fi eh i c a l gii s t o r yfi t mm a ls

G en er a l E dzt o r — JO H N D . C OM R I E ,

M A
. .
,
B sc
. . , M D . .
,

M E DI E VA L M E DI CIN E
 I N TH E S AM E S E R E S I

PAS T E U R AN D AF T E R PAST E U R

By STE P H E N PAG E T ,

W it h 8 fu ll p g Ill t r t i
-
a e us a on s .

E D I N BU R G H SC H O O L O F S U RG E RY
BE F O R E L I ST E R

By ALE X . M I LE S M D , , . .

W i th 8 fu ll p
-
ag e Ill t r t i
us a o n s.

A AN D c . B LAC K, LT D .
, 4 S O H O S Q. , LON DO N ,
w . 1
 AN A M P U TA TI O N B E LO W TH E K NE E
Th l S IS th e fi rs t p lc t ur e of an a p utat i o
m n kn ow n

“
G esc k zc /zt e d er CIz zr u rg w
’

p r od u c ed
’

fi w o odc u t , G u r lt
’
F r om G er sm or s re m s
 S CEE NCES

JAM E S J W AL
. SH
M D . PH D . .
, Sc D .
,
L I TT . D .

E DI CA LD I RECT OR S OC I O L O G I C A L D E AR T ME N T FOR DH AM N I ER S I TY
P U V AN D
PROFE SS OR HYS I O LO G I C A L SYCH O L O G Y CA T H E D RA L CO LL E G E
P
,

P Y OR NE W
,

MEM ER T H E FRE N C H G ERMA N I TAL I A N

,

E L L OW A A A S A ND
’
B OF
O C I E T ES T H E H I S TOR Y ME D I C I N E E T C
. . .
, , ,

S I F OR OF

MA ER S MO D ER N ME D I C I N E \ O T H E O L ME S O N
.
,

A THO
U R OF
“
K OF AI D R V U
M ED I C A L H ST OR Y I
,

[Va li u m t gui seal m m fi er eg er zm t

eg em n a n te n os f uer zm t,
”
t u D ea r u m
’
ta m m m m at n c o len a z.

S E N EC A : Ep ‘
zs z. L XI V .

A . 8: C . BL AC K, L TD .

4 , 5 8c 6 , SO HO SQ U ARE ,
LO N DO N , W C . . 1

192 0
 CONTENTS
CH T
AP ER P AQ B

P R E FACE

\I . IN T R OD U CTI ON
II . R Y M E D I E VAL ME D I CI N E
EA L

III . SALE R N O AN D TH E B E GI N N I N G S OF M OD E R N M E D I CAL

E D U CATI ON

IV . MON T P E LLI E R AN D M E D I CAL E D U CATI ON IN TH E

W E ST

LATE R D I E VAL ME D I CI N E
ME
\
VI . ME D IE VAL S UR GE ON S : I TALY

VI I . SUR G E ON S OU TSI D E OF I TAL Y S UR G E ON S OF TH E

.

W E S T OF E UR OP E

VI I I . O R AL S UR G E R Y AN D TH E M I N O R S UR G I CAL S P E CI ALI

TI E S
IX . ME D I CAL E D U CATI ON F OR W OM E N

X . ME D I E VAL H OS P I TALS

XI . ME D I E VAL CA E R OF TH E I N SAN E
t

A PPE N D I X I

A PPE ND I X II

IN DE X
 L I ST OF I LLU ST R AT I O N S

AM PUTAT I ON B E LOW TH E KNE E F r on t zsp i ece

&
FAC NG AG E
I P

H OL Y GH OST P
H OS I TAL

f S U R GI CAL I N STRUME N TS OF G UY DE CH AULI AC

BRU N SCHW I G S S UR G I CAL AR M AME N TAR I UM
’

S U R G I CAL I N ST RU M E N TS OF TH E ARABS

/ T H I R T E E N TH CE
-
N T U R Y H OSP I TAL I N T E R I O R
WLE P E R P
H OS I TAL OF ST . B AR TH OLOME W

TH E R
H A BLE DOW N H OS I TAL P
 W HEN we t h in k of a ll t h e wo r k , b ig wit h
p ro mi se O f t h e fu t u r e t h a t w en t o n i n
, t h o se
cen t u r i es wh ic h m o d ern w r i t r s i n e t h ei r
i g n o r a n c e u sed o n c t o et a p a r t a n d st i g m a t i z e
e s

as the
‘
Da r k Ag e “ swh en we c o n sid er h o w
t h e seed s O f wh a t i s n o b l est i n m o d er n li fe
w er e t h n p a i n fully so wn u p o n t h e so il wh i h
e c

I m p e r i a l R o m e h a d p r ep a r ed when we t h in k
o f t h e va r io u w o r k o f a G r eg o r y a B en edi t
s ,
c ,

a B o n i fa c e a n A l fr e d a C h a r l e m a n e we feel
, , g ,

t h a t t h e e i s a sen se i n wh ic h t h e m o st b r illi a n t
r

a c h i e v e m en t s o f a a n a n t iq u i t a r e d w a r fe d
p g y
i n c o m p a r i so n w i t h t h ese FI SKE ”
. Th e
B eg i n n i n g s o
f N ew E n
g la n d, o r t h e P u r i ta n

Th eo c r a c y in i t s R ela t i o n s t o Ci v i l a n d R elig io u s
Li ber ty .
 MO ST R EVE R EN D P . J . H AYE S
B
AR CH I SH OP OF NE W Y OR K

AS A S L I G H T TO KE N O F GR ATI TU DE F OR TH E P R I VI L E GE

OF C O OP E R ATI N G
-
IN TH E E DU CATI O N AL F O U N DATI O N

TH AT I S A M O N U M E N T TO H I S P R U DE N T WI S D OM
 PR E F ACE

M E D I E V A L M E D I C I N E is t h e s t ory o f t h e medic a l
sciences in the M iddle Ages The M iddle Ages
.

are usually assumed to begin w ith t h e deposition of

Romulus Au g u st u lu s 4 7 6 and end W ith t h e fall O f
, ,

C onstantinople 14 5 3 I n this lit t le volume t hen

, .
, ,

we have to out line t h e history of human efforts to

prevent and treat the ills of mankind for nearly one
thousand years . Until recent ly it has b een the
,

cust om to believe that there was so lit tle of genuine

interest in anyt hing like the scient ific care of aili ng
hu man beings during these centuries that even a ,

volume of this kind might seem large for the tale

of it N ow we know h o w much these men of: the
.
, ,

”
M iddle Ages for so long called t h e D ark Ages
, ,

w ere interested in every phase of human progress .

They created a great art and lit erature and above ,

all a magnificent architec t ure . We have bee n

c u lt ivating the knowledge of t hese for several
generations and it would indeed be a surprise to
,

fi nd that the men who made such surpassing

vu
 PR E F A CE

a chievements in all the other lines of human effort

Should have failed only in medicine .

As a mat ter of fact we have found that the

,

history of medicine and surgery and of the medical

,

education of the M iddle Ages are quite as

,

interesting as all the other phases of their aecom

p li sh m e n t
. s Hence the compression that has been
necessary to bring a purview of all that we know
wit h regard to medieval medicine within the
compass of a brief b O Ok of this kind The treatment
.

has been necessarily fragmentary and yet it is

,

hoped t hat the det ail s which are given here may
prove suggestive for those who have sufficien t
interest in the subj ect to wish to follow it and may
,

provide an incentive for others to learn more O f this

magnificent chapter O f the work of the medieval
p hysicians
.
 M E D I E VA L M E DIC I N E

C HAPT E R I
I N T R O DU CT O R Y

TO understand the story of M edieval M edic i ne the ,

reader must recall briefly the course of Roman

hi story . Rome founded some eight centuries
,

b efore C hrist was at first the home of a group of

,

adventurers who in the absence O f women enough

,

to supply wives for their warriors went out and ,

captured the maidens of a neighbouring Sabine

town . The feud which b roke out as a result was
brought to an end by the women now become the
wives of the Romans and an alliance was made
, .

Gradually Rome conquered t h e neighbouring cities ,

b u t was ever so much more interested in war and

conquest than in the higher lif e The E truscan
.

cit ies which came under her domination now

, ,

reveal in their ruins art O bject s of ex q uisi t e beauty

and t h e remains of a people of high art ist ic culture .

When Rome conquered C arthage C arthage wa s ,

probably the most magnificent city in the world ,

and Rome w as a very commonplace collection of

2 MEDIEVAL MED I CINE
houses C ulture did not come to Rome until after
.

her conquest of Greece when captive Greece led

,

”
her captor captive .

’
Sir Henry M aine s expression that whatever lives
and moves in the intellectual life is Greek in origin
may not be unexceptionably true b ut it represents ,

a generalization of very wide application .

Rome w as stimulated in art and architecture and

literature by touch with the Greeks and her own ,

achievements important though they were were

, ,

little better than Copies of Greek originals The .

Romans themselves acknowledged t his very frankly .

When in the course of time the barbarian nations

from the N orth and West of E urope came down in
large numbers into I taly and finally gained control,

of the Roman E mpire they had b ut very little

‘
,

interest in the Greek sources and decadence of the ,

intellectual life was inevitable This was p a r t i c u

la r ly t r ue as regards scientific subjects and ab ove ,

all for medicine ; for the Romans had always

depended on Greek physicians and Galen in the ,

second century like Ale x ander of Tralles in the

,

seventh represent terms in the series Of physicians

,

who reached distinction at Rome .

The key to the history of medicine in the M iddle

Ages then is always the presence O f Greek
, ,

influence This persisted in the N ear E ast and

. ,

c onse quentl y seriou s sc i enti fi c medicin e cont inue d

 INTR ODU CTOR Y 3

to flourish there at fi rst among the C hristians and

,

later among the Arab s I t w as not for any special

.

incentive of their own that the Arabs became the

intellectual leaders of E urope during the tenth and
eleventh centuries but the fact that their geo
,

graphical position i n Asia M inor close to Gree k

sources provided t hem with the opportunity to
know t h e old Gree k authors especially in philosophy
,

and medicine and therefore to be almost forced

,

to b ecome the channels through whi ch Greek

influences were carried into the West once more .

Before the coming of the Ara b s ho w ever that ,

—

is before the rise of M ohammedanism there w as

,
—

an important chapter O f medieval medicine which

is Often not appreciated at its true worth The .

cont ributors to it deserve to b e well known and ,

fortunately for us in t h e modern time were properly

appreciated during the early d ays of the art of
print ing in t h e Renaissance time and accordingly
, ,

their books were printed and came to be distributed

,

in many copies which have rendered them r ea dily

,
M
flw
M

available 111 the modern t ime .

I n Asia M inor where Greek influence persisted

,

as it did n o t in I taly w e have a series Of distin

,

g u i sh e d contributors to medicine or rather medical, ,

literature that is men whose books represent a

,

valuable compilation and digestion of the important

medical writings from before their time O ften ,
4s MED I E VAL ME DICINE

enriched by t heir own experience The fi rst of

.

these was A ét i o s A m i den u s that is A é t i o s of

—
,

Amida born in the town of t hat name in M esopo

—

tamia on the Upper Tigris ( now D iarbekir) who ,

flourished in t h e sixt h century A etios or in the

.
,

L at in form A é t iu s wrote a te xtbook that has oft en

,

been republished in the modern time and that ,

shows very clearly ho w well the physicians of this

period faced t heir medical and surgical problems ,

how t horoughly equipped they were by faithful

study of the O ld Greek writers and how successfully
,

they coped with the diffi culties of the cases pre

sented to them . He is eminent ly conservative a ,

careful O bserver who uses all the means at his

,

command and who well deserves the interest that

has been manifested in him at many periods during
t h e almost millennium and a half elapsed since his
death .

Aft er Actin s came Ale x ander O f Tralles from ,

another of these towns O f Asia M inor that we would

consider insignificant sometimes t ermed Tr a lli a n u s
,

for this reason . He must be reputed one of the

great independent t hinkers in medicine whose
writings have deservedly att racted attention n o t
only in his own t ime but long afterwards in the
,

Renaissance period and wit h whose works everyone

,

w ho cares to know anything about the development

of medical history must be familiar One detail Of
.
 IN TRO DUCTOR Y 5

his life has always seemed to me to correct a W hole

series of misapprehensions with regard to the earlier
M iddle Ages . Alexander was one of five brothers ,

all O f whose names have come down to us through

nearly years because Of what they aecom
p li sh e d at the great C apital of the E ast The .

eldest of t hem was A n t h em i o s the archit ect of the

,

great C hurch O f Santa Sophia A second brother

.

was M et h r o do r o s a distinguished grammarian and

,

teache r at C onst antinople A third brother was a

.

prominent jurist in the Imperial C ourts of the

capit al ; while a fourth brother D i o sc o r o s was like
, , ,

Alexander a physician of repute but remained in

, ,

hi s birthplace Tralles and acquired a substantial

,

pract ice there .

There is sometimes the feeling that at this time

’
in the world s history the end Of the sixt h and the
,

beginning of t h e seventh century men had b u t ,

litt le initiative and above all very little power of

,

achievement in the intellectual order Anyone

.

who knows Santa Sophia in C ons t antinople how ,

ever W ill recognize a t once t hat the archit ect who

,

conceived and superint ended t h e const ruct ion of

t hat great edifice was a genius O f a high order not ,

lacking in init i a t ive b u t on t h e cont rary possessed

,

of a wonderful power of original accomplishment .

N O greater constructive work considering all t h e

,

circumst ances has perhaps ever been successfully

,
6 MEDIE VAL M EDICINE
planned and e x ecuted I t would scarcely be
.

expected that the brother of t h e man who conceived

and finished Santa Sophia w ould if he set out to
‘

w rit e a textb ook of medicine make an egregious ,

failure of it
. . Sur ely his work would not b e all
’
unworthy of his b rother s reputation and the family ,

genius should lift him up to important accomplish

ment This is literally what we find true with
regard to Alexander After years of travel which
.

led him int o I taly Gaul Spain and Africa he

, , , ,

settled down at Rome and practised medicine

,

successfully unt il a very old age and probably ,

lect ured there for some of his books are in the form
,

of lectures .

Fortunat ely for us he committed his k nowledge

,

and his experience to writing which has come down ,

to us.

A third of these greater writers on medicine in

the early M iddle Ages was Paul of n ina
ZE g i n et u s as he is somet imes known There has .

been some quest ion as to his date in history b u t as ,

he quotes Alexander of Tralles there seems to be

no doub t now t hat his career must b e placed in the
first half of the seventh century We shall see .

more of him a s also of his great contemporaries and

,

predecessors of the early M iddle Ages A etios and ,

Alexander Of Tralles in a sub sequent chapter

, .

Besides these men who were known for their

 IN TRO DUC TOR Y 7

writings a series of less known C hristian physicians

,

were praised by their contemporaries for their

knowledge of medicine A mong them are par
.

t i c u la r ly t o be noted certain members of an Arabian

family with the t itle B a c h t i sc h u a a name which is
,

derived from the Arabic words B o c h t Jesu that is —

,

servant of Jcsus who having studied among the

—
,

G reek C hristians in the cities of Asia M inor were ,

called to the C ourt of H aroun a l Raschid and int ro

-

du c ed Gree k medicine to the M ohammedans I .

have pointed out in my volume Old Time M akers -

of M edicine that it was their teaching which

aroused M oslem scholars from the apathy that
characterized the attitude of the A rab ian people
towards science at the beginning of M oham
”
m eda n i sm .

Aft er this preliminary period O f early medieval

medical develo pment the next important phase of
,

medicine and surgery in the M iddle A ges developed

in the southern part Of Italy at Salerno H ere .

came the real awakening from that inattention to

intellectual interests which characterized Italy after
the invasion of the northern b arbarians The .

reason for the early Renaissance in this neighbour

hood is n o t far to seek I n the older times Sicily
.

had been a Greek colony and the southern portion

,

of It aly had been settled by Greek s and came to

F o r dh a m U n iv er si t y P r ess, New Yo r k , 19 11 .
8 MED I EV AL MEDICINE
b e known as M agna Grascia The Greek language
.

continued to b e spoken in many parts even duri ng

the earlier medieval centuries and Greek never ,

became t h e utterly unknown tongue it was in

N ort hern I t aly . Wi t h t h e t urning Of at tent ion to
educat ion in t h e later M iddle Ages t h e Southern ,

It alians were brought almost at once in contact

wit h Greek sources and t h e earlier Renaissance
,

began . Wit h this in mind it is comparatively easy

,

to understand t h e e fflorescence of cult ure in

Southern I taly and the development of the
,

important U niversity of Salerno and its great

accomplishment particularly in scientific matt ers
, ,

though all this cam e almost entirely as a c o n se

q u e n c e of the opportunity for Greek influence to
have its e ffect there .

I t is sometimes said that Arabian influence meant

much for the development of Sa la m i , and that it “

was b ecause the southern part of the I talian

peninsula was necessarily rather closely in touch
with Arabian culture that an early awakening took
place down there The M ohammedans occupied
.

so many of the islands O f the M edit erranean as ,

w ell as Spain that their influence was felt deeply

,

all along its shore and hence the first universit y O f

,

E urope in modern times came into existence i n

t his part of the world M ontpellier is sometimes
.
,

though not so often said to have had the same

,
 IN TRO DUCTOR Y 9

fac t or in its early development U ndoubtedly .

there was some Arabian influence in the foundation

O f Salerno .The Oldest traditions Of the Universit y
show this rather clearly This Arabian influence
.
,

however has been greatly exaggerated by some

,

modern historical writers L ed by the thought

.

t hat C hris t ianity was opposed t o cul t ure and above ,

all to science they were quit e willing to suggest

,

any other influences t han C hristian as the source

of so important a movement in the history of human
progress as S alerno proved t o be The main .

influence at Salerno however was Greek and the

, , ,

proof of this is as insisted by G u r lt in his History

,

”
of Surgery that the great surgeons of Salerno do
,

not refer to Arabian sources but to Greek authors , ,

and their books do not show traces O f Arabian

influences but on the contrary have many
,

Graecisms in them .

Salerno represents an especially important

chap t er in the history of M edieval M edicine As
we shall see the teachers at the great medical school
,

there set themselves in s t renuous opposi t ion t o t h e

Ar a bian tendency to polypharmacy by which t h e ,

O riental mind had seriously hurt medicine and ,

what is still more t o the credit of t hese Salernitan

teachers they developed surgery far beyond
,

anything that the Arabs had at tempted I ndeed .

,

surgery in the later centuries of Arabian influence

2
10 MEDIEV AL MED I CINE
had been distinctly neglected but enjoyed a great ,

revival at Salerno Besides the Salernitan

. .

physicians used all the nat ural methods of cure air , ,

water exercise and diet very successfully

, , , If .

any oth er proof were needed th a t Arabian influence

was not prominent at Salerno surely it would b e ,

found in the fact that wome n physicians enjoyed

so many privileges there This is so entirely
.

opposed to M ohammedan way s as to be quite con

vi n c i n g as a demonstration Of the absence O f
Arabian influence .

From Salerno the tradition of medicine and

,

surgery spread t o Bologna early in the thirteenth

century and t lICn c e fO t h e other universities of
‘

I taly and to France M ontp ellier represented an

.

independent focus Of modern progress in me dicine ,

p artly due to close relationship with the M oors I n

Spain and the Greek influences they earn ed with
them from Asia M inor b ut not a little of it c o n se
,

quent upon the remnants of the Older Greek

culture still not entirely dead even in the thirteent h
,

cent ury because M arseilles not far away had been

, , ,

a Greek colony originally and still retained living

,

Greek influence and wherever Greek got a chance

,

to exercise its stimulant incentive modern scientific

m e di c m e began to develop .

France owed most O f her development in

medicine and surgery at the end of the M iddle
 I N TRO DUCTOR Y 11

A ges t o the stream of influence that flowed out of

I t alian universit ies Such men as L anfranc who
.
,

was an I talian born but exiled ; M ondeville who ,

studied in I t aly ; and Guy de C hauliac who has ,

so freely acknowledged his O bligation to I t alian

teachers were t h e capital sources of medical and
,

surgical teaching in France in the later M iddle

Ages .

I t is thus easy to see how the t wo periods of

hist orical import in medicine at the beginning and
end of t h e M iddle Ages may be placed in their
int imat e relation to Greek influences At the .

beginning Greek medicine was not yet dead in

,

Asia M inor and it influenced t h e Arab s

, When .

the revival came i t made itself first felt in the

,

port ions Of Southern I taly and S outhern France

where Greek influence had been st rongest and still
persist ed . Fort unat ely for us the great Renais
,

sance printers and scholars themselves touched by

,

the Greek spiri t of t heir t ime put the books of

,

the writ ers O f these t wo periods int o enduring

printed form and in more recent years many
,

reprints of t hem have been issued These volumes .

make it possible for us t o underst and just how

t horoughly t hese colleagues of t h e M iddle A ges
faced t heir problems and solved them with a
,

practical genius that deserves the immortality that

t heir works have been given .
12 MED I EVAL MEDIC I NE
The history of medicine and surgery during the
M iddle Ages has been great ly obscured by the
assumption that at this time scientific medicine and
surgery could scarcely have developed because men
were lacking in the true spirit of science The .

dis t inc t ion between modern and medieval educat ion

is oft en said t o be t hat the old t ime universit ies
-

sought to increase knowledge by deduction while ,

the modern universities depend on induc t ion .

I nduct ive science 1s often said to be the invention

""
T t hé R éIi ai ssa n c e p eriod and to have h ad
n “ -

O ”
,

practically no existence during the M iddle Ages .

The medieval scholars are commonly declared t o

have preferred to appeal to authority while modern ,

invest igators turn to experience Respect for

.

a uthori t y is oft en said to have gone so far in the

M iddle Ages that no one ventured practically to

assert any t hing unless he could find some authorit y
for it On t h e other hand if t here was any
,

acknowledged aut hority say Aristotle or G a len

, ,

men so hesit ated to contradict him that they usually

followed one another like sheep quoting their ,

favourit e author and swearing by the aut horit y of

their chosen master I ndeed many mode r n
,

writ ers have n o t hesit ated t o express t h e greatest

possible wonder that the men of t h e M iddle Ag es
a

did not think more for themselves and above ,

all did not t rust to their own observat ion ,

 INTRO DU C TOR Y 13

rather than constantly rest under the shadow of

aut hority .

Above all it is often asked why there was no

,

nat ure s t udy in t h e M iddle Ages that is why ,

men did not look around t hem and see t h e beauties

and the wonders of t h e world and of nature and ,

becoming interest ed in t hem endeavour t o learn ,

as much as possible about them Anyone who .

thinks that there was no nature study in t h e M iddle

Ages however is qui t e ignorant of the books of
, ,

the M iddle Ages D ante for inst ance is full of

.
, ,

t h e knowledge of nature What he knows about

.

the ants and the bees and many o t her insects ;

, ,

about the flowers and t h e birds and t h e habit s of

, ,

animals ; about the phosphorescence at sea and the

cloud e ff ects and nearly everyt hing else in the
,

world of nature around him adds greatly t o the ,

interest of his poems He uses all t hese de t ails

.

”
of information as figures in his D ivine C omedy ,

not in order t o displ a y his e r udi t ion b u t to bring ,

home his meaning wit h striking concret eness by

the met aphors which he employs There is .

probably no poet in the modern t ime who knows

more about the science of his time t han D ante or ,

uses i t to bet ter advant age .

I t is somet imes t hought that t h e medieval

scholars did not consider that experience and o b ser
vat ion were of any value in the search for t rut h ,
14 MEDIEVAL MEDIC I NE
and that therefore there could have been no
development of science I n an article on Science
.

at the M edieval U niversities I made a series of .

quotations from the two great scientific scholars of

the t hirteenth century A lbertus M agnus and ,

Roger Bacon wi t h regard to the quest ion of

,

the relative value of aut horit y and O bservat ion in

all that relates to physical science S t ronger .

expressions in commendation of observation and

experiment as t h e only real sources of knowledge
in such matters could scarcely be found in any
’
modern scient ist I n Albert s tenth book of his
.

”
Summa ,
in which he cat alogues and describes
all the trees plants and herbs known in his t ime
, , ,

“
he declares : All that is here set down is the
result of our own e x perience or has been borrowed ,

from aut hors whom w e know to have w ritten what

t heir personal experience has confirmed ; for in
”
these matters experience alone can be of certaint y .

I n his impressive L at in phrase exp er im en t a m ,

so lu m c er t ifi c a t i n t a li b u s Wit h regard to the

.

study of nature in general he w as quite emphatic .

He was a theologian as well as a scient ist yet in ,

”
his t reat ise on The Heavens and the E art h he ,

declared t hat : I n s t udying nature we have not

to inquire how God the C reator may as He freely ,

wills use His creatures t o work miracles and

, ,

thereby Show forth His power We h a ve rat her .

if
P o p u la r S c i en c e M o n t h ly M a y , ,
 IN TRO DUC TOR Y 15

to inquire what nature with its immanent causes

can naturally bring to pass .

Roger ja co n , t h e recent celebration of whose

m

seven hundredth anniversary has made him ever so

much bet ter known t han before furnishes a ,

number of quotations on this subject One of .

them is so strong that it will serve our purpose

completely I n praising the work done by Petrus
.
,

one of his disciples whom we have come to know

as Peregrinus Bacon could scarcely say enough in
,

praise of the thoroughly scientific temper in our ,

fullest sense of the term of P er eg r i n u s s mind

,
’
.

Peregrinus wrote a letter on magnetism which is ,

really a monograph on the subject and it is mainly ,

with regard to this that Roger Bacon has words of

praise . H e says I know of only one person
who deserves praise for his work in experimental
philosophy for he does not care for the discourses
,

of men and their wordy warfare but quietly and ,

diligently pursu es the works of wisdom There .

fore what ot hers grope aft er blindly as bats in the

, ,

evening twi light this man contemplates in their

,

brilliancy b ec a u se h e is a m a st er of exp er im en t
, .

Hence he knows all of n atural science whether

, ,

pertaining to medicine and alchemy or to mat ters ,

celestial or terrestrial He has worked diligently

.

in the smelting of ores as also in the working of

,

minerals ; he is thoroughly acquainted with all sorts

16 MED I EVAL MED I C I NE
of arms and implements used in military service
and in hunting besides which he is skilled in agri
,

culture and in t h e measurement of lands . I t is

impossible to write a useful or correct treatise in
experimental philosophy without mentioning this
’
man s name . M oreover he pursues knowledge
,

for it s own sake ; for if he wished t o obtain royal

favour he could easily find sovereigns who would
,

honour and enrich him .

Roger Bacon actually wanted the Pope to

forbid t h e study of Aristotle b ecause his work s
were leading men astray from the true study of
science his authority being looked upon as so
great that men did not think for themselves but ,

accepted his assertions . Smaller men are always

’
prone to act thus at any period in the world s
history and we undoubtedly in our time have a
,

very large number who do not think for themselves ,

but swear on the word of some master or other ,

and very seldom so adequate a master as Aristotle .

Bacon insist ed that the four great grounds of

human ignorance are First trust in inade quate
,

authori t y ; second that force of custom which leads

,

men to accept without properly questioning what

has been accepted before their t ime third t h e ,

placing of confidence in the assertions of the i n ex

’
p e r i e n c e d ; and fourth
, the hiding of one s own
ignoranc e b ehin d the p ara de of sup erfi ci al k now
 IN TRO DUC TOR Y 17

ledge so that we are afraid to say

, I do not ,
’
know . Prof Henry M orley suggested t hat
.

N 0 part of t hat ground has yet been cut away

from beneath t h e feet of s t udents alt hough six ,

centuries have passed We still make sheepwalks

.

of second t hird and fourt h and fift h hand refer

, , ,

e n c es to authori t y ; still we are t h e Slaves of habit ,

s t ill we are found following too frequent ly t h e

unt aught crowd s t ill we flinch from the righteous
,

and wholesome phrase I do not know

, and ,
’

acquiesce actively in t h e opinion of others t hat we

”
know what we appear t o know .

I t used t o be the custom to make little of the

medieval scient ist s because of t heir reverence for
Aristot le .Generat ions who kne w li t tle about
Ari st o t le especially t hose of the sevent eent h and
,

eighteenth centuries w ere inclined to despise

,

preceding generations who had t hought so much

of him . We have come to know more about
Arist ot le in our own time however and as a c o n se
, ,

q u e n c e have learned t o apprecia t e better medieval

respect for him V ery probably at t h e present
.

moment t here would be almost unanimous agree

ment of scholars in t h e opinion t hat Arist ot le s ’

was t h e greatest mind humanity has ever b a d .

This is t rue n o t only because of his profound

{ intellec t ual penetrat ion b u t above all because of
,

t h e comprehensiveness of his intelligence For .

3
18 MEDIE VAL MEDICINE
depth and breadth of mental V iew on a multiplicity
of subjects Aristotle has never b een excelled and
,

has but very few rivals The admiration of the

.

M iddle Ages for him instead of b eing derogatory

,

in any way t o the judgment of the men of the time ,

or indicating any lack of critical appreciation ,

rather furnishes good reasons for high estimation

of both these intellectual modes of the medieval
mind . Proper appreciation of what is b est is a
much more difficult task than condemnation of what
is less worthy of regard I t is the difference
.

b etween constructive and destructive criticism .

M e dieval appreciation of Aristotle then consti , ,

t u t es rather a good reason for admiration of them

than for depreciat ion of their critical faculty ; and
yet they never carried respect and reverence to
unthinking worship much less slavish ado ration
, .

A lbertus M agnus for instance said :

, Whoever
,

b elieves t hat Aristotle was a God must also believe

t hat he never erred ; but if we believe that Aristotle
was a man then doubtless he w as liable to err just
,

as we are .
”
W e have a number of direct contra
dictions of Aristotle from Albert A w ell known
.
-

’
one is that with regard t o Aristotle s assertion that
lunar rainbows ap p eared only twice in fift y years .

Albert declared t hat he himself had seen two in a

single year .

Galen after Aristotle was the aut hor oft enest

, ,
 IN TRO DUCTOR Y 19

quoted in the M iddle Ages and most revered , .

Anyone who wants to understand this medieval

reverence needs only to read Galen There has
probably never been a greater clinical ob server in all
the world than this Greek from Pergamos whose ,

works were destined to have so much influence for a

millenniu m and a half after his time H ow well .

he deserved this prestige only a careful study of his

writings will reveal I t is simply marvellous what
.

he had seen and writes about Anatomy physio .

,

logy pat hological anatomy diagnosis therapeutics

, , ,

—
all these were magni fi cently developed under his
hands and he has left a record of accurate and
,

detailed ob servation There are many absurdities

.

easily to be seen in his writings now but no one ,

h a s yet written on medicine in any large way who

‘

has avoided absurdities nor can anyone hope to

, ,

until we know much more of the medical sciences

than at present The therapeutics of any generation
.

is always absurd to the second succeeding genera

tion it has been said
, Those in the modern time
.

who know their Galen best have almost as much

admiration for him in spite of all our advance in
,

the knowledge of medicine as the medieval people,

had NO wonder seeing t h e depth and breadt h of

.
,

his knowledge that he was thought so much of

, ,

and that men hesitated to contravene anything that

he said .
20 MEDIE VAL MEDICINE
E ven in the authorities to which they turned with
so much confidence the medieval physicians are
,

admirable . I f man must depend on aut horit y ,

then he could not have better than t hey had . As

with regard to t his so in all other matters relat ing
,

to the M iddle Ages t h e ordinarily accepted not ions

-

prove to have been founded on ignorance of actua l

details and misconceptions as to the true sig n i fi
,

cance of their point of view . To have cont emp t

give way to admiration we need only to know the
,

realities even in such meagre details as can be given

in a short manual of this kind The thousand
.

years of the M iddle Ages are now seen to have

been full of interesting and successful efforts in
every mode of human activity and medicine and
,

surgery shared in this to the full .

 C HAPT E R I I
R
E A LY M E D I E V AL M E D I CI N E

TH E R E are two distinct periods in t h e history o f

M edieval M edicine The first concerns t h e early
.

centuries from the six t h to t h e nint h a n d is

, ,

occupied mainly wit h t h e cont ribut ions t o medicine

made by those who were st ill in t ouch wi t h t h e old
Greek wri t ers ; while the second represent s t h e
early Renaissance when the knowledge of t h e
,

Greek writers was gradually filtering back a gain ,

mes t hrough t h e u ncer t ain channel of t h e

Both periods cont ain cont ributions t o
n e th a t are well wort hy of consideration and ,

nearly always t h e writ ings that have been preserved

for us demonstrate t h e fact t hat men were t hinking
for themselves as well as st udying t h e Greek writ ers ,

and w ere making observations and garnering

significant personal experience The later M iddle
.

Ages part icularly prese nt material in t his regard of

fa r greater interest t han was presumed to exist until
comparatively recent historical studies were com
p let e d .

The real history of medicine in t h e M iddle Ages

—
t hat is O f scientific medicine
, is eclipsed by the
—

21
22 MEDIE VAL MED I CINE
story of popular medicine . So much has been said
of the medical superstitions many of which were
,

rather striking that comparatively litt le space has

,

been left for the serious medical science and practice

of the t ime which cont ain many extremely int er
,

esting details . I t is true that after the C rusades

mummy was a favourite pharmacon sometimes ,

even in the hands of regular physicians and Usn ea ,

the moss from the skulls of the bodies of crimi nals

that had been hanged and exposed in chains was ,

declared by many to be a sovereign remedy for

many di fferent ills ; but it must not b e forgotten
that both of these substances cont inued to b e used
long after the medieval period mummy even down
,

to the middle of the eight eenth century and U snea

,

almost as late . I ndeed it is pro b able that the

,

seventeenth and eighteenth centuries present many

more absurdities in therapeutics than do the later
centuries of the M iddle Ages .I n this as in so
,

many other regards the modern use of the adjective

,

medieval has been symb olic of ignorance of the

time rather than representative of realities in
history.

Popular medicine is always ridiculous though ,

it s dicta are O ften accepted by supposedly educated

people . This has always been t r ue however and
, ,

was never more true than in o u r own time when ,

t h e vagaries of medical faddism are so strikingly

 E AR LY MEDIEVAL MEDICINE 23

illustrat ed and immense sums of money spent

,

every year in the advertising of proprietary

remedies whose virt ues are oft en sadly exaggerated
, ,

and whose t endency t o work harm rat her than good

is thoroughly appreciat ed by all who know any
thing about medicine The therapeutics of
.

supposedly scient ific medicine are Oft en dubious

enough . A dist inguished French professor Of
physiology quot ed n o t long since with approval
, , ,

t hat characteristic French expression The

therapeutics of any generation are always absurd
”
to the second succeeding generation When we
.

look back on the abuse of calomel and venes ection

a cent ury ago and of the coal tar derivatives a
,
-

generation ago and the overweening confidence in

,

serums and vaccines a lmost in our own day it is ,

easy to unders t and t hat t his law is sti ll true We .

can only hope t hat our generation will not be judged

seven cent uries from now by t h e remedies that were
accep t ed for a time and then proved to be eit her
,

utt erly ineff ect ual or even perhaps harmful to the

pat ient s t o whom they were given .

When we t urn our at t ent ion away from this

popular pseudo history of M edieval M edicine
-

which has unfortunat ely led so many even well

informed persons int o entirely wrong no t ions wit h
regard t o medical progress during an important
period we fi nd much that is of enduring int eres t
,
.
24 MEDIEV AL MEDICINE
The first document s that w e have in the genuine
hist ory of M edieval M edicine aft er t h e references
,

t o t h e organizat ions of C hrist ian hospit als at Rome

and Asi a M inor in t h e fourt h and fift h centuries
( see chap t er M edieval Hospit als) a r e t o be found ,

in t h e directions provided in t h e rules of t h e

religious orders for t h e care of the ailing St . .

Benedic t ( 4 8 0 t h e founder of the monks of

t h e West was par t icul a rly insistent on the thorough
,

performance of t hi s du t v The rule he wrote t o

.

guide his religious is famous in history as a great

consti tut ion of democracy and none o f its pro
,

visions are more significant t han t hose which relat e

to t h e care of t h e health of members of the com
muni t y .

One of t h e rules of St Benedict required the

.

Abbot t o provide in t h e monast ery an i n fi r m a r y

for t h e ailing and to organize particular care of
,

them as a special C hrist ian duty The wording of

‘

the rule in this regard is very emphat ic fi The .

‘

care of t h e sick is to be placed a b ove and before

every other dut y as if indeed C hrist were being
, , ,

directly served in wait ing on them I t mus t be

.

t h e peculiar c a re of the Abbo t t hat t hey su ff er

from no negligence . The I n fi r m a r i a n must be
t horoughly reliable , known for his pie t y and
diligence and solicitude for his charge The last.

’
words of the rule are characteristic of Benedict s
 E AR LY MEDIEVAL MEDICINE 25

appreciation of cleanliness as a religious duty ,

though doubt less also the curative e ffect of water

was in mind . L et baths be provided for the
”
sick as oft en as t hey need them As to what the
.

religious i n fi r m a r i a n s knew of medicine at least as ,

regards the sources of their knowledge and the

aut hors they were supposed to have read we have ,

more defini t e informat ion from the next historical

document that concerning medical matters in the
,

religious foundation of C assiodorus .

C assiodorus ( 4 6 8 who had been t h e p r i m e /

minister of the Ostrogoth E mperors when he ,

resigned his dignities and established his monastery

a t Sc illa c e in C alabria was influenced deeply by St
, .

Benedict and was visited by the saint not long after

,

the foundation .

His rule was founded on that of the Benedictines .

L ike that it insist ed especially on the care of the

,

sick and the necessi t y for the deep st udy of

,

medicine on t h e part of t hose who cared for them .

C assiodorus laid down the law in this regard as

follows I insist bro t hers that those who t rea t
, ,

t h e heal t h o f the body of the brethren who have

come into the s a cred pl a ces from the world should
fulfil t heir dut ies with exemplary pie t y L et t hem .

be sad wit h ot hers suffering sorrowful over others

’
,
’

dangers sympat hetic to the g rief of those whom

,

they have t o care for and always ready z ealously

,
26 MED I EVAL MEDIC I NE
’
to help others misfortunes L et them serve with
.

sincere study to help those who are ailing as

becomes their knowledge of medicine and let t hem ,

look for their reward from Him who can com

pensat e temporal work by eternal wages L earn .
,

t herefore the nature of herbs and s t udy diligently

, ,

t h e w ay t o combine their various species for human

health ; but do not place your entire hope on herbs ,

nor seek to restore health only by human counsels .

Since medicine has been created by God and since ,

it is He who gives back health and rest ores life ,

turn to Him Remember do all t hat you do in

.
,

word or deed in the name of the L ord Jesus giving ,

thanks to God the Father t hrough Him And if .

you are not capable of reading Greek read above ,

all t h e t ranslations of the Herbarium of D ioscorides ,

which describes wi t h su r p r rsrn g exactness the herbs

of the field .After this read translat ions of
,

Hippocrat es and Galen especially the Therapeutics

, ,

’ ’
and Aurelius C elsus D e M edicina and Hippo ,

cra tes ’
D e H er b i s et C uris and divers o t her
,
’

books written on t h e art of medicine which by ,

God s help I have been able t o provide for you in

’

my library .

The monast eries are thus seen to have been in

touch wit h Greek medicine from t h e earliest
medieval time The other important historical
.

documents relat ing to M edieval M edicine which we

 E AR LY MEDIE VAL MEDICINE 27

possess concern the work of the men born and

brought up in Asia M inor for whom t h e Greeks ,

were so close as t o be living influences A ét iu s .

,

Alexander of Tralles a n d Paul of I E g i n a have each

,
Z

writ ten a series of import ant chap t ers on medical

subject s full of int erest because t h e writ ers knew
,

t heir Greek classic medicine and were t hemselves ,

m a king import ant observations Aet iu s for .

,

ir
r st a n c a h a d a
-

g o dw
o d i g f d i l
p lt h e rja
m
He s peaks .

of it in connec t ion wi t h ot her throat manifestat ions

under t h e heading of crust y and pes t ilent ulcers
”
of the tonsils He divides t h e anginas generally
.

int o four kinds The first consists of inflammation

.

of t h e fauces wit h t h e classic symp t oms ; t h e second

presents no inflammat ion of t h e mouth nor of t h e
fauces but is complicated by a sense of suff ocation
,

—
apparently our neurotic croup The third con
.

sist s of ex t ernal and int ernal inflammat ion of the

mouth a n d throat extending t owards t h e chin
, .

Th e fourth is an a ffection ra t her of the neck due to ,

a n inflammation of t h e vertebr ae ret roph a ryngeal

—

abscess which may be followed by luxat ion and

—
,

is complicat ed by great di fficulty of respirat ion .

All of t hese have as a common symptom di fficulty

of swallowing This is great er in one varie t y t han
.

in another at di fferent t imes I n cert ain a ffections

.

he remarks that even drinks when t aken are

”
returned through the nose .
28 MEDIE VA L MEDICINE
Actin s declares quite positivel y that all the
tumours of the neck region with the exception of ,

scirrhus are easily cured yielding either to surgery

, ,

Or to remedies .The exception is noteworthy .

H e evidently saw a good many of the funct ional

disturb ances and the enlargements of the thyroid
gland which are often so variable in character as
,

apparently to be qui t e amenable to treatment and ,

which have actually been cured in t h e history

of medicine by all sorts of things from the touch
of the hangman s rope to the wrapping of t h e shed
’

Sk in of the snake around the neck A few cervical .

tumours were beyond resource A ét iu s suggest s

.

the connection between hypertrophy of the clit oris

and certain exaggerated manifestations of the
sexual instinct as well as the development of
,

vicious sexual habits .

I t requires o n ly a little study of th1s early

medieval author to understand why C ornelius at ,

t h e time of the Renaissance was ready to declare,

Believe me that whoever is deeply desirous of

,

studying things medical if he would have the whole

,

of Galen ab b reviated and the whole of O r b i a siu s

ex t ended and the whole of Paulus ( of [E g in a )
,

amplified ; if he would have all the special remedies

of the old physicians as well in pharmacy as in
,

surgery boiled down to a summa for all affections

, ,

he will fi nd it in A et iu s .
 V
a{ E AR LY MEDIE V AL MEDICINE 29
1

Alex ander of Tralles was as we have said the

” a d v —“ m
, ,

brother Santa Sophia of C on

st a n t i n o p le
, and his writings on medical and
surgical subject s are worthy of such a relationship .

His p r in p a l work is a treatise on the Pathology

and Therapeutics of I nternal D iseases in twelve
books t h e first eleven books of which were evident ly
,

material gathered for lectures or teaching purposes .

He treats of cough as a symptom due to h ot or

cold dry or wet dyscrasias
, , Opium p r ep a r a t fi g.

judiciously used he thought the best remedies ,

though he recomm ended also the breathing in of

steam impregnat ed with V arious ethereal resins .

He outlines a ve ry i nteresting because thoroughly

-

mode r n t re a tme nt of consumption He r e c o m .

mends an abundance of milk with a hearty

nutritious diet as digestible as possible
, A good
auxiliary t o t his treatment in his opinion was change
of air a sea voyage and a stay at a watering place
, ,
-
.

’
Ass s and mare s milk are much better for these
’

’ ’
patients t han cow s and goat s milk We reali z e .

now that there is not enough di fference in the

composit ion of these various milks t o make t heir
special prescription of physical importance but it ,

is probable that the suggestive influence of the

t a king of an unusual milk had a very favourable
e ff ect upon patients and this e ffect w as renewed
,

with every drink taken so that much good ,

30 MEDIE V AL MED I CINE
was ultimately accomplished For h aemoptysis .
,

especially when it was acute and due as Alexander ,

felt to the rupture of a b lo o dvessel in t h e lungs

, ,

he recommended the opening of a vein a t the elbow

or the ankle i n order to divert the blood from the
—

place of rupture to the heal t hy parts of t h e circula

t ion .He insisted however t hat t h e pat ients mu
, st ,

in addition rest as well as take acid and astringent

,
’

drinks while cold c o m p r esses sh o u ld be placed up on

,

t h e chest [our ice bags ] and t hat t hey should t a k e

-

only a liquid diet a t most lukewarm or bet t er if

, , , ,

agreeable to them cold When the bleeding

, .

st opped he declared a milk cure [blood maker ]

,
-

very useful for the restoration of thes epatients t o

their former st rengt h .

He paid particular attention to diseases of the

nervous system and discussed headache at some
,

length .C hronic or recurrent headache he

attribut ed to diseases of t h e brain plethora bilious , ,

ness digestive disturbances insomnia and pro

, , ,

longed worry Hemicrania he t hought due to the

.

presence of to x ic materials though it was also ,

connect ed with abdominal disorders especially in ,

women Alexander has much t o say of t h e

.

paraly t ic and epileptic condit ions and r ec o m ,

mended m assage rubbings baths and warm , , ,

applications for the former and emphasized the ,

need for careful directions as t o the mode of life ,

 , E AR LY ME DI EVA L MEDICINE 31

and special attention to the gastro intestinal tract -

in the lat ter A plain simple diet with regular

.
, ,

bowels he considers t h e most important basis for

,

any successful t re a t ment of epilepsy Besides he .

,

recommended bat hs sexual abst inence and regular

, ,

exercise He rejected t reat ment of t h e condit ion

.

by surgery of the head eit her by trephining or by ,

incisions or by caut erizat ion His teaching is t hat .

of those who have had most experience wi t h the

dise a se in our own t ime For sore throat he .

prescribes gargles or light astringents at the

b eg l n m n g and s t ronger ast ringent s a lum and soda
, ,

dissolved in water lat er in t h e case , .

He part icularly emphasized t hat trust sh ould not

be placed in any single method of t reatment .

E very available means of b ringing relief t o the

pat ient should be tried The duty of the .

physician is t o cool what is hot to wa rm what is ,

cold to dry what is moist and to moisten what

, ,

is dry He should look upon t h e pat ient as a

.

besieged cit y and try to rescue him wit h every

,

me a ns that a rt and science placed at his command .

The
M
physician sho ul d be a n inventor and t hink out
~M ~ ,
-

new ways and means by which t h e cure of the

may
I
~ M
be¢
brou
M g h t abou t ” The most important ,

factor in Alex ander s t herapeutics is his die t

A

’
.

Watering places and various forms of minera l

82 MED I EV AL MEDICINE
waters as well as w arm b aths and sea b aths are
, ,

constantly recommended by him He took strong .

ground against t h e use of many drugs and the rage ,

for operating The prophylaxis of disease is in

Alexander s opinion t h e import ant part of the
’

’
physician s duty His treatment of fever shows
.

the application of his principle : cold baths cold ,

compre sses and a cooling diet were his favourite

, ,

remedies . H e encouraged diaphoresis nearly

always and gave wine and stimulating drugs when
,

the patient was very weak .

Some of the general p r m c ip les of medical practice

which Alexander lays down are very significant
even from our modern standpoint He deprecated .

drastic remedies of all kinds He did not believe .

in severe purgation nor in profuse or sudden blood

letting . His diagnosis was thorough and careful .

He insisted part icularly on inspection and palpat ion

of t h e whole body ; on careful examination of t h e
urine of the f aeces and the sputum ; on st udy of
, ,

t h e pulse and the bre a thing He dwelt on the .

’
fact that much might be learned from t h e patient s
history t aken carefully The general const it ution
.

was t h e most imp o r t a nt element in his est imat ion ,

.

His t herapeut ics is above all individual Remedies

, ,
.

must be adminis t ered wi t h c areful reference t o t h e

con stit ut ion t h e age the sex and t h e co n dition
, , ,

of t h e patient s streng t h ’
Special attention must
.
 E AR LY MEDIE VAL MEDICINE 33

always be paid t o seconding nature s efforts to cure ’

.

Alexander had no sympathy a t all wit h the idea

that nature was to be dist urbe d much l ess that ,

remedies must work in opposition t o natural

t endencies t o recovery .

Paul of n ina educat ed at the U niversity at

,

Alexandria prob a bly flourished during t h e reign

,

of t h e E mperor Heraclius who died 6 4 1 his works ,

cont a in more of surgical t han of medical interest .

The Arab writer Abul Farag t o whose refer

, ,

e n c es we owe t h e definite placing of the time when

Paul lived said that

, he had special experience
’
i n women s diseases and had devoted himself to
,

t hem wi t h great i ndustry and success The .

midwives of the time were accustomed to go to him

and ask his counsel with regard to accidents that
happen during and aft er parturition He willingly .

imparted his information and told t hem what they ,

should do .For this reason he came to be known

”
as the Obstetrician Perhaps the term should
.

be translated t h e man midwife for it w as rather

-

unusual for men to have much knowledge of this

subject . His knowledge of t h e phenomena of
menstruation was wide and definite He knew a .

great deal of how to treat its disturbances He .

seems to have been the first one to suggest that in

metrorrhagia with severe h aemorrhage from the
,

uterus the ble eding might b e stop ped by putting

,

5
34 ME DIE V AL MEDICINE
ligatures around the limbs This same method has
.

b een suggested for severe h aemorrhage from t h e

lungs as well as from the ut erus in our own t ime .

I n hys t eria he also suggest ed ligat ure of t h e limbs ,

and i t is easy t o understand t hat this might be a

very strongly suggestive treatment for t h e severer
forms of hysteria . I t is possible t o o t hat t h e
, ,

modification of t h e circulat ion to the nervous

system induced by t h e shutting o ff of t h e circulation
in large areas of the body might very well have a
favourable physical effect in this aff ec t ion Paul s .
’

description of the use of the speculum is as complete

as that in any modern textboo k of gyn aecology .

I n the chapter on the medieval care of the insane ,

there are some clinical observations and suggestions

as to treatment from Paul which make it very Clear
what a careful O bserver he was and how rational in
,

his application of such knowledge as he had to the

treatment of patients Probably his contributions
.

to the diffi cult subject psychiatry w ell above a ,

thousand years ago will serve t o make his genius as

,

a physician clearer than almost anything else that

could be said of him .

Among t h e great Arabian physicians who r ep r e

sent t h e transit ion period from the earlier M iddle
,

Ages direct ly under Greek influence still surviving ,

to the l at er M iddle Ages when t h e earlier

,

Renais sance b r ought bac k the Greek m asters onc e

 E AR LY MEDIE V AL MEDICINE 35

more were Rhaz es Ali Abbas Avicenna whose

, , ,
—

name had been transformed from the Arabic I bn

Sina Abulcasis Aven z o a r and Averroes the last
—
, , ,

named a philosophic theoris t but n o t a physician .

The first t hree named were born in the E ast the ,

last t hree in Spain Besides t hese M aimonides

.
,

t h e great Jewish physician who w as born and

,

educat ed a t C ordova in Spain deserves a place , .

I n t his earlier period Rhazes must be ment ioned ,

while t h e o t hers who merit special at tention will be

considered in the chapter on L ater M edieval
M edicine .

Rhaz es ( died 9 3 2) is one of the great epoch

makers I n the history of medicine He was t h e
first t o give us a clear descrip t ion of M g ,

Some of his medical aphorisms are well wort h

noting and make it very clear that he was a careful
,

observer .

When you can heal by diet prescribe no other ,

remedy ; and where simple remedies suffice do not ,

”
t ake complicated ones .

Rh a zes knew w ell t h e value of the influence of

mind over body even in serious organic disease and ,

even t hough death seemed impending One of .

his aphorisms is Physicians ought to console

their patient s even if the signs of impending death
seem to be present He considered the most
'

valuable t hing for the physician t o do was to

 36 MEDIEVAL MEDIC I NE
’
increase the patient s natural vitality Hence his
.

advice I n treating a patient let your fi rst

,

thought be to st rengthen his natural V itali t y If.

you s t rengthen that you remove ever so many ills

,

without more ado .I f you weaken it however by

, ,

”
the remedies that you use you always work harm
, .

The simpler the means by which t h e patient s cure ’

can be brought about the bet ter in his opinion

, .

He insist s again and again on diet rat her t han

art ificial remedies . I t is good for the physician
t hat he should be able to cure disease by means of
diet if possible rather than by means of medicine
, , .

Another of his apho r isms seems worth while

quoting The patient who consults a great many
p hysicians is likely to have a very confused state of
”
mind
\ D uring the ninth and tenth centuries the Arabs
.

7
continued to be the most important cont ributors
t o medicine unt il t h e rise of the school a t Salerno
,

gave a new impet us t o clinical observat ion and ,

furnished a new focus of medical attention in t h e

West C onstantine brought whatever of Arab
.

influence there was in Salerno as we have point ed

,

o u t in the chap t er on t h e Beginnings of M edical

E ducat ion ; b u t after his time t here is an originali t y

about Salernit an medicine which makes it of great
value as the foster mother of t h e sciences relat ed t o
-

medicine during the lat er M iddle Ages .

 C HAPT E R II I
S AL E RNO AND TH E B E G I NN I N G S O F M O D E R N M E D I CAL
E DU CAT I O N

TH E first medical school of modern history and ,

t h e ins t i t ution which more t han any other h a s

helped us t o understand t h e M iddle Ages is that ,

of Salerno . I ndeed the accumulation of i n fo r

,

mat ion wit h reg ard to t his medical school formally ,

organized in the t ent h century b u t founded a

cent ury earlier and , a magnificent climax

of development a t the end of t h e t welft h cent ury

has done more t han any t hing else t o revolut ionize
our ide a s wit h regard to medieval educat ion and t h e
scie n t ific int erest s of t h e M iddle Ages We owe
.

t his development of knowledge t o D e Renzi whose ,

researches wi t h regard t o mat t ers Salernit an and ,

medical educ a t ion generally in I t aly in t h e M iddle

Ages are well deserving of the prest ige t hat has
,

been at lengt h accorded t hem .

I n his S t oria dell a M edicina in I t ali a pub ,

li sh e d so modes t ly a t N a ples t h e p a t ient I t a li a n

,

st udent of medical hist ory made a n epoch m a king -

contribution t o the history of medicine Unless

.

one has ac t ually read his book it is di fficult t o

,

37
38 M E DI E VA
,
MEDICINE
'

understand how deep our obligations t o h i m are

, .

Anyone who might be t emp t ed to think that

medicine was n o t taken seriously or that careful
,

clinical observations a n d serious experiments for

the cure of disease were not made a t Salerno will ,

be amply undeceived by a reading of D e Renzi .

Above all he makes it very clear t hat medical

,

education was taken up with rigorous att ent ion to

de t ails and high standards maint ained . Three
years of college work were demanded in preparat ion
for medical studies and t hen four years at medicine
, ,

followed by a year of practice wit h a physician

and even an addi t ional year of special study in
anatomy had t o be taken if surgery were t o be
, ,

practised All t his before the licence to pract ise

.

medicine was given ; though the degree of doc t or ,

grant ing the privilege of teaching as t h e word

indicates was conferred apparent ly aft er the com
“

p l e t i o n of t h e four years a t the medical school .

We have had t o climb back to t hese medieval

standards of medical educat ion in many countries
in recent years aft er a period of deteriorat ion in
,

which oft en t h e requirements for t h e physician s ’

t raining for prac t ice were ever so much lower .

I t may seem surprising t hat t h e first medical

school should have arisen in the sout hern part of
I t aly but for those who know the historical con
,

di t i o n s i t will seem the most natural t hing in t h e

 B E G INNIN G S OF MEDIC AL EDUC AT I O N 39

world that this development should have come in

t his region . As we have said t ouch wit h Greek
,

has always been t h e mos t import ant fa ct or for

modern educat ional and int ellect u al development .

Salerno was si t u a t ed in t h e h eart of t hat Gre ek

colony in t h e sout hern part of I t aly which came
to be known as M ag p a 9 3 539 9 Apparent ly a t no
.

time during t he M iddle Ages was Greek ent irely

a de a d la n u a g e in t his p a rt of I t aly and t here
f
r
,

were Greek t ravellers Greek s a ilors and m a ny

, ,

ot her wanderers who made their way along t h e

,

shores of the M editerranean a t t his time and ,

carried wit h them everywhere t h e stimulus t hat

always came from association with the Greeks of
Asia M inor and of t h e Grecian I slands and
peninsula .

There were two other factors that made for the

development of the medical school at Salerno .

The first of these seems undoubtedly to have been

the presence of the Benedictines who had a rather
,

important school at S alerno and who w ere closely

,

in touch with their great mother house at M onte -

C assino not far away . I t was t hey who imparted

t h e academic at mosphere to the town and made i t ,

possible to gather together the elements for the

universi t y which gradu a lly came into existence
around the medic a l school aft er that began to
,

a t t ract E uropean a t tention.

40 MEDIEV AL MEDICINE
The actual foundation of the medical school ,

however seems to have been due to the fortunat e

,

accident t hat Salerno became a health resort a ,

place t o which invalids were at tracted from many

part s of E urope because t h e climat e was salubrious ,

and opport unit ies for obt aining t h e medical advice

of men of many diff erent schools of thought from
all over t h e M editerranean and securing t h e ,

Orient al drugs which were so much valued as

drugs from a distance always are were there —

a ff orded I t is easy to understand that especially

.
,

in t h e wint er time better class patients from all

-

,
-

over E urope would be glad to go do w n to the mild

temperate climate of Salerno and spend their time
there .

I t has been point ed out that the first modern

universit y that of Salerno had for a nucleus a
, ,

’
medical school representing man s interest in his
,

body as his primary intellect ual purpose in modern

hist ory The second modern university t hat of
.
,

Bologna gathered around a law school representing

,

man s interest in his property his second formal

’
—

purpose in life And the third that of Paris

.
, ,

developed around a school of theology a n d

’
philosophy demonstrating that man s intellect ual
,

int erest s rise finally to the consideration of his

relat ions to his fellow man and to God -
.

The fir st that we know definitely about the

 B E G I NNIN G S OF MEDIC AL ED U C AT I O N 41

medical school of Salerno the origin of which is

,

di fficult to trace is concerned wi th AJLIhg g g s

, ,
”
usually design a t ed t h e First because there are
,

several of t h e name He was a Benedictine monk

.
,

dist inguished as a lit erary man and known by his

contemporaries as bot h poet and physician who ,

was aft erwards raised to t h e Bishopric of S a lerno .

He had t aught at Salerno in t h e Benedictine school

t here before becoming Bishop and when exercising
,

t h e highes t ecclesiast ical aut horit y did much to

encourage t h e development of Salerno He stat es
.

that medicine flourished in the town even in the

ninth century and there is an old chronicle pub
,

lish ed by D e Renzi in his Co lle c t i o Salernitana

in which it is said t hat the medical school was
founded by four doctors a Jewish Rabbi E li n u s ;
—
,

a Greek Pontus ; a Saracen Adale ; and the fourth

, ,

a native of Salerno each of whom lect ured in his

—

nat ive language . This reads like a myt hical legend

that has formed around some real tradit ion of t h e
coming of physicians from many count ries .

P u sc h m a n n in his Hist ory of M edical E duca

t ion has suggest ed that t h e names are probably
as much varied a s t h e absolute t ru t h of t h e fact s .

E lin u s t h e Jew is probably Elias or E liseus Adale

, , ,

is prob a bly a corru p t ion of Abdallah and Pont us ,

Should be probably G a r i o p o n t u s .

There was a hospital at Salerno that wa ssome

6
42 MEDIEV AL MEDICINE
what famous as early as the fi rst quarter of the ninth
century . This was placed under the control of the
Benedictines ; and ot her i n fi r m a ri es and charitable
i nstit ut ions similarly under the care of religious
,

orders sprang up in Salerno to accommodate the

,

pat ient s t hat came The practical character of

.

the t eaching at Salerno as preserved for us in the

,

writings of the school would seem to argue that

,

probably those who came to study medicine here

were brought directly in contact with the patient s ,

though we have no definite evidence of t hat fact .

The most interesting feature of the medical

school at Salerno is undoubtedly the development
of legal standards of medical education in connec
tion with the school Before the middle of the
.

twelfth century Roger King of the Tw o Si c ili es

, ,

issued a decree according to which preliminary

studies at the University were required as a
preparation for the medical school and four years ,

of medical studies were made the minimum require

ment for the degree of doctor in medicine Which ,

was however as we have said not a licence to

, , ,

practise but only a certificate authorizing teaching

,
.

There seemed to have been even thus early some , ,

furt her state regulations with regard to practice .

About t h e middle of the next century however , ,

there came through a law of the E mperor

,

Frederick II a sti ll fu r the r evolution of l egal

.
,
 B E GI NN I N GS OF MEDIC AL E D U C AT I O N 43

standards for medical education and medical

practice in the Two Si c ili es This law required
.

that t h e student of medicine should have spent

some years probably t h e equivalent of our under
,

graduat e training in the university before studying

,

medicine and t hat he should then devo t e four years

,

to medicine aft er which on proper examination

, , ,

he might be given t h e degree of doct or t hat is —

,

t eacher of medicine ; but he must spend a further

ye a r of prac t ice wit h a physician before he would .

be allowed t o practise for himself .

This is such a high st andard t hat only t hat we,

have t h e act ual wording of the law it would see m

,

a lmos t impossible that it could have been evolved

at t his period in medical history I t actually

.

represents t h e standard that we have climbed back

t o generally only during t h e past generat ion or t wo ,

and in the int erval there have been many rather

serious derogat ions from it This law of t h e
.

E mperor Frederick is moreover a pure drug law

, , ,

regulating the sale of drugs and their purit y and ,

inflic t ing condign punishment for subst itution ; in

this regard also ant icipat ing our most recent well
considered legislat ion . The pen a lt y by which t h e
druggist was fined all his movable goods for
subs t it ution while t h e government inspector who
,

permitt ed such substitution was put t o deat h ,

would seem to us in the modern time to make t h e

44 MEDIEV AL MED I CIN E
punishment eminently fit the crime Almost .

needless to say then the law ( see Appendix for

, ,

full t ext) represents one of the most import ant

document s in t h e history of medicine part icularly ,

of medical educat ion The fee regulation included

.

in i t shows that medicine was looked upon as a

profession and was paid accordingly
, .

From S alerno come many of t h e t raditions of

the conferring of degrees which are st ill used in
a large number of modern medical schools Before .

receiving his degree the c a ndidat e had t o t ake an

,

oath of which t h e following were the principal

,

t ene t s N o t t o contradic t t h e teaching of his

college n o t t o teach what was false or lying and
, ,

n ot to receive fees from t h e poor even though

t hey were o ffered ; to commend t h e sacrament of
penance t o his patients to make no dishonest
,

a greement wi t h t h e dru ggist s to administ er no

,

abort ifacient drug t o t h e p regnant and t o prescribe

,

no medicament that was poisonous t o human

”
bodies .

I t has some t imes been said t hat yout hs of tender

age were admi t t ed t o t h e st udy of medicine a t
Salerno and t hat many of t hem were given t heir
,

D e R en z i s
’
degrees a t t h e age of t wenty one -
.

discussion would seem to Show t h a t t h e usu a l age

of receiving t h e degree was t wenty fi ve t o twent y-

seven .
As medical st udent s had t o have three
 B E G INNIN GS OF MEDIC AL EDUC AT I O N 45

years of preparatory studies in literature and

philosophy it would seem t hat t hey must have been
,

rat her mature on their admission to t h e medical

schools .

D e Renzi tells us that the medical school of

Salerno was of great import ance n o t o n ly for
medical educ a t ion but it acquired sufficient means
,

t o extend i t s benefit s over t h e ent ire ci t y Gift s .

were made of s t a t ues t o t h e churches and especially

,

t o the sh r i n e o f St M at t hew the Apost le si t uat ed

.
,

here ; monuments were set up inscrip t ions placed

,

and ample donations made t o t h e various i n st i t u

t ions of t h e city .The formal name of t h e medical
school was A lm u m et H ip p o c r a t i c um M edi c o r u m
Co lleg iu m. This I s t h e first use that I know of
t h e word a lm a m in connection wi t h a college and ,

may very well be t h e dist ant source of our term

a lm a m a t er . The medical school w a s situat ed in
the midst of an elevat ed valley which opened up
on t h e mount ain t hat dominat es Salerno and while ,

enjoying very pure air mus t have been scarcely

dist urbed a t all by t h e winds which can be blust ery
enough from t h e gulf D e Renzi s a ys t hat in his
.

t ime some of t h e remains could s t ill be seen t hough ,

V isit ors t o S alerno now come away very much

disappoint ed because not hing of int erest is left .

The most f a mous of the teachers a t Salerno was

C onstantine Africanu s so called because he was “
, -
46 MED I EVAL MED I CINE
b orn near C arthage .H is life runs from the early
part of the eleventh century to near its close and ,

he lived probably well beyond eighty years of age .

Having studied medicine in his native town he ,

wandered through the E ast became familiar with,

a number of Oriental languages and studied the ,

Arabian li t erature of science and above all of ,

medicine very diligently

, The Arabs owing to
.
,

their intimat e cont act wi t h the Greeks in Asia

M inor had the Greek authors const antly before
,

t hem , and Hippocrat es and Galen have always

roused men to do good work in medicine C on .

st an t i n e seems not to have learned Greek fi nding ,

enough to sat isfy h i m i n t h e Arabic commentaries

on t h e Greek authors and probably confident as
, ,

all young men have ever been that what his own ,

time was doing must represe n t an advance over the

Greek . He brought back wit h him Arabian h o oks
and a thorough knowledge of Arabian medicine .

When he set t led down in C art hage he was accused

of magical pract ices his medical colleagues being
,

apparent ly jealous of his success a t least t here is a

—
,

tradit ion to t hat e ffect t o account for his removal

t o Salerno t hough t h e immediat e reason seems t o
,

h a ve been t hat his reput at ion at t ract ed t h e at t ent ion

of D uke Robert of Salerno who invited him to ,

become his physician .

Aft er C onstantine s time the principal textbooks

’
 BE G INNIN GS OF MEDIC AL EDUC AT I O N 47

of the school became according to D e Renz i

, ,

Hippocrat es Galen and Avicenna

, , To t hese .

were added the An t i do t a ri um of M esu e and there ,

were various compendiums of medical knowledge ,

quite as in our own time one well known under —

the name of Ar t i c ella I n surgery the principal

.

textbook was t h e surgical works of the Four

M asters of Salerno which interest ingly enough was
,

the sort of combinat ion work gat hered from a series

of masters t hat we are accustomed to see so
frequently at the present day D e Renzi insists
.

that there was much less Arabic influence at Salerno

than is usually thought ; and G u r lt more recently
has emphasized as we have said the fact that the
, ,

great textbooks of surgery which we have from

Salerno contain not Arabisms as might b e expected ,

from the traditions of Arabic influence that we

hear so much of but Graecisms which Show t hat
, ,

here at Salerno there was a very early Renaissance ,

and the influence of Greek writers was felt even in

the twelfth century .

Probably the best way to convey in brief form

a good idea of the teaching in medicine at Salerno
is to quote the R eg im en S a n i t a t is S a ler n i t a n um ,

the C ode of Health of the School Of Sa ler n u m ,

which for many centuries was popular in E urope ,

and was issued in many editions even aft er the

invention of printing Professor O r dr o n a u x
.
,
48 MED I EVAL MEDICINE
Professor of M edical Jurisprudence in the l aw
school of C olumbia C ollege ( now C olumbia U ni
versit y N ew York ) issued a translat ion of i t in
, ,

V erse *
, whi ch gives a very good notion of the
cont ent s and the spirit and the mode of expression
of t h e lit tle volume .

The R eg im en was written in the rhymed verse s

which were so familiar at t his time . M any writ ers
on the hist ory of medicine have marvelled a t this
Use of verse b u t anyone who knows how many
,

verse makers there were in the twelfth and

-

thirteenth centuries all over E urope will not be

surprised I t used to b e the custom to make little
.

of these rhymed L atin verses of the M iddle Ages ,

but it may be well to recall that in recent years a

great change h a s come over the appreciation of the
world of lit erature in their regard . The rhymed
L atin hymns of the C hurch especially the D i es,

I r ee the S t a b a t M a t er and o t hers are now looked

, , ,

upon as representing some of the greatest poetry

t hat ever was written . Professor Saintsbury of
the University of E dinburgh has declared them the
most wondrous wedding of sense and sound that
the world has ever known . The R eg im en S a n i t a t is
of Salerno is of course no such poetry mainly ,

because its sub ject was commonplace and it could

not rise to poetic heights . A good deal of the
P h il a del p h i a : Li pp i n co t t 18 7 1
, .
 B E G I NNI NGS OF MEDICA L EDUC AT I O N 49

deprecation of its L atinity might well be spared ,

for most of the mistakes are undoubtedly due to

copyists and interpolation The verses not only
.

rhyme at the end but Oft en there are internal sub

,

rhymes . This t o o was a very common custom

among the hy m n writ ers as t h e great sequence of
-

Bernard of M orlaix so well known through its

,

translations in our time as Jerusalem the

,

Golden attests .

The R eg im en was not written for physicians ,

b u t for popular informat ion I t seems t o have

.

been a compilation of maxims of health from

various professors of t h e Salernitan School .

N othing that I know shows more clearly t h e

genuine knowledge of medicine and the careful ,

following of the first ru le of medical pract ice n o n

n o c er e to which S alerno had reached a t this time ,

than the fact that this popular volume contained

no recommendat ion of specific remedies but only ,

health rules for diet air exercise and t h e like

, , , ,

many of which are as valuable in our t ime as t hey

were in t hat and very few of which have been
,

ent irely superseded toge t her wit h some general

—

informat ion a s t o simples a n d a few det a ils of

,

medical knowledge that would g 1ve a convincing

air t o t h e compila t ion .

The book was dedic ated t o t h e King of t h e

E n glish An g lo r n m r eg i sc r i b i t sc h o la t o t a S a ler n i
, ,
50 MEDIEVAL MED I CINE
and in the translation made by Professor O r do n a u x g ,

begins as follows
I f t h o u t o h ea l t h a n d vi g o ur w o ul dst a t t a i n ,

S h un w ei g ht y ca r es a ll a n g er d ee m p r o fa n e
—
,

Fr o m h ea vy sup p er s a n d m u c h w i n e a b st a i n
M
.

No r t r i v i a l c o u n t i t a ft er p o m p o u s fa r e
, ,

To r i se fr o m t a b l e a n d t o t a k e t h e a i r .

S h u n idl e n o o n d a y sl u m b er n o r d el a y
, ,

Th e u r g en t c a ll s o f N a t u r e t o o b ey .

These r ul es i f t h o u w il t fo ll o w t o t h e en d ,

Th y li fe t o g r ea t er l en g t h t h o u m a yst ex t en d *
.

E vidently it was rather easy to commit such

rhymes to memory and this accounts for the fact ,

t hat we have m a ny di fferent versions of t h e R eg i m en

and dispu t ed readings of all kinds These medieval .

hygienist s believed very much in early rising cold ,

wat er thorough cleansing exercise in t h e open

, ,

air yet without sudden cooling aft erwards

, The .

lines on morning hygiene seem worth while giving

in O r do n a u x s translation
’
.

[A t ea r l
y d a wn wh en fi r st fr o m b ed
, yo u r i se ,

1W a sh i n c o ld w a t er b o t h yo u r h a n d s a n d eyes
, , .

W i t h b r u sh a n d c o m b t h en cl ea n se yo u r t eet h a n d h a i r ,

An d t h u s r efr eshed yo ur lim b s o u t st r et c h w i t h c a r e

, .

Th e L a t i n li n es r un t hu s
Si i s i n c o lu m em Si i s t e r edder e sa n u m
v
,
v

C ur es t o ll e g r a v es i r a s cr ed e p r o fa n u m
, .

Pa r c e m er o coc ua t o p a r u m n o n Si t t i b i
—
,
va n um

Su r g er e p o st e
p u la s ; so m n um fug e m er idi a n u m
Ne m ic t u m i
r e t n e, n e c c o mp r im e fo r t i t er n u m ;
’

H aec b en e Si ser ve s, tu l o n g o t em p o r e vi v es .
 B E G INNIN GS OF MEDIC AL EDUC AT I O N 51

S u ch t h i n g s r est o r e t h e wea r y,
’
o er t a s ked br a i n
An d t o a ll p a r t s en su r e a wh o l eso m e g a i n .

Fr e h
s fr o m t h e b a t h , g et wa r m R est a ft er fo o d
.
,

Or w a l k a s see m s m o st su i t ed t o yo ur m o o d
, .

i n w h a t e er en g a g ed o r sp o r t o r fea t
’

, , ,

1n ot t oo so o n th e b o dy wh en in h ea t .

The Salernitan writ ers were n o t believers in

noonday sleep though one might have e x pected
,

t hat t h e tradi t ion of the si est a in I t aly had been

already established They insist that it makes one
.

feel worse rather than better to break the day b y

a sleep at noonday .

Let n oon t id e sl eep b e b r i ef o r n o n e a t a ll ;

,

E l se st u p o r h ea d a ch e fe v er r h eu m s w ill fa ll
, , , ,

On h im wh o yi el d s t o n o o n t i d e s d r o w sy c a ll
’
.

They believed in light suppers

pp er s w ill the m a ch s p ea ce im p a i r
st o
’

li g h t l y r est ,
cu r t a il t hi n e ev en i n g fa r e .

Wit h regard t o the interval between meals the ,

Salerni t an rule was wait unt il your stomach is

,

surely empty
n ot a
g a n i ill t h
t o u d o st c er t a i n fee l

st o m a c h fr ee d o f a ll i t s r e vi o u s m ea l
y p .

h i s m a yst t h o u k n o w fr o m h u n g er s t ea si n g ca ll
’

r m o u t h t h a t w a t er s su r est si n o f a ll
g
—
.

Pure air and sunlight were favourite tonics at

Salerno
fL et a ir yo u br ea t h e b e sun n y cl ea r a n d li g ht , , ,

i Fr ee fr o m d i sea se o r c ess p o o l s fet t ed b li ght

-
’
.
52 MEDIE V AL MEDICIN E
Taking a hair of the dog that bit you
however a maxim with S alernitans for t h e cure
,

o f po t ation headaches .

Ar t ic k fr o m vi n o u s su r fei t i n g a t n i g h t
s

R epea t t h e d o se a t m o r n t w ill se t t h ee r i g ht
,
’
.

The t radition wi t h regard to the di fficult y of the

digestion of pork which we are trying to combat
,

in the modern time had already been established ,

at Salerno The digestibility of pork could how

.
,

ever b e improved by good wine

,
.

I n fer i o r fa r t o l a m b i s fl
esh o f sw i n e ,

U n q u a li fi ed b y g en r o u s d r a u g h t s o f w i n e
’

B ut a dd t h e w i n e a n d lo yo u ll q u ic k ly fi n d
’
,

I n t h em b o t h fo o d a n d m edici n e c o m b i n ed .

M il k for consumptives was a favourite r ec o m

m en da t i o n The tradition had come down from
.

very Old times and Galen i nsisted that fresh a ir

,

and milk and eggs was the best possible treatment

for consumption The Salernitan physicians
.

recommended various kinds of milk goat s ,

’
,

’ ’ ’
camel s ass s and sheep s milk as w ell as cow s
, ,
’
.

I t is probab le as I p o i n t ed o u t in my
, Psycho ’

”
therapy that t h e mental influence of taking some
,

one of the unusual forms of milk did a good deal

t o produce a favourable reaction in consumptives ,

who are so prone to be a ffected favourably by

unusual remedies The R eg im en warned however
.
, ,

t hat milk wil l n o t be g ood if it p roduc es h e a d a c h e

 B E G INNIN GS OF MEDIC AL E DUC AT I O N 53

’
or if there I S fever Apparently some patients had .

been seen wit h t h e idiosyncrasy for milk and t h e ,

t endency to const ipation and dist urbance after i t

which have been not ed also in t h e modern time .

G o a t s mil k a n d ca m el s a b y a ll i s k n o w n
’ ’

,
s ,

R li e v e p o o r m o r t a l s i n c o n su m p t i o n t hr o wn
e

W h il e a ss s mil k i s d ee m ed fa r m o r e n u t r i t i o u s
’

An d e en b eyo n d a ll c o w s o r sh eep s o ffi c i o u s
’ ’ ’

, .

Bu t sh o uld a fe v er i n t h e syst e m r i o t ,

Or h ea d a c h e let t h e p a t i en t sh u n t h i s di et
, .

Salerno s common sense w ith regard to diet is

’

very well illustrated by a number of maxims D iet .

t inkering was not much in favour .

W e h o ld t h a t m en o n n o a cc o un t sh o ul d v a r y
Th ei r d a ily di et u n t il n ece ssa r y
F o r a s Hi pp o cr a t es d o t h t r u ly Sh o w
D i sea ses sa d fr o m a ll su ch c h a n g es fl
, ,

ow .

A st a t ed di et a s i t i s w ell k n o w n
, ,

O f ph ysi o i s t h e st r o n g est c o r n er st o n e
By m ea n s o f wh ic h i f yo u c a n n o ug h t I m p a r t
, ,

R eli ef o r c u r e va i n i s yo ur H ea li n g Ar t
, .

They believed firmly t hat many of the condi t ions

of eat ing were quite as important as t h e die t i t self ,

and said
D o ct o r s sh o u l d t h u s t h ei r p a t i en t s fo o d r evi se ”

Wh a t i s i t Wh e t h e m ea l P An d wh a t i t s si z e 9
'
n .

How o t W h r e 9 l est b so m e sa d mi st a k e
f en 9 e
.

y .
, ,

I ll so r t e d t h i n g s sh o u ld m eet a n d t r o u b l e m a k e
-
.

They recommended t h e various simples mallow , ,

m int sage rue the vio l et for headache and catarrh

, , , ,
54 MEDIE V AL M EDICINE
the nettle mus t ard hyssop elecampane penny
, , , ,

royal cresses celandine saffron leeks a sovereign

, , , ,
—

remedy for sterili t y pepper fennel ver va i n e —

, , ,

henbane and others

, There were certain speci a l .

a ffect ions as hoarseness catarrh headaches fist ula

, , , , ,

for which specific direct ions for cure were given .

Here for instance are the directions t o be given a

pat ient suffering from rheum or catarrh The .

verses conveyed interesting information wit h nice

long names for the various a ffections as well as the ,

directions for its management .

Fa st w ell a n d w a t ch E a t h o t yo u r d a ily fa r e
.
,

W o r k so m e a n d b r ea t h e a wa r m a n d h u mid a i r
,

O f d r i n k b e sp a r e ; yo u r br ea t h a t t im e su sp en d ;
Th ese t h i n g s o b ser e i f yo u yo u r c o ld w o u ld en d
v .

A c o ld wh o se ill effe c t s ex t en d a s fa r
-

As i n t h e c h est i s k n o w n a s a c a t a r r h
B r o n ch i t i s i f i n t o t h e t h r o at i t fl
,

, o ws ;

C o r yz a i f i t r ea ch a l o n e t h e n o se
, .

The R eg im en conveyed a deal of information in

compact form I t gives t h e number of bones in
.

the body as 2 19 with 3 2 teeth and t h e number of ,

veins as 3 6 5 this numb er being chosen doubt less

,

because of some supposed relat ion to the number

of days in the year I t contains also a good brief
.

account of t h e four humou rs in the human body

black bile blood phlegm and yellow bile ; and of
, , ,

the four t emperaments the sanguine the bilious —

, ,

the phlegmat ic and the melancholy ,

These four .
 B E G INNIN GS OF MEDIC AL EDUC AT I O N 55

temperaments were discussed at considerable lengt h

by all t h e psychologist s and most of t h e writers on
religious life for centuries aft erwards largely on ,

t h e b a sis of the information conveyed by the

Salernit an handbook There are descriptions of .

t h e symp t oms of plet hora or excess of blood of ,

excess of bile of excess of phlegm and excess of

, ,

black bile The lit t le volume finally contain s

.

discussions as to bleeding its indications contra , ,

indications as in youth , E re seventeen years we

scarce need drawing blood a n d in old age ; and —

t hen of the mode of prac t ising it and the place ,

whence t h e blood should be drawn to relieve

*
di fferent symptoms .

E n g li sh l a t i o n s o f t h e R eg i m en w er e m a d e i n 15 75
t ra n s ,

16 07 a n d 16 17
,
Th e t wo l a t t er w er e p r i n t ed ; t h e fo r m er
.

ex i t s i n m a n u sc r i t i n t h e L i b r a r y o f C o r u s C h r i st i C o ll eg e
s
p p ,

O xfo d Th e o p en i n g li n es o f t h e edi t i o n o f 1607 d eser v e t o

r .

b e n o t ed b e c a u se t h ey a r e t h e o r i g i n o f a n ex p r essi o n t h a t
h a s b een fr eq u en t l y q u o t ed si n c e .

Th e S a l er n e S h o o l e d o t h b y t h ese li n es im p a r t
c

All h ea l t h t o E n g l a n d s Ki n g a n d d o t h a d v i se
’

F o m c r e h is h e d t o keepe fr o m w r a t h h i h a r t e
r a a , s .

Dr i n k n o t m u c h w i n e su p li g h t a n d so o n e a r i se
,
'

, .

W h en m ea t i s g o n e l o n g i t t i n g b r eedet h sm a r t s

A n d a ft er n o o n e st ill w a k i n g kee p e yo u r e i es ,

W h e m o u d yo u fi n d yo u r sel fe t o n a t ur e s n eed
’ ’

n ,

F o b a r e t h e m n o t f r t h t m u c h d n g r b r eed s
r e ,
o a a e ,

Use t h r ee p hysi t ia n s st ill r st D r Q u iet ,

—
fi .

A r
ea t D r JI er ry m a n , a n d t h i r d D r Dyet
.
-
. .
56 MEDIE VAL MEDICINE
Salerno impressed itself much more deeply on
surgery t han on medicine for the magnificent
,

development of medieval surgery the knowledge ,

of which has proved so su rprising in our day began ,

down a t S alerno . Some of t h e det ails of this phase

of Salerni t an accomplishm ent are given in t h e
ch a p t er on M edieval Surgeons of I taly Roger .

and Roland and the Four M asters were great

original founders in a phase of medical science that
proved ex t remely import ant for t h e ne x t three or .

four cent uries . U ndoubt edly t h e presence of a .

hospi t al at S alerno where there were gat hered a

,

number of t h e chronic cases from all over E urope ,

most of t hem of t h e better t o do classes looking
- -

for ease from their ills gave the incentive to this

,

development . When the natural means of cure ,

tried for a considerable time failed recourse was , ,

.

had to surgery for relief and oft en with excellent

,

’
results This chapter on S alerno s hist ory shows
.

how t horoughgoing was t h e e ffort of t h e members

of t h e facult y of t h e m edical school t o develop every
possible means of aid for t heir pat ients even when ,

t hat required pioneer work .

’ ’
Pagel s a ppreciat ion of S a lerno s place in t h e
hist ory of medici n e in his chap t er on M edicine i n
,
‘

t h e M iddle A ges in P u sc h m a n n s
’
Handbuch .

D er Geschichte der Me di c i n ”
Berlin 19 02 gives
, , ,

in very b rief space a summary of what wa s aecom

 B E G I NNIN G S OF MED I CAL ED UC AT I O N 57

p li sh e d at Salerno t hat emphasi z es what has been

said here and his aut hority will confirm t hose who
,

might possibly cont inue to doubt of any institution

of t h e M iddle Ages having achieved so much .

He said
I f we t ake up now the accomplishment s of
t h e S chool of Salerno in t h e di ff erent departments ,

t here is one t hing tha t is very remarkable I t is

.

the rich independent productivit y w ith which

,

Salerno advanced the banners of medical science

for hundreds of years almost as the only a u t o c h
,

t h o n o u s centre of medical influence in the whole

West . One might almost say that it was like
a v ersp r en g t en K eim a displaced embryonic
element which as it unfolded rescued from
—
, ,

destruction the ruined remains of Greek and Roman

medicine This produc t ivit y of Salerno which
.
,

may well be compared in quality and quant ity wi t h

that of the best periods of our science and in which ,

no department of medicine was left without some

advance is one of t h e s t riking phenomena of t h e
,

hist ory o f medicine While posit ive progress was

.

n ot made t here a r e many no t ewort hy o riginal

,

observat ions to be chro nicled I t mus t be acknow

.

ledged tha t pu p ils a n d scholars set t hemselves

fai t hfully t o t heir tasks t o furt her as far as their
’

st rength a llowed t h e science and a r t of healing

, .

I n the medical writers of the older period of

8
58 MED I EVAL MEDICINE
Salerno who had not yet been disturbed by
,

Arabian cult ure or scholasticism we cannot but

fl
,

admire t h e clear charmingly smooth easy o win g

, ,
-

diction the delicat e and hones t sett ing forth of

,

cases t h e simplici t y of their method of treatment

, ,

which was to a great extent dietetic and expectant ;

and while we admire the carefulness and yet t h e
copiousness of their therapy we cannot but envy
,

them a certain austerity in their pharmaceutic

formulas and an avoidance of medicamental poly
,

p r a g m a si a The
. work in internal medicine was
especially developed The contributions to it from
.

a theore t ic and literary st andpoint a s well as from

,

”
practical applications came from ardent devot ees
, .

One very interesting contribution t o medical

literature that comes to us from Salerno bears the
t i t le The C oming of a Physician to His Pat ient ,

”
or an I nstruction for the Physician Himself It .

illustrates very well t h e pract ical nature of the

t eaching of Salerno and gives a rat her vivid picture
,

of the medical customs of t h e time The inst ru o

.

tion as to the conduct of the physician when he

first comes into t h e house and is brought t o t h e
patient r uns as follows
When t h e doctor enters t h e dwelling of his
pat ient he should n o t appear h a ught y , nor
,

co vetous but should greet wit h kindly mo dest

, ,

demeanour those who are p r esent a n d then seating

,
 B E G INNIN GS OF MEDICA L EDUC AT I O N 59

himself near the sick man accept the drink which

is o ffered him [si c ] and praise in a few words t h e
,

beaut y of t h e neighbourhood t h e sit uat ion of t h e

,

house a n d t h e well known generosity of t h e family

,
-

—
i f it shoul d seem t o him sui t able t o do so The .

pat ient should be p u t a t his c a se before t h e

examinat ion begins and t h e pulse should be felt
,

deliber a t ely and carefully The fingers should be

.

kep t on the pulse at least unt il t h e h undredt h beat

in order to judge of i t s kind and charact er ; the
friends standing round will be all t h e more
impressed because o f t h e delay and t h e physician s
,
’

words will be received wi th just that much more

attent ion .

The rest of t h e advice smacks rather more of

sophistication than we care t o t hink of in a
professional man b ut its display of a profound
,

knowledge of human nat ure makes it interesting .

On the way to see the sick p erson he ( t h e

physician ) should quest ion t h e messenger who has
summoned him upon the circums t ances and t h e
condit ions of t h e illness of the p a t ient ; then if not
,

able t o make any posit ive diagnosis after exam ining

t h e pulse and t h e urine he will at leas t excite t h e
,

pat ient s as t onishment by his accurate knowledge

’

of t h e symp t oms of the disease and thus w in his ,

confidence .

Salerno taught as well as it could the science of

medicine and initiated great advances in surgery ;
,

b u t it also emphasized the art of medicine and ,

60 MEDIE VAL MEDICINE
recogni z ed very clearly that the personalit y of the
physician counted for a great deal and that his
,

influence upon his patients must be fostered quite

as sedulously as his knowledge of the resources of
medicine for t h eir ills
.
 C HAPT E R I V
M ONTP E LL I E R AND M E D I CAL E DU CAT I O N I N TH E W ES T

A F T E R Salerno t h e next great medical school was

that of M ont pellier in t h e Sout h of France The .

conditions which brought about its original estab

li sh m en t are very like those which occasioned the
foundation of Salerno M ontpellier situated not
.
,

far from the M editerranean came to be a health

,

resort . Patients flocked to it from many countries

of the West of E urope ; physicians settled t here
because patients were numerous and medical ,

instruction came to be o ffered to students Fame .

came to the school The fundament al reason for

.

this striking development of the intellectual life

seems to have been that M ontpellier was n o t far
from M arseilles which had been a Greek colony
,

originally and continued to be under Greek

influence for many centuries As a consequence
.

of t his the artistic and intellectual life of the

sout hern part of France was higher during t h e
earlier M iddle Ages than that of any other part of
E urope except cert ain portions of South I taly
,
.

The remains of the magnificent architecture of the

61
62 MEDIEV AL MEDICINE
Roman period are well known and Provence has
,
'

always been fa m ous for it s i n t ellec t u a l and literary

life. Among a people who were in this environ
ment we might well look for an early renaissance
,

of education .

I t is n o t surprising t hen that one of the earliest

, ,

o f t h e medical schools of modern history around

which there gradually developed a universit y Should

have come into existence in this part of the world .

What is even more interesting perhaps for us is ,

that this medical school has persisted down to our

own day and has always been for ne a rly ten
, ,

centuries now a centre of e x cellent medical

,

education .

There gathered around the story of its origin

such legends as were noted w ith regard to t h e
hist ory of Salerno and t here is no doub t that
,

Jewish and M oorish physicians who became pro

fesso r s there contributed not a lit tle to the prestige
of t h e school and t h e reput ation t hat it acquired
throughout E urope .The attempt to at tribute
all of the stimulus for the int ellectual life at
M ontpellier to these foreign elements is however, ,

simply due to that parado x ical state of mind which

has so oft en tried t o minimize the value of C hristian
cont ributions to science and t h e intellectual life ,

even b y the exaggerat ion of the significance of

what came from foreign and u m C hrist ian sources
-
.
 MEDICAL EDUC AT I O N IN TH E WE ST 63

Proper recognit ion must be accorded to bo t h

Jewish and M oorish fact ors a t M ontpellier b u t t h e ,

one important element is t hat these foreign pro

fesso r s brought wi t h t hem even t hough always i n
,

ra t her far fet ched t ranslat ions t h e ideas of the

-

great Greek mast ers of medicine to which t h e region

and t h e people around M ontpellier were particularly
sensitive because of the Greek element s in the
,

population and hence the development of a

,

significant cent re of education here .

The dat e of the rise of the medical school at

M ontpellier is as suggested by P u sc h m a n n veiled
, ,

in the obscuri t y of tradition There seems t o be

.

no doubt that it goes back to as early as the tenth

century i t was already famous in the elevent h and
, ,

i t att ract ed students from all over E urope during

t h e twelft h cent ury When Bishop Adalbert of
.

M ain z came t hit her in 113 7 the school possessed

‘

buildings of its own as we learn from the words of

,

a cont empora ry Bishop Anselm of Havelberg

, .

St Bernard in a letter written in 115 3 tells that

.

the Archbishop of L yons being ill repaired to , ,

M ontpellier t o be under the treatment of t h e

physicians t here Perhaps t h e most int erest ing
feat ure of this let t er is t h e fact t ha t t h e good
Archbishop n o t o n ly spen t what money he had with
him on physicians b u t ran int o debt
, .

The two schools Salerno a n d M ontpell ier came

, ,
64 MEDIE V AL ME DI CINE
to be mentioned by writers of the period as r ep r e
sent ing the twins of medical learning of the time .

John of Salisbury a writer of the early thirteenth

,

century declares t hat those who wished to devote

,

t hemselves to medicine at this time went either to

Salerno or M ontpellier ZE g i diu s or Gilles de
.

C orbeil the well known physician and Hartmann

,
-

von der Aue t h e M eistersinger both mention

, ,

Salerno and M ontpellier usually in association in

, ,

their writ ings and make it very clear that in the

,

West at least the two names had come to be almost

invariably connected as representing rival medical
schools of about equal prominence .

The reputati on of M ontpellier spread in I tal y

also however and we have the best evidence for
, ,

this from an incident that took place in Rome at

the b eginning of the thirteenth century which is ,

more fully dwelt on in the chapter on M edieval

Hospit als . Pope I nnocent II I wanted to create .

a model hospital at Rome and made inquiries a s ,

to who would be best fitted t o organize such an

in st it ut ion He was told of t h e work of Guy or
.

Guido of M ont pellier who was a member of t h e

,

Order of the Holy Ghost a n d had made a great

hospit al at M ont pellier A ccordingly Guy was
.

summoned t o Rome and the est a blishment of t h e

,

Santo Spiri t o Hospital was entrust ed to him It .

wa s o n the model of t his that a gr e at many hos p itals

 MED I CAL EDUCAT I O N IN TH E W E ST 65

were founded throughout the world for Pope ,

I nnocent insisted t hat every diocese in C hristianity

should have a hospital and Bishops wh o came on
,

formal v1sit s to the Holy See were asked to inspect

t h e Sant o Spi rito for guidance in their own diocesan
hospital establishments M any of the hospitals
.

throughout the world came as a result to b e hospitals

of the Holy Ghost and this contribution alone of
M ontpellier to the medical world of the time was
of great significance and must have added much t o
h er prestige .

M ontpellier like Salerno seems to have attracted

, ,

student s to its medical school from all over the

world There were undoubt edly many E nglish
there and probably also I rish and Scotch though
, ,

the journey must have been much longer and more

difficult to make t han is that from America to
E urope at t h e present t ime O f course t here came
.

many from Spain and from N ort h France and t h e

N et herlands The fact that a number of I talians
w ent t here before t h e close of t h e M iddle Ages
shows how deeply in t erest ed were t h e men of this
time in knowledge for i t s own s a ke a n d indicates
,
l

t hat some t hing of t ha t i n t er n a t i o n a lit y o f cul t ure

which we are priding ourselves on a t t h e present
t ime because our s t udent s from all coun t ries go
,

far afield for pos t graduat e work and t here is an

i nt e rcha n g e of professo r s e x isted a t t his pe riod
, .

9
66 ME DIEVAL MED I CINE
I n spite of the fact that books w ere only w r itten
by hand the teaching of distinguished professo r s
,

had a wide diffusion and students w ere quite ready

,

to go through the drudgery of making these hand

’
written copies o f a favourite master s work They.

had plenty of common sense as w ell as powers of

O bservation , and some of their w riti n g is still of
great practical value .

A numb er of men who are famous in the history

of medicine made their medical studies at M ont
p ell i er in the twel fth and thirteenth centuries .

Among them are M ondeville who af t erwards ,

taught surgery at Paris ; and Guy de C hau liac who ,

w as a Papal Physician at Avignon and at the same

time a professor at M ontpellier probab ly spending
,

a certain number of w eeks or perhaps months

, ,

each year in the university town Sketches o f

.

these men and of other students and teachers at

,

M ontpellier who reached distinction in surgery ,

w ill be found in t h e chapter on Surgeons of the

West of E urope . Some other distinguished
M o n t p elli er ia n s deser ve brief mention .

On e of the disti nguished p rofessors at M ont

p e ll i er was the well k nown
-
Arnold de V illan o va ,
"
of whose name there are a num ber O f vaTi an t s
'
i
’

including even R a in aldu s and R eg in a ldu s In .

128 5 he was a lready a famous physician and wa s ,

sent for to treat Peter I II King of Aragon who ,

 MEDIC AL EDUC AT I O N IN TH E WE S T 67

was severely ill I n 12 9 9 he was summoned on a

.

consultation to the bedside of King Philip the

H andsome (le Bel) at Paris After this we hear
.

of him in many places as at the C ourt of Pope

,

Benedict X I at Rome and in 13 08 as the

.
,

physician and friend of Pope C lement V at .

A vignon . His writings were printed in a number

of edit ions in the Renaissance time V enice 1 5 05 , ,

L yons 15 09 15 2 0 15 3 2 Basel 1 5 8 5 and his

, , , ,

medical and astronomical and chemical works in

separate volumes at L yons in 15 8 6 .

His aphorisms are well known and used to be ,

frequently quoted during the M iddle Ages and

afterwards and some of them deserve to b e remem
,

bered eve n at the present time For instance .

,

he said f lW h er e the veins and arteries are notably

’
‘‘

large i n c I SI O n and deep cauteriz ation should b e

,

”
'

avoided . When cauteri z ation is to be done

the di rect cautery should b e used ; caustic applica
”
tions are only suit able for very timid patients .

The lips of a w ound will glue together of

t hemselves if there is no foreign substance b etween
them and in this way the natural appearance of
,

”
the part will be preserved I n large wounds
.

su tures should be used and silk thread tied at short

,

”
distances makes the best sutures The i n fec
.

tion o f the du r a mater is followed in most cases

”
by death . A collection of p u s is b est dissolve d
68 MEDIE VAL M EDICINE
by incision and cleaning out of the purulent
”
material . To put o ff the opening of an abscess
”
b rings many dangers with it . I n most cases
of scrofula external applicat ions are better than the
use of the knife Scrofulous patients always have
.

other sources of infection within them and so it ,

”
does them no good to operate externally .

Tranquil and pure air is the b est friend for

convalescents
V illanova advised that the b ite of a mad dog
should not be permitted to heal at once but the ,

wound sho uld be enlarged and allowed to bleed

fr eely leeches and cups being used to encourage
,

bleeding and healing should not be permitted for

,

forty days .H e believed very thoroughly in

drainage and in the dilation of narrow fi st ulo u s
,

ope n i ngs .He describes anthrax or carbuncle and ,

has chapters on various painful conditions for which

he employs the terms arthritis sciatica chiragra
, , ,

podagra and gonagra

,
.

V illanova s treatment of t h e subject of hernia

’

shows how thoroughly conservative he was and how ,

careful were his ob servat ions I n young persons

in recent hernias he advised immediate complet e
reposi t ion of the contents of the sac t h e bringing
,

together of the hernial opening by means of

a dh esw e plaster above which a bandage was placed
‘

, ,

a n d the p a tient should b e pu t to b ed w ith t h e feet

 MEDIC AL EDUC AT I O N IN TH E W E ST 69

and legs elevated and the head depressed for ten

to fift een days or more if necessary .He says that
Il there are some especially surgeons who claim
‘‘
— —

that they can cu re herma by incision and some ,

others by means of a purse string ligat ure and

-

s t ill others b y the cautery or by some caut eri zing

material [they manifes t ly had our complete cata
logue of fakes in the matter ] but I prefer not
to mention these procedures since I have seen
,

many patients perish under them and others ,

brought into serious danger of deat h and I do not ,

t hi nk that the surgeon will acquire glory or a n

increase of his friends from such perilous pro
”
c e du r e s and I do not approve their use
, .

One of the important writers of M ontpellier w as

G ilb ert u s Angli cus ( Gilbert the E nglishman ) who ,

is called in one of the old translations of M esu e

D o c t o r D esi der a t i ssi m us which I suppose might
,

”
be Anglicized loveliest of doctors . After his
st udies in E n gland he went for graduate work t o
some of the famous foreign universities a n d is ,

named as a chancellor of M ontpellier His best

.

known work is his C ompendium M edi c in ae ,

which bore as it s full title The C ompendium of

M edicine of Gilbert the E nglishman ; useful n o t
only t o physicians but to clergymen for the t reat
,

ment of all and every disease . G u r lt says that

it contains li t tle that is original b eing a copy of
,
70 MEDIEVAL MED I C I NE
Roger of Parma and Theodoric of L ucca with a ,

number of quotations from the Arabs nearly all ,

of whom Gilbert seems to have read with consider

able attention I t is interesting to fi nd that
.

Gilbert was definitely of the o pinion that cancer is

incurable e x cept by l Il Cl Sl O Il or cauteri z ation He .

declares that it yields to no medicine except surgery .

A nother of the men whose names are connected

with M ontpell i er was John of Gaddesden Often ,

called JCa n n es An g li c us H e was

. a student of
M erton C ollege and received his degree of doctor
,

of medicine at O x ford H e studied afterw ards at

.

M ontpellier and also at Paris and settled down to ,

practise in L ondon He treated the son of King

.

E dward II for smallpo x and having wrapped him

.
,

in red cloth and made all the hangings of his bed

red so that the patient was completely surrounded
,

by this colour he declared that he made

, a good
cure and I cured him without any vestiges of the
,

”
pocks The treatment is interesting as an
.
,

’
ant icipation in a certain way of F i n sen s red light
treatment for smallpo x in our own time Hanging
.

the room and esp ecially the doors and the windows
, ,

with red when smallpox was to be treated was

a favourite treatment down at M ontpellier .

G a dde sden s book is called by the somewhat fan ei

’

ful name Rosa Anglica Bernard Gordon of

.

”
M ontpellier had w ritten a L ilium M edicin es ,
 MED I C AL ED U C AT I O N I N TH E W E ST 71

and we have a Flos M edi c i n ae from S alerno ,

so that flo we r names for medi cal te xtbooks were

evidently the fashion of the time .

G a ddesden s book is almost entirely a comp ila

’

tion and except in the relation of his surgical

,

e x perience contains little that is new

, Guy de .

C hauliac was quite impatient w ith it and declared ,

that lately there had arisen a foolish Anglican

rose which was sent to me and I looked it over .

I expected to fi nd the odour of sweetness in it but .

,

I found only some old fables The criticism is

.
,

however as G u r lt remarks too severe and not

, ,

’
quite justified representing rather Guy s high
,

ideal of the originality that a new tex t boo k should

‘

possess than a legitimate critical opinion

, I f our .

own t e xtbooks were to be judged by any such lofty

standard most of them woul d suffer rather severely
, .

Another of the well known teachers at M ont

-

p e ll i e r was V a le sc o de Taranta There are the .

u sual variants of his name his first name being ,

written also Ba lesc o and his last name sometimes

,

Th a r a n t a . H e wa s a Portuguese who studied in

L isbon and later in M ontpellier where he taught
, ,

aft erwards a n d was considered one of t h e dist in

g u i s h e d professors of his day being for a t ime ,

chancellor He became so well known that he

.

w as summ oned in consultation to t h e French King

C h a rl e s V I and there is some doubt as to whether
.
,
72 MED I EV AL MEDICINE
he did not become his regular physician One of .

his works the , Philonium P h a r m a c eu t i c u m et

Chirurgicum de m eden di s omni b us cum in t er n i s ,

”
tum ex t er n i s humani corporis a ff e c t i o n ib u s had
, ,

t h e honour of being printed at L y ons in two

edi t ions in 14 9 0 and one at V enice the same y ear
, ,

at L yons 15 00 V enice 15 02 L yons 15 16 15 2 1

, , , ,

1 5 3 2 15 3 5
, V enice 15 8 9 and Lyons 15 9 9
, , It .

has also been reprinted subsequently in a number

of editions so that it must have b een a much read
,
-

book Va lesc o had two favourite authors Galen ,

and Guy de C hauliac The fact t hat he should

.

have appreciated two such great men so thoroughly

is of itself the best evidence of his own ability and
crit ical judgment His book from the number of
.
,

printed edit ions must have been I n t h e hands of

,

pract ically all t h e progressive physicians of the

southern part of France at least during the ,

fift eent h si xteenth and part of the seventeenth

, ,

centuries .

A very well known t eacher of M ontpe llier who

-

has had a reput at ion in E nglish speaking countries -

because h i s name was supposed to indicat e that he

was a S co t chman was Bernard Gordon or ,

de Gordon whose name is however also wri tten

, , ,

Gourdon . He was a teacher at M ont pellier at

t h e end of t h e thirteenth and t h e b eginning of the
fourteent h century H is te xt boo k of me dici ne
.
,

in accordan ce with the c ustom of the ti m e is called ,

 MED I C AL EDU C AT I O N I N TH E WE S T 73

by the flowery title L ilium M edi c i n ae the L ily ,

of M edicine While much of his information was

.

derived from the Arabs some of his teaching was ,

an advance on theirs and he described the acute ,

fevers leprosy scabies anthrax as well as

, , , ,

erysipelas and still more strangely phthisis as

, ,

contagious D r Garrison has called attention in

. .

his Hist ory of M edicine to the fact that the

book is notable as containing the first description
of a modern truss and a very early mention of
,

spectacles under the L atin name o c u la s b er elli n us .

I n recent years it has come to be the custom to

think of Gordon or Gourdon as prob ably not of
S cotch but of French origin that is born some —
,

where i n the confines of w hat we now call France .

There are a number of French places of the name

of Gourdon from any of which he might have come .

M ontpellier represented for the West of E urope

then very nearly what Salerno did for I taly and
E astern E urope I t very probably attracted many
.

of the E nglish and S cotch students of medicine ,

t hough not all the names supposed to be of British

or igin have proved to be so w ith the development
of our knowledge M ontpellier has survived
.
,

however while Salerno disappeared as a force in

,

medical educ a tion I t s story would well deserve

.

t elling in detail and doubtless the new national

,

spi r it of the French aft er the war wi ll p r ove an

incentive to the writing of it .
 C HAPT E R V
LATE R M E D I E V AL M E D I CI NE

M E D I CI NE in t h e later M iddle Ages that is from , ,

the tent h to the middle of the fifteenth centuries ,

was greatly influenced by the medical schools

which arose in I taly and the West of E urope during
this period These were organized mainly in
connection with universities Salerno M ontpellier
, , .

Bologna Paris Padua in the order of their foun

, , ,

dat ions so far as they can be ascertained

, These .

university medical schools represented serious

scientific teaching in medicine and certainly were
,

not more prone to accept absurdities of therapeut ics

and other phases of supposed medical knowle dge
than have been the universities of any ot her
corresponding period of t i m e Five centuries
.

represent a very long interval in the history of

humani t y and provide opp ort unit ies for a great
,

many c urious developments and ups and downs of

inte r est all of which must not be considered as
,

r epre senting any p articular genera tion or even

74
 L ATE R MEDIEVAL MEDICINE 75

century in the history of that time The .

absurdities came and went quite as in more modern

times ; but all the while there w as an undercurrent
of solid medical knowledge founded on observation
,

and definite clinical research superadded t o the

,

in formation Obtained from the classics of medicine .

E ven as early as the t enth century the thoroughly

conservative t eaching of Salerno in medicine made
it self felt and above all counteracted the Oriental
,

tendencies to over r efi n em en t of drugging which

-

had led to the so called calendar prescription

-
This .

was the most noteworthy element in the medical

practice of t h e later M iddle Ages but its sig n ifi
,

cance has been dwelt on in the chapter on Salerno

and the Beginnings of M edical History While.

Arabic polypharmacy is the most striking feature

of M ohammedan influence on medicine at this time ,

there were a number of Arabian and Jewish

physicians who made a deep impression on t h e
medicine of t h e later M iddle Ages that is su b se
—
,

quent to the t enth century Their work was felt

.

not only in their own time but for many subsequent

,

centuries even down to and beyond the Renaissance ,

and they therefore must find a place in medieval

medical history . This influence was exerted ever
so much more outside of I taly than in t h e Italian
peninsula where t h e t radition of t heir contact wit h
,

the original Gree k authors sti ll remained and where

,
76 MED I EVAL MEDICINE
they we r e making medicine and surgery for them
selves quite apart from Arabian influence .

The more one knows about the c o nditions in

I talian medicine the less question is there of
Arabian contributions to it . D e Renz i in his
H istory of I talian M edicine makes it very clear
that the Arabs exercised no significant influence
ei t her at Salerno or elsewhere . The Benedictines
and C assiodoru s a fford evidence of the study of
the Greek medical classics in L atin translations .

M uratori cites a manuscript whi ch he had consulted

in the M edicean L ibrary at Florence and which , ,

though written b et ween the eighth and ninth

centuries says not a word of the A rab s and b ears
,

the title of Abstracts from Hippocrates Galen , ,

Orib asius H eli o do r u s Asclepiades Archigenes

, , , ,

D i o c li s Am yn t a s
, , Apollonius Nym p h i o do ru s
, ,

R u ffi u s E p h esi n u s Soranus n i n et a and Palla

, , , ,

”
din s. These and not t h e A rab s were the masters
of the I talia ns and it was fortunate for the world
, ,

was thus saved many A rab ian mistakes and their

tendenc y to neglect surgery .Before Salerno
b egan to e x ert its r eal influence some of the ,

Arabian physicians came t o occup y places of

prominence in the medicine of the time .

The most important of these wa s Ag gcg g ng , b ornz

toward t h e end of t h e tenth century in the Persian

province of Ch o r a sa n at the height of A rabian
,
 L ATE R MEDIE V AL MEDICINE 77

i n fluence He is sometimes spoken of as the

.

”
Arabian Galen His famous book . The C anon , ,

was the most consult ed medical book t hroughout

E urope for centuries There are very few subject
.

in medicine that did not receive suggest ive t reat

ment at his hands He has defini t e informat ion
.

with regard to Bubonic plague and the fi la ri a

m edi n en si s H e has special chapters with regard
.

to ob esity emaciation and general constitutional

, ,

conditions He has chap t ers on cosmetics and on

.

a ffections of the hair and nails that are interesting

reading . The Renaissance scholars wrote many
commentaries on his work and for long after the ,

introduction O f printing his influence was felt

widely .

His Arabic colleague in the West w as Aven z o a r ,

to call him by the transfo r mation of his Arabic

family name I bn Z ohr , He was born near
-
.

Seville and probably died there in 1 16 2 well past

, , ,

ninety years of age H e w as the teacher of

.

Averr Oes who always speaks of him with great

,

respect . H e is interesting as probably the first to

suggest nutrition per rectum His apparatus for .

the purpose consisted of the bladder of a goat with

a silver cannula fastened into its neck Having .

first carefully washed out the rectum with cleansing

and purifying clysters he inject ed the nutriment ,

eggs milk and gruel into the gut

, , His idea was
—
.
78 MEDIEV AL MED I CINE
that the intestine would take this and as he said , ,

suck it up carrying it back to the stomach where

, ,

i t would be digested .

The bladders of animals were very commonly

used by t hese M oorish physicians and by their
disciples and the profession generally for genera
, ,

t ions for a great many purposes for which we now

,

use rubber bags . Abulcasis for instance used a

, ,

sheep s bladder introduced int o t h e vag ina a n d filled

’

with air as a colpeurynter for supporting the organs

in the neighb ourhood and also in fractures of the
,

pubic arch .

Av en z o a r suggested feeding p er r ec t um in c ases

of stricture of the oesophagus but he also treated
,

the oesophageal stricture directly He inserte d a

.

cannula of silver through the mouth until its head

m et an o b struction .This was pushed firmly but ,

withdrawn whenever there w as a vomiting move

ment until it became engaged in the s t ricture
, .

Through it th en fr esh ly m i lked milk or gruel made ,

fr om farina or barley was to b e poured He had

, .

evident ly seen cases improve this way and there ,

fore must have had experience with functional

stricture of the oesophagus He adds that some
.

physicians b elieve that nutrition may be absorb ed

through the pores of the whole body and that ,

therefore in these cases the patient might be put in

a w arm milk or gruel bath ; but he has not ve r y
 LATE R MEDIEVAL MED I CINE 79

much fait h in the procedure and says t hat t h e ,

reasons urged for it are weak and rather frivolous .

I t is easy to understand tha t a man who could

recommend manipulat ive modes of treatment of
such kinds and discuss questions of nutrit ion so
,

sensibly knew his medicine very practically and

,

wrot e of it judiciously .

M aimonides ( 113 5 1204 ) was one of these wise

-

old Jews who quo t es with approval from a Rabbi

of Old who had counselled his students Teach
”
thy t ongue to say I do n o t know
, Kno wing
.

t hus t h e limitat ions of his own knowledge it is n o t ,

surprising t hat M aimonides should have left a series

of pract ical observ a t ions for t h e maintenance of .

health which represent the common sense of all t ime

in the matter . M aimonides ant icipated t h e
modern rule for taking fruits before meals as we ,

all do now at breakfast a n d so O ften as fruit cock

,

tails at the beginning of other meals He thought

.

that gr apes figs melons should be t aken before

, , ,

meals and not mixed wi t h other food

, He set .

down as a rule that what was easily diges t ible should

be eat en a t the begi n ning of t h e meal to be followe d,

by what was more di fficult of digest ion He .

declared it t o be an a x iom of me di cine t ha t so

long a s a man is able t o be active and vigorous ,

does n o t eat until he is o ver full a n d do e s n o t

,

”
suffer from co n st ip a tion he i s n o t li a ble t o di sea se
, .
80 MED I EVAL ME DI C I NE
I‘

’
Salerno s influence was felt much mo r e deeply
on surgery than on medicine as can be seen very,

clearly from the chapter on M edieval Surgeons

I taly
. These great surgeons of the period were
also the leaders in medicine for almost needless
—

to say there was no separation between the two

,

modes of practice men were as a rule both

—

physicians and surgeons even though for us their

,

most important work by far was done in surgery .

C ertain passages from the works of these great

surgeons that have come down to us deserve a place
in the treatment of the more distinctly medical
questions of the time .

’
L anfranc the great French surgeon s description
of the treatment of the bite of a rabid dog is inter
esting . He suggests that a large cupping glass -

shoul d be applied over the wound so as to draw , .

out as much blood as possible After t his the.

wound should b e dilat ed and thoroughly cauteri z e d

to its depths with a h o t iron I t should then be
.

covered with various substances that were supposed

to draw in order as far as possible to remove
,

the poison His description of how one may

.

recogni z e a rabid animal 1s rather striking in the

light of our present knowledge for he seems to ,

have reali z ed that the main diagnostic element

i s a change in the disp o sition of the animal b u t ,

ab ove all a defini te tendency to lac k playful ness .

 L ATE R MED I EV AL MEDIC I NE 81

L anfranc had manifest ly seen a numb e r of cases

of true rabies and descri b es and suggests tr eatment
,

fOr them though e videntl y without very much

,

confi dence in the success of the treatment .

The treatment of snak e b ites and the b ites of

-

other animals su pposed to b e poisonous or at least

,

suspicious followed the principles laid down for

,

handling the bite of a mad dog This was the case

particularly as to the encouragement of free blee d
ing and the use of the cautery .

A characteri stic e x ample of the powe r of clinical

observation of the medieval physicians and one ,

which illustrates much b etter than many of the

ab surd tales told as typical of their superst itious
tendencies b ut really representing that tendenc y
,

always present in mank ind t o b elieve wonders is ,

to b e found I n how much they learned of rabies .

E ven in our own time there are man y ab surd b eliefs

with regard to this disease with some den ials of
,

its e x ist ence and many grossly e x aggerated tales ,

widely believed ; y et the medieval people seem

to have reached some quite rational notions with
regard to it Bartholom aeus Anglicus is the
.

author of a p opular encyclopedia which was

very widely read in the medieval period He wa s
an E nglish Franciscan of the thirteenth centu r y ,

who gathered together a lot of information and

w rote a volume that fo r centuries after his time ,

11
82 MEDIEVAL MEDICINE
e ven d own to Shakespeare s b oyhood was popular ’
,

in E ngland .

H ere is his description of rab ies as he k new it .

The most important element is his recognit ion of

the uncertainty of the l e n gt h of the incub ation
period but it contains t wo other ideas that are
,

very interesting because medicine in subsequent

,

centuries has come b ac k to them over and over

again .One is that free bleeding may remove the
Virus and the other that the cautery may help in
,

preventing the infection .

The b iting of a wood hound is deadly and -

venomous and such venom is perilous

, For it is .

long hidden and unknown ; and increaseth and

multiplieth itself and is sometimes unknown to the
,

y ear s end and then t h e same day and hour of t h e

’
,

biting it cometh to the head and b r eedet h frenzy , .

They that are bitten of a wood hound have in their -

sleep dreadful sights and are fearful astonished

, , ,

and wroth w ithout c a use And they dread to be .

seen of other men and bark as b o u n ds and they

, ,

dread wat er most of all things and are afeared ,

thereof full sore and squeamous also Against the

, .

b iting of a wood hound wise men and ready use to

-

make the wounds bleed with fi re or with iron that ,

the venom may come out with the blood that

”
cometh out of the wound .

A very interesting development of therapeutics

in the M iddle Ages was the employment of t h e red
li g ht tre a tment to Short en the course and the
 LATE R MEDIE V AL ME DICINE 83

severity of the fever in smallpox a n d above all to

,

prevent pitting ; it was empl oyed successfully by

John of Gaddesden I n the case of t h e son of King
E dward II Recent investigation by Ch o lm eley
.

has shown that bo t h G ilb ert u s Anglicus ( 12 9 0) and

Bernard de Gordon ( 13 05 ) ant edated John of
Gaddesden in references to t h e red light treatment .

All of these m en w ere professors at M ontpellie r ,

showing that the medical school of the South of

France was a rival i n the use of natural methods of
cure to its better known predecessor of Southern
-

I taly . C ur iously enough the , Rosa Anglica

of Gaddesden in which the reference to the red
,

light is made is deservedly characteri z ed by

,

Garrison as a farrago of Arabist quacke ries and

c o u n t r ifi ed superstitions it well deserves Guy de
Ch a uli a c s bitter criticism of it as
’
a scentless
”
ro se.

The idea included under the word a u t o i n t o xi c a

t ion in our time t hat is that the human body has
—
,

a tendency t o produce poisons within itself which ,

act deleteriously on it and must be eliminated

was a favourite one during the M iddle Ages . It
became the cust om in our t ime to have recourse to
antiseptics or to surgical measures of various kinds
for t h e relief and prevention of autointo x ication .

I n the M iddle Ages they t hought to reduce its

harmfulness at least by di rect elimination hence ,
84 ME DIEVAL ME DI C I NE
the use of drastic purgatives I t seems worth while
.

remarking however that the employment of these

, ,

did not come into general use until the close of the
M iddle A ges . Basil V alentine if he really live d
,

in the M iddle Ages and i s not merely a name for

,

a w riter of the earl y si x teenth century as modern ,

historians seem inclined to think suggested the ,

use of antimony for the removal of the m a t er i es

m o r b i from the body th at has so much obsessed

p h y sicians for many generations Antimony. con

tinn ed to be used down to the nineteenth c entury .

I t was gradually replaced by venesection which ,

was employed very st r enuously during the

eighteenth and early nineteenth centuri es in spite ,

of the o bjection of such men as M orgagni ; who

refused to al low this mode of treatment to b e used
on hi m.

V enesection was succeeded by large doses of

calomel and the calomel era continue d on almost
,

to our own generation .

A s a rule however the medieval p hysicians

, ,

trusted nature much more than did their colleagues

of modern history that is after the R en a l ssa n c e
—
,

until the present epoch of medical science b egan

‘

I t has always been di fficult however for physicians

, ,

to continue long in the persuasion that nature is a

helpful auxiliary and not a hampering factor to
,

b e comb ated . I t is all the more to the credit of

 L ATE R MEDIEV AL MEDIC I NE 85

the medieval physicians to find then that in spite , ,

of many absurdities t hey cont inued for all t h e later

centuries of the M iddle Ages to extol the value of
the natural means of cure .

I shall have much to say of John of Ar der n in

t h e chapter on M edieval Surgeons of the West of
E urope but he des erves a place also in the chapter
,

on M edicine Ar der n s advice to patients suffer

.
’

in g from renal disease which is contained in a

,

separate tract of his lesser writings with the title

in an old E nglish version of The G o ver n a u n c e of
”
Nefr et ykes is extremely interesting because it
, ,

shows very clearly how long ago thoughtful

physicians anticipated most of the directions that
we now give such patients Though we are .

inclined to think that any real knowledge of renal

disease is quite modern and above all has come
,

since Bright s time this paragraph of Ar der n s

’
,
’

shows how long before definite pathological know

ledge had developed careful clinical O bservation
,

worked out e m pirically the indications of the

affection . The paragraph is of special interest ,

because it contains the first reference to the possible

danger that there may be for suff erers from kidne y
disease using t h e dark or red meats rather t han the
white meats The tradition as to the distinction
.

between the red and white meats has continued ever

since his time and though our modern chemistry
,
86 M E DI E VALgME DI CI NE

does not enable us to find any such distinct ion

bet ween these subst ances as would just ify the
di ff erent iation thus dwelt on it has b een maintained ,

for no other reason that I have ever b een able to

find than becau se of the long y ears of tradition and
*
clinical ob servation behind it .

Nefr et ykes must p utte ire h yg hly and a wey ,

moche b esyn esse and a lm a n er e [business and all

manner of ] t h yn g e that longeth to the soule saff
[ save ] only joye They schulle
. f o r b e r e
a lm a n e r e m et ys that ben t o grete of su b st a u n se and

viscous as olde b eeff that is m yg h t yly p o o u dr yd

,
r

and en h a r ded with salt and also fr essc h p o r ke but

f it lye in salt iiii dayes afore They mowe
fl
y .

use grete wyne and the f essc h of c a lvys t hat ben

S o me of t h ese ol d m edica l
di t i o n s c o m e d o w n t o us
t ra
fr o m m a n y m o r e c en t u r i es t h a n we h a v e a n y i d ea o f u n t il we
b eg i n t o t r a c e t h e m O r di n a r ily i t i s p r esu m ed t h a t t h e
o f sm a ll a m o u n t s o f fl
.

a d vic e wi t h r e a r d t o t h e t a k i n ui d
g g
d u r i n g m ea l s co m es t o u s fr o m t h e m o d er n p hysi o l o g i st s .

Th e B a b ees B o o k a v o l u m e o n e t iq u e t t e fo r
“ ”
In , y o un
g
fo l k s i ssued i n t h e t h i r t een t h c en t u r y t h er e i s a m o n g o t h er
,

a dvic es a s fo r i n st a n c e n o t t o l a u h o r S ea k wh il e t h e
, , , g p
m o ut h i s full o f m ea t o r d r i n k a n d a l so n o t t o p ic k t h e
“
,
”

t ee t h w i t h k n i fe o r st r a w o r w a n d o r st ic k a t t a b l e t hi s
”
,

w a r n i n g : W h il e t h o u h o ld est m ea t i n m o u t h b e w a r e t o
“

d r i n k ; t h a t i s a n u n h o n est ch a r e ; a n d a l so p hysic k fo r bid s

i t qu i t e I t wa s a n u n h o n est c h a r e b ec a u se t h e d r i n k i n g
”
.

c up s w er e u sed i n c o mm o n a n d d r i n k i n g w i t h m ea t i n t h e
,

m o u t h led t o t h ei r so ili n g t o t h e di sg u st o f su cc eedi n g

,

d r i n k er s All t h e g en er a t i o n s e v er si n ce h a v e b een i n sl a ver y

.

t o t h e ex p r essi o n t h a t si o fo r b i d s i t q u i t e
”
h a n d n o w we
p y ,

k n o w w i t h o u t g o o d r ea so n .
 LATE R MED I EV AL MEDICINE 87

so o wkyn g eand also of all ffo wlys saff thoo that b en

of the la kys and dichys [dykes ]
squamous ffyssc h es i e fyssc h of t h e rivere of
, . .
,
" and
,

the stony w a t erys and r en n yn g e ryver es and not of

the st a n dyn e wa t er ys a n d t hey schulle e sc h ywe
[ eschew ] a lm a n er mete made of p a a st [ pas t ries ]
and all bred that is do wg h b a ken e and all fa t n esse .

A nd they schulle use the reynes of t e b eest e other

rost e or sode And in especial] he schall use a
.

ffo wl that is c a llyd C auda t remula or W a g st er t t e

[ the w agtail an
, E nglish bird ] other f r es sc h or salte
or b a ken e wit h o u t e dr yn e sse ffo r and it be drye it
is nought wo o r t h And note that the use of the
fl
.

w d i r or of the essc h of the W a g st er t t e a v a ylet h

p o

g r et ly to breke the stone in the

Th e b o o k ca ll ed Th e H un d r ed M er r y Jest s sugg est s
t h a t t h e w a g t a il i s li g h t o f di g est i o n b eca u se i t i s ev er o n
t h e w i n g , a n d: t h er efo r e h a d, a s i t w er e a n essen t i a l li h t n ess
, g .
 C HAPT E R V I
ME DI E V AL S U R G E ON S : I TALY

S T RANG E as it may seem an d quite contrar y to the

,

usual impressions in the matter the most interesting

,

departm ent of the history of the medical science

during the M iddle Ages is that of surgery .

Because of this fact we have to divide t h e

sub ject into two chapters one for the surgery
,

of I taly the other for the surgery of the rest of

,

E urope .

We have two se r ies of medieval te x tb oo k s which

treat largely of surgical subjects in a thoroughly
scientific and professional way The first of these
.

comes to us from the earlier c en t u r I es of the M iddle

A ges when Greek classic influence on medicine
,

and the medical sciences was on the wane ; a nd the

other set comes to us from the later M iddle Ages ,

when the earlier Renaissance of Gree k influence

“

was just making itself felt in E urope Both sets

.

of b ooks serve to Show very well that the men of

these times were not only deeply interested in the
affections for which surgery can p rovide the only
88
 ME DI EV AL S UR G E O N S I TAL Y 89

r elief possi ble b ut that the y had r eached very

,

definite indeed sometimes ultimate solutions of a

, ,

large number of the constantly recurring pro blems

of surgery .

The greatest surprise of the whole range of

medical history is that these medieval surgeons of
b oth periods anticipated not a few of the surgical
advances that we have been accustomed to thin k of
as having been reserved for our ti me to make .

Our knowledge of these details of the work of the

medieval surgeons not only of the sixth and seventh
centuries but also of the thirteenth and fourteenth
, ,

is not founded on tradition nor on a few scattere d,

expressions which a modern medievalist might

e x aggerate but on a ctual te x tb ooks which fortun
, ,

ately for us were r eprinted as a rule during the

Renaissance period and have b een preserved for us
,

usually in a numb er of rather readily available

copies. M ost of them have been reprinted during
the past generation and have revolutioni z ed our
,

k nowledge of the history of surgery ; for these te x t

books exhibit in detail a deep knowledge of surgical
a ffections a well developed di fferential diagnosis
,
-

a thoroughl y conservative treatment and yet a ,

distinct e ffort to give the patient every possible

surgical opportu nity for hi s life compatible with ,

reasonable as surance of successful surgical inter

v en t i o n .A s I have pointed out the surgical ,

12
90 MED I EVAL MED I C I NE
history of the Old C rusades w as as interesting and
almost as valuable for civil surgery as that of our
*
own Great War .

Three w riters whom we have a lready mentioned

( E arly M edieval M edicine ) A e t i u s Alexander
—
of ,

T ralles and Paul of ZE g i n a were as we have seen

,
—
, ,

all of them interested in surgery and w rote very ,

interestingly on that sub ject I t is ho wever from

.
, ,

the end of t h e M iddle Ages that is from the —

,

writers of the twelfth century down to the end of

the fi ft een t h that surprising contri butions were
—

made t o surgical k nowledge This surgeryof the

.

end of t h e M iddle Ages b egan its devel opment at

Salerno The fi rst great te x tb oo k was that of
.

Roger k nown also as Rogero and Ruggiero with

—
,

the adjective P a r m en si s o r Sa ler n it a n u s of Parma ,

or Salerno who wrote his work about 1180

—
It .

is of this that G u r lt I n his Histo r y of Surgery , ,

“
vol i p 7 01 says :
. .
, . Though A rabian w orks
, “

on surgery had been b rought over to I taly by

C onstantine A fricanus a hundred years b efore
’
Roger s time these e x ercised no influence over
,

I talian surgery in the ne xt centur y and there is ,

scarcely a trace of the surgical knowledge of the

”’
A rabs to b e found in Roger s works H e insisted .
,

’
further that A rab isms are not found in Roger s
,

writings while many G r aec rsm s occur

,
The .

In t ern a t i o n a l C li n ic s vo l iii ser i es 28

, . .
, .
 ”
MEDIEV AL S U RGE O N S : I TAL Y 91

Salern i tan School of Surgery drank then at the , ,

fountain head of Greek surgery

-
.

After Roger comes Rolando his pupil who , ,

’
wrote a commentary on his master s w ork and then ,

the combined work of both of them was su b se

quently annotated by the Four M asters I t is this .

textbook the work of many hands and the combined

,

experience of many great teachers that is the ,

foundation stone of modern surgery Some of the

.

expressions in this volume will serve to give the

best idea of how t horoughly these surgeons of the
later medieval period studied their cases how ,

careful they were in observation and how well they

,

solved many problems that we are inclined to think

of as ha ving come up for serious consideration only
much later t han this time After studying their
.

chapter on I njuries of the Head it is easy to under

,

stand why G u r lt should declare that though there ,

is some doubt about the names of the aut hors this ,

volume makes it very clear that these w riters drew

their opinions from a rich experience .

They warn about the possibility of fracture of the

skull even when there is no penet rating wound of
the scalp and t hey even suggest t h e advisabili t y of
,

explorat ory incision when t here is some good reason

for suspicion of t hough no evident Sign of fract ure
, , .

iN ”
Old Time M akers of M edicine
‘‘
In -
I quoted ,

some of the details of this teachi n g as to head

92 MED I EV AL MED I C I NE
surgery that may serve to illustrate what these
surgeons taught on this important sub ject .

There are many warnings of the dange r of

opening the skull and of the necessity for
,

definitely deciding beforehand that there is good

reason for so doing H ow carefully their ob se r va
.

tion had been made and how well they had tak en
,

advantage of their o pportunities which were of , ,

course very frequent in those warlike times when

,

firearms were unknown hand to hand conflict ,

- -

common and blunt weapons were often used can

, ,

be appreciated very well from some Of t h e dir ec

tions. For i n stance they knew of the possi bility
,

of fracture by c o n t r ec oup The y say that quite

.

frequently though the pe r cussion comes in the

,

ante rior part of the cranium the cranium is ,

”
fractured on the opposite part The y even seem
.

to have known of accidents such as we now discuss

in connection with the laceration of the middle
meningeal artery Th ey warn surgeons of the
.

possibilities of these cases They t ell the story of

.

a youth who had a very small wound made by

a thrown stone and there seemed no serious results
,

or b ad si gns .He died the next day however ,

.

His cranium was opened and a large amount of ,

bla c k b lood was found coagulated a b out his dura

mater .

There are many interesting things said with

 MEDIEVAL S U R G E O N S : I TALY 93

r egard to depressed fractures and the necessity for

elevating the b one I f the depressed portion i s
.

w edged then an opening shoul d b e made with the

,

trephine and an elevating inst rument called a

,

sp a t u m en used to relieve the pres sure Great care .

should b e taken however in carrying out this pro

, ,

c e du r e lest the bone of the c r a m u m itself in being

, ,

lifted should injure the so f t structures within

, .

The dura mater should be carefully protected from

injury as well as the pia C are should especially be
.

e x ercised at the brow and the rear of the head

, ,

and at the commissures (p r o r a m et p up im et

c o m m i ssu r a s) since at these points the dura mater
,

is likely to b e adh erent Perhaps the most striking

.

e x pression the word i nfect being italici z ed by

,

G u r lt is
, I n elevating the cranium b e solicitous ,

”
lest you should i n f ec t or injure the dura mater .

While these old time surgeons insisted on the

-

necessity for treating all depressed fractures and ,

even suggested that many fi ssure fractures required

trephining they deprecated meddlesome surgery of
,

the cranium , unless there was evident necessity

“

quite as much as we do now Surgeons who in

.

every serious wound of the head have recourse to

the trephine must they said be looked U pon as
, ,

fools and idiots (i di o t i et st o lidi) W hen operations

.

were done on the head cold particularly w as to be

,

avoided . The operations were not to b e done in

94 MED I E VAL MED I C I NE
cold weather and ab ove all not in cold places The
, .

air of the operat ing room must be warmed arti

-

H o t plates should surround the patient s

’
fi c i a lly
.

head while the operation was b eing performed If .

this were not possible they were to be done by

candlelight the candle b eing held as close as possible
,

in a warm room They had many e x periences with

.

fractures at the base of the skull H aemorrhages

.

from t h e mouth and nose and from the ears were

considered a b ad sign They even suggested for
.
,

diagnostic purposes what seems to u s the rather

,

dangerous procedure that the patient should hold

his mouth and nostrils tight shut and blow strongly .

One of their methods of negative diagnosis for

fractures of the skull was that if the patient were
,

able to bring his teeth together strongly or to ,

crack a nut without pain then there was no fracture

,

present One of t h e commentators however adds

.
, ,

to this as w ell he might sed h o e a li qa a n do fa lli t

, ,

”
but this sign sometimes fails Split or crack
.

fractures were also diagnosticated by the methods

suggested by Hippocrates of pouring some coloured
fluid over the skull aft er the bone was exposed ,

when a linear fract ure would show by colo rat ion .

The Four M asters suggest a sort of red ink for this

purpose .

One might well e x pect that with trephining as

,

frequent as this te xtbook of the Four M asters more

 MEDIEV AL S U RG E O N S : I TALY 95

than hints the death rate of these medieval

,
-

surgeons must have been very high in head cases .

We can scarcely un derstand such intervention in

the conditions of operation assumed to exi st in the
M iddle Ages without almost inevitable infection
and consequent death They seem to have come
.

to an empiric recognition of the advantage of

ab solute cleanliness in such operations I ndeed .
,

in the light of our modern asepsis and its develop

ment during our own generation it is rather ,

startling to note the anticipation of what is most

recent in the directions that are given to a surgeon
to b e observed o n the day when he is to do a
trephining .I give it in the original L atin as it
may be found in G u r lt ( vol i p . . Et
, .

'

n o t a q uo d di e i lla c aven du m est m edi c o a c o i t a et

m a lis c i b i s aer a c o r r u m p en t i b u s, a t sun t a llia , c ep e ,

‘

et hn j
usm o di , et c o llo qui o m a li eris m en st ru o sae, et

m a n us e j
n s de b en t etc
esse m u n dw,
The dirce .
”

’
tions are most intere st ing The surgeon s hands
.

must be clean ; he must avoid coitus and the taking

of food that may corrupt t h e air such as onions , ,

leeks and the like ; must avoid menstruating

,

women ; and i n gen eral must k eep himself in a state

of absolute clea n l iness .

After the South I talian surgeons some of whom ,

taught at Bologna a group of N orth I talian

,

surgeons most of whom probably were eithe r di r ect

,
96 MEDIEVAL MED I C I NE
or indirect pupils of the Salernitan School must ,

b e considered . This includes such distinguished

names in the history of surgery as Bruno da
L o n g o b u r g o usually called simply Bruno ; Theo
,

doric and his father Hugh of L ucca ; William of

Salicet ; L anfranc the disciple of W illiam who
,

taught at Paris and gave that primacy to French

,

surgery which w as maintained all the centuries .

down to the nineteenth ( p l ) ; and M ondino the

.
,

author of the fi rst manual on dissection which con ,

tinn ed for t wo centuries to be used b y practically

everyone who anywhere did dissection throughout
E urope . Practically all of these men did thei r
b est wo r k b etween 12 5 0 and 13 00 Bruno of.

L o n g o b u r g o taught at Padua a n d V icen z a and his ,

te xtbook the C hirurgia M agna was comp l eted

, ,

in Padua in January 125 2 , G u r lt notes that

.

H e is the fi rst of the I tali an surgeons who b esides

the Greek s quotes also the A rabian writers on
”
surgery . E clecticism had definitely come into
vogue to replace exclusive devotion to the Gree k
authors and men were taking what w as goo d
,

whe rever they found it .

Bruno b egins his work by a definition of surgery ,

C h i r ur g i a
, tracing it to the Gree k and emphasi z ing
that it m eans handwork .H e then decla r es that
i t is the last inst rument of medicine to be used only ,

when the other two instr uments diet an d p o tions

, ,
 MEDIE V AL S URGE O N S : I TALY 97

have failed He insists that surgeons must learn

.

by seeing surgical operations and watching them ,

long and diligent ly They must be neither rash

nor over bold and should be ext remely cautious
-

about operat ing While he says that he does not

.

objec t t o a su rgeon taking a glass of wine t h e ,

followers of this specialt y must not drink to such

an ex t ent as to disturb their command over t hem
selves and they must not be habit ual drinkers
, .

While all t hat is necessary for their art cannot be

learned o u t of books t hey must n o t despise books
, ,

however for many t hings can be learned readily

,

from books even about the most diffi cult parts of

,

surgery . Three things t h e surgeon has to do

t o bring t ogether separat ed parts t o separate,

t hose t hat have become abnormally united and to ,

”
ex t irpate what is superfluous .

While the old t ex t books had emphasized t h e

n ecessi t y for n o t allowing t h e circulation in the head

t o be dis t urbed by the cold and insisted on the

,

t a king of special precaut ions in t his mat t er Bruno ,

insists t hat wounds must be more carefully looked

t o in summer t han in wint er because , p u t r e fa c

t ion is great er in warm t han in cold weat her

p n t r efa c t i o est m a j
o r i n a st a t e q a a m i n h y em .e

He is part icularly insistent on the necessity of

drainage I n wounds of t h e ext remities the limb
.

must alway s be so placed as to encourage drainage .

13
98 MEDIEV AL MEDICINE
To secure it the wound may b e enlarged ; if
necessary even a counter Opening must be made
,
-

to provide drainage I n order to secure proper

.

union care must b e exercised to bring t h e wound

edges accurately together and not allow hair or oil
,

or dressings to come between t hem I n large

.

w ounds he considers s t it ching indispens a ble and ,

the preferable sut ure material in his experience is

silk or linen . He discusses healing by fi rst and
second intention and declare s t hat with proper care
,

the healing of a great many wounds by fi rst i n t en

tion can be secured .All his treatment of wounds
is dry . Water he considered alway s did harm ,

and it is quite easy to understand that his experience

taught him this for the water generally available
,

for surgeons in camps and battlefields and in

emergency surgery was likely to do much more
harm than good .

Some of the details of his technique of ab dominal

w ounds w ill b e particularly interesting to modern
surgeons .

I f there was di ffi culty in bringing about the

reposition of the intestines they were first to be
,

pressed back wi t h a sponge soaked in warm wine .

Other manipulations are suggested and if necessary

,

the wound must be enlarged I f t h e oment um

.

finds it s way out of the wound all of it that is black

,

or g reen m ust b e cut o ff I n cases where the

.
 M EDIEVAL S U RGE O N S : ITALY 99

intestines are wounded they are to be sewed with a

small needle and a silk thread and care is to b e ,

exercised in bringing about complete closure of the

wound . This much will give a good idea of
B r uno s t horoughness Al ogether u r lt in hi
’
t . G s , ,

Hist ory of Surgery gives about fifteen large

,

octavo pages of rat her small type to a brief com

p e n diu m of Bruno s teachings
’
.

One or two other remarks of Bruno are rather f

interest ing in t h e light of m o dem deRSlo p m en t in

’’

medicine .For instance he suggests the possi ,

b ilit y of being able to feel a stone in the bladder

by means of bimanual palpation He teaches that .

mot hers may oft en be able to cure hernias both ,

umbilical and inguinal in children by promptly ,

taking up t h e treat ment of them as soon as noticed ,

bringing the edges of t h e hernial opening toget her

by bandages and then preventing the reopening
,

of t h e hernia by prohibit ing wrestling and loud

,

crying and violent mot ion He has seen over .

growt h o f t h e mamma in men and declares that it ,

is due to no t hing else but fat as a r ule He , .

suggest s if i t should hang down and be in t h e w ay

on account of its size it shoul d be ex t irpated
, He .

seems t o have known considerable about t h e

lipomas and advises that they need only be removed
,

in case t hey become bothersomely large The .

removal is easy and any bleeding that takes place

,
100 MEDIE VAL MEDICIN E
may be stopped by means of t h e cautery He.

divides rectal fi st u lae int o penetrat ing and non

penetrat ing and suggest s salves for the non pene
,
-

t r a t i n g and the actual caut ery for t hose t hat

penetrat e . He warns against t h e possibilit y of
producing incont inence by the incision of deep
fistulas for this would leave the patient in a worse
,

s t at e than before .

fi T h e mos t interesting fea t ure of the work of the

N orth I t a lian surgeons of t h e l a t er M iddle Ages is

t heir discovery and development of t h e t wo special
advances of our modern surgery in which we are
inclined t o t ake most pride . These are unio n by
,

first int ent ion a n d a n aest hesia I t is of course very

, .

s t artling t o t hink t hat surgeons of seven centuries

ago should ha ve made advances in t hese import ant
phases of surgery which were aft erwards t o be
forgo t t en ; b u t human hist ory is n o t a story of
cons t ant progress b u t of ups and downs and t h e
, ,

myst ery of human history is t h e decadence t hat

almost inevit ably follows any period of supremely
great accomplishment by mankind . The lat er
M iddle Age enjoyed a part icularly great period of
effi o r esc en c e and a chievement in surgery and t h 1s
, ,

quit e as wit h li t erat ure and ot her phases o f hum a n

accomplishment was followed by dist inct descent
,

of int erest in surgical t heory and decadence in

,

surgical practice until t h e Renaissance came to

,
 ”
MEDIEVAL S URGE O N S : I TALY 101

provide another climax of surgical development .

I t would be peri lous t o sa y however t h a t t h e acme

, ,

of t h e curve of Renaissance surgic a l progress was

higher t han i t s pre decessor t hough once more there
,

is t h e surpri se t o find t hat t his high point was fol

lowed by a not her descent unt il t h e curve ascended
,

a gain in our t ime .

What we have said already wit h regard t o t h e

requirement of cle a nliness in operat ing upon t h e
skull insist ed upon by t h e Sa ler n it
, c h oo l will ,

suggest t hat some of t h e pract ic a l value of asepsis

h a d come home t o t hese old t ime surgeons The .

N ort h It alian surgeons went however much , ,

fart her in t heir ant icipat ions of a sepsis They.

insist ed t hat i f a surgeon made a wound through

a n unbroken surface and did n o t secure union by

first int ent ion i t w a s usually his own fault

,
.

I t is t o t he m we owe t h e Cxpression union by

firs t int ent ion n n i o p er p r i m a m i n t en t i o n em
—

which means not hing t o us excep t t hrough it s L at in

equivalent . They boast ed of get t ing linear cic a
t rices which could sc a rcely be seen and evident ly ,

t heir prac t ice fos t ered t h e bes t of surgic a l t echni q ue

a n d was founded on excellent principles The .

N ort h I t a li a n su rgeons repl a ced t h e use of oint

ment s by win e and evident ly realized it s cleansing
,

t h a t is ant isep t ic
, q uali
—
t y V V.h a t I S of t en n o t
realized is t h a t t h e very old t radi t ional tre a tment
,
102 MEDIEV AL MEDICINE
of wounds by the pouring of wine and oil into them
represented a mild antiseptic and a soot hing pro
t e c t i ve dressing The wine inhibited the growth
.

of ordinary germs the oil protected the wound from

,

dust and dirt They were not ideal materials for

.

the purpose but the y w ere much better when dis

,

ere c tly used than many surgical dressings of much

more modern times founded on elaborate theories .

Professor C li ff ord Allb u t t reviewing the ,

practice of these N orth I t alian surgeons of the

thirteenth cent ury says ,

They washed the wound with wine sc r u p u ,

lo u sly removing every foreign part icle ; then t hey

brought the e dges toget her n o t allowing wine nor ,

anyt hing else t o remain wit hin dry adhesive —

surfaces were t heir desire N at ure t hey said .

, ,

produces t h e m eans of union in a viscous exudat ion

—
O r natural balm as it was afterwards called by
,

Paracelsus Paré and Wurtz

, I n older wounds
, .

they did t heir best to obt a in union by cleansing ,

desiccat ion and refreshing of t h e edges Upon t h e

, .

out er surface t hey laid only lint st eeped in wine .

Powder t hey regarded as t o o desiccating for ,

powder shut s in decomposing mat t ers ; wine aft er ,

w ashing purifying and drying t h e raw surfaces

, , ,

evaporat es
e i do r i e
Th g w in 1 2 6 6 on
w
t ha question
rot e
t that
so much disturbed the surgeons of the generations
Hi st o r ica l Rel a t i o n s o f M edici n e a n d S u r g er y d o wn to
the Si xt een t h Cen t ur y L o n d o n 19 04 .
”
, .
 MEDIE VAL S U RG E O N S : I TALY 103

b efore ours as to whether “ was a natural

,

development in t h e healing of wounds or n o t .

While laudable pus was for centuries aft er his time

supposedly a scient ific doct rine Theodoric did not
,

t hink so , and emphatically insist ed t hat such

t eaching represent ed a great error He said
.

For i t is not necessary as Roger a n d Roland

,

h a ve writ t en as many of t heir disciples t each and

, ,

as all m o der n surgeons profess that pus should be

,

generat ed in wounds N 0 error can be great er t h a n

.

this Such a prac t ice is indeed t o hinder nature

.
,

t o prolong the dise a se and to prevent the c o n g lu

,

”
t i n a t i o n and consolidat ion of t h e wound The .

italics in the word modern are mine but the whole ,

expression might well have been used by some early

advocat e of antisepsis or even by L ord L ister him
,

self Just six cent uries almost to the year would

.

separate the two declarations yet they would be

,

just as t r ue a t one time as at another W hen w e .

learn that Th eo do r i c was proud of t h e beautiful

cicatrices which his fat her had obtained without the
use of any oint ment p n lc h er r im a s c i c a t r i c es sin e
—

u n g u en t o i n du c eb a t t hen furt her t hat he

, ,

impugned t h e use of poultices and of oils in wounds ,

while powders were too drying and besides had a ,

t endency t o p r event drainage (t h e literal meaning

of t h e L atin words he employs sa n i em i n c a r c er a r e
, ,

i s to incarcera t e sanious material it is easy t o

104 MEDIE V AL M EDICINE

understand that the claim t hat ant iseptic surgery

was anticipat ed six cent uries ago is no ex a ggerat ion
and no far fet ched explan a t ion wi t h modern ideas
-

in mind o f cert ain clever modes of dressing h it upon

,

accident ally by medieval surgeons .

Aft er Bruno who brought wit h him the me t hods

,

and principles of surgery from t h e Sout h of I t aly ,

his cont emporary of t h e N ort h Hugh of L ucca ,

Ugo da L ucca or L u c c a n u s as he is also called

, ,

deserves t o be ment ioned He was called to

.

Bologna in 12 14 a s C it y Physician and was wit h ,

the regiment of crusaders from Bologna a t

D amiet ta in 12 2 0 He ret urned t o Bologna in
.

12 2 1 and occupied t h e pos t of legal physician The .

C ivic S t at ut es of Bologna are according to G u r lt

, ,

the oldest monument of legal medicine in the

M iddle Ages Hugh seems t o have been deeply
.

intent on chemical experiment s and especially ,

anodyne and an aest het ic drugs He is said t o have .

been t h e first to have t a ught t h e sublimation of

arsenic . L ike many anot her dist inguished prae
t i t i o n er of m edicine and surgery he left no ,

writ ings All t hat we know of him and his work

.
,

and above all his t echnique we owe to t h e filial

,

devo t ion of h is son Theodoric .

An aest hesia s perh a ps an even greater surprise

in t h e M iddle Ages t han pract ical ant i sepsis A .

great many o f these surgeons of the t ime seem to

 MEDI EVAL S URG E O N S : I TALY 105

have experiment ed with substances that might

produce an aesthesia . u was the base of
, “

most of these an aesthetics though a combinat ion

,

with M seem s to have been a favourite They .

succeeded apparently even with such crude means

, ,

in producing insensibility to pain w ithout very

serious dangers One of t hese met hods of D a L ucca
.

was by inhalat ion and seems to have been in use

,

for a full century Guy de C hauliac describes the

.

method as it was used in his day and a paragraph ,

with regard to it will be found in t h e chap t er on

Surgeons of th e West of E urope I t is quite clear .

that the extensive operations which are described

in their text books of surgery a t this t ime could not
possibly have been performed only t hat the ,

surgeons were able to secure rather a deep and

prolonged insensibility to pain With an aesthesia .

combined with antisepsis it is easy to understand

,

how well equipped the surgeons of this time were

for t h e development of t heir speciality .

The fourt h of these great surgeons a t the N orth

of I taly was Willi am of Salicet He was a pupil .

of Bruno of L o n g o b u r g o Some idea of his pract ice

.

as a surgeon m a y be Obtained from even t h e first

chapter of his first book He begins with the
.

treat ment of hydrocephalus e r as he calls i t —

, ,

water collected in the heads of children newly

born .
”
H e rejects o p ening of the head by incision
106 ME DIE VA L MED ICINE
b ecause of the danger of it He had successfully
.

treated some of t hese difficult cases however by , ,

punct uring t h e scalp and membrane by a cautery ,

a very small opening being made and fluid being

allowed to escape only drop by drop William did .

n o t quo t e his predecessors much b u t depended t o

,

a great ex t ent on his own experience ; He has

many interes t ing details of t echnique wit h regard
to t h e special subject of surgery of t h e nose t h e ,

ear the mouth ; a n d he did not even hesit at e t o

,

tre a t goitre when it grows large and says t hat if t h e

,

sac is allowed to remain it should be t horoughly

rubbed over on the inside wit h green ointment .

He warned t hat in this a ff ect ion many large

b lo o dvessels make t heir appeara nce and t hey find,

”
their way everywhere through t h e fleshy mass .

E A very interest ing development of surgery along

a line where it would probably be least expect ed
was in plas t ic surgery . I n t h e first half of t h e
fift eent h cent ury the t wo Brancas fat her and son
, ,

performed a series of successful operations for t h e

restorat ion of t h e nose part icul a rly and t h e son ,

invent ed a series of similar procedures for t h e

restorat ion of mut ilat ed lips and ears The fat her
‘

seems t o have built up t h e nose from ot her port ions

of the face possibly using as G u r lt suggests t h e
, , ,

skin of t h e forehead as t h e I ndian surgeons had

,

done t hough wit hout any known hint of their

,
 MEDIE VAL S U RGE O N S I T ALY ”
: 107

work Fazio t h e histori a n of King Alphonso I

.
, .

of N aples who died in 14 5 7 describes t h e favourit e

, ,

opera t ion of Ant onio Branca t h e son who in order , ,

n o t t o di sfi g u r e any fur t her t h e face in t hese cases ,

made t h e new nose from t h e Skin of t h e up per arm ;

and in ant icipat ion of T a gliacozzi who at t racted ,

much at t ent ion by a similar operat ion in t h e lat t er

half of t h e sixt eent h cent ury separat ed t h e new ,

nose from t h e arm somet ime duri n g the t hird week .

There is abundance of ot her evidence as t o t h e

’
Brancas work from cont emporary writers for —

inst a nce Bishop Pet er Ranzano the annalist the

, ,

poe t Ca le n z i o and Alexander Benedet t i t h e

, ,

physician and anatomist so t hat t here can be no

—

doubt o f t h e fact that t his wonderful invent ion in

surgic a l t echnique was actually made before t h e
close of t h e M iddle Ages .

I t is int eres t ing to realize t hat while we hear ,

much a bout t h e work of t h e Brancas and from ,

ecclesiast ical aut hori t ies t here is no word of con

,

dem n a t i o n of the prac t ice of resto ri ng the nose or

o t her facial feat ures unt il much l a t er in hist ory .

Ta gliacozzi who revived t h e operat ion of rhino

,

plast y just about t h e beginning of t h e seventeenth

cent ury did n o t sh a re so kind a fat e The lat t er
, .

I t alian surgeon w a s roundly abused by some of his

colleagues even it is said by Fallopius and Paré
, , , ,

”
and bi t t erly s a t irized in But ler s Hudibras ’
.
108 MEDIEVAL MEDICINE
As late as 17 8 8 ( l) the Paris faculty interdicted
face repairing alt oget her I t is this sort of i n t o ler
-
.

ance on some superstitious ground or other that

, ,

is usually att ributed to the M iddle Ages For such

.

events the adjective medieval seems particularly

adapted . As a matter of fact we find com
,

p a r a t i v ely li t tle trace of such intolerance in medieval

t imes ; but i t is comparatively easy to find the
bitterest treatment of fellow mortals for all sorts of
-

foolish reason s in the seventeenth and eighteent h

centuries .
 C HAPT E R V I I
SU R GE ON S OU T S ID E I T AL Y : S U R G E ONS
OF OF TH E

W E S T OF E U R O P E

Sci en c es a r e m a d e b y a d di t i o n a n d i t i s n o t p o ssi b l e t h a t
,

t h e sa m e m a n sh o u l d b eg i n a n d fi n i sh t h e m . I Ve a r e
li k e i n fa n t s a t t h e n e c k o f a g i a n t fo r we c a n see a ll t h a t t h e
,

g i a n t sees a n d so m et h i n
g m o r e.
”
( G
—
U Y D E C H A U L I A C P a,p a l
P hysici a n t o t h e Po p es a t Avi g n o n ) .

TH E very int erest ing and in many ways astonishing

development of surgery which occurred in I taly in
the t welft h and thirt eenth centuries was followed ,

up by similar developments in the west ern

count ries of E urope France was t h e first to fall
.

into the line of progress wit h important advances

in surgery and owes her teaching direct ly t o t h e
,

I t alians ; b u t in Flanders in E ngland in Spain , , ,

and in Germany we have records of some

,

significant advances in surgery and dist inguished ,

surgeons wro t e books t hat fort unat ely for t h e

hist ory of su rgery were preserved The most .

import ant of the surgical writ ings of t h e time p u t ,

in t ype during t h e great nascent peri od of printing

at t h e Renaissance have come down to us M any
, .

109
110 MEDIE VAL MEDICINE
of these have been republished in recent years and ,

as t h e t ext s are now readily available t hey enable

anyone t o see for himself just what were the interests
of the surgeons of t h e later medieval period t heir ,

technique and t heir successful applicat ions of great

,

practical principles to the solution of important

surgical problems .

The beginning of French scient ific surgery came

wit h t h e exile from I t aly of L anfranc as he is ,
N
known though his I t alian name was L anfranchi
,

or L anfranco and he is some t imes spoken of as

,

Ala n fr a n c u s He had prac t ised as physician and

.

surgeon in Milan unt il banished from t here by

M at t eo Viscont i about 12 9 0 He made his way
, .

then t o L yons where he attracted so much atten

,

t ion by his success as a surgeon that he was o ffered

t h e chair of professor of surgery at the U niversity
of Paris . He a t t racted an almost incredible
number of scholars t o his lessons in Paris and by ,

hundreds lit erally t hey accompanied him t o t h e

bedside of his pat ient and at t ended his operat ions
( G u r l
.t ) P a ris w a s a t t his t ime a t t h e very heigh t
of its glory a s a U niversit y I t had had a series of .

dist inguishe d professors whose writ ings are st i ll

known and honoured Albert t h e Great Thomas , ,

Aquinas Roger Bacon a n d D uns Scotus and

, ,

during t h e lat t er half of the thirt eent h century

L o uis I X had encouraged t h e Universi t y in every
.
 S U RGE O N S OF T H E W E ST OF EU ROPE 111

way and had helped in the foundation of t h e

,

Sorbonne There were probably more st udents in

.

att enda nce a t t h e Univer sit y of Paris about t h e

time t hat L anfranc was t here t han t here h a s ever
been in at t endance a t any U niversit y before or
since The prest ige of L a n fr a n c s posit ion t hen
.
’
, ,

and his opport unit y t o impress the world of his

time can be readily appreciated
, .

The D ean of the medical faculty of Paris Jean ,

de Passavant urged L anfranc t o writ e a text book

,

of surgery partly for the familiar academic reason

,

t hat the students were clamouring for some definite

record of his t eaching b u t also because t h e D ean
,

felt that t h e many copies of these lessons which t h e

s t udent s would take away wit h t hem a n d which ,

would be consult ed by o t hers would add greatly ,

t o t h e prestige of the medical school M edical .

school officials are not so di fferent aft er more than

six and a half cent uries L anfranc complet ed his
.

”
t ex t book of surgery called , C hirurgi a M agna ,

in 12 9 6 and dedicated it t o Philippe le Bel t h e

, ,

then reigning King of France I t is from this work

.

t hat we are able to judge exact ly what t h e value of

’
L a n fr a n c s surgic a l t eaching was .

I n t h e second chap t er of his t ex t book the first —

cont aining t h e definit ion of surgery a n d a general

introduct ion L anfranc devotes some paragraphs
—

to t h e surgeon himself and the qualities that a

,
112 MEDIE V AL MEDICINE
surgeon should possess if he is to b e successful in
his speciality I t is about the sort of advice that
.

older surgeons are still likely to give young men

who are entering on the practice of the speciality ,

and more or less what is said at many a commence

ment in the modern time when t h e maker of the
address to the graduates is a su rgeon .

I t is necessary that a surgeon should have a

temperate and moderate disposition That he
.

should have well formed hands long slender fingers

-

, ,

a st rong body not inclined to tremb le and with

, ,

all his memb ers trained to the capable fulfilment

of the wishes of his mind . He should be well
grounded in natural science and should k now not
,

only medicine but every part of philosophy ; should

know logic well so as to be able to underst and what
,

is w ritten ; to talk properly and to support what

,

”
he has to say by good reasons He suggests that
.

it would be well for the surgeon to have spent some

t ime teaching grammar and dialectics and rhetoric ,

especially if he is to teach others in surgery for ,

t his practice will add great ly to his teaching power

"
.

( Wha t a desideratum for the modern time is thus

outlined ) Some of his expressions might well b e
repeated to young surgeons in the modern time .

The surgeon should not love di ffi cult cases and ,

should not allow himself to be tempted to u nder

take those that a r e desp erat e H e shoul d help the
.
 S U RGE O N S OF TH E WE ST OF E UROPE 113

poor as far as he can but he should not hesitate to

,
”
ask for good fees from t h e rich .

L anfranc was himself a scholar well read in the

litera t ure of his profession but who had well ,

diges t ed his reading He quotes alt ogether more

.

th an a score of writers on surgery who had preceded

him and evidently was thoroughly familiar with
,

general surgical literature He is a particul ar

.

favourite of G u r lt t h e German historian of surgery

, ,

who has devo t ed more than twent y fi ve closely -

print ed large octavo pages to the discussion of this

’
old Paris professor and his work L a n fr a n c s di s .

c u ssi o n of wounds of nerves is of itself sufficient to

show t h e character of his work M any generations .

aft er h i s time have used t h e word nerves for tendons ,

and mist aken t h e funct ion of t hese two str uctures ,

but L anfranc dist inguished very clearly between

t hem . He declared t hat since t h e nerves are i n st r u
ment s of sense and motion wounds of t hem should
,

be carefully treated especially as the sensitiveness

,

of t hese structures is likely to cause the patient

much subsequent pain if they are neglec t ed .

L ongitudinal wounds of nerves are much less

dangerous than t hose across them When a nerve .

is completely divided in cross section L an franc w as

of the Opinion though Theodoric and some other s
,

we r e op posed to it that the n erve ends shoul d b e

,

s t i t ched together He says that the suture in sures

’

15
114 MEDIE VAL MEDICINE
the r eintegration of t h e nerve much b etter .

Besides aft er this operation the restoration of t h e

,

usefulness of the member is more assured and is

commonly more complet e .

Aft er at J en r i de
M ondeville whom L at in writ ers
, quote as
m At least a dozen variants of the second
portion of his name are found in lit erature from ,

Ar m o n devi lle t o H er m o n da ville He was ano t her

.

of the U niversity men of this t ime who wandered

far for opportunities in educat ion Though born.

in the N orth of France and receiving his preliminary

education there he made his medical studies in
,

t h e lat ter half of t h e t hirteenth cen t ury under

Theodoric in Italy Afterwards he st udied
.

medicine in M on t pellier and surgery in Paris .

L at er he gave a t least one course of lect ures a t

M ontpellier and then a series of lectures in Paris
, ,

at tracting t o bot h universit ies during his professor

ship a crowd of st udent s from every part of E urope .

One of his teachers at Paris had been his com

patriot Jean Pit ard the surgeon of Philippe le
, ,

Bel of whom he speaks as

, most skilful and
”
e x pert in the prac t ice of Surgery an d it
, wa s
doubtless to P it a r d s friendship t hat he owed his
’

appointment as one of t h e fo u r surgeons and

th r ee physicians who accompanied t h e King int o
Flan d ers .
 S U RG E O N S OF TH E W E ST OF EU ROP E 115

There is an hist orical t ra dit ion which has led

many t o believe that the surgery of the fourt eent h
century was mainly in t h e hands of t h e barber
surgeons ignorant men who plied a rude handi
—

cra ft i n connection wit h some conventional use of

t h e lancet and t hat the physicians quite despised
—

t heir surgical colleagues M ondeville is a striking

.

cont r a dict ion of t his He was a scholarly man who

.
,

quot es not only all t h e dist inguished cont ribut ors t o

medicine and surgery before his time the Greeks ,

and L at ins t h e Arabs and his I t alian mast ers but

, , ,

who also has q uotations from poet s and philosophers ,

Arist ot le Plato D iogenes C ato Horace O vid

, , , , , ,

Seneca and others

, .

The Regius Professors of M edicine at bot h

O xford and C ambridge in our generation are on
record wit h t h e declarat ion t hat medicine and
surgery have been allowed to drift t o o far apart ,

and t hat above a ll t h e physician should see more

of surgi cal operat ions for t h e confirmation of
diagnoses for t hey a r e real bioscopys I t is rat her
,
.
4

int erest ing t o find then t hat M ondeville felt t h e

, ,

necessit y in his t ime for close relat ions between

physici a ns and surgeons and said ,

I t is impossible that a surgeon should be

expert who does not know not only t h e principles ,

b ut everyt hing wort h while knowing about

j
” “
m edicine ,and then he added ust a s it i s ,
116 MEDIEV AL MEDICINE
impossi ble fo r a man to be a good physici a n who
”
is entirely ignorant of t h e art of surgery He .

says further : This our art of surgery which is ,

’

the third part of m edi c i n e [t h e other t w o parts were

diet and drugs ] is with all due deference to
,

physicians considered by us surgeons ourselves and

,

by the non medical as a more certain nobler

-

, ,

securer more perfect more necessary and more

, , ,
”
lucrative art than the other parts of medicine .

Surgeons have always been prone to glory in their

speciality .

is particularly interesting for the

y because he himself ventured to
trace some of the recent history of the development
’
of his speciality Following Galen s example who
.
,

had divided the physicians of the worl d into three

sects the M ethodists the E mpirics and the
, , ,

Rationalists M ondeville divides modern surgery

,

into three sects : First that of the Salerni t ans, ,

with Roger Roland and the Four M asters ;

, ,

second that of William of Salicet and L anfranc ;

, ,

a n d third that of U go da L ucca and his son

,
.

Theodoric and their modern [si c ] disciples .

The characteristics of these three sect s are in

’
brief . The first limited patients diet used no ,

stimulants dilated all wounds and looked for union

,

only after pus formation The second allowed a .

liberal diet to weak patients though n o t to the ,

 S U RG E O N S OF TH E W E ST OF EU ROPE 117

stron g but generally int erfered with wounds too

,

much The t hird believed in a li beral diet never

.
,

dil a t ed wounds never inserted t ents and it s

, ,

members were ex t rem ely careful not to complicat e

wounds of t h e head by unwise interference Almost .

needless t o say his crit ical discussion of the three

,

schools is ex t remely int eres t ing .

M ondeville was himself a broadly educat ed

scholar who considered t h a t the surgeon should
,

know every t hing wort h while knowing about

medicine for his work was great er t han t hat of t h e
,

physician While he had high ideas however of

.
, ,

t h e value of theoretic knowledge he insisted above

,

all on the v a lue of pra c t ical t raining He said in .

,

his t extbook on surgery a s to what t h e training of

,

t h e surgeon should be

A surgeon who wishes t o operat e regularly

ought first for a long t ime t o frequent places in
which skilled surgeons oft en operat e and he ought ,

t o p a y c a reful a t t en t ion t o t heir opera t ions and

commi t t heir t ech ni q ue t o memory Then he .

ought t o associat e himself wit h t hem in doing

operat ions A m a n cannot be a good surgeon unless
.

h e knows bo t h t h e a r t and science of medicine and ,

especially anat omy The ch a ract erist ics of a good

.

surgeon are t hat he should be modera t ely bold not ,

given t o disput at ions before t hose who do n o t know

medicine operat e wit h foresight and wisdom not
, ,

beginning d a ngerous operat ions unt il he has

provided himself wit h everyt hing n ecessary for
118 MEDIE VAL MEDICINE
lessening t h e danger He should have well Shaped
.
-

members especially hands wit h long slender

,

fingers mobile and not t remulous and wit h all his

, ,

members st ron g and healt hy so t hat he may per

,

form all t h e proper operat ions wit hout dist urbance

o f mind He must be highly moral should care
.
,

for t h e poor for God s sake see t hat he makes

’
,

himself well paid by t h e rich should comfort his ,

pat ient s by pleasant discourse a n d should always ,

accede t o their re q uest s if t hese do n o t int erfere

”
wit h t h e cure of t h e dise a se I t follows from
.

t his he says t hat t h e perfec t surgeon is more

'

, ,

t han t h e perfect physician and t hat while he must

,

know medicine he must in addition know his

h a n di c r a f

The other great French surgeon of the fourteenth

cent ury was Guy de Ch g p lig g who well deserves
‘ m ,

t h e name of father of modern surgery He wa s .

educated in a lit tle town in t h e Sout h of France ,

made his medical st udies at M ont pellier and then ,

went on a journey of hundreds of miles to It aly

in order to make his postgraduate studies While .

it is not generally realized for some seven c enturies

,

before the nineteenth I taly was the home of

graduat e teaching in all department s Whenever a .

man in any count ry in E urope from t h e beginning ,

of t h e twelft h until the end of the eight eent h

cent ury w anted t o secure opport unities for the
,

higher educat ion t hat were not available in his home

count ry he went down into I taly
, At t h e .
 S U RG E O N S OF TH E W E ST OF E UR OPE ‘
119

beginning of the nineteenth century France

’
usurped I taly s place for half a century and ,

Germa ny pre emp t ed t h e position to a great degree

-

during t h e latter half of t h e ninet eent h The .

journey t o I t aly in the M iddle Ages was more

di fficult a n d involved more expense and t ime t han
, ,

would even the voyage from America to E urope in

our time ; yet many a st udent from France ,

Germany and E ngland made i t for t h e sake of the

,

post graduat e opport unit ies and it is mat ter for

,

professional pride t hat this was particularly true of

our medieval colleagues in medicine and surgery .

To know Guy de Ch a u li a c s works well is t o have

’
'

ready contradict ions at hand to practically all of the

objections so frequent ly repeated as to the lack of
scholarly work during t h e M iddle Ages For .

inst ance Guy de C hauliac insist ed on t h e value of

,

experience rat her t han aut horit y and of original ,

work rat her t han mere copying He crit icized in .

bitt er sat ire John of G a ddesden s book on medicine

’
,

called aft er the fashion of t h e time by the poet ical

”
title Rosa Anglica , of which he said : L ast
of all bloomed the scent less Rose of E ngland which ,

on its being sent t o me I hoped t o find bearing

t h e odour of swee t ori g i nali t y Bu t ins t ead of t hat
.

I encount ere d only t h e fict ions of H i sp a n u s of ,

”
Gilbert a n d of Th eo do r ic
, . H i s mode of sat irical
expression is all the m ore inte resting and signi fi c a nt ,
120 MEDIE V AL MEDICINE
because it shows that the men of the t ime were
cri t ically minded enough as regards many of the
passages in the writ ings of t heir predecessors with
which fault has been found in t h e modern time ,

though we have usually b een inclined to think that

medieval readers accep t ed them quit e uncritically .

Ch a u li a c s bit teres t reproach for many of his pre

’

dec esso r s w as t hat t hey follow one another li k e

”
cranes whether for love or fear I cannot say
, .

description of the methods of a n aes

practised by t h e surgeons of his time
’
,

especially in cases of amputation is particularly ,

int eres t ing to us because t h e an aest he t ic w as

a dm m i st er e d by inhalation C hauliac says .

Some surgeons prescribe medicaments such as ,

opium t h e juice of t h e more] hyoscyamus man

, , ,

drake ivy hemlock let tuce which send t h e

, , , ,

pat ien t t o sleep so t hat the incision may not be

,

felt A new sponge is soaked by t hem in t h e juice

.

of t hese a n d left t o dry in the sun ; when t hey have

need of i t t hey p u t t his sponge int o warm water ,

a n d t hen hold i t under the nos t rils of the pat ien t

until he goes t o sleep Then t hey perform t h e

.

operation .

Th e su b seq uen t d i su se of a n aest h esia

m s a n a lm o stsee

im p o ssi b l e m yst er y t o m a n y b u t t h e p r a c t ica lly t o t a l

,

o b li v i o n i n t o wh ic h t h e p r a c t ic e fe ll i s i n c o m p r eh en si b l e .

Th l s I s e m p h a si z d b y t h e fa c t t h a t wh il e i t dr o p p ed o u t
e

o f m ed ic a l t r a di t i o n t h e m e m o ry o f i t r e m a i n ed a m o n g t h e
,

o et s a n d es e ci a ll a mo n
g t h e dr a m a t i st s S h k e
p , p y a s
p ea re
.
 S U RG E O N S OF TH E W E ST OF EU ROP E 121

C hauliac was part icularly interested in t h e

radic a l cure of hernia and he discusses six different ,

operat ions for this purpose G u r lt point s o u t that .

Ch a u li a c s crit icism of these O perations is qui t e

’

modern in i t s viewpoint He declared that .

pract ic a lly t h e object of radical operations for hernia

is t o produce a strong firm t issue support over t h e ,

ring through which the cord passes so t hat t h e ,

intestines cannot descend through i t I t is rather .

interesting to find that the surgeons of this time

tried to obli t erate t h e canal by means of the cautery
or i n fl
,

a m m a t i o n producing agen t s
-
arsenic and the —

like a pract ice t hat recalls some methods st ill used

—

more or less irregularly They also used gold wire .

as a support ; it was to be left in t h e tissues and ,

was supposed to protect and strengthen the closure

of t h e ring At t his time all these operat ions for
.

the radical cure of hernia involved t h e sacrifice of

the tes t icle because the old surgeons want ed t o
,

oblit erate t h e ring completely and thought this t h e ,

easiest way C hauliac criticizes the operat ion in

.

this respect b u t says that he has seen many cases

,

in which men possessed of but one testicle have

u se d t h e t ra di t i o n i n R o m eo n d J u li et To m M iddl et o n
a .
,

in th e tra ed
g y of
“
W o m en B e w a r e W o m en ( Ac t I V ”
.
,

Scen e i .
, sa
y s

I ll imi t a t e t h e p i t i es o f o ld sur g eo n s
’

To t h i s l o st lim b wh o er e t h ey Sh o w t h ei r
, , art,

C a st o n e a sl eep t h en c ut t h e di sea sed p a r t

,
12 2 MEDIE VAL MEDICINE
procreat ed and t his is a problem where the lesse r
,

”
of t w o evils is t o be chosen .

While he discussed hernia operations so freely ,

the great French surgeon did not believe t hat

everyone who suff ered from a hernia ought to be
submi t t ed t o an operation He quit e agreed with
.

M ondeville who in t h e preceding generat ion

, ,

declared t hat many operations for hernia were done

not for the benefit of t h e pat ient but for t h e benefit
of the surgeon a mode of expression t hat is likely
—

’
to strike a sympathetic chord in some physicians
minds even a t t h e present t ime Ch a u li a c s rule
.
’

was that no operat ion should be at tempted unless

’
the patient s life was put in danger by the hernia ,

but that a truss should be worn to re t ain it He .

emphasized t hat trusses should not be made accord

ing t o rule but must be adapted to each individual
, ,

and he invent ed several forms of t russes himself .

He developed t h e m e t hod of t axis by which hernias

might be reduced suggested an exa ggera t ed
,

Trendelenburg posi t ion for operat ions for herni a

and for t h e manipula t ions necessary for t h e redue
tion of hernia .

The t echnique of some of these old surgeons is

a never ending source for surpri se The e xa g g er
-
.

at ed Trendelenbu r g posi t ion in t h e operat ion for

t h e radical cure of hernia the p atient being
-

fast ened on an inclined board head down so that

, ,
 S U RG E O NS OF TH E W E S T OF EU ROP E 12 3

the int estines would fall away from the site of

operat ion was used by Guy de C hauliac who ,

probably obt ained a hint of it from I taly He also .

employed ext ension in t h e treatment of fract ure of

t h e thigh invent ing an appara t us by which t his
,

might be cont inued for a long t ime unt il t h e

muscles were relaxed from overt iredness He m a de .

use for t his purpose of a weight suspended on a

cord which ran over rollers . He also adap t ed
s t i ffened bandages of various kinds especially ,

employi n g whi t e of egg for t his and some t imes

,

moulding bandages to t h e limbs in cases of fract ure .

Yp er m a n t h e Flemish surgeon of this t ime knew

, ,

and used t h e oesophagus tube for art ificial feeding ,

and a number of various kinds of instrument s were

invent ed for the uret hra including bougies of wax
, ,

t in, and silver I n diseases of the bladder and

.

i n gonorrh oea John Ar der n employed as t ringen t

injec t ions .

Probably what ought t o be considered the most

import ant work of t h e French surgeons o f t h e
M iddle Ages has been quit e misunderst ood unt il
recent years I n his p a per on
. The Origin of
”
Syphilis ,
at the Sevent eent h I nt ernat ional C on
gress of M edicine ( L ondon , Professor Karl
Sii dh o ff of L eip zig ( see Tr a nsac t ions ) reviewed t h e
W W W

use of mercury In the form of m e r c u r l a l o m t m en t

.

during t h e later M iddle Ages and t h e reputation

,
12 4 MEDIE VAL MEDICINE
that i t had acquired for the c u r e o f ulcers skin ,

eruptions of various kinds and ot her distinctly

,

objective lesions I t is perfect ly clear now t hat the

.

success of t his form of therapy was due to the fac t

t hat syphilis was b eing trea t ed The French
.

surgeons of the Sout h of France developed t h e

empiric discovery of t h e value of this remedy t h e ,

first hint of which had probably come to them from

the I talians I t is one of the few specifics in the
.

hist ory of medicine N eedless t o say it is still with

.
,

us and still the accepted medication in spite as

, ,

Professor Sii dh o ff not es of the often at temp t ed

,
-

replacement of it down t h e centuries by some form

or other of arsenic treatment t hough t his has
,

always been afterwards abandoned and it would ,

seem as though our generation might furnish

another instance of the triumph of the medieval
mercurial t reatment over arsenic .

The real reason then i t would seem why syphilis

, ,

came to be called the m or b us G a lli c us or French ,

D isease was because when knowledge of it s differ

,

e n t i a l diagnosis was generalized

, physicians at the
same time learned of the remedy which could be
so successfully employed for it s treatment the ,

value of which had been determined as the result

of the careful observat ions of the surgeons of South
France I t is probable as I have said that the
.
, ,

original idea for this form of treatment came from

 S URG E O N S OF TH E W E ST OF EU ROP E 12 5

the I t ali a n surgical traditions brought over from

I t aly by L a n franc and his cont emporaries at the
end of t h e t hirteent h century There can be no .

doubt at all however of the power of clinical

, ,

observat ion of t h e medieval surgeons who gave us

this wonderful advance in t herapeut ics .

The most distinguished pupil of Guy de C hauliac

was Pietro d Ar g ela t a who died about 14 23 as a
’
,

professor at Bologna but whose t ext book

, The ,

”
C irurgia w as among t h e first of medical books to
,

be printed at V enice in 14 8 0 His teaching was .

st ill a living force at that t ime and it is evident ,

that he had attracted wide attent ion in his o wn

generation He taught the dry treatment of
.

wounds suggesting various powders to be employed

,

on t hem and gave his experience with sutures and

,

drainage tubes in wounds .

L igat ures are often supposed t o have been

invented much lat er They have been attributed
.

t o Ambroise Par é and other surgeons of the

Renaissance period but were probably used at
,

many times during t h e M iddle Ages and had been ,

invent ed and frequent ly employed by the Greeks .

They invariably went out of use after a t ime how ,

ever and had to be reinvented

, As I said in
Old Time M akers of M edicine
-

Itis hard to underst and how so useful an

auxiliary to the surgeon as t h e ligature it seems —
126 MEDIE VAL MEDICINE
indispensable to u s could possibly b e allowed to
—

go o u t of use and even be forgo t t en I t will n o t .

be di ffi cult however for anyone who recalls t h e

, ,

condit ions t hat obt ained in old time surgery t o —

u nders t and t h e succession of even t s The ligat ure .

is a most sa t isfying immediat e re source in st opping

bleeding from an art ery b u t a septic ligat ure ,

inevit ably causes suppurat ion and almost inevi t ably ,

leads t o secondary h ae morrhage I n t h e Old days .

of sep t ic surgery secondary h aemorrhage was t h e

,
’
surgeon s great est and most dreaded bane Some
t ime from t h e fifth t o t h e nint h day a sep t ic
ligat ure came a way under condi t ions such t hat
inflammatory dist urbance had prevent ed sealing of
t h e vessel I f t h e vessel was large t h e h aemorrhage
.
,

wa s fas t and furious and t h e pat ient died in a few

,

minut es Aft er a surgeon had had a few deaths of

.

this kind he dre a ded t h e ligat ure .

E vent ually he abandoned it s u se and took ,

kindly even to such met hods as the act ual caut ery ,

red h o t knives for ampu t at ions and the like t hat

-

would sear t h e surfaces of t issues and t h e blood ,

vessels and n o t give rise t o secondary h aemorrhage

, .

A lit t le lat er however someone n o t familiar wi t h

, ,

t h e secondary risks would reinvent t h e ligature .

I f he were cleanly in his methods and above all , , ,

if he were doing his work in a new hospital the ,

ligat ure worked very well for a while I f n o t it .

,

soon fell into innocuous desuet ude again I n any .

case i t was only a question of time until it would

,
”
be abandoned .

There was at least one and probably a number ,

of E n g lish surgeons who were doing excellent work

 S U RGE O N S OF TH E W E ST OF EUROPE 12 7

in the latt er part of the M iddle Ages but l ohg ,

of rot e a book which has come down to

us, we may judge t h e charact er of
his contemporaries .He was educated at M ont
p elli er
, and prac t ised surgery for a t ime in France .

About the middle of the fourteenth century ,

according to Pagel he went b a ck t o his native land

,

and settled for some t wenty years at N ewark in

N o t t i n g h a m sh i r e ; and for nearly thirty years
longer unt il near the end of the century practised
, ,

in L ondon Ar der n s speciality was diseases of the

.
’

rectum but he made special st udies I n t h e treat ment

,

of fistulas everywhere in the b ody He was an

.

expert operat or and seems t o have had excellent

,

success in t his field He made careful st atist ics of

.

his cases and was quite as proud as any modern

,

surgeon of the large numbers t hat he had Operat e d

on which he gives very exactly
, He was t h e
.

invent or of some new inst rument s and of a clyst er

a ppara t us We know somet hing also about his fees
.
,

and there is no doubt t ha t he ob t ained q uit e as good

fees in proport ion t o t h e value of money as even any
specialist of t h e modern time .

Ar de r n gives many evidences of his power of

‘

clinical observat ion and incident ally makes it Very

,

clear that t h e eye s of t h e men of his t ime we r e n o t

so held from seeing t h e t hin gs t hat lay before
them as is oft en as sumed M r D Ar c n o wer in
. .
’
,
12 8 MEDIE V AL M E DICIN E
the paper on The L esser Writings of John
Ar der n which he read before the section on t h e
History of M edicine a t the Seventeenth I nter
nat ional C ongress ( see Transact ions) has quot ed a ,

series of paragraphs from Ar der n which make it

very clear how accurate an O bse r ver t his fourt eent h
century E nglishman was Here for instance is
.
, ,

his descrip t ion of epidemic sore throat in his time ,

probably diphtheria for the death wit hin five days

,

through strangling would seem to point to t his

And note diligently that in the sq n a n c y

[quinsy ] and in all t h e swelly g
n e s of the t h r o t e and
t h e nekke and in all the let t yn g e s and swo lo wyn g e
as wh a n n e t h e p a c ien t thereof is o ft et ym ys dysp o syd
t o t h e deet h wit h i n n e schort time and I have seye
manye deyed thereof within v dayes thorough
st r a n g lyn g e To the weche it is t o know t hat t her
.

is n o t h yn g e more p r o fyt a b ler e t herefore t hane to

"
use g lyst er yes of m a lo wys m er c u r ye [cheno

gemme or c o m o n e salt
,

podium ] branne and oyle or butt re hony and Sal ,

This o p er a c io n e drawet h
.

t h e wykkyd humours t o t h e inner p a r t ye s t hat

causet h t h e sykn esse and so it helpeth the
sq n n a n c ye

Ar der n
description of rabies its fat alit y and
’
s , ,

of how a mad dog act s exemplifies st ill fu r ther his

,
‘

a ccuracy of clinical observa t i on Only one wh o.

had seen m a ny cases and understood them a n d h a d ,

had man y mad dogs under observation could have ,

 S U RG E O N S OF TH E W E S T OF EU ROP E 12 9

given the details he does A single paragraph con

.

firms the idea that the medieval surgeons had very

clearly recognized the disease and knew as much
, .

about i t a s was known unt il our own generat ion

added somet hing of more definite knowledge of t h e
a ff ect ion t han could be gained by mere clinical
observat ion Ar der n says
.

The b yt yn g e of a wood [mad ] dogge is more

venemous and perilous t hane i t is of a serpent e ,

ffo r t h e ven ym e of a wood dogge ys h ydd oft en

tymes by the hole yere t o g yde r e and o t her wh yle
by t h e ii [t w o ] yere and aft er some a u c t o u r s i t
wole endure V ii yere or it sle [slay ] a m a n . And
not e wh eyt h er i t be longe t ym e h ydd or sc h o r t e or
t hat it slee t her comene t ofore t o t h e p a c i e n t thes
t o ken ys m edlyn g e and c h a u n g yn g e of wyt t e a n d
r eso n e and a b h o m i n a c i o n e and lo t h so m n e sse of cold

wat er that is elene and pure And wh a n e suche

.

syg n ys fallen t o him t hat is byten of a wood hound

schall unnet he or ellys [seldom or never ] escape it .

The t o ken ys of a wood dogge ben t hese ; t h e

fu r st e is he knoweth not his lord n e his mays t er
and he fallet h into a vo yd g o yi n g e allone wit h
b o o wyn g e of his heed and h a n g yn g e of t h e crys
[ c a r s] as o t her wyse than n e he h a d de hemin his
h elt h e and the yene [eyes ] of him ben rede and
t h e fome come t h o u t a t t h e mowt h and he wole
berke a t his oune sc h a do w e and he hat h ane hos
[ hoarse ] b e r kyn g,e and other h o u n d es fleene from
h ym e and berken t o wa r dys h ym e . And yf a
sc h yve r e [slice ] of breed be folden or wett e in the

b yt yn g e of the sore and y oven a dogge t o et e yf ,

17
130 MEDIEV AL MEDICINE
that he et c it it is a token that the dogge is not
,

wood for and the dogge be wood tha other dogge

,

that the breed is yoven to wole not et c it b ut that ,

he be over moche hungry and yf he den ye to et c

'
,

t h e seyde breed out take [unless on ] the condicione

,
-

a fo r e seyd thane i s the dogge wood

, .

A r der n
'

’
description of a case of traumatic
s

tetanus is very interesting b ecause it contains so ,

many elements that are familiar in the history of

this a ffection The fact that it occurred in a
.

gardener from a hook so likely to b e infected with

,

tetanus b acilli from hay or grass and that the ,

w ound was made where the thumb joins the hand

and where as we k now now the construction of
, ,

the tis sues is so favourab le to that b urying of the

tetanus bacilli away from the free o x ygen of the air ,

giving it a chance to grow anaerob ically all show ,

the disease exactly as in our own time The other .

details of the case prob ably indicate a w ound of an

important b lo o dvessel secondary h aemorrhage ,

after suppuration had b een est ab lished a nd then ,

the development of fatal su b acute tetanus

A g a r di n e r e wh yle that he wr o wg h t e in the
vyn es kyt t e his o wn e hande wi t h ane hooke u p p o n e

a ffr yda y after the ffe st e of Seyn t Thomas of

Ca u n t er b u r y in so m er e so that the t h o o m b e was
a lt o g yder e dep a r t yd from the hande sa ff only in

the juncture that was j o yn e d to the hande , and he

m yg h t e b o o we b a kw a r d the t h o o m b e to his arme

a n d ther st r em yd out the r of moche blood .
 S U RGE O N S OF TH E WE ST OF E UROP E 13 1

And so t o u c h yn g e to t h e cure The t h o o m b e

.

was f urst reduced in t o his fu r st e ordre and so wyd

and t h e blood was r est r eyn ed wit h t h e reed pouder
of la u n fr a n kes [L a n fr a n c s red powder ] and with
’

t h e h eer ys [hairs ] of ane hare and i t was n o t

r em ev yd une t o t h e i i ide day when it was r em evyd
—

t t h er a p p er yd no blood . Th a n n e was t her putte

t h e r t o t h o medicines t hat engendren blood every ,

day ones r ep eyr yn g e t h e wo u n de and tho it b eg a n e

,

t o purge i t selff e and t o gadere mat er . And in the

i iii t h e n yg h t aft er the blood brak out a b o wt e
m ydn yg h t in t h e wh eyg h t e of ii p o u n des . And
wh a n e t h e b lo d was r est r eyn e d t h e wo u n de was
r ep e yr e d frome day t o day as i t w a s fu r st e .

Also in t h e xit he n yg h t a b o wt e t h e fo r seyd oure

the blood brake owt ayene [again ] in more qu a n t yt e
t hane it dyde afore t ym e nevert heless the blood
,

was staunched and by the morne t h e p a c i en t was

,

so t aken with t h e crampe in t h e chekes [cheeks ]

and in the arme t hat he m yg h t r esseyve no mete
i n to his mowt h n e n eyt h e r o p en e t h e m o wyt h
—

( lockj aw ) and so ve x y g
n e t h e p a c i e n t in t h e xv day
t h e blood brake o u t ayene o wt of mesure and a lw ey
t h e crampe endured forth and in t h e XX day he
dyde f
’

Another important surgeon of t h e West of

E urope whose book has come down to us was In h n\ J

Yp er m a n who owes his name to t h e fact t hat he

,

was a native of t h e town of Ypres (in Flemish

Ypern) in Flanders Yp er m a n was sent by his
.

fellow t ownsmen to Paris in order t o study surgery

-

apparently at the expense of the municipalit y ,

132 M E DIEV AL MED I CINE
be cause they w anted to have a good su rg eon in
t heir town and Paris seemed t h e best school at
,

that time Ypres so familiar now as t h e scene of

.
,

bloody batt les had become even before t h e war one

,

of the less important ci t ies even of Belgium wit h ,

less than people I t was in t h e t hirteent h

.

century one of the great est commercial ci t ies of

E urope and probably had several hundred
,

thousand inhabitants The great hall of t h e C lo t h

.

Guild one of t h e archi t ectural triumphs of t h e

,

time and such an att raction for visitors t o the town

,

ever since ( destroyed in the war) was built at this

time and is ano t her tribut e t o t h e communit y
,

feeling of the citizens who determined upon the

,

very sensible procedure of assuri ng t h e best possible

surgery for themselves and fellow cit izens by having -

one of t heir t o w n sm en sp ec i a lly educat ed for that

purpose Yp er m a n s book on surgery was well
.
’

known in his own t ime but remained unprint ed ,

unt il about half a cent ury ago when C arolus

of Ghent issued an edit ion Subsequent edit ions .

were issued by B r o ec kx t h e Belgian hist orian ,

( An t werp , and by van L eersum

wh o g a t hered some details of t h e gre a t Flemish
surgeon s life’
Aft er his re t urn from Par is
.
,

Yp e r m a n ob t ained great renown which main ,

t a ins in t h e cus t om extant in t h at part of the

count ry even yet of calling an expert surg eon an
 S URGE O N S OF TH E W E ST OF EU ROP E 18 3

Yp er m He I s the aut hor of t wo works in

an .

Flemish One of t hese is a smaller compendium of

.

int ernal medicine which is very int erest ing how, ,

ever because i t shows t h e many subject s t hat were

,

’
occupying physicians minds at t hat time He .

treat s of dropsy rheumat i sm under which occur

, ,

t h e t erms coryza and catarrh ( t h e flowing diseases ) ,

ict erus pht hisis ( he calls t h e t uberculous t ysi ken )

, , ,

apoplexy epilepsy, frenzy le t hargy fallen

, , ,

palat e cough short ness of breat h lung abscess

, , , ,

h aemorrhage blood spit t ing liver abscess harden

,
-

, ,

ing of t h e spleen a ff ections of the kidney bloody

, ,

urine diabe t es incont inence of urine dysuria

, , , ,

st rangury gonorrh oea and involunt ary seminal

, ,

emissions all t hese t erms are quo t ed direct ly from

—

Pagel s account of his work

’
.

There is n o t much t o be said of t h e surgery of

Germany during the M iddle Ages t hough toward ,

t h e end of t his period a series of import a nt docu

ments for t h e history of surgery were writ t en which
serve to show how much was being accomplished ,

though t h e subsequent religious and poli t ical

dist urbances in Germ a ny doub t less led to the
dest ruct ion of m a ny ot her document s t hat would
have supplied valuable informat ion Heinrich vo n .

P fo lsp eu n dt s book which is a work on bandaging

’
,

Bu n dt h E r t z n ey was published in 14 6 0
- —
,

and the experience for i t was t herefore all obtained

 MED I EVAL ME DICINE
in the M iddle Ages While its main purpose is.

bandaging it contains many hints of the surgical

,

knowledge of the time There are chapters

.

devot ed to injuries and wounds though it is dis ,

t i n c t ly stated that the book is for wound

physicians ( W a n d A er t z t e) and not for cutting
physicians (S c h n ei de A er t z t e) that is for those ,

who do operations apart from wounds There are .

two operations descri b ed however that have , ,

particular interest One of them involves the

.

plast ic surgery of the nose a n d the other the repair

,

of a hare lip -
.

fo lsp eu n dt suggested that stitches should be

&
placed on the mucous surface as well as on t h e skin
surface aft er the edges of the cleft in h
, had
been freshened in order to be brought closely
together for healing with as little deformity as
possible . Perhaps his most interest ing surgical
hint for us is a description of a silver t ube w ith
flanges t o be inserted in the intestines whenever
there were large wounds or when t h e intest ines ,

had been divided The ends of the gut w ere

.

brought toge t her carefully over the tube and

s t it ched t oge t her the tube being allowed to remain
,

i n si t u
. P fo lsp eu n dt says t hat he had often seen
these tubes used and the pat ient live for many years
afterwards While t his resembles some of the
.

mechanical aids to surgery of the intestines that

 G I CA L N TA R I U M
’
B R U N S CH W I G S SUR A R M AM E

F G u r lt
’
r om s Gesc /zzc /zt e ( fer Clazr u r g ze
 S URG E O N S OF TH E W E S T OF EU ROP E 18 5

have b een suggested in our time this was not the

,

first mechanical device of this kind that had been

t hought of One of the later medieval surgeons in
.

I taly one of the Branc a s had employed the trachea

, ,

of an animal as t h e tube over which t h e wounded

i ntestines w ere brought together This had t h e
.

advantage of not having to be passed for aft er a

,

t ime it became disint egrated in the secretions but ,

it remained intac t until after thorough agglutination

of t h e intestines had occurred .

Hans von G er ssdo r ff and Hieronymus Bruns

c h wi g ,
who flourished in the latter half of t h e fi f
t e en t h century in Germany have both left early
,

printed treatises on Surgery which give excellent

woodcuts showing pictures of instruments opera ,

t ions and costumes at the end of the medieval

, ,

period .
 C HAPT E R VII I
O R AL SU R GE RY AND TH E MI N O R SU R G I CAL
S P E CIAL I T I E S

TH E surgical specialit ies as they are called that ,

—

is the surgery of t h e mout h t hroat and nose and

, , , ,

of the eye and ear as well of course as of certain

,

other portions of the body have developed t o a —

st riking extent in our t ime As a consequence of .

this recent development there is an impression ,

prevalent that t his is the first time t hat serious

attention has been paid by surgeons t o these phases
of their work The feeling is probably t hat the
.

minor operations usually required in the surgical

specialit ies were either t hought so trivial or involved ,

such delicate technique t hat they never received ,

due attent ion rat her t h an that t hey were deliber

,

ately neglected .

Because of t his very general persuasion even ,

among physicians it is all t h e more int erest ing t o

,

t race the phases of att ent ion during t h e M iddle

Ages t o t hese special subject s in surgery which ,

was far from lacking a t any t ime and which led ,

at various periods to some rather import ant

developments While specialism is considered new
.

136
 MIN OR S U RG ICAL SPECI ALI T IE S 13 7

by most people it must not be forgotten that at

,

every time in the world s hi story when men have

’
,

had much chance to think about themselves rather

than the actual necessities of t h e situation in which
they were placed and the things t hey w ere com
,

p e ll e d t o do for actual self preservation

-
specialism
,

has enjoyed a period of more or less intense

evolution I t is rather easy to trace this in the
.

E bers Papyrus near t h e begin n i ng of t h e second

millennium B C ; and Herodotus called attention
. .

to the fact that the old E gyptians had di vided the

practice of medicine into many specialities His .

*
passage on t h e subject is well known .

I f the surgical speciali ties had been neglected in

the M iddle Ages then that fact would have consti
,

t u t ed the surest evidence of that backwardness of

medical and surgical progress which is usually
supposed to have existed at that time But the .

real story is exactly to t h e contrary and has many ,

su rprises in it because of t h e anticipations of very

recent advances which it r ep r esen t s l .
‘ ‘

P h ysi c ke i s so st u di e d a n d p r a c t i sed w i t h t h e E g yp t i a n s
t h a t e v er y di sea se h a t h h i s se v er a l p hysici a n s wh o st r iv et h
,

t o ex c ell i n h ea li n g t h a t o n e di sea se a n d n o t t o b e ex p er t i n
c ur i n g m a n y W her eo f i t c o m et h t h a t ev er y c o r n er o f t h a t
.

co un t r y i s full o f p hysici a n s S o m e fo r t h e eyes o t h er s fo r

.
,

t h e h ea d m a n y fo r t h e t eet h n o t a fe w fo r t h e st o m a c h a n d
, ,

t h e in wa r ds
”
.

1 Th e E b er s Pa p yr u s sh o w s t h a t sp eci a l a t t en t i o n wa s
“

a id t o d i sea ses o f t h e eyes t h e n o se a n d t h r o a t a n d we

p , , ,

18
 13 8 MED I E V AL MEDICINE
I t would b e surprising then if we were to fi nd
, ,

no attention paid t o dentistry during the M iddle

Ages As a matt er of fact a number of the old
.
,

surgeons include in their textbooks of surgery the

discussion of oral surgery A et iu s evident ly knew
.

much about t h e hygiene of t h e teeth and discusses ,

extract ion and the cure of fi st u lae of t h e gums as

well as t h e surgical t reatment of many o t her lesions
of t h e mouth Paul of Ailg i n a in t h e cent ury aft er
.

Aet iu s has even more details ; and while t hey both

ha ve i i o n s o f o p er a t i o n s u p o n t h ese fr o m v er y ea r l y
t ra d t
t im es C o n ser va t i v e sur g er y o f t h e t eet h a n d t h e a p p lica
.
,

t i o n o f p r o st h et ic d en t a l a p p a r a t u s b ei n g r a t h er c o sm et ic
,

t h a n a b so l u t el y n e c essa r y mi g h t p o ssi b l y b e ex p ec t ed n o t t o
,

h a v e d e v el o p ed u n t il c o m p a r a t iv el y r ec en t t im es ; b ut a p a r t
fr o m t h e t r a di t i o n s i n E g yp t w i t h r eg a r d t o t h i s sp eci a li t y,

wh ic h a r e r a t h er d u b i o u s we h a v e a b u n d a n t evid en c e o f t h e
,

d efi n i t e develo p m en t p f d en t i st r y fr o m t h e l o n g a g o Th e .

o ld E t r u sca n s e vid en t ly p a id c o n sid er a b l e a t t en t i o n t o

r o st h et ic d en t i st r f o r we h a v e s e cim en s fr o m t h e E t r usc a n
p y , p
t o m b s wh ic h sh o w t h a t t h ey did b r id g e w o r k i n g o ld ,

su
pp li ed a r t i fi ci a l t eet h,
a n d u se d m an
y fo r m s o f d en t a l

a ra t us A t R o m e t h e L a w s o f t h e T we l v e T a b les (c ir c a
a
pp .

45 0 fo r b a d e t h e b ur yi n g o f g o ld w i t h a c o r p se ex c ep t
su c h a s wa s fa st en e d t o t h e t ee t h sh o w i n t h a t t h e em l o
, g p y
m en t o f g o ld i n t h e m o u t h fo r d en t a l r ep a i r m ust ha v e b een
r a t h er c o mm o n . W e ha v e sp e cim en s o f g o ld ca p s fo r t eet h
fr o m t h e ea r l y R o m a n p er i o d ; a n d t h er e i s e ven a w ell c o n -

fi r m ed t r a di t i o n o f t h e t r a n sp l a n t a t i o n o f t eet h a p r a ct ice
,

wh ic h see m s t o h a v e b een t a k en u p a g a i n i n t h e l a t er M iddle

Ag es a n d t h en a ll o w ed t o l a p se o n ce m o r e un t il o ur o wn
,

t im e .
SU R G I C AL I N S T R U M E N TS OF TH E AR A BS , A CC O R D I NG T O A B U L CA S I M

Af t er p la t es
’
m G u r lt s G esc /zzc /zt e d er C/zzr u r g ze

A p m c h er fo r t ac t i g fo ig b od i f o h m t
yi g f
ex r n re n es r e ea r
An e a r s r n t io e o r i n ] ee
to gu pr or
ns

A n e de
C o cav c i o f h r oval of to i l
3 . ess
or t em
Curv d
4 n e s ss r s e ns
for i g b o d i h throat
. s

5 e h f
pm c ers or e n es m t e
to I tru t for h tr at t of h t th
.

6 m t m en t
F orc p
29. ns en s e e e ee
19 a n d
t o L v r d hook h r oval ofroot
2 0. e s
2 1 25 e e s an s fo r t e em s
St o g a
.

2 6 r n h f
pm h c or t e s m e
A tooth h t th
. er s
2 7. sa w d F il f 2 8 an 2 9 es or t e ee
 MIN OR S U RG IC AL SPECI ALIT IE S 139

quot e mainly from older authors there seems no ,

doub t t hat they t hemselves must have had consider

able prac t ical experience in t h e treat ment of the
tee t h and had made n o t a few observations The .

Arabi a ns t ook up t h e subject and discussed dent al

,

diseases and t heir t reatment rat ionally and in con

si de r a b le de t ail
. Ab u lc a ssi s p a rt icularly has much
t hat is of significance and interest .We have
pic t ures of t w o score of dental instrument s t hat
were used by him The Arabs not only treated and
.

filled carious t ee t h and even replaced t hose that

,

were lost b u t they also corrected deformit ies of

,

the mout h and t h e dental arches Ort hodont ia is

.

usually thought of as of much l a ter origin yet no ,

one who knows Ab u lc a ssi s s work can speak of

’

effort s at s t raightening the teeth as i n ven t ed after

his t ime .

The great surgeons of the later M iddle Ages in

t heir t ex t books of surgery usually include remarks
on oral surgery and suggest t reatment for t h e
,

various diseases of t h e t eet h Guy de C hauliac in

.

L a Grande C hirurgie lays down cert ain rules

for t h e preservation of the t eeth and shows t hat
,

t h e ordinary causes of dent al dec a y were well

recognized in his time E mphasis was l a id by him
.

on n o t t a king foods t o o h o t or t o o cold and above ,

all on t h e advisabilit y of not having either hot or

cold food followed by some t hing very di fferent from
140 MEDIE V AL MEDICINE
it in temperature The breaking of hard things
.

with the teeth was warned against as responsible

for such fissures in t h e enamel as gave opportunity
for the development of decay The eating of .

sweets and especially the sticky sweets preserves

, , ,

and the like were recogni z ed as an import ant source

,

of caries The teeth were supposed to be cleaned

.

frequently and not to b e cleaned too roughly for

, ,

this would do more harm than good .

iulian is part icularly emphatic in his insistence

n
on not permit t ing alimentary materials to remain
in the cavities and suggests that if cavities between
,

the teeth tend to ret ain food material they should

even be filled in such a way as to prevent these
accumulations .His directions for cleansing the
teeth w ere rather detailed His favourite treatment
.

for wounds was wine and he knew that he succeeded

,

by means of it in securing union b y first intention .

I t is not surprising then to find t hat he r e c o m

, ,

mends rinsing of the mouth wit h wine as a

precau t ion against dental decay A vinous .

decoc t ion of wild mint and of pepper he considered

part icularly fiben efi c i a l t hough he t hought that
,
f
den t ifr i c esjf eit h er powder or liquid should also be
’

, .

used H eseems to recommend the powder dent i

.

fri o es as more e ffi cacious His favourit e prescription

.

for a tooth powder while more elaborate resembles

-

, ,

to such an e xtent at least som e if not indeed most

, , ,
 MIN OR S U RG IC AL SPECI ALI T IE S 14 1

of those that are used at the present time that it ,

seems w ort h while giving his directions for it He .

t ook equal parts of cuttle bones small white sea-

’
shells pumice stone burnt stag s ho rn nitre alum
,
-

, , , ,

rock salt burnt roots of iris aristolochia and reeds

, , ,
.

All of t hese substances should be carefully reduced

to powder and then mix ed .

His favouri t e liquid dentifrice contained the

following ingredient s : Half a pound each of sal
ammoniac and rock salt and a quart er of a pound
,

of saccharin alum All these were to be reduced to

.

powder and placed in a glass alembic and dissolved .

The teeth should be r ubbed with it using a little ,

scarlet cloth for the purpose Just why this par .

t i c u la r colour of cleansing clo t h was recommended

is not quite clear .

He recognized however that cleansing of the

, ,

teeth properly often became impossible by any

scrubbing method no matter what t h e dent ifrice
,

used because of the presence of what he called

,

hardened li m o sit y or lim yn ess ( lim o si t é en du r c i e) .

When that condit ion is present he suggests the use

of rasps and sp a t u m i n a and o t her instrumental
means very similar to t hose we make use of for
removing tartar .

Guy de C hauliac was also interested in mechanical

dentist ry and the artificial replacement of lost
teeth ; and indeed dental prosthesis represents as
, , ,
14 2 M E DIE V AL MEDICIN E
treated by him a distinct anticipation of dental
,

procedures usually t hought quite modern .

When teeth become loose he advises that they

be fas t ened to t h e healt hy ones with a gold chain .

Guerini in his , Hist ory of D ent istry ( Phila

delphia , sugge st s t hat he evident ly means a
gold wire I f the teet h fall out C hauliac r ec o m
.

mends t hat t hey be replaced by t h e t ee t h of ano t her

person or wit h artificial t ee t h made from o x bone
,
-

which may be fixed in place by a fine metal ligat ure .

He says t hat such tee t h may be serviceable for a

long while This is a rather curt way of treating
.

so large a subject as dental prost hesis but it ,

cont ains a lot of suggest ive material He was .

quoting mainly t h e Arabian authors and especially ,

Ab u lc a ssi s a n d Ali Abbas and Rhazes and these —

of course as we have said ment ioned many methods

, ,

of art ificially replacing teeth as also of transplanta

,

t ion and of t reat ment of t h e deformities of the

dental arches .

Guerini called part icular at t ention t o the fact

t hat C hauliac recognized t h e dent ist s as specialists .

He observes t hat operat ions on the t eet h are in a

.

cl a ss by t hemselves and belong t o the den t a t o r es

,

t o whom t hey had been ent rust ed He remarks

.
,

however t hat t h e opera t ions on t h e mout h should

,

be performed under the direction of a surgeon I t .

is in order t o give surgeons the general principles

 MI NOR S U RG IC AL SPECI ALIT IE S 14 3

by means of which t hey may be able to judge of

the advisabilit y or necessity for dental operations ,

that his brief presen t at ion of t h e subject is made .

I f t heir a dvice is t o be of value physicians should ,

know t h e various me t hods of t reat ment suit able for

dental diseases including mouth washes gargles
, , ,

mastic a t ories and oint ment s rubbings fumigat ions

, , ,

”
cauterizat ions fillings filings
, , as well as t h e ,

various dent al operat ions He says t hat t h e

den t a t o r must be provided with appropriat e i n st r u
ment s among which he named scrapers rasps
, , ,

s t raight and curved sp a t u m i n a elevators simple

, , ,

and with two branches t oot hed t enacula and many

, ,

different forms of probes and cannulas He should .

have also small scalpels toot h trephines and files

, , .

After Guy de C hauliac t h e most import ant con

,

tribut or to dentistry is Giovanni of A r c o li o r —

simply Ar c o la n o but sometimes bett er known by

,

his L atin name Johannes Ar c u la n u s who was —

Professor of M edicine and Surgery a t Bologna just

before and aft er t h e middle of t h e fifteent h cent ury .

He is somet imes treated in history as belonging

rather t o t h e Renaiss a nce but he owed his training
,

to t h e M iddle Ages and was t eaching before they

closed so he has a place in M edieval M edicine
, .

Guerini in his History of D ent ist ry

, says that ,

A r c u la n u s treats t h e subject of dent istry rat her

f ully and with great accuracy The Italian historian
.
14 4 MEDIEV AL MEDICINE
makes a summary of Ar c u la n u s s ’

hygi ene w hich shows how thoroughly he appreciated

the care of the teeth The medieval surgeon
.

arranged his rules in ten distinct canons creating ,

in this way a kind of decalogue of dental hygiene .

These rules are : ( 1) I t is necessary to guard

against the corruption of food and drink within the
stomach ; t herefore easily corruptible food milk
,
—
,

sal t fish et c
,
—
must not be partaken of and aft er ,

meals all e x cessive movement running exercises , ,

b athing coitus and other causes that impair the

, ,

digestion must also be avoided

, ( )
2 E verything .

must be avoided that may provoke vomiting ( 3 ) .

S weet and viscous food such as dried figs —

,

preserves made with honey etc must not b e par , .

—

taken o f ( 4 ) Hard things must not b e broken

.

with the teeth ( )

5. All food drink and other , ,

sub stances that set the teeth on edge must b e

avoided and especially the rapid succession of hot
,

and cold and vi c e versa

, ( )
7 L eeks must
. not be
eaten as such a food by its own nature is injurious
, , ,

to the teeth .
( )
8 The teeth must be cleaned at
onc e after every meal from t h e particles of food
left in them ; and for this purpose thin pieces of
wood should be used somewhat b road at the ends
, ,

but not sharp pointed or edged ; and preference

-

should be given to small cypress twigs or the wood -

of a l o es or p ine r osemary o r j
, , uni p er and similar
, ,
 MIN OR S U RG IC AL SPECI ALIT IE S 1 45

sorts of wood which are rat her bitter and styptic ;

,

care must however be taken not t o search too

, ,

long in the dent al int erst ices and not to injure the ,

gums or shake the teeth ( )

9 After this it is .

necessary to rinse t h e mouth using by preference ,

a vinous decoct ion of sage or one of cinnamon , ,

mast ich g a llia moschat a cubeb juniper seeds

, , , , ,

root of cyperus and rosemary leaves , ( )

10 The .

teet h must be rubbed wit h suit able dent ifrices

before going t o bed or else in the morning before
,

breakfast Although Avicen na recommended

.

various oils for this purpose Giovanni of Ar c o li ,

appe a rs very hos t ile to oleaginous frict ions because ,

he considers them very injurious to the stomach .

He observes besides t hat whilst moderate fric t ions

, ,

of br i ef duration are helpful to the teet h strengthen ,

t h e gums prevent the formation of tartar and

, ,

sweeten the breath too rough or t o o prolonged ,

rubbing is on the contrary harmful t o t h e teeth

, , ,

and makes t hem liable t o many diseases .

Short ly aft er Ar c u la n u s when t h e M iddle Ages ,

are over i f t hey end wit h t h e middle of t h e

—

fifteent h cent ury t hough perhaps not if t h e lat er

,

d a t e of t h e disc o very of America is t o be t aken a s

t h e medieval t erminal John de Vigo has in a few
—

lines a very complete descrip t ion of t h e met hod of

filling t ee t h wit h gold leaf which deserves to be -

quot ed Only t hat i t was a c ommon practice he

.

19
14 6 MEDIE VAL MEDICINE
would surely have described it more in detail ,

t hough he could have added nothing to the s1g n 1fi

cance of wh a t he has to say By means of a drill
or file the p u t r efi ed or corroded part of t h e teeth
should be comple t ely removed The cavity left .

should t hen be filled with gold leaf -

.

M uch more is known about t h e medieval ant ici

p a t i o n of o t her speciali t ies t hose of t h e t hroat
—
and
nose and eye and ear and t h e surprise is with
,
—

regard t o dent istry which is usually quite unknown

, .

The fact however th a t dentist ry developed so

, ,

much more t han is usually t hought prepares t h e

mind for t h e anticipat ions in ot her departments .

Following t hat of dent is t ry should come nat ura lly

t h e mout h and t hroat and it happens that t h e men
,

whose writ ings in dentist ry are known also touched

on t hese subjects .

The medical w rit ers of the early M iddle Ages ,

part icularly A et i u s Alexander of Tralles and Paul

, ,

of ZE g i n a have not a lit t le t o say wit h regard t o

,

a ffec t ions of t h e t hro a t and nose and t h e eye a n d ,

’
ea r . Alexander s chap t er on t h e Treat ment of
A ffec t ions o f t h e E a r G u r lt considers a mple
,

evidence of large pra c t ic a l experience a n d power of

observa t ion .Alex a nder describes t h e ordin a ry
mode of ge t t ing w at er o u t of t h e ext ernal audit ory
can a l by st anding on t h e leg corresponding t o t h e
side in which t h e wa t er is and kicking o u t with t h e
,
 MIN OR S U RG IC AL SPECI ALI T IE S 14 7

opposit e leg Foreign bodies should be removed by

.

an ear spoon or a small inst rument wrapped in wool

,

and dipped in s t icky mat eri a l He suggest s sn e ez

.

ing wit h t h e he a d leaning t ow a rd t h e side on which

t h e foreign body is present I nsect s or worms t h a t
.

find t heir way into t h e ear may be killed by i n j ec

t ions of dilut e a cid and oil or o t her subs t ances .

W h a s a very pract ical t echnique for

or ot her object s caught

He also gives the detailed t echnique
e larynx or trachea wit h the indica
,

tions for this operation . He also describes how

wounds of the neck should be sewed aft er at t emp t s
at suicide I n a word t h e more one knows of t hese
.
,

old time medieval writ ers of t h e sixt h and sevent h

-

centuries t h e clearer it becomes t h a t t hey had

learned their lessons well from t h e ancient s a n d ,

p a ssed o n an excellent t radi t ion t o t heir colle a gues

of su cceeding genera t ions I f t hese les sons were n o t
.

properly t ake n it was bec a use t h e di st urb a n ce o f

,

c i vi liz a t ion c a used by t h e coming down of t h e

Teut onic invaders int o I t aly t ook away int erest in
t h e t hings of t h e mind and of t h e body unt il t h e
,

coming of ano t her upward t urn in progress .

Ag u la n u s h a s some very in t eres t ing paragraph s

W i t h reg a rd t o t h e t reatment of condit ions in t h e

nose For instance in the tre a t ment of polyps
.
, ,

he say s that the y should be incise d a n d caut erized .

14 8 MEDIE V AL MEDICINE
Soft polyps should be drawn out with a toothed
tenaculum as far as can be without risk of breaking
them o ff The incision should be made at t h e root
.
,

so that nothing or just as little as possible of the

pat hological struct ure be allowed to remain It .

should b e c u t o ff wit h fine scissors ; or with a narro w

file just small enough to permit ingress into the
nostrils ; or with a scalpel without cutting edges on
t h e sides b ut only at its extremity and this cutting
, ,

edge should be broad and well sharpened I f there .

is danger of h aemorrhage or if there is fear of it

,
,
,

t h e instruments with which the section is made

should be fi red ( ig n i a n t ur ) that is heated at least
—
,

to a dull redness Afterwards the stump if any

.
,

remains should be touched with a hot iron or else

,

with cauteri zing agents so that as far as possible it

,

should b e obliterated .

Aft er the operation a pledget of cotton dipped

,

in the green ointment described by Rhaz es should

b e placed in the nose This pledget should have
.

a string fastened to it hanging from t h e nose in

, ,

order that it may be easily removed At times it .

m a y be necessary t o touch the root of the polyp

with a st yle t on which cotton has been placed that

,

has been dipped in a qu a f o r t is ( ni t ric acid) I t is .

import ant that this cauterizing fluid should be

rather strong so that after a certain number of
,

t ou c hes a rath er fi r m esch a r is p roduced I n all .

 MIN OR S U RG IC AL SPECI ALI T IE S 14 9

these manipulations in the nose A r c u la n u s r e c o m

mends t hat the nose should be held well open by
means of a nasal speculum Pic t ures of all t hese .

inst rument s occur in his ex t ant works and indeed ,

t his cons t i t utes one of t heir mos t int erest ing and
valuable features They are t o be seen in G u r lt s
.
’

”
History of Surgery .

I n some of the cases he had seen t h e polyp was ,

so di fficult to get at or was situated so far back

,

in the nose that it could not be reached by means

,

of a tenaculum or scissors or even the special knife

,

devised for that purpose For t hese patients

.

Ar c u la n u s describes an operat ion that is to be found

in the older wri t ers on surgery Paul of ZE g in a —

ZE
( g i n et a s) Avicenna
, and some , of the other
Arabian surgeons For t his t hree horse tail hairs
.
,
-

are twisted toget her and knotted in three or four

places and one end is passed through the nost rils
,

and out through the mouth The ends of this are .

then pulled on b ackward and forward after the

fashion of a saw Ar c u la n u s remarks evident ly
.
,

wi t h t h e air of a man who has tried it and not been

sat isfied t hat t his operat ion is quite uncertain and
, ,

seems to depend a great deal on chance and much ,

reliance must not be placed on it Ar c u la n u s .

suggests a subs t i t ute method by which lat ent polyps

—
or occult polyps as he calls t hem may be
,
—

removed .
15 0 MEDIE V AL MEDICINE
Among t h e a ffections of t h e upper air passages
mentioned by Ar c u la n u s are various forms of sore
throat which he calls Synanche or C ynanche or
, ,

angina A milder form of t h e a ffection was called

.

P a r a syn a n c h e The medieval t eaching wit h r eg a rd

.

to a n angi na that was causing severe di fficult y of

breat hing was t o perform t racheo t omy A r c u la n u s
.

goes into some det ail wit h regard t o a ff ect ions of

the uvula which was made much more responsible
,

for throat affect ions t han at the present time The .

popular tradition in our t ime of the uvula and it s

fall is evident ly a remnant of t h e medieval teaching
w ith regard to it Ar c u la n u s s descrip t ion of t h e
.
’

removal of the uvula or at least of t h e t ip of it

, ,

gives a very good idea of how t horough the teaching

of surgical techni q ue was in his time His di r ec .

tions are Se a t t h e pat ient upon a stool in a

bright light while an assistant holds t h e head ;
,

aft er the t o n gue has been firmly d epressed by me a ns

of a speculum let t h e assist ant hold t his speculum
,

in place Wi t h t h e left hand t hen insert an i n st r u

.

ment a stilus by which t h e uvul a is pulled forward ;

, ,

and t he n remove t h e end of it by means of a heat ed

knife or some ot her process of caut erizat ion The .

mout h should aft erwards be washed o u t wi t h fresh

milk .

The application of a caut erizing solut ion by

means of a cotton swab wrap p ed round t h e end of
 MIN OR S U RG IC AL SP ECIALI T IE S 15 1

a sound m a y be of service in patients who refuse

t h e ac t ual cau t ery. To be successful he insist s ,

that t h e application must be firmly made and must

be frequent ly repeated .

Wit h regard to ophthalmology the older history

has always been t horoughly appreciat ed E ven as .

early as t h e t ime of Hammurabi ( 2 2 00 some

rather ex t ensive and interest ing surgery of t h e 3312
was pract ised for t h e fees for these operat ions are
,

ment ioned in the code All of t h e early medieval

.

w rit ers on medicine and surgery Aet iu s Alex —

,

ander of Tra lles and Paul of ZE g i n a have

,
—

paragraphs a t least and some t imes more w ith

, ,

regard t o eye operat ions and t h e care of the eyes .

O perat ions above all for cataract have been

pra c t ised from very early t imes and are ment ioned
,

also by many mediev a l writers on medicine and

surgery . I t is n o t surprising t hen to find t hat
, ,

t h e medieval surgeons par t icularly discussed a

number of eye diseases a n d t h e operations for t hem .

Pope John XX L who before he bec a me Pope

,

w a s known as P e t m s H i sp a n a s ( t h e Spani a rd ) and ,

w h o h a d been a professor of surgery a n d a p a p a l

physici a n wro t e a book on eye diseases in t h e la t t er
,

h a lf of t h e t hirt eent h cent ury which has come down

,

t o us
. He h a d much t o sa y of c a t a ract dividing ,

i t int o t ra um a tic and spont aneous a n d sugges t ing

, .

operat ion by needling a gold needle being used

,
 15 2 MEDIE V AL MEDICINE
for that purpose Pope John descri b es a form of
.

hardness of the eye which w ould seem to be what

we now call glaucoma and has a numb er of,

external applications for eye diseases M ost of his .

collyria had some bile in them the b ile of various ,

kinds of animals and birds being supposed to be

progressively more e ffi cient for the cure of external
a ffections of the eye This very general use of bile
.
,

or of an ex t ract of the livers of animals or fishes ,

seems to be a heritage from b ib lical times when ,

old Toby was cured of his blindness b y the gall of

*
the fi sh The Pope ophthalmologist ( see Op t h a l
.

m o lo g y M ilwaukee January 19 09 ) recommended

, , ,

t h e urine of infants as an eye wash e x perience -

having evidently shown that this fluid which is ,

usually bland and unirritating a solution of salts of

,

a specific gravity such t hat it would not set up

osmotic processes in the eye was empirically of ,

value I n the M iddle Ages the idea of using it

.

woul d be much less deterrent because it was quite,

a common pract ice for physicians to taste urine in

order to test it for pat hological condit ions .

Spe ct acles were rather commonly used in t h e

M iddle Ages probably having been invented in t h e
,

second half of the t hirt eenth century b y Salvino

Dr P et ells,
. di sc u ssi n g t h i s u se o f liv er s (Ja n us ,

sa s t h a t t h er e h a s b ee n so m e t en d en cy t o r e v er t t o t h e id ea
y
o f b ili a r y p r i n ci p l es a s o f v a l u e i n e x t er n a l eye d i sea ses.
 MIN OR S U RG IC AL SPECI AL I T IE S 15 3

de Armato of Florence .Bernard de Gordon

ment ions t hem under the name o c u lus b er elli n us
early in the fourt eent h century They were
.

originally made from a kind of smoky crystal ,

b er i llu s whence t h e German name B r i llen and the

,

French b esi d es ( Garrison) Guy de C hauliac

.

suggests that when collyria failed to improve the

sight spectacles should be employed Almos t need
.

less to say this use of spec t acles meant very much

,

for the comfort and convenience of old people U p .

t o that t ime most of those who reached t h e age of

three score w ould be utterly unable to read and
-

would h a ve to depend eit her on ot hers or on their

memory for teaching and many o t her purposes .

E xt ern a l eye troubles as those due to t richiasis and

,

to various dist urbances of t h e lachrymal apparat us ,

were treated by direct mechanical means Some .

very ingenious suggest ions and manipulations were

made with regard to t hem .
 C HAPT E R I X
M E D I CAL E DU CAT I ON F OR W OME N

A M ONG the rathe r startling surprises that have

developed as the growth of our knowledge of
,

medieval history through consultation of the

,

documents in recent years is constantly contra

,

dict ing tradi t ions founded on lack of informat ion ,

perhaps the greatest has been to learn that women

were given opportunities for the higher education
at practically all of the I talian universities and ,

that t hey became not only students but professors , ,

a t many of t hese institutions N o century from

.

t h e twelft h down to the nineteenth was without

some dist inguished women professors at It alian
universit ies and in the later M iddle Ages t here
,

w as a particularly active period of feminine

education .

The mos t interesting feature of t his development

for us is t hat t h e a p plication of women t o medical
st udies from t h e t welft h t o the fourteenth c enturies
was not on ly not discou r aged but wa s distinctly ,

encouraged and we find evi d ence that a numb er

,

15 4
 EDUC AT I O N FOR W O MEN 15 5

of women studied and taught medicine wrote books ,

on medical subjects were consult ed wit h regard to

,

medico legal quest ions and in general w ere looked

-

upon as medical colleagues in practically every

sense of the w ord The very first medical school
.

that developed in modern times that of Sa le rno , ,

which came into E uropean prominence in the

eleventh century w as quite early in its history
,

opened to women students and a number of women

,

professors were on its faculty .

C onsidering the modern idea that ours is the

first time when women have ever had any real
opportun i ty for the higher education and ab ove all ,

professional education it is a source of no little

,

astonishment to find t hat at S alerno not only an

opportunity was a ff orded to w omen to study
’
medicine but the department of women s diseases
,

was handed over entirely to them and as a c o n se ,

q u e n c e we have a Salernitan S chool of Women

Physicians some of whom wrot e textbooks on the
,

subject relating to this speciali t y D e Renz i in .

( ,

his S t oria della S cuola di Salerno has brought ,

t o light many details of the history of this phase

of medical education for women at the fi rst
important medical school that developed in modern
E urope The best k nown of
. val w omen
physicians
series of books on medical subjects though doubt —
15 6 MEDIE V AL MEDICINE
less some of these w ere due rather to disciples but ,

became identified with the more famous master ,

as so often happened wit h medieval books .

M s mos t important book bears two sub ti t les -

Tr o t u la s U nique Book for the C uring of

’

D iseases of Women Before D uring and Aft er

, , ,

L abour , and t h e o t her sub t it le Tr o t u la s

-

,
’

Wonderful Book of E xperiences ( ewp en m en t a lis)

in the D iseases of Women Before D uring and , , ,

After L abour with Other D etails L ikewi se

,

Relating to L abour .

Prob ably the most interesting passage in her

b ook for the modern t ime is that wit h regard to a
torn perineum and its repair even when prolapse ,

of the uterus is a complication The passage which .

,

may be found readily in D e Renzi or in G u r lt ,

runs
C ert a in pat ient s from the severit y of t h e
,

labour run int o a rup t ure of t h e genit alia

, In .

some even the vulva and anus become one foramen ,

having the same course As a consequence pro

.
,

lapse of t h e uterus occurs and it becomes indurat ed

,
.

I n order to relieve t his condit ion we apply t o the ,

ut erus warm wine in which but ter has b een boiled ,

and these fomentations are cont inued unt il t h e

u t erus becomes soft and then it is gent ly replaced
,
.

Aft er this we sew t h e tear be t ween the anus and

vulva in t hree or four places wit h silk t hread The .

wom a n should t hen be placed in bed with the fee t ,

elevated and must ret ain that position even for

, ,
 EDUC AT I O N FOR WO MEN 15 7

eat ing and drinking and all t h e necessit ies of life

, ,

for eight or nine days D uring t his t ime also

.
, ,

t here mus t be no bat hing and care must be t aken

,

t o avoid every t hing t h a t might cause coughing and ,

all indigestible mat erials .

There is a passage almost more int erest ing with

regard t o prop s of r upture of t h e perineum .

Tr o t u la sa y s order t o avoid t h e afore said

danger , p rovision should be made and ,

precautions should be taken during labour after the

following fashion : A cloth folded in somewhat
oblong shape should be placed on the anus and ,

during every effort for the expulsion of the child ,

t hat should be pressed firmly in order that there ,

may not be any solution of the continuit y of tissue .

There are records of ot her women professors of

Salerno though none of them as fa mous as Trotula
,
.

A lady of t h e name of M er c u r i a de is said to have

writ t en On C rises in Pestilent Fever and as ,

she occupied herself with surgery as well as

medicine there is also a work on
,
The C ure of
Wounds . Rebecca Guarna who belonged t o the
,

old Salerni t an family of t hat name a member of ,

which in t h e twelft h century was Romuald priest , ,

”
physician and historian wrote
,
O n Fevers
, ,

”
On t h e U rine an d
,
On the E mbryo .

Abella acquired a great reput at ion wi t h her work

”
On Black Bile and curiously enough on The
,
15 8 MEDIE V AL MEDICINE
N ature of Seminal Fluid From these books it is
.

clear that while as professors they had charge of

,

’
the department of women s diseases they st udied ,

all branches of medicine There are a number of .

licences preserved in the Archives of N aples in

which women are accorded the privilege of
pract ising medicine and apparent ly these licences
,

were without limitation as to the scope of practice .

The preamble of the licence however suggests t h e , ,

’
eminent su itability of women treating women s
diseases I t ran as follows
.

Since then the law permits women to

, ,

exercise the profession of physicians and since , ,

besides due regard being had to purity of morals

, ,

women are bet t er suit ed for t h e t reatment of

’
women s diseases aft er having received the oath
,
”
of fidelit y we permit etc
, , .

The story of medical education for women with

the free opportunit y for pract ice and above all the ,

recognit ion accorded by making them professors at

hfi
m t of Salerno will seem all the more
/
f

surprising to those who recall that the Benedictines

,

largely influenced the foundation at Salerno a nd ,

were important factors in its subsequent growth

and management Ordinarily it would be presumed
.

that monastic influence would b e distinctly against

permitting women t o secure such opport unities for
education and a b ove all encouraging t heir o c c u
, , ,
 EDUCAT I O N FOR W O MEN 15 9

p a t i o with medical prac t ice As a matter of fact

n .
,

it seems indeed to have been monastic influence

which secured t his special development The Bene .

di et ines were already habituat ed to the idea that

w omen were quite capable if given the opportu n i ty
, ,

of taking advantage of the hi ghest education ; and

besides they were accustomed t o see them occupied
, ,

and successfully with the care of the ailing When

, .

St Benedict established the monks of the West in

.

retreats where the men of t h e earlier M iddle Ages

,

could secure in the midst of troubled times and

,

wi t h men in the cities utterly neglectful of

intellect ual interests a refuge from the disturbed
,

life around them and an opportunity for intel

,

lectual development his sister Scholastica aff orded

,

similar opportunities for such women as felt that

they w ere called rather to t h e intellectual and
spiritual life than to the taking up of the burden
’
of domestic dut ies and a wife s labours .

I n these Benedict ine convent s for w omen as ,

t hey spread throughout I taly and afterwards

—

throughout Germany and France and E ngland

, , ,

though t h e fact is often ignored the in t ellect ual—

life was pursued as fai t hfully as t h e spirit ual .

B e sides t here gat hered around t h e convent gat es

,

as around t h e monast eries t h e farmers who worked

t heir estates and who found it so good
, t o live
”
unde r t h e c r o zier as the rule of t h e Abbot or
,
160 MEDIE VAL MEDICINE
Abbess w as called and who always suff ered severe ly
,

whenever by confiscation or war or like disturb

,

a n c es the monastic lands passed into the hands of

,

laymen For their own large numbers as well as

.

for their peasantry and for the travellers who

,

stayed in t heir guest houses the nuns had t o

-

provide medical att endance ; and t h e i n fi r m a r i a n s

of t h e convents sit uated as t hey were so oft en far
,

from cities or towns acquired considerable medical

,

knowledge and came to apply it wit h excellent

success The tradit ions were gat hered from many
.

quarters and passed on for cent uries from one

,

house to another ; and they gathered simples and

treat ed the ordinary ailments and nursed t h e ,

ailing into moods of greater courage and states of

mind t hat predisposed to recover y .

Probably the most important book on medicine

that we have from the twelfth century is written
by a Benedictine Abbess since known as St , .

Hildegarde She was born of noble parents at

.

B o ec kelh eim in t h e county of Sponheim about ,

t h e en d of t h e elevent h century She was .

educat ed a t t h e Benedic t ine cloist er of D isi

bodenberg and when her educat ion was finished
,

she ent ered the house as a religious and at t h e age of ,

about fi f ty she bec a me abbess Her writings .

,

reput a t ion for s a nc t it y and her w ise rule eminent ly

, ,

symp athetic a s she w a s attract ed so many new

,
 EDUC AT I O N FOR WO MEN 16 1

members to the community that t h e convent

became overcrowded Accordingly with eighteen
.
‘

of her nuns Hildegarde wit hdrew to a new convent

,

at R u p er t sb u r g which E nglish and American

,

travellers will doubt l ess recall because it is not far

from Bingen on t h e Rhine made famous in the ,

later time by M rs H em a n s s poem Here she came

.
’
.

to be a sort of centre for the intellectual life of her

period . According to t raditions some of which ,

are dubious she was in active correspondence wi t h

,

nearly every important personage of her generation .

She was an intimate friend of St Bernard of .

C lairvaux who was himself perhaps the most

,

influential man of E urope in t his century Her .

correspondence was enormous and she was con ,

su lt ed from all sides because her advice on di ffi cult

pro blems of any and every kind was considered so

valuable .

I n spit e of all this time taking correspondence -

she found leisure to w rite a series of books most ,

of t hem on mystical subjects but two of t hem , ,

strange as it may seem on medicine The first is

,

called L iber Sim p li c i s M e di c i n ae and the ,

second L iber C omposit ae M edi c i n ae These .

books were wri t t en as a contribut ion of her views

wi t h regard to the medical knowledge of her time ,

but were evidently due partly at least to the , ,

Benedictine traditions of interest in medicine .

21
162 MEDIEVA L MEDICINE
D r M elanie L ip i n ska in her
. Histoire des
Femmes M édi ci n s ”
a thesis present ed for the
,

doctorate in medicine at the U niversity of Paris

in 19 00 which was subsequently awarded a special
,

’
pri ze by the French Academy reviews Hildegarde s
,

work critically from t h e medical standpoint She .

does not hesit ate t o declare t h e Abbess Hildegarde

the most import ant medical writ er of her t ime .

Reuss the editor of the works of Hildegarde as

,

they are published in M i g n e s Patrologia

’ ”
,
the
immense French edition of all t h e import ant works
of the Fathers D octors and Saints of the C hurch
, , ,

says

Among all the saintly religious who have

practised medicine or writt en about it in the M iddle
Ages the most import ant is wit hout a n y doubt
,

St Hildegarde
. Wi t h regard to her book
he says All t hose who wish to writ e the hist ory
of t h e medical and nat ural sciences must r ead this
work in which t his religious woman evidently well
, ,

grounded in all t hat was known at t hat time in t h e 4

secret s of nat ure discusses and examines c a refully
,
”
all t h e knowledge of the time He adds
. It
is certain that St Hildegarde knew many t hings
.

that were unknown to the physicians of her time

’
Some of Hildegarde s expressions are st artling
enough because they indicate discussion of and ,

attemp t s t o elucidate problems which many people

,

o f t h e modern time are likely to think occurred

 EDUC AT I O N FOR W O ME N 63

only to the last few generations For instance in .

,

talking about t h e stars and describing t heir course

through t h e fi r m a m en t she makes use of a com
,

parison t hat seems st rangely ahead of her t ime .

She says Just as the blood moves in the veins ,

causing t hem to vibrate and pulsat e so the stars ,

move in t h e fi rm a m en t and send o u t sparks as it

,

”
were of light like t h e vibrat ions of the veins
.
, .

This is of course n o t an ant icipation of t h e dis

, ,

c o v e r y of t h e circulat ion of the blood but it shows ,

how close were men s ideas t o some such t hought

’

’
five cent uries before Harvey s discovery For .

Hildegarde the brain was t h e regulator of all the

vit al qualit ies t h e cent re of life She connec t s the
, .

nerves in t heir passage from t h e brain and the spinal

cord t hrough t h e body wit h manifestations of life .

She has a series of chap t ers with regard to

psychology norm a l and morbid She talks about
, .

frenzy insanit y despair dread obsession anger

, , , , , ,

idiocy and innocency She says very strongly in

,
.

one place t hat when headache and migraine and

vert igo at t ack a pat ient simult aneously t hey render ,

a man foolish and upse t his reason This makes .

many people t hink t hat he is possessed of a demon ,

”
b u t t hat is n o t t rue These are t h e exact words
.

’
of t h e saint as quot ed in M lle L i p i n ska s t hesis . .

Wi t h this story of St Hildegarde in mind and .

,

t h e recall of other educational developments among

16 4 MEDIEV AL MEDICI NE
the Benedictine nuns it is easy to understand the
,

developments that took place at Salerno where ,

monast ic influence was so prominent Just as the .

medical and above all the surgical traditions of

, ,

Salerno found their way to Bologna at the beginning

of t h e t hirteenth cent ury so also did the regulations
,

regarding st andards in medical education and with ,

t hem medical educat ion for women There are .

definit e historical documents which show that

w omen not only studied but t aught in t h e medical
department of Bologna The name of one of them
.

at least is very well know n She was Alessandra .

G ili a n i and strange as it might appear was one

, , ,

of the prosectors in anatomy of M ondino the ,

founder of t eaching by human dissection Accord .

”
ing to the C ronaca P er si c et a n a quoted by ,

M edici in his History of t h e Anat omical School a t

Bologna
She became most valuable t o M ondino because
she would cleanse most skilfu lly t h e smallest vein ,

t h e a rt eries all ramific a t ions of t h e vessels wi t hout

, ,

lacerat ing or dividing t he m and t o prepare t hem

,

for demonst rat ion she would fill t hem wit h various
coloured liquids which aft er h a ving been driven
, ,

int o the vessels would harden wit h out dest roying

,

t h e vessels . Again she would paint t hese same

,

vessels t o t heir minut e branches so perfec t ly and ,

colour them so nat urally t hat added t o t h e wonder

, ,

ful expl a nat ions and t eachings of t h e m a st er they ,

brought him great fame and credit .

 EDUC AT I O N FOR WO MEN 16 5

This passage wit h it s descrip t ion a s coming from ,

a woman of a very early ant icipat ion of our most

,

modern anat omical technique inject ion harden —

,

ing and colouring so as t o imit ate nature for the

, ,

making of anatomical preparations for class and ,

demonst rat ion purposes is all t h e more int eresting

—

because t h e next great improvement in anatomical

t eaching t h e use of wax m odels of dissected
,

specimens coloured to imitat e nat ure came also ,

from a woman M adame M a n z o li n i also of

, ,

Bologna Feminine inst inct aroused women to use

.

t heir inventive abilit y to do away with the necessit y

for always recurring to t h e deterrent material of
fresh dissecti ons and yet securing such preparations
,

as would make t eaching n o t less but more eff ect ive .

Some doubt has been t hrown on certain details

of the st ory of Alessandra G ili a n i b u t t h e memorial
,

t ablet erected at the t ime of her deat h in the

Hosp it al C hurch of S ant a M aria de M aret o in
Florence gives all t h e important fac t s and t ells t h e ,

st ory of t h e grief of her fi a n c é who was himself ,

M o n di n o s o t her assist ant

’
L ike her he died
.
,

young also when t here were high hopes of his

,

abili t y and t here is more t han t h e suspicion that

,

these t wo unt imely deat hs m a y have been due to

dissect ing wound infec t ions She died con sumed
.

”
by her labours so that it may have been phthisis ;
,

but he was taken by a swift and lamentable

death .
 MEDIEV AL MEDICINE
N icaise in the I ntroduction to his edit ion of Guy
,

de Ch a u li a c s Grande C hirurgie
’
( Paris ,

has a brief review of the hist ory of women in

medicine wi t h special reference t o France
, He .

supplies practically all t h e informat ion available in

very short compass as well as the references where
,

more det ails can be obt ained .

Women continued to pract ise medicine in

I t aly for cent uries and t h e names of some who
,

a t t ained great renown have been preserved for us .

Their works are still quoted from in the fift eent h

century .

There was none of t hem in France who became

dist inguished but women could pra ct ise medicine
,

in cert ain t owns a t least on condit ion of passing an

examina t ion before regul a rly appoint ed mast ers .

An edict of 13 1 1 a t the same time t hat it int erdict s

,

unaut horized women from pract ising surgery ,

recognizes t heir right s t o pract ise t h e art if t hey

have undergone an ex a min a t ion before t h e
regularly appoint ed mast er surgeons of t h e corpora
t io n of Paris An edict of King John April
.
, ,

13 5 2 cont ains t h e same expressions a s t h e previous

edic t. D u Bouley in his Hist ory of the
,

U niversi t y o f Paris gives ano t her edict by t h e

,
’

same king also published in t h e year 13 5 2 as a

, ,

result of t h e complaint s of t h e facult ies a t P a ris in ,

which t here is also q uest ion of women physici a ns .

This responded t o a pet i t ion : Having he a rd t h e

pet it ion of t h e D ean and M ast ers of t h e F a cult y
of M edicine a t t h e U niversi t y of Paris who declare ,

t hat t here are very many of bo t h sexes some of ,

the women wi t h legal t i t le t o practise and some of

 EDUC AT I O N FOR WO MEN 167

them merely old pre t enders to a knowledge of

medicine who come t o Paris in order t o pract ise
, ,

be i t enact ed et c , ( The edict t hen proceeds to

’
.

repeat t h e terms of previous legisl a t ion in this

mat t er ).

Guy de C hauliac speaks also of women who

prac t ised surgery They formed t h e fift h and l a st
.

class of operat ors in his t ime He compl a ins t hat .

t hey a r e accus t omed t o t o o great an ex t ent t o give

over pat ient s suff ering from all kinds of m a ladies
t o t h e will of Heaven founding t heir prac t ice on
,
,

the maxim The L ord has given as he has pleased ;

,

the L ord will t ake away when he pleases ; may the

’
name of the L ord be blessed .

I n the sixt eenth century according t o ,

Pasquier the practice of medicine by women almost

,

entirely disappeared The number of women

physicians becomes more and more rare in the
following cent uries just in proportion a s we
,

approach our own t ime Pas q uier says t hat we

.

find a cert ain number of t hem anxious for know

ledge and wit h a special penchant for t h e study
,

of t h e nat ural sciences and even of medicine but ,

”
very few of t hem t ake up practice .

There seems however t o have been n o t nearly

, ,

so much freedom or so much encouragement for

women in medicine in France as in I taly I ndeed .
,

in t h e whole matt er of educat ion for women ,

medieval France has but lit tle to record compared

t o I t aly s significant chap t er in the his t ory of
’

feminine educat ion One reason for t his was

.

doubt less t h e H el oise Ab elard incident early in the

-
168 MEDIEVAL MEDICINE
history of the U niversity of Paris This seems to
.

have discouraged e ffort s in the direction of t h e

securing of the higher education for women in most
of the Western U niversities . Oxford was a
daughter university of Paris and C ambridge of
,

Oxford and they and all the ot her universities of

,

the West were more deeply influenced in their

customs and organization b y Paris than by Italy ,

and as a consequence we hear little of feminine

education in the West generally One result of
.

this has been the e xistence of a f eeling that since

,

women had very few opportunities for the higher

education in Western E urope they must have had
,

them nowhere else This presumption forms the

.

b asis of not a little mi sunderstanding of the M iddle

'
A ges in our time . I t often takes but a little
incident to set the current of history in a ve r y
di fferent direction from that in which it might have
gone and this seems to have b een the case as
,

regards the higher education for women m France

and Spain and E ngland .
 C HAPT E R X
M E D I E V AL H OS P I TAL S

O UR recent experience makes it easy to understand

that such magnificent advance in surgery as has
been described in the preceding chapters would
have been quite impossible unless there were
excellent hospitals in the medieval period Good .

surgery demands good hospitals and indeed i n evi t ,

ably creates t hem Whenever hospitals are in a

.

state of neglect surgery is hopeless

, We have .
,

however abundant evidence of the existence of fine

,

hospitals in the M iddle Ages quite apart from this

,

assumption of them b ecause of the surprising

,

surgery of the period Historical traditions from

.

the earlier as well as the later medieval t imes

demonstrate a magnificent development of hospit al
organizat ion
. While there had been military
hospit als and a few civic institutions for the care
of cit iz ens in Roman t imes and some hospital ,

'
tra dit ions in the E ast and in connection with the
t emples in E gypt hospital organization as we know
,

i t is C hristian in origin ; and part icularly t h e

16 9 22
17 0 MEDIE VAL MEDICINE
erection of i n st i t u t i o n s fo r t hg fi a r e of the ailing
“
w a

“ w M M

poor came to be looked upon very ea r ly a s a ~sp ec ia l ‘

m
u m

" M ’

duty of C hristians E ven th e R o m a n E mperor

.
,

Julian the Apost ate declared that the old Olympian

,

religion would inevi t ably lose its hold on t h e people ,

unless somehow it could show such care for ot hers

in need as the C hrist ians exhibited wherever they
obt ained a foothold I t was not however unt il
.
, ,

nearly t h e beginning of the M iddle Ages t hat the

C hristians were in su fficient numbers in the cities ,

and were free enough from interference by govern

ment to take up seriously t h e problem of public
,

hospital organization The rapidity of the develop

.

ment once external obstacles were removed shows

, ,

clearly how close to the heart of C hristianity was

the subject of care for the ailing poor St Basil s . .
’

magnificent foundation at C aesarea in C appadocia ,

called the B a si li a s which took on the dimensions of

,

a cit y ( termed N ewt own) with regul ar streets ,

buildings for diff erent classes of patients dwellings ,

for physicians and nurses and for the convalescent ,

and apparent ly even workshops and indust rial

schools for the care and instruction of foundlings
and of children that had been under the care of t h e
monastery as well as for what we would now call
,

reconstruction work shows how far hospital ,

organizat ion even in the latter part of the fou rth

,

century had develop ed

,
.
 MEDIE V AL HOSP I TAL S 17 1

About the year 4 00 Fabiola a t Rome according ,

t o St .
Jerome ‘
es t ablished a N, osocomium t o

gather in t h e sick from t h e streets and to nurse ,

the wret ched sufferers wasted from povert y and

”
disease A lit tle later P a m m a c h iu s a Roman
.
,

Sen a tor founded a Xenodochium for the care of

,

strangers which St Jerome praises in one of his .

let ters . At the end of t h e fift h cent ury Pope

built hospita l s m con n ection with the
M M M M a

three most import ant churches of Rome St , .

Pet er s St P aul s and St L awrenc es D uring

’
, .
’
, .
’
.

the P o n t ifi c a t e of Vigilius Belisarius fo unded a ,

Xenodochium in the Vi a L a t a a t Rome shortly ,

aft er t h e middle of the sixt h cent ury C hrist ian .

hospi t als were early established i n the cities of

France ; and n o t long aft er t h e conversion of
E ngland in t hat country , .

I n connection with these hospitals it is rather ,

easy to underst and t h e fine development of surgery

by early C hrist ian physicians which we have traced .

The lat er medieval period of hospi t al building ,

however is of part icular int erest in t h e hist ory of

,

medicine because we have such det ails of it as show

,

i t s excellent ad a p t at ion to medical and surgical

needs Accordi ng t o Virchow in h i s art i cle on t h e
.
,

History of German Hospi t als which is t o be found ,

in the second volume of his collected E ssays on

17 2 MEDIE VAL MEDICINE
Public M edicine and the History of E pidemics ,

t h e s tory of the foundat ion of these hospit als of

the M iddle Ages even those of Germany cent res
, ,

around the name of one man Pope I nnocent I II , .

Virch ow was not at all a papistically inclined writer ,

so that his tribute to the great Pope who solved so

finely the medico social problems of his t ime
-

undoubt edly represent s a merit ed recognit ion of a

great social development in history .

The beginning of t h e history of all these

Germ a n hospi t als is connected wit h the name of
that Pope who made t h e boldest and farthest
reaching at t empt t o gather the sum of human
int erest s int o t h e organization o f t h e C at holi c
C hurch The hospit als of t h e Holy Ghost were one
.

of t h e many means by which I nnocent III t hought .

t o hold humani t y to the Holy See And surely i t

.

was one of the most e ffect ive Was it n o t c a lc u .

lat ed t o creat e the most profound impression to see

how t h e might y Pope who humbled emperors and
,

deposed kings who was t h e unrelent ing adversary

,

of t h e Albigenses t urned his eyes sympat het ically

,

upon t h e poor and t h e sick sought t h e helpless an d

,

t h e neglec t ed upon t h e s t ree t s and saved t h e ille

,

g i t i m a t e children from dea t h in t h e wa t ers There

is somet hing a t once conciliat ing and fascinating in
t h e fact t hat , a t t h e very t ime whe n t h e fourt h

crusade was inaugurated t hrough his influence the ,

thought of founding a great organization of an

essentially humane charac t er which was eventually
,

G esa mm el t e Abha n dl un g en a u s de m Geb i et e der

Oeffen t li c h e M edi z i n Hi r sc hwa l d B er li n 18 77
”
, , , .
TH I R TE E N TH -
CE N T U R Y H O S P I TA L I N TE R I O R (TO N E R R E )
F r om T/ze T/zzn ‘
t /z Gr ea t est ”
een
f Cen t a r zes ,
o 5] f . IVa Zs/i
 MEDIE VAL HO S P I TAL S 173

to extend throughout all C hrist endom was also ,

t aking form in h i s soul ; and t hat in t h e same year

( 1 2 04 ) in which t h e new L a t in E mpire was founded
in C onst ant inople the newly erected hospi t al of t h e
,

Holy Spirit by t h e old bridge on t h e o t her side of

,

t h e Tiber was blessed and dedicat ed as t h e fut ure

,
”
cent re of t his organizat ion .

According t o t radition just about the beginning

,

of t h e t hirt eent h cent ury Po p e l n n ec e n t resolved

t o build a hospit al in Rome On inquiry he found .
,

t hat probably t h e bes t man t o p u t in charge of

hospit al organizat ion was Guy or Guido of M ont
p e lli e r of
, t h e Bro t hers of the Holy Ghos t who ,

had founded a hospit al a t M ont pellier which

became famous t hroughout E urope for i t s t horough
organizat ion Accordingly he summoned Guido
.

t o Rome and gave int o his hands t h e organizat ion

,

of t h e new hospit a l which was erect ed on t h e o t her

,
’
side of Tiber in t h e Borgo n o t far from St Peter s . .

I ndeed Sant o Spirit o Hospi t al as i t came t o be

, ,

called was prob a bly t h e direct successor of t h e

,

hospit a l which Pope Symmachus ( 4 8 8 5 14 ) had had -

built in connec t ion wit h St Pet er s n o t long aft er .

’

t h e beginning of t h e M iddle Ages I t is easy t o .

underst a nd t hat at the time when magnificent

municipal s t ruct ures c a t hedrals t own halls abbeys
, , , ,

and educational inst it ut ions of various kinds were

being erected wit h exemplary devot ion t o art and
,

use t h e Hospit al of Sant o Spiri t o under the special

,
17 4 MEDIEVAL MEDICINE
patronage of the Pope was not unworthy of i t s
*
time . We know very little however about the , ,

actu al s t ructure .

Then as now Bishops made regular visit s at

, ,

int ervals a d li m i n a t hat is t o t h e Pope as C hief —

,

Bishop of t h e C hurch ; and according to tradit ion

Pope I nnocent called their at t ention part icularly t o
this hospit al of Santo Spirit o one of his favourite ,

institutions and sugges t ed that every diocese in

,

C hristendom ought to have such a refuge for t h e

ailing poor The consequence was the erection of
.

hospitals everywhere t hroughout E urope Virchow .

has t old the story of these hospital foundations of

t h e Holy Ghost as they were called and makes it
, ,

very clear that probably every town of

inhabi t ant s everywhere throughout E urope at t his
t ime had a hospital The traditions with regard t o .

France are quit e as complet e as those t hat concern

Germany and t h e great hospit als of L ondon St —
.

Thomas s ; St Bartholomew s which had been a

’
.
’
,

priory wi t h a house for the c a re of t h e poor b u t ,

was now t urned int o a hospit al ; Be t hlehem aft er ,

wards Bedlam ; Bridewell and C hris t s Hospi t al

’
, ,

t h e firs t of which aft erwards bec a me a prison while ,

C hrist s Hospit al t hough re t aining its name

’
, ,

became a school The Five Royal Hospitals as .

,

See W a l sh ,
“
Th e Th i r t een t h Gr ea t est
,
of C en t u r i es ,
”

Ne w Yo r k ,
se v en t h edi t i o n ,
19 14 .
 MEDIE VAL HOSP I TAL S 175

they were called were either founded or received

, ,

a great stimulus and t horough reorganization ,

during the thirtee nth century .

I t would be easy t o suppose these hospitals w ere

rat her rude s t ruct ures inexpert ly built poorly
, ,

arranged and above all badly light ed and vent ilated

, .

They might be expect ed to furnish pro t ect ion from

the element s for t h e poor b u t scarcely more and
, ,

probably became in the course of t ime hotbeds of

infect ion because of their lack of air and unclean
ness As a matter of fact t hey were almost exactly
.
,

the opposit e of any such supposit ion Those in t h e .

larger towns at least were model hospitals in many

w ays and ever so much better than many hospital
,

structures erected in post medieval centuries -

.

I ndeed the ordinary impression as to the medieval

,

hospitals and their lack of suitability to their

,

p urpose would
, apply perfectly t o the hospitals of
the latter half of the eighteenth and the early
nineteenth centuries I t is because our generation
.

st ill has t h e memory of t hese hospitals of the past

generat ion and assumes that if these were so bad
, ,

the hospitals of an earlier time must have been

worse and the hospitals of t h e medieval period must
have been intolerable that the derogatory t radit ion
,

wit h regard to medieval hospitals and many other

medical subjects maint ained it self until the coming
of real information with regard to them .
176 MEDIEVAL MED I CINE
The ecclesiastical architecture of the later M iddle
Ages was n o t only beautiful but it was eminently,

suitable for its purpose and above all provided light

,

and air The churches the town halls the monas

.
, ,

t er i es and abbeys were models in their kind a n d

, ,

i t would have been quite surprising if the hospitals

alone had been unworthy products of that great
architectural period As abundant remains serve
.

to show even to t h e present time they were not , .

The hospitals built in the t hirteenth century par

t i c u la r ly usually were of one story had high ceilings
,

with large windows of t en were built near the water

,

in order that there might be abundance of water

fo r cleansing purposes and also so that the sewage
,

of the hospital might be carried o ff had tiled floors ,

that facilit at ed thorough cleansing and many ,

other provisions that the architects of our time are

reintroducing into hospital construction They .

were a complete contrast to the barrack li k e -

hospit als w it h small windows narrow corridors , ,

cell like rooms which were built even two genera

-

tions ago and which represented the lowest period

,

I n hospital building for seven centuries .

V i o llet le D u e in his
,
D ict ionary of Archi
”
tecture has given a picture of the int erior of one
,

of t hese medieval hospitals that of Tonnerre in

,

France erected by M arguerite of Bourgogne t h e

, ,

sister of St L ouis in 12 9 3 which we rep ro duce

.
, ,
 MEDIE VAL HO S P I TAL S 177

here M r Art hur D illon discussing this hospital

. .
,

from the standpoint of an archi t ect says ,

It was an admirable hospit al in every way and ,

it is doubtful if we to day surpass i t -

I t was .

isolat ed t h e ward was separat ed from t h e other

,

buildings it had t h e advant ages we so oft en lose

,

of being b u t one st ory high and more space was ,

given t o each pat ient t han we c an now afford .

The vent ilat ion by t h e great windows and

ventilat ors in t h e ceiling was excellent ; it was
cheerfully light ed and t h e arrangement of t h e
,

g a llery shielded t h e pat ient s from dazzling light and

from draught s from t h e windows and aff orded an ,

easy means of supervision ; while t h e division by

the roofless low part it ions isolat ed the sick and
, ,

obviat ed t h e depression t hat comes from the sight

of o t hers in pain .

I t was moreover in great contrast to the

, ,

cheerless whit e wards of t o da y The vault ed -

ceiling was very beaut iful ; t h e woodwork was

richly carved and t h e great window s over t h e
,

alt ars were filled wi t h coloured glass Alt ogether .

,

i t was one of t h e best examples of the best period

of Got hic archit ect ure .

The hospit al ward i t self was 5 5 fee t wide and

2 7 0 fee t long and had a high arched ceiling of wood .

The Princess herself lived in a separa t e building ,

connec t ed wit h t h e hospit al by a covered passage .

The ki t chen and storehouse for provisions were also

in separate buildings The whole hospital plant was
.

plac ed between the branches of a sm all st ream con

178 MEDIE VAL MEDICINE
duc t ed around it which served to temper the
,

atmosphere and was a source of w ater supply at

,

one end of the grounds and helped in the disposal

of sewage from the o t her end .

A hospit al of the Holy Ghost which may be

taken as t h e t ype of such struct ures is still standing
at L ii b e c k in Germany and was like the hospital, ,

at Tonnerre also built during the thirteenth

,

cent ury I t was erected as t h e result of the move

.

’
ment initiated by Pope I nnocent s foundation of
t h e S a nt o Spirit o a t Rome The pict ure of this in .
,

”
my Thirt eent h C entury will serve to show wh a t ,

Holy Ghost hospit als in import ant cities at least

were like . L ubeck w as one of t h e rich Hansa
t owns in t h e thirteent h century but t here were ,

many others of equal importance or very nearly ,

so and all of these t owns were rivals in t h e archi

,

t e c t u r a l adornment of t heir municipali t ies and ,

part icularly in the erect ion of cat hedrals town ,

halls guild halls and other buildings for the use

, ,

of ci t i z ens .

The older portion of the Hospi t al of St Jean .

at Bruges also gives an e x cellent idea of a lat er

medieval hospi t al as it was construct ed in a populous
commercial t own Bruges almost needless to say
.
, ,

w a s one of t h e most importan t cit ies of E urope in

t h e four t een t h cent ury The Hospi t a l of St Jean
. .
,

then was built like t h e c a t hedra l a n d churches

, ,
 MEDIE V A L H OSP ITA L S 17 9

and the town hall so as t o be wort hy of the city s

,
’

prestige The older part which is now used for a

.
,

storeroom has t h e charact erist ics of t h e best

,

medieval hospit als The ward was one st ory in

.

height t h e windows were large high in the walls

, , ,

and t h e canals t hat flowed around the hospit al made

pleasant vist as for t h e pat ient while t h e gardens ,

at tached were eminent ly suit able for convalescents .

The phases of hospi t al building down t h e centuries

can be studied a t St Jean a n d st range as it may
.
, ,

seem t h e oldest port ion of t h e hospit al that of t h e

, ,

medieval period provided t h e most light and air for

,

t h e pat ient s and t h e best opportuni t y for t horough

cleansing as well as for occupa t ion of t h e patients
,
’

minds wi t h det ails of t h e const ruction that were

visible from any part of t h e ward .

The hospit a ls of t h e M iddle Ages are part icularly

int erest ing because they represent a solution of t h e
,

social problems o t her t han merely t h e relief of pain

and su ffering or t h e c a re of t h e needy who h a ve
,

none t o care for t hem They represent a ready .

,

const ant ly near opport uni t y for t h e bet t er t o do - -

classes t o exercise charit y t oward t hose who needed

it mos t The hospit als were always in t h e busiest
.

port ions of t h e t owns and were oft en visi t ed by t h e

,

cit izens both men and women

,
D r John S . . .

Billings in his descrip t ion of The Johns Hopkins

,

Hospital ( Bal t imore touched upon this

,
18 0 MEDIE VA L MEDICINE
spirit of the hospit al movement of the Middle Ages
in a very appropriat e w ay when he said
When the medieval priest est ablished in each
great cit y of France a Ho t el D ieu a place for God s
,
’

hospit ali t y i t was in t h e int erest of charit y as he

,

underst ood i t includi n g bot h t h e helping of t h e

,

sick poor and t h e affording of t hose who were

,

neit her sick nor poor an opport unit y and a st imulus

to help t heir fellow men ; and doub t less the cause
-

of humanit y a n d religion was advanced more by t h e

”
e ff ect on the givers t han on the receivers .

‘
A rather significant hist orical detail with regard
to medieval hospit als is the foundation of a special
order to take care of t h e hospit als in which St .

’
Anthony s Fire or what we know as erysipelas was
, ,

treated Apparent ly t his indicated the recognition

.

of t h e cont agiousness of t his disease by the medieval

people Pope Honorius I II approved the foun
. .

dation of an order of nurses part icularly devoted to

the care of pat ients suffering from t his affect ion .

Other religious congregations for t h e same works

seem to have been est ablished We did not recog
.

nize t h e cont agiousness of the disease until t h e last

generat ion U ndoubt edly t hese special foundations
.

made i t possible t o cont rol many of t h e epidemics of

erysipelas t hat used t o make surgical care in our
hospit a ls in the modern t ime such a di ffi cult mat t er
.

E ven as lat e as our C ivil War here in America ,

e ry sipelas wa s the special dread of the hos p ital

 MEDIE VA L HOSP I TAL S 18 1

surgeon Oliver Wendell Holmes point ed o u t t hat

.

erysipelas might readily be carried t o t h e part urient

woman wi t h t h e production of child bed fever I t -
.

is int erest ing t o realize t hen t h e at t emp t of t h e

, ,

medieval period t o segregat e t h e dise a se .

Besides hospit als a series of lazaret t os t h a t is

,
—

of buildings for t h e segregat ion of lepers were —

erec t ed in t h e various count ries of E urope during

t h e medieval period Just about t h e end of t h e
.

C rusades i t was discovered t hat leprosy had become

very common t hroughout E urope I t is oft en said .

tha t leprosy was int roduced a t t his t ime b u t i t h a d ,

evident ly been in t h e West for many cent uries

before Gregory of To urs ment ions leper hospit als
.

as early as 5 6 0 and t h e disease evident ly cont inued

,

t o progress in spi t e of t hese speci a l hospi t als unt il

, ,

in t h e t hirt eent h cent ury it became clear t hat

strenuous e ff ort s would have t o be made to wipe
o ut the disease Accordingly leproseries were
.
,

erect ed in connect ion wi t h pract ic a lly every t own

in E urope a t t his time Baas est imat es t h a t t here
.

were some of t hem in E urope alt oget her .

Virchow has list ed a large number of t h e leper

hospit als of t h e German cit ies quit e enough t o
,

show t hat probably no org a nized communit y w as

without one .

As a consequence of t his widespread movement

of enforced segregat ion leprosy gr a du a lly died o u t
,
18 2 MEDIE VAL MEDICINE
in E urope remaining only here and th ere in back
,

ward localit ies The disease was p robably as

.

common during t h e lat er M iddle Ages as tuber

c u lo si s is among us a t t h e present t ime The .

recent ly discovered relat ions bet ween the bacterial

cause of t h e t wo diseases may give rise to t h e
quest ion as to whe t her we shall succeed as well wi t h
the great social and hygienic problem t hat confront s
our generat ion of lowering t h e de a t h rat e from
,
-

”
the great whi t e plague as t h e medieval genera
,

tions did wit h their chronic folk disease leprosy -

, .

I t would be a consummation devoutly t o be

wished . We are now beginning to have as many
sanatoria for tuberculosis in proport ion to the p o p u
lation as they had of leproseries These leproseries.
,

or lazarettos as they were called were not a t a ll

, ,

the dreadful places t hat the imagination has been

wont to pict ure t hem in recent years ; on t h e
contrary they were as a rule beaut ifully situat ed
, ,

on a side hill t o favour drainage consist ed of a

-

series of dwellings wit h a chapel in t heir midst

surrounded by trees a n d encomp a ssed by what was
,

alt oget her a park effec t M iss C lay in M edieval

.
,

”
Hospit als ,
has given a pict ure of one of t hem ,

which we reproduce because it serves to cont radict

,

the popular false notion with regard t o t h e bare

and ugly and more or less jail like character of these
-

insti t utions .
 C HAPT E R X I
M E D I E V AL R
CA E OF TH E I N SAN E

Q U I T E cont rary to the usual impression rather ,

ext ensive and well managed institutions for t h e care

-

of the insane came into exist ence during the M iddle

Ages and continued t o fulfil a very necessary social
,

and medical duty For t h e unspeakable neglect of

.

the insane which is a disgrace to civiliz ation we ,

must look t o t h e cent uries much nearer our own

than t hose of t h e M iddle Ages Above all t h e
.
,

M iddle Ages did n o t segregat e t h e insane ent irely

from ot her ailing pat ient s unt il their affections had
become so chronic as t o h e certainly incurable and ,

t hey t ook t h e insane into ordinary hospi t als to care

for t hem a t t h e beginning of t heir affect ion This .

mode of procedure has many advant ages mainly in ,

get t ing t h e pat ients o u t of unfavourable environ

ment s and put t ing t hem under skilled care early in
t heir a ffec t ions so t hat a defini t e e ff ort is being
,

made t o res t ore what is called t h e psychopat hic ward

in t h e general hospit a ls in our t ime Only a c a reful
.

18 3
18 4 MEDIE VAL MEDICINE
s t udy of the details of act ual historical references to
t h e medieval care of the insane will serve t o contra
dict unfort unate t radit ions which have gat hered
around t h e subject entirely wit hout justification in
real history .

The t raditions of medical knowledge with regard

to the insane i n h erit ed by the early M iddle Ages
from t h e ancient s w ere of the best and the books
,

writ t en at t his t ime have some int eresting material

on t h e subject Paulus A eg i n et a ( Aég i n et u s) wh o
.
,

wro t e in t h e sevent h cent ury and it must not be

—

forgotten t hat already a t this time some 2 00 years

of t h e M iddle Ages have passed has some excellent
—

directions wit h regard t o t h e care and treatment of

pat ients suffering from melancholia and mania .

He says in his paragraph on t h e cure of melan

,

c h o ly Those who are subject to melancholy from

a primary a ffect ion of t h e brain are to be treat ed
wi t h frequent bat hs and a wholesome and humid
diet t oget her wit h suit able e x hilaration of mind
, ,

and wit hout any ot her remedy unless when from,

i t s long cont inuance t h e o ff ending humour i s

,

di fficul t t o evacuat e in which case we mus t have

,

recourse t o more p owerful and complicated plans

”
of treat ment . He t hen gives a series of direct ions
,

some of t hem quite absurd t o us apparently in

,

order to sat isfy t hose who feel that they must keep
on doing something for these cases though ,
 MEDIE VAL C ARE OF TH E INS ANE 18 5

evidently his own opinion is expressed in the first

port ion of t h e para graph and in the simple laxat ive
,

t reatmen t that he outlines These cases are to

.

be purged firs t with dodder of thyme ( ep i t h ym us)

or aloes ; for if a small quant ity of t hese be t aken
every day it will be of t h e great est service and open ,

”
the bowels gently .

His direct ions as to diet for those suffering from

melancholia are all in t h e line of limit ing the con
sump t ion of mat erials that might possibly cause
digest ive dist urbance for evident ly hi s e x perience
,

had taught him that t h e depression w as deeper

w henever indigest ion occurs He says The di et
.

for melancholics shall be wholesome and moderately

’
moist ening ; abst aining from beef roe s flesh dried , ,

lentils cabbages snails thick and dark coloured

, , ,

wines and in a word from whatever things engender

,

”
black b i le . M ania was to be treated very nearly
like melancholi a with special warnings as t o t h e
,

necessit y for p articular care of these pat ient s .

But above all t hings t hey must be secured in bed ,

so t hat t hey may n o t be able t o injure t hemselves

o r t hose who approach t hem ; or swung wi t hin a

wicker basket in a small co uch suspended from on

”
hi gh. This last suggest i o n would seem t o be
eminent ly pract ical especially for young people
,

who are n o t t o o heavy and enforces t h e idea t hat

,

t h e physicians o f t his t ime w er e t hinki ng se r iou sly

24
18 6 MED I EVAL MED I CINE
of t heir problems of care for t h e insane and ex er
cising t heir ingenui t y in inventions for t heir benefit .

Paul of [E g i n a seems then to have thought that

, ,

mania and melancholia were definitely related to

each ot her and to have held a similar opinion in
,

this regard to Aret aeus who declared t hat melan

,

c h o li a was an incipient mania Both had evident ly

.

no t ed t hat in most cases t here were melancholic

and maniacal stages in t h e same pat ient These .

early medieval students of ment al disease then , ,

ant icipated to a rat her st artling extent our most

recent conclusions wi t h reg a rd t o the essenti a l
insanities . They would have been much readier
’
t o agree with Kraepelin s t erm manic depressive ,
-

insanit y than wi t h the t eaching of the hundred

,

years before our time which so absolutely separated

,

t hese two co ndit ions .

All t his represent s an organized knowledge of

insanity that could n o t be acquired by chance nor ,

by a few int ermit tent observations on a small

number of pat ients b u t must have been due to
,

act ual careful cont inued observation of m any of

, ,

them ove r a long period Here is t h e presum p t ive

.

evidence for t h e e xis t ence of special inst i t utions for

their care a t t his period in t h e M iddle Ages This .

presump t ion is confirmed by Du c an g e in his

”
C omment ary on Byz ant ine H istory in which
,

he t ells of t h e exist ence of a m o r o t r o p h ia m o r hou se,

 MEDIE VAL C AR E OF TH E IN SANE 18 7
'

for lunatics at Byzantium in the fourth cent ury

, ,

and one is known to have existed a t Jerusalem lat e

in the fift h century Furt her confirmat ion of the
.

existence of special arrangement s and inst i t ut ions

for the care of t h e insane even t hus early in t h e
M iddle Ages is obt ained from the r eg u la
m o n a c h o r ui n of St . Jerome which enjoins upon ,

t h e monks the duty of making careful provision for

t h e isolation and proper treatment of the sick bo t h
in mind and body whilst t hey were enjoined to
,

leave nothing undone to secure appropriate care

*
and speedy recovery of such patients .

Among t h e first C hristian institutions for the

care of t h e ailing founded by private benevolence ,

a refuge for t h e insane was undoubtedly built in

E ngland before the seventh c ent ury Burdett says .

t hat How far the t wo insti t ut ions established

in E ngland prior t o A D 7 00 were ent it led to be
. .

considered asylums we have discovered insufficient

,

”
evidence to enable us to decide H e evident ly
.

inclines t o t h e O pinion however t hat provision was

, ,

made in them for the care of those ailing in mind

as well as in body .

There is a rather well grounded tradit ion that -

Sig ib a ldu s the t hirt y sixth bishop of M et z during

,
-

t h e papacy of L eo IV about A D 8 5 0 erected

.
, . .
,

two monasteries and paid special at tent ion t o t h e

B ur d et t
, H o sp i t a l s a n d Asyl u m s o f t h e W o r ld .
18 8 MEDIEVAL MEDICINE
sick in body and mind There are records that the
.

insane in M etz were placed under the guardianship

of persons regularly appointed The attendants in
.

t h e hospitals had t o take a special oath of allegiance

t o the King and t hat they would fulfil t heir dut ies
,

properly .

There is definite evidence of Bet hlehem in

L ondon afterwards known as Bedlam cont aining
, ,

lunatics during the t hirt eent h cent ury for there is ,

the report of a Royal C ommission in the next

century stating that there were six lunatics there
who were under duress Burdett says t hat Bedlam
.

has been devot ed e x clusively to the treatment of

lunatics from some years prior to 14 00 down to
the present time so that i t t akes precedence in
,

this matt er of the asylum founded in V alencia in

Spain which D e sm a i so n s has erroneously held as
,

t h e first established in E urope E squirol states that

.

the Parliament of Paris ordered the general hospital ,

t hat of t h e Ho t el D ieu to provide a place for the

,

confinement of lunatics centuries before this ; and

while definit e evidence is lacking there seems no ,

doubt that in most places t here were as we have ,

said what we would call psychopathic wards in

,

connection wit h medieval hospit als .

E arly in t h e fift eenth century there are a numb er

of bequests made to Bedlam which specifically
mention the care of the insane I ndeed. the ,
 MEDIE VAL C AR E OF TH E IN S ANE 18 9

poor madmen of Be t hlehem seem t o have been

favourit e objects of chari t y The care of the insane
.

t here seems t o have t ouched a responsive chord

in many hearts M ayor Gregory describes in
.

his Hist orical C ollect ions ( abou t 14 5 1) this

L ondon asylum and it s work of mercy and from ,

him we have evidence of t h e fact t hat some of t h e

pat ient s were res t ored to reason aft er t heir st a y in
t h e asylum .He has words of praise for how
honest ly the pat ient s were cared for ; b u t
recognizes of course that some could n o t be cured
, , .

I n his quaint old E nglish he emphasizes part icularly

t h e church feature of t h e establishment .

A c h yr c h e of Owre L ady that ys n a m yde

Bedlam And yn t ha t place ben fo u n de many men
.

t hat ben fa llyn o w t e of b yr wyt t e And fulle

.

h o n e st ely t hey ben kep t e in t hat place ; and sum

ben r est o ryde unt o b yr wi t t e and b elt h e a gayne -
.

And sum ben a b ydyn g t here yn for evyr for t hey

-

ben falle soo moche o wt e of hem selfe that b yt ys

u n c u r e r a b ylle unt o man .

I n her chap t er on Hospitals for the I nsane in

M edieval Hospitals of M iss C lay
gives a number of det ails of the care of the insane
in E ngland and not es that t h e Rolls of Parliament
,

( 1 4 1 4 ) mention hospit a ls to main t ain men

and women who had lost t heir wi t s and memory
manifest ly t hey had some experience which
L o n d o n 19 09
at
, .
19 0 MEDIE VAL MEDICINE
differentiated cases of aphasia from t hose of
insani t y .She says t hat out side of L ondon it
was customary t o receive persons suff ering from
at tacks of m a ni a int o genera l i n fi r m a r i es At Holy .

Trinit y Salisbury not only were sick persons and

, ,

women in childbirt h received b u t mad people were

,

to be t aken care of (fur i osi c u st o di a n t a r do n ec

sen su m a dip i sc a n t u r ) This was a t t h e close of t h e
.

fourt eent h cent ury I n t h e pet it ion for the r efo r

.

mat ion of hospitals it is st ated t hat t hey

exist ed part ly t o maint ain t hose who had lost their
wits and memory ( h o r s de lea r sen n es et m ém o i r e) .

Furt her evidence of t h e presence of the insane

w it h ot her pat ient s is t o be found in t h e fact t hat
in cert ain hospi t als and a lmshouses i t was forbidden
to receive t h e insane showing t hat in many places
,

t hat mus t h ave been the cus t om M iss C lay notes

.

M any almshouse st at ut es however prohibi t ed

-

, ,

t heir admission A regulat ion co n cerning an

.

’
endowed bed in St John s C ovent ry .
,

declared t hat a candidat e must be n o t mad ,

quarrelsome leprous infect ed

, ,
At E welme no .
’

wood man [crazy person ] must be r ec el ve d ; and

’
an inmat e becomi ng madd or woode was t o be
, ,
”
removed from t h e C roydon almshouse .

Desm a i so n s is responsible for t h e t radit ion which

declares t here were no asylums for t h e I nsane unt il
t h e beginning of t h e fi f t eent h cen t ury a n d t h a t ,

then t hey were founded by the Spaniards under the

 MEDIEVAL CAR E OF TH E IN S ANE 19 1

influence of t h e M ohammedans L ecky in his .

,

”
Hist ory of E uropean M orals has cont radicted ,

t his assert ion of D esm a i so n s and declares t hat ’

,

there is absolut ely no proof for i t Burdet t in his .

,
“ ”
His t ory of Hospitals vol i p 4 2 says wi t h , . .
, .
,

regard t o this quest ion

Again D esm a i so n s s t a tes that t h e origin of

,

the first est ablishment exclusively devot ed t o t h e

insane dat es back t o A D 14 09 This dat e consti
. . .

t u t e s an his t oric fac t t h e impor t a nce of which

,

doubt less needs no demonst rat ion I t s import ance .

stands o u t all t h e more clearly when we calcul a t e

t h e lapse of t ime be t ween t h e period just spoken
of ( 14 09 ) and that in which Spain s example ’

( D e sm a i so n s is here referring t o t h e V alencia

asylum as t h e first in E urope ) found so many
followers N ow as a mat t er of fact an asylum
.
’
, ,

exclusively for t h e use of t h e m ent ally infirm exist ed

at M e t z in t h e year A D 1 100 and ano t her a t . .
,

E lbing near B anzie in 13 2 0 Again t here was

, , .
,

an ancient asylum a c c ording t o D ugdale known

, ,

as B er ki n g C hurch Hospi t al near t h e Tower of ,

L ondon for which Robert D ent on chaplain

, , ,

ob t ained a licence from King E dward II I in .

A D
. . 13 7 1 D ent on paid fort y shillings for t his
.

licence which empowered him t o found a ho spit a l

,

in a house of his own in t h e parish of B er ki n g ,

C hurch L ondon for t h e poor priest s a n d for m e n

, , ,

and women in t h e s a id cit y who sudde n ly fall int o

a fre n zy and lose t h ei r m em o r y who were t o reside
‘

t here till cured wi t h a n or a t o r y t o t h e s a id hospi t al

t o t h e invocat ion of t h e Blessed Vi rgin M ary
’
.
19 2 MEDIEVAL MEDICINE
The passages from A eg i n et a a t the beginning of
t his chap t er represent a t horough understanding of
ment al diseases often suppos ed not t o exist at this
time . Oft en it is presumed t hat t his t horough
appreciation of insanity gradually disappeared
during subsequent centuries and was n o t revived ,

unt il almost our own t ime I t is quit e easy how

.
,

ever t o illustrat e by quot at ions from the second

,

half of t h e M iddle Ages a like sensible treat ment

of the subject of insanity by scient ific and even
popular writers How diff erent was t h e attitude of
.

mind of t h e medieval people toward lunacy from

t hat which is usually a ssumed as exist ing at t hat
time may be gat hered very readily from t h e para
’
graph i n Bart holomeus E ncyclop aedia with
regard to madness I doubt whet her in a brief
.

discussion so much that is absolut ely t rue could be

bet t er said in our t ime I nsanit y according to
.
,

old Bart holomew was due to some poison auto

, ,

into x icat ion or strong drink

, The treatment is .

prevention of injury t o t hemselves or ot hers quiet ,

and peaceful retirement music and occupat ion of

, ,

mind The paragraph it self is wort h while having

.

near one in order t o show clearly t h e medieval

,

at t itude t oward t h e insane of even o rdinarily well n

inf o r med fol k for Bart holomew was t h e mos t read

,

book of popular information duri n g t h e M iddle

Ages .
 MEDIEVAL C AR E OF TH E IN S ANE 19 3

Bart holomew himself was only a compiler of

information a very learned man it is true but a
—
, ,

clergyman teacher not a physician Translations

-

, .

of his book were probably more widely read i n

E ngland in proport ion t o the number of the
,

reading public t han any modern encyclop aedia has

,

ever been He said .

M adness comet h sometime of passions of t h e

soul as of business and of great t hought s of sorrow
, ,

and of too great study and of dread somet ime of ,

t h e biting of a wood hound [mad dog ] or some -

other venomous beast ; somet ime of melancholy

meat s and somet ime of drink of strong wine
, .

And as t h e causes be diverse t h e t okens and signs ,

be diverse For some cry and leap and hurt and

.

wound t hemselves and ot her men and darken and ,

hide t hemselves in privy and secret places Th e .

m edi c i n e of t h em i s t h a t t h ey b e b o u n d t h a t t h ey
, ,

h u r t n o t t h em selv es a n d o t h er m en A n d n a m ely .

su c h sh a ll b e r efr esh ed a n d c o m f o r t ed a n d wi t h , ,

dr a wn f r o m c a u se a n d m a t t er of dr ea d a n d b u sy
t h o ug h t s An d t h ey m ust b e g la dded wi t h i n st r u
.

”
m en t s o f m u si c a n d so m e d ea l b e o c c up i ed .

( I talics ours ) .

Bart holomew recognizes t h e two classes of causes

of mental disturbance the mental and t h e physica l , ,

and it wi ll be noted has nothing t o say about the

, ,

Spiri t ual that is diabolic possession Wr iting i n

-

,
.

the thirteenth century diab olism wa s not a favourite ,

thought of the m en of his time and Bartho l om e w ,

25
19 4 MEDIE VAL MEDICINE
omi t s reference to i t as a cause of madness ent irely .

Food and drink and especially strong sp i r it u o u

,

liquor are set down as prominent causes I t may

, .

seem curious in our t ime t hat the b ite of a mad dog ,

”
or a wood hound as Bart holomew put it should
, ,

be given so important a place ; but in t h e absence

of legal regulation rabies must have been rather
common and t h e disease was so striking from t h e
,

fact that it s onset was oft en delayed for a prolonged

interva l aft er the bit e that it is no wonder t hat
,

a popular en c yc lo p m di st should make special note

of it .

The effect of alcohol in producing insanity was

well recognized during the M iddle Ages and many ,

wri t ers have alluded to it Pagel in the chapters

.
,

’
on M edieval M edicine in P u sc h m a n n s Hand
”
book ,says that A r c u la n u s of whom there is
,

ment ion in t h e chap t er on Oral Surgery and t h e

M inor Surgical Specialit ies has an e x cellent,

descrip t ion of alcoholic insanity The ordinary

.

assump t ion t hat medieval physicians did n o t

recognize t h e physical factors whi ch lead up t o
insani t y and pract ically always at t ributed ment a l
,

derangement t o spiritual co ndit ions especially t o ,

diabolic possession is quit e unfounded so far as

,

aut horitat ive phy sicians were concerned Their .

sug gest ions as t o t reat ment ab ove all in th eir care

,

fo r the gene r al health of the patient and the su pply

 MEDIE VA L C AR E OF T H E IN S ANE 19 5

ing of diversion of mind was in principle quit e as

,

good as anyt hing that we have been able to a c c o m

p li sh in mental diseases down t o t h e present time .

Their insanit y rat e and above all t heir suicide rat e

, ,

w as much lower t han ours for life was less st renuous

,

and conscious and t hough men and women oft en

,

had to suff er from severe physical strains and

stresses their free out door life made t hem more
,

capable of s t anding them .

The history of human care for t h e ins a ne i t i s ,

oft en said by those who are reviewing t h e whole

subject briefly may be represented by t h e steps in
,

progress from t h e presump t ion of diabolical posses

sion and exorcism for its relief to int elligent
, ,

understanding sympathet ic t reatment and gent le

, ,

surveillance with t h e implication that this has all

,

been a gradual evolution There is no doub t t hat

.

during the M iddle Ages even physicians oft en

thought of possession by the devil as t h e cause of
irrational states of mind N ot only some of the .

genuinely insane though not all be it no t ed b u t

—

,
—

also sufferers from dreads and inhibit ions of various

kinds t h e vict ims of tics and uncont rollable habits
, ,

especially t h e childish repe t i t ion of blasphemous

words and sufferers from o t her psychoses and
,

neuroses were considered t o be t h e victims of

,

diabolic action E xorcism t hen became a favourite

.

form of treatment of all th ese conditions but i t s ,

19 6 MED I E VAL MEDIC I NE
general acceptance came a b out b ecause it was so
often successful The mental influence of the cere
.

monies o f e x orcism w as often quite as e fficient in

t h e cure of these mental states as mesmerism ,

hyp notism psycho analy sis and other mental

,
-

influences in the modern time .

I t may particularly b e compared in this regard

to psycho analysis in our own day for this cures
-

patients b y making them feel that they have b een

the victims of some very early evil impression ,

usually sexual in character which has continued

,

unconsciousl y to them to colour all their subsequent

mental life Some of the curious theories of
.

secondary personality the subliminal self and what

,

”
has recently been called our hidden guest r ep r e ,

sent i n other terms what the medieval observers and

thinkers e x p ressed in their way b y an appeal to
diab olic influence They felt that there was a spirit
.

influencing these patients quite independent of

th emselves in some way and t heir thoroughgoing
,

b elief in a personal devil led them t o t hink that there

must b e some such explanation of the phenomena .

E ven g r eat scientists in the modern time who have

studied p sy chic research have not been able to get
away entirely from the feeling that there is some
thing i n such possession and have admitted that
,

there may b e even alien influence b y an evil spirit .

h
T e mor e o n e s t udi es the questio n fro m all sides ,
 M EDIE VAL C ARE OF TH E IN S ANE 19 7

and not merely from a narrow mat erialistic stand

point the less one is ready to condemn the
,

medievalists for their various theories of diabolic

possession The C hristian C hurch st ill teaches not
.

only it s possibility b u t it s actual occurrence .

Such conservat ive think ers as Sir Thomas M ore ,

’
o n e of E ngland s greatest L ord C h a ncellors the ,

only one who ever cleared the docket of the C ourt

of C hancery continued to believe in it nearly a
,

century aft er the M iddle Ages had closed but above ,

all is quit e frank in t h e expression of his opinion

that some of t h e mut ism t h e tics and bad habi t s
, , ,

and repeated blasphemies attributed to it may be

, ,

cured by soundly thrashing t h e young folks who

are subject t o t hem N eurological experts will
.

recall similar experiences in the modern time .

’
C harcot s well known s t ory of the lit tle boy whose
-

t i c was t h e use of the word ut t ered by the corpor a l

a t Waterloo and was c u red by being soundly licked
,

by some playmates at the Sa lp ét r iér e gat e is a ,

classic Some of t h e medieval cruelty represented

.

unfor t unat e developments from t h e observat ions

t hat had been made t hat a number of t h e impulsive
neuroses and psychoneuroses could be favourably
modified or even entirely corrected by attaching
, ,

t o the continuance of t h e habit a frequently

repeated memory of distinctly unpleasant c o n se
u e n c es th at h a d come upon the a t i nt because of
q p e
19 8 MEDIE VAL MEDICINE
it. Our e x perience in the recent war called to
attention a great m any cases of mutism functional ,

blindness tremors and incapacities of all kinds

, , ,

some of which were cured by painful applications

of electricity The medieval use of the lash for such
.

cases can be be t t er understood now as t h e result of

this very modern set of clinical observations .

I n the meant ime it must not be forgotten that

the people of t h e M id dl e Ages even when they
,

thought of insane and psychoneurotic persons as the

subjects of diabolic possession felt themselves under
,

the necessity of providing proper physical care for

these victims of disease or evil spirits and as w e ,

know actually made e x cellent provision for them .

N ot only were the insane given shelter and kept

from injuring themselves and others but in many ,

ways much better care was provided for them than

has been the cus t om down almost to our own time .

They had many fewer insane to care for ; life was

not so strenuous or rather fussy as it is in our time
, ,

large city life had not developed and simple ,

existence in the country was the best possible

prophylactic against many of the mental afflictions
that develop so frequently in the storm and stress of
competit ive industrial city existence This prophy
.

la x is was accidental b ut it was part of the life of the

,

time that needs to b e appreciated since it represents

,

one of the helpful hints that the M iddle Ages can

 MED I E VAL C AR E OF TH E IN S ANE 19 9

give us for the reduct ion of our own alarmingly

increasing insanity rate .

They had no large asylums such as we have now ,

but neit her did t hey have any poor houses ; yet we -

h a ve come to recognize how readily they solved the

social evils of poverty The almshouses at Stratford
.
,

wi t h t heir accommodations for an old man and his

wife living together are a typical st ill extant
, ,

example of t his E ach small communit y cared for

.

it s own suff erers They did n o t solve their social

.

problems in t h e mass fashion which we have learned

is so liable to abuse but each litt le town cared to a
,

great extent for it s own m ent ally ailing The y .

were able to do this mainly because hospitals were

rat her frequent ; and psychic cases were at the ,

beginning cared for in hospit a ls and when in mi lder

, ,

st at e t heir near relat ives were willing t o take more

bot her in caring for them than in our time .

D elirious s t ates due to fever had not yet been

definitely di fferent iated from the acute insanities ,

and all t hese cases then were t aken in by the

hospitals This was an excellent thing for patients
.
,

because t hey came u n der h o sp it a l care early ; and

,

one of t h e developments t hat must come in our

moder n hospit als is a psychopat hic wa r d in every
one of t hem for pat ient s will be saved t h e worst
,

de velopment s of thei r affec t ion .

Th e b etter to do classes found refuges for their

- -
200 MEDIEVAL MEDICINE
non violent insane in certain monasteries and
-

convent s or in parts of monastic est ablishments

,

particularly set aside for t his purpose When the .

pa t ient was of t h e higher nobili t y he was oft en put

,

in charge of a monk or of several religious and ,

confined in a port ion of his own or a kinsman s ’

cast le and cared for for years There are traditions

.

of similar care for t h e pe a santry who were connected

with monast ic establishments and somet imes small
,

houses were set apart for their use on the monast ery
grounds As cit ies grew in extent certain hospitals
.
,

received ment al patients as well as the physically

ailing keeping t hem segregated
, Aft er a time
.

some of these hospit als were ent irely set aside for
this purpose Bedlam 1n E ngland which had been
.
,

the old Royal Bet hlehem Hospi t al for t h e care of

all forms of illness came to be just before the end
,

of t h e thirt eent h century exclusively for t h e care of

the insane I n Spain part icularly t h e asylums for
.

the insane were well managed and came t o be ,

models for ot her countries This development in

.

Spain is some t imes attributed to t h e M oors but ,

there is absolutely no reason for t his att ribution ,

excep t t h e desire t o minimiz e C hristianit y s ’

influence even t hough t his e ff ort should att emp t

,

the impossible feat of demonst ra t ing M ohammed

a n i sm as a n organi z er of chari t y a n d soci a l service .

Som e of the developments of thei r car e fo r the

 MEDIEV AL C AR E OF TH E I N S ANE 201

insane in the M iddle Ages are very interesting .

Before this period closed there was a cu st om estab

,

li sh e d at Bedlam by which those who had been

insane but had become much better were allowed t o
leave the institut ion This was true even though
.
,

apparently there might be no friends to care for

them particularly or to guarantee their conduct or
,

their return in case of redevelopment of their

,

symptoms This amounted practically to the open

.

door system The authorities of the hospital how

.
,

ever made one requirement Those who had been

, .

insane and were allo wed to leave Be dl am were

required to wear a badge or plate on the arm ,

indicat ing t hat they had been for some time in this
hospital for the insane These people came to be
.

known as Bedlamites or Bedlams or B edla m er s

, , ,

and attracted so much sympathy from the com

’
munity generally that some of the ne er do w ells - -

the tramps and sturdy vagrants who have always

b een with the world as a problem quite as well as
the insane obtained possession of these insignia by
,

fraud or stealth and imposed on the charity of t h e

,

people of the t ime .

I t is ea sy to unde r stand that wherever these

patient s were recogniz ed by their b adges as havi ng
been for a time in an asylum for t h e insane they ,

wer e treate d quite diffe r entl y from o r din a ry

people Though all ow
. e d t o leave the a sylum and ,

26
202 MED I EV AL MED I CINE
left as it w ere wit hout surveillance they were
, , ,

really committed to the care of the community

generally N o one who knows the history is likely
.

to irritate a person who has been insane nor are ,

such people treated in t h e same spirit as those who

are supposed to have been always normal but out ,

of pity and sympathy they are particularly cared

for They are not expected t o live the same worka
.

day e x istence as mentally healt hy individuals but ,

their pathway in life is smoothed as much as possible .

M any an unfortunate incident in modern times is

due to the fact that a p r ev10 u s I nmate of an asylum
is irritated b eyond his power to control himself in
the ordinary affairs of life b y those who k now
nothing of his previous mental weakness I t is not.

unlikely that our open door system will have to b e

-

supplemented by some such arrangement as this

medieval requirement of a b adge and that we can
,

actually get suggestions from t h e medieval people

with regard to the care of the insane that will be
valuable for us .

A nother very int eresting development of care for

t h e mentally a fflicted was the organi z at ion of insti
t ut i o n s like the vil l age of Gheel in Belgium in ,

which part icularly children who were o f low grade -

mentality were cared for This was pr a t i c a lly t h e

.

origin of wha t h a s come in our tim e t o "b e called t h e

c olony sy stem of c a r in g fo r de fectives W e n o w
.
 MEDIE VAL C AR E OF TH E IN S ANE 2 03

have colonies for imbeciles of various grades and ,

village systems of caring for t hem At Gheel the .

system developed it m i ght b e said more or less

, ,

accidentally but really quite naturally

, St . .

D ym p n a was an I rish girl martyr whose shrine -

said to be o n the site of her martyrdom e x isted in

,
,

t h e village of Gheel Her intercession was said to

. ,

be very valuable in helping children of low grade -

mentality . These were b rought t o the shrine ,

sometimes from a long distance and when the ,

prayers of relatives were not answered immediately

the children were often left near the shrine in the
care of some of the villagers to have the benefit of
,

’
the martyr s intercession for a prolonged period .

As a consequence of this custom many of the ,

houses of the village came to harbour one or more

of these mentally defectives who were cared for by
,

the family as memb ers of it .

The religious feelings and particularly the

,

impression that the defectives were under the special

pat ronage of the patron saint of the village not ,

only kep t t hem from being abused or taken a dva n

tage of in any w ay but made t hem an object of
,

special care They were given vari ous simple tasks

.

to perform and the public spirit of the community

,

cared for them I t was only with the development

.

of modern sophist icat ion that the ten dency to take

advantage of social defectives came and special
204 MEDIE VAL MEDICINE
government regulations had to be made and
inspectors appointed This sy stem of caring for
.

these defective children however was eminently , ,

satisfactory O t her villages took up the work

.
,

especially in the L o w Co u n t r ie s and in France The

. .

village and colony system of caring for the insane ,

which we are now developing with so much satis

fact ion was entirely ant icipated under the most
,

favourable circumstances and wit h religious sanc ,

tions during the M iddle Ages N ot a few of the

, .

defe c tives when they grew up came to b e att ached

, ,

in va ri ous humble occupations to monastic estab

li sh m en t s Here they were out of the current of
.

the busy life around them and were cared for ,

particularly They were not overworked b ut asked

.

to do what they could and given their b oard and

,

clothes and the sympathetic attention of the

religi ous There are many more of such c ases at
.

the present t ime t han are at all appreciated They .

emphasi z e how much of this fraternal care there

must have been in the M iddle Ages .

Between the village system of caring for defee

t i ves and the germ of the colony idea in their
,

recognit ion of the value of the country or small

town as a dwelling place for those suffering from
-

backwardness of mind or chronic bodily ills that

disturb mentality and the , open door system -

for the insane as practised at Bedlam and other

,
 MEDIE VAL C AR E OF T H E IN S ANE 205

places the M iddle Ages anticipated some of the

,

best features of what is most modern in our care for

mental pat ients Their use of severe pain as a
.

corrective for the psychoneuroses even when they

,

thought of them in connection wit h diabolic posses

sion is another striking instance of their very
,

practical way of dealing wit h these patient s in a

manner likely to do them most good We have
.

had t o make our own developments in these mat ters ,

however b efore we could appreciate the true value

,

of what they were doing in the M iddle Ages .

 APP EN DI X I

L AW of the E mperor Frederick II .

( 1 1 9 4 1—
2 5 0)
*
regulating the practice of M edicine .

While we are bent on making regulations for

t h e common weal of our loyal subjects we keep
ever under our observation the health of the indi
vidual I n consideration of the serious damage and
.

the irreparable suffering which may occur as a

consequence of the inexperience of physicians we ,

decree that in future no one who claims the tit le of

physician shall exercise the art of healing or dare to
t reat the ailing except such as have beforehand in
,

our U niversity of Salerno passed a public examina

tion under a regular teacher of medicine and been
given a cert ificat e n o t only by the professor of
fl
,

medicine but also by one of our civil o i c i a ls which

, ,

declares his trust worthiness of character and

su fficiency of knowledge This document must be .

present ed to us or in our absence from the

‘

kingdom to the person who remains behind in our

,

stead in the kingdom and must b e followed b y the

,

“ To
9
fo u n d i n H u illa r d Br eh o lli s D i p l o m a t ic Hi st o r y
be -
’

of Fr eder ic k II w i t h D o cu m en t s (i ssu ed i n t welv e q ua r t o

.
”

v o l um es Pa r i s
, , 18 5 1 18 6 1)
—
 APP ENDI X I 207

obtaining of a licence to pract ise medicine eit her

from u s or from our representat ive aforesaid .

Violat ion of t his la w is t o be punished by confiscation

of goods and a year in prison for all t hose who in
future dare to prac t ise medicine wit hout such per
mission from our authority .

Since t h e st udent s cannot be expected t o learn

medical science unless t hey have previously been
grounded in logic we furt her decree t hat no one be
,

perm i t t ed to t ake up t h e st udy of medical science

wit hout beforehand having devot ed at least t hree
*
full years t o the study of logic Aft er t hree years .

devoted to t hese studies he (t h e student ) may if he ,

will proceed t o t h e study of medicine provided

, ,

always that during t h e prescribed t ime he devotes

himself also to surgery which is a part of medicine , .

Un der l o g ic a t t h i s t im e wa s i n cl u d ed t h e st udy o f
p r a c t ic a ll
y j
a ll t h e su b e c t s t h a t a r e n o w i n cl u d ed u n d er

t h e t er m t h e sev en li b er a l a r t s .H u x l ey i n h i s a dd r ess,

b efo r e t h e Un iv er si t y o f Ab er d een o n t h e o cca si o n o f h i s

,

i n a ug ur a t i o n a s r e ct o r o f t h a t u n i v er si t y sa id Th e , :

sc h o l a r s (o f t h e ea r l d a s o f t h e u n iv er si t i es fi r t h a l f o f t h e
y y ,
s

t h i r t een t h c en t u r y) st u di e d g r a mm a r r h e t o r ic a r i t h m et ic
, ,

eo m et r a st r o n o m h eo l o a n d m u sic e a dd ed
”
an d t H
g y , y , gy .

“
Thu s t hei r w o r k h o w ev er im p er fe c t a n d fa u l t y j
,
ud e d b
g y ,

m o d er n li g h t s i t m a y h a v e b een b r o u g h t t h e m fa ce t o fa ce
, ,

w i t h a ll t h e l ea di n g a sp ect s o f t h e m a n y sid ed mi n d o f m a n -
.

F o r t h ese st udi es did r ea lly c o n t a i n t n y r a t e i n e m b r yo

,
a a

—
so m et i m es , i t m a y b e i n ca r ic a t u re w h a t we n o w ca ll
,
—

p h il o so h
p y,
m a t h e m a t ic a l a n d
p yh si a l sci en e
c n d a rt A
c nd a .

I d o ub t i f t h e c u rr ic ul u m o f a n y m o d er n u n i v er si t y sh o w s so
so cl ea r a n d en er o u s a c o m r e h en si o n o f wh a t i s m ea n t b
g p y
c u lt ur e a s t h e o ld t r i v i u m a n d q ua d r i v i u m d o es Sci en c e .
”

a n d E d u ca t i o n E ssa s 19 7 N ew Yo r k D A l et o n
y p , . .
pp , .

and Co . 18 96 .
208 MED I E VAL M E DICINE
After this and not b efore will he b e given t
, ,

licence to practise provided he has passed

,

e x aminat ion in legal form as well as o b t a i n e

, ,

certificate from his t eacher as to his studies in

preceding t ime After having spent
.

study he shall not practise medicine

during a full year devoted himself
practice wit h advice and under
experienced physician I n the .

professors shall during t hese five

selves to the recogni z ed books both ,

Hippocrates as well as those of Galen ,

teach not only theoretic but also pract ical

We also decree as a measure intend
furtherance of public health that
be allowed t o pract ise unless he has ,

certificate which he must present to the

,

in the medical faculty stating that he ha ,

least a year at that part of medicine which i s

necessary as a guide to t h e practice of surgery a n d ,

that above all he has learned the anatomy of t h e

, ,

human body at the medical school and is fully ,

equipped in this department of medicine wit hout ,

which neither operations of any ki n d can be under

taken with success nor fractures be p roperly treated .

I n every province of our kingdom which i s

under our legal authority we decree that t wo ,

prudent and trustworthy men whose names must b e ,

sent to our court shall be appointed and bound b y

,

formal oat h under whose inspec t ion electua r ies a n d

,

syrups and other medicines be prepared according

to law and be sold on ly aft er such in sp ection I n .

Salerno in p a r ticu lar We d ecree t hat this inspector

,

shi p shall b e lim ited to t hose wh o h ave t a ken thei r

deg r ee as ma ste r s i n p h ysi o .
 APP END I X I 209

We also decree by the present law that no one

in t h e kingdom excep t in S a lerno or in N aples [in
which were the t wo universit ies of the kingdom ]
l
shall undert ake t o give lect ures on me dicine or
surgery or presume to assume t h e name of t eacher
, ,

unless he shall have been very thoroughly examined

in t h e presence of a government o ffi cial a n d of a
professor in t h e art of medicine [N o set t ing up .

of medical schools without t h e proper aut hority ] .

E very physician given a licence t o pract ise

must take an oat h t hat he shall fait hfully fulfil all
t h e requirements of the law and in addit ion t hat ,

whenever it comes to his knowledge t hat any

apothecary has for sale drugs that are of less
than normal strength he shall report him t o t h e ,

court and besides that he shall give his advice to

,

the poor wit hout asking for any compens a tion A .

physician shall visit his patient at least t wice a day

and at the wi sh of his patient once also a t night ,

and shall charge him in case the visit does not ,

require him to go out of the village or beyond t h e

walls of the city n o t more than one half t a r r en e in
,
-

* ’
gold for each day s service From a patient whom .

he visits out side of the village or the wall of the

’
town he has a right t o demand for a day s service
,

A t a r r en u s t a r r en e i n g o
or ld
wa s e q ua l t o a b o u t t hi r t y
c en t s o f o ur m on e
y . M
on e
y a t t ha t t im e h a d fr o m t en t o
fift een t im es t h e p c h a si n
ur
g p o w er t h a t i t h a s a t t h e p r esen t

t im e . An o r di n a r y w o r k m a n a t t h i s t im e i n E n g l a n d
r e c e iv ed a b o u t fo u r p en c e a da y wh ic h wa s j
,
u st t h e
p r ic e o f

a p a i r o f sh o es wh il e a fa t g o o se c o u ld b e b o u g h t fo r t wo
,

a n d a h a l f p en ce a sh ee fo r o n e sh illi n a n d t wo en c e a fa t
, p g p ,

h o g fo r t h r ee sh illi n g s a n d a st a ll fed o x fo r si x t een sh illi n g s

,
-

( A c t o f E d w a r d I II fix i.n
g p r ic es) .
210 MED I E VAL MED I CINE
not more than three t a r r en es to which may b e ,

added however his expenses provided that he does

, , ,

not demand more t han four t a r r en es alt ogether .

He (the regularly licensed physician) must not

enter into any business relations with the apothecary
nor must he take any of t hem under his protection
nor incur any money obligations in their regard .

N or must any licensed physician keep an a p o t h e

’
cary s shop himself Apothecaries must conduct
.

their business with a certificat e from a physician

according to the regulat ions and on t heir own credit
and responsibility and they shall not b e permitted
,

to sell their products without having taken an oath

that all their drugs have been prepared in the
prescribed form wi t hout any fraud The a p o t h e
, .

cary may derive the following profits from his sales

Such extracts and simples as he need not keep in
stock for more than a year b efore they may be ,

employed may b e charged for at the rate of three

,

t a r r en e s an ounce Other medicines however

.
, ,

which in consequence o f the special conditions

required for their preparation or for any other
reason the apothecary has to have in stock for more
,

than a year he m a y charge for at the rate of six

,

t a r r en es an ounce Stations for the preparation of

.

medicines may not be located anywhere b ut only in

certain communities in the kingdom as we prescribe
below .

We decree also that the growers of plants

meant for medical purpose shall b e bound by a
solemn oath that they shall prepare t heir medicines
conscientiously accor ding to the rules of their art ,

and so far as it is humanly possible that t hey shall

prepare them in the presence of the inspectors .

Viol a tions of this l aw shall b e p unished by the con

 A PP ENDI X I 2 11

fi sc a t io n
of their movable goods I f the inspectors
.
,

however t o whose fideli t y to dut y t h e keeping of

,

t h e regulat ions is committed should allow any fraud

,

in t h e m a tters that are entrusted t o them they sha ll

,
”
be condemned to punishment by death .
 APP END I X II

B U LL of Pope John XX II issued Fe b r uary 18 .

, ,

1 3 2 1 as a chart er for the M edical D epartment of

,

*
the U niversity of Pe r ugia .

While with deep feelings of solicitous consider

ation we mentally revolve how precious the gift of
science is and how desirable and glorious is its
possession s i nce through it the darkness of
,

ignorance is p u t t o flight and the clouds of error

complet ely done away wit h so that the t rained
int elligence of st udents disposes and orders t heir
act s and modes of life in t h e light of truth we are ,

moved by a very great desire that the study of

let t ers in which t h e priceless pearl of knowledge is
found should everywhere make praisewort hy pro
gress and should especially flourish more abundantly
,

in such places as are considered to be more suit able

Th e Un iv er si t y o f P er ug i a h a d a l r ea dy a ch i e ved a
E u r o p ea n r ep u t a t i o n fo r i t s L a w Sch o o l a n d t h i s Pa p a l
,

d o c u m en t wa s e vid en t ly m ea n t t o m a i n t a i n st a n d a r d s a n d
,

k eep t h e n e w M edica l Sc h o o l u p t o t h e b est cr i t er i a o f t h e

t im e s .Th e o r i g i n a l L a t i n o f t h i s d o c u m en t a s w e ll a s o f
,

t h e L a w o f Fr ed er ic k II m a y b e fo u n d i n W a l sh
“
.
, ,
Th e
P o p es a n d Sci en ce Fo r d ha m Un iv er si t y Pr ess New Yo r k
,
”
, ,

19 08 T h ey a r e q u o t ed d i r ect l y fro m t h e o ffi ci a l c o ll ec t i o n o f
.

Pa p a l B u ll s .
 APPENDI X 11 2 13

and fitting for the multiplication of the seeds and

salutary germs of right t eaching Whereas some .

t ime a g o Pope C lement of pious memory our

, ,

predecessor considering t h e purity of faith and the

,

excelling devot ion which t h e cit y of Pe r ugia ,

belonging t o our Papal s t at es is recognized to have,

maint ained for a long period t owards t h e C hurch ,

wishing t hat t hese might increase from good to

bet t er in t h e course of t ime deemed it fit t ing and
,

equi t a ble t hat t his same cit y which had been ,

endowed by D ivine Grace wi t h t h e prerogatives of

many special favours should be dist inguished by
,

t h e grant ing of university powers in order that by ,

the goodness of God men might be raised up in t h e

cit y i t self p re eminent for t heir learning decreed
-

by t h e Apost olic aut hority th a t a universit y should

be sit uated in t h e cit y and t hat it should flourish
t here for all fut ure t ime wit h a ll t hose fa cult ies t hat
may be found more fully set fort h in t h e let t er of
t ha t same predecessor aforesaid And whereas w e.
, ,

subsequent ly t hough unworthy having been raised

, ,

t o t h e digni t y of t h e Apost olic primacy are desirous ,

t o reward with a s t ill richer gift t h e same ci t y of

Pe r ugi a for t h e proofs of it s devo t ion by which it
has proven i t sel f wort hy of t h e favour of the
Apost olic See by our Apost olic a ut hori t y and
,

in accordance wit h t h e council of our bro t her

bishops we gr a nt t o our venera ble bro t her
, ,

t h e Bishop of Peru gia and t o t hose who may

,

be his successors in t h a t diocese t h e right of ,

conferring on persons who are wort hy of i t

t h e licence t o t e a ch ( t h e D octor a t e ) in c a non and
civil law according to t hat fixed me t hod which is
,

more fully described and regulated more at length

in t his our letter .
2 14 ME DI E VAL MEDICINE
C onsidering therefore that this same city
, , ,

because of its convenience and its many favouring

conditions is altogether suitable for student s and
,

wishing on that account to amplify the educational

concessions hitherto made because of t h e public
benefits which we hope will flow from them we ,

decree by Apostolic authori t y t hat if there are any

who in the course of time shall in t hat same
university attain t h e goal of knowledge in medical
science and the liberal arts and should ask for
licence to teach in order that they may be able to
t rain others wi t h more freedom t hat they may b e
,

examined in that university in t h e aforesaid medical

sciences and in the arts and be decorated with the
t i t le of M aster in t hese same faculties We further .

decree that as often as any are to receive the decree

of D oct or in medicine and arts as aforesaid t hey
, ,

must be present ed to the Bishop of Perugia who ,

rules the diocese at t h e t ime or t o him whom the

,

bishop shall have appointed for this purpose who ,

having selected teachers of t h e same faculty in

which t h e examinat ions are t o be made who are a t ,

that time present in the university to the number

of a t least four they shall come t ogether wit hout
,

any charge t o t h e candidate and every di fficult y ,

being removed should diligent ly endeavour that t h e

,

candidate be examined in science in eloquence in , ,

his mode of lec t uring and any t hing else which is

,

required for promotion to t h e degree of doct or or

mast er. Wit h regard t o t hose who are found
worthy t heir teachers should be furt her consult ed
,

privat ely and any revelat ion of informat ion

,

obt ained at such consultations as might redound to

the disadvant age or injury of t h e consultors i s
strictly forbidden I f all is satisfactory t h e candi
.
 APP ENDI X II 215

dat es should b e approved and admitted and the

licence to t each grant ed Those who are found
.

unfit must n o t be admi t t ed t o t h e degree of doctor ,

all leniency or prejudice or favour being set aside .

I n order t hat t h e said university may in t h e

aforesaid st udies of medicine and the arts so much
more fully grow in st rengt h according as t h e pro
,

fesso r s who ac t ually begin t h e work and teaching

t here are more skilful we have decided t hat un t il
,

four or five years have passed some professors two ,

at least who have secured t heir degree in t h e

,

medical sciences at the U niversit y of Paris under ,

the auspices of the C athedral of Paris and who shall ,

have t aught or acted as masters in the before

ment ioned U niversity of Paris shall be selected for
,

the duties of the masterships and the p rofessorial

chairs in the said department in the University of
Peru gia and that t hey shall cont inue their work
,

in t his last mentioned university until not ewort hy

-

progress in the formation of good students shall

have been made .

With regard to those who are to receive the

degree of doctor in medical science it must be ,

especially observed that all those seeking the degree

shall have heard lectures in all the books of t his same
science which are usually required to be heard by
similar st udents a t t h e U niversi t y of Bologna or of
Paris and t hat this shall continue for seven years
,
.

Those however who have elsewhere received

, ,

su fficient inst ru ction in logic or philosophy having

applied themselves to these studies for five years i n
t h e aforesaid universities wi t h t h e provision how
, ,

ever t hat at least three years of t h e aforesaid five

,

or seven year term shall have been devoted to

hearing lectures in me dical science in some
2 16 MEDIEV AL MEDICINE
university and according to custom shall have b een
,

examined under duly authorized teachers and shall

have besides read such b ooks outside the regular
, ,

course as may be required may with due observa

, ,

tion of all t h e regul a t ions which are demanded for

t h e t aking of degrees in P a ris or Bologna also be
,
’
allowed to take the examination at Perugia .
 I ND E X

B
A DALLAH 4 1 Ar t i fi c i a l t eet , 14 2 h
w
.

Ab d o m i n a l o un d s 9 8 Asep si s, 9 5 101
Ab ll 15 7
. .

e a, Asy lum s 19 1
Ab l
,

i 35 78
u c a s s, r
Au e, H a t m a n n v o n der , 64
Ab l F r g 3 3 r
,

u a a Au eli u s Cel su s 2 6
Ad l b t f M i
, ,

a er o a n z, 63 Aut h rit i f m di v l p h y i i
o es o e e a s c a n s,
Ad a l e 41 20
A t h it y i fl
.

E gidi us, 6 4 u or f 12 . n uen c e o

P l A t i t xi t i
,

ZE g i n a , au o f, 6, 27. 3 3, 138 , 14 6 , u o n 83 o ca on .

14 9 , 18 4 . 186 Av en zoa r , 35 77 .

ZE gi n et us S ee E n e, au of
. gi P l rr
Av e o es 35 ,

E t i u s, 4 , 28 . 13 8 , 14 6 Avi c en n a , 35 . 4 7 76 , 14 9 .

Aet i us, 2 7
lb r r
A e t t h e G ea t , 110 Ba a s, 18 1
lb r M g
A e t u s a n us, 14 , 18 Ba c h t i sc h ua , 7
l h l
A c o o 19 4 . Ba c o n , Rg
o er 14 , 110 .

l dr
A essa n a Gili a n i , 16 4 dg
Ba n a es st en e i ff
12 3 d
lx dr T ll rb r rg
. .

A e an e o f r a es, 4 , 27. 29 , Ba e su eo n s, 115

14 6 rhl
Ba t o om aeu s An c u s, 8 1 gli
lx di
A e a n r a , 33 hl w
Ba r t o o m e o n c a uses o f n sa n t i iy
bb
,

Ali A a s, 35 19 2
Alp h a n u s, 4 1 Ba s il V l i
a en t n e, 8 4
h i
An aest es a , 100, 104 . 105 , 120 h
Ba t s, 32
l
An se m o f H a e er . 63 v lb g for m e a n c o a , 18 4l h li
An t h em i os, 5 dl
Be a m , 188
i
An t sep t c su er , 104 i rg y dl i
Be a m t es, 2 01
wi 101 n e a s, li r i
Be sa us, H o sp t a o f, 17 1 i l
Ar b ia lt 8
an cu ur e. i i
Ben ed c t n e c on en t s, 15 9 v
rg su 149 eon s. r d
Be n a r d e G o o n , 70, 72 , 15 3 rd
A bi
ra 139 a n s. r rd M
Be n a of or a 49 l ix
Ar b 4 6
,

a s, il
B e i n eye di sea ses, 15 2

Ar h b i h p f Ly
c s 63 o o o n s, B al dd re s o f a n m a s 78 i l ,

A l 1 4 7 15 0
r c u a n u s, , l di g
B ee n 5 5 , 84
,

Adr J h 8 5 123 127

er n , o n , ,
l dl i g
B oo et t n , 32
-

l g
,

A t
r e aeus,18 6 Bo o n a , 4 0
A g l t Pi t r d 125 Bo n es, n u m er o f, 5 4 b
’
r e a a, e o ,

Ar i t t l 18
s o e, gi
Bo u es, 123
t d y f 16
s u o , Bra n c a , 106
Ar m t S lvi
a o, d a 15 2
no e, An t o n o , 107 i
Ar ld d Vill
no v e an o a . 66 Bru n o da Lon g o b ur g o , 9 6
ph r i m a o s s o f 67 Br un sc ,h wi g
H er o n y m us, 13 5 i
b i l
.

Arsen ic i n s y h ili
p s, 124 Bu on c p a g ue. 77
2 17
2 18 I N DE X
Ca lo m el. 85 F a b io la . H o sp i t a l o f, 171
Ca r e o f t h e i n sa n e 34 , 18 3, 189 . F ee . la w a s t o , 4 4
Ca re o f t h e si c , 24 , 2 5 k v
F e er , 32
Ca ssi o d o r u s 2 5 , F il r i
a a me di n en s s. i 77
Ca t a ra c t , 15 1 F i t ul
s 100 ae.
Ca ut e , 100, 126 ry F l st ula s, 12 7
l
Ce su s, Au e us, 2 6 r li r
F o u m a st e s o f Sa er n o . 4 7, 9 1 r l
h r
C a t er o f t h e n er s t o f er ug a . U iv i y P i r r
F a c tu e of t h e s u , 9 1 k ll
2 12 of t h e t h ig h x i
e t en s on i n . 123
k ll
,

h li
C a u a c , Guy de 11, 6 6 , 71, 72, . r
F a c t ur es o f t h e s u , 9 4
1 18 , 14 0, 15 3 . d d
ep r esse , 9 3

16 7 Fr e e i cd r k II , 42 .

C h ri
st i a n o sp t a s, 2 4 h i l la w o f, 4 3 206
l
C ea n n ess 9 5li .

l
C y st er a pp a a t us, 127 r G a dd esd en Jo h n . o f, 70, 119
Co ld
c o m p esses, 30 r G a l en 18 19 2 6, , , , 4 7, 72, 1 16
il
Co m p a t i o n 3 . a r i op on t u s, 4 1
Co n st a n t n e, 3 6 , 4 5 i er ssd or ff, Ha n s v on 1 35
G il b er t 6 9
.

Co n t r ec o up , 9 2 ,

v
Con en t s Ben e c t n e, 15 9 di i G i o va n n i o f Ar c oli 14 3 ,

Co e rb il ill
G es de, 6 4 G la u c o m a 15 2 ,

Co sm et i c s, 7 7 G on o rrh oea 123 .

r d
C usa es, 8 9 . 18 1 Gr ego r y M aj o r 189, ,

T r
of o u s, 18 1

D t l i st rum n t s 143 G ua r n a Rb ,
e ec c a , 15 7
en
D t i t y 138
a n e .
G ue n ri i 14 2 , 14 3
id f M
,
en s r
D p r ed f c t u es 9 3
e ess
,

ra r
Gu o o on t p e er . 6 4 lli
,
G ur lt , 9 , 4 7, 6 9 , 9 0, 9 3, 9 5 , 9 6 , 9 9 .
D R e i 37 4 1 4 4 4 5
en z , , , , ,
4 7, 76,
15 6
Di b lic p osse si 19 5 19 6 G uy d e C a u a c h li S ee C h li au ac
M M t p lli
.

Di et 31 36
o s on . .
G uy o f on t p e lli er See
. on e er
, ,

fo m el a c h o lic s 185
Di c id e 26
r n .
H aem o p t y s s, 3 0 i
o s or
Di o sc or o s, 5
s,
g
H a n m a n s r o p e, 2 8
’

H a r e li p , 134
Dip h t h r i
-

27, 128
Di s f
e a,

v y st em 30
r
H a t m a n n v o n der Aue. 6 4
sea se
w m 15 6
of
o n er o us s ,
d h
H ea a c e, 30
Dr i g 9 7
o en ,
i i
H em c ra n a , 30

t b
a na
12 5
e,
rb
H e s 26 .

D k R b t 46
u es .
H er n a 6 8 i .
u
D S t 110
e, o er ,
i
o p er a t o n s t o o equ en t , 122 fr
un s
D m t i f ti
c o us.
o n o f, 93
ra di l ca c ur e o f 12 1 ,
ur a a er , n ec
re du t i c o n o f, 122

He r i n a s, 99
E b er s P py a ru s, 137 He rd o 137o t u s,
E du c a t on i , c h a r a c t er s of m ed e a ivl , i r
H p p oc a t es . 26 , 4 7
12 l h
H o y G o st H o sp t a . 172 i l
li
E a s, 4 1 i l
H osp t a , 6 4 , 6 5
li
E h u s, 4 1 a t Lu ec . 178 b k
En gli h i g
s , K n o f t h e, 4 0 for un a t c s, 18 7 l i
l i di i
E p i ep t c c o n t o n s, 30 o f Be a m , 18 8 dl
xri
E o c sm 19 5 o f Be sa us, 171 li ri
b il bi l
.

E ye di
sea ses, e in 15 2 o f Fa o a , 171

w h P
.

a s , ur n e o f n a n t s i i f a s, 15 2 of o
p e y
S m m ac hu s, 171
 I N DE X 2 19

Hosp i t a l St Ba s l 170
of . i . M di l t h 44
e ca oa ,

o f St ea n , 178 . J h l t iv i t i 74
sc oo s a un ers es,
ofT o n n err e 176 p r
sut i t i 2 2 e s on s.

M di i 164
.

H os p i t l 16 9
a s, e c
M di i
,

Ch r i t i s an , 2 e d
c ne g y l ti an sur er ,
re a on s o f,

fo r ep er s, l 181 115
of t h e Ho G o st 172 ly h l r 22
o
p p u a
M di v l duc t i c h
. ,

r o y a , 174 l e e a e a on , a ra c t er s o f, 12
Hot e l Di
eu , 188 m di i p r i de c n e, e o s o f, 21
di r
H u b a s, 107 x b k 88
te t oo s,
Hu gh
o f Lu c c a , 9 6, 104 M l h li di t f 18 5
e an c o c s, e or ,

H um o ur s 5 4 M t l d f t iv
en a l i f 2 02e ec es, c o o n es or ,

M i g l r t ry l
,

H ym n s La t i n , 4 8 . en n ti
ea f 92 a e ,
a c era on o ,

Hy st er a , 3 4 i M i d
er c u r a15 7 e,

M r ry
e cu f 123 use o ,

M
,

I di
n a n su 106 rg eo n s, 47
esn e,

I f
n ec t i o n o f u a m ate . 9 3 d r r M th d
e ro5 or o s,

I n i i r i n a ri es i n m o n a st e es, 2 4 ri M t r rr h gi 33
e o a a,

I n li a la t i o n s . st ea m . 29 M iddl Ag lim i t f
e es, s o , Vi i
I n sa n e, c a r e o f t h e, 34 , 18 3 , 18 9 M ilk 2 9 5 2 ,

b t h 78
,

I i
n sa n t y . 19 4 a
M t r i i fi m i i 24
,

l h as fo r , 19 8 on a s e es, n r a r es n,

I i r
n t est n e s ut u e o f, 13 4 M d vill H ri d 11 6 6 114
on e e, en e, , ,

w d
,

I i
n t est n es, o un s o f, 9 9 116
I l gr d
t a y t h e p o st a ua t e me dic l
a M di 9 6 16 4
on no,
M t C i 39
,

c en t r e . 118 on e a ss n o ,
M t p lli G y d 10 6 1 173
on e er , u e, , ,

Jho n of Sa li burys . 64 M ri h p hy i i
oo s 62 s c a n s,
of Ga dd d es en , 70, 119 M b G lli 12 4
or us a c u s,

M l y H ry 17
or e en .

M g g i 84
,

Ki n g of th e En gli h s 49 or a n
M u t i 76
, ,

r a or
i iddl e i g l
7

La c er a t on o f th e m m en n ea
a rt e 92 ry , N l c ut y 14 8
a sa a er ,

fr
La n a n c , 11. 8 0, 9 6, 110 p l y p i o1 4 7 .

h
Las for n sa n t y , 19 8 i i p sc u l u m e 1 4 9 ,

i
La t n h ym n s, 4 8 N t u t udy 13
a re s .

La w a s t o fee, 4 4 N dli g f
ee n ta ct or c a ra 15 1
r d ri k II
.

of F e e c ,
4 3 2 06 . . efr et ykes, 85
r h
Lep e s, osp t a s for , 18 1 i l N r v ut ur 113
e e s e,
ig r
L a t u es 125 N v u y t m 30
er o s s s e
M di i
. ,

Li um li e c n es 73 . N i i 16 6
c a se,
i i i
L n ea r c c a t r c es 101 N s urg ry f t h 106
o e, s e o e,

N um b f b
.

i r d
L st e , Lor , 103 er o54 on es,
Lo u i s I X 110 fv i
o 54 e n s,
b k h
. .

Lu ec , o sp i t a a t , 178 l N ur d f 18 0
ses, o r er o ,

i
Lun a t c s, osp t a fo r , 18 7 h i l Nu t i t i p
r c tu m
on 77 er r e ,

Lu c c a , H u o f, 9 6 . 104 gh
Ly o n s, Ar c s o
p o f, 63 hbi h h di l
Oa t , m e c a 4 4
b
,

hg
(E so p a u s t u e. 123
Ma n z o li n i M d m
, a a e, 16 5 h h l l gy
Op t a m o o ,
15 1
Ma d d o g 68 , 8 0 i
Op um , 2 9
Mg
,

a n et i sm , 15 rd
O er o f n u r ses, 18 0
Mi a m on id
es. 35 . 79 Or dron a ux, 4 7, 5 0
220 I NDE X
Or b a si i u 28 s, i lli
Sa l c et W i a m o f, 9 6 105
.

li b y J h
.

Or t o h d t i 139 on a, Sa s ur , o n o f, 6 4
lv
Sa i n o de Ar m a t o , 15 2
P a gl
5 6 , 12 7, 19 4
e , h i r hi
Sa n t a So p a , a c t ec t o f, 5
P a m m a c h i us, 171 h l l
Sc oo o f Sa ern o , 5 7
P i
a r s. 4 0, 110 D
Sc o t u s, un s 4 0
P
.

a ssa a n t , v
c a n 111 J . Sec t s i n su er y 116 rg
P
.

l
a u o f ZE i n a . 6 , 2 7. 3 3, 138 , 14 6
g ik r
S c , c a e o f t h e, 24, 25
P gi
er e r n us, 15 ki
S n o f t h e sn a e, 2 8 k
P i
er n eu m , u p t ur e o f, 15 7 r k ll fr
S u , a c t u es o f, 9 1 9 4 r
P
.

e u r gi
a , C a r t er o f t h e n h
er s t U iv i y o p en n i g th e, 92
ll x
,
212 Sm a p o , 3 5 , 70
P fo lsp eun dt . H e i i hv
nr c on .133, 134 Sn a ke s n o f 28 . ki
Phy i i d t f th
s c a n , c on uc o e, 58 r hr
So e t o a t , 3 1
Phy i i M i h 62
s c a n s, o or s , Sp ec t a c es, 73, 15 2l
Pi t d Jar 114 , ea n , i h l i
St ea m n a a t o n s . 29
Pl g bub i 77
a u e, on c , i
St ffen e db d g
a n a es 12 3
Pl t i g y 106 134
.

as c sur er d
St u en t s, 6 5
P l yp i
. .

o l 14 7 n a sa ii
Sup er st t o n s m e c a l 22 di
P t 41
. , . .

on us, rg
Su eo n , t a n n o f. 117 ri i g
P p Sym m h u H p i t
o e ac s. os a l o f, 171 rg
Su eon s, Ar a a n , 14 0 bi
P p l m di i 22
o u ar e c n e, b b
a r er , 11
P w D A y 127
o er .
’
rc n I di
a n , 106
Pyh
,

s c l y i 19 6o an a -
s s, t em p e a n c e i n , 9 7 r
P d g l w 43
ur e ru a . gr
Sur e y , a n t sep t c , 104 i i
P us 103 . o f t h e n o se 106 .

P usc h m a n n , 5 6 l
p a st c , 106 , 134 i
P f i
ut r e a c t on , 9 7 r ec t a , 12 7 l
sec t s i n 116 .

R bi 8 1 128
a es, , gi l
Sur c a sp ec a t es 136 i li i .

R t l f di g 78
ec a ee n , y h ili
S p s, 12 3
g y 12 7
su r er , a rsen c t r ea t m en t 0i12 4 .

R d li g h t t
e tm t 70 8 2 r ea en , .

R g im 4 8 4 9
e en , , Ta gli a c oz z i 107:
T
,

it t i 47
sa n a s, a an r t a, Va lesc o de, 71
R l di
en a 85 sea se, Ta rt v l f 141
a r , r em o a o

T
,

Rh 3 5 14 8
a z es . , ee th r t i fi i l 14 2
, a c a ,

R g 42 5 6 20 9 0 103
o er , , , , , l i g f 140
c ea n n o ,

R l d 5 6 103
o an , , fi lli g f 14 5 n o ,

R l d 91
o an o. p r r v t
ese i f 139 14 4 a on o
igi f 2
, ,

R m m di i
o an e c n e. o r n o . t r i gh t
s a i g f 139 en n o
T mp m t 54
.

R A gli osa 70 n ca ,
”
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 I N TH E SA M E S E R I E S

PAST E UR A F T E R PAST E U R
By ST E P H E N PA G E T ,
HON . S E C R E TAR Y DE F E N CE S O CI E TY

La rg e Crown 8 vo , c lo t h , wi t h 8 f a ll p a g e i llust ra t i o n s
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We h ea t i ly o g a t ula t e M P a g et o n h i b o o k wh i c h i s d eep ly i n t er
r c n r r. s ,

e t i n g a d h ld s t h e a t t e t i o n f o m st a t t o fi n i sh
”
s n o n N tu r r .
—
a r e.

Th e c o uld b e n o b et t er wa y o f a o u i g a n i n t elli g en t i t e est in t h e

re r s n n r

a i m s a d m e t h d s o f sc i e t i fi c m e d i c i e t h a n t h
n o n st ud y o f t h i s b kn We e oo .

c o m m en d i t t o ll i n t en di n g t o en t e t h e p o fessi o
a as a e x c elle n t i n t e l
r r n n

le c t ua l p r ep a r a t i o n fo r t h e w o k t h ey w i ll h a e t o d o r M edi c a l v .

j ou r n a l .

TH E E DI N BU R G H SC H O O L OF
SU R G E R Y BE F O R E LI ST E R

By AL E XAN D E R M I L E S, M D . .
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S U R GE O N TO TH E R O YAL I N F I R M AR Y, E DI N BU R GH

Cro wn 8va , c lo t h , wi t h 8 p a g es f i llust ra t i o n s

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( By p ost P RI C E NET ( By p ost 5 15 )

A m o st fa sc i n a t i n g v o lum e wh i c h sh o uld a p p ea l t o st u d en t s o f sur g er y

wh o d esi r e t o kn o w
m o r e o f t h e i st o r o f t e i r a r t h y
W e fe el sur e t h e h .

w w
b o o k i ll sc o r e a n i n st a n t a n eo us a n d e ll m er i t e d suc c ess M ea zc a l Tzm es
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M r M ile s s a c c o un t i s a d m i r a b ly w r i t t en so m u c h so t h a t we felt so r r y
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’
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wh en we r ea c h ed t h e la st p a g e o n wh i c h a p p ea r s t h e w o r d b r i lli a n t I t is
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t h i s sa m e w o r d b r i ll i a n t w h i c h m i g h t b e a p p li e d t o t h e a ut h o r sh i p o f t h i s
‘ ’

m o st i n t er e st i n g v o lum e M ea zc a 1 W or ld ’ '
—
. .

a w e ll w r i t t en a n d w o r t h y c o n t r ib ut i o n t o t h e h i st o r y o f sur g er y
-
.

Th i s u n p r e t en t o us a n d ext r em el
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n r n a.

v a lua b le r eco r d o f t h e g r ea t sc h o o l wh i c h i t c o m m em o r a t e s
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A a 0 BLAC K. LTD . 4 , s a 6 $ 0 110 SQ UAR E , LO N DO N .

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C . e n et . s e n et . s

PU B LI SH E D BY

A . C . B LAC K, LTD ., 4, 5 8 6 SO H O SQ UAR E . L O N DO N , W l .