The Project Gutenberg eBook, Medicine in the Middle Ages, by Edmond Dupouy, Translated by Thomas C. Minor

Transcriber’s Note

It should be noted that almost all of the French in the book is unaccented. No attempt has been made to correct this.

Medicine in the Middle Ages.

EXTRACTS FROM “LE MOYEN AGE MEDICAL”

OF

DR. EDMOND DUPOUY.

TRANSLATED BY T. C. MINOR, M.D.

Reprinted from the Cincinnati Lancet-Clinic, Dec. 1, 1888, to Feb. 16, 1889.

CINCINNATI:
CINCINNATI LANCET PRESS PRINT,
1889.

[THE PHYSICIANS OF THE MIDDLE AGES].

[THE GREAT EPIDEMICS OF THE MIDDLE AGES].

[THE DEMONOMANIA OF THE MIDDLE AGES].

[MEDICINE IN THE LITERATURE OF THE MIDDLE AGES].

MEDICINE IN THE MIDDLE AGES.

EXTRACTS FROM “LE MOYEN AGE MEDICAL” OF DR. EDMOND DUPOUY.

TRANSLATED BY T. C. MINOR, M.D.

THE PHYSICIANS OF THE MIDDLE AGES.

In the fourth century of the Christian era Roman civilization expired; Western Europe was invaded by the barbarians; letters and science sought a last refuge at Alexandria; the Middle Age commenced.

Greek medicine strove to survive the revolution in the city of the Ptolemies, and even produced a few celebrated physicians, i.e., Alexander Ætius, Alexander Trallian, and Paulus Ægineta, but at the end of the seventh century the school of Alexandria also fell and disappeared in the clouds of a false philosophy, bequeathing all Hippocratic traditions to the Arabs, who advanced as conquerors to the Occident.

The Arabian schools of Dschondisabur, Bagdad, Damascus, and Cordova were founded and became flourishing institutions of learning, thanks to a few Nestorian Greeks and Jews who were attracted to these centers of learning; such men as Aaron, Rhazes, Haly-Abas, Avicenna, Avenzoar, Averrhoes, Albucasis, and other writers, who continued the work left by the Greeks, leaving remarkable books on medicine and surgery. Unfortunately the ordinance of Islamism prevented these scientists from following anatomical work too closely, and consequently limited the progress they might otherwise have made in medicine.[1]

What occurred in Western Europe during this period of transition? The torch of science was extinguished; the sacred fire on the altar of learning only remained a flickering emblem whose pale light was carefully guarded in the chapel of monasteries. Medicine was abandoned to the priests, and all practice naturally fell into an empirical and blind routine. “The physician-clergy,” says Sprengel, “resorted in the majority of cases to prayers and holy water, to the invocations of saints and martyrs, and inunction with sacred ointments. These monks were unworthy of the name of doctor—they were, in fact, nothing else than fanatical hospital attendants.”

An ephemeral ray of light broke from the clouds in the renaissance of 805, when Charlemagne ordered the cathedral schools to add medicine to their studies as a part of the quadrivium. Some of the monks now commenced to study the works of Celsus and Cœlius Aurelianus, but, ever as with the Mussulmen, the Catholic religion forbade the dissection of the human body, and the monks made no more progress than the barbarians; so that the masses of the people had little or no confidence in clerical medical skill. We find the proof of a lack of confidence in the Gothic laws promulgated by Theodoric about this period—laws kept even into the eleventh century in the greater portion of Western Europe. These ordinances, among other things, proclaim as follows:

“No physician must open a vein of a woman or a daughter of the nobility without being assisted by a relative or body-servant; quia difficillium non est, ut sub tali occasione ludibrium interdum adhærescat.” (Their morality was then a subject for caution.)

“When a physician is called to dress a wound or treat a disease, he must take the precaution to settle on his fee, for he cannot claim any in case the patient’s life is endangered.

“He shall be entitled to five sous for operating on hard cataract.

“If a physician wound a gentleman by bleeding, he shall be condemned to pay a fine of one hundred sous; and should the gentleman die following the operation, the physician must be delivered into the hands of the dead man’s relatives, who may deal with the doctor as they see fit.

“When a physician has a student he shall be allowed twelve sous for his services as tutor.”

Towards the tenth century, however, progress in medicine is at last noticeable. We see some monks going to make their studies at Salerno and at Mount Cassin, where the Benedictine friars had established a medical college in the previous century. Constantine had given these friars Arabian manuscripts, which had been translated into Latin, with commentaries. Also the works of the early Greek physicians and the treatises of Aristotle on “Natural Science.” It was at Salerno that Ægidius de Corbeil studied physic before becoming physician to Philip Augustus. Nevertheless, medicine remained in darkness with clerical ignorance, the superstition and despotism of the church offering an insurmountable barrier to all science. Finally a reform was instituted in 1206 by the foundation of the University of Paris, which included among its school of learning a college of medicine, wherein many students matriculated. The physicus Hugo, and Obiso, physician to Louis the Great, were the first professors in the institution. Degrees were accorded indiscriminately to the clergy or to the laity, the condition of celibacy being imposed on the latter likewise.

A medical and surgical service was organized at the Hotel Dieu, which hospital was erected before the entrance of Notre Dame, under the direction of the clergy. On certain days the priests would assemble around the holy water font of the cathedral, supra cupam, in order to discuss questions in medicine or the connection of scholastic learning with the healing art.

The University only recognized as students of medicine persons who held the degree of master-in-arts. They absolutely separated the meges and mires, surgeons, bonesetters, and barbers, who had made no classical studies, and to whom was abandoned as unworthy of the real physicians all that concerned minor surgery. These officers of health, so-called, of the Middle Ages were unimportant and little respected persons; they kept shops and never went out without carrying one or two dressing cases; they were only comparable to drug peddlers; and the University imposed no vows of celibacy in their case.

In many literary works in Latin it is often a question whether to call in a physician or mire, and certain passages admirably serve to prove this historical fact. In the Roman de Dolopatos,[2] for example, the poet tells how to prevent the poisoning of wounds, as they are easy to cure when the injury is recent:

You have heard it told

To dress a wound while new;

’Tis hard to heal when old.

You’ll find this statement true.[3]

When the doctor cometh late

The wound may poisoned be;

The sore may irritate

And most sad results we see.

In another troubadour song, The Wicked Surgeon (Vilain Mire), from which Moliere purloined his play “A Doctor in Spite of Himself,” we see the wife of the bone-setter assure every one that her husband is not only a good surgeon, but likewise knows as much of medicine and uroscopy as Hippocrates himself. (We must not forget that a knowledge of urine was claimed by mires and meges.) Thus the bone setter’s wife says:

“My husband is, as I have said,

A surgeon who can raise the dead.

He sees disease in urine hid,

Knows more than e’en Ypocras did.”

The Roman de la Rose shows us a poor devil who complains of not being able to find a surgeon (mire) to dress his wounds, i.e.:

“Ne sceus que faire, ne que dire,

Ne pour ma playe trover mire,

Ne par herbe, ne par racine

Je ne peus trover medecine.”

Some years after the founding of the University of Paris, a great scientific movement occurred in the Occident. The Faculty of Montpellier had already acquired much celebrity. The College of Surgeons of Paris was established in 1271. Medical circles counted a brilliant galaxy of remarkable men, i.e. Richard de Wendmere, Jean de Saint Amand, Guillaume Saliceto, the great Albert, Bernard Gordon, Arnauld de Villeneuve, Lanfranc, and Roger Bacon. The school of Paris now wished to direct its own affairs, and accordingly, in 1280 A.D., separated from the University and assumed the title Physicorum Facultas, and its members became physicians. Sustained by Royal edict, they obtained rich grants from the church and from public taxes, but these marks of favor aroused bitter jealousies; criticism rained down on the healing art on every hand, and medicine was lampooned; these physicians of the thirteenth century were ridiculed so bitterly as to make the age historical, and thus inspire the comedy writers of future generations. This is more than evidenced in the wicked satires of Guyot de Provins (Bible Guiot), who cruelly assails the doctors; it was he who wrote the poem that said:

“Young doctors just come from Salern(o)

Sell blown-up bladders for lantern.”

As we see, from perusing these numerous lampoons, physicians were not held in high esteem, notwithstanding the sacerdotal character in which the profession was invested. Meantime, in the Roman du Noveau Renard, we find a passage[4] that permits the supposition that physicians already possessed a certain amount of medical erudition; that they were acquainted with the works of Galen, and had full knowledge of all writers of the Arabian school, as well as that of the school of Salerno.

“Je faisoie le physicien

Et allegoie Galien,

Et montrois oeuvre ancienne

Et de Rasis et d’Avicenne,

Et a tous les faisoie entendre

In’estoie drois physiciens

Et maistre des practiciens.”

In revenge, the author of the “Romance of Renard” accords but little confidence to medical art, for he adds very maliciously:

“All belief in medicine is folly,

Trust it and you lose your life;

For it is a fact most melancholy—

Where one is cured two perish in the strife.”

Why the poet of the Roman du Renard was so full of rancor against the doctors of his time is a problem too difficult to solve; yet, while he considered them no better than criminals and dangerous men to society, he did not fail to call a doctor before dying. Physicians, for some strange and unknown reason, have always been criticised by French literary men in modern as well as ancient times. Our French authors have never, as did the masters of Greek poesy, recognized us as brothers in Apollo. Permit me here to call their attention to one of the writers of Greek anthology, who said of physicians:

“The son of Phœbus himself, Æsculapius, has instilled into thy mind, O Praxagorus, the knowledge of that divine art which makes care to be forgotten. He has given into thy hands the balm that cures all evils. Thou, too, hast learned from the sweet Epion what pains accompany long fevers, and the remedies to be applied to divided flesh; if mortals possessed medicines such as thine, the ferry of Charon would not be overloaded in crossing the Styx.”

Notwithstanding sarcasm, in spite of epigrams and calumny, medicine has always been a source of sublime consolation to the sick and afflicted, the sufferer—rich and poor. At all ages the priest has been inclined to indulge in the practice of physic, and it was at their instigation that those nuns known as Sisters of Charity practiced medicine to a certain extent in the Middle Ages. In the twelfth century we see the nuns of the Convent of Paraclet, in Champagne, following the advice of Abelard, essaying the surgical treatment of the sick. It is true the first abbess of this nunnery was Heloise, in whose history conservative surgery is not even mentioned. The nuns who dressed wounds were called medeciennes or miresses. Gaulthier de Conisi has left a history of their good works:

“And the world wondered when it did learn

That woman had found a new mission;

When the doctors of Montpellier and Salern(o)

Saw each nun to be a physician.

A fever they knew, a pulse they could feel,

And best of it all is, they managed to heal.”

This tendency of women to care for the sick now became general. “In our ancient poets and romancers,” says Roquefort, “we often notice how young girls[5] were employed to cure certain wounds, because they were more tender-hearted and gentle-handed; as, for example, Gerard de Nevers, having been wounded, was carried into a chapel, where “a beautiful maiden took him in hand to effect a cure, and he thought so much of her that in brief space of time he commenced to mend; and was so much better that he could eat and drink; and he had such confidence in the skill of the maiden that, before a month passed, he was most perfectly cured.”

As early as the sixth century, we note in the recital, Des Temps Merovingiens, by Augustin Thierry, that Queen Radegond, wife of Clotaire I., transformed her royal mansion into a hospital for indigent women. “One of the Queen’s pastimes was to go thither not simply to visit, but to perform all the most repulsive duties of nurse.”

In Feudal times it was the custom to educate the girls belonging to the nobility in practical medicine; also in surgery, especially that variety of surgery applied to wounds. This was immensely useful, inasmuch as their fathers, brothers, husbands or lovers were gallant “Knights,” who ofttimes returned from combat or tourney mutilated or crippled. It was the delicate hand of titled ladies that rendered similar service to strange foreign knights who might be brought wounded to the castle gates. This is why the knights of old rendered such devout homage to the gentler sex—knowing their kindness and love in time of distress, when bleeding wounds were to be staunched and fever allayed. In a Troubadour song, Ancassin et Nicolette, we find this passage:

“Nicolette, in great alarm,

Asked about his pain;

Found out of joint his arm,

Put it in again;

Dressed with herbs the aching bone—

Plants to her had virtues known.”

Although the church was hostile to the philosophy of Aristotle, whose works were publicly burned in 1209 A.D. by order of the Council, Pierre de Vernon published, in the same thirteenth century, a short poem by the title Les Enseignements d’Aristote, the object of which was to vulgarize the scientific portion of the great Greek author’s Encyclopedia. This treatise commenced as follows:

“Primes saciez ke icest tretiez

Est le secre de secrez numez,

Ke Aristotle le Philosophe y doine,

La fiz Nichomache de Macedoine

A sun deciple Alisandre en bone fei,

Le grant, le fiz, a Philippe le Rei,

Le fist en sa graunt vielesce.”

Which, translated from old French, reads: “From whence learn that this treatise is the secret of secrets, that Aristotle the philosopher, son of Nichomachus, gave to his pupil, Alexander the Great, son of King Philip, and which was composed in his old age.”

In recalling the fact that Aristotle was the son of Nichomachus, Pierre de Vernon probably desired to call the attention of his readers more to the knowledge of medicine that the author derived from his father, the celebrated physician, than to the brilliant pupil of Plato.

Among the interesting passages in this poem we distinguish some that advise abstinence to persons whose maladies are engendered by excesses at table:

“One man cannot live without wine,

While another without it should dine;

For the latter, ’tis clear,

All grape juice and beer

For his own stomach’s sake should decline.”

The author claims drinking at meals induces gastralgia from acidity of the stomach:

“The signs of bad stomach thus trace:

Poor digestion, a red bloated face,

With out-popping eyes,

Palpitation, and sighs.

With oppression, as though one did lace.”

He mentions eructations and sour belching as indicating frigidity of the stomach, and advises the drinking of very hot water before meals. Aside from this, he gives good counsel relative to all the advantages of a sober and peaceful life:

“If passion within you wax hot,

Pray don’t eat and drink like a sot.

Give wine no license;

From rich food abstinence;

And luxurious peace is your lot.”

The author then advises that the mouth and gums be well taken care of, that the teeth be neatly cleaned after each meal, and the entire buccal cavity be rinsed out with an infusion of bitter-sweet plants or leaves.

“Puis apres si froterez

Vos dents et gencives assez,

Od les escorces tut en tur

D’ arbre chaud, sec. amer de savur

Kar iceo les dents ennientit,” etc.

Notwithstanding their want of scientific form, these precepts still strongly contrast with the superstitious practices employed by the monks in the treatment of disease. When holy relics failed the priesthood had resource to supernatural power; they believed in the faith cure; the touch of a Royal hand could heal disease. They took all their scrofulous and goitre patients to Phillip I. and to Saint Louis. These sovereigns had not always an excessive faith in the miraculous gifts they were desired to bestow, but reasons of State policy forced them to accept this monkish deceit, which was regularly practiced by the clergy every Pentecost Day.

The mise en scene was easily arranged: the King of France, after holy communion at Saint Francis Convent, left the building surrounded by men at arms and Benedictine friars; then he touched the spots on his people, saying to each of his afflicted subjects: “Rex tangit te, Deus sanat te, in nomine Patris et filii et Spiritus sancti.”[6]

Block pretends that the King of England also enjoyed the power of curing epilepsy, and remarks apropos to this fact that the invention is not new, since Pyrrhus, King of Epirus, possessed the power of curing individuals attacked by enlarged spleen by simply pressing his right foot on that viscera.

But this is no longer a superstition to-day, since the age of miracles is past and the divinity of kings a belief almost without a disciple. However, Gilbert and Daniel Turner, physicians of the thirteenth century, give it credence in their writings, but they are fully entitled to express their independent opinion.

The priests of the Middle Ages could not employ themselves as obstetricians, neither could they treat uterine diseases. The ventrieres were the only midwives of the period; these women were allowed to testify as experts in the courts of justice, but the burden of proof rested on the testimony of at least three sage femmes when a newly-married woman was accused of pregnancy by a husband, as witness the following:

“Should a man declare his wife just wedded be pregnant and she deny the charge, it is well to conduct the accused woman to the house of some prudent female friend, and then that three ventrieres be summoned who may regard the suspect. If they declare her to be in a family way, the provost shall call the midwives as witnesses as before stated; but if the sage femmes declare the accused is not pregnant, then shall the wife have cause against her husband; but better is it when the husband, seeing the wrong wrought, shall humble himself and beg pardon.”

Midwives were sworn, according to statutes and ordinances, which contained formulæ reports to be presented to the judges, to visit girls who complained of having been raped; fourteen signs of such deflowerment were admitted in testimony. Laurent Joubert has transcribed three of such reports, of which we will reproduce only one that was addressed to the Governor of Paris on October 23d, 1672:

“We, Marie Miran, Christophlette Reine, and Jeannie Porte, licensed midwives of Paris, certify to whom it may concern, that on the 22d day of October in the present year, by order of the Provost of Paris, of date 15th of aforesaid month, we visited a house in Rue Pompierre and there examined a girl aged thirty years, named Olive Tisserand, who had made complaint against one Jaques Mudont Bourgeois, whom she insisted deflowered her by violence. We examined the plaintiff by sight and the finger, and found as follows:

“Her breasts relaxed from below the neck downwards; mammaæ marcidæ et flaccidæ; her vulva chafed; os pubis collisum; the hair on the os pubis curled; pubes in orbem finuata; the perineum wrinkled; perinæum corrugatum; the nature of the woman lost; vulva dissoluta et mercessans; the lips of private pendant; labia pendenta; the lesser lips slightly peeled; labiorum oræ pilis defectæ; the nymphæ depressed; nymphæ depressæ; the caroncles softened; carunculæ dissolutæ; the membrane connecting the caroncles retracted; membrana connecteus inversa; the clitoris was excoriated; clitoris excoriata; the uterine neck turned; collum uteri; the vagina distended; finus pudoris; in fact, the lady’s hymen is missing; hymen deductum; finally, the internal orifice of the womb is open; os internum matricis. Having viewed this sad state of affairs, sign by sign, we have found traces omnibus figillatum perspectis et perforutatis, etc., and the above-named midwives certify to the before-mentioned Provost that the aforesaid statement under oath is true.”

Physicians were not obliged by the magistrates to determine the nature of rapes on women; all gynecological questions were remanded to midwives. In truth, among all the physicians of antiquity only Hippocrates discussed uterine complaints and Ætius studied obstetrics. It was only in the sixteenth century that midwifery took its place among the medical sciences, thanks to Rhodion, Ambroise Parè, Reif, Rousset, and Guillemeau. Shortly before this time, that is to say, in the fifteenth century, Jacques de Foril published his “Commentaires” on generation, his ideas being derived from Avicenna; his notions, however, were absurd, being wholly based on astrological considerations. He pretended that an infant is not viable in the eighth month, because in the first month the pregnant woman is protected by Jupiter, from whom comes life; and in the seventh month by the moon, which favorizes life by its humidity and light; while in the eighth month or reign of Saturn, who eats children, the influence is hostile. But on the ninth month the benevolent influence of Jupiter is again experienced, and for this reason the infant is more apt to be alive at this period of gestation.

To the scholastic philosophy of the Middle Ages we must attribute the prejudice that, the human body being in direct connection with the universe, especially the planets, it was impossible for physical change to occur without the influence of the constellations. Thus astrology came to be considered as an essential part of medicine. This belief in the influence of the stars came from the Orient, and was carried through Europe after the crusades.

As to the treatise on “Diseases of Women,” attributed to Trotula, a midwife of the school of Salerno, it is only a formulary of receipts for the use of women—baths in the sea-sands under a hot sun to thin ladies suffering from overfat; signs by which a good wet-nurse may be recognized: a method of kneading the head, the nose, and the limbs of new-born children before placing them in swaddling clothes; the use of virgin wine mixed with honey as a remedy for removing the wrinkles of old age.

“The Commentaires of Bernard de Provincial informs us,” says Daremberg, “that certain practices, not only superstitious but disgusting, were common among the doctrines of Salerno; one, for instance, was to eat themselves, and also oblige their husbands to eat, the excrement of an ass fried in a stove in order to prevent sterility; likewise, to eat the stuffed heart of a diseased sow in order to forget dead friends,” etc.

We can form some judgment, from such observations, as to the therapeutic wisdom of these doctrines of the school of Salerno. It is true, however, that at this epoch but little medicine save that of an unique and fantastic order was prescribed. Gilbert, the Englishman, advised, with the greatest British sang froid, tying a pig to the bed of a patient attacked by lethargy; he ordered lion’s flesh in case of apoplexy, also scorpion’s oil and angle-worm eggs; to dissolve stone in the bladder, he prescribed the blood of a young billy-goat nourished on diuretic herbs.

Peter of Spain, who was archbishop, and afterwards Pope, under the name of John XXI., was a man whom historians claim was more celebrated as a physician than as Pope; it was this Peter who adapted the curious medical formulary known by the title of Circa Instans, and, had improved on the invention. Those who wore on their bodies the words “Balthazar,” “Gaspar” and “Melchior” need never fear attacks of epilepsy; in order to produce a flux in the belly, it was only necessary to put a patient’s excrement in a human bone and throw it into a stream of water.

Hugo de Lucgnes, in fractures of the bone, employed a powder composed of ginger and cannella, which he used in connection with the “Lord’s Prayer,” in the meantime also invoking the aid of the Trinity. He treated hernia by cauterization, and leprosy by inunctions of mercurial ointment.

If therapeutics made only slight progress in the thirteenth century, we cannot say as much for other branches of the medical and natural sciences.

Arnauld de Villeneuve, physician, chemist and astrologer, particularly distinguished himself by discovering sulphuric, nitric and hydrochloric acids, and also made the first essence of turpentine.

Lanfranc attracted large numbers of students to the College of Saint Come, and exhibited his skill as an anatomist and surgeon. In one of his publications he gives a very remarkable description of chancres and other venereal symptoms.

At the Faculty of Montpellier, which was founded in 1220 A.D., we see as the Dean Roger of Parma, and as professor Bernard de Gordon, who left a very accurate account of leprosy and a number of observations on chancres following impure connection; these observations are valuable, inasmuch as they are corroborated by Lanfranc and his contemporary, Guillaume de Saliceto, of Italy, two centuries before the discovery of America.

Albert the Great (Albertus Magnus) and Roger Bacon also belonged to the thirteenth century.

Albert de Ballstatt, issue of a noble family of Swabia, monk of the order of St. Dominicus, after studying in the principal schools of Italy and Germany, arrived at Paris in 1222 A.D., and soon had numerous auditors, among whom may be mentioned Saint Augustin, Roger Bacon, Villeneuve, and other distinguished men. His lectures attracted such crowds of students from the University that he was obliged to speak from a public place in the Latin Quarter, which, in commemoration of his success, was called Place Maitre Albert, afterwards corrupted to Place Maubert.

His writings were encyclopedic, their principal merit being commentaries on the works of Aristotle, of whom but little was known at that period; he studied also the Latin translations of the Arabian school, and reviewed Avicenna and Averrhoes, adding to such works some original observations.

Albert the Great, or Albertus Magnus, the name posterity has bestowed on this genius, was also much occupied with alchemy, and passed for a magician. He was considered a sorcerer by many, as he was said to evoke the spirits of the departed, and produced wonderful phenomena.

Albert’s works on natural history, his botany and mineralogy are, in reality, taken from the works of Aristotle, as well as his parva naturalis, which is only a reproduction of the Organon of the Greek philosopher; nevertheless, Albert deserves credit for his good work in relighting the torch of science in the Occident.

His disciple, Roger Bacon, was also a monk; he studied in Paris and afterwards removed to Oxford, England, where he actively devoted himself to natural science, especially physics. He left behind him remarkable observations on the refraction of light; explanation of the formation of rainbows, inventing the magnifying glass and telescope. His investigations in alchemy led him to discover a combustible body similar to phosphorus, while his work on “Old Age” (De retardtandus senectutis occidentibus) entitled him to a high position among the physicians of the thirteenth century. Although one of the founders of experimental science, one of the initiators—if the expression may be used—of scientific positivism, he also devoted much time to astrology. Denounced as a magician and sorcerer by his own confreres in religion, he was condemned to perpetual imprisonment, and was only released a few years before his death, leaving many writings on almost every branch of science.

It was more than a century after these two great men died that medical science commenced its upward flight.

Anatomy, proscribed by the Catholic Church, had an instant’s toleration in the middle of the thirteenth century, thanks to the protection of Frederick II., King of the Two Sicilies. But an edict of Pope Boniface VIII., published in 1300, forbid dissections once more, not only in Italy, but in all countries under Papal rule. Nevertheless, in 1316, Mondinus, called the restorer of anatomy, being professor at the University of Bologna, had the courage to dissect the cadavers of two patients in public; he then published an account of the same, which Springer declares had “the advantage of having been made after nature, and which is preferable to all works on anatomy published since Galen’s time.”

Some years later the prejudice against human dissection disappeared in France, and anatomy was allowed to be taught by the Faculties of Paris and Montpellier. Henri de Hermondaville, Pierre de Cerlata, and Nicholas Bertrucci were particularly distinguished anatomists during the fourteenth century, and traced the scientific path followed by Vesalius, Fallopius, Eustachius, Fabrica de Aguapendente, Sylvius, Plater, Varola de Torre, Charles Etienne, Ingrassias, and Arantius in the sixteenth century.

From this time dates the escape of medicine from ecclesiastical authority.

In 1452, Cardinal d’Estouteville, charged by the Pope with the reorganization of the University of Paris, obtained a revocation of the order obliging celibacy, claiming it to be “impious and senseless” in the case of doctors.

It was at this moment that the Faculty of Physicians renounced the hospitality of the University and installed themselves in a house on the Rue de la Bucherie, the same being graciously tendered them by Jacques Desparts, physician to the King. This faculty now opened a register of its acts, which later became the Commentaries of the Society, and, already confident of a brilliant future and its own strength, the college engraved on its escutcheon these words: “Urbi et Orbi Salus,” and declared itself the guardian of antique morality; veteris disciplinæ retinentissima. Soon the dean of the faculty obtained from royalty the right to coin medals, the same being bestowed on physicians who rendered valuable public services; these bore the imprint of the college coat of arms, and Guy Patin went so far as to issue his own coined effigy in 1632 A.D.

The royal authority still further aided the medical profession and the faculty in gathering students: for instance, an order was issued granting physicians titles of nobility and coats of arms in cases of great merit; they were also exempted from taxes and other contributions to the crown, for, says Louis XIV., who speaks, “We cannot withhold such marks of honor to men of learning and others who by their devotion to a noble profession and personal merit are entitled to a rank of high distinction.” Besides, some of the greatest names in France were inscribed on the registers of the faculty; let us cite, for instance, Prader, Mersenne, Saint Yon, Montigny, Mauvillain, Sartes, Revelois, Montrose, Farcy, Jurency, and others. Can it be astonishing that the Faculty of Medicine, considering such high favors, was so deeply attached to the royalty that gave liberty and reputation to the great thinkers of the age?

The dean, who before the thirteenth century only had the title Magister Scolarum, administered the affairs of the faculty without control, and was recognized as the chief hierarch of the corporation; but he was elected by all the professors, and often chosen outside the professors of the Faculty. This high office was thus duly dignified, and it was only justice.

Above the dean, however, was the first Physician to the King, who was a high officer of the crown, having the same rights and privileges as the nobility, securing on his appointment the title of Count with hereditary transmission of same to his family; he was also a Councillor of State and wore the costume and decorations of this order. When he came to the faculty meetings he was received by the dean and bachelors, for he was also grand master of hygiene and legal medicine in the realm; he named all the salaried medical appointments, notably those of experts in medical jurisprudence.

Under Charles VIII., Adam Fumee and Jean Michel, sitting in Parliament as Councillors; Jacques Coictier, physician to Louis XI., was the President of the Tax Commission; while Fernel, no less celebrated as a mathematician than as a physician, was the intimate friend of Henri II. at the same time that Ambroise Pare was surgeon to the latter King and his two successors; F. Miron, too, afterwards became Embassador to Henri III.

Later we see Vautier, physician to Marie de Medecis, one of the malcontents sent to the Bastile for political reasons. Valot, Daquin and Fagon, all physicians to Louis XIV., were politicians, but were also great dispensers of Royal favor. Medical politicians figured largely in the time of Louis XIV. Among the independents, we may cite Guy Patin, the intimate friend and adviser of Lamoignan and Gabriel Naude, who was one of the most erudite men of the age. Under such conditions, no wonder that medicine entered into a new phase of progress. The time of study was now fixed at six years; after this there were examinations, from which, unfortunately, however, clinical medicine was excluded; examinations corresponded with the grades of Bachelor and doctor; finally—triumphant act of culmination—came the thesis with the obligation of the solemn Hippocratic oath.

The degree of Bachelor had existed since the foundation of the University of Paris. The Bacchalauri, or Bachalarrii,[7] were always students for the doctoral title. After numerous other tests, they signed the following obligation:

1. I swear to faithfully observe all secrets with honor, to follow the code and statutes laid down by the Faculty, and to do all in my power to assist them.

2. I swear to always obey and respect the Dean of the Faculty.

3. I swear to aid the Faculty in resisting any undertaking against their honor or ordinances, especially against those so-called doctors who practice illicitly; and also submit to any punishment inflicted for a proscribed action.

4. I swear to assist in full robes, at all meetings, when ordered by the Faculty.

5. I swear to assist at the exercises of the Academy of Medicine and the school for the space of two years, and sustain any question assigned me, in medicine or hygiene, by a thesis. Finally, I swear to be a good citizen, loving peace and order, and observe a decent manner in discussion on all questions laid down by the Faculty.

This oath was read in Latin by the Dean, and, as enumerated, each candidate for a degree solemnly answered “I swear” after each article.

Ranged with physicians at this period, although on a lower plane, came the surgeons and barbers; these had been created under the title of mires and meges, by medical monks, who could not, under the canons, resort to surgical operations, as it is written Ecclesia abhorrhet a sanguine.

Let us continue their history. When the College of Physicians was added to the University of Paris, in the twelfth century, it was specified by the other Faculties of the institution that surgeons formed no portion of the medical Faculty, and were not entitled to any consideration. These surgeons kept shops and wandered through the streets with instrument cases on their backs, seeking clients, and were assisted in their work by the barbers, who were even more illiterate than the surgeons; but, thanks to the exertions of Jean Pitard, surgeon to Saint Louis, these surgeons succeeded in forming a corporation in 1271. Their meetings were held in the dead-house of the Cordeliers’ church, and they were allowed the same privileges as the magistri in physica. They were the surgeons wearing a long robe.

It was only at the end of the century that Lanfranc obtained from Phillip the Beautiful an order to reorganize and bestow degrees for the exercise of surgical art. The studies were extremely practical; they required several years’ attendance at the Hotel Dieu or in the service of some city surgeon, likewise a certain amount of literary education. Like the doctors, these surgeons were permitted to wear a robe and hat. They were a great success.

Unfortunately, the barbers of the fourteenth century obtained, in their turn, an edict from Charles V., who recognized their corporation and authorized the knights of the razor to practice bleeding, and also all manner of minor surgery.

The Faculty of Medicine, jealous of the Surgeons’ College, encouraged the barbers with all their influence. They founded for the face scrapers a special course in anatomy on condition that the barber would always acknowledge the physician as superior to the surgeon. The barbers made this promise, but the time arrived when they thought themselves stronger than the Faculty of Medicine; this was in 1593; but this same year, an order passed by Parliament, at the instigation of the doctors, deprived the barbers of all the power granted them by Charles V.

The barbers thus had their punishment for defying the Faculty of Medicine.

The College of Surgeons, relieved from the competition of the barber surgeons, now claimed the right to become part of the Medical Faculty, and an ordinance of Francois I. gave them this privilege. Letters patent were issued that read:

“It is ordained that the before-mentioned, professors, bachelors, licentiates or masters, be they married or single, shall enjoy all the privileges, franchises, liberties, immunities and exemptions accorded to the other medical graduates of the University.”

Notwithstanding this Royal edict and confirmation of privileges accorded to surgeons by Henri II., Charles IX., and Henri III., the Faculty of Medicine positively refused to open their doors to their mortal enemies, the much despised barber-surgeons, as they were termed.

Even Louis XIV. gave up the idea of making the doctors associate socially with the surgeons; the latter, then, continued to keep shops, with a sign of three sacrament boxes supported by a golden lily, and were only allowed the cadavers of malefactors for purposes of dissection; these bodies were stolen from the Faculty of Medicine. In the meantime, the regular barber-surgeons renewed their ancient allegiance to the doctors, who had vainly attempted to substitute students in their places.

To put an end to the struggle, the College of Surgeons took the desperate but injurious resolve to admit all barbers to their institution and recognize their rights to a surgical degree. A year later, 1660, the Faculty of Medicine demanded that, inasmuch as the College of Surgeons admitted ignorant barbers to their school, the right of surgeons to wear a medical robe and hat and bestow degrees be denied. The Faculty of medicine gained their suit.

As an indispensable adjunct to the doctor at this period, let us now mention the apothecary and the bath-keeper.

The patron of the apothecaries was Saint Nicholas; they belonged to the corporation of grocers, where they were represented by three members. Their central bureau was at the Cloister Saint Opportune.

The inspection of drug stores and apothecary shops in Paris occurred once a year, and was made by three members elected from the central bureau and two doctors in medicine. A druggist in Paris served four years as an apprentice and six years as an under-dispenser; then the applicant was obliged to pass two examinations, and, finally, five extra examinations, the latter in the presence of the master apothecaries and two doctors. Notwithstanding their oath[8] to not prescribe medicine for the sick and not to sell drugs without a doctor’s written order, druggists then, as now, had frequent conflicts with physicians, as the latter are ever jealous of non professional interference and always asserting supremacy.

However, it is well to say that druggists never violated the rule relative to strict inspection of all drugs before using such articles. All medicines were passed at the central bureau before any apothecary would purchase for dispensing purposes.

As to bath-keepers, they belonged in antique times, as now, more to the order of empirics; their history dates far back to the period when the Romans introduced their bathing system into Gaul—a system which was perpetuated up to as late as the sixteenth century.

The baths constructed by the ancients and destroyed by the barbarians, reappeared again in the Middle Ages, under the names of vapor baths and furnace baths. These baths were shops, usually kept by barbers, where one could be sheared, sweated or leeched by a tonsorial artist. All the world then took baths—even the monks washed themselves sometimes; in fact, almost every monastery had its bath-rooms, where the poor could wash and be bled without pay.

In those days gentlemen bathed before receiving the order of chivalry. When one gave a ball it was customary and gallant to offer all the guests, especially the ladies, a free bath. When Louis XI. went out to sup with his loyal subjects, the honest tradespeople of Paris, he always found a hot bath at his disposal. Finally, it was considered a severe penance to forbid a person from bathing, as was done in the case of Henry IV., who was excommunicated.

Paris had many bath-houses. From early dawn until sunset the streets were filled, with cryers for bath-houses, who invited all passers-by to enter. In the time of Charles VI., bath-keepers introduced vapor baths. Some of these latter were entirely given up to women; others were reserved for the King and gentlemen of the court. The price of vapor baths was fixed by Police ordinance at twenty centimes for a vapor bath and forty centimes for those who washed afterwards. This price was subject to revision only at the pleasure of the municipal authorities.

During times of epidemics vapor baths were discontinued. It was for sanitary reasons, probably, that an order of the Mayor of Paris, named Delamere, forbade all persons taking vapor baths until after Christmas eve, “on penalty of a heavy fine.” This same proclamation was repeated by act of Parliament on December 13th, 1553, “the penalty corporeal punishment for offending bath-keepers.”

Parisian vapor baths had such wide-spread reputations and success that an Italian doctor of the sixteenth century by the name of Brixanius, who arrived in Paris, wrote the following verses:

“Balnea si calidis queras sudantia thermis,

In claris intrabis aqua, ubi corpus inungit,

Callidus, et multo medicamine spargit aliptes’,

Mox ubi membra satis geminis mundata lacertis

Laverit et sparsos crines siccaverit, albo

Marcida subridens componit corpora lecto.”

Already, in the time of Saint Louis, the number of bath-keepers was so great that they had a trades union; they were almost all barbers, too; they washed the body, cut hair, trimmed corns and nails, shaved and leeched.

Bath houses more than multiplied from the twelfth century, imitations of Oriental customs, due to the crusaders. Baths were run not only by men, but by old harridans and fast girls. No respectable woman ever entered a public bath-house; Christine de Pisan bears witness to that fact in the following lines: “As to public baths and vapor baths, they should be avoided by honest women except for good cause; they are expensive and no good comes out of them, for many obvious reasons; no woman, if she be wise, would trust her honor therein, if she desire to keep it.”

The establishments known as vapor baths, as early as the time of Saint Louis, had already degenerated into houses of prostitution. The police, in defense of public morality, were finally obliged to forbid fast women and diseased men from frequenting such places.

In Italy, vapor baths were recognized officially and tolerated as places of public debauchery; this was also the case in Avignon. The Synodal statutes of the Church of Avignon, in the year 1441, bear an ordinance drawn by the civil magistrates and applicable to married men and also to priests and clergy, forbidding access to the vapor baths on the Troucat Bridge, which were set apart as a place of tolerated debauchery by the municipal authorities. This ordinance contained a provision that was very uncommon in the Middle Ages, i.e., a fine of ten marks for a violation of the law during day time and twenty marks fine for a violation occurring under cover of night.

In 1448 the city council of Avignon again tried its hand at regulating the vapor baths at the bridge; but the golden days of debauched women had long before passed away, and the previous century had witnessed the acme of the courtesans’ fortunes. The sojourn of the Popes at Avignon had gathered together from all over the Globe a motley collection of pilgrims and begotten a frightful condition of libertinage; we have the authority of Petrarch in saying that it even surpassed that of the Eternal City, and Bishop Guillaume Durand presented the Council of Vienna with a graphic picture of this social evil.

According to the proclamation of Etienne Boileau, Mayor of Paris in the reign of Louis IX., barber bath keepers were forbidden to employ women of bad reputation in their shops in order to carry on under cover, as in the massage shops of the present day, an infamous commerce, on penalty of losing their outfit—seats, basins, razors, etc.,—which were to be sold at public auction for the profit of the public treasury and the Crown. But we know full well that the Royal Ordinance of 1254, which had for its object the reformation of public debauchery, was only applied for the space of two years, and that the new law of 1256 re-established and legalized public prostitution which offered less objectionable features than clandestine prostitution.

The use of public baths and hydrotherapy lasted until the sixteenth century. At this epoch, and without any known reason, the public suddenly discontinued all balneary practices, and this was noticeable among the aristocratic class as among the common people. A contrary evil was developed. “Honest women,” says Vernille, “took a pride in claiming that they never permitted themselves certain ablutions.” Nevertheless, Marie de Romien, (Instruction pour les Jeunes Dames) in her classical work for the instruction of young women, remarks: “They should keep clean, if it be only for the satisfaction of their husbands; it is not necessary to do as some women of my acquaintance, who have no care to wash until they be foul under their linen. But to be a beautiful damoyselle one may wash reasonably often in water which has been previously boiled and scented with fragrants, for nothing is more certain than that beauty flourishes best in that young woman who not only looks but smells clean.”

In an opuscle published in 1530, by one called De Drusæ, we observe that “notwithstanding the natural laws of propriety, women use scents more than clean water; and they thus only increase the bad smells they endeavor to disguise. Some use greasy perfumed ointments, others sponges saturated in fragrants”

“Entre leur cuisses et dessoubz les aisselles,

Pour ne sentir l’espaulle de mouton.”

This horror of water did not last long, however, and at the commencement of the seventeenth century the false modesty of women ended with the creation of river baths, such as exist to-day along the banks of the Seine.

Was this restoration of cleanly habits due to medical advice? This question cannot be answered, but it may not be out of place to cite that remarkable passage from the “Essays of Montaigne” on the hygiene of bathing, which he recommends in certain maladies:

“It is good to bathe in warm water, it softens and relaxes in ports where it stagnates over sands and stones. Such application of external heat, however, makes the kidneys leathery and hard and petrifies the matter within. To those who bathe: it is best to eat little at night to the end that the waters drank the next morning operate more easily, meeting with an empty stomach. On the other hand, it is best to eat a little dinner, in order not to trouble the action of the water, which is not in perfect accord; nor should the stomach be filled too suddenly after its other labor; leave the work of digestion to the night, which is better than the day, when the body and mind are in perpetual movement and activity.

“I have noted, on the occasion of my voyages, all the famous baths of Christendom, and for some years past have made use of waters, for as a general rule I consider bathing healthy and deem it no risk to one’s physical condition. The custom of ablution, so generally observed at times past in all nations, is now only practiced in a few as a daily habit. I cannot imagine why civilized people ever allow their bodies to become encrusted with dirt and their pores filled with filth.”[9]

If Montaigne made great use of mineral waters, he had in revenge a formidable dread of physicians and their medicines, a sentiment he inherited from his father, “who died,” says he, “at the age of seventy-four years,” and his “grandfather and great-grandfather died at eighty years without tasting a drop of physic.”

Montaigne has justly criticized medicine in several essays on the healing art. He knew well the intividia medicorum, and it was for this reason that he remarked that a physician should always treat a case without a consultant. “There never was a doctor,” says Montaigne, “who, on accepting the services of a consultant, did not discontinue or readjust something.” Is not the same criticism deserved at the present day? How absurd are our medical consultations. The examples Montaigne gives of disagreements of doctors in consultation as to doctrines are equally applicable to modern times. The differences of Herophilus, Erasistratus, and the Æsclepiadæ as to the original causation of disease were no greater than those of the schools of Broussais and Pasteur, which have both acquired a universal celebrity in less than half a century.

Montaigne insisted that medicine owed its existence only to mankind’s fear of death and pain, an impatience at poor health and a furious and indiscreet thirst for a speedy cure, but the author of the “Essays” adds in concluding: “I honor physicians, not following the feeling of necessity, but for the love of themselves, having seen many honest doctors who were honorable and well worthy of being loved.”

The reputation for disagreement among doctors so much insisted on by Montaigne has served as a well-worn text for many other critics.

In Les Serres of Guillaume Bouchet, a contemporary of the author, we find the same shaft of sarcasm directed at physicians. Where will you find men in any other profession save that of medicine who envy and hate each other so heartily? What other profession on earth is given over to such bitter disagreements? How can common people be expected to honor and respect experts and savants so-called when the professors call each other ignoramusses and asses? Call these doctors into a case and one after the other they will disagree as to the diagnosis as well as to the method of cure. As Pellisson wrote:

“When an enemy you wish to kill

Don’t call assasins full of vice,

But call two doctors of great skill

To give contrary advice.”

Or in the verses of the original:

“D’un ennemi voulez vous defaire?

Ne cherchez pas d’assasins

Donnez lui deux medecins,

Et qui’ils soient d’avis contrarie.”

This professional jealousy is always more apparent than real. Aside from the rivalry for public patronage physicians are a very social class of men, as witness their many festive meetings. We banquet in honor of St. Luke the physician, and St. Come, after each thesis, at anniversaries, at the election of the Dean, and on many other occasions. It is these co-fraternal meetings at which are reinagurated the old feelings of good-fellowship; our little quarrels only serve to discipline the medical body and to increase the grandeur of the Faculty. It is the constant rubbing of surfaces that makes the true professional metal glitter.

When we hear new doctors, young graduates, swear the Hippocratic oath, we do not forget that the principal articles of the statute prescribe the cultivation of friendships, respect for the older members of the profession, benevolence to the young beginners, and the preservation of professional decency and kindness. It may be insisted that banquets are not to be considered as medical assemblages, for there they laugh long and loud, and drink many a bumper of rich Burgundy; making joyous discourse; holding to the famous compliment of Moliere:

Salus, honor et argentum

Atque bonum appetitum.

We know to-day many of the truthful precepts of the School of Salerno and their bearing on the medical records of the middle ages. Then as now the doctor had the ever increasing ingratitude of the patient (ad proccarendam oegrorum ingratitudinem).

“The disciple of Hippocrates meeteth often treatment rude,

The payment of his trouble is base ingratitude.

When the patient is in grievous pain the time is opportune

For a keen, sharp-witted doctor to make a good fortune.

Let him profit by the sufferer’s aches and gather in the money,

For the ant gets winter provender and the summer bee its honey.”

Our ancient friends had no pity for charlatans, however. They rightfully abused all medical impostors, as we read in the precepts of Salerno’s school:

“Il n’est par d’ignorant, de chartatan stupide,

D’histron imposteur, ou de Juif fourbe avide,

De sorciere crasseuse ou de barbier bavard,

De faussiare inpudent, ou de moine cafard,

De marchand de savon, ou de avengle oculiste,

De baigneur imbecile, ou d’absurde alchimiste,

Pas d’heretique impur qui ne se targue, enfin,

Du beau titre, du nom sacre de medecin.”

The investigation of medical science was far from being an honor to the middle ages. The best of the profession was hidden in the doctoral sanctuary, enveloped in those mysteries which are never penetrated by the profane and only known to the initiated.

The recommendations as to the secrets of our art are addressed to all young doctors in that famous epilogue commencing:

“Gardez surtout, gardez qui’un profane vulgaire

De votre art respecte ne perce le mystere;

Son eclat devoile perdrait sa dignite

D’un mystere connu decroit la majeste,”

Let us invoke God, the Supreme physician, let us demand the professional banishment of every doctor who reveals a professional secret.

“Exsul sit medicus physicius secreta revelans.”—Amen!

THE GREAT EPIDEMICS OF THE MIDDLE AGES.

THE PLAGUE

Several great epidemics of the Plague had already devastated the world; the plague of Athens in the fifth century, B. C.; the plague of the second century, in the reign of Marcus Aurelius; the plague of the third century, in the reign of Gallus; then came that most terrible epidemic of the sixth century, known by the name of the inguinal pestilence, which, after ravaging Constantinople spread into Liguria, then into France and Spain. It was in 542, according to Procopius, that an epidemic struck the world and consumed almost all the human species.[10]

“It attacked the entire earth,” says our author, “striking every race of people, sparing neither age nor sex; differences in habitation, diet, temperament or occupation of any nature did not stop its ravages; it prevailed in summer and in winter, in fact, at every season of the year.

“It commenced at the town of Pelusa in Egypt, from whence it spread by two routes, one through Alexandria and the rest of Egypt, the other through Palestine. After this it covered the whole world, progressing always by regular intervals of time and force. In the springtime of 543 it broke out in Constantinople and announced itself in the following manner:

“Many victims believed they saw the spirits of the departed rehabilitated in human form. It appeared as though these spirits appeared before the subject about to be attacked and struck him on certain portions of the body. These apparitions heralded the onset of the malady. It is but fair to say that the commencement of the disease was not the same in all cases. Some victims did not see the apparitions, but only dreamed of them, but all believed they heard a ghostly voice announcing their inscription on the list of those who were going to die. Some claim that the greater number of victims were not haunted either sleeping or waking by these ghosts and the mysterious voice that made sinister predictions.

“The fever at the onset of the attack came on suddenly,—some while sleeping, some while waking, some while at work. Their bodies exhibited no change of color, and the temperature was not very high. Some indications of fever were perceptible, but no signs of acute inflammation. In the morning and at night the fever was slight, and indicated nothing severe either to the patient or to the physician who counted the pulse. Most of those who presented such symptoms showed no indications of approaching dissolution; but the first day among some, the second day in others, and after several days in many cases, a bubo was observed on the lower portion of the abdomen, in the groin, or in the folds of the axilla, and sometimes back of the ears or on the thighs.

“The principal symptoms of the disease on its invasion were as I have pointed out; for the remainder, nothing can be precisely indicated of the variations of the type of the disease following temperament; these other symptoms were only such as were imprinted by the Supreme Being at his divine will.

“Some patients were plunged into a condition of profound drowsiness; others were victims to furious delirium. Those who were drowsy remained in a passive state, seeming to have lost all memory of the things of ordinary life. If they had any one to nurse them they took food when offered from time to time, and if they had no care soon died of inanition. The delirious patients, deprived of sleep, were eternally pursued by their hallucinations; they imagined themselves haunted by men ready to slay them, and they sought flight from such fancied foes, uttering dreadful screams. Persons who were attacked while nursing the sick were in the most pitiable condition—not that they were more liable to contract the disease by contact, however, for nurses and doctors did not get the disease from actual contact with the sufferers, for some who washed and laid out the dead never contracted the malady, but enjoyed perfect health throughout the epidemic; some, however, died suddenly without apparent cause. Many of the nurses were overworked keeping patients from rolling out of bed and preventing the delirious from jumping from high windows. Some patients endeavored to throw themselves in running water, not to quench their thirst, but because they had lost all reason. It was necessary to struggle with many of the sick in order to make them swallow any nourishment, which they would not accept without more or less resistance. The buboes enfeebled certain patients who were neither drowsy nor delirious, but who finally succumbed to their atrocious sufferings.

“As nothing was known of this strange disease, certain physicians thought its origin was due to some source of evil hidden in the buboes, and they accordingly opened these glandular bodies. The dissection of the bubo showed sub-adjacent carbuncles, whose rapid malignity brought on sudden death or an illness of but few days’ duration. In some instances the entire body was covered by black spots the size of a bean. Such unfortunates rarely lived a day, and generally expired in an hour. Many cases died suddenly, vomiting blood. One thing I can solemnly affirm, that is, that the wisest physicians gave up all hope in the case of many patients who afterwards recovered; on the contrary, many persons perished at the very time their health was almost re-established. For all these causes, the malady passed the confines of human reasoning, and the outcome always deceived the most natural predictions.

“As to treatment, the effects were variable, following the condition of the victim. I may state that, as a fact, no efficacious remedies were discovered that could either prevent the onset of the disease or shorten its duration. The victims could not tell why they were attacked, nor how they were cured.

“Pregnant women attacked inevitably aborted at death, some succumbing while miscarrying; some going on to the end of gestation, dying in labor along with their infants. Only three cases are known where women recovered of plague after aborting; while only one instance is on record where a newly-born child survived its mother in this epidemic. Those in whom the buboes increased most rapidly in size, maturated and suppurated, most often recovered, for the reason, no doubt, that the malignant properties of the bubonic carbuncle were weakened or destroyed.

“Experience proved that such symptoms were an almost sure presage of a return to health. Those, on the contrary, in whom the tumor did not change its aspect from the time of its eruption, were attacked with all the symptoms I have before described. In some cases the skin dried and seemed thus to prevent the tumor, although it might be well developed, from suppurating. Some were cured at the price of a loss of power in the tongue, which reduced the victims to stammer and articulate words in a confused and unintelligible manner for the rest of their days.

“The epidemic at Constantinople lasted four months, three months of which time it raged with great violence. As the epidemic progressed the mortality-rate increased from day to day, until it reached the point of 5,000 deaths per day, and on several occasions ran up to as high as 10,000 deaths in the twenty four hours.”

Let us pass over this very important description that Procopius gives of the moral effect of this epidemic on the people, of the scenes of wild and heart-rending terror, of curious examples of egotism and sublime devotion, of instances of blind superstition developed in a great city under the influence of fear and the dread of a very problematical contagion.

Evagre, the scholastic, another Greek historian of the sixth century, recounts in his works the story of the plague at Constantinople. He states that he frequently observed that persons recovering from a first and second attack subsequently died on a third attack; also that persons flying from an infected locality were often taken sick after many days of an incubating period, falling ill in their places of refuge in the midst of populations free, up to that time, from the pestilence.

In following the progress of this epidemic from the Orient to the Occident, it was noticed that it always commenced at the sea-ports and then traveled inland. The disease was carried much more easily by ships than it could be at the present time, inasmuch as there were no quarantines and no pest-houses for isolating patients. It entered France by the Mediterranean Sea. It was in 549 that the plague struck Gaul. “During this time,” says Gregory of Tours, “the malady known as the inguinal disease ravaged many sections and the province of Arles was cruelly depopulated.”[11]

This illustrious historian wrote in another passage: “We learned this year that the town of Narbonne was devastated by the groin disease, of so deadly a type that when one was attacked he generally succumbed. Felix, the Bishop of Nantes, was stricken down and appeared to be desperately ill. The fever having ceased, the humor broke out on his limbs, which were covered with pustules. It was after the application of a plaster covered with cantharides that his limbs rotted off, and he ceased to live in the seventieth year of his age.

“Before the plague reached Auvergne it had involved most all the rest of the country. Here the epidemic attacked the people in 567, and so great was the mortality that it is utterly impossible to give even the approximate number of deaths. Populations perished en masse. On a single Sunday morning three hundred bodies were counted in St. Peter’s chapel at Clermont awaiting funeral service. Death came suddenly; it struck the axilla or groin, forming a sore like a serpent that bit so cruelly that men rendered up their souls to God on the second or third day of the attack, many being so violent as to lose their senses. At this time Lyons, Bourges, Chalons, and Dijon were almost depopulated by the pestilence.”

In 590 the towns of Avignon and Viviers were cruelly ravaged by the inguinal disease.

The plague reached Marseilles, however, in 587, being carried there by a merchant vessel from Spain which entered the port as a center of an infection. Several persons who bought goods from this trading vessel, all of whom lived in one house nevertheless, were carried off by the plague to the number of eight. The spark of the epidemic did not burn very rapidly at first, but after a certain time the baleful fire of the pest, after smouldering slowly, burst out in a blaze that almost consumed Marseilles.

Bishop Theodorus isolated himself in a wing of the cloister Saint Victor, with a small number of persons who remained with him during the plague, and in the midst of their general desolation continued to implore Almighty God for mercy, with fasting and prayer until the end of the epidemic. After two months of calm the population of the city commenced to drift back, but the plague reappeared anew and most of those who returned died. The plague has devastated Marseilles many times since the epoch just mentioned.

Anglada[12] who, like the writer, derives most of his citations from Gregory of Tours, thinks that the plague that devastated Strasbourg in 591 was only the same inguinal disease that ravaged Christendom. He cites, in support of his assertion, that passage from the historian poet Kleinlande translated by Dr. Boersch: “In 591 there was a great mortality throughout our country, so that men fell down dying in the streets, expiring suddenly in their houses, or even at business. When a person sneezed his soul was apt to fly the body; hence the expression on sneezing, ‘God bless you!’ And when a person yawned they made the sign of the cross before their mouths.”

Such are the documents we possess on the great epidemic of inguinal plague of the fourth century, documents furnished by historians, to whom medical history is indebted, and not from medical authors, who left no marks at that period.

THE BLACK PLAGUE.

The Black Plague of the fourteenth century was more destructive even than the bubonic pest of the sixth century, and all other epidemics observed up to the present day. In the space of four years more than twenty five millions of human beings perished—one-half the population of the world. Like all other pestilences, it came from the Orient—from India, and perhaps from China. Europe was invaded from east to west, from south to north. After Constantinople, all the islands and shores of the Mediterranean were attacked, and successively became so many foci of disease from which the pestilence radiated inland. Constantinople lost two-thirds of its population. Cyprus and Cairo counted 15,000 deaths. Florence paid an awful tribute to the disease, so great being the mortality that the epidemic has often been called Peste de Florence; “100,000 persons perished,” says Boccaccio. Venice lost 20,000 victims, Naples 60,000, Sicily 53,000, and Genoa 40,000, while in Rome the dead were innumerable.

In Spain, Germany, England, Poland, and Russia the malady was as fatal as in Italy. At London they buried 100,000 persons in the cemeteries. It was the same in France. Avignon lost 150,000 citizens in seven months, among whom was the beautiful Laura de Noves, immortalized by Petrarch, who expired from the plague in 1348, aged forty-one years. At Marseilles 56,000 people died in one month; at Montpellier three quarters of the population, including all the physicians, went down in the epidemic. Narbonne had 30,000 deaths and Strasbourg 16,000 in the first year of the outbreak. Paris was not spared; the Chronique de Saint Denis informs us that “in the year of Grace 1348, commenced the aforesaid mortality in the Realms of France, the same lasting about a year and a half, increasing more and more until Paris lost each day 800 inhabitants; so that the number who died there amounted to more than 500,000 people, while in the town of Saint Denis the number reached 16,000.[13]

Among the victims were Jeanne de Bourgogne, wife of Philip VI.; Jeanne II., Queen of Navarre, grandchild of Philip the Beautiful. In Spain, died Alphonse XI. of Castille. “Happily,” says the Chronicle, “during the years following the plague the fecundity of women was prodigious—as though nature desired to repair the ravages wrought by death.” The symptoms and history of this plague have been described by several ocular witnesses, among others Guy de Chauliac, the celebrated surgeon and professor at Montpellier, who has left the following recital in quaint old French:

“The disease was such that one never before saw a like mortality. It appeared in Avignon in the year of our Saviour 1348, in the sixth year of the Pontificate of Clement VI., in whose service I entered, thanks to his Grace.

“Not to displease you, I shall briefly narrate for your edification the advent of the disease.

“It commenced—the aforesaid mortality—in January and lasted for the space of seven months.

“The disease was of two kinds. The first type lasted two months, with a continued fever and spitting of blood. This variety killed in three days, however.

“The second type of the disease, prevailing during the epidemic time, also had a continued fever, with apostumes and carbuncles at the external parts, principally on the axilla and in the groin; all such attacked usually died in five days.

“The malady was so contagious, especially that form in which blood-spitting was noticed, that one not only caught it from sojourning with the sick, but also, it sometimes seemed, from looking at the disease, so that men died without their servants and were buried without priests.

“The father visited not his son, nor the son his father. Charity was dead and hope disappeared.

“I call the epidemic great, inasmuch as it conquered all the earth.

“For the pestilence commenced at the Orient, and cast its fangs against all the world, passing through Paris towards the West.

“It was so destructive that it left only a quarter of the population of mankind behind.

“It was a shame and disgrace to medicine, as many doctors dared not visit the sick through fear of becoming infected; and those who visited the sick made few cures and fewer fees, for the sick all died save a few. Not many having buboes escaped death.

“For preservation, there was no better remedy than to fly from the infection, to purge one’s self with aloe pills, to diminish the blood by phlebotomy, to purify the air with fire, to comfort the heart with cordials and apples and other things of good odor; to console the humors with Armenian bole and resist dry rot by the use of acid things. For the cure of the plague we used bleedings and evacuations, electuaries, syrups and cordials, and the external apostumes or swellings were poulticed with boiled figs and onions mixed with oil and butter; the buboes were afterwards opened and treated by the usual cures for ulcers.

“Carbuncles were leeched, scarified and cauterized.

“I, to avoid infamy, dared not absent myself from the care of the sick, but lived in continual fear, preserving myself as long as possible by the before-mentioned remedies.

“Nevertheless, towards the end of the epidemic, I fell into a fever, which continued with an aposthume in the groin, and was ill for nigh on six weeks, being in such danger that all my companions believed I should die; nevertheless, the bubo being poulticed and treated as I have above indicated, I recovered, thanks be to the will of God.”

According to the records of that time, many persons died the first day of their illness. These bad cases were announced by a violent fever, with cephalgia, vertigo, drowsiness, incoherency in ideas, and loss of memory; the tongue and palate were black and browned, exhaling an almost insupportable fetidity. Others were attacked by violent inflammation of the lungs, with hemorrhage; also gangrene, which manifested itself in black spots all over the body; if, to the contrary, the body was covered by abscesses, the patients seemed to have some chance for recovery.

Medicines were powerless, all remedies seeming to be useless. The disease attacked rich and poor indiscriminately; it overpowered the robust and debilitated; the young and the old were its victims. On the first symptom the patients fell into a profound melancholy and seemed to abandon all hope of recovery. This moral prostration aggravated their physical condition, and mental depression hastened the time of death. The fear of contagion was so great that but few persons attended the sick.

The clergy, encouraged by the Pope, visited the bedsides of the dying who bequeathed all their wealth to the Church. The plague was considered on all sides as a punishment inflicted by God, and it was this idea that induced armies of penitents to assemble on the public streets to do penance for their sins. Men and women went half naked along the highways flagellating each other with whips, and, growing desperate with the fall of night, they committed scandalous crimes. In certain places the Jews were accused of being the authors of the plague by poisoning the wells; hence the Hebrews were persecuted, sometimes burned alive by the fanatical sects known as Flagellants, Begardes and Turlupins, who were encouraged in their acts of violence by the priests, notwithstanding the intervention of Clement VI.