Glaucon’s confidence in me and in the medical art, after this episode, was unbounded.
Thirty or forty years elapsed after Galen’s death before the Profession began to realize how great an authority he had become in all matters relating to medicine; not perhaps among the majority of physicians, but among the better educated and those more given to reasoning about the various problems in physiology and pathology. Then came the invasion of Rome by the Barbarians, and with it the scattering of nearly all those who were at the time practicing medicine in that great city. This was the beginning of the long period known as the Middle Ages, a period during which, so far as Italy and Gaul were concerned, the science of medicine made no advance whatever. The physicians living in a precarious manner in the towns, and the monks who practiced medicine in the country districts, took very little interest, as may readily be imagined, in the achievements of Galen. Through all those years they clung to the doctrines of the Methodists, as revealed to them in the work of Caelius Aurelianus, the favorite medical treatise of that period. It was only during the latter part of the Middle Ages that Galen’s teachings began once more to be appreciated at their true value; and, as time went on, they gained a stronger and stronger hold on the minds of medical men, until finally they held undisputed sway. Friedlaender, speaking of medicine in those dark times, uses these words: “Galen’s colossal personality loomed up throughout that long night as a brilliant guiding star to light the intricate pathways of medicine.”
CHAPTER XVI
THE INFLUENCE OF CHRISTIANITY UPON THE EVOLUTION OF MEDICINE
The religion established by Jesus Christ in Judea during the early part of the first century remained confined within the limits of that region for a number of years, but already during the latter half of that period groups of Christians were to be found in every part of the Roman Empire, and in certain localities the membership of the new church had increased so greatly in numbers as to excite the alarm and hostility of the temple priests and of the governing officials. Persecutions, especially in the city of Rome and at the instigation of Nero, became more and more frequent and more and more pitiless, but they failed utterly to destroy the new religion, so firmly was it rooted in the followers of Jesus Christ. As a matter of fact its spread was checked for only a few years, and then its adherents increased in numbers more rapidly than ever. Neuburger, in his “History of Medicine,” makes the following quotation from the account which Dionysius of Alexandria gives of the great plague that occurred during the third century A. D.:
The majority of our brethren in their love for their neighbors did not spare themselves, but acted as a unit in their efforts to assist. They visited the sick without the slightest fear and gave them the very best of care, for the sake of Christ.... Among the non-Christians, however, the very opposite was true. As soon as any of their number fell ill they pushed them to one side, even those who were dearest to them, and, before they were more than half-dead, they threw them out into the street and took no care to bury the dead bodies.
Such an example of self-sacrifice and humanity—and there must have been very many similar examples—could not possibly have failed to make a profound impression upon the community at large. Daniel Le Clerc says that three physicians suffered martyrdom for their Christian faith during the reigns of the Emperors Marcus Aurelius, Lucius Verus and Commodus. They were Papila (of Pergamum), Alexander (of Lyons) and Sanctus (a contemporary of Galen), whose death was of a particularly cruel character. Credit should also be given to Christianity, says the same writer, for having established the rule that every community should assume the expense and responsibility of caring for its own poor and sick. This was a step of the greatest importance; and, at a still later period, when Christianity became largely an affair of the state, a complete hospital organization was effected, with the bishop as the chief officer and, under him, deacons and deaconesses. Such well-organized institutions proved to be of the greatest possible benefit to the advance of medical science. They were the worthy successors of those more ancient hospitals, the Aesculapian temples, which were first established by the Greeks in the pre-Hippocratic age, and they have continued in an unbroken chain from the institutions of those primitive times to the thoroughly well-equipped hospitals of the present day.
In 330 A. D. the new capital of the Roman Empire was established in Byzantium, afterward called Constantinople, and Rome, which for hundreds of years had been the metropolis of the world and the source from which a large part of Roman history had emanated, was given a subordinate position. Then followed, in 410 A. D., the conquest of the latter city by the Visigoths, a horde of uneducated Barbarians who had felt the might of Rome in previous years, and who now doubtless took immense satisfaction in humiliating her and in destroying her valuable possessions. There are good reasons for believing that, when the Emperor Constantine established his residence in Byzantium, the leading physicians of Rome followed him; and it is not likely that many of those who, for one reason or another, preferred to remain in the old capital, continued to do so after it became known that the Barbarians were approaching the city. But the migration of these physicians to the new capital did not mean a renewal there of the scientific activity which had characterized the growth of Greek medicine in Rome during the first two centuries of the Christian Era. It is probable that the fugitives, being obliged to travel with the smallest amount of baggage possible, left the major part of their books and papyrus rolls behind, hoping, no doubt, that they might be able at some later date to recover them. But the favorable occasion never arrived, and thus a great deal of valuable medical literature entirely disappeared. The loss, however, might have been even more serious than it was if the Christian church had not already (during the third century) begun to establish monasteries in secluded and inaccessible spots. It was to these institutions that not only books of a religious character, but also those relating to the science of medicine, were transported for safe keeping during the early Middle Ages. Farther on, I shall have occasion to refer to this subject again and to discuss more fully certain other benefits which accrued to medical science from these monastic institutions.
But while, on the one hand, the Christian church through the instrumentality of the monasteries was lending its aid to the preservation of the sources of medical knowledge, it was, on the other, doing its best to arrest all further evolution of that branch of science; not consciously, it must be admitted, but through a mistaken sense of its duty to God. Thus it came about that the Emperor Justinian I. (527–567 A. D.), acting under the narrow-minded advice of his ecclesiastical counsellors, closed the medical schools at Athens and Alexandria and at the same time withdrew the regular allowance of money which up to that time had been paid to the state physicians and to special scholars. A few years later, however (i.e., in the early part of the seventh century A. D.), some of the more highly educated physicians of Alexandria got together and made the attempt to organize a school of medicine in that city. A course of lectures was planned and sixteen of Galen’s works, carefully chosen for the purpose, were made the basis of the new course of instruction. The books selected were first carefully edited and simplified, and then commentaries were added in order that in their final shape these treatises might be better suited to the uses of students. The invasion of Alexandria by the Arabs, however, soon put an effectual stop to this promising attempt to revive Greek medicine.
In this brief sketch I have thus far mentioned only the more direct effects produced by the new religion upon the evolution of medicine. The indirect effects, however, were also in some cases of very great importance. At the beginning of her history there developed in the Christian church, among her chief men, a strong disposition to quarrel over dogmas. To apply the term quarrelsomeness to this tendency may easily convey a wrong impression. It was, more strictly speaking, a highly developed conscientiousness on the part of men whose minds were deeply imbued with the idea that they were rendering God a service by keeping what they believed to be the true and only religion free from errors of all kinds. It took many centuries to impress the leaders of the church with the fact that the religion of Jesus Christ, like the science of medicine or the natural sciences, was capable of development to an almost indefinite extent; and it is owing to our appreciation of this important fact that we moderns look with so much more lenient eyes upon the distressing, not to say cruel, events of mediaeval ecclesiastical history. At the time of which I am now writing, however, it was considered highly unchristian—especially for one holding authority in the church—to believe otherwise than as her doctrines taught; and accordingly, in the early part of the fifth century A. D., Nestorius, the Patriarch of Constantinople, was deposed from his high office by a Council of the church and imprisoned because he was unwilling to teach the doctrine of the miraculous birth of Jesus Christ. Those who accepted the view held by Nestorius—and they eventually became a very numerous and a very influential body of Christians—were driven out of Constantinople and compelled to seek homes in distant places. This affords, perhaps, an explanation of the fact that, during the eighth century A. D., many Nestorian Christians were found living in the eastern part of Syria and in Persia; and it seems fair to assume that these Christian communities represented to some extent the direct successors of those Nestorians who had taken refuge in this remote corner of Asia Minor three hundred years earlier. Furthermore, it is highly probable that there were Christian communities in this region several centuries before the Nestorians arrived, for it is believed that the Apostles James and Thomas visited Persia and the northeastern part of Syria in the course of their work as evangelists. It is not known, though, how many of the descendants of these earlier Christians adopted the peculiar beliefs of the Nestorian refugees.
And here it should be stated that the facts which have thus far been mentioned are not the only ones that throw some light upon the relationship subsisting between Christianity and the spread of medical knowledge to Western Europe. Those which remain to be considered are of two kinds, viz., facts relating to the origin of the Arabic Renaissance, and facts which show that the Christian church, from the fourth century onward, was contributing not a little, through the establishment of the great monastic orders, such as the Benedictines, the Dominicans, and the Franciscans, to the preservation if not to the further evolution of Graeco-Roman medical knowledge. I shall reserve for consideration in a later chapter this particular part of the history of medicine; and in the meantime I shall endeavor to describe the events which preceded and rendered possible the active study of Greek medicine on the part of the followers of Mohammed.