He advised that the air of the sick-room should be kept cool by the evaporation of water, and he administered iron in enlargement of the spleen.
ARCHIMATTHÆUS lived soon after Constantine; his name occurs about the year 1100 as the author of two important books on medicine, The Instruction of the Physician and The Practice. The former work is occupied with advice, sometimes exaggerated, on the dignity of the healing art; and though it appears childish enough to our more sophisticated age, it is not without evidence of a desire to instruct the doctor in all that relates to the welfare of the patient and the dangers incurred by any deviation from the strictest code of professional rectitude. It is unfortunately, however, blended with so much that is crafty and sly that it approaches in some directions very closely to charlatanism. Archimatthæus very minutely instructs the doctor how to comport himself when called to visit a patient.[759]
He should place himself under the protection of God and under the care of the angel who accompanied Tobias. On the way to the patient’s home he should take care to learn from the messenger sent for him the state of the patient, so that he may be, on reaching the bedside, well posted in all that concerns the case; then if, after he has examined the urine and the state of the pulse, he is not able to make an accurate diagnosis, he will at least be able, thanks to his previous information, to impress the patient with the conviction that he completely understands his case, and so will gain his confidence. The author considers it very important that the sick person, before the arrival of the physician, should send for a priest to hear his confession, or at least promise to do so; for if the doctor were to see reason to suggest this himself, it would give the patient cause to suppose that his case was hopeless. “Upon entering the house of his patient, the physician should salute all with a grave and modest air, not exhibiting any eagerness, but seating himself to take breath; he should praise the beauty of the situation,[760] the good arrangements of the house, the generosity of the family; by this means he wins the good opinion of the household, and gives the sick person time to recover himself a little.” After the most careful directions as to the examination of the patient, the author takes the doctor from the house with as much artfulness as he has brought him hither. He is to promise the patient a good recovery, but privately to the friends he is to explain that the illness is a very serious one: “if he recovers, your reputation is increased; if he succumbs, people will not fail to remember that you foresaw the fatal termination of the disease.” If he is asked to dine, “as is the custom,” he is to show himself neither indiscreet nor over-nice. If the table is delicate, he is not to become absorbed in its pleasures, but to leave the table every now and then to see how the patient progresses, so as to show that he has not been forgotten while the doctor was feasting. He is honestly to demand his fee, and then go in peace, his heart content and his purse full. In the Practice of the same author, we have, says Daremberg, a true Clinic, the first work of the kind since the Epidemics of Hippocrates; it exhibits a skilful practitioner, a good observer, and a bold therapeutist. The doctrines and methods are those of Hippocrates and Galen, but not of the Arabs. It is also interesting as proving that at this period the distinction was established between the true physicians and the common physicians, or the specialists and the general practitioners or physician-apothecaries.
A remarkable and interesting feature in the history of the school of Salerno is the fact that some of its most famous professors of medicine were ladies. About the year 1059, Trotula, a female physician, wrote a well-known book on the diseases of women, and their treatment before, during, and after labour. She discusses all branches of pathology, even of the male sexual organs.[761] It was supposed that she was the wife of John Platearius the elder, and that she belonged to the noble family of Roger. Her person and name were at one time considered legend and myth, but M. Renzi’s investigations have proved her to be sufficiently historical. Trotula lived at Salerno, as is shown by the Compendium Salernitanum, and she practised in that city, as is clear from her work on the diseases of women. Her name occurs variously as Trotula, Trotta, and Trocta.[762]
Abella wrote a treatise De Natura Seminis Humani; she was a colleague of Trotula’s. Costanza Calenda was the daughter of the principal of the medical school, and was distinguished both for her beauty and her talents; she left no writings. Mercuriadis and Rebecca Guarna were doctresses of the fifteenth century. They wrote chiefly on midwifery and diseases of women.[763]
Copho, in the early part of the twelfth century, was an anatomist, and probably a Jew; he wrote the Anatomy of the Pig. Students were instructed in dissections by operating on dead animals when, as in those days, human bodies were not accessible. The pig was killed by severing the vessels of the neck, and was then hung up by the hind legs, and when the blood had escaped the body was used for teaching purposes; it was not dissected in the modern sense at all, the examination consisting merely in observation of the great cavities and the vital organs, according to the suggestions of Galen and the old anatomists.[764]
Nicholas Præpositus, about 1140, was the president of the school, and wrote a famous book called the Antidotarium—a Pharmacopœia as we should call it. This book of recipes was compiled from the works of the Arabian doctors Mesues, Avicenna, Actuarius, Nicolaus Myrepsus, as well as from Galen. It is interesting as giving the forms which the compounders of the prescriptions were sworn on their oath to observe; they promised to make up all their potions, syrups, etc., “secundum prædictam formam,” and they further promised that their drugs should be fresh and sufficient. It shows also that there was a habit of writing a prescription when a patient was visited; this, it seems, was a custom which originated with the Arabian physicians.[765]
Nicholas was also the author, says Dr. Baas,[766] of a work called “Quid pro Quo,” which was a list of drugs which were equivalent to other drugs, and might be used as substitutes for each other in case of either running short. Dr. Baas says our expression “Quid pro Quo” originated from this.
The writings of Bartholomæus and of Copho the Younger (between 1100 and 1120), says Daremberg, are of great interest in the history of medicine; they show how great was the freedom of spirit which existed at Salerno at this time. Copho described certain diseases which were not referred to in the works of other writers of Salerno; for example, ulceration of the palate and trachea, polypi, scrofulous tumours of the throat, condylomata, etc. Bartholomæus and Copho also held certain original ideas as to the classification of fevers. Copho distinguished between medicine for the rich and for the poor: the rich are delicate, and must be cured agreeably; the poor wish only to be cured at as little cost as possible. Thus the nobles must be purged with finely powdered rhubarb, the poor, with a decoction of mirobalanum, sweetened or not. Naturally the more precious drugs would be used for the wealthy, and probably the poor, who could not afford the complicated and terrible confections of mediæval pharmacy, might have congratulated themselves on being treated with a few simples instead of the precious messes which the wealthy had to swallow.
Johannes Platearius deserves notice as having been the inventor of the term “Cataracta,” in place of the ancient Egyptian “ascent” and the Greek “hypochosis,” in classical Latin “suffusio humorum” (Hirsch).[767]