The growth of medicine from the earliest times to about 1800

by Albert H. Buck

Hospitals and Other Kindred Institutions.—Toward the end of the fourth century of the present era the first hospital was established in Rome by the widow Fabiola, a member of the distinguished Fabian family, and her example induced other wealthy Roman ladies to found similar institutions. But already several years before this time the influence of Christianity had made itself felt so strongly in the eastern branch of the Roman Empire that the Emperor Julian, who had previously been among its most bitter opponents, was forced to say, in one of his letters:—

Now we can see what it is that makes these Christians such powerful enemies of our gods; it is the brotherly love which they manifest toward strangers and toward the sick and the poor, the thoughtful manner in which they care for the dead, and the purity of their own lives.

Moved by these considerations, he decided forthwith to erect hospitals in all the cities of the empire. We do not know whether he acted upon this resolution or not, but it is a matter of record that St. Basil, Bishop of Caesarea (370–379 A. D.), founded in that city, which is about thirty miles distant from Jerusalem, a settlement composed of numerous dwellings that were devoted to the use of the poor and the sick. This institution was managed in an admirable manner, a special corps of physicians and nurses being assigned to the duty of caring for its inmates. At Edessa, the capital of Northern Mesopotamia, another hospital was founded in 375 A. D. The date of the establishment of the celebrated hospital at Djondisabour in Persia, of which mention is made elsewhere (see page 204 et seq.), is not known. About the middle of the sixth century of the present era, Childebert I., King of the Franks and son of Clovis, founded at Lyons, France, the Hôtel-Dieu, a hospital which has afforded shelter and comfort to thousands of human beings during the past fourteen hundred years, and which is in active operation at the present time; a hospital, too, which has served as a training school for a long line of distinguished physicians, surgeons and gynaecologists. It is an interesting fact that Childebert intrusted the management of this great institution to laymen (instead of the ecclesiastical powers). Finally, toward the end of the sixth century, Bishop Masona founded in Merida, Spain, a hospital in which Jews, slaves and freemen were received and treated on the same footing; and he laid down the rule that one-half of the moneys and other gifts received by the church was to be devoted to the maintenance of this institution. The list of hospitals and other charitable organizations which were established in these early centuries is very long, and it reveals the fact that in every known land there existed, throughout these years, a strong wish to give aid and comfort to the poor, the sick and the helpless. The Musulmans appear to have been as zealous as the Christians in promoting works of this kind; for the records show that in Bagdad, Cairo, Damascus, Cordova and many of the other cities which were under their control, they provided ample hospital accommodations. Indeed, one of the largest and most perfectly equipped institutions of this character of which the history of the Middle Ages furnishes any record, was that planned and constructed at Cairo, Egypt, in 1283 A. D., by the Sultan El Mansur Gilavun. While it was building, the workmen employed were not permitted to engage in any undertaking for private citizens, and the Sultan himself never failed to visit the spot every day during the progress of the work. The site chosen was that of one of the royal palaces, and in tearing down this structure, in order to make room for the new building, the workmen brought to light a large chest filled with gold and precious stones, the value of which was sufficient to pay the entire expense of erecting the hospital. Upon the completion of the building and the equipment of its spacious wards in the most perfect manner possible, the Sultan expressed himself in the following terms:—

I have founded this institution for people of my own class and for those who occupy an humbler station in life—for the king and for the servant, for the common soldier and for the Emir, for the rich man and for the poor, for the freeman and for the slave, for men and also for women. I have made ample provision for all the remedial agents that may be required, for physicians, and for everything else that may prove useful in any form of illness....

One of the characteristic features in the management of this hospital, says Le Clerc, was the custom of giving to each of the poorer inmates, when he left the institution, five pieces of gold, in order that he might be spared the necessity of undertaking immediately work of an exhausting character.

Monasteries in Their Relation to Medicine.—While at first these institutions were designed chiefly as places of refuge from the turmoil of the world and from the violence of frequent warfare, it became evident in the course of time that the evils incident to such a secluded and self-centered life hindered rather than promoted the development of those particular virtues which Jesus Christ urged his followers to cultivate. This experience led to the adoption of a different kind of cloister life; and so it came about, as stated by Neuburger, that in 529 A. D. Benedictus of Nursia founded, at an isolated spot high up on the slope of Monte Cassino, in Campania, Italy, the now famous parent monastery of the Benedictine Order. According to the original regulations of this order, the monks were obliged to perform every day a certain amount of manual labor as well as devotional exercises. Nine years later Cassiodorus, who had for a long period been a sort of Secretary of State under Theodoric the Great and his successors, became a monk, and, from that time to the day of his death, “devoted all his energies to the service of God and the advancement of science.” He secured a house not far from the Benedictine monastery on Monte Cassino, gathered together there a considerable library, and made it a rule of the place that the copying of original codices (the majority of them theological) constituted the most useful and honorable form of manual labor. A few years later, this smaller establishment was made a part of the monastery at Monte Cassino, and the rule just mentioned was thereafter adopted by the enlarged institution. But the care of the sick, the feeble, and children was the particular work which Benedictus, the founder of this institution, had most at heart. Cassiodorus went even farther and urged upon the brethren the desirability of studying the healing art and of utilizing, for this purpose, the works of ancient medical authors.

Learn all you can, he said, about the characteristics of different plants and about the methods of preparing medicinal mixtures, but set all your hopes upon the Lord who is the preserver of our lives. In your search for knowledge about drugs consult the herbarium of Dioscorides, who has described and pictured the different herbs with great accuracy. Afterward read Latin translations of the works written by Hippocrates and by Galen, particularly the latter’s treatise on therapeutics, the one which he addresses to the philosopher Glaucon; and, in addition, study the work of Caelius Aurelianus on the practice of medicine, that of Hippocrates on medicinal plants and methods of treatment, and some of the other writings on medicine which you will find in my library and which I have left behind me for the benefit of my brethren in this institution.

The advice given by Cassiodorus was heeded, not only by those to whom it was addressed, but also by many succeeding generations of monks. Even at the present time, says Neuburger, the books which Cassiodorus recommended are still to be found, either in the form of original manuscript copies or in that of translations, in the library of the parent institution. Furthermore, when it is remembered how large a number of affiliated Benedictine monasteries were established in different parts of Europe, it will readily be appreciated that the good accomplished by the advice which Cassiodorus gave must have been very great.

Among the later abbots of Monte Cassino there were three who attained considerable distinction as physicians. They were Bertharius, who wrote two treatises on medical topics; Alphanus II., Archbishop of Salerno, who was celebrated both as a physician and as a poet; and Desiderius (1027–1087 A. D.), who was skilled, not only in medicine, but also in jurisprudence, and who was elected Pope under the title of Victor III. The monastery attained the height of its celebrity at the time when Constantinus the African became one of its regular members. Although Constantinus was a native Arab (born at Carthage about 1018 A. D.), he became converted to Christianity quite early in life. It is said that he was a great traveler as well as a great scholar, and that he devoted several years to visiting foreign lands—Babylonia, India, Egypt and Ethiopia. It was in this way that he became so well versed in the languages of the East. Upon visiting Spain as a fugitive from his native city, he took with him several of the works of Hippocrates and Galen, and in course of time translated them into Latin. Finally, he accepted the position of secretary to Robert Guiscard, the first Norman Duke of Calabria and Apulia, who appears to have selected Salerno as his place of residence. At the same time he became one of the teachers at the medical school of that city, and served in this capacity for a certain length of time; but, at the end of a few years, he was formally accepted by the Abbot Desiderius as a member of the Monte Cassino community, and it was here that he did the larger part of his literary work. His death occurred in 1087 A. D., the same year in which the Abbot Desiderius—or, rather, Pope Victor III.—died.

Constantinus was a prodigious worker, but it is doubtful whether he did anything of an original character. Not a few of the treatises which were, at that time, credited to him as original productions, are now known—thanks largely to the researches of the great French historian and linguist, Daremberg—to be simply translations from the Arabic.