Their post-graduate work was just as fine as their undergraduate work. They made the law of the world in the thirteenth century, and laid the foundations on which the philosophy and theology of the after-time have been built up. Strange as it may seem to many accustomed to give credence to far different traditions, they did the same thing in medicine. Take as a single example what they did for the regulation of medical education and practice. A law of the Emperor Frederick II, issued in 1241 for the Two Sicilies (Southern Italy and Sicily proper), required three years of preliminary training in the ordinary undergraduate course at the university before a man was allowed to take up medicine, and four years at medicine before he got his degree. But even this was not all; after graduation, a year of practice with a physician was required before he was allowed to practise for himself. If he were going to practise surgery an extra year of the study of anatomy was required. But it may [{393}] be said by those who cannot persuade themselves that the Middle Ages so far anticipated us: since they knew almost nothing of medicine and surgery, what did they spend their time at during these four years? The more we know about the details of that early teaching, the more we respect them and the more we admire the magnificent work of the old-time professors and their schools.
Probably the most surprising feature of their teaching was surgery. We are rather likely to think that the development of surgery was reserved for our day. Nothing could be more untrue. The greatest period in the history of surgery, with the possible exception of our own time, is the century and a half from 1250 to 1400. What they taught in surgery we know not from tradition, but from the text-books of the great teachers which have been preserved for us, and which have been recently republished. Three men stand out pre-eminent: William of Salicet; Lanfranc, who taught at Paris, having been invited there from Italy, where he had been a pupil of William of Salicet, and Guy de Chauliac, to whom has been given by universal accord the title of Father of Modern Surgery.
There is practically nothing in modern surgery that these men did not touch in their text-books. Perhaps the most surprising thing is to find that William of Salicet, in discussing his [{394}] cases, suggested that sometimes he succeeded in obtaining union by first intention by keeping his wounds clean. Alas for the surgery of succeeding centuries, Guy de Chauliac, a greater mechanical genius than William, insisted that union by first intention was an illusion and that it could only come through pus formation. Laudable pus became the shibboleth of surgery for centuries, imposed upon it by the genius of a great man. Most men think that they think, they really follow leaders, and so we followed blindly after Guy until Lister came and showed us our mistake.
Guy was the professor of surgery down at Montpellier, and also the physician to the Popes, who for the time were at Avignon. His text-book of surgery is full of expressions that reveal the man and the teacher. He said the surgeon who cuts the human body without a knowledge of anatomy is like a blind carpenter carving wood. He insisted that men should make observations for themselves and not blindly follow others. He discussed operations on the head, the thorax and the abdomen. He said that wounds of the intestines would surely be fatal unless sewed up, and he described the technique of suture for them. His specialty was operation for hernia. There are pictures still extant of operations for hernia done about this time in an exaggerated Trendelenberg position. The patient is fastened to a board by the legs, head down, the board at an angle of [{395}] forty-five degrees against the wall. The intestines dropped back from the site of operation and allowed the surgeon to proceed without danger. Guy said that more patients were operated on for the sake of the doctor's pocket in hernia cases than for their own benefit. His instructions to his students, his high standard of professional advice, all show us one of the great physicians of all time and historians of medicine are unanimous in their praise of him.
The next great development in medicine came at the time of the Renaissance with the reorganization of the universities. In the sixteenth century Italy particularly did magnificent work in the universities, stimulated by close touch with old Greek medicine. At Padua, at Bologna, above all, at Rome, the great foundations of the modern medical sciences were laid. I need only mention the names of Vesalius, Varolius, Eustachius, Fallopius, Columbus (who discovered the circulation of the blood in the lungs), Caesalpinus, to whom and rightly the Italians attribute the discovery of the systemic circulation nearly half a century before Harvey. These men all of them did fine work, everywhere in Italy. They were doing original investigation of the greatest value. Whenever anybody anywhere in Europe at this time wanted to do good work in science of any kind,--astronomy, mathematics, physics and, above all, in any of the medical sciences,--he went down to Italy; Italy was and continued for five [{396}] centuries after the thirteenth to be what France was for a scant half a century in the nineteenth, and Germany for a corresponding period just before our own time. How curiously the history of science and of medicine was written when it seems to contradict this.
Above all, what ridiculous nonsense has been talked about Papal opposition to science. The great universities of Italy in the thirteenth and fourteenth centuries had charters from the Popes. They were immediately under ecclesiastical influence, yet they did fine work in anatomy and surgery. The Father of Modern Surgery was a Papal physician. The Papal physicians for seven centuries have been the greatest contributors to medicine. The Popes deliberately selected as their physicians the greatest investigators of the time. Besides Guy de Chauliac such men as Eustachius, Varolius, Columbus, Caesalpinus, Lancisi, Malpighi were Papal physicians. We have even a more striking testimony to the Papal patronage and encouragement of medicine and to the Church's fostering care of medical education, here in America. The first university medical school in America was not, as has so often been said, the medical school of the University of Pennsylvania founded in 1767, but the medical school of the University of Mexico, where medical lectures were first delivered in 1578. Our medical schools in this country have only become genuine university medical schools in the sense [{397}] of being organic portions of the university in the last twenty-five years. Before that their courses were brief and unworthy and no preliminary education was required.
The universities of Spanish America from the very beginning required three years of preliminary training in the university before medicine could be taken up, and then four years of medical studies. These four years became five and six years in certain countries, and at no time during the nineteenth century did the medical education of Spanish America sink to the low level unfortunately reached in the United States. The lesson of it is clear. When medical education is seriously undertaken as a university department, all is well. When it is not, the results are disastrous.
In our day and country another great awakening of university life has come and with it a drawing together in intimate union of universities and their graduate departments. Above all, the medical schools have profited by this closer connection with university work, and the prospects for medical education in the United States and a new period of wonderful progress in it are very bright. You have my hearty congratulations, then, on your graduation from a great university medical school here in the West, and I hope sincerely that you shall prove worthy of Alma Mater. You have had the privileges of university education and these involve duties. [{398}] This is ever true, though unfortunately it is somewhat seldom realized. Noblesse oblige. We hear much in these days of the stewardship of wealth, and do not let us forget that there is a stewardship of talent and education. Much more will be demanded of you because of your opportunities, and we look for an accomplishment on your part far above the ordinary in medical work and maintenance and uplift of professional dignity, that shall mean much for your fellows.
Remember that you are doing only half your duty if you but make your living or even make money. You are bound besides to make medicine. For all that the forefathers have done for us we in this generation must make return by a broadening of their medical views for the benefit of posterity. If you were graduates of some fourth-rate proprietary medical school, perhaps it would be sufficient if you succeeded in making your living out of your profession. Perhaps even your teachers would then be quite satisfied with you. No such meagre accomplishment can possibly satisfy those who are sending you out to-day. Above all, you must remember that your education is not for yourself, but for the benefit of others as well. If, somehow, its influence becomes narrowed so as only to affect yourself and your intimate friends then it is essentially a failure. You must not only live your lives for yourselves, but so that at the end of them the community shall have been benefited and medicine [{399}] and its beneficent mission to mankind shall be broader and more significant because you have lived. With this message, then, I welcome you as brother physicians and bid you God-speed in your professional work.