Mediaeval Medicine : Part 8

The Evolution of Modern Medicine
by William Osler

(Page 11 of 16)

Bacon wrote a number of medical treatises, most of which remain in manuscript. His treatise on the "Cure of Old Age and the Preservation of Youth" was printed in English in 1683. His authorities were largely Arabian. One of his manuscripts is "On the Bad Practices of Physicians." On June 10, 1914, the eve of his birth, the septencentenary of Roger Bacon will be celebrated by Oxford, the university of which he is the most distinguished ornament. His unpublished MSS. in the Bodleian will be issued by the Clarendon Press, and it is hoped that his unpublished medical writings will be included.

What would have been its fate if the mind of Europe had been ready for Roger Bacon's ferment, and if men had turned to the profitable studies of physics, astronomy and chemistry instead of wasting centuries over the scholastic philosophy and the subtleties of Duns Scotus, Abelard and Thomas Aquinas? Who can say? Make no mistake about the quality of these men - giants in intellect, who have had their place in the evolution of the race; but from the standpoint of man struggling for the mastery of this world they are like the members of Swift's famous college "busy distilling sunshine from cucumbers." I speak, of course, from the position of the natural man, who sees for his fellows more hope from the experiments of Roger Bacon than from the disputations of philosophy on the "Instants, Familiarities, Quiddities and Relations," which so roused the scorn of Erasmus.

Mediaeval Medical Studies

IT will be of interest to know what studies were followed at a mediaeval university. At Oxford, as at most of the continental universities, there were three degrees, those of Bachelor, Licentiate and Doctor. The books read were the "Tegni" of Galen, the "Aphorisms" of Hippocrates, the "De Febribus" of Isaac and the "Antidotarium" of Nicolaus Salernitanus: if a graduate in arts, six years' study in all was required, in other faculties, eight. One gets very full information on such matters from a most interesting book, "Une Chaire de Medecine au XVe Siecle," by Dr. Ferrari. The University of Pavia was founded in 1361, and like most of those in Italy was largely frequented by foreigners, who were arranged, as usual, according to their nationalities; but the students do not appear to have controlled the university quite so much as at Bologna.

The documents of the Ferrari family, on which the work is based, tell the story of one of its members, who was professor at Pavia from 1432 to 1472. One is surprised at the range of studies in certain directions, and still more at the absence of other subjects. A list is given of the teachers in medicine for the year 1433, twenty in all, and there were special lectures for the morning, afternoon and evening. The subjects are medicine, practical medicine, physics, metaphysics, logic, astrology, surgery and rhetoric: very striking is the omission of anatomy, which does not appear in the list even in 1467. The salaries paid were not large, so that most of the teachers must have been in practice: four hundred and five hundred florins was the maximum.

The dominance of the Arabians is striking. In 1467, special lectures were given on the "Almansor" of Rhazes, and in the catalogue of the Ferrari's library more than one half of the books are Arabian commentaries on Greek medicine. Still more striking evidence of their influence is found in the text-book of Ferrari, which was printed in 1471 and had been circulated earlier in MS. In it Avicenna is quoted more than 3000 times, Rhazes and Galen 1000, Hippocrates only 140 times. Professor Ferrari was a man who played an important role in the university, and had a large consultation practice. You will be interested to know what sort of advice he gave in special cases.

I have the record of an elaborate consultation written in his own hand, from which one may gather what a formidable thing it was to fall into the hands of a mediaeval physician. Signor John de Calabria had a digestive weakness of the stomach, and rheumatic cerebral disease, combined with superfluous heat and dryness of the liver and multiplication of choler. There is first an elaborate discussion on diet and general mode of life; then he proceeds to draw up certain light medicines as a supplement, but it must have taken an extensive apothecary's shop to turn out the twenty-two prescriptions designed to meet every possible contingency.

One of the difficulties in the early days of the universities was to procure good MSS. In the Paris Faculty, the records of which are the most complete in Europe, there is an inventory for the year 1395 which gives a list of twelve volumes, nearly all by Arabian authors. Franklin gives an interesting incident illustrating the rarity of medical MSS. at this period. Louis XI, always worried about his health, was anxious to have in his library the works of Rhazes. The only copy available was in the library of the medical school. The manuscript was lent, but on excellent security, and it is nice to know that it was returned.

It is said that one of the special advantages that Montpellier had over Paris was its possession of so many important MSS., particularly those of the Arabian writers. Many "Compendia" were written containing extracts from various writers, and no doubt these were extensively copied and lent or sold to students. At Bologna and Padua, there were regulations as to the price of these MSS. The university controlled the production of them, and stationers were liable to fines for inaccurate copies. The trade must have been extensive in those early days, as Rashdall mentions that in 1323 there were twenty-eight sworn booksellers in Paris, besides keepers of bookstalls in the open air.

Mediaeval Practice

THE Greek doctrine of the four humors colored all the conceptions of disease; upon their harmony alone it was thought that health depended. The four temperaments, sanguine, phlegmatic, bilious and melancholic, corresponded with the prevalence of these humors. The body was composed of certain so-called "naturals," seven in number - the elements, the temperaments, the humors, the members or parts, the virtues or faculties, the operations or functions and the spirits. Certain "non-naturals," nine in number, preserved the health of the body, viz. air, food and drink, movement and repose, sleeping and waking, excretion and retention, and the passions. Disease was due usually to alterations in the composition of the humors, and the indications for treatment were in accordance with these doctrines. They were to be evacuated, cooled, heated, purged or strengthened. This doctrine prevailed throughout the Middle Ages, and reached far into modern times - indeed, echoes of it are still to be heard in popular conversations on the nature of disease.

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).