Old-Time Makers of Medicine — Ap. 2 Science at the Medieval Universities, part 2/2

There is no pretence that this view of the medieval universities is a new idea in the history of education.

Those who have known the old universities at first hand by the study of the actual books of their professors and by familiarity with their courses of study, have not been inclined to make the mistake of thinking that the medieval university neglected science.

Professor Huxley in his "Inaugural Address as Rector of Aberdeen University" some thirty years ago stated very definitely his recognition of medieval devotion to science.

His words are well worth remembering by all those who are accustomed to think of our time as the first in which the study of science was taken up seriously in our universities.

Professor Huxley said: The scholars of the medieval universities seem to have studied grammar, logic, and rhetoric; arithmetic and geometry;

astronomy, theology, and music.

Thus their work, however imperfect and faulty, judged by modern lights, it may have been, brought them face to face with all the leading aspects of the many-sided mind of man.

For these studies did really contain, at any rate in embryo, sometimes it may be in caricature, what we now call philosophy, mathematical and physical science, and art.

_And I doubt if the curriculum of any modern university shows so clear and generous a comprehension of what is meant by culture, as this old Trivium and Quadrivium does.

_ It would be entirely a mistake, however, to think that these great writers and teachers who influenced the medieval universities so deeply and whose works were the text-books of the universities for centuries after, only had the principles of physical and experimental science and did not practically apply them.

As a matter of fact their works are full of observation.

Once more, the presumption that they wrote only nonsense with regard to science comes from those who do not know their writings at all, while great scientists who have taken the pains to study their works are enthusiastic in praise.

Humboldt, for instance, says of Albertus Magnus, after reading some of his works with care: Albertus Magnus is equally active and influential in promoting the study of natural science and of the Aristotelian philosophy.

His works contain some exceedingly acute remarks on the organic structure and physiology of plants.

One of his works bearing the title of "Liber Cosmographicus De Natura Locorum" is a species of physical geography.

I have found in it considerations on the dependence of temperature concurrently on latitude and elevation and on the effect of different angles of the sun's rays in heating the ground which have excited my surprise.

It is with regard to physical geography of course that Humboldt is himself a distinguished authority.

Humboldt's expression that he found some exceedingly acute remarks on the organic structure and physiology of plants in Albert the Great's writings will prove a great surprise to many people.

Meyer, the German historian of botany, however, has re-echoed Humboldt's praise with emphasis.

The extraordinary erudition and originality of Albert's treatise on plants drew from Meyer the comment: No botanist who lived before Albert can be compared with him unless Theophrastus, with whom he was not acquainted; and after him none has painted nature in such living colors or studied it so profoundly until the time of Conrad Gessner and Caesalpino.

These men, it may be remarked, come three centuries after Albert's time.

A ready idea of Albert's contributions to physical science can be obtained from his life by Sighart, which has been translated into English by Dixon and was published in London in 1870. Pagel, in Puschmann's "History of Medicine," already referred to, gives a list of the books written by Albert on scientific matters with some comments which are eminently suggestive, and furnish solid basis for the remark that I have made, that men's minds were occupied with nearly the same problems in science in the thirteenth century as we are now, while the conclusions they came to were not very different from ours, though reached so long before us.

This catalogue of Albertus Magnus' works shows very well his own interest and that of his generation in physical science of all kinds.

There were eight treatises on Aristotle's physics and on the underlying principles of natural philosophy and of energy and of movement; four treatises concerning the heavens and the earth, one on physical geography which also contains, according to Pagel, numerous suggestions on ethnography and physiology.

There are two treatises on generation and corruption, six books on meteors, five books on minerals, three books on the soul, two books on the intellect, a treatise on nutritives, and then a treatise on the senses and another on the memory and on the imagination.

All the phases of the biological sciences were especially favorite subjects of his study.

There is a treatise on the motion of animals, a treatise in six books on vegetables and plants, a treatise on breathing things, a treatise on sleep and waking, a treatise on youth and old age, and a treatise on life and death.

His treatise on minerals contains, according to Pagel, a description of ninety-five different kinds of precious stones.

Albert's volumes on plants were reproduced with Meyer, the German botanist, as editor (Berlin, 1867).

All of Albert's books are available in modern editions.

Pagel says of Albertus that His profound scholarship, his boundless industry, the almost incontrollable impulse of his mind after universality of knowledge, the many-sidedness of his literary productivity, and finally the almost universal recognition which he received from his contemporaries and succeeding generations, stamp him as one of the most imposing characters and one of the most wonderful phenomena of the Middle Ages.

In another passage Pagel has said: While Albert was a Churchman and an ardent devotee of Aristotle, in matters of natural phenomena he was relatively unprejudiced and presented an open mind.

He thought that he must follow Hippocrates and Galen, rather than Aristotle and Augustine, in medicine and in the natural sciences.

We must concede it a special subject of praise for Albert that he distinguished very strictly between natural and supernatural phenomena.

The former he considered as entirely the object of the investigation of nature.

The latter he handed over to the realm of metaphysics.

Roger Bacon is, however, the one of these three great teachers who shows us how thoroughly practical was the scientific knowledge of the universities and how much it led to important useful discoveries in applied science and to anticipations of what is most novel even in our present-day sciences.

Some of these indeed are so startling, that only that we know them not by tradition but from his works, where they may be readily found without any doubt of their authenticity, we should be sure to think that they must be the result of later commentators' ideas.

Bacon was very much interested in astronomy, and not only suggested the correction of the calendar, but also a method by which it could be kept from wandering away from the actual date thereafter.

He discovered many of the properties of lenses and is said to have invented spectacles and announced very emphatically that light did not travel instantaneously but moved with a definite velocity.

He is sometimes said to have invented gunpowder, but of course he did not, though he studied this substance in various forms very carefully and drew a number of conclusions in his observations.

He was sure that some time or other man would learn to control the energies exhibited by explosives and that then he would be able to accomplish many things that seemed quite impossible under present conditions.

He said, for instance: Art can construct instruments of navigation, such that the largest vessels governed by a single man will traverse rivers and seas more rapidly than if they were filled with oarsmen.

One may also make carriages which without the aid of any animal will run with remarkable swiftness.

In these days when the automobile is with us and when the principal source of energy for motor purposes is derived from explosives of various kinds, this expression of Roger Bacon represents a prophecy marvellously surprising in its fulfilment.

It is no wonder that the book whence it comes bears the title "De Secretis Artis et Naturae."

Roger Bacon even went to the extent, however, of declaring that man would some time be able to fly.

He was even sure that with sufficient pains he could himself construct a flying machine.

He did not expect to use explosives for his motor power, however, but thought that a windlass properly arranged, worked by hand, might enable a man to make sufficient movement to carry himself aloft or at least to support himself in the air, if there were enough surface to enable him to use his lifting power to advantage.

He was in intimate relations by letter with many other distinguished inventors and investigators besides Peregrinus and was a source of incentive and encouragement to them all.

The more one knows of Aquinas the more surprise there is at his anticipation of many modern scientific ideas.

At the conclusion of a course on cosmology delivered at the University of Paris he said that "nothing at all would ever be reduced to nothingness" (_nihil omnino in nihilum redigetur_).

He was teaching the doctrine that man could not destroy matter and God would not annihilate it.

In other words, he was teaching the indestructibility of matter even more emphatically than we do.

He saw the many changes that take place in material substances around us, but he taught that these were only changes of form and not substantial changes and that the same amount of matter always remained in the world.

At the same time he was teaching that the forms in matter by which he meant the combinations of energies which distinguish the various kinds of matter are not destroyed.

In other words, he was anticipating not vaguely, but very clearly and definitely, the conservation of energy.

His teaching with regard to the composition of matter was very like that now held by physicists.

He declared that matter was composed of two principles, prime matter and form.

By _forma_ he meant the dynamic element in matter, while by _materia prima_ he meant the underlying substratum of material, the same in every substance, but differentiated by the dynamics of matter.

It used to be the custom to make fun of these medieval scientists for believing in the transmutation of metals.

It may be said that all three of these greatest teachers did not hold the doctrine of the transmutation of metals in the exaggerated way in which it appealed to many of their contemporaries.

The theory of matter and form, however, gave a philosophical basis for the idea that one kind of matter might be changed into another.

We no longer think that notion absurd.

Sir William Ramsay has actually succeeded in changing one element into another and radium and helium are seen changing into each other, until now we are quite ready to think of transmutation placidly.

The Philosopher's Stone used to seem a great absurdity until our recent experience with radium, which is to some extent at least the philosopher's stone, since it brings about the change of certain supposed elements into others.

A

distinguished American chemist said not long ago that he would like to extract all the silver from a large body of lead ore in which it occurs so commonly, and then come back after twenty years and look for further traces of silver, for he felt sure that they would be found and that lead ore is probably always producing silver in small quantities and copper ore is producing gold.

Most people will be inclined to ask where the fruits of this undergraduate teaching of science are to be found.

They are inclined to presume that science was a closed book to the men and women of that time.

It is not hard, however, to point the effect of the scientific training in the writings of the times.

Dante is a typical university man of the period.

He was at several Italian universities, was at Paris and perhaps at Oxford.

His writings are full of science.

Professor Kuehns, of Wesleyan, in his book "The Treatment of Nature in Dante," has pointed out how much Dante knows of science and of nature.

Few of the poets not only of his own but of any time have known more.

There are only one or two writers of poetry in our time who go with so much confidence to nature and the scientific interpretation of her for figures for their poetry.

The astronomy, the botany, the zooelogy of Albertus Magnus and Thomas Aquinas, Dante knew very well and used confidently for figurative purposes.

Anyone who is inclined to think nature study a new idea in the world forgets, or has never known, his Dante.

The birds and the bees, the flowers, the leaves, the varied aspects of clouds and sea, the phenomena of phosphorescence, the intimate habits of bird and beast and the ways of the plants, as well as all the appearances of the heavens, Dante knew very well and in a detail that is quite surprising when we recall how little nature study is supposed to have attracted the men of his time.

Only that his readers appreciated it all, Dante would surely not have used his scientific erudition so constantly.

So much for the undergraduate department of the universities of the Middle Ages, and the view is absolutely fair, for these were the men to whom the students flocked by thousands.

They were teaching science, not literature.

They were discussing physics as well as metaphysics, psychology in its phenomena as well as philosophy, observation and experiment as well as logic, the ethical sciences, economics, practically all the scientific ideas that were needed in their generation--and that generation saw the rise of the universities, the finishing of the cathedrals, the building of magnificent town halls and castles and beautiful municipal buildings of many kinds, including hospitals, the development of the Hansa League in commerce, and of wonderful manufacturers of all the textiles, the arts and crafts, as well as the most beautiful book-making and art and literature.

We could be quite sure that the men who solved all the other problems so well could not have been absurd only in their treatment of science.

Anyone who reads their books will be quite sure of that.

While most people might be ready, then, to confess that possibly Huxley was not mistaken with regard to the undergraduate department of the universities, most of them would feel sure that at least the graduate departments were sadly deficient in accomplishment.

Once more this is entirely an assumption.

The facts are all against any such idea.

There were three graduate departments in most of the universities--theology, law, and medicine.

While physical scientists are usually not cognizant of it apparently, theology is a science, a department of knowledge developed scientifically, and most of these medieval universities did more for its scientific development than the schools of any other period.

Quite as much may be said for philosophy, for there are many who hesitate to attribute any scientific quality to modern developments in the matter.

As for law, this is the great period of the foundation of scientific law development; the English common law was formulated by Bracton, the deep foundations of basic French and Spanish law were laid, and canon law acquired a definite scientific character which it was always to retain.

All this was accomplished almost entirely by the professors in the law departments of the universities.

It was in medicine, however, where most people would be quite sure without any more ado that nothing worth while talking about was being done, that the great triumphs of graduate teaching at the medieval universities were secured.

Here more than anywhere else is there room for supreme surprise at the quite unheard-of anticipations of our modern medicine and, stranger still, as it may seem, of our modern surgery.

The law regulating the practice of medicine in the Two Sicilies about the middle of the thirteenth century shows us the high standard of medical education.

Students were required to have three years of preliminary study at the university, four years in the medical department, and then practise for a year with a physician before they were allowed to practise for themselves.

If they wanted to practise surgery, an extra year in the study of anatomy was required.

I published the text of this law, which was issued by the Emperor Frederick II about 1241, in the _Journal of the American Medical Association_ three years ago.

It also regulated the practice of pharmacy.

Drugs were manufactured under the inspection of the government and there was a heavy penalty for substitution, or for the sale of old inert drugs, or improperly prepared pharmaceutical materials.

If the government inspector violated his obligations as to the oversight of drug preparations the penalty was death.

Nor was this law of the Emperor Frederick an exception.

We have the charters of a number of medical schools issued by the Popes during the next century, all of which require seven years or more of university study, four of them in the medical department, before the doctor's degree could be obtained.

When new medical schools were founded they had to have professors from certain well-recognized schools on their staff at the beginning in order to assure proper standards of teaching, and all examinations were conducted under oath-bound secrecy and with the heaviest obligations on professors to be assured of the knowledge of students before allowing them to pass.

It might be easy to think, and many people are prone to do so, that in spite of the long years of study required there was really very little to study in medicine at that time.

Those who think so should read Professor Clifford Allbutt's address on the "Historical Relations of Medicine and Surgery" delivered at the World's Fair at St. Louis in 1904. He has dwelt more on surgery than on medicine, but he makes it very clear that he considers that the thinking professors of medicine of the later Middle Ages were doing quite as serious work in their way as any that has been done since.

They were carefully studying cases and writing case histories, they were teaching at the bedside, they were making valuable observations, and they were using the means at their command to the best advantage.

Of course there are many absurdities in their therapeutics, but then we must not forget there have always been many absurdities in therapeutics and that we are not free from them in our day.

Professor Richet, at the University of Paris, said not long ago: "The therapeutics of any generation is quite absurd to the second succeeding generation."

We shall not blame the medieval generations for having accepted remedies that afterwards proved inert, for every generation has done that, even our own.

Their study of medicine was not without lasting accomplishment, however.

They laid down the indications and the dosage for opium.

They used iron with success, they tried out many of the bitter tonics among the herbal medicines, and they used laxatives and purgatives to good advantage.

Down at Montpellier, Gilbert, the Englishman, suggested red light for smallpox because it shortened the fever, lessened the lesions, and made the disfigurement much less.

Finsen was given the Nobel prize partly for re-discovery of this.

They segregated erysipelas and so prevented its spread.

They recognized the contagiousness of leprosy, and though it was probably as widespread as tuberculosis is at the present time, they succeeded not only in controlling but in eventually obliterating it throughout Europe.

It was in surgery, however, that the greatest triumphs of teaching of the medieval universities were secured.

Most people are inclined to think that surgery developed only in our day.

The great surgeons of the thirteenth and fourteenth centuries, however, anticipated most of our teaching.

They investigated the causes of the failure of healing by first intention, recognized the danger of wounds of the neck, differentiated the venereal diseases, described rabies, and knew much of blood poisoning, and operated very skilfully.

We have their text-books of surgery and they are a never-ending source of surprise.

They operated on the brain, on the thorax, on the abdominal cavity, and did not hesitate to do most of the operations that modern surgeons do.

They operated for hernia by the radical cure, though Mondeville suggested that more people were operated on for hernia for the benefit of the doctor's pocket than for the benefit of the patient.

Guy de Chauliac declared that in wounds of the intestines patients would die unless the intestinal lacerations were sewed up, and he described the method of suture and invented a needle holder.

We have many wonderful instruments from these early days preserved in pictures at least, that show us how much modern advance is merely re-invention.

They understood the principles of aseptic surgery very well.

They declared that it was not necessary "that pus should be generated in wounds."

Professor Clifford Allbutt says: They washed the wound with wine, scrupulously removing every foreign particle; then they brought the edges together, not allowing wine or anything else to remain within--dry adhesive surfaces were their desire.

Nature, they said, produces the means of union in a viscous exudation, or natural balm, as it was afterwards called by Paracelsus, Pare, and Wurtz.

In older wounds they did their best to obtain union by cleansing, desiccation, and refreshing of the edges.

Upon the outer surface they laid only lint steeped in wine.

Powders they regarded as too desiccating, for powder shuts in decomposing matters; wine after washing, purifying, and drying the raw surfaces evaporates.

Almost needless to say these are exactly the principles of aseptic surgery.

The wine was the best antiseptic that they could use and we still use alcohol in certain cases.

It would seem to many quite impossible that such operations as are described could have been done without anaesthetics, but they were not done without anaesthetics.

There were two or three different forms of anaesthesia used during the thirteenth and fourteenth centuries.

One method employed by Ugo da Lucca consisted of the use of an inhalant.

We do not know what the material employed was.

There are definite records, however, of its rather frequent employment.

What a different picture of science at the medieval universities all this makes from what we have been accustomed to hear and read with regard to them.

It is difficult to understand where the old false impressions came from.

The picture of university work that recent historical research has given us shows us professors and students busy with science in every department, making magnificent advances, many of which were afterwards forgotten, or at least allowed to lapse into desuetude.

The positive assertions with regard to old-time ignorance were all made in the course of religious controversy.

In English-speaking countries particularly it became a definite purpose to represent the old Church as very much opposed to education of all kinds and above all to scientific education.

There is not a trace of that to be found anywhere, but there were many documents that were appealed to to confirm the protestant view.

There was a Papal bull, for instance, said to forbid dissection.

When read it proves to forbid the cutting up of bodies to carry them to a distance for burial, an abuse which caused the spread of disease, and was properly prohibited.

The Church prohibition was international and therefore effective.

At the time the bull was issued there were twenty medical schools doing dissection in Italy and they continued to practise it quite undisturbed during succeeding centuries.

The Papal physicians were among the greatest dissectors.

Dissections were done at Rome and the cardinals attended them.

Bologna at the height of its fame was in the Papal States.

All this has been ignored and the supposed bull against anatomy emphasized as representing the keynote of medical and surgical history.

Then there was a Papal decree forbidding the making of gold and silver.

This was said to forbid chemistry or alchemy and so prevent scientific progress.

The history of the medical schools of the time shows that it did no such thing.

The great alchemists of the time doing really scientific work were all clergymen, many of them very prominent ecclesiastics.

Just in the same way there were said to be decrees of the Church councils forbidding the practice of surgery.

President White says in his "Warfare of Science with Theology in Christendom," that, as a consequence of these, surgery was in dishonor until the Emperor Wenceslaus, at the beginning of the fifteenth century, ordered that it should be restored to estimation.

As a matter of fact, during the two centuries immediately preceding the first years of the fifteenth century, surgery developed very wonderfully, and we have probably the most successful period in all the history of surgery except possibly our own.

The decrees forbade monks to practise surgery because it led to certain abuses.

Those who found these decrees and wanted to believe that they prevented all surgical development simply quoted them and assumed there was no surgery.

The history of surgery at this time is one of the most wonderful chapters in human progress.

The more we know of the Middle Ages the more do we realize how much they accomplished in every department of intellectual effort.

Their development of the arts and crafts has never been equalled in the modern time.

They made very great literature, marvellous architecture, sculpture that rivals the Greeks', painting that is still the model for our artists, surpassing illuminations; everything that they touched became so beautiful as to be a model for all the after time.

They accomplished as much in education as they did in all the other arts, their universities had more students than any that have existed down to our own time, and they were enthusiastic students and their professors were ardent teachers, writers, observers, investigators.

While we have been accustomed to think of them as neglecting science, their minds were occupied entirely with science.

They succeeded in anticipating much more of our modern thought, and even scientific progress, than we have had any idea until comparatively recent years.

The work of the later Middle Ages in mathematics is particularly strong, and was the incentive for many succeeding generations.

Roger Bacon insisted that, without mathematics, there was no possibility of real advance in physical science.

They had the right ideas in every way.

While they were occupied more with the philosophical and ethical sciences than we are, these were never pursued to the neglect of the physical sciences in the strictest sense of that term.

Is it not time that we should drop the foolish notions that are very commonly held because we know nothing about the Middle Ages--and, therefore, the more easily assume great knowledge--and get back to appreciate the really marvellous details of educational and scientific development which are so interesting and of so much significance at this time?