The Evolution of Modern Medicine, by William Osler is part of HackerNoon’s Book Blog Post series. You can jump to any chapter in this book . here THE RISE OF THE UNIVERSITIES THE most striking intellectual phenomenon of the thirteenth century is the rise of the universities. The story of their foundation is fully stated in Rashdall's great work (Universities of Europe in the Middle Ages, Oxford, 1895). Monastic and collegiate schools, seats of learning like Salernum, student guilds as at Bologna, had tried to meet the educational needs of the age. The word "university" literally means an association, and was not at first restricted to learned bodies. The origin appears to have been in certain guilds of students formed for mutual protection associated at some place specially favorable for study—the attraction generally being a famous teacher. The University of Bologna grew up about guilds formed by students of law, and at Paris, early in the twelfth century, there were communities of teachers, chiefly in philosophy and theology. In this way arose two different types of mediaeval university. The universities of Northern Italy were largely controlled by students, who were grouped in different "nations." They arranged the lectures and had control of the appointment of teachers. On the other hand, in the universities founded on the Paris model the masters had control of the studies, though the students, also in nations, managed their own affairs. 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 (professor from 1306 to 1326) 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.(19) 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 travelled 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 (Berlin, 1889-1892), and the fine French edition by Nicaise (Paris, 1893). 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 (Paris, 1890). 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. You will find a very discerning sketch of the relation of these two men to the history of surgery in the address given at the St. Louis Congress in 1904 by Sir Clifford Allbutt.(20) They were strong men with practical minds and good hands, whose experience taught them wisdom. In both there was the blunt honesty that so often characterizes a good surgeon, and I commend to modern surgeons de Mondeville's saying: "If you have operated conscientiously on the rich for a proper fee, and on the poor for charity, you need not play the monk, nor make pilgrimages for your soul." One other great mediaeval physician may be mentioned, Peter of Abano (a small town near Padua, famous for its baths). He is the first in a long line of distinguished physicians connected with the great school of Padua. Known as "the Conciliator," from his attempt to reconcile the diverse views on philosophy and medicine, he had an extraordinary reputation as a practitioner and author, the persistence of which is well illustrated by the fact that eight of the one hundred and eighty-two medical books printed before 1481 were from his pen. He seems to have taught medicine in Paris, Bologna and Padua. He was a devoted astrologer, had a reputation among the people as a magician and, like his contemporary, Arnold of Villanova, came into conflict with the Church and appears to have been several times before the Inquisition; indeed it is said that he escaped the stake only by a timely death. He was a prolific commentator on Aristotle, and his exposition of the "problems" had a great vogue. The early editions of his texts are among the most superb works ever printed. He outlived his reputation as a magician, and more than a century after his death Frederick, Duke of Urbino, caused his effigies to be set up over the gate of the palace at Padua with this inscription: It is said that Abano caused to be painted the astronomical figures in the great hall of the palace at Padua. One characteristic of mediaeval medicine is its union with theology, which is not remarkable, as the learning of the time was chiefly in the hands of the clergy. One of the most popular works, the "Thesaurus Pauperum," was written by Petrus Hispanus, afterwards Pope John XXI. We may judge of the pontifical practice from the page here reproduced, which probably includes, under the term "iliac passion," all varieties of appendicitis. For our purpose two beacons illuminate the spirit of the thirteenth century in its outlook on man and nature. Better than Abelard or St. Thomas Aquinas, and much better than any physicians, Albertus Magnus and Roger Bacon represent the men who were awake to greet the rising of the sun of science. What a contrast in their lives and in their works! The great Dominican's long life was an uninterrupted triumph of fruitful accomplishment—the titanic task he set himself was not only completed but was appreciated to the full by his own generation—a life not only of study and teaching, but of practical piety. As head of the order in Germany and Bishop of Regensburg, he had wide ecclesiastical influence; and in death he left a memory equalled only by one or two of his century, and excelled only by his great pupil, Thomas Aquinas. There are many Alberts in history—the Good, the Just, the Faithful—but there is only one we call "Magnus" and he richly deserved the name. What is his record? Why do we hold his name in reverence today? Albertus Magnus was an encyclopaedic student and author, who took all knowledge for his province. His great work and his great ambition was to interpret Aristotle to his generation. Before his day, the Stagirite was known only in part, but he put within the reach of his contemporaries the whole science of Aristotle, and imbibed no small part of his spirit. He recognized the importance of the study of nature, even of testing it by way of experiment, and in the long years that had elapsed since Theophrastus no one else, except Dioscorides, had made so thorough a study of botany. His paraphrases of the natural history books of Aristotle were immensely popular, and served as a basis for all subsequent studies. Some of his medical works had an extraordinary vogue, particularly the "De Secretis Mulierum" and the "De Virtutibus Herbarum," but there is some doubt as to the authorship of the first named, although Jammy and Borgnet include it in the collected editions of his works. So fabulous was his learning that he was suspected of magic and comes in Naude's list of the wise men who have unjustly been reputed magicians. Ferguson tells(22) that "there is in actual circulation at the present time a chapbook . . . containing charms, receipts, sympathetical and magicalcures for man and animals, . . . which passes under the name of Albertus." But perhaps the greatest claim of Albertus to immortality is that he was the teacher and inspirer of Thomas Aquinas, the man who undertook the colossal task of fusing Aristotelian philosophy with Christian theology, and with such success that the "angelic doctor" remains today the supreme human authority of the Roman Catholic Church. A man of much greater interest to us from the medical point of view is Roger Bacon and for two reasons. More than any other mediaeval mind he saw the need of the study of nature by a new method. The man who could write such a sentence as this: "Experimental science has three great prerogatives over other sciences; it verifies conclusions by direct experiment; it discovers truth which they never otherwise would reach; it investigates the course of nature and opens to us a knowledge of the past and of the future," is mentally of our day and generation. Bacon was born out of due time, and his contemporaries had little sympathy with his philosophy, and still less with his mechanical schemes and inventions. From the days of the Greeks, no one had had so keen an appreciation of what experiment meant in the development of human knowledge, and he was obsessed with the idea, so commonplace to us, that knowledge should have its utility and its practical bearing. "His chief merit is that he was one of the first to point the way to original research—as opposed to the acceptance of an authority—though he himself still lacked the means of pursuing this path consistently. His inability to satisfy this impulse led to a sort of longing, which is expressed in the numerous passages in his works where he anticipates man's greater mastery over nature."(23) 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.(24) 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 (1915-1920), 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. About HackerNoon Book Series: We bring you the most important technical, scientific, and insightful public domain books. This book is part of the public domain. Urbana, Illinois: Project Gutenberg. Retrieved April 2022 from Osler, William. 2006. The Evolution of Modern Medicine. https://www.gutenberg.org/files/1566/1566-h/1566-h.htm#link2H_4_0020 This eBook is for the use of anyone anywhere at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this eBook or online at , located at . www.gutenberg.org https://www.gutenberg.org/policy/license.html Photo by on National Cancer Institute Unsplash

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