The century of Columbus

by James J. Walsh

The spirit of the physicians of the time as regards scientific methods in clinical medicine and their attitude towards [{401}] observation as by far the most important means of obtaining medical truth is very well brought out by some passages written by John Hall, a poet and medical writer who wrote a translation of Lanfranc's "Chirurgia Parva" published shortly after the close of Columbus' Century. To this was appended "A very Frutefull and Necessary Briefe Worke of Anatomie" and "An Historiall Expostulation: against the beastlye Abusers, both of Chyrurgerie and Physyke in our Tyme: with a Goodlye Doctrine and Instruction Necessarye to be marked & folowed of all Chirurgiens." In the Expostulation, which may be found in the Percy Society's republication of old texts for 1844, Dr. Hall said: "Galen also hath freely admonished that we ought not if we will be perfectly cunning to trust only to doctrine written in books, but rather to our proper eyes which are to be trusted above all other authors, yea! before Hippocrates and Galen."

It is this trusting to observation rather than books that is, of course, the key-note of clinical medicine and of medical progress. The men of this time are often blamed for not having trusted to their observation more and to their books too much. There is no doubt that some of them erred rather seriously in this matter. Yet at all times in the history of medicine the great majority of physicians have not observed for themselves, but have taken their observation at second hand from others. Hall has insisted over and over again that as regards surgery the necessity for observation was extremely important. In the chapter on Surgery a quotation from his Expostulation on this matter will be found.

Even in the department of mental diseases there were distinct contributions to the problems of this intricate specialty of great value. This is not so surprising, for above all the men of the Renaissance could see things for themselves and describe what they saw. Shakespeare represents the Renaissance in England and no one has ever succeeded so well as he in describing forms of the milder mental diseases as they occur in characters like Ophelia or King Lear. Paracelsus even attempted what has not been achieved yet, a definition of the insane person. "The person is sick in mind in whom the reasonable and unreasonable spirit are not present in proper [{402}] proportion and strength." He distinguished fools "who are animals without any sense" from the imbeciles and idiots "who are deranged beasts." His contemporary, Montanus, who was professor at Padua, and has been called the second Galen, treated of melancholy in his medical consultations and ascribed its etiology to intemperies cerebri. He recommended treatment by water, by venesection and by hellebore. Jean Fernel divided melancholy into what we now know as melancholy in the proper sense of the word and mania. He considered that both affections were due to disturbances of the fluids of the brain. Jodocus Lommius differentiated between delirium, phrenitis, melancholia and mania and described a particular variety of this last form as hydrophobia. William Rondelet, Professor at Montpellier, frankly abandoned all metaphysics in this subject and considered that melancholia was due either to a defect of the brain or to some disturbance of the body which brought about a sympathetic derangement of the brain, the stomach particularly being likely to do this. He gave a rather striking picture of the fixed ideas that take possession of those suffering from melancholia. He differentiated mania from melancholia by saying that the melancholia was due to a frigid humor, while mania was due to the malignity of the thin and bilious humors of the body. His contemporary, Francis Varreliora, described cases in which insanity had occurred as a consequence of love troubles and in which the cure of melancholy came about through the successful treatment of an affection such as haemorrhoids that had been disturbing the patient for a good while. It was a good many generations before medicine advanced very far beyond the ideas that were put forward by these physicians of the Renaissance in discussing their mental cases.

The extent to which balneotherapy was appreciated in this century may be realized very well from the fact that just after the close of it Winternach mentions some seventy-five places in Europe where there were bathing establishments. About the same time Dr. Ruland of Regensburg, published a monograph of twenty-eight pages containing an alphabetically arranged list of diseases with the indication of the particular watering place that would do them good. Indeed just after [{403}] the close of Columbus' Century there is abundant evidence of the very great revival of interest in the old hydrotherapeutic methods which had taken place during the Renaissance.

One of the most interesting things about the medicine of this century, that is often not appreciated, is that it did not go to that excess in the employment of certain means of treatment to which some of the succeeding centuries unfortunately did. Columbus' medical contemporaries corrected the Arabian abuse of polypharmacy, which had a tendency to manifest itself over and over again during the later Middle Ages in spite of the well directed efforts of thoughtful physicians to suppress it. The diffusion of a knowledge of the classic authors in medicine did more than anything else to secure its eradication at this time. Physicians used bleeding, but not in every case, as came to be the custom later, and not to the excess in which it was employed at the end of the eighteenth and the beginning of the nineteenth century. Poor Mirabeau, the orator of the French Revolution, under the best French skilled care a century ago, was bled some eighty ounces in the course of forty-eight hours. Under the impetus given by Basil Valentine's "Triumphant Chariot of Antimony" they used antimony frequently, but not at all to the extent that it was employed in the eighteenth century. Purgatives were much more abused in the later seventeenth and eighteenth centuries than during Columbus' Century. Under the immediate influence of the Greeks the physicians of this time were thoroughly conservative, and there is as little of regrettable therapeutics to be chronicled as at any time in the world's history.

Jerome Cardan of this time is one of the geniuses of the history of science whose career is extremely difficult to understand. His mixture of credulity with a genuine scientific temper of mind that tests everything by experiment, combined with his wonderful ability in mathematics, adds to the difficulty of understanding him. He was a great believer in dreams but then that was because he was sure that so many of his own dreams had come true. He was a serious student of all the borderland subjects between spirit and matter and constituted a Psychic Research Society in himself, but with the tendency to accept the marvellous on general principles. He [{404}] heard that instruments which had been magnetized could be used for surgical operations without producing pain and having tried some experiments in the matter he announced this as a great discovery. He was sure that he had the power to magnetize others in such a way as to prevent pain, but, after all, it must not be forgotten that in these he only imitated what has attracted much attention at many times in the history of medicine and electricity. As the publisher of the formula for cubic equations he has a distinguished place in mathematics, and he was looked upon as one of the great thinkers of his time. His contributions to medicine, and the estimation he secured for the profession by his popularity among the great ones of Europe at this time, have made his life most interesting to our generation.

Cardan's almost infantile absurdities have sometimes been cited as indicating a lack of the critical scientific spirit at this time. Anyone who recalls, however, the attitude of mind of some of the most prominent scientists of our time towards certain questions, as, for instance, vaccination, spiritism, and even phrenology and other psychic subjects, will not be likely to accept any criterion of lack of the critical faculty that might be set up arbitrarily, because a scientist exhibited a tendency to accept some things without as absolute proof as other men demand. Nearly all the great scientists had certain peculiarities in this regard and Cardan is only an exaggeration of this tendency. His absurdities have sometimes been quoted as if they represented common opinions of the learned men of this time and exhibited their lack of critical judgment, but no one has scored Cardan's absurd opinions more severely, nor called attention more emphatically to the fact that this great scientific genius accepted some childish trivialities, than his contemporary, Scaliger, who so often entered into controversies with him.

An instructive contrast to some of Cardan's absurdities is a little book that has been a classic ever since in popular medicine, Louis Cornaro's "Means of Obtaining a Long and Healthy Life," which was published at this time (Padua, 1558). Editions of it have been issued in nearly every generation since. Cornaro, to give a sentence or two from Addison's essay [{405}] on the volume "was of an infirm constitution till about forty, when by obstinately persisting in the Rules recommended in this Book, he recovered a perfect state of health, insomuch, that at four-score he published this Treatise. He lived to give a fourth edition of it, and after having passed his hundredth year, died without pain or agony, like one who falls asleep. This Book is highly extolled by many eminent authors, and is written with such a spirit of cheerfulness and good sense, as are the natural concomitants of temperance and virtue."

The little book insists very much on temperance in eating and drinking and is quite as sensible in its way as any popular book on medicine ever written. It is a living proof that in spite of the popular medical delusions of many kinds so frequent in this period, though not more frequent than they are in our own, men of sense could view the question of right living from the proper standpoint and give good advice with regard to it. In the preface to the latest American edition (New York, 1912) the publisher said: "The methods followed by Cornaro and the recommendations and suggestions submitted by him can be compared to advantage with the teachings of authorities of the present day, such as Metchnikoff. The book is now presented to the American public, not only as a literary and scientific curiosity, but as a manual of practical instruction." [Footnote 40]

[Footnote 40: The first American edition, annotated by Mason L. Weems (Philadelphia, 1809), had with what might be thought characteristic American enterprise Benjamin Franklin's "Way to Wealth" as an Appendix.]