CHAPTER IV.
Age of Transition (concluded).—The School of Montpellier: Raimond Lulli, 1235-1315. John of Gaddesden, 1305—(?). Arnold of Villanova, 12341313. Establishment of Various Universities. Gerard of Cremona, 1187. William of Salicet, 1280. Lanfranc, 1315. Mondino, 1275-1327. Guy de Chauliac, 1300-1370. Age of Renovation, 1400 to Present Time.—Erudite Period, including Fifteenth and Sixteenth Centuries. Thomas Linacre, 1461-1524. Sylvius, 1478-1555. Vesalius, 1514-1564. Columbus, 1490-1559. Eustachius, 1500-1574. Fallopius, 1523-1562. Fabricius ab Aquapendente, 1537-1619. Fabricius Hildanus, 1560-1634.
Although I have taken up so much time with an account of the school of Salernum, a few words must be devoted to the school of Montpellier, which was second in time and in importance among the great influences in the culture of western Europe. There was a time when to have studied there lent a special halo of glory, for, being near the sea, and in the vicinity of thermal baths, even so early as A.D. 1153 it was famous as a school of medicine; moreover, those who presided over it did not lapse unconditionally into mediæval philosophy, with its bewildering subtleties. It is said to have been founded A.D. 738, but first mention of it as a source of medical education occurs in 1137, when Bishop Adelbert II, of Mayence, visited the city to listen to its medical teachers. A faculty of philosophy was added in 1242, and one of law in 1298. Within the walls of the city sojourned both Christians and Jews, the latter being subject directly to the civil authorities, and particularly esteemed as translators. One of the most famous of the sons of Israel was Profatius Judicus, who became a rector of the faculty.
Prior to 1370, when the university became subject to the kings of France, it was under the control of the Pope; and then, as now, the school of medicine was the chief ornament of this ancient seat of learning.
One of the most illustrious and famous pupils of Montpellier was that religious mystic and alchemistic visionary, Raimond Lull, or Lulli, a would-be transmuter of metals and seeker for the philosopher's stone. Born in 1234, at the age of thirty he began to see visions, and was thereby roused from an atheistic tendency to soon become wonderfully pious; ultimately he entered the order of Minorites, studied Arabic, and appeared as a missionary in Africa, seeking to convert the Saracens—who, however, declined the honor, and finally (in 1315) rewarded his zeal by stoning him to death. Beside works on alchemy and theology, he wrote on medical subjects, and, like all great minds of the period, passed among the common people as a sorcerer in league with the devil. Nevertheless, he was a notable figure in his age and country.
Quite celebrated became the compendium of Gilbert of England (1290), which contained the same speculative nonsense, the same polypharmacy, and the same superstition as other works of that time; what little it contained of value was taken largely from other writers. While this Gilbert, often known as Gilbertus Anglicus, was not the first English writer on practical medicine, he was the earliest whose works have been preserved.
Still more famous was John Gaddesden, physician-in-ordinary to the King of England, professor in Merton College, Oxford, who wrote the famous treatise known as Rosa Anglica, which appeared between 1305 and 1315. This treatise was characterized by mysticism and disgusting therapeutic measures, and tainted by medical avarice, superstition, and charlatanry. Gaddesden was, perhaps, the first to formally recommend the "laying on of hands" by the king for the cure of scrofula (first performed by Edward the Confessor—1042-1056), whence comes the ancient name for this disease,—i.e., "king's evil." *
*A special "Service of Healing" was used in the English
Church under Henry VIII, 1484-1509.
Arnold de Villeneuve (1234-1313) studied seven years at Montpellier, twenty years at Paris, visited all the universities in Italy, then went to Spain to levy on the Arabian authors. He wrote on medicine, theology and especially on chemistry—in which art he obtained great renown both as an author and teacher. To him is due the discovery of spirit of wine, oil of turpentine, aromatic waters, besides several preparations of less note, and the introduction of chemical compounds into therapeutics. His was a very stirring life, for he traveled extensively; he became a teacher at Bologna, and physician to Peter III, of Arragon. Shortly before his demise he went to Paris, having fallen under the ban because of a declaration that papal bulls, far from being sacredly inspired, were human works, and that acts of charity were dearer to God than hecatombs, etc. He finally perished by shipwreck, but the spirit of fanaticism followed him after death, for his volumes were condemned by the Inquisition, because they commended experiments rather than mere speculations. In spite of his general honesty in accordance with the spirit of the times he inculcated deceit in medicine, and one of his declarations is: "If thou canst not find anything in the examination of the renal secretion, declare that an obstruction of the liver exists. Particularly use the word 'obstruction,' since it is not understood, and it is of great importance that people should not understand what thou say est." He was one of the first to administer brandy, which he regarded as the elixir of life—whence the modern Eau de Vie.
Connected with this school, also, or well known as having studied there, were many men whose names became more or less famous—among them John Arden, who settled in London about the middle of the fourteenth century; Vinario, a contemporary of Guy de Cliauliac, and the well-known surgeon and anatomist Henri de Mondeville, who was a teacher of Guy de Chauliac. But an idea of the doctrines prevalent in the medical literature of this part of the world, at this time, may be had from the fact that most writers chose titles for their works after the style of ballad singers: for instance, those describing the plague and venereal diseases were called Flowers and Lilies of Medicine; the Rosa Anglica of John Gaddesden was another example. Matters had arrived at such a pass, indeed, that men of science no longer hesitated to confess superstition and mingle it openly with deceit, to oppose the interests of the most needy, and to extort from their fellow-creatures fees in proportion to their supposed ability to pay.
In the time of Charlemagne each cathedral possessed a school in which were taught arithmetic, theology, singing, and sometimes medicine; the Episcopal College had medical teachers who gave advice and dressed wounds at the doors of the Church of Notre Dame, Paris; but when the medical profession had been divorced from the sacerdotal by councils and popes, many of these cathedral schools closed. In order to preserve the jurisdiction which they for a long time had exercised over the learned professions, many were erected into universities, and thus the clergy gave instruction in philosophy, theology, and later in medicine. During the thirteenth century arose many of the great universities in Europe, notably those of Bologna, Padua, and Naples, in Italy; of Paris, Montpellier, and Toulouse, in France; of Valencia and Tortosa, in Spain; of Oxford, in England. Pope Innocent III by papal bull guaranteed that the professors and students at Paris should be exempt from all excommunications save those which emanated directly from the Holy See; French sovereigns conferred many privileges upon the universities, and soon the members of the University of Paris formed practically a second city, with its own laws, customs, police, citizens, and magistrates. Still, however, all science belonged to the clergy, and its teachers, though removed from the cloister, were none the less Roman Catholic; so that the popes reigned over the people through the parish clergy, and over the latter by the clerical teachers and professors. Nevertheless, in all candor it must be acknowledged that these studious men, thus associated together for mutual instruction and emulation in learning, contributed, in a large measure, to elevate Christian civilization above all others, though several generations were required to secure the results calculated to make men celebrated; hence the early periods of the universities developed very few names. Many were conspicuous by their love of instruction, but not by originality of research. Men undertook expensive and wearisome voyages without encouragement or hope of reward, simply to obtain some rare manuscript or to hear some renowned professor; and they appeal to us of the nineteenth century by their devotion, if not by the results of their work.
Among the somewhat scattered and more or less eminent men of this period was Gerard, of Cremona in Lombardy, a man of great purity and studiousness, who arduously pursued all that Latin authors could teach him, and, not being able to procure in Italy certain manuscripts which dated from the time of Ptolemy, determined to go to Toledo in search of an Arabian translation. At this time he was unacquainted with Arabic, but soon mastered it, and—armed with this powerful resource, which no other physician had possessed since the time of Constantine the African—he could not see so many Arabic works devoted to all branches of science as were gathered at the Spanish University without a desire to translate and transmit the same to his own country; hence he gave the remainder of his life to this work. He rendered into Latin the treatises of Hippocrates and Galen, of Serapion, and of all the famous Arabian authors from the time of Phazes, including the Canon of Avicenna and the work on surgery by Albucassis. He died at the age of seventy-three, in 1187, at Cremona, and left all his books to the monastery of St. Lucy, within whose walls he was buried.
William of Salicet, born at Plaisance in the first years of the thirteenth century, became a professor in the University of Bologna, and later at Verona. He wrote extensively on medicine, and earned a reputation as a surgeon that preserves his fame to the present day. It is claimed that his status in medical literature depends, in large measure, upon the fact that he was, perhaps, the first to refuse slavish obedience to preceding authors, preferring, instead, to draw upon the results of personal study and experience. He died in 1280.
Lanfranc, or Lanfranchi (according to whether one prefers his French or Italian name), studied under William of Salicet. Of his early life very little is known, save that he practiced surgery in Milan at the time of the great dissension between the Guelphs and Ghibellines, and, for attaching himself to the weaker party, was exiled and forced to seek an asylum in France; he resided in Lyons for several years, and here wrote a work on minor surgery; in 1295 he went to Paris on the invitation of the faculty of medicine, opened a course on surgery which met with great success, and then published a second and larger treatise on the subject. It is said of him by Malgaigne that, less from his fault perhaps than that of his age, after his death (about 1315) surgery began to decline. From the time of Brunus, who practiced in Padua in 1250, the barbers had done the scarifying and bleeding. After the time of Lanfranchi there were others who applied leeches and often cauteries, and even the women meddled with surgery and in all operations competed with the barbers; the lay surgeons held themselves rivals to the clergy. Lanfranchi inherited from his old master, William, an aversion for them all, and often had to contend with uneducated and incompetent laymen. Clerical surgeons regarded operations as beneath their dignity; and Lanfranchi, who deplored this condition of affairs, confessed he had sometimes bled with his own hands, but had never operated for ascites, hernia, cataract, or stone.
John Pitard has descended to fame not as a writer, but as the founder of the surgical schools of St. Come and St. Damien, which occupy so eminent a position in the surgical annals of France. In 1306 he was surgeon to the King of France, Philip le Bel, and the sworn surgeon of Chatelet. The College of St. Come, in 1311, was only a little brotherhood of lay-surgeons, who gradually grew in importance as the result of the obstinate struggles sustained,—on the one hand, against the faculty of medicine, and, on the other, against the barber-surgeons. Malgaigne has, with great patience and clearness, shown that the importance of this body of men has been greatly exaggerated by historians; he has traced their various turns of fortune from beginning to end; I shall have occasion to consider them again farther on.
Mondino, sometimes known as Mundinus, born in 1275, became a professor in the University of Bologna, and died in 1327. He was the author of a celebrated treatise on anatomy, said to have reached twenty-five editions, and which was the first of its kind since Galen. This science had been greatly neglected; in Salernum, for instance, they were, for a long time, contented with the treatise of Copho on the anatomy of the hog, and most of the anatomical knowledge of the age was apparently derived from this source; Mondino resurrected the study and pursued it with interest and enthusiasm, though under the greatest difficulties. His works for more than two centuries, along with the writings of Galen and the Arabic authors, served for anatomical demonstration, although very incomplete,—as witness the statement:—
"Beneath the veins of the forearm we see many muscles and many large and strong cords, of which it is not necessary to attempt the anatomy on such a corpse (i.e., a recent one), but on one dried in the sun for three years, as I have shown otherwise, in developing the number and the anatomy of those of the superior and inferior extremity."
On the other hand, he took the opposite course to discover and demonstrate the nerves, and advised maceration in running water. It required almost superhuman boldness to substitute demonstrations on the human cadaver for those upon swine, yet this was done by Mondino; and at the time the prejudice against dissection was so general that for more than a century after Mondino—who died in 1327—no one dared, at least publicly, to emulate his example. It was in the year 1315 that he publicly dissected the bodies of two women in Bologna. Anatomical study was further complicated at this time by certain bulls of Pope Boniface VIII, forbidding evisceration or boiling or cooking any part of the human body; these deliverances were really aimed, not against scientific investigation, but at the absurd custom introduced by the crusaders of cutting up and boiling the bodies of their relatives who died in infidel countries, in order to send them home for burial in holy ground; nevertheless, the papal injunction certainly operated to discourage and prohibit anatomical dissection, since nearly two hundred years later the University of Tübingen was obliged to apply to Pope Sixtus IV for permission to authorize dissection.
Guy de Chauliac, born in Gévaudan about 1300. was the most famous physician and surgeon in Christendom during the Arabic period. He studied at the cathedral college of Mende, which at that time was quite celebrated, and was taught medicine at Montpellier under the best masters of his day. It is probable, also, that he studied in Paris, and certain that later, in Bologna, he saw dissections made. Dissatisfaction with the writings of the ancients and the knowledge which he obtained at the schools stimulated his own powers of observation, and he became, in every respect, an original student and acquired a degree of erudition far more extended than that possessed by any of his contemporaries. He practiced in various places, longest at Lyons; and finally entered the service of Pope Clement VI, at Avignon, and probably enjoyed the same honor under Innocent V and Urban V; when the latter was made pope, in 1362, de Chauliac became his chaplain, or chapel-reader. In 1363 he published a work on surgery called The Inventory, upon which his fame chiefly rests, though several other volumes emanated from his pen. None knew better than he how to unite respect for the ancients with justice toward contemporaries, and he cited a large number of Greek, Arabian, and Latin authors, some of whom are now utterly unknown. The sciences, he declared, are "created by successive additions; the same man cannot lay the foundation and perfect the superstructure. We are as children carried on the neck of a giant; aided by the labors of our predecessors we see all that they have seen, and something beside." In tracing the character of a surgeon he recommends that he be "learned, expert, ingenious, bold where he is sure, timid when in doubt, avoiding bad cures and practices, being gracious to the sick, generous and compassionate, wise in prediction, chaste, sober, pitiful, and merciful; not covetous nor extortionate, but receiving moderate fees according to the circumstances of his patients, the character of the case, and his own dignity."
"Never since Hippocrates," says Malgaigne, "has medicine learned a language stamped with such nobility and in such few words." Although a follower of Galen, in anatomy he insisted on the necessity of dissection, and proposed to make use of the corpses of executed criminals for this purpose. The drawings made by Henri de Mondeville were known to him; he divided abscesses into hot and cold, although among the latter he included oedcma, tympanites, dropsy, scirrhus, and other conditions. In practice he was more timid, yet more active, than Lan franchi, who never cut for stone, but left that operation to the traveling surgeons. De Ghauliac described it as he had seen it performed; he opened the abdomen for dropsy, did not hesitate to attempt the radical cure of hernia, and operated for cataract. The plague which raged during the fourteenth century and depopulated the known world of one-fourth of its inhabitants, twice appeared in Avignon while Guy de Chauliac was a resident there—and he acknowledges that nothing but shame prevented him from fleeing. He remained at his post, visited the sick, and was himself attacked and left for dead. "In this frightful position he had sufficient presence of mind to follow the peculiarities of his case, analyze his own sufferings, and to give a description of them worthy of Hippocrates" (Renouard). His work soon became the surgical code of Christendom, and was commented upon and translated into all tongues, remaining for a long time a classic, and even at this day it preserves much of its interest as representing the condition of medical science at the close of the Middle Ages; moreover, its literary style was much superior to that of any of his contemporaries, all of whom wrote very barbarous Latin. He died about 1370.
With the death of de Chauliac terminates our interest, not merely in the Arabian physicians and those who were intimately connected with them, but in the so-called Arabic Period. It may be added, in passing, that the followers of Mahomet, like those of Christ, erected by the side of each of their mosques a school, and often a hospital, endowed with more or less generosity by caliphs or the wealthy, who hoped to purchase redemption and eternal happiness by such liberality.
A certain number of religious orders or communities were established during the Middle Ages to give succor to the deserving sick, the most widely known being those of St. Mary; St. Lazarus; St. John, of Jerusalem; and the Daughters of God. To be sure, some, through the endowment of the opulent, became rich beyond all reason, and departed from their primitive purposes, and thus not only excited the covetousness of monarchs, but had even the temerity to resist their authority. This compelled, every now and again, a suppression of some order or institution—partly, perhaps, for laxity of morals, and partly because of their turbulence. Of this period it may be said that charitable zeal for the sick was never more pronounced; princes, bishops, and popes gave examples of devotion by dressing with their own hands the ulcers of lepers—and leprosy was in those days a frightful disease, having been contracted by the crusaders in the Orient, and everywhere spread as they returned, being, moreover, favored by the miserable uncleanliness which was then so common. Ignorance, dread, and fear rendered this disease worse than usual, and it was confounded with other maladies less formidable. It has been estimated that in the fifteenth century Europe harbored no less than nineteen thousand lepers; and that the disease was a great terror is manifest by the excessive caution taken against its spread: its victims were forbidden to enter cities, and on the highway were compelled to stand aside lest they should taint passers-by with their breath; even a healthy person convicted of being touched by a leper was banished from society; any infraction of these rules was punishable by death. It will thus be seen what depth of genuine humanity it required to have anything to do with one of these outcasts.
Another institution prevailed widely during these days,—namely, public baths, which were established in nearly every city and increased to such an extent that in the fifteenth century the bathers of Paris constituted a powerful brotherhood, so powerful, in fact, that Jacque Despars, physician to Charles VII, and one of the most renowned professors of the faculty, for speaking openly against the abuse of public baths, was obliged to leave the capital to avoid persecution.
A study of the general history of the Arabic Period reveals that the Arabs, previously obscure and uncivilized, emerged rapidly from the demi-savage state, and took the first rank among the polished nations of the world. During the earliest portion of this period these people were religious vandals and destructive fanatics, but later embraced with enthusiasm and persistence a study of the humanities, and endeavored to repair their early ravages by collecting the débris of the literary and scientific monuments of Greece; but, though they cultivated medicine with zeal and success, they added little to the Greek treasures. Later, Arabia was overrun by hordes from the deserts of Tartary, a people yet more barbarous and unknown, who established themselves in all parts of the globe then under Saracenic dominion, and by their brutal despotism degraded the Arabians to a condition approaching that from which they had emerged. This seems to have been ever the result of Turkish conquest.
Meanwhile the Greek nation, which was for so many ages at the head of civilization, gradually lost its power, virtue, courage, glory, and independence, and continued to descend, until now it exercises no influence whatever on the course of events. During the course of the Arabic Period only one Grecian physician merits mention on account of his writings, and in these there was nothing-new except what he had borrowed without credit from the Saracens.
The Empire of the West,—that is the western part of the ancient Roman Empire,—after subjugation by barbarians from Germany and Scandinavia, fell under a cloud whose darkness overwhelmed it. Its people, however, gradually received new life by commingling their blood with that of the invaders. Later they were able to repulse the Saracens who poured in upon them from Spain; then they turned their armies against each other, and wrought mutual havoc and ruin for several centuries. Again, roused by religious fanaticism, as had been the Mohammedans previously, they rushed by thousands upon the plains of Asia Minor, Syria, and Egypt, which had been for centuries occupied by the Arabs; and their adventures and enterprises, and the new and varied scenes through which they passed, gave rise among the "Francs" to some taste for poetry and works of imagination During the twelfth and thirteenth centuries governments became more stable, liberal institutions were created, the rust of ignorance gradually disappeared, and by the end of the Arabic Period there were really apparent brilliant streaks of mentality in the horizon of the nations of Europe. In this progressive movement the study of medicine shared. In the thirteenth century it was worthily represented in Italy, in Paris, and became established in Montpellier. Notwithstanding, up to this time physicians apparently only knew how to timidly follow in the track of the Arabians, and approached little, or not at all, in their studies, the purer lore of the Greeks.