There were three graduate departments in most of the universities—theology, law, and medicine. While physical scientists are usually not cognizant of it apparently, theology is a science, a department of knowledge developed scientifically, and most of these medieval universities did more for its scientific development than the schools of any other period. Quite as much may be said for philosophy, for there are many who hesitate to attribute any scientific quality to modern developments in the matter. As for law, this is the great period of the foundation of scientific law development; the English common law was formulated by Bracton, the deep foundations of basic French and Spanish law were laid, and canon law acquired a definite scientific character which it was always to retain. All this was accomplished almost entirely by the professors in the law departments of the universities.
It was in medicine, however, where most people would be quite sure without any more ado that nothing worth while talking about was being done, that the great triumphs of graduate teaching at the medieval universities were secured. Here more than anywhere else is there room for supreme surprise at the quite unheard-of anticipations of our modern medicine and, stranger still, as it may seem, of our modern surgery.
The law regulating the practice of medicine in the Two Sicilies about the middle of the thirteenth century shows us the high standard of medical education. Students were required to have three years of preliminary study at the university, four years in the medical department, and then practise for a year with a physician before they were allowed to practise for themselves. If they wanted to practise surgery, an extra year in the study of anatomy was required. I published the text of this law, which was issued by the Emperor Frederick II about 1241, in the Journal of the American Medical Association three years ago. It also regulated the practice of pharmacy. Drugs were manufactured under the inspection of the government and there was a heavy penalty for substitution, or for the sale of old inert drugs, or improperly prepared pharmaceutical materials. If the government inspector violated his obligations as to the oversight of drug preparations the penalty was death. Nor was this law of the Emperor Frederick an exception. We have the charters of a number of medical schools issued by the Popes during the next century, all of which require seven years or more of university study, four of them in the medical department, before the doctor's degree could be obtained. When new medical schools were founded they had to have professors from certain well-recognized schools on their staff at the beginning in order to assure proper standards of teaching, and all examinations were conducted under oath-bound secrecy and with the heaviest obligations on professors to be assured of the knowledge of students before allowing them to pass.
It might be easy to think, and many people are prone to do so, that in spite of the long years of study required there was really very little to study in medicine at that time. Those who think so should read Professor Clifford Allbutt's address on the "Historical Relations of Medicine and Surgery" delivered at the World's Fair at St. Louis in 1904. He has dwelt more on surgery than on medicine, but he makes it very clear that he considers that the thinking professors of medicine of the later Middle Ages were doing quite as serious work in their way as any that has been done since. They were carefully studying cases and writing case histories, they were teaching at the bedside, they were making valuable observations, and they were using the means at their command to the best advantage. Of course there are many absurdities in their therapeutics, but then we must not forget there have always been many absurdities in therapeutics and that we are not free from them in our day. Professor Richet, at the University of Paris, said not long ago: "The therapeutics of any generation is quite absurd to the second succeeding generation." We shall not blame the medieval generations for having accepted remedies that afterwards proved inert, for every generation has done that, even our own.
Their study of medicine was not without lasting accomplishment, however. They laid down the indications and the dosage for opium. They used iron with success, they tried out many of the bitter tonics among the herbal medicines, and they used laxatives and purgatives to good advantage. Down at Montpellier, Gilbert, the Englishman, suggested red light for smallpox because it shortened the fever, lessened the lesions, and made the disfigurement much less. Finsen was given the Nobel prize partly for re-discovery of this. They segregated erysipelas and so prevented its spread. They recognized the contagiousness of leprosy, and though it was probably as widespread as tuberculosis is at the present time, they succeeded not only in controlling but in eventually obliterating it throughout Europe.
It was in surgery, however, that the greatest triumphs of teaching of the medieval universities were secured. Most people are inclined to think that surgery developed only in our day. The great surgeons of the thirteenth and fourteenth centuries, however, anticipated most of our teaching. They investigated the causes of the failure of healing by first intention, recognized the danger of wounds of the neck, differentiated the venereal diseases, described rabies, and knew much of blood poisoning, and operated very skilfully. We have their text-books of surgery and they are a never-ending source of surprise. They operated on the brain, on the thorax, on the abdominal cavity, and did not hesitate to do most of the operations that modern surgeons do. They operated for hernia by the radical cure, though Mondeville suggested that more people were operated on for hernia for the benefit of the doctor's pocket than for the benefit of the patient. Guy de Chauliac declared that in wounds of the intestines patients would die unless the intestinal lacerations were sewed up, and he described the method of suture and invented a needle holder. We have many wonderful instruments from these early days preserved in pictures at least, that show us how much modern advance is merely re-invention.
They understood the principles of aseptic surgery very well. They declared that it was not necessary "that pus should be generated in wounds." Professor Clifford Allbutt says:
They washed the wound with wine, scrupulously removing every foreign particle; then they brought the edges together, not allowing wine or anything else to remain within—dry adhesive surfaces were their desire. Nature, they said, produces the means of union in a viscous exudation, or natural balm, as it was afterwards called by Paracelsus, Paré, and Wurtz. In older wounds they did their best to obtain union by cleansing, desiccation, and refreshing of the edges. Upon the outer surface they laid only lint steeped in wine. Powders they regarded as too desiccating, for powder shuts in decomposing matters; wine after washing, purifying, and drying the raw surfaces evaporates.
Almost needless to say these are exactly the principles of aseptic surgery. The wine was the best antiseptic that they could use and we still use alcohol in certain cases. It would seem to many quite impossible that such operations as are described could have been done without anæsthetics, but they were not done without anæsthetics. There were two or three different forms of anæsthesia used during the thirteenth and fourteenth centuries. One method employed by Ugo da Lucca consisted of the use of an inhalant. We do not know what the material employed was. There are definite records, however, of its rather frequent employment.
What a different picture of science at the medieval universities all this makes from what we have been accustomed to hear and read with regard to them. It is difficult to understand where the old false impressions came from. The picture of university work that recent historical research has given us shows us professors and students busy with science in every department, making magnificent advances, many of which were afterwards forgotten, or at least allowed to lapse into desuetude.