The Evolution of Modern Medicine Part 10

CHAPTER IV -- THE RENAISSANCE AND THE RISE OF ANATOMY AND PHYSIOLOGY

THE "reconquest of the cla.s.sic world of thought was by far the most important achievement of the fifteenth and sixteenth centuries.

It absorbed nearly the whole mental energy of the Italians.... The revelation of what men were and what they wrought under the influence of other faiths and other impulses, in distant ages with a different ideal for their aim, not only widened the narrow horizon of the Middle Ages, but it also restored self-confidence to the reason of humanity."(1)

(1) J. A. Symonds: The Renaissance in Italy; the Revival of Learning, 1877, p. 52.

Everywhere throughout the Middle Ages learning was the handmaid of theology. Even Roger Bacon with his strong appeal for a new method accepted the dominant mediaeval conviction--that all the sciences did but minister to their queen, Theology. A new spirit entered man's heart as he came to look upon learning as a guide to the conduct of life.

A revolution was slowly effected in the intellectual world. It is a mistake to think of the Renaissance as a brief period of sudden fruitfulness in the North Italian cities. So far as science is concerned, the thirteenth century was an aurora followed by a long period of darkness, but the fifteenth was a true dawn that brightened more and more unto the perfect day. Always a reflex of its period, medicine joined heartily though slowly in the revolt against mediaevalism. How slowly I did not appreciate until recently. Studying the earliest printed medical works to catch the point of view of the men who were in the thick of the movement up to 1480--which may be taken to include the first quarter of a century of printing--one gets a startling record. The mediaeval mind still dominates: of the sixty-seven authors of one hundred and eighty-two editions of early medical books, twenty-three were men of the thirteenth and fourteenth centuries, thirty men of the fifteenth century, eight wrote in Arabic, several were of the School of Salernum, and only six were of cla.s.sical antiquity, viz., Pliny (first 1469), Hippocrates (1473) (Hain (*)7247), Galen (1475) (Hain 7237), Aristotle (1476), Celsus (1478), and Dioscorides (1478).(**)

(*) This asterisk is used by Hain to indicate that he had seen a copy.--Ed.

(**) Data added to a ma.n.u.script taken from the author's summary on "Printed Medical Books to 1480" in Transactions of the Bibliographical Society, London, 1916, XIII, 5-8, revised from its "News-Sheet" (February, 1914). "Of neither Hippocrates nor Galen is there an early edition; but in 1473 at Pavia appeared an exposition of the Aphorisms of Hippoerates, and in 1475 at Padua an edition of the Tegni or Notes of Galen." Ibid., p. 6.

Osler's unfinished Ill.u.s.trated Monograph on this subject is now being printed for the Society of which he was President.--Ed.

The medical profession gradually caught the new spirit. It has been well said that Greece arose from the dead with the New Testament in the one hand and Aristotle in the other. There was awakened a perfect pa.s.sion for the old Greek writers, and with it a study of the original sources, which had now become available in many ma.n.u.scripts. Gradually Hippocrates and Galen came to their own again. Almost every professor of medicine became a student of the MSS. of Aristotle and of the Greek physicians, and before 1530 the presses had poured out a stream of editions. A wave of enthusiasm swept over the profession, and the best energies of its best minds were devoted to a study of the Fathers. Galen became the idol of the schools. A strong revulsion of feeling arose against the Arabians, and Avicenna, the Prince, who had been clothed with an authority only a little less than divine, became anathema. Under the leaders.h.i.+p of the Montpellier School, the Arabians made a strong fight, but it was a losing battle all along the line. This group of medical humanists--men who were devoted to the study of the old humanities, as Latin and Greek were called--has had a great and beneficial influence upon the profession. They were for the most part cultivated gentlemen with a triple interest--literature, medicine and natural history. How important is the part they played may be gathered from a glance at the "Lives" given by Bayle in his "Biographic Medicale"

(Paris, 1855) between the years 1500 and 1575. More than one half of them had translated or edited works of Hippocrates or Galen; many of them had made important contributions to general literature, and a large proportion of them were naturalists: Leonicenus, Linacre, Champier, Fernel, Fracastorius, Gonthier, Caius, J. Sylvius, Brasavola, Fuchsius, Matthiolus, Conrad Gesner, to mention only those I know best, form a great group. Linacre edited Greek works for Aldus, translated works of Galen, taught Greek at Oxford, wrote Latin grammars and founded the Royal College of Physicians.(*) Caius was a keen Greek scholar, an ardent student of natural history, and his name is enshrined as co-founder of one of the most important of the Cambridge colleges.

Gonthier, Fernel, Fuchs and Mattioli were great scholars and greater physicians. Champier, one of the most remarkable of the group, was the founder of the Hotel Dieu at Lyons, and author of books of a characteristic Renaissance type and of singular bibliographical interest. In many ways greatest of all was Conrad Gesner, whose mors inopinata at forty-nine, bravely fighting the plague, is so touchingly and tenderly mourned by his friend Caius.(2) Physician, botanist, mineralogist, geologist, chemist, the first great modern bibliographer, he is the very embodiment of the spirit of the age.(2a) On the flyleaf of my copy of the "Bibliotheca Universalis" (1545), is written a fine tribute to his memory. I do not know by whom it is, but I do know from my reading that it is true:

(*) Cf. Osler: Thomas Linacre, Cambridge University Press, 1908.--Ed.

(2) Joannis Caii Britanni de libris suis, etc., 1570.

(2a) See J. C. Bay: Papers Bibliog. Soc. of America, 1916, X, No. 2, 53-86.

"Conrad Gesner, who kept open house there for all learned men who came into his neighborhood. Gesner was not only the best naturalist among the scholars of his day, but of all men of that century he was the pattern man of letters. He was faultless in private life, a.s.siduous in study, diligent in maintaining correspondence and good-will with learned men in all countries, hospitable--though his means were small--to every scholar that came into Zurich. Prompt to serve all, he was an editor of other men's volumes, a writer of prefaces for friends, a suggestor to young writers of books on which they might engage themselves, and a great helper to them in the progress of their work. But still, while finding time for services to other men, he could produce as much out of his own study as though he had no part in the life beyond its walls."

A large majority of these early naturalists and botanists were physicians.(3) The Greek art of observation was revived in a study of the scientific writings of Aristotle, Theophrastus and Dioscorides and in medicine, of Hippocrates and of Galen, all in the Greek originals.

That progress was at first slow was due in part to the fact that the leaders were too busy sc.r.a.ping the Arabian tarnish from the pure gold of Greek medicine and correcting the anatomical mistakes of Galen to bother much about his physiology or pathology. Here and there among the great anatomists of the period we read of an experiment, but it was the art of observation, the art of Hippocrates, not the science of Galen, not the carefully devised experiment to determine function, that characterized their work. There was indeed every reason why men should have been content with the physiology and pathology of that day, as, from a theoretical standpoint, it was excellent. The doctrine of the four humors and of the natural, animal and vital spirits afforded a ready explanation for the symptoms of all diseases, and the practice of the day was admirably adapted to the theories. There was no thought of, no desire for, change. But the revival of learning awakened in men at first a suspicion and at last a conviction that the ancients had left something which could be reached by independent research, and gradually the paralytic-like torpor pa.s.sed away.

(3) Miall: The Early Naturalists, London, 1912.

The sixteenth and seventeenth centuries did three things in medicine--shattered authority, laid the foundation of an accurate knowledge of the structure of the human body and demonstrated how its functions should be studied intelligently--with which advances, as ill.u.s.trating this period, may be a.s.sociated the names of Paracelsus, Vesalius and Harvey.

PARACELSUS

PARACELSUS is "der Geist der stets verneint." He roused men against the dogmatism of the schools, and he stimulated enormously the practical study of chemistry. These are his great merits, against which must be placed a flood of hermetical and transcendental medicine, some his own, some foisted in his name, the influence of which is still with us.

"With what judgment ye judge it shall be judged to you again" is the verdict of three centuries on Paracelsus. In return for unmeasured abuse of his predecessors and contemporaries he has been held up to obloquy as the arch-charlatan of history. We have taken a cheap estimate of him from Fuller and Bacon, and from a host of scurrilous scribblers who debased or perverted his writings. Fuller(4) picked him out as exemplifying the drunken quack, whose body was a sea wherein the tide of drunkenness was ever ebbing and flowing--"He boasted that shortly he would order Luther and the Pope, as well as he had done Galen and Hippocrates. He was never seen to pray, and seldome came to Church.

He was not onely skilled in naturall Magick (the utmost bounds whereof border on the suburbs of h.e.l.l) but is charged to converse constantly with familiars. Guilty he was of all vices but wantonnesse: ... "

(4) Fuller: The Holy and Profane State, Cambridge, 1642, p. 56.

Francis Bacon, too, says many hard things of him.(5)

(5) Bacon: Of the Proficience and Advancement of Learning, Bk.

II, Pickering ed., London, 1840, p. 181. Works, Spedding ed., III, 381.

To the mystics, on the other hand, he is Paracelsus the Great, the divine, the most supreme of the Christian magi, whose writings are too precious for science, the monarch of secrets, who has discovered the Universal Medicine. This is ill.u.s.trated in Browning's well-known poem "Paracelsus," published when he was only twenty-one; than which there is no more pleasant picture in literature of the man and of his aspirations. His was a "searching and impetuous soul" that sought to win from nature some startling secret--"... a tincture of force to flush old age with youth, or breed gold, or imprison moonbeams till they change to opal shafts!" At the same time with that capacity for self-deception which characterizes the true mystic he sought to cast

Light on a darkling race; save for that doubt, I stood at first where all aspire at last To stand: the secret of the world was mine.

I knew, I felt (perception unexpressed, Uncomprehended by our narrow thought, But somehow felt and known in every s.h.i.+ft And change in the spirit,--nay, in every pore Of the body, even)--what G.o.d is, what we are, What life is--...(6)

(6) Robert Browning: Paracelsus, closing speech.

Much has been done of late to clear up his story and his character.

Professor Sudhoff, of Leipzig, has made an exhaustive bibliographical study of his writings,(7) there have been recent monographs by Julius Hartmann, and Professors Franz and Karl Strunz,(8) and a sympathetic summary of his life and writings has been published by the late Miss Stoddart.(9) Indeed there is at present a cult of Paracelsus. The hermetic and alchemical writings are available in English in the edition of A. E. Waite, London, 1894. The main facts of his life you can find in all the biographies. Suffice it here to say that he was born at Einsiedeln, near Zurich, in 1493, the son of a physician, from whom he appears to have had his early training both in medicine and in chemistry. Under the famous abbot and alchemist, Trithemiusof Wurzburg, he studied chemistry and occultism. After working in the mines at Schwatz he began his wanderings, during which he professes to have visited nearly all the countries in Europe and to have reached India and China. Returning to Germany he began a triumphal tour of practice through the German cities, always in opposition to the medical faculty, and constantly in trouble. He undoubtedly performed many important cures, and was thought to have found the supreme secret of alchemistry.

In the pommel of his sword he was believed to carry a familiar spirit.

So dominant was his reputation that in 1527 he was called to the chair of physic in the University of Basel. Embroiled in quarrels after his first year he was forced to leave secretly, and again began his wanderings through German cities, working, quarrelling, curing, and dying prematurely at Saltzburg in 1541--one of the most tragic figures in the history of medicine.

(7) Professor Sudhoff: Bibliographia Paracelsica, Berlin, 1894, 1899.

(8) R. Julius Hartmann: Theophrast von Hohenheim, Berlin, 1904; ditto, Franz Strunz, Leipzig, 1903.

(9) Anna M. Stoddart: The Life of Paracelsus, London, John Murray, 1911.

Paracelsus is the Luther of medicine, the very incarnation of the spirit of revolt. At a period when authority was paramount, and men blindly followed old leaders, when to stray from the beaten track in any field of knowledge was a d.a.m.nable heresy, he stood out boldly for independent study and the right of private judgment. After election to the chair at Basel he at once introduced a startling novelty by lecturing in German.

He had caught the new spirit and was ready to burst all bonds both in medicine and in theology. He must have startled the old teachers and pract.i.tioners by his novel methods. "On June 5, 1527, he attached a programme of his lectures to the black-board of the University inviting all to come to them. It began by greeting all students of the art of healing. He proclaimed its lofty and serious nature, a gift of G.o.d to man, and the need of developing it to new importance and to new renown.

This he undertook to do, not retrogressing to the teaching of the ancients, but progressing whither nature pointed, through research into nature, where he himself had discovered and had verified by prolonged experiment and experience. He was ready to oppose obedience to old lights as if they were oracles from which one did not dare to differ.

Ill.u.s.trious doctor smight be graduated from books, but books made not a single physician.(10) Neither graduation, nor fluency, nor the knowledge of old languages, nor the reading of many books made a physician, but the knowledge of things themselves and their properties. The business of a doctor was to know the different kinds of sicknesses, their causes, their symptoms and their right remedies. This he would teach, for he had won this knowledge through experience, the greatest teacher, and with much toil. He would teach it as he had learned it, and his lectures would be founded on works which he had composed concerning inward and external treatment, physic and surgery."(11) Shortly afterwards, at the Feast of St. John, the students had a bonfire in front of the university. Paracelsus came out holding in his hands the "Bible of medicine," Avicenna's "Canon," which he flung into the flames saying: "Into St. John's fire so that all misfortune may go into the air with the smoke." It was, as he explained afterwards, a symbolic act: "What has perished must go to the fire; it is no longer fit for use: what is true and living, that the fire cannot burn." With abundant confidence in his own capacity he proclaimed himself the legitimate monarch, the very Christ of medicine. "You shall follow me," cried he, "you, Avicenna, Galen, Rhasis, Montagnana, Mesues; you, Gentlemen of Paris, Montpellier, Germany, Cologne, Vienna, and whomsoever the Rhine and Danube nourish; you who inhabit the isles of the sea; you, likewise, Dalmatians, Athenians; thou, Arab; thou, Greek; thou, Jew; all shall follow me, and the monarchy shall be mine."(12)

(10) And men have oft grown old among their books To die case hardened in their ignorance.

--Paracelsus, Browning.

(11) Anna M. Stoddart: Life of Paracelsus, London, 1911, pp.

95-96.

(12) Browning's Paracelsus, London, 1835, p. 206 (note).

This first great revolt against the slavish authority of the schools had little immediate effect, largely on account of the personal vagaries of the reformer--but it made men think. Paracelsus stirred the pool as had not been done for fifteen centuries.

Much more important is the relation of Paracelsus to the new chemical studies, and their relation to practical medicine. Alchemy, he held, "is to make neither gold nor silver: its use is to make the supreme sciences and to direct them against disease." He recognized three basic substances, sulphur, mercury and salt, which were the necessary ingredients of all bodies organic or inorganic. They were the basis of the three principles out of which the Archaeus, the spirit of nature, formed all bodies. He made important discoveries in chemistry; zinc, the various compounds of mercury, calomel, flowers of sulphur, among others, and he was a strong advocate of the use of preparations of iron and antimony. In practical pharmacy he has perhaps had a greater reputation for the introduction of a tincture of opium--labdanum or laudanum--with which he effected miraculous cures, and the use of which he had probably learned in the East.

Through Paracelsus a great stimulus was given to the study of chemistry and pharmacy, and he is the first of the modern iatro-chemists. In contradistinction to Galenic medicines, which were largely derived from the vegetable kingdom, from this time on we find in the literature references to spagyric medicines and a "spagyrist" was a Paracelsian who regarded chemistry as the basis of all medical knowledge.

One cannot speak very warmly of the practical medical writings of Paracelsus. Gout, which may be taken as the disease upon which he had the greatest reputation, is very badly described, and yet he has one or two fruitful ideas singularly mixed with mediaeval astrology; but he has here and there very happy insights, as where he remarks "nec praeter synoviam locqum alium ullum podagra occupat."(13) In the tract on phlebotomy I see nothing modern, and here again he is everywhere dominated by astrological ideas--"Sapiens dominatur astris."

(13) Geneva ed., 1658, Vol. I, p. 613.

As a protagonist of occult philosophy, Paracelsus has had a more enduring reputation than as a physician. In estimating his position there is the great difficulty referred to by Sudhoff in determining which of the extant treatises are genuine. In the two volumes issued in English by Waite in 1894, there is much that is difficult to read and to appreciate from our modern standpoint. In the book "Concerning Long Life" he confesses that his method and practice will not be intelligible to common persons and that he writes only for those whose intelligence is above the average. To those fond of transcendental studies they appeal and are perhaps intelligible. Everywhere one comes across shrewd remarks which prove that Paracelsus had a keen belief in the all-controlling powers of nature and of man's capacity to make those powers operate for his own good: "the wise man rules Nature, not Nature the wise man." "The difference between the Saint and the Magus is that the one operates by means of G.o.d, and the other by means of Nature."

He had great faith in nature and the light of nature, holding that man obtains from nature according as he believes. His theory of the three principles appears to have controlled his conception of everything relating to man, spiritually, mentally and bodily; and his threefold genera of disease corresponded in some mysterious way with the three primary substances, salt, sulphur and mercury.

How far he was a believer in astrology, charms and divination it is not easy to say. From many of the writings in his collected works one would gather, as I have already quoted, that he was a strong believer. On the other hand, in the "Paramirum," he says: "Stars control nothing in us, suggest nothing, incline to nothing, own nothing; they are free from us and we are free from them" (Stoddart, p. 185). The Archaeus, not the stars, controls man's destiny. "Good fortune comes from ability, and ability comes from the spirit" (Archaeus).

No one has held more firmly the dualistic conception of the healing art.