,old-,time ,makers of ,medicine ,,the ,,story ,,of ,,the ,,students ,,and ,,teachers ,,of ,,the ,,sciences ,,related ,,to ,,medicine ,,during ,,the ,,middle ,,ages ,,by ,james ,j4 ,walsh1 ,k4,c4,st4,g41 ,m4,d4 ,ph4,d41 ,,ll4,d41 ,litt4,d41 ,sc4,d4 ,,dean ,,and ,,professor ,,of ,,nervous ,,diseases ,,and ,,of ,,the ,,history ,,of ,,medicine ,,at ,,fordham ,,university ,,school ,,of ,,medicine2 ,,professor ,,of ,,physiological ,,psychology ,,at ,,the ,,cathedral ,,college1 ,,new ,,york ,,new ,,york ,,fordham ,,university ,,press #aiaa ,,copyright #aiaa ,,james ,j4 ,,walsh ,,the ,,quinn ,,goden ,,co4 ,,press ,,rahway1 ,n4,j4 ,,to ,,reverend ,,daniel ,j4 ,,quinn1 ,s4,j4 ,the historical material here presented was gathered for my classes at ,fordham ,university ,school of ,medicine during your term as president of the ,university4 ,it seems only fitting then1 that when put into more permanent form it should appear under the patronage of your name and tell of my cordial appreciation of more than a quarter of a century of valued friendship4 ,when we have thoroughly mastered contemporary science it is time to turn to past science2 nothing fortifies the judgment more than this comparative study2 impartiality of mind is developed thereby1 the uncertainties of any system become manifest4 ,the authority of facts is there confirmed1 and we discover in the whole picture a philosophic teaching which is in itself a lesson2 in other words1 we learn to know1 to understand1 and to judge4--,,littr3 ,o,euvres d',hippocrate1 ,t4 ,i1 p4 #dgg4 ,there is not a single development1 even the most advanced of contemporary medicine1 which is not to be found in embryo in the medicine of the olden time4--,,littr3 ,introduction to the ,works of ,hippocrates4 ,how true it is that in reading this history one finds modern discoveries that are anything but discoveries1 unless one supposes that they have been made twice4--,,dujardin3 ,histoire de la ,chirurgie1 ,paris1 #aggd 7quoted by ,gurlt on the post title-page of his ,geschichte der ,chirurgie1 ,berlin1 #ahih74 ,,preface ,the material for this book was gathered partly for lectures on the history of medicine at ,fordham ,university ,school of ,medicine1 and partly for articles on a number of subjects in the ,catholic ,encyclopedia4 ,some of it was developed for a series of addresses at commencements of medical schools and before medical societies1 on the general topic how old the new is in surgery1 medicine1 dentistry1 and pharmacy4 ,the information thus presented aroused so much interest1 the accomplishments of the physicians and surgeons of a period that is usually thought quite sterile in medical science proved1 indeed1 so astonishing1 that ,i was tempted to connect the details for a volume in the ,fordham ,university ,press series4 ,there is no pretence to any original investigation in the history of medicine1 nor to any extended consultation of original documents4 ,i have had most of the great books that are mentioned in the course of this volume in my hands1 and have given as much time to the study of them as could be afforded in the midst of a rather busy life1 but ,i owe my information mainly to the distinguished ,german and ,french scholars who have in recent years made deep and serious studies of these ,old ,makers of ,medicine1 and ,i have made my acknowledgments to them in the text as opportunity presented itself4 ,there is just one feature of the book that may commend it to present-day readers1 and that is that our medieval medical colleagues1 when medicine embraced most of science1 faced the problems of medicine and surgery and the allied sciences that are now interesting us1 in very much the same temper of mind as we do1 and very often anticipated our solutions of them--much oftener1 indeed1 than most of us1 unless we have paid special attention to history1 have any idea of4 ,the volume does not constitute1 then1 a contribution to that theme that has interested the last few generations so much1--the supposed continuous progress of the race and its marvellous advance1--but rather emphasizes that puzzling question1 how is it that men make important discoveries and inventions1 and then1 after a time1 forget about them so that they have to be made over again8 ,this is as true in medical science and in medical practice as in every other department of human effort4 ,it does not seem possible that mankind should ever lose sight of the progress in medicine and surgery that has been made in recent years1 yet the history of the past would seem to indicate that1 in spite of its unlikelihood1 it might well come about4 ,whether this is the lesson of the book or not1 ,i shall leave readers to judge1 for it was not intentionally put into it4 ,,our ,,lady',s ,,day ,,in ,,harvest1 #aiaa4 ,,contents ,,chapter ,,page ,i4 ,,introduction #a ,,ii4 ,,great ,,physicians ,,in ,,early ,,christian ,,times #bc ,,iii4 ,,great ,,jewish ,,physicians #fa ,,iv4 ,,maimonides #ij ,v4 ,,great ,,arabian ,,physicians #aji ,,vi4 ,,the ,,medical ,,school ,,at ,,salerno #ada ,,vii4 ,,constantine ,,africanus #afc ,,viii4 ,,medieval ,,women ,,physicians #agg ,,ix4 ,,mondino ,,and ,,the ,,medical ,,school ,,of ,,bologna #bjb ,x4 ,,great ,,surgeons ,,of ,,the ,,medieval ,,universities #bcd ,,xi4 ,,guy ,,de ,,chauliac #bhb ,,xii4 ,,medieval ,,dentistry--,,giovanni ,,of ,,arcoli #cac ,,xiii4 ,,cusanus ,,and ,,the ,,first ,,suggestion ,,of ,,laboratory ,,methods ,,in ,,medicine #ccf ,,xiv4 ,,basil ,,valentine1 ,,last ,,of ,,the ,,alchemists1 ,,first ,,of ,,the ,,chemists #cdi ,,appendices ,i4 ,,st4 ,,luke ,,the ,,physician #cha ,,ii4 ,,science ,,at ,,the ,,medieval ,,universities #djj ,,iii4 ,,medieval ,,popularization ,,of ,,science #dbg ,of making many books there is no end4--,eccles4 xii1 #ab 7circa #ajjj ,b4,c474 ,the little by-play between ,socrates and ,euthydemus suggests an advanced condition of medical literature3 ',of course1 you who have so many books are going in for being a doctor1' says ,socrates1 and then he adds1 'there are so many books on medicine1 you know4' ,as ,dyer remarks1 whatever the quality of these books may have been1 their number must have been great to give point to this chaff4--,aequanimitas1 ,,william ,,osler1 ,m4,d41 ,f4,r4,s41 ,blakistons1 ,philadelphia1 #aijf4 ,augescunt aliae gentes1 aliae minuuntur2 ,inque brevi spatio mutantur saecla animantum1 ,et1 quasi cursores vitai lampada tradunt4 --,,ovid4 ,one nation rises to supreme power in the world1 while another declines1 and1 in a brief space of time1 the sovereign people change1 transmitting1 like racers1 the lamp of life to some other that is to succeed them4 ,there is one ,science of ,medicine which is concerned with the inspection of health equally in all times1 present1 past and future4 --,,plato4 ,i ,,introduction ,under the term ,old-,time ,medicine most people probably think at once of ,greek medicine1 since that developed in what we have called ancient history1 and is farthest away from us in date4 ,as a matter of fact1 however1 much more is known about ,greek medical writers than those of any other period except the last century or two4 ,our histories of medicine discuss ,greek medicine at considerable length and practically all of the great makers of medicine in subsequent generations have been influenced by the ,greeks4 ,greek physicians whose works have come down to us seem nearer to us than the medical writers of any but the last few centuries4 ,as a consequence we know and appreciate very well as a rule how much ,greek medicine accomplished1 but in our admiration for the diligent observation and breadth of view of the ,greeks1 we are sometimes prone to think that most of the intervening generations down to comparatively recent times made very little progress and1 indeed1 scarcely retained what the ,greeks had done4 ,the ,romans certainly justify this assumption of non-accomplishment in medicine1 but then in everything intellectual ,rome was never much better than a weak copy of ,greek thought4 ,in science the ,romans did nothing at all worth while talking about4 ,all their medicine they borrowed from the ,greeks1 adding nothing of their own4 ,what food for thought there is in the fact1 that in spite of all ,rome's material greatness and wide empire1 her world dominance and vaunted prosperity1 we have not a single great original scientific thought from a ,roman4 ,though so much nearer in time medieval medicine seems much farther away from us than is ,greek medicine4 ,most of us are quite sure that the impression of distance is due to its almost total lack of significance4 ,it is with the idea of showing that the medieval generations1 as far as was possible in their conditions1 not only preserved the old ,greek medicine for us in spite of the most untoward circumstances1 but also tried to do whatever they could for its development1 and actually did much more than is usually thought1 that this story of ,old-,time ,makers of ,medicine is written4 ,it represents a period--that of the ,middle ,ages--that is1 or was until recently1 probably more misunderstood than any other in human history4 ,the purpose of the book is to show at least the important headlands that lie along the stream of medical thought during the somewhat more than a thousand years from the fall of the ,roman ,empire under ,augustulus 7#dgf7 until the discovery of ,america4 ,after that comes modern medicine1 for with the sixteenth century the names and achievements of the workers in medicine are familiar--,paracelsus1 ,vesalius1 ,columbus1 ,servetus1 ,csalpinus1 ,eustachius1 ,varolius1 ,sylvius are men whose names are attached to great discoveries with which even those who are without any pretence to knowledge of medical history are not unacquainted4 ,in spite of nearly four centuries of distance in time these men seem very close to us4 ,their lives will be reserved for a subsequent volume1 ,our ,forefathers in ,medicine4 ,it is usually the custom to contemn the ,middle ,ages for their lack of interest in culture1 in education1 in literature1 in a word1 in intellectual accomplishment of any and every kind1 but especially in science4 ,there is no doubt about the occurrence of marked decadence in the intellectual life of the first half of this period4 ,this has sometimes been attributed to what has been called the inhibitory effect of ,christianity on worldly interests4 ,religion is said to have occupied people so much with thoughts of the other world that the beauties and wonders1 as well as much of the significance1 of the world around them were missed4 ,those who talk thus1 however1 forget entirely the circumstances which brought about the serious decadence of interest in culture and science at this time4 ,the ,roman ,empire had been the guardian of letters and education and science4 ,while the ,romans were not original in themselves1 at least they had shown intense interest in what was accomplished by the ,greeks and their imitation had often risen to heights that made them worthy of consideration for themselves4 ,they were liberal patrons of ,greek art and of ,greek literature1 and did not neglect ,greek science and ,greek medicine4 ,galen's influence was due much more to the prominence secured by him as the result of his stay in ,rome than would have been possible had he stayed in ,asia4 ,there are many other examples of ,roman patronage of literature and science that might be mentioned4 ,as we shall see1 ,rome drained ,greece and ,asia ,minor of their best1 and appropriated to herself the genius products of the ,spanish ,peninsula4 ,rome had a way of absorbing what was best in the provinces for herself4 ,just as soon as ,rome was cut off from intimate relations with the provinces by the inwandering of barbarians1 intellectual decadence began4 ,the imperial city itself had never been the source of great intellectual achievement1 and the men whom we think of as important contributors to ,rome's literature and philosophy were usually not born within the confines of the city4 ,it is surprising to take a list of the names of the ,latin writers whom we are accustomed to set down simply as ,romans and note their birthplaces4 ,rome herself gave birth to but a very small percentage of them4 ,virgil was born at ,mantua1 ,cicero at ,arpinum1 ,horace out on the ,sabine farm1 the ,plinys out of the city1 ,terence in ,africa1 ,persius up in ,central ,italy somewhere1 ,livy at ,padua1 ,martial1 ,quintilian1 the ,senecas1 and ,lucan in ,spain4 ,when the government of the city ceased to be such as assured opportunity for those from outside who wanted to make their way1 decadence came to ,roman literature4 ,large cities have never in history been the fruitful mothers of men who did great things4 ,genius1 and even talent1 has always been born out of the cities in which it did its work4 ,it is easy to understand1 then1 the decadence of the intellectual life that took place as the ,empire degenerated4 ,for the sake of all that it meant in the ,roman ,empire to look towards ,rome at this time1 however1 it seemed better to the early ,christians to establish the centre of their jurisdiction there4 ,necessarily1 then1 in all that related to the purely intellectual life1 they came under the influences that were at work at ,rome at this time4 ,during the first centuries they suffered besides from the persecutions directed against them by the ,emperors at various times1 and these effectually prevented any external manifestations of the intellectual life on the part of ,christians4 ,it took much to overcome this serious handicap1 but noteworthy progress was made in spite of obstacles1 and by the time of ,constantine many important officials of the ,empire1 the educated thinking classes of ,rome1 had become ,christians4 ,after the conversion of the ,emperor opportunities began to be afforded1 but political disturbances consequent upon barbarian influences still further weakened the old civilization until much of the intellectual life of it almost disappeared4 ,gradually the barbarians1 finding the ,roman ,empire decadent1 crept in on it1 and though much more of the invasion was peaceful than we have been accustomed to think1 the ,romans simply disappearing because family life had been destroyed1 children had become infrequent1 and divorce had become extremely common1 it was not long before they replaced the ,romans almost entirely4 ,these new peoples had no heritage of culture1 no interest in the intellectual life1 no traditions of literature or science1 and they had to be gradually lifted up out of their barbarism4 ,this was the task that ,christianity had to perform4 ,that it succeeded in accomplishing it is one of the marvels of history4 ,the ,church's first grave duty was the preservation of the old records of literature and of science4 ,fortunately the monasteries accomplished this task1 which would have been extremely perilous for the precious treasures involved but for the favorable conditions thus afforded4 ,libraries up to this time were situated mainly in cities1 and were subject to all the vicissitudes of fire and war and other modes of destruction that came to cities in this disturbed period4 ,monasteries1 however1 were usually situated in the country1 were built very substantially and very simply1 and the life in them formed the best possible safeguard against fire1 which worked so much havoc in cities4 ,as we shall see1 however1 not only were the old records preserved1 but excerpts from them were collated and discussed and applied by means of direct observation4 ,this led the generations to realize more and more the value of the old ,greek medicine and made them take further precautions for its preservation4 ,the decadence of the early ,middle ,ages was due to the natural shifting of masses of population of this time1 while the salvation of scientific and literary traditions was due to the one stable element in all these centuries--the ,church4 ,far from ,christianity inhibiting culture1 it was the most important factor for its preservation1 and it provided the best stimulus and incentive for its renewed development just as soon as the barbarous peoples were brought to a state of mind to appreciate it4 ,bearing this in mind1 it is easier to understand the course of medical traditions through the ,middle ,ages1 and especially in the earlier period1 with regard to which our documents are comparatively scanty1 and during which the disturbed conditions made medical developments impossible1 and anything more than the preservation of the old authors out of the question4 ,the torch of medical illumination lighted at the great ,greek fires passes from people to people1 never quenched1 though often burning low because of unfavorable conditions1 but sometimes with new fuel added to its flame by the contributions of genius4 ,the early ,christians took it up and kept it lighted1 and1 with the ,jewish physicians1 carried it through the troublous times of the end of the old order1 and then passed it on for a while to the ,arabs4 ,then1 when favorable conditions had developed again1 ,christian schools and scholars gave it the opportunity to burn brightly for several centuries at the end of the ,middle ,ages4 ,this medieval age is probably the most difficult period of medical history to understand properly1 but it is worth while taking the trouble to follow out the thread of medical tradition from the ,greeks to the ,renaissance medical writers1 who practically begin modern medicine for us4 ,it is easy to understand that ,christianity's influence on medicine1 instead of hampering1 was most favorable4 ,the ,founder of ,christianity ,himself had gone about healing the sick1 and care for the ailing became a prominent feature of ,christian work4 ,one of the ,evangelists1 ,st4 ,luke1 was a physician4 ,it was the custom a generation ago1 and even later1 when the ,higher ,criticism became popular1 to impugn the tradition as to ,st4 ,luke having been a physician1 but this has all been undone1 and ,harnack's recent book1 ,luke the ,physician1 makes it very clear that not only the ,third ,gospel1 but also the ,acts1 could only have been written by a man thoroughly familiar with the ,greek medical terms of his time1 and who had surely had the advantage of a training in the medical sciences at ,alexandria4 ,this makes such an important link in medical traditions that a special chapter has been devoted to it in the ,appendix4 ,very early in ,christianity care for the ailing poor was taken up1 and hospitals in our modern sense of the term became common in ,christian communities4 ,there had been military hospitals before this1 and places where those who could afford to pay for service were kept during illness4 ,our modern city hospital1 however1 is a ,christian institution4 ,besides1 deformed and ailing children were cared for and homes for foundlings were established4 ,before ,christianity the power even of life and death of the parents over their children was recognized1 and deformed or ailing children1 or those that for some reason were not wanted1 were exposed until they died4 ,christianity put an end to this1 and in two classes of institutions1 the hospitals and the asylums1 abundant opportunity for observation of illness was afforded4 ,just as soon as ,christianity came to be free to establish its institutions publicly1 hospitals became very common4 ,the ,emperor ,julian1 usually known as the ,apostate1 who hoped to re-establish the old ,roman ,olympian religion1 wrote to ,oribasius1 one of the great physicians of this time1 who was also an important official of his household1 that these ,christians had established everywhere hospitals in which not only their own people1 but also those who were not ,christians1 were received and cared for1 and that it would be idle to hope to counteract the influence of ,christianity until corresponding institutions could be erected by the government4 ,from the very beginning1 or1 at least1 just as soon as reasonable freedom from persecution gave opportunity for study1 ,christian interest in the medical sciences began to manifest itself4 ,nemesius1 for instance1 a ,bishop of ,edessa in ,syria1 wrote toward the end of the fourth century a little work in ,greek on the nature of man1 which is a striking illustration of this4 ,nemesius was what in modern times would be called a philosopher1 that is1 a speculative thinker and writer1 with regard to man's nature1 rather than a physical scientist4 ,he was convinced1 however1 that true philosophy ought to be based on a complete knowledge of man1 body and soul1 and that the anatomy of his body ought to be a fundamental principle4 ,it is in this little volume that some enthusiastic students have found a description that is to them at least much more than a hint of knowledge of the circulation of the blood4 ,hyrtl doubts that the passage in question should be made to signify as much as has been suggested1 but the occurrence of any even distant reference to such a subject at this time shows that1 far from there being neglect of physical scientific questions1 men were thinking seriously about them4 ,just as soon as ,christianity brought in a more peaceful state of affairs and had so influenced the mass of the people that its place in the intellectual life could be felt1 there comes a period of cultural development represented in philosophy by the ,fathers of the ,church1 and during which we have a series of important contributors to medical literature4 ,the first of these was ,atius1 whose career and works are treated more fully in the chapter on ,great ,physicians in ,early ,christian ,times4 ,he was followed by ,alexander of ,tralles1 probably a ,christian1 for his brother was the architect of ,santa ,sophia1 and by ,paul of gina1 with regard to whom we know only what is contained in his medical writings1 but whose contemporaries were nearly all ,christians4 ,their books are valuable to us1 partly because they contain quotations from great ,greek writers on medicine1 not always otherwise available1 but also because they were men who evidently knew the subject of medicine broadly and thoroughly1 made observations for themselves1 and controlled what they learned from the ,greek forefathers in medicine by their own experience4 ,just at the beginning of the ,middle ,ages1 then1 under the fostering care of ,christianity there is a period of considerable importance in the history of medical literature4 ,it is one of the best proofs that we have not only that ,christianity did not hamper medical development1 but that1 directly and indirectly1 by the place that it gave to the care of the ailing in life as well as the encouragement afforded to the intellectual life1 it favored medical study and writing4 ,a very interesting chapter in the story of the early ,christian physician is to be found in what we know of the existence of women physicians in the fourth and fifth centuries4 ,theodosia1 the mother of ,st4 ,procopius the martyr1 was1 according to ,carptzovius1 looked upon as an excellent physician in ,rome in the early part of the fourth century4 ,she suffered martyrdom under ,diocletian4 ,there was also a ,nicerata who practised at ,constantinople under the ,emperor ,arcadius4 ,it is said that to her ,st4 ,john ,chrysostom owed the cure of a serious illness4 ,from the very beginning ,christian women acted as nurses1 and deaconesses were put in charge of hospitals4 ,fabiola1 at ,rome1 is the foundress of the first important hospital in that city4 ,the story of these early ,christian women physicians has been touched upon in the chapter on ,medieval ,women ,physicians1 as an introduction to this interesting feature of ,salernitan medical education4 ,during the early ,christian centuries much was owed to the genius and the devotion to medicine of distinguished ,jewish physicians4 ,their sacred and rabbinical writers always concerned themselves closely with medicine1 and both the ,old ,testament and the ,talmud must be considered as containing chapters important for the medical history of the periods in which they were written4 ,at all times the ,jews have been distinguished for their knowledge of medicine1 and all during the ,middle ,ages they are to be found prominent as physicians4 ,they were among the teachers of the ,arabs in the ,east and of the ,moors in ,spain4 ,they were probably among the first professors at ,salerno as well as at ,montpellier4 ,many prominent rulers and ecclesiastics selected ,jewish physicians4 ,some of these made distinct contributions to medicine1 and a number of them deserve a place in any account of medicine in the making during the ,middle ,ages4 ,one of them1 ,maimonides1 to whom a special chapter is devoted1 deserves a place among the great makers of medicine of all time1 because of the influence that he exerted on his own and succeeding generations4 ,any story of the preservation and development of medical teaching and medical practice during the ,middle ,ages would be decidedly incomplete without due consideration of the work of ,jewish physicians4 ,western medical literature followed ,roman literature in other departments1 and had only the ,greek traditions at second hand4 ,during the disturbance occasioned by the invasion of the barbarians there was little opportunity for such leisure as would enable men to devote themselves with tranquillity to medical study and writing4 ,medical traditions were mainly preserved in the monasteries4 ,cassiodorus1 who1 after having been ,imperial ,prime ,minister1 became a monk1 recommended particularly the study of medicine to the monastic brethren4 ,with the foundation of the ,benedictines1 medicine became one of the favorite studies of the monks1 partly for the sake of the health of the brethren themselves1 and partly in order that they might be helpful to the villages that so often gathered round their monasteries4 ,there is a well-grounded tradition that at ,monte ,cassino medical teaching was one of the features of the education provided there by the monks4 ,it is generally conceded that the ,benedictines had much to do with the foundation of ,salerno4 ,in the convents for women as well as the monasteries for men serious attention was given to medicine4 ,women studied medicine and were professors in the medical department of ,salerno4 ,other ,italian universities followed the example thus set1 and so there is abundant material for the chapter on ,medieval ,women ,physicians4 ,the next phase of medical history in the medieval period brings us to the ,arabs4 ,utterly uninterested in culture1 education1 or science before the time of ,mohammed1 with the growth of their political power and the foundation of their capitals1 the ,arab ,caliphs took up the patronage of education4 ,they were the rulers of the cities of ,asia ,minor in which ,greek culture had taken so firm a hold1 and captive ,greece has always led its captors captive4 ,with the leisure that came for study1 ,arabians took up the cultivation of the ,greek philosophers1 especially ,aristotle1 and soon turned their attention also to the ,greek physicians ,hippocrates and ,galen4 ,for some four hundred years then they were in the best position to carry on medical traditions4 ,their teachers were the ,christian and ,jewish physicians of the cities of ,asia ,minor1 but soon they themselves became distinguished for their attainments1 and for their medical writings4 ,interestingly enough1 more of their distinguished men flourished in ,spain than in ,asia ,minor4 ,we have suggested an explanation for this in the fact that ,spain had been one of the most cultured provinces of the ,roman ,empire1 providing practically all the writers of the ,silver ,age of ,latin literature1 and evidently possessing a widely cultured people4 ,it was into this province1 not yet utterly decadent from the presence of the northern ,goths1 that the ,moors came and readily built up a magnificent structure of culture and education on what had been the highest development of ,roman civilization4 ,the influence of the ,arabs on ,western civilization1 and especially on the development of science in ,europe1 has been much exaggerated by certain writers4 ,closely in touch with ,greek thought and ,greek literature during the eighth1 ninth1 and tenth centuries1 it is easy to understand that the ,arabian writers were far ahead of the ,christian scholars of ,europe of the same period1 who were struggling up out of the practical chaos that had been created by the coming of the barbarians1 and who1 besides1 had the chance for whatever ,greek learning came to them only through the secondary channels of the ,latin writers4 ,rome had been too occupied with politics and aggrandizement ever to become cultured4 ,in spite of this heritage from the ,greeks1 decadence took place among the ,arabs1 and1 as the centuries go on1 what they do becomes more and more trivial1 and their writing has less significance4 ,just the opposite happened in ,europe4 ,there1 there was noteworthy progressive development until the magnificent climax of thirteenth century accomplishment was reached4 ,it is often said that ,europe owed much to the ,arabs for this1 but careful analysis of the factors in that progress shows that very little came from the ,arabs that was good1 while not a little that was unfortunate in its influence was borrowed from them with the translations of the ,greek authors from that language1 which constituted the main1 indeed often the only1 reason why ,arabian writers were consulted4 ,with the foundation of the medical school of ,salerno in the tenth century1 the modern history of medical education may be said to begin1 for it had many of the features that distinguish our modern university medical schools4 ,its professors often came from a distance and had travelled extensively for purposes of study2 they attracted patients of high rank from nearly every part of ,europe1 and these were generous in their patronage of the school4 ,students came from all over1 from ,africa and ,asia1 as well as ,europe1 and when abuses of medical practice began to creep in1 a series of laws were made creating a standard of medical education and regulating the practice of medicine1 that are interesting anticipations of modern movements of the same kind4 ,finally a law was passed requiring three years of preliminary work in logic and philosophy before medicine might be taken up1 and then four years at medicine1 with a subsequent year of practice with a physician before a license to practise for one's self was issued4 ,in addition to this there was a still more surprising feature in the handing over of the department of women's diseases to women professors1 and the consequent opening up of licensure to practise medicine to a great many women in the southern part of ,italy4 ,the surprise that all this should have taken place in the south of ,italy is lessened by recalling the fact that the lower end of the ,italian peninsula had been early colonized by ,greeks1 that its name in later times was ,magna ,grcia1 and that the stimulus of ,greek tradition has always been especially favorable to the development of scientific medicine4 ,salerno's influence on ,bologna is not difficult to trace1 and the precious tradition of surgery particularly1 which was carried to the northern university1 served to initiate a period of surgery lasting nearly two centuries1 during which we have some of the greatest contributions to this branch of medical science that were ever made4 ,the development of the medical school at ,bologna anticipated by but a short time that of a series of schools in the north ,italian universities4 ,padua1 ,piacenza1 ,pisa1 and ,vicenza had medical schools in the later ,middle ,ages1 the works of some of whose professors have attracted attention4 ,it was from these north ,italian medical schools that the tradition of close observation in medicine and of thoroughly scientific surgery found its way to ,paris4 ,lanfranc was the carrier of surgery1 and many ,french students who went to ,italy came back with ,italian methods4 ,in the fourteenth century ,guy de ,chauliac made the grand tour in ,italy1 and then came back to write a text-book of surgery that is one of the monuments in this department of medical science4 ,before his time1 ,montpellier had attracted attention1 but now it came to be looked upon as a recognized centre of great medical teaching4 ,the absence of the ,popes from ,italy and the influence of their presence at ,avignon made itself felt4 ,while culture and education declined in ,italy in the midst of political disturbances1 they advanced materially at the south of ,france4 ,for our generation undoubtedly the most interesting chapter in the history of medieval medicine is that which tells of the marvellous development of surgery that took place in the thirteenth and fourteenth centuries4 ,considerable space has been devoted to this1 because it represents not only an important phase of the history of medicine1 and recalls the names and careers of great makers of medicine1 but also because it illustrates exquisitely the possibility of important discoveries in medicine being made1 applied successfully for years1 and then being lost or completely forgotten1 though contained in important medical books that were always available for study4 ,the more we know of this great period in the history of surgery1 the more is the surprise at how much was accomplished1 and how many details of our modern surgery were anticipated4 ,most of us have had some inkling of the fact that ansthesia is not new1 and that at various times in the world's history men have invented methods of producing states of sensibility in which more or less painless operations were possible4 ,very few of us have realized1 however1 the perfection to which ansthesia was developed1 and the possibility this provided for the great surgeons of the later medieval centuries to do operations in all the great cavities of the body1 the skull1 the thorax1 and the abdomen1 quite as they are done in our own time and apparently with no little degree of success4 ,of course1 any such extensive surgical intervention even for serious affections would have been worse than useless under the septic conditions that would surely have prevailed if certain principles of antisepsis were not applied4 ,until comparatively recent years we have been quite confident in our assurance that antisepsis and asepsis were entirely modern developments of surgery4 ,more knowledge1 however1 of the history of surgery has given a serious set-back to this self-complacency1 and now we know that the later medieval surgeons understood practical antisepsis very well1 and applied it successfully4 ,they used strong wine as a dressing for their wounds1 insisted on keeping them clean1 and not allowing any extraneous material of any kind1 ointments or the like1 to be used on them4 ,as a consequence they were able to secure excellent results in the healing of wounds1 and they were inclined to boast of the fact that their incisions healed by first intention and that1 indeed1 the scar left after them was scarcely noticeable4 ,we know that wine would make a good antiseptic dressing1 but until we actually read the reports of the results obtained by these old surgeons1 we had no idea that it could be used to such excellent purpose4 ,antisepsis1 like ansthesia1 was marvellously anticipated by the surgical forefathers of the medieval period4 ,it has always seemed to me that the story of ,medieval ,dentistry presented an even better illustration of a great anticipatory development of surgery4 ,this department represents only a small surgical specialty1 but one which even at that period was given over to specialists1 who were called dentatores4 ,guy de ,chauliac's review of the dentistry of his time and the state of the specialty1 as pictured by ,john of ,arcoli1 is likely to be particularly interesting1 because if there is any department of medical practice that we are sure is comparatively recent in origin1 it is dentistry4 ,here1 however1 we find that practically all our dental manipulations1 the filling of teeth1 artificial dentures1 even orthodontia1 were anticipated by the dentists of the ,middle ,ages4 ,we have only the compressed account of it which is to be found in text-books of general surgery1 and while in this they give mainly a heritage from the past1 yet even this suffices to give us a picture very surprising in its detailed anticipation of much that we have been inclined to think of as quite modern in invention and discovery4 ,medicine developed much more slowly than surgery1 or1 rather1 lagged behind it1 as it seems nearly always prone to do4 ,surgical problems are simple1 and their solution belongs to a great extent to a handicraft4 ,that is1 after all1 what chirurgy1 the old form of our word surgery1 means4 ,medical problems are more complex and involve both art and science1 so that solutions of them are often merely temporary and lack finality4 ,during the ,middle ,ages1 however1 and especially towards the end of them1 the most important branches of medicine1 diagnosis and therapeutics1 took definite shape on the foundations that lie at the basis of our modern medical science4 ,we hear of percussion for abdominal conditions1 and of the most careful study of the pulse and the respiration4 ,there are charts for the varying color of the urine1 and of the tints of the skin4 ,with ,nicholas of ,cusa there came the definite suggestion of the need of exact methods of diagnosis4 ,a mathematician himself1 he wished to introduce mathematical methods into medical diagnosis1 and suggested that the pulse should be counted in connection with the water clock1 the water that passed being weighed1 in order to get very definite comparative values for the pulse rate under varying conditions1 and also that the specific gravity of fluids from the body should be ascertained in order to get another definite datum in the knowledge of disease4 ,it was long before these suggestions were to bear much fruit1 but it is interesting to find them so clearly expressed4 ,at the very end of the ,middle ,ages came the father of modern pharmaceutical chemistry1 ,basil ,valentine4 ,already the spirit that was to mean so much for scientific investigation in the ,renaissance period was abroad4 ,valentine1 however1 owes little to anything except his own investigations1 and they were surprisingly successful1 considering the circumstances of time and place4 ,his practical suggestions so far as drugs were concerned did not prove to have enduring value1 but then this has been a fate shared by many of the masters of medicine4 ,there were many phases of medical practice1 however1 that he insisted on in his works4 ,he believed that the best agent for the cure of the disease was nature1 and that the physician's main business must be to find out how nature worked1 and then foster her efforts or endeavor to imitate them4 ,he insisted1 also that personal observation1 both of patients and drugs1 was more important than book knowledge4 ,indeed1 he has some rather strong expressions with regard to the utter valuelessness of book information in subjects where actual experience and observation are necessary4 ,it gives a conceit of knowledge quite unjustified by what is really known4 ,what is interesting about all these men is that they faced the same problems in medicine that we have to1 in much the same temper of mind that we do ourselves1 and that1 indeed1 they succeeded in solving them almost as well as we have done1 in spite of all that might be looked for from the accumulation of knowledge ever since4 ,it was very fortunate for the after time that in the period now known as the ,renaissance1 after the invention of printing1 there were a number of serious1 unselfish scholars who devoted themselves to the publication in fine printed editions of the works of these old-time makers of medicine4 ,if the neglect of them that characterized the eighteenth and early nineteenth centuries had been the rule at the end of the fifteenth and during the sixteenth century1 we would almost surely have been without the possibility of ever knowing that so many serious physicians lived and studied and wrote large important tomes during the ,middle ,ages4 ,for our forefathers of a few generations ago had very little knowledge1 and almost less interest1 as to the ,middle ,ages1 which they dismissed simply as the ,dark ,ages1 quite sure that nothing worth while could possibly have come out of the ,nazareth of that time4 ,what they knew about the people who had lived during the thousand years before #aejj only seemed to them to prove the ignorance and the depths of superstition in which they were sunk4 ,that medieval scholars should have written books not only well worth preservation1 but containing anticipations of modern knowledge1 and1 though of course they could not have known that1 even significant advances over their own scientific conditions1 would have seemed to them quite absurd4 ,fortunately for us1 then1 the editions of the early printed books1 so many of them monuments of learning and masterpieces of editorial work with regard to medieval masters of medicine1 were lying in libraries waiting to be unearthed and restudied during the nineteenth century4 ,german and ,french scholars1 especially during the last generation1 have recovered the knowledge of this thousand years of human activity1 and we know now and can sympathetically study how the men of these times faced their problems1 which were very much those of our own time1 in almost precisely the same spirit as we do ours at the present time1 and that their solutions of them are always interesting1 often thorough and practical1 and more frequently than we would like to think possible1 resemble our own in many ways4 ,for the possibility of this we are largely indebted originally to the scholars of the ,renaissance4 ,without their work that of our investigators would have been quite unavailing4 ,it is to be hoped1 however1 that our recovery of this period will not be followed by any further eclipse1 though that seems to be almost the rule of human history1 but that we shall continue to broaden our sympathetic knowledge of this wonderful medieval period1 the study of which has had so many surprises in store for us4 ,,ii ,,great ,,physicians ,,in ,,early ,,christian ,,times ,what we know of the life of the ,founder of ,christianity and how much ,he did for the ailing poor would make us expect that the religion that ,he established would foster the care and the cure of suffering humanity4 ,as we have outlined in the ,introduction1 the first of the works of ,christian service that was organized was the care of the sick4 ,at first a portion of the bishop's house was given over to the shelter of the ailing1 and a special order of assistants to the clergy1 the deaconesses1 took care of them4 ,as ,christians became more numerous1 special hospitals were founded1 and these became public institutions just as soon as freedom from persecution allowed the ,christians the liberty to give overt expression to their feelings for the poor4 ,while hospitals of limited capacity for such special purposes as the sheltering of slaves or of soldiers and health establishments of various kinds for the wealthy had been erected before ,christianity1 this was the first time that anyone who was ill1 no matter what the state of his pecuniary resources1 could be sure to find shelter and care4 ,the expression of the ,emperor ,julian the ,apostate1 that admission to these hospitals was not limited to ,christians1 is the best possible evidence of the liberal charity that inspired them4 ,the ordinary passing student of the history of medicine or of hospital foundation and organization1 can have no idea of the magnitude of some of these institutions1 and their importance in the life of the time1 unless it is especially pointed out4 ,st4 ,basil1 about the middle of the fourth century1 erected what was spoken of as a city for the sick1 before the gates of ,csarea4 ,gregory of ,nazianzen1 his friend1 says that well built and furnished houses stood on both sides of streets symmetrically laid out about the church1 and contained rooms for the sick1 and the infirm of every variety were intrusted to the care of doctors and nurses4 ,there were separate buildings for strangers1 for the poor1 and for the ailing1 and comfortable dwellings for the physicians and nurses4 ,an important portion of the institution was set apart for the care of lepers1 which constituted a prominent feature in ,basil's work in which he himself took a special interest4 ,earlier in the same century ,helena1 the mother of the ,emperor ,constantine1 had built similar institutions around ,jerusalem1 and during this same century nearly everywhere we have evidence of organization of hospitals and of care for the ailing poor4 ,not only were hospitals erected1 but arrangements were made for the care of the ailing poor in their own homes and for the visitation of them1 and for the bringing to places adapted for their care and treatment of such as were found on the street1 or neglected in their homes4 ,the ,church evidently considered itself bound to care for men's bodies as well as their souls1 and many of the expressions in common use among ,christians referred to this fact4 ,religion itself was spoken of as a medicine of the soul and the body4 ,christianity was defined as the religion of healing4 ,the word salvation had a reference to both body and soul4 ,baptism was spoken of as the bath of the soul1 the holy ,eucharist as the elixir of immortal life1 and penance as the medicine of the soul4 ,it is not surprising to find1 then1 that ,harnack has found among the texts that illustrate the history of early ,christian literature this one3 ,in every community there shall be at least one widow appointed to assist women who are stricken with illness1 and this widow shall be trained in her duties1 neat and careful in her ways1 shall not be self-seeking1 must not indulge too freely in wine in order that she may be able to take up her duties at night as well as by day1 and shall consider it her duty to keep the ,church officials informed of all that seems necessary4 ,the saving of deformed and ailing infants or children whose parents did not care to have the trouble of rearing them1 required the establishment by the ,christians of another set of institutions1 ,foundling ,asylums and ,hospitals for ,children4 ,until the coming of ,christianity parents were supposed to have the right of life and death over their children1 and no one questioned it4 ,in every country in the world until the coming of ,christianity this had always been the case4 ,besides1 there were institutions for the care of the old4 ,these are the classes of mankind who are especially liable to suffer from disease1 and the opportunity to study human ailments in such institutions could scarcely help but provide facilities for clinical observation such as had not existed before4 ,unfortunately the work of ,christianity was hampered1 first by the ,roman persecutions1 and then later by the invasion of the barbarians1 who had to be educated and lifted up to a higher plane of civilization before they could be brought to appreciate the value of medical science1 much less contribute to its development4 ,harnack1 whose writings in the higher criticism of ,scripture have attracted so much attention in recent years1 began his career in the study of ,christian antiquities with a monograph on ,medical ,features of ,early ,christianity4#a ,he mentions altogether some sixteen physicians who reached distinction in the earliest days of ,christianity4 ,some of these were priests1 some of them bishops1 as ,theodotos of ,laodicea2 ,eusebius1 ,bishop of ,rome2 ,basilios1 ,bishop of ,ancyra1 and at least one1 ,hierakas1 was the founder of a religious order4 ,the first ,christian physicians came mainly from ,syria1 as might be expected1 for here the old ,greek medical traditions were active4 ,among them must be enumerated ,cosmas and ,damian1 physicians who were martyred in the persecution of ,diocletian1 and who have been chosen as the patrons of the medical profession4 ,justinian erected a famous church to them4 ,it became the scene of pilgrimages4 ,organizations of various kinds since1 as the ,college of ,st4 ,come1 and medical societies1 have been named after them4 ,some idea of the interest of ecclesiastics in medical affairs may be gathered from a letter of ,bishop ,theodoret of ,cyrus1 directed to the prefect of the city1 when he was about to leave the place4 ,he wrote 7see ,puschmann1 ,vol4 ,i41 p4 #did73 ,when ,i took up the ,bishopric of ,cyrus ,i made every effort to bring in from all sides the arts that would be useful to the people4 ,i succeeded in persuading skilled physicians to take up their residence here4 ,among these is a very pious priest1 ,peter1 who practises medicine with great skill1 and is well known for his care for the people4 ,now that ,i am about to leave the city1 some of those who came at my invitation are preparing also to go4 ,peter seems resolved to do this4 ,i appeal to your highness1 therefore1 in order to commend him to your special care4 ,he handles patients with great skill and brings about many cures4 ,distinguished ,christian writers and scholars1 and the ,fathers of the ,church in the early centuries1 evidently paid much attention to medicine4 ,tertullian speaks of medical science as the sister of philosophy1 and has many references to the medical doctrines discussed in his time4 ,lactantius1 in his work1 ,de ,opificio ,dei1 has much to say with regard to the human body as representing the necessity for design in creation4 ,his teleological arguments have much more force now than they would have had for people generally twenty years ago4 ,we have come back to recognize the place of teleology4 ,clement of ,alexandria was an early ,christian temperance advocate1 who argued that the use of wine was only justified when it did good as a medicine4 ,the problems of embryology and of diseases of childhood interested him as they did many other of the early ,christian writers4 ,a,,tius ,the first great ,christian physician whose works meant much for his own time1 and whose writings have become a classic in medicine1 was ,atius ,amidenus1 that is1 ,atius of ,amida1 who was born in the town of that name in ,mesopotamia1 on the upper ,tigris 7now ,diarbekir71 and who flourished about the middle of the sixth century4 ,his medical studies1 as he has told us himself1 were made at ,alexandria4 ,after having attracted attention by his medical learning and skill1 he became physician to one of the emperors at ,byzantium1 very probably ,justinian1 7#ebg-efe74 ,he seems to have been succeeded in the special post that was created for him at court by ,alexander of ,tralles1 the second of the great ,christian physicians4 ,there is no doubt that ,atius was a ,christian1 for he mentions ,christian mysteries1 and appeals to the name of the ,saviour and the martyrs4 ,he was evidently a man of wide reading1 for he quotes from practically every important medical writer before his time4 ,indeed1 he is most valuable for the history of medicine1 because he gives us some idea of the mode of treatment of various subjects by predecessors whose fame we know1 but none of whose works have come to us4 ,his official career and the patronage of the ,emperor1 the breadth of his scholarship1 and the thoroughly practical character of his teaching1 show how medical science and medical art were being developed and encouraged at this time4 ,atius' work that is preserved for us is known in medical literature as his sixteen books on medical practice4 ,in most of the manuscript it is divided into four ,tetrabibloi1 or four book parts1 each of which consists of four sections called ,logoi in ,greek1 ,sermones in ,latin4 ,this work embraces all the departments of medicine1 and has a considerable portion devoted to surgery1 but most of the important operations and the chapters on fractures and dislocations are lacking4 ,atius himself announces that he had prepared a special work on surgery1 but this is lost4 ,doubtless the important chapters that we have noted as lacking in his work would be found in this4 ,he is much richer in pathology than most of the older writers1 at least of the ,christian era2 for instance1 ,gurlt says that he treats this feature of the subject much more extensively even than ,paulus ginetus1 but most of his work is devoted to therapeutics4 ,at times those who read these old books from certain modern standpoints are surprised to find such noteworthy differences between writers on medicine1 who are separated sometimes only by a generation1 and sometimes by not more than a century1 in what regards the comparative amount of space given to pathology1 etiology1 and therapeutics4 ,just exactly the same differences exist in our own day1 however4 ,we all know that for those who want pathology and etiology the work of one of our great teachers is to be consulted1 while for therapeutics it is better to go to someone else4 ,when we find such differences among the men of the olden time we are not so apt to look at them with sympathetic discrimination1 as we do with regard to our contemporaries4 ,we may even set them down to ignorance rather than specialization of interest4 ,these differences depend on the attitude of mind of the physician1 and are largely the result of his own personal equation4 ,they do not reflect in any way either on his judgment or on the special knowledge of his time1 but are the index of his special receptivity and teaching habit4 ,atius' first and second books are taken up entirely with drugs4 ,the first book contains a list of drugs arranged according to the ,greek alphabet4 ,in the third book other remedial measures1 dietetic1 manipulative1 and even operative1 are suggested4 ,in these are included venesection1 the opening of an artery1 cupping1 leeches1 and the like4 ,the fourth and fifth books take up hygiene1 special dietetics1 and general pathology4 ,in the sixth book what the ,germans call special pathology and therapy begins with the diseases of the head4 ,the first chapter treats of hydrocephalus4 ,in this same book rabies is treated4 ,what ,atius has consists mainly of quotations from previous authors1 many of whom he had evidently read with great care4 ,concerning those bitten by a rabid dog or those who fear water1 ,gurlt has quoted the following expression1 with regard to which most people will be quite ready to agree with him when he says that it contains a great deal of truth1 usually thought to be of much later origin3 ,when1 therefore1 any one has been bitten by a rabid dog the treatment of the wound must be undertaken just as soon as possible1 even though the bite should be small and only superficial4 ,one thing is certain1 that none of those who are not rightly treated escape the fatal effect4 ,the first thing to do is to make the wound larger1 the mouth of it being divided and dilated by the scalpel4 ,then every portion of it and the surrounding tissues must be firmly pressed upon with the definite purpose of causing a large efflux of blood from the part4 ,then the wound should be deeply cauterized1 etc4 ,there are special chapters devoted to eye and ear diseases1 and to various affections of the face4 ,under this the question of tattooing and its removal comes in4 ,it is surprising how much ,atius has with regard to such nasal affections as polyps and ulcers and bleedings from the nose4 ,in this book1 however1 he treats only of their medicinal treatment4 ,what he has to say about affections of the teeth is so interesting that it deserves a paragraph or two by itself4 ,he had much to say with regard to the nervous supply of the mucous membranes of the gums1 tongue1 and mouth1 and taught that the teeth received nerves through the small hole existing at the end of every root4 ,for children cutting teeth he advised the chewing of hard objects1 and thought that the chewing of rather hard materials was good also for the teeth of adults4 ,for fistulas leading to the roots of teeth he suggests various irritant treatments1 and1 if they do not succeed1 recommends the removal of the teeth4 ,he seems to have known much about affections of the gums and recognizes a benignant and malignant epulis4 ,he thought that one form of epulis was due to inflammation of a chronic character1 and suggests that if remedies do not succeed it should be removed4 ,his work is of interest mainly as showing that even at this time1 when the desire for information of this kind is usually supposed to have been in abeyance1 physicians were gathering information about all sorts even of the minor ailments of mankind1 gathering what had been written about them1 commenting on it1 adding their own observations1 and in general trying to solve the problems as well as they could4 ,atius seems to have had a pretty good idea of diphtheria4 ,he speaks of it in connection with other throat manifestations under the heading of crusty and pestilent ulcers of the tonsils4 ,he divides the anginas generally into four kinds4 ,the first consists of inflammation of the fauces with the classic symptoms1 the second presents no inflammation of the mouth nor of the fauces1 but is complicated by a sense of suffocation--apparently our croup4 ,the third consists of external and internal inflammation of the mouth and throat1 extending towards the chin4 ,the fourth is an affection rather of the neck1 due to an inflammation of the vertebr--retropharyngeal abscess--that may be followed by luxation and is complicated by great difficulty of respiration4 ,all of these have as a common symptom difficulty of swallowing4 ,this is greater in one variety than in another at different times4 ,in certain affections even drinks when taken are returned through the nose4 ,hypertrophy of the tonsils--,atius speaks of them as glands--is to be treated by various astringent remedies1 but if these fail the structures should be excised4 ,his description of the excision is rather clear and detailed4 ,the patient should be put in a good full light1 and the mouth should be held open and each gland pulled forward by a hook and excised4 ,the operator should be careful1 however1 only to excise those portions that are beyond the natural size1 for if any of the natural substance of the gland is cut into1 or if the incision is made beyond the projecting portion of the tonsil1 there is grave danger of serious hemorrhage4 ,after excision a mixture of water and vinegar should be kept in the mouth for some time4 ,this should be administered cold in order to prevent the flow of blood4 ,after this very cold water should be taken4 ,in this same book1 ,chapter ,l1 he treats of foreign bodies in the respiratory and upper digestive tracts4 ,if there is anything in the larynx or the bronchial tubes the attempt must be made to secure its ejection by the production of coughing or sneezing4 ,if the foreign body can be seen it should be grasped with a pincers and removed4 ,if it is in the esophagus1 ,atius suggests that the patient should be made to swallow a sponge dipped in grease1 or a piece of fat meat1 to either of which a string has been attached1 in order that the foreign body may be caught and drawn out4 ,if it seems preferable to carry the body on into the stomach1 the swallowing of large mouthfuls of fresh bread or other such material is recommended4 ,with regard to goitre1 ,atius has some interesting details4 ,he says that all tumors occurring in the throat region are called bronchoceles1 for every tumor among the ancients was called a cele1 and1 though the name is common to them1 they differ very much from one another4 ,some of them are fatty1 some of them are pultaceous1 some of them are cancerous1 and some of them he calls honey tumors1 because of a honey-like humor they contain4 ,sometimes they are due to a local dilatation of the blood vessels1 and this is most frequently connected with parturition1 apparently being due to the drawing of the breath being prevented or repressed during the most violent pains of the patient4 ,such local dilatation at this point of the veins is incurable1 but there are also hard tumors like scirrhus and malignant tumors1 and those of great size4 ,with the exception of these last1 all the tumors of this region are easily cured1 yielding either to surgery or to remedies4 ,surgery must be adapted to the special tumor1 whether it be honey-like or fatty1 or pultaceous4 ,the prognosis of goitrous tumors is much better than might be expected1 but evidently ,atius saw a number of the functional disturbances and enlargements of the thyroid gland1 which are so variable in character as apparently to be quite amenable to treatment4 ,atius' treatment of the subject of varicosities is quite complete in its suggestions4 ,the term varices1 he says1 is applied to dilated veins1 which occur sometimes in connection with the testes and sometimes in the limbs4 ,operations on testicular varices patients do not readily consent to2 those on the limbs may be cured in several ways4 ,first1 simple section of the skin lying above the dilated vessel is made1 and with the hook it is separated from the neighboring tissues and tied4 ,after this the dilated portion is removed and pressure applied by means of a bandage4 ,the patient is ordered to remain quiet1 but with the legs higher than the head4 ,some people prefer treatment by means of the cautery4 ,gurlt1 in his ,history of ,surgery1 calls attention to the fact that two of our modern methods of treating varicose veins are thus discussed in ,atius1 that by ligation and that by the cautery4 ,the cautery was applied over a space the breadth of a finger at several points along the dilated veins4 ,atius' chapters on obstetrics and gyncology are of special interest1 because1 while we are prone to think that gyncology particularly is a comparatively modern development of surgery1 this surgical authority of the early ,middle ,ages treats it rather exhaustively4 ,his sixteenth book is for the most part 7one hundred and eleven chapters of it7 devoted to these two subjects4 ,he has a number of interesting details in the first thirty-six chapters with regard to conception1 pregnancy1 labor1 and lactation1 which show how practical were the views of the physicians of the time4 ,gurlt has given us some details of his chapters on diseases of the breast4 ,atius differentiates phagedenic and rodent ulcers and cancer4 ,all the ordinary forms of phagedenic ulcer yield to treatment1 while malignant growths are rendered worse by them4 ,where ulcers are old1 he suggests the removal of their thickened edges by the cautery1 for this hastens cure and prevents hemorrhage4 ,with regard to cancer1 he quotes from ,archigenes and ,leonides4 ,he says that these tumors are very frequent in women1 and quite rare in men4 ,even at this time cancer had been observed and recognized in the male breast4 ,he emphasizes the fact that cancerous nodules become prominent and become attached to surrounding tissues4 ,there are two forms1 those with ulcer1 and those without4 ,he describes the enlargement of the veins that follows1 the actual varicosities1 and the dusky or livid redness of the parts which seem to be soft1 but are really very hard4 ,he says that they are often complicated by very painful conditions1 and that they cause enlargement of the glands and of the arms4 ,the pain may spread to the clavicle and the scapula1 and he seems to think that it is the pain that causes the enlargement of the glands at a distance4 ,his description of ulcerative cancer of the breast is very striking4 ,he says that it erodes without cause1 penetrating ever deeper and deeper1 and cannot be stopped until it emits a secretion worse than the poison of wild beasts1 copious and abominable to the smell4 ,with these other symptoms pains are present4 ,this form of cancer is especially made worse by drugs and by all manner of manipulation4 ,the paragraph from ,leonides quoted by ,atius gives a description of operation for cancer of the breast1 in which he insists particularly on the extensive removal of tissue and the free use of the cautery4 ,the cautery is used at first in order to prevent bleeding1 but also because it helps to destroy the remains of diseased tissues4 ,when the burning is deep1 prognosis is much better4 ,even in cases where indurated tumors of the breast occur that might be removed without danger of bleeding1 it is better to use the cautery freely1 though the amputation of such a portion down to the healthy parts may suffice4 ,atius quotes this with approval4 ,others before ,atius had suggested the connection between hypertrophy of the clitoris and certain exaggerated manifestations of the sexual instinct1 and the development of vicious sexual habits4 ,as might be expected from this first great ,christian physician and surgeon1 he emphasizes this etiology for certain cases1 and outlines an operation for it4 ,this operation had been suggested before1 but ,atius goes into it in detail and describes just how the operation should be done1 so as to secure complete amputation of the enlarged organ1 yet without injury4 ,he warns of the danger of removing more than just the structure itself1 because this may give rise to ugly and bothersome scars4 ,after the operation a sponge wet with astringent wine should be applied1 or cold water1 especially if there is much tendency to bleeding1 and afterwards a sponge with manna or frankincense scattered over it should be bound on4 ,he treats of other pathological conditions of the female genitalia1 varicose veins1 growths of various kinds1 hypertrophy of the portio vaginalis uteri1 an operation for which is described1 and of various tumors4 ,he describes epithelioma very clearly1 enumerates its most frequent locations in their order1 lays down its bad prognosis1 and hence the necessity for early operation with entire removal of the new growth whenever possible4 ,he feared hemorrhage very much1 however1 and warns with regard to it1 and evidently had had some very unfortunate experiences in the treatment of these conditions4 ,atius seems to have had as thoroughly scientific an interest in certain phases of chemistry apart from medicine as any educated physician of the modern time might have4 ,mr4 ,a4,p4 ,laurie1 in his ,materials of the ,printer's ,craft1#b calls attention to the fact that the earliest reference to the use of drying oil for varnish is made by the physician ,atius4 ,atius1 or ,atios1 to use for the nonce the ,greek spelling of his name1 which sometimes occurs in medical literature1 and should be known1 has been the subject of very varied estimation at different times4 ,about the time of the ,renaissance he was one of the first of the early writers on medicine accorded the honor of printing1 and then was reprinted many times1 so that his estimation was very high4 ,with the reawakening of clinical medicine in the seventeenth century his reputation waxed again1 and ,boerhaave declared that the works of ,atius had as much importance for physicians as had the ,pandects of ,justinian for lawyers4 ,this high estimation had survived almost from the time of the ,renaissance1 when ,cornelius went so far as to say3 ,believe me1 that whoever is deeply desirous of studying things medical1 if he would have the whole of ,galen abbreviated and the whole of ,oribasius extended1 and the whole of ,paulus 7of gina7 amplified1 if he would have all the special remedies of the old physicians as well in pharmacy as in surgery boiled down to a summa for all affections1 he will find it in ,atius4 ,naturally enough1 this exaggerated estimation was followed by a reaction1 in which ,atius came to be valued at much less than he deserved4 ,after all is taken into account in the vicissitudes of his fame1 it is clear1 however1 that he is one of the most important links in the chain of medical tradition1 and himself worthy to be classed among makers of medicine for his personal observations and efforts to pass on the teachings of the old to succeeding generations4 ,,alexander ,,of ,,tralles ,an even more striking example than the life and work of ,atius as evidence for the encouragement and patronage of medicine in early ,christian times1 is to be found in the career of ,alexander of ,tralles1 whose writings have been the subject of most careful attention in the ,renaissance period and in our own1 and who must be considered one of the great independent thinkers in medicine4 ,while it is usually assumed that whatever there was of medical writing during the ,middle ,ages was mere copying and compilation1 here at least is a man who could not only judiciously select1 but who could critically estimate the value of medical opinions and procedure1 and weighing them by his own experience and observation1 turn out work that was valuable for all succeeding generations4 ,the modern ,german school of medical historians have agreed in declaring him an independent thinker and physician1 who represents a distinct link in medical tradition4 ,he came of a distinguished family1 in which the following of medicine as a profession might be looked upon as hereditary4 ,his father was a physician1 and it is probable that there were physicians in preceding generations1 and one of his brothers1 ,dioscoros1 was also a successful physician4 ,altogether four of his brothers reached such distinction in their life work that their names have come down to us through nearly fifteen hundred years4 ,the eldest of them was ,anthemios1 the builder of the great church of ,santa ,sophia in ,constantinople4 ,as this is one of the world's great churches1 and still stands for the admiration of men a millennium and a half after its completion1 it is easy to understand that ,anthemios' reputation is well founded4 ,a second brother was ,metrodoros1 a distinguished grammarian and teacher1 especially of the youthful nobility of ,byzantium1 as it was then called1 or ,constantinople1 as we have come to call it4 ,a third brother was a prominent jurist1 also in ,constantinople4 ,the fourth brother1 ,dioscoros1 like ,alexander1 a physician1 remained in his birthplace1 ,tralles1 and acquired there a great practice4 ,it was with his father at ,tralles that ,alexander received his early medical training4 ,the father of a friend and colleague1 ,cosmas1 who later dedicated a book to ,alexander1 was also his teacher1 while he was in his native city4 ,as a young man1 ,alexander undertook extensive travels1 which led him into ,italy1 ,gaul1 ,spain1 and ,africa1 everywhere gathering medical knowledge and medical experience4 ,then he settled down at ,rome1 probably in an official position1 and practised medicine successfully until a very old age4 ,he was probably eighty years of age when1 some time during the first decade of the seventh century1 he died4 ,puschmann1 who has made a special study of ,alexander's life and work1 suggests that since some of his books have the form of academic lectures he was probably a teacher of medicine at ,rome4 ,as might be expected from what we know of the relations of the rest of the family to the nobility of the time1 it is easy to understand1 especially in connection with hints in ,alexander's favorite modes of therapeutics1 that costliness of remedies made no difference to his patients1 that he must have had the treatment of some of the wealthiest families in ,rome4 ,his principal work is a ,treatise on the ,pathology and ,therapeutics of ,internal ,diseases1 in twelve books4 ,the first eleven books were evidently material gathered for lectures or teaching of some kind4 ,the twelfth book1 in which considerable use of ,atius' writings is made1 was written1 according to ,puschmann1 toward the end of ,alexander's life1 and was meant to contain supplementary matter1 comprising especially his views gathered from observation as to the pathology of internal diseases4 ,a shorter treatise of ,alexander is with regard to intestinal parasites4 ,there are many printed editions of these books1 and many manuscript copies are in existence4 ,alexander was often quoted during the ,middle ,ages1 and in recent years1 with the growth of our knowledge of medical history1 he has come to be a favorite subject of study4 ,alexander's first book of pathology and therapeutics treats of head and brain diseases4 ,for baldness1 the first symptom of which is falling out of the hair1 he counsels cutting the hair short1 washing the scalp vigorously1 and the rubbing in of sulphur ointments4 ,for grey hair he suggests certain hair dyes1 as nutgalls1 red wine1 and so forth4 ,for dandruff1 which he described as the excessive formation of small flake-like scales1 he recommends rubbing with wine1 with certain salves1 and washing with salt water4 ,he gives a good deal of attention to diseases of the nervous system4 ,he has a rather interesting chapter on headache4 ,the affection occurs in connection with fevers1 after excess in drinking1 and as a consequence of injury to the skull4 ,besides1 it develops as a result of disturbances of the natural processes in the head1 the stomach1 the liver1 and the spleen4 ,headache1 as the first symptom of inflammation of the brain1 is often the forerunner of convulsions1 delirium1 and sudden death4 ,chronic or recurrent headache occurs in connection with plethora1 diseases of the brain1 biliousness1 digestive disturbances1 insomnia1 and continued worry4 ,hemicrania has its origin in the brain1 because of the presence of toxic materials1 and specially their transformation into gaseous substances4 ,it also occurs in connection with abdominal affections4 ,this latter remark particularly is directed to the cases which occur in women4 ,for apoplexy and the consequent paralysis1 ,alexander considered venesection the best remedy4 ,massage1 rubbings1 baths1 and warm applications are recommended for the paralytic conditions4 ,he had evidently had considerable experience with epilepsy4 ,it develops either from injuries of the head or from disturbances of the stomach1 or occasionally other parts of the body4 ,when it occurs in nursing infants1 nourishment is the best remedy1 and he gives detailed directions for the selection of a wet nurse1 and very careful directions as to her mode of life4 ,he emphasizes very much the necessity for careful attention to the gastro-intestinal tract in many cases of epilepsy4 ,planned diet and regular bowels are very helpful4 ,he rejects treatment of the condition by surgery of the head1 either by trephining or by incisions1 or cauterization4 ,regular exercise1 baths1 sexual abstinence are the foundation of any successful treatment4 ,it is probable that we have returned to ,alexander's treatment of epilepsy much more nearly than is generally thought4 ,there are those who still think that remedies of various kinds do good1 but in the large epileptic colonies regular exercise1 bland diet1 regulation of the bowels1 and avoidance of excesses of all kinds1 with occupation of mind1 constitute the mainstay of their treatment4 ,alexander has much to say with regard to phrenitis1 a febrile condition complicated by delirium1 which1 following ,galen1 he considers an affection of the brain4 ,it is evidently the brain fever of the generations preceding the last1 an important element of which was made up of the infectious meningitises4 ,alexander suggests its treatment by opiates after preliminary venesection1 rubbings1 lukewarm baths1 and stimulating drinks4 ,every disturbance of the patient must be avoided1 and visitors must be forbidden4 ,the patient's room should rather be light than dark4 ,his teaching crops up constantly in the centuries after his time1 until the end of the nineteenth century1 and while we now understand the causes of the condition better1 we can do little more for it than he did4 ,alexander divided mental diseases into two1 the maniacal and melancholic4 ,mania was1 however1 really a further development of melancholia1 and represented a high grade of insanity4 ,under melancholy he groups not only what we denominate by that term1 but also all depressed conditions1 and the paranoias1 as also many cases of imbecility4 ,the cause of mental diseases was to be found in the blood4 ,he counselled the use of venesection1 of laxatives and purgatives1 of baths and stimulant remedies4 ,he insisted very much1 however1 on mental influence in the disease1 on change of place and air1 visits to the theatre1 and every possible form of mental diversion1 as among the best remedial measures4 ,after his book on diseases of the head1 his most important section is on diseases of the respiratory system4 ,in this he treats first of angina1 and recommends as gargles at the beginning light astringents2 later stronger astringents1 as alum and soda dissolved in warm water1 should be employed4 ,warm compresses1 venesection from the sublingual veins1 and from the jugular1 and purgatives in severe cases1 are the further remedies4 ,he treats of cough as a symptom due to hot or cold1 dry or wet dyscrasias4 ,opium preparations carefully used are the best remedies4 ,the breathing in of steam impregnated with various ethereal resins1 was also recommended4 ,he gives a rather interestingly modern treatment of consumption4 ,he recommends an abundance of milk with a strong nutritious diet1 as digestible as possible4 ,a good auxiliary to this treatment was change of air1 a sea voyage1 and a stay at a watering-place4 ,asses' and mares' milk are much better for these patients than cows' and goats' milk4 ,there is not enough difference in the composition of these various milks to make their special consumption of import1 but it is probable that the suggestive influence of the taking of an unusual milk had a very favorable effect upon patients1 and this effect was renewed frequently1 so that much good was ultimately accomplished4 ,for hemoptysis1 especially when it was acute and due as ,alexander thought to the rupture of a blood vessel in the lungs1 he recommended the opening of a vein at the elbow or the ankle--in order to divert the blood from the place of rupture to the healthy parts of the circulation4 ,he insisted that the patients must rest1 that they should take acid and astringent drinks1 that cold compresses should be placed upon the chest 7our ice bags71 and that they should take only a liquid diet at most lukewarm1 or1 better1 if agreeable to them1 cold4 ,when the bleeding stopped1 a milk cure was very useful for the restoration of these patients to strength4 ,it is not surprising1 then1 to find that ,alexander suggests a thoroughly rational treatment for pleurisy4 ,he recognizes this as an inflammation of the membrane covering the ribs1 and its symptoms are severe pain1 disturbance of breathing1 and coughing4 ,in certain cases there is severe fever1 and ,alexander knows of purulent pleurisy1 and the fact that when pus is present the side on which it is is warmer than the other4 ,pleurisy can be1 he says1 rather easily confounded with certain liver affections1 but there is a peculiar hardness of the pulse characteristic of pleurisy1 and there is no expectoration in liver cases1 though it also may be absent in many cases of pleurisy4 ,sufferers from liver disease usually have a paler color than pleuritics4 ,his treatment consists in venesection1 purgatives1 and1 when pus is formed1 local incision4 ,he recommends the laying on of sponges dipped in warm water1 and the internal use of honey lemonade4 ,opium should not be used unless the patient suffers from sleeplessness4 ,some of the general principles of therapeutics that ,alexander lays down are very interesting1 even from our modern standpoint4 ,trust should not be placed in any single method of treatment4 ,every available means of bringing relief to the patient should be tried4 ,the duty of the physician is to cool what is hot1 to warm what is cold1 to dry what is moist1 and to moisten what is dry4 ,he should look upon the patient as a besieged city1 and try to rescue him with every means that art and science places at his command4 ,the physician should be an inventor1 and think out new ways and means by which the cure of the patient's affection and the relief of his symptoms may be brought about4 ,the most important factor in his therapeutics is diet4 ,watering-places and various forms of mineral waters1 as well as warm baths and sea baths1 are constantly recommended by him4 ,he took strong ground against the use of many drugs1 and the rage for operating4 ,the prophylaxis of disease is in ,alexander's opinion the important part of the physician's duty4 ,his treatment of fever shows the application of his principle3 cold baths1 cold compresses1 and a cooling diet1 were his favorite remedies4 ,he encouraged diaphoresis nearly always1 and gave wine and stimulating drugs only when the patient was very weak4 ,he differentiates two kinds of quartan fever4 ,one of these he attributes to an affection of the spleen1 because he had noticed that the spleen was enlarged during it1 and that1 after purgation1 the enlarged spleen decreased in size4 ,alexander was a strong opponent of drastic remedies of all kinds4 ,he did not believe in strong purgatives1 nor in profuse and sudden blood-lettings4 ,he opposed arteriotomy for this reason1 and refused to employ extensive cauterization4 ,his diagnosis is thorough and careful4 ,he insisted particularly on inspection and palpation of the whole body2 on careful examination of the urine1 of the feces1 and the sputum2 on study of the pulse and the breathing4 ,he thought that a great deal might be learned from the patient's history4 ,the general constitution is also of importance4 ,his therapeutics is1 above all1 individual4 ,remedies must be administered with careful reference to the constitution1 the age1 the sex1 and the condition of the patient's strength4 ,special attention must always be paid to nature's efforts to cure1 and these must be encouraged as far as possible4 ,alexander had no sympathy at all with the idea that remedies must work against nature4 ,his position in this matter places him among the dozen men whose name and writings have given them an enduring place in the favor of the profession at all times1 when we were not being carried away by some therapeutic fad or imagining that some new theory solved the whole problem of the causation and cure of disease4 ,gurlt1 in his ,history of ,surgery1 has abstracted from ,alexander particularly certain phases of what the ,germans call external pathology and therapeutics4 ,for instance1 ,alexander's treatment of troubles connected with the ear is very interesting4 ,gurlt declares that this chapter alone provides striking evidence for ,alexander's practical experience and power of observation1 as well as for his knowledge of the literature of medicine4 ,he considers that only a short abstract is needed to show that4 ,for water that has found its way into the external ear1 ,alexander suggests a mode of treatment that is still popularly used4 ,the patient should stand upon the leg corresponding to the side on which there is water in his ear1 and then1 with head leaning to that side1 should hop or kick out with the other leg4 ,the water may be drawn out by means of suction through a reed4 ,in order to get foreign bodies out of the external auditory canal1 an ear spoon or other small instrument should be wrapped in wool and dipped in turpentine1 or some other sticky material4 ,occasionally he has seen sneezing1 especially if the mouth and nose are covered with a cloth1 and the head leant toward the affected side1 bring about a dislodgment of the foreign body4 ,if these means do not succeed1 gentle injections of warm oil or washing out of the canal with honey water should be tried4 ,foreign bodies may also be removed by means of suction4 ,insects or worms that find their way into the ear may be killed by injections of acid and oil1 or other substances4 ,gurlt also calls attention to ,alexander's careful differentiation of certain very dangerous forms of inflammation of the throat from others which are rather readily treated4 ,he says1 ,inflammation of the throat may1 under certain circumstances1 belong to the severest diseases4 ,the patients succumb to it as a consequence of suffocation1 just as if they were choked or hanged4 ,for this reason1 perhaps1 the affection bears the name synanche1 which means constriction4 ,he then points out various other forms of inflammation of the throat1 acute and chronic1 suggesting various names and the differential diagnostic signs4 ,one of the most surprising chapters of ,alexander's knowledge of pathology and therapeutics is to be found in his treatment of the subject of intestinal worms1 which is contained in a letter sent by him to his friend1 ,theodore1 whose child was suffering from them4 ,he describes the oxyuris vermicularis with knowledge manifestly derived from personal observation4 ,he dwells on the itching in the region of the anus1 caused by the oxyuris1 and the fact that they probably find their way into the upper part of the digestive tract because of the soiling of the hands4 ,he knew that the tapeworms often reached great length1--he has seen one over sixteen feet long1--and also that they had a life cycle1 so that they existed in two different forms4 ,he describes the roundworms as existing in the intestines1 but occasionally wandering into the stomach to be vomited4 ,his vermifuges were the flowers and the seeds of the pomegranate1 the seeds of the heliotrope1 castor-oil1 and certain herbs that are still used1 by country people1 at least1 as worm medicines4 ,for roundworms he recommended especially a decoction of artemisia maritima1 coriander seeds1 and decoctions of thyme4 ,our return to thymol for intestinal parasites is interesting4 ,for the oxyuris he prescribed clysters of ethereal oils4 ,we have not advanced much in our treatment of intestinal worms in the fifteen hundred years since ,alexander's time4 ,,paul ,,of ,,gina ,another extremely important writer in these early medieval times1 whose opportunities for study in medicine and for the practice of it1 were afforded him by ,christian schools and ,christian hospitals1 was ,paul of gina4 ,he was born on the island of gina1 hence the name ginetus1 by which he is commonly known4 ,there used to be considerable doubt as to just when ,paul lived1 and dates for his career were placed as widely apart as the fifth and the seventh centuries4 ,we know that he was educated at the ,university of ,alexandria4 ,as that institution was broken up at the time of the capture of the city by the ,arabs1 he cannot have been there later than during the first half of the seventh century4 ,an ,arabian writer1 ,abul ,farag1 in ,the ,story of the ,reign of the ,emperor ,heraclius1 who died #fda1 says that among the celebrated physicians who flourished at this time was ,paulus ginetus4 ,in his works ,paul quotes from ,alexander of ,tralles1 so that there seems to be no doubt now that his life must be placed in the seventh century4 ,the most important portion of ,paul's work for the modern time is contained in his sixth book on surgery4 ,in this his personal observations are especially accumulated4 ,gurlt has reviewed it at considerable length1 devoting altogether nearly thirty pages to it1 and it well deserves this lengthy abstract4 ,paul quotes a great many of the writers on surgery before his time1 and then adds the results of his own observation and experience4 ,in it one finds careful detailed descriptions of many operations that are usually supposed to be modern4 ,very probably the description quoted by ,gurlt of the method of treating fishbones that have become caught in the throat will give the best idea of how thoroughly practical ,paul is in his directions4 ,he says3 ,it will often happen in eating that fishbones or other objects may be swallowed and get caught in some part of the throat4 ,if they can be seen they should be removed with the forceps designed for that purpose4 ,where they are deeper1 some recommend that the patient should swallow large mouthfuls of bread or other such food4 ,others recommend that a clean soft sponge of small circumference to which a string is attached be swallowed1 and then drawn out by means of the string4 ,this should be repeated until the bone or other object gets caught in the sponge and is drawn out4 ,if the patient is seen immediately after eating1 and the swallowed object is not visible1 vomiting should be brought on by means of a finger in the throat or irritation with the feather1 and then not infrequently the swallowed object will be brought up with the vomit4 ,in the chapter immediately following this1 ,,xxxiii1 there is a description of the method of opening the larynx or the trachea1 with the indications for this operation4 ,the surgeon will know that he has opened the trachea when the air streams out of the wound with some force1 and the voice is lost4 ,as soon as the danger of suffocation is over1 the edges of the wound should be freshened and the skin surfaces brought together with sutures4 ,only the skin without the cartilage should be sutured1 and general treatment for encouraging union should be employed4 ,if the wound fails to heal immediately1 a treatment calculated to encourage granulations should be undertaken4 ,this same method of treatment will be of service whenever we happen to have a patient who1 in order to commit suicide1 has cut his throat4 ,paul's exact term is1 perhaps1 best translated by the expression1 slashed his larynx4 ,one of the features of ,paul's ,treatise on ,surgery is his description of a radical operation for hernia4 ,he describes scrotal hernia under the name enterocele1 and says that it is due either to a tearing or a stretching of the peritoneum4 ,it may be the consequence either of injury or of violent efforts made during crying4 ,when the scrotum contains only omentum1 he calls the condition epiplocele2 when it also contains intestine1 an epiplo-enterocele4 ,hernia that does not descend into the scrotum he calls bubonocele4 ,for operation the patient should be placed on the back1 and1 the skin of the inguinal region being stretched by an assistant1 an oblique incision in the direction in which the blood vessels run should be made4 ,the incision should then be stretched by means of retractors1 until the contents of the sac can be lifted out4 ,all adhesions should be broken up and the fat be removed1 and the hernia replaced within the abdomen4 ,care should be taken that no loop of intestine is allowed to remain4 ,then a large needle with double thread made of ten strands should be run through the middle of the incision in the end of the peritoneum1 and tied firmly in cross sutures4 ,the outer structures should be brought together with a second ligature1 and the lower end of the incision should have a wick placed in it for drainage1 and the site of operation should be covered with an oil bandage4 ,the ,arab writer1 ,abul ,farag1 to whose references we owe the definite placing of the time when ,paul lived1 said that he had special experience in women's diseases1 and had devoted himself to them with great industry and success4 ,the midwives of the time were accustomed to go to him and ask his counsel with regard to accidents that happen during and after parturition4 ,he willingly imparted his information1 and told them what they should do4 ,for this reason he came to be known as the ,obstetrician4 ,perhaps the term should be translated the man-midwife1 for it was rather unusual for men to have much knowledge of this subject4 ,his knowledge of the phenomena of menstruation was as wide and definite4 ,he knew a great deal of how to treat its disturbances4 ,he seems to have been the first one to suggest that in metrorrhagia1 with severe hemorrhage from the uterus1 the bleeding might be stopped by putting ligatures around the limbs4 ,this same method has been suggested for severe hemorrhage from the lungs as well as from the uterus in our own time4 ,in hysteria he also suggested ligature of the limbs1 and it is easy to understand that this might be a very strongly suggestive treatment for the severer forms of hysteria4 ,it is possible1 too1 that the modification of the circulation to the nervous system induced by the shutting off of the circulation in large areas of the body might very well have a favorable physical effect in this affection4 ,paul's description of the use of the speculum is as complete as that in any modern text-book of gyncology4 ,,further ,,christian ,,physicians ,another distinguished ,christian medical scientist was ,theophilus ,protosbatharius1 who belonged to the court of the ,greek ,emperor ,heraclius1 in the seventh century4 ,he seems to have had a life very full of interest and surprisingly varied duties4 ,he was a bishop1 and1 at the same time1 commander of the imperial bodyguard1 and the author of a little work on the fabric of the human body4 ,the most surprising chapter in the history of the book is that for some two centuries1 in quite modern times1 it was used as a text-book of anatomy at the ,university of ,paris4 ,it was printed in a number of editions early in the history of printing1 at least one very probably before #aejj1 and several later4 ,there are very interesting phases of medicine delightfully surprising in their modernity to be found here and there in many of these early ,christian writers on medicine4 ,for instance1 in a compend of medicine written by one ,leo1 who1 under the ,emperor ,theophilus1 seems to have been a prominent physician of ,byzantium 7the compend was written for a young physician just beginning practice71 we find the following classification of hydrops or abdominal dilatation3 ,there are three kinds2 the first is ascites1 due to the presence of watery fluid1 for which we do paracentesis2 second1 tympany1 when the abdomen is swollen from the presence of air or gas4 ,this may be differentiated by percussion of the belly4 ,when air is present the sound given forth is like that of a drum1 while in the first form ascites the sound is like that from a sack the word used is the same as for a wine sack2 the third form is called anasarca1 when the whole body swells4 ,it has often been the subject of misunderstanding as to why medicine should have developed among the ,latin ,christian nations so much more slowly than among the ,arabs during the early ,middle ,ages4 ,anyone who knows the conditions in which ,christianity came into existence in ,italy will not be surprised at that4 ,the ,arabs in the ,east were in contact with ,greek thought1 and that is eminently prolific and inspiring4 ,at the most1 the ,christians in ,italy got their inspiration at second hand through the ,romans4 ,the ,romans themselves1 in spite of intimate contact with ,greek physicians1 never made any important contributions to medical science1 nor to science of any kind4 ,their successors1 the ,christians of ,rome and ,italy1 then could scarcely be expected to do better1 hampered especially1 as they were1 by the trying social conditions created by the invasion of the barbarians from the ,north4 ,whenever the ,christians were in contact with ,greek thought and ,greek medicine1 above all1 as at ,alexandria1 or in certain of the cities of the near ,east1 we have distinguished contributions from them4 ,,arabian ,,christian ,,physicians ,that this is not a partial view suggested by the desire to make out a better case for ,christianity in its relation to science will be very well understood1 besides1 from the fact that a number of the original physicians of ,arab stock who attracted attention during the first period of ,arabian medicine1 that is1 during the eighth and ninth centuries1 were ,christians4 ,there are a series of physicians belonging to the ,christian family ,bachtischua1 a name which is derived from ,bocht ,jesu1 that is1 servant of ,jesus1 who1 from the middle of the eighth to the middle of the eleventh century1 acquired great fame4 ,the first of them1 ,george 7,dschordschis71 after acquiring fame elsewhere1 was called to ,bagdad by the ,caliph ,el-,mansur1 where1 because of his medical skill1 he reached the highest honors4 ,his son became the body-physician of ,harun al-,raschid4 ,in the third generation ,gabriel 7,dschibril7 acquired fame and did much1 as had his father and grandfather1 for the medicine of the time1 by translations of the ,greek physicians into ,arabian4 ,these men may well be said to have introduced ,greek medicine to the ,mohammedans4 ,it was their teaching that aroused ,moslem scholars from the apathy that had characterized the attitude of the ,arabian people toward science at the beginning of ,mohammedanism4 ,as time went on1 other great ,christian medical teachers distinguished themselves among the ,arabs4 ,of these the most prominent was ,messui the elder1 who is also known as ,janus ,damascenus4 ,both he and his father practised medicine with great success in ,bagdad1 and his son became the body-physician to ,harun al-,raschid either after or in conjunction with ,gabriel ,bachtischua4 ,like his colleague or predecessor in official position1 he1 too1 made translations from the ,greek into ,arabic4 ,another distinguished ,arabian ,christian physician was ,serapion the elder4 ,he was born in ,damascus1 and flourished about the middle of the ninth century4 ,he wrote a book on medicine called the ,aggregator1 or ,breviarium1 or ,practica ,medicin1 which appeared in many printed editions within the century after the invention of printing4 ,during the ninth century1 also1 we have an account of ,honein ,ben ,ischak1 who is known in the ,west as ,johannitius4 ,after travelling much1 especially in ,greece and ,persia1 he settled in ,bagdad1 and1 under the patronage of the ,caliph ,mamum1 made many translations4 ,he translated most of the old ,greek medical writers1 and also certain of the ,greek philosophic and mathematical works4 ,the accuracy of his translations became a proverb4 ,his compendium of ,galen was the text-book of medicine in the ,west for many centuries4 ,it was known as the ,isagoge in ,artem ,parvam ,galeni4 ,his son1 ,ishac ,ben ,honein1 and his nephew1 ,hobeisch1 were also famous as medical practitioners and translators4 ,still another of these ,arabian ,christians1 who acquired a reputation as writers in medicine1 was ,alkindus4 ,he wrote with regard to nearly everything1 however1 and so came to be called the philosopher4 ,he is said altogether to have written and translated about two hundred works1 of which twenty-two treat of medicine4 ,he was a contemporary of ,honein ,ben ,ischak in the ninth century4 ,another of the great ninth-century ,christian physicians and translators from the ,greek was ,kostaben ,luka4 ,he was of ,greek origin1 but lived in ,armenia and made translations from ,greek into ,arabic4 ,nearly all of these men took not alone medical science1 but the whole round of physical science1 for their special subject4 ,a typical example in the ninth century was ,abuhassan ,ben ,korra1 many of whose family during succeeding generations attracted attention as scholars4 ,he became the astronomer and physician of the ,caliph ,motadhid4 ,his translations in medical literature were mainly excerpts from ,hippocrates and ,galen meant for popular use4 ,these ,christian translators1 thoroughly scientific as far as their times permitted them to be1 were wonderfully industrious in their work as translators1 great teachers in every sense of the word1 and they are the men who formed the traditions on which the greater ,arabian physicians from ,rhazes onward were educated4 ,it would be easy to think that these men1 occupied so much with translations1 and intent on the re-introduction of ,greek medicine1 might have depended very little on their own observations1 and been very impractical4 ,all that is needed to counteract any such false impression1 however1 is to know something definite about their books4 ,gurlt1 in his ,history of ,surgery1 has some quotations from ,serapion the elder1 who is often quoted by ,rhazes4 ,in the treatment of hemorrhoids ,serapion advises ligature and insists that they must be tied with a silk thread or with some other strong thread1 and then relief will come4 ,he says some people burn them medicinis acutis 7touching with acids1 as some do even yet71 and some incise them with a knife4 ,he prefers the ligature1 however4 ,he calmly discusses the removal of stones from the kidney by incision of the pelvis of the kidney through an opening in the loin4 ,he considers the operation very dangerous1 however1 but seems to think the removal of a stone from the bladder a rather simple procedure4 ,his description of the technique of the use of a catheter and of a stylet with it1 and apparently also of a guide for it in difficult cases1 is extremely interesting4 ,he suggests the opening of the bladder in the median line1 midway between the scrotum and the anus1 and the placing of a canula therein1 so as to permit drainage until healing occurs4 ,even this brief review of the careers and the writings of the physicians of early ,christian times shows how well the tradition of old ,greek medicine was being carried on4 ,there was much to hamper the cultivation of science in the disturbances of the time1 the gradual breaking up of the ,roman ,empire1 and the replacement of the peoples of southern ,europe by the northern nations1 who had come in1 yet in spite of all this1 medical tradition was well preserved4 ,the most prominent of the conservators were themselves men whose opinions on problems of practical medicine were often of value1 and whose powers of observation frequently cannot but be admired4 ,there is absolutely no trace of anything like opposition to the development of medical science or medical practice1 but1 on the contrary1 everywhere among political and ecclesiastical authorities1 we find encouragement and patronage4 ,the very fact that1 in the storm and stress of the succeeding centuries1 manuscript copies of the writings of the physicians of this time were preserved for us in spite of the many vicissitudes to which they were subjected from fire1 and war1 and accidents of various kinds for hundreds of years1 until the coming of printing1 shows in what estimation they were held4 ,during this time they owed their preservation to churchmen1 for the libraries and the copying-rooms were all under ecclesiastical control4 ,,iii ,,great ,,jewish ,,physicians#c ,any account of ,old-,time ,makers of ,medicine without a chapter on the ,jewish ,physicians would indeed be incomplete4 ,they are among the most important factors in medieval medicine1 representing one of the most significant elements of medical progress4 ,in spite of the disadvantages under which their race labored because of the popular feeling against them on the part of the ,christians in the earlier centuries and of the ,mohammedans later1 men of genius from the race succeeded in making their influence felt not only on their own times1 but accomplished so much in making and writing medicine as to influence many subsequent generations4 ,living the segregated life that as a rule they had to1 from the earliest times 7the ,ghettos have only disappeared in the nineteenth century71 it would seem almost impossible for them to have done great intellectual work4 ,it is one of the very common illusions1 however1 that great intellectual work is accomplished mainly in the midst of comfortable circumstances and as the result of encouraging conditions4 ,most of our great makers of medicine at all times1 and never more so than during the past century1 have been the sons of the poor1 who have had to earn their own living1 as a rule1 before they reached manhood1 and who have always had the spur of that necessity which has been so well called the mother of invention4 ,their hard living conditions probably rather favored than hampered their intellectual accomplishments4 ,it is not unlikely that the difficult personal circumstances in which the ,jews were placed had a good deal to do at all times with stimulating their ambitions and making them accomplish all that was in them4 ,certain it is that at all times we find a wonderful power in the people to rise above their conditions4 ,with them1 however1 as with other peoples1 luxury1 riches1 comfort1 bring a surfeit to initiative and the race does not accomplish so much4 ,at various times in the early ,middle ,ages1 particularly1 we find ,jewish physicians doing great work and obtaining precious acknowledgment for it in spite of the most discouraging conditions4 ,later it is not unusual to find that there has been a degeneration into mere money-making as the result of opportunity and consequent ease and luxury4 ,at a number of times1 however1 both in ,christian and in ,mohammedan countries1 great ,jewish physicians arose whose names have come to us and with whom every student of medicine who wants to know something about the details of the course of medical history must be familiar4 ,there are men among them who must be considered among the great lights of medicine1 significant makers always of the art and also in nearly all cases of the science of medicine4 ,a little consideration of the history of the ,jewish people and their great documents eliminates any surprise there may be with regard to their interest in medicine and successful pursuit of it during the ,middle ,ages4 ,the two great collections of ,hebrew documents1 the ,old ,testament and the ,talmud1 contain an immense amount of material with reference to medical problems of many kinds4 ,both of these works are especially interesting because of what they have to say of preventive medicine and with regard to the recognition of disease4 ,our prophylaxis and diagnosis are important scientific departments of medicine dependent on observation rather than on theory4 ,while therapeutics has wandered into all sorts of absurdities1 the advances made in prophylaxis and in diagnosis have always remained valuable1 and though at times they have been forgotten1 re-discovery only emphasizes the value of preceding work4 ,it is because of what they contain with regard to these two important medical subjects that the ,old ,testament and the ,talmud are landmarks in the history of medicine as well as of religion4 ,baas1 in his ,outlines of the ,history of ,medicine1 says3 ,it corresponds to the reality in both the actual and chronological point of view to consider the books of ,moses as the foundation of sanitary science4 ,the more we have learned about sanitation in the prophylaxis of disease and in the prevention of contagion in the modern time1 the more have we come to appreciate highly the teachings of these old times on such subjects4 ,moses made a masterly exposition of the knowledge necessary to prevent contagious disease when he laid down the rules with regard to leprosy1 first as to careful differentiation1 then as to isolation1 and finally as to disinfection after it had come to be sure that cure had taken place4 ,the great lawgiver could insist emphatically that the keeping of the laws of ,god not only was good for a man's soul but also for his body4 ,with this tradition familiarly known and deeply studied by the mass of the ,hebrew people1 it is no surprise to find that when the next great ,hebrew development of religious writing came in the ,talmud during the earlier ,middle ,ages1 that also contains much with regard to medicine1 not a little of which is so close to absolute truth as never to be out of date4 ,friedenwald1 in his ,jewish ,physicians and the ,contributions of the ,jews to the ,science of ,medicine1 a lecture delivered before the ,gratz ,college of ,philadelphia fifteen years ago1 summed up from ,baas' ,history of ,medicine the instructions in the ,talmud with regard to health and disease4 ,the summary represents so much more of genuine knowledge of medicine and surgery than might be expected at the early period at which it was written1 during the first and second century of our era1 that it seems well to quote it at some length4 ,fever was regarded as nature's effort to expel morbific matter and restore health2 which is a much safer interpretation of fever1 from a practical point of view1 than most of the theories bearing on this point that have been taught up to a very recent period4 ,they attributed the halting in the hind legs of a lamb to a callosity formed around the spinal cord4 ,this was a great advance in the knowledge of the physiology of the nervous system4 ,an emetic was recommended as the best remedy for nausea4 ,in many cases no better remedy is known to-day4 ,they taught that a sudden change in diet was injurious1 even if the quality brought by the change was better4 ,that milk fresh from the udder was the best4 ,the ,talmud describes jaundice and correctly ascribes it to the retention of bile1 and speaks of dropsy as due to the retention of urine4 ,it teaches that atrophy or rupture of the kidneys is fatal4 ,induration of the lungs 7tuberculosis7 was regarded as incurable4 ,suppuration of the spinal cord had an early1 grave meaning4 ,rabies was known4 ,the following is a description given of the dog's condition3 ',his mouth is open1 the saliva issues from his mouth2 his ears drop2 his tail hangs between his legs2 he runs sideways1 and the dogs bark at him2 others say that he barks himself1 and that his voice is very weak4 ,no man has appeared who could say that he has seen a man live who was bitten by a mad dog4' ,the description is good1 and this prognosis as to hydrophobia in man has remained unaltered till in our day when ,pasteur published his startling revelation4 ,the anatomical knowledge of the ,talmudists was derived chiefly from dissection of the animals4 ,as a very remarkable piece of practical anatomy for its very early date is the procuring of the skeleton from the body of a prostitute by the process of boiling1 by ,rabbi ,ishmael1 a physician1 at the close of the first century4 ,he gives the number of bones as #beb instead of #bcb4 ,the ,talmudists knew the origin of the spinal cord at the foramen magnum and its form of termination2 they described the oesophagus as being composed of two coats2 they speak of the pleura as the double covering of the lungs2 and mention the special coat of fat about the kidneys4 ,they had made progress in obstetrics2 described monstrosities and congenital deformities2 practised version1 evisceration1 and ,csarian section upon the dead and upon the living mother4 ,a4,h4 ,israels has clearly shown in his ',dissertatio ,historico-,medica ,inauguralis' that ,csarian section1 according to the ,talmud1 was performed among the ,jews with safety to mother and child4 ,the surgery of the ,talmud includes a knowledge of dislocation of the thigh bone1 contusions of the skull1 perforation of the lungs1 oesophagus1 stomach1 small intestines1 and gall bladder2 wounds of the spinal cord1 windpipe1 of fractures of the ribs1 etc4 ,they described imperforate anus and how it was to be relieved by operation4 ,chanina ,ben ,chania inserted natural and wooden teeth as early as the second century1 ,c4,e4 ,there is a famous summing up of the possibilities of life and happiness in the ,talmud that has been often quoted--its possible wanting in gallantry being set down to the times in which it was written4 ,life is compatible with any disease1 provided the bowels remain open2 any kind of pain1 provided the heart remain unaffected2 any kind of uneasiness1 provided the head is not attacked2 all manner of evils1 except it be a bad woman4 ,there are many other interesting suggestions in the ,talmud4 ,sometimes they have come to be generally accepted in the modern time1 sometimes they are only curious notions that have not1 however1 lost all their interest4 ,the crucial incision for carbuncle is a typical example of the first class and the suggestion of the removal of superfluous fat from within the abdomen or in the abdominal wall itself by operation is another4 ,that they had some idea of the danger of sepsis may be gathered from the fact that they suspected iron surgical instruments and advised the use of others of less enduring character4 ,the ,talmud itself was indeed a sort of encyclopedia in which was gathered knowledge of all kinds from many sources4 ,it was not particularly a book of medicine1 though it contains so many medical ideas4 ,in many parts of it the authors' regard for science is emphatically expressed4 ,landau1 in his ,history of ,jewish ,physicians1 closes his account of the ,talmud with this paragraph3 ,i conclude this brief review of ,talmudic medicine with some reference to how high the worth of science was valued in this much misunderstood work4 ,in one place we have the expression 'occupation with science means more than sacrifice4' ,in another 'science is more than priesthood and kingly dignity4'#d ,after all this of national tradition in medicine before and after ,christ1 it is only what we might quite naturally expect to find1 that there is scarcely a century of the ,middle ,ages which does not contain at least one great ,jewish physician and sometimes there are more4 ,many of these men made distinct contributions to medical science and their names have been held in high estimation ever since4 ,perhaps ,i should say that they were held in high estimation until that neglect of historical studies which characterized the eighteenth century developed1 and that there has been a reawakening of interest in our time4 ,we forget this curious decadence of the later seventeenth and eighteenth centuries which did so much to obscure history and especially the history of the sciences4 ,fortunately the scholars of the sixteenth and early seventeenth centuries accomplished successfully the task of printing many of the books of these old-time physicians and secured their publication in magnificent editions4 ,these were bought eagerly by scholars and libraries all over ,europe in spite of the high price they commanded in that era of slow1 laborious printing4 ,the ,renaissance exhibits some of its most admirable qualities in its reverence for these old workers in science and above all for the careful preparation by its scholars of the text of these first editions of old-time physicians4 ,the works have often been thus literally preserved for us1 for some of them at least would have disappeared among the vicissitudes of the intervening time1 most of which was anything but favorable to the preservation of old-time works1 no matter what their content or value4 ,during the second and third centuries of our era1 while the ,talmudic writings were taking shape1 three great ,jewish physicians came into prominence4 ,the first of them1 ,chanina1 was a contemporary of ,galen4 ,according to tradition1 as we have said1 he inserted both natural and artificial teeth before the close of the second century4 ,the two others were ,rab or ,raw and ,samuel4 ,rab has the distinction of having studied his anatomy from the human body4 ,according to tradition he did not hesitate to spend large sums of money in order to procure subjects for dissection4 ,at this time it is very doubtful whether ,galen1 though only of the preceding generation1 ever had the opportunity to study more than animals or1 at most1 a few human bodies4 ,samuel1 the third of the group1 was an intimate friend of ,rab's1 perhaps a disciple1 and his fame depends rather on his practice of medicine than of research in medical science4 ,he was noted for his practical development of two specialties that cannot but seem to us rather distant from each other4 ,his reputation as a skilful obstetrician was only surpassed by the estimation in which he was held as an oculist4 ,he seems to have turned to astronomy as a hobby1 and was highly honored for his knowledge of this science4 ,probably there is nothing commoner in the story of great ,jewish physicians than their successful pursuit of some scientific subject as a hobby and reaching distinction in it4 ,their surplus intellectual energy needed an outlet besides their vocation1 and they got a rest by turning to some other interest1 often accomplishing excellent results in it4 ,like most great students with a hobby1 the majority of them were long-lived4 ,their lives are a lesson to a generation that fears intellectual overwork4 ,during the fourth century we have a number of very interesting traditions with regard to a great ,jewish physician1 ,abba ,oumna1 to whom patients flocked from all over the world4 ,he seems particularly to have been anxious to make his services available to the scholars of his time4 ,he looked upon them as brothers in spirit1 fellow-laborers whose investigations were as important as his own and whose labors for mankind he hoped to extend by the helpfulness of his profession4 ,in order that it might be easy for them to come to him without feeling abashed by their poverty1 and yet so that they might pay him anything that they thought they were able to1 he hung up a box in his anteroom in which each patient might deposit whatever he felt able to give4 ,his kindliness towards men became the foundation for many legends4 ,needless to say he was often imposed upon1 but that seems to have made no difference to him1 and he went on straightforwardly doing what he thought he ought to do1 regardless of the devious ways of men1 even those whom he was generously assisting4 ,while we do not know much of his scientific medicine1 we do know that he was a fine example of a practitioner of medicine on the highest professional lines4 ,with the foundation of the school at ,djondisabour in ,arabistan or ,khusistan by the ,persian monarch ,chosroes1 some ,jewish physicians come into prominence as teachers1 and this is one of the first important occasions in history when they teach side by side with ,christian colleagues4 ,djondisabour seems distant from us now1 lying as it does in the province just above the head of the ,persian ,gulf1 and it is a little hard to understand its becoming a centre of culture and education1 yet according to well-grounded historical traditions students flocked here from all parts of the world1 and its medical instruction particularly became famous4 ,according to the documents and traditions that we possess1 clinical teaching was the most significant feature of the school work and made it famous4 ,as a consequence graduates from here were deemed fully qualified to become professors in other institutions and were eagerly sought by various medical schools in the ,east4 ,with the rise of the strong political power of the ,mohammedans enough of peace came to the ,east at least to permit the cultivation of arts and sciences to some extent again1 and then at once the eminence of ,jewish physicians1 both as teachers and practitioners of medicine1 once more becomes manifest4 ,the first of the race who comes into prominence is ,maser ,djawah ,ebn ,djeldjal1 of ,basra4 ,to him we owe probably more than to anyone else the preservation of old scientific writings and the cultivation of arts and sciences by the ,mohammedans4 ,he prevailed on ,caliph ,moawia ,i1 whose physician he had become1 to cause many foreign works1 and especially those written in ,greek1 to be translated into ,arabic4 ,he seems to have taken a large share of the labor of the translation on himself and prevailed upon his pupil1 the son of ,moawia1 to translate some works on chemistry4 ,the translation for which ,maser ,djawah is best known is that of the ,pandects of ,haroun1 a physician of ,alexandria4 ,the translation of this work was made toward the end of the seventh century4 ,unfortunately the ,pandects has not come down to us1 either in original or translation1 but we have fragments of the translation preserved by ,rhazes1 the distinguished ,arabian medical writer and physician of the ninth century1 and there seems no doubt that it contained the first good description of smallpox1 a chapter in medicine that is often--though incorrectly--attributed to ,rhazes himself4 ,rhazes quoted ,maser ,djawah freely and evidently trusted his declarations implicitly4 ,the succeeding ,caliphs of the first ,arabian dynasty did not exhibit the same interest in education1 and above all in science1 that characterized ,moawia4 ,political ambition and the desire for military glory seem to have filled up their thoughts and perhaps they had not the good fortune to fall under the influence of physicians so wise and learned as ,maser ,djawah4 ,more probably1 however1 they themselves lacked interest4 ,toward the end of the seventh century they were succeeded by the ,abbassides4 ,almansor1 the second ,caliph of this dynasty1 was attacked by a dangerous disease and sent for a physician of the ,nestorian school4 ,after his restoration to health he became a liberal patron of science and especially medical science4 ,the new city of ,bagdad1 which had become the capital of the realm of the ,abbassides1 was enriched by him with a large number of works on medicine1 which he caused to be translated from the ,greek4 ,he did not confine himself to medicine1 however1 but also brought about translations of works with regard to other sciences4 ,one of these1 astronomy1 was a favorite4 ,he made it a particular point to search out and encourage the translation of such books as had not previously been translated from ,greek into ,arabic4 ,while he provided a translation of ,ptolemy he also had translations made of ,aristotle and ,galen4 ,it is not surprising1 then1 that the school of ,bagdad became celebrated4 ,jewish physicians seem to have been most prominent in its foundation1 and the most distinguished product of it is ,isaac ,ben ,emran1 almost as celebrated as a philosopher as he is as a physician4 ,one of his expressions with regard to the danger of a patient having two physicians whose opinions disagree with regard to his illness has been deservedly preserved for us4 ,zeid1 an ,emir of one of the chief cities of the ,arabs in ,barbary1 fell ill of a tertian fever and called ,isaac and another physician in consultation4 ,their opinions were so widely in disaccord that ,isaac refused to prescribe anything1 and when the ,emir1 who had great confidence in him1 demanded the reason1 he replied1 disagreement of two physicians is more deadly than a tertian fever4 ,this ,isaac1 who is said to have died in #gii1 is the great ,jewish physician1 one of the most important members of the profession in the eighth century4 ,his principal work was with regard to poisons and the symptoms caused by them4 ,this is often quoted by medical writers in the after time4 ,the prominent ,jewish physician of the ninth century was ,joshua ,ben ,nun4 ,haroun al-,raschid1 whose attempts to secure justice for his people are the subject of so much legendary lore1 and whose place in history may be best recalled by the fact that he is a contemporary of ,charlemagne1 was particularly interested in medicine4 ,he founded the city of ,tauris as a memorial of the cure of his wife4 ,he was a generous patron of the school of ,djondisabour and established a medical school also at ,bagdad4 ,he provided good salaries for the professors1 insisted on careful examinations1 and raised the standard of medical education for a time to a noteworthy degree4 ,the greatest teacher of this school at ,bagdad was ,joshua ,ben ,nun1 sometimes known as the ,rabbi of ,seleucia4 ,his teaching attracted many students to ,bagdad and his fame as one of the great practitioners of medicine of this time brought many patients4 ,among his disciples was ,john ,masue1 whose ,arabian name is so different1 ,yahia ,ben ,masoviah1 that in order to avoid confusion in reading it is important to know both4 ,almost better known1 perhaps1 at this time was ,abu ,joseph ,jacob ,ben ,isaac ,kendi4 ,fortunately for the after time1 these men devoted themselves not only to their own observations and writings but made a series of valuable translations4 ,joshua ,ben ,nun seems to have been particularly zealous in this matter1 following the example of ,maser ,djawah of ,basra4 ,bagdad then became a centre for ,arabian culture4 ,mahmoud1 one of ,haroun's successors1 provided in ,bagdad a refuge for the learned men of the ,east who were disturbed by the wars and troubles of the time4 ,he became a liberal patron of literature and education4 ,when the ,emperor ,michael ,,iii of ,constantinople was conquered in battle1 one of the obligations imposed upon him was to send many camel loads of books to ,bagdad1 and ,aristotle and ,plato were studied devotedly and translated into ,arabic4 ,the era of culture affected not only the capital but all the cities1 and everywhere throughout the ,arabian empire schools and academies sprang up4 ,we have records of them at ,basra1 ,samarcand1 ,ispahan4 ,from here the thirst for education spread to the other cities ruled by the ,mohammedans1 and each town became affected by it4 ,alexandria1 the cities of the ,barbary ,states1 those of ,sicily and ,provence1 where ,moorish influences were prominent1 and of distant ,spain1 ,cordova1 ,seville1 ,toledo1 ,granada1 ,saragossa1 all took up the rivalry for culture which made this a glorious period in the history of the intellectual life4 ,already1 in the chapter on ,great ,physicians in ,early ,christian ,times1 ,i have pointed out that many of the teachers of the ,arabs were ,christian physicians4 ,here it is proper to emphasize the other important factor in ,arabian medicine1 the ,jewish physicians1 who influenced the great ,arabian rulers1 and were the teachers of the ,arabs in medicine and science generally4 ,these ,christian and ,jewish physicians particularly encouraged the translation of the works of the great ,greek physicians and thus kept the ,greek medical tradition from dying out4 ,it is not until the end of the ninth1 or even the beginning of the tenth1 century that we begin to have important contributors to medicine from among the ,arabs themselves4 ,even at this time they have distinguished rivals among ,jewish physicians4 ,indeed these acquired such a reputation that they became the physicians to monarchs and even high ecclesiastics1 and we find them nearly everywhere throughout ,europe4 ,their success was so great that it is not surprising that after a time the vogue of the ,jewish physicians should have led to jealousy of them and to the passage of laws and decrees limiting their sphere of activity4 ,the great ,jewish physician of the ninth century was ,isaac ,ben ,soliman1 better known as ,isaac el ,israili1 and who is sometimes spoken of as d',israeli4 ,he was a pupil of ,isaac ,ben ,amram the younger1 probably a grandson of another ,isaac ,ben ,amram1 who1 after having become famous in ,bagdad1 went to ,cairo and became the physician of the ,emir ,zijadeth ,,iii4 ,the younger ,isaac established a school1 and it was with him that ,israeli obtained his introduction to medicine4 ,he practised first as an oculist and then became body-physician to the ,sultan of ,morocco4 ,because of the sympathy of his character and his unselfishness he acquired great popularity4 ,hyrtl refers to him respectfully as that scholarly son of ,israel4 ,curiously enough1 considering racial feeling in the matter1 he never married1 and when asked why he had not1 and whether he did not think that he might regret it1 he replied1 ,i have written four books through which my memory will be better preserved than it would be by descendants4 ,the four books are his ,treatise on ,fevers1 his ,treatise on ,simple ,medicines and ,ailments1 a treatise on the ,elements1 and a treatise ,on the ,urine4 ,besides these1 we have from him shorter works1 ,on the ,pulse1 ,on ,melancholy1 and ,on ,dropsy4 ,his hope with regard to his fame from these works was fulfilled1 for they were printed as late as #aeae at ,leyden1 and ,sprengel declared them the best compendium of simple remedies and diet that we have from the ,arabian times4 ,one of his translators into ,latin has called him the monarch of physicians4 ,some of his maxims are extremely interesting in the light of modern notions on the same subjects4 ,he declared emphatically that the most important duty of the physician is to prevent illness4 ,most patients get better without much help from the physician by the power of nature4 ,he emphasized his distrust of using many medicines at the same time in the hope that some of them would do good4 ,he laid it down as a rule3 ,employ only one medicine at a time in all your cases and note its effects carefully4 ,he was as wise with regard to medical ethics as therapeutics4 ,he advised a young physician1 ,never speak unfavorably of other physicians4 ,every one of us has his lucky and unlucky hours4 ,it is pleasant to learn that the old gentleman lived to fill out a full hundred years of life1 and that in his declining years he was surrounded by the good will and the affection of many who had learned to know his precious qualities of heart and mind4 ,more than of any other class of physicians do we find the large human sympathies of the ,jewish physicians of the ,middle ,ages praised by their contemporaries and succeeding generations4 ,during the next centuries a number of ,jewish physicians became prominent1 though none of them until ,maimonides impressed themselves deeply upon the medical life of their own and succeeding centuries4 ,very frequently they were the physicians to royal personages4 ,zedkias1 for instance1 was the physician to ,louis the ,pious and later to his son ,charles the ,bald4 ,his reputation as a physician was great enough to give him the popular estimation of a magician1 but it did not save him from the accusation of having poisoned ,charles when that monarch died suddenly4 ,there seem to be no good grounds1 however1 for the accusation4 ,there were a number of schools of medicine1 in ,sicily and the southern part of ,italy1 in which ,jewish1 ,arabian1 and ,christian physicians taught side by side4 ,one of these teachers was ,jude ,sabatai ,ben ,abraham1 usually known by the name of ,donolo1 who was famous both as a writer on medicine and on astronomy4 ,donolo studied and probably taught at ,tarentum1 and there were similar schools at ,palermo1 at ,bari1 and then later on the mainland at ,salerno4 ,the foundation of ,salerno1 in which ,jewish physicians also took part1 we shall discuss later in the special chapter devoted to that subject4 ,one of the great translators whose work meant very much for the medical science of his own and succeeding generations was the distinguished ,jewish physician1 ,faradj ,ben ,salim1 sometimes spoken of as ,farachi ,faragut or ,ferrarius1 who was born at ,girgenti in ,sicily4 ,he made his medical studies in ,salerno and did his work under the patronage of ,charles of ,anjou towards the end of the thirteenth century4 ,his greatest work is the translation of the whole of the ,continens of ,rhazes4 ,the translation is praised as probably the best of its time made in the ,middle ,ages4 ,faradj came at the end of a great century1 when the intellectual life of ,europe had reached a high power of expression1 and it is not surprising that he should have proved equal to his environment4 ,this translation has also some additions made by ,faradj himself1 notably a glossary of ,arabian names4 ,in ,spain also ,jewish physicians rose to distinction4 ,the most distinguished in the tenth century was ,chasdai ,ben ,schaprut4 ,like many other of the great physicians of this time1 he had studied astronomy as well as the medical sciences4 ,he became the physician of the ,caliph ,abd-er-,rahman ,,iii of ,cordova4 ,he seems also to have exercised some of the functions of ,prime ,minister to the ,caliph1 and took advantage of diplomatic relations between his sovereign and the ,byzantine ,emperor to obtain some works of ,dioscorides4 ,these he translated into ,arabian with the help of a ,greek monk1 whom he seems also to have secured through the diplomatic relations4 ,undoubtedly he did much to usher in that enthusiasm for education and study which characterized the next centuries1 the eleventh and twelfth1 at ,cordova in ,spain1 when such men as ,avenzoar1 ,avicenna1 and ,averros attracted the attention of the educational world of the time4 ,jewish writers have sometimes claimed one of the most distinguished of these1 ,avenzoar himself1 as a ,jew1 but ,hyrtl and other good authorities consider him of ,arabic extraction and point to the fact that his ancestors bore the name of ,mohammed4 ,this is not absolutely conclusive evidence1 but because of it ,i have preferred to class ,avenzoar among the ,arabian physicians4 ,the one historical fact of importance for us is that everywhere in ,europe at that time ,jews were being accorded opportunities for the study and practice of medicine4 ,there are local incidents of persecution1 but we are not so far away from the feelings that brought these about as to misunderstand them or to think that they were anything more than local1 popular manifestations4 ,the more we know about the details of the medical history of these times the deeper is the impression of academic freedom and of opportunities for liberal education4 ,much has been said about the intolerance of ecclesiastical authorities toward the ,jews1 and of ,church decrees that either absolutely forbade their practice of the medical profession and their devotion to scientific study1 or at least made these pursuits much more difficult for them than for others4 ,of course it has to be conceded1 even by those who most insistently urge the existence of formal legislation in the matter1 that in spite of these decrees and intolerance and opposition1 ,jews continued to practise medicine and to be the chosen physicians of kings and even of high ecclesiastical dignitaries1 as well indeed of the ,popes themselves4 ,this1 it is usually declared1 must be attributed to the surpassing skill of the ,jewish physicians1 causing men to overcome their prejudices and override even their own legal regulations4 ,there is no doubt at all about the skill of ,jewish physicians at many times during the ,middle ,ages4 ,there is no doubt also of the sentiment of opposition that often developed between the ,christian peoples and the ,jews4 ,any excuse is good enough to justify men1 to themselves at least1 in putting obstacles in the paths of those who are more successful than they are themselves4 ,religion often became a cloak for ill-will and persecution4 ,the state of affairs that has been presumed however1 according to which laws and decrees were being constantly issued forbidding the practice of medicine to ,jews by the ecclesiastical authorities1 while at the same time they themselves and those who were nearest to them were employing ,jewish physicians1 is an absurdity that on the face of it calls for investigation of the conditions and from its very appearance would indicate that the ordinary historical assumption in the matter must be wrong4 ,i have been at some pains1 then1 to try to find out just what were the conditions in ,europe with regard to the practice of medicine by the ,jews4 ,there is no doubt that at ,salerno1 where the influence of the ,benedictines was very strong and where the influence of the ,popes and the ecclesiastical authorities was always dominant1 full liberty of studying and teaching was from the earliest days allowed to the ,jews4 ,down at ,montpellier it seems clear that ,jewish physicians had a large part in the foundation of the medical school1 and continued for several centuries to be most important factors in the maintenance of its reputation and the upbuilding of that fame which draw students from even distant parts of ,europe to this medical school of the south of ,france4 ,during the ninth1 tenth1 eleventh1 and twelfth centuries ,jewish physicians were frequently in attendance on kings and the higher nobility1 on bishops and archbishops1 cardinals1 and even ,popes4 ,every now and then the spirit of intolerance among the populace was aroused1 and occasionally the death of some distinguished patient while in a ,jewish physician's hands was made the occasion for persecution4 ,we must not forget1 after all1 that even as late as ,elizabeth's time1 when ,shakespeare wrote ,the ,merchant of ,venice1 he was taking advantage of the popular sentiment aroused by the execution of ,lopez1 the ,queen's physician1 for a real or supposed participation in a plot against her ,majesty's life4 ,shylock was presented the next season for the sake of adventitious popularity that would thus accrue to the piece4 ,the character was played so as to depict all the worst traits of the ,jew1 and was scornfully laughed at at every representation4 ,this is an index of the popular feeling of the time4 ,bitter intolerance of the ,jew has continued4 ,down almost to our own time the ,ghettos have existed in ,europe1 and popular tumults against them continue to occur4 ,quite needless to say1 these do not depend on ,christianity1 but on defective human nature4 ,during the ,middle ,ages the best possible criterion of the attitude of the ,church authorities towards the ,jews is to be found in the legislation of ,pope ,innocent ,,iii4 ,he is the greatest of the ,popes of the ,middle ,ages2 he shaped the policy of the ,church more than any other2 his influence was felt for many generations after his own time4 ,his famous edict with regard to them was well known3 ,let no ,christian by violence compel them to come dissenting or unwilling to ,baptism4 ,further1 let no ,christian venture maliciously to harm their persons without a judgment of the civil power or to carry off their property or change their good customs which they have hitherto in that district which they inhabit4 ,innocent himself and several of his predecessors and successors are known to have had ,jewish physicians4 ,example speaks even louder than precept1 and the example of such men must have been a wonderful advertisement for the ,jewish physicians of the time4 ,besides ,innocent ,,iii1 many of the ,popes of the twelfth and thirteenth centuries issued similar decrees as to the ,jews4 ,it may be recalled that this was the time when the ,papacy was most powerful in ,europe and when its decrees had most weight in all countries4 ,alexander ,,ii1 ,gregory ,,ix1 and ,innocent ,,iv all issued formal documents demanding the protection of the ,jews1 and especially insisting that they must not be forced to receive ,baptism nor disturbed in the celebration of their festivals4 ,clement ,,vi did the same thing in the next century1 and even offered them a refuge from persecution throughout the rest of ,france at ,avignon4 ,distinguished ,jewish scholars1 who know the whole story from careful study1 have given due credit to the ,popes for all that they did for their people4 ,they have even declared that if the ,jews were not exterminated in many of the ,european countries it was because of the protection afforded by the ,church4 ,we have come to realize in recent years that persecution of the ,jews is not at all a religious matter1 but is due to racial prejudice and jealousy of their success by the peoples among whom they settle4 ,all sorts of pretexts are given for this persecution at all times4 ,formal ,church documents and the personal activities of the responsible ,church officials show that during the ,middle ,ages the ,church was a protector and not a persecutor of the ,jews4 ,there is abundant historical authority for the statement that the ,popes were uniformly beneficent in their treatment of the ,jews4 ,in order to demonstrate this there is no need to quote ,catholic historians1 for non-,catholics have been rather emphatic in bringing it out4 ,neander1 the ,german ,protestant historian1 for instance1 said3 ,it was a ruling principle with the ,popes after the example of their great predecessor1 ,gregory the ,great1 to protect the ,jews in the rights which had been conceded to them4 ,when the banished ,popes of the twelfth century returned to ,rome1 the ,jews went forth in their holiday garments to meet them1 bearing before them the 'thora1' and ,innocent ,,ii1 on an occasion of this sort1 blessed them4 ,english non-,catholic historians can be quoted to the same effect4 ,the ,anglican ,dean ,milman1 for instance1 said3 ,of all ,european sovereigns1 the ,popes1 with some exceptions1 have pursued the most humane policy towards the ,jews4 ,in ,italy1 and even in ,rome1 they have been more rarely molested than in the other countries4 ,hallam has expressed himself to the same effect1 especially as regards the protection afforded to the ,jew by the laws of the ,church from the injustice of those around him4 ,laws sometimes fail of their purpose and the persecuting spirit of the populace is often hard to control1 but everything that the central authority could do to afford protection was done and essential justice was enshrined in the ,church laws4 ,prominent ecclesiastics would naturally follow the lines laid down by their ,papal superiors4 ,the attitude of those whose lives mark epochs in the history of ,christianity and who had more to do almost with the shaping of the policy of the ,church at many times than the ,popes themselves1 can be quoted readily to this same effect4 ,neander has called particular attention to ,st4 ,bernard's declarations with regard to the evils that would follow any tolerance of such an abuse as the persecution of the ,jews4 ,the most influential men of the ,church protested against such un-,christian fanaticism4 ,when the ,abbot ,bernard of ,clairvaux was rousing up the spirit of the nations to embark in the second crusade1 and issued for this purpose1 in the year #aadf1 his letters to the ,germans 7,east ,franks71 he at the same time warned them against the influence of those enthusiasts who strove to inflame the fanaticism of the people4 ,he declaimed against the false zeal1 without knowledge1 which impelled them to murder the ,jews1 a people who ought to be allowed to live in peace in the country4 ,but it has been said that there are decrees against ,jewish physicians1 issued especially in the south of ,france1 by various councils and synods of the ,church4 ,attention needs to be called at once to the fact that these are entirely local regulations and have nothing to do with the attitude of the ,church as a whole1 but represent what the ecclesiastical authorities of a particular part of the country deem necessary for some special reason in order to meet local conditions4 ,indeed at the end of the thirteenth and the early fourteenth century1 when these decrees were being issued in ,france1 full liberty was allowed in ,italy1 and there were no restrictions either as to medical practice or education founded on adhesion to ,judaism4 ,what need to be realized in order to understand the issuance of certain local ecclesiastical regulations forbidding ,jews to practise medicine are the special conditions which developed in ,france at this time4 ,many ,jews had emigrated from ,spain to ,france1 and the reputation acquired by ,jewish physicians at ,montpellier led to a number of the race taking up the practice of medicine without any further qualification than the fact that they were ,jews4 ,that gave them a reputation for curative powers of itself because of the fame of some ,jewish doctors and their employment by the nobility and the highest ecclesiastics4 ,it was hard to regulate these wandering physicians4 ,as a consequence of this1 the faculty at ,paris1 always jealous of its own rights and those of its students1 at the beginning of the fourteenth century absolutely forbade ,jews from practising on ,christian patients within its jurisdiction4 ,of course the faculty of the ,university of ,paris was dominated by ecclesiastical authorities4 ,the medical school was1 however1 almost entirely independent of ecclesiastical influence1 and was besides largely responsible for this decree4 ,it was felt that something had to be done to stop the evil that had arisen and the charlatanry and quackery which was being practised4 ,this was1 however1 rather an attempt to regulate the practice of medicine and keep it in the hands of medical school graduates than an example of intolerance towards the ,jews4 ,practically no ,jews had graduated at its university1 ,montpellier being their favorite school1 and ,paris was not a little jealous of its rights to provide for physicians from the northern part of ,france4 ,we have not got away from manifestations of that spirit even yet1 as our non-reciprocating state medical laws show4 ,during the next quarter of a century decrees not unlike those of the ,university of ,paris were issued in the south of ,france1 especially in ,provence and ,avignon4 ,anyone who knows the conditions which existed in the south of ,france at this time with regard to medical practice will be aware that a number of attempts were made by the ecclesiastical authorities just at this time to regulate the practice of medicine4 ,great abuses had crept in4 ,almost anyone who wished could set up as a physician1 and those who were least fitted were often best able to secure a large number of patients by their cleverness1 their knowledge of men1 and their smooth tongues4 ,the bishops of various dioceses met1 and issued decrees forbidding anyone from practising medicine unless he was a graduate of the medical school of the neighboring ,university of ,montpellier4 ,after a time it was found that the greatest number of violators of these decrees were ,jews4 ,accordingly special regulations were made against them4 ,they happen to be ecclesiastical regulations1 because no other authority at that time claimed the right to regulate medical education and the practice of medicine4 ,what is sure is that many ,jewish physicians reached distinction under ,christian as well as ,arabian rulers at all times during the ,middle ,ages4 ,it would be quite impossible in the limited space at command here to give any adequate mention of what was accomplished by these ,jewish physicians1 whose names we have scarcely been able to more than catalogue1 nor of the place they hold in their times4 ,as the physicians of rulers1 their influence for culture and the cultivation of science was extensive1 and as a rule they stood for what was best and highest in education4 ,the story of one of them1 who is generally known in the ,christian world at least1 ,maimonides1 given in some detail1 may serve as a type of these ,jewish physicians of the ,middle ,ages4 ,he lived just before the flourishing period of university life in the thirteenth century brought about that wonderful development of medicine and surgery in the west of ,europe that meant so much for the final centuries of the ,middle ,ages4 ,his works influenced not a little the great thinkers and teachers whose own writings were to be the foundations of education for several centuries after their time4 ,maimonides was well known in the ,western universities4 ,though his life had been mainly spent in the ,east1 and he died there1 there was scarcely a distinguished scholar of ,europe who was not acquainted directly or indirectly with his works1 and the greater the reputation of the scholar1 as a rule1 the more he knew of ,maimonides1 ,moses gyptus1 as he was called1 and the more frequently he referred to his writings4 ,,iv ,,maimonides ,the life of one of the great ,jewish physicians1 who has come to be known in history as ,maimonides1 is of such significance in medical biography that he deserves to have a separate sketch4 ,born in ,spain1 his life was lived in the ,east1 where his connection as royal physician with the great ,sultan ,saladin of ,crusades fame made his influence widely felt4 ,he is a type of the broadly educated man1 conversant with the culture of his time and of the past1 knowing much besides medicine1 who has so often impressed himself deeply on medical practice4 ,while the narrow specialists in each generation1 the men who are quite sure that they are curing the special ills of men to which they devote themselves1 have always felt that whatever of progress there was in any given time was due to them1 they occupy but little space as a rule in the history of medicine4 ,the men who loom large were the broad-minded1 humanely sympathetic1 deeply educated physicians1 who treated men and their ills rather than their ills without due consideration of the individual1 and who not only relieved the discomfort of their patients and greatly lessened human suffering1 and added to the sum of human happiness in their time1 but also left precious deeply significant lessons for succeeding generations of their profession4 ,hippocrates1 ,galen1 ,sydenham1 ,auenbrugger1 ,morgagni1 these are representatives of this great class1 and ,maimonides must be considered one of them4 ,moses ,ben ,maimum1 whose ,arabic name was ,abu ,amran ,musa ,ben ,maimum ,obaid ,alla el-,cordovi1 who was called by his ,jewish compatriots ,ramban or ,rambam1 was born at ,cordova in ,spain1 on the #cjth of ,march in #aace or #aaci1 the year is in doubt4 ,it might not seem of much import now after nearly eight centuries1 but not a little ink is spilt over it yet by devoted biographers4 ,we are rather prone to think in our time that the conditions in which men were born and reared before what we are pleased to call modern times1 and1 above all1 in the ,middle ,ages1 must have made a distinct handicap for their intellectual development4 ,most of us are quite sure that the conditions in medieval cities were eminently unsuited for the stimulation of the intellect1 for incentive to art impulse1 for uplift in the intellectual life1 or for any such broad interest in what has been so well called the humanities--the humanizing things that lift us above animal necessities--as would make for genuinely liberal education4 ,we are likely to be set in the opinion that the environment of the growing youth of an old-time city1 especially so early as the middle of the twelfth century1 was poor and sordid4 ,the cares of the citizens are presumed to have been mainly for material concerns1 and1 indeed1 mostly for the wants of the body4 ,they were only making a start on the way from barbarism to something like our glorious culmination of civilization4 ,as the heirs to all the ages in the foremost files of time we are necessarily far in advance of them1 and we are only sorry that they did not have the opportunity to live to see our day and enjoy the benefits of the evolution of humanity that is taking place during the eight centuries that have elapsed4 ,as a matter of fact1 there was much more of abiding profound interest in real civilization in many a medieval city1 much more general appreciation of art1 much more breadth of intelligence and sympathy with what we call the humanities1 than in most of our large cities4 ,the large city1 as we know it1 is eminently a discourager of breadth of intelligence4 ,specialism in the various phases of money-making obscures culture4 ,maimonides1 born in ,cordova1 was brought up amid surroundings that teemed with incentives of every kind to the development of intelligence1 of artistic taste1 and everything that makes for cultivation of intellect rather than of interest in merely material things4 ,it is well said that it is hard to judge the ,cordova of old by its tawdry ruins of to-day4 ,the educated visitor still stands in awe and admiration of the great mosque which expressed the high cultivation of the ,moors of this time4 ,it is a never-ending source of wonder to ,americans4 ,the city itself has many reminders of that fine era of ,moorish culture and refinement of taste and of art expression1 which made it in the best sense of the word a city beautiful4 ,the ,arab invaders had found a great prosperous country which had been the most cultured province of the ,roman ,empire1 and on this foundation they made a marvellous development4 ,the banks of the ,guadalquivir1 says ,mr4 ,s4 ,lane-,poole in ,the ,moors in ,spain 7,london1 #ahhg71 were bright with marble houses1 mosques1 and gardens1 in which the rarest flowers and trees of other countries were carefully cultivated1 and the ,arabs introduced their system of irrigation which the ,spaniards both before and since have never equalled4 ,the greatest beauty of the city1 of course1 had come1 and some of it had gone1 before ,maimonides' time4 ,so much remains in spite of time and war1 and many unfortunate influences1 that we can have some idea how beautiful it must have been in his youth seven centuries ago1 and how even more beautiful in the foretime4 ,of the great mosque writers of travel can scarcely say enough4 ,mr4 ,lane-,poole says3 ,travellers stand amazed among the forest of columns which open out apparently endless vistas on all sides4 ,the porphyry1 jasper1 and marbles are still in their places2 the splendid glass mosaics1 which artists from ,byzantium came to make1 still sparkle like jewels in the walls2 the daring architecture of the sanctuary1 with its fantastic crossed arches1 is still as imposing as ever2 the courtyard is still leafy with the orange trees that prolong the vistas of columns4 ,as one stands before the loveliness of the great mosque1 the thought goes back to the days of the glories of ,cordova1 the palmy days of the ,great ,khalif1 which will never return4 ,of all the countries in which the ,jews all down the centuries have lived there is probably none of which they have been more loud in praise than ,spain4 ,their poets sang of it as if it were their own country2 for centuries the people were happier here than probably they have been anywhere else for so long a period4 ,elsewhere in this book ,i have called attention to all that ,spain meant in ,europe during all the centuries from the beginning of the ,roman ,empire down to the end of the ,middle ,ages4 ,maimonides was fortunate in his birthplace1 then1 and while circumstances compelled the family to move away1 this change did not come until a good effect had been produced on the mind of the growing youth4 ,even when persecution came1 ,maimonides clung to ,spain with a tenacity born of deep affection and emphasized by admiration for all that she was and had been4 ,cordova was the jewel of the ,spain of this time1 and though much less than she had been in the long preceding time1 when she was the birthplace of ,lucan and the two ,senecas1 or even than what she had been in ,abd-er-,rahman's days1 or when she was the birthplace of ,averros1 still she remained wonderfully beautiful and attractive1 winning and holding the affections of men4 ,maimonides' father1 ,maimum ,ben ,joseph1 was a member of the ,rabbinical ,college of ,cordova1 and famous for his knowledge of the ,talmud4 ,there are some writings of his on mathematics and astronomy extant4 ,he directed the education of his son1 who1 like many another distinguished scholar in later life1 seems to have exhibited very little talent in his early years4 ,there is no rule in the matter4 ,precocity often disappoints4 ,genius is often dull in childhood1 but there are exceptions that prove both rules4 ,the basis of education in ,spain at that time among the ,jews was the ,bible1 the ,talmud1 mathematics1 and astronomy1 a good rounded education in literature1 the basis of law1 and some exact physical science4 ,after his preliminary education at home ,maimonides studied the natural sciences and medicine with ,moorish teachers4 ,nature-study1 in spite of frequent expressions that declare it new in modern times1 is as old as man4 ,he also received a grounding in philosophy as a preparation for his scientific studies4 ,at the age of twenty-three he began the composition of a commentary on the ,talmud1 which he continued to work at on his journeys in ,spain and in ,egypt4 ,this is considered to be one of the most important of this class of works extant1 though1 almost needless to say1 similar writings are very numerous4 ,in the light of wanderings in philosophy during the centuries since1 it is rather interesting to quote from that work the end of man as this ,jewish philosopher of the middle of the twelfth century saw it4 ,recent teleological tendencies in biology add to the interest of his views4 ,according to ,maimonides1 ,man is the end of the whole creation1 and we have only to look to him for the reason for its existence4 ,every object shows the end for which it was created4 ,the palm-trees are there to provide dates2 the spider to spin her webs4 ,all the properties of an animal or a plant are directed so as to enable it to reach its purpose in life4 ,what is the purpose of man8 ,it cannot lie alone in eating and drinking or yielding to passion1 nor in the building of cities and the ruling of others1 since these objects lie outside of him1 and do not touch his essential being4 ,such material striving he has in common with the animal4 ,a man is lifted from a lower to a higher condition by his reason4 ,only through his reason is he placed above the animals4 ,he is the only reasonable animal4 ,his reason enables him to understand all things1 especially the ,unity of ,god1 and all knowledge and science serve only to direct man to the knowledge of ,god4 ,passions are to be subdued1 since the man who yields to passion subjects his spirit to his body1 and does not reveal in himself the divine power which in him lies in his reason1 but is swallowed up in the ocean of matter4 ,not long after ,maimonides passed his twentieth year the family1 consisting of the father and his two sons1 ,moses and ,david1 and a daughter1 moved from ,cordova to ,fez1 compelled by ,jewish persecutions4 ,here it is said that they had to submit to wearing the mask of ,islam in order to lead a peaceful existence4 ,this has been doubted1 however1 and his whole life is in flagrant contradiction with any such even apparent apostasy from the faith of his fathers4 ,father and son took advantage of the opportunity of intercourse with ,moorish physicians and philosophers to increase their store of knowledge1 but could not be content in the political and religious conditions in which they were compelled to live4 ,about #aaee1 then1 they went to ,jerusalem1 but found conditions even more intolerable there1 and turned back to ,egypt1 where they settled down in ,old ,cairo4 ,in #aaff the father died1 and after this we learn that the sons made a livelihood1 and even laid the foundation of a fortune1 by carrying on a jewelry trade4 ,moses still devoted most of his time to study1 while his brother did most of the business1 but the brother was lost in the ,indian ,ocean1 and with him went not only a large sum of his own money1 but also much that had been entrusted to him by others4 ,maimonides undertook to pay off these debts and at the same time had to meet the necessities not only of himself and sister1 but also of the family of his dead brother4 ,it was then that he took up the practice of medicine and succeeded in making a great name and reputation for himself4 ,he continued to write1 however1 and completed his commentary on the ,talmud4 ,about the age of fifty ,maimonides1 as seems to be true of a good many men who live to old age1 became rather discouraged and despondent about himself4 ,he refers to himself in his letters and writings rather frequently as an old and ailing man4 ,he had nearly twenty years of active life ahead of him1 but he had the persuasion that comes to many that he was probably destined to an early death4 ,his son was born shortly after this time1 and that seems to have had not a little to do with brightening his life4 ,while in ,egypt ,maimonides married the sister of one of the royal secretaries1 who1 in turn1 wedded ,maimonides' sister4 ,maimonides took on himself the education of his son1 who also became a physician1 though his father was not to have the satisfaction of watching his success in the practice of his chosen profession4 ,this son1 ,abraham1 became the physician of ,malie ,alkamen1 the brother of ,saladin1 and1 besides1 was a physician to the hospital at ,cairo4 ,his son1 ,david1 the grandson of ,maimonides1 practised medicine also at ,cairo till #acjj4 ,he in turn left two sons1 ,abraham and ,solomon1 who achieved reputation in the chosen profession of their great-grandfather4 ,maimonides1 after the birth of his son1 became one of the busiest of practising physicians4 ,indeed1 it is hard to understand how he had the time to do any writing in his busy life4 ,still less can we understand his time for teaching4 ,he was the physician to ,saladin1 whose relations with ,richard ,coeur de ,lion have made him known to ,english-speaking people4 ,every morning1 as the ,court physician1 ,maimonides went to the palace1 situated half a mile away from his dwelling1 and if any of the many officials and dependents that then1 as now1 were at ,oriental courts1 were ill1 he stayed there for some time4 ,as a rule he could only get back to his own home in the afternoon1 and then he was1 as he says himself1 almost dying with hunger4 ,knowing the scantiness of the ,oriental breakfast1 we are not surprised4 ,there he found his waiting-room full of patients1 ,jews and ,mohammedans1 prominent and unimportant1 friends and enemies1 he says himself1 a varied crowd1 who are looking for my medical advice4 ,there is scarcely time for me to get down from my carriage and wash myself and eat a little1 and then until night ,i am constantly occupied1 so that1 from sheer exhaustion1 ,i must lie down4 ,only on the ,sabbath day have ,i the time to occupy myself with my own people and my studies1 and so the day is away from me4 ,what a picture it is of the busy medical teacher at all times in the world's history1 yet it must not be forgotten that it is from these busy men that we have derived our most precious lessons in caring for patients rather than disease1 in the art of medicine rather than medical science--and their practical lessons have been valuable long after the fine-spun theories of the scientist that took so long to elaborate have been placed definitely in the lumber room4 ,his reputation as a writer on medical topics is not as great as that which has been accorded him for his writings on philosophy and in ,talmudic literature1 but he well deserves a place among the great practical masters of medicine1 as well as high rank among the physicians of his time4 ,there is little that is original in his writing1 but his thoroughgoing common sense1 his wide knowledge1 and his discriminating1 eclectic faculty make his writings of special value4 ,as might have been expected1 the ,aphorisms of ,hippocrates attracted his attention1 and1 besides1 he wrote a series of aphorisms of his own4 ,the most interesting of his writings1 however1 is a series of letters on dietetics written for the son of his patron ,saladin4 ,the young prince seems to have suffered from one of the neurotic conditions that so often develop in those who have their lives all planned for them1 and little incentive to do things for themselves4 ,the main portion of his complaints centred1 as in the case of many another individual of leisure1 in disturbances of digestion4 ,besides1 he suffered from constipation and feelings of depression4 ,doubtless1 like many a young person of the modern time1 he was quite sure that these symptoms portended some insidious organic ailment that would surely bring an early death4 ,when fathers1 having done all that there is to do1 just expect their sons to enjoy the fruits of the paternal accomplishments1 conditions of this kind very often develop1 unless the young man proceeds to occupy himself with even more dangerous distractions than he finds in unending thought about his own feelings4 ,the rules of life and health that ,maimonides laid down in these letters have become part of our popular medical tradition4 ,probably more of the ordinarily current maxims as to health have been derived from them than would possibly be suspected by anyone not familiar with them4 ,in various forms his rules have been published a number of times4 ,a good idea of them can be obtained from the following compendium of them1 which ,i abbreviate from a biographical sketch of ,maimonides by ,dr4 ,oppler1 which appeared in the ,deutsches ,archiv fr ,geschichte der ,medizin und ,medicinische ,geographie 7,bd4 #b1 ,leipzig1 #ahgi74 #a4 ,man is bound to lead a life pleasing to ,god if he wants to have a healthy body1 and he must hold himself far from everything that can hurt his health and accustom himself to whatever renews his strength4 ,he should eat and drink only when hungry and thirsty and should be particularly careful of the regular evacuation of his bowels and of his bladder4 ,he must not delay either of these operations1 but as far as possible satisfy the inclination at once4 #b4 ,a man must not overload his stomach but be content always with something less than is necessary to make him feel quite satisfied4 ,he should not drink much during the meal and only of water and wine mixed1 taking somewhat more after digestion has begun and after digestion is completed1 in moderation according to his needs4 ,before a man sits down to table he should note whether he has any tendency to evacuation and should make the body warm by movement and activity4 ,after this exercise he should rest a little before taking food4 ,it is very beneficial after work to take a bath and then the meal4 #c4 ,food should be taken always in the sitting position4 ,there should be no riding nor walking1 nor movements of the body until digestion is finished4 ,the man who takes a walk or any strenuous occupation immediately after eating subjects himself to serious dangers of disease4 #d4 ,day and night should be divided into twenty-four hours4 ,men should sleep for eight hours1 and so arrange their sleep that the end of it comes with the dawn1 so that from the beginning of sleep until sunrise there should be an eight-hour interval4 ,we should all leave our beds about the time that the sun rises4 #e4 ,during sleep a man should lie neither on his face nor on his back but on his side1 the beginning of the night on his left and at the end on his right4 ,he should not go to sleep for three or four hours after eating and should not sleep during the day4 #f4 ,fruits that are laxative1 as grapes1 figs1 melons1 gourds1 should be taken only before meal time and not mixed with other food4 ,it would be better to let these get into the abdominal organs and then take other food4 #g4 ,eat what is easily digestible before what is difficult of digestion4 ,the flesh of birds before beef and the flesh of calves before that of cows and steers4 7,birds were then thought more digestible than other flesh2 we have reversed the ruling4 ,the note shows how light and digestible their flesh was considered and the reason therefor47 #h4 ,in summer eat cooling food1 acids1 and no spices4 ,in winter1 on the contrary1 eat warming foods1 rich in spices1 mustard1 and other heating substances4 ,in cold and warm climates one should eat according to the climatic conditions4 #i4 ,there are certain harmful foods that should be avoided4 ,large salt fish1 old cheese1 old pickled meat1 young new wine1 evil-smelling and bitter foods are often poisonous4 ,there are also some which are less harmful1 but are not to be recommended as ordinary nutritive materials4 ,large fish1 cheese1 milk more than twenty-four hours after milking1 the flesh of old oxen1 beans1 peas1 unleavened bread1 sauerkraut1 onions1 radishes and the like4 ,these are to be taken only in small quantities and only in the winter time and they should be avoided in the summer4 ,beans and lentils are to be recommended neither in winter nor summer4 #aj4 ,as a rule one should avoid the eating of tree fruits1 or not eat much of them1 especially when they are dry and even less when they are green4 ,if they are unripe they may cause serious damage4 ,johannesbrod is very harmful at all times1 as are also all the sour fruits1 and only small amounts of them should be eaten in summer or in warm countries4 #aa4 ,the fruits that are to be recommended dry as well as fresh1 are figs1 grapes1 and almonds4 ,these may be eaten as one has the appetite for them1 but one should not accustom himself to eat them much1 though they are healthier than all other fruits4 #ab4 ,honey and wine are not good for children1 though they are beneficial for older people1 especially in winter4 ,in summer one-third less of them should be eaten than in winter4 #ac4 ,special care should be taken to have regular movements of the bowels that carry off the impurities of the body4 ,it is an axiom in medicine1 that so long as evacuations are absent1 or difficult1 or require strong efforts1 the individual is liable to serious disease4 ,every medical means should be taken to overcome constipation in order to escape its dangers4 ,for this purpose young people should be given salty food1 materials that have been soaked in olive oil1 salt itself1 or certain vegetable soups with olive oil and salt4 ,older people should take honey mixed with warm water early in the morning and four hours later should take their breakfast4 ,this proceeding should be followed up from one to four days until the constipation is overcome4 #ad4 ,another axiom of medicine is that so long as a man is able to be active and vigorous1 does not eat until he is over-full1 and does not suffer from constipation1 he is not liable to disease4 ,even such men1 however1 are much safer if they do not take food that may disagree with them4 #ae4 ,whoever gives himself up to inactivity1 or puts off evacuations of the bowels1 or suffers from constipation1 will be sure to suffer from many diseases and will see his strength disappear even should he eat the best food in the world and make use of all the remedies that physicians have4 ,immoderate eating is a poison for men and the cause of many diseases which attack them4 ,most diseases come from either eating too much or partaking of unsuitable food4 ,that was what ,solomon meant with his proverb3 ,he who puts a guard over his mouth and his tongue protects himself from many evils1 that is to say1 whoever protects his mouth from the overindulgence in food and his tongue from unsuitable speech protects himself from many evils4 #af4 ,every week at least a man should take a warm bath4 ,one should not bathe when hungry1 nor after eating until the food is digested1 and bathe the whole body in warm but not too hot water and the head in hot water4 ,afterwards the body should be washed in lukewarm and cool water until finally cold water is used4 ,one should pour neither cold nor even lukewarm water on the head1 nor bathe in cold water in the winter time1 nor when the body is tired and in perspiration4 ,at such times the bath should be put off for a while4 #ag4 ,as soon as one leaves the bath one should cover oneself1 and especially cover the head1 so that no draught may strike it4 ,even in summer1 care must be taken to observe this rule4 ,after this one should rest for a while until the heat of the body passes off and then should go to table4 ,if one could sleep a little just before a meal it is often very beneficial4 ,neither during the bath nor immediately after it should cold water be drunk1 and if there is an inappeasable thirst a little wine and water or water and honey should be taken4 ,in winter it is beneficial to rub the body with oil after the bath4 #ah4 ,venesection should not be practised frequently1 for it is only meant for serious illness4 ,it should not be permitted in winter or summer1 nor during the months of ,april or ,september 7the r months74 ,after passing his fiftieth year an individual should abstain from venesection4 ,venesection should not be practised on the day when one takes a bath or goes on a journey or returns from it4 ,on the day when it is practised less than usual should be eaten and drunk1 and the patient should give himself to rest1 undertake no work nor bothersome occupation1 and take no walk4 #ai4 ,whoever observes these rules of life faithfully ,i guarantee him a long life without disease4 ,he shall reach a good old age1 and when he comes to die will not need a physician4 ,his body will remain always strong and healthy1 unless of course he has been born with a weak nature1 or has had an unfortunate bringing up1 or should be attacked by epidemic disease or by famine4 #bj4 ,only the healthy should keep these rules4 ,whoever is ill or a sufferer from any injuries1 or has lost his health through bad habits1 for him there are special rules for each disease1 only to be found in the medical books4 ,let it be remembered that every change in a life habit is the beginning of an ailment4 #ba4 ,if no physician can be secured1 then ailing people may use these rules as well as the healthy4 ,these rules are1 of course1 full of the common sense of medicine that endures at all times4 ,for the tropical climate of the ,eastern countries they probably represent as good advice as could be given even at the present time4 ,with them before us it is not surprising to find that on other subjects ,maimonides was just as sensible4 ,perhaps in nothing is this more striking than in his complete rejection of astrology4 ,considering how long astrology1 in the sense of the doctrine of the stars influencing human health and destinies1 had dominated men's minds1 and how universal was the acceptance of it1 ,maimonides' strong expressions show how much genius lifts itself above the popular persuasions of its time1 even among the educated1 and how much it anticipates subsequent knowledge4 ,it is well to remind ourselves that as late as the middle of the eighteenth century ,mesmer's thesis on ,the ,influence of the ,stars on ,human ,constitutions was accepted by the faculty of the ,university of ,vienna as a satisfactory evidence not only of his knowledge of medicine1 but of his power to reason about it4 ,at the end of the twelfth century ,maimonides was trying to argue it out of existence on the best possible grounds4 ,know1 my masters1 he writes1 that no man should believe anything that is not attested by one of these three sanctions3--rational proof as in mathematical science1 the perception of the senses1 or traditions from the prophets and learned men4 ,his biographer in the monograph ,maimonides1 published by the ,jewish ,publication ,society of ,america#e1 expresses his further views on the subject in compendious form1 and then gives his final conclusion as follows3 ',works on astrology are the product of fools1 who mistook vanity for wisdom4 ,men are inclined to believe whatever is written in a book1 especially if the book be ancient2 and in olden times disaster befell ,israel because men devoted themselves to such idolatry instead of practising the arts of martial defence and government4' ,he says1 that he had himself studied every extant astrological treatise1 and had convinced himself that none deserved to be called scientific4 ,maimonides then proceeds to distinguish between astrology and astronomy1 in the latter of which lies true and necessary wisdom4 ,he ridicules the supposition that the fate of man could be dependent on the constellations1 and urges that such a theory robs life of purpose1 and makes man a slave of destiny4 ',it is true1' he concludes1 'that you may find strange utterances in the ,rabbinical literature which imply a belief in the potency of the stars at a man's nativity1 but no one is justified in surrendering his own rational opinions because this or that sage erred1 or because an allegorical remark is expressed literally4 ,a man must never cast his own judgment behind him2 the eyes are set in front1 not in the back4' ,while ,maimonides could be so positive in his opinions with regard to a subject on which he felt competent to say something1 he was extremely modest with regard to many of the great problems of medicine4 ,he often uses the expression in his writings1 ,i do not see how to explain this matter4 ,he quotes with approval from a ,rabbi of old who had counselled his students1 teach thy tongue to say1 ,i do not know4 ,in this1 of course1 he has given the best possible evidence of his largeness of mind and his capacity for making advance in knowledge4 ,it is when men are ready to say1 ,i do not know1 that progress becomes possible4 ,it is very easy to rest in a conscious or unconscious pretence of knowledge that obscures the real question at issue4 ,a great thinker1 who lived in the century in which ,maimonides died1 ,roger ,bacon1 set down as one of the four principal obstacles to advance in knowledge indeed1 as the one of the four that hampered intellectual progress the most1 the fact that men feared to say1 ,i do not know4 ,one of the most interesting features of ,maimonides' career for the modern time is the influence that his writings exerted over the rising intellectual life of ,europe within a half century after his death4 ,most people would be rather inclined to think that this ,jewish author of the ,east would have very little influence over the thinkers and teachers of ,europe within a generation after his death4 ,he died in #abjd1 just at the beginning of one of the great productive centuries of humanity1 perhaps one of the greatest of them all4 ,in literature1 in art1 in architecture1 in philosophy1 and in education1 this century made wonderful strides4 ,two of its greatest teachers1 ,albertus ,magnus and his pupil1 ,thomas ,aquinas1 quote from ,moses gyptus1 the ,european name for ,maimonides at that time1 and evidently knew his writings very well4 ,maimonides was for them an important connecting link with the world of old ,greek thought4 ,others of the writers and teachers of this time1 as ,william of ,auvergne1 and the two great ,franciscans1 ,alexander of ,hales and ,duns ,scotus1 were also influenced by ,maimonides4 ,in a word1 the educational world of that time was much more closely united than we might think1 and it did not take long for a great writer's thoughts to make themselves felt several thousand miles away4 ,maimonides was1 then1 in his own time one of the world teachers1 and1 in a certain sense1 he must always remain that1 as representing a special development of what is best in human nature4 ,v ,,great ,,arabian ,,physicians ,in order to understand the place of the ,arabs in medicine and in science1 a few words as to the rise of this people to political power1 and then to the cultivation of literature and of science1 are necessary4 ,we hear of the ,arabs as hireling soldiers fighting for others during the centuries just after ,christ1 and especially in connection with the story of the famous ,queen ,zenobia at ,palmyra4 ,after the destruction of this city we hear nothing more of them until the time of ,mohammed4 ,during these six and a half centuries there is little question of education of any kind among them except that at the end of the sixth century1 the ,persian ,king ,chosroes ,i1 who was much interested in medicine1 encouraged the medical school in ,djondisabour1 in ,arabistan1 founded at the end of the fifth century by the ,nestorian ,christians1 who continued as the teachers there until it became one of the most important schools of the ,east4 ,it was here that the first ,arab physicians were trained1 and here that the ,christian physicians who practised medicine among the ,arabs were educated4 ,among the ,arabs themselves1 before the time of ,mohammed1 there had been very little interest in medicine4 ,gurlt notes that even the physician of the ,prophet himself was1 according to tradition1 a ,christian4 ,mohammed's immediate successors were not interested in education1 and their people mainly turned to ,christian and ,jewish physicians for whatever medical treatment they needed4 ,when the ,caliphs came to be rulers of the ,mohammedan ,empire1 they took special pains to encourage the study of philosophy and medicine2 though dissection was forbidden by the ,koran1 most of the other medical sciences1 and especially botany and all the therapeutic arts1 were seriously cultivated4 ,until the coming of ,mohammed1 the ,arabs had been wandering tribes1 getting some fame as hireling soldiers1 but now1 under the influence of a feeling of community in religion1 and led by the military genius of some of ,mohammed's successors1 whose soldiers were inspired by the religious feelings of the sect1 they made great conquests4 ,the ,mohammedan ,empire extended from ,india to ,spain within a century after ,mohammed's death4 ,carthage was taken and destroyed1 ,constantinople was threatened4 ,in #ffa1 scarcely forty years after the hegira or flight of ,mohammed1 from which good ,mohammedans date their era1 the capital was transferred from ,medina to ,damascus1 to be transferred from here to ,bagdad just about a century later1 where it remained until the ,mongols made an end of the ,abbasside rulers about the middle of the thirteenth century4 ,at the beginning the followers of ,mohammed were opposed to knowledge and education of all kinds4 ,mohammed himself had but little4 ,according to tradition1 he could not read or write4 ,the story told with regard to the ,caliph ,omar and the great library of ,alexandria1 seems to have a foundation in reality1 though such legends usually are not to be taken literally4 ,certainly it represents the traditional view as to the attitude of the earlier ,moslem rulers to education4 ,omar was asked what should be done with the more than two million volumes4 ,he said that the books in it either agreed with the ,koran1 or they did not4 ,if they agreed with it they were quite useless4 ,if they did not1 they were pernicious4 ,in either case1 they should be done away with1 because there was an element of danger in them4 ,accordingly1 the precious volumes that had been accumulating for nearly ten centuries1 served1 it is said1 to heat the baths of ,alexandria for some six months--probably the most precious fuel ever used4 ,fortunately for posterity1 the edict was not quite as universal in its application as the story would indicate1 and exceptions were made for books of science4 ,in the course of their conquests1 however1 the ,mohammedan ,arabs captured the ,greek cities of ,asia ,minor4 ,they were brought closely in contact with ,greek culture1 ,greek literature1 and ,greek thought4 ,as has always been the case1 captive ,greece took its captors captive4 ,what happened to the ,romans earlier came to pass also among the ,arabs4 ,inspired by ,greek philosophy1 science1 and literature1 they became ardent devotees of science and the arts4 ,while not inventing or discovering anything new1 like the ,romans they carried on the old4 ,damascus1 ,basra1 ,bagdad1 ,bokhara1 ,samarcand all became centres of culture and of education4 ,large sums were paid for ,greek manuscripts1 and for translations from them4 ,under the famous ,harun al-,raschid1 at the end of the eighth century1 whose name is better known to us than that of any others1 because of the stories of his wandering by night among his people in order to see if justice were done1 three hundred scholars were sent at the cost of the ,caliph to the various parts of the world in order to bring back treasures of science1 and especially of geography and medicine4 ,it is an interesting historical reflection that the ,japanese and ,chinese are doing the same thing now4 ,the ,arabs were very much taken by the philosophy of ,aristotle1 and it became the foundation of all their education4 ,greek thought1 as always1 inspired its students to higher things4 ,soon everywhere in the dominions of the ,caliphs1 philosophy1 science1 art1 literature1 and education nourished4 ,medicine was taken up with the other sciences and cultivated assiduously4 ,freind1 in his ,historia ,medicin1 says that the writings of the old ,greeks which treated of medicine were saved from destruction with the other books at ,alexandria1 for the desire of health did not have less strength among the ,arabs than among other nations4 ,since these books taught them how to preserve health1 and were not otherwise contrary to the laws of the ,prophet1 that served to bring about their preservation4 ,freind also calls attention to the fact that grammars and books which treated of the science of language were likewise saved from destruction4 ,besides the library1 the ,arabs1 after their conquest of ,alexandria in the eighth century1 came under the influence of the university still in existence there4 ,in the ,west1 in ,spain1 the ,arabs enjoyed the same advantages as regards contact with culture and education as their conquest of the ,eastern cities and ,alexandria brought them in the ,east4 ,while it is not generally realized1 ,spain was1 as we have pointed out1 the province of the ,roman ,empire in the ,west that advanced most in culture before the breaking up of the ,empire4 ,the ,silver ,age of ,latin literature owes all of its geniuses to ,spain4 ,lucan1 the ,senecas1 ,martial1 ,quintilian1 are all ,spaniards4 ,spain itself was a most flourishing province1 and under the ,spanish ,csars1 from the end of the first to about the end of the second century1 increased rapidly in population4 ,spain was the leader in these prosperous times1 and the tradition of culture maintained itself4 ,when ,spain became ,christian the first great ,christian poet1 ,prudentius1 born about the middle of the fourth century1 came from there4 ,he has been called the ,horace and ,virgil of the ,christians4 ,the coming down of the barbarians from the ,north disturbed ,spain's prosperity and the peace and culture of her inhabitants1 but it should not be forgotten that the first medieval popularization of science1 a sort of encyclopedia of knowledge1 the first of its kind after that of ,pliny in the classical period1 came from ,st4 ,isidore of ,seville1 a ,spanish bishop4 ,there has been considerable tendency to insist that ,spanish culture and intellectuality owe nearly all to the presence of the ,moors in ,spain4 ,this can only be urged1 however1 by those who know nothing at all of the ,spanish ,csars1 the place of ,spain in the history of the ,roman ,empire1 and the continuance of the culture that then reached a climax of expression during succeeding centuries4 ,on the contrary1 the ,moors who came to ,spain owe most of their tendency to devote themselves to culture and education to the state of affairs existent in ,spain when they came4 ,there is no doubt that they raised standards of education and of culture above the level to which they had sunk under the weight of the invading barbarians from the ,north1 and ,spain owes much to the wise ruling and devotion to the intellectual life of her ,moorish invaders4 ,all the factors1 however1 must be taken together in order to appreciate properly the conditions which developed under the ,arabs in both the ,east and the ,west4 ,the ,arabs invented little that was new in science or philosophy2 they merely carried on older traditions4 ,it is for that that the modern time owes them a great debt of gratitude4 ,,rhazes ,the most distinguished of the ,arabian physicians was the man whose rather lengthy ,arabian name1 beginning with ,abu ,bekr ,mohammed1 finished with el-,razi1 and who has hence been usually referred to in the history of medicine as ,rhazes4 ,he was born about #hej at ,raj1 in the ,province of ,chorasan in ,persia4 ,he seems to have had a liberal early education in philosophy and in philology and literature4 ,he did not take up medicine until later in life1 and1 according to tradition1 supported himself as a singer until he was thirty years of age4 ,then he devoted himself to medical studies with the ardor and the success so often noted in those whose opportunity to study medicine has been delayed4 ,his studies were made at ,bagdad1 where ,ibn ,zein el-,taberi was his teacher4 ,he returned to his native town and was for some time the head of the hospital there4 ,later he was called by the ,sultan to ,bagdad to take charge of the renovated and enlarged hospital of the capital4 ,his medical career1 then1 is not unlike that of many another successful physician1 especially of the modern time4 ,at ,bagdad he had abundant opportunities for study1 and the ambition to make medicine as well as to make money and gain fame4 ,his studies in science were all founded on ,aristotle4 ,though he was called the ,galen of his time1 and looked up to the ,greek physician as his master1 even the authority of ,galen did not override that of the ,stagirite in his estimation4 ,one of his aphorisms is said to have been1 ,if ,galen and ,aristotle are of one mind on a subject1 then surely their opinion is true4 ,when they differ1 however1 it is extremely difficult for the scholar to decide which opinion should be accepted4 ,he drew many pupils to ,bagdad1 and1 when one knows his teaching1 this is not surprising4 ,some of his aphorisms are very practical4 ,while the expressions just quoted with regard to ,galen and ,aristotle might seem to indicate that ,rhazes was absolutely wedded to authority1 there is another well-known maxim of his which shows how much he thought of the value of experience and observation4 ,truth in medicine1 he said1 is a goal which cannot be absolutely reached1 and the art of healing1 as it is described in books1 is far beneath the practical experience of a skilful1 thoughtful physician4 ,some of his other medical aphorisms are worth noting4 ,at the beginning of a disease choose such remedies as will not lessen the patient's strength4 ,when you can heal by diet1 prescribe no other remedy1 and1 where simple remedies suffice1 do not take complicated ones4 ,rhazes knew well the value of the influence of mind over body even in serious organic disease1 and even though death seemed impending4 ,one of his aphorisms is3 ,physicians ought to console their patients even if the signs of impending death seem to be present4 ,for the bodies of men are dependent on their spirits4 ,he considered that the most valuable thing for the physician to do was to increase the patient's natural vitality4 ,hence his advice3 ,in treating a patient1 let your first thought be to strengthen his natural vitality4 ,if you strengthen that1 you remove ever so many ills without more ado4 ,if you weaken it1 however1 by the remedies that you use you always work harm4 ,the simpler the means by which the patient's cure can be brought about1 the better in his opinion4 ,he insists again and again on diet rather than artificial remedies4 ,it is good for the physician that he should be able to cure disease by means of diet1 if possible1 rather than by means of medicine4 ,another of his aphorisms seems worth while quoting3 ,the patient who consults a great many physicians is likely to have a very confused state of mind4 ,some idea of ,rhazes' strenuous activity as a writer on medical subjects may be obtained from the fact that thirty-six of his works are still extant1 and there are nearly two hundred others of which only the titles have been preserved4 ,some of these are doubtless the works of pupils and students of succeeding generations1 published under his name to attract attention4 ,his principal work is ,continens1 or ,comprehensor1 which owes its title to the fact that it was meant to contain the whole practice of medicine and surgery4 ,it includes references to the writings of all previous distinguished medical writers1 from ,hippocrates to ,honein ,ben ,ishac1 also known as ,johannitius1 a ,christian ,arabian physician1 one of ,rhazes' teachers4 ,the most frequently quoted of these authorities are ,galen1 ,oribasius1 ,atius1 and ,paul of gina4 ,the work1 however1 is not made up entirely of quotations1 but contains many observations made by the author himself4 ,gurlt says that the foundation of the theoretic medicine of ,rhazes is the system of ,galen1 while in practice he seems to cling more to the aphorisms of ,hippocrates4 ,he has many practical points which show that he thought for himself4 ,for instance1 in wounds of the abdomen1 if the intestines are extruded and cannot be replaced1 he suggests the suspension of the patient by his hands and feet in a bath in order to facilitate their return4 ,if they do not go back readily1 compresses dipped in warm wine should be used4 ,cancer he declares to be almost incurable4 ,he has much to say about the bites of animals and their tendency to be poisonous1 knew rabies very well1 and knew also that the bites of men might have similar serious consequences4 ,it is impossible to give any adequate idea of the thoroughly practical character of ,rhazes' medical writing in a few lines1 but it may suffice to say that there is scarcely any feature of modern medicine and surgery that he does not touch1 and oftener than not his touch is sure and rational and frequently much better than the advice of successors long after him in the same matters4 ,an example or two will suffice to illustrate this4 ,in the treatment of nasal polyps he says that whenever drug treatment of these is not successful1 they should be removed with a snare made of hair4 ,for fall of the uvula he suggests gargles1 but when these fail he advises resection and cauterization4 ,among the affections of the tongue he numbers abscess1 fissure1 ulcer1 cancer1 ranula1 shortening of the ligaments1 hypertrophy1 erythema of the mucous membrane1 and inflammatory swelling4 ,in general his treatment of the upper respiratory tract is much farther advanced than we might think possible at this time4 ,he advises tracheotomy whenever there is great difficulty of respiration1 and describes how it should be done4 ,after the dyspnea has passed the edges of the wound should be brought together with sutures4 ,it is not surprising1 then1 to find that the treatment of fractures and luxations is eminently practical1 and1 indeed1 on any subject that he touches he throws practical light4 ,in the introduction to his edition of the works of ,ambroise ,par1 ,malgaigne says that the first reference to a metal band in connection with trusses is to be found in ,rhazes4 ,hernia was1 of course1 one of the serious ailments that1 because of its superficial character1 was rather well understood1 and so it is not surprising to find that much of our modern treatment of it was anticipated4 ,the manipulations for taxis1 the use of a warm bath for the relaxation of the patient by means of heat and by putting the head and feet higher than the abdomen while in the bath1 and the employment of various kinds of trusses to prevent strangulation of the hernia recur over and over again1 in the authors of the ,middle ,ages4 ,many of the suggestions are to be found in the early ,greek authors1 but subsequent writers give a certain personal expression to them which shows how much they had learned by personal observation in the employment of various methods4 ,pagel1 in ,puschmann's ,handbook of the ,history of ,medicine1 declares that ,rhazes' most important work for pure medicine is his monograph on smallpox4 ,its principal value is due to the fact that1 though he has consulted old authorities carefully1 his discussion of the disease is founded almost entirely on his own experience4 ,his description of the various stages of the disease1 of the forms of the eruption1 and of the differential diagnosis1 is very accurate4 ,he compares the course of the fever with that of other fevers1 and brings out exactly what constitutes the disease4 ,his suggestions as to prognosis are excellent4 ,those cases1 he declares1 are particularly serious in which the eruption takes on a dark1 or greenish1 or violet color4 ,the prognosis is also unfavorable for those cases which1 having considerable fever1 have only a slight amount of rash4 ,his treatment of the disease in young persons was by venesection and cool douches4 ,cold water and acid drinks should be administered freely1 so that sweat and other excretions may carry off poisonous materials4 ,care must be taken to watch the pulse1 the breathing1 the appearance of the feet1 the evacuations from the bowels1 and to modify therapy in accordance with these indications4 ,the eruption is to be encouraged by external warmth and special care must be taken with regard to complications in the eyes1 the ears1 the nose1 the mouth1 and the pharynx4 ,a fact that will1 perhaps1 give the best idea to modern readers of the place of ,rhazes in the history of medicine is that ,vesalius considered it worth his while to make a translation of his principal work4 ,unfortunately that translation has not come down to us4 ,when ,vesalius1 pestered by the controversies that had come upon him because of his venturing to make his observations for himself1 accepted the post of physician to the ,emperor ,charles ,v1 he burnt a number of his manuscripts4 ,among these were his translation of ,rhazes and some annotations on ,galen1 which1 as he says himself1 had grown into a huge volume4 ,the ,galenists were bitterly decrying his refusal to accept ,galen on many points1 and both of these works would have added fuel to the flame of controversy4 ,he deemed it wiser1 then1 not to give any further opportunities for rancorous criticism1 and1 feeling presumably that in his new and important post it was not worth while to bother further over the matter1 he burnt them4 ,he tells the reason in his letters to ,joachin ,roelant3 ,when ,i was about to leave ,italy to go to ,court1 since a number of the physicians whom you know had made the worst kind of censure of my books1 both to the ,emperor himself1 and to other rulers1 ,i burned all the manuscripts that were left1 although ,i had never suffered a moment under the displeasure of the ,emperor because of these complaints1 and in spite of the fact that a number of friends who were present urged me not to destroy them4 ,vesalius' translation of ,rhazes was probably undertaken because he recognized in him a kindred spirit of original investigation and inquiry1 whose work1 because it was many centuries old1 would command the weight of an authority and at the same time help in the controversy over ,galenic questions4 ,this1 of itself1 would be quite enough to make the reputation of ,rhazes1 even if we did not know from the writings themselves and from the admiration of many distinguished men as well as the incentive that his works have so often proved to original observation1 that he is an important link in the chain of observers in medicine1 who1 though we would naturally expect them to be so frequent1 are really so rare4 ,,ali ,,abbas ,rhazes lived well on into the tenth century4 ,his successor in prestige1 though not his serious rival1 was ,ali ,ben el-,abbas1 usually spoken of in medical literature as ,ali ,abbas1 a distinguished ,arabian physician who died near the end of the tenth century4 ,he wrote a book on medicine which1 because of its dedication to the ,sultan1 to whom he was body-physician1 is known as the ,liber ,regius1 or ,royal ,book of ,medicine4 ,this became the leading text-book of medicine for the ,arabs until replaced by the ,canon of ,avicenna some two centuries later4 ,the ,liber ,regius was an extremely practical work and1 like most of the ,arabian books of the early times1 is simple and direct1 quite without many of the objectionable features that developed later in ,arabian medicine4 ,it is valuable mainly for its contributions to diet and the fact that ,ali ,abbas tested many of his medicines on ailing animals before applying them to men4 ,of course1 it owes much to earlier writers on medicine1 and especially to ,paul of gina4 ,an example of its practical value is to be found in his description of the treatment of a wound of the brachial artery1 when1 as happened often in venesection from the median basilic vein1 it was injured through carelessness or inadvertence4 ,if astringent or cauterizing methods do not stop the bleeding1 the artery should be exposed1 carefully isolated1 tied in two places above and below the wound1 and then cut across between them4 ,he has many similar practical bits of technique4 ,for instance1 in pulling a back tooth he recommends that the gums be incised so as to loosen them around the roots1 and then the tooth itself may be drawn with a special forceps which he calls a molar forceps4 ,in ascites he recommends that when other means fail an opening should be made three finger-breadths below the navel with a pointed phlebotomy knife1 and a portion of the fluid allowed to evacuate itself4 ,a tube should then be inserted1 but closed4 ,the next day more of the fluid should be allowed to come away1 and then the tube removed and the abdomen wrapped with a firm bandage4 ,it is easy to understand that ,ali ,abbas' book should have been popular1 and the more we know of it the easier it is to explain why ,constantine ,africanus should have selected it for translation4 ,it contains ten theoretic and ten practical books1 and gives an excellent idea of the medical knowledge and medical practice of the time4 ,probably the fact that ,constantine had translated it led to its early printing1 so that we have an edition of it published at ,venice in #adib1 and another at ,lyons in #aebc4 ,during the ,middle ,ages the book was often spoken of as ,regalis ,dispositio1 the ,royal ,disposition of ,medicine4 ,,moorish ,,physicians ,after ,rhazes1 the most important contributors to medical literature from among the ,arabs1 with the single exception of ,avicenna1 were born in ,spain4 ,they are ,albucasis or ,abulcasis1 the surgeon2 ,avenzoar1 the physician1 and ,averros1 the philosophic theorist in medicine4 ,besides1 it may be recalled here that ,maimonides1 the great ,jewish physician1 was born and educated at ,cordova1 in ,spain4 ,it might very well be a surprise that these distinguished men among the ,arabs should have flourished in ,spain1 so far from the original seat of ,arabian and ,mohammedan dominion in the ,east1 where1 owing to conditions in the modern time1 the ,english-speaking world particularly is not likely to assume that the environment was favorable for the development of science and philosophy4 ,anyone who recalls1 however1 the history of ,spanish intellectual influence in the ,roman ,empire1 as we have traced it at the beginning of this chapter1 will appreciate how favorable conditions were in ,spain for the fostering of intellectual development4 ,with the disturbances that had come from political strife and the invasion of the barbarians in ,italy1 ,spain had undoubtedly come to hold the primacy in the intellectual life of ,europe at the time when the ,arabs took possession of the peninsula4 ,,abulcasis ,the most important of the ,arabian surgeons of the ,middle ,ages is ,albucasis or ,abulcasis1 also ,abulkasim1 who was born near ,cordova1 in ,spain4 ,the exact year of his birth is not known1 but he flourished in the second half of the tenth century4 ,he is said to have lived to the age of #aja4 ,the name of his principal work1 which embraces the whole of medicine1 is ,altasrif1 or ,tesrif1 which has been translated ,the ,miscellany4 ,most of what he has to say about medical matters is taken from ,rhazes4 ,his work on surgery1 however1 in three books1 represents his special contribution to the medical sciences4 ,it contains a number of illustrations of instruments1 and is the first illustrated medical book that has come to us4 ,it was translated into ,latin1 and was studied very faithfully by all the surgeons of the ,middle ,ages4 ,guy de ,chauliac has quoted ,albucasis about two hundred times in his ,chirurgia ,magna4 ,even as late as the beginning of the sixteenth century ,fabricius de ,acquapendente1 the teacher of ,harvey1 confessed that he owed most to three great medical writers1 ,celsus 7first century71 ,paul of gina 7seventh century71 and ,abulcasis 7tenth century74 ,abulcasis insisted that for successful surgery a detailed knowledge of anatomy was1 above all1 necessary4 ,he said that the reason why surgery had declined in his day was that physicians did not know their anatomy4 ,the art of medicine1 he added further1 required much time4 ,unfortunately1 to quote ,hippocrates1 there are many who are physicians in name only1 and not in fact1 especially in what regards surgery4 ,he gives some examples of surgical mistakes made by his professional brethren that were particularly called to his attention4 ,they are the perennially familiar instances of ignorance causing death because surgeons were tempted to operate too extensively4 ,his description of the procedure necessary to stop an artery from bleeding is an interesting example of his method of teaching the practical technique of surgery4 ,apply the finger promptly upon the opening of the vessel and press until the blood is arrested4 ,having heated a cautery of the appropriate size1 take the finger away rapidly and touch the cautery at once to the end of the artery until the blood stops4 ,if the spurting blood should cool the cautery1 take another4 ,there should be several ready for the purpose4 ,take care1 he says1 not to cauterize the nerves in the neighborhood1 for this will add a new ailment to the patient's affection4 ,there are only four ways of arresting arterial hemorrhage4 ,first1 by cautery2 second1 by division of the artery1 when that is not complete--for then the extremities contract and the blood clots--or by a ligature1 or by the application of substances which arrest blood flow1 aided by a compressive bandage4 ,other means are inefficient1 and seldom and1 at most1 accidentally successful4 ,his instruction for first aid to the injured in case of hemorrhage in the absence of the physician1 is to apply pressure directly upon the wound itself4 ,the development of the surgical specialties among the ,arabs is particularly interesting4 ,abulcasis has much to say about nasal polyps4 ,he divided them into three classes3 7#a7 cancerous1 7#b7 those with a number of feet1 and 7#c7 those that are soft and not living1--these latter1 he says1 are neither malignant nor difficult to treat4 ,he recommends the use of a hook for their removal1 or a snare for those that cannot be removed with that instrument4 ,his instructions for the removal of objects from the external ear are interestingly practical4 ,he advises the use of bird lime on the end of a sound to which objects will cling1 or1 where they are smaller1 suction through a silver or copper canula4 ,hooks and pincettes are also suggested4 ,insects should be removed with a hook1 or with a canula1 or1 having been killed by warm oil1 removed by means of a syringe4 ,some of his observations with regard to genito-urinary surgery are quite as interesting4 ,he even treated congenital anomalies4 ,he suggests cutting of the meatus when narrowed1 dilatation of strictures with lead sounds1 and even suggests plans of operations to improve the condition in hypospadias4 ,he gives the signs for differentiation between epitheliomata and condylomata1 and distinguishes various forms of ulceration of the penis4 ,abulcasis discusses varicose veins in very much the same spirit as a modern surgeon does4 ,they occur particularly in people who work much on their feet1 and especially who have to carry heavy burdens4 ,they should not be operated on unless they produce great discomfort1 and make it impossible for the sufferer to make his living4 ,they may be operated on by means of incision or extirpation4 ,incision consists of cutting the veins at two or three places when they have been made prominent by means of tight bandages around the limb4 ,the blood should be allowed to flow freely out of the cut ends1 and then a bandage applied4 ,for extirpation1 the skin having been shaved beforehand1 the vein should be made prominent1 and then carefully laid bare4 ,when freed from all adhesions1 it should be lifted out on a hook1 and either completely extirpated or several rather long pieces removed4 ,he lays a good deal of stress on the necessity for freeing the vein thoroughly and lifting it well out of tissues before incising it4 ,in old cases special care must be taken not to tear the vein4 ,minute details of technique are often found in these old authors4 ,abulcasis1 for instance1 treats of adherent fingers with up-to-date completeness4 ,they can occur either congenitally or from injury1 as1 for instance1 burning4 ,they should be separated1 and then separation maintained by means of bandages or by the insertion between them of a thin lead plate1 which prevents their readhesion4 ,adhesions of the fingers with the palm of the hand1 which ,abulcasis has also seen1 should be treated the same way4 ,at times there is surprise at finding some rare lesion treated with modern technique1 and a hint at least of our modern apparatus4 ,fracture of the pubic arch1 for instance1 is described in ,abulcasis quite as if he had had definite experience with it4 ,when this occurs in a woman1 the reposition of the bone is often greatly facilitated by a cotton tampon in the vagina4 ,this tampon must be removed at every urination4 ,there is another way1 however1 of better securing the same purpose of counterpressure4 ,one may take a sheep's bladder into the orifice of which a tube is fastened4 ,one should introduce the bladder into the vagina1 and then blow strongly through the tube1 until the bladder becomes swollen and fills up the vaginal cavity4 ,the fracture will1 as a rule1 then be readily reduced4 ,here is1 of course1 not alone the first hint of the colpeurynter1 but a very practical form of the apparatus complete4 ,old-time physicians used the bladders of animals very generally for nearly all the medical purposes for which we now use rubber bags4 ,,avicenna ,undoubtedly the most important of ,abulcasis' contemporaries is the famous physician whose ,arabic name1 ,ibn ,sina1 was transformed into ,avicenna4 ,he was born toward the end of the tenth century in the ,persian province of ,chorasan1 at the height of ,arabian influence1 and is sometimes spoken of as the chief representative of ,arabian medicine1 of as much importance for it as ,galen for later ,greek medicine4 ,his principal book is the so-called ,canon4 ,it replaced the compendium ,continens of ,rhazes1 and1 in the ,east1 continued until the end of the fifteenth century to be looked upon as the most complete and best system of medicine4 ,avicenna came to be better known in the ,west than any of the other ,arabian writers1 and his name carried great weight with it4 ,there are very few subjects in medicine that did not receive suggestive1 if not always adequate1 treatment at the hands of this great ,arabian medical thinker of the eleventh century4 ,he copied freely from his predecessors1 but completed their work with his own observations and conclusions4 ,one of his chapters is devoted to leprosy alone4 ,he has definite information with regard to bubonic plague and the filaria medinensis4 ,here and there one finds striking anticipations of what are supposed to be modern observations4 ,nothing was too small for his notice4 ,one portion of the fourth book is on cosmetics1 in which he treats the affections of the hair and of the nails4 ,he has special chapters with regard to obesity1 emaciation1 and general constitutional conditions4 ,his book1 the ,antidotarium1 is the foundation of our knowledge of the drug-giving of his time4 ,some idea of the popularity and influence of ,avicenna1 five centuries after his time1 can be readily derived from the number of commentaries on him issued during the ,renaissance period by the most distinguished medical scholars and writers of that time4 ,hyrtl1 in his ,das ,arabische und ,hebrische in der ,anatomie1 quotes some of them1--,bartholomus de ,varignana1 ,gentilis de ,fulgineis1 ,jacobus de ,partibus1 ,didacus ,lopez1 ,jacobus de ,forlivio1 ,ugo ,senesis1 ,dinus de ,garbo1 ,matthus de ,gradibus1 ,nicolaus ,leonicenus1 ,thaddus ,florentinus1 ,galeatus de ,sancta ,sophia4 ,a more complete list1 with the titles of the books1 may be found in ,haller's ,bibliotheca ,anatomica4 ,for over three centuries after the foundation of medical schools in ,europe 7and even after ,mondino's book had been widely distributed71 ,avicenna was still in the hands of all those who had an enthusiasm for medical science4 ,,avenzoar ,another of the distinguished ,arabian physicians was ,avenzoar--the transformation of his ,arabic family name1 ,ibn-,zohr4 ,he was probably born in ,penaflor1 not far from ,seville4 ,he died in ,seville in #aafb at the age1 it is said1 of ninety-two years4 ,he was the son of a physician descended from a family of scholars1 jurists1 physicians1 and officials4 ,he received the best education of the time not only in internal medicine1 but in all the specialties1 and must be counted among the greatest of the ,spanish ,arabian physicians4 ,he was the teacher of ,averros1 who always speaks of him with great respect4 ,he is interesting as probably being the first to suggest nutrition per rectum4 ,a few words of his description show how well he knew the technique4 ,his apparatus for the purpose consisted of the bladder of a goat or some similar animal structure1 with a silver canula fastened into its neck1 to be used about as we use a fountain syringe4 ,having first carefully washed out the rectum with cleansing and purifying clysters1 he injected the nutriment--eggs1 milk1 and gruels--into the gut4 ,his idea was that the intestine would take this1 and1 as he said1 suck it up1 carrying it back to the stomach1 where it would be digested4 ,he was sure that he had seen his patients benefited by it4 ,some light on his studies of cases that would require such treatment may be obtained from what he has to say about the handling of a case of stricture of the esophagus4 ,he says that this begins with some discomfort1 and then some difficulty of swallowing1 which is gradually and continuously increased until finally there comes complete impossibility of swallowing4 ,it was in these cases that he suggested rectal alimentation1 but he went farther than this1 and treated the stricture of the esophagus itself4 ,the first step in this treatment is that a canula of silver or tin should be inserted through the mouth and pushed down the throat till its head meets an obstruction1 always being withdrawn when there is a vomiting movement1 until it becomes engaged in the stricture4 ,then freshly milked milk1 or gruel made from farina or barley1 should be poured through it4 ,he says that in these cases the patient might be put in a warm milk or gruel bath1 since there are some physicians who believe that through the lower parts of the body1 and also through the pores of the whole body1 nutrition might be taken up4 ,while he considers that this latter method should be tried in suitable cases1 he has not very much faith in it1 and says that the reasons urged for it are weak and rather frivolous4 ,it is easy to understand that a man who has reached the place in medicine where he can recommend manipulative treatments of this kind1 and discuss nutritional modes so rationally1 knew his practical medicine well1 and wrote of it judiciously4 ,,averro,s ,among the distinguished contributors to medicine at this time1 though more a philosopher than a physician1 is the famous ,averros1 whose full ,arabic name among his contemporaries was ,abul-,welid ,mohammed ,ben ,ahmed ,ibn ,roschd el-,maliki4 ,like ,avenzoar1 of whom he was the intimate personal friend1 and ,abulcasis and ,maimonides1 he was born in the south of ,spain4 ,he was in high favor with the ,king of ,morocco and of ,spain1 ,el-,mansur ,jacub1 often known as ,almansor1 who made him one of his counsellors4 ,his works are much more important for philosophy than for medicine1 and his philosophical writings gave him a place only second to that of ,aristotle in the ,western world during the ,middle ,ages4 ,averroism is still a subject of at least academic interest1 and ,renan's monograph on it and its author was one of the popular books of the latter half of the nineteenth century in philosophic circles4 ,in spite of his friendship with the ,moorish ,king and with ,avenzoar1 he fell under the suspicion of free thinking and was brought to trial with a number of personal friends1 who occupied high positions in the ,moorish government4 ,he escaped with his life1 but only after great risks1 and he was banished to a suburb of ,cordova1 in which only ,jews were allowed to live4 ,by personal influence he succeeded in securing the pardon of himself and friends1 and then was summoned to the court of the son and successor of ,el-,mansur in ,morocco4 ,he died1 not long after1 in #aaih4 ,altogether there are some thirty-three works of ,averros on philosophy and science4 ,only three of these are concerned with medicine4 ,one is the ,colliget1 so-called1 containing seven books1 on anatomy1 physiology1 pathology1 diagnostics1 materia medica1 hygiene1 and therapy4 ,then there is a commentary on the ,cantica of ,avicenna1 and a tractate on the ,theriac4 ,averros' idea in writing about medicine was to apply his particular system of philosophy to medical science4 ,his intimate relations with other great physicians of the time1 and in particular his close friendship with ,avenzoar1 enabled him to get abundant medical information in faultless order so far as knowledge then went1 but his theoretic speculations1 instead of helping medicine1 as he thought they would1 and as philosophers have always been inclined to think as regards their theoretic contributions1 were not only not of value1 but to some extent at least hindered human progress by diverting men from the field of observation to that of speculation4 ,it is interesting to realize that ,averros did in his time what ,descartes did many centuries later1 and many another brilliant thinker has done before and since4 ,,arabian ,,influence ,the fame of these great thinkers and writers in philosophy and in medicine came to be known not only through the distribution of their books long after their death1 but during their lifetime1 and in immediately subsequent generations1 ardent seekers after knowledge1 who were themselves afterwards to become famous by their teaching and writing1 found their way into the ,arabian dominions in order to take advantage of the educational opportunities afforded4 ,these were better than they could secure at home in ,christian countries1 because the process of bringing culture and devotion to literature and science into the minds of the ,northern nations1 who had replaced the old ,romans in ,europe1 was not yet completed4 ,bagdad and ,cordova were the two favorite places of educational pilgrimage4 ,the names that are most familiar among the scholars in the ,middle ,ages in ,europe are those of whom it is recorded that they made long journeys in order to get in touch with what the ,arabs had preserved of the old ,greek civilization and culture4 ,among them are such men as ,michael ,scot or ,scotus1 ,matthew ,platearius1 who was afterwards a great teacher at ,salerno2 ,daniel ,morley1 ,adelard of ,bath1 ,egidius1 otherwise known as ,gilles de ,corbeil2 ,romoaldus1 ,gerbert of ,auvergne1 who later became ,pope under the name of ,sylvester ,,ii2 ,gerard of ,cremona1 and the best known of them all1 at least in medicine1 ,constantine ,africanus1 whose wanderings1 however1 were probably not limited to ,arabian lands1 but who seems also to have been in ,hindustan4 ,we are rather prone to think that this great spirit of going far afield for knowledge's sake is recent1 or1 at least1 quite modern4 ,as a matter of fact1 one finds it everywhere in history4 ,long before ,herodotus did his wanderings there were many visitors who went to ,egypt1 and many more later who went to ,crete1 and many more a few centuries later who went to the shores of ,asia ,minor seeking for the precious pearl of knowledge1 and sometimes finding it without finding the even more precious pearl of wisdom1 whose worth is from the farthest coasts4 ,to the ,arabs we owe the foundation of a series of institutions for the higher learning1 like those which had existed around them in ,asia ,minor and in ,egypt at the time they made their conquests4 ,alexandria1 ,pergamos1 ,cos1 ,cnidos1 ,tarsus1 and many other ,eastern cities had had what we would call at least academies1 and many of them deserved the name of universities4 ,the ,arabs continued the tradition in education that they found1 and established educational institutions which attracted wide attention4 ,as we have said1 the two most famous of these were at ,bagdad and at ,cordova4 ,mostanser1 the predecessor of the last ,caliph of the family of the ,abbassides1 built a handsome palace1 in which the academy of ,bagdad was housed4 ,it is still in existence1 and gives an excellent idea of the beneficent interest of this monarch and of other of the ,abbasside rulers in education4 ,its fate at the present time is typical of the attitude of the ,mohammedans towards education4 ,though the building is still standing1 the institution of learning is no longer there4 ,as ,hyrtl remarks1 it is not ideas that are exchanged in it now1 but articles of commerce4 ,it has become the chief office of the ,turkish customs department in ,bagdad4 ,these institutions of the higher learning1 founded by the ,arabs1 at first as rather strict imitations of the museums or academies of ,egypt and ,asia ,minor1 gradually changed their character under the ,arabs4 ,their courses became much more formal1 examinations became much more important4 ,scholarship was sought not so much for its own sake1 as because it led to positions in the civil service1 to the favor of princes1 and1 in general1 to reputation and pecuniary reward4 ,formal testimonials proclaiming education1 signed by the academic authorities1 were introduced and came to mean much4 ,lawyers could not practise without a license1 physicians also required a license4 ,these formalities were adopted by the ,western medieval universities to a considerable degree and have been perpetuated in the modern time4 ,undoubtedly they did much to hamper real education among the ,arabs by setting in place of the satisfaction of learning for its own sake and the commendation of teachers the formal recognition of a certain amount of work done as recognized by the educational authorities4 ,there was always a tendency among the ,arabs to formulate and formalize1 to over-systematize what they were at2 to think that new knowledge could be obtained simply by speculating over what was already acquired1 and developing it4 ,there are a number of comparisons between this and later periods of education that might be suggested if comparisons were not odious4 ,the influence of ,arabian medicine on modern medicine can1 perhaps1 best be judged from the number of words in our modern nomenclature1 which1 though bearing ,latin forms1 often with suggestion of ,greek origins1 still are not derived from the old ,latin or ,greek authors1 but represent ,arabic terms translated into ,latin during the ,renaissance period4 ,hyrtl1 without pretence of quoting them all1 gives a list of these which is surprising in its comprehensiveness4 ,for instance1 the mediastinum1 the sutura sagittalis1 the scrobiculus cordis1 the marsupium cordis1 the chambers of the heart1 the velum palati1 the trochanter1 the rima glottidis1 the fontanelles1 the al of the nose1 all have their present names1 not from original ,latin expressions1 but from the translation of ,arabic terms4 ,for all such words the ,greeks and ,romans have quite other expressions1 in which the sense of our modern terms is not contained4 ,this has given rise to many misunderstandings1 and to many attempts in the modern times to return to the classic terminology rather than preserve what in many cases are the barbarisms introduced through the ,arabic1 but it is doubtful whether any comprehensive reform in the matter can be effected1 so strongly entrenched in medical usage have these terms now become4 ,freind1 in his ,history of ,medicine1 already cited1 calls attention to the fact that the ,arabs had an unfortunate tendency to change by addition or subtraction of their own views the authors that they studied1 and wished to translate to others4 ,this seems to have been true even of some of the most distinguished of them4 ,of course1 the idea of preserving an author's text untouched1 and making it clear just where note and commentary came in1 had not yet come to men's view1 but quite apart from this the ,arabs apparently often tried to gain acceptance for their own ideas by having them masquerade as the supposed ideas of favorite classic authors4 ,another unfortunate tendency among the ,arabs was their liking for the discussion of many trivial questions4 ,hyrtl1 in his volume on ,arabian and ,hebrew ,words in ,anatomy1#f declares that it is almost incredible how earnestly some trivial questions in anatomy and physiology were discussed by the ,arabs4 ,he gives some examples4 ,why does no hair grow on the nose of men8 ,why does the stomach not lie behind the mouth8 ,why does the windpipe not lie behind the esophagus8 ,why are the breasts not on the abdomen8 ,why are not the calves on the anterior portion of the legs8 ,even such men as ,rhazes and ,avicenna discuss such questions4 ,it was this tendency of the ,arabs that passed over to the ,western ,europeans with ,arabian commentaries on philosophy and science1 and brought so many similar discussions in the scholastic period4 ,these trivialities have usually been supposed to originate with the scholastics themselves1 for they are not to be found in the ,greek authors on whom the scholastics were writing commentaries1 but they are typically ,oriental in character1 and it must be remembered that during the twelfth and early thirteenth centuries1 at least1 ,greek philosophy found its way largely into ,europe in ,arab versions1 and these characteristically ,arabian additions of the discussion of curious trivial questions came with them and produced an imitative tendency among the ,europeans4 ,as a rule the more careful has been the study of ,arabian writers in the modern time1 particularly by specialists1 the clearer has it become that they lacked nearly all originality4 ,especially were they faulty in their observations2 besides1 they had a definite tendency to replace observation by theory1 a fatal defect in medicine4 ,the fine development of surgery that came at the end of the ,arabian period of medicine in ,europe could never have come from the ,arabs themselves4 ,gurlt has brought this out particularly1 but it will not be difficult to cite many other good authorities in support of this opinion4 ,hyrtl1 in his ,thesis on the ,rarer ,old ,anatomists1#g says that the ,arabs paid very little attention to anatomy1 and1 of course1 because of the prohibition in the ,koran1 added nothing to it4 ,whatever they knew they took from the ,greeks1 and especially ,galen4 ,not only did they not add anything new to this1 but they even lost sight of much that was important in the older authors4 ,the ,arabs were much more interested in physiology2 they could study this by giving thought to it without soiling their hands4 ,they delighted in theory1 rather than in observation4 ,while we thus discuss the lack of originality and the tendency to over-refinement among the ,arabian medical writers1 it must not be thought that we would make little of what they accomplished4 ,they not only preserved the old medical writers for us1 but they kept alive practical medicine with the principles of the great ,greek thinkers as its basis4 ,there are a large number of writers of ,arabian medicine whose names have secured deservedly a high place in medical history4 ,if this were a formal history of ,arabian medicine1 their careers and works would require discussion4 ,for our purpose1 however1 it seems better to confine attention to a few of the most prominent ,arabian writers on medicine1 because they will serve to illustrate how thoroughly practical were the ,arabian physicians and how many medical problems that we are prone to think of as modern they occupied themselves with1 solving them not infrequently nearly as we do in the modern time4 ,,vi ,,the ,,medical ,,school ,,at ,,salerno ,the ,medical ,school at ,salerno1 probably organized early in the tenth century1 often spoken of as the darkest of the centuries1 and reaching its highest point of influence at the end of the twelfth century1 is of great interest in modern times for a number of reasons4 ,first it brought about in the course of its development an organization of medical education1 and an establishment of standards that were to be maintained whenever and wherever there was a true professional spirit down to our own time4 ,they insisted on a preliminary education of three years of college work1 on at least four years of medical training1 on special study for specialist's work1 as in surgery1 and on practical training with a physician or in a hospital before the student was allowed to practise for himself4 ,at ,salerno1 too1 the department of women's diseases was given over to women professors1 and we have the text-books of some of these women medical teachers4 ,the license to practise given to women1 however1 seems to have been general and did not confine them merely to the care of women and children4 ,we have records of a number of these licenses issued to women in the neighborhood of ,salerno4 ,this subject of feminine medical education at ,salerno1 because of its special interest in our time1 will have a chapter by itself4 ,these are the special features of medical education in our own time that we are rather prone to think of as originating with ourselves and as being indices of that evolution of humanity and progress in mankind which are culminating in our era4 ,it is rather interesting1 then1 to study just how these developments came about and what the genesis of this great school was4 ,the books of its professors were widely read1 not only in their own generation but for centuries afterwards4 ,with the invention of printing at the time of the ,renaissance most of them were printed and exerted profound influence over the revival of medicine which took place at that time4 ,salerno became the first of the universities in the modern sense of the word4 ,here there gathered round the medical school1 first a preparatory department representing modern college work1 and then departments of theology and law1 though this latter department particularly was never quite successful4 ,the fact that the first university1 that of ,salerno1 should have been organized round a medical school1 the second1 that of ,bologna1 around a law school1 and the third1 that of ,paris1 around a school of theology and philosophy1 would seem to represent the ordinary natural process of development in human interests4 ,first man is interested in himself and in his health1 then in his property1 and finally in his relations to his fellow-man and to ,god4 ,though much work has been done on the subject in recent years1 it is not easy to trace the origin of the medical school at ,salerno4 ,the difficulty is emphasized by the fact that even the earliest chroniclers whose accounts we have were not sure as to its origin1 and even had some doubt about the age of the school4 ,alphanus1 usually designated ,alphanus ,i because there are several of the name1 who is one of the earliest professors whose name and fame have come down to us1 gives us the only definite detail as to the age of the school4 ,he was a ,benedictine monk1 distinguished as a literary man1 known both as poet and physician1 who was afterwards raised to the ,bishopric of ,salerno4 ,as a bishop he was one of the beneficent patrons1 to whom the school owed much4 ,he lived in the tenth century1 and states that medicine flourished in the town before the time of ,guimarus ,,ii1 who reigned in the ninth century4 ,in the ancient chronicle of ,salerno1 re-discovered by ,de ,renzi and published in his ,collectio ,salernitana1 it is definitely recorded that the medical school was founded by four doctors1--a ,jewish ,rabbi ,elinus1 a ,greek ,pontus1 a ,saracen ,adala1 an ,arab1 and a native of ,salerno1 each of whom lectured in his native language4 ,there are many elements in this tradition1 however1 that would seem to indicate its mythical origin and that it was probably invented after the event to account for the presence of teachers in all these languages and the coming of students from all over the world4 ,the names1 for instance1 are apparently corruptions of real names1 as can be readily recognized4 ,elinus1 the ,jew1 is probably ,elias or ,eliseus1 ,adala is a corruption of ,abdallah1 and ,pontus1 as pointed out by ,puschmann in his ,history of ,medical ,education1 should probably be ,gario-,pontus4 ,while we do not know exactly when the medical school at ,salerno was founded1 we know that a hospital was established there as early as #hbj4 ,it was founded by the ,archdeacon ,adelmus1 and was placed under the control of the ,benedictines after it was realized that a religious order1 by its organization1 was best fitted for carrying on such charitable work continuously4 ,other infirmaries and charitable institutions1 mainly under control of the religious1 sprang up in ,salerno4 ,it was the presence of these hospitals in a salubrious climate that seems first to have attracted the attention of patients and then of physicians from all over ,europe and even adjacent ,africa and ,asia4 ,puschmann says that it is uncertain whether clinical instruction was imparted in these institutions or not1 but the whole tenor of what we know about the practical character of the teaching at ,salerno and of the fine development of professional medicine there1 would seem to argue that probably those who came to study medicine here were brought directly in contact with patients4 ,as early as the ninth century ,salerno was famous for its great physicians4 ,we know the names of at least two physicians1 ,joseph and ,joshua1 who practised there about the middle of the ninth century4 ,ragenifrid1 a ,lombard by his name1 was private physician to ,prince ,wyamar of ,salerno in the year #ijj4 ,the fact that he was from ,north ,italy indicates that already foreigners were being attracted1 but more than this that they were obtaining opportunities unhampered by any ,chauvinism4 ,from early in the tenth century physicians from ,salerno were frequently brought to foreign courts to become the attending physicians to rulers4 ,patients of the highest distinction from all over ,europe began to flock to ,salerno1 and we have the names of many of them4 ,in the tenth century ,bishop ,adalberon1 when ailing1 went there1 though he found no cure for his ills4 ,abbot ,desiderius1 however1 the great ,benedictine scholar of the time1 who afterwards became ,pope ,victor ,,iii1 regained his health at ,salerno under the care of the great ,constantine ,africanus1 who was so much impressed by the gentle kindness and deep learning and the example of the saintly life of his patient that not long after he went to ,monte ,cassino to become a ,benedictine under ,desiderius1 who was abbot there4 ,duke ,guiscard sent his son ,bohemund to ,salerno for the cure of a wound received in battle1 which had refused to heal under the ordinary surgical treatment of the time4 ,william the ,conqueror1 early in the eleventh century and while still only the ,duke of ,normandy1 is said to have passed some time at ,salerno for a similar reason4 ,the most interesting feature of the medical life at ,salerno at this time is the relations between the clergy and the physicians4 ,in the sketch of the life of ,constantine ,africanus1 which follows this chapter1 there is some account of the friendship between ,abbot ,desiderius of ,monte ,cassino and ,constantine ,africanus1 and the latter's withdrawal from his professorship to become a ,benedictine4 ,one of the physicians of the early tenth century who stood high in favor with ,prince ,gisulf was raised to the ,bishopric of ,salerno4 ,this was ,alphanus1 whom we have already mentioned as a chronicler1 a monk1 a poet1 a physician1 and finally the ,bishop of ,salerno4 ,the best proof of how thorough was the medical education at ,salerno and how much influence it exerted even over public opinion is to be found in the regulation of the practice of medicine1 which soon began1 and the insistence upon proper training before permission to practise medicine was granted4 ,the medical school at ,salerno early came to be a recognized institution in the kingdom of the ,two ,sicilies1 representing a definite standard of medical training4 ,it is easy to understand that the attraction which ,salerno possessed for patients soon also brought to the neighborhood a number of irregular physicians1 travelling quacks1 and charlatans4 ,wealthy patients were coming from all over the world to be treated at ,salerno4 ,many of them doubtless were sufferers from incurable diseases and nothing could be done for them4 ,often they would be quite unable to return to their homes and would be surely unwilling to give up all hope if anybody promised them anything of relief4 ,there was a rich field for the irregular1 and of course1 as always1 he came4 ,salerno had already shown what a good standard of medical education should be1 and it is not surprising1 then1 that the legal authorities in this part of the country proceeded to the enforcement of legal regulations demanding the attainment of this standard1 in order that unfit and unworthy physicians might not practise medicine to their own benefit but to the detriment of the patients4 ,accordingly1 as early as the year #aadj1 ,king ,ruggiero 7,roger7 of the ,two ,sicilies promulgated the law3 ,whoever from this time forth desires to practise medicine must present himself before our officials and judges1 and be subject to their decision4 ,anyone audacious enough to neglect this shall be punished by imprisonment and confiscation of goods4 ,this decree has for its object the protection of the subjects of our kingdom from the dangers arising from the ignorance of practitioners4 ,just about a century later the ,emperor ,frederick ,,ii1 the ,hohenstaufen1 in the year #abdj1 extended this law1 emphasized it1 and brought it particularly into connection with the great medical school of the ,two ,sicilies1 of which territory he was the ruler4 ,this law has often been proclaimed as due to his personality rather than to his times1--as representing his very modern spirit and his progressive way of looking at things4 ,there is no doubt that certain personal elements for which he should be given due credit are contained in the law4 ,to understand it properly1 however1 one must know the law of ,king ,roger of the preceding century2 and then it is easy to appreciate that ,frederick's regulation is only such a development of the governmental attitude toward medical practice as might have been expected during the century since ,roger's time4 ,it has sometimes been suggested that this law made by the ,emperor ,frederick1 who was so constantly in bitter opposition to the ,papacy1 was issued in despite of the ,church authorities and represents a policy very different from any which they would have encouraged4 ,the early history of ,salerno1 even briefly as we have given it1 completely contradicts any such idea4 ,the history of medical regulation at the beginning of the next century down at ,montpellier moreover1 where the civil authorities being weak the legal ordering of the practice of medicine was effectively taken up by the ,church1 and the authority for the issuance of licenses to practise was in the hands of the bishops of the neighborhood1 shows clearly that it is not because of any knowledge of the real medical history of the times that such remarks are made1 but from a set purpose to discredit the ,church4 ,the ,emperor ,frederick's law deserves profound respect and consideration because of the place that it holds in the legal regulation of the practice of medicine4 ,anyone who thinks that evolution must have brought us in seven centuries much farther in this matter than were the people of the later ,middle ,ages should read this law attentively4 ,everyone who is interested in medical education should have a copy of it near him1 because it will have a chastening effect in demonstrating not only how little we have done in the modern time rather than how much1 but above all how much of decadence there was during many periods of the interval4 ,the law may be found in the original in ,the ,popes and ,science 7,fordham ,university ,press1 ,n4,y41 #aijh74 ,three years of preliminary university education before the study of medicine might be taken up1 four years of medical studies proper before a degree was given1 a year of practice with a regularly licensed physician before a license to practise could be obtained1 a special course in anatomy if surgery were to be practised2 all this represents an ideal we are striving after at the present time in medical education4 ,besides this1 ,frederick's law also regulates medical fees1 requires gratuitous attendance on the poor for the privilege of practice accorded by the license1 though the general fees are of a thoroughly professional character and represent for each visit of the physician about the amount of daily wage that the ordinary laborer of that time earned4 ,curiously enough1 this same ratio of emolument has maintained itself4 ,this law was also a pure drug law1 regulating the practice of pharmacy1 and the price as well as the purity of drugs1 and the relations of physicians1 druggists1 and the royal drug inspectors whose business it was to see that only proper drugs were prepared and sold4 ,all this is so much more advanced than we could possibly have imagined1 only that the actual documents are in our possession1 that most people refuse to let themselves be persuaded in spite of the law that it could have meant very much4 ,especially as regards medical education are they dubious as to conditions at this time4 ,to them it seems that it can make very little difference how much time was required for medical study or for studies preliminary to medicine1 since there was so little to be learned4 ,the age was ignorant1 men knew but little1 and so very little could be imparted no matter how much time was taken4 ,this is1 ,i fear1 a common impression1 but an utterly false one4 ,the preliminary training that is the undergraduate work at the universities consisted of the ,seven ,liberal ,arts--the trivium and quadrivium1 which embraced logic1 rhetoric1 grammar1 metaphysics1 under which was included not a little of physics1 cosmology in which some biology was studied1 as well as psychology and mathematics1 astronomy1 and music4 ,this was a thoroughly rounded course in intellectual training4 ,no wonder that ,professor ,huxley said in his ,inaugural ,address as ,rector of ,aberdeen1 ,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 does4 ,there is no doubt at all about the value of the undergraduate training1 nor of the scholarship of the men who were turned out under the system1 nor of their ability to concentrate their minds on difficult subjects--a faculty that we strive to cultivate in our time and do not always congratulate ourselves on securing to the degree1 at least1 that we would like4 ,as to the medical teaching1 gidius1 often called ,gilles of ,corbeil1 who was a graduate of ,salerno and afterward became the physician-in-ordinary to ,philip ,augustus1 ,king of ,france1 thought that he could not say too much for the training in medicine that was given at this first of the medical schools4 ,one thing is sure1 the professors were eminently serious1 the work taken up was in many ways thoroughly scientific1 and some of the results of the medical investigations of that early day are interesting even now4 ,the descriptions of diseases that we have from the ,salernitan school are true to nature and are replete with many original observations4 ,puschmann says3 ,the accounts given of intermittent fever1 pneumonia1 phthisis1 psoriasis1 lupus1 which they called the malum mortuum1 of ulcers on the sexual organs1 among which it is easy to recognize chancre1 and of the disturbances of the mental faculties1 especially deserve mention4 ,they seem to have been quite expert in their knowledge of phthisis4 ,in the treatment of it they laid great stress upon the giving up of a strenuous life1 the living a rather easy existence in the open air1 and a suitable diet4 ,when the commencement of consumption was suspected1 the first prescription was a good course of strengthening nourishment for the patient4 ,on the other hand1 they declared that the cases in which diarrhea supervened during consumption soon proved fatal4 ,in general1 with regard to people who were liable to respiratory diseases1 they insisted upon life in an atmosphere of equable temperature4 ,though the custom was almost unheard of in the ,salerno of that time1 and indeed at the present time there is very little heating during the winter in southern ,italy1 they insisted that patients who were liable to pulmonary affections should have their rooms heated4 ,on the other hand1 they suggested the cooling of the air of the sick-room1 as we have noted in the chapter on ,constantine ,africanus1 and ,afflacius recommended the employment of an apparatus from which water trickled continuously in drops to the ground and then evaporated4 ,baths and bleeding were employed according to definite indications and diet was always a special feature4 ,they had a number of drugs and simples1 and the employment of some of them is interesting4 ,iron was prescribed for enlargement of the spleen4 ,the internal use of sea sponge1 in which of course there is a noteworthy proportion of iodine1 was recommended for relief from the symptoms of goitre by reducing its size4 ,iodine has been used so much ever since in this affection1 even down to our own day1 that this employment of one of its compounds is rather striking4 ,massage of the goitre was also recommended1 and this mode of treatment was commonly employed for a number of ailments4 ,probably the best idea that can be obtained in brief space of the achievements of the ,university of ,salerno is to be found in ,pagel's appreciation of ,salerno's place in the history of medicine in his chapters on ,medicine in the ,middle ,ages in ,puschmann's ,handbuch der ,geschichte der ,medizin 7,berlin1 #aijb74 ,he said3 ,if we take up now the accomplishments of the school of ,salerno in the different departments there is one thing that is very remarkable4 ,it is the rich independent productivity with which ,salerno advanced the banners of medical science for hundreds of years almost as the only autochthonous centre of medical influence in the whole ,west4 ,one might almost say that it was like a versprengten ,keim--a displaced embryonic element--which1 as it unfolded1 rescued from destruction the ruined remains of ,greek and ,roman medicine4 ,this productivity of ,salerno1 which may well be compared in quality and quantity with that of the best periods of our science1 and in which no department of medicine was left without some advance1 is one of the striking phenomena of the history of medicine4 ,while positive progress was not made1 there are many noteworthy original observations to be chronicled4 ,it must be acknowledged that pupils and scholars set themselves faithfully to their tasks to further as far as their strength allowed the science and art of healing4 ,in the medical writers of the older period of ,salerno who had not yet been disturbed by ,arabian culture or scholasticism1 we cannot but admire the clear1 charmingly smooth1 light-flowing diction1 the delicate and honest setting forth of cases1 the simplicity of their method of treatment1 which was to a great extent dietetic and expectant1 and while we admire the carefulness and yet the copiousness of their therapy1 we cannot but envy them a certain austerity in their pharmaceutic formulas and an avoidance of medicamental polypragmasia4 ,the work in internal medicine was especially developed4 ,the contributions to it from a theoretic and a literary standpoint1 as well as from practical applications1 found ardent devotees4 ,less than this could scarcely have been expected from the medical school which brought such an uplift of professional dignity and advance in the standards of medical education that are to be noticed in connection with ,salerno4 ,registration1 licensure1 preliminary education1 adequate professional studies1 clinical experience under expert guidance1 even special training for surgical work1 all came in connection with this great medical school4 ,such practical progress in medical education could not have been made but by men who faced the problems of the practice of medicine without self-deception and solved them as far as possible by common-sense1 natural1 and rational methods4 ,it is usually said that at ,salerno surgery occupied an inferior position4 ,it is true that we have less record of it in the earlier years of ,salerno than we would like to see4 ,it was somewhat handicapped by the absence of human dissection4 ,this very important defect was not due to any ,church opposition to anatomy1 as has often been said1 but to the objection that people have to seeing the bodies of their friends or acquaintances used for anatomical purposes4 ,in the comparatively small towns of the ,middle ,ages there were few strangers1 and therefore very seldom were there unclaimed bodies4 ,the difficulty was in the obtaining of dissecting material4 ,we had the same difficulty in this country until about two generations ago1 and the only way that bodies could be obtained regularly was by resurrecting them1 as it was called1 from graveyards4 ,in the absence of human subjects1 anatomy was taught at ,salerno upon the pig4 ,the principal portion of the teaching in anatomy consisted of the demonstration of the organs in the great cavities of the body and their relations1 with some investigations of their form and the presumed functions of the corresponding organs in man4 ,copho's well-known ,anatomy of the ,pig was a text-book written for the students of ,salerno4 ,in spite of its limitations1 it shows the beginnings of rather searching original inquiry and even some observations in pathological anatomy4 ,it is simple and straightforward and does not profess to be other than it is1 though it must be set down as the first reasonably complete contribution to comparative anatomy4 ,when their surgery came to be written down1 however1 it gave abundant evidence of the thoroughness with which this department of medicine had been cultivated by the ,salernitan faculty4 ,we have the text-book of ,roger1 with the commentary of ,rolando1 and then the so-called commentary of the ,four ,masters4 ,these writings were probably made rather for the medical school at ,bologna than that of ,salerno1 though there is no doubt that at least ,roger and ,rolando received their education at ,salerno and embodied in their writings the surgical traditions of that school4 ,while ,i have preferred1 in order to have a connected story of surgical development1 to treat of their contributions to their specialty under the head of the ,great ,surgeons of the ,medieval ,universities1 it seems well to point out here that they must be considered as representing especially the surgical teaching of the older medical school of ,salerno4 ,there are many interesting features of the old teaching that they have embodied in their books4 ,for instance1 at ,salerno both sutures and ligatures were employed in order to prevent bleeding4 ,we are rather accustomed to think of such uses of thread1 and especially the ligature1 as being much later inventions4 ,the fact of the matter is1 however1 that ligatures and sutures were reinvented over and over again and then allowed to go out of use until someone who had no idea of their dangers came to reinvent them once more4#h ,much is often said about the place of ,arabian surgery and medicine at this time1 and the influence that they had over the medical teaching and thinking of the period4 ,to trust many of the shorter histories of medicine the ,arabs must be given credit for more of the medical thought of this time than any other medical writers or thinkers4 ,it is forgotten1 however1 apparently1 that in the southern part of ,italy1 where ,salerno was situated1 ,greek influence never died out4 ,this had been a ,greek colony in the olden time and continued to be known for many centuries after the ,christian era as ,magna ,grcia4 ,greek medicine1 then1 had more influence here than anywhere else4 ,as a matter of fact1 the beginnings of ,salernitan teaching are all ,greek and not at all ,arabian4 ,this is as true in surgery as in medicine4 ,i have quoted ,gurlt in the chapter on ,great ,surgeons of the ,medieval ,universities1 insisting that the ,salernitan school owed nothing at all to ,arabian surgery4 ,salernitan medicine was1 during the twelfth century1 just as free from ,arabian influence4 ,when ,arabian medicine makes itself felt1 as pointed out by ,pagel in his ,geschichte der ,heilkunde im ,mittelalter1#i far from exerting a beneficial influence1 it had a rather unfortunate effect4 ,it led especially to an oversophistication of medicine from the standpoint of drug therapeutics4 ,the ,arabian physicians trusted nature very little4 ,in this they were like our forefathers of medicine one hundred years ago1 of whom ,rush was the typical representative--so history repeats itself4 ,before the introduction of ,arabian medicine the ,salernitan school of medicine was noted for its common-sense methods and its devotion to all the natural modes of healing4 ,it looked quite as much to the prevention of disease as its treatment4 ,diet and air and water were always looked upon as significant therapeutic aids4 ,with the coming of ,arabian influence there began1 says ,pagel1 as the literature of the times shows very well1 that rule of the apothecary in therapeutics which was an unfortunate exaggeration4 ,now all the above-mentioned complicated prescriptions came to be the order of the day4 ,apparently the more complicated a prescription the better4 ,dietetics especially was relegated to the background4 ,salerno1 at the end of the twelfth century1 had already reached its highest point of advance in medicine and was beginning to decline4 ,decadence was evident in so far as all the medical works that we have from that time are either borrowings or imitations from ,arabian medicine with which eventually ,salernitan medical literature became confounded4 ,only a few independent authors are found after this time4 ,this is so very different from what is ordinarily presumed to have been the case and openly proclaimed by many historians of medicine because apparently they would prefer to attribute scientific advance to the ,arabs than to the ,christian scholars of the time1 that it is worth while noting it particularly4 ,salerno was particularly rich in its medical literary products4 ,very often we have not the names of the writers4 ,apparently there is good reason to think that a number of the professors consulted together in writing a book1 and when it was issued it was considered to be a text-book of the ,salernitan school of medicine rather than of any particular professor4 ,this represents a development of co-operation on the part of colleagues in medical teaching that we are likely to think of as reserved for much later times4 ,the most important medical writing that comes to us from ,salerno1 in the sense at least of the work that has had most effect on succeeding generations1 has been most frequently transcribed1 most often translated and committed to memory by many generations of physicians1 is the celebrated ,salernitan medical poem on hygiene4 ,the title of the original ,latin was ,regimen ,sanitatis ,salernitanum4 ,it was probably written about the beginning of the twelfth century4 ,a century or so later it came to be the custom to call medical books after flowers1 and so we had the ,lilium ,medicin and the ,flos ,medicin down at ,montpellier1 and this became the ,flos ,medicin of ,salerno4 ,pagel calls it the quintessence of ,salernitan therapeutics4 ,for many centuries portions at least of this ,latin medical poem were as common in the mouths of physicians all over ,europe as the aphorisms of ,hippocrates or the sayings of ,galen4 ,probably this enables us to understand the great reputation that the ,salernitan school enjoyed and the influence that it wielded better than anything else4 ,the poem is divided into ten principal parts1 containing altogether about #c1ejj lines4 ,the first part on hygiene has #hee lines in eight chapters4 ,the second part on materia medica1 though containing only four chapters1 has also about #hjj lines4 ,anatomy and physiology are crowded into about #bjj lines1 etiology has something over #bjj1 semiotics has about #bej1 pathology has but thirty lines more or less1 and therapeutics about #djj2 nosology has about #fjj more1 and finally there is something about the physician himself1 and an epilogue4 ,as ,latin verses go1 when written for such purposes1 these are not so bad1 though some of them would grate on a literary ear4 ,the whole work makes a rather interesting compendium of medicine1 with therapeutic indications and contra-indications1 and whatever the physician of the medieval period needed to have ready to memory4 ,some of its prescriptions1 both in the sense of formul and of directions to the patient1 have quite a modern air4 ,one very interesting contribution to medical literature that comes to us from ,salerno bears the title1 ,the ,coming of a ,physician to ,his ,patient1 or ,an ,instruction for the ,physician ,himself4 ,we have had a number of such works published in recent years1 but it is a little surprising to have the subject taken up thus early in the history of modern professional life4 ,it is an extremely valuable document1 as demonstrating how practical was the teaching at ,salerno4 ,the work is usually ascribed to ,archimattheas1 and it certainly gives a vivid picture of the medical customs of the time4 ,the instruction for the immediate coming of the physician to his patient runs as follows3 ,when the doctor enters the dwelling of his patient1 he should not appear haughty1 nor covetous1 but should greet with kindly1 modest demeanor those who are present1 and then seating himself near the sick man accept the drink which is offered him 7sic7 and praise in a few words the beauty of the neighborhood1 the situation of the house1 and the well-known generosity of the family1--if it should seem to him suitable to do so4 ,the patient should be put at his ease before the examination begins and the pulse should be felt deliberately and carefully4 ,the fingers should be kept on the pulse at least until the hundredth beat in order to judge its kind and character2 the friends standing round will be all the more impressed because of the delay and the physician's words will be received with just that much more attention4 ,the old physician evidently realized very well how much influence on the patient's mind meant for the course of the disease4 ,for instance1 he recommends that the patient should be asked to confess and receive the sacraments of the ,church before the doctor sees him1 for if mention is afterwards made of this the patient may believe that it is because the doctor thinks that there is no hope for him4 ,for the purpose of producing an effect upon the patient's mind1 the old physician does not hesitate even to suggest the taking advantage of every possible source of information1 so as to seem to know all about the case4 ,on the way to see the sick person he the physician should question the messenger who has summoned him upon the circumstances and the conditions of the illness of the patient2 then1 if not able to make any positive diagnosis after examining the pulse and the urine1 he will at least excite the patient's astonishment by his accurate knowledge of the symptoms of the disease and thus win his confidence4 ,at the end of these preliminary instructions there is a rather diplomatic--to say the least--bit of advice that might perhaps to a puritanic conscience seem more politic than truthful4 ,since the old professor insists so much on not disturbing the patient's mind by a bad prognosis or any hint of it1 and since even some exaggeration of what he might think to be the serious outlook of the case to friends would only lead to greater care of the patient1 there is probably much more justification for his suggestion than might be thought at first glance4 ,he says1 ,when the doctor quits the patient he should promise him that he will get quite well again1 but he should inform his friends that he is very ill2 in this way1 if a cure is affected1 the fame of the doctor will be so much the greater1 but if the patient dies people will say that the doctor had foreseen the fatal issue4 ,the story of the medical school of ,salerno1 even thus briefly and fragmentarily told1 illustrates very well how old is the new in education1--even in medical education4 ,there is scarcely a phase of modern interest in medical education that may not be traced very clearly at ,salerno though the school began its career a thousand years ago1 and ceased to attract much attention over six hundred years ago4 ,we owe most of our knowledge of the details of its organization and teaching to ,de ,renzi4 ,without the devotion of so ardent a scholar it would have been almost impossible for us to have attained so complete a picture of ,salernitan activities4 ,as it is1 as a consequence of his work we are able to see this first of modern medical schools developing very much as do our most modern medical schools4 ,there has been an accumulation of medical information in the thousand years1 but the ways and modes of facing problems and many of the solutions of them do not differ from what they were in the distant past4 ,the more we know about any particular period1 the more is this brought home to us4 ,it is for this that study of particular periods and institutions of the olden time1 as of ,salerno1 grows increasingly interesting1 because each new detail helps to fill in sympathetically the new-old picture of human activity as it may be seen at all times4 ,,vii ,,constantine ,,africanus ,probably the most important representative of the medical school at ,salerno1 certainly the most significant member of its faculty1 if we consider the wide influence for centuries after his time that his writings had1 was ,constantine ,africanus4 ,he is interesting1 too1 for many other reasons1 for he is the first representative1 in modern times1 that is1 who1 after the incentive of antiquity had passed1 devoted himself to creating a medical literature by translations1 by editions1 and by the collation of his own and others' observations on medical subjects4 ,he is the connecting link between ,arabian medicine and ,western medical studies4 ,the fact that he was first a traveller over most of the educational world of his time1 then a professor at the ,university of ,salerno who attracted many students1 and finally a ,benedictine monk in the great abbey at ,monte ,cassino1 shows how his life ran the gamut of the various phases of interest in the intellectual world of his time4 ,it was his retirement to the famous monastery that gave him the opportunity1 the leisure1 the reference library for consultation that a writer feels he must have near him1 and probably also the means necessary for the publication of his works4 ,not only did the monks of ,monte ,cassino itself devote themselves to the copying of his many books1 but other ,benedictine monasteries in various parts of the world made it a point to give wide diffusion to his writings4 ,as a study in successful publication1 that is1 in the securing of wide attention to writings within a short time1 the career of ,constantine and the story of his books would be extremely interesting4 ,medieval distribution of books is usually thought to have been rather halting1 but here was an exception4 ,it was largely because ,benedictines all over the world were deeply interested in what this brother ,benedictine was writing that wide distribution was secured for his work within a very short time4 ,his superiors among the ,benedictines had a profound interest in what he was doing4 ,the great ,benedictine ,abbot ,desiderius of ,monte ,cassino1 who afterwards became ,pope1 used all of his extensive influence in both positions to secure an audience for the books--hence the many manuscript copies of his writings that we have4 ,it is probable that ,constantine established a school of writers at ,monte ,cassino1 for he could scarcely have accomplished so much by himself as has been attributed to him4 ,besides1 his works attracted so much attention that writers of immediately succeeding generations who wanted to secure attention for their works sometimes attributed them to him in order to take advantage of his popularity4 ,it is rather difficult1 then1 to determine with absolute assurance which are ,constantine's genuine works4 ,some of those attributed to him are undoubtedly spurious4 ,what we know with certainty1 however1 is that his authentic works meant much for his own and after generations4 ,constantine was born in the early part of the eleventh century1 and died near its close1 having lived probably well beyond eighty years of age1 his years running nearly parallel with his century4 ,his surname1 ,africanus1 is derived from his having been born in ,africa1 his birthplace being ,carthage4 ,early in life he seems to have taken up with ardor the study of medicine in his native town1 devoting himself1 however1 at the same time to whatever of physical science was available4 ,like many another young man since his time1 not satisfied with the knowledge he could secure at home1 he made distant journeys1 gathering medical and scientific information of all kinds wherever he went4 ,according to a tradition that seems to be well grounded1 some of these journeys took him even into the far ,east4 ,during his travels he became familiar with a number of ,oriental languages1 and especially studied the ,arabian literature of science very diligently4 ,at this time the ,arabs1 having the advantage of more intimate contact with the ,greek medical traditions in ,asia ,minor1 were farther advanced in their knowledge of the medical sciences than the scholars in the ,west4 ,they had better facilities for obtaining the books that were the classics of medicine1 and1 with any desire for knowledge1 could scarcely fail to secure it4 ,what was best in ,arabian medicine was brought to ,salerno by ,constantine and1 above all1 his translation of many well-known ,arabian medical authors proved eminently suggestive to seriously investigating physicians all over the world in his time4 ,before he was to be allowed to settle down to his literary work1 however1 ,constantine was to have a very varied experience4 ,some of this doubtless was to be valuable in enabling him to set the old ,arabian teachers of medicine properly before his generation4 ,after his ,oriental travels he returned to his native ,carthage in order to practise medicine4 ,it was not long1 however1 before his superior medical knowledge1 or1 at least1 the many novelties of medical practice that he had derived from his contact with the ,east1 drew upon him the professional jealousy of his colleagues4 ,it is very probable that the reputation of his extensive travels and wide knowledge soon attracted a large clientele4 ,this was followed quite naturally by the envy at least of his professional brethren4 ,feeling became so bitter1 that even the possibility of serious personal consequences for him because of false accusations was not out of the question4 ,whenever novelties are introduced into medical science or medical practice1 their authors are likely to meet with this opposition on the part of colleagues1 and history is full of examples of it4 ,galvani was laughed at and called the frogs' dancing-master2 ,auenbrugger was made fun of for drumming on people2 ,harvey is said to have lost half of his consulting practice2--all because they were advancing ideas that their contemporaries were not ready to accept4 ,we are rather likely to think that this intolerant attitude of mind belongs to the older times1 but it is rather easy to trace it in our own4 ,in ,constantine's day men had ready to hand a very serious weapon that might be used against innovators4 ,by craftily circulated rumors the populace was brought to accuse him of magical practices1 that is1 of producing his cures by association with the devil4 ,we are rather prone to think little of a generation that could take such nonsense seriously1 but it would not be hard to find analogous false notions prevalent at the present time1 which sometimes make life difficult1 if not dangerous1 for well-meaning individuals4#aj ,life seems to have been made very uncomfortable for ,constantine in ,carthage4 ,just the extent to which persecution went1 however1 we do not know4 ,about this time ,constantine's work attracted the attention of ,duke ,robert of ,salerno4 ,he invited him to become his physician4 ,after he had filled the position for a time a personal friendship developed1 and1 as has often happened to the physicians of kings1 he became a royal counsellor and private secretary4 ,when the post of professor of medicine at ,salerno fell vacant1 it is not surprising1 then1 that ,constantine should have been made professor1 and from here his teaching soon attracted the attention of all the men of his time4 ,constantine seems to have greatly enhanced the reputation of the medical school1 and added to the medical prestige of ,salerno4 ,after teaching for some ten years there1 however1 he gave up his professorship--the highest position in the medical world of the time--apparently with certain plans in mind4 ,he wanted leisure for writing the many things in medicine that he had learned in his travels in the ,east1 so as to pass his precious treasure of knowledge on to succeeding generations2 and then1 too1 he seems to have longed for that peace that would enable him not only to do his writing undisturbed1 but to live his life quietly far away from the strife of men and the strenuous existence of a court and of a great school4 ,there was probably another and more intimate personal reason for his retirement4 ,abbot ,desiderius of the ,benedictine ,abbey of ,monte ,cassino1 not far away1 had become a close and valued friend4 ,before having been made abbot1 ,desiderius and ,constantine probably were fellow professors at ,salerno1 for we know that ,desiderius himself and many of his fellow ,benedictines taught in the undergraduate department there4 ,desiderius enjoyed the reputation of being one of the most learned men of the time when his election to the abbacy at ,monte ,cassino took him away from ,salerno4 ,his departure was a blow to ,constantine1 who had learned by years of friendship that to be near his intimate friend1 the pious scholarly ,benedictine1 was a solace in life and a never failing incentive to his own intellectual work4 ,desiderius seems1 indeed1 to have been a large factor in influencing the great physician to write his books rather than devote himself to oral teaching1 since the circulation of his writing would confer so much more of benefit on a greater number of people4 ,perhaps another element in the situation was that ,desiderius was desirous of having the learned physician1 the travelled scholar1 at ,monte ,cassino1 for the sake of his influence on the scholarship of the abbey1 and for the incentive that he would be to the younger monks to apply themselves to the varied field of knowledge which the ,benedictines had chosen for themselves at this time4 ,whatever hopes of mutual solace and helpfulness and of the joys of intimate close friendship may have been in the minds of these two most learned men of their time1 they were destined to be grievously disappointed4 ,only a few years after ,constantine's entrance into the monastery at ,monte ,cassino ,desiderius was elected ,pope4 ,the humble ,benedictine did not want to take the exalted position1 but it was plainly shown to him that it was his duty1 and that he must not shirk it4 ,accordingly1 under the name of ,pope ,victor ,,iii1 he became one of the great ,popes of the eleventh century4 ,one might think that he could have summoned ,constantine to ,rome1 but perhaps he knew that his friend would prefer the quietude of the cloister1 and then1 too1 probably he wanted to allow him the opportunity to accomplish that writing for which ,constantine and himself had planned when the great physician entered the monastery4 ,all that we know for sure is that some twenty years of ,constantine's life were spent as a monk in ,monte ,cassino1 where he devoted his time mainly to the writing of his books4 ,one bond of union there was4 ,each of the works1 as soon as completed1 was sent off to the ,pope as long as he lived4 ,on the other hand1 though busy with his ,papal duties1 ,pope ,victor constantly stimulated ,constantine1 even from distant ,rome1 to go on with his work4 ,there were messages of brotherly interest and solicitude just as in the old days4 ,the great ,african physician's best known work1 the so-called ,liber ,pantegni1 which is really a translation of the ,khitaab el ,maleki of ,ali ,ben el-,abbas1 is dedicated to ,desiderius4 ,constantine wrote a number of other books1 most of them original1 but it is difficult now to decide just which of those that pass under his name are genuine4 ,many were subsequently attributed to him that are surely not his4 ,these translators of the ,middle ,ages proved to be not only the channels through which information came to their generations1 but they were also incentives to study and investigation4 ,it is when men can get a certain amount of information rather easily that they are tempted to seek further in order to solve the problems that present themselves4 ,there are three great translators whose work meant much for the ,middle ,ages at this time4 ,they were1 besides ,constantine in the eleventh century1 ,gerard of ,cremona1 in the twelfth1 and the ,jewish ,faradj ,ben ,salim1 at ,naples1 in the thirteenth4 ,gerard did in ,spain for the greater ,arabian writers what ,constantine had accomplished for those of lesser import4 ,under the patronage of the ,emperor ,frederick ,barbarossa1 he published translations of ,rhazes1 ,isaac ,judus1 ,serapion1 ,abulcasis1 and ,avicenna4 ,his work was done in ,toledo1 the city in which1 during the twelfth and thirteenth centuries1 so many translators were at work making books for the ,western world4 ,constantine did much more than merely bring out his translations of ,arabian works4 ,he gave a zest to the study of the old masters1 issued editions of certain1 at least1 of the works of ,hippocrates 7,aphorisms7 and ,galen 7,microtechnics71 and1 in general1 called attention to the precious treasure of medical lore that must be used to advantage if men were to teach the rising generation out of the accumulated knowledge of the past4 ,pagel1 in ,puschmann's ,handbook1 does not hesitate to say that a farther merit of ,constantine must be recognized1 inasmuch as that not long after his career the second epoch of the school of ,salerno begins1 marked not only by a wealth of writers and writings on medicine1 but1 above all1 because from this time on the study of ,greek medicine received renewed encouragement through the ,latin versions of the ,arabian literature4 ,we may think as we will of the worth of these works1 but this much is sure1 that in many ways they brought about a broadening and an improvement of ,greek knowledge1 especially from the pharmacopeia standpoint4 ,probably the best evidence that we have for ,constantine's influence on his generation is to be found in what was accomplished by men who acknowledged with pride that he was their master1 and who thought it a mark of distinction to be reckoned as his disciples4 ,among these especially noteworthy is ,johannes ,afflacius1 or ,saracenus 7whose surname of the ,saracen probably means that he1 too1 came from ,africa1 as his master did74 ,he was the author of two treatises on ,fevers and ,urines1 and the so-called ,cures of ,afflacius4 ,some of these cures he directly attributed to ,constantine4 ,then there is a ,bartholomew who wrote a ,practica1 or ,manual of the ,practice of ,medicine1 with the sub-title1 ,introductions to and ,experiments in the ,medical ,practice of ,hippocrates1 ,constantine1 and the ,greek ,physicians4 ,bartholomew represents himself as a disciple of ,constantine4 ,this ,practica of ,bartholomew was one of the most commonly used books of the twelfth and thirteenth centuries throughout ,europe4 ,there are manuscript commentaries and translations1 and abstracts from it not only in the ,latin tongues1 but especially in the ,teutonic languages4 ,pagel refers to manuscripts in ,high and ,low ,dutch1 and even in ,danish4 ,the ,middle ,high ,dutch manuscripts of this ,practica of ,bartholomew come mainly from the thirteenth century1 and have not only a special interest because of their value in the history of philology1 but because they are the main sources of all the later books on drugs which appeared in very large numbers in ,german4 ,they have a very great historico-literary interest1 especially for pharmacology4 ,to ,afflacius we owe a description of a method of reducing fever that is not only ingenious1 but1 in the light of our recently introduced bathing methods for fever1 is a little startling4 ,in his book on ,fevers and ,urines1 ,afflacius suggests that when the patient's fever makes him very restless1 and especially if it is warm weather1 a sort of shower bath should be given to him4 ,he thought that rain water was the best for this purpose1 and he describes its best application as in rainy fashion1 modo pluviali4 ,the water should be allowed to flow down over the patient from a vessel with a number of minute perforations in the bottom4 ,a number of the practical hints for treatment given by ,afflacius have been attributed to ,constantine4 ,constantine's reputation has1 in the opinion of some writers1 been hurt by two features of his published works1 as they have come to us1 that we find it difficult to understand4 ,one of these is that his translations from the ,arabic were made mainly not of the books of the great leaders of ,arabian medicine1 but from certain of the less important writers4 ,the other is that it does not seem always to have been made clear in the manuscripts that have come down to us1 whether these writings were translations or original writings4 ,some have even gone so far as to suggest that ,constantine himself would have been quite willing to receive the credit for these writings4 ,as to the first of these objections1 it may be said that very probably ,constantine1 in his travels1 had come to realize that the books of the great ,arabian physicians1 ,rhazes1 ,abulcasis1 ,avicenna1 and others1 already received so much attention that the best outlook for medicine was to call particular notice to the writings of such lesser lights as ,ali ,abbas1 ,isaac ,judus1 ,abu ,dschafer1 and others of even less note4 ,certainly we cannot but feel that his judgment in the matter must have been directed by reasons that we may not be able to understand at present1 but that must have existed1 for all that we know of the man proves his character as a practical1 far-sighted scholar4 ,besides1 it seems not unlikely that but for his interest in them we would not at the present time possess the translations of these minor ,arabian writers1 and that would be an unfortunate gap in medical history4 ,the other misunderstanding with regard to ,constantine refers to the fact that it is now almost impossible to decide which are his own and which are the writings of others4 ,it has been said that he even tried to palm off some of the writings of others as his own4 ,this seems extremely unlikely1 however1 knowing all that we do about his life2 and the suspicion is founded entirely on manuscripts as we have them at the present time1 about a thousand years after he lived4 ,what mutilations these manuscripts underwent in the course of various copyings is hard now to estimate4 ,monastic copyists might very well have left out ,arabian names1 because they were mainly interested in the fact that they were providing for their readers works that had received the approval of ,constantine1 and the translation of which at least had been made under his direction4 ,it is quite clear that he did not do all the translating himself1 and that he probably must have organized a school of medical translators at ,monte ,cassino4 ,then just how the various works would be looked at is very dubious4 ,undoubtedly many of the translations were done after his death1 or certainly finished after his time1 and at last attributed to him1 because he was the moving spirit and had probably selected the books that should be translated1 and made suggestions with regard to them4 ,for all of his monks he was1 as masters have ever been for disciples1 much more important1 and rightly so1 than those writers to whom he referred them4 ,the whole question of plagiarism in these medieval times1 as ,i have pointed out elsewhere1 is entirely different from that of the present time4 ,now a writer may consciously or unconsciously claim another writing as his own4 ,we have come to a time when men think much of their individual reputations4 ,it was no uncommon thing1 however1 in the ,middle ,ages1 and even later in the ,renaissance1 for a writer to attribute what he had written to some distinguished literary man of the preceding time1 and sign that writer's name to his own work4 ,the idea of the later author was to secure an audience for his thoughts4 ,he seemed to be quite indifferent whether people ever knew just who the writer was1 but he wanted to influence humanity by his writings4 ,he thought much more of this than of any possible reputation that might come to him4 ,of course1 there was no question of money4 ,there never has been any question of money-making whenever the things written have been really worth while4 ,literature that has deeply influenced mankind has never paid4 ,publications that have paid are insignificant works that have touched superficially a whole lot of people4 ,to think of ,constantine as a plagiarist in our modern sense of the word1 as trying to take the credit for someone else's writings1 is to misunderstand entirely the times in which he lived1 and to ignore the real problem of plagiarism at that time4 ,with the accumulation of information with regard to the history of medicine in his time1 ,constantine's reputation has been constantly enhanced4 ,it is not so long since he was considered scarcely more than a monkish chronicler1 who happened to have taken medicine rather than history for his field of work4 ,gradually we have come to appreciate all that he did for the medicine of his time4 ,undoubtedly his extensive travels1 his wide knowledge1 and then his years of effort to make ,oriental medicine available for the ,western civilization that was springing up again among the peoples who had come to replace the ,romans1 set him among the great intellectual forces of the ,middle ,ages4 ,salerno owed much to him1 and it must not be forgotten that ,salerno was the first university of modern times1 and1 above all1 the first medical school that raised the dignity of the medical profession1 established standards of medical education1 educated the public mind and the rulers of the time to the realization of the necessity for the regulation of the practice of medicine1 and in many ways anticipated our modern professional life4 ,that the better part of his life work should have been done as a ,benedictine only serves to emphasize the place that the religious had in the preservation and the development of culture and of education during the ,middle ,ages4 ,,viii ,,medieval ,,women ,,physicians ,very probably the most interesting chapter for us of the modern time in the history of the medical school at ,salerno is to be found in the opportunities provided for the medical education of women and the surrender to them of a whole department in the medical school1 that of ,women's ,diseases4 ,while it is probable that ,salerno did not owe its origin to the ,benedictines1 and it is even possible that there was some medical teaching there for all the centuries of the ,middle ,ages from the ,greek times1 for it must not be forgotten that this part of ,italy was settled by ,greeks1 and was often called ,magna ,grcia1 there is no doubt at all that the ,benedictines exercised great influence in the counsels of the school1 and that many of the teachers were ,benedictines1 as were also the ,archbishops1 who were its best patrons1 and the great ,pope ,victor ,,iii1 who did much for it4 ,for several centuries the ,benedictines represented the most potent influence at ,salerno4 ,for most people who are not intimately familiar with monastic life1 and1 above all1 with the story of the ,benedictines1 their prestige at ,salerno might seem to be enough of itself to preclude all possibility of the education of women in medicine at ,salerno4 ,for those who know the ,benedictines well1 however1 such a departure as the accordance of opportunities for women to study medicine would seem eminently in keeping with the practical wisdom of their rules and the development of their work4 ,from the beginning the ,benedictines recognized that a monastic career should be open to women as well as to men1 and ,benedict's sister1 ,scholastica1 established convents for them1 as her brother did the ,benedictine monasteries1 thus providing a vocation for women who did not feel called upon to marry4 ,that the members of the order should recognize the advisability of affording women the opportunity to study medicine1 and of handing over to them the department of women's diseases in a medical school in which they had a considerable amount of authority1 seems1 then1 indeed1 only what might have been expected of them4 ,we are prone in the modern time to think that our generation is the first to offer to women any facilities or opportunities for education in medicine4 ,we are prone1 however1 just in the same way1 to consider that a number of things that we are doing are now being done for the first time4 ,as a matter of fact1 it is extremely difficult to find any important movement or occupation that is not merely a repetition of a previous interest of mankind4 ,the whole question of feminine education we are apt to think of as modern1 forgetting that ,plato insisted in his ,republic1 as absolutely as any modern feminist1 that women should have the same opportunities for education as men1 and that at ,rome1 at the end of the ,republic and the beginning of the ,empire1 the women occupied very much the same position in social life as our own at the present time4 ,their husbands supplied the funds1 and they patronized the artists1 gave receptions to the poets1 lionized the musicians1 and1 in general1 went after culture in a way that is a startling reminder of what we are familiar with in our own time4 ,just as soon as ,christianity began to influence education1 women were given abundant opportunities for higher education in all forms4 ,in ,ireland1 the first nation completely converted to ,christianity1--where1 therefore1 the national policy in education could be shaped by the ,church without hindrance1--,st4 ,brigid's school at ,kildare was scarcely less famous than ,st4 ,patrick's at ,armagh4 ,it had several thousand students1 and1 to a certain extent at least1 co-education existed4 ,in ,charlemagne's time1 with the revival of education on the ,continent1 the women of the ,imperial ,court attended the ,palace ,school1 as well as the men4 ,in the thirteenth century we find women professors in every branch at ,italian universities4 ,some of them were at least assistants in anatomy4 ,the ,renaissance women were1 of course1 profoundly educated4 ,in a word1 we have many phases of feminine education1 though with intervals of absolutely negative interest1 down the centuries4 ,there had evidently been quite a considerable amount of opportunity1 if not of actual encouragement1 for women in medicine1 both among the ,greeks and the ,romans1 in the early centuries of the ,christian era4 ,galen1 for instance1 quotes certain prescriptions from women physicians4 ,one ,cleopatra is said to have written a book on cosmetics4 ,this name came afterwards to be confounded with that of ,queen ,cleopatra1 giving new prestige to the book1 but neither ,galen nor ,atius1 the early ,christian physician1 both of whom quote from her work1 speak of her as anything except a medical writer4 ,some monuments to women physicians from these old times have escaped the tooth of time4 ,there was the tomb of one ,basila1 and also of a ,thecla1 both of whom are said to have been physicians4 ,two other names of ,greek women physicians we have1 ,origenia and ,aspasia1 the former mentioned by ,galen1 the latter by ,atius in his ,tetrabiblion4 ,daremberg1 the medical historian1 announced in #ahea that he had found a ,greek manuscript with the title1 ,on ,women's ,diseases1 written by one ,metrodora1 a woman physician4 ,he promised to publish it4 ,it was unpublished at the time of his death1 but could not be found among his papers4 ,there is a manuscript on medical subjects1 bearing this name1 mentioned in the catalogue of the ,greek ,codices of the ,laurentian ,library at ,florence1 but this is said to give no indication of the time when its author lived4 ,we have evidence enough1 however1 to show that ,greek women physicians were not very rare4 ,the ,romans imitated the ,greeks so faithfully--one might almost say copied them so closely--that it is not surprising to find a number of ,roman women physicians4 ,the first mention of them comes from ,scribonius ,largus1 in the first century after ,christ4 ,octavius ,horatianus1 whom most of us know better as ,priscian1 dedicated one of his books on medicine to a woman physician named ,victoria4 ,the dedication leaves no doubt that she was a woman in active practice1 at least in women's diseases1 and it is a book on this subject that ,priscian dedicates to her4 ,he mentions another woman physician1 ,leoparda4 ,the word medica for a woman physician was very commonly used at ,rome4 ,martial1 whose epigrams have been a source of so much information in medical history1 especially on subjects with regard to which information was scanty1 mentions a medica in an epigram4 ,apuleius also uses the word4 ,there are a number of inscriptions in which women physicians are mentioned4 ,among the ,christians we find women physicians1 and ,theodosia1 the mother of ,st4 ,procopius1 the martyr1 is said to have been very successful in the practice of both medicine and surgery4 ,she is numbered among the martyrs1 and occurs in the ,roman ,martyrology on the #bith of ,may4 ,father ,bzowski1 the ,polish ,jesuit1 who compiled ,nomenclatura ,sanctorum ,professione ,medicorum 7,rome1 #afba2 the book is usually catalogued under the ,latin form of his name1 ,bzovius71 has among his list of saints who were physicians by profession a woman1 ,st4 ,nicerata1 who lived at ,constantinople in the reign of the ,emperor ,arcadius1 and who is said to have cured ,st4 ,john ,chrysostom of a serious disease4 ,the organization of the department of women's diseases at ,salerno1 under the care of women professors1 and the granting of licenses to women to practise medicine1 is not so surprising in the light of this tradition among ,greeks and ,romans1 taken up with some enthusiasm by the ,christians4 ,we are not sure just when this development took place4 ,the first definite evidence with regard to it comes in the life of ,trotula1 who seems to have been the head of the department4 ,some of her books are well known1 and often quoted from1 and she contributed to a symposium on the treatment of disease1 in which there are contributions1 also1 from men professors of ,salerno at the time4 ,she seems to have flourished about the middle of the eleventh century4 ,ordericus ,vitalis1 a monk of ,utica1 who wrote an ecclesiastical history1 tells of one ,rudolph ,malcorona1 who1 in #ajei1 came to ,utica and remained there for a long time with ,father ,robert1 his nephew4 ,this ,rudolph had been a student all his life1 devoting himself with great zeal to letters1 and had become famous for his visits to the schools of ,france and ,italy1 in order to gather there the secrets of learning4 ,as a consequence he was well informed not only in grammar and dialectics1 but also in astronomy and in music4 ,he also possessed such an extensive knowledge of the natural sciences that in the town of ,salerno1 where1 since ancient times1 the best schools of medicine had existed1 there was no one to equal him with the exception of a very wise matron4 ,this wise matron has been identified with ,trotula1 many of the details of whose life have been brought to light by ,de ,renzi1 in his ,story of the ,school of ,salerno4#aa ,according to very old tradition1 ,trotula belonged to the family of ,ruggiero4 ,this was a noble family of ,salerno1 many of the members of which were distinguished in their native town at least1 but the name is not unusual in ,italy1 as readers of ,dante and ,boccaccio are likely to know4 ,it was1 indeed1 as common as our own ,rogers1 of which it is the ,italian equivalent4 ,de ,renzi has made out a rather good case for the tradition that ,trotula was the wife of ,john ,platearius ,i--so called because there were probably three professors of that name4 ,trotula was1 according to this1 the mother of the second ,platearius1 and the grandmother of the third1 all of them distinguished members of the faculty at ,salerno4 ,her reputation extended far beyond her native town1 and even ,italy itself1 and1 in later centuries1 her name was used to dignify any form of treatment for women's diseases that was being exploited4 ,rutebeuf1 one of the trouvres1 thirteenth-century ,french poets1 has a description of the scene in which one of the old herbalist doctors who used to go round and collect a crowd by means of songs and music1 and then talk medicine to them--just as is done even yet in many of the smaller towns of this country--is represented as saying to the crowd when he wants to make them realize that he is no ordinary quacksalver1 that he is one of the disciples of the great ,madame ,trot of ,salerno4 ,the old-fashioned speech runs somewhat as follows3 ,charming people3 ,i am not one of these poor preachers1 nor the poor herbalists1 who carry little boxes and sachets1 and who spread out before them a carpet4 ,i am the disciple of a great lady1 who bears the name of ,madame ,trot of ,salerno4 ,and ,i would have you know that she is the wisest woman in all the four quarters of the world4 ,two books are attributed to ,trotula2 one bears the title1 ,de ,passionibus ,mulierum1 and the other has been called ,trotula ,minor1 or ,summula ,secundum ,trotulam1 and is a compendium of what she wrote4 ,this is probably due to some disciple1 but seems to have existed almost in her own time4 ,her most important work bears two sub-titles1 ,trotula's ,unique ,book for the ,curing of ,diseases of ,women1 ,before1 ,during1 and ,after ,labor1 and the other sub-title1 ,trotula's ,wonderful ,book of ,experience 7experimentalis7 in the ,diseases of ,women1 ,before1 ,during1 and ,after ,labor1 with ,other ,details ,likewise ,relating to ,labor4 ,the book begins with a prologue on the nature of man and of woman1 and an explanation of how the author1 taking pity on the sufferings of women1 came to devote herself to the study of their diseases4 ,there are many interesting details in the book1 all the more interesting because in many ways they anticipate modern solutions of difficult problems in women's diseases1 and the care of the mother and child before1 during1 and after labor4 ,for instance1 there are a series of rules on the choice of the nurse1 and on the diet and the rgime which she should follow if the child is to be properly nourished without disturbance4 ,probably the most striking passage in her book is that with regard to a torn perineum and its repair4 ,this passage may be found in ,de ,renzi or in ,gurlt4 ,it runs as follows3 ,certain patients1 from the severity of the labor1 run into a rupture of the genitalia4 ,in some even the vulva and anus become one foramen1 having the same course4 ,as a consequence1 prolapse of the uterus occurs1 and it becomes indurated4 ,in order to relieve this condition1 we apply to the uterus warm wine in which butter has been boiled1 and these fomentations are continued until the uterus becomes soft1 and then it is gently replaced4 ,after this the tear between the anus and vulva we sew in three or four places with silk thread4 ,the woman should then be placed in bed1 with the feet elevated1 and must retain that position1 even for eating and drinking1 and all the necessities of life1 for eight or nine days4 ,during this time1 also1 there must be no bathing1 and care must be taken to avoid everything that might cause coughing1 and all indigestible materials4 ,there is a passage1 also1 almost more interesting with regard to prophylaxis of rupture of the perineum4 ,she says1 ,in order to avoid the aforesaid danger1 careful provision should be made1 and precautions should be taken during labor somewhat as follows3 ,a cloth should be folded in somewhat oblong shape1 and placed on the anus1 so that1 during every effort for the expulsion of the child1 that should be pressed firmly1 in order that there may not be any solution of the continuity of tissue4 ,her book contains1 also1 some directions for various cosmetics4 ,how many of these are original1 however1 is difficult to say4 ,trotula's name had become a word to conjure with1 and many a quack in the after time tried to make capital for his remedies in this line by attributing them to ,trotula4 ,as a consequence1 many of these remedies gradually found their way into the manuscript copies of her book1 and subsequent copyists incorporated them into the text1 until it became practically impossible to determine which were original4 ,there are manuscripts of ,trotula's work in ,florence1 ,vienna1 and ,breslau4 ,some of these contain chapters not in the others1 undoubtedly added by subsequent hands4 ,in one of these1 that at ,florence1 from which the edition of ,strasburg was printed in #aedd1 and of ,venice1 #aedg1 one of the ,aldine issues1 there is a mention in the last chapter of spectacles4 ,we have no record of these until the end of the thirteenth century1 when this passage was probably added4 ,it was also printed at ,basle1 #aeff1 and at ,leipzig as late as #aggh1 which would serve to show how much attention it has attracted even in comparatively recent times4 ,after ,trotula we have a number of women physicians of ,salerno whose names have come down to us4 ,the best known of these bear the names ,constanza1 ,calendula1 ,abella1 ,mercuriade1 ,rebecca ,guarna1 who belonged to the old ,salernitan family of that name1 a member of which1 in the twelfth century1 was ,romuald1 priest1 physician1 and historian1 ,louise ,trencapilli1 and others4 ,the titles of some of their books1 as those of ,mercuriade1 who occupied herself with surgery as well as medicine1 and who is said to have written on ,crises1 on ,pestilent ,fever1 on ,the ,cure of ,wounds1 and of ,abella1 who acquired a great reputation with her work on ,black ,bile1 and on the ,nature of ,seminal ,fluid1 have come down to us4 ,rebecca ,guarna wrote on ,fevers1 on the ,urine1 and on the ,embryo4 ,the school of ,salernitan women came to have a definite place in medical literature4 ,while1 as teachers1 they had charge of the department of women's diseases1 their writings would seem to indicate that they studied all branches of medicine4 ,besides1 there are a number of licenses preserved in the archives of ,naples in which women are accorded the privilege of practising medicine4 ,apparently these licenses were without limitation4 ,in many of these mention is made of the fact that it seems especially fitting that women should be allowed to practise in women's diseases1 since they are by constitution likely to know more and to have more sympathy with feminine ills4 ,the formula employed as the preamble of this license ran as follows3 ,since1 then1 the law permits women to exercise the profession of physicians1 and since1 besides1 due regard being had to purity of morals1 women are better suited for the treatment of women's diseases1 after having received the oath of fidelity1 we permit1 etc4 ,salerno continued to enjoy a reputation for training women physicians thoroughly1 until well on in the fifteenth century1 for we have the record of ,constance ,calenda1 the daughter of ,salvator ,calenda1 who had been dean of the faculty of medicine at ,salerno about #adae1 and afterwards dean of the faculty at ,naples4 ,his daughter1 under the diligent instruction of her father1 seems to have obtained special honors for her medical examination4 ,not long after this1 ,salerno itself lost all the prestige that it had4 ,the ,kings of ,naples endeavored to create a great university in their city in the thirteenth century4 ,they did not succeed to the extent that they hoped1 but the neighboring rival institution hurt ,salerno very much1 and its downfall may be traced from this time4 ,gradually its reputation waned1 and we have practically no medical writer of distinction there at the end of the fourteenth century1 though the old custom of opportunities for women students of medicine was maintained4 ,this custom seems also to have been transferred to ,naples1 and licenses to practise were issued to woman graduates of ,naples4 ,this never achieved anything like the reputation in this department that had been attained at ,salerno4 ,salerno influenced ,bologna and the north ,italian universities profoundly in all branches of medicine and medical education1 particularly in surgery1 as can be seen in the chapter on ,great ,surgeons of the ,medieval ,universities1 and the practice of allowing such women as wished to study medicine to enter the university medical schools is exemplified in the case of ,mondino's assistant in anatomy1 ,alessandra ,giliani1 though there are also others whose names have come down to us4 ,the ,university of ,salerno had developed round a medical school4 ,it was the first of the universities1 and1 in connection with its medical school1 feminine education obtained a strong foothold4 ,it is not surprising1 then1 that with the further development of universities in ,italy1 feminine education came to be the rule4 ,this rule has maintained itself all down the centuries in ,italy1 so that there has not been a single century since the twelfth in which there have not been one or more distinguished women teachers at the ,italian universities4 ,university life gradually spread westward1 and ,paris came into existence as an organized institution of learning after ,bologna1 and1 doubtless1 with some of the traditions of ,salerno in the minds of its founders4 ,feminine education1 however1 did not spread to the ,west4 ,this is a little bit difficult to understand1 considering the reverence that the ,teutonic peoples have always had for their women folk and the privileges accorded them4 ,a single unfortunate incident1 that of ,ablard and ,hlose1 seems to have been sufficient to discourage efforts in the direction of opportunities for feminine education in connection with the ,western universities4 ,perhaps1 in the less sophisticated countries of the ,north and ,west of ,europe1 women did not so ardently desire educational opportunities as in ,italy1 for whenever they have really wanted them1 as1 indeed1 anything else1 they have always obtained them4 ,in spite of the absence of formal opportunities for feminine education in medicine at the ,western universities1 a certain amount of scientific knowledge of diseases1 as well as valuable practical training in the care of the ailing1 was not wanting for women outside of ,italy4 ,the medical knowledge of the women of northern ,france and ,germany and ,england1 however1 though it did not receive the stamp of a formal degree from the university and the distinction of a license to practise1 was none the less thorough and extensive4 ,it came in connection with certain offices in their own communities1 held by members of religious orders4 ,genuine information with regard to what the religious were doing during the ,middle ,ages was so much obscured by the tradition of laziness and immorality1 created at the time of the so-called reformation in order to justify the confiscation of their property by those whose one object was to enrich themselves1 that we have only come to know the reality of their life and accomplishments in comparatively recent years4 ,we now know that1 besides being the home of most of the book knowledge of the earlier ,middle ,ages1 the monasteries were the constant patrons of such practical subjects as architecture1 agriculture in all its phases1 especially irrigation1 draining1 and the improvement of land and crops2 of art1 and even what we now know as physical science4 ,above all1 they preserved for us the old medical books and carried on medical traditions of practice4 ,the greatest surprise has been to find that this was true not only for the monks1 but also for the nuns4 ,one of the most important books on medicine that has come to us from the twelfth century is that of a ,benedictine abbess1 since known as ,st4 ,hildegarde1 whose life was spent in the ,rhineland4 ,her works serve to show very well that in the convents of the tenth1 eleventh1 and twelfth centuries there was much more of interest in things intellectual than we have had any idea of until recent years1 and that1 indeed1 one of the important occupations of convent life was the serious study of books of all kinds1 some of them even scientific1 as well as the writing of works in all departments4 ,the century before ,st4 ,hildegarde there is the record of ,hroswitha1 who wrote a series of dramas in imitation of ,terence1 that were meant to replace1 for the monks and nuns of that period1 the reading of that rather too human author4 ,hroswitha1 like ,hildegarde1 was a ,german1 and we have the record1 also1 of another religious writer1 abbess of the ,odilian ,cloister1 at ,hohenberg1 who wrote a book called ,hortus ,deliciarum1 the ,garden of ,delights1 a book of information on many subjects not unlike our popular encyclopedias of the modern time1 the title of which shows that the place of information in life was considered to be the giving of pleasure4 ,while this work deals mainly with ,biblical and theological and mystical questions1 there are many purely scientific passages and many subjects of strictly medical interest treated4 ,the life of the ,abbess ,hildegarde is worthy of consideration1 because it illustrates the period and makes it very clear that1 in spite of the grievous misunderstanding of their life and work1 so common in the modern time1 these old-time religious had most of the interests of the modern time1 and pursued them with even more than modern zeal and success1 very often4 ,her career illustrates very well what the foundation of the ,benedictines had done for women4 ,when ,st4 ,benedict founded his order for men1 his sister1 ,scholastica1 wanted to do a similar work for women4 ,we know that the ,benedictine monks saved the old classics for us1 kept burning the light of the intellectual life1 and gave a refuge to men who wanted to devote themselves in leisure and peace to the things of the spirit1 whether of this world or the other4 ,we have known much less of the ,benedictine nuns until now the study of their books shows that they provided exactly the same opportunities for women and furnished a vocation1 a home1 an occupation of mind1 and a satisfaction of spirit for the women who1 in every generation1 do not feel themselves called to be wives and mothers1 but who want to live their lives for others rather than for themselves and their kin1 seeking such development of mind and of spirit as may come with the leisure and peace of celibacy4 ,hildegarde was born of noble parents at ,bckelheim1 in the county of ,sponheim1 about the end of the eleventh century 7probably #ajih74 ,in her eighth year she went for her education to the ,benedictine cloister of ,disibodenberg4 ,when her education was finished1 she entered the cloister1 of which1 at the age of about fifty1 she became abbess4 ,her writings1 reputation for sanctity1 and her wise saintly rule attracted so many new members to the community that the convent became overcrowded4 ,accordingly1 with eighteen of her nuns1 ,hildegarde withdrew to a new convent at ,rupertsberg1 which ,english and ,american travellers will remember because it is not far from ,bingen on the ,rhine4 ,here she came to be a centre of attraction for most of the world of her time4 ,she was in active correspondence with nearly every important man of her generation4 ,she was an intimate friend of ,bernard of ,clairvaux1 who was himself1 perhaps1 the most influential man in ,europe in this century4 ,she was in correspondence with four ,popes1 and with the ,emperors ,conrad and ,frederick ,i1 and with many distinguished archbishops1 abbots1 and abbesses1 and teachers and teaching bodies of various kinds4 ,these correspondences were usually begun by her correspondents1 who consulted her because her advice in difficult problems was considered so valuable4 ,in spite of all this time-taking correspondence1 she found leisure to write a series of books1 most of them on mystical subjects1 but two of them on medical subjects4 ,the first is called ,liber ,simplicis ,medicin1 and the second ,liber ,composit ,medicin4 ,these books were written in order to provide information mainly for the nuns who had charge of the infirmaries of the monasteries of the ,benedictines4 ,almost constantly someone in the large communities1 which always contained aged religious1 was ailing1 and then1 besides1 there were other calls on the time and the skill of the sister infirmarians4 ,there were no hotels at that time1 and no hospitals1 except in the large cities4 ,there were always guest houses in connection with monasteries and convents1 in which travellers were permitted to pass the night1 and given what they needed to eat4 ,there are many people who have had experiences of monastic hospitality even in our own time4 ,sometimes travellers fell ill4 ,not infrequently the reason for travelling was to find health in some distant and fabulously health-giving resort1 or at the hands of some wonder-working physician4 ,such high hopes are nearly always set at a distance4 ,this of itself must have given not a little additional need for knowledge of medicine to the infirmarians of convents and monasteries4 ,there were around many of the monasteries1 moreover1 large estates2 often they had been cleared and made valuable by the work of preceding generations of monks1 and on these estates peasants came to live4 ,workingmen and workingwomen from neighboring districts came to help at harvest time1 and1 after a chance meeting1 were married and settled down on a little plot of ground provided for them near the monastery4 ,as these communities grew up1 they looked to the monasteries and convents for aid of all kinds1 and turned to them particularly in times of illness4 ,the need for definite instruction in medicine on the part of a great many of the monks and nuns can be readily understood1 and it was this need that ,hildegarde tried to meet in her books4 ,the first of her books that we have mentioned1 the ,liber ,simplicis ,medicin1 attracted attention rather early in the ,renaissance1 and was deemed worthy of print4 ,it was edited at the beginning of the sixteenth century by ,dr4 ,schott at ,strasburg1 under the title1 ,physica ,s4 ,hildegardis4 ,another manuscript of this part was found in the library of ,wolfenbuttel1 in #aheh1 by ,dr4 ,jessen4 ,this gave him an interest in ,hildegarde's contributions to medicine1 and1 in #ahei1 he noted in the library at ,copenhagen a manuscript with the title ,hildegardi ,cur et ,caus4 ,on examination1 he was sure that it was the ,liber ,composit ,medicin of the saint4 ,the first work consists of nine books1 treating of plants1 elements1 trees1 stones1 fishes1 birds1 quadrupeds1 reptiles1 and metals1 and is printed in ,migne's ,patrologia1 under the title ,subtilitatum ,diversarum ,naturarum ,libri ,novem4 ,the second1 in five books1 treats of the general diseases of created things1 of the human body and its ailments1 of the causes1 symptoms1 and treatment of diseases4 ,it would be very easy to think that these are small volumes and that they contain very little4 ,we are so apt to think of old-fashioned so-called books as scarcely more than chapters1 that it may be interesting to give some idea of the contents and extent of the first of these works4 ,the first book on ,plants has #bcj chapters1 the second on the ,elements has #ac chapters1 the third on ,trees has #cf chapters1 the fourth on various kinds of ,minerals1 including precious stones1 has #bbf chapters1 the fifth on ,fishes has #cf chapters1 the sixth on ,birds has #fh chapters1 the seventh on ,quadrupeds has #dc chapters1 the eighth on ,reptiles has #ah chapters1 the ninth on ,metals has #h chapters4 ,each chapter begins with a description of the species in question1 and then defines its value for man and its therapeutic significance4 ,modern scientists have not hesitated to declare that the descriptions abound in observations worthy of a scientific inquiring spirit4 ,we are1 of course1 not absolutely sure that all the contents of the books come from ,hildegarde4 ,subsequent students often made notes in these manuscript books1 and then other copyists copied these into the texts4 ,unfortunately we have not a number of codices to collate and correct such errors4 ,most of what ,hildegarde wrote comes to us in a single copy1 of none are there more than four copies1 showing how near we came to missing all knowledge of her entirely4 ,dr4 ,melanie ,lipinska1 in her ,histoire des ,femmes ,mdecins1 a thesis presented for the doctorate in medicine at the ,university of ,paris in #aijj1 subsequently awarded a special prize by the ,french ,academy1 reviews ,hildegarde's work critically from the medical standpoint4 ,she says that the saint distinguishes a double mode of action of different substances1 one chemical1 the other physical1 or what we would very probably call magnetic4 ,she discusses all the ailments of the various organs1 the brain1 the eyes1 the teeth1 the heart1 the spleen1 the stomach1 the liver4 ,she has special chapters on redness and paleness of the face1 on asthma1 on cough1 on fetid breath1 on bilious indigestion1 on gout4 ,besides1 she has other chapters on nervous affections1 on icterus1 on fevers1 on intestinal worms1 on infections due to swamp exhalations1 on dysentery1 and a number of forms of pulmonary diseases4 ,nearly all of our methods of diagnosis are to be found1 hinted at at least1 in her book4 ,she discusses the redness of the blood as a sign of health1 the characteristics of various excrementitious material as signs of disease1 the degrees of fever1 and the changes in the pulse4 ,of course1 it was changes in the humors of the body that constituted the main causes for disease in her opinion1 but it is well to remind ourselves that our frequent discussion of auto-intoxication in recent years is a distinct return to this4 ,some of ,hildegarde's anticipations of modern ideas are1 indeed1 surprising enough4 ,for instance1 in talking about the stars and describing their course through the firmament1 she makes use of a comparison that is rather startling4 ,she says3 ,just as the blood moves in the veins which causes them to vibrate and pulsate1 so the stars move in the firmament and send out sparks as it were of light like the vibrations of the veins4 ,this is1 of course1 not an anticipation of the discovery of the circulation of the blood1 but it shows how close were men's ideas to some such thought five centuries before ,harvey's discovery4 ,for ,hildegarde the brain was the regulator of all the vital qualities1 the centre of life4 ,she connects the nerves in their passage from the brain and the spinal cord through the body with manifestations of life4 ,she has a series of chapters with regard to psychology normal and morbid4 ,she talks about frenzy1 insanity1 despair1 dread1 obsession1 anger1 idiocy1 and innocency4 ,she says very strongly in one place that when headache and migraine and vertigo attack a patient simultaneously they render a man foolish and upset his reason4 ,this makes many people think that he is possessed of a demon1 but that is not true4 ,these are the exact words of the saint as quoted in ,mlle4 ,lipinska's thesis4 ,it is no wonder that ,mlle4 ,lipinska thinks ,st4 ,hildegarde the most important medical writer of her time4 ,reuss1 the editor of the edition of ,hildegarde published in ,migne's ,patrology1 says3 ,among all the saintly religious who have practised medicine or written about it in the ,middle ,ages1 the most important is without any doubt ,st4 ,hildegarde4444 ,with regard to her book he says3 ,all those who wish to write the history of the medical and natural sciences must read this work in which this religious woman1 evidently well grounded in all that was known at that time in the secrets of nature1 discusses and examines carefully all the knowledge of the time4 ,he adds1 ,it is certain that ,st4 ,hildegarde knew many things that were unknown to the physicians of her time4 ,when such books were read and widely copied1 it shows that there was an interest in practical and scientific medicine among women in ,germany much greater than is usually thought to have existed at this time4 ,such writers1 though geniuses1 and standing above their contemporaries1 usually represent the spirit of their times and make it clear that definite knowledge of things medical was considered of value4 ,the convents and monasteries of this time are often thought of by those who know least about them as little interested in anything except their own ease and certain superstitious practices4 ,as a matter of fact1 they cared for their estates1 and especially for the peasantry on them1 they provided lodging and food for travellers1 they took care of the ailing of their neighborhood1 and1 besides1 occupied themselves with many phases of the intellectual life4 ,it was a well-known tradition that country people who lived in the neighborhood of convents and monasteries1 and especially those who had monks and nuns for their landlords1 were much happier and were much better taken care of than the tenantry of other estates4 ,for this a cultivation of medical knowledge was necessary in certain1 at least1 of the members of the religious orders1 and such books as ,hildegarde's are the evidence that not only the knowledge existed1 but that it was collected and written down1 and widely disseminated4 ,nicaise1 in the introduction to his edition of ,guy de ,chauliac's ,grande ,chirurgie1 reviews briefly the history of women in medicine1 and concludes3 ,women continued to practise medicine in ,italy for centuries1 and the names of some who attained great renown have been preserved for us4 ,their works are still quoted from in the fifteenth century4 ,there was none of them in ,france who became distinguished1 but women could practise medicine in certain towns at least on condition of passing an examination before regularly appointed masters4 ,an edict of #acaa1 at the same time that it interdicts unauthorized women from practising surgery1 recognizes their right to practise the art if they have undergone an examination before the regularly appointed master surgeons of the corporation of ,paris4 ,an edict of ,king ,john1 ,april1 #aceb1 contains the same expressions as the previous edict4 ,du ,bouley1 in his ',history of the ,university of ,paris1' gives another edict by the same ,king1 also published in the year #aceb1 as a result of the complaints of the faculties at ,paris1 in which there is also question of women physicians4 ,this responded to the petition3 ',having heard the petition of the ,dean and the ,masters of the ,faculty of ,medicine at the ,university of ,paris1 who declare that there are very many of both sexes1 some of the women with legal title to practise and some of them merely old pretenders to a knowledge of medicine1 who come to ,paris in order to practise1 be it enacted1' etc4 7,the edict then proceeds to repeat the terms of previous legislation in this matter47 ,guy de ,chauliac speaks also of women who practised surgery4 ,they formed the fifth and last class of operators in his time4 ,he complains that they are accustomed to too great an extent to give over patients suffering from all kinds of maladies to the will of ,heaven1 founding their practice on the maxim ',the ,lord has given as he has pleased2 the ,lord will take away when he pleases2 may the name of the ,lord be blessed4' ,in the sixteenth century1 according to ,pasquier1 the practice of medicine by women almost entirely disappeared4 ,the number of women physicians becomes more and more rare in the following centuries just in proportion as we approach our own time4 ,pasquier says that we find a certain number of them anxious for knowledge and with a special penchant for the study of the natural sciences and even of medicine1 but very few of them take up practice4 ,just how the lack of interest in medical education for women gradually deepened1 until there was almost a negative phase of it1 only a few women in ,italy devoting themselves to medicine1 is hard to say4 ,it is one of the mysteries of the vicissitudes of human affairs that ups and downs of interest in things practical as well as intellectual keep constantly occurring4 ,the number of discoveries and inventions in medicine and surgery that we have neglected until they were forgotten1 and then had to make again1 is so well illustrated in chapters of this book1 that ,i need only recall them here in general4 ,it may seem a little harder to understand that so important a manifestation of interest in human affairs as the education and licensure of women physicians should not only cease1 but pass entirely out of men's memory1 yet such apparently was the case4 ,it would not be hard to illustrate1 as ,i have shown in ,cycles of ,feminine ,education and ,influence in ,education1 ,how ,old the ,new 7,fordham ,university ,press1 #aiaj71 that corresponding ups and downs of interest may be traced in the history of feminine education of every kind4 ,in that chapter ,i have discussed the possible reasons for these vicissitudes1 which have no place here1 but ,i may refer those who are interested in the subject to that treatment of it4 ,,ix ,,mondino ,,and ,,the ,,medical ,,school ,,of ,,bologna ,the most important contributions to medical science made by the ,medical ,school of ,salerno at the height of its development were in surgery4 ,the text-books written by men trained in her halls or inspired by her teachers were to influence many succeeding generations of surgeons for centuries4 ,salerno's greatest legacy to ,bologna was the group of distinguished surgical teachers whose text-books we have reviewed in the chapter1 ,great ,surgeons of the ,medieval ,universities4 ,bologna herself was to win a place in medical history1 however1 mainly in connection with anatomy1 and it was in this department that she was to provide incentive especially for her sister universities of north ,italy1 though also for ,western ,europe generally4 ,the first manual of dissection1 that is1 the first handy volume giving explicit directions for the dissection of human cadavers1 was written at ,bologna4 ,this was scattered in thousands of copies in manuscript all over the medical world of the fourteenth and early fifteenth centuries4 ,even after the invention of printing1 many editions of it were printed4 ,down to the sixteenth century it continued to be the most used text-book of anatomy1 as well as manual of dissection1 which students of every university had in hand when they made their dissection1 or wished to prepare for making it1 or desired to review it after the body had been taken away1 for with lack of proper preservative preparation1 bodies had to be removed in a comparatively short time4 ,probably no man more influenced the medical teaching of the fourteenth and fifteen centuries than ,mundinus1 or1 as he was called in the ,italian fashion1 ,mondino1 who wrote this manual of dissection4 ,mundinus quem omnis studentium universitas colit ut deum 7,mundinus1 whom all the world of students cultivated as a god71 is the expression by which the ,german scholar who edited1 about #aejj1 the ,leipzig edition of ,mundinus' well-known manual1 the ,anathomia1 introduces it to his readers4 ,the expression is well worth noting1 because it shows what was still the reputation of ,mundinus in the medical educational world nearly two centuries after his death4#ab ,until the time of ,vesalius1 whose influence was exerted about the middle of the sixteenth century1 ,mondino was looked up to by all teachers as the most important contributor to the science of anatomy in ,european medicine since the ,greeks4 ,he owed his reputation to two things3 his book1 of which we have already spoken1 and then1 the fact that he reintroduced dissection demonstrations as a regular practice in the medical schools4 ,his book is really a manual of making anatomical preparations for demonstration purposes4 ,these demonstrations had to be hurried1 owing to the rapid decomposition of material consequent upon the lack of preservatives4 ,the various chapters were prepared with the idea of supplying explicit directions and practical help during the anatomical demonstrations1 so that these might be made as speedily as possible4 ,the book does not comprise much that was new at that time1 but it is a good compendium of previous knowledge1 and contains some original observations4 ,it was entirely owing to its form as a handy manual of anatomical knowledge and1 besides1 because it was an incentive to the practice of human dissection1 that it attained and maintained its popularity4 ,mondino followed ,galen1 of course1 and so did every other teacher in medicine and its allied sciences1 until ,vesalius' time4 ,even ,vesalius permitted himself to be influenced overmuch by ,galen at points where we wonder that he did not make his observations for himself1 since1 apparently1 they were so obvious4 ,the more we know of ,galen1 however1 the less surprised are we at his hold over the minds of men4 ,only those who are ignorant of ,galen's immense knowledge1 his practical common sense1 and the frequent marvellous anticipations of what we think most modern1 affect to despise him4 ,his works have never been translated into any modern language except piecemeal1 there is no complete translation1 and one must be ready to delve into some large ,latin1 if not ,greek1 volumes to know what a marvel of medical knowledge he was1 and how wise were the men who followed him closely1 though1 being human1 there are times when necessarily he failed them4 ,for those who know even a little at first hand of ,galen1 it is only what might be expected1 then1 that ,mondino1 trying to break away from the anatomy of the pig1 which had been before this the basis of all anatomical teaching in the medical schools 7,copho's book1 used at ,salerno and ,bologna before ,mondino's was founded on dissections of the pig71 should have clung somewhat too closely to this old ,greek teacher and ,greek master4 ,the incentive furnished by ,mondino's book helped to break the tradition of ,galen's unquestioned authority4 ,besides this1 the group of men around ,mondino1 his master1 ,taddeo ,alderotti1 with his disciples and assistants1 form the initial chapter in the history of the medical school of ,bologna1 which gradually assumed the place of ,salerno at this time4 ,there is no better way of getting a definite idea of what was being done in medicine1 and how it was being done1 than by knowing some of the details of the life of this group of medical workers4 ,mondino di ,liucci1 or ,luzzi1 is usually said to have been born about #abge4 ,his first name is a diminutive for ,raimondo4 ,it used to be said of him that1 like many of the great men of history1 many cities claimed to be his birthplace4 ,five were particularly mentioned--,florence1 ,milan1 ,bologna1 ,forli1 and ,friuli4 ,there is1 however1 another ,mondino1 a distinguished physician1 who was born and lived at ,friuli1 and it is because of confusion with him that the claim for ,friuli has been set up4 ,florence and ,milan are considered out of the question4 ,mondino was probably born in or near ,bologna4 ,the fact that there should have been this multiple set of claims shows how much was thought of him4 ,indeed1 his was the best known name in the medical schools of ,europe for nearly two centuries and a half4 ,he seems to have been a particularly brilliant student1 for tradition records that he had obtained his degree of doctor of medicine when he was scarcely more than twenty4 ,this seems quite out of the question for us at the present time1 but we have taken to pushing back the time of graduation1 and it is not sure whether this is1 beyond peradventure1 so beneficial as is usually thought4 ,that his early graduation did not hamper his intellectual development1 the fact that1 in #acjf1 when he was about thirty-one years of age1 he was offered the professorial chair in anatomy1 which he continued to occupy with such distinction for the next twenty years1 would seem to prove4 ,his public dissections of human bodies1 probably the first thus regularly made1 attracted widespread attention1 and students came to him not only from all over ,italy1 but also from ,europe generally4 ,in this1 after all1 ,mondino was only continuing the tradition of world teaching that ,bologna had acquired under her great surgeons in the preceding century4 7,see ,great ,surgeons of the ,medieval ,universities47 ,mondino came from a family that had already distinguished itself in medicine at ,bologna4 ,his uncle was a professor of physic at the university4 ,his father1 ,albizzo di ,luzzi1 seems to have come from ,florence not long after the middle of the thirteenth century1 for the records show that1 about #abgj1 he formed a partnership with one ,bartolommeo ,raineri for the establishment of a pharmacy at ,bologna4 ,later this passed entirely under the control of the ,mondino family1 and came to be known as the ,spezieria del ,mondino4 ,in it were sold1 besides ,eastern perfumes1 spices1 condiments1 probably all sorts of toilet articles1 and even rugs and silks and feminine ornaments4 ,the stricter pharmacy of the earlier times developed into a sort of department store1 something like our own4 ,the ,mondini1 however1 insisted always on the pharmacy feature as a specialty1 and the fact was made patent to the general public by a sign with the picture of a doctor on it4 ,this drug shop of the ,mondini continued to be maintained as such1 according to ,dr4 ,pilcher1 until the beginning of the nineteenth century4#ac ,one of the fellow students of ,mondino at the ,university of ,bologna had been ,mondeville4 ,he came from distant ,france to take a course in surgery with ,theodoric1 whose high reputation in the olden time1 vague with us half a century ago1 is now amply justified by what we know of him from such ardent students and admirers as ,pagel and ,nicaise4 ,not long after ,mondino's death1 ,guy de ,chauliac came from ,france to reap similar opportunities to these1 which had proved so fruitful for ,mondeville4 ,the more that we learn about this time the more do we find to make it clear how deeply interested the generation was in education in every form1 artistic1 philosophic1 but1 also1 though this is often not realized1 scientific4 ,the long distances1 so much longer in that time than in ours1 to which men were willing1 and even anxious1 to go1 in order to obtain opportunities for research1 and to get in touch with a special master1 the associations with stimulating fellow pupils of other lands1 the scientific correspondences1 almost necessarily initiated by such circumstances1 all indicate an enthusiasm for knowledge such as we have not been accustomed to attribute to this period4 ,on the contrary1 we have been rather inclined to think them neglectful of all education1 and have1 above all1 listened acquiescently while men deprecated the lack of interest in things scientific displayed by these generations4 ,indeed1 many writers have gone out of their way to find a reason for the supposed lack of interest in science at this time1 and have proclaimed the ,church's opposition to scientific education and study as the cause4 ,at this time ,italy was the home of the graduate teaching for all ,europe4 ,the ,italian ,peninsula continued to be the foster-mother of the higher education in letters and art1 but also1 though this is less generally known1 in science1 for the next five centuries4 ,germany has come to be the place of pilgrimage for those who want higher opportunities in science than can be afforded in their own country only during the latter half of the nineteenth century4 ,france occupied it during the first half of the nineteenth century4 ,except for short intervals1 when political troubles disturbed ,italy1 as about the middle of the fourteenth century1 when the removal of the ,popes to ,avignon brought their influence for education over to ,france and a short period at the beginning of the eighteenth century1 when the ,netherlands for a time came into educational prominence1 ,italy has always been the ,european ,mecca for advanced students4 ,practically all our great discoverers in medicine1 until the last century1 were either ,italians1 or else had studied in ,italy4 ,mondino1 ,bertrucci1 ,salicet1 ,lanfranc1 ,baverius1 ,berengarius1 ,john ,de ,vigo1 who first wrote on gun-shot wounds2 ,john of ,arcoli1 first to mention gold filling and other anticipations of modern dentistry2 ,varolius1 ,eustachius1 ,csalpinus1 ,columbus1 ,malpighi1 ,lancisi1 ,morgagni1 ,spallanzani1 ,galvani1 ,volta1 were all ,italians4 ,mondeville1 ,guy de ,chauliac1 ,linacre1 ,vesalius1 ,harvey1 ,steno1 and many others who might be named1 all studied in ,italy1 and secured their best opportunities to do their great work there4 ,it would be amusing1 if it were not amazing1 to have serious writers of history in the light of this plain story of graduate teaching of science in ,italy for over five centuries1 write about the opposition of the ,church to science during the ,medieval and ,renaissance periods4 ,it is particularly surprising to have them talk of ,church opposition to the medical sciences4 ,the universities of the world all had their charters from the ,popes at this time1 and were all ruled by ecclesiastics1 and most of the students and practically all of the professors down to the end of the sixteenth century belonged to the clerical order4 ,the universities of ,italy were all more directly under the control of ecclesiastical authority than anywhere else1 and nearly all of them were dominated by papal influence4 ,bologna1 while doing much of the best graduate work in science1 especially in medicine1 was1 in the ,papal ,states1 absolutely under the rule of the ,popes4 ,the university was1 practically1 a department of the ,papal government4 ,the medical school at the ,university of ,rome itself was for several centuries1 at the end of the ,middle ,ages1 the teaching-place where were assembled the pick of the great medical investigators1 who1 having reached distinction by their discoveries elsewhere1 were summoned to ,rome in order to add prestige to the ,papal ,university4 ,all of them became special friends of the ,popes1 dedicated their books to them1 and evidently looked to them as beneficent patrons and hearty encouragers of original scientific research4 ,while this is so strikingly true of medical science as to make contrary declarations in the matter utterly ridiculous1 and to suggest at once that there must be some motive for seeing things so different to the reality1 the same story can be told of graduate science in other departments4 ,it was to ,italy that men came for special higher studies in mathematics and astronomy1 in botany1 in mineralogy1 and in applied chemistry1 so far as it related to the arts of painting1 illuminating1 stained-glass making1 and the like4 ,no student of science felt that he had quite exhausted the opportunities for study that were possible for him until he had been down in ,italy for some time4 ,to meet the great professors in ,italy was looked on as sure to be a source of special incentive in any department of science4 ,this is coming to be generally recognized just in proportion as our own interest in the arts and crafts1 and in the history of science1 leads us to go carefully into the details of these subjects at first hand4 ,the editors of the ,cambridge ,modern ,history1 in their preface1 declared ten years ago that we can no longer accept with confidence the declaration of any secondary writer on history4 ,this is particularly true of the medieval period4 ,we must go back to the writers of those times4 ,if it seems surprising that the ,university of ,bologna should have come into such great prominence as an institute for higher education at this time1 it would be well to recall some of the great work that is being done in this part of ,italy in other departments at this time4 ,cimabue laid the foundation of modern art towards the end of the thirteenth century1 and during ,mondino's life ,giotto1 his pupil1 raised an artistic structure that is the admiration of all generations of artists since4 ,dante's years are almost exactly contemporary with those of ,giotto and of ,mondino4 ,if men were doing such wondrous work in literature and in art1 why should not the same generation produce a man who will accomplish for the practical science of medicine what his friends and contemporaries had done in other great intellectual departments4 ,in recent years we have come to think much more of environment as an influence in human development and accomplishment than was the custom sometime ago4 ,the broader general environment in ,italy1 with genius at work in other departments1 was certainly enough to arouse in younger minds all their powers of original work4 ,the narrower environment at ,bologna itself was quite as stimulating1 for a great clinical teacher1 ,taddeo ,alderotti1 had come1 in #abfj1 from ,florence to ,bologna1 to take up there the practice and teaching of medicine4 ,it was under him that ,mondino was to be trained for his life work4 ,to understand the place of ,mondino1 and of the medical school of ,bologna1 in his time1 and the reputation that came to them as world teachers of medicine1 we must know1 first1 this great teacher of ,mondino and the atmosphere of progressive medicine that enveloped the university in the latter half of the thirteenth century4 ,in the chapter on ,great ,surgeons of the ,medieval ,universities we call particular attention to the series of distinguished men1 the first four of whom were educated at ,salerno1 and who came to ,bologna to teach surgery4 ,they were doing the best surgery in the world1 much better than was done in many centuries after their time2 indeed1 probably better than at any period down to our own day4 ,besides1 they seem to have been magnetic teachers who attracted and inspired pupils4 ,we have the surgical contributions of a series of men1 written at ,bologna1 that serve to show what fine work was accomplished4 ,at this time1 however1 the field of medicine was not neglected1 though we have but a single great historical name in it that has lived4 ,this was ,taddeo ,alderotti1 a man who lifted the medical profession as high in the estimation of his fellow citizens at ,florence as the great painters and literary men of his time did their departments1 and who then moved to ,bologna1 because of the opportunity to teach afforded him by the university4 ,it is sometimes a little difficult for casual students of the time to understand the marvellous reputation acquired by this medieval physician4 ,it should not be1 however1 when we recall the enthusiastic reception and procession of welcome accorded to ,cimabue's ,madonna1 and the almost universal acclaim of the greatness of ,dante's work1 even in his own time4 ,in something of that same spirit ,bologna came to appreciate ,taddeo1 as he is familiarly known1 looked upon him as a benefactor of the community1 and voted to relieve him of the burden of paying taxes4 ,he came to be considered as a public institution1 whose presence was a blessing to his fellow citizens1 and whose goodness to them should be recognized in this public way4 ,one is not surprised to hear ,villani1 the well-known contemporary historian1 speak of him as the greatest physician in ,christendom4 ,the feelings of the citizens of ,bologna1 it may well be confessed1 were not entirely unselfish1 or due solely to the desire to encourage a great scientific genius4 ,few men of his generation had done more for the city in a material way quite apart from whatever benefits he conferred upon the health of its citizens than ,dr4 ,taddeo4 ,it was he who organized medical teaching in the city on such a plane that it attracted students from all over the world4 ,bologna had had a great law school before this1 founded by ,irnerius1 to which students had come from all over the world4 ,with the advent of ,taddeo from ,florence1 and his success as a medical practitioner1 there began to flock to his lectures many students who spread his fame far and wide4 ,the city council could scarcely do less than grant the same privileges to the medical students and teachers of ,taddeo's school as they had previously accorded to the faculty of law and its students4 ,the city council recognized quite as clearly as any board of aldermen in the modern time how much1 even of material benefit1 a great university was to the building up of a city1 though their motives were probably much higher than that1 and their enlightened policy had its reward in the rapid growth of ,bologna until1 very probably at the end of the thirteenth century1 it had more students than any university of the modern time4 ,the number was not less than fifteen thousand1 and may have been twenty thousand4 ,to this great university success ,taddeo and his medical school contributed not a little4 ,the especially attractive feature of his teaching seems to have been its eminent practicalness4 ,he himself had made an immense success of the practice of medicine1 and accumulated a great fortune1 so much so that ,dante1 in his ,paradiso1 when he wishes to find a figure that would represent exactly the opposite to what ,st4 ,dominic1 the founder of the ,dominicans1 did for the love of wisdom and humanity1 he takes that of ,taddeo1 who had accomplished so much for personal reputation and wealth4 ,this might easily lead to the impression that ,taddeo's teaching was unscientific1 or merely empiric1 or that he himself was a narrow-minded maker of money1 intent only on his immediate influence1 and hampered by exclusive devotion to practical medicine4 ,nothing could be farther from the truth than any such impression4 ,taddeo was not only the head of a great medical school1 a great teacher whom his students almost worshipped1 a physician to whom patients flocked because of his marvellous success1 a fine citizen of a great city1 whom his fellow citizens honored1 but he was a broad-minded scholar1 a philosopher1 and even an author in branches apart from medicine4 ,in that older time it was the custom to combine the study of philosophy and medicine4 ,for centuries after that period in ,italy it was the custom for men to take both degrees1 the doctorate in philosophy and in medicine at the same time4 ,indeed1 most of those whose work has made them famous1 down to and including ,galvani1 did so4 ,taddeo wrote commentaries on the works of ,hippocrates and ,galen1 but he also translated the ethics of ,aristotle1 and did much to make the learning of the ,arabs easily available for his students4 ,his was a broad1 liberal scholarship4 ,dr4 ,lewis ,pilcher1 in his article on ,the ,mondino ,myth1#ad does not hesitate to say that to the spirit which1 from his professorial chair1 ,taddeo infused into the teaching and study of medicine undoubtedly is due the high position which for many generations thereafter the school of ,bologna continued to maintain as a centre of medical teaching4 ,of course1 erudition had its revenge1 and carried ,taddeo too far4 ,the difficult thing in human nature is to stay in the mean and avoid exaggeration4 ,his methods of illustrating medical truths from many literary and philosophical sources often caused the kernel of observation to be hidden beneath a blanket of speculation or1 at least1 to be concealed to a great extent4 ,even the ,germans1 who have insisted most on this unfortunate tendency of ,taddeo1 have been compelled to confess that there is much that is valuable in what he accomplished1 and that even his modes of expression were not without a certain vivacity which attracted attention and doubtless added materially to his success as a teacher4 ,pagel1 in ,puschmann's ,handbuch1 says3 ,it cannot be denied this is just after he has quoted a passage of ,taddeo with regard to dreams that ,taddeo's expressions have a certain liveliness all their own that gives us some idea why he was looked upon as so good a teacher1 a teacher who1 as we know now1 also gave instruction by the bedside of patients4 ,pagel adds1 ,taddeo's greatest merit and his highest significance in medical education consist in the fact that a great many 7zahlreiche7 physicians followed directly in his footsteps and were counted as his pupils4 ,they were all men1 as we know them1 who as writers and practitioners of medicine succeeded in going far beyond the level of mediocrity in what they accomplished4 ,this was the teacher who most influenced young ,mondino when he came to the ,university of ,bologna1 for it seems not unlikely that as a medical student he was actually the pupil of ,taddeo1 then in a vigorous old age4 ,if not1 he was at least brought under the direct influence of the teaching tradition created during more than thirty years by that wonderful old man4 ,knowing what we do of ,taddeo it is not surprising that his pupil should have accomplished work that was to influence succeeding generations more than any other of that wonderful thirteenth century4 ,dr4 ,pilcher in the article on ,the ,mondino ,myth1 so often placed under contribution in this sketch1 says that ,it needs no great stretch of the imagination to picture somewhat of the effect that contact with such a man as ,taddeo di ,alderotto#ae might have1 in molding the character of his young neighbor and pupil1 the chemist's son1 who a few years later1 by his devotion to the study of human anatomy1 was to re-establish the practical pursuit of study on the human cadaver as the common privilege of the skilled physician1 and was to engrave his own name deeply on the records of medicine4 ,under this worthy compatriot and contemporary of the great ,florentines1 ,mondino was inspired to be the teacher that did so much for ,bologna4 ,until recent years it has usually been the custom to give too much significance to the work of the men whose names stand out most prominently in the early history of departments of the intellectual life4 ,mondino's reputation has shared in this exaggerative tendency to some extent1 hence the necessity for realizing what was accomplished before his time and the fact that he only stands as the culmination of a progressive period4 ,carlyle spoke of ,dante as the man in whom ten silent centuries found a voice4 ,the centuries1 however1 were only silent because the moderns did not know how to listen to their message4 ,we know now that every country in ,europe had a great contributor to literature in the century before ,dante4 ,the ,cid1 the ,arthur ,legends1 the ,nibelungen1 the ,troubadours1 naturally led up to ,dante4 ,he was only the culmination of a great period of literature4 ,we know now that men had worked in art before ,cimabue and ,giotto1 and had done impressive work that made for the progress of art4 ,these names1 however1 have come to represent in many minds the sort of solitary phenomena that ,dante has seemed sometimes even to scholars4 ,because ,mondino did such good work in medical teaching it is sometimes declared1 even in rather serious histories1 that he was the first to accomplish anything in his department1 and that before his time there is a blank4 ,some historians1 for instance1 have insisted that ,mondino was the first to do human dissections1 and that he did at most but two or three4 ,only those who are unacquainted with the magnificent development of surgery that took place during the preceding century1 the evidence for which is so abundantly given in modern historians of medicine and especially in ,gurlt's great work on the history of surgery1 from which we have quoted enough to give a good idea of the extent to which the movement went1 are likely to accept any such declaration4 ,there could not have been all that successful surgery without much dissection not only of animals but also of human bodies4 ,the teaching of dissection was not regularly organized until ,mondino's time1 but it seems very clear that even he must have dissected many more bodies than the number usually attributed to him4 ,professor ,lewis ,stephen ,pilcher of ,brooklyn1 who made a special study of ,mondino traditions in ,bologna itself1 and collected some of the early editions of his books1 feels so acutely the absurdity of the ordinarily accepted tradition in this matter1 that he has written a paper on the subject bearing the suggestive title1 ,the ,mondino ,myth4 ,he says3#af ,we are accustomed to think of the practice of dissection as having been re-created by ,mondino1 and at once fully developed1 springing into acceptance4 ,the year #acae is the generally accepted date for the first public anatomical demonstration upon a human body made by ,mondino1 and yet it is true that among the laws promulgated by ,frederick ,,ii1 more than seventy-five years before 7,a4,d4 #abca71 was included a decree that a human body should be dissected at ,salernum at least once in five years in the presence of the assembled physicians and surgeons of the kingdom1 and that in the regulations established for admission to the practice of medicine and surgery in the kingdom it was decreed that no surgeon should be admitted to practise unless he should bring testimonials from the masters teaching in the medical faculty1 that he was 'learned in the anatomy of human bodies1 and had become perfect in that part of medicine without which neither incisions could safely be made nor fractures cured4' ,salernum was notable in its legalization of the dissection of human bodies before the first public work of ,mondino1 for1 according to a document of the ,maggiore ,consiglio of ,venice of #acjh1 it appears that there was a college of medicine at ,venice which was even then authorized to dissect a body every year4 ,common experience tells us that the embodiment of such regulations into formal law would occur only after a considerable preceding period of discussion1 and in this particular field of clandestine practice4 ,it is too much to ask us to believe that in all this period1 from the date of the promulgation of ,frederick's decree of #abca to the first public demonstration by ,mondino1 at ,bologna in #acae1 the decree had been a dead letter and no human body had been anatomized4 ,it is true there is not1 as far as ,i am aware1 any record of any such work1 and commentators and historians of a later date have1 without exception1 accepted the view that none was done1 and thereby heightened the halo assigned to ,mondino as the one who ushered in a new era4 ,such a view seems to me to be incredible4 ,be that as it may1 it is undeniable that at the beginning of the #adth century the idea of dissecting the human body was not a novel one2 the importance of a knowledge of the intimate structure of the body had already been appreciated by divers ruling bodies1 and specific regulations prescribing its practice had been enacted4 ,it is more reasonable to believe that in the era immediately preceding that of ,mondino human bodies were being opened and after a fashion anatomized4 ,all that we know of the work of ,mondino suggests that it was not a new enterprise in which he was a pioneer1 but rather that he brought to an old practice a new enthusiasm and better methods1 which1 caught on the rising wave of interest in medical teaching at ,bologna1 and preserved by his own energy as a writer in the first original systematic treatise written since the time of ,galen1 created for him in subsequent uncritical times the reputation of being the ,restorer of the practice of anatomizing the human body1 the first one to demonstrate and teach such knowledge since the time of the ,ptolemaic anatomists1 ,erasistratus and ,herophilus4 ,the changes have been rung by medical historians upon a casual reference in ,mondino's chapter on the uterus to the bodies of two women and one sow which he had dissected1 as if these were the first and the only cadavers dissected by him4 ,the context involves no such construction4 ,he is enforcing a statement that the size of the uterus may vary1 and to illustrate it remarks that 'a woman whom ,i anatomized in the month of ,january last year1 viz41 #acae ,anno ,christi1 had a larger uterus than one whom ,i anatomized in the month of ,march of the same year4' ,and further1 he says that 'the uterus of a sow which ,i dissected in #acaf 7the year in which he was writing7 was a hundred times greater than any ,i have seen in the human female1 for she was pregnant and contained thirteen pigs4' ,these happen to be the only reference to specific bodies that he makes in his treatise4 ,but it is a far cry to wring out of these references the conclusion that these are the only dissections he made4 ,it is quite true that if we incline to enshroud his work in a cloud of mystery and to figure it as an unprecedented awe-inspiring feature to break down the prejudices of the ages1 it is easy to think of him as having timidly profaned the human body by his anatomizing zeal in but one or two instances4 ,his own language1 however1 throughout his book is that of a man who was familiar with the differing conditions of the organs found in many different bodies2 a man who was habitually dissecting4 7,quotations from the work of ,mundinus showing his familiarity with dissections4 ,the leaf and line references are to the ,dryander edition1 ,marburg1 #aeda47 ,i do not consider separately the anatomy of component parts1 because their anatomy does not appear clearly in the fresh subject1 but rather in those macerated in water4 7,leaf #b1 lines #h-ac47 444 these differences are more noticeable in the cooked or perfectly dried body1 and so you need not be concerned about them1 and perhaps ,i will make an anatomy upon such a one at another time and will write what ,i shall observe with my own senses1 as ,i have proposed from the beginning4 7,leaf #fj1 lines #ad-ag47 ,what the members are to which these nerves come cannot well be seen in such a dissection as this1 but it should be liquefied with rain water1 and this is not contemplated in the present body4 7,leaf #fj1 lines #ca-cc47 ,after the veins you will note many muscles and many large and strong cords1 the complete anatomy of which you will not endeavor to find in such a body but in a body dried in the sun for three years1 as ,i have demonstrated at another time2 ,i also declared completely their number1 and wrote the anatomy of the muscles of the arms1 hands1 and feet in a lecture which ,i gave over the first1 second1 third1 and fourth subjects4 7,leaf #fa1 lines #a-g47 ,very probably the best evidence that we have of the comparative frequency at least of dissection at this time is to be found in the records of a trial for body-snatching that occurred in ,bologna4 ,the details would remind one very much of what we know of the difficulties with regard to dissection in ,america a couple of generations ago1 when no bodies were provided by law for dissection purposes4 ,in the course of some studies for the history of the ,new ,york ,state ,medical ,society 7,new ,york1 #aijf7 ,i found that nearly every one of the first half dozen presidents of the ,new ,york ,academy of ,medicine1 which is not much more than sixty years old1 had had body-snatching experiences when they were younger4 ,dr4 ,samuel ,francis1 the medico-historical writer1 tells of a personal expedition across the ferry in the winter time1 bringing a body from a ,long ,island graveyard4 ,in order to avoid the constables on the ,long ,island side and the police on the ,new ,york side1 because there had been a number of cases of body-snatching recently and the authorities were on the lookout1 the corpse was placed sitting beside the physician who drove the wagon1 with a cloak wrapped around it1 as if it were a living person specially protected against the cold4 ,similar experiences were not unusual4 ,the lack of bodies for dissection is sometimes attributed to religious scruples1 but they have very little to do with it1 as at all times men have refused to allow the bodies of their friends to be treated as anatomical material4 ,this is the natural feeling of abhorrence and not at all religious4 ,it is only when there are many unclaimed bodies of strangers and the poor1 as happens in large cities1 that there can be an abundance of anatomical material4 ,the details of this body-snatching case are strangely familiar to those who know the history of similar cases before the middle of the nineteenth century4 ,the case occurred in #acai in ,bologna1 just four years after ,mondino's public dissections4 ,four students were involved in the charge of body-snatching1 all of them from outside the city of ,bologna itself1 three from ,milan and one from ,piacenza4 ,in modern experience1 too1 as a rule1 students from outside of the town where the medical college was situated1 were always a little readier than natives to violate graveyards4 ,these four students were accused of having gone at night to the ,cemetery of ,st4 ,barnabas1 outside the gate of ,san ,felice1--suburban graveyards were usually the scene of such exploits1--and to have dug up the body of a certain criminal named ,pasino1 who had been hanged a few days before4 ,they carried the body to the school in the ,parish of ,san ,salvatore1 where ,alberto ,zancari was teaching4 ,the resurrection had been accomplished without witnesses1 but there were several witnesses who testified that they recognized the body of ,pasino in the school and students occupied with its dissection4 ,if evidence for the zeal of the medical students of that time for dissection were needed1 surely we have it in the testimony at this trial4 ,at a time when body-snatching has become a criminal offence usually there have been many repeated occurrences of it before the parties are brought to trial1 so that it seems not unlikely that a good many dissections of illegally secured bodies were being done at ,bologna at this time4 ,we know of a regulation of the ,university in force at this time1 which required the teachers at the ,university to do an anatomy or dissection for students if they secured a body for that purpose4 ,the students seem to have used all sorts of influence1 political1 monetary1 diplomatic1 and ecclesiastical1 in order to secure the bodies of criminals4 ,sometimes when they failed in their purpose they waited until after burial and then took the body without leave4 ,when we recall the awfully deterrent condition in which bodies must have been that were thus provided for dissecting purposes1 it is easy to understand that the enthusiasm of the students for dissection must have been at a very high pitch4 ,certainly it was far higher than at the present day1 when1 in spite of the fact that our dissecting-rooms have very few of the old-time dangers and unpleasantnesses1 dissection is only practised with assiduity if special care is exercised in requiring attendance and superintending the work of the department4 ,in my book on ,the ,popes and ,science ,i have gathered the traditions relating to ,mondino's assistants in the chair of anatomy at ,bologna4 ,they furnish abundant evidence of the fact that dissections1 far from being uncommon1 must have been not at all infrequent at the north ,italian universities at this time4 ,curiously enough1 one of these assistants was a young woman who1 as was not infrequently the custom at this time in the ,italian universities1 was matriculated as a student at ,bologna4 ,she took up first philosophy1 and afterwards anatomy1 under ,mondino4 ,while it is not generally realized1 co-education was quite common at the ,italian universities of the thirteenth and fourteenth centuries1 and at no time since the foundation of the universities has a century passed in ,italy without distinguished women occupying professors' chairs at some of the ,italian universities4 ,this young woman1 ,alessandra ,giliani1 of ,persiceto1 a country district not far from ,bologna1 took up the study of anatomy with ardor and1 strange as it may appear1 became especially enthusiastic about dissection4 ,she became so skilful that she was made the prosector of anatomy1 that is1 one who prepares bodies for demonstration by the professors4 ,according to the ,cronaca ,persicetana1 quoted by ,medici in his ,history of the ,anatomical ,school at ,bologna3 ,she became most valuable to ,mondino because she would cleanse most skilfully the smallest vein1 the arteries1 all ramifications of the vessels1 without lacerating or dividing them1 and to prepare them for demonstration she would fill them with various colored liquids1 which1 after having been driven into the vessels1 would harden without destroying the vessels4 ,again1 she would paint these same vessels to their minute branches so perfectly and color them so naturally that1 added to the wonderful explanations and teachings of the master1 they brought him great fame and credit4 ,the whole passage shows a wonderful anticipation of our most modern methods--injection1 painting1 hardening--of making anatomical preparations for class and demonstration purposes4 ,some of the details of the story have been doubted1 but her memorial tablet1 erected at the time of her death in the ,church of ,san ,pietro e ,marcellino of the ,hospital of ,santa ,maria de ,mareto1 gives all the important facts1 and tells the story of the grief of her fianc1 who was himself ,mondino's other assistant4#ag ,this was ,otto ,agenius1 who had made for himself a name as an assistant to the chair of anatomy in ,bologna1 and of whom there were great hopes entertained because he had already shown signs of genius as an investigator in anatomy4 ,these hopes were destined to grievous disappointment1 however1 for ,otto died suddenly1 before he had reached his thirtieth year4 ,the fact that both these assistants of ,mondino died young and suddenly1 would seem to point to the fact that probably dissection wounds in those early days proved even more fatal than they occasionally did a century or more ago1 when the proper precautions against them were not so well understood4 ,the death of ,mondino's two prosectors in early years would seem to hint at some such unfortunate occurrence4 ,as regards the evidence of what the young man had accomplished before his untimely death1 probably the following quotation1 which ,medici has taken from one of the old chroniclers1 will give the best idea3 ,what advantage indeed might not ,bologna have had from ,otto ,agenius ,lustrulanus1 whom ,mondino had used as an assiduous prosector1 if he had not been taken away by a swift and lamentable death before he had completed the sixth lustrum of his life6 ,how well the tradition created by ,mondino continued at the university will be best understood from what we know of ,guy de ,chauliac's visit to the medical school here about the middle of the century4 ,the great ,french surgeon tells us that he came to ,bologna to study anatomy under the direction of ,mondino's successor1 ,bertruccius4 ,when he wrote his preface to his great surgery he recalled this teaching of anatomy at ,bologna and said1 ,it is necessary and useful to every physician to know1 first of all1 anatomy4 ,for this purpose the study of books is indeed useful1 but it is not sufficient to explain those things which can only be appreciated by the senses and which need to be seen in the dead body itself4 ,he advises his students to consult ,mundinus' treatise but to demonstrate its details for themselves on the dead body4 ,he relates that he himself had often1 multitoties1 done this1 especially under the direction of ,bertruccius at ,bologna4 ,curiously enough1 as pointed out by ,professor ,pilcher1 ,mondino had used this same word multitotiens 7the variant spelling makes no difference in the meaning7 in speaking about his own work4 ,in describing the hypogastric lesion he mentions that he had demonstrated certain veins in it many times1 multitotiens4 ,mondino was just past fifty when he finished his little book and permitted copies of it to be made4 ,though the book occurs so early in the history of modern book-making the author offers his excuses to the public for writing it1 and quotes the authority of ,galen1 to whom he turns in other difficult situations1 for justification4 ,as prefaces go1 ,mondino's is so like that of many an author of more recent date that his words have a bibliographic1 as well as a personal1 interest4 ,he said3 ,a work upon any science or art--as saith ,galen--is issued for three reasons3 first1 that one may satisfy his friends4 ,second1 that he may exercise his best mental powers4 ,third1 that he may be saved from the oblivion incident to old age4 ,therefore1 moved by these three causes1 ,i have proposed to my pupils to compose a certain work on medicine4 ,and because a knowledge of the parts to be subjected to medicine 7which is the human body1 and the names of its various divisions7 is a part of medical science1 as saith ,averrhoes in his first chapter1 in the section on the definition of medicine1 for this reason among others1 ,i have set out to lay before you the knowledge of the parts of the human body which is derived from anatomy1 not attempting to use a lofty style1 but the rather that which is suitable to a manual of procedure4 ,some of the early editions of ,mondinus' book are said1 according to old writers1 to have contained illustrations4 ,none of these copies have come down to us1 but the assertion is made so definitely that it seems likely to have been the case4 ,the editions that we have contain wood engravings of the method of making a dissection as frontispiece1 so that it would not be difficult to think of further such illustrations having been employed in the book itself4 ,as we note in the chapter on ,great ,surgeons of the ,medieval ,universities1 ,mondeville1 according to ,guy de ,chauliac1 had pictures of anatomical preparations which he used for teaching purposes4 ,it is easy to understand that the value of such aids would be recognized at a time when the difficulty of preserving bodies made it necessary to do dissections hurriedly so as to get the rapidly decomposing material out of the way4 ,beyond his book and certain circumstances connected with it we know very little about ,mondino4 ,what we know1 however1 enables us to conclude that1 like many another great teacher1 he must have had the special faculty of inspiring his students with an ardent enthusiasm for the work that they were taking under him4 ,hence the body-snatching and other stories4 ,mondino continued to be held in high estimation by the ,bolognese for centuries after his death4 ,dr4 ,pilcher calls attention to the fact that his sepulchral tablet1 which is in the portico of the ,church of ,san ,vitari in ,bologna1 and a replica of which he was allowed to have made in order to bring it to ,america1 is the only one of the sepulchral tablets in the great churches of ,florence1 ,san ,domenico1 ,san ,martino1 the ,cathedral and the ,cloister of ,san ,giacomo degli ,ermitani1 which has not been removed from its original location and placed in the halls of the ,civic ,museum4 ,their removal he considers a kind of desecration which does violence to one's sense of sanctity and propriety4 ,fortunately1 thus far1 the ,mondino ,tablet has escaped the spoiler4 ,very probably ,dr4 ,pilcher's replica of the tablet which he was required to deposit in the ,civic ,museum at the time when the copy was made to be brought to ,america may save the tablet to be seen in its original position for many generations4 ,mondino's career is of special interest because it foreshadows the life and accomplishment of many another maker of medicine of the after time4 ,he did a great new thing in medicine in organizing regular public dissections1 and then in making a manual that would facilitate the work4 ,he waited patiently for years before completing his book in order that it might be the fruit of long experience1 and so be more helpful to others4 ,he was so modest as to require urging to secure the publication4 ,he had the reward of his patience in the popularity of his little work for centuries after his time4 ,the glimpse that we get of his relations to his young assistants1 ,agenius and ,alessandra1 seems to show us a teacher of distinct personal magnetism4 ,undoubtedly the reputation of his book did much for not only the medical school of the ,university of ,bologna1 but also for the medical schools of other north ,italian universities1 and helped to bring to them the crowds of students that flocked there during the fourteenth and fifteenth centuries4 ,taddeo and ,mondino turned the attention of the medical students of their generations ,bolognawards4 ,before that time they had mainly gone to ,salerno4 ,after their time most of the ardent students of medicine felt that they must study for a time at least at ,bologna4 ,other important medical schools of ,italian universities at ,padua1 at ,vicenza1 at ,piacenza1 arose and prospered4 ,during the time when the political troubles of ,italy reached a climax about the middle of the fourteenth century1 while the ,popes were at ,avignon1 there was a remission in the attendance at all the ,italian universities1 but with the ,popes' return to ,rome and the coming of even comparative peace to ,italy1 ,bologna once more became the term of medical pilgrimages for students from all over the world4 ,in the meantime ,mondino's book went forth to be the most used text-book of its kind until ,vesalius' great work came to replace it4 ,to have ruled in the world of anatomy for two centuries as the best known of teachers is of itself a distinction that shows us at once the teaching power and the scientific ability of this professor of anatomy of ,bologna in the early fourteenth century4 ,x ,,great ,,surgeons ,,of ,,the ,,medieval ,,universities ,strange as it may appear to those who have not watched the development of our knowledge of the ,middle ,ages in recent years the most interesting feature in the medical departments and1 indeed1 of the post-graduate work generally of the medieval universities1 is that in surgery4 ,there is a very general impression that this department of medicine did not develop until quite recent years1 and that particularly it failed to develop to any extent in the ,middle ,ages4 ,a good many of the historians of this period1 indeed1 though never the special historians of medicine1 have even gone far afield in order to find some reason why surgery did not develop at this time4 ,they have insisted that the ,church by its prohibition of the shedding of blood1 first to monks and friars1 and then to the secular clergy1 prevented the normal development of surgery4 ,besides they add that ,church opposition to anatomy completely precluded all possibility of any genuine natural evolution of surgery as a science4 ,there is probably no more amusing feature of quite a number of supposedly respectable and presumably authoritative historical works written in ,english than this assumption with regard to the absence of surgery during the later ,middle ,ages4 ,only the most complete ignorance of the actual history of medicine and surgery can account for it4 ,the writers who make such assertions must never have opened an authoritative medical history4 ,nothing illustrates so well the expression of the editors of the ,cambridge ,modern ,history referred to more than once in these pages that in view of changes and of gains such as these the jointing of original documents it has become impossible for historical writers of the present day to trust without reserve even to the most respected secondary authority4 ,the honest student finds himself continually deserted1 retarded1 misled by the classics of historical literature4 ,fortunately for us this sweeping condemnation does not hold to any great extent for the medical historical classics4 ,all of the classic historians of medicine tell us much of the surgery of the thirteenth and fourteenth centuries1 and in recent years the republication of old texts and the further study of manuscript documents of various kinds have made it very clear that there is almost no period in the history of the world when surgery was so thoroughly and successfully cultivated as during the rise and development of the universities and their medical schools in the thirteenth and fourteenth centuries4 ,it is interesting to trace the succession of great contributors to surgery during these two centuries4 ,we know their teaching not from tradition1 but from their text-books so faithfully preserved for us by their devoted students1 who must have begrudged no time and spared no labor in copying1 for many of the books are large1 yet exist in many manuscript copies4 ,modern surgery may be said to owe its origin to a school of surgeons1 the leaders of whom were educated at ,salerno in the early part of the thirteenth century1 and who1 teaching at various north ,italian universities1 wrote out their surgical principles and experiences in a series of important contributions to that department of medical science4 ,the fact that the origin of the school was at ,salerno1 where1 as is well known1 ,arabian influence counted for much and for which ,constantine's translations of ,arabian works proved such a stimulus a century before1 makes most students conclude that this later medieval surgical development is simply a continuation of the ,arabian surgery that1 as we have seen1 developed very interestingly during the earlier ,middle ,ages4 ,any such idea1 however1 is not founded on the realities of the situation1 but on an assumption with regard to the extent of ,arabian influence4 ,gurlt in his ,history of ,surgery 7,vol4 ,i1 page #gja7 completely contradicts this idea1 and says with regard to the first of the great ,italian writers on surgery1 ,rogero1 that though ,arabian works on surgery had been brought over to ,italy by ,constantine ,africanus a hundred years before ,roger's time1 these exercised no influence over ,italian surgery in the next century1 and there is scarcely a trace of the surgical knowledge of the ,arabs to be found in ,roger's works4 ,it is in the history of medicine particularly that it is possible to trace the true influence of the ,arabs on ,european thought in the later ,middle ,ages4 ,we have already seen in the chapter on ,salerno that ,arabian influence did harm to ,salernitan medical teaching4 ,the school of ,salerno itself had developed simple1 dietetic1 hygienic1 and general remedial measures that included the use of only a comparatively small amount of drugs4 ,its teachers emphasized nature's curative powers4 ,with ,arabian influence came polypharmacy1 distrust of nature1 and attempts to cure disease rather than help nature4 ,in surgery1 which developed very wonderfully in the thirteenth and fourteenth centuries1 ,salerno must be credited with the incentive that led up to the marvellous development that came4 ,with this1 however1 ,arabian influence has nothing to do4 ,gurlt1 besides calling attention to the fact that the author of the first great text-book on the subject not only did not draw his inspiration from ,arab sources1 insisted that instead of any ,arabisms being found in his ,roger's writings many ,grcisms occur4 ,the ,salernitan school of surgery drank at the fountain-head of ,greek surgery4 ,apart from ,greek sources ,roger's book rests entirely upon his own experiences1 those of his teachers and his colleagues1 and the tradition in surgery that had developed at ,salerno4 ,this tradition was entirely from the ,greek4 ,roger himself says in one place1 ,we have resolved to write out deliberately our methods of operation such as they have been derived from our own experience and that of our colleagues and illustrious men4 ,,roger1 ,,roland1 ,,and ,,the ,,four ,,masters ,ruggero1 or ,rogero1 who is also known as ,rogerio and ,rogerus with the adjective ,parmensis1 or ,salernitanus1 of ,parma or of ,salerno1 and often in ,german and ,english history simply as ,roger1 lived at the end of the twelfth or the beginning of the thirteenth century and probably wrote his text-book about #aahj4 ,this text-book was1 according to tradition1 originally drafted for his lessons in surgery at ,salerno4 ,it attracted much attention and after being commented on by his pupil ,rolando1 the work of both of them being subsequently annotated by the ,four ,masters1 this combined work became the basis of modern surgery4 ,roger was probably born either in ,palermo or ,parma4 ,there are traditions of his having taught for a while at ,paris and at the ,university of ,montpellier1 though these are not substantiated4 ,his book was printed at ,venice in #aedf1 and has been lately reprinted by ,de ,renzi in his ,collectio ,salernitana4 ,roland was a pupil of ,roger's1 and the two names that often occur in medieval romance became associated in a great historic reality as a consequence of ,roland's commentary on his master's work1 which was a favorite text-book in surgery for a good while in the thirteenth century at ,salerno4 ,some space will be given to the consideration of their surgical teaching after a few words with regard to some disciples who made a second commentary1 adding to the value of the original work4 ,this is the well-known commentary of the ,four ,masters1 a text-book of surgery written somewhat in the way that we now make text-books in various departments of medicine1 that is1 by asking men who have made specialties of certain subjects to write on that subject and then bind them all together in a single volume4 ,it represents but another striking reminder that most of our methods are old1 not new as we are likely to imagine them4 ,the ,four ,masters took the works of ,roger and ,rolando1 acknowledged their indebtedness much more completely than do our modern writers on all occasions1 ,i fear1 and added their commentaries4 ,gurlt says 7,geschichte der ,chirurgie1 ,vol4 ,i1 p4 #gjc7 that in spite of the fact that there is some doubt about the names of the authors1 this volume constitutes one of the most important sources for the history of surgery of the later ,middle ,ages and makes it very clear that these writers drew their opinions from a rich experience4 ,it is rather easy to illustrate from the quotations given in ,gurlt or from the accounts of their teaching in ,daremberg or ,de ,renzi some features of this experience that can scarcely fail to be surprising to modern surgeons4 ,for instance1 what is to be found in this old text-book of surgery with regard to fractures of the skull is likely to be very interesting to surgeons at all times4 ,one might be tempted to say that fewer men would die every year in prison cells who ought to be in hospitals1 if the old-time teaching was taken to heart4 ,for there are rather emphatic directions not to conclude because the scalp is unwounded that there can be no fracture of the skull4 ,where nothing can be felt care must be exercised in getting the history of the case4 ,for instance1 if a man is hit by a metal instrument shaped like the clapper of a bell or by a heavy key1 or by a rounded instrument made of lead--this would remind one very much of the lead pipe of the modern time1 so fruitful of mistakes of diagnosis in head injuries--special care must be taken to look for symptoms in spite of the lack of an external penetrating wound4 ,where there is good reason to suspect a fracture because of the severity of the injury1 the scalp should be incised and a fracture of the cranium looked for carefully4 ,that is carrying the exploratory incision pretty far4 ,if a fracture is found the surgeon should trephine so as to relieve the brain of any pressure of blood that might be affecting it4 ,there are many warnings1 however1 of the danger of opening the skull and of the necessity for definitely deciding beforehand that there is good reason for so doing4 ,how carefully their observations had been made and how well they had taken advantage of their opportunities1 which were1 of course1 very frequent in those warlike times when firearms were unknown1 hand-to-hand conflict common1 and blunt weapons were often used1 can be appreciated very well from some of the directions4 ,for instance1 they knew of the possibility of fracture by contrecoup4 ,they say that quite frequently though the percussion comes in the anterior part of the cranium1 the cranium is fractured on the opposite part4#ah ,they even seem to have known of accidents such as we now discuss in connection with the laceration of the middle meningeal artery4 ,they warn surgeons of the possibilities of these cases4 ,they tell the story of a youth who had a very small wound made by a thrown stone and there seemed no serious results or bad signs4 ,he died the next day1 however4 ,his cranium was opened and a large amount of black blood was found coagulated about his dura mater4 ,there are many interesting things said with regard to depressed fractures and the necessity for elevating the bone4 ,if the depressed portion is wedged then an opening should be made with the trephine and an elevating instrument called a spatumen used to relieve the pressure4 ,great care should be taken1 however1 in carrying out this procedure lest the bone of the cranium itself1 in being lifted1 should injure the soft structures within4 ,the dura mater should be carefully protected from injury as well as the pin4 ,care should especially be exercised at the brow and the rear of the head and at the commissures 7proram et pupim et commissuras71 since at these points the dura mater is likely to be adherent4 ,perhaps the most striking expression1 the word infect being italicized by ,gurlt1 is3 ,in elevating the cranium be solicitous lest you should infect or injure the dura mater4 ,for wounds of the scalp sutures of silk are recommended because this resists putrefaction and holds the wound edges together4 ,interrupted sutures about a finger-breadth apart are recommended4 ,the lower part of the wound should be left open so that the cure may proceed properly4 ,red powder was strewed over the wound and the leaf of a plant set above it4 ,in the lower angle of the wound a pledget of lint for drainage purposes was inlaid4 ,hemorrhage was prevented by pressure1 by the binding on of burnt wool firmly1 and by the ligature of veins and by the cautery4 ,there are rather interesting discussions of the prognosis of wounds of the head1 especially such as may be determined from general symptoms in this commentary of the ,four ,masters on ,roger's and ,rolando's treatises4 ,if an acute febrile condition develops1 the wound is mortal4 ,if the patient loses the use of the hands and feet or if he loses his power of direction1 or his sensation1 the wound is mortal4 ,if a universal paralysis comes on1 the wound is mortal4 ,for the treatment of all these wounds careful precautions are suggested4 ,cold was supposed to be particularly noxious to them4 ,operations on the head were not to be done in cold weather and1 above all1 not in cold places4 ,the air where such operations were done must be warmed artificially4 ,hot plates should surround the patient's head while the operation was being performed4 ,if this were not possible they were to be done by candlelight1 the candle being held as close as possible in a warm room4 ,these precautions are interesting as foreshadowing many ideas of much more modern time and especially indicating how old is the idea that cold may be taken in wounds4 ,in popular medicine this still has its place4 ,whenever a wound does badly in the winter time patients are sure that they have taken cold4 ,such popular medical ideas are always derived from supposedly scientific medicine1 and until we learned about microbes physicians used the same expressions4 ,we have not got entirely away from them yet4 ,these old surgeons must have had many experiences with fractures at the base of the skull4 ,hemorrhages from the mouth and nose1 for instance1 and from the ears were considered bad signs4 ,they were inclined to suggest that openings into the skull should be discovered by efforts to demonstrate a connection between the mouth and nares and the brain cavity4 ,for instance1 in their commentary the ,four ,masters said3 ,let the patient hold his mouth and nostrils tight shut and blow strongly4 ,if there was any lessening of the pressure or any appearance of air in the wound in the scalp1 then a connection between the mouth and nose was diagnosticated4 ,this is ingenious but eminently dangerous because of the infectious material contained in the nasal and oral cavities1 so likely to be forced by such pressure into the skull4 ,they were particularly anxious to detect linear fractures4 ,one of their methods of negative diagnosis for fractures of the skull was that if the patient were able to bring his teeth together strongly1 or to crack a nut without pain1 then there was no fracture present4 ,one of the commentators1 however1 adds to this sed hoc aliquando fallit--but this sign sometimes fails4 ,split or crack fractures were also diagnosticated by the method suggested by ,hippocrates of pouring some colored fluid over the skull after the bone was exposed1 when the linear fracture would show by coloration4 ,the ,four ,masters suggest a sort of red ink for this purpose4 ,while they have so much to say about fractures of the skull and insist1 over and over again1 that though all depressed fractures need treatment and many fissure fractures require trepanation1 still great care must be exercised in the selection of cases4 ,they say1 for instance1 that surgeons who in every serious wound of the head have recourse to the trephine must be looked upon as fools and idiots 7idioti et stolidi74 ,in the light of what we now know about the necessity for absolute cleanliness1--asepsis as we have come to call it1--it is rather startling to note the directions that are given to a surgeon to be observed on the day when he is to do a trepanation4 ,for obvious reasons ,i prefer to quote it in the ,latin3 ,et nota quod die ilia cavendum est medico a coitu et malis cibis aera corrumpentibus1 ut sunt allia1 cepe1 et hujusmodi1 et colloquio mulieris menstruos1 et manus ejus debent esse mund1 etc4 ,my quotation is from ,gurlt1 ,vol4 ,i1 p4 #gjg4 ,the directions are most interesting4 ,the surgeon's hands must be clean1 he must avoid the taking of food that may corrupt the air1 such as onions1 leeks1 and the like2 must avoid menstruating and other women1 and in general must keep himself in a state of absolute cleanliness4 ,to read a passage like this separated from its context and without knowing anything about the wonderful powers of observation of the men from whom it comes1 it would be very easy to think that it is merely a set of general directions which they had made on some general principle1 perhaps quite foolish in itself4 ,we know1 however1 that these men had by observation detected nearly every feature of importance in fractures of the skull1 their indications and contra-indications for operation and their prognosis4 ,they had anticipated nearly everything of importance that has come to be insisted on even in our own time in the handling of these difficult cases4 ,it is not unlikely1 therefore1 that they had also arrived at the recognition by observations on many patients that the satisfactory after-course of these cases which were operated on by the surgeon after due regard to such meticulous cleanliness as is suggested in the paragraph ,i have quoted1 made it very clear that these aseptic precautions1 as we would call them1 were extremely important for the outcome of the case and1 therefore1 were well worth the surgeon's attention1 though they must have required very careful precautions and considerable self-denial4 ,indeed this whole subject1 the virtual anticipation of our nineteenth-century principles of aseptic surgery in the thirteenth century1 is not a dream nor a far-fetched explanation when one knows enough about the directions that were laid down in the surgical text-books of that time4 ,,the ,,north ,,italian ,,surgeons ,after ,roger and ,rolando and the ,four ,masters1 who owe the inspiration for their work to ,salerno and the south of ,italy1 comes a group of north ,italian surgeons3 ,bruno da ,longoburgo1 usually called simply ,bruno2 ,theodoric and his father1 ,hugo of ,lucca1 and ,william of ,salicet4 ,immediately following them come two names that belong1 one almost feels1 to a more modern period3 ,mondino1 the author of the first text-book on dissection1 and ,lanfranc 7the disciple of ,william of ,salicet71 who taught at ,paris and gave that primacy to ,french surgery which it maintained all the centuries down to the nineteenth 7,pagel74 ,it might very well be thought that this group of ,italian surgeons had very little in their writings that would be of any more than antiquarian interest for the modern time4 ,it needs but a little knowledge of their writings as they have come down to us to show how utterly false any such opinion is4 ,to ,hugo da ,lucca and his son ,theodoric we owe the introduction and the gradual bringing into practical use of various methods of ansthesia4 ,they used opium and mandragora for this purpose and later employed an inhalant mixture1 the composition of which is not absolutely known4 ,they seem1 however1 to have been very successful in producing insensibility to pain for even rather serious and complicated and somewhat lengthy operations4 ,indeed it is to this that must be attributed most of their surprising success as surgeons at this early date4 ,we are so accustomed to think that ansthesia was discovered about the middle of the nineteenth century in ,america that we forget that literature is full of references in ,tom ,middleton's 7seventeenth century7 phrase to the mercies of old surgeons who put their patients to sleep before they cut them4 ,ansthetics were experimented with almost as zealously1 during the latter half of the thirteenth century at least1 as during the latter half of the nineteenth century4 ,they were probably not as successful as we are1 but they did succeed in producing insensibility to pain1 otherwise they could never have operated to the extent they did4 ,moreover the traditions show that the ,da ,luccas particularly had invented a method that left very little to be desired in this matter of ansthesia4 ,a reference to the sketch of ,guy de ,chauliac in this volume will show how practical the method was in his time4 ,nearly the same story as with regard to ansthetics has to be repeated for what are deemed so surely modern developments1--asepsis and antisepsis4 ,i have already suggested that ,roger seems to have known how extremely important it was to approach operations upon the skull with the most absolute cleanliness4 ,there are many hints of the same kind in other writers which show that this was no mere accidental remark1 but was a definite conclusion derived from experience and careful observation of results4 ,we find much more with regard to this same subject in the writings of the group of northern ,italian surgeons and especially in the group of those associated with ,william of ,salicet4 ,professor ,clifford ,allbutt1 ,regius ,professor of ,medicine at the ,university of ,cambridge1 ,england1 in his address before the ,st4 ,louis ,world's ,fair ,congress of ,arts and ,science in #aijd1 did not hesitate to declare that ,william discussed the causes for union by first intention and the modes by which it might be obtained4 ,he1 too1 insisted on cleanliness as the most important factor in having good surgical results1 and all of this group of men1 in operating upon septic cases1 used stronger wine as a dressing4 ,this exerted1 as will be readily understood1 a very definite antiseptic quality4 ,evidently some details of the teaching of this group of great surgeons in northern ,italy in the second half of the thirteenth century will make clearer to us how much the rising universities of the time were accomplishing in medicine and surgery as well as in their other departments4 ,the dates of the origin of some of these universities should perhaps be recalled so as to remind readers how closely related they are to this great group of surgical teachers4 ,salerno was founded very early1 probably in the tenth century1 ,bologna1 ,reggio1 and ,modena came into existence toward the end of the twelfth century2 ,vicenza1 ,padua1 ,naples1 ,vercelli1 and ,piacenza1 as well as ,arezzo1 during the first half of the thirteenth century2 ,rome1 ,perugia1 ,trevizo1 ,pisa1 ,florence1 ,sienna1 ,lucca1 ,pavia1 and ,ferrara during the next century4 ,the thirteenth century was the special flourishing period of the universities1 and the medical departments1 far from being behind1 were leaders in accomplishment4 7,see my ,the ,thirteenth ,greatest of ,centuries1 ,n4,y41 #aijh47 ,,bruno ,,da ,,longoburgo ,the first of this important group of north ,italian surgeons who taught at these universities was ,bruno of ,longoburgo4 ,while he was born in ,calabria1 and probably studied in ,salerno1 his work was done at ,vicenza1 ,padua1 and ,verona4 ,his text-book1 the ,chirurgia ,magna1 dedicated to his friend ,andrew of ,piacenza1 was completed at ,padua in ,january1 #abeb4 ,gurlt notes that he is the first of the ,italian surgeons who quotes1 besides the ,greeks1 the ,arabian writers on surgery4 ,eclecticism had definitely come into vogue to replace exclusive devotion to the ,greek authors1 and men were taking what was good wherever they found it4 ,gurlt tells us that ,bruno owed much of what he wrote to his own experience and observation4 ,he begins his work by a definition of surgery1 chirurgia1 tracing it to the ,greek and emphasizing that it means handwork4 ,he then declares that it is the last instrument of medicine to be used only when the other two instruments1 diet and potions1 have failed4 ,he insists that surgeons must learn by seeing surgical operations and watching them long and diligently4 ,they must be neither rash nor over bold and should be extremely cautious about operating4 ,while he says that he does not object to a surgeon taking a glass of wine1 the followers of this specialty must not drink to such an extent as to disturb their command over themselves1 and they must not be habitual drinkers4 ,while all that is necessary for their art cannot be learned out of books1 they must not despise books however1 for many things can be learned readily from books1 even about the most difficult parts of surgery4 ,three things the surgeon has to do3--to bring together separated parts1 to separate those that have become abnormally united1 and to extirpate what is superfluous4 ,in his second chapter on healing he talks about healing by first and second intention4 ,wounds must be more carefully looked to in summer than in winter1 because putrefactio est major in aestate quam in hyeme1 putrefaction is greater in summer than in winter4 ,for proper union care must be exercised to bring the wound edges accurately together and not allow hair1 or oil1 or dressings to come between them4 ,in large wounds he considers stitching indispensable1 and recommends for this a fine1 square needle4 ,the preferable suture material in his experience was silk or linen4 ,the end of the wound was to remain open in order that lint might be placed therein in order to draw off any objectionable material4 ,he is particularly insistent on the necessity for drainage4 ,in deep wounds special provision must be made1 and in wounds of extremities the limb must be so placed as to encourage drainage4 ,if drainage does not take place1 then either the wound must be thoroughly opened1 or if necessary a counter opening must be made to provide drainage4 ,all his treatment of wounds is dry1 however4 ,water1 he considered1 always did harm4 ,we can readily understand that the water generally available and especially as surgeons saw it in camps and on the battlefield1 was likely to do much more harm than good4 ,in penetrating wounds of the belly cavity1 if there was difficulty in bringing about the reposition of the intestines1 they were first to be pressed back with a sponge soaked in warm wine4 ,other manipulations are suggested1 and if necessary the wound must be enlarged4 ,if the omentum finds its way out of the wound1 all of it that is black or green must be cut off4 ,in cases where the intestines are wounded they are to be sewed with a small needle and a silk thread and care is to be exercised in bringing about complete closure of the wound4 ,this much will give a good idea of ,bruno's thoroughness4 ,altogether1 ,gurlt1 in his ,history of ,surgery1 gives about fifteen large octavo pages of rather small type to a brief compendium of ,bruno's teachings4 ,one or two other remarks of ,bruno are rather interesting in the light of modern developments in medicine4 ,for instance1 he suggests the possibility of being able to feel a stone in the bladder by means of bimanual palpation4 ,he teaches that mothers may often be able to cure hernias1 both umbilical and inguinal1 in children by promptly taking up the treatment of them as soon as noticed1 bringing the edges of the hernial opening together by bandages and then preventing the reopening of the hernia by prohibiting wrestling and loud crying and violent motion4 ,he has seen overgrowth of the mamma in men1 and declares that it is due to nothing else but fat1 as a rule4 ,he suggests if it should hang down and be in the way on account of its size it should be extirpated4 ,he seems to have known considerable about the lipomas and advises that they need only be removed in case they become bothersomely large4 ,the removal is easy1 and any bleeding that takes place may be stopped by means of the cautery4 ,he divides rectal fistul into penetrating and non-penetrating1 and suggests salves for the non-penetrating and the actual cautery for those that penetrate4 ,he warns against the possibility of producing incontinence by the incision of deep fistul1 for this would leave the patient in a worse state than before4 ,,hugh ,,of ,,lucca ,bruno brought up with him the methods and principles of surgery from the south of ,italy1 but there seems to have been already in the north at least one distinguished surgeon who had made his mark4 ,this was ,ugo da ,lucca or ,ugo ,luccanus1 sometimes known in the modern times in ,german histories of medicine as ,hugo da ,lucca and in ,english1 ,hugh of ,lucca4 ,he flourished early in the thirteenth century4 ,in #abad he was called to ,bologna to become the city physician1 and joined the ,bolognese volunteers in the crusade in #abah1 being present at the siege of ,damietta4 ,he returned to ,bologna in #abba and was given the post of legal physician to the city4 ,the civic statutes of ,bologna are1 according to ,gurlt1 the oldest monument of legal medicine in the ,middle ,ages4 ,ugo died not long after the middle of the century1 and is said to have been nearly one hundred years old4 ,of his five sons1 three became physicians4 ,the most celebrated of these was ,theodoric1 who wrote a text-book of surgery in which are set down the traditions of surgery that had been practised in his father's life4 ,theodoric is especially enthusiastic in praise of his father1 because he succeeded in bringing about such perfect healing of wounds with only wine and water and the ligature and without the employment of any ointments4 ,ugo seems to have occupied himself much with chemistry4 ,to him we owe a series of discoveries with regard to anodyne and ansthetizing drugs4 ,he is said to have been the first who taught the sublimation of arsenic4 ,unfortunately he left no writings after him1 and all that we know of him we owe to the filial devotion of his son ,theodoric4 ,,theodoric ,this son1 after having completed his medical studies at the age of about twenty-three1 entered the ,dominican ,order1 then only recently established1 but continued his practice of medicine undisturbed4 ,his ecclesiastical preferment was rapid4 ,he attracted the attention of the ,bishop of ,valencia1 and became his chaplain in ,rome4 ,at the age of about fifty he was made a bishop in ,south ,italy and later transferred to the ,bishopric of ,cervia1 not far from ,ravenna4 ,most of his life seems to have been passed in ,bologna however1 and he continued to practise medicine1 devoting his fees1 however1 entirely to charity4 ,his text-book of surgery was written about #abff and is signed with his full name and title as ,bishop of ,cervia4 ,even at this time however1 he still retained the custom of designating himself as a member of the ,dominican ,order4 ,the most interesting thing in the first book of his surgery is undoubtedly his declaration that all wounds should be treated only with wine and bandaging4 ,wine he insists on as the best possible dressing for wounds4 ,it was the most readily available antiseptic that they had at that time1 and undoubtedly both his father's recommendation of it and his own favorable experience with it were due to this quality4 ,it must have acted as an excellent inhibitive agent of many of the simple forms of pus formation4 ,at the conclusion of this first book he emphasizes that it is extremely important for the healing of wounds that the patient should have good blood1 and this can only be obtained from suitable nutrition4 ,it is essential therefore for the physician to be familiar with the foods which produce good blood in order that his wounded patients may be fed appropriately4 ,he suggests1 then1 a number of articles of diet which are particularly useful in producing such a favorable state of the tissues as will bring about the rebirth of flesh and the adhesion of wound surfaces4 ,shortly before he emphasizes the necessity for not injuring nerves1 though if nerves have been cut they should be brought together as carefully as possible1 the wound edges being then approximated4 ,probably the most interesting feature for our generation of the great text-books of the surgeons of the medieval universities is the occurrence in them of definite directions for securing union in surgical wounds1 at least by first intention and their insistence on keeping wounds clear4 ,the expression union by first intention comes to us from the olden time4 ,they even boasted that the scars left after their incisions were often so small as to be scarcely noticeable4 ,such expressions of course could only have come from men who had succeeded in solving some of the problems of antisepsis that were solved once more in the generation preceding our own4 ,with regard to their treatment of wounds1 ,professor ,clifford ,allbutt says3#ai ,they washed the wound with wine1 scrupulously removing every foreign particle2 then they brought the edges together1 not allowing wine nor anything else to remain within--dry adhesive surfaces were their desire4 ,nature1 they said1 produces the means of union in a viscous exudation1 or natural balm1 as it was afterwards called by ,paracelsus1 ,par1 and ,wurtz4 ,in older wounds they did their best to obtain union by cleansing1 desiccation1 and refreshing of the edges4 ,upon the outer surface they laid only lint steeped in wine4 ,powders they regarded as too desiccating1 for powder shuts in decomposing matters wine after washing1 purifying1 and drying the raw surfaces evaporates4 ,theodoric comes nearest to us of all these old surgeons4 ,the surgeon who in #abff wrote3 ,for it is not necessary1 as ,roger and ,roland have written1 as many of their disciples teach1 and as all modern surgeons profess1 that pus should be generated in wounds4 ,no error can be greater than this4 ,such a practice is indeed to hinder nature1 to prolong the disease1 and to prevent the conglutination and consolidation of the wound was more than half a millennium ahead of his time4 ,the italics in the word modern are mine1 but might well have been used by some early advocate of antisepsis or even by ,lord ,lister himself4 ,just six centuries almost to the year would separate the two declarations1 yet they would be just as true at one time as at another4 ,when we learn that ,theodoric was proud of the beautiful cicatrices which he obtained without the use of any ointment1 pulcherrimas cicatrices sine unguento aliquo inducebat1 then further that he impugned the use of poultices and of oils on wounds1 while powders were too drying and besides had a tendency to prevent drainage1 the literal meaning of the ,latin words saniem incarcerare is to incarcerate sanious material1 it is easy to understand that the claim that antiseptic surgery was anticipated six centuries ago is no exaggeration and no far-fetched explanation with modern ideas in mind of certain clever modes of dressing hit upon accidentally by medieval surgeons4 ,theodoric's treatment of many practical problems is interesting for the modern time4 ,for instance1 in his discussion of cancer he says that there are two forms of the affection4 ,one of them is due to a melancholy humor1 a constitutional tendency as it were1 and occurs especially in the breasts of women or latent in the womb4 ,this is difficult of treatment and usually fatal4 ,the other class consists of a deep ulcer with undermined edges1 occurring particularly on the legs1 difficult to cure and ready of relapse1 but for which the outlook is not so bad4 ,his description of noli me tangere and of lupus is rather practical4 ,lupus is eating herpes1 occurs mainly on the nose1 or around the mouth1 slowly increases1 and either follows a preceding erysipelas or comes from some internal cause4 ,noli me tangere is a corroding ulcer1 so called perhaps because irritation of it causes it to spread more rapidly4 ,he thinks that deep cauterization of it is the best treatment4 ,since these are in the department of skin diseases this seems the place to mention that ,theodoric describes salivation as occurring after the use of mercury for certain skin diseases4 ,he has already shown that he knows of certain genital ulcers and sores on the genital regions and of distinctions between them4 ,,william ,,of ,,salicet ,the third of the great surgeons in northern ,italy was ,william of ,salicet4 ,he was a pupil of ,bruno's and the master of ,lanfranc4 ,the first part of his life was passed at ,bologna and the latter part as the municipal and hospital physician of ,verona4 ,he probably died about #abhj4 ,he was a physician as well as a surgeon and was one of those who insisted that the two modes of practising medicine should not be separated1 or if they were both medicine and surgery would suffer4 ,he thought that the physician learned much by seeing the interior of the body during life1 while the surgeon was more conservative if he were a physician4 ,it is curiously interesting to find that the ,regius ,professors at both ,oxford and ,cambridge in our time have expressed themselves somewhat similarly4 ,professor ,clifford ,allbutt is quite emphatic in this matter and ,professor ,osler is on record to the same effect4 ,following ,theodoric1 ,william of ,salicet did much to get away from the ,arabic abuse of the cautery and brought the knife back to its proper place again as the ideal surgical instrument4 ,unlike those who had written before him1 ,william quoted very little from preceding writers4 ,whenever he quotes his contemporaries it is in order to criticise them4 ,he depended on his own experience and considered that it was only what he had actually learned from experience that he should publish for the benefit of others4 ,a very good idea of the sort of surgery that ,william of ,salicet practised may be obtained even from the beginning of the first chapter of his first book4 ,this is all with regard to surgery of the head4 ,he begins with the treatment of hydrocephalus or1 as he calls it1 water collected in the heads of children newly born4 ,he rejects opening of the head by an incision because of the danger of it4 ,in a number of cases1 however1 he had had success by puncturing the scalp and membranes with a cautery1 though but a very small opening was made and the fluid was allowed to escape only drop by drop4 ,he then takes up eye diseases1 a department of surgery rather well developed at that time1 as can be seen from our account of the work of ,pope ,john ,,xxi as an ophthalmologist during the thirteenth century4 ,see ,ophthalmology 7,january1 #aiji71 reprinted in ,catholic ,churchmen in ,science1 ,philadelphia1 ,the ,dolphin ,press1 #aiji4 ,william devotes six chapters to the diseases of the eyes and the eyelids4 ,then there are two chapters on affections of the ears4 ,foreign bodies and an accumulation of ear wax are removed by means of instruments4 ,a polyp is either cut off or its pedicle bound with a ligature1 and it is allowed to shrivel4 ,the next chapter is on the nose4 ,nasal polyps were to be grasped with a sharp tenaculum1 cum tenacillis acutis1 and either wholly or partially extracted4 ,ranula was treated by being lifted well forward by means of a sharp iron hook and then split with a razor4 ,it is evident that the tendency of these to fill up again was recognized1 and accordingly it was recommended that vitriol powder1 or alum with salt1 be placed in the cavity for a time after evacuation in order to produce adhesive inflammation4 ,in the same chapter on the mouth one finds that ,william did not hesitate to perform what cannot but be considered rather extensive operations within the oral cavity4 ,for instance1 he tells of removing a large epulis and gives an account in detail of the case4 ,to quote his own words3 ,i cured a certain woman from ,piacenza who was suffering from fleshy tumor on the gums of the upper jaw1 the tumor having grown to such a size above the teeth and the gums that it was as large or perhaps larger than a hen's egg4 ,i removed it at four operations by means of heated iron instruments4 ,at the last operation ,i removed the teeth that were loose with certain parts of the jawbone4 ,in the next chapter there is an account of the treatment of a remarkable case of abscess of the uvula4 ,in the following chapter the swelling of cervical glands is taken up4 ,in his experience expectant treatment of these was best4 ,he advises internal medication with the building up of the general health1 or suggests allowing the inflamed glands to empty themselves after pustulation4 ,after much meddlesome surgery we are almost back to his methods again4 ,he did not hesitate to treat goitre surgically1 though he considered there were certain internal remedies that would benefit it4 ,in obstinate cases he suggests the complete extirpation of cystic goitre1 but if the sac is allowed to remain it should be thoroughly rubbed over on the inside with green ointment4 ,he warns about the necessity for avoiding the veins and arteries in this operation1 and says that in this affection many large veins make their appearance and they find their way everywhere through the fleshy mass4 ,what ,i have given here is to be found in a little more than half a page of ,gurlt's abstract of the first twenty chapters of ,salicet's first book4 ,altogether ,gurlt has more than ten pages of rather small print with regard to ,william2 most of it is as interesting and as practical and as representative of anticipations of what is done in the modern time as what ,i have here quoted4 ,william1 as ,i have said1 depended much more upon his own experience than upon what was to be found in text-books4 ,he knew the old text-books very well however1 but as a rule did not quote from them unless he had tried the recommendations for himself1 or unless similar cases to these mentioned had come under his own observation4 ,he was evidently a thoroughly observant physician1 a skilled surgeon who was practical enough to see the simplest way to do things1 and he proceeded to do them4 ,it is no wonder that he influenced succeeding generations so much1 nor that his great pupil1 ,lanfranc1 continuing his tradition1 founded a school of surgery in ,paris1 the influence of which was to endure almost down to our time1 and give ,france a primacy in surgery until the nineteenth century4 ,,lanfranc ,after ,salicet's lifetime the focus of interest in surgery changes from ,italy to ,france1 and what is still more complimentary to ,william1 it is through a favorite disciple of his that the change takes place4 ,this was ,lanfranchi1 or ,lanfranco1 sometimes spoken of as ,alanfrancus1 who practised as physician and surgeon in ,milan until banished from there by ,matteo ,visconti about #abij4 ,he then went to ,lyons1 where in the course of his practice he attracted so much attention that he was offered the opportunity to teach surgery in ,paris4 ,he attracted what ,gurlt calls an almost incredible number of scholars to his lessons in ,paris1 and by hundreds they accompanied him to the bedside of his patients and attended his operations4 ,the dean of the medical faculty1 ,jean de ,passavant1 urged him to write a text-book of surgery1 not only for the benefit of his students at ,paris but for the sake of the prestige which this would confer on the medical school4 ,deans still urge the same reasons for writing4 ,lanfranc completed his surgery1 called ,chirurgia ,magna1 in #abif1 and dedicated it to ,philippe le ,bel1 the then reigning ,french ,king4 ,ten years later he died1 but in the meantime he had transferred ,italian prestige in surgery from ,italy to ,france and laid the foundations in ,paris of a thoroughly scientific as well as a practical surgery1 though this department of the medical school had been in a sadly backward state when he came4 ,in the second chapter of this text-book1 the first containing the definition of surgery and general introduction1 ,lanfranc describes the qualities that in his opinion a surgeon should possess4 ,he says1 ,it is necessary that a surgeon should have a temperate and moderate disposition4 ,that he should have well-formed hands1 long slender fingers1 a strong body1 not inclined to tremble and with all his members trained to the capable fulfilment of the wishes of his mind4 ,he should be of deep intelligence and of a simple1 humble1 brave1 but not audacious disposition4 ,he should be well grounded in natural science1 and should know not only medicine but every part of philosophy2 should know logic well1 so as to be able to understand what is written1 to talk properly1 and to support what he has to say by good reasons4 ,he suggests that it would be well for the surgeon to have spent some time teaching grammar and dialectics and rhetoric1 especially if he is to teach others in surgery1 for this practice will add greatly to his teaching power4 ,some of his expressions might well be repeated to young surgeons in the modern time4 ,the surgeon should not love difficult cases and should not allow himself to be tempted to undertake those that are desperate4 ,he should help the poor as far as he can1 but he should not hesitate to ask for good fees from the rich4 ,many generations since ,lanfranc's time have used the word nerves for tendons4 ,lanfranc1 however1 made no such mistake4 ,he says that the wounds of nerves1 since the nerve is an instrument of sense and motion1 are1 on account of the greater sensitiveness which these structures possess1 likely to involve much pain4 ,wounds along the length of the nerves are less dangerous than those across them4 ,when a nerve is completely divided by a cross wound ,lanfranc is of the opinion1 though ,theodoric and some others are opposed to it1 that the nerve ends should be stitched together4 ,he says that this suture insures the redintegration of the nerve much better4 ,after this operation the restoration of the usefulness of the member is more complete and assured4 ,his description of the treatment of the bite of a rabid dog is interesting4 ,a large cupping glass should be applied over the wound so as to draw out as much blood as possible4 ,after this the wound should be dilated and thoroughly cauterized to its depths with a hot iron4 ,it should then be covered with various substances that were supposed to draw1 in order as far as possible to remove the poison4 ,his description of how one may recognize a rabid animal is rather striking in the light of our present knowledge1 for he seems to have realized that the main diagnostic element is a change in the disposition of the animal1 but above all a definite tendency to lack playfulness4 ,lanfranc had seen a number of cases of true rabies1 and describes and suggests treatment for them1 though evidently without very much confidence in the success of the treatment4 ,the treatment of snake bites and the bites of other poisonous animals was supposed to follow the principles laid down for the bite of a mad dog1 especially as regards the encouragement of free bleeding and the use of the cautery4 ,lanfranc has many other expressions that one is tempted to quote1 because they show a thinking surgeon of the old time1 anticipating many supposedly modern ideas and conclusions4 ,he is a particular favorite of ,gurlt's1 who has more than twenty-five large octavo1 closely printed pages with regard to him4 ,there is scarcely any development in our modern surgery that ,lanfranc has not at least a hint of1 certainly nothing in the surgery of a generation ago that does not find a mention in his book4 ,on most subjects he has practical observations from his own experience to add to what was in surgical literature before his time4 ,he quotes altogether more than a score of writers on surgery who had preceded him and evidently was thoroughly familiar with general surgical literature4 ,there is scarcely an important surgical topic on which ,gurlt does not find some interesting and personal remarks made by ,lanfranc4 ,all that we can do here is refer those who are interested in ,lanfranc to his own works or ,gurlt4 ,,mondeville ,the next of the important surgeons who were to bring such distinction to ,french surgery for five centuries was ,henri de ,mondeville4 ,writers usually quote him as ,henricus4 ,his latter name is only the place of his birth1 which was probably not far from ,caen in ,normandy4 ,it is spelled in so many different ways1 however1 by different writers that it is well to realize that almost anything that looks like ,mondeville probably refers to him4 ,such variants as ,mundeville1 ,hermondaville1 ,amondaville1 ,amundaville1 ,amandaville1 ,mandeville1 ,armandaville1 ,armendaville1 ,amandavilla occur4 ,we owe a large amount of our information with regard to him to ,professor ,pagel1 who issued the first edition of his book ever published 7,berlin1 #ahib74 ,it may seem surprising that ,mondeville's work should have been left thus long without publication1 but unfortunately he did not live long enough to finish it4 ,he was one of the victims that tuberculosis claimed among physicians in the midst of their work4 ,though there are a great number of manuscript copies of his book1 somehow ,renaissance interest in it in its incompleted state was never aroused sufficiently to bring about a printed edition4 ,certainly it was not because of any lack of interest on the part of his contemporaries or any lack of significance in the work itself1 for its printing has been one of the surprises afforded us in the modern time as showing how thoroughly a great writer on surgery did his work at the beginning of the fourteenth century4 ,gurlt1 in his ,history of ,surgery1 has given over forty pages1 much of it small type1 with regard to ,mondeville1 because of the special interest there is in his writing4#bj ,his life is of particular interest for other reasons besides his subsequent success as a surgeon4 ,he was another of the university men of this time who wandered far for opportunities in education4 ,though born in the north of ,france and receiving his preliminary education there1 he made his medical studies towards the end of the thirteenth century under ,theodoric in ,italy4 ,afterwards he studied medicine in ,montpellier and surgery in ,paris4 ,later he gave at least one course of lectures at ,montpellier himself and a series of lectures in ,paris1 attracting to both universities during his professorship a crowd of students from every part of ,europe4 ,one of his teachers at ,paris had been his compatriot1 ,jean ,pitard1 the surgeon of ,philippe le ,bel1 of whom he speaks as most skilful and expert in the art of surgery1 and it was doubtless to ,pitard's friendship that he owed his appointment as one of the four surgeons and three physicians who accompanied the ,king into ,flanders4 ,besides his lectures1 ,mondeville had a large consultant practice and also had to accompany the ,king on his campaigns4 ,this made it extremely difficult for him to keep continuously at the writing of his book4 ,it was delayed in spite of his good intentions1 and we have the picture that is so familiar in the modern time of a busy man trying to steal or make time for his writing4 ,unfortunately1 in addition to other obstacles1 ,mondeville showed probably before he was forty the first symptoms of a serious pulmonary disease1 presumably tuberculosis4 ,he bravely fought it and went on with his work4 ,as his end approached he sketched in lightly what he had hoped to treat much more formally1 and then turned to what was to have been the last chapter of his book1 the ,antidotarium or suggestions of practical remedies against diseases of various kinds because his students and physician friends were urging him to complete this portion for them4 ,we of the modern time are much less interested in that than we would have been in some of the portions of the work that ,mondeville neglected in order to provide therapeutic hints for his disciples4 ,but then the students and young physicians have always clamored for the practical--which so far at least in medical history has always proved of only passing interest4 ,it is often said that at this time surgery was mainly in the hands of barbers and the ignorant4 ,henri de ,mondeville1 however1 is a striking example in contradiction of this4 ,he must have had a fine preliminary education and his book shows very wide reading4 ,there is almost no one of any importance who seriously touched upon medicine or surgery before his time whom ,mondeville does not quote4 ,hippocrates1 ,aristotle1 ,dioscorides1 ,pliny1 ,galen1 ,rhazes1 ,ali ,abbas1 ,abulcasis1 ,avicenna1 ,constantine ,africanus1 ,averros1 ,maimonides1 ,albertus ,magnus1 ,hugo of ,lucca1 ,theodoric1 ,william of ,salicet1 ,lanfranc are all quoted1 and not once or twice but many times4 ,besides he has quotations from the poets and philosophers1 ,cato1 ,diogenes1 ,horace1 ,ovid1 ,plato1 ,seneca1 and others4 ,he was a learned man1 devoting himself to surgery4 ,it is no wonder1 then1 that he thought that a surgeon should be a scholar1 and that he needed to know much more than a physician4 ,one of his characteristic passages is that in which he declares it is impossible that a surgeon should be expert who does not know not only the principles1 but everything worth while knowing about medicine1 and then he added1 just as it is impossible for a man to be a good physician who is entirely ignorant of the art of surgery4 ,he says further3 ,this our art of surgery1 which is the third part of medicine 7the other two parts were diet and drugs71 is1 with all due reverence to physicians1 considered by us surgeons ourselves and by the non-medical as a more certain1 nobler1 securer1 more perfect1 more necessary1 and more lucrative art than the other parts of medicine4 ,surgeons have always been prone to glory in their specialty4 ,mondeville had a high idea of the training that a surgeon should possess4 ,he says3 ,a surgeon who wishes to operate regularly ought first for a long time to frequent places in which skilled surgeons operate often1 and he ought to pay careful attention to their operations and commit their technique to memory4 ,then he ought to associate himself with them in doing operations4 ,a man cannot be a good surgeon unless he knows both the art and science of medicine and especially anatomy4 ,the characteristics of a good surgeon are that he should be moderately bold1 not given to disputations before those who do not know medicine1 operate with foresight and wisdom1 not beginning dangerous operations until he has provided himself with everything necessary for lessening the danger4 ,he should have well-shaped members1 especially hands with long1 slender fingers1 mobile and not tremulous1 and with all his members strong and healthy so that he may perform all the good operations without disturbance of mind4 ,he must be highly moral1 should care for the poor for ,god's sake1 see that he makes himself well paid by the rich1 should comfort his patients by pleasant discourse1 and should always accede to their requests if these do not interfere with the cure of the disease4 ,it follows from this1 he says1 that the perfect surgeon is more than the perfect physician1 and that while he must know medicine he must in addition know his handicraft4 ,thinking thus1 it is no wonder that he places his book under as noble patronage as possible4 ,he says in the preface that he began to write it for the honor and praise of ,christ ,jesus1 of the ,virgin ,mary1 of the ,saints and ,martyrs1 ,cosmas and ,damian1 and of ,king ,philip of ,france as well as his four children1 and on the proposal and request of ,master ,william of ,briscia1 distinguished professor in the science of medicine and formerly physician to ,pope ,boniface ,,iv and ,benedict and ,clement1 the present ,pope4 ,his first book on anatomy he proposed to found on that of ,avicenna and on his personal experience as he has seen it4 ,the second tractate on the treatments of wounds1 contusions1 and ulcers was founded on the second book of ,theodoric with whatever by recent study has been newly acquired and brought to light through the experience of modern physicians4 ,he then confesses his obligations to his great master1 ,john ,pitard1 and adds that all the experience that he has gained while operating1 studying1 and lecturing for many years on surgery will be made use of in order to enhance the value of the work4 ,he hopes1 however1 to accomplish all this briefly1 quietly1 and above all1 charitably4 ,there are many things in the preface that show us the reason for ,mondeville's popularity1 for they exhibit him as very sympathetically human in his interests4 ,while ,mondeville is devoted to the principle that authority is of great value1 he said that there was nothing perfect in things human1 and successive generations of younger men often made important additions to what their ancestors had left them4 ,while his work is largely a compilation1 nearly everywhere it shows signs of the modification of his predecessors' opinions by the results of his own experience4 ,his method of writing is1 as ,pagel declares1 always interesting1 lively1 and often full of meat4 ,he had a teacher's instinct1 for in several of the earlier manuscripts his special teaching is put in larger letters in order to attract students' attention4444 ,he seems to have introduced or re-introduced into practice the idea of the use of a large magnet in order to extract portions of iron from the tissues4 ,he made several modifications in needles and thread holders and invented a kind of small derrick for the extraction of arrows with barbs4 ,besides1 he suggested the surrounding of the barbs of the arrows with tubes1 to facilitate extraction4 ,in his treatment of wounds1 ,pagel considers that as a writer and teacher he is far ahead of his predecessors and even of those who came after him in immediately subsequent generations4 ,one of his great merits undoubtedly is that ,guy de ,chauliac1 the father of modern surgery1 in his text-book turned to him with a confidence that proclaims his admiration and how much he felt that he had gained from him4 ,one of the most interesting features of ,mondeville's work is his insistence on the influence of the mind on the body and the importance of using this influence to the best advantage4 ,it is especially important in ,mondeville's opinion to keep a surgical patient from being moody4 ,let the surgeon1 says he1 take care to regulate the whole regimen of the patient's life for joy and happiness by promising that he will soon be well1 by allowing his relatives and special friends to cheer him and by having someone to tell him jokes1 and let him be solaced also by music on the viol or psaltery4 ,the surgeon must forbid anger1 hatred1 and sadness in the patient1 and remind him that the body grows fat from joy and thin from sadness4 ,he must insist on the patient obeying him faithfully in all things4 ,he repeats with approval the expression of ,avicenna that often the confidence of the patient in his physician does more for the cure of his disease than the physician with all his remedies4 ,obstinate and conceited patients prone to object to nearly everything that the surgeon wants to do1 and who often seem to think that they surpass ,galen and ,hippocrates in science and wisdom1 are likely to delay their cure very much1 and they represent the cases with which the surgeon has much difficulty4 ,mondeville thought that nursing was extremely important and that without it surgery often failed of its purpose4 ,he says1 ,for if the assistants are not solicitous and faithful1 and obedient to the surgeons in each and every thing which may make for the cure of the disease1 they put obstacles and difficulties in the way of the surgeon4 ,it is especially important that the patient's nutrition should be cared for and that the bandages should be managed exactly as the surgeon directs4 ,he has no use for garrulous1 talkative nurses1 and does not hesitate to say that sometimes near relatives are particularly likely to disturb patients4 ,especially are they prone to let drop some hint of bad news which the surgeon may have revealed to them in secret1 or even the reports that they may hear from others1 friends or enemies1 and this provokes the patient to anger or anxiety and is likely to give him fever4 ,if the assistants quarrel among themselves1 or are heard murmuring1 or if they draw long faces1 all of these things will disturb the patients and produce worry and anxiety or fear4 ,the surgeon therefore must be careful in the selection of his nurses1 for some of them obey very well while he is present1 but do as they like and often just exactly the opposite of what he has directed when he is away4 ,we do not know enough of the details of ,mondeville's life to be sure whether he was married or not4 ,it is probable that he was not1 for all of these surgeons of the thirteenth century before ,mondeville's time1 ,theodoric1 ,william of ,salicet1 ,lanfranc1 and ,guy de ,chauliac1 after him belonged to the clerical order2 ,theodoric was a bishop2 the others1 however1 seem only to have been in minor orders4 ,it is therefore from the standpoint of a man who views married life from without that ,mondeville makes his remarks as to the difficulty often encountered when wives nurse their husbands4 ,he says that the surgeon has difficulty oftener when husbands or wives care for their spouses than at other times4 ,this is much more likely to take place when the wives are caring for the husbands4 ,in our days1 he says1 in this ,gallican part of the world1 wives rule their husbands1 and the men for the most part permit themselves to be ruled4 ,whatever a surgeon may order for the cure of a husband then will often seem to the wives to be a waste of good material1 though the men seem to be quite willing to get anything that may be ordered for the cure of their wives4 ,the whole cause of this seems to be that every woman seems to think that her husband is not as good as those of other women whom she sees around her4 ,it would be interesting to know how ,mondeville was brought to a conclusion so different from modern experience in the matter4 ,for those who are particularly interested in medical history one of the sections of ,henry's book has a special appeal1 because he gives in it a sketch of the history of surgery4 ,we are little likely to think1 as a rule1 that at this time1 full two centuries before the close of the ,middle ,ages1 men were interested enough in the doings of those who had gone before them to try to trace the history of the development of their specialty4 ,it is characteristic of the way that the scholarly ,mondeville views his own life work that he should have wanted to know something about his predecessors and teach others with regard to them4 ,he begins with ,galen1 and as ,galen divides the famous physicians of the world into three sects1 the ,methodists1 the ,empirics1 and the ,rationalists1 so ,mondeville divides modern surgery into three sects3 first1 that of the ,salernitans1 with ,roger1 ,roland1 and the ,four ,masters2 second1 that of ,william of ,salicet and ,lanfranc2 and third1 that of ,hugo de ,lucca and his brother ,theodoric and their modern disciples4 ,he states briefly the characteristics of these three sects4 ,the first limited patients' diet1 used no stimulants1 dilated all wounds1 and got union only after pus formation4 ,the second allowed a liberal diet to weak patients1 though not to the strong1 but generally interfered with wounds too much4 ,the third believed in a liberal diet1 never dilated wounds1 never inserted tents1 and its members were extremely careful not to complicate wounds of the head by unwise interference4 ,his critical discussion of the three schools is extremely interesting4 ,another phase of ,mondeville's work that is sympathetic to the moderns is his discussion of the irregular practice of medicine and surgery as it existed in his time4 ,most of our modern medicine and surgery was anticipated in the olden time2 but it may be said that all of the modes of the quack are as old as humanity4 ,galen's description of the travelling charlatan who settled down in his front yard1 not knowing that it belonged to a physician1 shows this very well4 ,there were evidently as many of them and as many different kinds in ,mondeville's time as in our own4 ,in discussing the opposition that had arisen between physicians and surgeons in his time and their failure to realize that they were both members of a great profession1 he enumerates the many different kinds of opponents that the medical profession had4 ,there were barbers1 soothsayers1 loan agents1 falsifiers1 alchemists1 meretrices1 midwives1 old women1 converted ,jews1 ,saracens1 and indeed most of those who1 having wasted their substance foolishly1 now proceed to make physicians or surgeons of themselves in order to make their living under the cloak of healing4 ,what surprises ,mondeville however1 as it has always surprised every physician who knows the situation1 is that so many educated1 or at least supposedly well-informed people of the better classes1 indeed even of the so-called best classes1 allow themselves to be influenced by these quacks4 ,and it is even more surprising to him that so many well-to-do1 intelligent people should1 for no reason1 though without knowledge1 presume to give advice in medical matters and especially in even dangerous surgical diseases1 and in such delicate affections as diseases of the eyes4 ,it thus often happens that diseases in themselves curable grow to be simply incurable or are made much worse than they were before4 ,he says that some of the clergymen of his time seemed to think that a knowledge of medicine is infused into them with the sacrament of ,holy ,orders4 ,he was himself probably a clergyman1 and ,i have in the modern time more than once known of teachers in the clerical seminaries emphasizing this same idea for the clerical students4 ,it is very evident that the world has not changed very much1 and that to know any time reasonably well is to find in it comments on the morning paper4 ,we are in the midst of just such a series of interferences with medicine on the part of the clergy as this wise1 common-sense surgeon of the thirteenth century deprecated4 ,in every way ,mondeville had the instincts of a teacher4 ,he took advantage of every aid4 ,he was probably the first to use illustrations in teaching anatomy4 ,guy de ,chauliac1 whose teacher in anatomy for some time ,mondeville was1 says in the first chapter of his ,chirurgia ,magna that pictures do not suffice for the teaching of anatomy and that actual dissection is necessary4 ,the passage runs as follows3 ,in the bodies of men1 of apes1 and of pigs1 and of many other animals1 tissues should be studied by dissections and not by pictures1 as did ,henricus1 who was seen to demonstrate anatomy with thirteen pictures4#ba ,what ,chauliac blames is the attempt to replace dissections by pictorial demonstrations4 ,hyrtl1 however1 suggests that this invention of ,mondeville's was probably very helpful1 and was brought about by the impossibility of preserving bodies for long periods as well as the difficulty of obtaining them4 ,,yperman ,one of the maxims of the old ,greek philosophers was that good is diffusive of itself4 ,as the scholastics put it1 bonum est diffusivum sui4 ,this proved to be eminently true of the old universities also1 and especially of their training in medicine and in surgery4 ,we have the accounts of men from many nations who went to the universities and returned to benefit their own people4 ,early in the thirteenth century ,richard the ,englishman was in ,italy1 having previously been in ,paris and probably at ,montpellier4 ,bernard ,gordon1 probably also an ,englishman1 was one of the great lights in medicine down at ,montpellier1 and his book1 ,lilium ,de ,medicina1 is well known4 ,two distinguished surgeons whose names have come down to us1 having studied in ,paris after ,lanfranc had created the tradition of great surgical teaching there1 came to their homes to be centres of beneficent influence among their people in this matter4 ,one was ,yperman1 of the town of ,ypres in ,belgium2 the other ,ardern of ,england4 ,yperman was sent by his fellow-townsmen to ,paris in order to study surgery1 because they wanted to have a good surgeon in their town and ,paris seemed the best school at that time4 ,ypres was at this period one of the greatest commercial cities of ,europe1 and probably had a couple of hundred thousand inhabitants4 ,the great hall of the cloth gild1 which has been such an attraction for visitors ever since1 was built shortly before the town determined upon the very sensible procedure of securing good surgery beyond all doubt by having a townsman specially educated for that purpose4 ,yperman's work was practically unknown to us until ,broeck1 the ,belgian historian1 discovered manuscript copies of his book on surgery and gathered some details of his life4 ,after his return from ,paris1 ,yperman obtained great renown1 which maintained itself in the custom extant in that part of the country even yet of calling an expert surgeon an ,yperman4 ,he is the author of two works in ,flemish4 ,one of these is a smaller compendium of internal medicine1 which is very interesting1 however1 because it shows the many subjects that were occupying physicians' minds at that time4 ,he treats of dropsy1 rheumatism1 under which occur the terms coryza and catarrh 7the flowing diseases71 icterus1 phthisis 7he calls the tuberculosis1 tysiken71 apoplexy1 epilepsy1 frenzy1 lethargy1 fallen palate1 cough1 shortness of breath1 lung abscess1 hemorrhage1 blood-spitting1 liver abscess1 hardening of the spleen1 affections of the kidney1 bloody urine1 diabetes1 incontinence of urine1 dysuria1 strangury1 gonorrhea1 and involuntary seminal emissions--all these terms are quoted directly from ,pagel's account of his work2 the original is not available in this country4 ,,john ,,ardern ,in ,english-speaking countries of course we are interested in what was done by ,englishmen at this time4 ,fortunately we have the record of one great ,english surgeon of the period worthy to be placed beside even the writers already mentioned4 ,this is ,john ,ardern1 whose name is probably a modification of the more familiar ,arden1 whose career well deserves attention4 ,i have given a sketch of his work in ,the ,popes and ,science4#bb ,he was educated at ,montpellier1 and practised surgery for a time in ,france4 ,about the middle of the century however1 according to ,pagel1 he went back to his native land and settled for some twenty years at ,newark1 in ,nottinghamshire1 and then for nearly thirty years longer1 until about the end of the century1 was in ,london4 ,he is the chief representative of ,english surgery during the ,middle ,ages4 ,his ,practica1 as yet unprinted1 contains1 according to ,pagel1 a short sketch of internal medicine1 but is mainly devoted to surgery4 ,contrary to the usual impression with regard to works in medicine and surgery at this time1 the book abounds in references to case histories which ,ardern had gathered1 partly from his own and partly from others' experience4 ,the therapeutic measures that he suggests are usually very simple1 in the majority of cases quite rational1 though1 of course1 there are many superstitions among them2 but ,ardern always furnished a number of suggestions from which to choose4 ,he must have been an expert operator1 and had excellent success in the treatment of diseases of the rectum4 ,he seems to have been the first operator who made careful statistics of his cases1 and was quite as proud as any modern surgeon of the large numbers that he had operated on1 which he gives very exactly4 ,he was the inventor of a new clyster apparatus4 ,fortunately we possess here in ,america1 in the ,surgeon ,general's ,library at ,washington1 a very interesting manuscript containing ,ardern's surgical writings1 though it has not yet been published4 ,even a little study of this and of the notes on it prepared by an ,english bibliophile before its purchase by the ,surgeon ,general's ,library1 serves to show how valuable the work is in the history of surgery4 ,there are illustrations scarcely less interesting than the text4 ,some of these illustrations were inserted by the original writer or copyist1 and some of them later4 ,in general1 however1 they show a rather high development of the mechanics of surgery at that time4 ,some of the pages have spaces for illustrations left unfilled1 so that evidently the copyist did not complete his work4 ,the titles of certain of the chapters are interesting1 as illustrating the fact that our medical and surgical problems were stated clearly in the olden time1 and thinking physicians1 even six centuries ago1 met them quite rationally4 ,there is1 for instance1 a chapter headed ,against ,colic and the ,iliac ,passion1 immediately followed by the subheading1 ,method of ,administering ,clysters4 ,the iliac passion1 passio iliaca of the old ,latin1 is usually taken to signify some obstruction of the intestines causing severe pain1 vomiting1 and eventually fecal vomiting4 ,a good many different forms of severe painful conditions1 especially all those complicated by peritonitis1 were included under the term1 and the modern student of surgery is likely to wonder whether these old observers had not noted that the right iliac region was particularly prone to be the source of fatal conditions4 ,there is a chapter entitled ,against ,pain in the ,loins and the ,kidneys1 followed by the chapter subheading1 ,against ,stone in the ,kidneys4 ,there is a chapter with the title1 ,against ,ulceration of the ,bladder or the ,kidneys4 ,another one1 with the title ,against ,burning of the ,urine and ,excoriation of the ,lower ,part of the ,yard4 ,gonorrhea is frankly treated under the name ,shawdepisse1 evidently an ,english alliteration of the corresponding ,french word4 ,as to the instrumentation of such conditions and for probing in general1 ,ardern suggests the use of a lead probe1 because it may readily be made to bend any way and not injure the tissues4 ,,medieval ,,surgery ,even this brief account of the surgeons who taught and studied at the medieval universities demonstrates what fine work they did4 ,it is surely not too much to say that the chapter on university education mainly concerned with them is one of the most interesting in the whole history of the universities4 ,their story alone is quite enough to refute most of the prevalent impressions and patronizing expressions with regard to medieval education4 ,their careers serve to show how interested were the men of many nations in the development of an extremely important application of science for the benefit of suffering humanity4 ,their work utterly contradicts the idea so frequently emphasized that the great students of the ,middle ,ages were lacking in practicalness4 ,besides1 they make very clear that we have been prone to judge the ,middle ,ages too much from its speculative philosophies4 ,it has been the custom to say that speculation ruled men's minds and prevented them from making observations1 developing science1 or applying scientific principles4 ,there was much speculation during the ,middle ,ages1 but probably not any more in proportion than exists at the present day4 ,we were either not acquainted with1 or failed to appreciate properly1 until comparatively recent years1 the other side of medieval accomplishment4 ,our ignorance led us into misunderstanding of what these generations really did4 ,it was our own fault1 because during the ,renaissance practically all of these books were edited and printed under the direction of the great scholars of the time in fine editions1 but during the eighteenth century nearly all interest was lost in them1 and we are only now beginning to get back a certain amount of the precious knowledge that they had in the ,renaissance period of this other side of medieval life4 ,we have learned so much about surgery because distinguished scholars devoted themselves to this phase of the history of science4 ,doubtless there are many other phases of the history of science which suffered the same fate of neglect and with regard to which the future will bring us equally startling revelations4 ,for this reason this marvellous chapter in the history of surgery is a warning as well as a startling record of a marvellous epoch of human progress4 ,,xi ,,guy ,,de ,,chauliac ,one of the most interesting characters in the history of medieval medicine1 and undoubtedly the most important and significant of these ,old-,time ,makers of ,medicine1 is ,guy de ,chauliac4 ,most of the false notions so commonly accepted with regard to the ,middle ,ages at once disappear after a careful study of his career4 ,the idea of the careful application of scientific principles in a great practical way is far removed from the ordinary notion of medieval procedure4 ,some observations we may concede that they did make1 but we are inclined to think that these were not regularly ordered and the lessons of them not drawn so as to make them valuable as experiences4 ,great art men may have had1 but science and1 above all1 applied science1 is a later development of humanity4 ,particularly is this supposed to be true with regard to the science and practice of surgery1 which is assumed to be of comparatively recent origin4 ,nothing could well be less true1 and if the thoroughly practical development of surgery may be taken as a symbol of how capable men were of applying science and scientific principles1 then it is comparatively easy to show that the men of the later ,middle ,ages were occupied very much as have been our recent generations with science and its practical applications4 ,the immediate evidence of the value of old-time surgery is to be found in the fact that ,guy de ,chauliac1 who is commonly spoken of in the history of medicine as the ,father of ,modern ,surgery1 lived his seventy-odd years of life during the fourteenth century and accomplished the best of his work1 therefore1 some five centuries before surgery in our modern sense of the term is supposed to have developed4 ,a glance at his career1 however1 will show how old are most of the important developments of surgery1 as also in what a thoroughly scientific temper of mind this subject was approached more than a century before the close of the ,middle ,ages4 ,the life of this ,french surgeon1 indeed1 who was a cleric and occupied the position of chamberlain and physician-in-ordinary to three of the ,avignon ,popes1 is not only a contradiction of many of the traditions as to the backwardness of our medieval forbears in medicine1 that are readily accepted by many presumably educated people1 but it is the best possible antidote for that insistent misunderstanding of the ,middle ,ages which attributes profound ignorance of science1 almost complete failure of observation1 and an absolute lack of initiative in applications of science to the men of those times4 ,guy de ,chauliac's life is modern in nearly every phase4 ,he was educated in a little town of the south of ,france1 made his medical studies at ,montpellier1 and then went on a journey of hundreds of miles into ,italy1 in order to make his post-graduate studies4 ,italy occupied the place in science at that time that ,germany has taken during the nineteenth century4 ,a young man who wanted to get into touch with the great masters in medicine naturally went down into the ,peninsula4 ,traditions as to the attitude of the ,church to science notwithstanding1 ,italy where education was more completely under the influence of the ,popes and ecclesiastics than in any other country in ,europe1 continued to be the home of post-graduate work in science for the next four centuries4 ,almost needless to say1 the journey to ,italy was more difficult of accomplishment and involved more expense and time than would even the voyage from ,america to ,europe in our time4 ,chauliac realized1 however1 that both time and expense would be well rewarded1 and his ardor for the rounding out of his education was amply recompensed by the event4 ,nor have we any reason for thinking that what he did was very rare1 much less unique1 in his time4 ,many a student from ,france1 ,germany1 and ,england made the long journey to ,italy for post-graduate opportunities during the later ,middle ,ages4 ,even this post-graduate experience in ,italy did not satisfy ,chauliac1 however1 for1 after having studied several years with the most distinguished ,italian teachers of anatomy and surgery1 he spent some time in ,paris1 apparently so as to be sure that he would be acquainted with the best that was being done in his specialty in every part of the world4 ,he then settled down to his own life work1 carrying his ,italian and ,french masters' teachings well beyond the point where he received them1 and after years of personal experience he gathered together his masters' ideas1 tested by his own observations1 into his ,chirurgia ,magna1 a great text-book of surgery which sums up the whole subject succinctly1 yet completely1 for succeeding generations4 ,when we talk about what he accomplished for surgery1 we are not dependent on traditions nor vague information gleaned from contemporaries and successors1 who might perhaps have been so much impressed by his personality as to be made over-enthusiastic in their critical judgment of him4 ,we know the man in his surgical works1 and they have continued to be classics in surgery ever since4 ,it is an honorable distinction for the medicine of the later fourteenth1 the fifteenth1 and sixteenth centuries that ,guy de ,chauliac's book was the most read volume of the time in medicine4 ,evidently the career of such a man is of import1 not alone to physicians1 but to all who are interested in the history of education4 ,chauliac derives his name from the little town of ,chauliac in the diocese of ,mende1 almost in the centre of what is now the department of ,lozre4 ,the records of births and deaths were not considered so important in the fourteenth century as they are now1 and so we are not sure of either in the case of ,chauliac4 ,it is usually considered that he was born some time during the last decade of the thirteenth century1 probably toward the end of it1 and that he died about #acgj4 ,of his early education we know nothing1 but it must have been reasonably efficient1 since it gave him a good working knowledge of ,latin1 which was the universal language of science and especially of medicine at that time2 and though his own style1 as must be expected1 is no better than that of his contemporaries1 he knew how to express his thoughts clearly in straightforward ,latin1 with only such a mixture of foreign terms as his studies suggested and the exigencies of a new development of science almost required4 ,later in life he seems to have known ,arabic very well1 for he is evidently familiar with ,arabian books and does not depend merely on translations of them4 ,pagel1 in the first volume of ,puschmann's ,handbook of the ,history of ,medicine1 says1 on the authority of ,nicaise and others1 that ,chauliac received his early education from the village clergyman4 ,his parents were poor1 and but for ecclesiastical interest in him it would have been difficult for him to obtain his education4 ,the ,church supplied at that time to a great extent for the foundations and scholarships1 home and travelling1 of our day1 and ,chauliac was amongst the favored ones4 ,how well he deserved the favor his subsequent career shows1 as it completely justifies the judgment of his patrons4 ,he went first to ,toulouse1 as we know from his affectionate mention of one of his teachers there4 ,toulouse was more famous for law1 however1 than for medicine1 and after a time ,chauliac sought ,montpellier to complete his medical studies4 ,for ,english-speaking people an added interest in ,guy de ,chauliac will be the fact that one of his teachers at ,montpellier was ,bernard ,gordon1 very probably a ,scotchman1 who taught for some thirty-five years at this famous university in the south of ,france1 and died near the end of the first quarter of the fourteenth century4 ,one of ,chauliac's fellow-students at ,montpellier was ,john of ,gaddesden1 the first ,english ,royal ,physician by official appointment of whom we have any account4 ,john is mentioned by ,chaucer in his ,doctor of ,physic1 and is usually looked upon as one of the fathers of ,english medicine4 ,chauliac did not think much of him1 though his reason for his dislike of him will probably be somewhat startling to those who assume that the men of the ,middle ,ages always clung servilely to authority4 ,chauliac's objection to ,gaddesden's book is that he merely repeats his masters and does not dare to think for himself4 ,it is not hard to understand that such an independent thinker as ,chauliac should have been utterly dissatisfied with a book that did not go beyond the forefathers in medicine that the author quotes4 ,this is the explanation of his well-known expression1 ,last of all arose the scentless rose of ,england ',rosa ,angli' was the name of ,john of ,gaddesden's book1 in which1 on its being sent to me1 ,i hoped to find the odor of sweet originality1 but instead of that ,i encountered only the fictions of ,hispanus1 of ,gilbert1 and of ,theodoric4 ,the presence of a ,scotch professor and an ,english fellow-student1 afterwards a royal physician1 at ,montpellier1 at the beginning of the fourteenth century1 shows how much more cosmopolitan was university life in those times than we are prone to think1 and what attraction a great university medical school possessed even for men from long distances4 ,after receiving his degree of ,doctor of ,medicine at ,montpellier ,chauliac went1 as we have said1 to ,bologna4 ,here he attracted the attention and received the special instruction of ,bertruccio1 who was attracting students from all over ,europe at this time and was making some excellent demonstrations in anatomy1 employing human dissections very freely4 ,chauliac tells of the methods that ,bertruccio used in order that bodies might be in as good condition as possible for demonstration purposes1 and mentions the fact that he saw him do many dissections in different ways4 ,in ,roth's life of ,vesalius1 which is usually considered one of our most authoritative medical historical works not only with regard to the details of ,vesalius' life1 but also in all that concerns anatomy about that time and for some centuries before1 there is a passage quoted from ,chauliac himself which shows how freely dissection was practised at the ,italian universities in the fourteenth century4 ,this passage deserves to be quoted at some length because there are even serious historians who still cite a ,bull of ,pope ,boniface ,,viii1 issued in #acjj1 forbidding the boiling and dismembering of bodies in order to transport them to long distances for burial in their own country1 as being1 either rightly or wrongly1 interpreted as a prohibition of dissection and1 therefore1 preventing the development of anatomy4 ,in the notes to his history of dissection during this period in ,bologna ,roth says3 ,without doubt the passage in ,guy de ,chauliac which tells of having frequently seen dissections1 must be considered as referring to ,bologna4 ,this passage runs as follows3 ',my master ,bertruccius conducted the dissection very often after the following manner3 the dead body having been placed upon a bench1 he used to make four lessons on it4 ,in the first the nutritional portions were treated1 because they are so likely to become putrefied4 ,in the second1 he demonstrated the spiritual members2 in the third1 the animate members2 in the fourth1 the extremities4' 7,roth1 ,andreas ,vesalius4 ,basel1 #ahif47 ,bertruccio's master1 ,mondino1 is hailed in the history of medicine as the father of dissection4 ,his book on dissection was for the next three centuries in the hands of nearly every medical scholar in ,europe who was trying to do good work in anatomy4 ,it was not displaced until ,vesalius came1 the father of modern anatomy1 who revolutionized the science in the ,renaissance time4 ,mondino had devoted himself to the subject with unfailing ardor and enthusiasm1 and from everywhere in ,europe the students came to receive inspiration in his dissecting-room4 ,within a few years such was the enthusiasm for dissection aroused by him in ,bologna that there were many legal prosecutions for body-snatching1 the consequence doubtless of a regulation of the ,medical ,department of the ,university of ,bologna1 that if the students brought a body to any of their teachers he was bound to dissect it for them4 ,bertruccio1 ,mondino's disciple and successor1 continued this great work1 and now ,chauliac1 the third in the tradition1 was to carry the ,bolognese methods back to ,france1 and his position as chamberlain to the ,pope was to give them a wide vogue throughout the world4 ,the great ,french surgeon's attitude toward anatomy and dissection can be judged from his famous expression that the surgeon ignorant of anatomy carves the human body as a blind man carves wood4 ,the whole subject of dissection at this time has been fully discussed in the first three chapters of my ,popes and ,science1 where those who are interested in the matter may follow it to their satisfaction4#bc ,after his ,bologna experience ,chauliac went to ,paris4 ,evidently his indefatigable desire to know all that there was to be known would not be satisfied until he had spent some time at the great ,french university where ,lanfranc1 after having studied under ,william of ,salicet in ,italy1 had gone to establish that tradition of ,french surgery which1 carried on so well by ,mondeville his great successor1 was to maintain ,frenchmen as the leading surgeons of the world until the nineteenth century 7,pagel74 ,lanfranc1 himself an ,italian1 had been exiled from his native country1 apparently because of political troubles1 but was welcomed at ,paris because the faculty realized that they needed the inspiration of the ,italian medical movement in surgery for the establishment of a good school of surgery in connection with the university4 ,the teaching so well begun by ,lanfranc was magnificently continued by ,mondeville and ,arnold of ,villanova and their disciples4 ,chauliac was fortunate enough to come under the influence of ,petrus de ,argentaria1 who was worthily maintaining the tradition of practical teaching in anatomy and surgery so well founded by his great predecessors of the thirteenth century4 ,after this grand tour ,chauliac was himself prepared to do work of the highest order1 for he had been in touch with all that was best in the medicine and surgery of his time4 ,like many another distinguished member of his profession1 ,chauliac did not settle down in the scene of his ultimate labors at once1 but was something of a wanderer4 ,his own words are1 ,et per multa tempora operatus fui in multis partibus4 ,perhaps out of gratitude to the clerical patrons of his native town to whom he owed so much1 or because of the obligations he considered that he owed them for his education1 he practised first in his native diocese of ,mende2 thence he removed to ,lyons1 where we know that he lived for several years1 for in #acdd he took part as a canon in a chapter that met in the ,church of ,st4 ,just in that city4 ,just when he was called to ,avignon we do not know1 though when the black death ravaged that city in #acdh he was the body-physician of ,pope ,clement ,,vi1 for he is spoken of in a ,papal document as venerabilis et circumspectus vir1 dominus ,guido de ,cauliaco1 canonicus et prpositus ecclesi ,sancti ,justi ,lugduni1 medicusque domini ,nostri ,pap4 ,all the rest of his life was passed in the ,papal capital1 which ,avignon was for some seventy years of the fourteenth century4 ,he served as chamberlain-physician to three ,popes1 ,clement ,,vi1 ,innocent ,,vi1 and ,urban ,v4 ,we do not know the exact date of his death1 but when ,pope ,urban ,v went to ,rome in #acfg1 ,chauliac was putting the finishing touches on his ,chirurgia ,magna1 which1 as he tells us1 was undertaken as a solatium senectutis--a solace in old age4 ,when ,urban returned to ,avignon for a time in #acgj ,chauliac was dead4 ,his life work is summed up for us in this great treatise on surgery1 full of anticipations in surgical procedures that we are prone to think much more modern4 ,nicaise has emphasized the principles which guided ,guy de ,chauliac in the choice and interpretation of his authorities by a quotation from ,guy himself1 which is so different in its tone from what is usually supposed to have been the attitude of mind of the men of science of the time that it would be well for all those who want to understand the ,middle ,ages better to have it near them4 ,speaking of the surgeons of his own and immediately preceding generations1 ,guy says3 ,one thing particularly is a source of annoyance to me in what these surgeons have written1 and it is that they follow one another like so many cranes4 ,for one always says what the other says4 ,i do not know whether it is from fear or from love that they do not deign to listen except to such things as they are accustomed to and as have been proved by authorities4 ,they have to my mind understood very badly ,aristotle's second book of metaphysics where he shows that these two things1 fear and love1 are the greatest obstacles on the road to the knowledge of the truth4 ,let them give up such friendships and fears4 ',because while ,socrates or ,plato may be a friend1 truth is a greater friend4' ,truth is a holy thing and worthy to be honored above everything else4 ,let them follow the doctrine of ,galen1 which is entirely made up of experience and reason1 and in which one investigates things and despises words4 ,after all1 this is what great authorities in medicine have always insisted on4 ,once every hundred years or so one finds a really great observer who makes new observations and wakes the world up4 ,he is surprised that men should not have used their powers of observation for themselves1 but should have been following old-time masters4 ,his contemporaries often refuse to listen to him at first4 ,his observations1 however1 eventually make their way4 ,we blame the ,middle ,ages for following authority1 but what have we been always doing but following authority1 except for the geniuses who come and lift us out of the rut and illuminate a new portion of the realm of medicine4 ,after they have come1 however1 and done their work1 their disciples proceed to see with their eyes and to think that they are making observations for themselves when they are merely following authority4 ,when the next master in medicine comes along his discovery is neglected because men have not found it in the old books1 and usually he has to suffer for daring to have opinions of his own4 ,the fact of the matter is that at any time there is only a very limited number of men who think for themselves4 ,the rest think other people's thoughts and think they are thinking and doing things4 ,as for observation1 ,john ,ruskin once said1 ,nothing is harder than to see something and tell it simply as you saw it4 ,this is as true in science as in art1 and only genius succeeds in doing it well4 ,chauliac's book is confessedly a compilation4 ,he has taken the good wherever he found it1 though he adds1 modestly enough1 that his work also contains whatever his own measure of intelligence enabled him to find useful 7qu juxta modicitatem mei ingenii utilia reputavi74 ,indeed it is the critical judgment displayed by ,chauliac in selecting from his predecessors that best illustrates at once the practical character of his intellect and his discerning spirit4 ,what the men of his time are said to have lacked is the critical faculty4 ,they were encyclopedic in intellect and gathered all kinds of information without discrimination1 is a very common criticism of medieval writers4 ,no one can say this of ,chauliac1 however1 and1 above all1 he was no respecter of authority1 merely for the sake of authority4 ,his criticism of ,john of ,gaddesden's book shows that the blind following of those who had gone before was his special bte noir4 ,his bitterest reproach for many of his predecessors was that they follow one another like cranes1 whether for love or fear1 ,i cannot say4 ,chauliac's right to the title of father of surgery will perhaps be best appreciated from the brief account of his recommendations as to the value of surgical intervention for conditions in the three most important cavities of the body1 the skull1 the thorax1 and the abdomen4 ,these cavities have usually been the dread of surgeons4 ,chauliac not only used the trephine1 but laid down very exact indications for its application4 ,expectant treatment was to be the rule in wounds of the head1 yet when necessary1 interference was counselled as of great value4 ,his prognosis of brain injuries was much better than that of his predecessors4 ,he says that he had seen injuries of the brain followed by some loss of brain substance1 yet with complete recovery of the patient4 ,in one case that he notes a considerable amount of brain substance was lost1 yet the patient recovered with only a slight defect of memory1 and even this disappeared after a time4 ,he lays down exact indications for the opening of the thorax1 that noli me tangere of surgeons at all times1 even our own1 and points out the relations of the ribs and the diaphragm1 so as to show just where the opening should be made in order to remove fluid of any kind4 ,in abdominal conditions1 however1 ,chauliac's anticipation of modern views is most surprising4 ,he recognized that wounds of the intestines were surely fatal unless leakage could be prevented4 ,accordingly he suggested the opening of the abdomen and the sewing up of such intestinal wounds as could be located4 ,he describes a method of suture for these cases and seems1 like many another abdominal surgeon1 even to have invented a special needleholder4 ,to most people it would seem absolutely out of the question that such surgical procedures could be practised in the fourteenth century4 ,we have the definite record of them1 however1 in a text-book that was the most read volume on the subject for several centuries4 ,most of the surprise with regard to these operations will vanish when it is recalled that in ,italy during the thirteenth century1 as we have already seen1 methods of ansthesia by means of opium and mandragora were in common use1 having been invented in the twelfth century and perfected by ,ugo da ,lucca1 and ,chauliac must not only have known but must have frequently employed various methods of ansthesia4 ,in discussing amputations he has described in general certain methods of ansthesia in use in his time1 and especially the method by means of inhalation4 ,it would not seem to us in the modern time that this method would be very successful1 but there is an enthusiastic accord of authorities attesting that operations were done at this time with the help of this inhalant without the infliction of pain4 ,chauliac says3 ,some prescribe medicaments which send the patient to sleep1 so that the incision may not be felt1 such as opium1 the juice of the morel1 hyoscyamus1 mandrake1 ivy1 hemlock1 lettuce4 ,a new sponge is soaked by them in these juices and left to dry in the sun2 and when they have need of it they put this sponge into warm water and then hold it under the nostrils of the patient until he goes to sleep4 ,then they perform the operation4 ,many people might be prone to think that the hospitals of ,chauliac's time would not be suitable for such surgical work as he describes4 ,it is1 however1 only another amusing assumption of this self-complacent age of ours to think that we were the first who ever made hospitals worthy of the name and of the great humanitarian purpose they subserve4 ,as a matter of fact1 the old-time hospitals were even better than ours or1 as a rule1 better than any we had until the present generation4 ,in ,the ,popes and ,science1 in the chapter on ,the ,foundation of ,city ,hospitals1 ,i call attention to the fact that architects of the present day go back to the hospitals of the ,middle ,ages in order to find the models for hospitals for the modern times4 ,mr4 ,arthur ,dillon1 a well-known ,new ,york architect1 writing of a hospital built at ,tonnerre in ,france1 toward the end of the thirteenth century 7#abib71 says3 ,it was an admirable hospital in every way1 and it is doubtful if we to-day surpass it4 ,it was isolated2 the ward was separated from the other buildings2 it had the advantage we so often lose of being but one story high1 and more space was given to each patient than we can now afford4 ,the ventilation by the great windows and ventilators in the ceiling was excellent2 it was cheerfully lighted2 and the arrangement of the gallery shielded the patients from dazzling light and from draughts from the windows and afforded an easy means of supervision1 while the division by the roofless low partitions isolated the sick and obviated the depression that comes from sight of others in pain4 ,it was1 moreover1 in great contrast to the cheerless white wards of to-day4 ,the vaulted ceiling was very beautiful2 the woodwork was richly carved1 and the great windows over the altars were filled with colored glass4 ,altogether it was one of the best examples of the best period of ,gothic ,architecture4#bd ,the fine hospital thus described was but one of many4 ,virchow1 in his article on hospitals quoted in the same chapter1 called attention to the fact that in the thirteenth and fourteenth centuries every town of five thousand or more inhabitants had its hospital1 founded on the model of the great ,santo ,spirito ,hospital in ,rome1 and all of them did good work4 ,the surgeons of ,guy de ,chauliac's time would indeed find hospitals wherever they might be called in consultation1 even in small towns4 ,they were more numerous in proportion to population than our own and1 as a rule1 at least as well organized as ours were until the last few years4 ,it is no wonder that with such a good hospital organization excellent surgery was accomplished4 ,hernia was ,chauliac's specialty1 and in it his surgical judgment is admirable4 ,mondeville before his time did not hesitate to say that many operations for hernia were done not for the benefit of the patient1 but for the benefit of the surgeon1--a very striking anticipation of remarks that one sometimes hears even at the present time4 ,chauliac discussed operations for hernia very conservatively4 ,his rule was that a truss should be worn1 and no operation attempted unless the patient's life was endangered by the hernia4 ,it is to him that we owe the invention of a well-developed method of taxis1 or manipulation of a hernia1 to bring about its reduction1 which was in use until the end of the nineteenth century4 ,he suggested that trusses could not be made according to rule1 but must be adapted to each individual case4 ,he invented several forms of truss himself1 and in general it may be said that his manipulative skill and his power to apply his mechanical principles to his work are the most characteristic of his qualities4 ,this is particularly noteworthy in his chapters on fractures and dislocations1 in which he suggests various methods of reduction and realizes very practically the mechanical difficulties that were to be encountered in the correction of the deformities due to these pathological conditions4 ,in a word1 we have a picture of the skilled surgeon of the modern time in this treatise of a fourteenth-century teacher of surgery4 ,chauliac discusses six different operations for the radical cure of hernia4 ,as ,gurlt points out1 he criticises them from the same standpoint as that of recent surgeons4 ,the object of radical operations for hernia is to produce a strong1 firm tissue support over the ring through which the cord passes1 so that the intestines cannot descend through it4 ,it is rather interesting to find that the surgeons of this time tried to obliterate the canal by means of the cautery1 or inflammation producing agents1 arsenic and the like1 a practice that recalls some methods still used more or less irregularly4 ,they also used gold wire1 which was to be left in the tissues and is supposed to protect and strengthen the closure of the ring4 ,at this time all these operations for the radical cure of hernia involved the sacrifice of the testicle because the old surgeons wanted to obliterate the ring completely1 and thought this the easiest way4 ,chauliac discusses the operation in this respect and says that he has seen many cases in which men possessed of but one testicle have procreated1 and this is a case where the lesser of two evils is to be chosen4 ,of course ,guy de ,chauliac would not have been able to operate so freely on hernia and suggest1 following his own experience1 methods of treatment of penetrating wounds of the abdomen only that he had learned the lessons of antiseptic surgery which had been gradually developed among the great surgeons of ,italy during the preceding century4 ,the use of the stronger wines as a dressing together with insistence on the most absolute cleanliness of the surgeon before the operation1 and careful details of cleanliness during the operation1 made possible the performance of many methods of surgical intervention that would otherwise surely have been fatal4 ,probably nothing is harder to understand than that after these practical discoveries men should have lost sight of their significance1 and after having carefully studied the viscous exudation which produces healthy natural union1 should have come to the thought of the necessity for the formation of laudable pus before union might be expected4 ,the mystery is really no greater than that of many another similar incident in human history1 but it strikes us more forcibly because the discovery and gradual development of antiseptic surgery in our own time has meant so much for us4 ,already even in ,chauliac's practice1 however1 some of the finer elements of the technique that made surgery antiseptic to a marked degree1 if not positively aseptic in many cases1 were not being emphasized as they were by his predecessors1 and there was a beginning of surgical meddlesomeness reasserting itself4 ,it must not be thought1 however1 that it was only with the coarse applications of surgery that ,chauliac concerned himself4 ,he was very much interested in the surgical treatment of eye diseases and wrote a monograph on cataract1 in which he gathers what was known before his time and discusses it in the light of his own experience4 ,the writing of such a book is not so surprising at this time if we recall that in the preceding century the famous ,pope ,john ,,xxi1 who had been a physician before he became ,pope1 and under the name of ,peter of ,spain was looked up to as one of the distinguished scientists of his time1 had written a book on eye diseases that has recently been the subject of much attention4 ,pope ,john had much to say of cataract1 dividing it into traumatic and spontaneous1 and suggesting the needling of cataract1 a gold needle being used for the purpose4 ,chauliac's method of treating cataract was by depression4 ,his care in the selection of patients may be appreciated from his treatment of ,john of ,luxembourg1 ,king of ,bavaria1 blind from cataract1 who consulted ,chauliac in #accf while on a visit to ,avignon with the ,king of ,france4 ,chauliac refused to operate1 however1 and put off the ,king with dietary regulations4 ,in the chapter on ,john of ,arcoli and ,medieval ,dentistry we call attention to the fact that ,chauliac discussed dental surgery briefly1 yet with such practical detail as to show very clearly how much more was known about this specialty in his time than we have had any idea of until recent years4 ,he recognized the dentists as specialists1 calls them dentatores1 but thinks that they should operate under the direction of a physician--hence the physician should know much about teeth and especially about their preservation4 ,he enumerates instruments that dentists should have and shows very clearly that the specialty had reached a high state of development4 ,a typical example of ,chauliac's common sense and dependence on observation and not tradition is to be found in what he has to say with regard to methods of removing the teeth without the use of extracting instruments4 ,it is characteristic of his method of dealing with traditional remedies1 even though of long standing1 that he brushes them aside with some impatience if they have not proved themselves in his experience4 ,the ancients mention many medicaments1 which draw out the teeth without iron instruments or which make them more easy to draw out2 such as the milky juice of the tithymal with pyrethrum1 the roots of the mulberry and caper1 citrine arsenic1 aqua fortis1 the fat of forest frogs4 ,but these remedies promise much and accomplish but little--mais ils donnent beaucoup de promesses1 et peu1 d'oprations4 ,it is no wonder that ,chauliac has been enthusiastically praised4 ,nicaise has devoutly gathered many of these praises into a sheaf of eulogies at the end of his biography of the great ,french surgeon4 ,he tells us that ,fallopius compared him to ,hippocrates4 ,john ,calvo of ,valencia1 who translated the ,great ,surgery into ,spanish1 looks upon him as the first law-giver of surgery4 ,freind1 the great ,english physician1 in #agbe called him the ,prince of ,surgeons4 ,ackermann said that ,guy de ,chauliac's text-book will take the place of all that has been written on the subject down to his time1 so that even if all the other works had been lost his would replace them4 ,dezimeris1 commenting on this1 says that if one should take this appreciation literally1 this surgeon of the fourteenth century would be the first and1 up to the present time1 the only author who ever merited such an eulogy4 ,at least1 he adds1 we cannot refuse him the distinction of having made a work infinitely superior to all those which appeared up to this time and even for a long time afterwards4 ,posterity rendered him this justice1 for he was for three centuries the classic par excellence4 ,he rendered the study easy and profitable1 and all the foreign nations the tributaries of our country4 ,peyrihle considered ,guy's ,surgery as the most valuable and complete work of all those of the same kind that had been published since ,hippocrates and added that the reading of it was still useful in his time in #aghd4 ,bgin1 in his work on ,ambroise ,par1 says that ,guy has written an immortal book to which are attached the destinies of ,french surgeons4 ,malgaigne1 in his ,history of ,surgery1 does not hesitate to say1 ,i do not fear to say that1 ,hippocrates alone excepted1 there is not a single treatise on surgery1--,greek1 ,latin1 or ,arabic1--which ,i place above1 or even on the same level with1 this magnificent work1 ',the ,surgery of ,guy de ,chauliac4' ,daremberg said1 ,guy seems to us a surgeon above all erudite1 yet expert and without ever being rash4 ,he knows1 above all1 how to choose what is best in everything4 ,verneuil1 in his ,confrence sur ,les ,chirurgiens rudits1 says1 ,the services rendered by the ',great ,surgery' were immense2 by it there commenced for ,france an era of splendor4 ,it is with justice1 then1 that posterity has decreed to ,guy de ,chauliac the title of ,father of ,french surgery4 ,the more one reads of ,chauliac's work the less is one surprised at the estimation in which he has been held wherever known4 ,it would not be hard to add a further sheaf of compliments to those collected by ,nicaise4 ,modern writers on the history of medicine have all been enthusiastic in their admiration of him1 just in proportion to the thoroughness of their acquaintance with him4 ,portal1 in his ,history of ,anatomy and ,surgery1 says1 ,finally1 it may be averred that ,guy de ,chauliac said nearly everything which modern surgeons say1 and that his work is of infinite price but unfortunately too little read1 too little pondered4 ,malgaigne declares ,chauliac's ,chirurgia ,magna to be a masterpiece of learned and luminous writing4 ,professor ,clifford ,allbutt1 the ,regius ,professor of ,physic at the ,university of ,cambridge1 says of ,chauliac's treatise3 ,this great work ,i have studied carefully and not without prejudice2 yet ,i cannot wonder that ,fallopius compared the author to ,hippocrates or that ,john ,freind calls him the ,prince of ,surgeons4 ,it is rich1 aphoristic1 orderly1 and precise4#be ,if to this account of his professional career it be added that ,chauliac's personality is1 if possible1 more interesting than his surgical accomplishment1 some idea of the significance of the life of the great father of modern surgery will be realized4 ,we have already quoted the distinguished words of praise accorded him by ,pope ,clement ,,vi4 ,that they were well deserved1 ,chauliac's conduct during the black death which ravaged ,avignon in #acdh1 shortly after his arrival in the ,papal ,city1 would have been sufficient of itself to attest4 ,the occurrence of the plague in a city usually gave rise to an exhibition of the most arrant cowardice1 and all who could1 fled4 ,in many of the ,european cities the physicians joined the fugitives1 and the ailing were left to care for themselves4 ,with a few notable exceptions1 this was the case at ,avignon1 but ,guy was among those who remained faithful to his duty and took on himself the self-sacrificing labor of caring for the sick1 doubly harassing because so many of his brother physicians were absent4 ,he denounces their conduct as shameful1 yet does not boast of his own courage1 but on the contrary says that he was in constant fear of the disease4 ,toward the end of the epidemic he was attacked by the plague and for a time his life was despaired of4 ,fortunately he recovered1 to become the most influential among his colleagues1 the most highly admired of the physicians of his generation1 and the close personal friend of all the high ecclesiastics1 who had witnessed his magnificent display of courage and of helpfulness for the plague-stricken during the epidemic4 ,he wrote a very clear account of the epidemic1 which leaves no doubt that it was true bubonic plague4 ,after this fine example1 ,chauliac's advice to brother physicians in the specialty of surgery carried added weight4 ,in the ,introductory chapter of his ,chirurgia ,magna he said3 ,the surgeon should be learned1 skilled1 ingenious1 and of good morals4 ,be bold in things that are sure1 cautious in dangers2 avoid evil cures and practices2 be gracious to the sick1 obliging to his colleagues1 wise in his predictions4 ,be chaste1 sober1 pitiful1 and merciful2 not covetous nor extortionate of money2 but let the recompense be moderate1 according to the work1 the means of the sick1 the character of the issue or event1 and its dignity4 ,no wonder that ,malgaigne says of him1 ,never since ,hippocrates has medicine heard such language filled with so much nobility and so full of matter in so few words4 ,chauliac was in every way worthy of his great contemporaries and the period in which his lot was cast4 ,ordinarily we are not apt to think of the early fourteenth century as an especially productive period in human history1 but such it is4 ,dante's ,divine ,comedy was entirely written during ,chauliac's life4 ,petrarch was born within a few years of ,chauliac himself2 ,boccaccio in ,italy1 and ,chaucer in ,england1 wrote while ,chauliac was still alive4 ,giotto did his great painting1 and his pupils were laying the deep1 firm foundations of modern art4 ,many of the great cathedrals were being finished4 ,most of the universities were in the first flush of their success as moulders of the human mind4 ,there are few centuries in history that can show the existence of so many men whose work was to have an enduring influence for all the after time as this upon which ,chauliac's career shed so bright a light4 ,the preceding century had seen the origin of the universities and the rise of such supremely great men as ,albertus ,magnus1 ,roger ,bacon1 ,thomas ,aquinas1 and the other famous scholars of the early days of the mendicant orders1 and had made the intellectual mould of university training in which men's minds for seven centuries were to be formed1 so that ,chauliac1 instead of being an unusual phenomenon is only a fitting expression of the interest of this time in everything1 including the physical sciences and1 above all1 medicine and surgery4 ,for some people it may be a source of surprise that ,chauliac should have had the intellectual training to enable him to accomplish such judicious work in his specialty4 ,many people will be apt to assume that he accomplished what he did in spite of his training1 genius succeeding even in an unfavorable environment1 and notwithstanding educational disadvantages4 ,those who would be satisfied with any such explanation1 however1 know nothing of the educational opportunities provided in the period of which ,chauliac was the fruit4 ,he is a typical university man of the beginning of the fourteenth century1 and the universities must be given due credit for him4 ,it is ordinarily assumed that the universities paid very little attention to science and that scientists would find practically nothing to satisfy in their curricula4 ,professor ,huxley in his address on ,universities1 ,actual and ,ideal1 delivered as the ,rectorial ,address at ,aberdeen ,university in #ahgd1 declared that they were probably educating in the real sense of the word better than we do now4 7,see quotation in ,the ,medical ,school at ,salerno47 ,in the light of ,chauliac's life it is indeed amusing to read the excursions of certain historians into the relationship of the ,popes and the ,church to science during the ,middle ,ages4 ,chauliac is typically representative of medieval science1 a man who gave due weight to authority1 yet tried everything by his own experience1 and who sums up in himself such wonderful advance in surgery that during the last twenty years the students of the history of medicine have been more interested in him than in anyone who comes during the intervening six centuries4 ,chauliac1 however1 instead of meeting with any opposition1 encountered encouragement1 liberal patronage1 generous interest1 and even enjoyed the intimate friendship of the highest ecclesiastics and the ,popes of his time4 ,in every way his life may be taken as a type of what we have come to know about the ,middle ,ages1 when we know them as we should1 in the lives of the men who counted for most in them1 and do not accept merely the broad generalizations which are always likely to be deceptive and which in the past have led men into the most absurd and ridiculous notions with regard to a wonderful period in human history4 ,that ,guy de ,chauliac was no narrow specialist is abundantly evident from his book1 for while the ,great ,surgery treats of the science and art of surgery as its principal subject1 there are remarks about nearly everything else relating to medicine1 and most of them show a deep interest1 a thorough familiarity1 and an excellent judgment4 ,besides we have certain expressions with regard to intellectual matters generally which serve to show ,guy as a profound thinker1 who thoroughly appreciated just how accumulations of knowledge came to men and how far each generation or member of a generation should go and yet how limited must1 after all1 be the knowledge obtained by any one person4 ,with regard to books1 for instance1 he said1 for everyone cannot have all the books1 and even if he did have them it would be too tiresome to read them all and completely1 and it would require a godlike memory to retain them all4 ,he realized1 however1 that each generation1 provided it took the opportunities offered it1 was able to see a little bit farther than its predecessor1 and the figure that he employs to express this is rather striking4 ,sciences1 he said1 are made by additions4 ,it is quite impossible that the man who begins a science should finish it4 ,we are like infants1 clinging to the neck of a giant2 for we can see all the giant sees and a little more4 ,one of the most interesting features of the history of ,guy de ,chauliac is the bibliography of his works which has been written by ,nicaise4 ,this is admirably complete1 labored over with the devotion that characterized ,nicaise's attitude of unstinted admiration for the subject4 ,altogether he has some sixty pages of a quarto volume with regard to the various editions of ,guy's works4 ,the first manuscript edition of ,guy de ,chauliac was issued in #acfc1 the first printed edition in #adgh4 ,even in the fourteenth century ,guy's great work was translated into all the languages generally used in ,europe4 ,nicaise succeeded in placing #cd complete manuscripts of the ,great ,surgery3 #bb of these are in ,latin1 #d are in ,french1 #c are in ,english1 #b only in ,provenal1 though that was the language spoken in the region where much of ,chauliac's life was passed1 and one each in ,italian1 in ,low ,dutch1 and in ,hebrew4 ,of the ,english manuscripts1 one is number twenty-five ,english of the ,bibliothque ,nationale1 ,paris2 a second is number #cfff ,english of the ,sloane collection in the ,british ,museum1 and a third is in the ,library of the ,university of ,cambridge4#bf ,paulin ,paris1 probably one of the best of recent authorities on the age and significance of old manuscripts1 says in the third volume of his ,manuscrits ,franais1 page #cdf1 ,this manuscript of ,guy de ,chauliac's ,great ,surgery was made1 if not during the life1 then certainly very shortly after the death of the author4 ,it is one of the oldest that can be cited1 and the fact that an ,english translation was made so near to the time of the original composition of the book attests the great reputation enjoyed by ,guy de ,chauliac at this time1 and which posterity has fully confirmed4 ,the ,sloane copy in the ,british ,museum contains some medical recipes at the end by ,francis ,verney4 ,it was probably written in the fifteenth century4 ,its title is3 ,the inventorie or the collectorie in cirurgicale parte of medicine compiled and complete in the yere of our ,lord #acfc1 with some additions of other doctours1 necessary to the foresaid arte or crapte 7crafte874#bg ,what we find in the period of manuscripts1 however1 is as nothing compared to the prestige of ,guy de ,chauliac's work1 once the age of printing began4 ,nicaise was able to find sixty different printed editions of the ,great ,surgery4 ,nine others that are mentioned by authors have disappeared and apparently no copies of them are in existence4 ,besides there are sixty editions of portions of the work1 of compendiums of it and commentaries on it4 ,altogether #abi editions are extant4 ,of these there are sixteen ,latin editions1 forty-three ,french1 five ,italian1 four ,low ,dutch1 five ,catalan1 and one ,english4 ,fourteen appeared in the fifteenth century1 thirty-eight in the sixteenth century1 and seventeen in the seventeenth century4 ,the fourteen editions belonging to the incunabula of printing1 issued1 that is1 before the end of the fifteenth century1 show what lively interest there was in the ,french surgeon of the preceding century1 since printing presses at this precious time were occupied only with the books that were considered indispensable for scholars4 ,the first edition of the ,great ,surgery was printed in #adgh at ,lyons4 ,printing had only been introduced there five years before4 ,this first edition1 primus primarius or editio princeps1 was a ,french translation by ,nicholas ,panis4 ,in #adhj an ,italian edition was printed at ,venice4 ,the first ,latin edition was printed also in ,venice in #adij4 ,it would be only natural to expect that the successors of ,guy de ,chauliac1 and especially those who had come personally in contact with him1 would take advantage of his thorough work to make still further advances in surgery4 ,as matter of fact1 decadence in surgery is noted immediately after his death4 ,three men taught at the ,university of ,montpellier at the end of the fourteenth and the beginning of the fifteenth century1 ,john de ,tornamira1 ,valesco de ,taranta1 and ,john ,faucon4 ,they cannot be compared1 ,gurlt says1 with ,guy de ,chauliac1 though they were physicians of reputation in their time4 ,faucon made a compendium of ,guy's work for students4 ,somehow there seemed to be the impression that surgery had now reached a point of development beyond which it could not advance4 ,unfortunate political conditions1 wars1 the withdrawal of the ,popes from ,avignon to ,rome1 and other disturbances1 distracted men's minds1 and surgery deteriorated to a considerable extent1 until the new spirit at the time of the ,renaissance came to inject fresh life into it4 ,,xii ,,medieval ,,dentistry--,,giovanni ,,of ,,arcoli ,if there is one phase of our present-day medicine and surgery that most of us are likely to be quite sure is of very recent development it is dentistry4 ,probably most people would declare at once that they had every reason to think that the science and art of dentistry1 as we have it now1 developed for the first time in the world's history during the last generation or two4 ,it is extremely interesting to realize then1 in the light of this almost universal persuasion1 founded to a great extent on the conviction that man is in process of evolution and that as a consequence we must surely be doing things now that men never did before1 to find that dentistry1 both as an art and science1 is old2 that it has developed at a number of times in the world's history1 and that as fortunately for history its work was done mainly in indestructible materials1 the teeth themselves and metal prosthetic apparatus1 we have actual specimens of what was accomplished at a number of periods in the olden times4 ,surprising as it will seem to those who hear of it for the first time1 dentistry reached high perfection even in what we know as ancient history4 ,it is rather easy to trace scientific and craftsmanlike interest in it during the medieval period and in the magnificent development of surgery that came just at the end of the ,middle ,ages1 dentistry shared to such degree that some of the text-books of the writers on surgery of this time furnish abundant evidence of anticipations of many of the supposedly most modern developments of dentistry4 ,there are a number of historical traditions with regard to dentistry and the treatment of the teeth in ,egypt that can be traced back to good authorities in ,egyptology of a generation or more ago1 but it is rather hard to confirm the accounts we have by actual specimens2 either none were found or for some reason those actually discovered are now not readily available for study4 ,among the ,phenicians however1 though we have good reasons to think that they learned their arts and crafts from the ,egyptians1 there is convincing evidence of a high development of dentistry4 ,m4 ,ernest ,renan1 during an exploring expedition in ,phenicia1 found in the old necropolis at ,sidon a set of teeth wired together1 two of which were artificial4 ,it was a striking example of bridgework1 very well done1 and may now be seen in the ,louvre4 ,it would be more than a little surprising1 from what we know of the lack of inventiveness on the part of the ,phenicians and their tendency to acquire their arts by imitation1 if they had reached such a climax of invention by themselves4 ,since they adapted and adopted most of their arts and crafts from ,egypt1 with which they were in close commercial relations1 it has been argued with some plausibility that the ,egyptians may have had many modes of dental prosthesis1 but removed all artificial teeth and dental appliances from the mouth of corpses before embalming them1 in preparation for the next world1 because there was some religious objection to such human handiwork being left in place for the hereafter1 as they hoped for it4 ,there is a well-authenticated tradition of intimate intercourse in a commercial way between the old ,etruscans who inhabited the ,italian hill country and the ,phenicians1 so that it is no surprise to find that the oldest of ,etruscan tombs contain some fine examples of bridgework4 ,an improvement has come over ,phenician work however1 and bands of gold instead of wire are used for holding artificial teeth in place4 ,guerini1 whose ,history of ,dentistry is the standard work on the subject1 on a commission from the ,italian government1 carefully studied these specimens of ,etruscan dental work in the museums of ,italy1 and has made some interesting observations on them4 ,in one specimen1 which is especially notable1 two incisor teeth are replaced by a single tooth from a calf4 ,this was grooved in such a way as to make it seem like two separate teeth4 ,guerini suggests a very interesting and quite unexpected source for this4 ,while examining the specimen he wondered where the old ,etruscan dentist had obtained a calf's tooth without a trace of wear on it4 ,he came to the conclusion that he must have cut into the gums of a young calf before the permanent tooth was erupted in order to get this structure absolutely unworn for his purpose4 ,a number of examples of bridgework have been found in the old ,etruscan tombs4 ,the dates of their construction are probably not later than #ejj ,b4,c41 and some of them are perhaps earlier than #gjj ,b4,c4 ,the ,etruscans affected the old ,romans in the matter of dentistry1 so that it is easy to understand the passage in the ,laws of the ,twelve ,tables1 issued about #dej ,b4,c41 which1 while forbidding the burial of gold with corpses1 made a special exception for such gold as was fastened to the teeth4 ,gold was rare at ,rome1 and care was exercised not to allow any unnecessary decrease of the visible supply almost in the same way as governments now protect their gold reserves4 ,it may seem like comparing little things with great1 but the underlying principle is the same4 ,hence this special law and its quite natural exception4 ,in ,pope ,julius' ,museum in ,rome there is a specimen of a gold cap made of two plates of gold riveted together and also riveted to bands of metal which were fastened around the neighboring teeth in order to hold the cap in place4 ,this is from later ,republican times at ,rome4 ,at the end of the ,republic and the beginning of the ,empire there appear to have been many forms of dental appliances4 ,martial says that the reason why one lady's teeth--whose name he does not conceal--are white and another's--name also given--were dark1 was that the first one bought hers and the second still had her own4 ,in another satiric poem he describes an elderly woman as so much frightened that when she ran away her teeth fell out1 while her friends lost their false hair4 ,fillings of many kinds were used1 dentrifices of nearly every kind were invented1 and dentistry evidently reached a high stage of development1 though we have nowhere a special name for dentist1 and the work seems to have been done by physicians1 who took this as a specialty4 ,while in the ,middle ,ages there was1 owing to conditions1 a loss of much of this knowledge of antiquity with regard to dentistry1 or an obscuration of it1 it never disappeared completely1 and whenever men have written seriously about medicine1 above all about surgery in relation to the face and the mouth1 the teeth have come in for their share of scientific and practical consideration4 ,atius1 the first important ,christian writer on medicine and surgery1 discusses1 as we have seen in the sketch of him1 the nutrition of the teeth1 their nerves1 which came from the third pair and entered the teeth by a small hole existing at the end of the root1 and other interesting details of anatomy and physiology4 ,he knows much about the hygiene of the teeth1 discusses extraction and the cure of fistula and other details4 ,paul of gina in the next century has much more1 and while they both quote mainly from older authors there seems no doubt that they themselves had made not a few observations and had practical experience4 ,it was from these men that the ,arabian physicians and surgeons obtained their traditions of medicine1 and so it is not surprising to find that they discuss dental diseases and their treatment rationally and in considerable detail4 ,abulcasis particularly has much that is of significance and interest4 ,we have pictures of two score of dental instruments that were used by them4 ,the ,arabs not only treated and filled carious teeth and even replaced those that were lost1 but they also corrected deformities of the mouth and of the dental arches4 ,orthodontia is sometimes said to be of much later origin and to begin many centuries after ,abulcasis' time1 yet no one who knows of his work can speak of ,orthodontia as an invention after him4 ,in this1 however1 as in most of the departments of medicine and surgery1 the ,arabs were merely imitators1 though probably they expanded somewhat the practical knowledge that had come to them4 ,when the great revival in surgery came in the twelfth and thirteenth centuries it is not surprising that there should also have been an important renewal of interest in dentistry4 ,a detailed review of this would take us too far afield1 but at least something may be said of two or three of the great representative surgical writers who touched on this specialty4 ,about the middle of the fourteenth century that prince of surgeons1 and model of surgical writers1 ,guy de ,chauliac1 wrote his great text-book of surgery1 ,le ,grande ,chirurgie4 ,an extremely interesting feature of this work is to be found in the chapters that treat of diseases of the teeth4 ,these are not very comprehensive1 and are evidently not so much the result of his experience1 as the fruit of his reading1 yet they contain many practical valuable ideas that are supposed to be ever so much later than the middle of the fourteenth century4 ,his anatomy and physiology at least are not without many errors4 ,his rules for the preservation of the teeth show that the ordinary causes of dental decay were well recognized even as early as this4 ,emphasis was laid on not taking foods too hot or too cold1 and above all not to follow either hot or cold food by something very different from it in temperature4 ,the breaking of hard things with the teeth was recognized as one of the most frequent causes of such deterioration of the enamel as gives opportunity for the development of decay4 ,the eating of sweets1 and especially the sticky sweets--preserves and the like--was recognized as an important source of caries4 ,the teeth were supposed to be cleaned frequently1 and not to be cleaned too roughly1 for this would do more harm than good4 ,we find these rules repeated by succeeding writers on general surgery1 who touch upon dentistry1 or at least the care of the teeth1 and they were not original with ,guy de ,chauliac1 but part of the tradition of surgery4 ,as noted by ,guerini in his ,history of ,dentistry1 the translation of which was published under the auspices of the ,national ,dental ,association of the ,united ,states of ,america1#bh ,chauliac recognized the dentists as specialists4 ,besides1 it should be added1 as is evident from his enumeration of the surgical instruments which he declares necessary for them1 they were not as we might easily think in the modern time mere tooth pullers1 but at least the best among them treated teeth as far as their limited knowledge and means at command enabled them to do so1 and these means were much more elaborate than we have been led to think1 and much more detailed than we have reason to know that they were at certain subsequent periods4 ,in fact1 though ,guy de ,chauliac frankly confesses that he touches on the subject of dentistry only in order to complete his presentation of the subject of surgery and not because he has anything of his own to say with regard to the subject1 there is much that is of present-day interest in his brief paragraphs4 ,he observes that operations on the teeth are special and belong to the dentatores1 or dentists1 to whom doctors had given them over4 ,he considers1 however1 that the operations in the mouth should be performed under the direction of a physician4 ,it is in order to give physicians the general principles with which they may be able to judge of the advisability or necessity for dental operations that his short chapters are written4 ,if their advice is to be of value1 physicians should know the various methods of treatment suitable for dental diseases1 including mouth washes1 gargles1 masticatories1 anointments1 rubbings1 fumigations1 cauterizations1 fillings1 filings1 and the various manual operations4 ,he says that the dentator must be provided with the appropriate instruments1 among which he names scrapers1 rasps1 straight and curved spatumina1 elevators1 simple and with two branches1 toothed tenacula1 and many different forms of probes and canulas4 ,he should also have small scalpels1 tooth trephines1 and files4 ,chauliac is particularly emphatic in his insistence on not permitting alimentary materials to remain in cavities1 and suggests that if cavities between the teeth tend to retain food material they should even be filed in such a way as to prevent these accumulations4 ,his directions for cleansing the teeth were rather detailed4 ,his favorite treatment for wounds was wine1 and he knew that he succeeded by means of it in securing union by first intention4 ,it is not surprising1 then1 to find that he recommends rinsing of the mouth with wine as a precaution against dental decay4 ,a vinous decoction of wild mint and of pepper he considered particularly beneficial1 though he thought that dentifrices1 either powder or liquid1 should also be used4 ,he seems to recommend the powder dentifrices as more efficacious4 ,his favorite prescription for a tooth powder1 while more elaborate1 resembles to such an extent1 at least some1 if not indeed most of those1 that are used at the present time1 that it seems worth while giving his directions for it4 ,he took equal parts of cuttle bone1 small white sea-shells1 pumice stone1 burnt stag's horn1 nitre1 alum1 rock salt1 burnt roots of iris1 aristolochia1 and reeds4 ,all of these substances should be carefully reduced to powder and then mixed4 ,his favorite liquid dentifrice contained the following ingredients1--half a pound each of sal ammoniac and rock salt1 and a quarter of a pound of sacharin alum4 ,all these were to be reduced to powder and placed in a glass alembic and dissolved4 ,the teeth should be rubbed with it1 using a little scarlet cloth for the purpose4 ,just why this particular color of cleansing cloth was recommended is not quite clear4 ,he recognized1 however1 that cleansing of the teeth properly often became impossible by any scrubbing method1 no matter what the dentifrice used1 because of the presence of what we call tartar and what he called hardened limosity or limyness 7limosit endurcie74 ,when that condition is present he suggests the use of rasps and spatumina and other instrumental means of removing the tartar4 ,evidently he did not believe in the removal of the teeth unless this was absolutely necessary and no other method of treatment would avail to save the patient from continuous distress4 ,he summarizes the authorities with regard to the extraction of teeth and the removal of dental fragments and roots4 ,he evidently knew of the many methods suggested before his time of removing teeth without recourse to instrumental extraction4 ,there were a number of applications to the gums that were claimed by older authors to remove the teeth without the need of metal instruments4 ,we might expect that ,chauliac would detect the fallacy with regard to these and expose it4 ,he says that while much is claimed for these methods he has never seen them work in practice and he distrusts them entirely4 ,the most interesting phase of what ,guy de ,chauliac has to say with regard to dentistry is of course to be found in his paragraphs on the artificial replacement of lost teeth and the subject of dental prosthesis generally4 ,when teeth become loose he advises that they be fastened to the healthy ones with a gold chain4 ,guerini suggests that he evidently means a gold wire4 ,if the teeth fall out they may be replaced by the teeth of another person or with artificial teeth made from oxbone1 which may be fixed in place by a fine metal ligature4 ,he says that such teeth may be serviceable for a long while4 ,this is a rather curt way of treating so large a subject as dental prosthesis1 but it contains a lot of suggestive material4 ,he was quoting mainly the ,arabian authors1 and especially ,abulcasis and ,ali ,abbas and ,rhazes1 and these of course1 as we have said1 mentioned many methods of artificially replacing teeth as also of transplantation and of treatment of the deformities of the dental arches4 ,on the whole1 however1 it must be confessed that we have here in the middle of the fourteenth century a rather surprising anticipation of the knowledge of a special department of medicine which is usually considered to be distinctly modern1 and indeed as having only attracted attention seriously in comparatively recent times4 ,after ,guy de ,chauliac the next important contributor to dentistry is ,giovanni of ,arcoli1 often better known by his ,latin name1 ,johannes ,arculanus1 who was a professor of medicine and surgery at ,bologna and afterwards at ,padua1 just before and after the middle of the fifteenth century1 and who died in #adhd4 ,he is famous principally for being the first we know who mentions the filling of teeth with gold4 ,it might possibly be suggested that coming at this time ,arculanus should rather be reckoned as a ,maker of ,medicine in the ,renaissance than as belonging to the ,middle ,ages and its influences4 ,his education1 however1 was entirely completed before the earliest date at which the ,renaissance movement is usually said to begin1 that is with the fall of ,constantinople in #adeb1 and he was dead before the other date1 that of the discovery of ,america in #adib1 which the ,germans have in recent years come to set down as the end of the ,middle ,ages4 ,besides1 what he has to say about dentistry occurs in typical medieval form4 ,it is found in a commentary on ,rhazes1 written just about the middle of the fifteenth century4 ,in the later true ,renaissance such a commentary would have been on a ,greek author4 ,in his commentary ,arculanus touches on most of the features of medicine and surgery from the standpoint of his own experience as well as from what he knows of the writings of his predecessors and contemporaries4 ,with the rest he has a series of chapters on diseases of the teeth4 ,guerini in his ,history of ,dentistry says that this subject dentistry is treated rather fully1 and with great accuracy4 ,even some short references to it will1 ,i think1 demonstrate this rather readily4#bi ,arculanus is particularly full in his directions for the preservation of the teeth4 ,we are rather prone to think that prophylaxis is comparatively a modern idea1 and that most of the principles of conservation of human tissues and the prevention of deterioration and disease are distinctly modern4 ,it needs only a little consideration of ,arculanus' instruction in the matter of the teeth1 however1 to undo any such false impression4 ,for obvious reasons ,i prefer to quote ,guerini's summation of this medieval student of dentistry's rules for dental hygiene3 ,for the preservation of teeth--considered by him1 quite rightly1 a matter of great importance--,giovanni of ,arcoli repeats the various counsels given on the subject by preceding writers1 but he gives them as ten distinct canons or rules1 creating in this way a kind of decalogue of dental hygiene4 ,these rules are3 7#a7 ,it is necessary to guard against the corruption of food and drink within the stomach2 therefore1 easily corruptible food--milk1 salt fish1 etc4--must not be partaken of1 and after meals all excessive movement1 running exercises1 bathing1 coitus1 and other causes that impair the digestion1 must also be avoided4 7#b7 ,everything must be avoided that may provoke vomiting4 7#c7 ,sweet and viscous food--such as dried figs1 preserves made with honey1 etc4--must not be partaken of4 7#d7 ,hard things must not be broken with the teeth4 7#e7 ,all food1 drink1 and other substances that set the teeth on edge must be avoided4 7#f7 ,food that is too hot or too cold must be avoided1 and especially the rapid succession of hot and cold1 and vice versa4 7#g7 ,leeks must not be eaten1 as such a food1 by its own nature1 is injurious to the teeth4 7#h7 ,the teeth must be cleaned at once1 after every meal1 from the particles of food left in them2 and for this purpose thin pieces of wood should be used1 somewhat broad at the ends1 but not sharp-pointed or edged2 and preference should be given to small cypress twigs1 to the wood of aloes1 or pine1 rosemary1 or juniper and similar sorts of wood which are rather bitter and styptic2 care must1 however1 be taken not to search too long in the dental interstices and not to injure the gums or shake the teeth4 7#i7 ,after this it is necessary to rinse the mouth by using by preference a vinous decoction of sage1 or one of cinnamon1 mastich1 gallia1 moschata1 cubeb1 juniper seeds1 root of cyperus1 and rosemary leaves4 7#aj7 ,the teeth must be rubbed with suitable dentrifices before going to bed1 or else in the morning before breakfast4 ,although ,avicenna recommended various oils for this purpose1 ,giovanni of ,arcoli appears very hostile to oleaginous frictions1 because he considers them very injurious to the stomach4 ,he observes1 besides1 that whilst moderate frictions of brief duration are helpful to the teeth1 strengthen the gums1 prevent the formation of tartar1 and sweeten the breath1 too rough or too prolonged rubbing is1 on the contrary1 harmful to the teeth1 and makes them liable to many diseases4 ,all this is so modern in many ways that we might expect a detailed exact knowledge of the anatomy of the teeth and even something of their embryology from ,arculanus4 ,it must not be forgotten1 however1 that coming as he does before the ,renaissance1 the medical sciences in the true sense of the word are as yet unborn4 ,men are accumulating information for practical purposes but not for the classification and co-ordination that was to make possible the scientific development of their knowledge4 ,giovanni of ,arcoli's acquaintance with the anatomy of the teeth was rather sadly lacking4 ,he does not know even with certainty the number of roots that the teeth have4 ,this has been attributed to the fact that he obtained most of his information from books1 and had not the time to verify descriptions that he had found4 ,it has been argued from this that he was himself probably not a practical dentist1 and turned to that specialty only as a portion of his work as a general surgeon1 and that consequently he was not sufficiently interested to verify his statements4 ,his chapters on dentistry would seem to bear out this conclusion to some extent1 though the very fact that one who was himself not specially interested in dental surgery should have succeeded in gathering together so much that anticipates modern ideas in dentistry1 is of itself a proof of how much knowledge of the subject there was available for a serious student of that time4 ,the anatomy of the teeth continued to be rather vague until about the middle of the next century when ,eustachius1 whose investigations of the anatomy of the head have deservedly brought him fame and the attachment of his name to the ,eustachian canal1 wrote his ,libellus de ,dentibus--,manual of the ,teeth1 which is quite full1 accurate1 and detailed4 ,very little has been added to the microscopic anatomy of the teeth since ,eustachius' time4 ,he had the advantage1 of course1 of being intimately in contact with the great group of ,renaissance anatomists1--,vesalius1 ,columbus1 ,varolius1 ,fallopius1 and the others1 the great fathers of anatomy4 ,besides1 his position as ,papal ,physician and ,professor of ,anatomy at the ,papal ,medical ,school at ,rome gave him opportunities for original investigation1 such as were not easily obtained elsewhere4 ,arculanus can scarcely be blamed1 therefore1 for not having anticipated the ,renaissance1 and we must take him as merely the culmination of medieval knowledge with regard to anatomy and surgery4 ,medieval medical men did not have the time nor apparently the incentive to make formal medical science1 though it must not be forgotten1 as has been said1 that they did use the knowledge they obtained by their own and others' observation to excellent advantage for the practical benefit of ailing humanity4 ,the sciences related to medicine are conscious developments that follow the evolution of practical medicine1 nor must it be forgotten that far from always serving as an auxiliary to applied medical science1 often indeed in the history of medicine scientific pursuits have led men away into side issues from which they had to be brought back by some genius medical observer4 ,as might be expected1 then1 it is with regard to the practical treatment and general consideration of ailments of the teeth that ,giovanni of ,arcoli is most interesting4 ,in this some of his chapters contain a marvellous series of surprises4 ,arculanus was probably born towards the end of the fourteenth century4 ,the date of his death is variously placed as either #adfj or #adhd1 with the probability in favor of the former4 ,from #adab to #adbg he was professor at ,bologna1 where in accordance with the non-specializing tendencies of the time he did not occupy a single chair but several in succession4 ,he seems first to have taught ,logic1 then ,moral ,philosophy1 and finally ,medicine4 ,his reputation in medicine drew many students to the university1 and his fame spread all over ,italy4 ,the rival ,university of ,padua then secured him1 and he seems to have been for some twenty years there4 ,later apparently he accepted a professor's chair at ,ferrara1 where the ,d',estes were trying to bring their university into prominence4 ,it was at ,ferrara that he died4 ,he was a man of wide reading1 of extensive experience1 both of men and medicine1 and one of the scholars of his time4 ,his works are1 as we have said1 mainly excerpts from earlier writers and particularly the ,arabians1 but they contain enough of hints drawn from his own observation and experience to make his work of great value4 ,while1 as ,gurlt remarks in his ,history of ,surgery1 ,arculanus' name is one of those scarcely known--he is usually considered just one of many obscure writers of the end of the ,middle ,ages--his writings deserve a better fate4 ,they contain much that is interesting and a great deal that must have been of the highest practical value to his contemporaries4 ,they attracted wide attention in his own and immediately succeeding generations4 ,the proof of this is that they exist in a large number of manuscript copies4 ,just as soon as printing was introduced his books appeared in edition after edition4 ,his ,practica was printed in no less than seven editions in ,venice4 ,three of them appeared before the end of the fifteenth century1 which places them among the incunabula of printing4 ,probably nothing in the history of human intellectual interest is more striking than the excellent judgment displayed by the editors who selected the works to be printed at this time4 ,very few of them were trivial or insignificant4 ,fewer still were idle speculations1 and most of them were almost of classical import for literature and science4 ,four editions of this work were printed in ,venice in the sixteenth century1 one of them as late as #aefj1 when the work done by such men as ,vesalius1 ,columbus1 ,eustachius1 and ,fallopius would seem to have made ,arculanus out of date4 ,the dates of the various editions are ,venice1 #adhc1 #adic1 #adig1 #aejd1 #aedb1 #aeeg1 and #aefj4 ,besides there was an edition printed at ,basel in #aedj4 ,arculanus is said to have re-introduced the use of the seton1 that is the method of producing intense counter-irritation by the introduction of some foreign body into an incision in the skin4 ,we owe to him1 too1 according to ,pagel in the chapters on medieval medicine in ,puschmann's ,handbook of the ,history of ,medicine1 an excellent description of alcoholic insanity4 ,his directions for the treatment of conditions in the mouth and nose apart from the teeth are quite as explicit and practical1 and in many ways quite as great an anticipation of some of our modern notions as what he has to say with regard to the teeth4 ,for instance1 in the treatment of polyps he says that they should be incised and cauterized4 ,soft polyps should be drawn out with a toothed tenaculum as far as can be without risk of breaking them off4 ,the incision should be made at the root so that nothing or just as little as possible of the pathological structure be allowed to remain4 ,it should be cut off with a fine scissors1 or with a narrow file just small enough to permit its ingress into the nostrils1 or with a scalpel without cutting edges on the sides1 but only at its extremity1 and this cutting edge should be broad and well sharpened4 ,if there is danger of hemorrhage1 or if there is fear of it1 the instruments with which dissection is made should be fired 7igniantur71 that is1 heated at least to a dull redness4 ,afterwards the stump1 if any remains1 should be touched with a hot iron or else with cauterizing agents so that as far as possible it should be obliterated4 ,after the operation a pledget of cotton dipped in the green ointment described by ,rhazes should be placed in the nose4 ,this pledget should have a string fastened to it1 hanging from the nose in order that it may be easily removed4 ,at times it may be necessary to touch the root of the polyp with a stylet on which cotton has been placed that has been dipped in aqua fortis 7nitric acid74 ,it is important that this cauterizing fluid should be rather strong so that after a certain number of touches a rather firm eschar is produced4 ,in all these manipulations in the nose ,arculanus recommends that the nose should be held well open by means of a nasal speculum4 ,pictures of all these instruments occur in his extant works1 and indeed this constitutes one of their most interesting and valuable features4 ,they are to be seen in ,gurlt's ,history of ,surgery4 ,in some cases he had seen the polyp was so difficult to get at or was situated so far back in the nose that it could not be reached by means of a tenaculum or scissors1 or even the special knife devised for that purpose4 ,for these patients ,arculanus describes an operation that is to be found in the older writers on surgery1 ,paul of gina 7ginetus71 ,avicenna1 and some of the other ,arabian surgeons4 ,for this three horse-tail hairs are twisted together and knotted in three or four places1 and one end is passed through the nostrils and out through the mouth4 ,the ends of this are then pulled on backward and forward after the fashion of a saw4 ,arculanus remarks evidently with the air of a man who has tried it and not been satisfied that this operation is quite uncertain1 and seems to depend a great deal on chance1 and much reliance must not be placed on it4 ,arculanus suggests a substitute method by which latent polyps or occult polyps as he calls them may be removed4 ,there is scarcely an important disease for which ,arculanus has not some interesting suggestions1 and the more one reads of him the more is one surprised to find how many things that we might think of as coming into the purview of medicine long after his time or at least as having been neglected from the time of the ,greeks almost down to our own time are here treated explicitly1 definitely1 and with excellent practical suggestions4 ,he has a good deal to say with regard to the treatment of angina1 which he calls synanche1 or synanchia1 or cynanche1 or angina4 ,parasynanche is a synonymous term1 but refers to a milder synanche4 ,he distinguished four forms of it4 ,in one called canine angina1 because the patient's tongue hangs out of his mouth1 somewhat the same as from an overheated dog in the summer time1 while at the same time the mouth is held open and he draws his breath pantingly1 ,arculanus suggests an unfavorable prognosis1 and would seem to refer to those cases of ,ludwig's angina in which there is involvement of the tongue and in which our prognosis continues to be of the very worst even to our own day4 ,at times the angina causes such swelling in the throat that the breathing is interfered with completely4 ,for this ,arculanus' master1 ,rhazes1 advised tracheotomy4 ,arculanus himself1 however1 apparently hesitated about that4 ,it is not surprising1 then1 to find that ,arculanus is very explicit in his treatment of affections of the uvula4 ,he divides its affections into apostema1 ulcus1 putredo sive corrosio1 et casus4 ,apostema was abscess1 ulcus any rather deep erosion1 putredo a gangrenous condition1 and casus the fall of the uvula4 ,this is the notorious falling of the soft palate which has always been in popular medical literature at least4 ,arculanus describes it as a preternatural elongation of the uvula which sometimes goes to such an extent as to make it resemble the tail of a mouse4 ,for shorter elongations he suggests the cautery2 for longer1 excision followed by the cautery so that the greater portion of the extending part may be cut off4 ,if people fear the knife he suggests following ,rhazes1 the application of an astringent powder directly to the part by blowing through a tube4 ,his directions for the removal of the uvula are very definite4 ,seat the patient upon a stool in a bright light while an assistant holds the head2 after the tongue has been firmly depressed by means of a speculum let the assistant hold this speculum in place4 ,with the left hand then insert an instrument1 a stilus1 by which the uvula is pulled forward1 and then remove the end of it by means of a heated knife or some other process of cauterization4 ,the mouth should afterwards be washed out with fresh milk4 ,the application of a cauterizing solution by means of a cotton swab wrapped round the end of a sound may be of service in patients who refuse the actual cautery4 ,to be successful the application must be firmly made and must be frequently repeated4 ,after this it is not surprising to find that ,arculanus has very practical chapters on all the other ordinary surgical affections4 ,empyema is treated very thoroughly1 liver abscess1 ascites1 which he warns must be emptied slowly1 ileus especially when it reaches stercoraceous vomiting1 and the various difficulties of urination1 he divides them into dysuria1 ischuria1 and stranguria1 are all discussed in quite modern fashion4 ,he gives seven causes for difficulty of urination4 ,one1 some injury of the bladder2 two1 some lesion of the urethra2 three1 some pathological condition in the power to make the bladder contract2 four1 some injury of the muscle of the neck of the bladder2 five1 some pathological condition of the urine2 six1 some kidney trouble1 and seven1 some pathological condition of the general system4 ,he takes up each one of these and discusses the various phases1 causes1 disposition1 and predispositions that bring them about4 ,one thing these men of the ,middle ,ages could do1 they reasoned logically1 they ordered what they had to say well1 and they wrote it out straightforwardly4 ,that ,arculanus' work with regard to dentistry was no mere chance and not solely theoretic can be understood very well from his predecessors1 and that it formed a link in a continuous tradition which was well preserved we may judge from what is to be found in the writings of his great successor1 ,giovanni or ,john de ,vigo1 who is considered one of the great surgeons of the early ,renaissance1 and to whom we owe what is probably the earliest treatise on ,gun-shot ,wounds4 ,john of ,vigo was a ,papal physician and surgeon1 generally considered one of the most distinguished members of the medical profession of his time4 ,two features of his writing on dental diseases deserve mention4 ,he insists that abscesses of the gums shall be treated as other abscesses by being encouraged to come to maturity and then being opened4 ,if they do not close promptly1 an irritant ,egyptian ointment containing verdigris and alum among other things should be applied to them4 ,in the cure of old fistulous tracts near the teeth he employs not only this ,egyptian ointment but also arsenic and corrosive sublimate4 ,what he has to say with regard to the filling of the teeth is1 however1 most important4 ,he says it with extreme brevity1 but with the manner of a man thoroughly accustomed to doing it4 ,by means of a drill or file the putrefied or corroded part of the tooth should be completely removed4 ,the cavity left should then be filled with gold leaf4 ,it is evident that the members of the ,papal court1 the ,cardinals and the ,pope himself1 had the advantage of rather good dentistry at ,john de ,vigo's hands even as early as the beginning of the sixteenth century4 ,john de ,vigo1 however1 is not medieval4 ,he lived on into the sixteenth century and was influenced deeply by the ,renaissance4 ,he counts among the makers of modern medicine and surgery1 as his authorship of the treatise on gun-shot wounds makes clear4 ,he comes in a period that will be treated of in a later volume of this series on ,our ,forefathers in ,medicine4 ,,xiii ,,cusanus ,,and ,,the ,,first ,,suggestion ,,of ,,laboratory ,,methods ,,in ,,medicine ,as illustrating how1 as we know more about the details of medical history1 the beginnings of medical science and medical practice are pushed back farther and farther1 a discussion in the ,berliner klinische ,wochenschrift a dozen years ago is of interest4 ,professor ,ernest von ,leyden1 in sketching the history of the taking of the pulse as an important aid in diagnostics1 said that ,john ,floyer was usually referred to as the man who introduced the practice of determining the pulse rate by means of the watch4 ,his work was done about the beginning of the eighteenth century4 ,professor von ,leyden suggested1 however1 that ,william ,harvey1 the ,english physiologist1 to whom is usually attributed the discovery of the circulation of the blood1 had emphasized the value of the pulse in medical diagnosis1 and also suggested the use of the watch in counting the pulse4 ,professor ,carl ,binz1 of the ,university of ,bonn1 commenting on these remarks of ,professor von ,leyden1 called attention to the fact that more than a century before the birth of either of these men1 even the earlier1 to whom the careful measurement of the pulse rate is thus attributed as a discovery1 a distinguished ,german churchman1 who died shortly after the middle of the fifteenth century1 had suggested a method of accurate estimation of the pulse that deserves a place in medical history4 ,this suggestion is so much in accord with modern demands for greater accuracy in diagnosis that it seems not inappropriate to talk of it as the first definite attempt at laboratory methods in the department of medicine4 ,the maker of the suggestion1 curiously enough1 was not a practising physician1 but a mathematician and scholar1 ,cardinal ,nicholas of ,cusa1 who is known in history as ,cusanus from the ,latin name of the town ,cues on the ,moselle ,river1 some twenty-five miles south of ,trves1 where he was born4 ,his family name1 ,nicholas ,krebs1 has been entirely lost sight of in the name derived from his native town1 which is the only reason why most of the world knows anything about that town4 ,cardinal ,cusanus suggested that in various forms of disease and at various times of life1 as in childhood1 boyhood1 manhood1 and old age1 the pulse was very different4 ,it would be extremely valuable to have some method of accurately estimating1 measuring1 and recording these differences for medical purposes4 ,at that time watches had not yet been invented1 and it would have been very difficult to have estimated the time by the clocks1 for almost the only clocks in existence were those in the towers of the cathedrals and of the public buildings4 ,the first watches1 ,nuremberg eggs1 as they were called1 were not made by ,peter ,henlein until well on into the next century4 ,the only method of measuring time with any accuracy in private houses was the clepsydra or water-clock1 which measured the time intervals by the flow of a definite amount of water4 ,cardinal ,cusanus suggested then that the water-clock should be employed for estimating the pulse frequency4 ,his idea was that the amount of water which flowed while a hundred beats of the pulse were counted1 should be weighed1 and this weight compared with that of the average weight of water which flowed while a hundred beats of the normal pulse of a number of individuals of the same age and constitution were being counted4 ,this was a very single and a very ingenious suggestion4 ,we have no means of knowing now whether it was adopted to any extent or not4 ,it may seem rather surprising that a cardinal should have been the one to make such a suggestion4 ,cusanus1 however1 was very much interested in mathematics and in the natural sciences1 and we have many wonderful suggestions from his pen4 ,he was the first1 for instance1 to suggest1 more than a century before ,copernicus1 that the earth was not the centre of the universe1 and that it would not be absolutely at rest or1 as he said1 devoid of all motion4 ,his words are3 ,terra igitur1 qu centrum esse nequit1 motu omni carere non potest4 ,he described very clearly how the earth moved round its own axis1 and then he added1 what cannot fail to be a surprising declaration for those in the modern times who think such an idea of much later origin1 that he considered that the earth itself cannot be fixed1 but moves as do the other stars in the heavens4 ,the expression is so astonishing at that time in the world's history that it seems worth the while to give it in its original form1 so that it may be seen clearly that it is not any subsequent far-fetched interpretation of his opinion1 but the actual words themselves1 that convey this idea4 ,he said3 ,consideravi quod terra ista non potest esse fixa1 sed movetur ut ali stell4 ,how clearly ,cusanus anticipated another phase of our modern views may be judged from what he has to say in ,de ,docta ,ignorantia with regard to the constitution of the sun4 ,it is all the more surprising that he should by some form of intuition reach such a conclusion1 for the ordinary sources of information with regard to the sun would not suggest such an expression except to a genius1 whose intuition outran by far the knowledge of his time4 ,the ,cardinal said3 ,to a spectator on the surface of the sun the splendor which appears to us would be invisible1 since it contains1 as it were1 an earth for its central mass1 with a circumferential envelope of light and heat1 and between the two an atmosphere of water and clouds and of ambient air4 ,after reading that bit of precious astronomical science announced nearly five centuries ago1 it is easy to understand how ,copernicus could have anticipated other phases of our knowledge1 as he did in his declarations that the figure of the earth is not a sphere1 but is somewhat irregular1 and that the orbit of the earth is not circular4 ,cusanus was an extremely practical man1 and was constantly looking for and devising methods of applying practical principles of science to ordinary life4 ,as we shall see in discussing his suggestion for the estimation of the pulse rate later on1 he made many other similar suggestions for diagnostic purposes in medicine1 and set forth other applications of mathematics and mechanics to his generation4 ,many of ,cusanus' books have curiously modern names4 ,he wrote1 for instance1 a series of mathematical treatises1 in ,latin of course1 on ,geometric ,transmutations1 on ,arithmetical ,complements1 on ,mathematical ,complements1 on ,mathematical ,perfection1 and on ,the ,correction of the ,calendar4 ,in his time the calendar was in error by more than nine days1 and ,cusanus was one of those who aroused sufficient interest in the subject1 so that in the next century the correction was actually made by the great ,jesuit mathematician1 ,father ,clavius4 ,perhaps the work of ,cusanus that is best known is that ,on ,learned ,ignorance--,de ,docta ,ignorantia1 in which the ,cardinal points out how many things that educated people think they know are entirely wrong4 ,it reminds one very much of ,josh ,billings's remark that it is not so much the ignorance of mankind that makes them ridiculous1 as the knowing so many things that ain't so4 ,it is from this work that the astronomical quotations which we have made are taken4 ,the book that is of special interest to physicians is his dialogue ,on ,static ,experiments1 which he wrote in #adej1 and which contains the following passages3 ,since the weight of the blood and the urine of a healthy and of a diseased man1 of a young man and an old man1 of a ,german and an ,african1 is different for each individual1 why would it not be a great benefit to the physician to have all of these various differences classified8 ,for ,i think that a physician would make a truer judgment from the weight of the urine viewed in connection with its color than he could make from its color alone1 which might be fallacious4 ,so1 also1 weight might be used as a means of identifying the roots1 the stems1 the leaves1 the fruits1 the seeds1 and the juice of plants if the various weights of all the plants were properly noted1 together with their variety1 according to locality4 ,in this way the physician would appreciate their nature better by means of their weight than if he judged them by their taste alone4 ,he might know1 then1 from a comparison of the weights of the plants and their various parts when compared with the weight of the blood and the urine1 how to make an application and a dosage of drugs from the concordances and differences of the medicaments1 and even might be able to make an excellent prognosis in the same way4 ,thus1 from static experiments1 he would approach by a more precise knowledge to every kind of information4 ,do you not think if you would permit the water from the narrow opening of a clepsydra water-clock to flow into a basin for as long as was necessary to count the pulse a hundred times in a healthy young man1 and then do the same thing for an ailing young man1 that there would be a noticeable difference between the weights of the water that would flow during the period8 ,from the weight of the water1 therefore1 one would arrive at a better knowledge of the differences in the pulse of the young and the old1 the healthy and the unhealthy1 and so1 also1 as to information with regard to various diseases1 since there would be one weight and1 therefore1 one pulse in one disease1 and another weight and another pulse in another disease4 ,in this way a better judgment of the differences in the pulse could be obtained than from the touch of the vein1 just as more can be known from the urine about its weight than from its color alone4 ,just in the same way would it not be possible to make a more accurate judgment with regard to the breathing1 if the inspirations and expirations were studied according to the weight of the water that passed during a certain interval8 ,if1 while water was flowing from a clepsydra1 one were to count a hundred expirations in a boy1 and then in an old man1 of course1 there would not be the same amount of water at the end of the enumeration4 ,then this same thing might be done for other ages and states of the body4 ,as a consequence1 when the physician once knew what the weight of water that represented the number of expirations of a healthy boy or youth1 and then of an individual of the same age ill of some infirmity or other1 there is no doubt that1 by this observation1 he will come to a knowledge of the health or illness and something about the case1 and1 perhaps1 also with more certainty would be able to choose the remedy and the dose required4 ,if he found in a healthy young man apparently the same weight as in an old and decrepit individual1 he might readily be brought to the conclusion that the young man would surely die1 and in this way have some evidence for his prognosis in the case4 ,besides1 if in fevers1 in the same way1 careful studies were made of the differences in the weight of water for pulse and respiration in the warm and the cold paroxysms1 would it not be possible thus to know the disease better and1 perhaps1 also get a more efficacious remedy8 ,as will be seen from this passage1 ,cusanus had many more ideas than merely the accurate estimation of the pulse frequency when he suggested the use of the water-clock4 ,evidently the thought had come to him that the specific gravity of the substances1 that is1 their weight in comparison to the weight of water1 might be valuable information4 ,before his time1 physicians had depended only on the color and the taste of the urine for diagnostic purposes4 ,he proposed that they should weigh it1 and even suggested that they should weigh1 also1 the blood1 ,i suppose in case of venesection1 for comparison's sake4 ,he also thought that the comparative weight of various roots1 stems1 leaves1 juices of plants might give hints for the therapeutic uses of these substances4 ,this is the sort of idea that we are apt to think of as typically modern4 ,specific gravities and atomic weights have been more than once supposed to represent laws in therapeutics1 which so far1 however1 we have not succeeded in finding1 but it is interesting to realize that it is nearly five hundred years since the first thought in this line was clearly expressed by a distinguished thinker and scientific writer4 ,there are many interesting expressions in ,cusanus' writings which contradict most of the impressions commonly entertained with regard to the scholars of the ,middle ,ages4 ,it is usually assumed that they did not think seriously1 but speculatively1 that they feared to think for themselves1 neglected the study of nature around them1 considered authority the important source of knowledge1 and were as far as possible from the standpoint of modern scientific students and investigators4 ,here is a passage from ,nicholas1 on knowing and thinking1 that might well have been written by a great intellectual man at any time in the world's history1 and that could only emanate from a profound scholar at any time4 ,to know and to think1 to see the truth with the eye of the mind1 is always a joy4 ,the older a man grows the greater is the pleasure which it affords him1 and the more he devotes himself to the search after truth1 the stronger grows his desire of possessing it4 ,as love is the life of the heart1 so is the endeavor after knowledge and truth the life of the mind4 ,in the midst of the movements of time1 of the daily work of life1 of its perplexities and contradictions1 we should lift our gaze fearlessly to the clear vault of heaven1 and seek ever to obtain a firmer grasp of and a keener insight into the origin of all goodness and beauty1 the capacities of our own hearts and minds1 the intellectual fruits of mankind throughout the centuries1 and the wondrous works of nature around us2 at the same time remembering always that in humility alone lies true greatness1 and that knowledge and wisdom are alone profitable in so far as our lives are governed by them4 ,the career of ,nicholas of ,cusa is interesting1 because it sums up so many movements1 and1 above all1 educational currents in the fifteenth century4 ,he was born in the first year of the century1 and lived to be sixty-four4 ,he was the son of a wine grower1 and attracted the attention of his teachers because of his intellectual qualities4 ,in spite of comparatively straitened circumstances1 then1 he was afforded the best opportunities of the time for education4 ,he went first to the school of the ,brethren of the ,common ,life at ,deventer1 the intellectual cradle of so many of the scholars of this century4 ,such men as ,erasmus1 ,conrad ,mutianus1 ,johann ,sintheim1 ,hermann von dem ,busche1 whom ,strauss calls the missionary of human wisdom1 and the teacher of most of these1 ,alexander ,hegius1 who has been termed the schoolmaster of ,germany1 with ,nicholas of ,cusa and ,rudolph ,agricola and others1 who might readily be mentioned1 are the fruits of the teaching of these schools of the ,brethren of the ,common ,life1 in one of which ,thomas ,kempis1 the author of ,the ,imitation of ,christ1 was1 for seventy years out of his long life of ninety1 a teacher4 ,cusanus succeeded so well at school that he was later sent to the ,university of ,heidelberg1 and subsequently to ,padua1 where he took up the study of ,roman law1 receiving his doctorate at the age of twenty-three4 ,this series of educational opportunities will be surprising only to those who do not know educational realities at the beginning of the fifteenth century4 ,there has never been a time when a serious seeker after knowledge could find more inspiration4 ,on his return to ,germany1 ,father ,krebs became canon of the cathedral in ,coblenz4 ,this gave him a modest income1 and leisure for intellectual work which was eagerly employed4 ,he was scarcely more than thirty when he was chosen as a delegate to the ,council at ,basel4 ,after this he was made ,archdeacon of the ,cathedral of ,lttich1 and from this time his rise in ecclesiastical preferment was rapid4 ,he had attracted so much attention at the ,council of ,basel that he was chosen as a legate of the ,pope for the bringing about certain reforms in ,germany4 ,subsequently he was sent on ecclesiastical missions to the ,netherlands1 and even to ,constantinople4 ,at the early age of forty he was made a ,cardinal4 ,after this he was always considered as one of the most important consultors of the ,papacy in all matters relating to ,germany4 ,during the last twenty-five years of his life in all the relations of the ,holy ,see to ,germany1 appeal was constantly made to the wisdom1 the experience1 and the thoroughly conservative1 yet foreseeing1 judgment of this son of the people1 whose education had lifted him up to be one of the leaders of men in ,europe4 ,it was during this time that he wrote most of his books on mathematics1 which have earned for him a prominent place in ,cantor's ,history of ,mathematics1 about a score of pages being devoted to his work4 ,much of his thinking was done while riding on horseback or in the rude vehicles of the day on the missions to which he was sent as ,papal ,legate4 ,he is said to have worked out the formula for the cycloid curve while watching the path described by flies that had lighted on the wheels of his carriage1 and were carried forward and around by them4 ,his scientific books1 though they included such startling anticipations of ,copernicus' doctrines as we have already quoted 7,copernicus did not publish the first sketch of his theory for more than a quarter of a century after ,cusanus' death71 far from disturbing his ecclesiastical advancement or injuring his career as a churchman1 seem actually to have been considered as additional reasons for considering him worthy of confidence and consultation4 ,as the result of his careful studies of conditions in ,germany1 he realized very clearly how much of unfortunate influence the political status of the ,german people1 with their many petty rulers and the hampering of development consequent upon the trivial rivalries1 the constant bickerings1 and the inordinate jealousies of these numerous princelings1 had upon his native country4 ,accordingly1 towards the end of his life he sketched what he thought would be the ideal political status for the ,german people4 ,as in everything that he wrote1 he went straight to the heart of the matter and1 without mincing words1 stated just exactly what he thought ought to be done4 ,considering that this scheme of ,cusanus for the prosperity and right government of the ,german people was not accomplished until more than four centuries after his death1 it is interesting1 indeed1 to realize how this clergyman of the middle of the fifteenth century should have come to any such thought4 ,nothing1 however1 makes it clearer than this1 that it is not time that fosters thinking1 but that great men at any time come to great thoughts4 ,cusanus wrote3 ,the law and the kingdom should be placed under the protection of a single ruler or authority4 ,the small separate governments of princes and counts consume a disproportionately large amount of revenue without furnishing any real security4 ,for this reason we must have a single government1 and for its support we must have a definite amount of the income from taxes and revenues yearly set aside by a representative parliament and before this parliament 7reichstag7 must be given every year a definite account of the money that was spent during the preceding year4 ,cusanus' life and work stand1 then1 as a type of the accomplishment1 the opportunities1 the power of thought1 the practical scholarship1 the mathematical accuracy1 the fine scientific foresight of a scholar of the fifteenth century4 ,for us1 in medicine1 it is interesting indeed to realize that it is from a man of this kind that a great new departure in medicine with regard to the employment of exact methods of diagnosis had its first suggestion in modern times4 ,the origin of that suggestion is typical4 ,it has practically always been true that it was not the man who had exhausted1 or thought that he had done so1 all previous medical knowledge1 who made advances in medicine for us4 ,it has nearly always been a young man early in his career1 and at a time when1 as yet1 his mind was not overloaded with the medical theories of his own time4 ,cusanus was probably not more than thirty when he made the suggestion which represents the first practical hint for the use of laboratory methods in modern medicine4 ,it came out of his thoughtful consideration of medical problems rather than from a store of garnered information as to what others thought4 ,it is a lesson in the precious value of breadth of education and serious training of mind for real progress at all times4 ,,xiv ,,basil ,,valentine1 ,,last ,,of ,,the ,,alchemists1 ,,first ,,of ,,the ,,chemists ,fieri enim potest ut operator erret et a via regia deflectat1 sed ut erret natura quando recte tractatur fieri non potest4 ,for it is quite possible that the physician should err and be turned aside from the straight 7royal7 road1 but that nature when she is rightly treated should err is quite impossible4 ,this is one of the preliminary maxims of a treatise on medicine written by a physician born not later than the first half of the fifteenth century1 and who may have lived even somewhat earlier4 ,we are so prone to think of the men of that time as utterly dependent on authority1 not daring to follow their own observation1 suspecting nature1 and almost sure to be convinced that only by going counter to her could success in the treatment of disease be obtained1 that it is a surprise to most people to find how completely the attitude of mind1 that is supposed to be so typically modern in this regard1 was anticipated full four centuries ago4 ,there are other expressions of this same great physician and medical writer1 ,basil ,valentine1 which serve to show how faithfully he strove with the lights that he had to work out the treatment of patients1 just as we do now1 by trying to find out nature's way1 so as to imitate her beneficent processes and purposes4 ,it is quite clear that he is but one of many faithful1 patient observers and experimenters--true scientists in the best sense of the word--who lived in all the centuries of the ,middle ,ages4 ,speculations and experiments with regard to the elixir of life1 the philosopher's stone1 and the transmutation of metals1 are presumed to have filled up all the serious interests of the alchemists1 supposed to be almost the only scientists of those days4 ,as a matter of fact1 however1 men were making original observations of profound significance1 and these were considered so valuable by their contemporaries that1 though printing had not yet been invented1 even the immense labor involved in the manifold copying of large folio volumes by the slow hand process did not suffice to deter them from multiplying the writings of these men so numerously that they were preserved in many copies for future generations1 until the printing press came to perpetuate them4 ,of this there is abundant evidence in the preceding pages as regards medicine1 and1 above all1 surgery1 while a summary of accomplishments of workers in other departments will be found in ,appendix ,,ii1 ,science at the ,medieval ,universities4 ,at the beginning of the twentieth century1 with some of the supposed foundations of modern chemistry crumbling to pieces under the influence of the peculiarly active light thrown upon our nineteenth century chemical theories by the discovery of radium1 and our observations on radio-active elements generally1 there is a reawakening of interest in some of the old-time chemical observers1 whose work used to be laughed at as so unscientific1 or1 at most1 but a caricature of real science1 and whose theory of the transmutation of elements into one another was considered so absurd4 ,it is interesting in the light of this to recall that the idea that the elementary substances were essentially distinct from each other1 and that it would be impossible under any circumstances to convert one element into another1 belongs entirely to the nineteenth century4 ,even so deeply scientific a mind as that of ,newton1 in the preceding century1 could not bring itself to acknowledge the tradition1 that came to be accepted subsequent to his time1 of the absurdity of metallic transformation4 ,on the contrary1 he believed quite formally in transmutation as a basic chemical principle1 and declared that it might be expected to occur at any time4 ,he had seen specimens of gold ores in connection with metallic copper1 and concluded that this was a manifestation of the natural transformation of one of these yellow metals into the other4 ,with the discovery that radium transforms itself into helium1 and that1 indeed1 all the so-called radioactivities of the heavy metals are probably due to a natural transmutation process constantly at work1 the ideas of the older chemists cease entirely to be a subject for amusement4 ,the physical chemists of the present day are very ready to admit that the old teaching of the absolute independence of something over seventy elements is no longer tenable1 except as a working hypothesis4 ,the doctrine of matter and form1 taught for so many centuries by the scholastic philosophers1 which proclaimed that all matter is composed of two principles1 an underlying material substratum1 and a dynamic or informing principle1 has now more acknowledged verisimilitude1 or lies at least closer to the generally accepted ideas of the most progressive scientists1 than it has at any time for the last two or three centuries4 ,not only the great physicists1 but also the great chemists1 are speculating along lines that suggest the existence of but one form of matter1 modified according to the energies that it possesses under a varying physical and chemical environment4 ,this is1 after all1 only a restatement in modern times of the teaching of ,st4 ,thomas of ,aquin1 in the thirteenth century4 ,it is not surprising1 then1 that there should be a reawakening of interest in the lives of some of the men1 who1 dominated by some of the earlier scholastic ideas1 by the tradition of the possibility of finding the philosopher's stone1 which would transmute the baser metals into the precious metals1 devoted themselves with quite as much zeal as any modern chemist to the observation of chemical phenomena4 ,one of the most interesting of these--indeed1 he might well be said to be the greatest of the alchemists--is the man whose only name that we know is that which appears on a series of manuscripts written in the ,high ,german dialect of the end of the fifteenth and the beginning of the sixteenth century4 ,that name is ,basil ,valentine1 and the writer1 according to the best historical traditions1 was a ,benedictine monk4 ,the name ,basil ,valentine may only have been a pseudonym1 for it has been impossible to trace it among the records of the monasteries of the time4 ,that the writer was a monk1 however1 there seems to be no room for doubt1 for his writings give abundant evidence of it1 and1 besides1 in printed form they began to have their vogue at a time when there was little likelihood of their being attributed to a monastic source1 unless an indubitable tradition connected them with some monastery4 ,this ,basil ,valentine 7to accept the only name we have7 did so much for the science of the composition of substances that he eminently deserves the designation that has been given him of the last of the alchemists and the first of the chemists4 ,there is practically a universal recognition of the fact now that he deserves also the title of the ,founder of ,pharmaceutical ,chemistry1 not only because of the value of the observations contained in his writings1 but also because of the fact that they proved so suggestive to certain scientific geniuses during the century succeeding ,valentine's life4 ,almost more than to have added to the precious heritage of knowledge for mankind1 it is a boon for a scientific observer to have awakened the spirit of observation in others1 and to be the founder of a new school of thought4 ,this ,basil ,valentine undoubtedly did1 and1 in the ,renaissance1 the incentive from his writings for such men as ,paracelsus is easy to appreciate4 ,besides1 his work furnishes evidence that the investigating spirit was abroad just when it is usually supposed not to have been1 for the ,thuringian monk surely did not do all his investigation alone1 but must have owed1 as well as given1 many a suggestion to his contemporaries4 ,some ten years ago1 when ,sir ,michael ,foster1 professor of physiology in the ,university of ,cambridge1 ,england1 was invited to deliver the ,lane ,lectures at the ,cooper ,medical ,college in ,san ,francisco1 he took for his subject ,the ,history of ,physiology4 ,in the course of his lecture on ,the ,rise of ,chemical ,physiology he began with the name of ,basil ,valentine1 who first attracted men's attention to the many chemical substances around them that might be used in the treatment of disease1 and said of him3 ,he was one of the alchemists1 but in addition to his inquiries into the properties of metals and his search for the philosopher's stone1 he busied himself with the nature of drugs1 vegetable and mineral1 and with their action as remedies for disease4 ,he was no anatomist1 no physiologist1 but rather what nowadays we should call a pharmacologist4 ,he did not care for the problem of the body1 all he sought to understand was how the constituents of the soil and of plants might be treated so as to be available for healing the sick and how they produced their effects4 ,we apparently owe to him the introduction of many chemical substances1 for instance of hydrochloric acid1 which he prepared from oil and vitriol of salt1 and of many vegetable drugs4 ,and he was apparently the author of certain conceptions which1 as we shall see1 played an important part in the development of chemistry and of physiology4 ,to him1 it seems1 we owe the idea of the three 'elements1' as they were and have been called1 replacing the old idea of the ancients of the four elements--earth1 air1 fire1 and water4 ,it must be remembered1 however1 that both in the ancient and the new idea the word 'element' was not intended to mean that which it means to us now1 a fundamental unit of matter1 but a general quality or property of matter4 ,the three elements of ,valentine were3 7#a7 sulphur1 or that which is combustible1 which is changed or destroyed1 or which at all events disappears during burning or combustion2 7#b7 mercury1 that which temporarily disappears during burning or combustion1 which is dissociated in the burning from the body burnt1 but which may be recovered1 that is to say1 that which is volatile1 and 7#c7 salt1 that which is fixed1 the residue or ash which remains after burning4 ,it is a little bit hard in our time for most people to understand just how such a development of thoroughly scientific chemical notions1 with investigations for their practical application1 should have come before the end of the ,middle ,ages4 ,this difficulty of understanding1 however1 we are coming to realize in recent years1 is entirely due to our ignorance of the period4 ,we have known little or nothing about the science of the ,middle ,ages1 because it was hidden away in rare old books1 in rather difficult ,latin1 not easy to get at1 and still less easy to understand always1 and we have been prone to conclude that since we knew nothing about it1 there must have been nothing4 ,just inasmuch as we have learned something definite about the medieval scholars1 our admiration has increased4 ,professor ,clifford ,allbutt1 the ,regius ,professor of ,medicine at the ,university of ,cambridge1 in his ,harveian ,oration1 delivered before the ,royal ,college of ,physicians in #aijj1 on ,science and ,medieval ,thought 7,london1 #aija71 declared that the schoolmen1 in digging for treasure1 cultivated the field of knowledge even for ,galileo and ,harvey1 for ,newton and ,darwin4 ,he might have added that they had laid foundations in all our modern sciences1 in chemistry quite as well as in astronomy1 physiology1 and the medical sciences1 in mathematics and botany4 ,in chemistry the advances made during the thirteenth1 fourteenth1 and fifteenth centuries were1 perhaps1 even more noteworthy than those in any other department of science4 ,albertus ,magnus1 who taught at ,paris1 wrote no less than sixteen treatises on chemical subjects1 and1 notwithstanding the fact that he was a theologian as well as a scientist1 and that his printed works fill some fifteen folio volumes1 he somehow found the time to make many observations for himself1 and performed numberless experiments in order to clear up doubts4 ,the larger histories of chemistry accord him his proper place1 and hail him as a great founder in chemistry1 and a pioneer in original investigation4 ,even ,st4 ,thomas of ,aquin1 much as he was occupied with theology and philosophy1 found some time to devote to chemical questions4 ,after all1 this is only what might have been expected of the favorite pupil of ,albertus ,magnus4 ,three treatises on chemical subjects from ,aquinas' pen have been preserved for us1 and it is to him that we are said to owe the use1 in the ,western world at least1 of the word amalgam1 which he first employed in describing various chemical methods of metallic combination with mercury that were discovered in the search for the genuine transmutation of metals4 ,albertus ,magnus' other great scientific pupil1 ,roger ,bacon1 the ,english ,franciscan friar1 followed more closely in the scientific ways of his great master1 devoting himself almost entirely to the physical sciences4 ,altogether he wrote some eighteen treatises on chemical subjects4 ,for a long time it was considered that he was the inventor of gunpowder1 though this is now known to have been introduced into ,europe by the ,arabs4 ,roger ,bacon studied gunpowder and various other explosive combinations in considerable detail1 and it is for this reason that he obtained the undeserved reputation of being an original discoverer in this line4 ,how well he realized how much might be accomplished by means of the energy stored up in explosives1 can1 perhaps1 be best appreciated from the fact that he suggested that boats would go along the rivers and across seas without either sails or oars1 and that carriages would go along the streets without horse or man power4 ,he considered that man would eventually invent a method of harnessing these explosive mixtures1 and of utilizing their energies for his purposes without danger4 ,it is curiously interesting to find1 as we begin the twentieth century1 and gasolene is so commonly used for the driving of automobiles and motor boats1 and is being introduced even into heavier transportation as the most available source of energy for suburban traffic1 at least1 that this generation should only be fulfilling the idea of the old ,franciscan friar of the thirteenth century1 who prophesied that in explosives there was the secret of eventually manageable energy for transportation purposes4 ,succeeding centuries were not as fruitful in great scientists as the thirteenth1 and yet1 in the second half of the thirteenth1 there was a ,pope1 ,john ,,xxi1 who had been a physician and professor of medicine before his election to the ,papacy1 three of whose scientific treatises--one on the transmutation of metals1 which he considers an impossibility1 at least as far as the manufacture of gold and silver was concerned2 a treatise on diseases of the eyes1 to which good authorities have not hesitated to give lavish praise for its practical value1 considering the conditions in which it was written2 and1 finally1 his treatise on the preservation of the health1 written when he was himself over eighty years of age--are all considered by good authorities as worthy of the best scientific spirit of the time4 ,during the fourteenth century1 ,arnold of ,villanova1 the inventor of nitric acid1 and the two ,hollanduses1 kept up the tradition of original investigation in chemistry4 ,altogether there are some dozen treatises from these three men on chemical subjects4 ,the ,hollanduses particularly did their work in a spirit of thoroughly frank1 original investigation4 ,they were more interested in minerals than in any other class of substances1 but did not waste much time on the question of transmutation of metals4 ,professor ,thompson1 the professor of chemistry at ,edinburgh1 said1 in his ,history of ,chemistry1 many years ago1 that the ,hollanduses give very clear descriptions of their processes of treating minerals in investigating their composition1 and these serve to show that their knowledge was by no means entirely theoretical1 or acquired only from books4 ,it is not surprising1 then1 to have a great investigating pharmacologist come along sometime about the beginning of the fifteenth century1 when1 according to the best authorities1 ,basil ,valentine was born4 ,from traditions he seems to have had a rather long life1 and his years run nearly parallel with his century4 ,his career is a typical example of the personally obscure and intellectually brilliant lives which the old monks lived4 ,probably in nothing have recent generations been more deceived in historical matters than in their estimation of the intellectual attainments and accomplishment of the old monks4 ,the more that we know of them1 not from second-hand authorities1 but from their own books and from what they accomplished in art and architecture1 in agriculture1 in science of all kinds1 the more do we realize what busy men they were1 and appreciate what genius they often brought to the solution of great problems4 ,we have had much negative pseudo-information brought together with the definite purpose of discrediting monasticism1 and now that positive information is gradually being accumulated1 it is almost a shock to find how different are the realities of the story of the intellectual life during the ,middle ,ages from what many writers had pictured them4 ,to those who may be surprised that a man who did great things in medicine should have lived during the fifteenth century1 it may be well to recall the names and a little of the accomplishment of the men of this period1 who were ,basil ,valentine's contemporaries1 at least in the sense that some portion of their lives and influence was coeval with his4 ,before the end of this century ,columbus had discovered ,america1 and by no happy accident1 for many men of his generation did correspondingly great work4 ,cardinal ,nicholas of ,cusa had developed mathematics and applied mathematical ideas to the heavens1 so that he could announce the conclusion that the earth was a star1 like the other stars1 and moved in the heavens as they do4 ,contemporary with ,cusanus was ,regiomontanus1 who has been proclaimed the father of modern astronomy1 and a distinguished mathematician4 ,toscanelli1 the ,florentine astronomer1 whose years run almost parallel with those of the fifteenth century1 did fine scholarly work1 which deeply influenced ,columbus and the great navigators of the time4 ,the universities in ,italy were attracting students from all over ,europe1 and such men as ,linacre and ,dr4 ,caius went down there from ,england4 ,raphael was but a young man at the end of the century1 but he had done some noteworthy painting before it closed4 ,leonardo da ,vinci was born just about the middle of the century1 and did some marvellous work before the end of that century4 ,michael ,angelo was only twenty-five at the close of the century1 but he1 too1 did fine work1 even at this early age4 ,among the other great ,italian painters of this century are ,fra ,angelico1 ,perugino1 ,raphael's master1 ,pinturicchio1 ,signorelli1 the pupil of his uncle1 ,vasari1 almost as distinguished1 ,botticelli1 ,titian1 and very many others1 who would have been famous leaders in art in any other but this supremely great period4 ,it was not only in ,italy1 however1 that there was a wonderful outburst of genius at this time1 for ,germany also saw the rise of a number of great men during this period4 ,jacob ,wimpheling1 the ,schoolmaster of ,germany1 as he has been called1 whose educational work did much to determine the character of ,german education for two centuries1 was born in #adej4 ,rudolph ,agricola1 who influenced the intellectual ,europe of this time deeply1 was born in #addc4 ,erasmus1 one of the greatest of scholars1 of teachers1 and of controversialists1 was born in #adfg4 ,johann ,reuchlin1 the great linguist1 who1 next to ,erasmus1 is the most important character in the ,german ,renaissance1 was born in #adee4 ,then there was ,sebastian ,brant1 the author of ,the ,ship of ,fools1 and ,alexander ,hegius1 both of this same period4 ,the most influential of them all1 ,thomas ,kempis1 who died in #adga1 and whose little book1 ,the ,following of ,christ1 has influenced every generation deeply ever since1 was probably a close contemporary of ,basil ,valentine4 ,when one knows what ,european1 and especially ,german scholars1 were accomplishing at this time1 no room is left for surprise that ,basil ,valentine should have lived and done work in medicine at this period that was to influence deeply the after history of medicine4 ,most of what ,basil ,valentine did was accomplished in the first half of the fifteenth century4 ,coming1 as he did1 before the invention of printing1 when the spirit of tradition was more rife and dominating than it has been since1 it is almost needless to say that there are many curious legends associated with his name4 ,two centuries before his time1 ,roger ,bacon1 doing his work in ,england1 had succeeded in attracting so much attention even from the common people1 because of his wonderful scientific discoveries1 that his name became a byword1 and many strange magical feats were attributed to him4 ,friar ,bacon was the great wizard1 even in the plays of the ,elizabethan period4 ,a number of the same sort of myths attached themselves to the ,benedictine monk of the fifteenth century4 ,he was proclaimed in popular story to have been a wonderful magician4 ,even his manuscript1 it was said1 had not been published directly1 but had been hidden in a pillar in the church attached to his monastery1 and had been discovered there after the splitting open of the pillar by a bolt of lightning from heaven4 ,it is the extension of this tradition that has sometimes led to the assumption that ,valentine lived in an earlier century1 some even going so far as to say that he1 too1 like ,roger ,bacon1 was a product of the thirteenth century4 ,it seems reasonably possible1 however1 to separate the traditional from what is actual in his existence1 and thus to obtain some idea at least of his work1 if not of the details of his life4 ,the internal evidence from his works enables the historian of science to place his writing within half a century of the discovery of ,america4 ,one of the myths that have gathered around the name of ,basil ,valentine1 because it has become a commonplace in philology1 has probably made him more generally known than any of his actual discoveries4 ,in one of the most popular of the old-fashioned text-books of chemistry in use about half a century ago1 in the chapter on antimony1 there was a story that students1 if ,i may judge from my own experience1 never forgot4 ,it was said that ,basil ,valentine1 a monk of the ,middle ,ages1 was the discoverer of this substance4 ,after having experimented with it in a number of ways1 he threw some of it out of his laboratory one day when the swine of the monastery1 finding it1 proceeded to gobble it up1 together with some other refuse4 ,just when they were finishing it1 the monk discovered what they were doing4 ,he feared the worst from it1 but took the occasion to observe the effect upon the swine very carefully4 ,he found that1 after a preliminary period of digestive disturbance1 these swine developed an enormous appetite1 and became fatter than any of the others4 ,this seemed a rather desirable result1 and ,basil ,valentine1 ever on the search for the practical1 thought that he might use the remedy to good purpose on the members of the community4 ,some of the monks in the monastery were of rather frail health and delicate constitution1 and most of them were rather thin1 and he thought that the putting on of a little fat1 provided it could be accomplished without infringement of the rule1 might be a good thing for them4 ,accordingly1 he administered1 surreptitiously1 some of the salts of antimony1 with which he was experimenting1 in the food served to these monks4 ,the result1 however1 was not so favorable as in the case of the hogs4 ,indeed1 according to one1 though less authentic1 version of the story1 some of the poor monks1 the unconscious subjects of the experiment1 perished as the result of the ingestion of the antimonial compounds4 ,according to the better version1 they suffered only the usual unpleasant consequences of taking antimony1 which are1 however1 quite enough for a fitting climax to the story4 ,basil ,valentine called the new substance which he had discovered antimony1 that is1 opposed to monks4 ,it might be good for hogs1 but it was a form of monks' bane1 as it were4#cj ,unfortunately for most of the good stories of history1 modern criticism has nearly always failed to find any authentic basis for them1 and they have had to go the way of the legends of ,washington's hatchet and ,tell's apple4 ,we are sorry to say that that seems to be true also of this particular story4 ,antimony1 the word1 is very probably derived from certain dialectic forms of the ,greek word for the metal1 and the name is no more derived from anti and monachus than it is from anti and monos 7opposed to single existence71 another fictitious derivation that has been suggested1 and one whose etymological value is supposed to consist in the fact that antimony is practically never found alone in nature4 ,notwithstanding the apparent cloud of unfounded traditions that are associated with his name1 there can be no doubt at all of the fact that ,valentinus--to give him the ,latin name by which he is commonly designated in foreign literatures--was one of the great geniuses1 who1 working in obscurity1 make precious steps into the unknown that enable humanity after them to see things more clearly than ever before4 ,there are definite historical grounds for placing ,basil ,valentine as the first of the series of careful observers who differentiated chemistry from the old alchemy and applied its precious treasures of information to the uses of medicine4 ,it is said to have been because of the study of ,basil ,valentine's work that ,paracelsus broke away from the ,galenic traditions1 so supreme in medicine up to his time1 and began our modern pharmaceutics4 ,following ,paracelsus came ,van ,helmont1 the father of modern medical chemistry1 and these three did more than any others to enlarge the scope of medication and to make observation rather than authority the most important criterion of truth in medicine4 ,indeed1 the work of this trio of men of the fifteenth and sixteenth centuries--the ,renaissance in medicine as in art--dominated medical treatment1 or at least the department of pharmaceutics1 down almost to our own day1 and their influence is still felt in drug-giving4 ,while we do not know the absolute data of either the birth or the death of ,basil ,valentine and are not sure of the exact period even in which he lived and did his work1 we are sure that a great original observer about the time of the invention of printing studied mercury and sulphur and various salts of the metals1 and above all introduced antimony to the notice of the scientific world1 and especially to the favor of practitioners of medicine4 ,his book1 ,the ,triumphal ,chariot of ,antimony1 is full of conclusions not quite justified by his premises nor by his observations4 ,there is no doubt1 however1 that the observational method which he employed furnished an immense amount of knowledge1 and formed the basis of the method of investigation by which the chemical side of medicine was to develop during the next two or three centuries4 ,great harm was done by the abuse of antimony1 but then great harm is done by the abuse of anything1 no matter how good it may be4 ,for a time it came to be the most important drug in medicine and was only replaced by venesection4 ,the fact of the matter is that doctors were looking for effects from their drugs1 and antimony is1 above all things1 effective4 ,patients1 too1 wished to see the effect of the medicines they took4 ,they do so even yet1 and when antimony was administered there was no doubt about its working4 ,the most interesting of ,basil ,valentine's books1 and the one which has had the most enduring influence1 is undoubtedly ,the ,triumphal ,chariot of ,antimony4#ca ,it has been translated and has had a wide vogue in every language of modern ,europe4 ,its recommendation of antimony had such an effect upon medical practice that it continued to be the most important drug in the pharmacopoeia down almost to the middle of the nineteenth century4 ,if any proof were needed that ,basil ,valentine or that the author of the books that go under the name was a monk it would be found in the introduction to this volume1 which not only states that fact very clearly1 but also in doing so makes use of language that shows the writer to have been deeply imbued with the old monastic spirit4 ,i quote the first paragraph of this introduction because it emphasizes this4 ,the quotation is taken from the ,english translation of the work as published in ,london in #afgh4 ,curiously enough1 seeing the obscurity surrounding ,valentine himself1 we do not know for sure who made the translation4 ,the translator apologizes somewhat for the deeply religious spirit of the book1 but considers that he was not justified in eliminating any of this4 ,the paragraph is left in the quaint1 old-fashioned form so eminently suited to the thoughts of the old master1 and the spelling and use of capitals is not changed4 ,basil ,valentine3 ,his ,triumphant ,chariot of ,antimony4--,since ,i1 ,basil ,valentine1 by ,religious ,vows am bound to live according to the order of ,st4 ,benedict and that requires another manner of ,spirit of ,holiness than the common state of ,mortals exercised in the profane business of this ,world2 ,i thought it my duty before all things1 in the beginning of this little book1 to declare what is necessary to be known by the pious ,spagyrist old-time name for medical chemist1 inflamed with an ardent desire of this ,art1 as what he ought to do1 and whereunto to direct his striving1 that he may lay such foundations of the whole matter as may be stable2 lest his ,building1 shaken with the ,winds1 happen to fall1 and the whole ,edifice to be involved in shameful ,ruine which otherwise being founded on more firm and solid principles1 might have continued for a long series of time4 ,which ,admonition ,i judged was1 is and always will be a necessary part of my religious ,office2 especially since we must all die1 and no one of us which are now1 whether high or low1 shall long be seen among the number of men4 ,for it concerns me to recommend these ,meditations of ,mortality to ,posterity1 leaving them behind me1 not only that honor may be given to the ,divine ,majesty1 but also that men may obey him sincerely in all things4 ,in this my meditation ,i found that there were five principal heads1 chiefly to be considered by the wise and prudent spectators of our ,wisdom and ,art4 ,the first of which is ,invocation of ,god4 ,the second1 ,contemplation of ,nature4 ,the third1 ,true ,preparation4 ,the fourth1 the ,way of ,using4 ,the fifth1 ,utility and ,fruit4 ,for he who regards not these1 shall never obtain place among true ,chymists1 or fill up the number of perfect ,spagyrists4 ,therefore1 touching these five heads1 we shall here following treat and so far declare them1 as that the general ,work may be brought to light and perfected by an intent and studious ,operator4 ,this book1 though the title might seem to indicate it1 is not devoted entirely to the study of antimony1 but contains many important additions to the chemistry of the time4 ,for instance1 ,basil ,valentine explains in this work how what he calls the spirit of salt might be obtained4 ,he succeeded in manufacturing this material by treating common salt with oil of vitriol and heat4 ,from the description of the uses to which he put the end product of his chemical manipulation1 it is evident that under the name of spirit of salt he is describing what we now know as hydrochloric acid4 ,this is said to be the first definite mention of it in the history of science1 and the method suggested for its preparation is not very different from that employed even at the present time4 ,he also suggests in his volume how alcohol may be obtained in high strengths4 ,he distilled the spirit obtained from wine over carbonate of potassium1 and thus succeeded in depriving it of a great proportion of its water4 ,we have said that he was deeply interested in the philosopher's stone4 ,naturally this turned his attention to the study of metals1 and so it is not surprising to find that he succeeded in formulating a method by which metallic copper could be obtained4 ,the material used for the purpose was copper pyrites1 which was changed to an impure sulphate of copper by the action of oil of vitriol and moist air4 ,the sulphate of copper occurred in solution1 and the copper could be precipitated from it by plunging an iron bar into it4 ,basil ,valentine recognized the presence of this peculiar yellow metal1 and studied some of its qualities4 ,he does not seem to have been quite sure1 however1 whether the phenomenon that he witnessed was not really a transmutation of at least some of the iron into copper as a consequence of the other chemicals present4 ,there are some observations on chemical physiology1 and especially with regard to respiration1 in the book on antimony which show their author to have anticipated the true explanation of the theory of respiration4 ,he states that animals breathe because air is needed to support their life1 and that all the animals exhibit the phenomenon of respiration4 ,he even insists that the fishes1 though living in water1 breathe air1 and he adduces in support of this idea the fact that whenever a river is entirely frozen the fishes die4 ,the reason for this being1 according to this old-time physiological chemist1 not that the fishes are frozen to death1 but that they are not able to obtain air in the ice as they did in the water1 and consequently perish4 ,there are many testimonials to the practical character of all his knowledge and his desire to apply it for the benefit of humanity4 ,the old monk could not repress the expression of his impatience with physicians who gave to patients for diseases of which they knew little1 remedies of which they knew less4 ,for him it was an unpardonable sin for a physician not to have faithfully studied the various mixtures that he prescribed for his patients1 and not to know not only their appearance and taste and effect1 but also the limits of their application4 ,considering that at the present time it is a frequent source of complaint that physicians often prescribe remedies with even whose physical appearance they are not familiar and whose composition is often quite unknown to them1 this complaint of the old-time chemist alchemist will be all the more interesting for the modern physician4 ,it is evident that when ,basil ,valentine allows his ire to get the better of him it is because of his indignation over the quacks who were abusing medicine and patients in his time1 as they have ever since4 ,there is a curious bit of aspersion on mere book learning in the passage that has a distinctly modern ring1 and one feels the truth of ,russell ,lowell's expression that to read a classic1 no matter how antique1 is like reading a commentary on the morning paper1 so up-to-date does genius ever remain3 ,and whensoever ,i shall have occasion to contend in the ,school with such a ,doctor1 who knows not how himself to prepare his own medicines1 but commits that business to another1 ,i am sure ,i shall obtain the ,palm from him2 ,for indeed that good man knows not what medicines he prescribes to the sick2 whether the color of them be white1 black1 gray1 or blew 7sic71 he cannot tell2 nor doth this wretched man know whether the medicine he gives be dry or hot1 cold or humid2 but he only knows that he found it so written in his books1 and then pretends to knowledge or as it were ,possession by ,prescription of a very long time2 yet he desires to further information4 ,here again let it be lawful to exclaim1 ,good ,god1 to what a state is the matter brought6 what ,goodness of ,minde is in these men6 what care do they take of the sick6 ,wo1 wo to them6 in the day of ,judgement they will find the fruit of their ,ignorance and ,rashness1 then they will see him whom they pierced1 when they neglected their ,neighbor1 sought after money and nothing else2 whereas were they cordial in their profession1 they would spend ,nights and ,days in ,labour that they might become more learned in their ,art1 whence more certain health would accrew to the sick with their estimation and greater glory to themselves4 ,but since ,labour is tedious to them they commit the matter to chance1 and being secure of their ,honour1 and content with their ,fame1 they 7like ,brawlers7 defend themselves with a certain garrulity1 without any respect had to ,confidence or ,truth4 ,perhaps one of the reasons why ,valentine's book has been of such enduring interest is that it is written in an eminently human vein and out of a lively imagination4 ,it is full of figures relating to many other things besides chemistry1 which serve to show how deeply this investigating observer was attentive to all the problems of life around him4 ,for instance1 when he wants to describe the affinity that exists between many substances in chemistry1 and which makes it impossible for them not to be attracted to one another1 he takes a figure from the attractions that he sees exist among men and women4 ,it is curious to find affinities discussed in our modern sense so long ago4 ,there are some paragraphs with regard to the influence of the passion of love that one might think rather a quotation from an old-time sermon than from a great ground-breaking book in the science of chemistry4 ,love leaves nothing entire or sound in man2 it impedes his sleep1 he cannot rest either day or night2 it takes off his appetite that he hath no disposition either to meat or drink by reason of the continual torments of his heart and mind4 ,it deprives him of all ,providence1 hence he neglects his affairs1 vocation1 and business4 ,he minds neither study1 labor1 nor prayer2 casts away all thoughts of anything but the body beloved2 this is his study1 this his most vain occupation4 ,if to lovers the success be not answerable to their wish1 or so soon and prosperously as they desire1 how many melancholies henceforth arise1 with griefs and sadness1 with which they pine away and wax so lean as they have scarcely any flesh cleaving to the bones4 ,yea1 at last they lose the life itself1 as may be proved by many examples6 for such men 7which is an horrible thing to think of7 slight and neglect all perils and detriments1 both of the body and life1 and of the soul and eternal salvation4 ,it is evident that human nature is not different in our sophisticated twentieth century from that which this observant old monk saw around him in the fifteenth4 ,he continues3 ,how many testimonies of this violence which is in love1 are daily found8 for it not only inflames the younger sort1 but it so far exaggerates some persons far gone in years as through the burning heat thereof1 they are almost mad4 ,natural diseases are for the most part governed by the complexion of man and therefore invade some more fiercely1 others more gently2 but ,love1 without distinction of poor or rich1 young or old1 seizeth all1 and having seized so blinds them as forgetting all rules of reason1 they neither see nor hear any snare4 ,but then the old monk thinks that he has said enough about this rather foreign subject1 and apologizes for his digression in another paragraph that should remove any lingering doubt there might be with regard to the genuineness of his monastic character4 ,at the end of the passage he makes the application in a very few words4 ,the personal element in his confession is so nave and so simply straightforward that instead of seeming to be the result of conceit1 which would surely have repelled the reader1 it rather attracts and enhances his kindly feeling for its author4 ,the paragraph would remind one in certain ways of that personal element that was to become more popular in literature after ,montaigne in the next century made it rather the fashion4 ,but of these enough2 for it becomes not a religious man to insist too long upon these cogitations1 or to give place to such a flame in his heart4 ,hitherto 7without boasting ,i speak it7 ,i have throughout the whole course of my life kept myself safe and free from it1 and ,i pray and invoke ,god to vouchsafe me his ,grace that ,i may keep holy and inviolate the faith which ,i have sworn1 and live contented with my spiritual spouse1 the ,holy ,catholick ,church4 ,for no other reason have ,i alleged these than that ,i might express the love with which all tinctures ought to be moved towards metals1 if ever they be admitted by them into true friendship1 and by love1 which permeates the inmost parts1 be converted into a better state4 ,the application of the figure at the end of his long digression is characteristic of the period in which he wrote1 as also to a considerable extent of the ,german literary methods of the time4 ,in this volume on the use of antimony there are in most of the editions certain biographical notes which have sometimes been accepted as authentic1 but oftener rejected4 ,according to these1 ,basil ,valentine was born in a town in ,alsace1 on the southern bank of the ,rhine4 ,as a consequence of this1 there are several towns that have laid claim to being his birthplace4 ,m4 ,jean ,reynaud1 the distinguished ,french philosophical writer of the first half of the nineteenth century1 once said that ,basil ,valentine1 like ,ossian and ,homer1 had many towns claim him years after his death4 ,he also suggested that1 like those old poets1 it was possible that the writings sometimes attributed to ,basil ,valentine were really the work not of one man1 but of several individuals4 ,there are1 however1 many objections to this theory1 the most forcible of which is the internal evidence derived from the books themselves showing similarities of style and method of treating subjects too great for us to admit non-identity in the writers4 ,m4 ,reynaud lived at a time when it was all the fashion to suggest that old works that had come down to us1 like the ,iliad and the ,odyssey1 and even such national epics as the ,cid and the ,arthur ,legends and the ,nibelungenlied were to be attributed to several writers rather than to one4 ,we have passed that period of criticism1 however1 and have reverted to the idea of single authorship for these works1 and the same conclusion has been generally come to with regard to the writings attributed to ,basil ,valentine4 ,other biographic details contained in ,the ,triumphal ,chariot of ,antimony are undoubtedly more correct4 ,according to them ,basil ,valentine travelled in ,england and ,holland on missions for his order1 and went through ,france and ,spain on a pilgrimage to ,st4 ,james of ,compostella4 ,besides this work1 there is a number of other books of ,basil ,valentine's1 printed during the first half of the sixteenth century1 that are well known and copies of which may be found in most of the important libraries4 ,the ,united ,states ,surgeon ,general's ,library at ,washington contains not a few of the works on medical subjects1 and the ,new ,york ,academy of ,medicine ,library has some valuable editions of certain of his works4 ,some of his other well-known books1 each of which is a good-sized octavo volume1 bear the following descriptive titles 7,i give them in ,english1 though as they are usually found1 they are in ,latin1 sixteenth-century translations of the original ,german73 ,the ,world in ,miniature3 or1 ,the ,mystery of the ,world and of ,human ,medical ,science1 published at ,mayburg1 #afji2 ,the ,chemical ,apocalypse3 or1 ,the ,manifestation of ,artificial ,chemical ,compounds1 published in ,erfurt in #afbd2 ,a ,chemico-,philosophic ,treatise ,concerning ,things ,natural and ,preternatural1 ,especially ,relating to the ,metals and the ,minerals1 published at ,frankfurt in #afgf2 ,haliography3 or1 ,the ,science of ,salts3 ,a ,treatise on the ,preparation1 ,use1 and ,chemical ,properties of ,all the ,mineral1 ,animal1 and ,vegetable ,salts1 published at ,bologna in #afdd2 ,the ,twelve ,keys of ,philosophy1 ,leipsic1 #afcj4 ,these are of interest to the chemist and physicist rather than to the physician1 and it is as a ,maker of ,medicine that we are concerned with ,valentine here4 ,the great attention aroused in ,basil ,valentine's work at the ,renaissance period can be best realized from the number of manuscript copies and their wide distribution4 ,his books were not all printed at one place1 but1 on the contrary1 in different portions of ,europe4 ,the original edition of ,the ,triumphal ,chariot of ,antimony was published in ,leipsic in the early part of the sixteenth century4 ,the first editions of the other books1 however1 appeared at places so distant from ,leipsic as ,amsterdam and ,bologna1 while various cities of ,germany1 as ,erfurt and ,frankfurt1 claim the original editions of still other works4 ,many of the manuscript copies still exist in various libraries in ,europe2 and while there is no doubt that some unimportant additions to the supposed works of ,basil ,valentine have come from the attribution to him of scientific treatises of other ,german writers1 the style and the method of the principal works mentioned is entirely too similar not to have been the fruit of a single mind and that possessed of a distinct investigating genius1 setting it far above any of its contemporaries in scientific speculation and observation4 ,the most interesting feature of all of ,basil ,valentine's writings that are extant is the distinctive tendency to make his observations of special practical utility4 ,his studies in antimony were made mainly with the idea of showing how that substance might be used in medicine4 ,he did not neglect to point out other possible uses1 however1 and knew the secret of the employment of antimony in order to give sharpness and definition to the impression produced by metal types4 ,it would seem as though he was the first scientist who discussed this subject1 and there is even some question of whether printers and typefounders did not derive their ideas in this matter from our chemist4 ,interested though he was in the transmutation of metals1 he never failed to try to find and suggest some medicinal use for all of the substances that he investigated4 ,his was no greedy search for gold and no cumulation of investigations with the idea of benefiting only himself4 ,mankind was always in his mind1 and perhaps there is no better demonstration of his fulfilment of the character of the monk than this constant solicitude to benefit others by every bit of investigation that he carried out4 ,for him1 with medieval nobleness of spirit1 the first part of every work must be the invocation of ,god1 and the last1 though no less important than the first1 must be the utility and fruit for mankind that can be derived from it4 ,the career of the last of the ,makers of ,medicine in the ,middle ,ages may be summed up briefly in a few sentences that show how thoroughly this old ,benedictine was possessed of the spirit of modern science4 ,he believed in observation as the most important source of medical knowledge4 ,he valued clinical experience far above book information4 ,he insisted on personal acquaintanceship on the part of the physician with the drugs he used1 and thought nothing more unworthy of a practitioner of medicine1--indeed he sets it down as almost criminal--than to give remedies of whose composition he was not well aware and whose effect he did not thoroughly understand4 ,he thought that nature was the most important aid to the physician1 much more important than drugs1 though he was the first to realize the significance of chemical affinities1 and he seems to have understood rather well how individual often were the effects obtained from drugs4 ,he was a patient student1 a faithful observer1 a writer who did not begrudge time and care to the composition of large books on medicine1 yet withal he was no dry-as-dust scholar1 but eminently human in his sympathies with ailing humanity1 and a strenuous upholder of the dignity of the profession to which he belonged4 ,scarcely more can be said of anyone in the history of medicine1 at least so far as good intentions go2 though many accomplished more1 none deserve more honor than the ,thuringian monk whom we know as ,basil ,valentine4 ,there are many other of these old-time ,makers of ,medicine of whom nearly the same thing can be said4 ,basil ,valentine is only one of a number of men who worked faithfully and did much both for medical science and professional life during the thousand years from the fall of ,rome to the fall of ,constantinople1 when1 according to what used to be commonly accepted opinion1 men were not animated by the spirit of research and of fine incentive to do good to men that we are so likely to think of as belonging exclusively to more modern times4 ,a man whom he greatly influenced1 ,paracelsus1 took up the tradition of scientific investigation where ,basil ,valentine had left it4 ,his work1 though more successfully revolutionary1 was not done in such a fine spirit of sympathy with humanity nor with that simplicity of life and purity of intention that characterized the old monk's work4 ,paracelsus' birth in the year of the discovery of ,america places him among the makers of the foundations of our modern medicine1 and he will be treated of in a volume on ,the ,forefathers in ,medicine4 ,,appendix ,i ,,st4 ,,luke ,,the ,,physician#cb ,in the midst of what has been called the higher criticism of the ,bible in recent times1 one of the long accepted traditions that has been most strenuously assailed and1 indeed1 in the minds of many scholars1 seemed1 for a time at least1 quite discredited1 was that ,st4 ,luke the ,evangelist1 the author of the ,third ,gospel and the ,acts of the ,apostles1 was a physician4 ,distinguished authorities in early ,christian apologetics have declared that the pillars of primitive ,christian history are the genuine ,epistles of ,st4 ,paul1 the writings of ,st4 ,luke1 and the history of ,eusebius4 ,it is quite easy to understand1 then1 that the attack upon the authenticity of the writings usually assigned to ,st4 ,luke1 which in many minds seemed successful1 has been considered of great importance4 ,in the very recent time there has been a decided reaction in this matter4 ,this has come1 not so much from ,roman ,catholics1 who have always clung to the traditional view1 and whose great ,biblical students have been foremost in the support of the previously accepted opinion1 but from some of the most strenuous of the ,german higher critics1 who now appreciate that destructive1 so-called higher criticism went too far1 and that the traditional view not only can be maintained1 but is the only opinion that will adequately respond to all the new facts that have been found1 and all the recently gathered information with regard to the relations of events in the olden time4 ,by far the most important contribution to the discussion in recent years came not long since from the pen of ,professor ,adolph ,harnack1 the professor of church history in the ,university of ,berlin4 ,professor ,harnack's name is usually cited as that of one of the most destructive of the higher critics4 ,his recent book1 however1 ,luke the ,physician1#cc is an entire submission to the old-fashioned viewpoint that the writer of the ,third ,gospel and of the ,acts of the ,apostles was a ,greek fellow-worker of ,st4 ,paul1 who had been in company for years with ,mark and ,philip and ,james1 and who had previously been a physician1 and was evidently well versed in all the medical lore of that time4 ,harnack does not merely concede the old position4 ,as might be expected1 his rediscussion of the subject clinches the arguments for the traditional view1 and makes it impossible ever to call it in question again4 ,it is easy to understand how important are such admissions when we recall how much this traditional view has been assailed1 and how those who have held it have been accused of old-fogyism and lack of scholarship1 and unwarranted clinging to antiquated notions just because they thought they were of faith1 and how1 lacking in true scholarship1 seriously hampering genuine investigation1 such conservatism has been declared to be4 ,the question of ,luke's having been a physician is an extremely valuable one1 and no one in our time is better fitted by early training and long years of study to elucidate it than ,professor ,harnack4 ,he began his excursions into historical writing years ago1 as ,i understand1 as an historian of early ,christian medicine4 ,some of his works on medical conditions just before and after ,christ are quoted confidently by the distinguished ,german medical historians4 ,from this department he graduated into the field of the higher criticism4 ,he is eminently in a position1 therefore1 to state the case with regard to ,st4 ,luke fully1 and to indicate absolutely the conclusions that should be drawn from the premises of fact1 writings1 and traditions that we have4 ,he does so in a very striking way4 ,perhaps no better example of his thoroughly lucid and eminently logical mode of argumentation is to be found than the paragraph in which he states the question4 ,it might well be recommended as an example of terse forcefulness and logical sequence that deserves the emulation of all those who want to write on medical subjects4 ,if we had more of these characteristic qualities of ,harnack's style1 our medical literature1 so called1 would not need to occupy so many pages of print as it does--yet would say more4 ,here it is3 ,st4 ,luke1 according to ,st4 ,paul1 was a physician4 ,when a physician writes a historical work it does not necessarily follow that his profession shows itself in his writing2 yet it is only natural for one to look for traces of the author's medical profession in such a work4 ,these traces may be of different kinds3 #a1 ,the whole character of the narrative may be determined by points of view1 aims1 and ideals which are more or less medical 7disease and its treatment72 #b1 marked preference may be shown for stories concerning the healing of diseases1 which stories may be given in great number and detail2 #c1 the language may be colored by the language of physicians 7medical technical terms1 metaphors of medical character1 etc474 ,all these three groups of characteristic signs are found1 as we shall see1 in the historical work which bears the name of ,st4 ,luke4 ,here1 however1 it may be objected that the subject matter itself is responsible for these traits1 so that their evidence is not decisive for the medical calling of the author4 ,jesus appeared as a great physician and healer4 ,all the evangelists say this of ,him2 hence it is not surprising that one of them has set this phase of ,his ministry in the foreground1 and has regarded it as the most important4 ,our evangelist need not therefore have been a physician1 especially if he were a ,greek1 seeing that in those days ,greeks with religious interests were disposed to regard religion mainly under the category of healing and salvation4 ,this is true1 yet such a combination of characteristic signs will compel us to believe that the author was a physician if1 #d1 the description of the particular cases of disease shows distinct traces of medical diagnosis and scientific knowledge2 #e1 if the language1 even where questions of medicine or of healing are not touched upon1 is colored by medical phraseology2 and1 #f1 if in those passages where the author speaks as an eye-witness medical traits are especially and prominently apparent4 ,these three kinds of tokens are also found in the historical work of our author4 ,it is accordingly proved that it proceeds from the pen of a physician4 ,the importance of the concession that ,luke was a physician should be properly appreciated4 ,his whole gospel is written from that standpoint4 ,for him the ,saviour was the healer1 the good physician who went about curing the ills of the body1 while ministering to people's souls4 ,he has more accounts of miracles of healing than any of the other ,evangelists4 ,he has taken certain of the stories of the other ,evangelists who were eye-witnesses1 and when they were told in nave and popular language that obscured the real condition that was present1 he has retold the story from the physician's standpoint1 and thus the miracle becomes clearer than ever4 ,in one case1 where ,mark has a slur on physicians1 ,luke eliminates it4 ,in a number of cases the correction of ,mark's popular language in the description of ailments is made in terms that could not have been used except by one thoroughly versed in the ,greek medical terminology of the times4 ,as a matter of fact1 there seems to be no doubt now that ,luke had been1 before he became an ,evangelist1 a practising physician in ,malta of considerable experience4 ,his testimony1 then1 to the miracles is particularly valuable as almost a medical eye-witness4 ,in medical science1 ,st4 ,luke's time was by no means barren of knowledge4 ,the ,alexandrian school of medicine had done some fine work in its time4 ,it was the first university medical school in the world's history1 and there dissection was first practised regularly and publicly for the sake of anatomy1 and even the vivisection of criminals who were supplied by the ,ptolemei for human physiology1 was a part of the school curriculum4 ,a number of important discoveries in brain anatomy are attributed to ,herophilus1 after whom the torcular herophili within the skull is named1 and who invented the term calamus scriptorius for certain appearances in the fourth ventricle4 ,his colleague1 ,erasistratus1 the co-founder of this school at ,alexandria1 did work in pathological anatomy1 and laid the foundation for serious study there4 ,for three centuries there is some good worker1 at or in connection with ,alexandria1 whose name is preserved for us in the history of medicine4 ,other ,greek schools of medicine in the ,east1 as1 for instance1 that of ,pergamos1 also did excellent work4 ,galen is the great representative of this school1 and he came in the century after ,st4 ,luke4 ,a physician educated in ,greek medicine at that time1 then1 would be in an excellent position to judge critically of the miracles of healing of the ,christ1 and it would seem to have been providential that ,luke was called for this purpose4 ,the evidence for his membership of our profession will doubtless be interesting to all physicians4 ,some of the distinctive passages in which ,luke's familiarity with medical terms to such an extent that to express his meaning he found himself compelled to use them1 will appeal at once to these1 for whom such terms are part of everyday speech4 ,the use of the word hydropikos1 which is not to be met with anywhere else in the ,new ,testament1 nor in the non-medical ,greek literature of that time1 though the word is of frequent occurrence as a designation for a person suffering from dropsy 7and always1 as in ,luke1 the adjective for the substantive71 in ,hippocrates1 ,dioscorides1 and ,galen is a typical example4 ,where such vague terms as paralyzed occur ,luke does not use the familiar word1 but the medical term that meant stricken with paralysis1 indicating not any inability to use the limbs1 but such a one as was due to a stroke of apoplexy4 ,we who1 as physicians1 have heard of so many cures of paralysis from our friends1 the ,eddyites1 are prone to ask1 as the first question1 what sort of a paralysis it was4 ,luke made inquiries from men who were eye-witnesses1 and then has described the scene with such details as convinced him as a physician of the reality of the miracle1 and his description was meant to carry conviction to the minds of others4 ,occasionally ,st4 ,luke uses words which only a physician would be likely to know at all4 ,that is to say1 even a man reasonably familiar with medical terminology and medical literature would not be likely to know them unless he had been technically trained4 ,one of these is the word sphudron1 a word which is only medical1 and is not to be found even in such large ,greek lexicons of ordinary words as that of ,passow4 ,sphudron is the anatomical term of the ,grco-,alexandrian school for the condyles of the femur4 ,galen and other medical authors use it1 and ,luke1 in giving the details of the story of the lame man cured1 in the third chapter of the ,acts1 seventh verse1 selects it because it exactly expresses the meaning he wished to convey4 ,in this story there are a number of added medical details4 ,these are all evidently arranged so as to give the full medical significance to the miracle4 ,for instance1 the man had been lame from birth1 literally from the womb of his mother4 ,at this time he was forty years of age1 an age at which the spontaneous cure of such an ailment or1 indeed1 any cure of it1 could scarcely be expected1 if1 during the preceding time1 there had been no improvement4 ,in the story of the cure of ,saul's blindness ,luke says in the ,acts that his blindness fell from him like scales4 ,the figure is a typically medical one4 ,the word for fall that is used is1 as was pointed out by ,hobart 7,medical ,language of ,st4 ,luke1 ,dublin1 #ahhb71 exactly the term that is used for the falling of scales from the body4 ,the term for scales is the specific designation of the particles that fall from the body during certain skin diseases or after certain of the infectious fevers1 as in scarlet fever4 ,hippocrates and ,galen have used it in many places4 ,it is distinctively a medical word4 ,in the story of the vision of ,st4 ,peter1 told also in the ,acts1 the word ecstasis1 from which we derive our word ecstasy1 is used4 ,this is the only word ,st4 ,luke uses for vision and he alone uses it4 ,this term is of constant employment in a technical sense in the medical writers of ,st4 ,luke's time and before it4 ,when the other evangelists talk of lame people they use the popular term4 ,this might mean anything or nothing for a physician4 ,luke uses one of the terms that is employed by physicians when they wish to indicate that for some definite reason there is inability to walk4 ,in the story of the ,good ,samaritan there are some interesting details that indicate medical interest on the part of the writer4 ,it is ,luke's characteristic story and a typical medical instance4 ,he employs certain words in it that are used only by medical writers4 ,the use of oil and wine in the treatment of the wounds of the stranger traveller was at one time said to indicate that it could not have been a physician who wrote the story1 since the ancients used oil for external applications in such cases but not wine4 ,more careful search of the old masters of medicine1 however1 has shown that they used oil and wine not only internally but externally4 ,hippocrates1 for instance1 has a number of recommendations of this combination for wounds4 ,it is rather interesting to realize this1 and especially the wine in addition to the oil1 because wine contains enough alcohol to be rather satisfactorily antiseptic4 ,there seems no doubt that wounds that had been bathed in wine and then had oil poured over them would be likely to do better than those which were treated in other ways4 ,the wine would cleanse and at least inhibit bacterial growth4 ,the subsequent covering with oil would serve to protect the wound to some degree from external contamination4 ,sometimes there is an application of medical terms to something extraneous from medicine that makes the phrase employed quite amusing4 ,for instance1 when ,luke wants to explain how they strengthened the vessel in which they were to sail he describes the process by the term which was used in medical ,greek to mean the splinting of a part or at least the binding of it up in such a way as to enable it to be used4 ,the word was quite a puzzle to the commentators until it was pointed out that it was the familiar medical term1 and then it was easy to understand4 ,occasionally this use of a medical term gives a strikingly accurate significance to ,luke's diction4 ,for instance1 where other evangelists talk of the ,lord looking at a patient or turning to them1 ,luke uses the expression that was technically employed for a physician's examination of his patient1 as if the ,lord carefully looked over the ailing people to see their physical needs1 and then proceeded to cure them4 ,manifestly in ,luke's mind the most interesting phase of the ,lord's life was ,his exhibition of curative powers1 and the ,saviour was for him the divine healer1 the ,god physician of bodies as well as of souls4 ,there are many little incidents which he relates that emphasize this4 ,for instance1 where ,st4 ,mark talks about the healing of the man with a withered hand1 ,st4 ,luke adds the characteristic medical note that it was the right hand4 ,when he tells of the cutting off of the ear of the servant of the high priest in the ,garden of ,olives ,st4 ,luke takes the story from ,st4 ,mark1 but adds the information that would appeal to a physician that it was the right ear4 ,moreover1 though all four evangelists record the cutting off of the ear1 only ,st4 ,luke adds the information that the ,lord healed it again4 ,it is as if he were defending the kindly feelings of the ,divine ,physician and as if it would have been inexcusable had ,he not exerted ,his miraculous powers of healing on this occasion4 ,it is ,st4 ,luke1 too1 who has constantly distinguished between natural illnesses and cases of possession4 ,this careful distinction alone would point to the author of the third gospel and the ,acts as surely a physician4 ,as it is it confirms beyond all doubt the claim that the writer of these portions of the ,new ,testament was a physician thoroughly familiar with all the medical writings of the time and probably a physician who had practised for a long time4 ,certain miracles of healing are related only by ,st4 ,luke as if he realized better than any of the other evangelists the evidential value that such instances would have for future generations as to the divinity of the personage who worked them4 ,the beautiful story of the raising from death of the son of the widow of ,nain is probably one of the oftenest quoted passages from ,st4 ,luke4 ,it is a charming bit of literature4 ,while it suggests the writer physician it makes one almost sure that the other tradition according to which ,st4 ,luke was also a painter must be true4 ,the scene is as picturesque as it can be4 ,the ,lord and ,his ,apostles and the multitudes coming to the gate of the little city just as in the evening sun the funeral cortge with the widow burying her only son came out of it4 ,the approach of the ,lord to the weeping mother1 ,his command to the dead son to arise1 and the simple words1 and he gave him back to his mother1 constitute as charming a scene as a painter ever tried to visualize4 ,besides this1 ,luke alone has the story of the man suffering with dropsy and the woman suffering from weakness4 ,the intensely picturesque quality of many of these scenes that he describes so vividly would indeed seem to place beyond all doubt the old tradition that he was an artist as well as a physician4 ,it is interesting to realize that it is to ,luke alone that we owe the account of the well-known message sent by ,christ ,himself to ,john the ,baptist when ,john sent his disciples to inquire as to ,his mission4 ,after describing ,his ministry ,he said3 ,go and relate to ,john what you have heard and seen3 the blind see1 the lame walk1 the deaf hear1 the lepers are made clean1 the dead rise again1 to the poor the ,gospel is preached4 ,to no one more than to a physician would that description of ,his mission appeal as surely divine4 ,to those who care to follow the subject still further1 and above all1 to read opinions given before the reversal of the verdict of the higher criticism on the ,lucan writings1 indeed before ever that trial was brought1 there is much in ,hor ,lucan--,a ,biography of ,st4 ,luke1 by ,henry ,samuel ,baynes 7,longmans1 #ahgj71 that will surely be of interest4 ,he has some interesting quotations which show how thoroughly previous centuries realized all the force of modern arguments4 ,for instance1 the following paragraph from ,dr4 ,nathaniel ,robinson1 a ,scotch physician of the eighteenth century1 will illustrate this4 ,dr4 ,robinson said3 ,it is manifest from his ,gospel1 that ,luke was both an acute observer1 and had even given professional attention to all our ,saviour's miracles of healing4 ,originally1 among the ,egyptians1 divinity and physic were united in the same order of men1 so that the priest had the care of souls1 and was also the physician4 ,it was much the same under the ,jewish economy4 ,but after physic came to be studied by the ,greeks1 they separated the two professions4 ,that a physician should write the history of our ,saviour's life was appropriate1 as there were divers mysterious things to be noticed1 concerning which his education enabled him to form a becoming judgment4 ,it is even interesting to realize that ,st4 ,luke's tendency to use medical terms has been of definite value in determining the question whether both the third gospel and the ,acts of the ,apostles are by the same man4 ,they have been attributed to ,st4 ,luke traditionally1 but in the higher criticism some doubt has been thrown on this and an elaborate hypothesis of dual authorship set up4 ,it has been asserted that it is very improbable on extrinsic grounds that they were both written by one hand and certain intrinsic evidence1 changes in the mode of narration1 especially the use of the first personal pronoun in the plural in certain passages1 has been pointed to as making against single authorship4 ,this tendency to deny old-time traditions of authorship with regard to many classical writings was a marked characteristic of the early part of the nineteenth century1 but the close of the century saw practically all of these denials discredited4 ,the nineteenth century ushered in studies of ,homer1 with the separatist school perfectly confident in their assertion that the ,iliad and the ,odyssey were not by the same person1 and even that the ,iliad itself was the work of several hands4 ,at the beginning of the twentieth century we are quite as sure that both the ,iliad and ,odyssey were written by the same person and that the separatists were hurried into a contrary decision not a little by the feeling of the sensation that such a contradiction of previously accepted ideas would create4 ,this is a determining factor in many a supposed novel discovery1 that it is hard always to discount sufficiently4 ,a thing may be right even though it is old1 and most new discoveries1 it must not be forgotten1 that is1 most of those announced with a great blare of trumpets1 do not maintain themselves4 ,the simple argument that the separatists would have to find another poet equal to ,homer to write the other poem has done more than anything else to bring their opinion into disrepute4 ,it is much easier to explain certain discrepancies1 differences of style1 and of treatment of subjects1 as well as other minor variants1 than to supply another great poet4 ,most of the works of our older literatures have gone through a similar trial during the over-hasty superficially critical nineteenth century4 ,the ,nibelungenlied has been attributed to two or three writers instead of one4 ,the ,cid1 the national epic of ,spain1 and the ,arthur ,legends1 the first ,british epic1 have been at least supposed to be amenable to the same sort of criticism4 ,in every case1 scholars have gone back to the older traditional view of a single author4 ,the phases of literary and historic criticism with regard to ,luke's writings are1 then1 only a repetition of what all our great national classics have gone through from supercilious scholarship during the past hundred years4 ,it is not surprising1 then1 that there should be dual or even triple ascriptions of authorship for various portions of the ,scriptures1 and ,luke's writings have on this score suffered as much or more even than others1 with the possible exception of ,moses4 ,it is now definitely settled1 however1 that the similarities of style between the ,acts and the third gospel are too great for them to have come from two different minds4 ,this is especially true1 as pointed out by ,harnack1 in all that regards the use of medical terms4 ,the writer of the ,acts and the writer of the third gospel knew ,greek from the standpoint of the physician of that time4 ,each used terms that we find nowhere else in ,greek literature except among medical writers4 ,what is thus true for one critical attack on ,luke's reputation is also true in another phase of recent higher criticism4 ,it has been said that certain portions of the ,acts which are called the we portions because the narration changes in them from the third to the first person were to be attributed to another writer than the one who wrote the narrative portions4 ,here1 once more1 the test of the medical words employed has decided the case for ,luke's sole authorship4 ,it is evidently an excellent thing to be able to use medical terms properly if one wants to be recognized with certainty later on in history for just what one's business was4 ,it has certainly saved the situation for ,st4 ,luke1 though there may be some doubt as to the real force of objections thus easily overthrown4 ,it is rather interesting to realize that many scholars of the present generation had allowed themselves to be led away by the ,german higher criticism from the old tradition with regard to ,luke as a physician and now will doubtless be led back to former views by the leader of ,german biblical critics4 ,it shows how much more distant things may influence certain people than those nearer home--how the hills are green far away4 ,harnack confesses that the best book ever written on the subject of ,luke as a physician1 the one that has proved of most value to him1 and that he still recommends everyone to read1 was originally written in ,english4 ,it is ,hobart's ,medical ,language of ,st4 ,luke1#cd written more than a quarter of a century before ,harnack4 ,the ,germans generally had rather despised what the ,english were doing in the matter of biblical criticism1 and above all in philology4 ,yet now the acknowledged coryphus of them all1 ,harnack1 not only admits the superiority of an old-time ,english book1 but confesses that it is the best statement of the subject up to the present time1 including his own4 ,he constantly quotes from it1 and it is evident that it has been the foundation of all of his arguments4 ,it is not the first time that men have fetched from afar what they might have got just as well or better at home4 ,harnack has made complete the demonstration1 then1 that the third gospel and the ,acts were written by ,st4 ,luke1 who had been a practising physician4 ,in spite of this1 however1 he finds many objections to the ,luke narratives and considers that they add very little that is valuable to the contemporary evidence that we have with regard to ,christ4 ,he impairs with one hand the value of what he has so lavishly yielded with the other4 ,he finds inconsistencies and discrepancies in the narrative that for him destroy their value as testimony4 ,a lawyer would probably say that this is that very human element in the writings which demonstrates their authenticity and adds to their value as evidence1 because it shows clearly the lack of any attempt to do anything more than tell a direct story as it had come to the narrator4 ,no special effort was made to avoid critical objections founded on details4 ,it was the general impression that was looked for4 ,sir ,william ,ramsay1 in his ,luke the ,physician and ,other ,studies in the ,history of ,religion 7,new ,york3 ,armstrong and ,sons1 #aijh71 has answered ,harnack from the side of the professional critic with much force4 ,he appreciates thoroughly the value of ,professor ,harnack's book1 and above all the reactionary tendency away from nihilistic so-called higher criticism which characterized so much of ,german writing on biblical themes in the nineteenth century4 ,he says 7p4 #g73 ,this book of ,harnack's alone carries ,lukan criticism a long step forwards1 and sets it on a new and higher plane4 ,never has the unity and character of the book been demonstrated so convincingly and conclusively4 ,the step is made and the plane is reached by the method which is practised in other departments of literary criticism1 viz41 by dispassionate investigation of the work and by discarding fashionable a priori theories4 ,the distinguished ,english traveller and writer on biblical subjects points out1 however1 that in detail many of ,harnack's objections to the ,lukan narratives are due to insufficient consideration of the circumstances in which they were written and the comparative significance of the details criticised4 ,he says1 ,harnack lays much stress on the fact that inconsistencies and inexactnesses occur all through ,acts4 ,some of these are undeniable2 and ,i have argued that they are to be regarded in the same light as similar phenomena in the poem of ,lucretius and in other ancient classical writers1 viz41 as proofs that the work never received the final form which ,luke intended to give it1 but was still incomplete when he died4 ,the evident need for a third book to complete the work1 together with those blemishes in expression1 form the proof4 ,ramsay's placing of ,harnack's writing in general is interesting in this connection4 7,p4 #h7 ,professor ,harnack stands on the border between the nineteenth and twentieth century4 ,his book shows that he is to a certain degree sensitive of and obedient to the new spirit2 but he is only partially so4 ,the nineteenth century critical method was false1 and is already antiquated4444 ,the first century could find nothing real and true that was not accompanied by the marvellous and the 'supernatural4' ,the nineteenth century could find nothing real and true that was4 ,which view was right and which was wrong8 ,was either complete8 ,of these two questions1 the second alone is profitable at the present4 ,both views were right--in a certain way of contemplating2 both views were wrong--in a certain way4 ,neither was complete4 ,at present1 as we are struggling to throw off the fetters which impeded thought in the nineteenth century1 it is most important to free ourselves from its prejudices and narrowness4 ,he adds 7pp4 #bf and #bg73 ,there are clear signs of the unfinished state in which this chapter was left by ,luke2 but some of the ,german scholar's criticisms show that he has not a right idea of the simplicity of life and equipment that evidently characterized the jailer's house and the prison4 ,the details which he blames as inexact and inconsistent are sometimes most instructive about the circumstances of this provincial town and ,roman colonia4 ,but it is never safe to lay much stress on small points of inexactness or inconsistency in any author4 ,one finds such faults even in the works of modern scholarship if one examines them in the microscopic fashion in which ,luke is studied here4 ,i think ,i can find them in the author ,harnack himself4 ,his point of view sometimes varies in a puzzling way4 ,as a matter of fact1 ,harnack1 as pointed out by ,ramsay1 was evidently working himself more and more out of the old conclusion as to the lack of authenticity of the ,lucan writings into an opinion ever more and more favorable to ,luke4 ,for instance1 in a notice of his own book1 published in the ,theologische ,literaturzeitung1 he speaks far more favorably about the trustworthiness and credibility of ,luke1 as being generally in a position to acquire and transmit reliable information1 and as having proved himself able to take advantage of his position4 ,harnack was gradually working his way to a new plane of thought4 ,his later opinion is more favorable4 ,ramsay also points out that ,professor ,giffert1 one of our ,american biblical critics1 had felt compelled by the geographical and historical evidence to abandon in part the older unfavorable criticism of ,luke and to admit that the ,acts is more trustworthy than previous critics allowed4 ,above all1 he saw that it was a living piece of literature written by one author4 ,in a word1 ,luke is being vindicated in every regard4 ,some of the supposed inaccuracies of ,luke vanish when careful investigation is made4 ,some of his natural history details1 for instance1 have been impugned and the story of the viper that fastened itself upon ,st4 ,paul in ,malta has been cited as an example of a story that would not have been told in that way by a man who knew medicine and the related sciences in ,luke's time4 ,because the passage illustrates a number of phases of the discussion with regard to ,luke's language ,i make a rather long quotation from ,ramsay3 ,take as a specimen with which to finish off this paper the passage ,acts xxviii1 #i et seq41 which is very fully discussed by ,harnack twice4 ,he argues that the true meaning of the passage was not understood until medical language was compared1 when it was shown that the ,greek word by which the act of the viper to ,paul's hand is described1 implies bit and not merely fastened upon4 ,but it is a well-assured fact that the viper1 a poisonous snake1 only strikes1 fixes the poison fangs on the flesh for a moment1 and withdraws its head instantly4 ,its action could never be what is attributed by ,luke the eye witness to this ,maltese viper2 that it hung from ,paul's hand and was shaken off into the fire by him4 ,on the other hand1 constrictors1 which have no poison fangs1 cling in the way described1 but as a rule do not bite4 ,are we1 then1 to understand in spite of the medical style and the authority of ,professor ,blass 7who translates momordit in his edition71 that the viper fastened upon the apostle's hand8 ,then1 the very name viper is a difficulty4 ,was ,luke mistaken about the kind of snake which he saw8 ,a trained medical man in ancient times was usually a good authority about serpents1 to which great respect was paid in ancient medicine and custom4 ,mere verbal study is here utterly at fault4 ,we can make no progress without turning to the realities and facts of ,maltese natural history4 ,a correspondent obligingly informed me some years ago that ,mr4 ,bryan ,hook1 of ,farnham1 ,surrey 7who1 my correspondent assures me1 is a thoroughly good naturalist71 had found in ,malta a small snake1 ,coronella austriaca1 which is rare in ,england1 but common in many parts of ,europe4 ,it is a constrictor1 without poison fangs1 which would cling to the hand or arm as ,luke describes4 ,it is similar in size to the viper1 and so like in markings and general appearance that ,mr4 ,hook1 when he caught his specimen1 thought he was killing a viper4 ,my friend1 ,prof4 ,j4,w4,h4 ,trail1 of ,aberdeen1 whom ,i consulted1 replied that ,coronella lvis or austriaca1 is known in ,sicily and the adjoining islands2 but he can find no evidence of its existence in ,malta4 ,it is known to be rather irritable1 and to fix its small teeth so firmly into the human skin as to need a little force to pull it off1 though the teeth are too short to do any real injury to the skin4 ,coronella is at a glance very much like a viper2 and in the flames it would not be closely examined4 ,while it is not reported as found in ,malta except by ,mr4 ,hook1 two species are known there belonging to the same family and having similar habits 7leopardinus and zamenis 7or coluber7 gemonensis74 ,the coloring of ,coronella leopardinus would be the most likely to suggest a viper4 ,the observations justify ,luke entirely4 ,we have here a snake so closely resembling a viper as to be taken for one by a good naturalist until he had caught and examined a specimen4 ,it clings1 and yet it also bites without doing harm4 ,that the ,maltese rustics should mistake this harmless snake for a venomous one is not strange4 ,many uneducated people have the idea that all snakes are poisonous in varying degrees1 just as the vulgar often firmly believe that toads are poisonous4 ,every detail as related by ,luke is natural1 and in accordance with the facts of the country4 ,in a word1 then1 the whole question as to ,luke's authority as a writer1 as an eye-witness of many things1 and as the relator of many others with regard to which he had obtained the testimony of eye-witnesses is fully vindicated4 ,twenty years ago many scholars were prone to doubt this whole question4 ,ten years ago most of them were convinced that the ,luke traditions were not justified by recent investigation4 ,now we have come back once more to the complete acceptance of the old traditions4 ,perhaps the most unfortunate characteristic of much nineteenth-century criticism in all departments1 even those strictly scientific1 was the marked tendency to reject previous opinions for new ones4 ,somehow men felt themselves so far ahead of old-time writers and thinkers that they concluded they must hold opinions different from their ancestors4 ,in nearly every case the new ideas that they evolved by supposedly newer methods are not standing the test of time and further study4 ,there had been a continuous belief in men's minds1 having its basis very probably on a passage in one of ,st4 ,peter's ,epistles1 that the earth would dissolve by fire4 ,this was openly contradicted all during the nineteenth century and the time when the earth would freeze up definitely calculated by our mathematicians4 ,now after having studied radioactivity and learned from the physicist that the earth is heating up and will eventually get too hot for life1 we calmly go back to the old ,petrine declaration4 ,some of the most distinguished of the ,german biologists of the present day1 such men as ,driesch and others1 calmly tell us that the edifice erected by ,darwin will have to come down because of newly discovered evidence1 and indeed some of them go so far as to declare that ,darwinism was a crude hypothesis very superficial in its philosophical aspects and therefore acceptable to a great many people who1 because it was easy to understand and was very different from what our fathers had believed1 hastened to accept it4 ,nothing shows the necessity for being conservative in the matter of new views in science or ethics or religion more than the curious transition state in which we are with regard to many opinions at the present time1 with a distinct tendency toward reaction to older views that a few years ago were thought quite untenable4 ,we are rather proud of the advance that we are supposed to be making along many lines in science and scholarship1 and yet over and over again1 after years of work1 we prove to have been following a wrong lead and must come back to where we started4 ,this has been the way of man from the beginning and doubtless will continue4 ,the present generation are having this curious regression that follows supposed progress strongly emphasized for them4 ,,appendix ,,ii ,,science ,,at ,,the ,,medieval ,,universities#ce ,with the growth of interest in science and in nature study in our own day1 one of the expressions that is probably oftenest heard is surprise that the men of preceding generations and especially university men did not occupy themselves more with the world around them and with the phenomena that are so tempting to curiosity4 ,science is usually supposed to be comparatively new and nature study only a few generations old4 ,men are supposed to have been so much interested in book knowledge and in speculations and theories of many kinds1 that they neglected the realities of life around them while spinning fine webs of theory4 ,previous generations1 of course1 have indulged in theory1 but then our own generation is not entirely free from that amusing occupation4 ,nothing could well be less true1 however1 than that the men of preceding generations were not interested in science even in the sense of physical science1 or that nature study is new1 or that men were not curious and did not try to find out all they could about the phenomena of the world around them4 ,the medieval universities and the school-men who taught in them have been particularly blamed for their failure to occupy themselves with realities instead of with speculation4 ,we are coming to recognize their wonderful zeal for education1 the large numbers of students they attracted1 the enthusiasm of their students1 since they made so many handwritten copies of the books of their masters1 the devotion of the teachers themselves1 who wrote at much greater length than do our professors even now and on the most abstruse subjects1 so that it is all the more surprising to think they should have neglected science4 ,the thought of our generation in the matter1 however1 is founded entirely on an assumption4 ,those who know anything about the writers of the ,middle ,ages at first hand are not likely to think of them as neglectful of science even in our sense of the term4 ,those who know them at second hand are1 however1 very sure in the matter4 ,the assumption is due to the neglect of history that came in the seventeenth and eighteenth centuries4 ,we have many other similar assumptions because of the neglect of many phases of mental development and applied science at this time4 ,for instance1 most of us are very proud of our modern hospital development and think of this as a great humanitarian evolution of applied medical science4 ,we are very likely to think that this is the first time in the world's history that the building of hospitals has been brought to such a climax of development1 and that the houses for the ailing in the olden time were mere refuges1 prone to become death traps and at most makeshifts for the solution of the problem of the care of the ailing poor4 ,this is true for the hospitals of the seventeenth and eighteenth centuries1 but it is not true at all for the hospitals of the thirteenth and fourteenth and fifteenth centuries4 ,miss ,nutting and ,miss ,dock in their ,history of ,nursing#cf have called attention to the fact that the lowest period in hospital development is during the eighteenth and early nineteenth centuries4 ,hospitals were little better than prisons1 they had narrow windows1 were ill provided with light and air and hygienic arrangements1 and in general were all that we should imagine old-time hospitals to be4 ,the hospitals of the earlier time1 however1 had fine high ceilings1 large windows1 abundant light and air1 excellent arrangements for the privacy of patients1 and in general were as worthy of the architects of the earlier times as the municipal buildings1 the cathedrals1 the castles1 the university buildings1 and every other form of construction that the late medieval centuries devoted themselves to4 ,the trouble with those who assume that there was no study of science and practically no attention to nature study in the ,middle ,ages is that they know nothing at all at first hand about the works of the men who wrote in the medieval period4 ,they have accepted declarations with regard to the absolute dependence of the scholastics on authority1 their almost divine worship of ,aristotle1 their utter readiness to accept authoritative assertions provided they came with the stamp of a mighty name1 and then their complete lack of attention to observation and above all to experiment4 ,nothing could well be more ridiculous than this ignorant assumption of knowledge with regard to the great teachers at the medieval universities4 ,just as soon as there is definite knowledge of what these great teachers wrote and taught1 not only does the previous mood of blame for them for not paying much more attention to science and nature at once disappear1 but it gives place to the heartiest admiration for the work of these great thinkers4 ,it is easy to appreciate1 then1 what ,professor ,saintsbury said in a recent volume on the thirteenth century3 ,and there have even been in these latter days some graceless ones who have asked whether the science of the nineteenth century after an equal interval will be of any more positive value--whether it will not have even less comparative interest than that which appertains to the scholasticism of the thirteenth4 ,three men were the great teachers in the medieval universities at their prime4 ,they have been read and studied with interest ever since4 ,they wrote huge tomes1 but men have pored over them in every generation4 ,they were ,albertus ,magnus1 the teacher of the other two1 ,thomas ,aquinas and ,roger ,bacon4 ,all three of them were together at the ,university of ,paris shortly after the middle of the thirteenth century4 ,anyone who wants to know anything about the attitude of mind of the medieval universities1 their professors and students1 and of all the intellectual world of the time towards science and observation and experiment1 should read the books of these men4 ,any other mode of getting at any knowledge of the real significance of the science of this time is mere pretence4 ,these constitute the documents behind any scientific history of the development of science at this time4 ,it is extremely interesting to see the attitude of these men with regard to authority4 ,in ,albert's tenth book 7of his ,summa71 in which he catalogues and describes all the trees1 plants1 and herbs known in his time1 he observes3 ,all that is here set down is the result of our own experience1 or has been borrowed from authors whom we know to have written what their personal experience has confirmed2 for in these matters experience alone can be of certainty4 ,in his impressive ,latin phrase experimentum solum certificat in talibus4 ,with regard to the study of nature in general he was quite as emphatic4 ,he was a theologian as well as a scientist1 yet in his treatise on ,the ,heavens and the ,earth he declared that in studying nature we have not to inquire how ,god the ,creator may1 as ,he freely wills1 use ,his creatures to work miracles and thereby show forth ,his power4 ,we have rather to inquire what nature with its immanent causes can naturally bring to pass4#cg ,just as striking quotations on this subject might be made from ,roger ,bacon4 ,indeed1 ,bacon was quite impatient with the scholars around him who talked over-much1 did not observe enough1 depended to excess on authority1 and in general did as mediocre scholars always do1 made much fuss on second-hand information--plus some filmy speculations of their own4 ,friar ,bacon1 however1 had one great pupil whose work he thoroughly appreciated because it exhibited the opposite qualities4 ,this was ,petrus--we have come to know him as ,peregrinus--whose observations on magnetism have excited so much attention in recent years with the republications of his epistle on the subject4 ,it is really a monograph on magnetism written in the thirteenth century4 ,roger ,bacon's opinion of it and of its author furnishes us the best possible index of his attitude of mind towards observation and experiment in science4 ,i know of only one person who deserves praise for his work in experimental philosophy for he does not care for the discourses of men and their wordy warfare1 but quietly and diligently pursues the works of wisdom4 ,therefore what others grope after blindly1 as bats in the evening twilight1 this man contemplates in their brilliancy because he is a master of experiment4 ,hence1 he knows all of natural science whether pertaining to medicine and alchemy1 or to matters celestial or terrestrial4 ,he has worked diligently in the smelting of ores as also in the working of minerals2 he is thoroughly acquainted with all sorts of arms and implements used in military service and in hunting1 besides which he is skilled in agriculture and in the measurement of lands4 ,it is impossible to write a useful or correct treatise in experimental philosophy without mentioning this man's name4 ,moreover1 he pursues knowledge for its own sake2 for if he wished to obtain royal favor1 he could easily find sovereigns who would honor and enrich him4 ,similar expressions might readily be quoted from ,thomas ,aquinas1 but his works are so easy to secure and his whole attitude of mind so well known1 that it scarcely seems worth while taking space to do so4 ,aquinas is still studied very faithfully in many universities1 and within the last few years one of his great text-books of philosophy has been replaced in the curriculum of ,oxford ,university1 in which it occupied a prominent position in the long ago1 as a work that may be offered for examination in the department of philosophy4 ,it is with regard to him particularly that there has been the greatest revulsion of feeling in recent years and a recognition of the fact that here was a great thinker familiar with all that was known in the physical sciences1 and who had this knowledge constantly in his mind when he drew his conclusions with regard to philosophical and theological questions4 ,it used to be the fashion to make little of the medieval scholars for the high estimation in which they held ,aristotle4 ,occasionally even yet one hears narrowly educated men1 ,i am sorry to say much more frequently scientific specialists than others1 talk deprecatingly of this ardent devotion to ,aristotle4 ,no one who knows anything about ,aristotle ever indulges in such an exhibition of ignorance of the realities of the history of philosophy and science4 ,to know ,aristotle well is to think of him as probably possessed of the greatest human mind that ever existed4 ,we do not need to go back to the ,middle ,ages to be confirmed in that opinion4 ,modern scientists who know their science well1 but who also know ,aristotle well1 and who are ardent worshippers at his shrine1 are not hard to find4 ,romanes1 the great ,english biologist of the end of the nineteenth century1 said3 ,it appears to me that there can be no question that ,aristotle stands forth not only as the greatest figure in antiquity but as the greatest intellect that has ever appeared upon this earth4 ,before ,romanes1 ,george ,h4 ,lewes1 in his interesting monograph in the history of thought1 ,aristotle1 a ,chapter in the ,history of ,science1 is quite as complimentary to the great ,greek thinker4 ,we may say that ,lewes was by no means partial to ,aristotle4 ,anything but inclined to accept authority as of value in philosophy1 he had been rendered impatient by the fact that so much of the history of philosophy was dominated by ,aristotle1 and it was only that the panegyric was forced from him by careful study of all that the ,stagirite wrote that he said3 ,history gazed on him with wonder4 ,his intellect was piercing and comprehensive2 his attainments surpassed those of every philosopher2 his influence has been excelled only by the founders of religion 444 his vast and active intelligence for twenty centuries held the world in awe4 ,professor ,osborn1 whose scholarly study of the theory of evolution down the ages ,from the ,greeks to ,darwin rather startled the world of science by showing not only how old was a theory of evolution1 but how frequently it had been stated and how many of them anticipated phases of our own thought in the matter1 pays a high compliment to the great ,greek scientist4 ,he says3 ,aristotle clearly states and rejects a theory of the origin of adaptive structures in animals altogether similar to that of ,darwin4 ,he then quotes certain passages from ,aristotle's ,physics1 and says3 ,these passages seem to contain absolute evidence that ,aristotle had substantially the modern conception of the evolution of life1 from a primordial1 soft mass of living matter to the most perfect forms1 and that even in these he believed that evolution was incomplete for they were progressing to higher forms4 ,modern ,french scientists are particularly laudatory in their estimation of ,aristotle4 ,the group of biologists1 ,buffon1 ,cuvier1 ,st4 ,hilaire1 and others who called world attention to ,french science and its attainments about a century ago1 are all of them on record in highest praise of ,aristotle4 ,cuvier said3 ,i cannot read his work without being ravished with astonishment4 ,it is impossible to conceive how a single man was able to collect and compare the multitude of facts implied in the rules and aphorisms contained in this book4 ,it is possible1 however1 to get opinions ardently laudatory of ,aristotle from the serious students of any nation1 provided only they know their ,aristotle4 ,sir ,william ,hamilton1 the ,scotch philosopher1 said3 ,aristotle's seal is upon all the sciences1 his speculations have determined those of all subsequent thinkers4 ,hegel1 the ,german philosophic writer1 is not less outspoken in his praise3 ,aristotle penetrated the whole universe of things and subjected them to intelligence4 ,kant1 who is often said to have influenced our modern thinking more than any other in recent generations1 has his compliment for ,aristotle4 ,it relates particularly to that branch of philosophy with which ,kant had most occupied himself4 ,the ,koenigsberg philosopher said3 ,logic since ,aristotle1 like ,geometry since ,euclid1 is a finished science4 ,i do not want to tire you or ,i could quote many other authorities who proclaim ,aristotle the genius of the race4 ,they would include poets like ,dante and ,goethe1 scholars like ,cicero and ,anthon1 literary men like ,lessing and ,reich and many others4 ,the scholars of the ,middle ,ages1 far from condemnation for their devotion to ,aristotle1 deserve the highest praise for it4 ,if they had done nothing else but appreciate ,aristotle as our greatest modern scholars have done1 that of itself would proclaim their profound scholarship4 ,the medieval writers are often said to have been uncritical in their judgment1 but in their lofty estimation of ,aristotle they displayed the finest possible critical judgment4 ,on the contrary1 the generations who made much of the opportunity to minimize medieval scholarship because of its worship at the shrine of ,aristotle1 must themselves fall under the suspicion at least of either not knowing ,aristotle or of not thinking deeply about the subjects with regard to which he wrote4 ,for in all the world's history the rule has been that whenever men have thought deeply about a subject and know what ,aristotle has written with regard to that subject1 they have the liveliest admiration for the great ,greek thinker4 ,this is true for philosophy1 logic1 metaphysics1 politics1 ethics1 dramatics1 but it is also quite as true for physical science4 ,he lacked our knowledge1 though not nearly to the degree that is usually thought1 and he had a marvellous accumulation of information1 but he had a breadth of view and a thoroughness of appreciation with a power of penetration that make his opinions worth while knowing even on scientific subjects in our enlightened age4 ,as for the supposed swearing by ,aristotle1 in the sense of literally accepting his opinions without daring to examine them critically1 which is so constantly asserted to have been the habit of the medieval scholars and teachers1 it is extremely difficult in the light of the expressions which we have from them1 to understand how this false impression arose4 ,aristotle they thoroughly respected4 ,they constantly referred to his works1 but so has every thinking generation ever since4 ,whenever he had made a declaration they would not accept the contradiction of it without a good reason1 but whenever they had good reasons1 ,aristotle's opinion was at once rejected without compunction4 ,albertus ,magnus1 for instance1 said3 ,whoever believes that ,aristotle was a ,god must also believe that he never erred1 but if we believe that ,aristotle was a man1 then doubtless he was liable to err just as we are4 ,a number of direct contradictions of ,aristotle we have from ,albert4 ,a well-known one is that with regard to ,aristotle's assertion that lunar rainbows appeared only twice in fifty years4 ,albert declared that he himself had seen two in a single year4 ,indeed1 it seems very clear that the whole trend of thought among the great teachers of the time was away from the acceptance of scientific conclusions on authority unless there was good evidence for them available4 ,they were quite as impatient as the scientists of our time with the constant putting forward of ,aristotle as if that settled a scientific question4 ,roger ,bacon wanted the ,pope to forbid the study of ,aristotle because his works were leading men astray from the study of science1 his authority being looked upon as so great that men did not think for themselves but accepted his assertions4 ,smaller men are always prone to do this1 and indeed it constitutes one of the difficulties in the way of advance in scientific knowledge at all times1 as ,roger ,bacon himself pointed out4 ,these are the sort of expressions that are to be expected from ,friar ,bacon from what we know of other parts of his work4 ,his ,opus ,tertium was written at the request of ,pope ,clement ,,iv1 because the ,pope had heard many interesting accounts of what the great thirteenth-century teacher and experimenter was doing at the ,university of ,oxford1 and wished to learn for himself the details of his work4 ,bacon starts out with the principle that there are four grounds of human ignorance4 ,these are1 first1 trust in inadequate authority2 second1 that force of custom which leads men to accept without properly questioning what has been accepted before their time2 third1 the placing of confidence in the assertions of the inexperienced2 and fourth1 the hiding of one's own ignorance behind the parade of superficial knowledge1 so that we are afraid to say ,i do not know4 ,professor ,henry ,morley1 a careful student of ,bacon's writings1 said with regard to these expressions of ,bacon3 ,no part of that ground has yet been cut away from beneath the feet of students1 although six centuries have passed4 ,we still make sheep-walks of second1 third and fourth1 and fiftieth hand references to authority2 still we are the slaves of habit1 still we are found following too frequently the untaught crowd1 still we flinch from the righteous and wholesome phrase ,i do not know and acquiesce actively in the opinion of others that we know what we appear to know4 ,in his ,opus ,majus ,bacon had previously given abundant evidence of his respect for the experimental method4 ,there is a section of this work which bears the title ,scientia ,experimentalis4 ,in this ,bacon affirms that without experiment nothing can be adequately known4 ,an argument may prove the correctness of a theory1 but does not give the certitude necessary to remove all doubt1 nor will the mind repose in the clear view of truth unless it finds its way by means of experiment4 ,to this he later added in his ,opus ,tertium3 ,the strongest argument proves nothing so long as the conclusions are not verified by experience4 ,experimental science is the queen of sciences1 and the goal of all speculation4 ,it is no wonder that ,dr4 ,whewell1 in his ,history of the ,inductive ,sciences1 should have been unstinted in his praise of ,roger ,bacon's work and writings4 ,in a well-known passage he says of the ,opus ,majus3 ,roger ,bacon's ,opus ,majus is the encyclopedia and ,novum ,organon of the thirteenth century1 a work equally wonderful with regard to its wonderful scheme and to the special treatises by which the outlines of the plans are filled up4 ,the professed object of the work is to urge the necessity of a reform in the mode of philosophizing1 to set forth the reasons why knowledge had not made greater progress1 to draw back attention to the sources of knowledge which had been unwisely neglected1 to discover other sources which were yet almost untouched1 and to animate men in the undertaking of a prospect of the vast advantages which it offered4 ,in the development of this plan all the leading portions of science are expanded in the most complete shape which they had at that time assumed2 and improvements of a very wide and striking kind are proposed in some of the principal branches of study4 ,even if the work had no leading purposes it would have been highly valuable as a treasure of the most solid knowledge and soundest speculations of the time2 even if it had contained no such details it would have been a work most remarkable for its general views and scope4 ,as a matter of fact the universities of the ,middle ,ages1 far from neglecting science1 were really scientific universities4 ,because the universities of the early nineteenth century occupied themselves almost exclusively with languages and especially formed students' minds by means of classical studies1 men in our time seem to be prone to think that such linguistic studies formed the main portion of the curriculum of the universities in all the old times and particularly in the ,middle ,ages4 ,the study of the classic languages1 however1 came into university life only after the ,renaissance4 ,before that the undergraduates of the universities had occupied themselves almost entirely with science4 ,it was quite as much trouble to introduce linguistic studies into the old universities in the ,renaissance time to replace science1 as it was to secure room for science by pushing out the classics in the modern time4 ,indeed the two revolutions in education are strikingly similar when studied in detail4 ,men who had been brought up on science before the ,renaissance were quite sure that that formed the best possible means of developing the mind4 ,in the early nineteenth century men who had been formed on the classics were quite as sure that science could not replace them with any success4 ,there is no pretence that this view of the medieval universities is a new idea in the history of education4 ,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 study1 have not been inclined to make the mistake of thinking that the medieval university neglected science4 ,professor ,huxley in his ,inaugural ,address as ,rector of ,aberdeen ,university some thirty years ago stated very definitely his recognition of medieval devotion to science4 ,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 universities4 ,professor ,huxley said3 ,the scholars of the medieval universities seem to have studied grammar1 logic1 and rhetoric2 arithmetic and geometry2 astronomy1 theology1 and music4 ,thus their work1 however imperfect and faulty1 judged by modern lights1 it may have been1 brought them face to face with all the leading aspects of the many-sided mind of man4 ,for these studies did really contain1 at any rate in embryo1 sometimes it may be in caricature1 what we now call philosophy1 mathematical and physical science1 and art4 ,and ,i doubt if the curriculum of any modern university shows so clear and generous a comprehension of what is meant by culture1 as this old ,trivium and ,quadrivium does4 ,it would be entirely a mistake1 however1 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 after1 only had the principles of physical and experimental science and did not practically apply them4 ,as a matter of fact their works are full of observation4 ,once more1 the presumption that they wrote only nonsense with regard to science comes from those who do not know their writings at all1 while great scientists who have taken the pains to study their works are enthusiastic in praise4 ,humboldt1 for instance1 says of ,albertus ,magnus1 after reading some of his works with care3 ,albertus ,magnus is equally active and influential in promoting the study of natural science and of the ,aristotelian philosophy4 ,his works contain some exceedingly acute remarks on the organic structure and physiology of plants4 ,one of his works bearing the title of ,liber ,cosmographicus ,de ,natura ,locorum is a species of physical geography4 ,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 surprise4 ,it is with regard to physical geography of course that ,humboldt is himself a distinguished authority4 ,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 people4 ,meyer1 the ,german historian of botany1 however1 has re-echoed ,humboldt's praise with emphasis4 ,the extraordinary erudition and originality of ,albert's treatise on plants drew from ,meyer the comment3 ,no botanist who lived before ,albert can be compared with him unless ,theophrastus1 with whom he was not acquainted2 and after him none has painted nature in such living colors or studied it so profoundly until the time of ,conrad ,gessner and ,csalpino4 ,these men1 it may be remarked1 come three centuries after ,albert's time4 ,a ready idea of ,albert's contributions to physical science can be obtained from his life by ,sighart1 which has been translated into ,english by ,dixon and was published in ,london in #ahgj4 ,pagel1 in ,puschmann's ,history of ,medicine1 already referred to1 gives a list of the books written by ,albert on scientific matters with some comments which are eminently suggestive1 and furnish solid basis for the remark that ,i have made1 that men's minds were occupied with nearly the same problems in science in the thirteenth century as we are now1 while the conclusions they came to were not very different from ours1 though reached so long before us4 ,this catalogue of ,albertus ,magnus' works shows very well his own interest and that of his generation in physical science of all kinds4 ,there were eight treatises on ,aristotle's physics and on the underlying principles of natural philosophy and of energy and of movement2 four treatises concerning the heavens and the earth1 one on physical geography which also contains1 according to ,pagel1 numerous suggestions on ethnography and physiology4 ,there are two treatises on generation and corruption1 six books on meteors1 five books on minerals1 three books on the soul1 two books on the intellect1 a treatise on nutritives1 and then a treatise on the senses and another on the memory and on the imagination4 ,all the phases of the biological sciences were especially favorite subjects of his study4 ,there is a treatise on the motion of animals1 a treatise in six books on vegetables and plants1 a treatise on breathing things1 a treatise on sleep and waking1 a treatise on youth and old age1 and a treatise on life and death4 ,his treatise on minerals contains1 according to ,pagel1 a description of ninety-five different kinds of precious stones4 ,albert's volumes on plants were reproduced with ,meyer1 the ,german botanist1 as editor 7,berlin1 #ahfg74 ,all of ,albert's books are available in modern editions4 ,pagel says of ,albertus that ,his profound scholarship1 his boundless industry1 the almost incontrollable impulse of his mind after universality of knowledge1 the many-sidedness of his literary productivity1 and finally the almost universal recognition which he received from his contemporaries and succeeding generations1 stamp him as one of the most imposing characters and one of the most wonderful phenomena of the ,middle ,ages4 ,in another passage ,pagel has said3 ,while ,albert was a ,churchman and an ardent devotee of ,aristotle1 in matters of natural phenomena he was relatively unprejudiced and presented an open mind4 ,he thought that he must follow ,hippocrates and ,galen1 rather than ,aristotle and ,augustine1 in medicine and in the natural sciences4 ,we must concede it a special subject of praise for ,albert that he distinguished very strictly between natural and supernatural phenomena4 ,the former he considered as entirely the object of the investigation of nature4 ,the latter he handed over to the realm of metaphysics4 ,roger ,bacon is1 however1 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 sciences4 ,some of these indeed are so startling1 that only that we know them not by tradition but from his works1 where they may be readily found without any doubt of their authenticity1 we should be sure to think that they must be the result of later commentators' ideas4 ,bacon was very much interested in astronomy1 and not only suggested the correction of the calendar1 but also a method by which it could be kept from wandering away from the actual date thereafter4 ,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 velocity4 ,he is sometimes said to have invented gunpowder1 but of course he did not1 though he studied this substance in various forms very carefully and drew a number of conclusions in his observations4 ,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 conditions4 ,he said1 for instance3 ,art can construct instruments of navigation1 such that the largest vessels governed by a single man will traverse rivers and seas more rapidly than if they were filled with oarsmen4 ,one may also make carriages which without the aid of any animal will run with remarkable swiftness4 ,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 kinds1 this expression of ,roger ,bacon represents a prophecy marvellously surprising in its fulfilment4 ,it is no wonder that the book whence it comes bears the title ,de ,secretis ,artis et ,natur4 ,roger ,bacon even went to the extent1 however1 of declaring that man would some time be able to fly4 ,he was even sure that with sufficient pains he could himself construct a flying machine4 ,he did not expect to use explosives for his motor power1 however1 but thought that a windlass properly arranged1 worked by hand1 might enable a man to make sufficient movement to carry himself aloft or at least to support himself in the air1 if there were enough surface to enable him to use his lifting power to advantage4 ,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 all4 ,the more one knows of ,aquinas the more surprise there is at his anticipation of many modern scientific ideas4 ,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 7nihil omnino in nihilum redigetur74 ,he was teaching the doctrine that man could not destroy matter and ,god would not annihilate it4 ,in other words1 he was teaching the indestructibility of matter even more emphatically than we do4 ,he saw the many changes that take place in material substances around us1 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 world4 ,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 destroyed4 ,in other words1 he was anticipating not vaguely1 but very clearly and definitely1 the conservation of energy4 ,his teaching with regard to the composition of matter was very like that now held by physicists4 ,he declared that matter was composed of two principles1 prime matter and form4 ,by forma he meant the dynamic element in matter1 while by materia prima he meant the underlying substratum of material1 the same in every substance1 but differentiated by the dynamics of matter4 ,it used to be the custom to make fun of these medieval scientists for believing in the transmutation of metals4 ,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 contemporaries4 ,the theory of matter and form1 however1 gave a philosophical basis for the idea that one kind of matter might be changed into another4 ,we no longer think that notion absurd4 ,sir ,william ,ramsay has actually succeeded in changing one element into another and radium and helium are seen changing into each other1 until now we are quite ready to think of transmutation placidly4 ,the ,philosopher's ,stone used to seem a great absurdity until our recent experience with radium1 which is to some extent at least the philosopher's stone1 since it brings about the change of certain supposed elements into others4 ,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 commonly1 and then come back after twenty years and look for further traces of silver1 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 gold4 ,most people will be inclined to ask where the fruits of this undergraduate teaching of science are to be found4 ,they are inclined to presume that science was a closed book to the men and women of that time4 ,it is not hard1 however1 to point the effect of the scientific training in the writings of the times4 ,dante is a typical university man of the period4 ,he was at several ,italian universities1 was at ,paris and perhaps at ,oxford4 ,his writings are full of science4 ,professor ,khns1 of ,wesleyan1 in his book ,the ,treatment of ,nature in ,dante1 has pointed out how much ,dante knows of science and of nature4 ,few of the poets not only of his own but of any time have known more4 ,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 poetry4 ,the astronomy1 the botany1 the zology of ,albertus ,magnus and ,thomas ,aquinas1 ,dante knew very well and used confidently for figurative purposes4 ,anyone who is inclined to think nature study a new idea in the world forgets1 or has never known1 his ,dante4 ,the birds and the bees1 the flowers1 the leaves1 the varied aspects of clouds and sea1 the phenomena of phosphorescence1 the intimate habits of bird and beast and the ways of the plants1 as well as all the appearances of the heavens1 ,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 time4 ,only that his readers appreciated it all1 ,dante would surely not have used his scientific erudition so constantly4 ,so much for the undergraduate department of the universities of the ,middle ,ages1 and the view is absolutely fair1 for these were the men to whom the students flocked by thousands4 ,they were teaching science1 not literature4 ,they were discussing physics as well as metaphysics1 psychology in its phenomena as well as philosophy1 observation and experiment as well as logic1 the ethical sciences1 economics1 practically all the scientific ideas that were needed in their generation--and that generation saw the rise of the universities1 the finishing of the cathedrals1 the building of magnificent town halls and castles and beautiful municipal buildings of many kinds1 including hospitals1 the development of the ,hansa ,league in commerce1 and of wonderful manufacturers of all the textiles1 the arts and crafts1 as well as the most beautiful book-making and art and literature4 ,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 science4 ,anyone who reads their books will be quite sure of that4 ,while most people might be ready1 then1 to confess that possibly ,huxley was not mistaken with regard to the undergraduate department of the universities1 most of them would feel sure that at least the graduate departments were sadly deficient in accomplishment4 ,once more this is entirely an assumption4 ,the facts are all against any such idea4 ,there were three graduate departments in most of the universities--theology1 law1 and medicine4 ,while physical scientists are usually not cognizant of it apparently1 theology is a science1 a department of knowledge developed scientifically1 and most of these medieval universities did more for its scientific development than the schools of any other period4 ,quite as much may be said for philosophy1 for there are many who hesitate to attribute any scientific quality to modern developments in the matter4 ,as for law1 this is the great period of the foundation of scientific law development2 the ,english common law was formulated by ,bracton1 the deep foundations of basic ,french and ,spanish law were laid1 and canon law acquired a definite scientific character which it was always to retain4 ,all this was accomplished almost entirely by the professors in the law departments of the universities4 ,it was in medicine1 however1 where most people would be quite sure without any more ado that nothing worth while talking about was being done1 that the great triumphs of graduate teaching at the medieval universities were secured4 ,here more than anywhere else is there room for supreme surprise at the quite unheard-of anticipations of our modern medicine and1 stranger still1 as it may seem1 of our modern surgery4 ,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 education4 ,students were required to have three years of preliminary study at the university1 four years in the medical department1 and then practise for a year with a physician before they were allowed to practise for themselves4 ,if they wanted to practise surgery1 an extra year in the study of anatomy was required4 ,i published the text of this law1 which was issued by the ,emperor ,frederick ,,ii about #abda1 in the ,journal of the ,american ,medical ,association three years ago4 ,it also regulated the practice of pharmacy4 ,drugs were manufactured under the inspection of the government and there was a heavy penalty for substitution1 or for the sale of old inert drugs1 or improperly prepared pharmaceutical materials4 ,if the government inspector violated his obligations as to the oversight of drug preparations the penalty was death4 ,nor was this law of the ,emperor ,frederick an exception4 ,we have the charters of a number of medical schools issued by the ,popes during the next century1 all of which require seven years or more of university study1 four of them in the medical department1 before the doctor's degree could be obtained4 ,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 teaching1 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 pass4 ,it might be easy to think1 and many people are prone to do so1 that in spite of the long years of study required there was really very little to study in medicine at that time4 ,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 ,st4 ,louis in #aijd4 ,he has dwelt more on surgery than on medicine1 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 since4 ,they were carefully studying cases and writing case histories1 they were teaching at the bedside1 they were making valuable observations1 and they were using the means at their command to the best advantage4 ,of course there are many absurdities in their therapeutics1 but then we must not forget there have always been many absurdities in therapeutics and that we are not free from them in our day4 ,professor ,richet1 at the ,university of ,paris1 said not long ago3 ,the therapeutics of any generation is quite absurd to the second succeeding generation4 ,we shall not blame the medieval generations for having accepted remedies that afterwards proved inert1 for every generation has done that1 even our own4 ,their study of medicine was not without lasting accomplishment1 however4 ,they laid down the indications and the dosage for opium4 ,they used iron with success1 they tried out many of the bitter tonics among the herbal medicines1 and they used laxatives and purgatives to good advantage4 ,down at ,montpellier1 ,gilbert1 the ,englishman1 suggested red light for smallpox because it shortened the fever1 lessened the lesions1 and made the disfigurement much less4 ,finsen was given the ,nobel prize partly for re-discovery of this4 ,they segregated erysipelas and so prevented its spread4 ,they recognized the contagiousness of leprosy1 and though it was probably as widespread as tuberculosis is at the present time1 they succeeded not only in controlling but in eventually obliterating it throughout ,europe4 ,it was in surgery1 however1 that the greatest triumphs of teaching of the medieval universities were secured4 ,most people are inclined to think that surgery developed only in our day4 ,the great surgeons of the thirteenth and fourteenth centuries1 however1 anticipated most of our teaching4 ,they investigated the causes of the failure of healing by first intention1 recognized the danger of wounds of the neck1 differentiated the venereal diseases1 described rabies1 and knew much of blood poisoning1 and operated very skilfully4 ,we have their text-books of surgery and they are a never-ending source of surprise4 ,they operated on the brain1 on the thorax1 on the abdominal cavity1 and did not hesitate to do most of the operations that modern surgeons do4 ,they operated for hernia by the radical cure1 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 patient4 ,guy de ,chauliac declared that in wounds of the intestines patients would die unless the intestinal lacerations were sewed up1 and he described the method of suture and invented a needle holder4 ,we have many wonderful instruments from these early days preserved in pictures at least1 that show us how much modern advance is merely re-invention4 ,they understood the principles of aseptic surgery very well4 ,they declared that it was not necessary that pus should be generated in wounds4 ,professor ,clifford ,allbutt says3 ,they washed the wound with wine1 scrupulously removing every foreign particle2 then they brought the edges together1 not allowing wine or anything else to remain within--dry adhesive surfaces were their desire4 ,nature1 they said1 produces the means of union in a viscous exudation1 or natural balm1 as it was afterwards called by ,paracelsus1 ,par1 and ,wurtz4 ,in older wounds they did their best to obtain union by cleansing1 desiccation1 and refreshing of the edges4 ,upon the outer surface they laid only lint steeped in wine4 ,powders they regarded as too desiccating1 for powder shuts in decomposing matters2 wine after washing1 purifying1 and drying the raw surfaces evaporates4 ,almost needless to say these are exactly the principles of aseptic surgery4 ,the wine was the best antiseptic that they could use and we still use alcohol in certain cases4 ,it would seem to many quite impossible that such operations as are described could have been done without ansthetics1 but they were not done without ansthetics4 ,there were two or three different forms of ansthesia used during the thirteenth and fourteenth centuries4 ,one method employed by ,ugo da ,lucca consisted of the use of an inhalant4 ,we do not know what the material employed was4 ,there are definite records1 however1 of its rather frequent employment4 ,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 them4 ,it is difficult to understand where the old false impressions came from4 ,the picture of university work that recent historical research has given us shows us professors and students busy with science in every department1 making magnificent advances1 many of which were afterwards forgotten1 or at least allowed to lapse into desuetude4 ,the positive assertions with regard to old-time ignorance were all made in the course of religious controversy4 ,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 education4 ,there is not a trace of that to be found anywhere1 but there were many documents that were appealed to to confirm the protestant view4 ,there was a ,papal bull1 for instance1 said to forbid dissection4 ,when read it proves to forbid the cutting up of bodies to carry them to a distance for burial1 an abuse which caused the spread of disease1 and was properly prohibited4 ,the ,church prohibition was international and therefore effective4 ,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 centuries4 ,the ,papal physicians were among the greatest dissectors4 ,dissections were done at ,rome and the cardinals attended them4 ,bologna at the height of its fame was in the ,papal ,states4 ,all this has been ignored and the supposed bull against anatomy emphasized as representing the keynote of medical and surgical history4 ,then there was a ,papal decree forbidding the making of gold and silver4 ,this was said to forbid chemistry or alchemy and so prevent scientific progress4 ,the history of the medical schools of the time shows that it did no such thing4 ,the great alchemists of the time doing really scientific work were all clergymen1 many of them very prominent ecclesiastics4 ,just in the same way there were said to be decrees of the ,church councils forbidding the practice of surgery4 ,president ,white says in his ,warfare of ,science with ,theology in ,christendom1 that1 as a consequence of these1 surgery was in dishonor until the ,emperor ,wenceslaus1 at the beginning of the fifteenth century1 ordered that it should be restored to estimation4 ,as a matter of fact1 during the two centuries immediately preceding the first years of the fifteenth century1 surgery developed very wonderfully1 and we have probably the most successful period in all the history of surgery except possibly our own4 ,the decrees forbade monks to practise surgery because it led to certain abuses4 ,those who found these decrees and wanted to believe that they prevented all surgical development simply quoted them and assumed there was no surgery4 ,the history of surgery at this time is one of the most wonderful chapters in human progress4 ,the more we know of the ,middle ,ages the more do we realize how much they accomplished in every department of intellectual effort4 ,their development of the arts and crafts has never been equalled in the modern time4 ,they made very great literature1 marvellous architecture1 sculpture that rivals the ,greeks'1 painting that is still the model for our artists1 surpassing illuminations2 everything that they touched became so beautiful as to be a model for all the after time4 ,they accomplished as much in education as they did in all the other arts1 their universities had more students than any that have existed down to our own time1 and they were enthusiastic students and their professors were ardent teachers1 writers1 observers1 investigators4 ,while we have been accustomed to think of them as neglecting science1 their minds were occupied entirely with science4 ,they succeeded in anticipating much more of our modern thought1 and even scientific progress1 than we have had any idea until comparatively recent years4 ,the work of the later ,middle ,ages in mathematics is particularly strong1 and was the incentive for many succeeding generations4 ,roger ,bacon insisted that1 without mathematics1 there was no possibility of real advance in physical science4 ,they had the right ideas in every way4 ,while they were occupied more with the philosophical and ethical sciences than we are1 these were never pursued to the neglect of the physical sciences in the strictest sense of that term4 ,is it not time that we should drop the foolish notions that are very commonly held because we know nothing about the ,middle ,ages--and1 therefore1 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 time8 ,,appendix ,,iii ,,medieval ,,popularization ,,of ,,science ,the idea of collecting general information from many sources1 of bringing it together into an easily available form1 so as to save others labor1 of writing it out in compendious fashion1 so that it could readily pass from hand to hand1 is likely to be considered typically modern4 ,as a matter of fact1 the ,middle ,ages furnish us with many examples of the popularization of science1 of the writing of compendia of various kinds1 of the gathering of information to save others the trouble1 and1 above all1 of the making of what1 in the modern time1 we would call encyclopedias4 ,handbooks of various kinds were issued1 manuals for students and specialists1 and many men of broad scholarship in their time devoted themselves to the task of making the acquisition of knowledge easy for others4 ,this was true not only for history and philosophy and literature1 but also for science4 ,it is not hard to find in each century of the ,middle ,ages some distinguished writer who devoted himself to this purpose1 and for the sake of the light that it throws on these scholars1 and the desire for information that must have existed very commonly since they were tempted to do the work1 it seems worth while to mention here their names1 and those of the books they wrote1 with something of their significance1 though the space will not permit us to give here much more than a brief catalogue raisonn of such works4 ,very probably the first who should be mentioned in the list is ,bothius1 who flourished in the early part of the sixth century4 ,he owed much of his education to his adoptive father1 afterwards his father-in-law1 ,symmachus1 who1 with ,festus1 represented scholarship at the court of the ,gothic ,king1 ,theodoric of ,verona4 ,these three--,festus1 ,symmachus1 and ,bothius--brought such a reputation for knowledge to the court that they are responsible for many of the wonderful legends of ,dietrich of ,bern1 as ,theodoric came to be called in the poems of the medieval ,german poets4 ,the three distinguished and devoted scholars did much to save ,greek culture at a time when its extinction was threatened1 and ,bothius particularly left a series of writings that are truly encyclopedic in character4 ,there are five books on music1 two on arithmetic1 one on geometry1 translations of ,aristotle's treatises on logic1 with commentaries2 of ,porphyry's ,isagoge1 with commentaries1 and a commentary on ,cicero's ,topica4 ,besides1 he wrote several treatises in logic and rhetoric himself1 one on the use of the syllogism1 and one on topics1 and in addition a series of theological works4 ,his great ,consolations of ,philosophy was probably the most read book in the early ,middle ,ages4 ,it was translated into ,anglo-,saxon by ,king ,alfred1 into old ,german by ,notker ,teutonicus1 the ,german monk of ,st4 ,gall1 and its influence may be traced in ,beowulf1 in ,chaucer1 in ,high ,german poetry1 in ,anglo-,norman and ,provenal popular poetry1 and also in early ,italian verse4 ,above all1 the ,divine ,comedy has many references to it1 while the ,convito would seem to show that it was probably the book that most influenced ,dante4 ,though it is impossible to confirm by documentary evidence the generally accepted idea that ,bothius died a martyr for ,christianity1 the tradition can be traced so far back1 and it has been so generally accepted that this seems surely to have been the case4 ,the fact is interesting1 as showing the attitude of scholars towards the ,church and of the ,church towards scholarship thus early4 ,the next great name in the tradition should probably be that of ,cassiodorus1 the ,roman writer and statesman1 prime minister of ,theodoric1 who1 after a busy political life1 retired to his estate at ,vivarium1 and1 in imitation of ,st4 ,benedict1 who had recently established a monastery at ,monte ,cassino1 founded a monastery there4 ,he is said to have lived to the age of ninety-three4 ,his retirement favored this long life1 for1 after the death of ,theodoric1 troublous times came1 and civil war1 and only his monastic privileges saved him from the storm and stress of the times4 ,he had been interested in literature and the collection of information of many kinds before his retirement1 and it is not unlikely that his recognition of the fact that the monastic life offered opportunities for the pursuit of this1 under favorable circumstances1 led him to take it up4 ,while still a statesman he wrote a series of works relating to history and politics and public affairs generally4 ,these consisted mainly of chronicles and panegyrics1 and twelve books of miscellanies called ,vari4 ,after his retirement to the monastery1 a period of ardent devotion to writing begins1 and a great number of books were issued4 ,he evidently gathered round him a number of men whom he inspired with his spirit1 or1 perhaps1 selected1 because he found that1 while they had a taste for a quiet1 peaceful spiritual life1 they were also devoted to the accumulation and diffusion of knowledge4 ,a series of commentaries on portions of the ,scriptures was written1 the ,jewish antiquities of ,josephus translated1 and the ecclesiastical histories of ,theodoric1 ,sozomen1 and ,socrates made available in ,latin4 ,cassiodorus himself is said to have made a compendium of these1 called the ,historia ,tripartita1 which was much used as a manual of history during succeeding centuries4 ,then there were treatises on grammar1 on orthography1 and a series of works on mathematics4 ,in all of his writings ,cassiodorus shows a special fondness for the symbolism of numbers4 ,there is a well-grounded tradition that he insisted on the study of the ,greek classics of medical literature1 especially ,hippocrates and ,galen1 and awakened the interest of the monks in the necessity for making copies of these fathers of medicine4 ,the tradition that he established at ,vivarium is also found to have existed at ,monte ,cassino among the ,benedictines1 and1 doubtless1 to this is to be attributed the foundation of the medical school of ,salerno1 where ,benedictine influence was so strong4 ,it is probable1 therefore1 that to ,cassiodorus must be attributed the preservation in as perfect a state as we have them of the old ,greek medical writers4 ,his main idea was1 of course1 the study of ,scriptures1 but with just as many helps as possible4 ,he thought that commentators1 and historians1 not alone ,christian1 but also ,hebrew and ,pagan1 should be studied to illustrate it1 and then the commentaries of the ,latin fathers1 so that a thoroughly rounded knowledge of it should be obtained4 ,he thus began an ,encyclopedia ,biblica1 and set a host of workers at its accomplishment4 ,every country in ,europe shared this movement for the diffusion of information during the early ,middle ,ages1 and the works of men from each of these countries in succeeding centuries has come down to us1 preserved in spite of all the vicissitudes to which they were so liable during the centuries before the invention of printing and the easy multiplication of books4 ,to many people it will seem surprising to learn that the next evidence of deep broad interest in knowledge is to be found in the next century in the distant west of ,europe1 in the ,spanish ,peninsula4 ,it is a long step from the semi-barbaric splendor of the ,gothic court at ,verona1 to the bishop's palace in ,seville in ,andalusia4 ,the two cities are separated by what is no inconsiderable distance in our day4 ,in the seventh century they must have seemed almost at the other end of the world from each other4 ,those who recall what we have insisted on in several portions of the body of this work with regard to the high place ,spanish genius won for itself in the ,roman ,empire1 and how much of culture among the ,spaniards of that time the occurrence of so many important writers of that nationality must imply1 will not be surprised at the distinguished work of a great ,christian ,spanish writer of the seventh century4 ,indeed1 it would be only what might be expected for evidences of early awakening of the broadest culture to be found in ,spain4 ,the important name in the popularization of science in the seventh century is ,st4 ,isidore of ,seville4 ,he made a compendium of all the scattered scientific traditions and information of his time with regard to natural phenomena in a sort of encyclopedia of science4 ,this consisted of twenty books--chapters we would call them now--treating almost de omni re scibili et quibusdam aliis 7everything knowable and a few other things besides74 ,it is possible that the work may have been written by a number of collaborators under the patronage of the bishop1 though there is no sure indication of this to be found either in the volume itself or even contemporary history4 ,all the ordinary scientific subjects are treated4 ,astronomy1 geography1 mineralogy1 botany1 and even man and the animals have each a special chapter4 ,pouchet1 in his ,history of the ,natural ,sciences ,during the ,middle ,ages1 calls attention to the fact that1 in grouping the animals for collective treatment in the different chapters1 sometimes the most heterogeneous creatures are brought under a common heading4 ,among the fishes1 for instance1 are classed all living things that are found in water4 ,the whale and the dolphin1 as well as sponges1 and oysters1 and crocodiles1 and sea serpents1 and lobsters1 and hippopotamuses1 all find a place together1 because of the common watery habitation4 ,the early ,spanish ,churchman would seem to have had an enthusiastic zeal for complete classification that would surely have made him a strenuous modern zologist4 ,the next link in the tradition of encyclopedic work is the ,venerable ,bede1 whose character was more fully honored by the decree on ,november #ac1 #ahii1 by ,pope ,leo ,,xiii declaring him a ,doctor of the ,church4 ,bede was the fruit of that ardent scholarship which had risen in ,england as a consequence of the introduction of ,christianity4 ,it had been fostered by the coming of scholar saints from ,ireland1 but was1 unfortunately1 disturbed by the incursions of the ,danes4 ,while ,bede is known for his greatest work1 the ,ecclesiastical ,history of the ,english ,people1 which gives an account of ,christianity in ,england from its beginning until his own day1 he wrote many other works4 ,his history is the foundation of all our knowledge of early ,british history1 secular as well as religious1 and has been praised by historical writers of all ages1 who turned to it for help with confidence4 ,he wrote a number of other historical works4 ,besides1 he wrote books on grammar1 orthography1 the metrical art1 on rhetoric1 on the nature of things1 the seasons1 and on the calculation of the seasons4 ,these latter books are distinctly scientific4 ,his contributions to ,gregorian ,music are now of great value4 ,after this1 ,alcuin and the monks1 summoned by ,charlemagne1 take up the tradition of gathering and diffusing information1 and the great monasteries of ,tours1 ,fulda1 and ,st4 ,gall carry it on4 ,besides these1 in the ninth century ,monte ,cassino comes into prominence as an institution where much was done of what we would now call encyclopedic work4 ,after his retirement from ,salerno ,constantine ,africanus made his translations and commentaries on ,arabian medicine1 constituting what was really a medical encyclopedia of information not readily available at that time4 ,after this1 of course1 the tradition is taken up by the universities1 and it is only when1 with the thirteenth century1 there came the complete development of the university spirit1 that encyclopedias reached their modern expression4 ,three great encyclopedists1 ,vincent of ,beauvais1 ,thomas of ,cantimprato1 and ,bartholomus ,anglicus1 are the most famous4 ,vincent consulted all the authors sacred and profane that he could lay hold on1 and the number was1 indeed1 prodigious4 ,i have given some account of him in ,the ,thirteenth ,greatest of ,centuries 7,catholic ,summer ,school ,press1 ,new ,york1 third edition1 #aiaj74 ,it would be very easy to conclude that these encyclopedias1 written by clergymen for the general information of the educated people of the times1 contain very little that is scientifically valuable1 and probably nothing of serious medical significance4 ,any such thought is1 however1 due entirely to unfamiliarity with the contents of these works4 ,they undoubtedly contain absurdities1 they are often full of misinformation1 they repeat stories on dubious authority1 and sometimes on hearsay1 but usually the source of their information is stated1 and especially where it is dubious1 as if they did not care to state marvels without due support4 ,books of popular information1 however1 have always had many queer things1--queer1 that is1 to subsequent generations1--and it is rather amusing to pick up an encyclopedia of a century ago1 much less a millennium ago1 and see how many absurd things were accepted as true4 ,the first edition of the ,encyclopedia ,britannica1 issued one hundred and fifty years ago1 furnishes an easily available source of the absurdities our more recent forefathers accepted4 ,the men of the ,middle ,ages1 however1 were much better observers as a rule1 and used much more critical judgment1 according to their lights1 than we have given them credit for4 ,often the information that they have to convey is not only valuable1 but well digested1 thoroughly practical1 and sometimes a marvellous anticipation of some of our most modern thoughts4 ,there is one of these encyclopedias which1 because it was written in my favorite thirteenth century1 ,i have read with some care4 ,it is simply a development of the work of preceding clerical encyclopedists1 and often refers to them4 ,because it contains some typical examples of the better sorts of information in these works1 ,i have thought it worth while to quote two passages from it4 ,the author is ,bartholomus ,anglicus1 and the quaint ,english in which it is couched is quoted from ,medical ,lore 7,london1 #ahic74 ,the book is all the more interesting because in a dear old ,english version1 issued about #aedj1 the spellings of which are among the great curiosities of ,english orthography1 it was often read and consulted by ,shakespeare1 who evidently quotes from it frequently1 for not a little of the quaint scientific lore that he uses for his figures can be traced to expressions used in this book4 ,the first of the paragraphs that deserves to be quoted1 discusses madness1 or1 as we would call it1 lunacy1 and sums up the causes1 the symptoms1 and the treatment quite as well as that has ever been done in the same amount of space3 ,madness cometh sometime of passions of the soul1 as of business and of great thoughts1 of sorrow and of too great study1 and of dread3 sometime of the biting of a wood hound1 or some other venomous beast2 sometime of melancholy meats1 and sometime of drink of strong wine4 ,and as the causes be diverse1 the tokens and signs be diverse4 ,for some cry and leap and hurt and wound themselves and other men1 and darken and hide themselves in privy and secret places4 ,the medicine of them is1 that they be bound1 that they hurt not themselves and other men4 ,and namely1 such shall be refreshed1 and comforted1 and withdrawn from cause and matter of dread and busy thoughts4 ,and they must be gladded with instruments of music1 and some deal be occupied4' ,the second discusses in almost as thorough a way the result of the bite of a mad dog4 ,the old ,english word for mad1 wood1 is constantly used4 ,the causes1 the symptoms1 and course of the disease1 and its possible prevention by early treatment1 are all discussed4 ,the old tradition was already in existence that sufferers from rabies or hydrophobia1 as it is called1 dreaded water1 when it is really only because the spasm consequent upon the thought even of swallowing is painful that they turn from it4 ,that tradition has continued to be very commonly accepted even by physicians down to our own day1 so that ,bartholomew1 the ,englishman1 in the thirteenth century1 will not be blamed much for setting it forth for popular information in his time some seven centuries ago4 ,the idea that free bleeding would bring about the removal of the virus is interesting1 because we have in recent years insisted in the case of the very similar disease1 tetanus1 on allowing or deliberately causing wounds in which the tetanus microbe may have gained an entrance1 to bleed freely4 ,the biting of a wood hound is deadly and venomous4 ,and such venom is perilous4 ,for it is long hidden and unknown1 and increaseth and multiplieth itself1 and is sometimes unknown to the year's end1 and then the same day and hour of the biting1 it cometh to the head1 and breedeth frenzy4 ,they that are bitten of a wood hound have in their sleep dreadful sights1 and are fearful1 astonied1 and wroth without cause4 ,and they dread to be seen of other men1 and bark as hounds1 and they dread water most of all things1 and are afeared thereof full sore and squeamous also4 ,against the biting of a wood hound wise men and ready use to make the wounds bleed with fire or with iron1 that the venom may come out with the blood1 that cometh out of the wound4 ,,footnotes3 ,footnote #a3 ,medicinisches aus der ,aeltesten ,kirchen ,geschichte4 ,leipzig1 #ahib4 ,footnote #b3 ,foulis1 ,london and ,edinburgh1 #aiaj4 ,footnote #c3 ,my attention was called to the interesting story of the ,jewish physicians of the ,middle ,ages and their scientific accomplishment while writing the article on ,joseph ,hyrtl for the ,catholic ,encyclopedia4 ,his ,das ,arabische und ,hebrische in der ,anatomie 7,wien1 #ahgi7 has some interestingly suggestive material on these important chapters of the history of medicine4 7,i owe my opportunity to consult it to the courtesy of the ,surgeon-,general's library47 ,biographic material has been obtained from ,carmoly's ,history of the ,jewish ,physicians1 translated by ,dr4 ,dunbar for the ,maryland ,medical and ,surgical ,journal1 some extra copies of which were printed by ,john ,murphy and ,co41 ,baltimore1 about the middle of the nineteenth century4 ,baas and ,haeser's ,histories of ,medicine and ,puschmann and ,pagel's ,handbook provided additional material1 and ,i have found ,landau's ,geschichte der ,jdischen ,aerzte 7,berlin1 #ahie7 of great service4 ,footnote #d3 ,of course there are many absurd things recommended in the ,talmud4 ,we cannot remind ourselves too often1 however1 that there have been absurd things at all times in medicine1 and especially in therapeutics4 ,it is curious how often some of these absurdities have repeated themselves4 ,we are liable to think it very queer that men should have presumed1 or somehow jumped to the conclusion1 that portions of animals might possess wonderful virtue for the healing of diseases of the corresponding special parts of man4 ,we ourselves1 however1 within a little more than a decade1 had a phase of opotherapy--how much less absurd it seems under that high-sounding ,greek term--that was apparently very learned in its scientific aspects yet quite as absurd as many phases of old-time therapy1 as we look at it4 ,we administered cardin for heart disease and nephrin for kidney trouble1 cerebrin for insanity 7save the mark671 and even prostate tissue for prostatism--and with reported good results6 ,how many of us realize now that in this we were only repeating the absurdities1 so often made fun of in old medicine1 with regard to animal tissue and excrement therapeutics8 ,the ,talmud has many conclusions with regard to the symptoms of patients drawn from dreams2 as1 for instance1 it is said to be a certain sign of sanguineous plethora when one dreams of the comb of a cock4 ,one phase of our psycho-analysis in the modern time1 however1 has taken us back to an interpretation of dreams different of course from this1 yet analogous enough to be quite striking4 ,footnote #e3 ,maimonides1 by ,david ,yellin and ,israel ,abrahams1 ,philadelphia1 #aijc4 ,footnote #f3 ,das ,arabische und ,hebrische in der ,anatomie1 ,dr4 ,joseph ,hyrtl1 ,wien1 #ahgi4 ,footnote #g3 ,anat4 ,antiq4 ,rariores1 ,vienna1 #ahce4 ,footnote #h3 ,it seems hard to understand how so useful an auxiliary to the surgeon as the ligature1--it seems indispensable to us1--could possibly be allowed to go out of use and even be forgotten4 ,it will not be difficult1 however1 for anyone who recalls the conditions that obtained in old-time surgery4 ,the ligature is a most satisfying immediate resource in stopping bleeding from an artery1 but a septic ligature inevitably causes suppuration and almost inevitably leads to secondary hemorrhage4 ,in the old days of septic surgery secondary hemorrhage was the surgeon's greatest and most dreaded bane4 ,some time from the fifth to the ninth day a septic ligature came away under conditions such that inflammatory disturbance had prevented sealing of the vessel4 ,if the vessel was large1 then the hemorrhage was fast and furious and the patient died in a few minutes4 ,after a surgeon had had a few deaths of this kind he dreaded the ligature4 ,he abandoned its use and took kindly to such methods as the actual cautery1 red-hot knives for amputations1 and the like1 that would sear the surfaces of tissues and the blood-vessels1 and not give rise to secondary hemorrhage4 ,a little later1 however1 someone not familiar with secondary risks would reinvent the ligature4 ,if he were cleanly in his methods and1 above all1 if he were doing his work in a new hospital1 the ligature worked very well for a while4 ,if not1 it soon fell into innocuous desuetude again4 ,footnote #i3 ,puschmann3 ,handbuch der ,geschichte der ,medizin1 ,vol4 ,i1 page #feb4 ,footnote #aj3 ,the first dentist who filled teeth with amalgam in ,new ,york1 some eighty years ago1 had to flee for his life1 because of a hue and cry set up that he was poisoning his patients with mercury4 ,footnote #aa3 ,storia de la ,scuola di ,salerno4 ,footnote #ab3 ,it is probably interesting to note that the word universitas as used here has no reference to our word university1 but refers to the whole world of students as it were4 ,in the ,middle ,ages universities were called studia generalia1 general studies--that is1 places where everything could be studied and where everyone from any part of the world could study4 ,our use of the word university in the special modern sense of the term comes from the formal mode of address to the faculty of a university when ,popes or rulers sent them authoritative documents4 ,such documents began with the expression ,universitas vestra1 all of you 7in the old-time ,english1 as preserved in the ,irish expression1 the whole of ye71 referring to all the members of the faculty4 ,the transfer to our term and signification university was not difficult4 ,footnote #ac3 ,physicians wore a particular garb consisting of a cloak and often a mask1 supposed to protect them from infections at this time1 so that it was not difficult to make a characteristic picture as a sign for a pharmacy4 ,these symbolic signs were much commoner and very necessary when people generally were not able to read4 ,it is from that period that we have the mortar and pestle as also the colored lights in the windows of the drug stores1 and the many-colored barber-pole4 ,also the big boot1 key1 watch1 hat1 bonnet1 and the like1 the last symbolic sign invention apparently being the wooden ,indian for the tobacco store4 ,footnote #ad3 ,the ,medical ,library and ,historical ,journal1 ,brooklyn1 ,december1 #aijf4 ,footnote #ae3 ,taddeo1 who was born in #abae1 according to our usually accepted traditions in the matter1 would have been seventy-five years of age when ,mondino as a youth of scarcely more than fifteen went to the ,university4 ,it might seem that so old a man would have very little influence over the young man4 ,taddeo1 however1 had1 as we have said1 a very strenuous old age4 ,everything in life had come to him late4 ,he was well past thirty before he began to study philosophy and medicine1 having been a seller of candles from necessity because of poverty in his younger years4 ,his great success in practice came when he was past forty4 ,he first began to teach when he was forty-five1 and he was nearly fifty-five before he began to write4 ,according to tradition he married when he was nearly eighty--whether for the first or second time is not said--and while this might be considered1 and would in some cases be1 an indication of weakness of character 7it would probably depend on whether he married or was married71 it seems in his case to have indicated a vigor of body and character which shows very clearly how great was the possibility of his influence as a teacher having been maintained even up to this late time of life1 and thus influencing a pupil who is to represent the most potent influence at the beginning of the next century4 ,footnote #af3 ,medical ,library and ,historical ,journal1 #aijf4 ,footnote #ag3 ,pilcher 7loc4 cit47 tells of her tomb4 ,i venture to change his translation of the inscription in certain unimportant particulars4 ,he says3 ,we know the very place where she was buried in front of the ,madonna delle ,lettre in the ,church of ,san ,pietro e ,marcellino of the ,hospital of ,santa ,maria de ,mareto1 where her associate1 ,agenio1 mourning and inconsolable1 placed a tablet with this inscription3 ,d 4 ,o 4 ,m 4 ,vrceo 4 ,contenti ,alexandrae 4 ,galinae 4 ,pvellae 4 ,persicetanae ,penicillo 4 ,egregiae 4 ,ad 4 ,anatomen 4 ,exhibendam ,et 4 ,insignissimi 4 ,medici 4 ,mundini 4 ,lucii ,paucis 4 ,comparandae 4 ,discipulae 4 ,cineres ,carnis 4 ,hic 4 ,expectant 4 ,resurrectionem ,vixit 4 ,ann 4 ,,xix 4 ,obiit 4 ,studio 4 ,absunta ,die ,,xxvi ,martii 4 ,a 4 ,s 4 ,,mcccxxvi ,otto 4 ,agenius 4 ,lustrulanus 4 ,ob 4 ,eam 4 ,demptam ,sui 4 ,potiori 4 ,parte 4 ,spoliatus 4 ,sodali 4 ,eximiae ,ac 4 ,de 4 ,se 4 ,optime 4 ,meritae 4 ,inconsolabilis 4 ,m 4 ,p 4 ,this inscription may be translated as follows3 ,in this urn enclosed ,the ashes of the body of ,alexandra ,giliani1 a maiden of ,periceto2 ,skilful with her brush in anatomical demonstrations ,and a disciple equalled by few1 ,of the most noted physician1 ,mundinus of ,luzzi1 ,await the resurrection4 ,she lived #ai years3 she died consumed by her labors ,march #bf1 in the year of grace #acbf4 ,otto ,agenius ,lustrulanus1 by her taking away ,deprived of his better part1 his excellent companion1 ,deserving of the best1 ,has erected this tablet4 ,footnote #ah3 ,this is so striking that ,i quote their actual words from ,gurlt1 p4 #gjd3 ,multoties fit percussio in anteriori parte cranei et craneum in parte frangitur contraria4 ,footnote #ai3 ,historical ,relations of ,medicine and ,surgery ,down to the ,sixteenth ,century1 ,london1 #aijd4 ,footnote #bj3 ,of course1 for any extended knowledge of ,mondeville1 a modern reader must turn to ,nicaise's translation of his ,chirurgia1 which1 with an introduction and a biography1 was published at ,paris in #ahic4 ,nicaise's publication of this and of ,guy de ,chauliac's treatise has worked a revolution in medical history and1 above all1 has made these old authors available for those who hesitate to take up a work written entirely in ,latin4 ,footnote #ba3 ,in the very first book containing some account of human anatomy1 a ,german volume by ,conradus ,mengenberger1 called ,puch der ,natur1 the date of printing of which is about #adgh1--that is1 less than ten years after the printing of the very first book1 the ,biblia pauperum1 which appeared in #adgj1--there are1 according to ,haller in his ,bibliotheca ,anatomica1 a series of illustrations4 ,this is the first illustrated medical work ever published4 ,footnote #bb3 ,fordham ,university ,press1 ,new ,york1 #aijh4 ,footnote #bc3 ,fordham ,university ,press1 ,new ,york1 #aijh4 ,footnote #bd3 ,see picture of the hospital ward at ,tonnerre1 in ,the ,thirteenth ,greatest of ,centuries1 #crd edit41 ,new ,york1 #aiaa4 ,footnote #be3 ,the ,historical ,relations of ,medicine and ,surgery1 by ,t4 ,clifford ,allbutt1 ,m4,a41 ,m4,d4 ,london3 ,macmillan ,co41 ,ltd41 #aije4 ,footnote #bf3 ,the beginning of the manuscript copy in the ,bibliothque ,nationale is extremely interesting as an example of the ,english of the period1 and alongside of it it seems worth while to quote the closing sentence as ,nicaise reproduces them3 ,in godes name here bygyneth the inventarie of gadryng to gedre medecyne in the partye of cyrurgie compilede and fulfilled in the zere 7yere87 of our ,loord #acfc by ,guide de ,cauliaco cirurgene and doctor of physik in the fulclere studye of ,mountpylerz4 ,on page #aia1 verso4--,here endeth the cyrurgie of ,maistre ,guyd' de ,cauliaco dottoure of phisik4 ,the ,university of ,cambridge copy has the title in the colophon4 ,it runs as follows3 ,ye inventorye of ,guydo de ,caulhiaco ,doctor of ,phisyk and ,cirurgien in ,ye ,universitie of ,mount ,pessulanee of ,montpeleres4 ,the fly-leaf contains the words1 ,jesu ,christ save ye soule of mich4 ,it is rather interesting to note how much closer to modern ,english is this copy1 made probably not much more than half a century later than the first one and1 above all1 how much more nearly the spelling has come4 ,at this time1 however1 and1 indeed1 for more than a century later1 spelling had no fixed rule1 and a man might spell the same word quite differently even on the same page4 ,the difference between doctor spelled thus in the early edition1 and doctours in the later one1 probably means nothing more than personal peculiarities of the original translator or copyist4 ,footnote #bg3 ,in ,nicaise this last word is written crapte4 ,i have ventured to suggest crafte1 since a misreading between the two letters would be so easy4 ,in the same way ,i have suggested tentatively a changing of the z in the title of the ,bibliothque ,nationale copy to y1 making the word yere instead of zere4 ,footnote #bh3 ,a ,history of ,dentistry from the ,most ,ancient ,times ,until the ,end of the ,eighteenth ,century1 by ,dr4 ,vincenzo ,guerini1 editor of the ,italian ,review ,l',odonto-,stomatologia1 ,philadelphia and ,new ,york1 ,lea and ,febriger1 #aiji4 ,footnote #bi3 ,the first printed edition of ,arculanus is that of ,venice1 #aedb1 bearing the ,latin title1 ,joannis ,arculani ,commentaria in ,nonum ,librum ,rasis1 etc4 ,footnote #cj3 ,it is curious to trace how old are the traditions on which some of these old stories1 that must now be rejected1 are founded4 ,i have come upon the story with regard to ,basil ,valentine and the antimony and the monks in an old ,french medical encyclopedia of biography1 published in the seventeenth century1 and at that time there was no doubt at all expressed as to its truth4 ,how much older than this it may be ,i do not know1 though it is probable that it comes from the sixteenth century1 when the kakothes scribendi attacked many people because of the facility of printing1 and when most of the good stories that have so worried the modern dry-as-dust historian in his researches for their correction became a part of the body of supposed historical tradition4 ,it is probably ,french in origin because in that language antimoine is a tempting bait for that pseudo-philology which has so often led to false derivations4 ,footnote #ca3 ,there is in the ,new ,york ,academy of ,medicine a thick #bdmo volume in which three of the classics of older medicine are bound together4 ,they are ,kerckringius's ,commentary on the ,triumphal ,chariot of ,antimony1 published at ,amsterdam1 #afga2 ,steno's ,dissertation on the ,anatomy of the ,brain1 published in ,leyden in #afga1 and ,father ,kircher's ,scrutinium ,physico ,contagiosae ,luis quae dicitur ,pestis 7,physico-medical ,discussions of the ,contagious ,disease which is called ,pest74 ,this was published at ,leipzig in #afei4 ,just how the three works came to be bound together is hard to say4 ,very probably they belonged to some old-time scholar1 though there is nothing about the books to tell anything of the story4 ,the fact that all three of the authors were ecclesiastics of the ,catholic ,church1 ,valentine a ,monk1 ,steno a ,bishop1 and ,kircher a ,jesuit1 would seem to be one common bond and perhaps a reason for the binding of these rather disparate treatises together4 ,in that case it is probable that the book came from an old monastic library dispersed after the suppression of the order by some government4 ,it seems not unlikely that the volume belonged at some time to an old ,jesuit library1 for they have suffered the most in that way4 ,that these three classics of medicine should have been republished in handy volume editions within practically ten years shows an interest in medical literature that has not existed again until our own time1 for during the eighteenth and early nineteenth centuries there was almost utter neglect of them4 ,footnote #cb3 ,paper read before the first meeting of the ,american ,guild of ,st4 ,luke4 ,footnote #cc3 ,published by ,putnams1 ,new ,york1 #aiji4 ,footnote #cd3 ,dublin1 #ahhb4 ,footnote #ce3 ,the material for this chapter was gathered for a paper read before the ,medical ,improvement ,society of ,boston in the spring of #aiaa4 ,in nearly its present form it was published in ,the ,popular ,science ,monthly for ,may1 #aiaa1 and thanks are returned to the editor of that magazine for permission to reprint it here4 ,the additions that have been made refer particularly to the estimation of ,aristotle in the ,middle ,ages4 ,footnote #cf3 ,new ,york1 ,putnam1 #aijh4 ,footnote #cg3 ,de ,coelo et ,mundo1 #a1 tr4 iv41 x4 ,,index ,a ,abbassides1 #gc ,abba ,oumna1 #gj ,abbas1 #cbd ,ablard1 #ahi ,abraham1 #ig1 #ih ,abu ,dschafer1 #agc ,abulcasis1 #abc1 #agj1 #bbf1 #cag1 #cah1 #cbc ,abul ,farag1 #ea ,abulkasim1 #abd ,academy of ,bagdad1 #ace ,acid1 hydrochloric1 #cfi ,ackermann1 #cjb ,adalberon1 #ade ,adelard of ,bath1 #acd ,adhesions1 #abh gidius1 #aej ,atius1 #aj1 #aag1 #ahj1 #cag ,atius1 ,amidenus1 #bh ,afflacius1 #aea1 #aga ,affinity1 #cgb ,agenius1 ,otto1 #bbg ,agricola1 #cde ,kempis1 ,thomas1 #cde1 #cfa ,alanfrancus1 #bfj ,albertus ,magnus1 #bfg1 #cjf1 #cef1 #djc ,alchemist1 #ced ,alcuin1 #dcb ,alderotti1 #bac ,alexander ,,ii1 ,pope1 #hc ,alexander of ,hales1 #ajh ,alexander of ,tralles1 #aj1 #bh1 #ci ,alexandria1 #ace1 #che ,allbutt1 ,sir ,clifford1 #bdg1 #bed1 #beg1 #cjd1 #cee1 #dba ,ali ,abbas1 #aba1 #agc1 #bff1 #cbc ,ali ,ben el ,abbas1 #agj ,almansor1 #acb ,alphanus1 #adc1 #ade ,amandaville1 #bfd ,ansthesia1 #ag2 inhalation of1 #bie1 #bif ,ansthetics1 #bdf ,anathomia1 #bjc ,anatomy1 ignorance of1 #bhi2 of the teeth1 #cbf ,anatomical 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,ugo da ,lucca1 #bea1 #bie ,ugo ,senesis1 #acj ,ulcer1 eroding1 #bef ,union by first intention1 #bed ,universitas1 #bjc ,universities1 ecclesiastical1 #baj2 medieval1 #daa ,university of ,bologna1 #adb2 of ,paris1 #hhg1 #adb1 #aii2 of ,salerno1 #adb ,university man1 typical1 #cjg ,urine1 #ai ,urination1 difficulty of1 #ccd ,uvula1 #aah1 #bei1 #ccb2 removal of1 #ccc ,v ,valentine1 #bj1 #cdi2 bibliography1 #cgf ,valesco de ,taranta1 #cab ,van ,helmont1 #cfe ,varices1 #cd ,varicose veins1 #abg ,varignana1 #acj ,varolius1 #b1 #bji1 #cbg ,vasari1 #cfj ,velum ,palati1 #acg ,venerable ,bede1 #dcb ,venesection1 #ajd ,vercelli1 #bdh ,verneuil1 #cjc ,verney1 ,francis1 #caa ,verona1 #bdh ,vesalius1 #b1 #abj1 #bjd1 #bji1 #bcc1 #bhi1 #cbg ,vicenza1 #af1 #bcb1 #bdh ,victoria1 #ahj ,vigo1 ,john ,de1 #ccd ,villani1 #cac ,vincent of ,beauvais1 #dcc ,virchow1 #big ,virgil1 #d ,vitality1 natural1 #aaf ,volta1 #bji ,von ,leyden1 #ccf ,w ,warfare of ,science and ,religion1 #dcd ,washington's hatchet1 #cfd ,water clock1 #cda ,water in the ear1 #dh ,watering places1 #dg ,wenceslaus1 ,emperor1 #dbd ,whewell1 #daj ,white1 ,pres41 #dbd ,wine for wounds1 #ahg ,william of ,auvergne1 #ajh ,william of ,briscia1 #bfh ,william of ,salicet1 #bde1 #bef1 #bfg ,william the ,conqueror1 #ade ,wimpheling1 #cfa ,wives as nurses1 #bgb ,women professors1 #ae ,women physicians1 #agg1 #agi ,wood hound1 #dce ,wounds1 penetrating1 #bej2 adhesion1 #bec2 gunshot1 #ccd2 of intestines1 #bej2 wine and oil1 #chg ,wurtz1 #bed ,y ,yahia ,ben ,masoviah1 #gd ,yard1 #bhj ,yperman1 #bgf ,ypres1 #bgf ,z ,zedkias1 #gh ,zenobia1 #aji ,zology1 #dah 99 99 99 99 99 ,other ,books by ,dr4 ,walsh ,,fordham ,,university ,,press ,,series ,,makers ,,of ,,modern ,,medicine--,a series of ,biographies of the men to whom we owe the important advances in the development of modern medicine4 ,by ,james ,j4 ,walsh1 ,m4,d41 ,ph4,d41 ,,ll4,d41 ,dean and ,professor of the ,history of ,medicine at ,fordham ,university ,school of ,medicine1 ,n4,y4 ,second ,edition1 #aiji4 #cfb pp4 ,price1 #b4jj net4 ,the ,london ,lancet said3 ,the list is well chosen1 and we have to express gratitude for so convenient and agreeable a collection of biographies1 for which we might otherwise have to search through many scattered books4 ,the sketches are pleasantly written1 interesting1 and well adapted to convey the thoughtful members of our profession just the amount of historical knowledge that they would wish to obtain4 ,we hope that the book will find many readers4 ,the ,new ,york ,times3 ,the book is intended primarily for students of medicine1 but laymen will find it not a little interesting4 ,il ,morgagni 7,italy73 ,professor ,walsh narrates important lives in modern medicine with an easy style that makes his book delightful reading4 ,it certainly will give the young physician an excellent idea of who made our modern medicine4 ,the ,lamp3 ,this exceptionally interesting book is from the practiced hand of ,dr4 ,james ,j4 ,walsh4 ,it is a suggestive thought that all of the great specialists portrayed were ,god-fearing men1 men of faith1 far removed from the shallow materialism that frequently flaunts itself as inherently worthy of extra consideration for its own sake4 ,the ,church ,standard 7,protestant ,episcopal73 ,there is perhaps no profession in which the lives of its leaders would make more fascinating reading than that of medicine1 and ,dr4 ,walsh by his clever style and sympathetic treatment by no means mars the interest which we might thus expect4 ,the ,new ,york ,medical ,journal3 ,we welcome works of this kind2 they are evidence of the growth of culture within the medical profession1 which betokens that the time has come when our teachers have the leisure to look backward to what has been accomplished4 ,science3 ,the sketches are extremely entertaining and useful4 ,perhaps the most striking thing is that every one of the men described was of the ,catholic faith1 and the dominant idea is that great scientific work is not incompatible with devout adherence to the tenets of the ,catholic religion4 ,,the ,,popes ,,and ,,science--,the story of the ,papal ,relations to ,science from the ,middle ,ages down to the ,nineteenth ,century4 ,by ,james ,j4 ,walsh1 ,m4,d41 ,ph4,d41 ,,ll4,d4 #ddj pp4 ,price1 #b4jj net4 ,,prof4 ,,pagel1 ,professor of ,history at the ,university of ,berlin3 ,this book represents the most serious contribution to the history of medicine that has ever come out of ,america4 ,,sir ,,clifford ,,allbutt1 ,regius ,professor of ,physic at the ,university of ,cambridge 7,england73 ,the book as a whole is a fair as well as a scholarly argument4 ,the ,evening ,post 7,new ,york7 says3 ,however strong the reader's prejudice 444 he cannot lay down ,prof4 ,walsh's volume without at least conceding that the author has driven his pen hard and deep into the 'academic superstition' about ,papal ,opposition to science4 ,in a previous issue it had said3 ,we venture to prophesy that all who swear by ,dr4 ,andrew ,d4 ,white's ,history of the ,warfare of ,science with ,theology in ,christendom will find their hands full1 if they attempt to answer ,dr4 ,james ,j4 ,walsh's ,the ,popes and ,science4 ,the ,literary ,digest said3 ,the book is well worth reading for its extensive learning and the vigor of its style4 ,the ,southern ,messenger says3 ,books like this make it clear that it is ignorance alone that makes people1 even supposedly educated people1 still cling to the old calumnies4 ,the ,nation 7,new ,york7 says3 ,the learned ,fordham ,physician has at command an enormous mass of facts1 and he orders them with logic1 force and literary ease4 ,prof4 ,walsh convicts his opponents of hasty generalizing if not anti-clerical zeal4 ,the ,pittsburg ,post says3 ,with the fair attitude of mind and influenced only by the student's desire to procure knowledge1 this book becomes at once something to fascinate4 ,on every page authoritative facts confute the stereotyped statement of the purely theological publications4 ,,prof4 ,,welch1 of ,johns ,hopkins1 quoting ,martial1 said3 ,it is pleasant indeed to drink at the living fountain-heads of knowledge after previously having had only the stagnant pools of second-hand authority4 ,,prof4 ,,piersol1 ,professor of ,anatomy at the ,university of ,pennsylvania1 said3 ,i have been reading the book with the keenest interest1 for it indeed presents many subjects in what to me at least is a new light4 ,every man of science looks to the beacon--truth--as his guiding mark1 and every opportunity to replace even time-honored misconceptions by what is really the truth must be welcomed4 ,the ,independent 7,new ,york7 said3 ,dr4 ,walsh's books should be read in connection with attacks upon the ,popes in the matter of science by those who want to get both sides4 ,,makers ,,of ,,electricity--,by ,brother ,potamian1 ,f4,c4,s41 ,sc4,d4 7,london71 ,professor of ,physics in ,manhattan ,college1 and ,james ,j4 ,walsh1 ,m4,d41 ,ph4,d41 ,litt4,d41 ,dean and ,professor of the ,history of ,medicine and of ,nervous ,diseases at ,fordham ,university ,school of ,medicine1 ,new ,york4 ,fordham ,university ,press1 #aaj ,west #gdth ,street4 ,illustrated4 ,price1 #b4jj net4 ,postage1 #ae cents extra4 ,the ,scientific ,american3 ,one will find in this book very good sketches of the lives of the great pioneers in ,electricity1 with a clear presentation of how it was that these men came to make their fundamental experiments1 and how we now reach conclusions in ,science that would have been impossible until their work of revealing was done4 ,the biographies are those of ,peregrinus1 ,columbus1 ,norman and ,gilbert1 ,franklin and some contemporaries1 ,galvini1 ,volta1 ,coulomb1 ,oersted1 ,ampre1 ,ohm1 ,faraday1 ,clerk ,maxwell1 and ,kelvin4 ,the ,boston ,globe3 ,the book is of surpassing interest4 ,the ,new ,york ,sun3 ,the researches of ,brother ,potamian among the pioneers in antiquity and the ,middle ,ages are perhaps more interesting than ,dr4 ,walsh's admirable summaries of the accomplishment of the heroes of modern science4 ,the book testifies to the excellence of ,catholic scholarship4 ,the ,evening ,post3 ,it is a matter of importance that the work and lives of men like ,gilbert1 ,franklin1 ,galvini1 ,volta1 ,ampre and others should be made known to the students of ,electricity1 and this office has been well fulfilled by the present authors4 ,the book is no mere compilation1 but brings out many interesting and obscure facts1 especially about the earlier men4 ,the ,philadelphia ,record3 ,it is a glance at the whole field of ,electricity by men who are noted for the thoroughness of their research1 and it should be made accessible to every reader capable of taking a serious interest in the wonderful phenomena of nature4 ,electrical ,world3 ,aside from the intrinsic interest of its matter1 the book is delightful to read owing to the graceful literary style common to both authors4 ,one not having the slightest acquaintance with electrical science will find the book of absorbing interest as treating in a human way and with literary art the life work of some of the greatest men of modern times2 and1 moreover1 in the course of his reading he will incidentally obtain a sound knowledge of the main principles upon which almost all present-day electrical development is based4 ,it is a shining example of how science can be popularized without the slightest twisting of facts or distortion of perspective4 ,electrical readers will find the book also a scholarly treatise on the evolution of electrical science1 and a most refreshing change from the 'engineering ,english' of the typical technical writer4 ,,education1 ,,how ,,old ,,the ,,new--,a ,series of ,lectures and ,addresses on ,phases of ,education in the ,past ,which ,anticipate ,most of ,our ,modern ,advances1 by ,james ,j4 ,walsh1 ,m4,d41 ,ph4,d41 ,litt4 ,d41 ,k4,c4,st4,g41 ,dean and ,professor of the ,history of ,medicine and of ,nervous ,diseases at ,fordham ,university ,school of ,medicine4 ,fordham ,university ,press1 #aiaj4 #dgj pp4 ,price1 #b4jj net4 ,postage1 #ae cents extra4 ,,cardinal ,,moran 7,sydney1 ,australia73 ,i have to thank you for the excellent volume ',education1 ,how ,old the ,new4' ,the lectures are admirable1 just the sort of reading we want for ,english readers of the present day4 ,new ,york ,sun3 ,it is all bright and witty and based on deep erudition4 ,the ,north ,american 7,philadelphia73 ,wide historical research1 clear graphic statement are salient elements of this interesting and suggestive addition to the modern welter of educational literature4 ,detroit ,free ,press3 ,full of interesting facts and parallels drawn from them that afford much material for reflection4 ,chicago ,inter-,ocean3 ,incidentally it does away with a number of popular misconceptions as to education in the ,middle ,ages and as to education in the ,latin-,american countries at a somewhat later time4 ,the book is written in a straight1 unpretentious and interesting style4 ,wilkes-,barre ,record3 ,the volume is most interesting and shows deep research bearing the marks of the indefatigable student4 ,pittsburg ,post3 ,there is no bitterness of controversy and one of the first things to strike the reader is that the dean of ,fordham quotes from nearly everybody worth while1 ,protestant or ,catholic1 poetry1 biography1 history1 science or what not4 ,the ,wall ,street ,news 7,new ,york73 ,the book is calculated to cause a healthy reduction in the conceit which each generation enjoys at the expense of that which preceded it4 ,rochester ,post ,express3 ,the book is well worth reading4 ,the ,new ,orleans ,democrat3 ,the book makes very interesting reading1 but there is a succession of shocks in store in it for the complacent ,new ,englander or ,bostonian and for the orthodox or perfunctory reader of ,american literature4 ,,catholic ,,summer ,,school ,,press ,,series ,the highest value attaches to historical research on the lines you so ably indicate1 especially at the present time1 when the enemies of ,holy ,church are making renewed efforts to show her antagonism to science and human progress generally4 ,i shall have much pleasure in perusing your work entitled ,the ,thirteenth ,greatest of ,centuries4 ,wishing you every blessing1 ,i am1 ,yours sincerely in ,xt41 ,r4 ,card4 ,,merry ,,del ,,val4 ,rome1 ,january #ahth1 #aijh4 ,jas4 ,j4 ,walsh1 ,esq41 ,new ,york4 ,,the ,,thirteenth ,,greatest ,,of ,,centuries--,by ,james ,j4 ,walsh1 ,m4,d41 ,ph4,d41 ,litt4,d41 ,dean and ,professor of ,nervous ,diseases and of the ,history of ,medicine at ,fordham ,university ,school of ,medicine2 ,professor of ,physiological ,psychology at ,cathedral ,college1 ,new ,york4 ,catholic ,summer ,school ,press1 #aaj ,west #gdth ,street1 ,n4,y41 ,georgetown ,university ,edition4 ,over #ajj additional illustrations and twenty-six chapters that might have been1 nearly #fjj pages4 ,price1 #c4ej1 post free4 ,,prof4 ,,william ,,osler1 of ,oxford1 delivering the ,linacre ,lecture before the ,university of ,cambridge1 said3 ,that good son of the ,church and of the profession1 ,dr4 ,james ,j4 ,walsh1 has recently published a charming book on ,the ,thirteenth as the ,greatest of ,centuries4 ,he makes a very good case for what is called the ,first ,renaissance4 ,the ,saturday ,review 7of ,london73 ,the volume contains a mass of interesting facts that will start a train of profitable thought in many readers' minds4 ,the ,educational ,review said3 ,the title of ,dr4 ,walsh's book1 ,the ,thirteenth ,greatest of ,centuries1 will startle many readers1 but we respectfully commend to the open-minded his presentation of that great epoch4 ,a century that witnessed such extraordinary achievements in architecture1 in arts and crafts1 in education1 and in literature and law1 as did the ,thirteenth1 is not to be lightly dismissed or unfavorably compared with periods nearer our own4 ,the ,pittsburg ,post said3 ,dr4 ,walsh writes infused with all the learning of the past1 enthusiastic in modern research1 and sympathetic1 in true scholarly style1 with investigation in every line4 ,one need only run over a few of the topical headings to feel how plausible the thesis is4 ,the assemblage of the facts and the elucidation of their mutual relations by ,dr4 ,walsh shows the master's skill4 ,the work bristles on every page with facts that may be familiar to many1 but which were never before so arranged in just perspective with their convincing force so clearly shown4 ,,cardinal ,,moran1 of ,sydney1 ,australia3 ,just the sort of literature we want for ,english readers at the present day4 ,,by ,,the ,,same ,,author ,,fordham ,,university ,,press ,,series ,,makers ,,of ,,modern ,,medicine ,lives of the men to whom nineteenth century medical science owes most4 ,second ,edition4 ,new ,york1 #aiaj4 #b4jj net4 ,,the ,,popes ,,and ,,science ,the story of ,papal patronage of the sciences and especially medicine4 #deth thousand4 ,new ,york1 #aiaa4 #b4jj net4 ,,makers ,,of ,,electricity ,lives of the men to whom important advances in electricity are due4 ,in collaboration with ,brother ,potamian1 ,f4,s4,c41 ,sc4,d4 7,london71 ,professor of ,physics at ,manhattan ,college4 ,new ,york1 #aiji4 #b4jj net4 ,,education1 ,,how ,,old ,,the ,,new ,addresses in the history of education on various occasions4 #crd thousand4 ,new ,york1 #aiaa4 #b4jj net4 ,,in ,,preparation ,,makers ,,of ,,astronomy ,,problems ,,old ,,and ,,new ,,in ,,education ,,the ,,thirteenth ,,greatest ,,of ,,centuries ,georgetown ,university edition4 #eth thousand4 #aaf illustrations1 nearly #fjj pages4 ,catholic ,summer ,school ,press1 ,new ,york1 #aiaa4 ,postpaid1 #c4ej4 ,,the ,,dolphin ,,press ,,series ,,catholic ,,churchmen ,,in ,,science ,first and second series1 each #a4jj net4 ,,in ,,collaboration ,,essays ,,in ,,pastoral ,,medicine ,o',,malley ,,and ,,walsh ,a manual of information on medical subjects for the clergy1 religious superiors1 superintendents of hospitals1 nurses and charity workers4 ,longmans1 ,new ,york1 #aiaa4 #b4ej net4 ,,transcriber',s ,,notes ,the list of the works by the same author has been moved from the beginning to the end of the book4