The Thirteenth Part 12

The danger of wounds of the neck is, of course, not a modern doctrine, and yet very few people would think for a moment that it could be traced back to the middle of the Thirteenth Century and to a practical teacher of surgery in a medieval Italian university. Here once more there is evidence of the work of a careful observer who has seen patients expire in a few minutes as the result of some serious incident during the course of operations upon the neck. He did not realize that the danger was due, in many cases, to the sucking in of air into the large veins, but even at the present time this question is not wholly settled and the problem as to the danger of the presence of air is still the subject of investigation.

As to the suture of divided nerves, it would ordinarily and as a matter of course be claimed by most modern historians of surgery and by practically all surgeons, as an affair entirely of the last half century. William of Salicet, however, neglected none of the ordinary surgical procedures that could be undertaken under the discouraging surgical circ.u.mstances in which he lived. The limitations of anesthesia, though there was much more of this aid than there has commonly been any idea of, and the frequent occurrence of suppuration must have been constant sources of disheartenment. His insistence on the use of the knife rather than on the cautery shows how much he appreciated the value of proper healing. It is from such a man that we might expect the advance by careful {87} investigation as to just what tissues had been injured, with the idea of bringing them together in such juxtaposition as would prevent loss of function and encourage rapid and perfect union.

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SCREEN (HEREFORD)

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DOORWAY OF SACRISTY (BOURGES)

Perhaps to the ordinary individual William's reference of certain known venereal affections to their proper cause, will be the most astonis.h.i.+ng in this marvelous list of antic.i.p.ations of what is supposed to be very modern. The whole subject of venereal disease in anything like a scientific treatment of it is supposed to date from the early part of the Sixteenth Century. There is even question in certain minds as to whether the venereal diseases did not come into existence, or at least were not introduced from America or from some other distant country that the Europeans had been exploring about this time. William's studies in this subject, however, serve to show that nothing escaped his watchful eye and that he was in the best sense of the word a careful observer and must have been an eminently suggestive and helpful teacher.

What has thus been learned about him will serve of itself and without more ado, to stamp all that has been said about the unpractical character of the medical teaching of the medieval universities as utterly unfounded. Because men have not taken the trouble to look up the teaching of these times, and because their works were until recent years buried in old folios, difficult to obtain and still more difficult to read when obtained, it has been easy to ignore their merit and even to impugn the value of their teaching completely.

William of Salicet was destined, moreover, to be surpa.s.sed in some ways by his most distinguished pupil, Lanfranc, who taught at the University of Paris at the end of the Thirteenth Century. Of Lanfranc, in the address already quoted from, Professor Allb.u.t.t has one very striking paragraph that shows how progressive was the work of this great French surgeon, and how fruitful had been the suggestive teaching of his great master. He says:

"Lanfranc's 'Chirurgia Magna' was a great work, written by a reverent but independent follower of Salicet. He distinguished between venous and arterial hemorrhage, and used styptics (rabbit's fur, aloes, and white of egg was a popular styptic in elder surgery), digital compression for an hour, or in severe cases ligature. His chapter on injuries of the head {88} is one of the cla.s.sics of medieval surgery. Clerk (cleric) as he was, Lanfranc nevertheless saw but the more clearly the danger of separating surgery from medicine."

Certain a.s.sertions in this paragraph deserve, as in the case of Lanfranc's master, to be discussed, because of their antic.i.p.ations of what is sometimes thought to be very modern in surgery. The older surgeons are supposed to have feared hemorrhage very much. It is often a.s.serted that they knew little or nothing about the ligature and that their control of hemorrhage was very inadequate. As a matter of fact, however, it was not primary hemorrhage that the old surgeons feared, but secondary hemorrhage. Suppuration often led to the opening of an important artery, and this accident, as can well be understood, was very much dreaded. Surgeons would lose their patients before they could come to their relief. How thoroughly Lanfranc knew how to control primary hemorrhage can be appreciated from the quotation just made from Dr. Allb.u.t.t's address. The ligature is sometimes said to have been an invention of Ambroise Pare, but, as a matter of fact, it had been in use for at least three centuries before his time, and perhaps even longer.

Usually it is considered that the difficult chapter of head injuries, with all the problems that it involves in diagnosis and treatment, is a product of the Nineteenth Century. Hence do we read, with all the more interest, Allb.u.t.t's declaration that Lanfranc wrote what is practically a cla.s.sical monograph, on the subject. It is not so surprising, then, to find that the great French surgeon was far ahead of his generation in other matters, or that he should even have realized the danger of separating surgery from medicine. Both the Regius professors of medicine at the two great English universities, Cambridge and Oxford, have, since the beginning of the Twentieth Century, made public expression of their opinion that the physician should see more of the work of the surgeon, and should not depend on the autopsy room for his knowledge of the results of internal disease.

Professor Osler, particularly, has emphasized his colleague, Professor Allb.u.t.t's opinion in this matter. That a surgical professor at the University of Paris, in the Thirteenth Century, should have antic.i.p.ated these two leaders {89} of medical thought in the Twentieth Century, would not be so surprising, only that unfortunately the history of medieval teaching has, because of prejudice and a lamentable tradition, not been read aright.

Occasionally one finds a startling bit of antic.i.p.ation of what is most modern, in medicine as well as in surgery. For instance, toward the end of the Thirteenth Century, a distinguished English professor of medicine, known as Gilbert, the Englishman, was teaching at Montpelier, and among other things, was insisting that the rooms of patients suffering from smallpox should be hung entirely with red curtains, and that the doors and the windows should be covered with heavy red hangings. He claimed that this made the disease run a lighter course, with lessened mortality, and with very much less disfigurement. Smallpox was an extremely common disease in the Thirteenth Century, and he probably had many chances for observation.

It is interesting to realize that one of the most important observations made at the end of the Nineteenth Century by Dr. Finsen, the Danish investigator whose studies in light and its employment in therapeutics, drew to him the attention of the world, and eventually the n.o.bel prize of $40,000 for the greatest advance in medicine was, that the admission of only red light to the room of smallpox patients modified the disease very materially, shortened its course, often prevented the secondary fever, and almost did away completely with the subsequent disfigurement.

It is evident that these men were searching and investigating for themselves, and not following blindly in the footsteps of any master.

It has often been said that during the Middle Ages it was a heresy to depart, ever so little, from the teaching of Galen. Usually it is customary to add that the first writer to break away from Galen, effectually, was Vesalius, in his De Fabrica Corporis Humani, published toward the end of the second quarter of the Sixteenth Century. It may be said, in pa.s.sing, that, as a matter of fact, Vesalius, though he accomplished much by original investigation, did not break so effectually with Galen as would have been for the best in his own work, and, especially, for its influence on his successors. He certainly did not set an example of independent research {90} and personal observation, any more fully, than did the medical teachers of the Thirteenth Century already mentioned, and some others, like Mondaville and Arnold of Villanova, whose names well deserve to be a.s.sociated with them.

One reason why it is such a surprise to find how thoroughly practical was the teaching of the Thirteenth Century university medical schools, is because it has somehow come to be a very general impression that medicine was taught mainly by disputations, and by the consultation of authorities, and that it was always more important to have a pa.s.sage of Galen to support a medical notion, than, to have an original observation. This false impression is due to the fact that the writers of the history of medical education have, until recent years, drawn largely on their imaginations, and have not consulted the old-time medical books. In spite of the fact that printing was not discovered for more than two centuries later, there are many treatises on medicine that have come down to us from this early time, and the historians of medicine now have the opportunity, and are taking the trouble, to read them with a consequent alteration of old-time views, as to the lack of encouragement for original observation, in the later Middle Ages. These old tomes are not easy reading, but nothing daunts a German investigator bound to get to the bottom of his subject, and such men as Pagel and Puschmann have done much to rediscover for us medieval medicine. The French medical historians have not been behind their German colleagues and magnificent work has been accomplished, especially by the republication of old texts. William of Salicet's surgery was republished by Pifteau at Toulouse in 1898. Mondaville's Surgery was republished under the auspices of the Society for the Publication of old French Texts in 1897 and 1898. These republications have made the works of the old-time surgeons readily available for study by all interested in our great predecessors in medicine, all over the world. Before this, it has always been necessary to get to some of the libraries in which the old texts were preserved, and this, of course, made it extremely difficult for the ordinary teacher of the history of medicine to know anything about them. Besides, old texts are such difficult reading that few, except the most earnest of students, {91} have patience for them, and they are so time-taking as to be practically impossible for modern, hurried students.

Unfortunately, writers of the history of medicine filled up this gap in their knowledge, only too frequently, either out of their imaginations, or out of their inadequate authorities, with the consequence of inveterating the old-time false impression with regard to the absence of anything of medical or surgical interest, even in the later Middle Ages.

Another and much more serious reason for the false impression with regard to the supposed blankness of the middle age in medical progress, was the notion, quite generally accepted, and even yet not entirely rejected, by many, that the Church was opposed to scientific advance in the centuries before the reformation so-called, and that even the sciences allied to medicine, fell under her ban. For instance, there is not a history of medicine, so far as I know, published in the English language, which does not a.s.sert that Pope Boniface VIII., by a Bull promulgated at the end of the Thirteenth Century, forbade the practise of dissection. To most people, it will, at once, seem a natural conclusion, that if the feeling against the study of the human body by dissection had reached such a pa.s.s as to call forth a papal decree in the matter, at the end of the century, all during the previous hundred years, there must have been enough ecclesiastical hampering of anatomical work to prevent anything like true progress, and to preclude the idea of any genuinely progressive teaching of anatomy.

There is not the slightest basis for this bit of false history except an unfortunate, it is to be hoped not intentional, misapprehension on the part of historical writers as to the meaning of a papal decree issued by Boniface VIII. in the year 1300. He forbade, under pain of excommunication, the boiling of bodies and their dismemberment in order that thus piecemeal they might be transported to long distances for burial purposes. It is now well known that the Bull was aimed at certain practises which had crept in, especially among the Crusaders in the East. When a member of the n.o.bility fell a victim to wounds or to disease, his companions not infrequently dismembered the body, boiled it so as to prevent putrefaction, or at least delay decay, and then transported it long distances to his home, in {92} order that he might have Christian burial in some favorite graveyard, and that his friends might have the consolation of knowing where his remains rested. The body of the Emperor Frederick Barbarosa, who died in the East, is said to have been thus treated. Boniface was one of the most broadly educated men of his time, who had been a great professor of canon and civil law at Paris when younger, and realized the dangers involved in such a proceeding from a sanitary standpoint, and he forbade it, requiring that the bodies should be buried where the persons had died. He evidently considered that the ancient custom of consecrating a portion of earth for the purpose of burial in order that the full Christian rites might be performed, was quite sufficient for n.o.ble as for common soldier.

For this very commendable sanitary regulation Boniface has been set down by historians of medicine as striking a death blow at the development of anatomy for the next two centuries. As a matter of fact, however, anatomy continued to be studied in the universities after this Bull as it had been before, and it is evident that never by any misapprehension as to its meaning was the practise of dissection lessened. Curiously enough the history of human dissection can only be traced with absolute certainty from the time immediately after this Bull. It is during the next twenty-five years at the University of Bologna, which was always closely in touch with the ecclesiastical authorities in Italy and especially with the Pope, that the foundations of dissection, as the most important practical department of medical teaching, were laid by Mondino, whose book on dissection continued to be the text book used in most of the medical schools for the next two centuries. Guy de Chauliac who studied there during the first half of the Fourteenth Century says he saw many dissections made there. It was at Montpellier, about the middle of the century, when the Popes were at Avignon not far away, that Guy de Chauliac himself made attendance at dissections obligatory for every student, and obtained permission to use the bodies of criminals for dissection purposes. At the time Chauliac occupied the post of chamberlain to the Popes. All during the Fourteenth and Fifteenth centuries constant progress was making in anatomy, especially in Italy, and some of it was accomplished at Rome {93} by distinguished teachers of anatomy who had been summoned by the popes to their capital in order to add distinction to the teaching staff at the famous Papal School of Science, the Sapienza, to which were attached during the next two centuries many of the distinguished scientific professors of the time.

This story with regard to the papal prohibition of dissection has no foundation in the history of the times. It has had not a little to do, however, with making these times very much misunderstood and one still continues to see printed references to the misfortune, which is more usually called a crime, that prevented the development of a great humanitarian science because of ecclesiastical prejudice. This story with regard to anatomy, however, is not a whit worse than that which is told of chemistry in almost the same terms. At the beginning of the Fourteenth Century Pope John XXII. is said to have issued a Bull forbidding chemistry under pain of excommunication, which according to some writers in the matter is said to have included the death penalty.

It has been felt in the same way as with regard to anatomy, that this was only the culmination of a feeling in ecclesiastical circles against chemistry which must have hampered its progress all during the Thirteenth Century.

An examination of the so-called Bull with regard to chemistry, it is really only a decree, shows even less reason for the slander of Pope John XXII. than of Boniface VIII. John had been scarcely a year on the papal throne when he issued this decree forbidding "alchemies" and inflicting a punishment upon those who practised them. The first sentence of the t.i.tle of the doc.u.ment is: "Alchemies are here prohibited and those who practise them or procure their being done are punished." This is evidently all of the decree that those who quoted it as a prohibition of chemistry seem ever to have read. Under the name "alchemies," Pope John, as is clear from the rest of the doc.u.ment, meant a particular kind of much-advertised chemical manipulations. He forbade the supposed manufacture of gold and silver.

The first sentence of his decree shows how thoroughly he recognized the falsity of the pretensions of the alchemists in this matter. "Poor themselves," he says, "the alchemists promise riches which are not forthcoming." He then forbids them further to impose upon the poor people {94} whose confidence they abuse and whose good money they take to return them only base-metal or none at all.

The only punishment inflicted for the doing of these "alchemies" on those who might transgress the decree was not death or imprisonment, but that the pretended makers of gold and silver should be required to turn into the public treasury as much gold and silver as had been paid them for their alchemies, the money thus paid in to go to the poor. As in the case of the Bull with regard to anatomy, it is very clear that by no possible misunderstanding at the time was the development of the science of chemistry hindered by this papal doc.u.ment. Chemistry had to a certain extent been cultivated at the University of Paris, mainly by ecclesiastics. Both Aquinas and his master Albertus wrote treatises on chemical subjects. Roger Bacon devoted much time to it as is well known, and for the next three centuries the history of chemistry has a number of names of men who were not only unhampered by the ecclesiastical authorities, but who were themselves usually either ecclesiastics, or high in favor with the churchmen of their time and place. This is true of Hollandus, of Arnold of Villanova, of Basil Valentine, and finally of the many abbots and bishops to whom Paracelsus in his time acknowledged his obligations for aid in his chemical studies.

Almost needless to say it has been impossible, in a brief sketch of this kind limited to a single chapter, to give anything like an adequate idea of what the enthusiastic graduate students and professors of the Thirteenth Century succeeded in accomplis.h.i.+ng. It is probably this department of University life, however, that has been least understood, or rather we should say most persistently misunderstood. The education of the time is usually supposed to be eminently unpractical, and great advances in the departments of knowledge that had important bearings on human life and its relations were not therefore thought possible. It is just here, however, that sympathetic interpretation and the pointing out of the coordination of intellectual work often considered to be quite distinct from university influences were needed. It is hoped then that this short sketch will prove sufficient to call the attention of modern educators to a field that has been neglected, or at least has {95} received very little cultivation compared to its importance, but which must be sedulously worked, if our generation is to understand with any degree of thoroughness the spirit manifested and the results attained by the medieval universities.

[Ill.u.s.tration]

DOUBLE FLYING b.u.t.tRESS (RHEIMS)

{96}

VI

THE BOOK OF THE ARTS AND POPULAR EDUCATION.

The most important portion of the history of the Thirteenth Century and beyond all doubt the most significant chapter in the book of its arts, is to be found in the great Gothic Cathedrals, so many of which were erected at this time and whose greatest perfection of finish in design and in detail came just at the beginning of this wonderful period. We are not concerned here with the gradual development of Gothic out of the older Romanesque architectural forms, nor with the Oriental elements that may have helped this great evolution. All that especially concerns us is the fact that the generations of the Thirteenth Century took the Gothic ideas in architecture and applied them so marvelously, that thereafter it could be felt that no problem of structural work had been left unsolved and no feature of ornament or decoration left untried or at least unsuggested. The great center of Gothic influence was the North of France, but it spread from here to every country in Europe, and owing to the intimate relations existing between England and France because of the presence of the Normans in both countries, developed almost as rapidly and with as much beauty, and effectiveness as in the mother country.

It is in fact in England just before the Thirteenth Century, that the spirit which gave rise to the Cathedrals can be best observed at work and its purposes most thoroughly appreciated. The great Cathedral at Lincoln had some of its most important features before the beginning of the Thirteenth Century and this was doubtless due to the famous St.

Hugh of Lincoln, who was a Frenchman by birth and whose experience in Normandy in early life enabled him successfully to set about the creation of a Gothic Cathedral in the country that had become his by adoption.

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ANGEL CHOIR (LINCOLN)

{97}

Hugh himself was so great of soul, so deeply interested in his people and their welfare, so ready to make every sacrifice for them even to the extent of incurring the enmity of his King (even Froude usually so unsympathetic to medieval men and things has included him among his Short Studies of Great Subjects), that one cannot help but think that when he devoted himself to the erection of the magnificent Cathedral, he realized very well that it would become a center of influence, not only religious but eminently educational, in its effects upon the people of his diocese. The work was begun then with a consciousness of the results to be attained and the influence of the Cathedral must not be looked upon as accidental. He must have appreciated that the creating of a work of beauty in which the people themselves shared, which they looked on as their own property, to which they came nearly every second day during the year for religious services, would be a telling book out of which they would receive more education than could come to them in any other way.

Of course we cannot hope in a short chapter or two to convey any adequate impression of the work that was done in and for the Cathedrals, nor the even more important reactionary influence they had in educating the people. Ferguson says: [Footnote 9 ]

[Footnote 9: Ferguson--History of Architecture. N. Y., Dodd, Mead & Co.]

"The subject of the cathedrals, their architecture and decoration is, in fact, practicably inexhaustible... . Priests and laymen worked with masons, painters, and sculptors, and all were bent on producing the best possible building, and improving every part and every detail, till the amount of thought and contrivance acc.u.mulated in any single structure is almost incomprehensible. If any one man were to devote a lifetime to the study of one of our great cathedrals--a.s.suming it to be complete in all its medieval arrangements--it is questionable whether he would master all its details, and fathom all the reasonings and experiments which led to the glorious result before him. And when we consider that not in the great cities alone, but in every convent and in every parish, thoughtful professional men were trying to excel what had been done and was doing, by their predecessors and their fellows, we shall {98} understand what an amount of thought is built into the walls of our churches, castles, colleges, and dwelling houses. If any one thinks he can master and reproduce all this, he can hardly fail to be mistaken. My own impression is that not one tenth part of it has been reproduced in all the works written on the subject up to this day, and much of it is probably lost and never again to be recovered for the instruction and delight of future ages."

This profound significance and charming quality of the cathedrals is usually unrecognized by those who see them only once or twice, and who, though they are very much interested in them for the moment, have no idea of the wealth of artistic suggestion and of thoughtful design so solicitously yet happily put into them by their builders. People who have seen them many times, however, who have lived in close touch with them, who have been away from them for a time and have come back to them, find the wondrous charm that is in these buildings.

Architects and workmen put their very souls into them and they will always be of interest. It is for this reason, that the casual visitor at all times and in all moods finds them ever a source of constantly renewed pleasure, no matter how many times they may be seen.

Elizabeth Robbins Pennell has expressed this power of Cathedrals to please at all times, even after they have been often seen and are very well known, in a recent number of the _Century_, in describing the great Cathedral of Notre Dame, "Often as I have seen Notre Dame," she says, "the marvel of it never grows less. I go to Paris with no thought of time for it, busy about many other things and then on my way over one of the bridges across the river perhaps, I see it again on its island, the beautiful towers high above the houses and palaces and the view now so familiar strikes me afresh with all the wonder of my first impression."

This is we think the experience of everyone who has the opportunity to see much of Notre Dame. The present writer during the course of his medical studies spent many months in daily view of the Cathedral and did a good deal of work at the old Morgue, situated behind the Cathedral. Even at the end of his stay he was constantly finding new beauties in {99} the grand old structure and learning to appreciate it more and more as the changing seasons of a Paris fall and winter and spring, threw varying lights and shadows over it. It was like a work of nature, never growing old, but constantly displaying some new phase of beauty to the pa.s.sers-by. Mrs. Pennell resents only the restorations that have been made. Generations down even to our time have considered that they could rebuild as beautifully as the Thirteenth Century constructors; some of them even have thought that they could do better, doubtless, yet their work has in the opinion of good critics served only to spoil or at least to detract from the finer beauty of the original plan. No wonder that R. M. Stevenson, who knew and loved the old Cathedral so well, said: "Notre Dame is the only un-Greek thing that unites majesty, elegance, and awfulness."

Inasmuch as it does so it is a typical product of this wonderful Thirteenth Century, the only serious rival the Greeks have ever had.

But of course it does not stand alone. There are other Cathedrals built at the same time at least as handsome and as full of suggestions. Indeed in the opinion of many critics it is inferior in certain respects to some three or four of the greatest Gothic Cathedrals.

It cannot be possible that these generations builded so much better than they knew, that it is only by a sort of happy accident that their edifices still continue to be the subject of such profound admiration, and such endless sources of pleasure after seven centuries of experience. If so we would certainly be glad to have some such happy accident occur in our generation, for we are building nothing at the present time with regard to which we have any such high hopes. Of course the generations of Cathedral builders knew and appreciated their own work. The triumph of the Thirteenth Century is therefore all the more marked and must be considered as directly due to the environment and the education of its people. We have then in the study of their Cathedrals the keynote for the modern appreciation of the character and the development of their builders.

It will be readily understood, how inevitably fragmentary must be our consideration of the Cathedrals, yet there is the consolation that they are the best known feature of Thirteenth {100} Century achievement and that consequently all that will be necessary will be to point out the significance of their construction as the basis of the great movement of education and uplift in the century. Perhaps first a word is needed with regard to the varieties of Gothic in the different countries of Europe and what they meant in the period.

Probably, the most interesting feature of the history of Gothic architecture, at this period, is to be found in the circ.u.mstance that, while all of the countries erected Gothic structures along the general lines which had been laid down by its great inventors in the North and Center of France, none of the architects and builders of the century, in other countries, slavishly followed the French models. English Gothic is quite distinct from its French ancestor, and while it has defects it has beauties, that are all its own, and a simplicity and grandeur, well suited to the more rugged character of the people among whom it developed. Italian Gothic has less merits, perhaps, than any of the other forms of the art that developed in the different nations.

In Italy, with its bright sunlight, there was less crying need for the window s.p.a.ce, for the provision of which, in the darker northern countries, Gothic was invented, but, even here the possibilities of decorated architecture along certain lines were exhausted more fully than anywhere else, as might have been expected from the esthetic spirit of the Italians. German Gothic has less refinement than any of the other national forms, yet it is not lacking in a certain straightforward strength and simplicity of appearance, which recommends it. The Germans often violated the French canons of architecture, yet did not spoil the ultimate effect. St. Stephen's in Vienna has many defects, yet as a good architectural authority has declared it is the work of a poet, and looks it.

A recent paragraph with regard to Spanish Gothic in an article on Spain, by Havelock Ellis, ill.u.s.trates the national qualities of this style very well. As much less is generally known about the special development of Gothic architecture in the Spanish peninsula, it has seemed worth while to quote it at some length:

"Moreover, there is no type of architecture which so {101} admirably embodies the romantic spirit as Spanish Gothic. Such a statement implies no heresy against the supremacy of French Gothic. But the very qualities of harmony and balance of finely tempered reason, which make French Gothic so exquisitely satisfying, softened the combination of mysteriously grandiose splendor with detailed realism, in which lies the essence of Gothic as the manifestation of the romantic spirit. Spanish Gothic at once by its ma.s.siveness and extravagance and by its realistic naturalness, far more potently embodies the spirit of medieval life. It is less esthetically beautiful but it is more romantic. In Leon Cathedral, Spain possesses one of the very n.o.blest and purest examples of French Gothic--a church which may almost be said to be the supreme type of the Gothic ideal, of a delicate house of gla.s.s finely poised between b.u.t.tresses; but there is nothing Spanish about it. For the typical Gothic of Spain we must go to Toledo and Burgos, to Tarragona and Barcelona. Here we find the elements of stupendous size, of mysterious gloom, of grotesque and yet realistic energy, which are the dominant characters, alike of Spanish architecture and of medieval romance."