Part 16

(FROM ABOUT A.D. 200 TO ABOUT A.D. 1500.)

§ 1. The Period of Depression in Europe.

The observational period of Antiquity closed with Galen. The centuries that follow exhibit progressive deterioration of the intellect. For that deterioration many causes have been assigned. An important factor was certainly the philosophical outlook of later paganism. Men lacked a motive for living. Their view of the World was dreary and without hope. It is sometimes alleged that the advent of Christianity was a factor in the decay of Science, but Science was, in fact, in headlong decay before Christianity was in a position to have any real effect on pagan thought.

Christianity came to the ancient world as a protest and a revulsion against the prevailing and extremely pessimistic pagan outlook. Christianity brought men something for which to live. It was natural that it should oppose the philosophical basis of pagan thought. In this sense Christianity was certainly anti-scientific. Early Christian thought exhibits an aversion to the view which places the whole of man’s fate under the dominion, the inescapable tyranny, of Natural Law. It is, however, essential to remember that the early Church, in developing this opposition, was not dealing with living observational Science. The conflict was simply with a philosophical tradition which contained dead, non-progressive and misunderstood scientific elements.

For some eight centuries from the time that Christianity finally replaced Paganism in the Roman Empire--from about A.D. 400 to about A.D. 1200--such remains of classical learning and classical science as survived were in monastic keeping. It was only in the monasteries that there were any who cared at all for these things, and it was only in the monasteries that manuscripts could be either written or preserved. We cannot be sufficiently grateful to the monks for having succeeded in preserving even as much as they did. Nevertheless, whether we consider what they saved or what they lost of medical literature, we can express no high opinion of either monastic taste or monastic judgment.

The curse of the Science of Medicine, as of all sciences, has always been the so-called ‘practical man’, who will consider only the immediate end of his art, without regard to the knowledge on which it is based. Monkish medicine had no thought save for the immediate relief of the patient. All theoretical knowledge was permitted to lapse. Anatomy and Physiology perished. Prognosis was reduced to an absurd rule of thumb. Botany became a drug-list. Superstitious practices crept in, and Medicine deteriorated into a collection of formulae, punctuated by incantations, which became less understood and further removed from their originals at each copying. Medicine remained surrounded by sacred associations (Fig. 22), but the scientific stream, which is its life-blood, was dried up at its source.

FIG. 22. EARLIEST KNOWN REPRESENTATION OF ST. LUKE AS A PHYSICIAN. From a seventh-century painting in the underground basilica of Saints Felix and ‘Adauctus’ at Rome. St. Luke, as an Evangelist, holds a scroll between his hands; as a Physician he carries suspended from his left arm a bag containing four instruments, one of which is a lancet. The head is tonsured like a monk’s. By courtesy of Rev. Father J. R. Fletcher.

FIG. 23. PICTURE OF TREPHINING from a thirteenth-century manuscript. The surgeon is using a well-known and primitive form of drill, the mode of action of which will be understood by the accompanying diagram, shown as Fig. 24.

There was just one area in the Latin West where a slightly higher standard prevailed. In the South of Italy the Greek tongue still continued for centuries to be spoken and written. Though civilization had sadly deteriorated with the disorders of the times, yet there remained here and there in that region a slightly higher intellectual standard than prevailed elsewhere in Europe. Moreover, about the same time as the Norman Conquest in England, there was a Norman Conquest of South Italy also. The strong arm of the Norman administrator might wield the weapon of a tyrant, but at least it brought order where there had been anarchy. Learning under the Normans could lift a timid head. Notably at the town of Salerno, not far from Naples, there arose something resembling a medical school. At Salerno in the eleventh century there was a certain amount of translation of medical works from Greek into Latin. The choice of works for translation was very poor, but it was something that enough mental energy existed for the effort.

FIG. 24. Figure to illustrate the mode of action of the instrument used by the surgeon in Fig. 23. The twist of the thong causes rapid rotation of the axis. The rotating point is pressed on the skull and gradually penetrates it. From a drawing of the sixteenth century.

Salerno differed too from other centers of learning of the time in that instruction was not entirely under monastic auspices (Fig. 25). Some, at least, of the Salernitan physicians were laymen. At the time of the Norman conquest of Salerno, the school was stimulated by the advent of a wanderer from the East, Constantine by name (died 1087). This man brought with him medical works in Arabic which he was able to translate into rude Latin. The Latin versions prepared by Constantine, corrupt, confused, barbarous, often almost incomprehensible, were yet a better intellectual fare than that on which the torpid mind of Europe had long fed. The Salernitan medical writings of the eleventh and twelfth centuries exhibit some faint-hearted attempts to return to Nature. Constantine was but the harbinger of the great ‘Arabian revival’ the further origins of which we must now seek to trace.

FIG. 25. SCENE AT A SIEGE OF SALERNO from a manuscript prepared in South Italy early in the thirteenth century. An archer transfixes two of the defenders through the cheeks. A medicus is aiding one of them. Two nurses, bearing drugs and dressings, attend the medicus. It illustrates the existence of lay physicians at Salerno at this date. The medicus is not tonsured.

§ 2. Arabic Medicine.

Barbarian incursions sapped and finally destroyed the Western Roman Empire. The influence of those incursions on the Eastern Empire was less dramatic. It is true that the intellectual outlook of the East Roman or Byzantine Empire was no less modified, in the course of time, than was that of the West. In the absence, however, of any collapse of the system of government, the ancient Greek learning or rather the documentary casing in which it was enshrined, was better preserved than were the Latin traditions. Men in the Eastern Empire could still read the ancient Greek medical works in the language in which they had been written, and, if their reading was unintelligent, it was at least persistent. Moreover, heretical Christian sects on the confines of the East Roman Empire prepared for themselves translations of many of the ancient Greek authors. One of these heretical sects, the Nestorians, exhibited great missionary activity. It was perhaps on this account that the Nestorians prepared translations of many Greek medical works into their own language, Syriac.

In the seventh century, Islam arose and soon swept over vast areas that had erstwhile belonged to the Emperor of the East. The territory occupied by the Nestorians in the Near East came early under Moslem rule. The Moslems, at first indifferent to infidel learning, came gradually to appreciate it. In the ninth century a great and united Moslem Empire was established with its center at Bagdad. The need for translation of Greek scientific works into Arabic, the common language of Islam, now asserted itself. One after another the medical writings that had been turned into Syriac were translated into Arabic, and Greek Science in general and Greek Medicine in particular were thus spread far and wide in the Moslem world.

Greek science in the Arabic version came in time to be better understood by Arabic-speaking students than it had been by any since Galen. Nor were the Arabic-speaking peoples content to rest on the texts that had thus descended to them from antiquity. A considerable number of Arabic writers produced works of their own, some not wholly devoid of originality. Unfortunately these men were without effective anatomical or physiological basis for their medical knowledge, though many of them were acute clinical observers, and, even from the modern point of view, some of their works are not wholly contemptible. Thus Rhazes (860-932), a native of Basra on the Persian Gulf, wrote a work containing the first known description of Measles, which he carefully distinguishes from Small-pox. The Persian Avicenna (980-1036) composed a vast encyclopaedia of medical knowledge, the so-called Canon, which served as the main text-book of Medicine both among the Arabic-speaking peoples and in the Latin West until the seventeenth century. The Jew, Isaac of Kairouan (852-952), composed a treatise on fevers which was the best account of the subject available in Europe during the entire Middle Ages. The Moor, Albucasis (11th cent.), left a text-book of surgery which was an important element in the revival of the subject in Italy and France.

These are only prominent members of a vast school of writers who flourished in Arabic-speaking countries between the ninth and thirteenth centuries. The bulk and number of their writings is portentous. Many of their works were translated into Latin, often by Jewish translators (Fig. 26). These Latin translations caused a reawakening of the intellect of Europe, and provided the staple reading in the medieval universities throughout the Middle Ages.

FIG. 26. A JEWISH TRANSLATOR receiving an Arabic medica volume from an Eastern potentate (right) and handing it, translated into Latin, to a Western monarch (left). From a thirteenth-century manuscript.

§ 3. The Medieval Awakening.

The Spanish peninsula had been inundated by the Islamic tide as early as the eighth century. After a while the waters began to recede. The speech and culture of Islam had become stamped upon the natives of the peninsula, and were only gradually replaced by the Latin civilization and dialect which we now call Spanish. During the centuries of Islamic retreat, there was thus a bilingual population in the peninsula, so that access to the Arabic learning became possible. The translations that were to have influence on Europe were always into Latin. To make or to obtain such translations many adventurous spirits journeyed from Christian Europe into Spain, or sometimes into Sicily where conditions were very similar. These men were aided in their work by native Jews or by Mohammedans. The heretical company which they kept, together with the strange and mysterious material which they brought back with them, earned them a reputation as magicians. The memory, for instance, of Michael Scot is connected with the Black Art, and has been presented by Sir Walter Scott in his poem The Lay of the Last Minstrel.

The wizard Michael Scot (died 1235) journeyed in both Spain and Sicily, learned Arabic and Hebrew, and had commerce with Mohammedans and Jews. He turned a number of Arabic works into Latin, and, in particular, he prepared versions of the biological works of Aristotle (pp. 28-33) which, though corrupt and second-hand, had much influence in determining the direction of medical thought during the Middle Ages.

There was a large class of such translators and commentators who made Arabic Medicine accessible to the West. This Arabic-Latin literature is generally characterized by the qualities most often associated with the words medieval and scholastic. It is extremely verbose and almost wholly devoid of the literary graces. An immense amount of attention is paid to the mere arrangement of the material, which often occupies its authors more than the ideas that are to be conveyed. Great stress is laid on argument, especially in the form of the syllogism, while observation of Nature is entirely in the background. Above all, there is a constant appeal to the authority of the ancient masters, especially Aristotle and Galen. Lip service is often paid to Hippocrates, but his spirit is absent from these windy discussions.

When the Latin translations from the Arabic reached the readers for whom they were intended, they were eagerly studied. The texts were, however, by no means permitted to remain in their pristine state, but were submitted to exactly the same process to which their Arabic authors had themselves subjected their Aristotelian and Galenic models. The Christian writers of the West treated the Latin translations of Rhazes, of Avicenna, of Isaac and of Albucasis (p. 67), as subjects for commentary. Their works were expanded, annotated, castigated again and again, and without any new inflow of ideas. The result is a progressive elaboration of form and deterioration of content throughout the centuries. Vast masses of argument, rebuttal, refutation and confirmation drowned again the human spirit which hardly recovered from its submersion until the sixteenth century.

§ 4. The Universities.

Nevertheless, when these translations were new to Europe, and especially in the thirteenth century, they caused much stir. In this awakening a large part was played by the Universities. These were established in numbers during the thirteenth and the following centuries. University life gradually came to exercise a profound effect on social, political and intellectual conditions. In most of the Universities Medical Faculties grew up. The medical teaching was entirely theoretical and there was no clinical instruction, though at the beginning of the fourteenth century some advance was made by the introduction of brief and superficial anatomical demonstrations (p. 74).

As a type of Medieval University, we may take Bologna, which was an important center of learning from a very early date (Fig. 27). As the Universities multiplied, they began to some extent to ‘specialize’. Bologna had appeared first as a Law School and continued to develop along the same line. In the second half of the thirteenth century it was by far the most important seat of legal learning in Europe.

An organized Medical Faculty existed there as far back as 1156. The teaching at Bologna, as in other medical schools, consisted entirely of readings of Latin translations from Arabic which were becoming ever more accessible. Yet it was at Bologna that public dissection was first practised. The early advent of dissection has often impressed the historian. There was still no botany worthy of the name, no zoology, hardly any naturalistic art, no experimental science, no systematic record of observation in any department. Yet dissection had become recognized at Bologna by the end of the first quarter of the fourteenth century. The question is why men, so little interested in Nature and Nature’s ways, should have lent themselves to so repellent a process as dissection of the human body? The answer is that the earliest reason for examining the human body was simply the gathering of evidence for legal processes. As time went on, post-mortem examination passed into anatomical study. But still dissection did no more, and was asked to do no more, than verify Avicenna--whom nobody doubted. It was, in fact, little but an aid to the memory of students.

At Bologna we can trace the rise of a surgical school beginning about the end of the twelfth century. Prominent among its early surgeons was William of Saliceto (1215?-1280?). He wrote a very able treatise on Surgery, containing a section on Anatomy. The anatomical portion is borrowed from the current Arabian anatomies, but contains some evidence of direct access to the dead human body. He includes in his work a good description of trephining the skull (Fig. 23).