Mediaeval Medicine : Part 6

The Evolution of Modern Medicine
by William Osler

(Page 9 of 16)

Two universities have a special interest at this period in connection with the development of medical studies, Bologna and Montpellier. At the former the study of anatomy was revived. In the knowledge of the structure of the human body no advance had been made for more than a thousand years - since Galen's day. In the process of translation from Greek to Syriac, from Syriac to Arabic, from Arabic to Hebrew, and from Hebrew or Arabic to Latin, both the form and thought of the old Greek writers were not infrequently confused and often even perverted, and Galen's anatomy had suffered severely in the transmission. Our earliest knowledge of the teaching of medicine at Bologna is connected with a contemporary of Dante, Taddeo Alderotti, who combined Arabian erudition with the Greek spirit. He occupied a position of extraordinary prominence, was regarded as the first citizen of Bologna and a public benefactor exempt from the payment of taxes. That he should have acquired wealth is not surprising if his usual fees were at the rate at which he charged Pope Honorius IV, i.e., two hundred florins a day, besides a "gratification" of six thousand florins.

The man who most powerfully influenced the study of medicine in Bologna was Mundinus, the first modern student of anatomy. We have seen that at the school of Salernum it was decreed that the human body should be dissected at least once every five years, but it was with the greatest difficulty that permission was obtained for this purpose. It seems probable that under the strong influence of Taddeo there was an occasional dissection at Bologna, but it was not until Mundinus took the chair that the study of anatomy became popular. The bodies were usually those of condemned criminals, but in the year 1319 there is a record of a legal procedure against four medical students for body-snatching - the first record, as far as I know, of this gruesome practice. In 1316, Mundinus issued his work on anatomy, which served as a text-book for more than two hundred years.

He quotes from Galen the amusing reasons why a man should write a book: "Firstly, to satisfy his own friends; secondly, to exercise his best mental powers; and thirdly, to be saved from the oblivion incident to old age." Scores of manuscripts of his work must have existed, but they are now excessively rare in Italy. The book was first printed at Pavia in 1478, in a small folio without figures. It was very often reprinted in the fifteenth and sixteenth centuries. The quaint illustration shows us the mediaeval method of teaching anatomy: the lecturer sitting on a chair reading from Galen, while a barber surgeon, or an "Ostensor," opens the cavities of the body.

I have already referred to the study of medicine by women at Salernum. Their names are also early met with in the school of Bologna. Mundinus is said to have had a valuable assistant, a young girl, Alessandra Giliani, an enthusiastic dissector, who was the first to practice the injection of the blood vessels with colored liquids. She died, consumed by her labors, at the early age of nineteen, and her monument is still to be seen.

Bologna honored its distinguished professors with magnificent tombs, sixteen or seventeen of which, in a wonderful state of preservation, may still be seen in the Civic Museum. That of Mundinus also exists - a sepulchral bas-relief on the wall of the Church of San Vitale at Bologna.

The other early mediaeval university of special interest in medicine is that of Montpellier. With it are connected three teachers who have left great names in our story - Arnold of Villanova, Henri de Mondeville and Guy de Chauliac. The city was very favorably situated not far from the Spanish border, and the receding tide of the Arab invasion in the eighth century had left a strong Arabic influence in that province. The date of the origin of the university is uncertain, but there were teachers of medicine there in the twelfth century, though it was not until 1289 that it was formally founded by a papal bull.

Arnold of Villanova was one of the most prolific writers of the Middle Ages. He had traveled much, was deeply read in Arabic medicine and was also a student of law and of philosophy. He was an early editor of the Regimen Sanitatis, and a strong advocate of diet and hygiene. His views on disease were largely those of the Arabian physicians, and we cannot see that he himself made any very important contribution to our knowledge; but he was a man of strong individuality and left an enduring mark on mediaeval medicine, as one may judge from the fact that among the first hundred medical books printed there were many associated with his name. He was constantly in trouble with the Church, though befriended by the Popes on account of his medical knowledge. There is a Bull of Clement V asking the bishops to search for a medical book by Arnold dedicated to himself, but not many years later his writings were condemned as heretical.

In Henri de Mondeville we have the typical mediaeval surgeon, and we know his work now very thoroughly from the editions of his "Anatomy" and "Surgery" edited by Pagel, and the fine French edition by Nicaise. The dominant Arabic influence is seen in that he quotes so large a proportion of these authors, but he was an independent observer and a practical surgeon of the first rank. He had a sharp wit and employed a bitter tongue against the medical abuses of his day. How the Hippocratic humors dominated practice at this time you may see at a glance from the table prepared by Nicaise from the works of de Mondeville. We have here the whole pathology of the period.

A still greater name in the history of this school is Guy de Chauliac, whose works have also been edited by Nicaise. His "Surgery" was one of the most important text-books of the late Middle Ages. There are many manuscripts of it, some fourteen editions in the fifteenth century and thirty-eight in the sixteenth, and it continued to be reprinted far into the seventeenth century. He too was dominated by the surgery of the Arabs, and on nearly every page one reads of the sages Avicenna, Albucasis or Rhazes. He lays down four conditions necessary for the making of a surgeon - the first is that he must be learned, the second, expert, the third that he should be clever, and the fourth that he should be well disciplined.

About the Author

William Osler (1849 - 1919) was a Canadian physician. He has been called one of the greatest icons of modern medicine and the Father of Modern Medicine (which is what he himself considered Avicenna to be).