CHAPTER XXXII. Some of the Leaders in Medicine in Italy, France and England

SOME OF THE LEADERS IN MEDICINE IN ITALY, FRANCE AND ENGLAND DURING THE SIXTEENTH AND SEVENTEENTH CENTURIES

Eminent French Physicians.--Among the physicians of France who attained a widespread and well-grounded celebrity throughout Europe during the sixteenth century, Pierre Brissot deserves to be given the first place. He was born in 1478 at Fontenay-le-Comte, not far from Rochelle, and was a professor of medicine at Paris. He attained considerable distinction, during the sixteenth century, by his advocacy of the superiority of the Hippocratic method of bloodletting over that introduced--or, rather, perpetuated--by the practitioners of that day in Central Europe. The rule which was laid down by Hippocrates was to the effect that, in venesection, the blood should be drawn from the vein lying nearest to the part inflamed. The Greek physicians of a later period forgot all about this rule and adopted in its place one that was based on the doctrine that venesection practiced in the vicinity of a focus of inflammation favors a determination of blood to that part and therefore does only harm; and they accordingly--especially in cases of pleuritis--abstracted blood from the arm on the side opposite to that on which the disease was located, or from one of the veins of the foot. This new rule was subsequently adopted by the Arabian physicians, and it remained in full force up to the end of the sixteenth century. A wide experience in the treatment of the epidemic pleuritis which raged in Paris in 1514 confirmed Brissot in the belief that the Hippocratic method is the one to be preferred; but, despite his pleadings, the Parisian physicians refused to adopt the method which he advocated and used their influence in securing from the French Parliament an order forbidding him to continue employing it in Paris. Discouraged by the treatment which he experienced in that city, Brissot removed to Lisbon in Portugal, and soon had occasion (in the epidemic which raged at Evora in 1516) further to satisfy himself that the Hippocratic rule is the correct one. But here too he encountered bitter opposition on the part of the Portuguese physicians; his most active opponent being Dionysius, the Physician-in-Ordinary to the King. Brissot then wrote an elaborate defense of the method which he advocated, and this treatise was submitted to the judgment of the Medical Faculty of the University of Salamanca. When the decision of this learned body was given in Brissot’s favor, his opponents, dissatisfied with the result, made still another effort to gain their point, viz., by appealing to the Emperor Charles the Fifth. They assured his Majesty that the Brissot Heresy, as they termed it, was fully as dangerous to the cause of humanity as that championed by Luther. But here again they failed. This final victory, however, brought no satisfaction to Brissot, who died of dysentery in 1522, just before the decision was rendered. Haeser speaks of this unusually bitter dispute as one of the last of the violent battles which occurred between the adherents of the Arabian physicians and the supporters of the teachings of Hippocrates, and which terminated in “a most brilliant victory of experience over Arabian dogmatism.”

(After the painting by Jan Steen, 1626–1679.)

One of this famous Dutch artist’s objects, in painting the scene here represented, was to satirize the practice, which was very prevalent among certain physicians of that period, of pretending to diagnose all sorts of maladies from the mere naked-eye inspection of his patient’s urine.

(Courtesy of Dr. Eugen Hollander, author of Die Medizin in der klassischen Malerei, Stuttgart, 1903.)]

During the first half of the sixteenth century there developed a belief, among the more ignorant physicians, that, in many cases of illness, important information may be derived from a simple naked-eye inspection of the patent’s urine as exposed to view in a flask-shaped glass vessel. In the Hippocratic writings no adequate grounds for such a belief are discoverable, but in one of Galen’s treatises there have been found statements which appear(?) to give some sanction to this new idea. However this may be, it is an established fact that uroscopy was taken up at the time named with great zeal by all the quacks in the land and by large numbers of practitioners of medicine who saw in this procedure an easy and safe method of bettering their fortunes. The public at large were greatly impressed with this new and wonderful manner of detecting disease, and for a long period--indeed, for more than half a century--this piece of clap-trap charlatanry continued to thrive, and to reflect only discredit upon the medical profession. There came a time, however, when people generally began to suspect that uroscopy was not all that the charlatans claimed it to be, and these suspicions were voiced in the popular saying, “The pulse is good, the urine is normal, and yet the patient dies.” The writers who were the most active in showing up the hollowness of the claims of the uroscopists were Scribonius of Marburg, Germany, Peter Foreest (1522–1597) of Alkmaar, Holland, and Leonardo Botallo of Asti, in Piedmont (born in 1530). The latter authority, it may be recalled, owes his chief distinction to the fact that he rediscovered what has been erroneously named in his honor the “foramen Botalli”--i.e., the ductus arteriosus in the foetus. He also attained some distinction in another direction. He revived the violent disputes about venesection by recommending a resort to this therapeutic procedure in nearly all illnesses. He went so far as to advocate four or five bloodlettings in the course of an acute attack, in each one of which operations from three to four pounds of blood should, as he believed, be abstracted. Indeed, he claimed that in an extreme case it might be perfectly proper to abstract as much as seventeen pounds(!). Inasmuch as Botallo’s practice was largely confined to the strong soldiers of Northern Italy it is easier to understand how such extravagant bloodletting did not more often prove fatal than it did. When, soon afterward, the Paris Faculty condemned the practice in the strongest possible terms, Botallo’s followers characterized sarcastically the French physicians as “pigmy bloodletters” (petits saigneurs).

But the efforts of Scribonius, Botallo and others to put an end to the uroscopy scandal were--I fully believe--not the only or perhaps even the most potent factors in bringing about the suppression of the evil. As many of our readers will remember, the art collections of European capitals contain admirably painted specimens of Dutch and Flemish genre pictures representing every phase of this uroscopic fraud, and these striking masterpieces, revealing, as they undoubtedly did to the community at large, the ridiculous character of the claims made by the charlatans, could scarcely have failed to give a deadly blow to the fraud. (See Fig. 17.)

In the early part of the sixteenth century Jean Fernel of Amiens (1497–1558) was one of the leading medical authorities of France. After receiving his degree of Doctor of Medicine at Paris, in 1530, he settled in that city and soon acquired considerable reputation, not only as a practitioner but also as a lecturer. In 1545 he was called upon to take charge, professionally, of Diane de Poitiers, the mistress of Henry, the son of Francis the First, King of France. About the same time he was asked to serve as First Physician to the Dauphin, but he was not disposed to accept the latter position, as he disliked the duties of the office and also because he feared that they would interfere with his favorite studies. He pleaded poor health, and his excuse was accepted as valid. That Fernel was held in very high esteem by the royal family is evident from the events which succeeded this refusal. In the first place, it was insisted that he should accept the stipend (600 livres) attached to the office, as a mark of the royal favor; and then, in 1547, when Henry was crowned king (Henry the Second), Fernel was urged to become his First Physician; but again he declined the honor, this time on the ground that Louis de Bourges, who had held the position with great credit under Francis the First (Henry’s father), was entitled to be retained in office. The King yielded to Fernel’s generous intervention in behalf of de Bourges. But in 1556, when the latter died, Fernel felt obliged to accept the position which had then become vacant; and from that time forward, until the time of his death on April 26, 1558, he accompanied the King on all his military expeditions. As he did not possess a robust constitution, his health suffered not a little from the frequent exposures to hardships of all sorts to which he was subjected; and, in addition, during this long period he saw very little of his wife to whom he was devotedly attached.

Fernel is universally admitted by French physicians to have been one of the most cultivated teachers and practitioners of medicine of his day. He was a very clear writer, and would doubtless have made a number of valuable additions to the science if he had not been carried off by illness at a comparatively early age.

Of his published writings the following are reckoned the most important: “Universa medicina,” Paris, 1567; “De abditis rerum causis,” Paris, 1548, and “Therapeutices universalis seu medendi rationis libri VII.,” Paris, 1554. (Many editions of each of these works were published.)

In his discussion of various questions relating to physiology Fernel maintains that the component elements of the body are vivified by means of heat, and he elaborates this idea very much in the same manner as Hippocrates does that of the “callidum innatum.” The spiritual life, he says, is presided over by the soul (“anima”). When he comes, however, to consider the individual powers of the soul, Fernel treats the subject exactly as does Galen. He gives expression to one rather bright idea: “The specific functions of each of the different organs may be inferred in large measure from the character of the structural elements of which they are composed.”

In his scheme of pathology Fernel divides diseases into simple (“similares”)--diseases of the tissues; compound (“organici”)--diseases involving entire organs; and complicated (“communes”)--diseases in which the normal relations between the different parts are broken up.

In the chapter which Fernel devotes to the subject of therapeutics, there is a section relating to venesection which, according to Haeser, is well worth reading, as it reveals the power of the writer to grasp the leading points and to reason correctly from them.

Two English Physicians Who Became Famous During the Sixteenth Century.--In the early part of the sixteenth century the medical profession of Great Britain was in a most unsatisfactory state. Humbuggery, ignorance and superstition were at that period of time the most prominent characteristics of the majority of physicians upon whom the people at large had to depend for the relief or cure of their bodily ailments, and there were very few and very untrustworthy measures in force for the production of a better class of practitioners. Just at this juncture there appeared on the scene a man who was eminently well equipped to rescue England from this lamentable state of affairs and to put her on the high road to the acquisition of an honorable body of medical men and of a corps of apothecaries who could be trusted to dispense pure drugs properly compounded. I refer to Thomas Linacre, who was born at Canterbury in 1461 or 1462, was a Fellow of All Souls College, Oxford, and a graduate of the University of Padua, and whose biography is sketched by John Freind (1675–1728) in such an admirably clear, concise and appreciative manner that I cannot do better--in view of the great importance of this event in the history of medicine in England--than to reproduce it here in considerable fulness of detail.

Thomas Linacre was a man of a bright genius and a clear understanding, as well as unusual knowledge in different parts of learning: ... and, being very desirous to make further improvements by travelling, he thought he could no where succeed in his designs so well as by going to Italy, which began then to be famous for reviving the ancient Greek and Roman learning. There he was treated with extraordinary kindness by Lorenzo de Medicis, one of the politest men in his age and a great patron of letters; who favoured him so far in his studies as to give him the privilege of having the same preceptors with his own sons. Linacre knew how to make all his advantages of so lucky an opportunity; and accordingly, by the instructions of Demetrius Chalcondylas, a native of Greece, he acquired a perfect knowledge of the Greek tongue; and so far improved under his Latin master Politian, as to arrive to a greater correctness of style than even Politian himself....

Having laid in such an uncommon stock of learning, he applied himself to the study of natural philosophy and physick; particularly he made it his business, and was the first Englishman who ever did so, to be well acquainted with the original works of Aristotle and Galen. He translated and published several tracts of the latter....

In his own Faculty he distinguished himself so much that, soon after his return, he was pitched upon by that wise king, Henry the Seventh, as the fittest person to be placed about Prince Arthur, and to take care both of his health and his education. He was afterward made successively Physician to that king, to his successor Henry the Eighth, and to the Princess Mary.... And indeed, as he was perfectly skilled himself in his own art, so he always shewed a remarkable kindness for all those who bent their studies that way; and wherever he found, in young students, any ingenuity, learning, modesty, good manners, and a desire to excel, he assisted them with his advice, his interest, and his purse. And to give a still stronger proof, how much he had the good of his own Profession and that of the Publick at heart, he founded two Lectures of Physick in Oxford, and one at Cambridge....

But he had still further views for the advantage of our Profession: he saw in how low a condition the practice of Physick then was, that it was mostly engrossed by illiterate monks and empiricks, who in an infamous manner imposed on the Publick; the Bishop of London or the Dean of St. Paul’s for the time being, having the chief power in approving and admitting the practitioners in London, and the rest of the bishops in their several dioceses. And he found that there was no way left of redressing this grievance, but by giving encouragement to men of reputation and learning, and placing this power of licensing in more proper hands. Upon these motives he projected the foundations of our College [of Physicians]; and using his interest at Court, particularly with that great patriot and munificent promoter of all learning, Cardinal Wolsey, he procured Letters Patent from the King, which were confirmed by Parliament, to establish a corporate Society of Physicians in this city, by virtue of which authority the College, as a corporation, now enjoys the sole privilege of admitting all persons whatever to the practice of physick, as well as that of supervising all prescriptions. And it is expressly declared that no one shall be admitted to exercise physick in any of the dioceses in England, out of London, till such time that he be examined by the President and three of the Elects, and have letters testimonial from them, unless he be a graduate in either University, who, as such, by his very Degree, has a right to practice all over England, except within seven miles of London, without being obliged to take any license from the Bishop....

By other Acts another weighty affair is committed to the care of the College, [viz.,] the visiting of shops and the inspection of medicines; a thing surely of as much consequence at least to the patient as to the prescriber....

Linacre was the first president of his new-erected college, and held that office for the seven years he lived after.... And perhaps no Founder ever had the good fortune to have his designs succeed more to his wish; this society has constantly produced one set of men after another, who have done both credit and service to their country by their practice and their writings.

If further evidence be needed to show what was the type of mind possessed by this remarkable English physician, I may be permitted to quote here a single brief statement made by his friend Erasmus, the famous Dutch scholar and theologian, in a letter addressed to John Fisher, Chancellor of Cambridge University: “Linacre is as deep and acute a thinker as I have ever met with.”

In England, during the seventeenth century, there appeared on the scene only one practicing physician of such conspicuous ability and of so marked personal traits of character as to place his name, after the lapse of a few years from the time of his death, and by the almost unanimous assent of his associates, high up on the roll of honor. I refer to the famous physician Sydenham.

(After the portrait in the hall of All Souls’ College, Oxford.)]

Thomas Sydenham was born at Wynford Eagle, Dorsetshire, England, in 1624. At the age of eighteen he entered Magdalen College, Oxford, and remained there until 1644, when he enlisted in the Parliamentary Army. After a brief military service, he resumed his studies at the university and received his Bachelor’s degree in 1648. It was only at a much later date (1676), however, that he was given (after he had pursued the prescribed course of studies) the degree of Doctor of Medicine,--and then not by Oxford, but by Cambridge. After leaving the university he first spent a few months at the Medical School of Montpellier, France, and then settled (1666) in London as a practicing physician, the necessary license having been granted him by the College of Physicians. His first medical treatise, which bore the title “Methodus Curandi Febres” [Method of Treating Fevers], was published in 1666. The third edition of this work was issued ten years later, but with the title changed to “Observationes Medicae etc.” Between 1666 and 1683 he published several other treatises, the more important of which deal with epidemic diseases--syphilis, small-pox, hysteria and gout.

During the later period of Sydenham’s career he attained great celebrity as a physician; but this celebrity would have been short-lived if it had rested on nothing more substantial than mere cleverness and professional success. As a matter of fact he had brought about, by his teaching and also by his example, a most important revolution in medicine, and it was the appreciation of this fact which led the physicians of England to bestow upon him, after his death, the appellation of “The English Hippocrates,” and which ultimately gave him so highly honorable a position in the history of medicine in general. A brief review of the state of medicine in England during the seventeenth century will enable the reader to understand the full importance of the change which Sydenham was instrumental in bringing about.

The physicians of that period were split up into three sects: the followers of Galen, with whom should be classed the Graeco-Arabists; the iatrochemists; and the iatrophysicists.

The Galenists were largely intent upon the strictest interpretation of the teachings of Hippocrates, Galen and some of the Arabian authors. Instead of studying disease itself they devoted their time and thoughts largely to the interpretation of the words used by these fathers in medicine--i.e., to philology. Real progress in the science of medicine was not possible along this route. Accepting without dispute the dogma of the four humoral qualities, together with the different temperaments which result from the predominance of any one of them, they combated these different temperaments or constitutions by prescribing drugs in a very great variety of combinations (polypharmacy).

The iatrochemists, attaching small importance to simple dietetic measures, prescribed without stint all the most active substances belonging to the mineral kingdom and all the new remedies which the chemists had evolved from their furnaces.

Finally, the iatrophysicists directed their efforts to the removal or diminution of all bodily conditions that appeared to act as mechanical hindrances to health.

Sydenham, who possessed a rare degree of common sense, cast aside all these hypotheses, disregarded the prevailing routine methods of treatment, and refused to accept the therapeutic novelties of the day. “Nature is to be my guide,” he declared, and from that time forward he studied disease at the bedside, and watched carefully, and with a mind free from prejudice, the effects of the remedies which he employed. Thus, pursuing the methods advocated by the great master Hippocrates, he was able to place his medical brethren once more on the pathway which leads to an increase in knowledge of the healing art. Practical medicine, which had previously been falling into an almost moribund condition, was by his efforts made again a living and growing science. That Sydenham had a perfectly clear conception of what was needed at that time to renew the vitality of the medical profession of England is plainly shown by the following statement which he makes in the dedication of one of his writings to Dr. Mapletoft:--

After studying medicine for a few years at the University of Oxford, I returned to London and entered upon the practice of my profession. As I devoted myself with all possible zeal to the work in hand it was not long before I realized thoroughly that the best way of increasing one’s knowledge of medicine is to begin applying, in actual practice, such principles as one may already have acquired; and thus I became convinced that the physician who earnestly studies, with his own eyes,--and not through the medium of books,--the natural phenomena of the different diseases, must necessarily excel in the art of discovering what, in any given case, are the true indications as to the remedial measures that should be employed. This was the method in which I placed my entire faith, being fully persuaded that if I took Nature for my guide, I should never stray far from the right road, even if from time to time I might find myself traversing ground that was wholly new to me.

In the brief account which I have thus far given of the part played by Sydenham in advancing the science of medicine, I have called attention only to the general character of the services which he rendered. It may now be interesting to furnish here a few details that will aid in completing the picture of this great English physician,--details relating to his life and personal character, to his views regarding certain diseases and the remedies which he was in the habit of employing for their relief or cure, and to his later writings.

Throughout the greater part of his professional career Sydenham was a frequent sufferer from gout, some of the attacks being of a severe type and occasionally of long duration. During the winter of 1676, for example, he was seriously ill from renal calculus, haematuria being brought on by the slightest movements of his body. All through the year 1677 he continued to experience frequent attacks of pain, and on one occasion he was unable to leave the house for a period of three months.

Speaking of the epidemic of the Plague in 1665, during the progress of which he left London, Sydenham says: “When I saw that the danger was in my immediate neighborhood I listened to the advice of my friends and joined the crowd of those who were fleeing to the country. A little later, when the epidemic had further increased in severity, and before any of my neighbors had returned, I yielded to the calls of those who had need of my services, and went back to London.” It is worthy of remark, says Laboulbène, who fully appreciated the heroism which prompted this last decision, that we should never have known of Sydenham’s weakness in regard to facing his duty, if he himself had not stated the facts. This famous epidemic, as is well known, was accompanied by an appalling mortality.

Andrew Browne, a Scotch physician of good standing, entertained serious objections to some of the advice given by Sydenham in the treatise entitled “Schedula monitoria de novae febris ingressu,” and, in order to learn more precisely what the author’s views on the subject really were, he decided to run down to London for a day or two. Sydenham gave him such a cordial reception and made his stay in the metropolis so pleasant that he remained there several months--instead of a day or two. “And when I returned to Scotland I felt contented and joyful as if I were carrying back with me a valuable treasure.”

As an instance of his thoughtful kindness, it is related that Sydenham had occasion to treat a poor man who lived in his neighborhood for an obstinate bilious colic, but his employment of narcotics did not effect very much in the way of relief. “I felt moved by pity for this poor man in his misery; and accordingly I loaned one of my horses to him in order that he might take long excursions on horseback.”

Sydenham had no eagerness for professional honors, although he appreciated highly those which came to him spontaneously. As already stated at the beginning of this sketch, the degree of Doctor of Medicine was not conferred upon him by Cambridge as a mere honorary affair, but was won by him after he had passed through the regular course of training required of all candidates for this degree. His case, however, was peculiar in one respect: he waited until after he had been in active practice several years before he decided to pass through the course of training required. He was not a member of the College of Physicians of London, and he held no official position at Court.

The following summary may serve to convey some idea of Sydenham’s views regarding pathology and treatment. He defines an acute disease as “a helpful effort made by Nature to drive out of the body or system, in every way possible, the morbific material.” As regards the latter he makes the following remarks:--

Certain diseases are caused by particles which are disseminated throughout the atmosphere, which possess qualities that are antagonistic to the humors of the body, and which--when once they gain an entrance into the system--become mingled with the blood and thus are distributed throughout the entire organism. Certain other diseases owe their origin to fermentations or putrefactions of the humors, which fermentations vary in their nature--in some cases the humors being excessive in quantity, while in others they are bad in quality; and in either event the body finds itself incapable of first assimilating them and then excreting them--a state of affairs which cannot continue beyond a certain length of time without producing further harmful effects.

According to Sydenham the fever, in the acute diseases, assists Nature by separating from the general (total) mass of the blood those particles which have undergone putrefaction or have been rendered unassimilable. Then they are driven out of the body by the route of the sweat-glands, by diarrhoea, by eruptions upon the skin, etc. On the other hand, in chronic diseases the morbific material is not of such a nature as to produce fever, which is a mechanism for securing complete purification. It is therefore deposited in one part or another of the body where no force exists which is capable of ejecting it; or its final transformation is not completed until after the lapse of a long period of time.

In some of Sydenham’s writings one is occasionally surprised to find teachings which seem to be strongly at variance with the advice which he was so fond of giving--namely, that physicians should be careful not to set up hypotheses which are not based upon observed facts. A conspicuous instance of such a disregard of his own rule may be found in his setting up of a pathological process to which he gives the name of “inflammation of the blood.” This process, he maintains, is the active cause of quite a large number of diseases, especially those of an epidemic nature--such, for example, as pleurisy, pneumonia, rheumatism, erysipelas, scarlet fever, etc. It is well-nigh impossible for us moderns to comprehend how so practical and clear-headed a man as Sydenham could have formulated such a purely hypothetical pathology, a doctrine so completely lacking in anything like a solid foundation of fact.

Sydenham excelled in the description of the clinical manifestations of certain diseases, as, for example, small-pox, hysterical affections, the encystment of a renal calculus, and the gout--a disease from which, as already stated, he was a very frequent sufferer throughout a large portion of his life. All his published works are in the Latin language, but translations have been made into English, French, German, Flemish and Italian. At All Souls College, Oxford, where Sydenham spent eight years of his life, it was a fixed rule that all its members should habitually converse and write in Latin.

Sydenham’s remarks upon liquid laudanum are worth recording:--

Of all the remedies which a kind Providence has bestowed upon mankind for the purpose of lightening its miseries there is not one which equals opium in its power to moderate the violence of so many maladies and even to cure some of them.... Medicine would be a one-arm man if it did not possess this remedy.... Laudanum is the best of all the cordials; indeed, it is the only genuine cordial that we possess to-day. [This was written in the middle of the seventeenth century.]

The laudanum employed by Sydenham was made according to the following formula: Spanish wine, 400 grammes; Opium, 62 grammes; Saffron, 31 grammes; Powder of Canella and Powder of Clove, of each 4 grammes.

After much suffering and extreme weakness, Sydenham died on December 31, 1689.

Andrew Browne, the Scotch physician of whom mention has already been made on an earlier page, makes the following comments on the closing days of Sydenham’s career: “It is a difficult matter to believe, and yet it is the truth: This great physician, who throughout his life gave the clearest proof of nobility of soul, generosity and clear-sightedness, died with the accusation hanging over his head that he was ‘an impostor and an assassin of humanity.’” Laboulbène adds: “After years of self-sacrifice in behalf of his fellow men Sydenham received as his final earthly reward calumny and ignominy, and the jealousy of many professional brethren.”