CHAPTER XXX. Advances Made in Internal Medicine and in the Collateral

ADVANCES MADE IN INTERNAL MEDICINE AND IN THE COLLATERAL BRANCHES OF BOTANY, PHARMACOLOGY, CHEMISTRY AND PATHOLOGICAL ANATOMY

General Remarks.--In the fundamental branches of medical knowledge--anatomy and physiology--advances of a very decided character were accomplished during the sixteenth and seventeenth centuries; and in the preceding chapters I have endeavored to give my readers some idea of the nature of these advances, of the men who were instrumental in effecting them, and of the extent to which the way was made easy, during this period, for the accomplishment of still further advances. In carrying on the work of correcting the many errors which were found to exist in the two departments mentioned, it was soon discovered that the obstacles to be overcome were of a serious character, and that the most formidable one of the group was what is universally known as Galenism. If I now refer to this subject once more, perhaps for the second or third time in the course of this history, it is because I fear that my remarks with regard to the harmful influence exerted by Galenism may not be rightly interpreted. For Galen’s personal character I entertain, as I have already stated in the section relating to Ancient and Mediaeval Medicine, the deepest respect, and I am filled with great admiration for what he accomplished in advancing the science of medicine; but at the same time I cannot overlook the fact that he was hemmed in by insurmountable limitations. No single human being, living at the beginning of the present era and surrounded, as Galen was, by a herd of jealous rivals, could have successfully bid defiance to those who considered it sacrilegious to dissect the dead body of a fellow man; and yet, without the knowledge which may only in this way be gained, how was it practicable for any individual, no matter how clever he might be, to lay the foundations for a further advance in medical knowledge? It seems to me therefore plain that Galen did all that lay in his power to advance the science of medicine; and whatever words of condemnation I may have employed in the text, when speaking of the Galenists, refer solely to those physicians of later centuries who were of such a narrow-minded type, so rigidly crystallized in the belief that Galen’s teachings had reached the limit of all possible knowledge in the science of medicine, that they did not hesitate to class the efforts of men like Vesalius as acts of unpardonable impiety. Galenism, then, refers to the very widely prevalent tendency among physicians of the fifteenth, sixteenth and seventeenth centuries to uphold the teachings of Galen as the only trustworthy code upon which they should depend for their guidance. In short, Galenism, at the period named, meant for medicine a complete arrest of development.

I have now arrived at a point in the history of medicine where, owing to the limited amount of space at my command, the difficulty of deciding as to what subjects and what individual workers in the field of medicine--a field now grown to very great proportions--shall receive consideration in my sketch. Having decided from the very outset that my best efforts shall be directed, consistently with a strict adherence to historical truth, toward making my account readable, I now find it absolutely necessary to jettison--if I may be permitted to use such a nautical expression--much really valuable cargo, and to put ashore, before continuing our voyage, many passengers of undoubted worth. Nobody need bemoan the loss of all these valuable treasures, for the great majority of them, I am confident, will be cared for properly by those authors who are privileged to treat this whole subject with some degree of thoroughness; and the reader, if he is familiar with German, will even now find, in the excellent general treatises of Haeser, von Gurlt, Pagel, Puschmann, Baas-Henderson and Neuburger, great stores of the most satisfactory information concerning the thousand and one details about which I am obliged to remain silent.

Internal Pathology.--During the fifteenth century the practitioners of medicine in Italy and France were still strongly under the influence of the teachings of the Arabian medical authors. One of the first writers in Italy to place the doctrines of internal medicine upon a firmer footing was Antonius Benevienus, a native of Florence (1440–1502). His treatise on some of the unusual causes of disease, which was printed in Florence in 1506, is said to be written in very clear language and to be based entirely upon cases which came under his own observation. According to Haeser the first improvements in the doctrines relating to pathological anatomy may be credited to Benevienus, who also taught that pathological phenomena should be studied by direct observation rather than from books.

Johannes Manardus of Ferrara (1462–1536) was a very sturdy opponent of astrology, and, in general, did all in his power to weaken the prevailing blind trust in the authority of the Arabian medical authors. But the two physicians who, next to Fabricius ab Acquapendente, stand out most conspicuously among their Italian contemporaries of the sixteenth and seventeenth centuries, are Fracastoro and Lancisi--the former a native of Northern and the latter of Southern Italy.

Hieronymus Fracastoro of Verona (1483–1553) ranks very high among the physicians of the first half of the sixteenth century for his valuable contributions to our knowledge of internal pathology. In the treatise which he published in 1546 on contagious maladies, he states in plain language his belief that the causes of diseases of this nature are to be found in living germs that are endowed with the power of propagating themselves. He divides these diseases into the following three groups:--

1, Those which infect only by contact; 2, Those which not only infect by contact, but at the same time leave behind a centre or focus of infection--in which category he places tuberculosis, elephantiasis, and similar diseases; and 3, Those which infect not only by direct contact, or through the agency of a residuary centre or focus of infection, but also those which are capable of spreading their infective elements over wide areas--for instance, the pestilential fevers, certain ophthalmias, variola, etc. (From Viktor Fossel’s version of Fracastoro’s treatise published in Leipzig in 1910.)

Speaking of tuberculosis (called by him “phthisis”), Fracastoro says that it is astonishing for how great a length of time the virus of this disease retains its infective power. “It has been noted, for example, that in quite a number of instances the clothes worn by a tuberculous patient have communicated the disease to a healthy individual as late as two years subsequently to the date at which they were removed from the original tuberculous individual.” The same power of communicating infection, he continues, may reside in such other objects as the bed, the walls and the floor of the room in which a tuberculosis patient has died. Under these circumstances, he adds, we are obliged to assume that germs of this infective disease have remained attached to the different objects mentioned.

Fracastoro was born in Verona, Italy, of parents who belonged to the patrician class and were in easy circumstances. He studied mathematics and philosophy at the University of Padua, and was quite prepared, on reaching the age of twenty, to pass the examinations required of candidates for the degree of Doctor of Medicine. Just at this time, however, Padua was not a safe place of residence, owing to the war that was threatened between the Emperor Maximilian the First and the Republic of Venice. Accordingly Fracastoro took his degree at the newly established Academy of Pordenone, in what is known to-day as the Province of Udine (northeast of Venice); and shortly afterward, upon the death of his father, he returned to Verona and began the practice of medicine. As he quickly gained the confidence of the people, he very soon found himself in a sufficiently prosperous condition to warrant him in retaining possession of the family residence, which was charmingly located at the foot of Monte Incaffi, midway between the Adige River and the Lake of Garda. Here it was that Fracastoro did a large part of his literary work, for he was a poet as well as a physician. Pope Paul the Third appointed him to the position of Physician-in-Ordinary to the Council of Trent, and it was by his advice that, upon the appearance of the Plague in that city, the sittings of the Council were thereafter held for a short season at Bologna. Later, still other honors fell to his lot. He enjoyed the esteem of the Emperor Charles the Fifth and of Francis the First, King of France; and the latter’s highly cultivated sister, Margaret of Navarre, offered him every inducement to settle at her Court, but the attractions of his own home made it easy for him to decline all these offers. He died at his villa on August 6, 1553, and six years later the city of Verona erected in his honor a marble memorial tablet.

Fossel, in his biographical sketch of Fracastoro, says that the most popular of his poetical writings was that entitled, “Syphilis sive morbus Gallicus.” It was published in several successive editions, and was translated into nearly all the languages of European countries. I shall have occasion to refer to it again in a later chapter.

Giovanni Maria Lancisi was born at Rome on October 26, 1654. Like Boerhaave he began his university studies under the service of the Church, but, as time went on, his leaning toward the profession of medicine became more and more pronounced, and he soon took up in earnest the study of that science at the University of Sapienza, devoting a large share of his time to dissecting and to clinical work in the hospitals. In 1672, when he was only eighteen years old, he was given the degree of Doctor of Medicine; and four years later, after a competitive examination, he was appointed an assistant at the Hospital of the Holy Ghost. In 1678 he was permitted, as a special honor, to enrol himself as a student in the Collège de Saint-Sauveur. During the following five years he enjoyed at this institution exceptional facilities for studying medical literature, and was thus able to accumulate an immense mass of useful extracts from the writings of the best authors. In 1684 he was assigned to the duty of teaching anatomy at the Sapienza, and for thirteen years he filled this post with great credit to himself; Malpighi being one of those who took pleasure in following his lectures. He had scarcely attained his thirtieth year when he was honored by being appointed Physician-in-Chief and Privy Councilor to Pope Innocent the Eleventh; and soon afterward he was made a Canon of the Church of Saint Lawrence, the main purpose of which appointment was to provide him with a suitable income. On the death of the Pope in 1689 he resigned the latter office, in order that he might have more leisure and freedom to pursue his professional duties. Subsequently he became the regular medical attendant, first of Pope Innocent the Twelfth and afterward of Pope Clement the Eleventh. He died on January 21, 1720.

Von Haller speaks of Lancisi as “a physician who was most highly esteemed by Pope Clement the Eleventh, who was very learned and very philanthropic, and who loved to give aid to the afflicted and to prevent litigation by wise counsels.” It was Lancisi also, as I have stated on a previous page, who discovered at Rome, in the possession of the heirs of the artist Pini who made the original drawings, the copper plates which Eustachius had ordered nearly two hundred years earlier, and which were to have been used by this celebrated anatomist in the production of a most beautiful set of anatomical illustrations.

The two most important original treatises published by Lancisi bear the following titles: “De motu cordis et aneurysmatibus” (on the movements of the heart and on aneurysms), Rome, 1728 (a later edition in 1745); and “De subitaneis mortibus Libri II” (on sudden deaths), Rome, 1707 (also later editions).

Botany and Botanical Gardens.--The Egyptians, the Persians, the inhabitants of India and China, and the ancient Greeks accumulated a great mass of information relating to plants which might be utilized in the treatment of different diseases. Then, in the early part of the present era, Galen contributed not a little to our further knowledge on this subject; but from that time forward, until the sixteenth century, pharmacology practically remained unchanged. The beginnings of a systematic study of all plants--in other words, modern botany--may be traced to the establishment of botanical gardens, first in Italy and afterward in Holland and France. According to Berendes the very earliest attempt in relatively modern times to cultivate such a garden was made at Salerno by Matthaeus Silvaticus. Then Master Gualterus, in 1333, was permitted by the Governing Council of Venice to make use of a certain plot of ground for the cultivation of the plants in which he was specially interested. So far as one may judge, however, both of these were private undertakings. In 1545, at the request of Francesco Buonafrede, Professor of Therapeutics at the University of Padua, the Senate of that city laid out a garden for his uses in teaching. This appears to be the earliest instance of the establishment of a botanical garden in connection with a regularly organized medical school. Then, in fairly quick succession, similar gardens were established at Pisa (1547), Bologna (1567), Leyden, Holland (by Boerhaave in 1577), and Heidelberg (1593). In France the University of Montpellier received its first botanical garden in the year last named. Thus it appears that about the middle of the sixteenth century botany began to receive attention as a branch of knowledge which, as was then believed, it was important for physicians to study; and from that time forward, for more than two centuries, it formed a regular part of the curriculum in all the leading medical schools. The two chairs of botany and anatomy were not infrequently combined. Fallopius, for example, held the Chair of Anatomy, Surgery and Botany in the University of Padua, and so also did Vesling in the same university at a somewhat later date. The first systematic works on botany were also published in the sixteenth century. They were all written by German or Swiss authors, the most noteworthy one of the collection being that of Conrad Gesner of Zürich (1516–1565), who is spoken of by Haeser as “a man of noble birth, of extraordinary industry, of extensive knowledge in every department of natural history, and the author of a large number of treatises, which, by reason of their intrinsic value, cannot fail to perpetuate the memory of this distinguished scientist throughout all time.” He had much to contend with throughout his short but eventful life. In the first place, he was very poor--so poor that both he and his young wife were obliged to support themselves during the early years of their married life by teaching school. Then he studied medicine at Basel, and afterward accepted the professorship of Greek, first at Lausanne and then in turn at Basel and at Zürich. From the beginning to the end of his career he was hampered by poverty and by frequent illnesses. But, despite these obstacles and also notwithstanding the fact that he was an indefatigable worker in matters relating to natural history, he is reported to have played one of the most influential parts in the drama of the Reformation. Only a man of exceptionally strong character and of unusual ability would have found it possible to attain the success which Gesner attained in these different undertakings and under such unfavorable circumstances. Andreas Caesalpinus, whom I have already mentioned as one of the earliest investigators of the question of the circulation of the blood, also interested himself in the science of botany. Puschmann speaks of him as the greatest botanist of the sixteenth century. For several years he was Professor of Philosophy and Medicine in the University of Pisa, but at a later date Pope Clement the Eighth chose him to be his private physician and also appointed him Professor of Medicine in the University of Sapienza at Rome. His death occurred in the latter city in 1603.

Before dismissing all further consideration of the part played by Italian and Spanish physicians during the sixteenth century in the advancement of the science of medicine, I shall briefly mention a few additional discoveries in botany and pharmacy that may serve to render the present account more complete. In 1518 the monk Romano Pane published the first account of the discovery of tobacco in America. In 1560 Jean Nicot, a French diplomatist, brought back with him from Portugal (to which country he had been sent as an ambassador) a small supply of the seeds of the plant. To commemorate this service the alkaloid found in the leaves of the tobacco plant was given the name of nicotine. Capsicum was made known to the world by Dr. Chanca, a companion of Christopher Columbus on the occasion of his second voyage (1493) to America. Balsam of Copaiva was discovered by a Portuguese monk in Brazil at some time between the years 1570 and 1600. It is mentioned for the first time in the Amsterdam Pharmacopoeia of 1636. Monardes described the Peruvian and Tolu balsams in 1565. Cacao was first made known to Europeans by Fernando Cortez in 1519. About the year 1550 coca was introduced as a drug that possesses the power of allaying hunger and of enabling one to endure the fatigues attending prolonged expeditions. Sarsaparilla came into use at about the same date. Then followed jalap in 1556 and sassafras toward the end of the century.

In Germany and in the Netherlands there were, during the sixteenth century, very few physicians who manifested any marked degree of learning in the science of medicine. The teachings of Paracelsus met with a favorable reception in these parts of Europe and they continued to hold supreme sway over the minds of men during a long period of time. There were some physicians, however, who had received their early professional training in Italy and France, and who for this reason were less ready to accept unreservedly the doctrines of Paracelsus; and, among these more independent spirits, Rembert Dodoens (Dodonaeus, 1517–1586) of Malines, near Antwerp, distinguished himself by making a number of valuable contributions to the science of medicine. He held the Chair of Medicine at the University of Leyden and was also the personal physician of the Emperors Maximilian the Second and Rudolphus the Second. He was a very accurate observer, and his writings are particularly rich in matters relating to pathological anatomy; for which reason not a few authorities are inclined to credit him with the honor of being the founder of this department of medical science. Felix Platter of Basel, Switzerland, of whose experiences as a student at the University of Montpellier I have given a brief account on a previous page, and who was at this time Professor of Medicine in his native city, was also greatly interested in pathological anatomy. Haeser gives him credit for publishing a number of valuable contributions to this department of medical knowledge, and also for making the first attempt at a classification of diseases.

Before I close this chapter it seems only fair that I should add a few comments upon the careers of two physicians whose professional attainments entitle them to some consideration. The men to whom I have reference are Marcello Donato and Raymond Minderer.

Marcello Donato was a distinguished medical practitioner of the city of Mantua, Northeastern Italy, who died about the year 1600. He was one of the few who, at that early period, taught that it was very important to study disease from nature--i.e., from direct observation--and not from books. His description of the epidemic of small-pox of 1567 (published at Mantua in 1569) is worthy of commendation. His chief work, however, is that which bears the title “De medica historia mirabili etc.” (Mantua, 1586.) It contains a remarkably large and complete collection of rare and extraordinary cases belonging to every department of medicine, and in his descriptions Donato pays particular attention to the pathologico-anatomical aspects of each case. He reports, for example, the instance of a Caesarian section performed on a living woman in 1540 by Christopher Bain; the child being found dead. Another interesting case reported by Donato is that of a child in whose ear a cherry pit had been allowed to remain undisturbed until it began to sprout; after which it was found easy to remove the impacted object. In a somewhat similar case which Donato also reports, the sprouting of the seed of Anagyris was hastened by the presence of a purulent discharge from the ear. In both instances all attempts to extract the foreign body had failed until the sprouting had caused the seed to split. Finally, there is recorded the case of a young man into whose nasal passage a leech had penetrated, while he was bathing, and had then taken up its abode far back in the canal. Donato, by aid of direct sunlight, “discovered the creature in that part where the nasal channel merges into the oral cavity.” Presumably he succeeded in removing the animal, but the text quoted by von Gurlt (Vol. II., p. 517) furnishes no further particulars.