At the end of the century pathological anatomy as a definite department of medicine had been firmly established. Dodoens (Dodonaeus), Royal physician to the Emperor Maximilian II and Rudolph II, made a large number of valuable observations at autopsies and described cases of pneumonia, ulcers of the stomach, inflammation of the abdominal organs, aneurisms of the coronary arteries and of the arteries of the stomach, stony concretions in the lungs, purulent conditions of the ureters and kidney, and ergotism. Even more important for the science was the work of Schenck von Graffenberg, official physician at Freiburg in Breisgau, who gathered together a larger collection of observations on the diseases of separate organs than had ever been made since Hippocrates' time. He paid special attention to the pathological anatomy of these cases and while many of the observations were his own, a great many of them had been collected from friends. His work was done after the close of Columbus' Century, but he [{397}] himself was over twenty before the century closed and he was only carrying out the inspiration that had been given by workers in that tune. Pieter van Foreest (Petrus Forestus), a practising physician in Delft, deserves almost as much credit as Schenck von Graffenberg and much more than many of the professors in medicine and anatomy of this tune. He made a special study of the pathological conditions of the ordinary diseases and was indefatigable in collecting information. His own observations include more than 100 cases with autopsies. With this spirit abroad the future of scientific medicine was assured.
A good idea of the accomplishment of the medical teachers of the time may be judged very well from the life of Fracastorius. Prof. Osler in his sketch of him published in his book, "An Alabama Student," [Footnote 38] says: "The scientific reputation of Fracastorius rests upon the work 'De Contagione.' It contains among other things three contributions of the first importance--a clear statement of the problems of contagion and infection, a recognition of typhus fever and a remarkable pronouncement on the contagiousness of phthisis." In the same sketch Osler adds: "Fracastorius draws a remarkable parallel between the processes of contagion and the fermentation of wine. It is not the same as putrefaction, which differs in the absence of any new generation and is accompanied with an abominable smell. Certain poisons resemble contagion in their action, but they differ essentially in not producing in the individual the principle or germ capable of acting on another poison." This discussion is wonderfully complete and thorough, yet conservative. Later Boyle declared that a time would come when someone would discover the cause of fermentation and probably at the same time throw light on the origin of contagious disease. That prophecy was fulfilled when Pasteur made his studies in the fermentation of wine and beer and then went on to lay the foundation of bacteriology. Fracastorius' thoroughly scientific spirit will be appreciated from the fact that, like Leonardo, he saw fossils in their true light and has the first reference in the history of science to the magnetic poles of the earth.
[Footnote 38: Oxford Press, 1908.]
Men whose names are usually associated with surgery often manifested successful interest, and above all, power of observation in pure medicine. A single example may be taken in illustration. Anyone who thinks that observation and theory and investigation of arthritism is new or that we have occupied ourselves much more with the study of its symptoms than they did in the olden time should read Paré's chapters on Gout. He says that the word gout, which appealed to him as French, was probably used because the humors distil drop by drop, goutte à goutte over the joints. Or perhaps because sometimes a single drop (goutte) of the humor of this disease causes very great pain. He describes the deposits of gypsum-like material, or stony matter like chalk, which occur in the affection. The severe pains which occur in connection with the disease Paré does not hesitate to attribute to alteration of the humors by a poison which he calls "virus arthritique" He notes that the pains are distinctly influenced by atmospheric fluctuations, so that one may well say of the gouty that they carry with them an almanac which may serve them as a weather indicator all their lives. Serious complications can arise in gout if the humors of the disease involve other organs than the joints. He attributed inflammations of the liver, of the pleura, colicky disturbances of the intestines, to this cause. Continuous fevers represented for him the effect of the gouty toxin upon the large vessels, while paralyses might occur if the gouty toxin involved the "porosities" of the nerves.
He described a sanguineous gout frequent in the springtime, especially among young people with acutely inflamed joints, the pain being most severe in the mornings and the urine red and dense. This is evidently acute rheumatic arthritis. Bilious gout occurred more among the middle-aged and the involved joints were yellow rather than red and the pain attained its maximum intensity in the early afternoons. The urine was lemon yellow in color but often cloudy. The third form was pituitary gout which occurred particularly in the winter, having as a main symptom coryza, affecting the old rather than the young, but usually without acute pain. The affected area is cold rather than hot to the touch and the discomfort is most noted during the night. The urine was pale in color and thick. [{399}] Melancholy gout, the fourth form of the disease, was also an affection of old age, producing a livid color in the joints and making them cold to the touch. The patients' pains were worse at intervals of three or four days and the urine had a deep cloudy color. Sanguineous gout was the most curable of these four and usually lasted two to three weeks; bilious gout was much more serious and often ended in death. Pituitary and melancholy gout were chronic diseases of long duration. It is rather easy to see Paré's powers of observation in all this. He jumped to conclusions and over-generalized, as men have always done and thus made mistakes. Down even to the present day, however, physicians have never quite got away from the tendency to group these acute and chronic painful conditions of joints under a single word, and rheumatism for many represents the key to a puzzle that still exists.
An important development in medicine was the publication early in the sixteenth century of regulations by the Bishop of Bamberg and the Elector of Brandenburg, by which physicians or midwives were authorized to be summoned as experts in medico-legal cases. Medico-legal autopsies are on record long before this, though there was always serious objection to their performance because of the natural feeling of deterrence men have toward the destruction of the human body. In general, however, the basis of our legal medicine and the status of the physician in court as an expert was determined at this time.
Probably nothing shows so well the great interest of this time in the development of medicine and particularly therapeutics, as the number of drugs imported from America and the East Indies, the many experiments and careful observations made with them and the books written about them. As a matter of fact no century has given us more new drugs of enduring value. Schaer in the chapter on the history of pharmacology and toxicology in modern times in Puschmann's "Handbook of the History of Medicine" has summed up the work of this period. Three well-known books of the time containing interesting scientific material were written by Gonzalo Fernandez, a personal friend of Columbus who, from his birthplace, is often known as Oviedo, Nicolas Monardes and Francisco Hernandez. Fernandez was the superintendent of the [{400}] government gold mines in South America, but after his return he wrote his great work, "Historia General y Natural de las Indias." The second of these, Monardes, deserves well of pharmacology and all that relates to drugs through his famous collection of the natural products of America which became widely known through his description of them. [Footnote 39] Hernandez wrote on Mexican and Central American plants and his "Historia Plantarum Novae Hispaniae" is an important source of information. Besides these, Pasi and Conti, Italians who had travelled in the East Indies, wrote books containing valuable observations on Oriental drugs and plants, and the Frenchman Bellonius (Pierre Belon) [(See chapter on Biological Sciences)] described Arabian, Persian and Indian products, while the Spaniard, Christobel Acosta, and the Portuguese, Garcia da Orta and Duarte Barbosa, visited various parts of the East and East African Malabar and wrote books which, while not specifically medical, had much to say with regard to the indigenous plants, especially such as either had been used by the natives for medical purposes or promised to be of significance in this way. The Portuguese apothecary Pirez directed a special letter with regard to Hindustan and Farther India and what might be expected for pharmacology from these regions to the king of Portugal which is of great importance.
[Footnote 39: Monardes proved of so much interest that he was translated into English before the end of the sixteenth century, and his book was widely read.]
The Belgian, Charles de l'Esclus, better known as a rule under his Latin name of Carolus Clusius, as professor of botany, director of the botanical garden and superintendent of the Museum in Vienna and later in Leyden, gathered together an immense amount of information, was in correspondence with all who were interested in botany and in pharmacology. He succeeded in making an encyclopedia of information with regard to these subjects that has ever since been considered one of the most important fundamental works in the history of this department of science.