CHAPTER V.
Age of Renovation (continued).—Erudite Period (continued): Benivieni, 11502. Jean Fern el, 1497-1553. Porta, 1536-1615. Severino, 1580-1656. Incorporation of Brotherhood of St. Come into the University of Paris, 1515. Ambroise Paré, 1510-1590. Guillemeau, 1550-1613. Influence of the Occult Sciences: Agrippa, 1486-1535. Jerome Cardan, f 1501. Paracelsus, 14931541. Botal, born 1530. Joubert, 1529-1583.
In the domain of pathology the Arabs had added only a very small number of observations to those contained in the works of Galen. The most interesting of these pertain to eruptive fevers. Most of their writers contented themselves with making an inventory of the acquisitions of the past, as did Guy de Chauliac, and this was about all they could do under existing circumstances; although they did not make discoveries, they prepared the way for their successors.
Two men about this time did a great deal in the direction of creating a desire for post-mortem study of cases, and in illustrating and succinctly describing symptoms.
The first of these was Benivieni, a Florentine, who died in 1502—the date of his birth being uncertain. To him, more than to any other, we owe the commencement of the study of gross pathology and pathological anatomy. He was the first to consider the knowledge that might be obtained by opening bodies for the sole purpose of ascertaining the location and cause of the diseases from which they had died. As Malgaigne remarks: "A eulogy which he merits, and which he shared with no other person, and which has not been accorded to him up to this time by the many historians of surgery who have superficially searched among these precious sources, is that he was the first who had the habit, felt the need, and set the useful example, which he transmitted to his successors, of searching in the cadaver, according to the title of his book, for the concealed causes of disease." The work referred to by Malgaigne was entitled: Concerning Some of the Secret and Strange Causes of Disease and was published in Florence in 1507. It is poor in quotations, but rich in original observations, which pertain especially to the etiology of disease, and gives a very concise symptomatology and history of each affection of which it treats, as well as a pathological explanation. Benivieni's observations on gall-stone, on the anatomical lesions of heart diseases, and on the conveyance of syphilis from the mother to the foetus were original, as well as many observations concerning the presence of worms and other parasites in the body.
He did not limit himself to dissection of his own cases, but sought autopsies in the cases of others. He examined the bodies of those who had been hung, always thinking to find in them something of interest. In this regard he was followed by one already mentioned,—namely, Eustachius.
After these two the men who most cultivated pathology and anatomy in the sixteenth century were Rembert Dodoens and Marcellus Donatus. The former was born in 1517, in Mecheln, traveled extensively, was physician to Maximilian II and the Emperor Rudolph, and died in 1585. The latter lived and worked in the latter half of the sixteenth century, the dates of his birth and death being somewhat uncertain.
The next man whom we must mention is one who did a great deal for internal medicine, pathology, and anatomy. Jean Fernel, who has been surnamed "the modern Galen," was born in Clermont in 1497. Even as a boy he showed great aptitude, and very early made himself a reputation in philosophy, law, and mathematics. In 1530 he was received as doctor, with the unanimous applause of the entire faculty of Paris. He seems to have been stimulated by this only to more extended study; in fact, so hard did he work at his studies that his friends became seriously alarmed for his health, and remonstrated with him; they received for reply: "Destiny reserves for us repose enough." He became physician to King Henry II, of France, and in the midst of a very extensive practice undertook to collect all the medical knowledge scattered in the Greek, Arabic, and Latin works, in order to form from it a body of doctrines. His work was written with a purity and elegance of Latin that reminds one of Cicero. Throughout its pages he was philosophic, and sought to unite the apparently irreconcilable doctrines of Plato and Aristotle.
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He divided medical science into three great sections,—physiology, pathology, and therapeutics. In his explanations of disease he was too often fanciful, following the speculations mainly of Galen, and making free use of the hypotheses of humors, temperaments, vital spirits, etc.; but the following statement of his would do credit to a trained pathologist of to-day: "As for myself, I shall never believe I have profound knowledge of any affection if I do not know positively, just as if I could see it with my eyes, in what part of the human body is the disease, its primitive seat, what suspicion of organic lesions constitute it, whence it proceeded, if it exists idiopathically or by sympathy, or if it be kept up by some exterior cause. He who pretends to be a rational physician must sound each of these subjects, and discern them by certain signs." The problem which he thus set himself he certainly, for his own part, considered as solved, although it was not long before his solutions were set aside and the original uncertainty reappeared.
In therapeutics he very early laid down the fundamental maxim that every disease must be combated by contrary remedies, justifying this by every species of argument, amounting to this: that every disease must be combated by its contrary because all that cures a disease is contrary to it. This was, in part, the doctrine of "Contraria contrariis curantur"—the antithesis of the equally absurd sophism: "Similia similibus curantur" which three hundred years later was erected into an excuse for the foundation of an alleged new school. There can be no doubt that Fernel rendered very great service to his time and to subsequent generations, despite the fact that his recommendations and statements were too often founded upon sophistry.
Just here we must digress for a moment to consider the status of bleeding. Hippocrates and Galen had advised to bleed largely from the arm on the affected side in pleurisy and pneumonia. That practice was gradually abandoned as Greek traditions were lost sight of, and finally the Arabs substituted for it something entirely different,—namely, pricking a vein in the foot in order to let blood flow drop by drop. Their method prevailed throughout Europe until the commencement of the sixteenth century, or about the time when Fernel appeared upon the scene. A Parisian physician named Brissot had revived the ancient (the Greek) practice during an epidemic of pleurisy, and had obtained thereby astonishing success, which he hastened to publish, commending the method employed. He thus created a great uproar in the medical world. The innovation found foes and defenders, and disputes grew warm, even to the fever point. Finally, the ancient method was generally revived, and Fernel accepted it.
Felix Plater was born in 1536, in Basel, Switzerland, and died in 1614. He had several sons who made their mark in medicine. In his large work, which preceded that of Fernel, he took perhaps the first step in an unexplored route,—namely, in the classification of disease according to the totality of apparent symptoms. Defective as this classification appears in our eyes, its author lived a long life as a very distinguished practitioner and professor in his native town.
Giovanni Batista Porta was born in Naples in 1536, traveled extensively in Italy, France, and Spain, and founded in 1560 an Academy of the Segreti. He was accused of magic, and was compelled to refute the charges in Rome. He died in 1615, having been one of the leading scientists of his time, and the founder of modern optics. In the first edition of his Magia Naturalis, published in Naples, 1587, is found the first description of the camera obscura,—of course, in a very incomplete form and without lenses.
Severino was a celebrated surgeon of Naples. He was born in 1580, in Calabria, studied in Naples, became a doctor in Salernum, and then became professor of anatomy in his native town. For a long time the victim of intrigue and of persecution by the Inquisition, he was finally driven out of Naples, but was called back by the populace. He then became the most celebrated teacher of his time, writing extensively on a variety of subjects. He died in 1656 of the plague, an epidemic of which was at that time raging in central Italy.
Arriving now at the surgery of this Age, we find that matters were more chaotic than in other departments of medicine, and for reasons which are easily given and appreciated. While, ordinarily, external diseases are more easily discerned than internal, and while in a corresponding degree they can be more satisfactorily treated; while, in other words, external pathology has ordinarily taken precedence of internal in professional as in lay minds, this view seems to have been inverted for a time during the Middle Ages. Previous to the period now under discussion the sciences had generally declined in Europe, and surgery had fallen even lower than medicine, for the reason that medicine was in the hands of the priests, who had at that time something of a liberal education, while the practice of surgery was abandoned to a class of ignorant barbers, bathers, and bone-setters. No mechanic or artisan could take as an apprentice any youth without a certificate affirming his legitimate birth, and that he came from a family in which there were neither barbers, bath-keepers, shepherds, nor butchers. Among the men who were thus made social outcasts were those into whose hands most of the surgery of the fifteenth century fell. This was particularly the case in Germany, and other European countries were little in advance. We have seen that in France and in Italy Lanfranc and Guy de Chauliac did their best to rescue surgery from the hands of these men, but their efforts did not prevent it from being completely abandoned by the clergy, who devoted themselves to the practice of medicine.
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When we come to inquire the reason for this—in other words, why an art so useful as surgery, and one which made such requirements for knowledge, sagacity, and dexterity, whose necessity was almost continually felt, particularly during these troublous times of almost constant warfare, should be so neglected by men who could best comprehend its utility and respond to its requirements—it is difficult to find a satisfactory answer. The social condition of the times sheds some light upon the question. The nations of southern Europe were socially divided at that time into the nobility, who were nearly always at war; the clergy, who monopolized learning and filled the so-called liberal professions; and, finally, the common people, who were common prey for both the other classes, and who yet had to support both without having any privileges of their own. While the practice of medicine was a clerical right, the canon of the church prohibited physicians from drawing blood, under pain of excommunication; and hence surgery, shunned by the priests, to whom it naturally belonged in connection with the practice of medicine, fell into the hands of the ignorant and vulgar, who practiced it in a purely mechanical way, without knowledge or appreciation of its possibilities. In addition to this, there was an almost total lack of detailed and precise anatomical knowledge, and but small reason to expect that the ignorant practitioners of surgery would feel the need of such knowledge. Moreover, most of the operators were itinerants, going from city to city, stopping so long as they had cases to operate upon or until some reverse forced them to depart. Most of these men limited themselves to one or two sorts of operations. Some operated for cataract, others for stone, others for hernia, nearly every one having a secret method which was transmitted to his posterity as a heritage.
In the history of medicine certain family names of itinerant operators have been preserved; for example, the Branca, the Norsini, in Italy, and the Colot in France.
Under such conditions there could be no such thing as the profession of the surgeon. The prejudice against dissection did not begin to abate until the thirteenth century, when a very few of the clergy dared, in a very timid manner, to perform surgical operations. Their numbers increased in the course of the fourteenth and fifteenth centuries, and in the sixteenth had become considerable. Most of the great anatomists of that period—such as Benivieni, de Carpi, Vesalius, Fallopius, and Fabricius ab Aquapendente—were great surgeons.
In due time it came about that while the clerical physicians were willing to descend to the rank of operators, the lay-surgeons aspired to the rank of doctors of medicine. This transformation took place especially in France, the only country where at that time there was a special college of surgeons—the small Brotherhood of St. Come, already alluded to, which was always contending against the faculty on one hand and against the barber-surgeons on the other, with varying results, and which, at last, sought peace with the university and was received by it. This took place in 1515, and was the renaissance of surgery, not only for Paris, but for the whole world. By this reunion the faculty acquired authority over the barbers, who were admitted to their lectures and took courses in anatomy and surgery, gradually attaining a knowledge which entitled them to be called barber-surgeons; their rights were not curtailed, but made more difficult of procurement, for, in addition to passing their initiation for the privilege of becoming barbersurgeons, they also had to pass an examination before the physicians and the two surgeons of the king, at Chatelet, for the right to practice surgery. The surgeons, as the price of their submission to the faculty, had, beside the university privilege, a sort of supremacy over the barbers; and thus it happened that the barbers were admitted to the rank of surgeons at St. Come, and that the surgeons of St. Come were admitted as barber-surgeons by the faculty of medicine. In this double capacity they approached nearer the profession of medicine, from which they should never have been separated, while surgery became an art which received numerous improvements. We must now devote a little time to the consideration of at least two or three of the men who most contributed to extend and elevate it.
Among those who most contributed to make the period of which we are now speaking a glorious one, raising himself from the lowest walks of life to the attainment of the highest professional honors, is Ambroise Paré, whose name will never die while the art of surgery is taught. Paré was born about the year 1510, at Laval, of poor parents. He was an early apprentice to the provincial barber-surgeons, after which a natural ambition for improvement led him to Paris (about the year 1532), where he studied three years at the Hôtel-Dieu, and obtained the confidence of his teachers to such an extent that he sometimes operated for them. He never learned Latin, the language at that time of the books and of the schools. Paré was most fond of recalling his hospital experience; he counted it among the highest honors of his life that he should have enjoyed what he there did enjoy, and gives us to suppose that he was a favorite upon whom peculiar favors were conferred. In one of his writings, a physician of Milan having expressed astonishment at so young a man's knowledge, he remarks with pride: "But the good man did not know that I had been house-surgeon for three years at the Hôtel-Dieu de Paris." The functions of the barber apprentices in the hospital in those days were probably to make dressings and bleedings, and sometimes post-mortem examinations ordered by the chiefs, to assist the latter in their operations, and to act in case of emergency; in other words, to do about as the internes at present do. They probably found there a precious and rare opportunity for anatomical dissection, but it does not appear that they had regular clinical instruction.
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Communication between master and pupil depended absolutely on the pleasure of the former.
In 1537 Paré was made surgeon to the Colonel-General of Infantry, René de Montijean, with whom he made his first campaign in Italy. (This was in the army which King Francis I assembled in Provence with which to repulse the invasion of Charles V.) He had never seen war nor recent gunshot wounds, and only knew of them by what he had read in the writings of John de Vigo. This was at a time when it was the custom of surgeons to pour boiling oil into every amputation or other wound in order to check haemorrhage; and Paré's experience in this, his first campaign, put him in the way of his first discovery,—a discovery which will never be forgotten. He has recounted in his Book of Arquebus Wounds and in his great Apology how after the affair of Pas-de-Suze he watched the other surgeons, dreaming of nothing else but to imitate them as far as he could; how the boiling oil gave out; how his anxiety about it prevented him from sleeping; and how to his great wonder he found that the wounded who had submitted to the operation suffered more than the others. This set him to thinking, and led him, a young man without name or authority, without letters or philosophical studies, to observe, to reason, and to combat a doctrine which was universally admitted and which the highest surgical authorities of the day sustained. At that time all authors who had spoken of gunshot wounds considered them as poisonous and complicated with burns; consequently they gave the precept to cauterize with boiling oil or a red-hot iron, and at the same time to administer certain alexipharmics which should serve as internal antidotes. John de Vigo, physician to Pope Julius II, assures us that the danger of these wounds results from the round formation of the balls, from heat, and from the poisonous qualities communicated to them by the powder. His theory and the method of treatment above given had been adopted without contradiction until the day when Paré dared to utter the first protest against them.
After a campaign of three years, in which he lost his master, he returned to Paris and married. In 1543 he was in the army of Perpignan, in the service of de Rohan, grand lord of Brittany, where he gave continuous proof of his sagacity. It was after this campaign that his reputation, so well established among warriors and the nobility, inspired Sylvius with the desire of seeing him. Paré has recounted how, in a conversation which they had together, he insisted upon the then entirely new precept, of which he had made many applications, that in order to extract bullets it was best to place the wounded in the position in which they were at the moment of injury.
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Sylvius, then at the height of his fame, invited the young physician to dinner, and listened to him with great attention while he explained his views on gunshot wounds, which made such an impression upon the mind of the host that he besought him eagerly to write them out and make them public. Encouraged by this advice from so high a source, Paré prepared his text, illustrated it, and in the year 1545 brought out his little work, which marked in a manner so glorious the revival of French surgery. It was published by Gaulterot, the sworn bookseller of the University of Paris, and was entitled "The Manner of Treating Wounds made by Arquebuses and other Fire-arms, and those made by Arrows, Darts, and the Like; and also by Burns made Especially by Gunpowder. Composed by Ambroise Paré, Master Barber-Surgeon in Paris."
A few months later appeared the second edition, in which he still recommended the actual cautery in haemorrhage; but each day he meditated upon the subject, and on one occasion discussed it with two surgeons of St. Come, submitting to them the idea that, since ligatures were applied to veins and arteries, and to recent wounds, there was nothing to prevent their being equally applied to amputations. Both agreed with him, and opportunity soon presented itself at the siege of Damvilliers, when a gentleman had his leg crushed by a shot from the fortress. Paré made an amputation, omitting for the first time the use of the cautery, and had the happiness to save his patient, who, full of joy at having escaped the red-hot iron, said he had got clear of his leg on very good terms. This was, in truth, the actual renaissance of surgery, which had been to that time a torture, but which became thereafter a blessed art. It was a barber-surgeon who produced the double marvel. This took place in 1552.
In 1554, after other campaigns, Paré was made, without examination, Master of the College of St. Come, and in 1559 was included among the surgeons of King Henry II (who was killed in a tourney, in Paris, in 1559)r which position he retained with Francis II and Charles IX. The latter raised him to the highest position among his surgeons, and King Henry III retained him, which caused the witty and true remark that the kings of France transferred him to their successors as a legacy of the crown.
Many anecdotes are related of Paré to show the remarkable esteem in which he was held by public and private citizens. For instance, in October, 1552, one of the most eminent generals of Charles V laid seige to the city of Metz, and the emperor came in person to join the army. Within the walls of this beleaguered city were gathered nearly all the nobility and princes of France. The city was defended by the Duke of Guise, and the besieged soldiers were at that time suffering alike from the attacks of the enemy, the results of the siege, and the rigors of a frightful winter. The duke had established two hospitals for the soldiers, and had put into requisition the barber-surgeons of the city, giving them money with which to furnish their supplies. But these surgeons were sadly incompetent against the combination of unfavorable circumstances, consequently nearly all the wounded perished, and a horrible suspicion was roused among the soldiers that they had been poisoned. Under these circumstances the duke dispatched one of his captains to the king to say that the place could hold out for ten months, and asked at the same time for fresh medicine. The king sent for Paré, gave him money, directed him to take all the medicine he thought necessary, and furnished him a letter to Marshal St. Andre, who commanded in Verdun, and who bribed an Italian captain for fifteen hundred crowns to introduce into the besieged city the celebrated surgeon. The expedition was perilous, and Paré himself would have willingly remained in Paris. But he entered Metz on the 8th of December, at midnight, without an accident. Having passed already sixteen years in war, he was known to the chiefs and common soldiers. The day after his arrival, the duke, who knew how to strike the imagination, presented him on the ramparts to all the princes, lords, and captains, who embraced and received him with clamor. By the soldiers he was received with shouts of triumph. "We shall not die," they exclaimed; "even though wounded; Paré is among us!" From this time the defense was conducted with renewed vigor, and it has been universally conceded that to the presence of this single man the city was indebted for its salvation. The siege itself was not raised until after a terrific conflict. On the very day of Paré's arrival he began to treat the leg of one of the prominent officers, who for four days had been in charge of a charlatan, and had suffered horrible tortures. The next day he decided to trephine another, who had been struck on the head by a fragment of stone, and who had been insensible for fourteen days. Both patients recovered.
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The little brotherhood of surgeons of St. Come were ready to seize on every circumstance which might redound to their advantage, and desired to have within their ranks the man who enjoyed such great renown. They, therefore, admitted him to an examination, in spite of the statute which required that the candidate should understand Latin, and in spite of opposition by the professors of the university. They not only admitted him to all their degrees, but awarded him a reception,—a hitherto unknown honor.
Description of Fig. 17.—A, the instrument named, on account
of its figure, lizard's beak; in Latin, "rostrum lacerti."
It is used to extract balls which have been flattened or
imbedded in bone. A displays particularly the cannula. B,
hinge, by means of which the lizard's beak is opened and
closed as much or as little as the surgeon wishes. C, the
rod which opens and closes the lizard's beak. When drawn
upon it closes and when pushed it opens the instrument. D,
dilator and mirror: in Latin, "dilatatorium,
speculum." The instrument is somewhat roughened and
dentated in order to take a firm hold of whatever it grasps.
It may serve two purposes: first, to dilate and enlarge the
wound so that it may be seen to the bottom, and also to make
way for some instrument, as pincers or crow's beak, and to
grasp more easily and withdraw the foreign body; secondly,
it may itself serve to extract the foreign body,—e.g., a,
double-headed ball; b, a small chain; c, c, some pieces of
mail. E, E, crane's beak; in Latin, "rostrum gruinum." H2,
H, duck's beak; in Latin, "rostrum arserinum." K, sound. L,
ball-extraetor without cannula. M, cannula with handle.
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Paré in his time met with a success which to-day would be pronounced extraordinary. He seemed to inspire the wounded with the utmost confidence, and to possess greatness and firmness of character in the highest degree. It is perhaps, even more extraordinary that with so strong a character he should have so long retained favor at court. In the midst of the excitement of camps, and a very extended practice, he found time to read all that had been published on his art, and to compose himself a great number of works, enriching all branches of surgery. Instead of keeping secret his inventions, as was the custom of the time, he made them as public as possible, saying, in the preface of his large work on surgery: "For my part, I have dispensed liberally to everybody the gifts that God has conferred upon me, and I am none the worse for it; just as the light of a candle will not diminish no matter how many may come to light their torches by it."
Besides his smaller treatises, his large, collective works passed through a number of editions, and were everywhere reprinted and studied. Not only was he great in surgery, but he attained a high degree of expertness in midwifery. Among other things, he restored the forgotten practice of podalic version in cases where this procedure is necessary. He died in 1590.
The doctrine of Paré on gunshot wounds was rapidly disseminated. From 1550, Maggi, of Bologna, advocated it without giving credit to its real author, and sustained it by decisive experiments. He observed that none of the wounded felt any heat, and that the torn portions of their clothing showed no trace of fire; and he shot balls through packages of powder without setting them on fire. At the same time Lange spread this view in Germany, and Botal, of Turin, took it up (withholding, however, the true author's name).
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While Ambroise Paré did not disdain to act as accoucheur, it was his friend and pupil, Jacob Guillemeau (1550-1613), who, in the sixteenth century, most occupied himself with the practice of obstetrics. We owe to Guillemeau the first improvements that the moderns made in this art; for instance, the proposition to rapidly and artificially terminate parturition in cases of considerable haemorrhage or when the woman is taken with convulsions during labor. Guillemeau supported this practice on the authority of Hippocrates, and operated on a great number of patients, proving its value and the danger of its neglect.
The Cæsarean operation was known to the ancient Greeks and Romans, but had been abandoned during the Middle Ages. It' remained for the accoucheurs and surgeons of the sixteenth century to re-establish it. Among others, Rousset, physician to the Duke of Savoy, who recommended it very warmly, reported several cases where it had a happy issue for both mother and child. He even reported the most remarkable case of all,—that of a woman who was six times delivered by this operation, and who perished in the seventh confinement, because, as he states, the surgeon who had been accustomed to operate on her was absent. Unfortunately, this case is not authenticated.
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Nothing shows better how the art of observation and accurate description of phenomena had progressed at the time of the revival of letters than the number of new diseases of which the authors of that period make mention. Then, for the first time did one read of whooping-cough, miliaria, scurvy, plica polonica, syphilis, and raphania. It is scarcely credible that these diseases fell upon Europe at this particular time. It is more probable that they had a more ancient existence and were not recognized.
Even to-day medical men are divided in their own opinions on the origin of syphilis, some believing that it was developed spontaneously in Europe toward the close of the sixteenth century, others that it was imported from the New World, others that it had a most ancient origin, and others yet that it represented a degenerated form of leprosy.
Certain it is that syphilis appeared almost simultaneously in all parts of Europe,—at Bologna, Halle, Brunswick, in Lombardy, Apulia, Auvergne, and so on. Léonicenus attributed this sudden outbreak to an extraordinary inundation that occurred in all parts of Italy toward the close of the fourteenth century, and supported his views with the authority of Hippocrates and Galen. Others attributed it to astrological influence; while still others regarded it as a scourge of God with which to punish men and turn them away from unbridled libertinism, Fallopius thought venereal disease was engendered by the poison which the perfidious Neapolitans had thrown into the wells from which the French drew their water. These wild views simply indicate the spirit of the age. Oviedo published in 1545 a history of the West Indies, in which he states that syphilis originated in America. He held that when Columbus returned from his second expedition to the New World, in 1496, his men enlisted under Gonsalvo de Cordova to go and fight the French, who had invaded the Kingdom of Naples, and that they communicated to the French and Neapolitans the disease which they had brought from San Domingo. Unhappily for his veracity, it is certain that syphilis broke out in Naples at least two years before the arrival of the Spanish fleet. It is equally certain that at none of the points at which Columbus touched on his return from his first expedition was there any manifestation of syphilis for years.
At this time the venereal disease, so-called, included those conditions which we now differentiate under the names of syphilis, chancroid, and gonorrhoea,—a confusion of diseases which persisted even up to the time of John Hunter. It is worth while to publish this fact, since writers of two or three hundred years ago may not have meant by the term "syphilis" just what we would mean to-day. Without going into this question here, it is enough to say that one who reads intelligently may see in the Sacred Scriptures unmistakable allusions to this disease. If the statements of David, as contained in the Psalms, are reliable, he was himself a serious sufferer from it. The ancient Greek and Arabian physicians make mention of lesions which could only be attributed to this disease; and the Latin satirists, like Horace and Juvenal, describe symptoms of a certain kind as being the fruit only of shameful practices.
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It is most likely that the sudden appearance of syphilis in nearly all parts of Europe at about the same time, which has been regarded as so extraordinary, can be explained by the clearer distinctions physicians began to make between symptoms of this disease and those of leprosy. Arrangements for the cure of lepers were very complete, and such syphilitic patients as responded kindly to the treatment thereby established themselves in a very different category of disease.
The first writer to systematically consider venereal disease was Astruc, who was born in Languedoc in 1684 and died in 1766. He was the principal advocate of the view that syphilis had an American origin, in which view he was bitterly opposed by Sanchez, a Portuguese physician, who collected a large amount of evidence to the effect that its first ravages were observed in Italy.
Summing up this whole matter, we may agree with Jourdan, who has examined all the opinions of these writers, and who, in his treatise published in 1826, concluded that all symptoms which had been hitherto connected with syphilis had been known and described from the remotest antiquity, but were not supposed to proceed from a common source, and to be attached to the same cause, until after the close of the fifteenth century.