 |
|
| A B C D E F G H I J K L M N O P Q R S T U V W X Y Z |
The history of medical science, considered as a part of the general history of civilization, should logically begin in Mesopotamia, where tradition and philological investigation placed the cradle of the human race. But, in a condensed article such as this, there are important reasons which dictate the choice of another starting point. Modern medical science rests upon a Greek foundation, and whatever other civilized peoples may have accomplished in this field lies outside our inquiry. It is certain that the Greeks brought much with them from their original home, and also that they learned a great deal from their intercourse with other civilized countries, especially Egypt and India; but the Greek mind assimilated knowledge in such a fashion that its origin can rarely be recognized.
Greek medical science, like that of all civilized peoples, shows in the beginning a purely theurgical character. Apollo is regarded as the founder of medical science, and, in post-Homeric times, his son Æsculapius (in Homer, a Thessalian prince) is represented, as the deity whose office it is to bring about man's restoration to health by means of healing oracles. His oldest place of worship was at Tricca in Thessaly. The temples of Æsculapius, of which those at Epidaurus and Cos are the best known, were situated in a healthy neighbourhood. The sick pilgrims went thither that, after a long preparation of prayer, fasting and ablutions, they might, through of mediation of the priests, receive in their dreams the healing oracles. This kind of medical science already shows a rational basis, for the priests interpreted the dreams and prescribed a suitable treatment, in most cases purely dietetic. Important records of sicknesses were made and left as votive-tablets in the temples. Side by side with the priestly caste, and perhaps out of it there arose the order of temple physicians, who, as supposed descendants of the god Æsculapius, were known as the Asclepiadae, and formed a kind of guild or corporation. This separation of offices must have occurred at an early time, for even in Homer we find lay physicians mentioned, especially "the sons of Æseulapius", Machaon and Podalirius. In the vegetable drugs of Egyptian origin mentioned in Homer we recognize the early influence of the country of the Pharaohs upon Greek medical science. The schools of the philosophers likewise exerted no small influence upon development, medical problems being studied by Pythagoras of Samos, Alcmaeon of Crotona, Parmenides of Elea, Heraclitus of Ephesus (sixth century B.C.), Empedocles of Agrigentum, and Anaxagoras of Clazomenae (fifth century B.C.). The earliest medical schools were at Cyrene in Northern Africa, Crotona, Cnidus and Cos. From Cnidus came Euryphon and also Ctesias the geographer, who was at first physician in the army of Cyrus and, after the battle of Cunaxa (401 B.C.), to Artaxerxes Memnon. Of greater interest is the medical school adjoining the shrine of Æseulapius at Cos, for from it arose the man who first placed medicine upon a scientific basis, and whose name is even today well known to all physicians, Hippocrates.
Tradition knows seven physicians named Hippocrates, of whom the second is regarded as the most famous. Of his life we know but little. He was born at Cos in 460 or 459 B.C., and died at Larissa about 379. How great his fame was during his lifetime is shown by the fact that Plato compares him with the artists Polycletus and Phidias. Later he was called "the Great" or "the Divine". The historical kernel is probably as follows: a famous physician of this name from Cos flourished in the days of Pericles, and subsequently many things, which his ancestors or his descendants or his school accomplished, were attributed to him as the hero of medical science. The same was true of his writings. What is now known under the title of "Hippocratis Opera" represents the work, not of an individual, but of several persons of different periods and of different schools. It has thus become customary to designate the writings ascribed to Hippocrates by the general title of the "Hippocratic Collection" (Corpus Hippocraticum), and to divide them according to their origin into the works of the schools of Cnidus and of Cos, and of the Sophists. How difficult it is, however, to determine their genuineness is shown that even in the third century before Christ the Alexandrian librarians, who for the first time collected the anonymous scrolls scattered through Hellas, could not reach a definite conclusion. For the development of medical science it is of little consequence who composed the works of the school of Cos for they are more or less permeated by the spirit of one great master. The secret of his immortality rests on the fact that he pointed out the means whereby medicine became a science. His first rule was the observation of individual patients, individualizing in contradistinction to the schematizing of the school of Cnidus. By the observation of all the principles were gradually derived from experience, and these, uniformly arranged, led by induction to a knowledge of the nature of the disease, its course, and its treatment. This is the origin of the famous "Aphorismi", short rules which contain at times principles derived from experience and at times conclusions drawn from the same source. They form the valuable part of the collection. The school of Cos and its adherents, the Hippocratics, looked upon medical science from a purely practical standpoint; they regarded it as the art of healing the sick, and therefore laid most stress on prognosis and treatment by aiding the powers of nature through dietetic means, while the whole school of Cnidus prided itself upon its scientific diagnosis and, in harmony with money with the East, adopted a varied medicinal treatment. The method which the school of Cos established more than 2000 years ago has proved to be the only one, and thus Hippocratic medial science celebrated its renascence in the eighteenth century with Boerhaave at Leyden and subsequently with Gerhard van Swieten at Vienna. In his endeavour to the truth the earnest investigation often reaches an impassable barrier. There is nothing more tempting than to seek an outlet by means of reflection and deduction. Such a delusive course may easily become fatal to the physicist; but a medical system, erected upon the results of speculative investigation, carries the germ of death within itself.
In their endeavour to complete the doctrine of their great master, the successors of the Hippocratics fell victims to the snares of speculation. In spite of this, we owe to this so-called "dogmatic school" some fruitful investigation. Diocles Carystius advanced the knowledge of anatomy, and tried to fathom the causal connection between symptom and disease, in which endeavours he was imitated by Praxagoras of Cos, who established the diagnostic importance of the pulse.
Unfortunately, there already began with Aristotle (38-22 B.C.) that tendency -- later rendered so fatal through Galen's teaching -- to regard organic structure and function not in accordance with facts but from the teleological standpoint.
The desire to give to medicine a scientific basis found rich nourishment in the ancient civilized soil of Egypt under the Ptolemies. Herophilus of Chalcedon (about 300 B.C.) and Erasistratus of Iulis (about 330-240 B.C.) are mentioned in this connection. As anatomists, they were the first systematic investigators, and, following Hippocrates, they tried to complete clinical experience by exact methods. This tendency was opposed by the empires, whose services lay solely in the field of drugs and toxicology. Erasistratus as well as Philinus, the empiric, attacked the doctrine of humors (humoral pathology), which developed out of the Hippocratic tendency. The former alone was a serious opponent since, as an anatomist, he looked for the seat of the disease in the solid parts, rather than in the four fundamental humors (blood, mucus, black and yellow gall) and their different mixtures.
One of the opponents of humoral pathology was Asclepiades of Prusa in Bithynia (born about 124 B.C.). He tried to use in medicine the atomistic theory of Epicurus and Heracleides of Pontus. He taught that health and disease depend upon the motion of the atoms in the fine capillaries or pores, which, endowed with sensation, pass through the entire body. With Themison as their leader, the followers of Asclepiades simplified his doctrine by supposing disease to be only a contraction or relaxation, and later only a mixed condition (partly contracted, partly relaxed) of the pores. This simple and convenient explanation of all diseases without regard to anatomy and physiology, taken in conjunction with its allied system of physical dietetic therapeutics, explains why this doctrine enjoyed so long a life, and why the works of the methodist, Caelius Aurelianus of Sicca in Numidia (beginning of fifth century A.D.), were diligently studied down to the seventh century.
Departure from the Hippocratic observation of nature led physicians to form numerous mutually opposing sects. A man of great industry and comprehensive knowledge, Galen of Pergamum (about A.D. 130-201), tried to rescue medical science from this labyrinth. He chose the path of eclecticism, on which he built his (as he thought) infallible system. Whatever sense-perception and clinical observation left obscure, he tried to explain in a speculative manner. That this system of teaching could hold medicine in bondage until modern times shows the genius of the master, who understood how to cover up the gaps by brilliancy of style. Galen took the entire anatomical knowledge of his time, and out of it produced a work the substance of which was for centuries regarded as inviolable. His anatomy was to a large extent based upon the dissection of mammals, especially of monkeys, and, like his physiology, was under teleological influence. His presentation of things lacks dispassionateness. Instead of explaining the functions of organs on the basis of their structure, Galen chose this reverse method. His anatomy and physiology were the most vulnerable part of his system, and an earnest re-examination of these fields must necessarily have shaken his entire scheme of teaching. Galen expressed the greatest respect for Hippocrates, published his most important works with explanatory notes, but never entered into the spirit of the school of Cos, although he adopted many of its doctrines. Galen is the culminating point and end of ancient Greek medical science. In his vanity he thought he had completed all investigation, and that his successors had only to accept without effort what he had discovered. As will be shown in the following paragraph, his advice was, unfortunately for science, followed literally.
Pedanus Dioscurides, who was from Anazarbe and lived in the time of Nero and Vespasian, may be mentioned here as the most important pharmaceutical writer of ancient times. He simplified greatly the pharmacopoeia, which had then assumed unwieldy dimensions, and freed it from ridiculous, superstitious remedies. Our modern pharmacology is based on his work, Ta ton tylikon biblia.
Cornelius Celsus (about 25-30 B.C. to A.D. 45-50) is the only Roman who worked with distinction in the medical field, but it is doubtful whether he was a physician. His work, "De re medica libri viii", which is written in classical Latin, and for which he used seventy-two works lost to posterity, gives a survey of medical science from Hippocrates to imperial times. Very famous is his description lithotomy. Celsus was altogether forgotten until the fifteenth century, when Pope Nicholas V (1447-55) is said to have discovered a manuscript of his works.
In Byzantine times medicine shows but little originality, and is of small importantance in the history of medical development. The work handed down to us are all compilations, but as they frequently contain excerpts from lost works they are of some historical value. The notable writers of this period are: Oreibasios (325-403), physician in ordinary to Julian the Apostate; and Aëtius of Amida, a Christian physician under Justinian (597-66). A little more originality than these men exhibited was shown by Alexander of Tralles (525-605), and Paulus Ægineta of the first half of the seventh century, of whose seven books, the sixth, dealing with surgery, was greatly valued in Arabian medicine. Paulus lived at Alexandria, and was one of the last to come from its once famous school, which became extinct after the capture of the city by Omar in 640. At the end of the thirteenth century Nicolaus Myrepsus, living at the court in Nicaea, made a collection of prescriptions which was extensively used. In the time of Emperor Andronicus III (1328-42) lived a highly gifted physician, Joannes Actuarius, and the mention of his writings closes the account of this period.
Arabian medical science forms an important chapter in the history of the development of medicine, not because it was especially productive but because it preserved Greek medical science with that of its most important representative Galen. It was, however, strongly influenced by oriental elements of later times. The adherents of the heretic Nestorius, who in 431 settled in Edessa, were the teachers of the Arabs. After the expulsion these Nestorians settled in Dschondisapor in 489, and there founded a medical school. After the conquest of Persia by the Arabs in 650, Greek culture was held in great esteem, and learned Nestorian, Jewish, and even Indian physicians worked diligently as translators of the Greek writings. In Arabian Spain conditions similarly developed from the seventh century. Among important physicians in the first period of Greek-Arabic medicine -- the period of dependence and of translations -- come first the Nestorian family Bachtischua of Syria, which flourished until the eleventh century; Abu Zakerijja Jahja ben Maseweih (d. 875), known as Joannes Damascenus, Mesue the Elder, a Christian who was a director of the hospital at Bagdad, did independent work, and supervised the translation of Greek authors, Abu Jusuf Jacub ben Ishak ben el-Subbah el-Kindi (Alkindus, 813-73), who wrote a work about compound drugs, and the Nestorian Abu Zeid Honein ben Ishak ben Soliman ben Ejjub el 'Ibadi (Joannitius, 809-about 873), a teacher in Baghdad who translated Hippocrates and Dioscurides, and whose work "Isagoge in artem parvam Galeni", early translated into Latin, was much read in the Middle Ages. Wide activity and independent observation -- based, however, wholly upon the doctrine of Galen -- were shown by Abu Bekr Muhammed ben Zakarijia er-Razi (Rhazes, about 850-923), whose chief work, however, "El-Hawi fi'l Tib" (Continens) is a rather unsystematic compilation. In the Middle Ages his "Ketaab altib Almansuri" (Liber medicinalis Almansoris) was well known and had many commentators. The most valuable of the thirty-six productions of Rhazes which have come down to us is "De variolis et morbillis", a book based upon personal experience. We ought also to mention the dietetic writer Abu Jakub Ishak ben Soleiman el-Israili (Isaac Judaeus, 830-about 932), an Egyptian Jew; the Persian, Ali ben el Abbas Ala ed-Din el-Madschhusi (Ali Abbas, d. 994) author of "El-Maliki" (Regalis dispositio, Pantegnum). Abu Dshafer Ahmed ben Ibrahim ben Abu Chalid Ihn el-Dshezzar (d. 1009) wrote about the causes of the plague in Egypt. A work on pharmaceutics was written by the physician in ordinary to the Spanish Caliph Hisham II (976-1013), Abu Daut Soleiman ben Hassan Ibn Dsholdschholl.
Of the surgical authors, Abu'l Kasim Chalaf ben Abbas el-Zahrewi of el-Zahra near Cordova (Abulkasem, about 912-1013) alone deserves mention, and he depends absolutely on Paulus Ægineta. While he received scant attention at home, since surgery was little cultivated by the Arabs, his work, written in a clear and perspicuous style, became known in the West through the Latin translation by Gerardus of Cremona (1187), and was extensively used even in later days. Arabian medicine reached its culmination with the Persian Abu Ali el-Hosein ben Abdallah Ibn Sina (Avicenna, 980-1037), who based his system entirely upon the teaching of Galen and tried in various ways to supplement the latter. His chief work, "El-Kanûn" (Canon Medicinae), written in a brilliant style and treating all branches of medical science, soon supplanted in the West the works of the Greeks and, until the time of the Humanists, served as the most important textbook for physicians, but in Arabian Spain his fame was small. One of his chief rivals was Abu-Merwan Abd el-Malik ben Abul-Ala Zohr ben Abd el-Malik Ibn Zohr (Avenzoar, 1113-62) from the neighbourhood of Seville. His friend, the philosopher and physician Abul-Welid Muhammed ben-Ahmed Ibn Roshd el-Maliki (Averroës, 1126 -98), of Cordova, is regarded as the complement of Avicenna. His book was also popular in the West and bears the title "Kitâbel-Kolijjat" (Colliget). With the decline of Arabian rule began the decay of medicine. In the Orient this decline began after the capture of Cordova in 1236, decay becoming complete after the loss of Granada in 1492. The predominance of Arabian medicine, which lasted scarcely three centuries, seriously delayed the development of our science. A brief survey of this period shows that the Arabs bent in slavish reverence before the works of Aristotle and Galen without examining them critically. No other Greek physician obtained such a hold on the Arabs as Galen, whose system, perfect in form, pleased them in philosophy. Nowhere did dialectics play a greater part in medicine than among the Arabs and their later followers in the West. Independent investigation in the fields of exact science, anatomy, and physiology was forbidden by the laws of the Koran. Symptomatology (semiotics) at the bedside, especially prognosis, based on the pulse and the of the urine, were developed by them with an equally exaggerated and fruitless subtlety. Much, and perhaps the only credit due to them is in the field of pharmaceutics. We are indebted to them for a series of simple and compound drugs of oriental and Indian origin, previously unknown, and also for the polypharmacy of later times. Until the discovery of America the Venetian drug-trade was controlled by Arabian dealers.
As long as the cruel persecution the Church lasted throughout the Roman Empire, it was impossible for Christians to take direct part in the development of medical science. But provision had been made for medical aid within the community, because the priest, like the rabbi of small Jewish communities in the late Middle Ages, was also a physician. This is clear from the story of the two brothers, Sts. Cosmas and Damian, who studied medicine in Syria and were martyred under Diocletian. The exercise of practical charity under the direction of deacons of the churches gave rise to systematic nursing and hospitals. In recent times it has, indeed been alleged that the existence of hospitals among the Buddhists, even in the third century before Christ, and their existence in ancient Mexico at the time of its discovery is demonstrable, and that hospitals had their origin in general philanthropy; but nobody denies that the nursing of the sick, especially during epidemics, had never before been so widespread, so well organized, so self-sacrificing as in the early Christian communities. Christianity tended the sick and devised and executed extensive schemes for the care of deserted children (foundling, orphans), of the feeble and infirm, of those out of work and of pilgrims. The era of persecution ended, we find large alms-houses and hospitals like that of St. Basilius in Caesarea (370), those of the Roman Lady Fabiola in Rome and Ostia (400), that of St. Samson adjoining the church of St. Sofia in Constantinople in the sixth century, the foundling asylum of Archbishop Datheus of Milan in 787, and many others. In 1198 Pope Innocent III rebuilt the pilgrims' shelter, which had been founded in 726 by a British king, but had been repeatedly destroyed by fire. He turned it into a refuge for travellers and a hospital, and entrusted it to the Brothers of the Holy Ghost established by Guy de Montpellier. Mention must also be made here of the religious orders of knights and the houses for lepers of later times. The great hospitals of the Arabs in Dschondisapor and Bagdad were built after Christian models. The celebrated ecclesiastical writer Tertullian (born A.D. 160) possessed a wide knowledge of medicine, which, following the custom of his time, he calls a "sister of philosophy". Clement of Alexandria, about the middle of the century, lays down valuable hygienic laws in his "Paedagogus". Lactantius in the fourth century speaks in his work "De Opificio Dei" about the structure of the human body. One of the most learned priests of his time, St. Isidore of Seville (d. 636), treats of medicine in the fourth book of his "Origines S. Etymologiae". St. Benedict of Nursia (480) made it a duty for the sciences, and among them medicine, as aids to the exercise of hospitality. Cassiodorus gave his monks direct instructions in the study in medicine. Bertharius, Abbot of Monte Cassino in the ninth century, was famous as a physician. Walafrid Strabo (d. 849), Abbot of Reichenau the oldest medical writer on German soil, describes in a poem (Hortulus) the value of native medicinal plants, and also the method of teaching medicine in monasteries. We must mention, furthermore, the "Physica", a description of drugs from the three kingdoms of nature, written by St. Hildegarde (1099-1179), abbess of a monastery near Bingen-on-the-Rhine. The curative properties of minerals are described by Marbodus of Angers, Bishop of Rennes (d. 1123), in his "Lapidarius".
How diligently medicine was studied in the monasteries is shown by the numerous manuscripts (many still unedited) in the old cathedral libraries and by those which were taken from the suppressed monasteries and are now to be found in the national libraries of various countries. Priests who possessed a knowledge ot medicine served as physicians-in-ordinary to princes as late as the fifteenth century, although they were forbidden to practice surgery by the Fourth Synod of the Lateran (1213). Thus, Master Gerhard, parish priest in Felling, who founded the Hospital of the Holy Ghost at Vienna (1211), was physician-in-ordinary to Duke Leopold VI of Austria, and Sigismund Albicus, who afterward became Archbishop of Prague (1411), held the same office at the court of King Wenzel of Bohemia (1391-1411). From this time, we constantly meet with priests possessing a knowledge of medicine and writing on medical subjects. The popes, the most important patrons of all the sciences, were friendly also to the development of medicine. That they ever at any time forbade the practice of anatomical investigation is a fable. Pope Boniface VIII in 1299-1300 forbade the practice then prevalent of boiling the corpses of noble persons who had died abroad, in order that their bones might be more conveniently transported to the distant ancestral tomb. This prohibitory rule had reference only to cases of death in Christian countries, while in the Orient (e.g. during the Crusades) the usage seems to have been tacitly allowed to continue.
Having voluntarily undertaken the education of the young in all branches of learning, the monasteries were aided in their endeavours by both Church and State. The foundation of state schools is the work of Charlemagne (768-814), whose activity, especially in the Germanic countries, was stimulated by the decree of the Synod of Aachen (789), that each monastery and each cathedral chapter should institute a school. According to the Capitulary of Charlemagne at Diedenhofen (Thionville) in 806, medicine was commonly taught in these schools. At the diocesan school in Reims, we find Gerbert d'Aurillac, later Pope Sylvester II (999-1003), long active as a teacher of medicine. Simultaneously with the rise of the cities there sprang up higher municipal schools, as for instance the Burgerschule at St. Stephan's in Vienna (about 1237). Out of the secular and religious schools, the curriculum of which institutions comprised the entire learning of the times, the first universities developed themselves partly under imperial and partly under papal protection, according as they sprang from the lay and the cathedral or monastic schools.
This is regarded as the oldest medical school of the West. Salerno on the Tyrrhenian Sea, originally probably a Doric colony, was from the sixth to the eleventh century under the rule of the Lombards, and from 1075 to 1130 under that of the Normans. In 1130 it became a part of the Kingdom of Naples and Sicily. The origin of the school is obscure, but, contrary to former belief, it was not a religious foundation, though very many priests were engaged there as teachers of medicine. Women and even Jews were admitted to these studies. Salerno was destined to cultivate for a long time Greek medical science in undimmed purity, until the twelfth century saw the school fall a victim to the all-powerful Arab influence. One of its oldest physicians was Alpuhans, later (1058-85) Archbishop of Salerno. With him worked the Lombard Gariopontus (d. 1050), whose "Passionarius" is based upon Hippocrates, Galen, and Caelius Aurelianus. Contemporary with him was the female physician Trotula who worked also in the literary field, and who is said to have been the wife of the physician Joannes Platearius. Perhaps the best known literary work of this school is the anonymous "Regimen sanitatis Salernitanum" a didactic poem consisting of 364 stanzas, which has been translated into all modern languages. It is said to have been dedicated to Prince Robert, son of William the Conqueror, upon his departure from S. Salerno in 1101. An important change in the intellectual tendency of the "Civitas Hippocratica", as this school called itself, was brought about by the physician Constantine of Carthage (Constantinus Africanus), a man learned in the Oriental languages and a teacher of medicine at Salerno, who died in 1087 a monk of Monte Cassino. While hitherto the best works of Greek antiquity had been known only in mediocre Latin translations, Constantine in the solitude of Monte Cassino began to translate to translate from the Arabic, Greek authors (e.g. the "Aphorisms" of Hippocrates and the "Ars parva" of Galen), as well as such Arabic writer as were accessible to him (Isaak, Ali Abbas). As he brought to the knowledge of his contemporaries first-class Greek authors, but only secondary Arab writers, the study of the former became more profound, while on the other hand an interest was awakened in the hitherto unknown Arabic literature. His pupils were Bartholomaeus, whose "Practica" was translated into German as early as the thirteenth century, and Johannes Afflacius (De febribus et urinis). To the twelfth century, when Arabian polypharmacy was introduced, belong Nicolaus Praepositus (about 1140), whose "Antidotarium", a collection of compounded pharmaceutical formulae, became a model for later works of this kind, and Matthaeus Platearius, who, towards the end of the century, wrote a commentary on the above-named "Antidotarium" (Glossae) and a work about simple drugs (Circa instans). Similar productions appeared from the hand of an otherwise unknown Magister Solernitanus. Maurus, following Arabian sources, wrote on uroscopy. Here must be also mentioned Petrus Musandinus (De cibis et potibus febricitantium), the teacher of Pierre Giles of Corbeil (Ægidius Corboliensis), who later became a canon and the physician-in-ordinary to Philip Augustus of France (1180-1223), and who even at this day began to complain about the decay of the school.
Its first misfortune dates from the death of King Roger III (1193), when the army of King Henry VI captured the city. The establishment of the University of Naples by Frederick II in 1224, the preponderance of Arabian influence, and the rise of the Montpellier school, all exerted so unfavourable an influence that by the fourteenth century Salerno was well-nigh forgotten. Salerno is the oldest school having a curriculum prescribed by the state. In 1140 King Roger II ordered a state examination to test the proficiency of prospective physicians, and Frederick II in 1240 prescribed five years of study besides a year of practical experience. When we consider the proximity of Northern Africa, that the neighbouring Sicily had been under Saracenic rule from the ninth to the eleventh century, and that the Norman kings, and to a far greater degree Frederick II, gave powerful protection to Arabian art and science, it seems wonderful that this oasis of Graeco-Roman culture endured so long. Down to the twelfth century this school was ruled by a purely Hippocratic spirit, especially in practical medicine, by its diagnosis and by the treatment of acute diseases dietetically. Arabian influence makes itself felt first of all in therapeutics, a fact which is easily explained by the proximity of Amalfi, where the Arabian drug-dealers used to land. Local conditions (resulting from the Crusades) explain how surgery, especially the treatment of wounds received in war, was diligently cultivated. In Rogerius we find a Salernitan surgeon armed with independent experience, but showing, nevertheless, reminiscences of Abulhasem. His "Practica Chirurgiae" dates from the year 1180. Although Salerno finally succumbed to Arabian influences, this school did not hand down to us a knowledge of the best Arabian authors.
Its focus was the city of Toledo, which was taken from the Moors in 1085 by Alfonso VI of Castile and Leon. Here Archbishop Raimund (1130-50) founded an institution for translations, in which Jewish scholars were the chief workers. Here lived Gerard of Cremona (1114-87, properly Carmona, near Seville), the translator of Rhazes and Avicenna. A later translator of Rhases (about 1279) was the Jew Faradsch ben Salem (Faragius), who was educated at Salerno.
When in the twelfth century all the Aristotelean works gradually became known, one of the results was the development of Scholasticism, that logically arranged systematic treatment and explanation of rational truths based upon the Aristotelean speculative method. Even though this tendency led to the growth of many excrescences in medicine and confirmed the predominance of Galen's system, also largely based on speculation, it is wrong to hold Scholasticism responsible for the mistakes which its disciples made in consequence of their faulty apprehension of the system, because Scholasticism, far from excluding the observation of nature, directly promotes it. The best proof of this is the fact that the most important scholastic of the thirteenth century, St. Albertus Magnus, was likewise the most important physicist of his time. He thus imitated his model, Aristotle, in both directions. The famous scholastic Roger Bacon (1214-94), an English Franciscan, lays chief stress his theory of cognition upon experience as far as the natural sciences are concerned, and this with even greater emphasis than Albertus Magnus.
Albertus Magnus (Albert Count of Bollstädt, 1193-1280) was a Dominican. For medical science his works about animals, plants, and minerals alone concern us. Formerly a work called "De secretis mulierum" was wrongly attributed to him. Albertus's most eminent service to medicine was in pointing out the way to an independent observation of nature. The following books were to a certain degree based upon the writings of Albertus: the encyclopedic works on natural history of the Franciscan Bartholomaeus Anglicus (about 1260), of Thomas of Cantimpré (1204-80), canon of Cambrai, of Vincent of Beauvais (d. 1264), the "Book of Nature" by Kunrad von Megenberg (1307-74), canon of Ratisbon, and the natural history of Meinau composed towards the end of the thirteenth century at the Monastery of Meinau on the Lake of Constance. In the medical schools the influence of scholasticism made itself felt, but this influence was always favourable. The scholastic physician, the philosopher at the bedside, with his compendious works of needy contents, with his endless game of question and answer, must not, however, be misjudged; he preserved interest in the observation of nature and was, as is freely conceded, a skilful practitioner, although he laid excessive stress upon formalism, and medicine in his hands made no special progress.
Bologna was the principal home of scholastic medicine, and, as early as the twelfth century, a medical school existed there. The most famous physician there was Thaddeus Alderotti (Th. Florentinus,1215-95), who even at that time gave practical clinical instruction and enjoyed great fame as a physician. Among his pupils were the four Varignana, Dino and Tommaso di Garbo, and Pietro Torrigiano Rustichelli -- later a Carthusian monk -- all well-known expounders of the writings of Galen. Indirect disciples were Pietro de Tussignana (d. 1410), who first described the baths at Bormio, and Bavarius de Bavariis (d. about 1480) who was for a long time physician to Pope Nicholas V.
Bologna has stained incomparable glory from the fact that Mondino de Liucci (about 1275-1326), the reviver of anatomy, taught there. There, for the first time since the Alexandrian period (nearly 1500 years), he dissected a human corpse, and wrote a treatise on anatomy based upon personal observation -- a work which, for nearly two and a half centuries, remained the official textbook of the universities. Although Mondino's work which appeared in 1316, contains many defects and errors, if nevertheless marked an advance and incited men to further investigation.
Padua, the famous rival of Bologna, received a university in 1222 from Frederick II. Just as the University Of Leipzig originated in consequence of the migration of students and professors from the University of Prague in 1409, so Padua came into existence through a secession from Bologna. Bologna was soon surpassed by the daughter institution, and, from the foundation of the University of Vienna in 1365 until the middle of the eighteenth century, Padua remained a shininng model for the medical school of Bologna. The first teacher of repute was Pietro d' Abano (Petrus Aponensis, 1250 to about 1320), known as the "great Lombard" -- an honorary title received during his residence at the Universlty of Paris. On account of his too liberalistic opinions and his derision of Christian teaching in his "Conciliator differentiarum", his chief medical work, he was accused of being a heretic. From this period also date the "Aggregator Brixiensis" of Guglielmo Corvi (1250-1326), a work in even greater demand in later times, and the "Consilia" of Gentile da Foligno (d. 1348), who, in 1341, performed the first anatomical dissection in Padua. The fame of the school of Padua was greatly advanced by the family of physicians, the Santa Sophia, which about 1292 emigrated from Constantinople, and whose most famous members were Marsilio (d. 1405) and Galeazzo (d. 1427). The latter, one of the first teachers in Vienna (about 1398-1407), and later professor at Padua, wrote in Vienna a pharmacopoeia which indicates absolutely independent observation in the field of botany. His antithesis and contemporary was Giacomo dalla Torre of Forli (Jacobus Foroliviensis, d. 1413), professor at Padua, known for his commentary on the "Ars parva" of Galen. Giacomo de Dondi (1298-1359), author of the "Aggregator Paduanus do medicinis simplicibus", tried to disengage a salt from the thermal waters of Abano, near Padua. As anatomist and practitioner we must mention Bartholomaeus de Montagnana (d.1460), and the grandfather of the unfortunate Savonarola, Giovanni Michele Savonarola (1390-1462), author of the "Practica Major", who worked along the same lines.
The earliest information about the medical school of this place dates from the twelfth century. Like Salerno, Montpellier developed great independence as far as the other schools were concerned, and laid the greatest stress upon practical medicine. With the decay of Salerno, Montpellier gained in importance. The chief representative of this school is the Spaniards, Arnold of Villanova (1235-about 1312). His greatest merit is that, inclining more towards the Hippocratic school, he did not follow unconditionally the teachings of Galen and Avicenna, but relied upon his own observation and experience, while employing in therapeutics a more dietetic treatment as opposed to Arabian tenets. To him we are indebted for the systematic use of alcohol in certain diseases. A very doubtful merit is his popularizing of alchemy to the study of which he was very much devoted. Other Montpellier representatives of purely practical medicine are Bernard of Gordon (d. 1314; "Lilium medicinae", 1305) a Scot educated in Salerno; Gerardus de Solo (about 1320; "Introductorium juvenurn"); Johannes de Tornamira (end of the fourteenth century, "Clarificatorium juvenum"), and the Portuguese Valeseus de Taranta ("Philonium pharmaceuticum et chirurgicum", 1418). The medical school of Paris, founded in 1180, remained far behind Montpellier in regard to the practice of medicine.
Surgery exhibited during this period in many respects a more independent development than practical medicine, especially in Bologna. The founder of the school there was Hugo Borgognoni of Lucca (d. about 1258). A more important figure was his son Teodorico, chaplain, penitentiary, and physician-in-ordinary to Pope Innocent IV, later Bishop of Cervia. In his "Surgery", completed in 1266, he recommends the simplification of the treatment of wounds, fractures, and dislocations. Guilielmo Saliceto from Piacenza (Guil. Placentinus), first of Bologna, then at Verona, where he completed his surgery in 1275, shows great individuality and a kneen diagnostic eye. Similarly his pupil Lanfranchi strongly recommended the reunion of surgery and internal medicine. Lanfranchi, banished in 1290 from his native city, Milan, transplanted Italian surgery to Paris. There the surgeons, like the physicians of the faculty, had, since 1260, been formed into a corporation, the College de St. Cosme (since 1713 Academie de Chirurgie), to which Lanfranchi was admitted. His "Chirurgia magna" (Ars completa), finished in 1296, is full of casuistic notes and shows us the author as an equally careful and lucky operator. The first important French surgeon is Henri de Mondeville (1260-1320), originally a teacher of anatomy at Montpellier whose treatise, although for the most part a compilation, does not lack originality and perspicuity. The culminating point in French surgery at this period is marked by the appearance of Guy de Chauliac (Chaulhac, d. about 1370). He completed his studies at Bologna, Montpellier, and Paris; later he entered the ecclesiastical state (canon of Reims, 1358), and was physician-in-ordinary to popes Clement VI, Innocent VI, and Urban V. From him we have a description of the terrible plague which he witnessed in 1348 at Avignon. His "Chirurgia magna" treated the subject with a completeness never previously attained, and gave its author during the following centuries the rank of a first-class authority. Among contemporary surgeons in other civilized countries we must mention John Ardern (d. about 1399), an Englishman, who studied at Montpellier and lived subsequently in London, famous for his skill in operating for anal fistulæ, and Jehan Yperman of the Netherlands (d. about 1329), who studied in Paris under Lanfranchi. Besides these surgeons where is no doubt that there were then in Italy many a number of itinerant practitioners who offered their services at fairs; as, specializing usually in certain operations (hernia and lithotomy), they often possessed great skill, and their advice and assistence of a wrong tendency in medicine, but they sought by people of the upper classes.
A short of the survey of the scholastic period gives us the following picture: On the appearance of Arabic literature in Latin translations, Hippocratic medicine was driven from its last stronghold, Salerno. Then came the rule of Arabism, of the system of Galen in Arabic form equipped with all sorts of sophistic subtleties. The works of Rhazes and Avicenna possessed the greatest authority. The latter's "Canon", written in clear language and covering the entire field of medicine became the gospel of physicians. The literature of these times is rich in writings but very poor in thought; for people were content when the long-winded commentaries gave them a better understanding of the Arabs, whom they deemed infallible. A good many things were incomprehensible, first of all the names of diseases and drugs, which translators rendered incorrectly. A comparative investigation of the Greek authors was practically impossible, as both their works and a knowledge of the Greek language had disappeared from among the Romance nations. Thus it happened that special books had to be written from which were learned foreign words and their meanings. The "Synonyma Medicinae" (Clavis sanationis) by the physician Sirnon of Genoa (Januensis, 1270-1303) and the "Pandectae medicinae" of Matthaeus Sylvaticus (d. 1342), both of which were alphabetically arranged, were in vogue. Woe to the physician who dared to doubt the authority of the Arabs! Only men of strong mind could successfully carry out such a dangerous undertaking. The influence of scholasticism in medicine was manifold. It encouraged the observation of nature at the bedside and logical thinking, but it also stimulated the love of disputation, wherein the main object was to force a possibly independent idea into the strait-jacket of the ruling system, and thus avoid all imputation of medical heresy. Signs of improvement are noticed first in anatomy (Mondino) and subsequently in surgery, which is based upon it.
The impulse to follow a new path came, however from without, first of all from a study of the Greek language, and then directly through the famous poet Francesco Petrarca (1304-74), the zealous patron of humanistic studies and thus of the Renaissance. Petrarch's instructor in the Greek language was the monk Barlaam, who procured for his pupil, Leontius Pilatus, a position as public teacher of the language in Florence in 1350. In later times, especially after the fall of Constantinople in 1453, numerous Greek scholars came to Italy. With the spread of a knowledge of Greek and the enthusiasm for the Hellenic masterpieces in art and science, there arose also an interest in classical Latin and a diligent search for manuscripts of Graeco-Roman antiquity, and efforts along these lines were, as is well known, energetically supported by the popes. The West now became acquainted with the works of the old Greek pre-Aristotelean philosophers and physicians in their original tongue, a fact which marks the beginning of the fall of the Arabian teaching. Petrarch fought as champion along the whole line of battle, especially against scholasticism and the medicine of that period. There is no doubt that his zeal was exaggerated in many respects. He blames the physicians of his time because they philosophize and do not cure. Medicine, he says is a practical art and, therefore, may not be treated according to the same methods for the investigation of truth as philosophy. The greatest misfortune had been the appearance of Arabism with all its superstitions (astrology, alchemy, uroscopy). On the other hand, he speaks with great respect of surgery; the reason for this is patent, since he was a friend of the most important surgeon of his time, Guy de Chauliac. There is no doubt that there were then in Italy many excellent physicians who, like Petrarch, recognized the existence of a wrong tendency in medicine, but they were far too weak to break the fetters of Arabism. The road to improvement had already been pointed out by Mondino, the anatomist of Bologna, but a complete change of view did not occur until the sixteenth century.
Associated with the name of Petrarch is the memory of the most terrible epidemic of historic times. The Black Death (bubonic plague with pulmonary infection), originating in Eastern Asia, passed through India to Asia Minor, Arabia, Egypt, Northern Africa, and directly to Europe by the Black Sea. In Europe the epidemic began in 1346, and spread first of all in the maritime cities of Italy (especially Genoa) and Sicily, in 1347 it appeared in Constantinople, Cyprus, Greece, Malta, Sardinia and Corsica, and, towards the end of the year, at Marseilles; in 1348 in Spain, Southern France (Avignon), Paris, the Netherlands, Italy, Southern England and London, Scbleswig-Holstein and Norway, and in December, in Dalmatia and Jutland; in 1349 in the Austrian Alpine countries, Vienna, and Poland; in 1350 in Russia, where in 1353 the last traces disappeared on the shores of the Black Sea. The entire period was preceded by peculiar natural phenomena, as floods, tidal waves, and abnormally damp weather. Petrarch, who witnessed the plague at Florence, declared that posterity would regard the description of all its horrors as fables. The loss of human life in Europe, the population of which is estimated to have been 100 millions, is said to have amounted to twenty-five millions. The disease usually began suddenly and death occurred within three days, and often after a few hours. Physicians were quite powerless in face of the enormous extent of the pestilence. Great self-sacrifice was shown by the clergy, especially by the Franciscans, who are said to have lost 100,000 (?) members through the epidemic. Concerning this terrible period we have reports from the jurist of Piacenza, Gabriel de Mussis; from Cantacuzenus and Nicephorus about the epidemic in Constantinople; from Boccaccio and Petrarch (Florence), from the physician Dionysius Colle of Belluno (Italy) the Belgian Simon of Covino (Montpellier), Guy de Chauliac (Avignon), and also from some Spanish physicians. Less voluminous accounts are to be found in the chronicles of the different countries. Europe has since been repeatedly visited by the plague, which has, however, never been so violent nor extended so widely. The last great epidemics occurred in Central Europe in 1679 and 1713.
The terrors of the Black Death, and the conviction which it brought of the powerlessness of current medicine, undoubtedly helped to effect a gradual change. The greatest influence, however, was exerted by the humanistic tendency which had found many adherents, especially among physicians. The desire after general cultivation in the natural sciences was substantially promoted by the great voyages of discovery made towards the end of the fifteenth century. It is worthy of mention that, at a time when the gifted Christopher Columbus was still ridiculed as a dreamer by the learned, the Florentine astronomer and physician, Toscanelli, and the house-physician of the Franciscan monastery of Santa Maria de Rabida, Garcia Fernandes, both heartily encouraged him and gave him material aid. The scientific endeavours for the reform of medicine are characterized by the activity of the translators, by the critical treatment and explanation of old authors, and by independent investigation especially in the field of botany. Concerning translations, those which had reference to the Hippocratic writings were of prime importance. Among the translators and commentators of these works we find Nicola Leoniceno of Vicenza (1428-1524), the Spaniards Franciscus Valesius (end of the sixteenth century), the Frenchman Jacques Houllier (Hollerius, 1498-1562), Johann Hagenbut of Saxony (Cornarus 1500-58), the two Paris professors, Jean de Gorris (Gorraeus, 1505-77), and Louis Duret (1527-86), and Anutius Foesius (1528-91), a physician of Metz. As investigators of Pliny there are Ermolao Barbaro (1454-93), later Patriarch of Aquileia, and Filippo Beroaldo (1453-1505). Students of other authors were Giovanni Manardo of Ferrara (1462-1536; Galen, Mesue), the Paduan professor Giovanni Battista de Monte (Montanus, 1498-1552; Galen, Rhazes, Avicenna), and the Englishmen Thomas Linacre (1461-1524), and John Kaye (1506-73), Wilhelm Copus, town physician of Basle (1471-1521), and Theodore Zwinger of Switzerland (1533-88), all students of Galen. As may be seen, the system of Galen still formed the central point of medical studies, but it must be regarded as an advance that people now read his works in the original or in accurate translations, not as before in their Arabic form, for in this way many changes and conflicting views introduced by the Arabs were detected. But the full beauty of the Hippocratic works could not be appreciated as long as Galen reigned supreme.
The first fruit of Humanism in medicine was primarily of a purely formal nature, the main stress being now laid upon philological subtleties and elegant diction. No longer content with prose, authors often recorded their thoughts in verse. Petrarch had blamed the physicians of his time because they knew how to construct syllogisms, but did not know how to cure; and now the place of the philosophizing practitioners was taken by the poet physicians. A more satisfactory sign of the times is the great number of medical botanists whose works show more or less independent investigation, and always regard the needs of the physician at the bedside. Among these we must mention the town physician of Bern, Otto Brunfels (d. 1534), Leonard Fuchs (1501-66) professor at Ingolstadt, Hieronymus Tragus (Bock) of Heiderbach (1498-1554), and his pupil Jacobus Theodorus Tabernaemontanus (d. 1590). The most important, however, is the Zurich physician Conrad Gesner (1516-65; Tabulae phytographicae), who was the first to experiment with tobacco brought from America. Only Andrea Cesalpini, professor art that Spienza in Rome, can be regarded as his equal. The interest taken in study of natural science in Germany by Hapsburg emperors, Ferdinand I (1522-64) and Maximilian (1564-76), was of great advantage to it. The physician-in-ordinary to the Archduke Ferdinand of Tyrol, Petrus Andreas Mathiolus of Siena (1500-77), published a translation of Dioscurides with a commentary, a work which was most highly valued until recent times. The special favour of Maximilian II was enjoyed by Rembert Dodoens (Dodonaeus) of Mechlin (1517-85), and by the founder of scientific botany, Charles de l'Ecluse (Clusius) of Antwerp (1525-1609). The latter was appointed professor in Leyden, and for a time lived in Vienna, where he found zealous followers in the physicians Johann Aicholtz (d. 1588) and Paul Fabricus (d. 1589).
From the time of Mondino, anatomy had been diligently cultivated at the universities, especially in Italy. In Bologna, Giovanni de Concoreggi (d. 1438) issued a work on anatomy. As commentators of Mondino we must mention Alessandro Achillini (1463-1512) and Jacopo Berengerio da Carpi (about 1470-1530). Anatomy made special progress because of the artists. Thus Raphael Sanzio (1488-1520) already makes use of the human skeleton when making his sketches, so as to give his figures the proper posture. We possess numerous anatomical descriptions and sketches by Leonardo da Vinci (1442-1519) which were intended partly for all anatomy planned by Marcantonio della Torre (Turrianus, 1473-1506), and partly for a work of his own. The great Michelangelo (1475-1564) left sketehes of the muscles and in 1495, in the monastery of Santo Spirito at Florence, made studies for a picture of the Crucified with cadavers as models.
As an indication of how much the popes endeavoured to advance the study of anatomy we may recall that the priest Gabriel de Zerbis for a time taught anatomy in Rome (towards the end of the fifteenth century) that Paul III (1534-49) appointed the surgeon Alfonso Ferri to teach this subject at the Sapienza in 1535, that the physician-in-ordinary of Julius III (1550-55), Giambattista Cannani, crowned his anatomical studies by discovering the valves in the veins; that Paul IV (1555-9) called to Rome the famous Realdo Colombo the teacher of Michelangelo, and that Colombo's sons dedicated their father's work, "De re anatomica", to Pope Pius IV (1559-1565). Foremost among the universities stood Padua, the stronghold of medical science whence was to issue the light which disclosed the weakness of Galen's system. In Padua, where Bartolomeo Montagna (d. 1460) performed no less than fourteen dissections, there existed since 1446 an anatomical theatre which in 1490 was rebuilt under Alessandro Benedetti (1460-1525). en reigned supreme. Of the anatomists who worked outside of Italy we may mention Guido Guidi (Vidus Vidius) of Florence (d. 1569), until 1531 professor at Paris; his successor François Jacques Dubois (Sylvius, d. 1551) and Gunther von Andernach (1487-1574), professor at Louvain. The two latter were the teachers of the great reformer of anatomy, Andreas Vesalius.
Vesalius (b. 1514), studied at Louvain, Montpellier and Paris, then became imperial field-surgeon. His eagerness to learn went so far that he stole corpses from the gallows to work on at night in his room. He soon became convinced of the weakness and falsity of the anatomy of Galen. His anatomical demonstrations on the cadaver, which he performed in several cities and which attracted attention, soon earned him a call to Padua where he had recently graduated and where, with some interruptions, he taught from 1539 to 1546. His chief work, "De corporis humani fabrica libri vii", which appeared at Basle in 1543, brought him great fame, but likewise aroused violent hostility, especially on the part of his former teacher, Sylvius. The supreme service of Vesalius is that he for the first time, with information derived from the direct study of the dead body, attacked with keen criticism the hitherto unassailable Galen, and thus brought about his overthrow, for soon after this serious weaknesses in other parts of Galen's medical science were also disclosed. Vesalius is the founder of scientific anatomy and of the technique of modern dissection. Unfortunately, he himself destroyed a part of his manuscripts on learning that his enemies intended to submit his work to ecclesiastical censure. While engaged on a pilgrimage, he received word in Jerusalem of his reappointment as professor in Padua, but he was shipwrecked in Zant and died there in great need on 15 October, 1565.
The authority of Galen was, however, still so deeprooted among physicians that Vesalius found opponents even among his own more intimate pupils. Nevertheless, the path which he had pointed out was further explored and anatomy enriched by new discoveries. His immediate successors as teacher in Padua were, in 1546, Realdo Colombo (d. 1569), later professor in Rome, the discoverer of the lesser circulation of the blood (pulmonary circulation); from 1551 the versatile Gabriele Fallopio (1523-62), an admirer of Versalius, who among other things described the organ of hearing; Girolamo Fabrizio of Acquapendente (Fabr. ab Aquapendente, 1537-1619), who worked in the field of embryogeny and studied carefully the valves in the veins, and finally Giulio Casserio (1561-1619), who published a series of anatomical charts. A similar undertaking was planned by Bartolommeo Eustacchi at the Sapienza in Rome, but he died before the completion of the work in 1574. Pope Clement XI (1700-21) caused his physician-in-ordinary, Giovanni Maria Lancisi, to print the rediscovered copper plates and to supply them with an explanatory text. Adrian van den Spieghel of Brussels (Spigelius, 1578-1625) worked on the anatomy of the liver and to the nervous system. In comparison with the excellent productions of Italy, the anatomical activity of Germanic countries appears slight. It was considered sufficient at the universities, if a surgeon now and then dissected a corpse, while a physician explained the functions of different organs. The only laudable exceptions were two physicians who rendered services both to anatomy and botany -- Felix Platter (1536-1614), professor in Basle, and his successor, Kaspar Bauhinus (1560-1624), the discoverer of the valve in the caecum named after him (Bauhin's valve).
Violent attacks upon ancient traditions were not confined to the domain of medicine, but also found expression in the general upheaval caused by Humanists, by the discovery of new countries, by the opening up new sources of knowledge, by the dissemination of education through the invention of printing, and by the schism of the Church brought about by Luther. Authority, both ecclesiastical and civil, had been considerably weakened. The investigations of Vesalius probably dealt the most serious blow to the teaching of Galen, but it was neither the first nor the only one; for even before Vesalius' critics had attacked the theories of Galen and the Arabs, although not quite so energetically as the anatomists attacked them. The chief representatives of these times down to the end of sixteenth century can be classed respectively into anti-Galenists or anti-Arabists and positive Hippocratics. The climax of this revolution was reached on the appearance of Theophrastus Paracelsus and his adherents although the Italian schools remained uninfluenced by this. The physician and philosopher, Geronimo Cardano of Milan (1501-76), attacked principally Galen's explanation of the origin of catarrhs of the brain, and also the validity of the therapeutical principle, Contraria contrariis curantur. Similar was the tendency shown by Bernadino Telesio of Piacenza (1508-88), Giovanni Argenterio of Piedmont (1513-72), and the chancellor of Montpellier, Laurent Joubert (1529-83), while Jean Fernel (1485-1558), made an attempt to modernize the system of Galen in accordance with the results of anatomical investigation.
A lively exchange of opinions was caused by the controversy on bleeding, which was begun by the Paris physician Pierre Brissot (1478-1522). Brissot assailed the Arabian doctrine that inflammatory diseases, especially pleurisy, should be treated by bleeding on the side opposite to the seat of inflammation, and favoured the Hippocratic doctrine of bleeding as near as possible to it. The controversy was decided in favour of the Hippocratics, who did not discard the doctrines of Galen as long as they agreed with Hippocratic views, but rejected the principles of Galen as modified by the Arabs. This is clearly shown by the importance attached to the state of the pulse and of the urine, upon which the Arabs laid much more stress than the Greeks. Of the great number of positive Hippocratics let us call attention to the above-mentioned de Monte, who introduced clinical instruction in Padua; to his successors Vellore Trincavella (1496-1568), Albertino Bottoni (d. about 1596), Marco degli Oddi (d. 1598), Giovanni Manardo (1462-1526), Prospero Alpino (1533-1617); to the Spaniards, Cristobal de Vega (1510 to about 1580) and Luis Mercado (1520-1606); to the Frenchman Guillaume Baillou (Ballonius, 1538-1616); to the Netherlanders, Peter Foreest (1522-97) and Jan van Heurne (1543-1601), who will be mentioned subsequently; Franz Emerich (1496-1560), the organizer of clinical instruction at Vienna; Johann Crato of Crafftheim (1519-85), and Johann Schenck von Grafenberg (1530-98). Epidemiological works were written by Antonio Brassavola (1500-55) on syphilis; Girolamo Fracastoro (1483-1553) on petechial fever and syphilis, Girolamo Dorzellini (d. 1558), and Alessandro Massaria (1510-98) on plagues; Jan van den Kasteele (about 1529) on "the English sweat"; and the Viennese physician, Thomas Jordanus (1540-85), on purple or petechial fever.
Theophrastus Bombast of Hohenheim (Paracelsus), the son of a physician, was born near Einsiedeln, Switzerland, in 1493. In 1506 he went to the University of Basle; from Trithemius he learned chemistry and metallurgy in the smelting houses at Schwaz (Tyrol), and he visited the principal universities of Italy and France. In 1526 he became town physician of Basle, and could as such give lectures. His first appearance is characteristic of him. He publicly burned the works of Avicenna and Galen and showed respect only to the "Aphorisms" of Hippocrates. He was the first to give lectures in the German language. But as early as 1528, he was compelled, on account of the hostility he evoked, to leave Basle secretly. After this he travelled through various countries working constantly at his numerous writings, until death overtook him at Salzburg in 1541. Paracelsus, like a blazing meteor, rose and disappeared; he shared the fate of those who have a violent desire to destroy the old without having any substitute to offer. Passing over his philosophic views, which were based upon neo-Platonism, we find practical medicine indebted to him in various ways, e.g. for the theory of the causes of disease (etiology) for the introduction of chemical therapeutics, and for his insistence on the usefulness of mineral waters and native vegetable drugs. He exaggerates indeed the value of experience. His classification and diagnosis of diseases are quite unscientific, anatomy and physiology being wholly neglected. He thought that for each disease there should exist a specific remedy, and that to discover this is the chief object of medical art. With him diagnosis hung upon the success of this or that remedy, and because of this he named the diseases according to their specific remedies. Directly repudiated by the Italian schools, Paracelsus found adherents mainly in Germany, among them being the Wittenberg professor Oswald Croll (about 1560-1609). He also found numerous friends among the travelling physicians and quacks. His teachings met with the most hostile reception from the Paris faculty. Although the further progress of anatomy and physiology indicated clearly to physicians the right path, we meet even in the eighteenth and nineteenth centuries with two men who start directly from Paracelsus: Samuel Friedrich Hahnemann (1755-1843), the originator of homeopathy, and Johann Gottfried Rademacher (1772-1850), advocate of empiricism.
The first fruits of the progress in anatomy were enjoyed by surgery, especially since most Italian anatomists were practical surgeons. After the introduction of firearms in war, the treatment of gunshot wounds was especially studied. While surgery had always enjoyed a high rank in Italy and France, in Germany it was in the hands of barbers and surgeons unconnected with the universities and poorly educated; hence it is readily understood why the best surgeons lived in the cities nearest the Romance countries, especially Strasburg. With the member of the Teutonic Order, Heinrich von Pfolspeundt ("Bündth Ertzney", 1460), the most important representatives were the Strasburg surgeons, Hieronymus Brunschwig (d. about 1534), and Hans von Gersdorff ("Feldtbuch der Wundtartzney", 1517). Their equal was a somewhat younger man, Felix Würtz of Basle (1518-74). We are indebted to the French field-surgeon Ambroise Paré for a marked change in the treatment of gunshot wounds and arterial hemorrhage. He abandoned the Arabic method of work with a red-hot knife, declared that supposedly poisoned gunshot wounds were simple contused wounds, and proceeded to bandage them without using hot oil. He was the first to employ the ligature in the case of arterial hemorrhage. Next to him in importance stands Pierre Franco (about 1560), known as the perfecter of the operation of lithotomy and that for hernia. Gaspare Tagliacozzi of Bologna (1546-99) deserves credit for reintroducing and improving the ancient plastic operations. In the sixteenth century the Caesarean operation (Sectio caesarea, laparotomy) was performed on living persons.
Galen's theory, according to which the left heart and the arteries contained air, the blood being generated in the liver, had long been regarded as improbable, but in spite of every effort no one had as yet discovered the truth about circulation. The solution of this problem, which brought about complete fall of Galen's system and a revolution in physiology, came from the English physician William Harvey of Folkstone (1578-1657), a pupil of Fabricius ab Aquapendente. Harvey's discovery published in 1628, that the heart is the centre of the circulation of the blood must return to the heart, at first received scant notice and was even directly opposed by Galen's adherents; but further investigation soon made truth victorious. Even as early as 1622, Gaspare Aselli (1581-1626) found the chyle vessels, but correct explanation was possible only after the discovery of the thoracic duct (ductus thoracius) and its opening into the circulation by Jean Pacquet (1622-74) and Johann van Horne (1621-70), and of the lymphatic vessels by Olaus Rudbeck (1630-1702) and Thomas Baltholinus (1616-80). A new field of investigation was opened by the invention of the microscope, by which Marcello Malpighi (1628-94) discovered the smaller blood-vessels and the blood corpuscles. From Harvey's time starts a series of important anatomists and physiologists, among them the Englishmen Thomas Wharton (1614-73; glands) and Thomas Willis (1621--75; brain); the Netherlanders Peter Paaw (1564-1617), his pupil Nikolas Pieterz Tulp (1593-1678), both teachers of anatomy at Leyden, and Antony van Leeuwenhoek (1632-1723) and Johann Swammnerdam (1647-80), microscopists, Reinier de Graaf (1641-73; ovary); Nikolaus Steno of Copenhagen (1638-86), and the Germans, Moriz Hofman (1621-98) and George Wirsung, who investigated the pancreas.
The doctrine of the circulation is based to a large extent upon the laws of physics. Consequently among a number of physicians, influenced by the works of Alfonso Borelli (1608-78) on animal motion, there was a marked effort to explain all physiological processes according to the laws of physics (iatrophysicists). Opposed to them was a party, which, influenced by the progress in chemistry, sought to make use of it for explaining medical facts (iatrochemists). This tendency goes back to Paracelsus and his adherent Johann Baptist von Helmont (1578-1644). Helmont, who was an important chemist (the discoverer of carbonic acid), recognized the importance of anatomy, and deserves credit for his work in therapeutics, although his failure to appraise the needs of his time prevented his doctrine from influencing the development of medicine. Iatrophysics was cultivated mainly in Italy and England; iatrochemistry in the Netherlands and Germany. The chief adherent of iatrophysics in Italy was Giorgio Baglivi (d. 1707), professor at the Sapienza in Rome; in practical medicine, however, he held mainly to Hippocratic principles, while the Englishman, Archibald Pitcairn (1652-1713), tried to follow out iatrophysics to its utmost consequences.
Owing to the greater progress made in physics, iatrochemistry found fewer followers, and that it took root at all is the service of its chief representative Franz de le Boë Sylvius (1614-72), who in 1658 became professor of practical medicine at Leyden. At the school there, founded in 1575, Jan Heurne had already tried to establish a clinic after the Paduan model, but it was not till 1637 that his son Otto was able to carry out his scheme. The immediate successors of the latter, Albert Kyper (d. 1658), and Ewald Schrevelius (1576-1646), continued this institution in the Hippocratic spirit. Before Sylvius began to teach there, the Leyden clinic had already gained worldwide fame. One of the first adherents of Harvey, Sylvius, depending in part on Paracelsus and Belmont sought to explain physiological processes by suggesting fermentation (molecular motion of matter) and "vital spirits" as moving forces. Through "effervescence" acid and alkaline juices are formed, and through their abnormal mixture hyperacidity and hyperalkalinity (i.e., sickness) originate. This simple doctrine, supported by the clinical activity of Sylvius, found numerous adherents especially in Germany, but it made just as many opponents among the iatrophysicists who were able to refute in part these untenable hypotheses. The two theories are, however, not absolutely opposed to each other, for both physics and chemistry offer the means necessary for an explanation of physiological processes and may form the basis for the construction of an exact medical science. At this time, however, physics and