Part 20

During the middle ages the greatest medical school in the world was situated at Salernum (or Salerno), but a short distance from Naples. This is not the place in which to discuss its history, although it became famous above almost every other institution of learning of any kind, and though, by one of the freaks of history, even the site of the buildings is now lost and no one seems to know just where they stood. In his time, namely, in 1240, the Emperor Frederick II was the great patron of this college; his decrees concerning the regulation of the study and practice of medicine deserve attention to-day. A part of one of his enactments reads as follows: "Since it is possible for a man to understand medical science only if he has previously learned something of logic, we ordain that no one shall be permitted to study medicine until he has given his attention to logic for three years. After these three years he may if he wishes proceed to the study of medicine." And again: "No surgeon shall be allowed to practise until he has submitted certificates in writing, of the teachers of the faculty of medicine, that he has spent at least one year in that part of medical science which gives skill in the practice of surgery, that in the college he has diligently and especially studied the anatomy of the human body, and is also thoroughly experienced in the way in which operations are successfully performed and healing afterwards brought about."

When first we hear of medical men in Great Britain they were commonly spoken of as leeches, as among the Danes and Saxons; later the clergy introduced books from Rome, and almost every Monastery had some brother possessed of more or less knowledge of the medicine of the day. The College of Salernum later gave great impetus to the study of medicine, even before the days of William the Conqueror, which was strengthened by the influence emanating from Naples, and particularly from Montpellier. For centuries the Catholic clergy were almost the only persons with sufficient education to study and practise physic; which profession became in time so lucrative that many of the monks abandoned their monasteries, neglecting their religious duties, and applied themselves to the study of medicine. To such an extent was this true that in 1163 the Council of Tours forbade monks staying out of the monastery for more than two months at a time, or teaching or practising physic. In taking this action the Council only repeated what had been ordained by decree of Henry III in 1216, and by the second Council of Lateran in 1139. No restraint was at first placed upon the secular clergy, and many of the Bishops and other church dignitaries gained both money and honor by acting as physicians to Kings and Princesses.

Next to the clergy the Jews possessed the largest share of learning. Their nomadic life permitted an intercourse with the different nations of the world, which was denied to most others, and there were many who studied medicine and practised, not only among those of their own race but amongst Moors and Christians alike. The priests became extremely jealous of Jewish physicians and of lay surgeons, and endeavored to secure through Rome a formal excommunication of all who committed themselves to the care of a Jew, while by canon law no Jew might give medicine to a Christian. But so celebrated were the Jewish physicians, and so superior to everything else was men's desire for life and strength, that even the power of Rome could not exclude them from practice. Still less could the clergy restrain the lay surgeons from the performance of their craft, and though it would appear that at first, in England, the priests were not disposed to separate surgery from medicine, the Pope became jealous of so much interruption to the duties of the clergy and looked upon the manual part of surgery as detracting from clerical dignity. Accordingly were made numerous attempts to debar priests from the performance of surgical operations. In 1215 the ecclesiastics were prohibited by Pope Innocent III from undertaking any operation involving the shedding of blood, while by Boniface VIII at the close of the thirteenth century, and Clement V, about the beginning of the fourteenth century, surgery was formally separated from physic and the priests positively forbidden to practice it. It is to the Church then that we owe this absolute abandonment of surgery to an illiterate and grasping laity. For some time, however, the priests kept their hold upon surgery by instructing their servants, the barbers, who were employed to shave their own priestly beards, in the performance of minor operations. It was these men, who were in some degree qualified by the instruction of the clergy, who first assumed the title of barber surgeons, and who gradually formed a great fraternity.

In France it was in the reign of Louis XIV that the hairdressers were formally separated from the barber-surgeons, the latter being incorporated as a distinct medical body. In London it was in 1375 that the Company of Barbers were practically divided into two sections, containing respectively those who practiced shaving, and those who practiced surgery. In 1460 the surgeons were finally incorporated by themselves as the Guild of Surgeons and took their place as one of the liveried companies of the city of London. Similar separation occurred in the original great Guild of Weavers, who divided into the Woollen Drapers and Linen Armourers, the latter afterwards becoming the wealthy and powerful Company of Merchant Tailors.

To trace the history of the London Company of Barbers a little more fully, it was first formed in 1308 and incorporated in 1462 by a charter. In one of the statutes of Henry VIII it was enacted that: "No person using any shaving or barbery in London shall occult (i. e. practise) any surgery, letting of blood or other matter except only drawing of teeth." In 1540 Parliament passed an act allowing the United Companies of Barbers and Surgeons each to have yearly the bodies of four criminals for dissection. In 1518 the barbers and surgeons were united in one company; the former being restricted from all operations except tooth drawing, and the latter having to abandon shaving and hair dressing.

It is interesting also to note that in Oxford, for instance, the Barbers, Surgeons, Waferers and Makers of "Singing bread" were all of the same fellowship, from 1348 to 1500; when, at last, the Cappers, or knitters of caps, were united to them, in 1551, the barbers and waferers abrogated their charter and took one in the name of the city, until 1675, when they received a charter from the University.

The London Guild of Surgeons appears to have been first a mere fraternity which had incorporated itself, and to have originated from an association of the military barber surgeons who had been trained in the hundred years war with France, 1337 to 1444. Its membership, however, was select, and when the physicians declined an alliance with it, it amalgamated with the barber companies in 1540. The United Company of Barbers and Surgeons was peculiar in that strangers and those who were not free men were admitted, while the journeymen of the craft formed a subordinate body within the company. In 1745 the surgeons separated from the barbers and formed a surgeon's company which rapidly acquired influence. By a foolish blunder it forfeited its charter in 1796 but was subsequently incorporated by George III, in 1800, as the Royal College of Surgeons in London; a body which has since maintained its identity, grown tremendously in wealth and strength, and having become one of the licensing bodies of England, has acquired the finest collection of books and specimens in the world and has numbered the brightest intellects which the English surgical profession has contained.

In Dublin the Barber Surgeons were incorporated as a guild by charter granted by Henry VI, in 1446. In 1576 they were amalgamated with the independent surgeons, and by Queen Elizabeth with the barber surgeons and wig-makers. This confraternity was dissolved in 1784 and the College of Surgeons founded immediately afterwards. In Edinburgh the barbers and surgeons were united in 1505, to be separated at about the same time as elsewhere in Great Britain.

During the eighteenth and nineteenth centuries on the continent medicine and surgery were abruptly separated, and the latter was almost entirely in the hands of the barbers. For hundreds of years the dissection of corpses and the embalming of those who could afford it, were in the hands of first the butchers and later of the barbers. The greatest contempt was everywhere shown for one who attempted any surgery. If for instance a nobleman while being bled by a barber received the slightest harm the poor barber was heavily fined, while, should the gentleman die, the culprit was given into the hands of the dead man's relatives to be dealt with as they desired. Throughout the monasteries and whenever the influence of the Church was felt it was forbidden to the monks, who had the monopoly of knowledge, to perform any surgical operation since the Church abhorred the shedding of blood.

I leave it to defenders of the Faith to reconcile this abhorrence with the persecutions of heretics and the tortures of the Inquisition permitted by the same Church.

For hundreds of years the monks were not allowed to wear a beard; this necessitated the employment of tonsors ("tonsorial-artists" they call themselves to-day) to whom was left also the performance of anything that partook of the nature of an operation, such as bleeding, bandaging, etc. This calling, was however, recognized as a most inferior one, and the barbers, like the bathkeeper, the shepherd and the hangman, were not considered of good repute. Consequently, such an one was not eligible for membership in any other guilds or fraternities. In 1406 the Emperor Wenzel was rescued from prison, in Prague, by the daughter of a bathkeeper; in gratitude he made her his mistress, and declared both barbers and bathkeepers to be respectable; but having lost his position his decree had no weight, and not until 1548, in Augsburg, were they really made eligible to the guilds. At this time their most dignified labor was the sharpening of instruments. In 1696 Leopold I. decreed their profession to be an art, and gave it a position above that of the apothecary so that in their most dignified occupation they were elevated to the making of ointments and plasters.

As surgery has for the profession of barber surgery to thank the existence upon man of a beard, so the European continent may thank the Crusaders of the eleventh century for having necessitated the existence of the bathkeeper, because of the leprosy which they brought home from the East. During the Crusades, as is well known, there were founded numerous Orders having for their original purpose the care and protection of pilgrims and injured soldiers. The three most celebrated Orders were the Knights of St. John, the Knights Templar and the Teutonic Order. Were this the place it would be most interesting to go into a history of these religio-medico-military Orders, and show how from most devout purposes and humble origin they grew into despotic and tyrannical associations of great power, which it finally took all the force of Church and State to suppress. As the then humble and enthusiastic members of these Orders returned from the Holy Land they established hospitals for the care of lepers, who became very numerous in Europe. For instance it is stated that in France, in 1225, there were two thousand hospitals for this purpose, while the King Louis the Great founded, in 1260, a special hospital for those made blind by Egyptian ophthalmia. It is well known also that during the middle ages there was the greatest neglect of the ordinary canons of cleanliness both among the upper and lower classes. The number of hospitals and cloisters dedicated to the lepers being insufficient, bath houses were built and bathkeepers were engaged in order, so far as possible, to prevent the spread of leprosy. At this time the bathkeeper was permitted to bathe and cup, later also to bleed, although the bleeding was required to be done in the bathkeepers' own house, since he was not usually permitted to enter a patient's house. As bathing became less necessary for purposes already mentioned the bathkeeper took to imitating the barber, though much later, and not until about 1750 in some countries, were they permitted to do this publicly, and only after having passed the examinations to which the barber was also subjected. In Prussia they were only allowed to treat wounds and chronic diseases, and so it came about that by the beginning of the eighteenth century a really conscientious and efficient barber surgeon was supposed to have served an apprenticeship in large hospitals, to have witnessed the work of noted surgeons and to have served in the Army or Navy. He was also supposed to be something of a linguist and to know a little botany; particularly was he expected to be conversant with anatomy, although there was a sad lack of cadavers--which was atoned for by the use of carcasses of animals, for the main part swine.

Eckardt, writing at this time of the sixteen different virtues of a barber, enumerated, first of all, fear of God; then that he should be careful, prudent, temperate, and ready to use both hands with equal dexterity; he claimed that "Arrogance seems most prevalent among barbers, as a common saying would imply 'barbers are proud animals.'" He expressed his surprise also at the envy and malice between bathkeepers and barbers, and advised them both to consult physicians and other masters.

The customs of the time must be blamed for this lamentable condition of affairs. The boy who was destined to become a barber was apprenticed at a time when he had scarcely learned to write. If he could write legibly and read a little Latin no one dared refuse him. He learned to shave and went from house to house for this purpose, spending the little time remaining in sharpening knives, spreading plasters, picking lint, taking care of children, doing all menial duties, and using the same light as the housemaid because it would have been disrespectful to his master's wife to use any other. After years of this work he was gradually taken to visit patients and then was taught how to bleed, cup, apply leeches, extract teeth and clysters. His master knowing nothing of anatomy could give him no instruction, though by the laws of apprenticeship he was bound to do so. Before concluding this apprenticeship he was supposed to pass an examination, which his master's laziness usually permitted him to escape. He then presented the master with some silver instruments and was dismissed with an injunction to be thankful that such a miserable specimen of God's creatures had ever been taught to shave a beard or spread a plaster. He now became a journeyman, still living at the house of his master, and was not allowed to marry; after a while he received a paltry sum as wages, got his dinners free and began to dabble on his own account. Study was out of the question; these men could not understand what little they did read and served the community mainly as bearers of tales. After some years of activity as journeyman they could become masters by applying to the authorities, presenting certificates, and passing an examination before the physicians of the district.

Prussia was the first country to appreciate the necessity of regulating medical practice, and the barbers and bathkeepers were placed under the control of the Medical College founded, in 1685, by Prince Frederick William. In 1724 this institution attained its greatest activity, having a subordinate school in each province. In 1725 King Frederick William issued a famous edict which did much to regulate medical affairs throughout the kingdom, and directed among other things that barbers and bathkeepers should "lead a religious, temperate, retired and sober life, in order to be at their best whenever their services were required." When their business was not sufficiently good they assumed other cares, as, for instance, one man was surgeon, municipal judge and post-master all at once. They were extremely envious of each other and often dabbled in medicine without permission. It was not until 1779 that the bathkeepers were permitted to rank in Prussia with the barbers, and were allowed to use more than four basins, the bathkeepers' guild being incorporated with that of the barber.

There being no temptation to enter these ranks it is not strange that so late even as 1790 good surgeons were rare in Germany; not one in fifty of the barbers really knowing the first principles of the work they were supposed to perform. It came to such a pass that surgeons were compelled to shave and perform other duties of the hairdresser, for no surgeon, however skilled, was allowed to practice as such, unless he was the proprietor of a head-shaving and bathing establishment, with assistants and apprentices, and belonged to the barbers' guild, or unless he was favored by Royal exemption. It was the general lament in Germany, all through the 18th century, that German surgeons were educated in barber shops. Even by the middle of that century the practice of surgery was not considered an honorable business, and those who practiced it were not permitted to carry a sword, neither was a surgeon admitted into society nor tolerated among physicians; moreover when unsuccessful he was bitterly and relentlessly pursued. Under existing conditions the Reichstag either could or would do nothing to alleviate the distressing condition. The physician boasted of his education and treated the surgeon and his craft with disdain, holding that surgery sustained the same relation to medicine that geometry does to higher mathematics and physics. All this time, however, while the physician contented himself with disdaining surgeons he made no attempt to elevate the craft nor to himself study and adorn it. Even by the beginning of the nineteenth century there were scarcely any physicians in Europe who could diagnose a surgical case, while dentistry they claimed called for no more skill than that sufficient for tooth extraction. It was even claimed that so long as the people generally were neglectful of their teeth the physician, or even the surgeon, should be ashamed to concern himself with dentistry.

Von Siebold, in his day, deplored the position of the surgeon; his large military experience had shown him the difficulties with which he had to contend before he could enter society, while his ambitions and high motives were scorned. Even the peasantry were bitterly opposed to all operations. So intense were their feelings that he repeatedly removed his patients to other towns before performing operations. Nevertheless it was true that there were the best of reasons for lack of confidence in any barber who dropped his razor for the purpose of treating a fracture, a hernia or an obstetric case. The State required a barber surgeon to call in a physician in all complicated surgical cases. In such a case the physician demanded the control of the case and reserved to himself the right to judge of what was required. He would not even consider a surgeon who had obtained the doctorate as his equal. Such consultations resulted in little but quarrels and disagreeable scenes. If a village contained no physician the surgeon treated also internal diseases, though he was not allowed to use strong medicines. Every district had its special surgeon who, alone, had charge of several villages where he had the right to keep journeymen and apprentices and to do shaving and cupping. In the Prussian capital city only twenty German and six French surgeons were allowed to practice in 1725, besides the court and private surgeons.

Until 1808 every German surgeon carried on a medico-legal business which was later separated from his surgery. In 1782 there were three classes of surgeons; from the lower one might be promoted to a higher after an examination. In Austria, in 1805, there were doctors of surgery who were required to show a general knowledge of medicine and who had the same rights as the physicians; there were also medical surgeons who could practice under restrictions, and bathkeepers for minor surgery. After the year 1773 barbers and bathkeepers were both spoken of in Austria as surgeons; this was to break up the disputes between them. According to an official feebill holding good in Prussia in 1815, the highest fee that could be charged for an operation was for lithotomy in adults, the maximum limit being about M. 140 ($35), while the majority of operations ranged from M. 20 to M. 50 ($5.00 to $13.00 expressed in U. S. money). Of course this was at a time when the value of money was much greater than now.

As already made plain, it was the Church which by its decrees brought about the separation of surgery from medicine, a condition not existing during the palmy days of Greece and Rome. Even the University of Paris at one time refused to admit a student who had not foresworn the study of surgery, while the denouncement of anatomy and surgery alike was promulgated by both papal bulls and clerical decrees. While many of the physicians considered surgery too burdensome a study, and many others had a severe prejudice against it, the principal cause operating to keep them apart was probably the fact that for surgeons there was absolutely no social position. In 1774 Mederer was made Professor of Surgery in Freiburg, in Breisgau; he delivered his opening address on the wisdom and necessity of combining medicine and surgery. As a result he was persecuted by the public, insulted by students, abused by surgeons and constantly threatened with personal assault. He maintained his position, however, and fought against the prejudice. Twenty-two years later, when he left Freiburg, he referred in his last lecture to his early experience. By this time public opinion had been so changed that the students serenaded him and humbly apologized for what their predecessors had done. Mederer could then see the success of his efforts in that the constitution of France contained a clause combining medicine and surgery, and the Royal Sanitary Commissioners of Vienna had unanimously resolved in favor of such union.

The movement begun by Mederer was continued by men like Richter, Von Siebold, Loder and others. In 1797, or over a hundred years ago, the Electoral Academy of Erfurt offered a prize for the best essay on the subject "Is it necessary and possible to combine medicine and surgery theoretically as well as practically?" Fourteen papers were submitted, of which twelve were in favor of union. Nevertheless the Academy awarded the prize to the only writer who had opposed such union. His reasons for such opposition were most puerile, as were all the arguments subsequently advanced against it. Nevertheless a great step was taken in advance, when the guilds and fraternities of barbers and bathkeepers were abolished, in which good work Vienna, in 1783, took the lead. It was then declared that shaving was the business of the hair-dresser, and that barber surgeons must attend lectures in surgery and anatomy. Bavaria followed in 1804, and four years later, in Prussia, no one was permitted to practice surgery without having studied medicine. The rules of 1786 regulating the respective positions and duties between physicians and surgeons were annulled in 1808, and by 1811 the barber license was no longer essential for the practice of surgery, the privileges of the barber, as such, being abolished, while for his trade only a common license was needed.

XII

THE STORY OF THE DISCOVERY OF THE CIRCULATION

A STUDY OF THE TIMES AND LABORS OF WILLIAM HARVEY

Address delivered at the Annual Commencement of the Medical Department of the University of Chicago, (Rush Medical College), June 13, 1906.

History in general is but a record of the succession of great events or epochs which have moulded the world's affairs. That which is of the greatest import in the life of the individual may count for little in the lives of his contemporaries, and yet it must be said that in the events of to-day there has occurred a great epoch in the life of each of you, presumably the most important as yet in your personal records. This day is then in your personal histories one of the greatest importance. It is desirable, therefore, that your lives be so moulded and influenced by it that you may long hence look back to it and recall its significance.

I do not know what advice I can give you which will be more fruitful of results, than that among your studies you include that of the lives of the great men who have moulded destiny and made the world's history. Their lives were modified by little things, as have been and will be yours, and yet out of small matters grew for them and for us some of the most far reaching effects. Select the really great men of whom you best happen to know and analyze their characters that you may appreciate how they have become great; while if they have, as all great men have, traits of smallness, study even wherein they are small, and how such faults may be avoided.

History runs as does a fairly steady stream, save that every now and then some event abruptly diverts its course or influences its current. It has been so, for instance, with the history of medicine. For the first sixteen hundred years of the Christian era men engaged in the crude practices of our profession, utterly ignorant of the course of the blood, as well as of its purposes. Then appeared upon the scene a man who did his own thinking, who was willing to free himself from the shackles of the past, to observe nature and to reason therefrom. In this way came suddenly upon the world, as it were, an appreciation of the Circulation of the Blood, than which perhaps no event in medical history has been of greater importance or reflected more credit upon its demonstrator.

It is my purpose, then, to-day to try to tell you, in a semipopular way, how William Harvey came to make this great discovery, as well as to give you some idea of the difficulties under which he worked, and of the men and influences that surrounded him, believing that rather than spend a half hour in humorous platitudes which may provoke a smile, but which are quickly forgotten, it is much better to try to implant something which may linger a while in your memories, and sufficiently impress you with the value of observation and inductive reasoning, since if you become thus fully impressed you will be spared in the future many sad errors of speech and even of thought.