History of Medicine

The history of medical science, considered as a part of the general history of civilization, should logically begin in Mesopotamia, where tradition and philological investigation placed the cradle of the human race. But, in a condensed article such as this, there are important reasons which dictate the choice of another starting point. Modern medical science rests upon a Greek foundation, and whatever other civilized peoples may have accomplished in this field lies outside our inquiry. It is certain that the Greeks brought much with them from their original home, and also that they learned a great deal from their intercourse with other civilized countries, especially Egypt and India ; but the Greek mind assimilated knowledge in such a fashion that its origin can rarely be recognized.

MYTHICAL, HOMERIC, AND PRE-HIPPOCRATIC TIMES

Greek medical science, like that of all civilized peoples, shows in the beginning a purely theurgical character. Apollo is regarded as the founder of medical science, and, in post-Homeric times, his son Æsculapius (in Homer, a Thessalian prince) is represented, as the deity whose office it is to bring about man's restoration to health by means of healing oracles. His oldest place of worship was at Tricca in Thessaly. The temples of Æsculapius, of which those at Epidaurus and Cos are the best known, were situated in a healthy neighbourhood. The sick pilgrims went thither that, after a long preparation of prayer, fasting and ablutions, they might, through of mediation of the priests, receive in their dreams the healing oracles. This kind of medical science already shows a rational basis, for the priests interpreted the dreams and prescribed a suitable treatment, in most cases purely dietetic. Important records of sicknesses were made and left as votive-tablets in the temples. Side by side with the priestly caste, and perhaps out of it there arose the order of temple physicians, who, as supposed descendants of the god Æsculapius, were known as the Asclepiadae , and formed a kind of guild or corporation. This separation of offices must have occurred at an early time, for even in Homer we find lay physicians mentioned, especially "the sons of Æseulapius", Machaon and Podalirius. In the vegetable drugs of Egyptian origin mentioned in Homer we recognize the early influence of the country of the Pharaohs upon Greek medical science. The schools of the philosophers likewise exerted no small influence upon development, medical problems being studied by Pythagoras of Samos, Alcmaeon of Crotona, Parmenides of Elea, Heraclitus of Ephesus (sixth century B.C.), Empedocles of Agrigentum, and Anaxagoras of Clazomenae (fifth century B.C.). The earliest medical schools were at Cyrene in Northern Africa, Crotona, Cnidus and Cos. From Cnidus came Euryphon and also Ctesias the geographer, who was at first physician in the army of Cyrus and, after the battle of Cunaxa (401 B.C.), to Artaxerxes Memnon. Of greater interest is the medical school adjoining the shrine of Æseulapius at Cos, for from it arose the man who first placed medicine upon a scientific basis, and whose name is even today well known to all physicians, Hippocrates.

HIPPOCRATES AND THE SO-CALLED CORPUS HIPPOCRATICUM

Tradition knows seven physicians named Hippocrates, of whom the second is regarded as the most famous. Of his life we know but little. He was born at Cos in 460 or 459 B.C., and died at Larissa about 379. How great his fame was during his lifetime is shown by the fact that Plato compares him with the artists Polycletus and Phidias. Later he was called "the Great" or "the Divine". The historical kernel is probably as follows: a famous physician of this name from Cos flourished in the days of Pericles, and subsequently many things, which his ancestors or his descendants or his school accomplished, were attributed to him as the hero of medical science. The same was true of his writings. What is now known under the title of "Hippocratis Opera" represents the work, not of an individual, but of several persons of different periods and of different schools. It has thus become customary to designate the writings ascribed to Hippocrates by the general title of the "Hippocratic Collection" (Corpus Hippocraticum), and to divide them according to their origin into the works of the schools of Cnidus and of Cos, and of the Sophists. How difficult it is, however, to determine their genuineness is shown that even in the third century before Christ the Alexandrian librarians, who for the first time collected the anonymous scrolls scattered through Hellas, could not reach a definite conclusion. For the development of medical science it is of little consequence who composed the works of the school of Cos for they are more or less permeated by the spirit of one great master. The secret of his immortality rests on the fact that he pointed out the means whereby medicine became a science. His first rule was the observation of individual patients, individualizing in contradistinction to the schematizing of the school of Cnidus. By the observation of all the principles were gradually derived from experience, and these, uniformly arranged, led by induction to a knowledge of the nature of the disease, its course, and its treatment. This is the origin of the famous "Aphorismi", short rules which contain at times principles derived from experience and at times conclusions drawn from the same source. They form the valuable part of the collection. The school of Cos and its adherents, the Hippocratics, looked upon medical science from a purely practical standpoint; they regarded it as the art of healing the sick, and therefore laid most stress on prognosis and treatment by aiding the powers of nature through dietetic means, while the whole school of Cnidus prided itself upon its scientific diagnosis and, in harmony with money with the East, adopted a varied medicinal treatment. The method which the school of Cos established more than 2000 years ago has proved to be the only one, and thus Hippocratic medial science celebrated its renascence in the eighteenth century with Boerhaave at Leyden and subsequently with Gerhard van Swieten at Vienna. In his endeavour to the truth the earnest investigation often reaches an impassable barrier. There is nothing more tempting than to seek an outlet by means of reflection and deduction. Such a delusive course may easily become fatal to the physicist ; but a medical system, erected upon the results of speculative investigation, carries the germ of death within itself.

THE DOGMATIC SCHOOL

In their endeavour to complete the doctrine of their great master, the successors of the Hippocratics fell victims to the snares of speculation. In spite of this, we owe to this so-called "dogmatic school " some fruitful investigation. Diocles Carystius advanced the knowledge of anatomy, and tried to fathom the causal connection between symptom and disease, in which endeavours he was imitated by Praxagoras of Cos, who established the diagnostic importance of the pulse.

Unfortunately, there already began with Aristotle (38-22 B.C.) that tendency -- later rendered so fatal through Galen's teaching -- to regard organic structure and function not in accordance with facts but from the teleological standpoint.

THE ALEXANDRIAN PERIOD

The desire to give to medicine a scientific basis found rich nourishment in the ancient civilized soil of Egypt under the Ptolemies. Herophilus of Chalcedon (about 300 B.C.) and Erasistratus of Iulis (about 330-240 B.C.) are mentioned in this connection. As anatomists, they were the first systematic investigators, and, following Hippocrates, they tried to complete clinical experience by exact methods. This tendency was opposed by the empires, whose services lay solely in the field of drugs and toxicology. Erasistratus as well as Philinus, the empiric, attacked the doctrine of humors (humoral pathology), which developed out of the Hippocratic tendency. The former alone was a serious opponent since, as an anatomist, he looked for the seat of the disease in the solid parts, rather than in the four fundamental humors (blood, mucus, black and yellow gall) and their different mixtures.

THE METHODIZERS

One of the opponents of humoral pathology was Asclepiades of Prusa in Bithynia (born about 124 B.C.). He tried to use in medicine the atomistic theory of Epicurus and Heracleides of Pontus. He taught that health and disease depend upon the motion of the atoms in the fine capillaries or pores, which, endowed with sensation, pass through the entire body. With Themison as their leader, the followers of Asclepiades simplified his doctrine by supposing disease to be only a contraction or relaxation, and later only a mixed condition (partly contracted, partly relaxed) of the pores. This simple and convenient explanation of all diseases without regard to anatomy and physiology, taken in conjunction with its allied system of physical dietetic therapeutics, explains why this doctrine enjoyed so long a life, and why the works of the methodist, Caelius Aurelianus of Sicca in Numidia (beginning of fifth century A.D.), were diligently studied down to the seventh century.

GALEN

Departure from the Hippocratic observation of nature led physicians to form numerous mutually opposing sects. A man of great industry and comprehensive knowledge, Galen of Pergamum (about A.D. 130-201), tried to rescue medical science from this labyrinth. He chose the path of eclecticism, on which he built his (as he thought) infallible system. Whatever sense-perception and clinical observation left obscure, he tried to explain in a speculative manner. That this system of teaching could hold medicine in bondage until modern times shows the genius of the master, who understood how to cover up the gaps by brilliancy of style. Galen took the entire anatomical knowledge of his time, and out of it produced a work the substance of which was for centuries regarded as inviolable. His anatomy was to a large extent based upon the dissection of mammals, especially of monkeys, and, like his physiology, was under teleological influence. His presentation of things lacks dispassionateness. Instead of explaining the functions of organs on the basis of their structure, Galen chose this reverse method. His anatomy and physiology were the most vulnerable part of his system, and an earnest re-examination of these fields must necessarily have shaken his entire scheme of teaching. Galen expressed the greatest respect for Hippocrates, published his most important works with explanatory notes, but never entered into the spirit of the school of Cos, although he adopted many of its doctrines. Galen is the culminating point and end of ancient Greek medical science. In his vanity he thought he had completed all investigation, and that his successors had only to accept without effort what he had discovered. As will be shown in the following paragraph, his advice was, unfortunately for science, followed literally.

PEDANIUS DIOSCURIDES

Pedanus Dioscurides, who was from Anazarbe and lived in the time of Nero and Vespasian, may be mentioned here as the most important pharmaceutical writer of ancient times. He simplified greatly the pharmacopoeia, which had then assumed unwieldy dimensions, and freed it from ridiculous, superstitious remedies. Our modern pharmacology is based on his work, Ta ton tylikon biblia .

CORNELIUS CELSUS

Cornelius Celsus (about 25-30 B.C. to A.D. 45-50) is the only Roman who worked with distinction in the medical field, but it is doubtful whether he was a physician. His work, "De re medica libri viii", which is written in classical Latin, and for which he used seventy-two works lost to posterity, gives a survey of medical science from Hippocrates to imperial times. Very famous is his description lithotomy. Celsus was altogether forgotten until the fifteenth century, when Pope Nicholas V (1447-55) is said to have discovered a manuscript of his works.

BYZANTINE PERIOD

In Byzantine times medicine shows but little originality, and is of small importantance in the history of medical development. The work handed down to us are all compilations, but as they frequently contain excerpts from lost works they are of some historical value. The notable writers of this period are: Oreibasios (325-403), physician in ordinary to Julian the Apostate ; and Aëtius of Amida, a Christian physician under Justinian (597-66). A little more originality than these men exhibited was shown by Alexander of Tralles (525-605), and Paulus Ægineta of the first half of the seventh century, of whose seven books, the sixth, dealing with surgery, was greatly valued in Arabian medicine. Paulus lived at Alexandria, and was one of the last to come from its once famous school, which became extinct after the capture of the city by Omar in 640. At the end of the thirteenth century Nicolaus Myrepsus, living at the court in Nicaea, made a collection of prescriptions which was extensively used. In the time of Emperor Andronicus III (1328-42) lived a highly gifted physician, Joannes Actuarius, and the mention of his writings closes the account of this period.

ARABIAN MEDICINE

Arabian medical science forms an important chapter in the history of the development of medicine, not because it was especially productive but because it preserved Greek medical science with that of its most important representative Galen. It was, however, strongly influenced by oriental elements of later times. The adherents of the heretic Nestorius, who in 431 settled in Edessa, were the teachers of the Arabs. After the expulsion these Nestorians settled in Dschondisapor in 489, and there founded a medical school. After the conquest of Persia by the Arabs in 650, Greek culture was held in great esteem, and learned Nestorian, Jewish, and even Indian physicians worked diligently as translators of the Greek writings. In Arabian Spain conditions similarly developed from the seventh century. Among important physicians in the first period of Greek-Arabic medicine -- the period of dependence and of translations -- come first the Nestorian family Bachtischua of Syria, which flourished until the eleventh century; Abu Zakerijja Jahja ben Maseweih (d. 875), known as Joannes Damascenus, Mesue the Elder, a Christian who was a director of the hospital at Bagdad, did independent work, and supervised the translation of Greek authors, Abu Jusuf Jacub ben Ishak ben el-Subbah el-Kindi (Alkindus, 813-73), who wrote a work about compound drugs, and the Nestorian Abu Zeid Honein ben Ishak ben Soliman ben Ejjub el 'Ibadi (Joannitius, 809-about 873), a teacher in Baghdad who translated Hippocrates and Dioscurides, and whose work "Isagoge in artem parvam Galeni", early translated into Latin, was much read in the Middle Ages. Wide activity and independent observation -- based, however, wholly upon the doctrine of Galen -- were shown by Abu Bekr Muhammed ben Zakarijia er-Razi (Rhazes, about 850-923), whose chief work, however, "El-Hawi fi'l Tib" (Continens) is a rather unsystematic compilation. In the Middle Ages his "Ketaab altib Almansuri" (Liber medicinalis Almansoris) was well known and had many commentators. The most valuable of the thirty-six productions of Rhazes which have come down to us is "De variolis et morbillis", a book based upon personal experience. We ought also to mention the dietetic writer Abu Jakub Ishak ben Soleiman el-Israili (Isaac Judaeus, 830-about 932), an Egyptian Jew ; the Persian, Ali ben el Abbas Ala ed-Din el-Madschhusi (Ali Abbas, d. 994) author of "El-Maliki" (Regalis dispositio, Pantegnum). Abu Dshafer Ahmed ben Ibrahim ben Abu Chalid Ihn el-Dshezzar (d. 1009) wrote about the causes of the plague in Egypt. A work on pharmaceutics was written by the physician in ordinary to the Spanish Caliph Hisham II (976-1013), Abu Daut Soleiman ben Hassan Ibn Dsholdschholl.

Of the surgical authors, Abu'l Kasim Chalaf ben Abbas el-Zahrewi of el-Zahra near Cordova (Abulkasem, about 912-1013) alone deserves mention, and he depends absolutely on Paulus Ægineta. While he received scant attention at home, since surgery was little cultivated by the Arabs, his work, written in a clear and perspicuous style, became known in the West through the Latin translation by Gerardus of Cremona (1187), and was extensively used even in later days. Arabian medicine reached its culmination with the Persian Abu Ali el-Hosein ben Abdallah Ibn Sina ( Avicenna, 980-1037), who based his system entirely upon the teaching of Galen and tried in various ways to supplement the latter. His chief work, "El-Kanûn" (Canon Medicinae), written in a brilliant style and treating all branches of medical science, soon supplanted in the West the works of the Greeks and, until the time of the Humanists, served as the most important textbook for physicians, but in Arabian Spain his fame was small. One of his chief rivals was Abu-Merwan Abd el-Malik ben Abul-Ala Zohr ben Abd el-Malik Ibn Zohr (Avenzoar, 1113-62) from the neighbourhood of Seville. His friend, the philosopher and physician Abul-Welid Muhammed ben-Ahmed Ibn Roshd el-Maliki ( Averroës, 1126 -98), of Cordova, is regarded as the complement of Avicenna. His book was also popular in the West and bears the title "Kitâbel-Kolijjat" (Colliget). With the decline of Arabian rule began the decay of medicine. In the Orient this decline began after the capture of Cordova in 1236, decay becoming complete after the loss of Granada in 1492. The predominance of Arabian medicine, which lasted scarcely three centuries, seriously delayed the development of our science. A brief survey of this period shows that the Arabs bent in slavish reverence before the works of Aristotle and Galen without examining them critically. No other Greek physician obtained such a hold on the Arabs as Galen, whose system, perfect in form, pleased them in philosophy. Nowhere did dialectics play a greater part in medicine than among the Arabs and their later followers in the West. Independent investigation in the fields of exact science, anatomy, and physiology was forbidden by the laws of the Koran. Symptomatology (semiotics) at the bedside, especially prognosis, based on the pulse and the of the urine, were developed by them with an equally exaggerated and fruitless subtlety. Much, and perhaps the only credit due to them is in the field of pharmaceutics. We are indebted to them for a series of simple and compound drugs of oriental and Indian origin, previously unknown, and also for the polypharmacy of later times. Until the discovery of America the Venetian drug-trade was controlled by Arabian dealers.

CHRISTIANITY'S SHARE IN THE DEVELOPMENT OF MEDICAL SCIENCE

As long as the cruel persecution the Church lasted throughout the Roman Empire, it was impossible for Christians to take direct part in the development of medical science. But provision had been made for medical aid within the community, because the priest, like the rabbi of small Jewish communities in the late Middle Ages, was also a physician. This is clear from the story of the two brothers, Sts. Cosmas and Damian, who studied medicine in Syria and were martyred under Diocletian. The exercise of practical charity under the direction of deacons of the churches gave rise to systematic nursing and hospitals. In recent times it has, indeed been alleged that the existence of hospitals among the Buddhists, even in the third century before Christ, and their existence in ancient Mexico at the time of its discovery is demonstrable, and that hospitals had their origin in general philanthropy; but nobody denies that the nursing of the sick, especially during epidemics, had never before been so widespread, so well organized, so self-sacrificing as in the early Christian communities. Christianity tended the sick and devised and executed extensive schemes for the care of deserted children (foundling, orphans ), of the feeble and infirm, of those out of work and of pilgrims. The era of persecution ended, we find large alms-houses and hospitals like that of St. Basilius in Caesarea (370), those of the Roman Lady Fabiola in Rome and Ostia (400), that of St. Samson adjoining the church of St. Sofia in Constantinople in the sixth century, the foundling asylum of Archbishop Datheus of Milan in 787, and many others. In 1198 Pope Innocent III rebuilt the pilgrims' shelter, which had been founded in 726 by a British king, but had been repeatedly destroyed by fire. He turned it into a refuge for travellers and a hospital, and entrusted it to the Brothers of the Holy Ghost established by Guy de Montpellier. Mention must also be made here of the religious orders of knights and the houses for lepers of later times. The great hospitals of the Arabs in Dschondisapor and Bagdad were built after Christian models. The celebrated ecclesiastical writer Tertullian (born A.D. 160) possessed a wide knowledge of medicine, which, following the custom of his time, he calls a "sister of philosophy ". Clement of Alexandria, about the middle of the century, lays down valuable hygienic laws in his "Paedagogus". Lactantius in the fourth century speaks in his work "De Opificio Dei" about the structure of the human body. One of the most learned priests of his time, St. Isidore of Seville (d. 636), treats of medicine in the fourth book of his "Origines S. Etymologiae". St. Benedict of Nursia (480) made it a duty for the sciences, and among them medicine, as aids to the exercise of hospitality. Cassiodorus gave his monks direct instructions in the study in medicine. Bertharius, Abbot of Monte Cassino in the ninth century, was famous as a physician. Walafrid Strabo (d. 849), Abbot of Reichenau the oldest medical writer on German soil, describes in a poem ( Hortulus ) the value of native medicinal plants, and also the method of teaching medicine in monasteries. We must mention, furthermore, the "Physica", a description of drugs from the three kingdoms of nature, written by St. Hildegarde (1099-1179), abbess of a monastery near Bingen-on-the-Rhine. The curative properties of minerals are described by Marbodus of Angers, Bishop of Rennes (d. 1123), in his "Lapidarius".

How diligently medicine was studied in the monasteries is shown by the numerous manuscripts (many still unedited) in the old cathedral libraries and by those which were taken from the suppressed monasteries and are now to be found in the national libraries of various countries. Priests who possessed a knowledge ot medicine served as physicians-in-ordinary to princes as late as the fifteenth century, although they were forbidden to practice surgery by the Fourth Synod of the Lateran (1213). Thus, Master Gerhard, parish priest in Felling, who founded the Hospital of the Holy Ghost at Vienna (1211), was physician-in-ordinary to Duke Leopold VI of Austria, and Sigismund Albicus, who afterward became Archbishop of Prague (1411), held the same office at the court of King Wenzel of Bohemia (1391-1411). From this time, we constantly meet with priests possessing a knowledge of medicine and writing on medical subjects. The popes, the most important patrons of all the sciences, were friendly also to the development of medicine. That they ever at any time forbade the practice of anatomical investigation is a fable. Pope Boniface VIII in 1299-1300 forbade the practice then prevalent of boiling the corpses of noble persons who had died abroad, in order that their bones might be more conveniently transported to the distant ancestral tomb. This prohibitory rule had reference only to cases of death in Christian countries, while in the Orient (e.g. during the Crusades ) the usage seems to have been tacitly allowed to continue.

FIRST UNIVERSITIES IN THE WEST

Having voluntarily undertaken the education of the young in all branches of learning, the monasteries were aided in their endeavours by both Church and State. The foundation of state schools is the work of Charlemagne (768-814), whose activity, especially in the Germanic countries, was stimulated by the decree of the Synod of Aachen (789), that each monastery and each cathedral chapter should institute a school. According to the Capitulary of Charlemagne at Diedenhofen (Thionville) in 806, medicine was commonly taught in these schools. At the diocesan school in Reims, we find Gerbert d'Aurillac, later Pope Sylvester II (999-1003), long active as a teacher of medicine. Simultaneously with the rise of the cities there sprang up higher municipal schools, as for instance the Burgerschule at St. Stephan's in Vienna (about 1237). Out of the secular and religious schools, the curriculum of which institutions comprised the entire learning of the times, the first universities developed themselves partly under imperial and partly under papal protection, according as they sprang from the lay and the cathedral or monastic schools.

SCHOOL OF SALERNO

This is regarded as the oldest medical school of the West. Salerno on the Tyrrhenian Sea, originally probably a Doric colony, was from the sixth to the eleventh century under the rule of the Lombards, and from 1075 to 1130 under that of the Normans. In 1130 it became a part of the Kingdom of Naples and Sicily. The origin of the school is obscure, but, contrary to former belief, it was not a religious foundation, though very many priests were engaged there as teachers of medicine. Women and even Jews were admitted to these studies. Salerno was destined to cultivate for a long time Greek medical science in undimmed purity, until the twelfth century saw the school fall a victim to the all-powerful Arab influence. One of its oldest physicians was Alpuhans, later (1058-85) Archbishop of Salerno. With him worked the Lombard Gariopontus (d. 1050), whose "Passionarius" is based upon Hippocrates, Galen, and Caelius Aurelianus. Contemporary with him was the female physician Trotula who worked also in the literary field, and who is said to have been the wife of the physician Joannes Platearius. Perhaps the best known literary work of this school is the anonymous "Regimen sanitatis Salernitanum" a didactic poem consisting of 364 stanzas, which has been translated into all modern languages. It is said to have been dedicated to Prince Robert, son of William the Conqueror, upon his departure from S. Salerno in 1101. An important change in the intellectual tendency of the "Civitas Hippocratica", as this school called itself, was brought about by the physician Constantine of Carthage (Constantinus Africanus), a man learned in the Oriental languages and a teacher of medicine at Salerno, who died in 1087 a monk of Monte Cassino . While hitherto the best works of Greek antiquity had been known only in mediocre Latin translations, Constantine in the solitude of Monte Cassino began to translate to translate from the Arabic, Greek authors (e.g. the "Aphorisms" of Hippocrates and the "Ars parva" of Galen), as well as such Arabic writer as were accessible to him (Isaak, Ali Abbas). As he brought to the knowledge of his contemporaries first-class Greek authors, but only secondary Arab writers, the study of the former became more profound, while on the other hand an interest was awakened in the hitherto unknown Arabic literature. His pupils were Bartholomaeus, whose "Practica" was translated into German as early as the thirteenth century, and Johannes Afflacius (De febribus et urinis). To the twelfth century, when Arabian polypharmacy was introduced, belong Nicolaus Praepositus (about 1140), whose "Antidotarium", a collection of compounded pharmaceutical formulae, became a model for later works of this kind, and Matthaeus Platearius, who, towards the end of the century, wrote a commentary on the above-named "Antidotarium" (Glossae) and a work about simple drugs (Circa instans). Similar productions appeared from the hand of an otherwise unknown Magister Solernitanus . Maurus, following Arabian sources, wrote on uroscopy. Here must be also mentioned Petrus Musandinus (De cibis et potibus febricitantium), the teacher of Pierre Giles of Corbeil (Ægidius Corboliensis), who later became a canon and the physician-in-ordinary to Philip Augustus of France (1180-1223), and who even at this day began to complain about the decay of the school.

Its first misfortune dates from the death of King Roger III (1193), when the army of King Henry VI captured the city. The establishment of the University of Naples by Frederick II in 1224, the preponderance of Arabian influence, and the rise of the Montpellier school, all exerted so unfavourable an influence that by the fourteenth century Salerno was well-nigh forgotten. Salerno is the oldest school having a curriculum prescribed by the state. In 1140 King Roger II ordered a state examination to test the proficiency of prospective physicians, and Frederick II in 1240 prescribed five years of study besides a year of practical experience. When we consider the proximity of Northern Africa, that the neighbouring Sicily had been under Saracenic rule from the ninth to the eleventh century, and that the Norman kings, and to a far greater degree Frederick II, gave powerful protection to Arabian art and science, it seems wonderful that this oasis of Graeco-Roman culture endured so long. Down to the twelfth century this school was ruled by a purely Hippocratic spirit, especially in practical medicine, by its diagnosis and by the treatment of acute diseases dietetically. Arabian influence makes itself felt first of all in therapeutics, a fact which is easily explained by the proximity of Amalfi, where the Arabian drug-dealers used to land. Local conditions (resulting from the Crusades ) explain how surgery, especially the treatment of wounds received in war, was diligently cultivated. In Rogerius we find a Salernitan surgeon armed with independent experience, but showing, nevertheless, reminiscences of Abulhasem. His "Practica Chirurgiae" dates from the year 1180. Although Salerno finally succumbed to Arabian influences, this school did not hand down to us a knowledge of the best Arabian authors.

SPAIN AS THE TRANSMITTER OF ARABIAN MEDICINE

Its focus was the city of Toledo, which was taken from the Moors in 1085 by Alfonso VI of Castile and Leon. Here Archbishop Raimund (1130-50) founded an institution for translations, in which Jewish scholars were the chief workers. Here lived Gerard of Cremona (1114-87, properly Carmona, near Seville), the translator of Rhazes and Avicenna. A later translator of Rhases (about 1279) was the Jew Faradsch ben Salem (Faragius), who was educated at Salerno.

THE SCHOLASTIC PERIOD

When in the twelfth century all the Aristotelean works gradually became known, one of the results was the development of Scholasticism, that logically arranged systematic treatment and explanation of rational truths based upon the Aristotelean speculative method. Even though this tendency led to the growth of many excrescences in medicine and confirmed the predominance of Galen's system, also largely based on speculation, it is wrong to hold Scholasticism responsible for the mistakes which its disciples made in consequence of their faulty apprehension of the system, because Scholasticism, far from excluding the observation of nature, directly promotes it. The best proof of this is the fact that the most important scholastic of the thirteenth century, St. Albertus Magnus, was likewise the most important physicist of his time. He thus imitated his model, Aristotle, in both directions. The famous scholastic Roger Bacon (1214-94), an English Franciscan, lays chief stress his theory of cognition upon experience as far as the natural sciences are concerned, and this with even greater emphasis than Albertus Magnus .

Albertus Magnus

Albertus Magnus (Albert Count of Bollstädt, 1193-1280) was a Dominican. For medical science his works about animals, plants, and minerals alone concern us. Formerly a work called "De secretis mulierum" was wrongly attributed to him. Albertus's most eminent service to medicine was in pointing out the way to an independent observation of nature. The following books were to a certain degree based upon the writings of Albertus: the encyclopedic works on natural history of the Franciscan Bartholomaeus Anglicus (about 1260), of Thomas of Cantimpré (1204-80), canon of Cambrai, of Vincent of Beauvais (d. 1264), the "Book of Nature " by Kunrad von Megenberg (1307-74), canon of Ratisbon, and the natural history of Meinau composed towards the end of the thirteenth century at the Monastery of Meinau on the Lake of Constance. In the medical schools the influence of scholasticism made itself felt, but this influence was always favourable. The scholastic physician, the philosopher at the bedside, with his compendious works of needy contents, with his endless game of question and answer, must not, however, be misjudged; he preserved interest in the observation of nature and was, as is freely conceded, a skilful practitioner, although he laid excessive stress upon formalism, and medicine in his hands made no special progress.

BOLOGNA

Bologna was the principal home of scholastic medicine, and, as early as the twelfth century, a medical school existed there. The most famous physician there was Thaddeus Alderotti (Th. Florentinus,1215-95), who even at that time gave practical clinical instruction and enjoyed great fame as a physician. Among his pupils were the four Varignana, Dino and Tommaso di Garbo, and Pietro Torrigiano Rustichelli -- later a Carthusian monk -- all well-known expounders of the writings of Galen. Indirect disciples were Pietro de Tussignana (d. 1410), who first described the baths at Bormio, and Bavarius de Bavariis (d. about 1480) who was for a long time physician to Pope Nicholas V.

Bologna and the Study of Anatomy

Bologna has stained incomparable glory from the fact that Mondino de Liucci (about 1275-1326), the reviver of anatomy, taught there. There, for the first time since the Alexandrian period (nearly 1500 years), he dissected a human corpse, and wrote a treatise on anatomy based upon personal observation -- a work which, for nearly two and a half centuries, remained the official textbook of the universities. Although Mondino's work which appeared in 1316, contains many defects and errors, if nevertheless marked an advance and incited men to further investigation.

PADUA

Padua, the famous rival of Bologna, received a university in 1222 from Frederick II. Just as the University Of Leipzig originated in consequence of the migration of students and professors from the University of Prague in 1409, so Padua came into existence through a secession from Bologna. Bologna was soon surpassed by the daughter institution, and, from the foundation of the University of Vienna in 1365 until the middle of the eighteenth century, Padua remained a shininng model for the medical school of Bologna. The first teacher of repute was Pietro d' Abano (Petrus Aponensis, 1250 to about 1320), known as the "great Lombard" -- an honorary title received during his residence at the Universlty of Paris. On account of his too liberalistic opinions and his derision of Christian teaching in his "Conciliator differentiarum", his chief medical work, he was accused of being a heretic. From this period also date the "Aggregator Brixiensis" of Guglielmo Corvi (1250-1326), a work in even greater demand in later times, and the "Consilia" of Gentile da Foligno (d. 1348), who, in 1341, performed the first anatomical dissection in Padua. The fame of the school of Padua was greatly advanced by the family of physicians, the Santa Sophia, which about 1292 emigrated from Constantinople, and whose most famous members were Marsilio (d. 1405) and Galeazzo (d. 1427). The latter, one of the first teachers in Vienna (about 1398-1407), and later professor at Padua, wrote in Vienna a pharmacopoeia which indicates absolutely independent observation in the field of botany. His antithesis and contemporary was Giacomo dalla Torre of Forli (Jacobus Foroliviensis, d. 1413), professor at Padua, known for his commentary on the "Ars parva" of Galen. Giacomo de Dondi (1298-1359), author of the "Aggregator Paduanus do medicinis simplicibus", tried to disengage a salt from the thermal waters of Abano, near Padua. As anatomist and practitioner we must mention Bartholomaeus de Montagnana (d.1460), and the grandfather of the unfortunate Savonarola, Giovanni Michele Savonarola (1390-1462), author of the "Practica Major", who worked along the same lines.

MONTPELLIER

The earliest information about the medical school of this place dates from the twelfth century. Like Salerno, Montpellier developed great independence as far as the other schools were concerned, and laid the greatest stress upon practical medicine. With the decay of Salerno, Montpellier gained in importance. The chief representative of this school is the Spaniards, Arnold of Villanova (1235-about 1312). His greatest merit is that, inclining more towards the Hippocratic school, he did not follow unconditionally the teachings of Galen and Avicenna, but relied upon his own observation and experience, while employing in therapeutics a more dietetic treatment as opposed to Arabian tenets. To him we are indebted for the systematic use of alcohol in certain diseases. A very doubtful merit is his popularizing of alchemy to the study of which he was very much devoted. Other Montpellier representatives of purely practical medicine are Bernard of Gordon (d. 1314; "Lilium medicinae", 1305) a Scot educated in Salerno ; Gerardus de Solo (about 1320; "Introductorium juvenurn"); Johannes de Tornamira (end of the fourteenth century, "Clarificatorium juvenum"), and the Portuguese Valeseus de Taranta ("Philonium pharmaceuticum et chirurgicum", 1418). The medical school of Paris, founded in 1180, remained far behind Montpellier in regard to the practice of medicine.

SURGERY IN THE AGE OF SCHOLASTICISM

Surgery exhibited during this period in many respects a more independent development than practical medicine, especially in Bologna. The founder of the school there was Hugo Borgognoni of Lucca (d. about 1258). A more important figure was his son Teodorico, chaplain, penitentiary, and physician-in-ordinary to Pope Innocent IV , later Bishop of Cervia. In his "Surgery", completed in 1266, he recommends the simplification of the treatment of wounds, fractures, and dislocations. Guilielmo Saliceto from Piacenza (Guil. Placentinus), first of Bologna, then at Verona, where he completed his surgery in 1275, shows great individuality and a kneen diagnostic eye. Similarly his pupil Lanfranchi strongly recommended the reunion of surgery and internal medicine. Lanfranchi, banished in 1290 from his native city, Milan, transplanted Italian surgery to Paris. There the surgeons, like the physicians of the faculty, had, since 1260, been formed into a corporation, the College de St. Cosme (since 1713 Academie de Chirurgie), to which Lanfranchi was admitted. His "Chirurgia magna" (Ars completa), finished in 1296, is full of casuistic notes and shows us the author as an equally careful and lucky operator. The first important French surgeon is Henri de Mondeville (1260-1320), originally a teacher of anatomy at Montpellier whose treatise, although for the most part a compilation, does not lack originality and perspicuity. The culminating point in French surgery at this period is marked by the appearance of Guy de Chauliac (Chaulhac, d. about 1370). He completed his studies at Bologna, Montpellier, and Paris ; later he entered the ecclesiastical state (canon of Reims, 1358), and was physician-in-ordinary to popes Clement VI, Innocent VI, and Urban V. From him we have a description of the terrible plague which he witnessed in 1348 at Avignon. His "Chirurgia magna" treated the subject with a completeness never previously attained, and gave its author during the following centuries the rank of a first-class authority. Among contemporary surgeons in other civilized countries we must mention John Ardern (d. about 1399), an Englishman, who studied at Montpellier and lived subsequently in London, famous for his skill in operating for anal fistulæ, and Jehan Yperman of the Netherlands (d. about 1329), who studied in Paris under Lanfranchi. Besides these surgeons where is no doubt that there were then in Italy many a number of itinerant practitioners who offered their services at fairs; as, specializing usually in certain operations (hernia and lithotomy), they often possessed great skill, and their advice and assistence of a wrong tendency in medicine, but they sought by people of the upper classes.

SIGNS OF IMPROVEMENT: HUMANISM

A short of the survey of the scholastic period gives us the following picture: On the appearance of Arabic literature in Latin translations, Hippocratic medicine was driven from its last stronghold, Salerno. Then came the rule of Arabism, of the system of Galen in Arabic form equipped with all sorts of sophistic subtleties. The works of Rhazes and Avicenna possessed the greatest authority. The latter's "Canon", written in clear language and covering the entire field of medicine became the gospel of physicians. The literature of these times is rich in writings but very poor in thought; for people were content when the long-winded commentaries gave them a better understanding of the Arabs, whom they deemed infallible. A good many things were incomprehensible, first of all the names of diseases and drugs, which translators rendered incorrectly. A comparative investigation of the Greek authors was practically impossible, as both their works and a knowledge of the Greek language had disappeared from among the Romance nations. Thus it happened that special books had to be written from which were learned foreign words and their meanings. The "Synonyma Medicinae" (Clavis sanationis) by the physician Sirnon of Genoa (Januensis, 1270-1303) and the "Pandectae medicinae" of Matthaeus Sylvaticus (d. 1342), both of which were alphabetically arranged, were in vogue. Woe to the physician who dared to doubt the authority of the Arabs ! Only men of strong mind could successfully carry out such a dangerous undertaking. The influence of scholasticism in medicine was manifold. It encouraged the observation of nature at the bedside and logical thinking, but it also stimulated the love of disputation, wherein t