Old-Time Makers of Medicine
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Title: Old-Time Makers of Medicine
Author: James J. Walsh
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Old-Time Makers of Medicine
THE STORY OF THE STUDENTS AND TEACHERS
OF THE SCIENCES RELATED TO MEDICINE
DURING THE MIDDLE AGES
BY
James J. Walsh, K.C.St.G., M.D.
Ph.D., LL.D., Litt.D., Sc.D.
DEAN AND PROFESSOR OF NERVOUS DISEASES AND OF THE HISTORY OF MEDICINE AT
FORDHAM UNIVERSITY SCHOOL OF MEDICINE; PROFESSOR OF PHYSIOLOGICAL
PSYCHOLOGY AT THE CATHEDRAL COLLEGE, NEW YORK
NEW YORK
FORDHAM UNIVERSITY PRESS
1911 COPYRIGHT 1911
JAMES J. WALSH
THE QUINN & GODEN CO. PRESS
RAHWAY, N.J.
TO
REVEREND DANIEL J. QUINN, S.J.
The historical material here presented was gathered for my classes at
Fordham University School of Medicine during your term as president of
the University. It seems only fitting then, that when put into more
permanent form it should appear under the patronage of your name and
tell of my cordial appreciation of more than a quarter of a century of
valued friendship.
"When we have thoroughly mastered contemporary science it is time to
turn to past science; nothing fortifies the judgment more than this
comparative study; impartiality of mind is developed thereby, the
uncertainties of any system become manifest. The authority of facts is
there confirmed, and we discover in the whole picture a philosophic
teaching which is in itself a lesson; in other words, we learn to know,
to understand, and to judge."--LITTRE: _OEuvres
d'Hippocrate_, T. I, p. 477.
"There is not a single development, even the most advanced of
contemporary medicine, which is not to be found in embryo in the
medicine of the olden time."--LITTRE: Introduction to the Works
of Hippocrates.
"How true it is that in reading this history one finds modern
discoveries that are anything but discoveries, unless one supposes that
they have been made twice."--DUJARDIN: _Histoire de la
Chirurgie_, Paris, 1774 (quoted by Gurlt on the post title-page of his
_Geschichte der Chirurgie_, Berlin, 1898).
PREFACE
The material for this book was gathered partly for lectures on the
history of medicine at Fordham University School of Medicine, and partly
for articles on a number of subjects in the Catholic Encyclopedia. Some
of it was developed for a series of addresses at commencements of
medical schools and before medical societies, on the general topic how
old the new is in surgery, medicine, dentistry, and pharmacy. The
information thus presented aroused so much interest, the accomplishments
of the physicians and surgeons of a period that is usually thought quite
sterile in medical science proved, indeed, so astonishing, that I was
tempted to connect the details for a volume in the Fordham University
Press series. There is no pretence to any original investigation in the
history of medicine, nor to any extended consultation of original
documents. I have had most of the great books that are mentioned in the
course of this volume in my hands, and have given as much time to the
study of them as could be afforded in the midst of a rather busy life,
but I owe my information mainly to the distinguished German and French
scholars who have in recent years made deep and serious studies of these
Old Makers of Medicine, and I have made my acknowledgments to them in
the text as opportunity presented itself.
There is just one feature of the book that may commend it to
present-day readers, and that is that our medieval medical colleagues,
when medicine embraced most of science, faced the problems of medicine
and surgery and the allied sciences that are now interesting us, in very
much the same temper of mind as we do, and very often anticipated our
solutions of them--much oftener, indeed, than most of us, unless we have
paid special attention to history, have any idea of. The volume does not
constitute, then, a contribution to that theme that has interested the
last few generations so much,--the supposed continuous progress of the
race and its marvellous advance,--but rather emphasizes that puzzling
question, how is it that men make important discoveries and inventions,
and then, after a time, forget about them so that they have to be made
over again? This is as true in medical science and in medical practice
as in every other department of human effort. It does not seem possible
that mankind should ever lose sight of the progress in medicine and
surgery that has been made in recent years, yet the history of the past
would seem to indicate that, in spite of its unlikelihood, it might well
come about. Whether this is the lesson of the book or not, I shall leave
readers to judge, for it was not intentionally put into it.
OUR LADY'S DAY IN HARVEST, 1911.
CONTENTS
CHAPTER PAGE
I. INTRODUCTION 1
II. GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES 23
III. GREAT JEWISH PHYSICIANS 61
IV. MAIMONIDES 90
V. GREAT ARABIAN PHYSICIANS 109
VI. THE MEDICAL SCHOOL AT SALERNO 141
VII. CONSTANTINE AFRICANUS 163
VIII. MEDIEVAL WOMEN PHYSICIANS 177
IX. MONDINO AND THE MEDICAL SCHOOL OF BOLOGNA 202
X. GREAT SURGEONS OF THE MEDIEVAL UNIVERSITIES 234
XI. GUY DE CHAULIAC 282
XII. MEDIEVAL DENTISTRY--GIOVANNI OF ARCOLI 313
XIII. CUSANUS AND THE FIRST SUGGESTION OF LABORATORY
METHODS IN MEDICINE 336
XIV. BASIL VALENTINE, LAST OF THE ALCHEMISTS,
FIRST OF THE CHEMISTS 349
APPENDICES
I. ST. LUKE THE PHYSICIAN 381
II. SCIENCE AT THE MEDIEVAL UNIVERSITIES 400
III. MEDIEVAL POPULARIZATION OF SCIENCE 427
"Of making many books there is no end."--_Eccles._ xii, 12 (circa 1000
B.C.).
"The little by-play between Socrates and Euthydemus suggests an advanced
condition of medical literature: 'Of course, you who have so many books
are going in for being a doctor,' says Socrates, and then he adds,
'there are so many books on medicine, you know.' As Dyer remarks,
whatever the quality of these books may have been, their number must
have been great to give point to this chaff."--_Aequanimitas_,
WILLIAM OSLER, M.D., F.R.S., Blakistons, Philadelphia, 1906.
"Augescunt aliae gentes, aliae minuuntur;
Inque brevi spatio mutantur saecla animantum,
Et, quasi cursores vitai lampada tradunt."
--OVID.
One nation rises to supreme power in the world, while another declines,
and, in a brief space of time, the sovereign people change,
transmitting, like racers, the lamp of life to some other that is to
succeed them.
"There is one Science of Medicine which is concerned with the inspection
of health equally in all times, present, past and future."
--PLATO.
I
INTRODUCTION
Under the term Old-Time Medicine most people probably think at once of
Greek medicine, since that developed in what we have called ancient
history, and is farthest away from us in date. As a matter of fact,
however, much more is known about Greek medical writers than those of
any other period except the last century or two. Our histories of
medicine discuss Greek medicine at considerable length and practically
all of the great makers of medicine in subsequent generations have been
influenced by the Greeks. Greek physicians whose works have come down to
us seem nearer to us than the medical writers of any but the last few
centuries. As a consequence we know and appreciate very well as a rule
how much Greek medicine accomplished, but in our admiration for the
diligent observation and breadth of view of the Greeks, we are sometimes
prone to think that most of the intervening generations down to
comparatively recent times made very little progress and, indeed,
scarcely retained what the Greeks had done. The Romans certainly justify
this assumption of non-accomplishment in medicine, but then in
everything intellectual Rome was never much better than a weak copy of
Greek thought. In science the Romans did nothing at all worth while
talking about. All their medicine they borrowed from the Greeks, adding
nothing of their own. What food for thought there is in the fact, that
in spite of all Rome's material greatness and wide empire, her world
dominance and vaunted prosperity, we have not a single great original
scientific thought from a Roman.
Though so much nearer in time medieval medicine seems much farther away
from us than is Greek medicine. Most of us are quite sure that the
impression of distance is due to its almost total lack of significance.
It is with the idea of showing that the medieval generations, as far as
was possible in their conditions, not only preserved the old Greek
medicine for us in spite of the most untoward circumstances, but also
tried to do whatever they could for its development, and actually did
much more than is usually thought, that this story of "Old-Time Makers
of Medicine" is written. It represents a period--that of the Middle
Ages--that is, or was until recently, probably more misunderstood than
any other in human history. The purpose of the book is to show at least
the important headlands that lie along the stream of medical thought
during the somewhat more than a thousand years from the fall of the
Roman Empire under Augustulus (476) until the discovery of America.
After that comes modern medicine, for with the sixteenth century the
names and achievements of the workers in medicine are
familiar--Paracelsus, Vesalius, Columbus, Servetus, Caesalpinus,
Eustachius, Varolius, Sylvius are men whose names are attached to great
discoveries with which even those who are without any pretence to
knowledge of medical history are not unacquainted. In spite of nearly
four centuries of distance in time these men seem very close to us.
Their lives will be reserved for a subsequent volume, "Our Forefathers
in Medicine."
It is usually the custom to contemn the Middle Ages for their lack of
interest in culture, in education, in literature, in a word, in
intellectual accomplishment of any and every kind, but especially in
science. There is no doubt about the occurrence of marked decadence in
the intellectual life of the first half of this period. This has
sometimes been attributed to what has been called the inhibitory effect
of Christianity on worldly interests. Religion is said to have occupied
people so much with thoughts of the other world that the beauties and
wonders, as well as much of the significance, of the world around them
were missed. Those who talk thus, however, forget entirely the
circumstances which brought about the serious decadence of interest in
culture and science at this time. The Roman Empire had been the guardian
of letters and education and science. While the Romans were not original
in themselves, at least they had shown intense interest in what was
accomplished by the Greeks and their imitation had often risen to
heights that made them worthy of consideration for themselves. They were
liberal patrons of Greek art and of Greek literature, and did not
neglect Greek science and Greek medicine. Galen's influence was due much
more to the prominence secured by him as the result of his stay in Rome
than would have been possible had he stayed in Asia. There are many
other examples of Roman patronage of literature and science that might
be mentioned. As we shall see, Rome drained Greece and Asia Minor of
their best, and appropriated to herself the genius products of the
Spanish Peninsula. Rome had a way of absorbing what was best in the
provinces for herself.
Just as soon as Rome was cut off from intimate relations with the
provinces by the inwandering of barbarians, intellectual decadence
began. The imperial city itself had never been the source of great
intellectual achievement, and the men whom we think of as important
contributors to Rome's literature and philosophy were usually not born
within the confines of the city. It is surprising to take a list of the
names of the Latin writers whom we are accustomed to set down simply as
Romans and note their birthplaces. Rome herself gave birth to but a very
small percentage of them. Virgil was born at Mantua, Cicero at Arpinum,
Horace out on the Sabine farm, the Plinys out of the city, Terence in
Africa, Persius up in Central Italy somewhere, Livy at Padua, Martial,
Quintilian, the Senecas, and Lucan in Spain. When the government of the
city ceased to be such as assured opportunity for those from outside who
wanted to make their way, decadence came to Roman literature. Large
cities have never in history been the fruitful mothers of men who did
great things. Genius, and even talent, has always been born out of the
cities in which it did its work. It is easy to understand, then, the
decadence of the intellectual life that took place as the Empire
degenerated.
For the sake of all that it meant in the Roman Empire to look towards
Rome at this time, however, it seemed better to the early Christians to
establish the centre of their jurisdiction there. Necessarily, then, in
all that related to the purely intellectual life, they came under the
influences that were at work at Rome at this time. During the first
centuries they suffered besides from the persecutions directed against
them by the Emperors at various times, and these effectually prevented
any external manifestations of the intellectual life on the part of
Christians. It took much to overcome this serious handicap, but
noteworthy progress was made in spite of obstacles, and by the time of
Constantine many important officials of the Empire, the educated
thinking classes of Rome, had become Christians. After the conversion of
the Emperor opportunities began to be afforded, but political
disturbances consequent upon barbarian influences still further weakened
the old civilization until much of the intellectual life of it almost
disappeared.
Gradually the barbarians, finding the Roman Empire decadent, crept in on
it, and though much more of the invasion was peaceful than we have been
accustomed to think, the Romans simply disappearing because family life
had been destroyed, children had become infrequent, and divorce had
become extremely common, it was not long before they replaced the Romans
almost entirely. These new peoples had no heritage of culture, no
interest in the intellectual life, no traditions of literature or
science, and they had to be gradually lifted up out of their barbarism.
This was the task that Christianity had to perform. That it succeeded in
accomplishing it is one of the marvels of history.
The Church's first grave duty was the preservation of the old records
of literature and of science. Fortunately the monasteries accomplished
this task, which would have been extremely perilous for the precious
treasures involved but for the favorable conditions thus afforded.
Libraries up to this time were situated mainly in cities, and were
subject to all the vicissitudes of fire and war and other modes of
destruction that came to cities in this disturbed period. Monasteries,
however, were usually situated in the country, were built very
substantially and very simply, and the life in them formed the best
possible safeguard against fire, which worked so much havoc in cities.
As we shall see, however, not only were the old records preserved, but
excerpts from them were collated and discussed and applied by means of
direct observation. This led the generations to realize more and more
the value of the old Greek medicine and made them take further
precautions for its preservation.
The decadence of the early Middle Ages was due to the natural shifting
of masses of population of this time, while the salvation of scientific
and literary traditions was due to the one stable element in all these
centuries--the Church. Far from Christianity inhibiting culture, it was
the most important factor for its preservation, and it provided the best
stimulus and incentive for its renewed development just as soon as the
barbarous peoples were brought to a state of mind to appreciate it.
Bearing this in mind, it is easier to understand the course of medical
traditions through the Middle Ages, and especially in the earlier
period, with regard to which our documents are comparatively scanty,
and during which the disturbed conditions made medical developments
impossible, and anything more than the preservation of the old authors
out of the question. The torch of medical illumination lighted at the
great Greek fires passes from people to people, never quenched, though
often burning low because of unfavorable conditions, but sometimes with
new fuel added to its flame by the contributions of genius. The early
Christians took it up and kept it lighted, and, with the Jewish
physicians, carried it through the troublous times of the end of the old
order, and then passed it on for a while to the Arabs. Then, when
favorable conditions had developed again, Christian schools and scholars
gave it the opportunity to burn brightly for several centuries at the
end of the Middle Ages. This medieval age is probably the most difficult
period of medical history to understand properly, but it is worth while
taking the trouble to follow out the thread of medical tradition from
the Greeks to the Renaissance medical writers, who practically begin
modern medicine for us.
It is easy to understand that Christianity's influence on medicine,
instead of hampering, was most favorable. The Founder of Christianity
Himself had gone about healing the sick, and care for the ailing became
a prominent feature of Christian work. One of the Evangelists, St. Luke,
was a physician. It was the custom a generation ago, and even later,
when the Higher Criticism became popular, to impugn the tradition as to
St. Luke having been a physician, but this has all been undone, and
Harnack's recent book, "Luke the Physician," makes it very clear that
not only the Third Gospel, but also the Acts, could only have been
written by a man thoroughly familiar with the Greek medical terms of his
time, and who had surely had the advantage of a training in the medical
sciences at Alexandria. This makes such an important link in medical
traditions that a special chapter has been devoted to it in the
Appendix.
Very early in Christianity care for the ailing poor was taken up, and
hospitals in our modern sense of the term became common in Christian
communities. There had been military hospitals before this, and places
where those who could afford to pay for service were kept during
illness. Our modern city hospital, however, is a Christian institution.
Besides, deformed and ailing children were cared for and homes for
foundlings were established. Before Christianity the power even of life
and death of the parents over their children was recognized, and
deformed or ailing children, or those that for some reason were not
wanted, were exposed until they died. Christianity put an end to this,
and in two classes of institutions, the hospitals and the asylums,
abundant opportunity for observation of illness was afforded. Just as
soon as Christianity came to be free to establish its institutions
publicly, hospitals became very common. The Emperor Julian, usually
known as the Apostate, who hoped to re-establish the old Roman Olympian
religion, wrote to Oribasius, one of the great physicians of this time,
who was also an important official of his household, that these
Christians had established everywhere hospitals in which not only their
own people, but also those who were not Christians, were received and
cared for, and that it would be idle to hope to counteract the influence
of Christianity until corresponding institutions could be erected by the
government.
From the very beginning, or, at least, just as soon as reasonable
freedom from persecution gave opportunity for study, Christian interest
in the medical sciences began to manifest itself. Nemesius, for
instance, a Bishop of Edessa in Syria, wrote toward the end of the
fourth century a little work in Greek on the nature of man, which is a
striking illustration of this. Nemesius was what in modern times would
be called a philosopher, that is, a speculative thinker and writer, with
regard to man's nature, rather than a physical scientist. He was
convinced, however, that true philosophy ought to be based on a complete
knowledge of man, body and soul, and that the anatomy of his body ought
to be a fundamental principle. It is in this little volume that some
enthusiastic students have found a description that is to them at least
much more than a hint of knowledge of the circulation of the blood.
Hyrtl doubts that the passage in question should be made to signify as
much as has been suggested, but the occurrence of any even distant
reference to such a subject at this time shows that, far from there
being neglect of physical scientific questions, men were thinking
seriously about them.
Just as soon as Christianity brought in a more peaceful state of affairs
and had so influenced the mass of the people that its place in the
intellectual life could be felt, there comes a period of cultural
development represented in philosophy by the Fathers of the Church, and
during which we have a series of important contributors to medical
literature. The first of these was Aetius, whose career and works are
treated more fully in the chapter on "Great Physicians in Early
Christian Times." He was followed by Alexander of Tralles, probably a
Christian, for his brother was the architect of Santa Sophia, and by
Paul of AEgina, with regard to whom we know only what is contained in his
medical writings, but whose contemporaries were nearly all Christians.
Their books are valuable to us, partly because they contain quotations
from great Greek writers on medicine, not always otherwise available,
but also because they were men who evidently knew the subject of
medicine broadly and thoroughly, made observations for themselves, and
controlled what they learned from the Greek forefathers in medicine by
their own experience. Just at the beginning of the Middle Ages, then,
under the fostering care of Christianity there is a period of
considerable importance in the history of medical literature. It is one
of the best proofs that we have not only that Christianity did not
hamper medical development, but that, directly and indirectly, by the
place that it gave to the care of the ailing in life as well as the
encouragement afforded to the intellectual life, it favored medical
study and writing.
A very interesting chapter in the story of the early Christian physician
is to be found in what we know of the existence of women physicians in
the fourth and fifth centuries. Theodosia, the mother of St. Procopius
the martyr, was, according to Carptzovius, looked upon as an excellent
physician in Rome in the early part of the fourth century. She suffered
martyrdom under Diocletian. There was also a Nicerata who practised at
Constantinople under the Emperor Arcadius. It is said that to her St.
John Chrysostom owed the cure of a serious illness. From the very
beginning Christian women acted as nurses, and deaconesses were put in
charge of hospitals. Fabiola, at Rome, is the foundress of the first
important hospital in that city. The story of these early Christian
women physicians has been touched upon in the chapter on "Medieval Women
Physicians," as an introduction to this interesting feature of
Salernitan medical education.
During the early Christian centuries much was owed to the genius and the
devotion to medicine of distinguished Jewish physicians. Their sacred
and rabbinical writers always concerned themselves closely with
medicine, and both the Old Testament and the Talmud must be considered
as containing chapters important for the medical history of the periods
in which they were written. At all times the Jews have been
distinguished for their knowledge of medicine, and all during the Middle
Ages they are to be found prominent as physicians. They were among the
teachers of the Arabs in the East and of the Moors in Spain. They were
probably among the first professors at Salerno as well as at
Montpellier. Many prominent rulers and ecclesiastics selected Jewish
physicians. Some of these made distinct contributions to medicine, and a
number of them deserve a place in any account of medicine in the making
during the Middle Ages. One of them, Maimonides, to whom a special
chapter is devoted, deserves a place among the great makers of medicine
of all time, because of the influence that he exerted on his own and
succeeding generations. Any story of the preservation and development of
medical teaching and medical practice during the Middle Ages would be
decidedly incomplete without due consideration of the work of Jewish
physicians.
Western medical literature followed Roman literature in other
departments, and had only the Greek traditions at second hand. During
the disturbance occasioned by the invasion of the barbarians there was
little opportunity for such leisure as would enable men to devote
themselves with tranquillity to medical study and writing. Medical
traditions were mainly preserved in the monasteries. Cassiodorus, who,
after having been Imperial Prime Minister, became a monk, recommended
particularly the study of medicine to the monastic brethren. With the
foundation of the Benedictines, medicine became one of the favorite
studies of the monks, partly for the sake of the health of the brethren
themselves, and partly in order that they might be helpful to the
villages that so often gathered round their monasteries. There is a
well-grounded tradition that at Monte Cassino medical teaching was one
of the features of the education provided there by the monks. It is
generally conceded that the Benedictines had much to do with the
foundation of Salerno. In the convents for women as well as the
monasteries for men serious attention was given to medicine. Women
studied medicine and were professors in the medical department of
Salerno. Other Italian universities followed the example thus set, and
so there is abundant material for the chapter on "Medieval Women
Physicians."
The next phase of medical history in the medieval period brings us to
the Arabs. Utterly uninterested in culture, education, or science before
the time of Mohammed, with the growth of their political power and the
foundation of their capitals, the Arab Caliphs took up the patronage of
education. They were the rulers of the cities of Asia Minor in which
Greek culture had taken so firm a hold, and captive Greece has always
led its captors captive. With the leisure that came for study, Arabians
took up the cultivation of the Greek philosophers, especially Aristotle,
and soon turned their attention also to the Greek physicians Hippocrates
and Galen. For some four hundred years then they were in the best
position to carry on medical traditions. Their teachers were the
Christian and Jewish physicians of the cities of Asia Minor, but soon
they themselves became distinguished for their attainments, and for
their medical writings. Interestingly enough, more of their
distinguished men flourished in Spain than in Asia Minor. We have
suggested an explanation for this in the fact that Spain had been one of
the most cultured provinces of the Roman Empire, providing practically
all the writers of the Silver Age of Latin literature, and evidently
possessing a widely cultured people. It was into this province, not yet
utterly decadent from the presence of the northern Goths, that the Moors
came and readily built up a magnificent structure of culture and
education on what had been the highest development of Roman
civilization.
The influence of the Arabs on Western civilization, and especially on
the development of science in Europe, has been much exaggerated by
certain writers. Closely in touch with Greek thought and Greek
literature during the eighth, ninth, and tenth centuries, it is easy to
understand that the Arabian writers were far ahead of the Christian
scholars of Europe of the same period, who were struggling up out of the
practical chaos that had been created by the coming of the barbarians,
and who, besides, had the chance for whatever Greek learning came to
them only through the secondary channels of the Latin writers. Rome had
been too occupied with politics and aggrandizement ever to become
cultured. In spite of this heritage from the Greeks, decadence took
place among the Arabs, and, as the centuries go on, what they do becomes
more and more trivial, and their writing has less significance. Just the
opposite happened in Europe. There, there was noteworthy progressive
development until the magnificent climax of thirteenth century
accomplishment was reached. It is often said that Europe owed much to
the Arabs for this, but careful analysis of the factors in that progress
shows that very little came from the Arabs that was good, while not a
little that was unfortunate in its influence was borrowed from them with
the translations of the Greek authors from that language, which
constituted the main, indeed often the only, reason why Arabian writers
were consulted.
With the foundation of the medical school of Salerno in the tenth
century, the modern history of medical education may be said to begin,
for it had many of the features that distinguish our modern university
medical schools. Its professors often came from a distance and had
travelled extensively for purposes of study; they attracted patients of
high rank from nearly every part of Europe, and these were generous in
their patronage of the school. Students came from all over, from Africa
and Asia, as well as Europe, and when abuses of medical practice began
to creep in, a series of laws were made creating a standard of medical
education and regulating the practice of medicine, that are interesting
anticipations of modern movements of the same kind. Finally a law was
passed requiring three years of preliminary work in logic and philosophy
before medicine might be taken up, and then four years at medicine, with
a subsequent year of practice with a physician before a license to
practise for one's self was issued. In addition to this there was a
still more surprising feature in the handing over of the department of
women's diseases to women professors, and the consequent opening up of
licensure to practise medicine to a great many women in the southern
part of Italy. The surprise that all this should have taken place in the
south of Italy is lessened by recalling the fact that the lower end of
the Italian peninsula had been early colonized by Greeks, that its name
in later times was Magna Graecia, and that the stimulus of Greek
tradition has always been especially favorable to the development of
scientific medicine.
Salerno's influence on Bologna is not difficult to trace, and the
precious tradition of surgery particularly, which was carried to the
northern university, served to initiate a period of surgery lasting
nearly two centuries, during which we have some of the greatest
contributions to this branch of medical science that were ever made. The
development of the medical school at Bologna anticipated by but a short
time that of a series of schools in the north Italian universities.
Padua, Piacenza, Pisa, and Vicenza had medical schools in the later
Middle Ages, the works of some of whose professors have attracted
attention. It was from these north Italian medical schools that the
tradition of close observation in medicine and of thoroughly scientific
surgery found its way to Paris. Lanfranc was the carrier of surgery, and
many French students who went to Italy came back with Italian methods.
In the fourteenth century Guy de Chauliac made the grand tour in Italy,
and then came back to write a text-book of surgery that is one of the
monuments in this department of medical science. Before his time,
Montpellier had attracted attention, but now it came to be looked upon
as a recognized centre of great medical teaching. The absence of the
Popes from Italy and the influence of their presence at Avignon made
itself felt. While culture and education declined in Italy in the midst
of political disturbances, they advanced materially at the south of
France.
For our generation undoubtedly the most interesting chapter in the
history of medieval medicine is that which tells of the marvellous
development of surgery that took place in the thirteenth and fourteenth
centuries. Considerable space has been devoted to this, because it
represents not only an important phase of the history of medicine, and
recalls the names and careers of great makers of medicine, but also
because it illustrates exquisitely the possibility of important
discoveries in medicine being made, applied successfully for years, and
then being lost or completely forgotten, though contained in important
medical books that were always available for study. The more we know of
this great period in the history of surgery, the more is the surprise at
how much was accomplished, and how many details of our modern surgery
were anticipated. Most of us have had some inkling of the fact that
anaesthesia is not new, and that at various times in the world's history
men have invented methods of producing states of sensibility in which
more or less painless operations were possible. Very few of us have
realized, however, the perfection to which anaesthesia was developed, and
the possibility this provided for the great surgeons of the later
medieval centuries to do operations in all the great cavities of the
body, the skull, the thorax, and the abdomen, quite as they are done in
our own time and apparently with no little degree of success.
Of course, any such extensive surgical intervention even for serious
affections would have been worse than useless under the septic
conditions that would surely have prevailed if certain principles of
antisepsis were not applied. Until comparatively recent years we have
been quite confident in our assurance that antisepsis and asepsis were
entirely modern developments of surgery. More knowledge, however, of
the history of surgery has given a serious set-back to this
self-complacency, and now we know that the later medieval surgeons
understood practical antisepsis very well, and applied it successfully.
They used strong wine as a dressing for their wounds, insisted on
keeping them clean, and not allowing any extraneous material of any
kind, ointments or the like, to be used on them. As a consequence they
were able to secure excellent results in the healing of wounds, and they
were inclined to boast of the fact that their incisions healed by first
intention and that, indeed, the scar left after them was scarcely
noticeable. We know that wine would make a good antiseptic dressing, but
until we actually read the reports of the results obtained by these old
surgeons, we had no idea that it could be used to such excellent
purpose. Antisepsis, like anaesthesia, was marvellously anticipated by
the surgical forefathers of the medieval period.
It has always seemed to me that the story of Medieval Dentistry
presented an even better illustration of a great anticipatory
development of surgery. This department represents only a small surgical
specialty, but one which even at that period was given over to
specialists, who were called dentatores. Guy de Chauliac's review of the
dentistry of his time and the state of the specialty, as pictured by
John of Arcoli, is likely to be particularly interesting, because if
there is any department of medical practice that we are sure is
comparatively recent in origin, it is dentistry. Here, however, we find
that practically all our dental manipulations, the filling of teeth,
artificial dentures, even orthodontia, were anticipated by the dentists
of the Middle Ages. We have only the compressed account of it which is
to be found in text-books of general surgery, and while in this they
give mainly a heritage from the past, yet even this suffices to give us
a picture very surprising in its detailed anticipation of much that we
have been inclined to think of as quite modern in invention and
discovery.
Medicine developed much more slowly than surgery, or, rather, lagged
behind it, as it seems nearly always prone to do. Surgical problems are
simple, and their solution belongs to a great extent to a handicraft.
That is, after all, what chirurgy, the old form of our word surgery,
means. Medical problems are more complex and involve both art and
science, so that solutions of them are often merely temporary and lack
finality. During the Middle Ages, however, and especially towards the
end of them, the most important branches of medicine, diagnosis and
therapeutics, took definite shape on the foundations that lie at the
basis of our modern medical science. We hear of percussion for abdominal
conditions, and of the most careful study of the pulse and the
respiration. There are charts for the varying color of the urine, and of
the tints of the skin. With Nicholas of Cusa there came the definite
suggestion of the need of exact methods of diagnosis. A mathematician
himself, he wished to introduce mathematical methods into medical
diagnosis, and suggested that the pulse should be counted in connection
with the water clock, the water that passed being weighed, in order to
get very definite comparative values for the pulse rate under varying
conditions, and also that the specific gravity of fluids from the body
should be ascertained in order to get another definite datum in the
knowledge of disease. It was long before these suggestions were to bear
much fruit, but it is interesting to find them so clearly expressed.
At the very end of the Middle Ages came the father of modern
pharmaceutical chemistry, Basil Valentine. Already the spirit that was
to mean so much for scientific investigation in the Renaissance period
was abroad. Valentine, however, owes little to anything except his own
investigations, and they were surprisingly successful, considering the
circumstances of time and place. His practical suggestions so far as
drugs were concerned did not prove to have enduring value, but then this
has been a fate shared by many of the masters of medicine. There were
many phases of medical practice, however, that he insisted on in his
works. He believed that the best agent for the cure of the disease was
nature, and that the physician's main business must be to find out how
nature worked, and then foster her efforts or endeavor to imitate them.
He insisted, also that personal observation, both of patients and drugs,
was more important than book knowledge. Indeed, he has some rather
strong expressions with regard to the utter valuelessness of book
information in subjects where actual experience and observation are
necessary. It gives a conceit of knowledge quite unjustified by what is
really known.
What is interesting about all these men is that they faced the same
problems in medicine that we have to, in much the same temper of mind
that we do ourselves, and that, indeed, they succeeded in solving them
almost as well as we have done, in spite of all that might be looked for
from the accumulation of knowledge ever since.
It was very fortunate for the after time that in the period now known as
the Renaissance, after the invention of printing, there were a number of
serious, unselfish scholars who devoted themselves to the publication in
fine printed editions of the works of these old-time makers of medicine.
If the neglect of them that characterized the eighteenth and early
nineteenth centuries had been the rule at the end of the fifteenth and
during the sixteenth century, we would almost surely have been without
the possibility of ever knowing that so many serious physicians lived
and studied and wrote large important tomes during the Middle Ages. For
our forefathers of a few generations ago had very little knowledge, and
almost less interest, as to the Middle Ages, which they dismissed simply
as the Dark Ages, quite sure that nothing worth while could possibly
have come out of the Nazareth of that time. What they knew about the
people who had lived during the thousand years before 1500 only seemed
to them to prove the ignorance and the depths of superstition in which
they were sunk. That medieval scholars should have written books not
only well worth preservation, but containing anticipations of modern
knowledge, and, though of course they could not have known that, even
significant advances over their own scientific conditions, would have
seemed to them quite absurd.
Fortunately for us, then, the editions of the early printed books, so
many of them monuments of learning and masterpieces of editorial work
with regard to medieval masters of medicine, were lying in libraries
waiting to be unearthed and restudied during the nineteenth century.
German and French scholars, especially during the last generation, have
recovered the knowledge of this thousand years of human activity, and we
know now and can sympathetically study how the men of these times faced
their problems, which were very much those of our own time, in almost
precisely the same spirit as we do ours at the present time, and that
their solutions of them are always interesting, often thorough and
practical, and more frequently than we would like to think possible,
resemble our own in many ways. For the possibility of this we are
largely indebted originally to the scholars of the Renaissance. Without
their work that of our investigators would have been quite unavailing.
It is to be hoped, however, that our recovery of this period will not be
followed by any further eclipse, though that seems to be almost the rule
of human history, but that we shall continue to broaden our sympathetic
knowledge of this wonderful medieval period, the study of which has had
so many surprises in store for us.
II
GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES
What we know of the life of the Founder of Christianity and how much He
did for the ailing poor would make us expect that the religion that He
established would foster the care and the cure of suffering humanity. As
we have outlined in the Introduction, the first of the works of
Christian service that was organized was the care of the sick. At first
a portion of the bishop's house was given over to the shelter of the
ailing, and a special order of assistants to the clergy, the
deaconesses, took care of them. As Christians became more numerous,
special hospitals were founded, and these became public institutions
just as soon as freedom from persecution allowed the Christians the
liberty to give overt expression to their feelings for the poor. While
hospitals of limited capacity for such special purposes as the
sheltering of slaves or of soldiers and health establishments of various
kinds for the wealthy had been erected before Christianity, this was the
first time that anyone who was ill, no matter what the state of his
pecuniary resources, could be sure to find shelter and care. The
expression of the Emperor Julian the Apostate, that admission to these
hospitals was not limited to Christians, is the best possible evidence
of the liberal charity that inspired them.
The ordinary passing student of the history of medicine or of hospital
foundation and organization, can have no idea of the magnitude of some
of these institutions, and their importance in the life of the time,
unless it is especially pointed out. St. Basil, about the middle of the
fourth century, erected what was spoken of as "a city for the sick,"
before the gates of Caesarea. Gregory of Nazianzen, his friend, says
"that well built and furnished houses stood on both sides of streets
symmetrically laid out about the church, and contained rooms for the
sick, and the infirm of every variety were intrusted to the care of
doctors and nurses." There were separate buildings for strangers, for
the poor, and for the ailing, and comfortable dwellings for the
physicians and nurses. An important portion of the institution was set
apart for the care of lepers, which constituted a prominent feature in
Basil's work in which he himself took a special interest. Earlier in the
same century Helena, the mother of the Emperor Constantine, had built
similar institutions around Jerusalem, and during this same century
nearly everywhere we have evidence of organization of hospitals and of
care for the ailing poor.
Not only were hospitals erected, but arrangements were made for the care
of the ailing poor in their own homes and for the visitation of them,
and for the bringing to places adapted for their care and treatment of
such as were found on the street, or neglected in their homes. The
Church evidently considered itself bound to care for men's bodies as
well as their souls, and many of the expressions in common use among
Christians referred to this fact. Religion itself was spoken of as a
medicine of the soul and the body. Christianity was defined as the
religion of healing. The word salvation had a reference to both body and
soul. Baptism was spoken of as the bath of the soul, the holy Eucharist
as the elixir of immortal life, and penance as the medicine of the soul.
It is not surprising to find, then, that Harnack has found among the
texts that illustrate the history of early Christian literature this
one: "In every community there shall be at least one widow appointed to
assist women who are stricken with illness, and this widow shall be
trained in her duties, neat and careful in her ways, shall not be
self-seeking, must not indulge too freely in wine in order that she may
be able to take up her duties at night as well as by day, and shall
consider it her duty to keep the Church officials informed of all that
seems necessary."
The saving of deformed and ailing infants or children whose parents did
not care to have the trouble of rearing them, required the establishment
by the Christians of another set of institutions, Foundling Asylums and
Hospitals for Children. Until the coming of Christianity parents were
supposed to have the right of life and death over their children, and no
one questioned it. In every country in the world until the coming of
Christianity this had always been the case. Besides, there were
institutions for the care of the old. These are the classes of mankind
who are especially liable to suffer from disease, and the opportunity
to study human ailments in such institutions could scarcely help but
provide facilities for clinical observation such as had not existed
before. Unfortunately the work of Christianity was hampered, first by
the Roman persecutions, and then later by the invasion of the
barbarians, who had to be educated and lifted up to a higher plane of
civilization before they could be brought to appreciate the value of
medical science, much less contribute to its development.
Harnack, whose writings in the higher criticism of Scripture have
attracted so much attention in recent years, began his career in the
study of Christian antiquities with a monograph on Medical Features of
Early Christianity.[1] He mentions altogether some sixteen physicians
who reached distinction in the earliest days of Christianity. Some of
these were priests, some of them bishops, as Theodotos of Laodicea;
Eusebius, Bishop of Rome; Basilios, Bishop of Ancyra, and at least one,
Hierakas, was the founder of a religious order. The first Christian
physicians came mainly from Syria, as might be expected, for here the
old Greek medical traditions were active. Among them must be enumerated
Cosmas and Damian, physicians who were martyred in the persecution of
Diocletian, and who have been chosen as the patrons of the medical
profession. Justinian erected a famous church to them. It became the
scene of pilgrimages. Organizations of various kinds since, as the
College of St. Come, and medical societies, have been named after them.
Some idea of the interest of ecclesiastics in medical affairs may be
gathered from a letter of Bishop Theodoret of Cyrus, directed to the
prefect of the city, when he was about to leave the place. He wrote (see
Puschmann, Vol. I., p. 494): "When I took up the Bishopric of Cyrus I
made every effort to bring in from all sides the arts that would be
useful to the people. I succeeded in persuading skilled physicians to
take up their residence here. Among these is a very pious priest, Peter,
who practises medicine with great skill, and is well known for his care
for the people. Now that I am about to leave the city, some of those who
came at my invitation are preparing also to go. Peter seems resolved to
do this. I appeal to your highness, therefore, in order to commend him
to your special care. He handles patients with great skill and brings
about many cures."
Distinguished Christian writers and scholars, and the Fathers of the
Church in the early centuries, evidently paid much attention to
medicine. Tertullian speaks of medical science as the sister of
philosophy, and has many references to the medical doctrines discussed
in his time. Lactantius, in his work, "De Opificio Dei," has much to say
with regard to the human body as representing the necessity for design
in creation. His teleological arguments have much more force now than
they would have had for people generally twenty years ago. We have come
back to recognize the place of teleology. Clement of Alexandria was an
early Christian temperance advocate, who argued that the use of wine
was only justified when it did good as a medicine. The problems of
embryology and of diseases of childhood interested him as they did many
other of the early Christian writers.
AETIUS
The first great Christian physician whose works meant much for his own
time, and whose writings have become a classic in medicine, was Aetius
Amidenus, that is, Aetius of Amida, who was born in the town of that
name in Mesopotamia, on the upper Tigris (now Diarbekir), and who
flourished about the middle of the sixth century. His medical studies,
as he has told us himself, were made at Alexandria. After having
attracted attention by his medical learning and skill, he became
physician to one of the emperors at Byzantium, very probably Justinian,
(527-565). He seems to have been succeeded in the special post that was
created for him at court by Alexander of Tralles, the second of the
great Christian physicians. There is no doubt that Aetius was a
Christian, for he mentions Christian mysteries, and appeals to the name
of the Saviour and the martyrs. He was evidently a man of wide reading,
for he quotes from practically every important medical writer before his
time. Indeed, he is most valuable for the history of medicine, because
he gives us some idea of the mode of treatment of various subjects by
predecessors whose fame we know, but none of whose works have come to
us. His official career and the patronage of the Emperor, the breadth
of his scholarship, and the thoroughly practical character of his
teaching, show how medical science and medical art were being developed
and encouraged at this time.
Aetius' work that is preserved for us is known in medical literature as
his sixteen books on medical practice. In most of the manuscript it is
divided into four Tetrabibloi, or four book parts, each of which
consists of four sections called Logoi in Greek, Sermones in Latin. This
work embraces all the departments of medicine, and has a considerable
portion devoted to surgery, but most of the important operations and the
chapters on fractures and dislocations are lacking. Aetius himself
announces that he had prepared a special work on surgery, but this is
lost. Doubtless the important chapters that we have noted as lacking in
his work would be found in this. He is much richer in pathology than
most of the older writers, at least of the Christian era; for instance,
Gurlt says that he treats this feature of the subject much more
extensively even than Paulus AEginetus, but most of his work is devoted
to therapeutics.
At times those who read these old books from certain modern standpoints
are surprised to find such noteworthy differences between writers on
medicine, who are separated sometimes only by a generation, and
sometimes by not more than a century, in what regards the comparative
amount of space given to pathology, etiology, and therapeutics. Just
exactly the same differences exist in our own day, however. We all know
that for those who want pathology and etiology the work of one of our
great teachers is to be consulted, while for therapeutics it is better
to go to someone else. When we find such differences among the men of
the olden time we are not so apt to look at them with sympathetic
discrimination, as we do with regard to our contemporaries. We may even
set them down to ignorance rather than specialization of interest. These
differences depend on the attitude of mind of the physician, and are
largely the result of his own personal equation. They do not reflect in
any way either on his judgment or on the special knowledge of his time,
but are the index of his special receptivity and teaching habit.
Aetius' first and second books are taken up entirely with drugs. The
first book contains a list of drugs arranged according to the Greek
alphabet. In the third book other remedial measures, dietetic,
manipulative, and even operative, are suggested. In these are included
venesection, the opening of an artery, cupping, leeches, and the like.
The fourth and fifth books take up hygiene, special dietetics, and
general pathology. In the sixth book what the Germans call special
pathology and therapy begins with the diseases of the head. The first
chapter treats of hydrocephalus. In this same book rabies is treated.
What Aetius has consists mainly of quotations from previous authors,
many of whom he had evidently read with great care.
Concerning those "bitten by a rabid dog or those who fear water," Gurlt
has quoted the following expression, with regard to which most people
will be quite ready to agree with him when he says that it contains a
great deal of truth, usually thought to be of much later origin: "When,
therefore, any one has been bitten by a rabid dog the treatment of the
wound must be undertaken just as soon as possible, even though the bite
should be small and only superficial. One thing is certain, that none of
those who are not rightly treated escape the fatal effect. The first
thing to do is to make the wound larger, the mouth of it being divided
and dilated by the scalpel. Then every portion of it and the surrounding
tissues must be firmly pressed upon with the definite purpose of causing
a large efflux of blood from the part. Then the wound should be deeply
cauterized, etc."
There are special chapters devoted to eye and ear diseases, and to
various affections of the face. Under this the question of tattooing and
its removal comes in. It is surprising how much Aetius has with regard
to such nasal affections as polyps and ulcers and bleedings from the
nose. In this book, however, he treats only of their medicinal
treatment. What he has to say about affections of the teeth is so
interesting that it deserves a paragraph or two by itself.
He had much to say with regard to the nervous supply of the mucous
membranes of the gums, tongue, and mouth, and taught that the teeth
received nerves through the small hole existing at the end of every
root. For children cutting teeth he advised the chewing of hard objects,
and thought that the chewing of rather hard materials was good also for
the teeth of adults. For fistulas leading to the roots of teeth he
suggests various irritant treatments, and, if they do not succeed,
recommends the removal of the teeth. He seems to have known much about
affections of the gums and recognizes a benignant and malignant epulis.
He thought that one form of epulis was due to inflammation of a chronic
character, and suggests that if remedies do not succeed it should be
removed. His work is of interest mainly as showing that even at this
time, when the desire for information of this kind is usually supposed
to have been in abeyance, physicians were gathering information about
all sorts even of the minor ailments of mankind, gathering what had been
written about them, commenting on it, adding their own observations, and
in general trying to solve the problems as well as they could.
Aetius seems to have had a pretty good idea of diphtheria. He speaks of
it in connection with other throat manifestations under the heading of
"crusty and pestilent ulcers of the tonsils." He divides the anginas
generally into four kinds. The first consists of inflammation of the
fauces with the classic symptoms, the second presents no inflammation of
the mouth nor of the fauces, but is complicated by a sense of
suffocation--apparently our croup. The third consists of external and
internal inflammation of the mouth and throat, extending towards the
chin. The fourth is an affection rather of the neck, due to an
inflammation of the vertebrae--retropharyngeal abscess--that may be
followed by luxation and is complicated by great difficulty of
respiration. All of these have as a common symptom difficulty of
swallowing. This is greater in one variety than in another at different
times. In certain affections even "drinks when taken are returned
through the nose."
Hypertrophy of the tonsils--Aetius speaks of them as glands--is to be
treated by various astringent remedies, but if these fail the structures
should be excised. His description of the excision is rather clear and
detailed. The patient should be put in a good full light, and the mouth
should be held open and each gland pulled forward by a hook and excised.
The operator should be careful, however, only to excise those portions
that are beyond the natural size, for if any of the natural substance of
the gland is cut into, or if the incision is made beyond the projecting
portion of the tonsil, there is grave danger of serious hemorrhage.
After excision a mixture of water and vinegar should be kept in the
mouth for some time. This should be administered cold in order to
prevent the flow of blood. After this very cold water should be taken.
In this same book, Chapter L, he treats of foreign bodies in the
respiratory and upper digestive tracts. If there is anything in the
larynx or the bronchial tubes the attempt must be made to secure its
ejection by the production of coughing or sneezing. If the foreign body
can be seen it should be grasped with a pincers and removed. If it is in
the esophagus, Aetius suggests that the patient should be made to
swallow a sponge dipped in grease, or a piece of fat meat, to either of
which a string has been attached, in order that the foreign body may be
caught and drawn out. If it seems preferable to carry the body on into
the stomach, the swallowing of large mouthfuls of fresh bread or other
such material is recommended.
With regard to goitre, Aetius has some interesting details. He says
that "all tumors occurring in the throat region are called bronchoceles,
for every tumor among the ancients was called a cele, and, though the
name is common to them, they differ very much from one another." Some of
them are fatty, some of them are pultaceous, some of them are cancerous,
and some of them he calls honey tumors, because of a honey-like humor
they contain. "Sometimes they are due to a local dilatation of the blood
vessels, and this is most frequently connected with parturition,
apparently being due to the drawing of the breath being prevented or
repressed during the most violent pains of the patient. Such local
dilatation at this point of the veins is incurable, but there are also
hard tumors like scirrhus and malignant tumors, and those of great size.
With the exception of these last, _all the tumors of this region are
easily cured_, yielding either to surgery or to remedies. Surgery must
be adapted to the special tumor, whether it be honey-like or fatty, or
pultaceous." The prognosis of goitrous tumors is much better than might
be expected, but evidently Aetius saw a number of the functional
disturbances and enlargements of the thyroid gland, which are so
variable in character as apparently to be quite amenable to treatment.
Aetius' treatment of the subject of varicosities is quite complete in
its suggestions. "The term varices," he says, "is applied to dilated
veins, which occur sometimes in connection with the testes and sometimes
in the limbs. Operations on testicular varices patients do not readily
consent to; those on the limbs may be cured in several ways. First,
simple section of the skin lying above the dilated vessel is made, and
with the hook it is separated from the neighboring tissues and tied.
After this the dilated portion is removed and pressure applied by means
of a bandage. The patient is ordered to remain quiet, but with the legs
higher than the head. Some people prefer treatment by means of the
cautery." Gurlt, in his "History of Surgery," calls attention to the
fact that two of our modern methods of treating varicose veins are thus
discussed in Aetius, that by ligation and that by the cautery. The
cautery was applied over a space the breadth of a finger at several
points along the dilated veins.
Aetius' chapters on obstetrics and gynaecology are of special interest,
because, while we are prone to think that gynaecology particularly is a
comparatively modern development of surgery, this surgical authority of
the early Middle Ages treats it rather exhaustively. His sixteenth book
is for the most part (one hundred and eleven chapters of it) devoted to
these two subjects. He has a number of interesting details in the first
thirty-six chapters with regard to conception, pregnancy, labor, and
lactation, which show how practical were the views of the physicians of
the time. Gurlt has given us some details of his chapters on diseases of
the breast. Aetius differentiates phagedenic and rodent ulcers and
cancer. All the ordinary forms of phagedenic ulcer yield to treatment,
while malignant growths are rendered worse by them. Where ulcers are
old, he suggests the removal of their thickened edges by the cautery,
for this hastens cure and prevents hemorrhage. With regard to cancer,
he quotes from Archigenes and Leonides. He says that these tumors are
very frequent in women, and quite rare in men. Even at this time cancer
had been observed and recognized in the male breast. He emphasizes the
fact that cancerous nodules become prominent and become attached to
surrounding tissues. There are two forms, those with ulcer, and those
without. He describes the enlargement of the veins that follows, the
actual varicosities, and the dusky or livid redness of the parts which
seem to be soft, but are really very hard. He says that they are often
complicated by very painful conditions, and that they cause enlargement
of the glands and of the arms. The pain may spread to the clavicle and
the scapula, and he seems to think that it is the pain that causes the
enlargement of the glands at a distance.
His description of ulcerative cancer of the breast is very striking. He
says that it erodes without cause, penetrating ever deeper and deeper,
and cannot be stopped until it emits a secretion worse than the poison
of wild beasts, copious and abominable to the smell. With these other
symptoms pains are present. This form of cancer is especially made worse
by drugs and by all manner of manipulation. The paragraph from Leonides
quoted by Aetius gives a description of operation for cancer of the
breast, in which he insists particularly on the extensive removal of
tissue and the free use of the cautery. "The cautery is used at first in
order to prevent bleeding, but also because it helps to destroy the
remains of diseased tissues. When the burning is deep, prognosis is
much better. Even in cases where indurated tumors of the breast occur
that might be removed without danger of bleeding, it is better to use
the cautery freely, though the amputation of such a portion down to the
healthy parts may suffice." Aetius quotes this with approval.
Others before Aetius had suggested the connection between hypertrophy of
the clitoris and certain exaggerated manifestations of the sexual
instinct, and the development of vicious sexual habits. As might be
expected from this first great Christian physician and surgeon, he
emphasizes this etiology for certain cases, and outlines an operation
for it. This operation had been suggested before, but Aetius goes into
it in detail and describes just how the operation should be done, so as
to secure complete amputation of the enlarged organ, yet without injury.
He warns of the danger of removing more than just the structure itself,
because this may give rise to ugly and bothersome scars. After the
operation a sponge wet with astringent wine should be applied, or cold
water, especially if there is much tendency to bleeding, and afterwards
a sponge with manna or frankincense scattered over it should be bound
on. He treats of other pathological conditions of the female genitalia,
varicose veins, growths of various kinds, hypertrophy of the _portio
vaginalis uteri_, an operation for which is described, and of various
tumors. He describes epithelioma very clearly, enumerates its most
frequent locations in their order, lays down its bad prognosis, and
hence the necessity for early operation with entire removal of the new
growth whenever possible. He feared hemorrhage very much, however, and
warns with regard to it, and evidently had had some very unfortunate
experiences in the treatment of these conditions.
Aetius seems to have had as thoroughly scientific an interest in certain
phases of chemistry apart from medicine as any educated physician of the
modern time might have. Mr. A.P. Laurie, in his "Materials of the
Printer's Craft,"[2] calls attention to the fact that the earliest
reference to the use of drying oil for varnish is made by the physician
Aetius.
Aetius, or Aetios, to use for the nonce the Greek spelling of his name,
which sometimes occurs in medical literature, and should be known, has
been the subject of very varied estimation at different times. About the
time of the Renaissance he was one of the first of the early writers on
medicine accorded the honor of printing, and then was reprinted many
times, so that his estimation was very high. With the reawakening of
clinical medicine in the seventeenth century his reputation waxed again,
and Boerhaave declared that the works of Aetius had as much importance
for physicians as had the Pandects of Justinian for lawyers. This high
estimation had survived almost from the time of the Renaissance, when
Cornelius went so far as to say: "Believe me, that whoever is deeply
desirous of studying things medical, if he would have the whole of Galen
abbreviated and the whole of Oribasius extended, and the whole of Paulus
(of AEgina) 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 find it in Aetius." Naturally enough, this
exaggerated estimation was followed by a reaction, in which Aetius came
to be valued at much less than he deserved. After all is taken into
account in the vicissitudes of his fame, it is clear, however, that he
is one of the most important links in the chain of medical tradition,
and himself worthy to be classed among makers of medicine for his
personal observations and efforts to pass on the teachings of the old to
succeeding generations.
ALEXANDER OF TRALLES
An even more striking example than the life and work of Aetius as
evidence for the encouragement and patronage of medicine in early
Christian times, is to be found in the career of Alexander of Tralles,
whose writings have been the subject of most careful attention in the
Renaissance period and in our own, and who must be considered one of the
great independent thinkers in medicine. While it is usually assumed that
whatever there was of medical writing during the Middle Ages was mere
copying and compilation, here at least is a man who could not only
judiciously select, but who could critically estimate the value of
medical opinions and procedure, and weighing them by his own experience
and observation, turn out work that was valuable for all succeeding
generations. The modern German school of medical historians have agreed
in declaring him an independent thinker and physician, who represents a
distinct link in medical tradition.
He came of a distinguished family, in which the following of medicine as
a profession might be looked upon as hereditary. His father was a
physician, and it is probable that there were physicians in preceding
generations, and one of his brothers, Dioscoros, was also a successful
physician. Altogether four of his brothers reached such distinction in
their life work that their names have come down to us through nearly
fifteen hundred years. The eldest of them was Anthemios, the builder of
the great church of Santa Sophia in Constantinople. As this is one of
the world's great churches, and still stands for the admiration of men a
millennium and a half after its completion, it is easy to understand
that Anthemios' reputation is well founded. A second brother was
Metrodoros, a distinguished grammarian and teacher, especially of the
youthful nobility of Byzantium, as it was then called, or
Constantinople, as we have come to call it. A third brother was a
prominent jurist, also in Constantinople. The fourth brother, Dioscoros,
like Alexander, a physician, remained in his birthplace, Tralles, and
acquired there a great practice.
It was with his father at Tralles that Alexander received his early
medical training. The father of a friend and colleague, Cosmas, who
later dedicated a book to Alexander, was also his teacher, while he was
in his native city. As a young man, Alexander undertook extensive
travels, which led him into Italy, Gaul, Spain, and Africa, everywhere
gathering medical knowledge and medical experience. Then he settled down
at Rome, probably in an official position, and practised medicine
successfully until a very old age. He was probably eighty years of age
when, some time during the first decade of the seventh century, he died.
Puschmann, who has made a special study of Alexander's life and work,
suggests that since some of his books have the form of academic lectures
he was probably a teacher of medicine at Rome. As might be expected from
what we know of the relations of the rest of the family to the nobility
of the time, it is easy to understand, especially in connection with
hints in Alexander's favorite modes of therapeutics, that costliness of
remedies made no difference to his patients, that he must have had the
treatment of some of the wealthiest families in Rome.
His principal work is a Treatise on the Pathology and Therapeutics of
Internal Diseases, in twelve books. The first eleven books were
evidently material gathered for lectures or teaching of some kind. The
twelfth book, in which considerable use of Aetius' writings is made, was
written, according to Puschmann, toward the end of Alexander's life, and
was meant to contain supplementary matter, comprising especially his
views gathered from observation as to the pathology of internal
diseases. A shorter treatise of Alexander is with regard to intestinal
parasites. There are many printed editions of these books, and many
manuscript copies are in existence. Alexander was often quoted during
the Middle Ages, and in recent years, with the growth of our knowledge
of medical history, he has come to be a favorite subject of study.
Alexander's first book of pathology and therapeutics treats of head and
brain diseases. For baldness, the first symptom of which is falling out
of the hair, he counsels cutting the hair short, washing the scalp
vigorously, and the rubbing in of sulphur ointments. For grey hair he
suggests certain hair dyes, as nutgalls, red wine, and so forth. For
dandruff, which he described as the excessive formation of small
flake-like scales, he recommends rubbing with wine, with certain salves,
and washing with salt water.
He gives a good deal of attention to diseases of the nervous system. He
has a rather interesting chapter on headache. The affection occurs in
connection with fevers, after excess in drinking, and as a consequence
of injury to the skull. Besides, it develops as a result of disturbances
of the natural processes in the head, the stomach, the liver, and the
spleen. Headache, as the first symptom of inflammation of the brain, is
often the forerunner of convulsions, delirium, and sudden death. Chronic
or recurrent headache occurs in connection with plethora, diseases of
the brain, biliousness, digestive disturbances, insomnia, and continued
worry. Hemicrania has its origin in the brain, because of the presence
of toxic materials, and specially their transformation into gaseous
substances. It also occurs in connection with abdominal affections. This
latter remark particularly is directed to the cases which occur in
women.
For apoplexy and the consequent paralysis, Alexander considered
venesection the best remedy. Massage, rubbings, baths, and warm
applications are recommended for the paralytic conditions. He had
evidently had considerable experience with epilepsy. It develops either
from injuries of the head or from disturbances of the stomach, or
occasionally other parts of the body. When it occurs in nursing infants,
nourishment is the best remedy, and he gives detailed directions for the
selection of a wet nurse, and very careful directions as to her mode of
life. He emphasizes very much the necessity for careful attention to the
gastro-intestinal tract in many cases of epilepsy. Planned diet and
regular bowels are very helpful. He rejects treatment of the condition
by surgery of the head, either by trephining or by incisions, or
cauterization. Regular exercise, baths, sexual abstinence are the
foundation of any successful treatment. It is probable that we have
returned to Alexander's treatment of epilepsy much more nearly than is
generally thought. There are those who still think that remedies of
various kinds do good, but in the large epileptic colonies regular
exercise, bland diet, regulation of the bowels, and avoidance of
excesses of all kinds, with occupation of mind, constitute the mainstay
of their treatment.
Alexander has much to say with regard to phrenitis, a febrile condition
complicated by delirium, which, following Galen, he considers an
affection of the brain. It is evidently the brain fever of the
generations preceding the last, an important element of which was made
up of the infectious meningitises. Alexander suggests its treatment by
opiates after preliminary venesection, rubbings, lukewarm baths, and
stimulating drinks. Every disturbance of the patient must be avoided,
and visitors must be forbidden. The patient's room should rather be
light than dark. His teaching crops up constantly in the centuries after
his time, until the end of the nineteenth century, and while we now
understand the causes of the condition better, we can do little more for
it than he did.
Alexander divided mental diseases into two, the maniacal and
melancholic. Mania was, however, really a further development of
melancholia, and represented a high grade of insanity. Under melancholy
he groups not only what we denominate by that term, but also all
depressed conditions, and the paranoias, as also many cases of
imbecility. The cause of mental diseases was to be found in the blood.
He counselled the use of venesection, of laxatives and purgatives, of
baths and stimulant remedies. He insisted very much, however, on mental
influence in the disease, on change of place and air, visits to the
theatre, and every possible form of mental diversion, as among the best
remedial measures.
After his book on diseases of the head, his most important section is on
diseases of the respiratory system. In this he treats first of angina,
and recommends as gargles at the beginning light astringents; later
stronger astringents, as alum and soda dissolved in warm water, should
be employed. Warm compresses, venesection from the sublingual veins, and
from the jugular, and purgatives in severe cases, are the further
remedies. He treats of cough as a symptom due to hot or cold, dry or wet
dyscrasias. Opium preparations carefully used are the best remedies.
The breathing in of steam impregnated with various ethereal resins, was
also recommended.
He gives a rather interestingly modern treatment of consumption. He
recommends an abundance of milk with a strong nutritious diet, as
digestible as possible. A good auxiliary to this treatment was change of
air, a sea voyage, and a stay at a watering-place. Asses' and mares'
milk are much better for these patients than cows' and goats' milk.
There is not enough difference in the composition of these various milks
to make their special consumption of import, but it is probable that the
suggestive influence of the taking of an unusual milk had a very
favorable effect upon patients, and this effect was renewed frequently,
so that much good was ultimately accomplished. For hemoptysis,
especially when it was acute and due as Alexander thought to the rupture
of a blood vessel in the lungs, he recommended the opening of a vein at
the elbow or the ankle--in order to divert the blood from the place of
rupture to the healthy parts of the circulation. He insisted that the
patients must rest, that they should take acid and astringent drinks,
that cold compresses should be placed upon the chest (our ice bags), and
that they should take only a liquid diet at most lukewarm, or, better,
if agreeable to them, cold. When the bleeding stopped, a milk cure was
very useful for the restoration of these patients to strength.
It is not surprising, then, to find that Alexander suggests a thoroughly
rational treatment for pleurisy. He recognizes this as an inflammation
of the membrane covering the ribs, and its symptoms are severe pain,
disturbance of breathing, and coughing. In certain cases there is severe
fever, and Alexander knows of purulent pleurisy, and the fact that when
pus is present the side on which it is is warmer than the other.
Pleurisy can be, he says, rather easily confounded with certain liver
affections, but there is a peculiar hardness of the pulse characteristic
of pleurisy, and there is no expectoration in liver cases, though it
also may be absent in many cases of pleurisy. Sufferers from liver
disease usually have a paler color than pleuritics. His treatment
consists in venesection, purgatives, and, when pus is formed, local
incision. He recommends the laying on of sponges dipped in warm water,
and the internal use of honey lemonade. Opium should not be used unless
the patient suffers from sleeplessness.
Some of the general principles of therapeutics that Alexander lays down
are very interesting, even from our modern standpoint. Trust should not
be placed in any single method of treatment. Every available means of
bringing relief to the patient should be tried. "The duty of the
physician is to cool what is hot, to warm what is cold, to dry what is
moist, and to moisten what is dry. He should look upon the patient as a
besieged city, and try to rescue him with every means that art and
science places at his command. The physician should be an inventor, and
think out new ways and means by which the cure of the patient's
affection and the relief of his symptoms may be brought about." The most
important factor in his therapeutics is diet. Watering-places and
various forms of mineral waters, as well as warm baths and sea baths,
are constantly recommended by him. He took strong ground against the use
of many drugs, and the rage for operating. The prophylaxis of disease is
in Alexander's opinion the important part of the physician's duty. His
treatment of fever shows the application of his principle: cold baths,
cold compresses, and a cooling diet, were his favorite remedies. He
encouraged diaphoresis nearly always, and gave wine and stimulating
drugs only when the patient was very weak. He differentiates two kinds
of quartan fever. One of these he attributes to an affection of the
spleen, because he had noticed that the spleen was enlarged during it,
and that, after purgation, the enlarged spleen decreased in size.
Alexander was a strong opponent of drastic remedies of all kinds. He did
not believe in strong purgatives, nor in profuse and sudden
blood-lettings. He opposed arteriotomy for this reason, and refused to
employ extensive cauterization. His diagnosis is thorough and careful.
He insisted particularly on inspection and palpation of the whole body;
on careful examination of the urine, of the feces, and the sputum; on
study of the pulse and the breathing. He thought that a great deal might
be learned from the patient's history. The general constitution is also
of importance. His therapeutics is, above all, individual. Remedies must
be administered with careful reference to the constitution, the age, the
sex, and the condition of the patient's strength. Special attention must
always be paid to nature's efforts to cure, and these must be
encouraged as far as possible. Alexander had no sympathy at all with
the idea that remedies must work against nature. His position in this
matter places him among the dozen men whose name and writings have given
them an enduring place in the favor of the profession at all times, when
we were not being carried away by some therapeutic fad or imagining that
some new theory solved the whole problem of the causation and cure of
disease.
Gurlt, in his "History of Surgery," has abstracted from Alexander
particularly certain phases of what the Germans call external pathology
and therapeutics. For instance, Alexander's treatment of troubles
connected with the ear is very interesting. Gurlt declares that this
chapter alone provides striking evidence for Alexander's practical
experience and power of observation, as well as for his knowledge of the
literature of medicine. He considers that only a short abstract is
needed to show that.
For water that has found its way into the external ear, Alexander
suggests a mode of treatment that is still popularly used. The patient
should stand upon the leg corresponding to the side on which there is
water in his ear, and then, with head leaning to that side, should hop
or kick out with the other leg. The water may be drawn out by means of
suction through a reed. In order to get foreign bodies out of the
external auditory canal, an ear spoon or other small instrument should
be wrapped in wool and dipped in turpentine, or some other sticky
material. Occasionally he has seen sneezing, especially if the mouth and
nose are covered with a cloth, and the head leant toward the affected
side, bring about a dislodgment of the foreign body. If these means do
not succeed, gentle injections of warm oil or washing out of the canal
with honey water should be tried. Foreign bodies may also be removed by
means of suction. Insects or worms that find their way into the ear may
be killed by injections of acid and oil, or other substances.
Gurlt also calls attention to Alexander's careful differentiation of
certain very dangerous forms of inflammation of the throat from others
which are rather readily treated. He says, "Inflammation of the throat
may, under certain circumstances, belong to the severest diseases. The
patients succumb to it as a consequence of suffocation, just as if they
were choked or hanged. For this reason, perhaps, the affection bears the
name synanche, which means constriction." He then points out various
other forms of inflammation of the throat, acute and chronic, suggesting
various names and the differential diagnostic signs.
One of the most surprising chapters of Alexander's knowledge of
pathology and therapeutics is to be found in his treatment of the
subject of intestinal worms, which is contained in a letter sent by him
to his friend, Theodore, whose child was suffering from them. He
describes the _oxyuris vermicularis_ with knowledge manifestly derived
from personal observation. He dwells on the itching in the region of the
anus, caused by the _oxyuris_, and the fact that they probably find
their way into the upper part of the digestive tract because of the
soiling of the hands. He knew that the tapeworms often reached great
length,--he has seen one over sixteen feet long,--and also that they had
a life cycle, so that they existed in two different forms. He describes
the roundworms as existing in the intestines, but occasionally wandering
into the stomach to be vomited. His vermifuges were the flowers and the
seeds of the pomegranate, the seeds of the heliotrope, castor-oil, and
certain herbs that are still used, by country people, at least, as worm
medicines. For roundworms he recommended especially a decoction of
_artemisia maritima_, coriander seeds, and decoctions of thyme. Our
return to thymol for intestinal parasites is interesting. For the
_oxyuris_ he prescribed clysters of ethereal oils. We have not advanced
much in our treatment of intestinal worms in the fifteen hundred years
since Alexander's time.
PAUL OF AEGINA
Another extremely important writer in these early medieval times, whose
opportunities for study in medicine and for the practice of it, were
afforded him by Christian schools and Christian hospitals, was Paul of
AEgina. He was born on the island of AEgina, hence the name AEginetus, by
which he is commonly known. There used to be considerable doubt as to
just when Paul lived, and dates for his career were placed as widely
apart as the fifth and the seventh centuries. We know that he was
educated at the University of Alexandria. As that institution was broken
up at the time of the capture of the city by the Arabs, he cannot have
been there later than during the first half of the seventh century. An
Arabian writer, Abul Farag, in "The Story of the Reign of the Emperor
Heraclius," who died 641, says that "among the celebrated physicians who
flourished at this time was Paulus AEginetus." In his works Paul quotes
from Alexander of Tralles, so that there seems to be no doubt now that
his life must be placed in the seventh century.
The most important portion of Paul's work for the modern time is
contained in his sixth book on surgery. In this his personal
observations are especially accumulated. Gurlt has reviewed it at
considerable length, devoting altogether nearly thirty pages to it, and
it well deserves this lengthy abstract. Paul quotes a great many of the
writers on surgery before his time, and then adds the results of his own
observation and experience. In it one finds careful detailed
descriptions of many operations that are usually supposed to be modern.
Very probably the description quoted by Gurlt of the method of treating
fishbones that have become caught in the throat will give the best idea
of how thoroughly practical Paul is in his directions. He says: "It will
often happen in eating that fishbones or other objects may be swallowed
and get caught in some part of the throat. If they can be seen they
should be removed with the forceps designed for that purpose. Where they
are deeper, some recommend that the patient should swallow large
mouthfuls of bread or other such food. Others recommend that a clean
soft sponge of small circumference to which a string is attached be
swallowed, and then drawn out by means of the string. This should be
repeated until the bone or other object gets caught in the sponge and is
drawn out. If the patient is seen immediately after eating, and the
swallowed object is not visible, vomiting should be brought on by means
of a finger in the throat or irritation with the feather, and then not
infrequently the swallowed object will be brought up with the vomit."
In the chapter immediately following this, XXXIII, there is a
description of the method of opening the larynx or the trachea, with the
indications for this operation. The surgeon will know that he has opened
the trachea when the air streams out of the wound with some force, and
the voice is lost. As soon as the danger of suffocation is over, the
edges of the wound should be freshened and the skin surfaces brought
together with sutures. Only the skin without the cartilage should be
sutured, and general treatment for encouraging union should be employed.
If the wound fails to heal immediately, a treatment calculated to
encourage granulations should be undertaken. This same method of
treatment will be of service whenever we happen to have a patient who,
in order to commit suicide, has cut his throat. Paul's exact term is,
perhaps, best translated by the expression, slashed his larynx.
One of the features of Paul's "Treatise on Surgery" is his description
of a radical operation for hernia. He describes scrotal hernia under the
name enterocele, and says that it is due either to a tearing or a
stretching of the peritoneum. It may be the consequence either of injury
or of violent efforts made during crying. When the scrotum contains
only omentum, he calls the condition epiplocele; when it also contains
intestine, an epiplo-enterocele. Hernia that does not descend into the
scrotum he calls bubonocele. For operation the patient should be placed
on the back, and, the skin of the inguinal region being stretched by an
assistant, an oblique incision in the direction in which the blood
vessels run should be made. The incision should then be stretched by
means of retractors, until the contents of the sac can be lifted out.
All adhesions should be broken up and the fat be removed, and the hernia
replaced within the abdomen. Care should be taken that no loop of
intestine is allowed to remain. Then a large needle with double thread
made of ten strands should be run through the middle of the incision in
the end of the peritoneum, and tied firmly in cross sutures. The outer
structures should be brought together with a second ligature, and the
lower end of the incision should have a wick placed in it for drainage,
and the site of operation should be covered with an oil bandage.
The Arab writer, Abul Farag, to whose references we owe the definite
placing of the time when Paul lived, said that "he had special
experience in women's diseases, and had devoted himself to them with
great industry 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 after parturition. He willingly imparted his information, and
told them what they should do. For this reason he came to be known as
the Obstetrician." Perhaps the term should be translated the
man-midwife, for it was rather unusual for men to have much knowledge of
this subject. His knowledge of the phenomena of menstruation was as 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 hemorrhage from the uterus, the bleeding might be stopped by
putting ligatures around the limbs. This same method has been suggested
for severe hemorrhage from the lungs as well as from the uterus in our
own time. In hysteria he also suggested ligature of the limbs, and it is
easy to understand that this might be a very strongly suggestive
treatment for the severer forms of hysteria. It is possible, too, that
the modification of the circulation to the nervous system induced by the
shutting off of the circulation in large areas of the body might very
well have a favorable physical effect in this affection. Paul's
description of the use of the speculum is as complete as that in any
modern text-book of gynaecology.
FURTHER CHRISTIAN PHYSICIANS
Another distinguished Christian medical scientist was Theophilus
Protosbatharius, who belonged to the court of the Greek Emperor
Heraclius, in the seventh century. He seems to have had a life very full
of interest and surprisingly varied duties. He was a bishop, and, at the
same time, commander of the imperial bodyguard, and the author of a
little work on the fabric of the human body. The most surprising chapter
in the history of the book is that for some two centuries, in quite
modern times, it was used as a text-book of anatomy at the University of
Paris. It was printed in a number of editions early in the history of
printing, at least one very probably before 1500, and several later.
There are very interesting phases of medicine delightfully surprising in
their modernity to be found here and there in many of these early
Christian writers on medicine. For instance, in a compend of medicine
written by one Leo, who, under the Emperor Theophilus, seems to have
been a prominent physician of Byzantium (the compend was written for a
young physician just beginning practice), we find the following
classification of hydrops or abdominal dilatation: "There are three
kinds; the first is ascites, due to the presence of watery fluid, for
which we do paracentesis; second, tympany, when the abdomen is swollen
from the presence of air or gas. This may be differentiated by
percussion of the belly. When air is present the sound given forth is
like that of a drum, while in the first form ascites the sound is like
that from a sack [the word used is the same as for a wine sack]; the
third form is called anasarca, when the whole body swells."
It has often been the subject of misunderstanding as to why medicine
should have developed among the Latin Christian nations so much more
slowly than among the Arabs during the early Middle Ages. Anyone who
knows the conditions in which Christianity came into existence in Italy
will not be surprised at that. The Arabs in the East were in contact
with Greek thought, and that is eminently prolific and inspiring. At the
most, the Christians in Italy got their inspiration at second hand
through the Romans. The Romans themselves, in spite of intimate contact
with Greek physicians, never made any important contributions to medical
science, nor to science of any kind. Their successors, the Christians of
Rome and Italy, then could scarcely be expected to do better, hampered
especially, as they were, by the trying social conditions created by the
invasion of the barbarians from the North. Whenever the Christians were
in contact with Greek thought and Greek medicine, above all, as at
Alexandria, or in certain of the cities of the near East, we have
distinguished contributions from them.
ARABIAN CHRISTIAN PHYSICIANS
That this is not a partial view suggested by the desire to make out a
better case for Christianity in its relation to science will be very
well understood, besides, from the fact that a number of the original
physicians of Arab stock who attracted attention during the first period
of Arabian medicine, that is, during the eighth and ninth centuries,
were Christians. There are a series of physicians belonging to the
Christian family Bachtischua, a name which is derived from Bocht Jesu,
that is, servant of Jesus, who, from the middle of the eighth to the
middle of the eleventh century, acquired great fame. The first of them,
George (Dschordschis), after acquiring fame elsewhere, was called to
Bagdad by the Caliph El-Mansur, where, because of his medical skill, he
reached the highest honors. His son became the body-physician of Harun
al-Raschid. In the third generation Gabriel (Dschibril) acquired fame
and did much, as had his father and grandfather, for the medicine of the
time, by translations of the Greek physicians into Arabian.
These men may well be said to have introduced Greek medicine to the
Mohammedans. It was their teaching that aroused Moslem scholars from the
apathy that had characterized the attitude of the Arabian people toward
science at the beginning of Mohammedanism. As time went on, other great
Christian medical teachers distinguished themselves among the Arabs. Of
these the most prominent was Messui the elder, who is also known as
Janus Damascenus. Both he and his father practised medicine with great
success in Bagdad, and his son became the body-physician to Harun
al-Raschid either after or in conjunction with Gabriel Bachtischua. Like
his colleague or predecessor in official position, he, too, made
translations from the Greek into Arabic. Another distinguished Arabian
Christian physician was Serapion the elder. He was born in Damascus, and
flourished about the middle of the ninth century. He wrote a book on
medicine called the "Aggregator," or "Breviarium," or "Practica
Medicinae," which appeared in many printed editions within the century
after the invention of printing. During the ninth century, also, we have
an account of Honein Ben Ischak, who is known in the West as
Johannitius. After travelling much, especially in Greece and Persia, he
settled in Bagdad, and, under the patronage of the Caliph Mamum, made
many translations. He translated most of the old Greek medical writers,
and also certain of the Greek philosophic and mathematical works. The
accuracy of his translations became a proverb. His compendium of Galen
was the text-book of medicine in the West for many centuries. It was
known as the "Isagoge in Artem Parvam Galeni." His son, Ishac Ben
Honein, and his nephew, Hobeisch, were also famous as medical
practitioners and translators.
Still another of these Arabian Christians, who acquired a reputation as
writers in medicine, was Alkindus. He wrote with regard to nearly
everything, however, and so came to be called the philosopher. He is
said altogether to have written and translated about two hundred works,
of which twenty-two treat of medicine. He was a contemporary of Honein
Ben Ischak in the ninth century. Another of the great ninth-century
Christian physicians and translators from the Greek was Kostaben Luka.
He was of Greek origin, but lived in Armenia and made translations from
Greek into Arabic. Nearly all of these men took not alone medical
science, but the whole round of physical science, for their special
subject. A typical example in the ninth century was Abuhassan Ben Korra,
many of whose family during succeeding generations attracted attention
as scholars. He became the astronomer and physician of the Caliph
Motadhid. His translations in medical literature were mainly excerpts
from Hippocrates and Galen meant for popular use. These Christian
translators, thoroughly scientific as far as their times permitted them
to be, were wonderfully industrious in their work as translators, great
teachers in every sense of the word, and they are the men who formed
the traditions on which the greater Arabian physicians from Rhazes
onward were educated.
It would be easy to think that these men, occupied so much with
translations, and intent on the re-introduction of Greek medicine, might
have depended very little on their own observations, and been very
impractical. All that is needed to counteract any such false impression,
however, is to know something definite about their books. Gurlt, in his
"History of Surgery," has some quotations from Serapion the elder, who
is often quoted by Rhazes. In the treatment of hemorrhoids Serapion
advises ligature and insists that they must be tied with a silk thread
or with some other strong thread, and then relief will come. He says
some people burn them _medicinis acutis_ (touching with acids, as some
do even yet), and some incise them with a knife. He prefers the
ligature, however. He calmly discusses the removal of stones from the
kidney by incision of the pelvis of the kidney through an opening in the
loin. He considers the operation very dangerous, however, but seems to
think the removal of a stone from the bladder a rather simple procedure.
His description of the technique of the use of a catheter and of a
stylet with it, and apparently also of a guide for it in difficult
cases, is extremely interesting. He suggests the opening of the bladder
in the median line, midway between the scrotum and the anus, and the
placing of a canula therein, so as to permit drainage until healing
occurs.
Even this brief review of the careers and the writings of the
physicians of early Christian times shows how well the tradition of old
Greek medicine was being carried on. There was much to hamper the
cultivation of science in the disturbances of the time, the gradual
breaking up of the Roman Empire, and the replacement of the peoples of
southern Europe by the northern nations, who had come in, yet in spite
of all this, medical tradition was well preserved. The most prominent of
the conservators were themselves men whose opinions on problems of
practical medicine were often of value, and whose powers of observation
frequently cannot but be admired. There is absolutely no trace of
anything like opposition to the development of medical science or
medical practice, but, on the contrary, everywhere among political and
ecclesiastical authorities, we find encouragement and patronage. The
very fact that, in the storm and stress of the succeeding centuries,
manuscript copies of the writings of the physicians of this time were
preserved for us in spite of the many vicissitudes to which they were
subjected from fire, and war, and accidents of various kinds for
hundreds of years, until the coming of printing, shows in what
estimation they were held. During this time they owed their preservation
to churchmen, for the libraries and the copying-rooms were all under
ecclesiastical control.
III
GREAT JEWISH PHYSICIANS[3]
Any account of Old-Time Makers of Medicine without a chapter on the
Jewish Physicians would indeed be incomplete. They are among the most
important factors in medieval medicine, representing one of the most
significant elements of medical progress. In spite of the disadvantages
under which their race labored because of the popular feeling against
them on the part of the Christians in the earlier centuries and of the
Mohammedans later, men of genius from the race succeeded in making their
influence felt not only on their own times, but accomplished so much in
making and writing medicine as to influence many subsequent generations.
Living the segregated life that as a rule they had to, from the earliest
times (the Ghettos have only disappeared in the nineteenth century), it
would seem almost impossible for them to have done great intellectual
work. It is one of the very common illusions, however, that great
intellectual work is accomplished mainly in the midst of comfortable
circumstances and as the result of encouraging conditions. Most of our
great makers of medicine at all times, and never more so than during the
past century, have been the sons of the poor, who have had to earn their
own living, as a rule, before they reached manhood, and who have always
had the spur of that necessity which has been so well called the mother
of invention. Their hard living conditions probably rather favored than
hampered their intellectual accomplishments.
It is not unlikely that the difficult personal circumstances in which
the Jews were placed had a good deal to do at all times with stimulating
their ambitions and making them accomplish all that was in them. Certain
it is that at all times we find a wonderful power in the people to rise
above their conditions. With them, however, as with other peoples,
luxury, riches, comfort, bring a surfeit to initiative and the race does
not accomplish so much. At various times in the early Middle Ages,
particularly, we find Jewish physicians doing great work and obtaining
precious acknowledgment for it in spite of the most discouraging
conditions. Later it is not unusual to find that there has been a
degeneration into mere money-making as the result of opportunity and
consequent ease and luxury. At a number of times, however, both in
Christian and in Mohammedan countries, great Jewish physicians arose
whose names have come to us and with whom every student of medicine who
wants to know something about the details of the course of medical
history must be familiar. There are men among them who must be
considered among the great lights of medicine, significant makers always
of the art and also in nearly all cases of the science of medicine.
A little consideration of the history of the Jewish people and their
great documents eliminates any surprise there may be with regard to
their interest in medicine and successful pursuit of it during the
Middle Ages. The two great collections of Hebrew documents, the Old
Testament and the Talmud, contain an immense amount of material with
reference to medical problems of many kinds. Both of these works are
especially interesting because of what they have to say of preventive
medicine and with regard to the recognition of disease. Our prophylaxis
and diagnosis are important scientific departments of medicine dependent
on observation rather than on theory. While therapeutics has wandered
into all sorts of absurdities, the advances made in prophylaxis and in
diagnosis have always remained valuable, and though at times they have
been forgotten, re-discovery only emphasizes the value of preceding
work. It is because of what they contain with regard to these two
important medical subjects that the Old Testament and the Talmud are
landmarks in the history of medicine as well as of religion.
Baas, in his "Outlines of the History of Medicine," says: "It
corresponds to the reality in both the actual and chronological point of
view to consider the books of Moses as the foundation of sanitary
science. The more we have learned about sanitation in the prophylaxis of
disease and in the prevention of contagion in the modern time, the more
have we come to appreciate highly the teachings of these old times on
such subjects. Moses made a masterly exposition of the knowledge
necessary to prevent contagious disease when he laid down the rules with
regard to leprosy, first as to careful differentiation, then as to
isolation, and finally as to disinfection after it had come to be sure
that cure had taken place. The great lawgiver could insist emphatically
that the keeping of the laws of God not only was good for a man's soul
but also for his body."
With this tradition familiarly known and deeply studied by the mass of
the Hebrew people, it is no surprise to find that when the next great
Hebrew development of religious writing came in the Talmud during the
earlier Middle Ages, that also contains much with regard to medicine,
not a little of which is so close to absolute truth as never to be out
of date. Friedenwald, in his "Jewish Physicians and the Contributions of
the Jews to the Science of Medicine," a lecture delivered before the
Gratz College of Philadelphia fifteen years ago, summed up from Baas'
"History of Medicine" the instructions in the Talmud with regard to
health and disease. The summary represents so much more of genuine
knowledge of medicine and surgery than might be expected at the early
period at which it was written, during the first and second century of
our era, that it seems well to quote it at some length.
"Fever was regarded as nature's effort to expel morbific
matter and restore health; which is a much safer
interpretation of fever, from a practical point of view, than
most of the theories bearing on this point that have been
taught up to a very recent period. They attributed the halting
in the hind legs of a lamb to a callosity formed around the
spinal cord. This was a great advance in the knowledge of the
physiology of the nervous system. An emetic was recommended as
the best remedy for nausea. In many cases no better remedy is
known to-day. They taught that a sudden change in diet was
injurious, even if the quality brought by the change was
better. That milk fresh from the udder was the best. The
Talmud describes jaundice and correctly ascribes it to the
retention of bile, and speaks of dropsy as due to the
retention of urine. It teaches that atrophy or rupture of the
kidneys is fatal. Induration of the lungs (tuberculosis) was
regarded as incurable. Suppuration of the spinal cord had an
early, grave meaning. Rabies was known. The following is a
description given of the dog's condition: 'His mouth is open,
the saliva issues from his mouth; his ears drop; his tail
hangs between his legs; he runs sideways, and the dogs bark at
him; others say that he barks himself, and that his voice is
very weak. No man has appeared who could say that he has seen
a man live who was bitten by a mad dog.' The description is
good, and this prognosis as to hydrophobia in man has remained
unaltered till in our day when Pasteur published his startling
revelation. The anatomical knowledge of the Talmudists was
derived chiefly from dissection of the animals. As a very
remarkable piece of practical anatomy for its very early date
is the procuring of the skeleton from the body of a
prostitute by the process of boiling, by Rabbi Ishmael, a
physician, at the close of the first century. He gives the
number of bones as 252 instead of 232. The Talmudists knew the
origin of the spinal cord at the foramen magnum and its form
of termination; they described the oesophagus as being
composed of two coats; they speak of the pleura as the double
covering of the lungs; and mention the special coat of fat
about the kidneys. They had made progress in obstetrics;
described monstrosities and congenital deformities; practised
version, evisceration, and Caesarian section upon the dead and
upon the living mother. A.H. Israels has clearly shown in his
'Dissertatio Historico-Medica Inauguralis' that Caesarian
section, according to the Talmud, was performed among the Jews
with safety to mother and child. The surgery of the Talmud
includes a knowledge of dislocation of the thigh bone,
contusions of the skull, perforation of the lungs,
oesophagus, stomach, small intestines, and gall bladder;
wounds of the spinal cord, windpipe, of fractures of the ribs,
etc. They described imperforate anus and how it was to be
relieved by operation. Chanina Ben Chania inserted natural and
wooden teeth as early as the second century, C.E."
There is a famous summing up of the possibilities of life and happiness
in the Talmud that has been often quoted--its possible wanting in
gallantry being set down to the times in which it was written. "Life is
compatible with any disease, provided the bowels remain open; any kind
of pain, provided the heart remain unaffected; any kind of uneasiness,
provided the head is not attacked; all manner of evils, except it be a
bad woman."
There are many other interesting suggestions in the Talmud. Sometimes
they have come to be generally accepted in the modern time, sometimes
they are only curious notions that have not, however, lost all their
interest. The crucial incision for carbuncle is a typical example of the
first class and the suggestion of the removal of superfluous fat from
within the abdomen or in the abdominal wall itself by operation is
another. That they had some idea of the danger of sepsis may be gathered
from the fact that they suspected iron surgical instruments and advised
the use of others of less enduring character.
The Talmud itself was indeed a sort of encyclopedia in which was
gathered knowledge of all kinds from many sources. It was not
particularly a book of medicine, though it contains so many medical
ideas. In many parts of it the authors' regard for science is
emphatically expressed. Landau, in his "History of Jewish Physicians,"
closes his account of the Talmud with this paragraph:
"I conclude this brief review of Talmudic medicine with some
reference to how high the worth of science was valued in this
much misunderstood work. In one place we have the expression
'occupation with science means more than sacrifice.' In
another 'science is more than priesthood and kingly
dignity.'"[4]
After all this of national tradition in medicine before and after
Christ, it is only what we might quite naturally expect to find, that
there is scarcely a century of the Middle Ages which does not contain at
least one great Jewish physician and sometimes there are more. Many of
these men made distinct contributions to medical science and their names
have been held in high estimation ever since. Perhaps I should say that
they were held in high estimation until that neglect of historical
studies which characterized the eighteenth century developed, and that
there has been a reawakening of interest in our time. We forget this
curious decadence of the later seventeenth and eighteenth centuries
which did so much to obscure history and especially the history of the
sciences. Fortunately the scholars of the sixteenth and early
seventeenth centuries accomplished successfully the task of printing
many of the books of these old-time physicians and secured their
publication in magnificent editions. These were bought eagerly by
scholars and libraries all over Europe in spite of the high price they
commanded in that era of slow, laborious printing. The Renaissance
exhibits some of its most admirable qualities in its reverence for these
old workers in science and above all for the careful preparation by its
scholars of the text of these first editions of old-time physicians. The
works have often been thus literally preserved for us, for some of them
at least would have disappeared among the vicissitudes of the
intervening time, most of which was anything but favorable to the
preservation of old-time works, no matter what their content or value.
During the second and third centuries of our era, while the Talmudic
writings were taking shape, three great Jewish physicians came into
prominence. The first of them, Chanina, was a contemporary of Galen.
According to tradition, as we have said, he inserted both natural and
artificial teeth before the close of the second century. The two others
were Rab or Raw and Samuel. Rab has the distinction of having studied
his anatomy from the human body. According to tradition he did not
hesitate to spend large sums of money in order to procure subjects for
dissection. At this time it is very doubtful whether Galen, though only
of the preceding generation, ever had the opportunity to study more than
animals or, at most, a few human bodies. Samuel, the third of the group,
was an intimate friend of Rab's, perhaps a disciple, and his fame
depends rather on his practice of medicine than of research in medical
science. He was noted for his practical development of two specialties
that cannot but seem to us rather distant from each other. His
reputation as a skilful obstetrician was only surpassed by the
estimation in which he was held as an oculist. He seems to have turned
to astronomy as a hobby, and was highly honored for his knowledge of
this science. Probably there is nothing commoner in the story of great
Jewish physicians than their successful pursuit of some scientific
subject as a hobby and reaching distinction in it. Their surplus
intellectual energy needed an outlet besides their vocation, and they
got a rest by turning to some other interest, often accomplishing
excellent results in it. Like most great students with a hobby, the
majority of them were long-lived. Their lives are a lesson to a
generation that fears intellectual overwork.
During the fourth century we have a number of very interesting
traditions with regard to a great Jewish physician, Abba Oumna, to whom
patients flocked from all over the world. He seems particularly to have
been anxious to make his services available to the scholars of his time.
He looked upon them as brothers in spirit, fellow-laborers whose
investigations were as important as his own and whose labors for mankind
he hoped to extend by the helpfulness of his profession. In order that
it might be easy for them to come to him without feeling abashed by
their poverty, and yet so that they might pay him anything that they
thought they were able to, he hung up a box in his anteroom in which
each patient might deposit whatever he felt able to give. His kindliness
towards men became the foundation for many legends. Needless to say he
was often imposed upon, but that seems to have made no difference to
him, and he went on straightforwardly doing what he thought he ought to
do, regardless of the devious ways of men, even those whom he was
generously assisting. While we do not know much of his scientific
medicine, we do know that he was a fine example of a practitioner of
medicine on the highest professional lines.
With the foundation of the school at Djondisabour in Arabistan or
Khusistan by the Persian monarch Chosroes, some Jewish physicians come
into prominence as teachers, and this is one of the first important
occasions in history when they teach side by side with Christian
colleagues. Djondisabour seems distant from us now, lying as it does in
the province just above the head of the Persian Gulf, and it is a little
hard to understand its becoming a centre of culture and education, yet
according to well-grounded historical traditions students flocked here
from all parts of the world, and its medical instruction particularly
became famous. According to the documents and traditions that we
possess, clinical teaching was the most significant feature of the
school work and made it famous. As a consequence graduates from here
were deemed fully qualified to become professors in other institutions
and were eagerly sought by various medical schools in the East.
With the rise of the strong political power of the Mohammedans enough of
peace came to the East at least to permit the cultivation of arts and
sciences to some extent again, and then at once the eminence of Jewish
physicians, both as teachers and practitioners of medicine, once more
becomes manifest. The first of the race who comes into prominence is
Maser Djawah Ebn Djeldjal, of Basra. To him we owe probably more than to
anyone else the preservation of old scientific writings and the
cultivation of arts and sciences by the Mohammedans. He prevailed on
Caliph Moawia I, whose physician he had become, to cause many foreign
works, and especially those written in Greek, to be translated into
Arabic. He seems to have taken a large share of the labor of the
translation on himself and prevailed upon his pupil, the son of Moawia,
to translate some works on chemistry. The translation for which Maser
Djawah is best known is that of the Pandects of Haroun, a physician of
Alexandria. The translation of this work was made toward the end of the
seventh century. Unfortunately the "Pandects" has not come down to us,
either in original or translation, but we have fragments of the
translation preserved by Rhazes, the distinguished Arabian medical
writer and physician of the ninth century, and there seems no doubt that
it contained the first good description of smallpox, a chapter in
medicine that is often--though incorrectly--attributed to Rhazes
himself. Rhazes quoted Maser Djawah freely and evidently trusted his
declarations implicitly.
The succeeding Caliphs of the first Arabian dynasty did not exhibit the
same interest in education, and above all in science, that characterized
Moawia. Political ambition and the desire for military glory seem to
have filled up their thoughts and perhaps they had not the good fortune
to fall under the influence of physicians so wise and learned as Maser
Djawah. More probably, however, they themselves lacked interest. Toward
the end of the seventh century they were succeeded by the Abbassides.
Almansor, the second Caliph of this dynasty, was attacked by a dangerous
disease and sent for a physician of the Nestorian school. After his
restoration to health he became a liberal patron of science and
especially medical science. The new city of Bagdad, which had become the
capital of the realm of the Abbassides, was enriched by him with a large
number of works on medicine, which he caused to be translated from the
Greek. He did not confine himself to medicine, however, but also brought
about translations of works with regard to other sciences. One of these,
astronomy, was a favorite. He made it a particular point to search out
and encourage the translation of such books as had not previously been
translated from Greek into Arabic. While he provided a translation of
Ptolemy he also had translations made of Aristotle and Galen.
It is not surprising, then, that the school of Bagdad became celebrated.
Jewish physicians seem to have been most prominent in its foundation,
and the most distinguished product of it is Isaac Ben Emran, almost as
celebrated as a philosopher as he is as a physician. One of his
expressions with regard to the danger of a patient having two physicians
whose opinions disagree with regard to his illness has been deservedly
preserved for us. Zeid, an Emir of one of the chief cities of the Arabs
in Barbary, fell ill of a tertian fever and called Isaac and another
physician in consultation. Their opinions were so widely in disaccord
that Isaac refused to prescribe anything, and when the Emir, who had
great confidence in him, demanded the reason, he replied, "disagreement
of two physicians is more deadly than a tertian fever." This Isaac, who
is said to have died in 799, is the great Jewish physician, one of the
most important members of the profession in the eighth century. His
principal work was with regard to poisons and the symptoms caused by
them. This is often quoted by medical writers in the after time.
The prominent Jewish physician of the ninth century was Joshua Ben Nun.
Haroun al-Raschid, whose attempts to secure justice for his people are
the subject of so much legendary lore, and whose place in history may be
best recalled by the fact that he is a contemporary of Charlemagne, was
particularly interested in medicine. He founded the city of Tauris as a
memorial of the cure of his wife. He was a generous patron of the school
of Djondisabour and established a medical school also at Bagdad. He
provided good salaries for the professors, insisted on careful
examinations, and raised the standard of medical education for a time to
a noteworthy degree. The greatest teacher of this school at Bagdad was
Joshua Ben Nun, sometimes known as the Rabbi of Seleucia. His teaching
attracted many students to Bagdad and his fame as one of the great
practitioners of medicine of this time brought many patients. Among his
disciples was John Masuee, whose Arabian name is so different, Yahia Ben
Masoviah, that in order to avoid confusion in reading it is important to
know both. Almost better known, perhaps, at this time was Abu Joseph
Jacob Ben Isaac Kendi. Fortunately for the after time, these men devoted
themselves not only to their own observations and writings but made a
series of valuable translations. Joshua Ben Nun seems to have been
particularly zealous in this matter, following the example of Maser
Djawah of Basra.
Bagdad then became a centre for Arabian culture. Mahmoud, one of
Haroun's successors, provided in Bagdad a refuge for the learned men of
the East who were disturbed by the wars and troubles of the time. He
became a liberal patron of literature and education. When the Emperor
Michael III of Constantinople was conquered in battle, one of the
obligations imposed upon him was to send many camel loads of books to
Bagdad, and Aristotle and Plato were studied devotedly and translated
into Arabic. The era of culture affected not only the capital but all
the cities, and everywhere throughout the Arabian empire schools and
academies sprang up. We have records of them at Basra, Samarcand,
Ispahan. From here the thirst for education spread to the other cities
ruled by the Mohammedans, and each town became affected by it.
Alexandria, the cities of the Barbary States, those of Sicily and
Provence, where Moorish influences were prominent, and of distant Spain,
Cordova, Seville, Toledo, Granada, Saragossa, all took up the rivalry
for culture which made this a glorious period in the history of the
intellectual life.
Already, in the chapter on "Great Physicians in Early Christian Times,"
I have pointed out that many of the teachers of the Arabs were Christian
physicians. Here it is proper to emphasize the other important factor in
Arabian medicine, the Jewish physicians, who influenced the great
Arabian rulers, and were the teachers of the Arabs in medicine and
science generally. These Christian and Jewish physicians particularly
encouraged the translation of the works of the great Greek physicians
and thus kept the Greek medical tradition from dying out. It is not
until the end of the ninth, or even the beginning of the tenth, century
that we begin to have important contributors to medicine from among the
Arabs themselves. Even at this time they have distinguished rivals among
Jewish physicians. Indeed these acquired such a reputation that they
became the physicians to monarchs and even high ecclesiastics, and we
find them nearly everywhere throughout Europe. Their success was so
great that it is not surprising that after a time the vogue of the
Jewish physicians should have led to jealousy of them and to the passage
of laws and decrees limiting their sphere of activity.
The great Jewish physician of the ninth century was Isaac Ben Soliman,
better known as Isaac el Israili, and who is sometimes spoken of as
d'Israeli. He was a pupil of Isaac Ben Amram the younger, probably a
grandson of another Isaac Ben Amram, who, after having become famous in
Bagdad, went to Cairo and became the physician of the Emir Zijadeth III.
The younger Isaac established a school, and it was with him that Israeli
obtained his introduction to medicine. He practised first as an oculist
and then became body-physician to the Sultan of Morocco. Because of the
sympathy of his character and his unselfishness he acquired great
popularity. Hyrtl refers to him respectfully as "that scholarly son of
Israel." Curiously enough, considering racial feeling in the matter, he
never married, and when asked why he had not, and whether he did not
think that he might regret it, he replied, "I have written four books
through which my memory will be better preserved than it would be by
descendants." The four books are his "Treatise on Fevers," his "Treatise
on Simple Medicines and Ailments," a treatise on the "Elements," and a
treatise "On the Urine." Besides these, we have from him shorter works,
"On the Pulse," "On Melancholy," and "On Dropsy." His hope with regard
to his fame from these works was fulfilled, for they were printed as
late as 1515 at Leyden, and Sprengel declared them the best compendium
of simple remedies and diet that we have from the Arabian times. One of
his translators into Latin has called him the monarch of physicians.
Some of his maxims are extremely interesting in the light of modern
notions on the same subjects. He declared emphatically that "the most
important duty of the physician is to prevent illness." "Most patients
get better without much help from the physician by the power of nature."
He emphasized his distrust of using many medicines at the same time in
the hope that some of them would do good. He laid it down as a rule:
"Employ only one medicine at a time in all your cases and note its
effects carefully." He was as wise with regard to medical ethics as
therapeutics. He advised a young physician, "Never speak unfavorably of
other physicians. Every one of us has his lucky and unlucky hours." It
is pleasant to learn that the old gentleman lived to fill out a full
hundred years of life, and that in his declining years he was
surrounded by the good will and the affection of many who had learned to
know his precious qualities of heart and mind. More than of any other
class of physicians do we find the large human sympathies of the Jewish
physicians of the Middle Ages praised by their contemporaries and
succeeding generations.
During the next centuries a number of Jewish physicians became
prominent, though none of them until Maimonides impressed themselves
deeply upon the medical life of their own and succeeding centuries. Very
frequently they were the physicians to royal personages. Zedkias, for
instance, was the physician to Louis the Pious and later to his son
Charles the Bald. His reputation as a physician was great enough to give
him the popular estimation of a magician, but it did not save him from
the accusation of having poisoned Charles when that monarch died
suddenly. There seem to be no good grounds, however, for the accusation.
There were a number of schools of medicine, in Sicily and the southern
part of Italy, in which Jewish, Arabian, and Christian physicians taught
side by side. One of these teachers was Jude Sabatai Ben Abraham,
usually known by the name of Donolo, who was famous both as a writer on
medicine and on astronomy. Donolo studied and probably taught at
Tarentum, and there were similar schools at Palermo, at Bari, and then
later on the mainland at Salerno. The foundation of Salerno, in which
Jewish physicians also took part, we shall discuss later in the special
chapter devoted to that subject.
One of the great translators whose work meant very much for the medical
science of his own and succeeding generations was the distinguished
Jewish physician, Faradj Ben Salim, sometimes spoken of as Farachi
Faragut or Ferrarius, who was born at Girgenti in Sicily. He made his
medical studies in Salerno and did his work under the patronage of
Charles of Anjou towards the end of the thirteenth century. His greatest
work is the translation of the whole of the "Continens" of Rhazes. The
translation is praised as probably the best of its time made in the
Middle Ages. Faradj came at the end of a great century, when the
intellectual life of Europe had reached a high power of expression, and
it is not surprising that he should have proved equal to his
environment. This translation has also some additions made by Faradj
himself, notably a glossary of Arabian names.
In Spain also Jewish physicians rose to distinction. The most
distinguished in the tenth century was Chasdai Ben Schaprut. Like many
other of the great physicians of this time, he had studied astronomy as
well as the medical sciences. He became the physician of the Caliph
Abd-er-Rahman III of Cordova. He seems also to have exercised some of
the functions of Prime Minister to the Caliph, and took advantage of
diplomatic relations between his sovereign and the Byzantine Emperor to
obtain some works of Dioscorides. These he translated into Arabian with
the help of a Greek monk, whom he seems also to have secured through the
diplomatic relations. Undoubtedly he did much to usher in that
enthusiasm for education and study which characterized the next
centuries, the eleventh and twelfth, at Cordova in Spain, when such men
as Avenzoar, Avicenna, and Averroes attracted the attention of the
educational world of the time. Jewish writers have sometimes claimed one
of the most distinguished of these, Avenzoar himself, as a Jew, but
Hyrtl and other good authorities consider him of Arabic extraction and
point to the fact that his ancestors bore the name of Mohammed. This is
not absolutely conclusive evidence, but because of it I have preferred
to class Avenzoar among the Arabian physicians.
The one historical fact of importance for us is that everywhere in
Europe at that time Jews were being accorded opportunities for the study
and practice of medicine. There are local incidents of persecution, but
we are not so far away from the feelings that brought these about as to
misunderstand them or to think that they were anything more than local,
popular manifestations. The more we know about the details of the
medical history of these times the deeper is the impression of academic
freedom and of opportunities for liberal education.
Much has been said about the intolerance of ecclesiastical authorities
toward the Jews, and of Church decrees that either absolutely forbade
their practice of the medical profession and their devotion to
scientific study, or at least made these pursuits much more difficult
for them than for others. Of course it has to be conceded, even by those
who most insistently urge the existence of formal legislation in the
matter, that in spite of these decrees and intolerance and opposition,
Jews continued to practise medicine and to be the chosen physicians of
kings and even of high ecclesiastical dignitaries, as well indeed of
the Popes themselves. This, it is usually declared, must be attributed
to the surpassing skill of the Jewish physicians, causing men to
overcome their prejudices and override even their own legal regulations.
There is no doubt at all about the skill of Jewish physicians at many
times during the Middle Ages. There is no doubt also of the sentiment of
opposition that often developed between the Christian peoples and the
Jews. Any excuse is good enough to justify men, to themselves at least,
in putting obstacles in the paths of those who are more successful than
they are themselves. Religion often became a cloak for ill-will and
persecution.
The state of affairs that has been presumed however, according to which
laws and decrees were being constantly issued forbidding the practice of
medicine to Jews by the ecclesiastical authorities, while at the same
time they themselves and those who were nearest to them were employing
Jewish physicians, is an absurdity that on the face of it calls for
investigation of the conditions and from its very appearance would
indicate that the ordinary historical assumption in the matter must be
wrong.
I have been at some pains, then, to try to find out just what were the
conditions in Europe with regard to the practice of medicine by the
Jews. There is no doubt that at Salerno, where the influence of the
Benedictines was very strong and where the influence of the Popes and
the ecclesiastical authorities was always dominant, full liberty of
studying and teaching was from the earliest days allowed to the Jews.
Down at Montpellier it seems clear that Jewish physicians had a large
part in the foundation of the medical school, and continued for several
centuries to be most important factors in the maintenance of its
reputation and the upbuilding of that fame which draw students from even
distant parts of Europe to this medical school of the south of France.
During the ninth, tenth, eleventh, and twelfth centuries Jewish
physicians were frequently in attendance on kings and the higher
nobility, on bishops and archbishops, cardinals, and even Popes. Every
now and then the spirit of intolerance among the populace was aroused,
and occasionally the death of some distinguished patient while in a
Jewish physician's hands was made the occasion for persecution. We must
not forget, after all, that even as late as Elizabeth's time, when
Shakespeare wrote "The Merchant of Venice," he was taking advantage of
the popular sentiment aroused by the execution of Lopez, the Queen's
physician, for a real or supposed participation in a plot against her
Majesty's life. Shylock was presented the next season for the sake of
adventitious popularity that would thus accrue to the piece. The
character was played so as to depict all the worst traits of the Jew,
and was scornfully laughed at at every representation. This is an index
of the popular feeling of the time. Bitter intolerance of the Jew has
continued. Down almost to our own time the Ghettos have existed in
Europe, and popular tumults against them continue to occur. Quite
needless to say, these do not depend on Christianity, but on defective
human nature.
During the Middle Ages the best possible criterion of the attitude of
the Church authorities towards the Jews is to be found in the
legislation of Pope Innocent III. He is the greatest of the Popes of the
Middle Ages; he shaped the policy of the Church more than any other; his
influence was felt for many generations after his own time. His famous
edict with regard to them was well known: "Let no Christian by violence
compel them to come dissenting or unwilling to Baptism. Further, let no
Christian venture maliciously to harm their persons without a judgment
of the civil power or to carry off their property or change their good
customs which they have hitherto in that district which they inhabit."
Innocent himself and several of his predecessors and successors are
known to have had Jewish physicians. Example speaks even louder than
precept, and the example of such men must have been a wonderful
advertisement for the Jewish physicians of the time.
Besides Innocent III, many of the Popes of the twelfth and thirteenth
centuries issued similar decrees as to the Jews. It may be recalled that
this was the time when the Papacy was most powerful in Europe and when
its decrees had most weight in all countries. Alexander II, Gregory IX,
and Innocent IV all issued formal documents demanding the protection of
the Jews, and especially insisting that they must not be forced to
receive Baptism nor disturbed in the celebration of their festivals.
Clement VI did the same thing in the next century, and even offered them
a refuge from persecution throughout the rest of France at Avignon.
Distinguished Jewish scholars, who know the whole story from careful
study, have given due credit to the Popes for all that they did for
their people. They have even declared that if the Jews were not
exterminated in many of the European countries it was because of the
protection afforded by the Church. We have come to realize in recent
years that persecution of the Jews is not at all a religious matter, but
is due to racial prejudice and jealousy of their success by the peoples
among whom they settle. All sorts of pretexts are given for this
persecution at all times. Formal Church documents and the personal
activities of the responsible Church officials show that during the
Middle Ages the Church was a protector and not a persecutor of the Jews.
There is abundant historical authority for the statement that the Popes
were uniformly beneficent in their treatment of the Jews. In order to
demonstrate this there is no need to quote Catholic historians, for
non-Catholics have been rather emphatic in bringing it out. Neander, the
German Protestant historian, for instance, said:
"It was a ruling principle with the Popes after the example of
their great predecessor, Gregory the Great, to protect the
Jews in the rights which had been conceded to them. When the
banished Popes of the twelfth century returned to Rome, the
Jews went forth in their holiday garments to meet them,
bearing before them the 'thora,' and Innocent II, on an
occasion of this sort, blessed them."
English non-Catholic historians can be quoted to the same effect. The
Anglican Dean Milman, for instance, said: "Of all European sovereigns,
the Popes, with some exceptions, have pursued the most humane policy
towards the Jews. In Italy, and even in Rome, they have been more rarely
molested than in the other countries."
Hallam has expressed himself to the same effect, especially as regards
the protection afforded to the Jew by the laws of the Church from the
injustice of those around him. Laws sometimes fail of their purpose and
the persecuting spirit of the populace is often hard to control, but
everything that the central authority could do to afford protection was
done and essential justice was enshrined in the Church laws.
Prominent ecclesiastics would naturally follow the lines laid down by
their Papal superiors. The attitude of those whose lives mark epochs in
the history of Christianity and who had more to do almost with the
shaping of the policy of the Church at many times than the Popes
themselves, can be quoted readily to this same effect. Neander has
called particular attention to St. Bernard's declarations with regard to
the evils that would follow any tolerance of such an abuse as the
persecution of the Jews.
"The most influential men of the Church protested against such
un-Christian fanaticism. When the Abbot Bernard of Clairvaux
was rousing up the spirit of the nations to embark in the
second crusade, and issued for this purpose, in the year 1146,
his letters to the Germans (East Franks), he at the same time
warned them against the influence of those enthusiasts who
strove to inflame the fanaticism of the people. He declaimed
against the false zeal, without knowledge, which impelled them
to murder the Jews, a people who ought to be allowed to live
in peace in the country."
But it has been said that there are decrees against Jewish physicians,
issued especially in the south of France, by various councils and
synods of the Church. Attention needs to be called at once to the fact
that these are entirely local regulations and have nothing to do with
the attitude of the Church as a whole, but represent what the
ecclesiastical authorities of a particular part of the country deem
necessary for some special reason in order to meet local conditions.
Indeed at the end of the thirteenth and the early fourteenth century,
when these decrees were being issued in France, full liberty was allowed
in Italy, and there were no restrictions either as to medical practice
or education founded on adhesion to Judaism.
What need to be realized in order to understand the issuance of certain
local ecclesiastical regulations forbidding Jews to practise medicine
are the special conditions which developed in France at this time. Many
Jews had emigrated from Spain to France, and the reputation acquired by
Jewish physicians at Montpellier led to a number of the race taking up
the practice of medicine without any further qualification than the fact
that they were Jews. That gave them a reputation for curative powers of
itself because of the fame of some Jewish doctors and their employment
by the nobility and the highest ecclesiastics. It was hard to regulate
these wandering physicians. As a consequence of this, the faculty at
Paris, always jealous of its own rights and those of its students, at
the beginning of the fourteenth century absolutely forbade Jews from
practising on Christian patients within its jurisdiction. Of course the
faculty of the University of Paris was dominated by ecclesiastical
authorities. The medical school was, however, almost entirely
independent of ecclesiastical influence, and was besides largely
responsible for this decree. It was felt that something had to be done
to stop the evil that had arisen and the charlatanry and quackery which
was being practised. This was, however, rather an attempt to regulate
the practice of medicine and keep it in the hands of medical school
graduates than an example of intolerance towards the Jews. Practically
no Jews had graduated at its university, Montpellier being their
favorite school, and Paris was not a little jealous of its rights to
provide for physicians from the northern part of France. We have not got
away from manifestations of that spirit even yet, as our
non-reciprocating state medical laws show.
During the next quarter of a century decrees not unlike those of the
University of Paris were issued in the south of France, especially in
Provence and Avignon. Anyone who knows the conditions which existed in
the south of France at this time with regard to medical practice will be
aware that a number of attempts were made by the ecclesiastical
authorities just at this time to regulate the practice of medicine.
Great abuses had crept in. Almost anyone who wished could set up as a
physician, and those who were least fitted were often best able to
secure a large number of patients by their cleverness, their knowledge
of men, and their smooth tongues. The bishops of various dioceses met,
and issued decrees forbidding anyone from practising medicine unless he
was a graduate of the medical school of the neighboring University of
Montpellier. After a time it was found that the greatest number of
violators of these decrees were Jews. Accordingly special regulations
were made against them. They happen to be ecclesiastical regulations,
because no other authority at that time claimed the right to regulate
medical education and the practice of medicine.
What is sure is that many Jewish physicians reached distinction under
Christian as well as Arabian rulers at all times during the Middle Ages.
It would be quite impossible in the limited space at command here to
give any adequate mention of what was accomplished by these Jewish
physicians, whose names we have scarcely been able to more than
catalogue, nor of the place they hold in their times. As the physicians
of rulers, their influence for culture and the cultivation of science
was extensive, and as a rule they stood for what was best and highest in
education. The story of one of them, who is generally known in the
Christian world at least, Maimonides, given in some detail, may serve as
a type of these Jewish physicians of the Middle Ages. He lived just
before the flourishing period of university life in the thirteenth
century brought about that wonderful development of medicine and surgery
in the west of Europe that meant so much for the final centuries of the
Middle Ages. His works influenced not a little the great thinkers and
teachers whose own writings were to be the foundations of education for
several centuries after their time. Maimonides was well known in the
Western universities. Though his life had been mainly spent in the East,
and he died there, there was scarcely a distinguished scholar of Europe
who was not acquainted directly or indirectly with his works, and the
greater the reputation of the scholar, as a rule, the more he knew of
Maimonides, Moses AEgyptaeus, as he was called, and the more frequently he
referred to his writings.
IV
MAIMONIDES
The life of one of the great Jewish physicians, who has come to be known
in history as Maimonides, is of such significance in medical biography
that he deserves to have a separate sketch. Born in Spain, his life was
lived in the East, where his connection as royal physician with the
great Sultan Saladin of Crusades fame made his influence widely felt. He
is a type of the broadly educated man, conversant with the culture of
his time and of the past, knowing much besides medicine, who has so
often impressed himself deeply on medical practice. While the narrow
specialists in each generation, the men who are quite sure that they are
curing the special ills of men to which they devote themselves, have
always felt that whatever of progress there was in any given time was
due to them, they occupy but little space as a rule in the history of
medicine. The men who loom large were the broad-minded, humanely
sympathetic, deeply educated physicians, who treated men and their ills
rather than their ills without due consideration of the individual, and
who not only relieved the discomfort of their patients and greatly
lessened human suffering, and added to the sum of human happiness in
their time, but also left precious deeply significant lessons for
succeeding generations of their profession. Hippocrates, Galen,
Sydenham, Auenbrugger, Morgagni, these are representatives of this great
class, and Maimonides must be considered one of them.
Moses Ben Maimum, whose Arabic name was Abu Amran Musa Ben Maimum Obaid
Alla el-Cordovi, who was called by his Jewish compatriots Ramban or
Rambam, was born at Cordova in Spain, on the 30th of March in 1135 or
1139, the year is in doubt. It might not seem of much import now after
nearly eight centuries, but not a little ink is spilt over it yet by
devoted biographers.
We are rather prone to think in our time that the conditions in which
men were born and reared before what we are pleased to call modern
times, and, above all, in the Middle Ages, must have made a distinct
handicap for their intellectual development. Most of us are quite sure
that the conditions in medieval cities were eminently unsuited for the
stimulation of the intellect, for incentive to art impulse, for uplift
in the intellectual life, or for any such broad interest in what has
been so well called the humanities--the humanizing things that lift us
above animal necessities--as would make for genuinely liberal education.
We are likely to be set in the opinion that the environment of the
growing youth of an old-time city, especially so early as the middle of
the twelfth century, was poor and sordid. The cares of the citizens are
presumed to have been mainly for material concerns, and, indeed, mostly
for the wants of the body. They were only making a start on the way from
barbarism to something like our glorious culmination of civilization. As
"the heirs to all the ages in the foremost files of time" we are
necessarily far in advance of them, and we are only sorry that they did
not have the opportunity to live to see our day and enjoy the benefits
of the evolution of humanity that is taking place during the eight
centuries that have elapsed.
As a matter of fact, there was much more of abiding profound interest in
real civilization in many a medieval city, much more general
appreciation of art, much more breadth of intelligence and sympathy with
what we call the humanities, than in most of our large cities. The large
city, as we know it, is eminently a discourager of breadth of
intelligence. Specialism in the various phases of money-making obscures
culture. Maimonides, born in Cordova, was brought up amid surroundings
that teemed with incentives of every kind to the development of
intelligence, of artistic taste, and everything that makes for
cultivation of intellect rather than of interest in merely material
things.
It is well said that it is hard to judge the Cordova of old by its
tawdry ruins of to-day. The educated visitor still stands in awe and
admiration of the great mosque which expressed the high cultivation of
the Moors of this time. It is a never-ending source of wonder to
Americans. The city itself has many reminders of that fine era of
Moorish culture and refinement of taste and of art expression, which
made it in the best sense of the word a city beautiful. The Arab
invaders had found a great prosperous country which had been the most
cultured province of the Roman Empire, and on this foundation they made
a marvellous development. "The banks of the Guadalquivir," says Mr. S.
Lane-Poole in "The Moors in Spain" (London, 1887), "were bright with
marble houses, mosques, and gardens, in which the rarest flowers and
trees of other countries were carefully cultivated, and the Arabs
introduced their system of irrigation which the Spaniards both before
and since have never equalled." The greatest beauty of the city, of
course, had come, and some of it had gone, before Maimonides' time. So
much remains in spite of time and war, and many unfortunate influences,
that we can have some idea how beautiful it must have been in his youth
seven centuries ago, and how even more beautiful in the foretime. Of the
great mosque writers of travel can scarcely say enough. Mr. Lane-Poole
says: "Travellers stand amazed among the forest of columns which open
out apparently endless vistas on all sides. The porphyry, jasper, and
marbles are still in their places; the splendid glass mosaics, which
artists from Byzantium came to make, still sparkle like jewels in the
walls; the daring architecture of the sanctuary, with its fantastic
crossed arches, is still as imposing as ever; the courtyard is still
leafy with the orange trees that prolong the vistas of columns. As one
stands before the loveliness of the great mosque, the thought goes back
to the days of the glories of Cordova, the palmy days of the Great
Khalif, which will never return."
Of all the countries in which the Jews all down the centuries have lived
there is probably none of which they have been more loud in praise than
Spain. Their poets sang of it as if it were their own country; for
centuries the people were happier here than probably they have been
anywhere else for so long a period. Elsewhere in this book I have called
attention to all that Spain meant in Europe during all the centuries
from the beginning of the Roman Empire down to the end of the Middle
Ages. Maimonides was fortunate in his birthplace, then, and while
circumstances compelled the family to move away, this change did not
come until a good effect had been produced on the mind of the growing
youth. Even when persecution came, Maimonides clung to Spain with a
tenacity born of deep affection and emphasized by admiration for all
that she was and had been. Cordova was the jewel of the Spain of this
time, and though much less than she had been in the long preceding time,
when she was the birthplace of Lucan and the two Senecas, or even than
what she had been in Abd-er-Rahman's days, or when she was the
birthplace of Averroes, still she remained wonderfully beautiful and
attractive, winning and holding the affections of men.
Maimonides' father, Maimum Ben Joseph, was a member of the Rabbinical
College of Cordova, and famous for his knowledge of the Talmud. There
are some writings of his on mathematics and astronomy extant. He
directed the education of his son, who, like many another distinguished
scholar in later life, seems to have exhibited very little talent in his
early years. There is no rule in the matter. Precocity often
disappoints. Genius is often dull in childhood, but there are exceptions
that prove both rules. The basis of education in Spain at that time
among the Jews was the Bible, the Talmud, mathematics, and astronomy, a
good rounded education in literature, the basis of law, and some exact
physical science. After his preliminary education at home Maimonides
studied the natural sciences and medicine with Moorish teachers.
Nature-study, in spite of frequent expressions that declare it new in
modern times, is as old as man. He also received a grounding in
philosophy as a preparation for his scientific studies. At the age of
twenty-three he began the composition of a commentary on the Talmud,
which he continued to work at on his journeys in Spain and in Egypt.
This is considered to be one of the most important of this class of
works extant, though, almost needless to say, similar writings are very
numerous.
In the light of wanderings in philosophy during the centuries since, it
is rather interesting to quote from that work the end of man as this
Jewish philosopher of the middle of the twelfth century saw it. Recent
teleological tendencies in biology add to the interest of his views.
According to Maimonides, "Man is the end of the whole creation, and we
have only to look to him for the reason for its existence. Every object
shows the end for which it was created. The palm-trees are there to
provide dates; the spider to spin her webs. All the properties of an
animal or a plant are directed so as to enable it to reach its purpose
in life. What is the purpose of man? It cannot lie alone in eating and
drinking or yielding to passion, nor in the building of cities and the
ruling of others, since these objects lie outside of him, and do not
touch his essential being. Such material striving he has in common with
the animal. A man is lifted from a lower to a higher condition by his
reason. Only through his reason is he placed above the animals. He is
the only reasonable animal. His reason enables him to understand all
things, especially the Unity of God, and all knowledge and science serve
only to direct man to the knowledge of God. Passions are to be subdued,
since the man who yields to passion subjects his spirit to his body, and
does not reveal in himself the divine power which in him lies in his
reason, but is swallowed up in the ocean of matter."
Not long after Maimonides passed his twentieth year the family,
consisting of the father and his two sons, Moses and David, and a
daughter, moved from Cordova to Fez, compelled by Jewish persecutions.
Here it is said that they had to submit to wearing the mask of Islam in
order to lead a peaceful existence. This has been doubted, however, and
his whole life is in flagrant contradiction with any such even apparent
apostasy from the faith of his fathers. Father and son took advantage of
the opportunity of intercourse with Moorish physicians and philosophers
to increase their store of knowledge, but could not be content in the
political and religious conditions in which they were compelled to live.
About 1155, then, they went to Jerusalem, but found conditions even more
intolerable there, and turned back to Egypt, where they settled down in
Old Cairo. In 1166 the father died, and after this we learn that the
sons made a livelihood, and even laid the foundation of a fortune, by
carrying on a jewelry trade. Moses still devoted most of his time to
study, while his brother did most of the business, but the brother was
lost in the Indian Ocean, and with him went not only a large sum of his
own money, but also much that had been entrusted to him by others.
Maimonides undertook to pay off these debts and at the same time had to
meet the necessities not only of himself and sister, but also of the
family of his dead brother. It was then that he took up the practice of
medicine and succeeded in making a great name and reputation for
himself. He continued to write, however, and completed his commentary on
the Talmud.
About the age of fifty Maimonides, as seems to be true of a good many
men who live to old age, became rather discouraged and despondent about
himself. He refers to himself in his letters and writings rather
frequently as an old and ailing man. He had nearly twenty years of
active life ahead of him, but he had the persuasion that comes to many
that he was probably destined to an early death. His son was born
shortly after this time, and that seems to have had not a little to do
with brightening his life. While in Egypt Maimonides married the sister
of one of the royal secretaries, who, in turn, wedded Maimonides'
sister. Maimonides took on himself the education of his son, who also
became a physician, though his father was not to have the satisfaction
of watching his success in the practice of his chosen profession. This
son, Abraham, became the physician of Malie Alkamen, the brother of
Saladin, and, besides, was a physician to the hospital at Cairo. _His_
son, David, the grandson of Maimonides, practised medicine also at Cairo
till 1300. He in turn left two sons, Abraham and Solomon, who achieved
reputation in the chosen profession of their great-grandfather.
Maimonides, after the birth of his son, became one of the busiest of
practising physicians. Indeed, it is hard to understand how he had the
time to do any writing in his busy life. Still less can we understand
his time for teaching. He was the physician to Saladin, whose relations
with Richard Coeur de Lion have made him known to English-speaking
people. Every morning, as the Court physician, Maimonides went to the
palace, situated half a mile away from his dwelling, and if any of the
many officials and dependents that then, as now, were at Oriental
courts, were ill, he stayed there for some time. As a rule he could only
get back to his own home in the afternoon, and then he was, as he says
himself, "almost dying with hunger." Knowing the scantiness of the
Oriental breakfast, we are not surprised. There he found his
waiting-room full of patients, "Jews and Mohammedans, prominent and
unimportant, friends and enemies," he says himself, "a varied crowd, who
are looking for my medical advice. There is scarcely time for me to get
down from my carriage and wash myself and eat a little, and then until
night I am constantly occupied, so that, from sheer exhaustion, I must
lie down. Only on the Sabbath day have I the time to occupy myself with
my own people and my studies, and so the day is away from me." What a
picture it is of the busy medical teacher at all times in the world's
history, yet it must not be forgotten that it is from these busy men
that we have derived our most precious lessons in caring for patients
rather than disease, in the art of medicine rather than medical
science--and their practical lessons have been valuable long after the
fine-spun theories of the scientist that took so long to elaborate have
been placed definitely in the lumber room.
His reputation as a writer on medical topics is not as great as that
which has been accorded him for his writings on philosophy and in
Talmudic literature, but he well deserves a place among the great
practical masters of medicine, as well as high rank among the physicians
of his time. There is little that is original in his writing, but his
thoroughgoing common sense, his wide knowledge, and his discriminating,
eclectic faculty make his writings of special value. As might have been
expected, the Aphorisms of Hippocrates attracted his attention, and,
besides, he wrote a series of aphorisms of his own. The most interesting
of his writings, however, is a series of letters on dietetics written
for the son of his patron Saladin. The young prince seems to have
suffered from one of the neurotic conditions that so often develop in
those who have their lives all planned for them, and little incentive to
do things for themselves. The main portion of his complaints centred, as
in the case of many another individual of leisure, in disturbances of
digestion. Besides, he suffered from constipation and feelings of
depression. Doubtless, like many a young person of the modern time, he
was quite sure that these symptoms portended some insidious organic
ailment that would surely bring an early death. When fathers, having
done all that there is to do, just expect their sons to enjoy the
fruits of the paternal accomplishments, conditions of this kind very
often develop, unless the young man proceeds to occupy himself with even
more dangerous distractions than he finds in unending thought about his
own feelings.
The rules of life and health that Maimonides laid down in these letters
have become part of our popular medical tradition. Probably more of the
ordinarily current maxims as to health have been derived from them than
would possibly be suspected by anyone not familiar with them. In various
forms his rules have been published a number of times. A good idea of
them can be obtained from the following compendium of them, which I
abbreviate from a biographical sketch of Maimonides by Dr. Oppler, which
appeared in the "Deutsches Archiv fuer Geschichte der Medizin und
Medicinische Geographie" (Bd. 2, Leipzig, 1879).
1. Man is bound to lead a life pleasing to God if he wants to
have a healthy body, and he must hold himself far from
everything that can hurt his health and accustom himself to
whatever renews his strength. He should eat and drink only
when hungry and thirsty and should be particularly careful of
the regular evacuation of his bowels and of his bladder. He
must not delay either of these operations, but as far as
possible satisfy the inclination at once.
2. A man must not overload his stomach but be content always
with something less than is necessary to make him feel quite
satisfied. He should not drink much during the meal and only
of water and wine mixed, taking somewhat more after digestion
has begun and after digestion is completed, in moderation
according to his needs. Before a man sits down to table he
should note whether he has any tendency to evacuation and
should make the body warm by movement and activity. After this
exercise he should rest a little before taking food. It is
very beneficial after work to take a bath and then the meal.
3. Food should be taken always in the sitting position. There
should be no riding nor walking, nor movements of the body
until digestion is finished. The man who takes a walk or any
strenuous occupation immediately after eating subjects himself
to serious dangers of disease.
4. Day and night should be divided into twenty-four hours. Men
should sleep for eight hours, and so arrange their sleep that
the end of it comes with the dawn, so that from the beginning
of sleep until sunrise there should be an eight-hour interval.
We should all leave our beds about the time that the sun
rises.
5. During sleep a man should lie neither on his face nor on
his back but on his side, the beginning of the night on his
left and at the end on his right. He should not go to sleep
for three or four hours after eating and should not sleep
during the day.
6. Fruits that are laxative, as grapes, figs, melons, gourds,
should be taken only before meal time and not mixed with other
food. It would be better to let these get into the abdominal
organs and then take other food.
7. Eat what is easily digestible before what is difficult of
digestion. The flesh of birds before beef and the flesh of
calves before that of cows and steers. (Birds were then
thought more digestible than other flesh; we have reversed the
ruling. The note shows how light and digestible their flesh
was considered and the reason therefor.)
8. In summer eat cooling food, acids, and no spices. In
winter, on the contrary, eat warming foods, rich in spices,
mustard, and other heating substances. In cold and warm
climates one should eat according to the climatic conditions.
9. There are certain harmful foods that should be avoided.
Large salt fish, old cheese, old pickled meat, young new wine,
evil-smelling and bitter foods are often poisonous. There are
also some which are less harmful, but are not to be
recommended as ordinary nutritive materials. Large fish,
cheese, milk more than twenty-four hours after milking, the
flesh of old oxen, beans, peas, unleavened bread, sauerkraut,
onions, radishes and the like. These are to be taken only in
small quantities and only in the winter time and they should
be avoided in the summer. Beans and lentils are to be
recommended neither in winter nor summer.
10. As a rule one should avoid the eating of tree fruits, or
not eat much of them, especially when they are dry and even
less when they are green. If they are unripe they may cause
serious damage. Johannesbrod is very harmful at all times, as
are also all the sour fruits, and only small amounts of them
should be eaten in summer or in warm countries.
11. The fruits that are to be recommended dry as well as
fresh, are figs, grapes, and almonds. These may be eaten as
one has the appetite for them, but one should not accustom
himself to eat them much, though they are healthier than all
other fruits.
12. Honey and wine are not good for children, though they are
beneficial for older people, especially in winter. In summer
one-third less of them should be eaten than in winter.
13. Special care should be taken to have regular movements of
the bowels that carry off the impurities of the body. It is an
axiom in medicine, that so long as evacuations are absent, or
difficult, or require strong efforts, the individual is liable
to serious disease. Every medical means should be taken to
overcome constipation in order to escape its dangers. For
this purpose young people should be given salty food,
materials that have been soaked in olive oil, salt itself, or
certain vegetable soups with olive oil and salt. Older people
should take honey mixed with warm water early in the morning
and four hours later should take their breakfast. This
proceeding should be followed up from one to four days until
the constipation is overcome.
14. Another axiom of medicine is that so long as a man is able
to be active and vigorous, does not eat until he is over-full,
and does not suffer from constipation, he is not liable to
disease. Even such men, however, are much safer if they do not
take food that may disagree with them.
15. Whoever gives himself up to inactivity, or puts off
evacuations of the bowels, or suffers from constipation, will
be sure to suffer from many diseases and will see his strength
disappear even should he eat the best food in the world and
make use of all the remedies that physicians have. Immoderate
eating is a poison for men and the cause of many diseases
which attack them. Most diseases come from either eating too
much or partaking of unsuitable food. That was what Solomon
meant with his proverb: "He who puts a guard over his mouth
and his tongue protects himself from many evils," that is to
say, whoever protects his mouth from the overindulgence in
food and his tongue from unsuitable speech protects himself
from many evils.
16. Every week at least a man should take a warm bath. One
should not bathe when hungry, nor after eating until the food
is digested, and bathe the whole body in warm but not too hot
water and the head in hot water. Afterwards the body should be
washed in lukewarm and cool water until finally cold water is
used. One should pour neither cold nor even lukewarm water on
the head, nor bathe in cold water in the winter time, nor when
the body is tired and in perspiration. At such times the bath
should be put off for a while.
17. As soon as one leaves the bath one should cover oneself,
and especially cover the head, so that no draught may strike
it. Even in summer, care must be taken to observe this rule.
After this one should rest for a while until the heat of the
body passes off and then should go to table. If one could
sleep a little just before a meal it is often very beneficial.
Neither during the bath nor immediately after it should cold
water be drunk, and if there is an inappeasable thirst a
little wine and water or water and honey should be taken. In
winter it is beneficial to rub the body with oil after the
bath.
18. Venesection should not be practised frequently, for it is
only meant for serious illness. It should not be permitted in
winter or summer, nor during the months of April or September
(the "r" months). After passing his fiftieth year an
individual should abstain from venesection. Venesection should
not be practised on the day when one takes a bath or goes on a
journey or returns from it. On the day when it is practised
less than usual should be eaten and drunk, and the patient
should give himself to rest, undertake no work nor bothersome
occupation, and take no walk.
19. Whoever observes these rules of life faithfully I
guarantee him a long life without disease. He shall reach a
good old age, and when he comes to die will not need a
physician. His body will remain always strong and healthy,
unless of course he has been born with a weak nature, or has
had an unfortunate bringing up, or should be attacked by
epidemic disease or by famine.
20. Only the healthy should keep these rules. Whoever is ill
or a sufferer from any injuries, or has lost his health
through bad habits, for him there are special rules for each
disease, only to be found in the medical books. Let it be
remembered that every change in a life habit is the beginning
of an ailment.
21. If no physician can be secured, then ailing people may use
these rules as well as the healthy.
These rules are, of course, full of the common sense of medicine that
endures at all times. For the tropical climate of the Eastern countries
they probably represent as good advice as could be given even at the
present time. With them before us it is not surprising to find that on
other subjects Maimonides was just as sensible. Perhaps in nothing is
this more striking than in his complete rejection of astrology.
Considering how long astrology, in the sense of the doctrine of the
stars influencing human health and destinies, had dominated men's minds,
and how universal was the acceptance of it, Maimonides' strong
expressions show how much genius lifts itself above the popular
persuasions of its time, even among the educated, and how much it
anticipates subsequent knowledge.
It is well to remind ourselves that as late as the middle of the
eighteenth century Mesmer's thesis on "The Influence of the Stars on
Human Constitutions" was accepted by the faculty of the University of
Vienna as a satisfactory evidence not only of his knowledge of medicine,
but of his power to reason about it. At the end of the twelfth century
Maimonides was trying to argue it out of existence on the best possible
grounds. "Know, my masters," he writes, "that no man should believe
anything that is not attested by one of these three sanctions:--rational
proof as in mathematical science, the perception of the senses, or
traditions from the prophets and learned men." His biographer in the
monograph "Maimonides," published by the Jewish Publication Society of
America[5], expresses his further views on the subject in compendious
form, and then gives his final conclusion as follows:
"'Works on astrology are the product of fools, who mistook
vanity for wisdom. Men are inclined to believe whatever is
written in a book, especially if the book be ancient; and in
olden times disaster befell Israel because men devoted
themselves to such idolatry instead of practising the arts of
martial defence and government.' He says, that he had himself
studied every extant astrological treatise, and had convinced
himself that none deserved to be called scientific. Maimonides
then proceeds to distinguish between astrology and astronomy,
in the latter of which lies true and necessary wisdom. He
ridicules the supposition that the fate of man could be
dependent on the constellations, and urges that such a theory
robs life of purpose, and makes man a slave of destiny. 'It is
true,' he concludes, 'that you may find strange utterances in
the Rabbinical literature which imply a belief in the potency
of the stars at a man's nativity, but no one is justified in
surrendering his own rational opinions because this or that
sage erred, or because an allegorical remark is expressed
literally. A man must never cast his own judgment behind him;
the eyes are set in front, not in the back.'"
While Maimonides could be so positive in his opinions with regard to a
subject on which he felt competent to say something, he was extremely
modest with regard to many of the great problems of medicine. He often
uses the expression in his writings, "I do not see how to explain this
matter." He quotes with approval from a Rabbi of old who had counselled
his students, "teach thy tongue to say, I do not know." In this, of
course, he has given the best possible evidence of his largeness of mind
and his capacity for making advance in knowledge. It is when men are
ready to say, "I do not know," that progress becomes possible. It is
very easy to rest in a conscious or unconscious pretence of knowledge
that obscures the real question at issue. A great thinker, who lived in
the century in which Maimonides died, Roger Bacon, set down as one of
the four principal obstacles to advance in knowledge indeed, as _the_
one of the four that hampered intellectual progress the most, the fact
that men feared to say, "I do not know."
One of the most interesting features of Maimonides' career for the
modern time is the influence that his writings exerted over the rising
intellectual life of Europe within a half century after his death. Most
people would be rather inclined to think that this Jewish author of the
East would have very little influence over the thinkers and teachers of
Europe within a generation after his death. He died in 1204, just at the
beginning of one of the great productive centuries of humanity, perhaps
one of the greatest of them all. In literature, in art, in architecture,
in philosophy, and in education, this century made wonderful strides.
Two of its greatest teachers, Albertus Magnus and his pupil, Thomas
Aquinas, quote from Moses AEgyptaeus, the European name for Maimonides at
that time, and evidently knew his writings very well. Maimonides was for
them an important connecting link with the world of old Greek thought.
Others of the writers and teachers of this time, as William of Auvergne,
and the two great Franciscans, Alexander of Hales and Duns Scotus, were
also influenced by Maimonides. In a word, the educational world of that
time was much more closely united than we might think, and it did not
take long for a great writer's thoughts to make themselves felt several
thousand miles away. Maimonides was, then, in his own time one of the
world teachers, and, in a certain sense, he must always remain that, as
representing a special development of what is best in human nature.
V
GREAT ARABIAN PHYSICIANS
In order to understand the place of the Arabs in medicine and in
science, a few words as to the rise of this people to political power,
and then to the cultivation of literature and of science, are necessary.
We hear of the Arabs as hireling soldiers fighting for others during the
centuries just after Christ, and especially in connection with the story
of the famous Queen Zenobia at Palmyra. After the destruction of this
city we hear nothing more of them until the time of Mohammed. During
these six and a half centuries there is little question of education of
any kind among them except that at the end of the sixth century, the
Persian King Chosroes I, who was much interested in medicine, encouraged
the medical school in Djondisabour, in Arabistan, founded at the end of
the fifth century by the Nestorian Christians, who continued as the
teachers there until it became one of the most important schools of the
East. It was here that the first Arab physicians were trained, and here
that the Christian physicians who practised medicine among the Arabs
were educated.
Among the Arabs themselves, before the time of Mohammed, there had been
very little interest in medicine. Gurlt notes that even the physician of
the Prophet himself was, according to tradition, a Christian.
Mohammed's immediate successors were not interested in education, and
their people mainly turned to Christian and Jewish physicians for
whatever medical treatment they needed. When the Caliphs came to be
rulers of the Mohammedan Empire, they took special pains to encourage
the study of philosophy and medicine; though dissection was forbidden by
the Koran, most of the other medical sciences, and especially botany and
all the therapeutic arts, were seriously cultivated.
Until the coming of Mohammed, the Arabs had been wandering tribes,
getting some fame as hireling soldiers, but now, under the influence of
a feeling of community in religion, and led by the military genius of
some of Mohammed's successors, whose soldiers were inspired by the
religious feelings of the sect, they made great conquests. The
Mohammedan Empire extended from India to Spain within a century after
Mohammed's death. Carthage was taken and destroyed, Constantinople was
threatened. In 661, scarcely forty years after the _hegira_ or flight of
Mohammed, from which good Mohammedans date their era, the capital was
transferred from Medina to Damascus, to be transferred from here to
Bagdad just about a century later, where it remained until the Mongols
made an end of the Abbasside rulers about the middle of the thirteenth
century. At the beginning the followers of Mohammed were opposed to
knowledge and education of all kinds. Mohammed himself had but little.
According to tradition, he could not read or write. The story told with
regard to the Caliph Omar and the great library of Alexandria, seems to
have a foundation in reality, though such legends usually are not to be
taken literally. Certainly it represents the traditional view as to the
attitude of the earlier Moslem rulers to education. Omar was asked what
should be done with the more than two million volumes. He said that the
books in it either agreed with the Koran, or they did not. If they
agreed with it they were quite useless. If they did not, they were
pernicious. In either case, they should be done away with, because there
was an element of danger in them. Accordingly, the precious volumes that
had been accumulating for nearly ten centuries, served, it is said, to
heat the baths of Alexandria for some six months--probably the most
precious fuel ever used. Fortunately for posterity, the edict was not
quite as universal in its application as the story would indicate, and
exceptions were made for books of science.
In the course of their conquests, however, the Mohammedan Arabs captured
the Greek cities of Asia Minor. They were brought closely in contact
with Greek culture, Greek literature, and Greek thought. As has always
been the case, captive Greece took its captors captive. What happened to
the Romans earlier came to pass also among the Arabs. Inspired by Greek
philosophy, science, and literature, they became ardent devotees of
science and the arts. While not inventing or discovering anything new,
like the Romans they carried on the old. Damascus, Basra, Bagdad,
Bokhara, Samarcand all became centres of culture and of education. Large
sums were paid for Greek manuscripts, and for translations from them.
Under the famous Harun al-Raschid, at the end of the eighth century,
whose name is better known to us than that of any others, because of the
stories of his wandering by night among his people in order to see if
justice were done, three hundred scholars were sent at the cost of the
Caliph to the various parts of the world in order to bring back
treasures of science, and especially of geography and medicine. It is an
interesting historical reflection that the Japanese and Chinese are
doing the same thing now.
The Arabs were very much taken by the philosophy of Aristotle, and it
became the foundation of all their education. Greek thought, as always,
inspired its students to higher things. Soon everywhere in the dominions
of the Caliphs, philosophy, science, art, literature, and education
nourished. Medicine was taken up with the other sciences and cultivated
assiduously. Freind, in his "Historia Medicinae," says that the writings
of the old Greeks which treated of medicine were saved from destruction
with the other books at Alexandria, for the desire of health did not
have less strength among the Arabs than among other nations. Since these
books taught them how to preserve health, and were not otherwise
contrary to the laws of the Prophet, that served to bring about their
preservation. Freind also calls attention to the fact that grammars and
books which treated of the science of language were likewise saved from
destruction. Besides the library, the Arabs, after their conquest of
Alexandria in the eighth century, came under the influence of the
university still in existence there.
In the West, in Spain, the Arabs enjoyed the same advantages as regards
contact with culture and education as their conquest of the Eastern
cities and Alexandria brought them in the East. While it is not
generally realized, Spain was, as we have pointed out, the province of
the Roman Empire in the West that advanced most in culture before the
breaking up of the Empire. The Silver Age of Latin literature owes all
of its geniuses to Spain. Lucan, the Senecas, Martial, Quintilian, are
all Spaniards. Spain itself was a most flourishing province, and under
the Spanish Caesars, from the end of the first to about the end of the
second century, increased rapidly in population. Spain was the leader in
these prosperous times, and the tradition of culture maintained itself.
When Spain became Christian the first great Christian poet, Prudentius,
born about the middle of the fourth century, came from there. He has
been called the Horace and Virgil of the Christians.
The coming down of the barbarians from the North disturbed Spain's
prosperity and the peace and culture of her inhabitants, but it should
not be forgotten that the first medieval popularization of science, a
sort of encyclopedia of knowledge, the first of its kind after that of
Pliny in the classical period, came from St. Isidore of Seville, a
Spanish bishop.
There has been considerable tendency to insist that Spanish culture and
intellectuality owe nearly all to the presence of the Moors in Spain.
This can only be urged, however, by those who know nothing at all of the
Spanish Caesars, the place of Spain in the history of the Roman Empire,
and the continuance of the culture that then reached a climax of
expression during succeeding centuries. On the contrary, the Moors who
came to Spain owe most of their tendency to devote themselves to culture
and education to the state of affairs existent in Spain when they came.
There is no doubt that they raised standards of education and of culture
above the level to which they had sunk under the weight of the invading
barbarians from the North, and Spain owes much to the wise ruling and
devotion to the intellectual life of her Moorish invaders. All the
factors, however, must be taken together in order to appreciate properly
the conditions which developed under the Arabs in both the East and the
West. The Arabs invented little that was new in science or philosophy;
they merely carried on older traditions. It is for that that the modern
time owes them a great debt of gratitude.
RHAZES
The most distinguished of the Arabian physicians was the man whose
rather lengthy Arabian name, beginning with Abu Bekr Mohammed, finished
with el-Razi, and who has hence been usually referred to in the history
of medicine as Rhazes. He was born about 850 at Raj, in the Province of
Chorasan in Persia. He seems to have had a liberal early education in
philosophy and in philology and literature. He did not take up medicine
until later in life, and, according to tradition, supported himself as a
singer until he was thirty years of age. Then he devoted himself to
medical studies with the ardor and the success so often noted in those
whose opportunity to study medicine has been delayed. His studies were
made at Bagdad, where Ibn Zein el-Taberi was his teacher. He returned to
his native town and was for some time the head of the hospital there.
Later he was called by the Sultan to Bagdad to take charge of the
renovated and enlarged hospital of the capital. His medical career,
then, is not unlike that of many another successful physician,
especially of the modern time. At Bagdad he had abundant opportunities
for study, and the ambition to make medicine as well as to make money
and gain fame.
His studies in science were all founded on Aristotle. Though he was
called the Galen of his time, and looked up to the Greek physician as
his master, even the authority of Galen did not override that of the
Stagirite in his estimation. One of his aphorisms is said to have been,
"If Galen and Aristotle are of one mind on a subject, then surely their
opinion is true. When they differ, however, it is extremely difficult
for the scholar to decide which opinion should be accepted." He drew
many pupils to Bagdad, and, when one knows his teaching, this is not
surprising. Some of his aphorisms are very practical. While the
expressions just quoted with regard to Galen and Aristotle might seem to
indicate that Rhazes was absolutely wedded to authority, there is
another well-known maxim of his which shows how much he thought of the
value of experience and observation. "Truth in medicine," he said, "is a
goal which cannot be absolutely reached, and the art of healing, as it
is described in books, is far beneath the practical experience of a
skilful, thoughtful physician." Some of his other medical aphorisms are
worth noting. "At the beginning of a disease choose such remedies as
will not lessen the patient's strength." "When you can heal by diet,
prescribe no other remedy, and, where simple remedies suffice, do not
take complicated ones."
Rhazes knew well the value of the influence of mind over body even in
serious organic disease, and even though death seemed impending. One of
his aphorisms is: "Physicians ought to console their patients even if
the signs of impending death seem to be present. For the bodies of men
are dependent on their spirits." He considered that the most valuable
thing for the physician to do was to increase the patient's natural
vitality. Hence his advice: "In treating a patient, let your first
thought be to strengthen his natural vitality. If you strengthen that,
you remove ever so many ills without more ado. If you weaken it,
however, by the remedies that you use you always work harm." The simpler
the means by which the patient's cure can be brought about, the better
in his opinion. He insists again and again on diet rather than
artificial remedies. "It is good for the physician that he should be
able to cure disease by means of diet, if possible, rather than by means
of medicine." Another of his aphorisms seems worth while quoting: "The
patient who consults a great many physicians is likely to have a very
confused state of mind."
Some idea of Rhazes' strenuous activity as a writer on medical subjects
may be obtained from the fact that thirty-six of his works are still
extant, and there are nearly two hundred others of which only the
titles have been preserved. Some of these are doubtless the works of
pupils and students of succeeding generations, published under his name
to attract attention. His principal work is "Continens," or
"Comprehensor," which owes its title to the fact that it was meant to
contain the whole practice of medicine and surgery. It includes
references to the writings of all previous distinguished medical
writers, from Hippocrates to Honein Ben Ishac, also known as
Johannitius, a Christian Arabian physician, one of Rhazes' teachers. The
most frequently quoted of these authorities are Galen, Oribasius,
Aetius, and Paul of AEgina. The work, however, is not made up entirely of
quotations, but contains many observations made by the author himself.
Gurlt says that the foundation of the theoretic medicine of Rhazes is
the system of Galen, while in practice he seems to cling more to the
aphorisms of Hippocrates. He has many practical points which show that
he thought for himself. For instance, in wounds of the abdomen, if the
intestines are extruded and cannot be replaced, he suggests the
suspension of the patient by his hands and feet in a bath in order to
facilitate their return. If they do not go back readily, compresses
dipped in warm wine should be used. Cancer he declares to be almost
incurable. He has much to say about the bites of animals and their
tendency to be poisonous, knew rabies very well, and knew also that the
bites of men might have similar serious consequences.
It is impossible to give any adequate idea of the thoroughly practical
character of Rhazes' medical writing in a few lines, but it may suffice
to say that there is scarcely any feature of modern medicine and surgery
that he does not touch, and oftener than not his touch is sure and
rational and frequently much better than the advice of successors long
after him in the same matters. An example or two will suffice to
illustrate this. In the treatment of nasal polyps he says that whenever
drug treatment of these is not successful, they should be removed with a
snare made of hair. For fall of the uvula he suggests gargles, but when
these fail he advises resection and cauterization. Among the affections
of the tongue he numbers abscess, fissure, ulcer, cancer, ranula,
shortening of the ligaments, hypertrophy, erythema of the mucous
membrane, and inflammatory swelling. In general his treatment of the
upper respiratory tract is much farther advanced than we might think
possible at this time. He advises tracheotomy whenever there is great
difficulty of respiration, and describes how it should be done. After
the dyspnea has passed the edges of the wound should be brought together
with sutures. It is not surprising, then, to find that the treatment of
fractures and luxations is eminently practical, and, indeed, on any
subject that he touches he throws practical light.
In the introduction to his edition of the works of Ambroise Pare,
Malgaigne says that the first reference to a metal band in connection
with trusses is to be found in Rhazes. Hernia was, of course, one of the
serious ailments that, because of its superficial character, was rather
well understood, and so it is not surprising to find that much of our
modern treatment of it was anticipated. The manipulations for taxis, the
use of a warm bath for the relaxation of the patient by means of heat
and by putting the head and feet higher than the abdomen while in the
bath, and the employment of various kinds of trusses to prevent
strangulation of the hernia recur over and over again, in the authors of
the Middle Ages. Many of the suggestions are to be found in the early
Greek authors, but subsequent writers give a certain personal expression
to them which shows how much they had learned by personal observation in
the employment of various methods.
Pagel, in Puschmann's "Handbook of the History of Medicine," declares
that Rhazes' most important work for pure medicine is his monograph on
smallpox. Its principal value is due to the fact that, though he has
consulted old authorities carefully, his discussion of the disease is
founded almost entirely on his own experience. His description of the
various stages of the disease, of the forms of the eruption, and of the
differential diagnosis, is very accurate. He compares the course of the
fever with that of other fevers, and brings out exactly what constitutes
the disease. His suggestions as to prognosis are excellent. Those cases,
he declares, are particularly serious in which the eruption takes on a
dark, or greenish, or violet color. The prognosis is also unfavorable
for those cases which, having considerable fever, have only a slight
amount of rash. His treatment of the disease in young persons was by
venesection and cool douches. Cold water and acid drinks should be
administered freely, so that sweat and other excretions may carry off
poisonous materials. Care must be taken to watch the pulse, the
breathing, the appearance of the feet, the evacuations from the bowels,
and to modify therapy in accordance with these indications. The eruption
is to be encouraged by external warmth and special care must be taken
with regard to complications in the eyes, the ears, the nose, the mouth,
and the pharynx.
A fact that will, perhaps, give the best idea to modern readers of the
place of Rhazes in the history of medicine is that Vesalius considered
it worth his while to make a translation of his principal work.
Unfortunately that translation has not come down to us. When Vesalius,
pestered by the controversies that had come upon him because of his
venturing to make his observations for himself, accepted the post of
physician to the Emperor Charles V, he burnt a number of his
manuscripts. Among these were his translation of Rhazes and some
annotations on Galen, which, as he says himself, had grown into a huge
volume. The Galenists were bitterly decrying his refusal to accept Galen
on many points, and both of these works would have added fuel to the
flame of controversy. He deemed it wiser, then, not to give any further
opportunities for rancorous criticism, and, feeling presumably that in
his new and important post it was not worth while to bother further over
the matter, he burnt them. He tells the reason in his letters to Joachin
Roelant: "When I was about to leave Italy to go to Court, since a number
of the physicians whom you know had made the worst kind of censure of
my books, both to the Emperor himself, and to other rulers, I burned
all the manuscripts that were left, although I had never suffered a
moment under the displeasure of the Emperor because of these complaints,
and in spite of the fact that a number of friends who were present urged
me not to destroy them."
Vesalius' translation of Rhazes was probably undertaken because he
recognized in him a kindred spirit of original investigation and
inquiry, whose work, because it was many centuries old, would command
the weight of an authority and at the same time help in the controversy
over Galenic questions. This, of itself, would be quite enough to make
the reputation of Rhazes, even if we did not know from the writings
themselves and from the admiration of many distinguished men as well as
the incentive that his works have so often proved to original
observation, that he is an important link in the chain of observers in
medicine, who, though we would naturally expect them to be so frequent,
are really so rare.
ALI ABBAS
Rhazes lived well on into the tenth century. His successor in prestige,
though not his serious rival, was Ali Ben el-Abbas, usually spoken of in
medical literature as Ali Abbas, a distinguished Arabian physician who
died near the end of the tenth century. He wrote a book on medicine
which, because of its dedication to the Sultan, to whom he was
body-physician, is known as the "Liber Regius," or "Royal Book of
Medicine." This became the leading text-book of medicine for the Arabs
until replaced by the "Canon of Avicenna" some two centuries later. The
"Liber Regius" was an extremely practical work and, like most of the
Arabian books of the early times, is simple and direct, quite without
many of the
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