentators' ideas.
Bacon was very much interested in astronomy, and
not only suggested the correction of the calendar, but
also a method by which it could be kept from wander-
ing away from the actual date thereafter. He dis-
covered many of the properties of lenses and is said
to have invented spectacles and announced very em-
phatically that light did not travel instantaneously
but moved with a definite velocity. He is sometimes
said to have invented gunpowder, but of course he
did not, though he studied this substance in various
forms very carefully and drew a number of conclu-
sions in his observations. He was sure that some
time or other man would learn to control the energies
exhibited by explosives and that then he would be
able to accomplish many things that seemed quite
impossible under present conditions.

He said, for instance :

Art can construct instruments of navigation, such that the largest
vessels governed by a single man will traverse rivers and seas more
rapidly than if they were filled with oarsmen. One may also make
carriages which without the aid of any animal will run with re-
markable swiftness.

In these days when the automobile is with us and
when the principal source of energy for motor pur-
poses is derived from explosives of various kinds,
this expression of Eoger Bacon represents a

416 OLD-TIME MAKERS OF MEDICINE

prophecy marvellously surprising in its fulfilment.
It is no wonder that the book whence it comes bears
the title " De Secretis Artis et Naturae." Roger
Bacon even went to the extent, however, of declaring
that man would some time be able to fly. He was
even sure that writh sufficient pains he could himself
construct a flying machine. He did not expect to
use explosives for his motor power, however, but
thought that a windlass properly arranged, worked
by hand, might enable a man to make sufficient move-
ment to carry himself aloft or at least to support
himself in the air, if there were enough surface to
enable him to use his lifting power to advantage.
He was in intimate relations by letter with many
other distinguished inventors and investigators be-
sides Peregrinus and was a source of incentive and
encouragement to them all.

The more one knows of Aquinas the more surprise
there is at his anticipation of many modern scientific
ideas. At the conclusion of a course on cosmology
delivered at the University of Paris he said that
" nothing at all would ever be reduced to nothing-
ness " (nihil omnino in nihilum redigetur). He was
teaching the doctrine that man could not destroy
matter and God would not annihilate it. In other
words, he was teaching the indestructibility of mat-
ter even more emphatically than we do. He saw
the many changes that take place in material sub-
stances around us, but he taught that these were only
changes of form and not substantial changes and
that the same amount of matter always remained in
the world. At the same time he was teaching that
the forms in matter by which he meant the combina-
tions of energies which distinguish the various kinds
of matter are not destroyed. In other words, he
was anticipating not vaguely, but very clearly and
definitely, the conservation of energy. His teaching
jwdth regard to the composition of matter was very

APPENDIX 417

like that now held by physicists. He declared that
matter was composed of two principles, prime mat-
ter and form. By forma he meant the dynamic ele-
ment in matter, while by materia prima he meant the
underlying substratum of material, the same in every
substance, but differentiated by the dynamics of
matter.

It used to be the custom to make fun of these me-
dieval scientists for believing in the transmutation
of metals. It may be said that all three of these
greatest teachers did not hold the doctrine of the
transmutation of metals in the exaggerated way in
which it appealed to many of their contemporaries.
The theory of matter and form, however, gave a
philosophical basis for the idea that one kind of
matter might be changed into another. We no longer
think that notion absurd. Sir William Ramsay has
actually succeeded in changing one element into an-
other and radium and helium are seen changing into
each other, until now we are quite ready to think of
transmutation placidly. The Philosopher's Stone
used to seem a great absurdity until our recent ex-
perience with radium, which is to some extent at
least the philosopher's stone, since it brings about
the change of certain supposed elements into others.
A distinguished American chemist said not long ago
that he would like to extract all the silver from a
large body of lead ore in which it occurs so com-
monly, and then come back after twenty years and
look for further traces of silver, for he felt sure that
they would be found and that lead ore is probably
always producing silver in small quantities and
copper ore is producing gold.

Most people will be inclined to ask where the fruits
of this undergraduate teaching of science are to be
found. They are inclined to presume that science
was a closed book to the men and women of that time.
It is not hard, however, to point the effect of the

418 OLD-TIME MAKERS OF MEDICINE

scientific training in the writings of the times. Dante
is a typical university man of the period. He was
at several Italian universities, was at Paris and per-
haps at Oxford. His writings are full of science.
Professor Kiihns, of Wesleyan, in his book " The
Treatment of Nature in Dante," has pointed out
how much Dante knows of science and of nature.
Few of the poets not only of his own but of any
time have known more. There are only one or
two writers of poetry in our time who go
with so much confidence to nature and the
scientific interpretation of her for figures for their
poetry. The astronomy, the botany, the zoology
of Albertus Magnus and Thomas Aquinas, Dante
knew very well and used confidently for fig-
urative purposes. Anyone who is inclined to think
nature study a new idea in the world forgets, or
has never known, his Dante. The birds and the bees,
the flowers, the leaves, the varied aspects of clouds
and sea, the phenomena of phosphorescence, the
intimate habits of bird and beast and the ways of
the plants, as well as all the appearances of the
heavens, Dante knew very well and in a detail that
is quite surprising when we recall how little nature
study is supposed to have attracted the men of his
time. Only that his readers appreciated it all, Dante
would surely not have used his scientific erudition
so constantly.

So much for the undergraduate department of the
universities of the Middle Ages, and the view is abso-
lutely fair, for these were the men to whom the
students flocked by thousands. They were teaching
science, not literature. They were discussing physics
as well as metaphysics, psychology in its phenomena
as well as philosophy, observation and experiment
as well as logic, the ethical sciences, economics, prac-
tically all the scientific ideas that were needed in
their generation — and that generation saw the rise

APPENDIX 419

of the universities, the finishing of the cathedrals,
the building of magnificent town halls and castles
and beautiful municipal buildings of many kinds, in-
cluding hospitals, the development of the Hansa
League in commerce, and of wonderful manufac-
turers of all the textiles, the arts and crafts, as
well as the most beautiful book-making and art and
literature. We could be quite sure that the men who
solved all the other problems so well could not have
been absurd only in their treatment of science. Any-
one who reads their books will be quite sure of that.

While most people might be ready, then, to con-
fess that possibly Huxley was not mistaken with
regard to the undergraduate department of the uni-
versities, most of them would feel sure that at least
the graduate departments were sadly deficient in
accomplishment. Once more this is entirely an as-
sumption. The facts are all against any such idea.

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

It was in medicine, however, where most people
would be quite sure without any more ado that noth-

420 OLD-TIME MAKERS OF MEDICINE

ing worth while talking about was being done, that
the great triumphs of graduate teaching at the me-
dieval universities were secured. Here more than
anywhere else is there room for supreme surprise at
the quite unheard-of anticipations of our modern
medicine and, stranger still, as it may seein, of our
modern surgery.

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

APPENDIX 421

professors to be assured of the knowledge of students
before allowing them to pass.

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

Their study of medicine was not without lasting
accomplishment, however. They laid down the indi-
cations and the dosage for opium. They used iron
with success, they tried out many of the bitter tonics
among the herbal medicines, and they used laxatives
and purgatives to good advantage. Down at Mont-
pellier, Gilbert, the Englishman, suggested red light
for smallpox because it shortened the fever, lessened
the lesions, and made the disfigurement much less.
Finsen was given the Nobel prize partly for re-dis-

422 OLD-TIME MAKERS OF MEDICINE

covery of this. They segregated erysipelas and so
prevented its spread. They recognized the con-
tagiousness of leprosy, and though it was probably
as widespread as tuberculosis is at the present time,
they succeeded not only in controlling but in eventu-
ally obliterating it throughout Europe.

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

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

They washed the wound with wine, scrupulously removing every
foreign particle; then they brought the edges together, not allowing

APPENDIX 423

wine or anything else to remain within — dry adhesive surfaces were
their desire. Nature, they said, produces the means of union in a
viscous exudation, or natural balm, as it was afterwards called by
Paracelsus, Par6, and Wurtz. In older wounds they did their best
to obtain union by cleansing, desiccation, and refreshing of the
edges. Upon the outer surface they laid only lint steeped in wine.
Powders they regarded as too desiccating, for powder shuts in decom-
posing matters; wine after washing, purifying, and drying the raw
surfaces evaporates.

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

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

The positive assertions with regard to old-time
ignorance were all made in the course of religious
controversy. In English-speaking countries partic-
ularly it became a definite purpose to represent the
old Church as very much opposed to education of all
kinds and above all to scientific education. There
is not a trace of that to be found anywhere, but there
were many documents that were appealed to to con-

424 OLD-TIME MAKERS OF MEDICINE

firm the protestant view. There was a Papal bull,
for instance, said to forbid dissection. When read
it proves to forbid the cutting up of bodies to carry
them to a distance for burial, an abuse wihich caused
the spread of disease, and was properly prohibited.
The Church prohibition was international and there-
fore effective. At the tim'e the bull was issued there
were twenty medical schools doing dissection in
Italy and they continued to practise it quite undis-
turbed during succeeding centuries. The Papal phy-
sicians were among the greatest dissectors. Dis-
sections were done at Rome and the cardinals at-
tended them. Bologna at the height of its fame was
in the Papal States. All this has been ignored and
the supposed bull against anatomy emphasized as
representing the keynote of medical and surgical his-
tory. Then there was a Papal decree forbidding the
making of gold and silver. This was said to forbid
chemistry or alchemy and so prevent scientific prog-
ress. The history of the medical schools of the time
shows that it did no such thing. The great al-
chemists of the time doing really scientific work were
all clergymen, many of them very prominent ecclesi-
astics.

Just in the same way there were said to be decrees
of the Church councils forbidding the practice of
surgery. President White says in his " Warfare
of Science with Theology in Christendom," that,
as a consequence of these, surgery was in dishonor
until the Emperor Wenceslaus, at the beginning of
the fifteenth century, ordered that it should be re-
stored to estimation. As a matter of fact, during
the two centuries immediately preceding the first
years of the fifteenth century, surgery developed
very wonderfully, and we have probably the most
successful period in all the history of surgery ex-
cept possibly our own. The decrees forbade monks
to practise surgery because it led to certain abuses.

APPENDIX 425

Those who found these decrees and wanted to be-
lieve that they prevented all surgical development
simply quoted them and assumed there was no
surgery. The history of surgery at this time is
one of the most wonderful chapters in human
progress.

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

Is it not time that we should drop the foolish no-
tions that are very commonly held because we know

426 OLD-TIME MAKERS OF MEDICINE

nothing about the Middle Ages — and, therefore, the
more easily assume great knowledge — and get back
to appreciate the really marvellous details of educa-
tional and scientific development which are so inter-
esting and of so much significance at this time ?

APPENDIX HI
MEDIEVAL POPULARIZATION OF SCIENCE

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

Very probably the first who should be mentioned
in the list is Boethius, who flourished in the early

427

428 OLD-TIME MAKERS OF MEDICINE

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

APPENDIX 429

scholars towards the Church and of the Church
towards scholarship thus early.

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

While still a statesman he wrote a series of works
relating to history and politics and public affairs
generally. These consisted mainly of chronicles
and panegyrics, and twelve books of miscellanies
called Variae. After his retirement to the mon-
astery, a period of ardent devotion to writing be-
gins, and a great number of books were issued. He
evidently gathered round him a number of men
whom he inspired with his spirit, or, perhaps,
selected, because he found that, while they had a
taste for a quiet, peaceful spiritual life, they were
also devoted to the accumulation and diffusion of
knowledge. A series of commentaries on portions
of the Scriptures was written, the Jewish antiquities
of Josephus translated, and the ecclesiastical his-
tories of Theodoric, Sozomen, and Socrates made
available in Latin. Cassiodorus himself is said to
have made a compendium of these, called the ' ' His-
toria Tripartita," which was much used as a manual

430 OLD-TIME MAKERS OF MEDICINE

of history during succeeding centuries. Then there
were treatises on grammar, on orthography, and a
series of works on mathematics. In all of his writ-
ings Cassiodorus shows a special fondness for the
symbolism of numbers.

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

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

Every country in Europe shared this movement
for the diffusion of information during the early
Middle Ages, and the works of men from each of
these countries in succeeding centuries has come
down to us, preserved in spite of all the vicissitudes
to which they were so liable during the centuries
before the invention of printing and the easy multi-
plication of books. To many people it will seem
surprising to learn that the next evidence of deep
broad interest in knowledge is to be found in the
next century in the distant west of Europe, in the

APPENDIX 431

Spanish Peninsula. It is a long step from the semi-
barbaric splendor of the Gothic court at Verona, to
the bishop's palace in Seville in Andalusia. The
two cities are separated by what is no inconsider-
able distance in our day. In the seventh century
they must have seemed almost at the other end of
the world from each other. Those who recall what
we have insisted on in several portions of the body
of this work with regard to the high place Spanish
genius won for itself in the Roman Empire, and how
much of culture among the Spaniards of that time
the occurrence of so many important writers of
that nationality must imply, will not be surprised at
the distinguished work of a great Christian Spanish
writer of the seventh century.

Indeed, it would be only what might be expected
for evidences of early awakening of the broadest Cul-
ture to be found in Spain. The important name in
the popularization of science in the seventh cen-
tury is St. Isidore of Seville. He made a compen-
dium of all the scattered scientific traditions and
information of his time with regard to natural
phenomena in a sort of encyclopedia of science.
This consisted of twenty books — chapters we would
call them now — treating almost de omni re scibili et
quibusdam aliis (everything knowable and a few
other things besides). It is possible that the work
may have been written by a number of collaborators
under the patronage of the bishop, though there is
no sure indication of this to be found either in the
volume itself or even contemporary history. All
the ordinary scientific subjects are treated. Astron-
omy, geography, mineralogy, botany, and even man
and the animals have each a special chapter.
Pouchet, in his " History of the Natural Sciences
During the Middle Ages, ' ' calls attention to the fact
that, in grouping the animals for collective treat-
ment in the different chapters, sometimes the most

432 OLD-TIME MAKERS OF MEDICINE

heterogeneous creatures are brought under a com-
mon heading. Among the fishes, for instance, are
classed all living things that are found in water.
The whale and the dolphin, as well as sponges, and
oysters, and crocodiles, and sea serpents, and lob-
sters, and hippopotamuses, all find a place together,
because of the common watery habitation. The
early Spanish Churchman would seem to have had
an enthusiastic zeal for complete classification that
would surely have made him a strenuous modern
zoologist.

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

After this, Alcuin and the monks, summoned by
Charlemagne, take up the tradition of gathering and
diffusing information, and the great monasteries of

APPENDIX 433

Tours, Fulda, and St. Gall carry it on. Besides
these, in the ninth century Monte Cassino comes
into prominence as an institution where much was
done of what we would now call encyclopedic work.
After his retirement from Salerno Constantine
Africanus made his translations and commentaries
on Arabian medicine, constituting what was really
a medical encyclopedia of information not readily
available at that time.

After this, of course, the tradition is taken up
by the universities, and it is only when, with the
thirteenth century, there came the complete develop-
ment of the university spirit, that encyclopedias
reached their modern expression. Three great en-
cylopedists, Vincent of Beauvais, Thomas of Can-
timprato, and Bartholomseus Anglicus, are the most
famous. Vincent consulted all the authors sacred
and profane that he could lay hold on, and the num-
ber was, indeed, prodigious. I have given some ac-
count of him in " The Thirteenth Greatest of Cen-
turies " (Catholic Summer School Press, New York,
third edition, 1910).

It would be very easy to conclude that these en-
cyclopedias, written by clergymen for the general
information of the educated people of the times, con-
tain very little that is scientifically valuable, and
probably nothing of serious medical significance.
Any such thought is, however, due entirely to un-
familiarity with the contents of these works. They
undoubtedly contain absurdities, they are often full
of misinformation, they repeat stories on dubious
authority, and sometimes on hearsay, but usually
the source of their information is stated, and espe-
cially where it is dubious, as if they did not care to
state marvels without due support. Books of pop-
ular information, however, have always had many
queer things, — queer, that is, to subsequent genera-
tions,— and it is rather amusing to pick up an en-

434 OLD-TIME MAKERS OF MEDICINE

cyclopedia of a century ago, much less a millen-
nium ago, and see how many absurd things were ac-
cepted as true. The first edition of the " Encyclo-
pedia Britannica," issued one hundred and fifty
years ago, furnishes an easily available source of
the absurdities our more recent forefathers accepted.
The men of the Middle Ages, however, were much
better observers as a rule, and used much more crit-
ical judgment, according to their lights, than we
have given them credit for. Often the information
that they have to convey is not only valuable, but
well digested, thoroughly practical, and sometimes a
marvellous anticipation of some of our most modern
thoughts. There is one of these encyclopedias which,
because it was written in my favorite thirteenth
century, I have read with some care. It is simply
a development of the work of preceding clerical en-
cyclopedists, and often refers to them. Because it
contains some typical examples of the better sorts
of information in these works, I have thought it
worth while to quote two passages from it. The
author is Bartholomaeus Anglicus, and the quaint
English in which it is couched is quoted from * ' Med-
ical Lore'11 (London, 1893). The book is all the
more interesting because in a dear old English ver-
sion, issued about 1540, the spellings of which are
among the great curiosities of English orthography,
it was often read and consulted by Shakespeare, who
evidently quotes from it frequently, for not a little
of the quaint scientific lore that he uses for his
figures can be traced to expressions used in this
book.

The first of the paragraphs that deserves to be
quoted, discusses madness, or, as we would call it,
lunacy, and sums up the causes, the symptoms, and
the treatment quite as well as that has ever been
done in the same amount of space :

Madness cometh sometime of passions of the soul, as of business
and of great thoughts, of sorrow and of too great study, and of dread:

APPENDIX 435

sometime of the biting of a wood hound, or some other venomous
beast; sometime of melancholy meats, and sometime of drink of strong
wiue. And as the causes be diverse, the tokens and signs be diverse.
For some cry and leap and hurt and wound themselves and other men,
and darken and hide themselves in privy and secret places. The medi-
cine of them is, that they be bound, that they hurt not themselves and
other men. And namely, such shall be refreshed, and comforted, and
withdrawn from cause and matter of dread and busy thoughts. And
they must be gladded with instruments of music, and some deal be oc-
cupied. '

The second discusses in almost as thorough a way
the result of the bite of a mad dog. The old Eng-
lish word for mad, wood, is constantly used. The
causes, the symptoms, and course of the disease, and
its possible prevention by early treatment, are all
discussed. The old tradition was already in ex-
istence that sufferers from rabies or hydrophobia,
as it is called, dreaded water, when it is really only
because the spasm consequent upon the thought
even of swallowing is painful that they turn from it.
That tradition has continue^ to be very commonly
accepted even by physicians down to our own day,
so that Bartholomew, the Englishman, in the thir-
teenth century, will not be blamed much for setting
it forth for popular information in his time some
seven centuries ago. The idea that free bleeding
would bring about the removal of the virus is inter-
esting, because we have in recent years insisted in
the case of the very similar disease, tetanus, on al-
lowing or deliberately causing wounds in which the
tetanus microbe may have gained an entrance, to
bleed freely.

The biting of a wood hound is deadly and venomous. And such
venom is perilous. For it is long hidden and unknown, and in-
creaseth and multiplieth itself, and is sometimes unknown to the
year's end, and then the same day and hour of the biting, it cometh
to the head, and breedeth frenzy. They that are bitten of a wood
hound have in their sleep dreadful sights, and are fearful, astonied,
and wroth without cause. And they dread to be seen of other men,
and bark as hounds, and they dread water most of all things, and
are afeared thereof full sore and squeamous also. Against the biting
of a wood hound wise men and ready use to make the wounds bleed
with fire or with iron, that the venom may come out with the
blood, that cometh out of the wound.

INDEX

A

Abbassides, 73

Abba Oumna, 70

Abbas, 324

Aboard, 189

Abraham, 97, 98

Abu Dschafer, 173

Abulcasis, 123, 170, 226, 317,

318, 323
Abul Farag, 51
Abulkasim, 124
Academy of Bagdad, 135
Acid, hydrochloric, 369
Ackermann, 302
Adalberon, 145
Adelard of Bath, 134
Adhesions, 128
^Egidius, 150
Aetius, 10, 117, 180, 317
Aetius, Amidenus, 28
Afflacius, 151, 171
Affinity, 372
Agenius, Otto, 227
Agricola, 345

A Kempis, Thomas, 345, 361
Alanfrancus, 260
Albertus Magnus, 267, 306, 356,

403

Alchemist, 354
Alcuin, 432
Alderotti, 213
Alexander II, Pope, 83
Alexander of Hales, 108
Alexander of Tralles, 10, 28, 39
Alexandria, 135, 385
Allbutt, Sir Clifford, 247, 254,

257, 304, 355, 421
Ali Abbas, 121, 173, 266, 323
AH Ben el Abbas, 170
Almansor, 132
Alphanus, 143, 145
Amandaville, 264
Anaesthesia, 17; inhalation of,

295, 296

Anaesthetics, 246

Anathomia, 203

Anatomy, ignorance of, 289; of

the teeth, 326
Anatomical material, 224
Anatomical injection, 227
Anatomical preparations, 277
Andrew of Piacenza, 248
Animals, motion of, 414
Anthemios, 40
Angelico, Fra, 360
Angina, 32, 44, 332
Anthon, 407
Antimony, 362
Antiseptic, 253
Antisepsis, 17, 246
Apocalypse, the chemical, 376
Aquinas, 306, 403
Arabian lack of originality, 140
Arabian words in anatomy, 138
Arabs, 7
Arabisms, 237
Archimattheas, 160
Arcoli, John of, 208
Arculanus, 323
Arezzo, 248

Arithmetical complements, 340
Armandaville, 264
Arnold of Villanova, 290, 858
Arrows, extraction of, 270
Arpinum, 4
Arsenic, 335
Artemisia maritima, 50
Arterial hemorrhage, 126
Arthur Legends, 218, 375, 392
Arts, 7; liberal, 149; and

crafts, 425

Asepsis, 17, 244, 246, 387
Aspasia, 180
Astrology, 105; and astronomy,

106, 418
Asylums, 8
Auenbrugger, 91, 166
Authority, 269, 292, 404
Authorship, dual, 391

437

438

OLD-TIME MAKERS OF MEDICINE

Automobile, 415

Aven7x>ar, 80, 123, 130, 132

Averroes (Averrhoes), 80, 123,

132, 230, 267
Avicenna, 80, 128, 170, 266,

268, 331
Avignon, 16, 233

B

Baas, 61, 63

Bachtischua, 56

Bacon, Roger, 107, 306, 356, 361,

403

Bagdad, 110, 111, 115, 134, 135
Barbarians, 5

Bartholomaeus Anglicus, 433
Bartholomew, 172
Basilios, 26
Basil, St., 24
Basila, 180

Basil Valentine, 20, 180, 349
Basra, 111
Bath, 103
Bath, milk, 131; in fever, 172;

of the soul, 25
Baverius, 209

Baynes, Henry Samuel, 390
Bede, 432
Benedict, St., 178
Benedictines, 12, 164
Benedictine Nuns, 191
Beowulf, 428
Berengarius, 209
Bernard of Clairvaux, 192
Bernard, St., 85
Bertruccio, 209, 287
Bertruccius, 229
Binz, Prof. Carl, 338
Birthplace, Latin writers, 4
Black Death, 304
Boccaccio, 183, 306
Body-snatching, 224
Boerhaave, 38
Boethius, 427
Bokhara, 111

Bologna, 16, 142.. 202, 206, 248
Book-learning, 371
Botany, 413; medieval, 414,

418*

Botticelli, 360
Bracton, 419
Brain substance, loss of, 294

Brant, 361

Brethren of the Common Life
344

Bridgework, dental, 315

Broeck, 277

Bronchoceles, 34

Bruno da Longoburgo, 245, 248

Bubonocele, 53

Buffon, 406

Bull, supposed against dissec-
tion, 424

Busche, 344

Bzowski, S. J., 181

Caesalpinus, 2, 209

Caius, 360

Calenda, Constance, 187

Calendar, correction of, 340

Calvo, 302

Cancer, 255

Cantor, 346

Carmoly, 61

Carthage, 165

Cases, desperate, 262

Cassiodorus, 12, 429

Cataract, 300

Cato, 267

Chanina Ben Chania, 66, 69

Charlatans, numbers of, 274

Charters, medical school, 420

Charts, 19

Chasdai Ben Schaprut, 79

Chaucer, 306, 428

Chauliac, 18, 285, 301, 319

Chauliac, bibliography, 308; edi-
tio princeps, 312

Chemical compounds, artificial,
376

Chirurgia Magna, 261, 284

Chirurgy, 19

Chosroes T, 109

Church and Jews, 80; and anat-
omy, 234; and surgery, 234

Cicatrices, beautiful, 255

Cicero, 4, 427

Cid, The, 218, 375, 392

Cimabue, 211

Circulation of the blood, 147

Cities, large, 5

City hospitals, 8; for the sick,
24, 296

INDEX

439

City physician, 251
Clavius, S. J., Father, 340
Classics of Medicine, 165
Clement of Alexandria, 83; VI,

Pope, 83
Cleopatra, 179
Clepsydra, 341
Clinical experience, 378
Clitoris hypertrophy, 37
Clysters, 279
Cnidos, 135
Colic, 279

Collectio Salernitana, 143, 238
College of St. Come, 26
Colpeurynter, 128
Columbus, 2, 209, 327, 329, 359
Conception, 35
Constantine Africanus, 5, 24,

123, 134, 145, 151, 163, 236,

266, 433

Constitution of the sun, 339
Consolations, 428
Consumption, 44
Conrad, 192
Conrad Mutianus, 344
Contrecoup, 240
Convito, 428
Copernicus, 346
Copho, 154, 205
Cordova, 75, 92, 134, 135
Cornelius, 38
Corrosive sublimate, 335
Cos, 135

Cosmas and Damien, 26
Criticism, higher, 7
Crown, dental, 316; cap, 316
Cusanus, 336
Cures of Afflacius, 171
Cuvier, 406
Cycloid curve, 346

Dental appliances, 316; decay,
318; hygiene, 325; surgery,
327; instruments, 320

Dentatores, 320

Dentrifices, 316

Descartes, 133

Desiderius, 145, 164, 168

Deventer, 344

Dezimeres, 302

Diaphoresis, 47

Diarbekir, 28

Didacus Lopez, 130

Diet, 46, 116

Dietetics, 99, 157

Di Liucci, 205

Dinus de Garbo, 130

Diogenes, 267

Dioscorides, 79, 266, 385

Diphtheria, 32

Diseases made incurable, 274;
eye, 300

D'Israeli, 76

Dissecting material, 134 ;
wounds, 227

Dissection, 224; supposed pro-
hibition of, 424

Divine Comedy, 428

Divorce, 5

Djondisabour, 71, 109

Dock (Miss), 401

Dog, rabid, 31

Donolo, 78

Drainage, 241, 249

Dreams, 68

Driesch, 399

Dschibril, 57

Dschordschis, 56

Du Bouley, 199

Duke, Robert, 167

Duns Scotus, 108

Da Lucca, 246

Damascus, 111

Daniel Morley, 134

Dante, 183, 211, 306, 407, 417

Daremberg, 180, 303

Darwin, 355, 399

David, 97

D«cadence, 6

E

Eclecticism, 248

Eclipse, 22

Ecstasis, 386

Eddyites, 385

Edessa, 9

Egidius, 134

Elixir of immortal life, 25

Embryology, 28

De Renzi, 143, 162, 182, 238, 239 Encyclopedia biblica, 430

440

OLD-TIME MAKERS OF MEDICINE

Energy, Conservation of, 417
Epilepsy, 43
Epiplocele, 53
Epiplo-enterocele, 53
Epithelioma, 37
Epulis, 32

Erasistratus, 221, 385
Erasmus, 344, 361
Esophagus, 33
Ethics, medical, 77
Ethnography, 414
Etruscans, 315
Eusebius, 26
Eustachius, 2, 209
Eustachian canal, 327, 329
Examinations, 136
Experience, 403
Experiment, master of, 404

F

Fabiola, 11

Fabricius de Acquapendente,

125

Fallopius, 302, 327
Farad j Ben Salim, 79, 170
Faragut, 79

Father of Modern Surgery, 283
Faucon, 312
Feminine education, 178, 188;

cycles of, 200
Ferrara, 248, 328
Festus, 428

Filling of the teeth, 335
Finsen, 421
First intention, 18
Fish bones, 51
Florence, 206, 248
Floyer, 336

Forefathers in medicine, 380
Foreign body, 33
Foreign bodies, 48
Forli, 206

Foster, Sir Michael, 354
Foundlings, 8
Foundling asylums, 25
Founder of Pharmaceutical

Chemistry, 353
Four Masters, 154, 238, 242, 243,

273
Fractures, 240; of pubic arch,

128; of base, 242; of skull,

244; split or crack, 243

Francis, Dr. Samuel, 223
Frederick I, 192; II, 147
Freind, 112, 302
Friedenwald, 64
Friuli, 206

G

Gaddesden, 287

Galeatus de Sancta Sophia,

130

Galileo, 355
Galen, 3, 13, 35, 43, 73, 91,

115, 117, 129, 179, 266, 230,

204, 430, 385
Galenists, 120
Galvani, 166, 209
Gario Pontus, 43
Gentilis de Fulgineis, 130
Geography, physical, 413
Geometric transmutation, 340
Gerard of Cremona, 134, 170
Ghetto, 62
Giffert, Prof., 396
Gilbert, 421

Giliani, Alessandra, 188
Gilles de Corbeil, 134, 150
Giotto, 211, 306
Giovanni of Arcoli, 313, 324,

328

Glands, cervical, 259
Goitre, 33, 151; cystic, 259
Gold reserve, 316
Gordon, Bernard, 276, 286
Graduate, 208
Gracisms, 237
Granada, 75
Gratz College, 75
Gravity, specific, 342
Greeks, From the, to Darwin,

406
Gregory IX, 83; of Nazianzen,

24

Gruel, 131
Guadalquivir, 93
Guerini, 315
Guimarus II, 143
Guiscard, 145
Gurlt, 29, 48, 109, 139, 156, 219,

236, 239, 244, 248, 259, 312,

329, 331
Guy de Chauliac, 16, 208, 229,

270, 275, 232, 422

INDEX

441

Haeser, 61

Haliography, 376

Hallam, 85

Hamilton, Sir Wm., 407

Harnack, 25, 26, 382, 392

Haroun al-Raschid, 74

Harvey, 166, 209, 355

Harun al-Raschid, 56, 112

Headache, 42

Hegel, 407

Hegira, 170

Hegius, 345, 361

Heidelberg, 345

Helena, 24

Helofee, 189

Hemicrania, 42

Hemoptyses, 45

Heraclius, 54

Hermondaville, 264

Hernia, 298; radical cure of, 299

Herophilus, 221, 384

Hierakas, 26

Hildegarde, 190

Hippocrates, 13, 91, 99, 117, 266,
385, 429

" Histoire des Femraes Medecins,"
195

Historia Tripartita, 429

History of the Inductive Sci-
ences, 410

Hobart, 393

Hobei'sch, 58

Hollanduses, 358

Homer, 375, 391

Honein Ben Ischak, 57

Honein Ben Ishac, 117

Honey, 103

Horse Lucana?, 390

Horace, 267

Hortus Deliciarum, 191

Hospitals, 8

Hospitals for children, 25

Hroswitha, 190

Hugh of Lucca, 257

Hugo of Lucca, 245, 267, 273

Humboldt, 412

Huxley, 150, 307, 412

Hydrocephalus, 257

Hydropikos, 385

Hydrophobia, 435

Hysteria, 54

Ibn Sina, 128

Ibn Zeinel-Taberi, 115

Ibn-Zohr, 130

Ignorance, on learned, 340;

grounds of, 409
Ignorantia, De Docta, 339
Iliac passion, 279
Iliad, 375
Illustrations, 230; dental, 331;

first medical, 275
Incunabula, 311, 329
Infection, 241
Innocent III, 83; IV, 83
Insanity, 434
Inspection, 47

Invasion of the barbarians, 26
Isaac Ben Amram, 76
Isaac Ben Emram, 73
Isaac Ben Soliman, 76
Isaac Judseus, 170, 173
Isagoge, 58
Ishac Ben Honein, 58
Isidore of Seville, St., 113, 431
Israels, A. H., 66
Israeli, 76

Jacobus de Forlivio, 130

Jacobus de Partibus, 130

Jewish physicians, 7

Johannes Afflacius, 171

Johannesbrod, 102

Johannitius, 57

John Chrysostom, St., 11, 181

John de Vigo, 209

John Masu6e, 74

John of Arcoli, 18, 209

John of Gaddesden, 286

Josephus, 29

Joshua Ben Nun, 74

Jude Sabatai, 78

Julian the Apostate, 8, 23

Justinian, 26, 28

Kant, 407
Kerckringius, 366
Kircher, 366

442

OLD-TIME MAKERS OF MEDICINE

Koran, 106, 139
Kostaben Luka, 58
Kuhns, 418

Lactantius, 27

Lancisi, 209

Landau, 67

Lane Lectures, 354

Lanfranc, 16, 209, 245, 260, 267

Laurentian Library, 180

Lead pipe, 239

Leo, 55

Leonardo da Vinci, 360

Leonides, 36

Leoparda, 181

Lewes, 406

Libraries, 6

Life, intellectual, 5

Ligatures, 155; around the

limbs, 54

Lilium Medicinae, 158
Lrhacre, 209, 360
Lipinska, Dr. Melanie, 195
Livy, 4
Lopez, 82
Love, 373

Lowell, Russell, 371
Lucan, 4, 94, 113
Lucca, 248
Lucretius, 395
Ludwig's angina, 332
Luke, St., 7; the physican, 8;

supposed inaccuracies, 397
Lupus, 256

M

Machine, Flying, 416

Madness, 434

Magna Grsecia, 15, 156, 177

Magnet, 269

Magnetism, 404

Mahmoud, 75

Maimonides, 12, 88, 90; rules

of life, 100
Malcorona, 182
Malgaigne, 118, 303, 306
Malpighi, 209
Malta, 97
Man, 95

Mandeville, 264

Mania, 44

Manipulation, surgical, 250

Mantua, 4

Marsupium cordis, 15

Martial, 4, 113, 181

Maser Djawah, 72

Matter and form, 351, 417

Matter, indestructibility of, 416

Matthseus de Gradibus, 130

Matthew Platearius, 134

Mediastinum, 137

Medica, 181

Medical, first illustrations, 275

Medicine, legal, 252; New York

Academy of, 223
Melancholia, 44
Mengenberger, 276
Meningitis, 43
Mental influence, 44
"Merchant of Venice, The," 82
Mercuriade, 186
Mesmer, 105
Meteors, 414
Metrodora, 180
Metrorrhagia, 54
Meyer, 413
Michael Angelo, 360
Michael Scot, 134
Microtechnics, 171
Middle meningeal artery, 37
Middleton, 246
Migne, 194
Milan, 206

Milk, bath, 131; cure, 45
Milman, 84

Ministry of Christ, 390
Miscellany, 124
Modena, 248
Mohammed, 13
Monasteries, 6
Mondeville, 207, 209, 231, 264,

298, 422
Mondino, 202, 209, 245; career,

232; myth, 216
Monks' bane, 364
Montaigne, 374
Monte Cassino, 12, 145, 163, 168,

433

Montpellier. 11, 16, 87, 265
Morgagni, 91, 209
Moses, 64
Moses Ben Maimum, 91

INDEX

443

N

Nain, widow of, 389

Naples, 248

Nature, 47, 77, 378; in Dante,

418

Neander, 84
Needleholder, 295
Nemesius, 9
Nerve suture, 253, 202
Nestor ian, 73, 109
Newton, 351, 355
Nibelungen, 218
Nibelungenlied, 375, 392
Nicaise, 198, 208, 265, 286, 292,

302, 309
Nicerata, 181

Nicholas of Cusa, 19, 337, 344
Nicolaus, Leonicenus, 130
Nobel Prize, 421
Noli me tangere, 256
Nosology, 159
Notker Teutonicus, 428
Novelties, medical, 166
Nuremberg eggs, 337
Nursing, 271; history of, 401
Nutrition per rectum, 130
Nutting, 401

Observations, 282, 293, 378
Octavius Horatianus, 180
Odyssey, 375
Oil and wine, 387
Old Testament, 63
Omar, 110
Omentum, 250
Operation for hernia, 52
Ophthalmology, 258
Opotherapy, 68
Oppler, 100
Opus Majus, 409
Opus Tertium, 409
Ordericus Vitalis, 182
Organization of medical educa-
tion, 141

Oribasius, 8, 38, 117
Origenia, 180
Orthodontia, 318
Osborn, 406
Osier, 257

Ossian, 375
Ovid, 267
Oxygen, 49

Padua, 4, 16, 232, 248, 328, 345
Pagel, 61, 111, 119, 152, 156,

157, 172, 208, 216, 245, 264,

277, 286, 230
Palmyra, 109
Palpation, 47

Pandects, 38; of Haroun, 72
Paracelsus, 2, 254, 379
Paracentesis, 122, 365
Paradiso, 215
Par6, Ambroise, 254, 303
Paris, 141
Paris, Paulin, 310
Passavant, Jean de, 260
Passow, 386
Pasquier, 200
Paul of ^Egina, 10, 50, 117, 122,

125, 317, 331
Paulus yEginetus, 29, 38
Pavia, 248
Percussion, 19
Peregrinus, 404
Pergamos, 135, 385
Perineum, torn, 184
Persecutions, Christian, 4; of

Jews, 83
Persius, 4
Perugia, 248
Perugino, 360
Peter of Spain, 300
Petrarch, 306
Petrus de Argentaria, 290
Phagedenic ulcer, 35
Pharmacy, 207
Pharmacologist, 354
Phenicia, 314
Philip Augustus, 150
Philosopher's stone, 369, 412
Philosopher's keys, 376
Phrenitis, 43

Physicians and surgery, 267
Physiology, history of, 354, 414
Piacenza, 16, 232, 248
Pilcher, Dr. Lewis, 215, 216,

219, 229

Pinturicchio, 360
Pisa, 16, 248

444

OLD-TIME MAKERS OF MEDICINE

Pitard, Jean, 265, 269

Plagiarism, medieval, 174

Plague, 305

Platearius I, 183

Plato, 267, 292

Pleurisy, 45

Pliny, 4, 113

Polyps, 31, 118, 258, 330; nasal,
126, 258

Pool, 93

Pope Boniface VIII, 288

Pope Clement VI, 300

Pope Innocent VI, 300

Pope John XXI, 300, 357

Pope Urban V, 300

Popes and Jews, 80; and sci-
ence, 148

Popular Science Monthly, 400

Porphyry, 428

Portal, 304

Portio vaginalis hypertrophy, 37

Pouchet, 431

Practice, medical, 15

Preface, 230

Priscian, 180

Probe, 280

Professional spirit, 141

Professione Medicorum, 181

Prohibition of chemistry, 424

Prophylaxis, 47; perineal, 185

Prudentius, 113

Pseudo-philology, 364

Psycho-analysis, 68

Ptolemy, 73, 384

"Puch der Natur," 275

Pulse, 19, 160

Pure Drug Law, 420

Puschraann, 41, 61, 144, 150

Pus, unnecessary, 255

Q

Quackery, 273
Quacks, 371
Quadrivium, 149
Quintilian, 4, 113

R

Rab, 69

Rabbi Ishmael, 66
Rabies, 30; diagnosis of, 263,
435; treatment, 262

Radio-active elements, 350

Radio-activity, 399

Radium, 350

Ragenifrid, 144

Ramsay, Sir William, 394, 417

Raphael, 360

Rebecca Guarna, 186

Reggio, 248

Regimen Sanitatis, 158

Regiomontanus, 360

Religion of healing, 25

Religious scruples, 224

Renaissance, 20, 142

Renan, 132, 314

Respiration rate, 342

Reuchlin, 361

Reynaud, M. Jean, 375

Rhazes, 59, 114, 170, 266, 323,

331; aphorisms, 116
Richard Coeur de Lion, 98
Richard the Englishman, 276
Rima glottidis, 23
Robinson, Dr. Nathaniel, 390
Rodent ulcer, 35
Rogero, 237
Roland, 273
Rolando, 154, 238, 242
Romanes, 405

Roman Empire decadent, 5
Roman patronage, 2
Roman persecutions, 26
Rome, 248
Romoaldus, 134
Rosa Anglice, 287
Roth, 288
Rudolph, 82
Ruggero, 237
Ruggiero, 146
Rules of life, 100
Rupertsberg, 192
Rutebeuf, 183

S

St. Benedict, 191

St. Brigid, 179

St. Dominic, 215

St. Gall, 433

St. Luke, 381, 382

St. Patrick, 179

St. Peter's Epistle, 398

St. Thomas of Aquin, 352

INDEX

445

Saintsbury, 402

Sacrament. 164

Saladin, 90

Salerno, 11, 13, 78, 141, 236,

273

Salicet, 209, 247
Salvation, 25
Samarcand, 111
Sanctions of belief, 105
Sanitary science, 64
Santa Sophia, 10, 40
Saracenus, 171
Saragossa, 75
Scholarship, 136
Scholastica, 178, 191
Science, biological, 413; popular

medieval, 425; medieval, 400
Scientia Experimentalis, 410
Scotus, 134

Scribonius Largus, 180
Scrobiculus cordis, 137
Sea sponge, 151
Semiotics, 159
Seneca, 4, 94, 113, 267
Serapion, 170
Servetus, 2
Seville, 75
Shakespeare, 82
Shawdepisse, 280
Shower bath, 172
Sidon, 314
Sienna, 248
Sighart, 413
Signorelli, 360
Silver Age, 13, 113
Sintheim, 344
Small-pox, 119
Snake bites, 263
Snare, 126
Socrates, 292, 429
Solomon, 98
Sozomen, 429
Spagyrist, 369
Spallanzani, 209
Spanish peninsula, 4
Speculum, 331
Sphudron, 386
Sprengel, 77
Standards of medical education,

420

Static experiments, 340
Steno, 366
Studia generalia, 203

Studies, post-graduate, 283

Superstitions, 21

Surgeon, as teacher, 261 ; qual-
ities of, 261, 305; good, 268;
perfect, 268; training of, 267

Surgery, aseptic, 245; antisep-
tic, 255; dishonor of, 424;
epoch of, 281; Genito-urinary,
126, 234; history of, 273;
of the mind, 270; quality of,
305; union in, 249, 260

Surgical, meddlesomeness, 300 ;
nursing, 271

Sydenham, 91

Sylvester II, 134

Sylvius, 2

Symmachus, 428

Synanche, 332

Taddeo Alderotti, 212, 215, 232

Talmud, 11, 63, 65, 94

Tarsus, 135

Tartar, 321

Tattooing, 31

Taxes, 298

Technique, Surgical, 125

Teleology, 27, 95

Tell's apple, 364

Tenaculum, 258, 330

Terence, 4, 190

Tertullian, 27

Testament, Old, 11

Thaddseus Florentinus, 130

Thecla, 180

Theodoret, 27

Theodoric, 245, 252, 267, 273,
429

Theodosia, 10, 181

Theodotos, 26

"Theology and Science," 419

Theophilus, 54, 55

"Thirteenth Greatest of Centu-
ries," 433

Thomas Cantimprato, 433

Thompson, 358

Thorax, 295

Thymol, 50

Titian, 360

Toledo, 75, 170

Tonnerre Hospital, 296

446

OLD-TIME MAKERS OF MEDICINE

Tonsils, 29

Tooth powder, 321; replacement

of, 322

Tornamira, 312
Toscanelli, 360
Toulouse, 286
Tours, 433

U

Ugo da Lucca, 251, 295

Ugo Senesis, 130

Ulcer, eroding, 256

Union by first intention, 254

Universitas, 203

Universities, ecclesiastical, 210;

medieval, 411
University of Bologna, 142; of

Paris, 887, 142, 199; of

Salerno, 142

University man, typical, 307
Urine, 19

Urination, difficulty of, 334
Uvula, 118, 259, 332; removal

of, 333

Valentine, 20, 349; bibliogra-
phy, 376

Valesco de Taranta, 312

Van Helmont, 365

Varices, 34

Varicose veins, 127

Varignana, 130

Varolius, 2, 209, 327

Vasari, 360

Velum Palati, 137

Venerable Bede, 432

Venesection, 104

Vercelli, 248

Verneuil, 303

Verney, Francis, 311

Verona, 248

Vesalius, 2, 120, 204, 209, 233,
289, 327

Vicenza, 16, 232, 248

Victoria, 180

Vigo, John De, 334

Villani, 313

Vincent of Beauvais, 433

Virchow, 297

Virgil, 4

Vitality, natural, 116

Volta, 209

Von Leyden, 336

W

" Warfare of Science and Reli-
gion," 434

Washington's hatchet, 364

Water clock, 341

Water in the ear, 48

Watering places, 47

Wenceslaus, Emperor, 424

Whewell, 410

White, Pres., 424

Wine for wounds, 187

William of Auvergne, 108

W'illiam of Briscia, 268

William of Salicet, 245, 256,
267

William the Conqueror, 145

Wimpheling, 361

Wives as nurses, 272

Women professors, 15

Women physicians, 177, 179

Wood hound, 435

Wounds, penetrating, 250; ad-
hesion, 253; gunshot, 334; of
intestines, 250; wine and oil,
387

Wurtz, 254

Yahia Ben Masoviah, 74
Yard, 280
Yperman, 276
Ypres, 276

Zedkias, 78
Zenobia, 109
Zoology, 418

Other Books by Dr. Walsh

FORDHAM UNIVERSITY PRESS SERIES

MAKERS OF MODERN MEDICINE— A series of Biogra-
phies of the men to whom we owe the important advances in
the development of modern medicine. By James J. Walsh,
M. D., Ph. D., LL. D., Dean and Professor of the History of Medi-
cine at Fordham University School of Medicine, N. Y. Second
Edition, 1909. 362 pp. Price, $2.00 net.

The London Lancet said : " The list is well chosen, and we have to
express gratitude for so convenient and agreeable a collection of
biographies, for which we might otherwise have to search through
many scattered books. The sketches are pleasantly written, inter-
esting, and well adapted to convey the thoughtful members of our
profession just the amount of historical knowledge that they would
wish to obtain. We hope that the book will find many readers."

The New York Times: "The book is intended primarily for stu-
dents of medicine, but laymen will find it not a little interesting."

// Morgagni (Italy) : "Professor Walsh narrates important lives
in modern medicine with an easy style that makes his book delight-
ful reading. It certainly will give the young physician an excellent
idea of who made our modern medicine."

The Lamp: "This exceptionally interesting book is from the prac-
ticed hand of Dr. James J. Walsh. It is a suggestive thought that
all of the great specialists portrayed were God-fearing men, men
of faith, far removed from the shallow materialism that frequently
flaunts itself as inherently worthy of extra consideration for its
own sake."

The Church Standard (Protestant Episcopal) : " There is perhaps
no profession in which the lives of its leaders would make more
fascinating reading than that of medicine, and Dr. Walsh by his
clever style and sympathetic treatment by no means mars the interest
which we might thus expect."

The New York Medical Journal: "We welcome works of this
kind ; they are evidence of the growth of culture within the medical
profession, which betokens that the time has come when our teachers
have the leisure to look backward to what has been accomplished."

Science: "The sketches are extremely entertaining and useful.
Perhaps the most striking thing is that every one of the men de-
scribed was of the Catholic faith, and the dominant idea is that great
scientific work is not incompatible with devout adherence to the
tenets of the Catholic religion."

THE POPES AND SCIENCE— The story of the Papal Rela-
tions to Science from the Middle Ages down to the Nineteenth
Century. By James J. Walsh, M. D Ph. D., LL. D. 440 pp.
Price, $2.00 net.

PROF. PAGEL, Professor of History at the University of Berlin:
" This book represents the most serious contribution to the history
of medicine that has ever come out of America."

SIR CLIFFORD ALLBUTT, Regius Professor of Physic at the Uni-
versity of Cambridge (England) : "The book as a whole is a fair
as well as a scholarly argument."

The Evening Post (New York) says: "However strong the
reader's prejudice * * * * he cannot lay down Prof. Walsh's volume
without at least conceding that the author has driven his pen hard
and deep into the ' academic superstition ' about Papal Opposition to
science." In a previous issue it had said : " We venture to prophesy
that all who swear by Dr. Andrew D. White's History of the War-
fare of Science with Theology in Christendom will find their hands
full, if they attempt to answer Dr. James J. Walsh's The Popes
and Science."

The Literary Digest said : " The book is well worth reading for
its extensive learning and the vigor of its style."

The Southern Messenger says : " Books like this make it clear
that it is ignorance alone that makes people, even supposedly edu-
cated people, still cling to the old calumnies."

The Nation (New York) says: "The learned Fordham Physician
has at command an enormous mass of facts, and he orders them
with logic, force and literary ease. Prof. Walsh convicts his oppo-
nents of hasty generalizing if not anti-clerical zeal."

The Pittsburg Post says : " With the fair attitude of mind and in-
fluenced only by the student's desire to procure knowledge, this
book becomes at once something to fascinate. On every page
authoritative facts confute the stereotyped statement of the purely
theological publications."

PROF. WELCH, of Johns Hopkins, quoting Martial, said : " It is
pleasant indeed to drink at the living fountain-heads of knowledge
after previously having had only the stagnant pools of second-hand
authority."

PROF. PIERSOL, Professor of Anatomy at the University of Penn-
sylvania, said : " I have been reading the book with the keenest
interest, for it indeed presents many subjects in what to me at least
is a new light. Every man of science looks to the beacon — truth —
as his guiding mark, and every opportunity to replace even time-
honored misconceptions by what is really the truth must be wel-
comed."

The Independent (New York) said: "Dr. Walsh's books should
be read in connection with attacks upon the Popes in the matter of
science by those who want to get both sides."

MAKERS OF ELECTRICITY — By Brother Potamian,
F. C. 8., Sc. D. (London), Professor of Physics in Manhattan
College, and James J. Walsh, M. D., Ph. D., Litt. D., Dean and
Professor of the History of Medicine and of Nervous Diseases
at Fordham University School of Medicine, New York. Ford-
ham University Press, 110 West 74th Street. Illustrated.
Price, $2.0O net. Postage, 15 cents extra.

The Scientific American: "One will find in this book very good
sketches of the lives of the great pioneers in Electricity, with a
clear presentation of how it was that these men came to make their
fundamental experiments, and how we now reach conclusions in
Science that would have been impossible until their work of reveal-
ing was done. The biographies are those of Peregrinus, Columbus,
Norman and Gilbert, Franklin and some contemporaries, Galvini,
Volta, Coulomb, Oersted, Ampere, Ohm, Faraday, Clerk Maxwell,
and Kelvin."

The Boston Globe: " The book is of surpassing interest."

The New York Sun: "The researches of Brother Potamian
among the pioneers in antiquity and the Middle Ages are perhaps
more interesting than Dr. Walsh's admirable summaries of the
accomplishment of the heroes of modern science. The book tes-
tifies to the excellence of Catholic scholarship."

The Evening Post: " It is a matter of importance that the work
and lives of men like Gilbert, Franklin, Galvini, Volta, Ampere and
others should be made known to the students of Electricity, and this
office has been well fulfilled by the present authors. The book is no
mere compilation, but brings out many interesting and obscure facts,
especially about the earlier men."

The Philadelphia Record: " It is a glance at the whole field of
Electricity by men who are noted for the thoroughness of their re-
search, and it should be made accessible to every reader capable of
taking a serious interest in the wonderful phenomena of nature."

Electrical World: "Aside from the intrinsic interest of its mat-
ter, the book is delightful to read owing to the graceful literary
style common to both authors. One not having the slightest ac-
quaintance with electrical science will find the book of absorbing
interest as treating in a human way and with literary art the life
work of some of the greatest men of modern times; and, moreover,
in the course of his reading he will incidentally obtain a sound
knowledge of the main principles upon which almost all present-
day electrical development is based. It is a shining example of how
science can be popularized without the slightest twisting of facts or
distortion of perspective. Electrical readers will find the book also
a scholarly treatise on the evolution of electrical science, and a
most refreshing change from the ' engineering English ' of the
typical technical writer."

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