CHAPTER XXIII. Further Progress of Medicine and Surgery in Western Europe

FURTHER PROGRESS OF MEDICINE AND SURGERY IN WESTERN EUROPE DURING THE THIRTEENTH, FOURTEENTH AND A PART OF THE FIFTEENTH CENTURIES

Among the men who, during the thirteenth century, exerted more or less influence upon the growth of medical knowledge there are three who deserve to receive some consideration at our hands. They were not physicians, but yet some of their writings deal with topics which are closely related to the science of medicine. They are: Albert von Bollstädt, a German who is generally known as Albertus Magnus, one of the greatest scholastic philosophers of the Middle Ages; Vincent of Beauvais (Vincentius Bellovacensis), a French Dominican monk, who was reader to Louis IX., and who compiled a general encyclopaedia which brought him great fame at that period; and Roger Bacon, an Englishman who, by reason of the extraordinary extent of his knowledge and his remarkable powers of observation, was given the name of “Doctor mirabilis.”

Albertus Magnus.--Albertus Magnus was born at Lauingen, Swabia, in 1193 A. D., obtained his education in Italy (at the University of Padua, during the latter part of his stay), joined the Order of the Dominicans on arriving at the age of thirty, and afterwards, throughout his long life, devoted himself largely to teaching, particularly at Paris and Cologne. He was a prolific writer and his works, particularly those which treat of topics belonging to the domain of natural history, were greatly appreciated. The effect, however, which they produced upon a certain class of readers was to persuade them that he was a great magician. The chief distinction of his writings lies in the fact that they contain a large number of original observations which he made during the course of his journeys afoot through Germany in the character of Provincial of the Dominican Order. This habit of exercising entire independence in the use of his reasoning powers was something quite rare in those days. His observations were directed chiefly to matters belonging to the domains of zoölogy, botany, climatology, mineralogy, chemistry and physics. The following significant advice, says Neuburger, is attributed to him: “As regards the doctrines which relate to questions of belief and of morality, it is the part of wisdom to attach greater authority to Saint Augustine than to the philosophers; in matters belonging to the domain of medicine put your chief trust in Galen and in Hippocrates; in natural history, however, your best guide is Aristotle.” Neuburger adds that, throughout the writings of Albertus Magnus, there appear interesting statements relating to anatomy, physiology, psychology, and the plants and minerals which may be used for remedial purposes.

An edition of the writings of Albertus Magnus (21 folio volumes) was published in Lyons by Petrus Jamy in 1651. The work was republished in Paris in 1892 and following years.

Vincent of Beauvais.--Vincent of Beauvais, France, a Dominican monk who lived during the first half of the thirteenth century and was the tutor of Louis the Ninth’s children, devoted the major part of his time to literary work. He wrote many theological treatises and also edited a large encyclopaedia in which information is furnished regarding everything that was known at that time. Several hundred authors aided him in compiling this work, which is entitled “Speculum Majus.” It is arranged in three parts, one of which (“Speculum Naturale”) consists of 33 books that are divided into 3740 chapters; and quite a number of the divisions are devoted to topics relating to medicine. The authors, from whose writings this medical information has been abstracted, are Hippocrates, Aristotle, Dioscorides, Haly Abbas, Rhazes, Avicenna and several others--not to mention the Church Fathers and other encyclopaedic writers connected with the Church. The first printed edition of this great work appeared toward the end of the fifteenth century (1473–1475 A. D.); the last, or one of the last, in 1624. Lack of space will not permit me to give any details concerning the works of a somewhat similar character which were prepared, about the same time, by the English Franciscan monk Bartholomaeus of Glanvilla (1260); by the Dominican, Thomas of Cantimpré (1204–1280 A. D.), a pupil of Albertus Magnus; and by others.

Roger Bacon.--Roger Bacon was born about 1210 A. D. in Ilchester, Somersetshire, England, and received his early training at Oxford. When he was thirty years of age he went to Paris and, after devoting himself assiduously for seven years to the study of various branches of learning, he received the Doctor’s degree (1247). The wish to acquire a thorough knowledge of whatever subject he undertook to study constituted a prominent feature of his character. He was fond of languages, but he had an even greater love for mathematics, particularly in connection with astronomy, and for experimental work in the department of chemistry. It is said that he expended a large sum of money (£2000) upon these chemical investigations. He left Paris in 1250, returned to England, and not long afterward joined the Order of the Franciscans. Robert Grossetête, Bishop of Lincoln, and the Franciscan monk Adam of Marisco--two men whom Neuburger describes as theologians of a very liberal type--exercised a strong influence upon Bacon at this period of his life. They confirmed him in the belief that familiarity with the learned languages was an acquisition greatly to be prized, and at the same time they gave him every encouragement to pursue his researches in mathematics and in natural history. For a certain length of time he was an instructor at Oxford, but his views with regard to ecclesiastic and moral questions and the discoveries which he made in physics (especially in optics) were beyond the comprehension of his contemporaries, who did not hesitate to pronounce them works of the Devil and to subject Bacon to all sorts of punishments and deprivations. Fortunately for him and for the cause of science the newly elected Pope, Clement IV. (1266), came to his rescue in those dark days and granted him--under the promise of absolute secrecy--permission to continue his researches without hindrance and to perfect the plans which he had in mind for reforms of different kinds. I cannot follow this pioneer of scientific research work, this man who was several centuries ahead of the time in which he lived, through all the vicissitudes of his interesting and extraordinarily fruitful life; I may simply add that his death occurred about the year 1294; that he left behind him many important treatises, only a small portion of which have thus far been published, and that from these alone one is justified in classing Roger Bacon as one of the greatest thinkers whom history has recorded. So far as is now known, he wrote very little concerning medicine, and--strange to say--he seems to have attached considerable importance to astrology; indeed, he went so far as to blame the physicians of his day for their ignorance regarding this science, “as a result of which they neglect the best part of medicine.” In strange contrast with these views, which to-day we characterize as foolishness, is Bacon’s famous dictum: “Experiment is a firmer and more trustworthy basis of knowledge than argument”--a maxim which is the guiding principle of modern medicine.

The Medical School of Bologna.--The Medical School of Bologna first began to assume a certain degree of prominence in the early part of the thirteenth century, under the teaching of Thaddeus Alderotti--also frequently called Thaddeus of Florence.

Thaddeus Alderotti.--Thaddeus Alderotti, who was born at Florence, Italy, 1223 A. D., of humble parentage, began the study of philosophy and medicine at Bologna only after he had reached manhood; but he was such an earnest student and made such good use of his opportunities that in 1260 he was chosen to serve as one of the teachers in the school. Throughout a period of many years he filled the office so acceptably that his colleagues bestowed upon him the name of “Master of Physicians.” Before this time arrived, however, his lack of funds was sorely felt, for he was obliged, in order to support himself, to offer consecrated wax candles for sale at the entrance of the church. He is reported to have been not merely a most learned physician, but also a very successful practitioner. He was called into consultation from all parts of the country, so highly was his opinion valued by other physicians; and thus in due time he accumulated a large fortune. His charges were by no means small. It is related, for example, that Pope Honorius IV. sent for him to come to Rome, and, after the treatment was completed, paid him a fee of 10,000 gold pieces--but not until after he had expressed surprise that Thaddeus should have charged as much as 100 gold pieces per day for his services. To this demurrer on the part of the Pope, Thaddeus replied that the petty princes and even the simple nobles made no objection to paying him 50 or more gold pieces per day. It is scarcely necessary to add that the Holy Father did not wish to be outdone by his inferiors.

Alderotti died 1303 A. D.

Among the writings of Thaddeus Alderotti which have come down to our time there are to be found a number of autobiographical references which are not without interest. In one place, for example, he mentions the fact that he occasionally walks in his sleep, and then proceeds (in Latin) to discuss the phenomenon of sleep-walking as observed in his own case. I give here a free translation of the text printed in Neuburger’s History:--

The fourth question which suggests itself is this: Can the senses during sleep come into active operation? Touching this fourth question I reason thus: It appears as if, when one is asleep, the senses must act, for a person may move about without incurring any harm when he is in that state, as is often observed in the case of those who, like myself, walk in their sleep.... Furthermore, it has been remarked that these people are able to harness a horse and then to ride the animal safely,--acts which it is not possible to perform without the aid of the senses. On the other hand, Aristotle maintains that a man, when asleep, is not capable of using his senses. To this I reply by conceding that during sleep a man certainly does not perceive what is going on about him. Wherefore, if you answer me by saying that the mere fact of a man’s ability to walk while he is asleep furnishes conclusive evidence that he possesses his senses, I reply that movements like that of walking are not the result of an impression made upon the mind (“impressio imaginativa”), but the product of a different mechanism, of a nature which permits it to operate during sleep.... As to the second point to which you call attention--that, namely, with regard to the power of bridling and riding a horse while one is asleep--I make this reply: These acts are performed as a result of an impression made upon the mind through the working of the imagination, and not as a direct consequence of any images created upon the eye; for, if the sleep-walker happens to be in a strange house when the impulse to walk seizes him, he will not go to the stable. The route which he is sure to take will be one with which he is familiar, as happened in the case of the blind teacher who, unaccompanied by any person, walked habitually through the streets of Bologna. And then, besides, I am able to speak from personal experience, for in one of my sleep walks I jumped down from an elevation about four feet above the ground without awaking from my sleep.... When, in the course of one of these walks, I am exposed to cold, or when I hear somebody speaking near me, I refer these phenomena entirely to something within myself, and I return to my bed.

Of the four medical schools to which a brief reference was made on a preceding page, that of Bologna was probably the first to attain a certain degree of celebrity; and it owed this distinction very largely to the work done by men who were primarily surgeons, viz.: Hugo of Lucca; Theodoric, Hugo’s son; William of Saliceto; and possibly, to a very slight extent, Roland of Parma, who spent only a part of his professional life in Bologna. But there was one other who, while he was not a surgeon, yet contributed very greatly to the fame of the Bologna school and at the same time to the real advance in surgical knowledge which characterized the work of the men whose names have just been mentioned--viz., Mondino. These men, especially Mondino, cultivated the study of anatomy much more earnestly than their rivals at Salerno had ever done, and the surgical methods which they adopted were of a more scientific character than those practiced by Roger. In the treatment of wounds, for example, instead of striving to bring about healing by the application of remedies which stimulate suppuration, they favored the dry method; in which practice they were justified not only by their own experience but also by Galen’s teaching: “A dry state of the wound approaches more nearly to what may be considered the normal condition, whereas a moist state is surely unhealthy.” (Methodi medend., IV., 5.) As an offset to the latter authority the Salerno surgeons quoted that particular aphorism of Hippocrates (V., 67) which reads: “Laxa bona, cruda vero mala.”--almost the very opposite of Galen’s doctrine. Then again, the Bologna surgeons effected improvements in other directions: They materially restricted the use of the red-hot cautery iron, and they cast aside as useless many of the complicated apparatuses which had previously been employed in the treatment of fractures and dislocations. It is evident from these facts that the Bologna surgeons were not, as were most of the physicians of the twelfth and thirteenth centuries (Thaddeus of Florence perhaps excepted), slavish followers of the ancients or even of the more modern Arabs, but men who thought independently and who were not afraid to use their own powers of observation.

Hugo of Lucca.--Hugo Borgognoni, more commonly called Hugo of Lucca--was born in that city about the middle of the twelfth century, served as municipal physician to the city of Bologna, accompanied the Bolognese Crusaders on their expedition to Syria and Egypt, was present at the siege of Damietta in 1219 A. D., and died a short time before 1258, at the age of nearly one hundred. He acquired a great reputation as a surgeon and brought up several sons who followed in the same walk of life, among the number being Theodoric, who gained even greater celebrity than his father in the domain of surgery. As Hugo himself left no writings of any kind, we are largely dependent, for a knowledge of his achievements, on the treatises which his son Theodoric wrote. From this source we learn that Hugo recommended, for use in surgical operations, the employment of narcotizing sponges like those described on page 253, and was also an advocate of the plan of treating wounds by the dry method (compresses soaked in wine over which simple dressings were applied). In the treatment of empyema, of abscesses, of penetrating wounds of the chest, and of both complicated and simple wounds of the skull, he emphasized the wisdom of adopting simple measures, of interfering with the parts as little as possible, of abstaining from the use of the probe, and of observing strict cleanliness. In cases of fracture of a rib it was his practice to place the patient in a bath, and then, with fingers which had been thoroughly oiled, to attempt the replacement of the separated ends of the fractured bone. Neuburger regards Hugo of Lucca as the founder of the Bologna School of Surgery.

Theodoric of Lucca, known also as Bishop Theodoric, was born 1206 A. D. While still quite a young man he joined the recently established order of preachers, and not long afterward was appointed Almoner (Poenitentiarius) to Pope Innocent IV. Eventually he became Bishop of Cervia, near Ravenna. By special permission of the Pope, he was able to complete the surgical training which he had received from his father, Hugo of Lucca; and thus, while he still held the office of Bishop, he practiced surgery to some extent in Bologna. In course of time his practice became very extensive and also very lucrative; as a result of which he was able to leave a large fortune to various charitable institutions. The first printed edition of his work on surgery appeared in Venice in 1498, and was followed by numerous later issues.

Theodoric, says Neuburger, was a most uncompromising advocate of the dry method of treating wounds. His (Theodoric’s) words are these: “For it is not necessary--as Roger and Roland have said, as most of their disciples teach, and as almost all modern surgeons practice--to favor the generation of pus in wounds. This doctrine is a very great error. To follow such teaching is simply to put an obstacle in the way of nature’s efforts, to prolong the diseased action, and to prohibit the agglutination and final consolidation of the wound.”

In his enumeration of the different means that may be employed for arresting hemorrhage, Theodoric mentions cauterization, tamponading, the application of a ligature, and the complete division of the injured blood-vessel. He attached great importance to the proper feeding of the patient. In Book III., chapter 49, of his treatise on surgery, he gives minute instructions with regard to the proper manner of employing a salve made with quicksilver, and at the same time he mentions the fact that he observed a flow of saliva as one of the results of its use.

The expressions “healing by first intention” and “healing by second intention” are encountered for the first time in the writings of Brunus, a surgeon who practiced in the cities of Verona and Padua about the middle of the thirteenth century, and who was a vigorous advocate of the dry method of treating wounds. His two treatises (“Chirurgia magna” and “Chirurgia minor”) were printed in Venice in 1546. Neuburger says that although a large part of the text in these volumes consists of extracts from Galen, Avicenna, Hippocrates, Abulcasis and other authorities, there are to be found at the same time not a few observations of an original character.

William of Saliceto.--William of Saliceto (Guglielmo da Saliceto) is accorded by Neuburger the honor of being Bologna’s greatest surgeon--if not, indeed, the greatest surgeon of that period. He was born in the early part of the thirteenth century and spent a large portion of his professional life in Bologna, where he not only practiced medicine but also acted in the capacity of a teacher of this science. During the latter part of his career he lived in Verona, where he held the position of Municipal Physician and Attending Physician of the City Hospital. He died about the year 1280.

Saliceto’s work on surgery is of a thoroughly practical character and reveals the author to have been a born surgeon. In addition to the “Cyrurgia,” which was first printed in Piacenza 1476 A. D., he wrote a treatise which bears the title “Summa conservationis et curationis” (printed first in Piacenza in 1475). The “Surgery” is divided into five books, preceded by a short chapter on general methods, etc. Book I. is devoted to affections of the cranium, eruptions on the head, eye diseases, ear diseases (snaring of ear polypi), nasal polypi, abscesses in the axilla, affections of the mammary gland, tumors in different parts of the body, venereal lesions in the groin, and a long list of other surgical maladies. Book II. describes wounds of all sorts, including those produced by arrows (with reports of cases), penetrating wounds of the chest and abdomen (with instructions about sewing both longitudinal and transverse wounds of the intestine), etc. Under the head of penetrating wounds of nerves (declared by the author to be very dangerous), Saliceto recommends enlargement of the wound, the application of oil, and the employment of opium or hyoscyamus to quiet the pain. Book III. treats the subject of fractures and dislocations in a most thorough manner. Mention is made of the crepitation noise heard in fractures (sonitus ossis fracti) and a warning is given not to apply the bandages too tightly and to be careful to change the dressings every three or four days. The instructions given with regard to the reduction of dislocations are said by Neuburger to be most sensible.