Part 15

It was about the beginning of the fifteenth century that the better class of physicians began to belong to the laity, and were called "physici" in contrast to the "clerici." Later they were known as "doctores." Until the fourteenth century most of them studied in Italian or French universities, the Germans even being compelled to go to these foreign institutions. In Paris they were required to take an oath that they would not join the surgeons. This regulation was founded as much upon spite and envy as upon any other motive. Many of the clerical physicians belonged to the lower class, and were so ignorant that even the Church itself was forced to declare many of their successes miracles. Although monks and the clergy in general had been frequently forbidden to practice medicine, the decrees to this effect were quite generally disregarded, except in the matter of surgical operations. In the ranks of the higher clergy it must be said that well-educated physicians were occasionally found. There is, for instance, the record of a certain bishop of Basel, who was deputed to seek from Pope Clement V. an archbishopric for another person, but finding the Pope seriously ill, cured him, and received for himself in return the electorate of Mayence, which was perhaps one of the largest honorariums ever given to a physician.

These were the days when magic, mingled with mystery, played no small rôle in the practice of medicine, and when disgusting and curious remedies were quite in vogue. Superstition and ignorance everywhere played a most prominent part. For instance, it was, in those days, an excellent remedy to creep under the coffin of a saint. When a person was poisoned it was considered wise to hang him up by the feet and perhaps to gouge out one of his eyes, in order that the poison might run out. It should be noted that putting out the eyes was frightfully common in the Middle Ages, mainly as a matter of punishment. It is said, for instance, that the Emperor Basil II. on one occasion put out the eyes of 15,000 Bulgarians, leaving one eye to one of every thousand, in order that he might lead his more unfortunate fellow-sufferers back to their ruler, who, it is said, at the sight of this outrage swooned and died in two days. It is said, too, that this is the reason why the Emperor Albrecht was one-eyed.

What the revival of learning could thus and did accomplish under these conditions as above portrayed may be readily appreciated. The restoration of Greek literature, the revival of anatomy, the habit of independent observation--all told materially in this renaissance of medicine. The Italian universities became the objective point of all who desired a thorough medical education. The students chose the lecturers and officers of the university and had a large voice in the construction of the curriculum. The officers of their selection negotiated with those of the State, at least until the close of the sixteenth century.

In spite of this general renaissance of medical learning and the impetus felt by the inspired few during the sixteenth century, it must be said that the general condition of medical science and of those who practised it was not greatly improved. The superstition of the common people and the timidity and indolence of all concerned were about as marked as they have ever been in the history of human error, and the practice of medicine was at least a century behind the applied knowledge of the other arts and sciences. At that time the best physicians and doctors were to be found in the Italian universities, the French coming next, and, last of all, the German. The Italian universities were the Mecca sought by those who desired the best education of the day, and of all the Italian medical faculties those of Bologna, Pisa, and Padua ranked highest.

Those were the days, also, of the travelling scholars--a very marked feature of mediæval life. They migrated from one of the Latin schools to another, and from one famous teacher to another, sometimes travelling alone, at other times in groups or bands, and practising often the worst barbarities while en route, supporting themselves by begging and stealing. On their marches they stole almost everything which was not tightly fastened down, and prepared their food even in the open fields. The result was that most of them fell into dissolute habits of life. A somewhat better class of vagrant students sang hymns before doors and received food as pay. Some earned money singing in the churches. They apparently both drank more beer and at less cost than at present. At that time the cost of beer was about one cent for a large glass.

The younger students were called "schutzen," and, like apprentices in trades, were obliged to perform the most menial duties. The older students were known as the "bacchanten," and each bacchant was honored in proportion to the number of "schutzen" who waited upon him. When, however, this bacchant himself reached the university he was compelled to lay aside his rough clothing and rude manners and take an oath to behave himself.

Not only the students, however, wandered from place to place, but even the professors of the sixteenth century were nomadic, wandering from one university to another; for example, Vesalius, the great teacher of anatomy, taught in Padua, in Pisa, in Louvain, in Basel, in Augsburg, and in Spain. These habits may be partly accounted for by the fact that the students elected at least some of their teachers, and the professors who failed of re-election certainly may be considered to have had a motive for moving on. Salaries were certainly not large in those days. Melanchthon, the great theologian, received during his first eight years a salary of $43 per annum, and by strict economy was able during this period to buy his wife a new dress. During his later years his salary attained the sum of $170, which would be equivalent to $750 to-day. When Vesalius died his salary was $1,000 per annum, to which certain fees were added. It is not strange, therefore, that many of the professors pursued reputable occupations during their odd hours or that they took students to board. We hear to-day of frequent illustrations of the pursuit of knowledge under difficulty, but certainly during the ages to which I have referred the ardent student, were he undergraduate or professor, put up with an amount of hardship, meagre fare, and trouble of all kinds which would stagger most of the young men of to-day.

Men were human then as now, and the universities were not above disputes and quarrels, which sometimes became very bitter and dishonorable, but were the indirect instrument of good, since they led in not a few instances to the founding of other universities. Thus, about the beginning of the sixteenth century, Pistorius and Pollich were both teachers in Leipzig, but holding antagonistic views regarding the nature of syphilis, became so embittered that they could not bear each other's presence, and each resolved to seek another home. The former influenced the elector to select Frankfort-on-the-Oder as the site of a new university, while the latter was the means of founding another at Wittenberg.

It is pretty hard to keep away from the relation of the barber to the anatomist and surgeon when discussing this subject. In another place I have dealt with the evolution of the surgeon from the barber, (See page 296) and have endeavored to show that the principal factor which operated to keep back the progress of surgery during the eighteen centuries previous to the last was the influence of the Church, which opposed the study of anatomy and degraded the practice of surgery. In the times to which I am referring now, an operation which caused the shedding of blood was considered beneath the dignity of an educated physician, and, in some circles, was regarded even as disreputable. It was, therefore, left to the only class of men who were supposed to know how to handle a knife or sharp instrument, i. e., the barbers. When operations were done in universities papal indulgences were often required, and these cost money, since in those days the Pope gave nothing for nothing. Public dissection required also papal indulgences, although in Strasburg, in 1517, permission to dissect the body of an executed criminal was granted by the magistrates in spite of papal prohibition.

The ceremonies attending demonstrations of this kind were both fantastic and amusing. A corpse was ordinarily regarded as disreputable, and had first to be made reputable by reading a decree to that effect from the chief magistrate or lord of the land, and then, by order of the University, stamping the body with the seal of the corporation. It was carried upon the cover of the box in which it had been transported into the anatomical hall, which cover, upon which it rested through the ceremonies, was taken back afterward to the executioner, who remained at some distance with his vehicle. If the corpse was that of one who had been beheaded, the head during the performance of these solemn ceremonies lay between its legs. After the completion of the ceremonies the occasion was graced with music by the city fifers, trumpeters, etc., or an entertainment was given by itinerant actors (Baas).

In time, however, this folly was given up, and by the latter half of the sixteenth century public anatomical theatres were established. The most celebrated was built by Fabricus ab Aquapendente, in Padua. It was so high, however, and so dark that dissections even in broad daylight could only be made visible by torchlight.

The zeal with which gradually the better class of physicians pursued their scientific studies became more and more conspicuous, evidenced in many ways by the hardships with which some of them had to deal, as witness the struggles of many of the great anatomists of those days.

And so in time the clergy disappeared almost entirely from the ranks of public physicians, and after the Thirty Years' War completely lost their supremacy even in literary matters, this being gradually usurped by the nobility and the more educated laymen; but even then knowledge was pursued under difficulties, especially the study of anatomy. It was not until 1658 that a mounted skeleton could be found in Vienna. Strasburg obtained one in 1671. The handling of the dead body, which we regard as so necessary, was in those days avoided as much as possible. The professor of anatomy rarely, if ever, touched it himself, but he lectured or read a lecture while the actual dissection was done with a razor by a barber, under his supervision.

Practical instruction in obstetrics, which would seem almost as important as that in anatomy, was not given in those days; male students only studied it theoretically. In the Hôtel Dieu, in Paris, that part which was devoted to instruction in midwifery was closed against men. It was the midwives in those days who enjoyed the monopoly of this teaching, and upon whom the greatest dependence for obstetrical ability was placed. The physicians proper, or medici puri of the seventeenth century, were individuals of greatest dignity and profoundest gravity, who wore fur-trimmed robes, perukes, and carried swords, who considered it beneath them to do anything more than write prescriptions in the old Galenic fashion. Some continuation of this is seen in the distinction made even to-day in England between the physicians who enjoy the title of doctor and the surgeons who affect to disdain it. These old physicians knowing nothing of surgery, nevertheless demanded to be always consulted in surgical cases, claiming that only by this course could things go right. Still when elements of danger were introduced, as in treating the plague, they were glad enough to send the barber surgeons into the presence of the sick, whom they merely inspected through panes of glass. Very entertaining pictures could be furnished you illustrating the habits of the physicians of two or three hundred years ago in dealing with these contagious cases. The masks and armor which they wore and the precautions which they took would seem to indicate protection rather against the weapons of mediæval warfare. At one time they were advised that if they must go into actual contact with these patients they should first repeat the Twenty-second Psalm. You may find in the old books, if you will hunt for them, curious pictures illustrating the precautions taken a few hundred years ago against the pestilence, of whose nature they knew nothing, and seeing them you may imagine the vague dread and even the abject fear which led the physici puri or physicians to send the barbers in to minister to plague-stricken patients, while they contented themselves with ministering at long range to their needs.

But gentlemen, I fear lest I weary you with a longer rehearsal of mediæval customs and student follies. While they have all passed away some of them have survived either in tradition or in modified form, as will surely have occurred to you while they were rehearsed. You will not fail to note the steady progress of an ethical evolution which has toned down the barbarities and the asperities of the past, and which has substituted a far more ennobling life-purpose and method of its accomplishment than seemed to actuate your predecessors of long ago.

It is small wonder that the students of those days bore an ill-repute with their surrounding neighbors. You may see better now, perhaps, why the medical student even of to-day has to contend with a prejudice against both his calling and himself, a prejudice begotten of the many debaucheries and misdeeds of his predecessors, and, I am sorry to say, even certain excesses of to-day. I do not know how I may more fittingly terminate these remarks than by reminding you that the profession which you students hope to enter has suffered most seriously in time past from the character of the men who have entered it, and that even to-day certain of its members fail to have a proper regard for its dignity. It is axiomatic that those slights and indignities from which we often suffer, and the neglect and indifference of which we often complain, are in effect the result of our own shortcomings, and that we are ourselves largely to blame because of that which does not suit us. I beg you then to remember that even at the outset of student life there should be ever before you such an ideal of intellectual force and dignity, of power, of co-ordination of mind and body, as may keep you ever in the right way, so that when you at last attain your goal you may deserve that sort of benediction which I find in one of Beaumont and Fletcher's plays (Custom of the Country, v. iv.):

"So may you ever Be styled the 'Hands of Heaven,' Nature's restorers; Get wealth and honors, and, by your success In all your undertakings, propagate A great opinion in the world."

A STUDY OF MEDICAL WORDS, DEEDS AND MEN

Address in Medicine, delivered June 24, 1902, at Yale University Commencement.

Study nature for facts; study lives of great men for inspiration how to use them

Never have I more earnestly craved the gift of eloquence than on occasions like this, when young men are about to leave the halls in which and the men with whom they have grown into man's estate, in order to assume the solemn and weighty responsibilities not only of their own lives but those as well of others. The day upon which you are thus released from duties of one kind to assume those of another, welcome and joyous though it may be, should nevertheless be interspersed with some serious and earnest thoughts and resolutions. Old Yale sets now her stamp upon you. It will prove a passport to many homes, but must never be abused. It will entitle you to the society of the cultivated and to the respect of scholars everywhere. It will admit you to the ranks of the learned and cause you to be treated with respect and equality by some of the profoundest and most scholarly thinkers the world has even known. Yale has now furnished you with that which her ripe experience has shown to be requisite for young men commencing professional careers. As contrasted with the total of human knowledge its aggregate is not large, but it has not for centuries been the custom for men to grow gray in studies before undertaking to practice medicine, and when your own qualifications are compared with those which we of the passing generation possessed at the corresponding period of our lives, the comparison will furnish at the same time the most startling illustration of the rapid advance of medicine in the past twenty-five years.

Yale has always been eminent for the versatility and originality of her teachers. Her medical history has been so well told during the past year by one of her most honored sons, Dr. Welch, that it is not necessary nor wise to go now into such historical details. The trend of science to-day is along the lines of comparative investigation, and the Bible is by no means the only literary collection which to-day is being subjected to the "higher criticism." The inspiration claimed for the contributors to that great ancient Collection is denied to the writers of great modern works, where, nevertheless, fundamental truth is as requisite for the welfare of the body as in the other for that of the soul. Only by painstaking research, laboriously repeated, do we clear the old paths of the rubbish of centuries or discover totally new ones.

Pathfinders of this description have always abounded in this great institution, drawn by common impulses or attracted by some centripetal force. And though it were perhaps invidious to mention names, I nevertheless must select two of Yale's great teachers whose names are still green in the memory of all men, and ask you to note how the examples they have set and the work they have done may furnish the line of thought in which I wish you to follow me for a little while.

The science of comparative philology would seem to be far removed from that of medicine. Still, it is based upon an ultimate analysis of parts of speech, and men like Professor Whitney were, not only the comparative anatomists, but even the histologists--if I may use the phrase--of words. Comparative philology then is to medical terminology what embryology and comparative anatomy are to a study of the structure of the human body. The philologist loves to dissect words and trace them back through rudimentary stages and roots to their earliest forms. He loves also to study the evolution of an idea as conveyed by a word, and trace atavism or reversion in human speech.

Again you have here at Yale a wonderful collection of extinct animal remains restored with marvellous accuracy to semblance of their original form and appearance. The indefatigable industry and wonderful ability of Professor Marsh and his co-workers have enabled us to form ideographs of the living forms of earlier geologic ages upon this earth, which could not have been furnished had it not been for their remarkable knowledge of morphology and skill in synthesis. Indeed, where have powers of analysis and synthesis been more brilliantly displayed than by these men. It used to be said of Cuvier, the great French comparative anatomist, that if given a tooth from any beast, past or present, he could describe the animal and its habits as well as reconstruct his skeleton, so wonderfully are minute differences perpetuated, and so familiar was he with them.

Let us see, then, if it be possible to take some of our common medical words and by applying to them the methods of Whitney and of Marsh follow them back to their early forms and significances, and then construct from them ideographs of the customs, habits and superstitions of the men who used them. Such a plan systematically carried out might furnish both a fitting and a novel introduction to the history of medicine. Coleridge, you know, said we might often derive more useful knowledge from the history of a word than from the history of a campaign.

Take, for instance, our word idiocy. The Greeks, especially the Athenians, were a race of politicians. Private citizens who cared little or naught for office were the idiotai, as distinguished from the public officials and office holders. It came about in time that men of such retiring habits and modest tastes were regarded as persons of degraded intellect and taste. And so the iviwrai were considered of inferior intellectual capacity. In other words, the idiot of those days was the man content with private life. How different from the present day when conditions seem so nearly reversed.

Our kindred word imbecile has also present reference to those of feeble, dwarfed or perverted intellect, and refers rather to mental than physical defects, though both must often be associated. But originally the lame and the deformed who were obliged to use artificial support, walked as it was said, in bacillum, upon a stick or crutch, and from this expression we derive our word imbecile.