The Popes and Science / The History of the Papal Relations to Science During the Middle Ages and Down to Our Own Time

by James J. Walsh

PAPAL PHYSICIANS.

Most of what historical writers generally, who follow the old traditions of the medieval eclipse of medicine, have to say with regard to the supposed Papal opposition to the development of medical science, is founded on the assumption that men who believed in miracles and in the efficacy of prayer for the relief of disease could not possibly be interested to any serious degree in scientific medicine. As Dr. White says, "out of all these inquiries came inevitably that question whose logical answer was especially injurious to the development of medical science: why should men seek to build up scientific medicine and surgery, when relics, pilgrimages, and sacred observances, according to an overwhelming mass of concurrent testimony, have cured and are curing hosts of sick folk in all parts of Europe." He goes even farther than this, however, when he suggests that "it would be expecting too much from human nature to imagine that Pontiffs who derived large revenues from the sale of the Agnus Dei, or priests who derived both wealth and honors from cures wrought at shrines under their care, or lay dignitaries who had invested heavily in relics, should favor the development of any science which undermined their interests."

On the strength of assumptions such as these, that "medieval belief in miracles of healing must have checked medical science," and that therefore it did actually prevent the development of scientific medicine, statements are made with regard to the history of [{200}] medicine that are utterly at variance with the plain facts of history. Once more, as in the case of the supposed failure of surgery to develop during the Middle Ages, it is a deduction that has been made from certain supposed principles, and not an induction from the actual facts as we know them. Such historians would be the first to emphasize the narrowness of the schoolmen for their supposed dependence on deduction, but what they have to say on medical history is entirely deductive, and unfortunately from premises that will not stand in the presence of the story of the wonderful rise and development of medical science and medical education, mainly under the patronage of ecclesiastics, in the Middle Ages.

The argument may be stated formally with perfect fairness as follows: When men believe in miracles they cannot build up scientific medicine and surgery; but men believed in miracles in the Middle Ages, therefore they did not build up scientific medicine and surgery. When stated thus baldly in formal scholastic form, the argument loses most of the glamor that has been thrown around it. This is one of the advantages of the old scholastic method--it strips argument to its naked significance. Logic asserts herself and rhetoric loses its force.

With regard to the major premise that when men believe in miracles they will not successfully pursue investigations in the medical science, there are two answers. One of these concerns the actual attitude of mind towards scientific medicine of men who believe in miracles, for we have such men still with us, and have always had them all during the past seven centuries. The other portion of the answer concerns what men who were distinguished scientific investigators thought of [{201}] miracles, and how much they accomplished for the medical sciences while all the time maintaining their belief in the possibility of miraculous intervention for the cure of disease.

Apparently the writers who insist on the incompatibility of the belief in miracles with devotion to scientific medicine do not realize that the greater number of thinking physicians during the last seven centuries, and quite down to our own day, have been ready to confess their belief in the possibility of miraculous healing, yet have tried to do everything in their power to relieve suffering and cure human ills by the natural means at their command. Their attitude has been very much that attributed to Ignatius of Loyola, who said to the members of his order: "Do everything that you can with the idea that everything depends on you, and then hope for results just as if everything depended on God." There is no lack of logic in this; and the physician of the present day who realizes his impotency in the presence of so many of the serious ailments of mankind is not a scoffer at the attitude of mind that looks for help from prayer; but if he is sensible, welcomes the placidity of mind this will give his patient, even if he does not, as many actually do, however, believe in the possible interposition of supernatural forces.

If Prof. White knew anything about the lives of the men whose names are most distinguished in the history of medicine during the thirteenth, fourteenth and fifteenth centuries, we would have heard nothing of his almost incomprehensible negation of the existence of scientific medicine, during centuries when so many men who have stamped their names indelibly on the history of the medical sciences were doing their work and [{202}] writing. If he had taken any pains to learn even a few details of the personal relations of these old-time makers of medicine to the Popes, we would have heard none of this utter absurdity of Papal opposition to medicine or ecclesiastical hampering of medical science. To answer Prof. White's argument, that "it would be expecting too much from human nature to imagine that Pontiffs should favor the development of any science which undermined their interests," the simple story of the men the Popes choose as their own medical advisers, and who because of the prestige of their appointment as Papal Physicians helped to raise up in the eyes of the people the dignity of the medical profession which they represented, will be quite enough. It will also serve to show how different is history founded on an assumption from history founded on actual facts.

The best, most easily obtainable, and most impressive data for the inductive method of reaching the truth as regards the relation of the Popes to medical science and (because of the fact that physicians were the scientists par excellence of the Middle Ages) to all science, will be found in a brief consideration of the lives of the men who occupied the position of Papal Physician during the last seven centuries. I do not think that this group of men has ever been treated together before; at least I have been unable to find any work on the subject. While I am able to present a considerable amount of interesting material in brief form with regard to them, I am sure that there are many of them whom I have omitted. Practically up to the day of going to press I have been finding new references that led to further precious information with regard to this most wonderful group of men in medical history. It will be well [{203}] understood, then, that impressive as the consideration of the work and character of the men whose names I have found must be, this does not represent all the truth in the matter, but can be supplemented without much difficulty from other sources.

If the Popes had been interested only in the miraculous healing of disease, and had wished to teach the lesson that men should depend solely for their recovery from serious symptoms and ailments of all kinds on prayers and relics and pilgrimages, then they would either have had no physicians at all in regular attendance on them, or at least their physicians would not have been selected from among the men who were doing most to advance the cause of practical and scientific medicine and of medical education. The very opposite of this is the case. The Papal physicians were as a rule the most scientific medical men of their time. This is not a pious exaggeration, but is literally true for seven centuries of history, as we shall see presently. The wonder of it is that there were not some charlatans among them. The physicians whom educated people select are not, as physicians we'll know, always worthy examples of progressive medical men. Literary folk particularly seem to have a distinct tendency to want to be different from other people, and their physicians are often the veriest theorizers. A medical friend who occasionally quotes, but perverts the old line, "the people people have for friends are often very queer," says, half in jest of course, but alas! more than half in earnest, that "the people literary folk and the clergy have for doctors are the queerest ducks (docs.) of all."

It is only too true that clergymen are especially prone to be erratic in the choice of their medical advisers and [{204}] lacking in a critical judgment as to the remedies and methods of treatment of which they become the willing recipients, and occasionally even the sponsors as regards other people, who look up to their judgment for other reasons with confidence. Prof. Osler once said that the nearer to the Council of Trent the clergyman, the nearer he was likely to be to truth and common sense in medical matters; but then perhaps all would not agree with him. It is all the more surprising under the circumstances, and very greatly to their credit, that the Popes should have had as their physicians a list of men whose names are the brightest on the roll of great contributors to medical literature and some of the most distinguished among the great discoverers in medical science.

This fact alone constitutes the most absolute contradiction of the declarations as to supposed Church opposition to medicine that could possibly be given. No better means of encouraging, fostering, and patronizing medical science could be thought of than to give the prestige and the emoluments of physician to the head of the Church to important makers of medicine in every generation. The physicians to the rulers of Europe have not always been selected with as good judgment, and, as I have already said, there is no list of physicians to any European Court, nor indeed any list of names of medical men connected together by any bond in history--no list, for instance, of any medical faculty of a university--which can be compared for prestige in scientific medicine with the Papal Physicians.

Before the beginning of the thirteenth century very little is known of the medical attendants of the Popes. We point out in the following chapter that the Papacy was closely in touch with the medical school at Salernum. [{205}] It seems not unlikely, and indeed there are some traditions to that effect, that in cases of severe illnesses of the Popes, important members of the medical faculty were sometimes summoned from the South of Italy to Rome. The relations of the Popes to the neighboring abbey of Monte Cassino might, as we have said, suggest this. We have, however, very few details in this matter. With the beginning of the great thirteenth century, however, the records of human achievement in every line are better kept, and at once we begin to know something definite about Papal Physicians. The first one of decided prominence was Guy or Guido of Montpelier, who was summoned to Rome by Pope Innocent III. in order that he might re-establish the hospital of the Santo Spirito at Rome, in accordance with what were considered to be the latest ideas in the matter of hospital building and the enlightened care of the sick. How well he accomplished this work, and how well he deserves to head the glorious roll of Papal Physicians, will be seen in the chapter on The Popes and City Hospitals.

The next of the Papal Physicians of whom much is known in the history of medicine was Richard the Englishman, usually spoken of as Ricardus Anglicus. He was the physician to the famous Pope Gregory IX. (1237-1241). Richard, who was born in England not long before the beginning of the thirteenth century, died shortly after the middle of that century. For a time he was at Paris, and accordingly is sometimes spoken of as Ricardus Parisiensis. According to Gabriel Naudé he was at Paris after the death of his patient, Gregory IX., and towards the end of his life retired to the Abbey of St. Victor, to spend his last days in recollection and prayer. In this he anticipated another great English physician [{206}] with a European reputation--Linacre--who, three centuries later, after having been the royal physician for many years to King Henry VIII., became a clergyman. It is interesting to realize that, early in history as Richard's life occurs, some works attributed to him contain definite information with regard to anatomy. Most of this, it is true, is taken from Hippocrates, Galen, and the Arabs, but some of it seems to be the result of his own personal experience, on the living, if not on the dead.

After Richard, the next of the physicians to the Popes who has an important place in the history of medicine is the famous Thaddeus Alderotti, who lived for more than eighty years during the thirteenth century. He has the added interest for this generation of having been a self-made man, for he was the son of very poor parents of the lowest rank. Up to his thirtieth year he remained without any special education. He made his living, it is said, by selling candles. Having acquired a little competency, at the age of thirty he began with great zeal the study of philosophy and of medicine, two sciences which in the old days were supposed to go very well together, though, unfortunately, they are often rigidly separated from each other in later times. Fifteen years after he began the study of medicine we hear of him as a medical teacher, and then ten years later he began to be famous as a writer on all sorts of medical topics. He became the physician of Pope Honorius IV., himself one of the most liberal and broadly educated of men, and as the result of the confidence awakened by his occupancy of this honorable position, he secured an immense success in practice and made an enormous fortune. Alderotti's work represents what is best in medicine for the whole of the thirteenth century.

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A curiously interesting episode that deserves a place in the history of Papal Physicians occurred during Alderotti's life. One of the Popes elected to fill the Papal chair had been earlier in life a physician. This was the famous Peter of Spain, though he was really a Portuguese, who, under the name of John XXI., occupied the Papal throne during the years 1276-1277. Peter of Spain had been one of the most distinguished natural scientists of this interesting century. Dr. J. B. Petella, in an article published in Janus about ten years ago, entitled A Critical and Historical Study of the Knowledge of Ophthalmology of a Philosopher Physician who became Pope, gives an excellent account of the life of Pope John XXI. [Footnote 27]

[Footnote 27: Janus, Archives International es pour l'histoire de la Medicine et pour la Geographie Medicale, paraissant tous les deux mois. Amsterdam, 1897-1898.]

Petella does not hesitate to say of him that he was "one of the most renowned personages of Europe during the thirteenth century, from the point of view of the triple evolution of his extraordinary mind, which caused him to make his mark in the physical sciences, in the metaphysical sciences, and in the religious world. In him there was an incarnation of the savant of the time, and he must be considered the most perfect encyclopedist of the Middle Ages in their first renascence."

Anyone who reads Dr. Petella's account of this book by Pope John XXI. will be surprised at how much was known about diseases of the eye at the middle of the thirteenth century. For instance, hardening of the eye is spoken of as a very serious affection, so that there seems to be no doubt that the condition now known as glaucoma was recognized and its bad prognosis appreciated. His account of the external anatomy of the eye, eight coats of which he describes, beginning with the [{208}] conjunctiva and ending with the retina, is quite complete. The eye is said to have eight muscles, the levator of the upper eyelid and the sphincter muscle of the eye being counted among them. The other muscles are picturesquely described as reins, that is, guiding ribbons for the eye. Cataract is described as water descending into the eye, and two forms of it are distinguished--one traumatic, due to external causes, and the other due to internal causes. Lachrimal fistula is described and its causes discussed. Various forms of blepharitis are touched upon. Many suggestions are made for the treatment of trichiasis. That a man who was as distinguished in medicine as Peter of Spain should have been elected Pope, is the best possible proof that there was no opposition between science and religion during the thirteenth century.

But to return to the Papal Physicians in our original meaning of the term. Alderotti's successor as physician to the Papal Court was scarcely, if any, less distinguished. This was Simon Januensis, the medical attendant to Pope Nicholas IV., whose pontificate lasted from 1288-1292. Simon did much to make the use of opium more scientific than it had been, and he established definite rules for its administration. Before this the anodyne effects of the drug had been well known, but the difficulty had been to regulate its dosage properly and prevent the use of too large quantities, while at the same time securing the administration of sufficient of the drug to relieve pain. At the beginning there was much prejudice with regard to opium. Indeed, as every physician knows, this prejudice has not entirely died out even in our own day. How much of good, then, Simon was able to accomplish because the prestige of his position as [{209}] Papal Physician helped to break down this prejudice, and how much human suffering he saved as a consequence, it is easy to understand.

Simon is best known in the history of medical science as the author of what was probably the first important dictionary of medicine. This was called the Synonyma Medicinae or Clavis Sanationis, the Key of Health. Steinschneider has declared this book to be one of the most important works in the field of Synonymies. Julius Pagel, in his chapter on Therapeutics in the Middle Ages, in Puschmann's Handbook of the History of Medicine, already quoted, says that this Papal Physician succeeded in solving very happily the problem which he set himself, of gathering together the information that had been collected during past centuries with regard to medical words, and especially those relating to the use of various remedial measures. The industry of the writer may be very well appreciated from the fact that his glossary contains some six thousand articles. Its place in the history of science, as given by Meyer, the German historian of botany, is that for the understanding of the older words in natural science, no better aid than this can be found. He considers it the best work of its kind until Caspar Bauhin's similar volume came to replace it, but that was not until well on in the seventeenth century. Simon was greatly encouraged in this work by Popes Nicholas IV. and Boniface VIII., to both of whom he was body physician and at the same time an intimate friend.

The custom of having for medical attendant one of the leading physicians of the day, if not actually the most prominent medical scientist of the time, which had obtained at Rome during the thirteenth century, was maintained at Avignon during the three-quarters of a [{210}] century in which the Papal See had its seat there. Just who the regular medical attendant of Clement V., the first of the Avignon Popes, was is not very sure. When he became seriously ill toward the end of his life, however, Arnold of Villanova, one of the professors of physic at Paris and probably the most distinguished living physician of the time, was summoned in consultation, and began his journey down to Avignon. This summons attracted widespread attention, which was still further emphasized by the fact that Arnold of Villanova died on the journey. It is not difficult to appreciate even at this distance of time how much weight the summoning of a physician from a long distance to attend His Holiness would have on the minds of the people, and how much it would tend to call their attention to the important medical school from which the great man came. People generally, who heard the facts, would want at least to have in attendance on them, if possible, a physician who had been graduated at the school from which Arnold of Villanova was summoned on his important medical mission. How much this would mean for the encouragement of scientific medicine as it was developing at the University of Paris can scarcely be overestimated.

The distinct tendency of the Popes to keep in touch with the best men in medicine and surgery in their time is well illustrated by the case of Guy de Chauliac. This great French surgeon and professor at the University of Montpelier is hailed by the modern medical world as the Father of Modern Surgery. There is no doubt at all of his intensely modern character as a teacher, nor of his enterprise as a progressive surgeon. Few men have done more for advance in medicine, and his name is [{211}] stamped on a number of original ideas that have never been eclipsed in surgery. After studying anatomy very faithfully, especially by means of dissections, in Italy, where he tells us that his master at Bologna, Bertrucci, made a larger number of dissections scarcely more than thirty years after the supposed Papal decree of prohibition, he returned to Montpelier to become the professor of surgery there, and introduced the Italian methods of investigation into the famous old university.

At this time the Popes were at Avignon, not far distant from Montpelier. From them Guy received every encouragement in his scientific work. He insisted that no one could practice surgery with any hope of success unless he devoted himself to careful dissection of the human body. If we were to believe some of the things that have been said with regard to the Popes forbidding dissection, this should have been enough to keep the French surgeon from the favor of the Popes, but it did not. On the contrary, he was the intimate friend and consultant medical attendant of two of the Avignon Popes, and was the chamberlain to one of them. The good influence of Chauliac on the minds of the Popes is reflected in their interest in the medical department of the University of Montpelier. About this time Pope Urban VI. founded the College of Twelve Physicians at Montpelier. He was an alumnus of the university, and had been appealed to to enlarge the opportunities of his Alma Mater. He did so in the manner just related.

One of the Papal Physicians of the Avignon times was unfortunate. This was the ill-fated Cecco di Ascolo, who was distinguished as a poet and a philosopher as well as a physician. But for his sad end, one might be tempted to say, that he had so many irons in the fire [{212}] that it was scarce to be wondered at that he suffered the fate of many another tender of too many irons, and eventually got his fingers burnt. He was body physician of Pope John XXII. during a good part of the long pontificate of that strenuous old man, who became Pope when over seventy, lived to be ninety, yet accomplished important work in every year of his career. After leaving Avignon Cecco went to Italy and became the Professor of Astrology at Bologna. The term astrology had none of the unfortunate or derisory signification that it has at the present time. It was, as the etymology of the word implies, the science of the stars, though it was cultivated with due reference to the influence of these heavenly bodies on human fate and human constitutions. Hence a physician's interest in it. This continued to be a characteristic of astrology down to the time of Tycho-Brahe, the Danish astronomer, at the beginning of the seventeenth century. Cecco and another distinguished physician of the time, Dino de Garbo, became involved in a public controversy, as the result of which Cecco was denounced to the public authorities as undermining the basis of government and virtually teaching anarchy, though it was called heresy, and as a result of the bitter feud he suffered the penalty of death by fire.

The last of the Papal Physicians connected with the Pontifical Court at Avignon was almost as illustrious as any of his predecessors. He was the well-known Joannes de Tornamira, who was the body physician to Gregory XI. until that Pontiff brought the Papal Court back to Rome. Then Tornamira became the chancellor of the University of Montpelier. He wrote an introduction to the study of medicine, meant for the use of students and young physicians, called a Clarificatorium, which, [{213}] according to Puschmann's History of Medicine, was the most used text-book of medicine during the fourteenth and fifteenth centuries. Besides this he wrote a long and important work On Fevers and the Accidents of Fevers, in which he sums up all the medical knowledge of the time on these subjects.

That the policy of the Popes did not change as regards the selection of their physicians on their return from Avignon to Rome, is to be seen from the physician of the Popes whose See was in both places. This was the famous Francis of Siena, who is known best in history as the intimate friend of Petrarch, and who was physician to Pope Gregory XI. and to his successor, Urban VI. He had been a professor of medicine at the University of Pisa, and by special invitation went to fill the same position in the University of the Papal City, and became at the same time the medical adviser of the Popes. His influence on medicine was not very important, but he occupied a very prominent position among the learned men of the time, and his personal prestige did much to add to the dignity of the profession. In our own time, the medical men who have been best known and whose membership in the profession has added greatly to its popular estimation, have at times not been distinguished for great things in medicine. Francis of Siena was such a man, and the fact that he was medical adviser to the Popes at the same time must be counted as an important factor in the evolution of medical dignity.

One of the first writers on medical cases who did not indulge much in theory was Baverius de Baveriis, of Imola, who died about 1480, and who was the physician to Pope Nicholas V. shortly before and after the middle of the fifteenth century. In the light of the fact that a [{214}] recent Papal physician, Dr. Lapponi, has written a book on hypnotism and spiritism, it is interesting to find that his predecessor in the post of Papal Physician four centuries and a half ago, discussed the differential diagnosis of hysteria, catalepsy, epilepsy and syncope. He also discusses certain interesting cases of vertigo due to stomach trouble, and in general anticipates very unexpectedly neurotic conditions that are supposed to have been recognized in medicine much later than his time. Perhaps the most startling thing to be found in his works is his recommendation of iron for chlorosis, which he claimed to have treated with the greatest success by means of this remedy. Of course, there was no idea at the time that chlorosis was due in any sense to a lack of iron in the system, and its value as a therapeutic agent must have come entirely from empiric considerations; but then most of our advances in drug therapeutics have come by no better way.

Another of the distinguished Papal Physicians of the fifteenth century was John of Vigo (1460-1520), who, as Professor Allbutt notes, was attached to the court of the fighting Pontiff, Julius II., and as a consequence saw much of field surgery. His text-book of surgery, printed at Rome in the early part of the sixteenth century, went through an enormous number of editions. No standard surgical treatise had appeared since that of Guy de Chauliac, and Vigo's continued to be the standard for the next full century. He was a shrewd and skilful as well as a learned physician. His surgical acumen deserves to be noted. He recognized that fracture of the inner table of the skull might take place without that of the outer, and made some very practical remarks with regard to gangrene and its causes. He attributed [{215}] gangrene in certain cases to faulty bandaging in fractures, and discussed its origin also as the result of severe cold. He treated syphilis with mercurial inunctions, a practice still followed by the best specialists in this line. His greatest claim to fame, however, is founded on the fact that he was the first to write a surgical treatise on wounds made by firearms.

At this time, during the first half of the sixteenth century, the Papal Medical School begins to assume an importance in the history of medicine which it was to continue to hold for the next two centuries. After the refoundation of the Sapienza by Pope Alexander VI., and its development under Pope Leo X., special care was taken and no expense spared by their successors, to secure the greatest teachers in anatomy in the world for the medical department of the Papal University. At this time all the great physicians were distinguished for their attainments in anatomy, somewhat as in the nineteenth century great physicians obtained their prestige by original work in pathology. The situations in the two centuries had much more in common than the casual reader of history or even the ordinary student of medicine would appreciate. The list of Papal Physicians, then, becomes to a great extent the roll of the professors of anatomy at the Papal University Medical School. The Popes of this period were wise enough in their generation to realize that the men who devoted themselves to original research in increasing the knowledge of the human body, were also those likely to know most about the diseases of the body and their treatment. These scientific anatomists, with the chastening knowledge of the complexity of the human body before them, probably made less claims to power to cure diseases than many an [{216}] enthusiastic therapeutist of the time, who thought, as have representatives of this specialty in every generation, that he has many infallible remedies for the cure of disease, though subsequent generations have not agreed with him.

The true significance of the lives of the men who occupied the post of Papal Physician after this time will be best appreciated from our treatment of them in the chapter on The Papal Medical School. It will be sufficient here simply to recall the names of the distinguished men who, besides being professors in the Papal Medical School, were the medical advisers of the Popes.

The first and most important of the great Renaissance professors of anatomy of the Roman Medical School who were also Papal Physicians was Columbus. He had been Vesalius's assistant at Padua and later his successor. He had lectured also at Bologna. When a special effort was made to give prestige to the University of Pisa, he was tempted by particularly liberal offers to become the professor of anatomy in that city. It was from here, by still more generous patronage, that the Popes obtained him for their medical school. On treating of the Papal Medical School, we shall have more to say of him and his successor in the professorship of anatomy and medicine as well as in the post of Papal Physician, who was the third of the first anatomists of the time--Eustachius. He with Columbus and Vesalius constitute the trinity of great original investigators in anatomy about the middle of the sixteenth century. It is extremely interesting, with the traditions that exist in the matter, to find that the Popes secured two of these great anatomists for their personal physicians as well as for their medical school. The third one, Vesalius, became the body [{217}] physician first to the Emperor Charles V. and then to his son Philip II., whom many would declare to be as Catholic as the Popes themselves in religious tendencies.

After Eustachius came Varolius, whose name is engraved in the history of medicine because the Pons Varolii or bridge of Varolius, an important structure in the brain now often simply called the pons, was named after him. To Varolius we owe one of the earliest detailed descriptions of the anatomy of the brain. He was the Papal Physician to Gregory XIII., who will be remembered as the Pope under whom the reform of the calendar was made by the great Jesuit mathematician and astronomer, Father Clavius. Pope Gregory's enlightened patronage of medicine in the person of Varolius will be better appreciated if we add that he was chosen as Papal Physician when he was not yet thirty years of age, though he had already given abundant evidence of his talent for original investigation in anatomy. He died at the early age of thirty-two, but not until after he had accomplished a life's work sufficient to give him an enduring place in the history of anatomy. After Varolius as Papal Physician came Piccolomini and then Caesalpinus, whom the Italians hail as the discoverer of the circulation of the blood before Harvey, and of whom we shall have much to say in the next chapter. Piccolomini was not as great an original thinker and worker as many of his predecessors and successors, but he was a man whose prestige in medicine was scarcely less than theirs.

That this same liberal patronage of distinguished physicians was continued in the next century may be realized from the fact that Malpighi, the great founder of comparative anatomy, became one of the Papal Physicians. His intimate friend, Borelli, to whom we owe the [{218}] introduction of physics into medicine, had spent some years in Rome, where, having been robbed by his servants, with the consent of the Pope he took up his abode with the Society of the Pious Schools of San Pantaleone. Here he finished his important work De Motu Animalium, in which the principles of mechanics were first definitely introduced into anatomy and physiology. The preface to this book was written by an ecclesiastic, who praises the piety of Borelli during his stay in Rome and chronicles his encouragement by the Popes in his medical work. Malpighi was succeeded as Papal Physician by Tozzi, who is famous for his commentaries on the ancients rather than for original observation, but who was looked upon in his time as one of the most prominent physicians in Italy, and at this period that meant one of the most prominent physicians in the world. At the beginning of the next century, the eighteenth, Lancisi, by many considered the Father of Modern Clinical Medicine, became the Papal Physician.

Among the consultant physicians to the Popes of the eighteenth century, though he never occupied the post of regular medical attendant, was Morgagni. His advice was often sought by a succession of Popes not only with regard to their personal health, but also with regard to the teaching of medicine and other questions of like nature. Virchow has called Morgagni the Father of Modern Pathology, because he was the first to point out, that for a knowledge of disease it is quite as important to know where the disease has been as to try to learn what it has been. All of the Popes, five in number, of the latter part of Morgagni's life were on terms of intimacy with him. Pope Benedict XIV., one of the very great Popes of the century, a native of Bologna, was [{219}] an intimate friend of Morgagni. His scarcely less famous successor, Pope Clement XIII., had known Morgagni before his elevation to the Papacy, and after his election he wrote assuring Morgagni of his continued esteem and friendship, and asks him to consider the Papal palace always open to him on his visits to Rome. In an extant letter Clement praises his wisdom, his culture, his courtesy, his piety toward God, his charity toward men, and holds him up as an example to all others for the special reason that, notwithstanding all his qualities, he had not aroused the enmity or envy of those around him, thus showing what a depth of humanity there was in him in addition to his scientific attainments.

At this time Morgagni was looked upon by all the medical world as probably the greatest of living medical scientists. Visitors who came to Italy who were at all interested in science, always considered that their journey had not been quite complete unless they had had an opportunity of meeting Morgagni. He had more personal friends among the scientists of all the countries of Europe than any other man of his time. The fact that this leader in science should be at the same time a great personal friend of the Popes of his time is the best possible evidence of the more than amicable relations which existed between the Church and medicine during this century. Morgagni's life of nearly ninety years indeed, covers most of the eighteenth century, and is of itself, without more ado, an absolute proof that there was not only no friction between religion and medicine, but shows on the contrary that medical science encountered patronage and encouragement as far as ecclesiastics were concerned, while success in it brought honor and emolument. [{220}] Morgagni's personal relations to the Church are best brought out by the fact that, of his fifteen children, ten of whom lived to adult life, eight daughters became members of religious orders and one of his two surviving sons became a Jesuit. The great physician was very proud and very glad that his children should have chosen what he did not hesitate to call the better part.

After Morgagni's time, the days of the French Revolution bring a cloud over the Papacy. There were political disturbances in Italy and the Popes were shorn of their temporal power. As a consequence their medical school loses in prestige and finally disappears. The Papal Physicians after this, while distinguished among their fellow members of the Roman medical profession, were no longer the world-known discoverers in medicine that had so often been the case before. So long as the Popes had the power and possessed the means, they used both to encourage medicine in every way, as the list of Papal Physicians shows better than anything else, and a study of this chapter of their history will undo all the false assertions with regard to the supposed opposition between the Church and science.

We have already said, and it seems to deserve repetition here, that during most of these centuries in which the Papal Physicians were among the most distinguished discoverers in medicine, the term medicine included within itself most of what we now know as physical science. Botany was studied as a branch of medicine, and as we have seen, one of the Papal Physicians, Simon Januensis, compiled a dictionary that a modern German Historian of Botany finds excellent. Astrology, under which term astronomy was included, was studied for the sake of the supposed influence of the stars on [{221}] men's constitutions.--Chemistry was a branch of medical study. Mineralogy was considered a science allied to medicine, and the use of antimony and other metals in medicine originated with physicians trying to extend the domain of knowledge to minerals. Comparative anatomy was founded by a Papal Physician. These were the principal physical sciences. To talk of opposition between science and religion, then, with the most distinguished scientists of these centuries in friendly personal and official relations with the Popes, is to indulge in one of those absurdities common enough among those who must find matter for their condemnation of the Popes and the Church, but that every advance in modern history has pushed farther back into the rubbish chamber of outlived traditions.

[{222}]

THE POPES AND MEDICAL EDUCATION AND
THE PAPAL MEDICAL SCHOOL.

After the story of the Papal Physicians, the most important phase of the relations of the Popes to the medical sciences is to be found in the story of the Papal Medical School. While it seems to be generally ignored by those who are not especially familiar with the history of medical education, a medical school existed in connection with the Papal University at Rome during many centuries--according to excellent authorities, from the beginning of the fourteenth century--and this medical school had, as we have said elsewhere, during nearly two centuries some of the most distinguished professors of medicine in its ranks, and boasts among its faculty some of the greatest discoverers in the medical sciences, and especially in anatomy. For these two centuries it had but two important rivals, Padua and Bologna. Both of these were in Italy, and one, that of the University of Bologna, was in a Papal city, that is, was under the political dominion of the Popes. The best medical teaching, then, was to be found in the Papal States and under conditions such, that if there had been the slightest opposition, or indeed anything but the most cordial encouragement for medical study, the medical schools of Rome and Bologna would surely have languished instead of flourishing beyond all others.

Just about the beginning of the fourteenth century [{223}] Pope Boniface VIII., who was himself one of the distinguished scholars of his time, determined that, besides the university of the Papal Court, which had existed for nearly a century at Rome, but which was mainly occupied with philosophy and theology and mainly attended by ecclesiastics, there should also be a university of the City of Rome for the people of his capital. This determination was reached only a short time before the culmination of the difficulty between Pope Boniface and the King of France, which eventually resulted in what has been called the outrage of Anagni and the subsequent death of the Pope within a short time. It has usually been thought, then, that in spite of certain extant Papal documents creating the University of the City of Rome, this university had not been organized before Pope Boniface's death, and as his successor did not take his seat at Rome, but at Avignon, it has usually been assumed that the University of the City came into existence at most only in an abortive form. Denifle, whose History of the Universities of the Middle Ages is looked upon as the best authority in such matters, however, insists that a complete university of the City of Rome did come into existence as a result of Boniface's decree.

All during the time when the Popes were at Avignon this university continued to exist, and in spite of the fact that at one time, as a consequence of a great earthquake followed by a pestilence, and then serious political troubles because of the absence of the Popes, Rome had only something less than ten thousand inhabitants, the university continued its work. Denifle calls attention to the fact that there are letters of Pope John XXII. which show that he paid out of the Papal revenues [{224}] the salary of a teacher of physic at the University of the City of Rome while the Papal Court was at Avignon. It is rather interesting to find the names of the two Popes, Boniface VIII. and John XXII., whose Papal decrees are supposed to have prevented the study of anatomy and chemistry, thus cropping up on unquestionable authority as the founder and the patron of medical teaching in the City of Rome. Pope Boniface VIII. is now generally credited with having been the founder of the Sapienza, the medical school of which, at the beginning of the sixteenth century, was to develop into one of the most important schools of its kind in Europe, and to have on its faculty list the greatest teachers of their time, who had been tempted to come to Rome because the Popes wished to enhance the prestige of the medical school of their capital.

While it may be a surprise for those who have been accustomed to think of the Popes as inalterably opposed to all science, and especially to medical science, thus to find them encouraging and fostering medical teaching, it will only be what would naturally be expected by those who know anything of the real history of medicine in the earlier Middle Ages. There is no doubt at all, that during the so-called "dark ages," that is, when the invasion of the barbarians had put out the lights of the older civilizations, it was mainly ecclesiastics who preserved whatever traditions there were of the old medical learning and carried on whatever serious teaching of medicine, in the sense of medical science, that existed during this time. The monks were the most prominent in this; and the Benedictines, after their foundation in the sixth century, added to their duties of caring for the other temporal needs of the poor, who so [{225}] often appealed to them, that of helping them as far as they could in any bodily ailments with which they might be afflicted. There are even definite traditions that a certain amount of training in medicine, or at least in the care of the sick, was one of the features of the Benedictine monasteries.

Dr. Payne in his article on the History of Medicine in the Encyclopaedia Brittanica said: "In civil history there is no real break. A continuous thread of learning and practice must have connected the last period of Roman medicine with the dawn of science in the Middle Ages. But the intellectual thread is naturally traced with greater difficulty than that which is the theme of civil history; and in periods such as that from the fifth to the tenth century in Europe, it is almost lost. The chief homes of medical as of other learning in these disturbed times were the monasteries. Though the science was certainly not advanced by their labors, it was saved from total oblivion, and many ancient medical works were preserved in Latin or the vernacular versions. It was among the Benedictines that the monastic studies of medicine first received a new direction and aimed at a higher standard. The study of Hippocrates, Galen, and other classics was recommended by Cassiodorus (sixth century), and in the original mother abbey of Monte Cassino medicine was studied, though there was probably not what could be called a medical school there; nor had this foundation any connection (as has been supposed) with the famous school of Salerno."

A review of some of the interesting features of the early history of medical education will serve to show that, not only was there no ecclesiastical interference with the new developing science, but, on the contrary, [{226}] without the personal aid and the intelligent patronage of ecclesiastics of all degree, and especially of archbishops and Popes, the development of medical teaching that took place at Salerno would probably not have had the significance in history that it now enjoys. While there was no institutional connection between the medical school of Salerno and the Benedictine Monastery at Monte Cassino, it is known that at the end of the seventh century there was a branch Benedictine monastery at Salerno, and some of the prelates and higher clergy occupied posts as teachers in the school, and even became distinguished for medical acquirements.

Though the Salernitan medical school proper was a secular institution, there is no doubt that the Benedictines had great influence in it and had fostered its formation. How close the monks of Monte Cassino were allied to the Popes, everyone knows. The Benedictines considered themselves the special wards of the Papacy, and a number of the Abbots of Monte Cassino, or monks belonging to the community, and of men who had been educated in the monastery, had been raised to the Papacy during the Middle Ages. The origin of modern medical teaching is thus closely associated not only with the Benedictines, but through them with the Popes, without whose encouragement and sanction the work would not have flourished as it did.

In advance of the formal establishment of medical schools, in the modern sense of the word, two Popes were distinguished before their elevation to the Papacy for their attainments in all the sciences, and especially in medicine, one of whom actually founded an important school of thought in medicine, while the other was a professor at Salerno. The first of these is the famous [{227}] Gerbert, who, under the name of Sylvester II., was Pope at the end of the millenium and carried Christianity over what was supposed to be the perilous period of the completion of the first thousand years, when the end of the world was so universally looked for. Gerbert was famous for his attainments in every branch of science, and indeed so many wonderful traditions have collected around his name in this matter that one hesitates to accept most of them. There seems to be no doubt, however, that he was the beloved master of Fulbert of Chartres, who did much for medicine in France at the beginning of the eleventh century and who was the founder of the so-called school of Chartres and himself the teacher of John of Chartres, who became the physician to King Henry I., of France, and of Peter of Chartres and Hildier and Goisbert.

Before the end of the eleventh century Pope Victor III., who had been the Abbot of Monte Cassino, was elected Pope much against his will. He occupied the Papal throne only for about a year and a half. He had been especially recommended by Pope Gregory VII., the famous Hildebrand, as a very suitable successor. Desiderius, as he was called before becoming Pope, was one of the best scholars of his time, and had taught for some years with great distinction at Salerno. It is not known absolutely that he taught medicine, but, as the university of Salerno is usually considered not to have been founded until the middle of the next century, and as before that time the main teaching faculty was that of the medical school and all other teaching was subordinated to it, Desiderius must surely be considered as a teacher at least of medical students. At that time a physician was expected to know something more than merely his [{228}] profession. Mathematics and philosophy were the two favorite subjects to which, besides medicine, they devoted themselves. The presence of the future Pope at Salerno is, moreover, the best possible index of the sympathy between the ecclesiastical authorities and the medical school.

Besides there are definite records of the friendship which existed between Alphanus, Archbishop of Salerno, and Desiderius, while they were both members of the Benedictine Community of Monte Cassino. Alphanus subsequently taught medicine at Salerno, and some of his writings on medicine have been preserved for us. He was the author of a work bearing the title De Quatuor Elementis Corporis Humani, a treatise on the four elements of the human body, which is a compendium of most of the knowledge of anatomy and physiology of the time, though it also contains much more than the information with regard to the merely physical side of man's being. The fact that Alphanus should have been promoted from the professorship in the medical faculty to the Archbishopric of Salerno is only another proof of the entire sympathy which existed between the Church and the professors of medical science at that time.

During the thirteenth century universities were founded in some twenty important cities in Europe, and in connection with most of them a medical school was established. These educational institutions were the result of the initiative of ecclesiastics; their officials all belonged to the clerical body, most of their students were considered as clerics--and indeed this was the one way to secure them against the calls for military service which would otherwise have disturbed the enthusiasm for study--and the Popes were considered the supreme [{229}] authority over all the universities. In spite of this thoroughly ecclesiastical character of the universities and educational institutions, there is not a hint of interference with the teaching of medical science and abundant evidence of its encouragement. Indeed, for anyone who knows the story of the universities of the thirteenth century, it is practically impossible to understand how there could have arisen any tradition of ecclesiastical opposition to education in any form, and there is not a trace of foundation for the stories with regard to ecclesiastical intolerance of science, which are supposed to be supported by certain Papal decrees.

The best possible demonstration of the maintenance of the most amicable relations between churchmen and physicians during the century in which these decrees were issued is also the most interesting fact in the history of medicine during the thirteenth century. It is not generally known that one of the most distinguished physicians of the thirteenth century, one who wrote a book on the special subject of eye diseases that is still a classic, afterwards became Pope under the name of John. He is variously known as John XIX., John XX., or John XXI., according as certain occupants of the Papal throne are considered to be of authority or not. He was educated at Paris, and probably spent some time at Montpelier. Under the name of Peter of Spain, though he was what we should now call a Portuguese, he subsequently taught physic at the University of Sienna. Here he wrote the famous little work on the Diseases of the Eye, which was reviewed by Dr. Petella, physician-in-chief of the Royal Italian Marine, in Janus, the International Archives for the History of Medicine and for Medical Geography in 1898. Petella does not [{230}] hesitate to proclaim him one of the greatest men of his time. Daunou, one of the continuators of the Benedictines' literary history of France, [Footnote 28] says that this Peter of Spain was one of the most notable persons in Europe in his generation.

[Footnote 28: Histoire Litteraire de la France, Vol. XVI. This is the famous work begun by the Benedictines of St. Maur.]

Pope John XXI., before his accession to the Papacy, had certainly accomplished remarkable work in medicine, and of a kind that makes his writings of great interest even at the present day. There is scarcely an important pathological condition of the eye which does not receive some consideration in this little book, and it is a constant source of surprise in reading it to find, with their limited knowledge and lack of instruments, what good diagnosticians the ophthalmologists of the thirteenth century were. Cataract is described, for instance, under the name of "water that descends into the eye," and a distinction is made between cataract from internal and external causes. Hardening of the eye is mentioned and is declared to be very serious in its effects. There seems no doubt that this was glaucoma. Conditions of the lids, particularly, were differentiated and treated by rational measures, some of them quite modern in substance. A curious anticipation of modern therapeutics is the frequent recommendation of extracts of the livers of various fishes for external and internal use, that is a reminder of the present employment of cod-liver oil. The book is acknowledged to be a classic in medicine. The fact that its author should have become Pope later, is the best proof that instead of opposition there was the greatest sympathy between medicine and ecclesiasticism in his time.

[{231}]

With these thoroughly amicable relations between the Church and the medical schools during the thirteenth and preceeding centuries, it will not be so much of a surprise as it might otherwise be, to learn of the foundation of the Medical School of Rome and of the continuation of Papal patronage of it even while the Popes were absent at Avignon. University records do not say much about it during the next two centuries. With the coming of the Renaissance, however, and the entrance of a new spirit into education, the Popes also were touched by the educational time-spirit, and there came a rejuvenation of the University of the City, which now acquired a new name, that of the Sapienza, and became the home of some of the most distinguished teaching in Europe in every department. Early in the sixteenth century the medical department of the Sapienza, or Papal University at Rome, became one of the most noteworthy institutions of Europe because of the work in medicine accomplished there, and had among its faculty the most distinguished investigators in medical science, and especially in that department of medicine--anatomy--which by an unfortunate tradition the Popes are said to have hampered.

The most important event in the history of the institution, after its foundation, was its establishment in the home which it was to occupy down to our own time. Its new habitation was prepared for it by the Pope who has probably been the most maligned in history--Alexander VI. A magnificent site was appropriated for it, and the construction of suitable buildings begun. A little more than a decade later, Leo X., another one of the misunderstood Popes, came to the conclusion that the two universities in Rome, that of the Papal Court and that of [{232}] the City, would do better work if combined into one, and accordingly this combination was effected. This made provision for one very strong teaching faculty in Rome. The final steps for the completion of the union of the two universities were taken by Pope Alexander VII., and the buildings which the new university was to occupy were finished in a manner worthy of the great institution of learning which it was hoped to create in Rome.

The first of the great professors who made the Papal Medical School famous was Realdo Colombo, often spoken of as Columbus simply, who was invited to teach in Rome by Pope Paul III., the same Pope who issued the bull founding the Jesuits. Some people might consider the two actions as representing contrary tendencies in education, but they are not such as know either the history of the Jesuits, or of the constant endeavor of the Popes to foster education. Columbus came to Rome, as we have said, with the prestige of having succeeded Vesalius at Padua, and later having been specially tempted by the reigning prince in Pisa, who wanted to create a great medical school in connection with his university in that city, which he was at that moment trying to raise to distinction, to accept the professorship of anatomy there.

Vesalius was still alive at this time, and the period when, if we would credit certain historians who emphasize the opposition between the Church and science, it was dangerous to dissect human bodies had not yet passed. It is interesting to read the account of Columbus's reception in Rome, and the interest manifested in his work by all classes in the Roman University at this time. His course in anatomy was so enthusiastically [{233}] attended that, as he himself tells in a letter to a friend, he often had several hundred persons in his audience when he gave his anatomical demonstrations on the cadaver. These were not all medical students, but many of them were ecclesiastics, and some of them important members of the hierarchy. Even cardinals manifested their interest in anatomy, and occasionally attended the public dissections--public, that is, as far as the University is concerned--which were made by Columbus.

Columbus's enthusiasm for anatomy was such that, as Dr. Fisher said of him in the Annals of Anatomy and Surgery, Brooklyn, 1878-1880, "he dissected an extraordinary number of human bodies, and so devoted himself to the solution of problems in anatomy and physiology that he has been most aptly styled the Claude Bernard of the sixteenth century." In one year, for instance, he is said to have dissected no less than fourteen bodies, demonstrating, as Dr. Fisher has said, that "it was an age of remarkable tolerance for scientific investigation."

Besides being an investigator, Columbus was a great teacher, and many of our modern methods of instruction in medical schools had their origin in the system of demonstrations introduced by him. His descriptions of the demonstrations for students upon living animals, show that some of the most recent ideas in medical teaching were anticipated by this Roman professor of anatomy and medicine in the Renaissance period. His demonstrations of the heart and blood-vessels and of the actions of the lungs are particularly complete, and must have given his students a very practical working knowledge of these important physiological functions. In a word, the medical teaching of the Roman [{234}] University, under him at this time, far from being merely theoretic and distant from actual experience and demonstration, was thoroughly modern in its methods.

It is no wonder, then, that practically all the ecclesiastical visitors who came in such numbers to Rome, made it a custom at this time to attend one or more of Columbus's anatomical lectures. They were looked upon as one of the features of the Roman university life of the time. How much good was accomplished by this can scarcely be estimated. The example must have had great influence especially on members of faculties of various educational institutions who came to the Papal See. To some degree at least these interesting teaching methods must have aroused in such men the desire to see them emulated in their own teaching institutions, and therefore must have done much to advance medical education. The fact that these things were done in the Papal Medical School only emphasized the significance of them for ecclesiastics, and made them more ready to bring about their imitation in other teaching centers.

How well the Popes were justified in their estimation of Columbus's genius as an anatomical investigator will be best appreciated from his discovery of the pulmonary circulation, which formed, as Harvey confesses at the beginning of his work on the circulation, the foundation on which Harvey's great discovery naturally arose. It is probable that Columbus would not have come to Rome, in spite of the flattering offers held out to him, only that he was already the personal friend of a number of high ecclesiastics, and even of the Pope who extended the invitation. How well the Popes continued to think of Columbus after his years of work in the [{235}] Roman Medical School will be well understood from the fact that, when his great work De Re Anatomica was published after his death by his sons, Pope Pius IV. accepted the dedication of it. This was of course not an unusual thing, for many books on other sciences were dedicated to the Popes, and the example thus set was subsequently imitated. Twenty-five years later, Professor Piccolomini dedicated his Anatomical Lectures to Pope Sixtus V. Subsequent anatomical publications of the Papal Medical School were issued under like patronage. The famous edition of Eustachius's anatomical sketches, published under the editorship of Lancisi, is a notable example of this, and went to press mainly at the expense of Pope Clement XI., who realized how valuable they were likely to be for the teaching of anatomy.

These two great discoverers in anatomy, Columbus and Eustachius, were succeeded, as is so often the case in the history of university faculties, by a man more capable of writing about great discoveries than of making them himself. This was Piccolomini, who devoted himself to showing how much the ancients had taught about anatomy, though at the same time he also made clear the place occupied by modern anatomical discoveries. While his name is not attached to any great discovery in the science of anatomy, he is generally acknowledged to have been one of the great teachers of his time and one who was needed just then in order to make people realize how the old and the new in anatomy must be coordinated. Piccolomini's successor in the chair of anatomy at Rome was another original genius and investigator whose name, however, and fame has never been as great among English-speaking people as in Italy, or among the Latin races generally. The fact that he was a rival [{236}] of Harvey's in the matter of the discovery of the circulation of the blood has always made the Italians exaggerate his position in medical history, while it has undoubtedly made English writers of medical history diminish the importance of his work.

Historians of science consider him worthy to be called the greatest living scientist of his time--the end of the sixteenth century. He was not only a scientific physician, but he was an authority in all the sciences related to medicine, and indeed had profound interests in every branch of physical science. His contemporaries looked up to him as a leader in scientific thought. To anyone who examines the question of the discovery of the circulation of the blood with freedom from bias, there can be no doubt but that the honor for this discovery has been unduly taken away from Caesalpinus in English-speaking countries, to be conferred solely on Harvey. Not that there is any wish to lessen the value of Harvey's magnificent original work, nor make little of his wonderful powers of observation, nor of the marvelous experimental and logical method by which he followed out his thoughts to their legitimate conclusion, but that I would insist on giving honor where honor is due, though most writers in English refuse to give Caesalpinus's claims a proper share of attention.

The Italians have always declared that Caesalpinus was the real discoverer of the circulation, and there is no doubt that his career occurs just at that point in the evolution of the medical sciences, and especially anatomy and physiology in Italy, where this discovery would naturally come. Lest it should be thought, however, that my interest in the Popes and the Papal Medical School has led me to exaggerate the claims of [{237}] Caesalpinus as a great naturalist and medical scientist, I prefer to quote the description of him given by Professor Michael Foster in his lectures on the History of Physiology, delivered in this country as the Lane Lectures, at the Cooper Medical College in San Francisco, and published by the Cambridge University Press, 1901. Professor Foster was not one to exaggerate the claims of any Italian, and least of all of any Italian who might be supposed to have a claim that would stand against Harvey's. The soupçon of Chauvinism in his treatment of Servetus and Columbus in this regard is indeed rather amusing. He said:--

"Of a very different stamp to Columbus was Andreas Caesalpinus. Born at Arezzo in 1519, he was for many years Professor of Medicine at Pisa, namely, from 1567 to 1592, when he passed to Rome, where he became Professor at the Sapienza University and Physician to Pope Clement VIII., and where at a ripe old age he died in 1603.
"If Columbus lacked general culture, Caesalpinus was drowned in it. Learned in all the learning of the ancients and an enthusiastic Aristotelian, he also early laid hold of all the new learning of the time. Naturalist as well as physician, he taught at Pisa botany as well as medicine, being from 1555 to 1575 Professor of Botany, with charge of the Botanic garden founded there in 1543, the first of its kind--one remaining until the present day."

Professor Foster admits that Caesalpinus had a wonderful power of synthetising knowledge already in hand and anticipating conclusions in science that were to be confirmed subsequently. In his Medical Questions, though the work is written in rambling, discursive vein, he enunciated views which, however he arrived at them, certainly foreshadowed or even anticipated those which [{238}] were later to be established on a sound basis. Foster quotes a passage in which Caesalpinus made it very clear that he thoroughly understood the mechanism of the circulation and grasped every detail essential to it. After quoting this passage, which it must be confessed is rambling, Foster thus sums up what Caesalpinus has to say with regard to the circulation:--

"He thus appears to have grasped the important truth, hidden, it would seem, from all before him, that the heart, at its systole, discharges its contents into the aorta (and pulmonary artery), and at its diastole receives blood from the vena cava (and pulmonary vein)."
"Again, in his Medical Questions he seems to have grasped the facts of the flow from the arteries to the veins, and of the flow along the veins to the heart."

That there was no change of Papal policy in the next century can be gathered from an interesting phase of Papal interest in science which, though not directly concerned with medicine, eventually resulted in important theoretic advances in medical science. This was the encouragement of Father Kircher's work at Rome. Father Kircher was the Jesuit who made the first scientific museum. As the result of his general interest in things scientific he wrote a little book on the pest. In this book he stated in very clear terms the modern doctrine of the origin of disease from little living things, which he called corpuscles. Because of this Tyndall attributes to Father Kircher the first realization of the role that bacteria play in disease. Even more wonderful than this, however, was Father Kircher's anticipation of modern ideas with regard to the conveyance of disease. He insisted that contagious diseases, as a rule, were not carried, as had been thought, by the air, but [{239}] were conveyed from one person to another, either directly, or by the intermediation of some living thing. He considered that cats and dogs were surely active in conveying diseases, and he even reached the conclusion that insects were also important in this matter. His expressions with regard to this are not of the indefinite character which one often encounters in the supposed anticipation of important principles in medicine, but are very precise and definite. Father Kircher is quoted by Dr. Howard Kelly, of Baltimore, in his life of Major Walter Reed, whose work in showing that yellow fever is transmitted by mosquitoes is well known, as saying in one place, "Flies carry the plague," and in another place, "There can be no doubt that flies feed on the internal secretions of the diseased dying, then flying away they deposit their excretions on the food in neighboring dwellings, and persons who eat it are thus infected." It is interesting to find that the Professor of the Practice of Medicine in the Papal University at Rome when this book was published, far from resenting, as many professors of medicine might, the excursion of an outsider into his science, said Father Kircher's book "not only contains an excellent resume of all that is known about the pest or plague, but also many valuable hints and suggestions on the regional spread of the disease which had never before been made." He did not hesitate to add that it was marvelous for a man, not educated as a physician, to have reached such surprising conclusions, which seemed worthy of general acceptance. All this, it may be said in passing, was within a few years after the trial of Galileo. In this next century the Popes continued their special efforts to secure the greatest teachers of anatomy and physiology for their Roman medical school. One of the [{240}] results was the appointment of Malpighi, whose name has deservedly become attached to more structures in the human body because of tissues which he first studied in detail, than any other man in the history of medicine. Malpighi represents the beginning of most of the comparative biological sciences, and his original observations upon plants, upon the lower animals, on fishes and then on the anatomical structure of man and the higher animals, stamp him as an investigating genius of the highest order. He was the personal friend of Innocent XI., who wished to have him near him at Rome as his own medical adviser, and besides desired the prestige of his fame and the stimulating example of his investigating spirit for the students of the medical school of the Sapienza. The closing years of Malpighi's life were rendered happier, and his wonderful researches were as well rewarded as such work can be, by the estimation in which he was held at Rome.

Malpighi was succeeded as Papal Physician and Professor in Rome by Tozzi, who is distinguished in the history of medicine for his commentaries on the ancients rather than for original observation, but who was looked upon in his time as one of the most prominent physicians in Italy. Tozzi had been the Professor of Medicine and Mathematics at the University of Naples, where he became famous. From here he received a flattering invitation to the chair of physic at Padua. In order that he might not desert Naples, his salary was raised and he was given the post of Protomedicus or Chief Physician to the Court. It was after this that the death of Malpighi left an important chair vacant in Rome, and there being no one apparently more worthy than this man for whom other important universities were contending, he [{241}] was offered the chair on such excellent conditions that he accepted it. It is another case of the Popes being not only willing and even anxious, but also able because of their position, to secure the best talent available for their medical school at the Roman University.

Undoubtedly one of the greatest members of the faculty that the Papal Medical School ever had is Lancisi, one of the supreme medical teachers of history, who is usually considered one of the founders of modern clinical medicine. When at the beginning of the eighteenth century Boerhaave attracted the attention of the world by his bedside teaching of medicine at Leyden, there were two occupants of thrones in Europe who proved to have particular interest in this new departure. They were perhaps the last two who might ordinarily be expected to have much use for such improvements in medical education. One of them was the Empress Maria Theresa, of Austria, whose patronage of Boerhaave 's pupil, Van Swieten, secured the establishment of that system of clinical teaching which has since made the Vienna Medical School famous. The other was the Pope. With his approbation Lancisi established clinical teaching at Rome, and thus did much to maintain at Rome a great center of medical progress during the eighteenth century.

Lancisi was graduated at the Sapienza, the Roman University, at the early age of eighteen. When only twenty-two he became assistant physician at the Santo Spirito Hospital and began to show the first hint of the brilliant genius he was to display later in life.

Some ten years later, as the result of a competitive examination which still further demonstrated his talents, he was chosen Professor of Anatomy in his Alma Mater, [{242}] the Sapienza. He was only thirty-three at the time, and the fact that he should be chosen shows that the Papal University was ready to take advantage of talent wherever it found it and did not allow itself to be won only by notoriety at a distance. The excellence of the choice was demonstrated before long by Lancisi's brilliant career as a teacher and an original investigator. Some of the most distinguished medical men from all over the world came to listen to his lectures (according to Hirsch's Biographical Lexicon of the Most Prominent Physicians of All Times and Peoples), and even Malpighi and Tozzi, the Papal physicians during the time, were among his auditors. [Footnote 29]

[Footnote 29: Most of these details are taken from Hirsch's Biographisches Lexicon der hervorragenden Aertzte aller Zeiten und Völker. Wien und Leipzig, 1886.]

After the departure of Tozzi from Rome Lancisi became the Papal physician. He continued to be the medical adviser of Popes Innocent XI. and XII. and of Clement XI. until his death in 1720. It was under Clement that he had the new clinic built, in which teaching after the manner of Boerhaave was to be established. At his death Lancisi left his fortune and his library to Santo Spirito Hospital, on condition that a new portion of the hospital should be erected for women. There is no doubt that he belongs among the most distinguished of contributors to medical science, and Hirsch declares that anatomy, practical medicine, and hygiene are indebted to him for notable achievements. His books are still classics. The one on Sudden Death worked a revolution in the medical diseases of the brain and heart. His work De Motu Cordis et Aneurysmatibus has been pronounced epoch-making, and his suggestion of percussion over the sternum in order to [{243}] determine the presence of an aneurysm, made him almost an anticipator of Auenbrugger and prompted Morgagni's famous book De Sedibus et Causis Morborum, which appeared after his death. Lancisi's work on Aneurysms was not published until after his death.

Two others of his books deserve mention because they show how broad were the interests of the man in many phases of progress in medicine. Their titles are Diseases and Infections of Domestic Animals and The Climate of Rome.

The next great name in Italian medicine is that of Morgagni. He was not a regular Papal physician, nor a member of the faculty of the Papal Medical School, but he was often consulted, as we told in the chapter on Papal Physicians, both as to the health of the Popes and the methods of teaching at the Roman Medical School. His life brings us down almost to the nineteenth century, and the cordial relations of the Popes to him, far from being an exception in the history of medicine, are only typical of the attitude of the Roman Pontiffs to medical and all other scientists from the dawn of the history of science in modern times.

While the Papal Medical School at Rome, attached to the university of the city and directly under the control of the Papal Curia, more especially deserves the name thus given it, it must not be forgotten that there was in the Papal States a series of medical schools in various cities. One of these, at Perugia, founded by a bull of Pope John XXII., has come under consideration in the chapter on A Papal Patron of Medical Education. Another medical school, that of Ferrara, which also was in the Papal States, had considerable prestige. Some distinguished professors taught there before going to [{244}] Padua or Bologna. At the beginning of the sixteenth century, Bologna, after having been during the preceding three centuries under the domination of one powerful family or another, from the Pepoli to the Bentivogli, and then to the Visconti and back again to the Bentivogli, was incorporated in the Papal States under Pope Julius II. At this time the Medical School of Bologna was at the height of its reputation and was one of the two greatest medical schools in Italy. Padua was its only rival. Shortly after this Rome became a serious competitor in medical education. Practically, then, this was a second Papal medical school, almost as directly under the control of the Popes as the Roman Medical School. Far from there being any diminution in the glory or the efficiency of the Bolognese Medical School, its reputation even became enhanced after the city came under the control of the Popes.

This is all the more surprising because, as we have shown, just about this time the Popes began the work of making their Medical School at Rome the most important center for medical education, especially in the scientific phases of medicine--anatomy, physiology, and comparative anatomy--that there was at that time in the world. In spite of this rivalry, however, nothing was done directly to hurt the prestige of the school of Bologna, and indeed the rivalry seems to have been more of an encouraging competition than in any sense a destructive struggle for existence. When the Popes took possession of Bologna, Alexander Achillini was professor of anatomy and medicine in the Bolognese school, and his discoveries and methods of investigation attracted the attention of students from all over the world. His assistant for many years and his successor in the [{245}] post was Berengar of Carpi, of whom we have already said much in the chapter Anatomy Down to the Renaissance. For some time Vesalius lectured on medicine and anatomy at Bologna, and one of Berengar's most distinguished successors in the sixteenth century was Aranzi, who occupied the post of anatomical professor for thirty-two years and who corrected a number of errors in anatomical detail that had been made by Vesalius and others of the preceding generation. He confirmed Columbus's discoveries at Rome with regard to the course which the blood follows in passing from the right to the left side of the heart, and made many important additions to the knowledge of the anatomical relations of the cavities of the heart, the valves, and the great blood vessels. There are a number of important structures in the brain which owe their names to him, and his descriptions of them are better, according to Prof. Turner, than those of other anatomists for a century after his time.

The tradition of great teachers thus carried on during the first century after the absorption of Bologna into the Papal States, continued uninterruptedly in the next century, when we find on the list of professors at Bologna such names as those of Malpighi, the greatest mind in the medical sciences of the seventeenth century, and his colleague Fracassati, who, though over-shrouded by Malpighi, still claims a prominent place in the history of medicine. Bologna has a special feature of medical development to its credit which, because of its importance for science in general as well as for medicine, deserves to be mentioned here. During the century after the Popes became the rulers of the city scientific societies were founded here, and as the professors and [{246}] students of the medical school were also the most interested in science in general, the membership of these societies was largely made up of individuals connected with the medical school. A special society for the cultivation of anatomical knowledge, the first of its kind ever founded, was established in Bologna scarcely more than a century after the city came under the Papal dominion. It was called the Coro Anatomico, or anatomical choir, and had at first only nine members. Among these, however, were such distinguished men as Malpighi, Fracassati, Capponi, and Massari, to the last of whom the initiative of the foundation of the society is said to have been due. Bologna was noted during the sixteenth and seventeenth centuries for the number of foreign students of medicine who were attracted to its hospitable medical school and who carried the tradition of science for its own sake, so characteristic of this Papal Medical School, to all parts of the world.

After this consideration of the relation of the Popes to medical science during many centuries when medicine practically included all the physical sciences, it may seem utterly inexplicable to any fair-minded person that the tradition of the opposition of the Popes to science and scientific educational development should have apparently become a commonplace in history. This will not be a surprise, however, to those who know how perversive and influential has been the Protestant tradition which from the beginning of the sixteenth century has devoted itself to blackening the reputation of the Church, the Popes, and Catholic ecclesiastics generally. Nowhere is this more true than in history as written for English-speaking people. Those who left the old Church and their immediate descendants, justified their [{247}] withdrawal to themselves as well as others, by taking every possible excuse and inventing every possible pretext, to show how unworthy of their continued allegiance the old Church had been. The point of view thus assumed was taken quite seriously by succeeding generations, until at length a whole body of historical traditions, utterly unfounded in fact, accumulated, especially in England, where it must be remembered that for several centuries Catholics were not in a position to impugn and eradicate it. This unfortunate state of affairs, and not real opposition on the part of the Popes to science, is the source of the tradition with regard to the supposed opposition between the Church and science.

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