Part 10 (1/2)

[Footnote 27: Ja.n.u.s, Archives International es pour l'histoire de la Medicine et pour la Geographie Medicale, paraissant tous les deux mois. Amsterdam, 1897-1898.]

Petella does not hesitate to say of him that he was ”one of the most renowned personages of Europe during the thirteenth century, from the point of view of the triple evolution of his extraordinary mind, which caused him to make his mark in the physical sciences, in the metaphysical sciences, and in the religious world. In him there was an incarnation of the savant of the time, and he must be considered the most perfect encyclopedist of the Middle Ages in their first renascence.”

Anyone who reads Dr. Petella's account of this book by Pope John XXI.

will be surprised at how much was known about diseases of the eye at the middle of the thirteenth century. For instance, hardening of the eye is spoken of as a very serious affection, so that there seems to be no doubt that the condition now known as glaucoma was recognized and its bad prognosis appreciated. His account of the external anatomy of the eye, eight coats of which he describes, beginning with the {208} conjunctiva and ending with the retina, is quite complete. The eye is said to have eight muscles, the levator of the upper eyelid and the sphincter muscle of the eye being counted among them. The other muscles are picturesquely described as reins, that is, guiding ribbons for the eye. Cataract is described as water descending into the eye, and two forms of it are distinguished--one traumatic, due to external causes, and the other due to internal causes. Lachrimal fistula is described and its causes discussed. Various forms of blepharitis are touched upon. Many suggestions are made for the treatment of trichiasis. That a man who was as distinguished in medicine as Peter of Spain should have been elected Pope, is the best possible proof that there was no opposition between science and religion during the thirteenth century.

But to return to the Papal Physicians in our original meaning of the term. Alderotti's successor as physician to the Papal Court was scarcely, if any, less distinguished. This was Simon Januensis, the medical attendant to Pope Nicholas IV., whose pontificate lasted from 1288-1292. Simon did much to make the use of opium more scientific than it had been, and he established definite rules for its administration. Before this the anodyne effects of the drug had been well known, but the difficulty had been to regulate its dosage properly and prevent the use of too large quant.i.ties, while at the same time securing the administration of sufficient of the drug to relieve pain. At the beginning there was much prejudice with regard to opium. Indeed, as every physician knows, this prejudice has not entirely died out even in our own day. How much of good, then, Simon was able to accomplish because the prestige of his position as {209} Papal Physician helped to break down this prejudice, and how much human suffering he saved as a consequence, it is easy to understand.

Simon is best known in the history of medical science as the author of what was probably the first important dictionary of medicine. This was called the Synonyma Medicinae or Clavis Sanationis, the Key of Health.

Steinschneider has declared this book to be one of the most important works in the field of Synonymies. Julius Pagel, in his chapter on Therapeutics in the Middle Ages, in Puschmann's Handbook of the History of Medicine, already quoted, says that this Papal Physician succeeded in solving very happily the problem which he set himself, of gathering together the information that had been collected during past centuries with regard to medical words, and especially those relating to the use of various remedial measures. The industry of the writer may be very well appreciated from the fact that his glossary contains some six thousand articles. Its place in the history of science, as given by Meyer, the German historian of botany, is that for the understanding of the older words in natural science, no better aid than this can be found. He considers it the best work of its kind until Caspar Bauhin's similar volume came to replace it, but that was not until well on in the seventeenth century. Simon was greatly encouraged in this work by Popes Nicholas IV. and Boniface VIII., to both of whom he was body physician and at the same time an intimate friend.

The custom of having for medical attendant one of the leading physicians of the day, if not actually the most prominent medical scientist of the time, which had obtained at Rome during the thirteenth century, was maintained at Avignon during the three-quarters of a {210} century in which the Papal See had its seat there. Just who the regular medical attendant of Clement V., the first of the Avignon Popes, was is not very sure. When he became seriously ill toward the end of his life, however, Arnold of Villanova, one of the professors of physic at Paris and probably the most distinguished living physician of the time, was summoned in consultation, and began his journey down to Avignon. This summons attracted widespread attention, which was still further emphasized by the fact that Arnold of Villanova died on the journey. It is not difficult to appreciate even at this distance of time how much weight the summoning of a physician from a long distance to attend His Holiness would have on the minds of the people, and how much it would tend to call their attention to the important medical school from which the great man came. People generally, who heard the facts, would want at least to have in attendance on them, if possible, a physician who had been graduated at the school from which Arnold of Villanova was summoned on his important medical mission. How much this would mean for the encouragement of scientific medicine as it was developing at the University of Paris can scarcely be overestimated.

The distinct tendency of the Popes to keep in touch with the best men in medicine and surgery in their time is well ill.u.s.trated by the case of Guy de Chauliac. This great French surgeon and professor at the University of Montpelier is hailed by the modern medical world as the Father of Modern Surgery. There is no doubt at all of his intensely modern character as a teacher, nor of his enterprise as a progressive surgeon. Few men have done more for advance in medicine, and his name is {211} stamped on a number of original ideas that have never been eclipsed in surgery. After studying anatomy very faithfully, especially by means of dissections, in Italy, where he tells us that his master at Bologna, Bertrucci, made a larger number of dissections scarcely more than thirty years after the supposed Papal decree of prohibition, he returned to Montpelier to become the professor of surgery there, and introduced the Italian methods of investigation into the famous old university.

At this time the Popes were at Avignon, not far distant from Montpelier. From them Guy received every encouragement in his scientific work. He insisted that no one could practice surgery with any hope of success unless he devoted himself to careful dissection of the human body. If we were to believe some of the things that have been said with regard to the Popes forbidding dissection, this should have been enough to keep the French surgeon from the favor of the Popes, but it did not. On the contrary, he was the intimate friend and consultant medical attendant of two of the Avignon Popes, and was the chamberlain to one of them. The good influence of Chauliac on the minds of the Popes is reflected in their interest in the medical department of the University of Montpelier. About this time Pope Urban VI. founded the College of Twelve Physicians at Montpelier. He was an alumnus of the university, and had been appealed to to enlarge the opportunities of his Alma Mater. He did so in the manner just related.

One of the Papal Physicians of the Avignon times was unfortunate. This was the ill-fated Cecco di Ascolo, who was distinguished as a poet and a philosopher as well as a physician. But for his sad end, one might be tempted to say, that he had so many irons in the fire {212} that it was scarce to be wondered at that he suffered the fate of many another tender of too many irons, and eventually got his fingers burnt. He was body physician of Pope John XXII. during a good part of the long pontificate of that strenuous old man, who became Pope when over seventy, lived to be ninety, yet accomplished important work in every year of his career. After leaving Avignon Cecco went to Italy and became the Professor of Astrology at Bologna. The term astrology had none of the unfortunate or derisory signification that it has at the present time. It was, as the etymology of the word implies, the science of the stars, though it was cultivated with due reference to the influence of these heavenly bodies on human fate and human const.i.tutions. Hence a physician's interest in it. This continued to be a characteristic of astrology down to the time of Tycho-Brahe, the Danish astronomer, at the beginning of the seventeenth century. Cecco and another distinguished physician of the time, Dino de Garbo, became involved in a public controversy, as the result of which Cecco was denounced to the public authorities as undermining the basis of government and virtually teaching anarchy, though it was called heresy, and as a result of the bitter feud he suffered the penalty of death by fire.

The last of the Papal Physicians connected with the Pontifical Court at Avignon was almost as ill.u.s.trious as any of his predecessors. He was the well-known Joannes de Tornamira, who was the body physician to Gregory XI. until that Pontiff brought the Papal Court back to Rome.

Then Tornamira became the chancellor of the University of Montpelier.

He wrote an introduction to the study of medicine, meant for the use of students and young physicians, called a Clarificatorium, which, {213} according to Puschmann's History of Medicine, was the most used text-book of medicine during the fourteenth and fifteenth centuries.

Besides this he wrote a long and important work On Fevers and the Accidents of Fevers, in which he sums up all the medical knowledge of the time on these subjects.

That the policy of the Popes did not change as regards the selection of their physicians on their return from Avignon to Rome, is to be seen from the physician of the Popes whose See was in both places.

This was the famous Francis of Siena, who is known best in history as the intimate friend of Petrarch, and who was physician to Pope Gregory XI. and to his successor, Urban VI. He had been a professor of medicine at the University of Pisa, and by special invitation went to fill the same position in the University of the Papal City, and became at the same time the medical adviser of the Popes. His influence on medicine was not very important, but he occupied a very prominent position among the learned men of the time, and his personal prestige did much to add to the dignity of the profession. In our own time, the medical men who have been best known and whose members.h.i.+p in the profession has added greatly to its popular estimation, have at times not been distinguished for great things in medicine. Francis of Siena was such a man, and the fact that he was medical adviser to the Popes at the same time must be counted as an important factor in the evolution of medical dignity.

One of the first writers on medical cases who did not indulge much in theory was Baverius de Baveriis, of Imola, who died about 1480, and who was the physician to Pope Nicholas V. shortly before and after the middle of the fifteenth century. In the light of the fact that a {214} recent Papal physician, Dr. Lapponi, has written a book on hypnotism and spiritism, it is interesting to find that his predecessor in the post of Papal Physician four centuries and a half ago, discussed the differential diagnosis of hysteria, catalepsy, epilepsy and syncope.

He also discusses certain interesting cases of vertigo due to stomach trouble, and in general antic.i.p.ates very unexpectedly neurotic conditions that are supposed to have been recognized in medicine much later than his time. Perhaps the most startling thing to be found in his works is his recommendation of iron for chlorosis, which he claimed to have treated with the greatest success by means of this remedy. Of course, there was no idea at the time that chlorosis was due in any sense to a lack of iron in the system, and its value as a therapeutic agent must have come entirely from empiric considerations; but then most of our advances in drug therapeutics have come by no better way.

Another of the distinguished Papal Physicians of the fifteenth century was John of Vigo (1460-1520), who, as Professor Allb.u.t.t notes, was attached to the court of the fighting Pontiff, Julius II., and as a consequence saw much of field surgery. His text-book of surgery, printed at Rome in the early part of the sixteenth century, went through an enormous number of editions. No standard surgical treatise had appeared since that of Guy de Chauliac, and Vigo's continued to be the standard for the next full century. He was a shrewd and skilful as well as a learned physician. His surgical ac.u.men deserves to be noted.

He recognized that fracture of the inner table of the skull might take place without that of the outer, and made some very practical remarks with regard to gangrene and its causes. He attributed {215} gangrene in certain cases to faulty bandaging in fractures, and discussed its origin also as the result of severe cold. He treated syphilis with mercurial inunctions, a practice still followed by the best specialists in this line. His greatest claim to fame, however, is founded on the fact that he was the first to write a surgical treatise on wounds made by firearms.

At this time, during the first half of the sixteenth century, the Papal Medical School begins to a.s.sume an importance in the history of medicine which it was to continue to hold for the next two centuries.

After the refoundation of the Sapienza by Pope Alexander VI., and its development under Pope Leo X., special care was taken and no expense spared by their successors, to secure the greatest teachers in anatomy in the world for the medical department of the Papal University. At this time all the great physicians were distinguished for their attainments in anatomy, somewhat as in the nineteenth century great physicians obtained their prestige by original work in pathology. The situations in the two centuries had much more in common than the casual reader of history or even the ordinary student of medicine would appreciate. The list of Papal Physicians, then, becomes to a great extent the roll of the professors of anatomy at the Papal University Medical School. The Popes of this period were wise enough in their generation to realize that the men who devoted themselves to original research in increasing the knowledge of the human body, were also those likely to know most about the diseases of the body and their treatment. These scientific anatomists, with the chastening knowledge of the complexity of the human body before them, probably made less claims to power to cure diseases than many an {216} enthusiastic therapeutist of the time, who thought, as have representatives of this specialty in every generation, that he has many infallible remedies for the cure of disease, though subsequent generations have not agreed with him.

The true significance of the lives of the men who occupied the post of Papal Physician after this time will be best appreciated from our treatment of them in the chapter on The Papal Medical School. It will be sufficient here simply to recall the names of the distinguished men who, besides being professors in the Papal Medical School, were the medical advisers of the Popes.

The first and most important of the great Renaissance professors of anatomy of the Roman Medical School who were also Papal Physicians was Columbus. He had been Vesalius's a.s.sistant at Padua and later his successor. He had lectured also at Bologna. When a special effort was made to give prestige to the University of Pisa, he was tempted by particularly liberal offers to become the professor of anatomy in that city. It was from here, by still more generous patronage, that the Popes obtained him for their medical school. On treating of the Papal Medical School, we shall have more to say of him and his successor in the professors.h.i.+p of anatomy and medicine as well as in the post of Papal Physician, who was the third of the first anatomists of the time--Eustachius. He with Columbus and Vesalius const.i.tute the trinity of great original investigators in anatomy about the middle of the sixteenth century. It is extremely interesting, with the traditions that exist in the matter, to find that the Popes secured two of these great anatomists for their personal physicians as well as for their medical school. The third one, Vesalius, became the body {217} physician first to the Emperor Charles V. and then to his son Philip II., whom many would declare to be as Catholic as the Popes themselves in religious tendencies.

After Eustachius came Varolius, whose name is engraved in the history of medicine because the Pons Varolii or bridge of Varolius, an important structure in the brain now often simply called the pons, was named after him. To Varolius we owe one of the earliest detailed descriptions of the anatomy of the brain. He was the Papal Physician to Gregory XIII., who will be remembered as the Pope under whom the reform of the calendar was made by the great Jesuit mathematician and astronomer, Father Clavius. Pope Gregory's enlightened patronage of medicine in the person of Varolius will be better appreciated if we add that he was chosen as Papal Physician when he was not yet thirty years of age, though he had already given abundant evidence of his talent for original investigation in anatomy. He died at the early age of thirty-two, but not until after he had accomplished a life's work sufficient to give him an enduring place in the history of anatomy.

After Varolius as Papal Physician came Piccolomini and then Caesalpinus, whom the Italians hail as the discoverer of the circulation of the blood before Harvey, and of whom we shall have much to say in the next chapter. Piccolomini was not as great an original thinker and worker as many of his predecessors and successors, but he was a man whose prestige in medicine was scarcely less than theirs.

That this same liberal patronage of distinguished physicians was continued in the next century may be realized from the fact that Malpighi, the great founder of comparative anatomy, became one of the Papal Physicians. His intimate friend, Borelli, to whom we owe the {218} introduction of physics into medicine, had spent some years in Rome, where, having been robbed by his servants, with the consent of the Pope he took up his abode with the Society of the Pious Schools of San Pantaleone. Here he finished his important work De Motu Animalium, in which the principles of mechanics were first definitely introduced into anatomy and physiology. The preface to this book was written by an ecclesiastic, who praises the piety of Borelli during his stay in Rome and chronicles his encouragement by the Popes in his medical work. Malpighi was succeeded as Papal Physician by Tozzi, who is famous for his commentaries on the ancients rather than for original observation, but who was looked upon in his time as one of the most prominent physicians in Italy, and at this period that meant one of the most prominent physicians in the world. At the beginning of the next century, the eighteenth, Lancisi, by many considered the Father of Modern Clinical Medicine, became the Papal Physician.

Among the consultant physicians to the Popes of the eighteenth century, though he never occupied the post of regular medical attendant, was Morgagni. His advice was often sought by a succession of Popes not only with regard to their personal health, but also with regard to the teaching of medicine and other questions of like nature.

Virchow has called Morgagni the Father of Modern Pathology, because he was the first to point out, that for a knowledge of disease it is quite as important to know where the disease has been as to try to learn what it has been. All of the Popes, five in number, of the latter part of Morgagni's life were on terms of intimacy with him.