The Evolution of Modern Medicine Part 9

On June 10, 1914, the eve of his birth, the septencentenary of Roger Bacon will be celebrated by Oxford, the university of which he is the most distinguished ornament. His unpublished MSS. in the Bodleian will be issued by the Clarendon Press (1915-1920), and it is hoped that his unpublished medical writings will be included.

(24) It may be interesting to note the three causes to which he attributes old age: "As the World waxeth old, Men grow old with it: not by reason of the Age of the World, but because of the great Increase of living Creatures, which infect the very Air, that every way encompa.s.seth us, and Through our Negligence in ordering our Lives, and That great Ignorance of the Properties which are in things conducing to Health, which might help a disordered way of Living, and might supply the defect of due Government."

What would have been its fate if the mind of Europe had been ready for Roger Bacon's ferment, and if men had turned to the profitable studies of physics, astronomy and chemistry instead of wasting centuries over the scholastic philosophy and the subtleties of Duns Scotus, Abelard and Thomas Aquinas? Who can say? Make no mistake about the quality of these men--giants in intellect, who have had their place in the evolution of the race; but from the standpoint of man struggling for the mastery of this world they are like the members of Swift's famous college "busy distilling suns.h.i.+ne from cuc.u.mbers." I speak, of course, from the position of the natural man, who sees for his fellows more hope from the experiments of Roger Bacon than from the disputations of philosophy on the "Instants, Familiarities, Quiddities and Relations," which so roused the scorn of Erasmus.

MEDIAEVAL MEDICAL STUDIES

IT will be of interest to know what studies were followed at a mediaeval university. At Oxford, as at most of the continental universities, there were three degrees, those of Bachelor, Licentiate and Doctor. The books read were the "Tegni" of Galen, the "Aphorisms" of Hippocrates, the "De Febribus" of Isaac and the "Antidotarium" of Nicolaus Salernita.n.u.s: if a graduate in arts, six years' study in all was required, in other faculties, eight. One gets very full information on such matters from a most interesting book, "Une Chaire de Medecine au XVe Siecle," by Dr.

Ferrari (Paris, 1899). The University of Pavia was founded in 1361, and like most of those in Italy was largely frequented by foreigners, who were arranged, as usual, according to their nationalities; but the students do not appear to have controlled the university quite so much as at Bologna. The doc.u.ments of the Ferrari family, on which the work is based, tell the story of one of its members, who was professor at Pavia from 1432 to 1472. One is surprised at the range of studies in certain directions, and still more at the absence of other subjects. A list is given of the teachers in medicine for the year 1433, twenty in all, and there were special lectures for the morning, afternoon and evening. The subjects are medicine, practical medicine, physics, metaphysics, logic, astrology, surgery and rhetoric: very striking is the omission of anatomy, which does not appear in the list even in 1467. The salaries paid were not large, so that most of the teachers must have been in practice: four hundred and five hundred florins was the maximum.

The dominance of the Arabians is striking. In 1467, special lectures were given on the "Almansor" of Rhazes, and in the catalogue of the Ferrari's library more than one half of the books are Arabian commentaries on Greek medicine. Still more striking evidence of their influence is found in the text-book of Ferrari, which was printed in 1471 and had been circulated earlier in MS. In it Avicenna is quoted more than 3000 times, Rhazes and Galen 1000, Hippocrates only 140 times. Professor Ferrari was a man who played an important role in the university, and had a large consultation practice. You will be interested to know what sort of advice he gave in special cases. I have the record of an elaborate consultation written in his own hand, from which one may gather what a formidable thing it was to fall into the hands of a mediaeval physician. Signor John de Calabria had a digestive weakness of the stomach, and rheumatic cerebral disease, combined with superfluous heat and dryness of the liver and multiplication of choler.

There is first an elaborate discussion on diet and general mode of life; then he proceeds to draw up certain light medicines as a supplement, but it must have taken an extensive apothecary's shop to turn out the twenty-two prescriptions designed to meet every possible contingency.

One of the difficulties in the early days of the universities was to procure good MSS. In the Paris Faculty, the records of which are the most complete in Europe, there is an inventory for the year 1395 which gives a list of twelve volumes, nearly all by Arabian authors.(25) Franklin gives an interesting incident ill.u.s.trating the rarity of medical MSS. at this period. Louis XI, always worried about his health, was anxious to have in his library the works of Rhazes. The only copy available was in the library of the medical school. The ma.n.u.script was lent, but on excellent security, and it is nice to know that it was returned.

(25) Franklin: Recherches sur la Bibliotheque de la Faculte de Medecine de Paris, 1864.

It is said that one of the special advantages that Montpellier had over Paris was its possession of so many important MSS., particularly those of the Arabian writers. Many "Compendia" were written containing extracts from various writers, and no doubt these were extensively copied and lent or sold to students. At Bologna and Padua, there were regulations as to the price of these MSS. The university controlled the production of them, and stationers were liable to fines for inaccurate copies. The trade must have been extensive in those early days, as Rashdall mentions that in 1323 there were twenty-eight sworn booksellers in Paris, besides keepers of bookstalls in the open air.

MEDIAEVAL PRACTICE

THE Greek doctrine of the four humors colored all the conceptions of disease; upon their harmony alone it was thought that health depended.

The four temperaments, sanguine, phlegmatic, bilious and melancholic, corresponded with the prevalence of these humors. The body was composed of certain so-called "naturals," seven in number--the elements, the temperaments, the humors, the members or parts, the virtues or faculties, the operations or functions and the spirits. Certain "non-naturals," nine in number, preserved the health of the body, viz.

air, food and drink, movement and repose, sleeping and waking, excretion and retention, and the pa.s.sions. Disease was due usually to alterations in the composition of the humors, and the indications for treatment were in accordance with these doctrines. They were to be evacuated, tenuated, cooled, heated, purged or strengthened. This humoral doctrine prevailed throughout the Middle Ages, and reached far into modern times--indeed, echoes of it are still to be heard in popular conversations on the nature of disease.

The Arabians were famous for their vigor and resource in matters of treatment. Bleeding was the first resort in a large majority of all diseases. In the "Practice" of Ferrari there is scarcely a malady for which it is not recommended. All remedies were directed to the regulation of the six non-naturals, and they either preserved health, cured the disease or did the opposite. The most popular medicines were derived from the vegetable kingdom, and as they were chiefly those recommended by Galen, they were, and still are, called by his name.

Many important mineral medicines were introduced by the Arabians, particularly mercury, antimony, iron, etc. There were in addition scores of substances, the parts or products of animals, some harmless, others salutary, others again useless and disgusting. Minor surgery was in the hands of the barbers, who performed all the minor operations, such as bleeding; the more important operations, few in number, were performed by surgeons.

ASTROLOGY AND DIVINATION

AT this period astrology, which included astronomy, was everywhere taught. In the "Gouernaunce of Prynces, or Pryvete of Pryveties,"

translated by James Yonge, 1422,(26) there occurs the statement: "As Galian the lull wies leche Saith and Isoder the G.o.de clerk, hit witnessith that a man may not perfitely can the sciens and craft of Medissin but yef he be an astronomoure."

(26) Early English Text Society, Extra Series, No. LXXIV, p. 195, 1898; Secreta Secretorum, Rawl. MS. B., 490.

We have seen how the practice of astrology spread from Babylonia and Greece throughout the Roman Empire. It was carried on into the Middle Ages as an active and aggressive cult, looked upon askance at times by the Church, but countenanced by the courts, encouraged at the universities, and always by the public. In the curriculum of the mediaeval university, astronomy made up with music, arithmetic and geometry the Quadrivium. In the early faculties, astronomy and astrology were not separate, and at Bologna, in the early fourteenth century, we meet with a professors.h.i.+p of astrology.(27) One of the duties of this salaried professor, was to supply "judgements" gratis for the benefit of enquiring students, a treacherous and delicate a.s.signment, as that most distinguished occupant of the chair at Bologna, Cecco d'Ascoli, found when he was burned at the stake in 1357, a victim of the Florentine Inquisition.(28)

(27) Rashdall: Universities of Europe in the Middle Ages, Vol.

I, p. 240.

(28) Rashdall, l.c., Vol. I, p. 244.--Rashdall also mentions that in the sixteenth century at Oxford there is an instance of a scholar admitted to practice astrology. l.c., Vol. II, p. 458.

Roger Bacon himself was a warm believer in judicial astrology and in the influence of the planets, stars and comets on generation, disease and death.

Many of the stronger minds of the Renaissance broke away from the follies of the subject. Thus Cornelius Agrippa in reply to the request of a friar to consult the stars on his behalf says:(29) "Judicial astrology is nothing more than the fallacious guess of superst.i.tious men, who have founded a science on uncertain things and are deceived by it: so think nearly all the wise; as such it is ridiculed by some most n.o.ble philosophers; Christian theologians reject it, and it is condemned by sacred councils of the Church. Yet you, whose office it is to dissuade others from these vanities, oppressed, or rather blinded by I know not what distress of mind, flee to this as to a sacred augur, and as if there were no G.o.d in Israel, that you send to inquire of the G.o.d of Ekron."

(29) H. Morley: The Life of Henry Cornelius Agrippa, London, 1856, Vol. II, p. 138.

In spite of the opposition of the Church astrology held its own; many of the universities at the end of the fifteenth century published almanacs, usually known as "Prognosticons," and the practice was continued far into the sixteenth century. I show you here an ill.u.s.tration. Rabelais, you may remember, when physician to the Hotel Dieu in Lyons, published almanacs for the years 1533, 1535, 1541, 1546. In the t.i.tle-page he called himself "Doctor of Medicine and Professor of Astrology," and they continued to be printed under his name until 1556. In the preparation of these he must have had his tongue in his cheek, as in his famous "Pantagrueline Prognostication," in which, to satisfy the curiosity of all good companions, he had turned over all the archives of the heavens, calculated the quadratures of the moon, hooked out all that has ever been thought by all the Astrophils, Hypernephilists, Anemophylakes, Uranopets and Ombrophori, and felt on every point with Empedocles.(30)

(30) Pantagrueline Prognostication, Rabelais, W. F. Smith's translation, 1893, Vol. II, p. 460.

Even physicians of the most distinguished reputation practised judicial astrology. Jerome Cardan was not above earning money by casting horoscopes, and on this subject he wrote one of his most popular books (De Supplemento Almanach, etc., 1543), in which astronomy and astrology are mixed in the truly mediaeval fas.h.i.+on. He gives in it some sixty-seven nativities, remarkable for the events they foretell, with an exposition. One of the accusations brought against him was that he had "attempted to subject to the stars the Lord of the stars and cast our Saviour's horoscope."(31) Cardan professed to have abandoned a practice looked upon with disfavor both by the Church and by the universities, but he returned to it again and again. I show here his own horoscope.

That remarkable character, Michael Servetus, the discoverer of the lesser circulation, when a fellow student with Vesalius at Paris, gave lectures upon judicial astrology, which brought him into conflict with the faculty; and the rarest of the Servetus works, rarer even than the "Christianismi Rest.i.tutio," is the "Apologetica disceptatio pro astrologia," one copy of which is in the Bibliotheque Nationale. Nor could the new astronomy and the acceptance of the heliocentric views dislocate the popular belief. The literature of the seventeenth century is rich in astrological treatises dealing with medicine.

(31) De Thou, Lib. LXII, quoted by Morley in Life of Jerome Cardan, Vol. II, p. 294.

No one has ever poured such satire upon the mantic arts as did Rabelais in chapter twenty-five of the third book of "Pantagruel." Panurge goes to consult Her Trippa--the famous Cornelius Agrippa, whose opinion of astrology has already been quoted, but who nevertheless, as court astrologer to Louise of Savoy, had a great contemporary reputation.

After looking Panurge in the face and making conclusions by metoposcopy and physiognomy, he casts his horoscope secundum artem, then, taking a branch of tamarisk, a favorite tree from which to get the divining rod, he names some twenty-nine or thirty mantic arts, from pyromancy to necromancy, by which he offers to predict his future. While full of rare humor, this chapter throws an interesting light on the extraordinary number of modes of divination that have been employed. Small wonder that Panurge repented of his visit! I show here the t.i.tle-page of a popular book by one of the most famous of the English astrological physicians, Nicholas Culpeper.

Never was the opinion of sensible men on this subject better expressed than by Sir Thomas Browne:(32) "Nor do we hereby reject or condemn a sober and regulated Astrology; we hold there is more truth therein than in ASTROLOGERS; in some more than many allow, yet in none so much as some pretend. We deny not the influence of the Starres, but often suspect the due application thereof; for though we should affirm that all things were in all things; that Heaven were but Earth Celestified, and earth but Heaven terrestrified, or that each part above had an influence upon its divided affinity below; yet how to single out these relations, and duly to apply their actions, is a work ofttimes to be effected by some revelation, and Cabala from above, rather than any Philosophy, or speculation here below."

(32) Sir Thomas Browne: Pseudodoxia Epidemica, Bk. IV, Chap.

XIII. (Wilkin's ed., Vol. III, p. 84.)

As late as 1699, a thesis was discussed at the Paris Faculty, "Whether comets were harbingers of disease," and in 1707 the Faculty negatived the question propounded in a thesis, "Whether the moon had any sway on the human body."

The eighteenth and nineteenth centuries saw, among intelligent men, a progressive weakening of the belief in the subject; but not even the satire of Swift, with his practical joke in predicting and announcing the death of the famous almanac maker, nor contemptuous neglect of the subject of late years sufficed to dispel the belief from the minds of the public. Garth in the Dispensary (1699) satirizes the astrological pract.i.tioners of his day:

The Sage in Velvet Chair, here lolls at Ease To promise future Health for present Fees Then as from Tripod solemn Sham reveals And what the Stars know nothing of foretell. (Canto ii.)

The almanacs of Moore and Zadkiel continue to be published, and remain popular. In London, sandwich men are to be met with carrying advertis.e.m.e.nts of Chaldeans and Egyptians who offer to tell your fortune by the stars. Even in this country, astrology is still practiced to a surprising extent if one may judge from advertis.e.m.e.nts in certain papers, and from publications which must have a considerable sale. Many years ago, I had as a patient an estimable astrologer, whose lucrative income was derived from giving people astral information as to the rise and fall of stocks. It is a chapter in the vagaries of the human mind that is worth careful study.(33) Let me commend to your reading the sympathetic story called "A Doctor of Medicine" in the "Rewards and Fairies" of Kipling. The hero is Nicholas Culpeper, Gent., whose picture is here given. One stanza of the poem at the end of the story, "Our Fathers of Old," may be quoted:

Wonderful tales had our fathers of old-- Wonderful tales of the herbs and the stars-- The Sun was Lord of the Marigold, Basil and Rocket belonged to Mars.

Pat as a sum in division it goes-- (Every plant had a star bespoke)-- Who but Venus should govern the Rose?

Who but Jupiter own the Oak?

Simply and gravely the facts are told In the wonderful books of our fathers of old.

(33) It is not generally known that Stonewall Jackson practiced astrology. Col. J. W. Revere in "Keel and Saddle" (Boston, 1872) tells of meeting Jackson in 1852 on a Mississippi steamer and talking with him on the subject. Some months later, Revere received a letter from Jackson enclosing his (Revere's) horoscope. There was a "culmination of the malign aspect during the first days of May, 1863--both will be exposed to a common danger at the time indicated." At the battle of Chancellorsville, May 9, 1863, Revere saw Jackson mortally wounded!

James J. Walsh of New York has written a book of extraordinary interest called "The Thirteenth, Greatest of Centuries." I have not the necessary knowledge to say whether he has made out his case or not for art and for literature. There was certainly a great awakening and, inspired by high ideals, men turned with a true instinct to the belief that there was more in life than could be got out of barren scholastic studies. With many of the strong men of the period one feels the keenest mental sympathy. Grosseteste, the great Clerk of Lincoln, as a scholar, a teacher and a reformer, represents a type of mind that could grow only in fruitful soil. Roger Bacon may be called the first of the moderns--certainly the first to appreciate the extraordinary possibilities which lay in a free and untrammelled study of nature.

A century which could produce men capable of building the Gothic cathedrals may well be called one of the great epochs in history, and the age that produced Dante is a golden one in literature. Humanity has been the richer for St. Francis; and Abelard, Albertus and Aquinas form a trio not easy to match, in their special departments, either before or after. But in science, and particularly in medicine, and in the advance of an outlook upon nature, the thirteenth century did not help man very much. Roger Bacon was "a voice crying in the wilderness," and not one of the men I have picked out as specially typical of the period inst.i.tuted any new departure either in practice or in science. They were servile followers, when not of the Greeks, of the Arabians. This is attested by the barrenness of the century and a half that followed. One would have thought that the stimulus given by Mundinus to the study of anatomy would have borne fruit, but little was done in science during the two and a half centuries that followed the delivery of his lectures and still less in the art. While William of Wykeham was building Winchester Cathedral and Chaucer was writing the Canterbury Tales, John of Gaddesden in practice was blindly following blind leaders whose authority no one dared question.

The truth is, from the modern standpoint the thirteenth was not the true dawn brightening more and more unto the perfect day, but a glorious aurora which flickered down again into the arctic night of mediaevalism.

To sum up--in medicine the Middle Ages represent a restatement from century to century of the facts and theories of the Greeks modified here and there by Arabian practice. There was, in Francis Bacon's phrase, much iteration, small addition. The schools bowed in humble, slavish submission to Galen and Hippocrates, taking everything from them but their spirit and there was no advance in our knowledge of the structure or function of the body. The Arabians lit a brilliant torch from Grecian lamps and from the eighth to the eleventh centuries the profession reached among them a position of dignity and importance to which it is hard to find a parallel in history.