Part 6 (1/2)
Altogether there are some thirty-three works of Averroes on philosophy and science. Only three of these are concerned with medicine. One is the ”Colliget,” so-called, containing seven books, on anatomy, physiology, pathology, diagnostics, materia medica, hygiene, and therapy. Then there is a commentary on the ”Cantica of Avicenna,” and a tractate on the ”Theriac.” Averroes' idea in writing about medicine was to apply his particular system of philosophy to medical science. His intimate relations with other great physicians of the time, and in particular his close friends.h.i.+p with Avenzoar, enabled him to get abundant medical information in faultless order so far as knowledge then went, but his theoretic speculations, instead of helping medicine, as he thought they would, and as philosophers have always been inclined to think as regards their theoretic contributions, were not only not of value, but to some extent at least hindered human progress by diverting men from the field of observation to that of speculation. It is interesting to realize that Averroes did in his time what Descartes did many centuries later, and many another brilliant thinker has done before and since.
ARABIAN INFLUENCE
The fame of these great thinkers and writers in philosophy and in medicine came to be known not only through the distribution of their books long after their death, but during their lifetime, and in immediately subsequent generations, ardent seekers after knowledge, who were themselves afterwards to become famous by their teaching and writing, found their way into the Arabian dominions in order to take advantage of the educational opportunities afforded. These were better than they could secure at home in Christian countries, because the process of bringing culture and devotion to literature and science into the minds of the Northern nations, who had replaced the old Romans in Europe, was not yet completed. Bagdad and Cordova were the two favorite places of educational pilgrimage. The names that are most familiar among the scholars in the Middle Ages in Europe are those of whom it is recorded that they made long journeys in order to get in touch with what the Arabs had preserved of the old Greek civilization and culture. Among them are such men as Michael Scot or Scotus, Matthew Platearius, who was afterwards a great teacher at Salerno; Daniel Morley, Adelard of Bath, Egidius, otherwise known as Gilles de Corbeil; Romoaldus, Gerbert of Auvergne, who later became Pope under the name of Sylvester II; Gerard of Cremona, and the best known of them all, at least in medicine, Constantine Africa.n.u.s, whose wanderings, however, were probably not limited to Arabian lands, but who seems also to have been in Hindustan.
We are rather p.r.o.ne to think that this great spirit of going far afield for knowledge's sake is recent, or, at least, quite modern. As a matter of fact, one finds it everywhere in history. Long before Herodotus did his wanderings there were many visitors who went to Egypt, and many more later who went to Crete, and many more a few centuries later who went to the sh.o.r.es of Asia Minor seeking for the precious pearl of knowledge, and sometimes finding it without finding the even more precious pearl of wisdom, ”whose worth is from the farthest coasts.”
To the Arabs we owe the foundation of a series of inst.i.tutions for the higher learning, like those which had existed around them in Asia Minor and in Egypt at the time they made their conquests. Alexandria, Pergamos, Cos, Cnidos, Tarsus, and many other Eastern cities had had what we would call at least academies, and many of them deserved the name of universities. The Arabs continued the tradition in education that they found, and established educational inst.i.tutions which attracted wide attention. As we have said, the two most famous of these were at Bagdad and at Cordova. Mostanser, the predecessor of the last Caliph of the family of the Abba.s.sides, built a handsome palace, in which the academy of Bagdad was housed. It is still in existence, and gives an excellent idea of the beneficent interest of this monarch and of other of the Abba.s.side rulers in education. Its fate at the present time is typical of the att.i.tude of the Mohammedans towards education.
Though the building is still standing, the inst.i.tution of learning is no longer there. As Hyrtl remarks, it is not ideas that are exchanged in it now, but articles of commerce. It has become the chief office of the Turkish customs department in Bagdad.
These inst.i.tutions of the higher learning, founded by the Arabs, at first as rather strict imitations of the museums or academies of Egypt and Asia Minor, gradually changed their character under the Arabs. Their courses became much more formal, examinations became much more important. Scholars.h.i.+p was sought not so much for its own sake, as because it led to positions in the civil service, to the favor of princes, and, in general, to reputation and pecuniary reward. Formal testimonials proclaiming education, signed by the academic authorities, were introduced and came to mean much. Lawyers could not practise without a license, physicians also required a license. These formalities were adopted by the Western medieval universities to a considerable degree and have been perpetuated in the modern time. Undoubtedly they did much to hamper real education among the Arabs by setting in place of the satisfaction of learning for its own sake and the commendation of teachers the formal recognition of a certain amount of work done as recognized by the educational authorities. There was always a tendency among the Arabs to formulate and formalize, to over-systematize what they were at; to think that new knowledge could be obtained simply by speculating over what was already acquired, and developing it. There are a number of comparisons between this and later periods of education that might be suggested if comparisons were not odious.
The influence of Arabian medicine on modern medicine can, perhaps, best be judged from the number of words in our modern nomenclature, which, though bearing Latin forms, often with suggestion of Greek origins, still are not derived from the old Latin or Greek authors, but represent Arabic terms translated into Latin during the Renaissance period. Hyrtl, without pretence of quoting them all, gives a list of these which is surprising in its comprehensiveness. For instance, the mediastinum, the sutura sagittalis, the scrobiculus cordis, the marsupium cordis, the chambers of the heart, the velum palati, the trochanter, the rima glottidis, the fontanelles, the alae of the nose, all have their present names, not from original Latin expressions, but from the translation of Arabic terms. For all such words the Greeks and Romans have quite other expressions, in which the sense of our modern terms is not contained.
This has given rise to many misunderstandings, and to many attempts in the modern times to return to the cla.s.sic terminology rather than preserve what in many cases are the barbarisms introduced through the Arabic, but it is doubtful whether any comprehensive reform in the matter can be effected, so strongly entrenched in medical usage have these terms now become.
Freind, in his ”History of Medicine,” already cited, calls attention to the fact that the Arabs had an unfortunate tendency to change by addition or subtraction of their own views the authors that they studied, and wished to translate to others. This seems to have been true even of some of the most distinguished of them. Of course, the idea of preserving an author's text untouched, and making it clear just where note and commentary came in, had not yet come to men's view, but quite apart from this the Arabs apparently often tried to gain acceptance for their own ideas by having them masquerade as the supposed ideas of favorite cla.s.sic authors.
Another unfortunate tendency among the Arabs was their liking for the discussion of many trivial questions. Hyrtl, in his volume on ”Arabian and Hebrew Words in Anatomy,”[6] declares that it is almost incredible how earnestly some trivial questions in anatomy and physiology were discussed by the Arabs. He gives some examples. Why does no hair grow on the nose of men? Why does the stomach not lie behind the mouth? Why does the windpipe not lie behind the esophagus? Why are the b.r.e.a.s.t.s not on the abdomen? Why are not the calves on the anterior portion of the legs?
Even such men as Rhazes and Avicenna discuss such questions.
It was this tendency of the Arabs that pa.s.sed over to the Western Europeans with Arabian commentaries on philosophy and science, and brought so many similar discussions in the scholastic period. These trivialities have usually been supposed to originate with the scholastics themselves, for they are not to be found in the Greek authors on whom the scholastics were writing commentaries, but they are typically Oriental in character, and it must be remembered that during the twelfth and early thirteenth centuries, at least, Greek philosophy found its way largely into Europe in Arab versions, and these characteristically Arabian additions of the discussion of curious trivial questions came with them and produced an imitative tendency among the Europeans.
As a rule the more careful has been the study of Arabian writers in the modern time, particularly by specialists, the clearer has it become that they lacked nearly all originality. Especially were they faulty in their observations; besides, they had a definite tendency to replace observation by theory, a fatal defect in medicine. The fine development of surgery that came at the end of the Arabian period of medicine in Europe could never have come from the Arabs themselves. Gurlt has brought this out particularly, but it will not be difficult to cite many other good authorities in support of this opinion.
Hyrtl, in his ”Thesis on the Rarer Old Anatomists,”[7] says that ”the Arabs paid very little attention to anatomy, and, of course, because of the prohibition in the Koran, added nothing to it. Whatever they knew they took from the Greeks, and especially Galen. Not only did they not add anything new to this, but they even lost sight of much that was important in the older authors. The Arabs were much more interested in physiology; they could study this by giving thought to it without soiling their hands. They delighted in theory, rather than in observation.”
While we thus discuss the lack of originality and the tendency to over-refinement among the Arabian medical writers, it must not be thought that we would make little of what they accomplished. They not only preserved the old medical writers for us, but they kept alive practical medicine with the principles of the great Greek thinkers as its basis. There are a large number of writers of Arabian medicine whose names have secured deservedly a high place in medical history. If this were a formal history of Arabian medicine, their careers and works would require discussion. For our purpose, however, it seems better to confine attention to a few of the most prominent Arabian writers on medicine, because they will serve to ill.u.s.trate how thoroughly practical were the Arabian physicians and how many medical problems that we are p.r.o.ne to think of as modern they occupied themselves with, solving them not infrequently nearly as we do in the modern time.
VI
THE MEDICAL SCHOOL AT SALERNO
The Medical School at Salerno, probably organized early in the tenth century, often spoken of as the darkest of the centuries, and reaching its highest point of influence at the end of the twelfth century, is of great interest in modern times for a number of reasons. First it brought about in the course of its development an organization of medical education, and an establishment of standards that were to be maintained whenever and wherever there was a true professional spirit down to our own time. They insisted on a preliminary education of three years of college work, on at least four years of medical training, on special study for specialist's work, as in surgery, and on practical training with a physician or in a hospital before the student was allowed to practise for himself. At Salerno, too, the department of women's diseases was given over to women professors, and we have the text-books of some of these women medical teachers. The license to practise given to women, however, seems to have been general and did not confine them merely to the care of women and children. We have records of a number of these licenses issued to women in the neighborhood of Salerno. This subject of feminine medical education at Salerno, because of its special interest in our time, will have a chapter by itself.
These are the special features of medical education in our own time that we are rather p.r.o.ne to think of as originating with ourselves and as being indices of that evolution of humanity and progress in mankind which are culminating in our era. It is rather interesting, then, to study just how these developments came about and what the genesis of this great school was. The books of its professors were widely read, not only in their own generation but for centuries afterwards. With the invention of printing at the time of the Renaissance most of them were printed and exerted profound influence over the revival of medicine which took place at that time. Salerno became the first of the universities in the modern sense of the word. Here there gathered round the medical school, first a preparatory department representing modern college work, and then departments of theology and law, though this latter department particularly was never quite successful. The fact that the first university, that of Salerno, should have been organized round a medical school, the second, that of Bologna, around a law school, and the third, that of Paris, around a school of theology and philosophy, would seem to represent the ordinary natural process of development in human interests. First man is interested in himself and in his health, then in his property, and finally in his relations to his fellow-man and to G.o.d.
Though much work has been done on the subject in recent years, it is not easy to trace the origin of the medical school at Salerno. The difficulty is emphasized by the fact that even the earliest chroniclers whose accounts we have were not sure as to its origin, and even had some doubt about the age of the school. Alpha.n.u.s, usually designated Alpha.n.u.s I because there are several of the name, who is one of the earliest professors whose name and fame have come down to us, gives us the only definite detail as to the age of the school. He was a Benedictine monk, distinguished as a literary man, known both as poet and physician, who was afterwards raised to the Bishopric of Salerno. As a bishop he was one of the beneficent patrons, to whom the school owed much. He lived in the tenth century, and states that medicine flourished in the town before the time of Guimarus II, who reigned in the ninth century. In the ancient chronicle of Salerno, re-discovered by De Renzi and published in his ”Collectio Salernitana,” it is definitely recorded that the medical school was founded by four doctors,--a Jewish Rabbi Elinus, a Greek Pontus, a Saracen Adala, an Arab, and a native of Salerno, each of whom lectured in his native language. There are many elements in this tradition, however, that would seem to indicate its mythical origin and that it was probably invented after the event to account for the presence of teachers in all these languages and the coming of students from all over the world. The names, for instance, are apparently corruptions of real names, as can be readily recognized.
Elinus, the Jew, is probably Elias or Eliseus, Adala is a corruption of Abdallah, and Pontus, as pointed out by Puschmann in his ”History of Medical Education,” should probably be Gario-Pontus.
While we do not know exactly when the medical school at Salerno was founded, we know that a hospital was established there as early as 820.
It was founded by the Archdeacon Adelmus, and was placed under the control of the Benedictines after it was realized that a religious order, by its organization, was best fitted for carrying on such charitable work continuously. Other infirmaries and charitable inst.i.tutions, mainly under control of the religious, sprang up in Salerno. It was the presence of these hospitals in a salubrious climate that seems first to have attracted the attention of patients and then of physicians from all over Europe and even adjacent Africa and Asia.
Puschmann says that it is uncertain whether clinical instruction was imparted in these inst.i.tutions or not, but the whole tenor of what we know about the practical character of the teaching at Salerno and of the fine development of professional medicine there, would seem to argue that probably those who came to study medicine here were brought directly in contact with patients.
As early as the ninth century Salerno was famous for its great physicians. We know the names of at least two physicians, Joseph and Joshua, who practised there about the middle of the ninth century.
Ragenifrid, a Lombard by his name, was private physician to Prince Wyamar of Salerno in the year 900. The fact that he was from North Italy indicates that already foreigners were being attracted, but more than this that they were obtaining opportunities unhampered by any Chauvinism. From early in the tenth century physicians from Salerno were frequently brought to foreign courts to become the attending physicians to rulers. Patients of the highest distinction from all over Europe began to flock to Salerno, and we have the names of many of them. In the tenth century Bishop Adalberon, when ailing, went there, though he found no cure for his ills. Abbot Desiderius, however, the great Benedictine scholar of the time, who afterwards became Pope Victor III, regained his health at Salerno under the care of the great Constantine Africa.n.u.s, who was so much impressed by the gentle kindness and deep learning and the example of the saintly life of his patient that not long after he went to Monte Ca.s.sino to become a Benedictine under Desiderius, who was abbot there. Duke Guiscard sent his son Bohemund to Salerno for the cure of a wound received in battle, which had refused to heal under the ordinary surgical treatment of the time. William the Conqueror, early in the eleventh century and while still only the Duke of Normandy, is said to have pa.s.sed some time at Salerno for a similar reason.
The most interesting feature of the medical life at Salerno at this time is the relations between the clergy and the physicians. In the sketch of the life of Constantine Africa.n.u.s, which follows this chapter, there is some account of the friends.h.i.+p between Abbot Desiderius of Monte Ca.s.sino and Constantine Africa.n.u.s, and the latter's withdrawal from his professors.h.i.+p to become a Benedictine. One of the physicians of the early tenth century who stood high in favor with Prince Gisulf was raised to the Bishopric of Salerno. This was Alpha.n.u.s, whom we have already mentioned as a chronicler, a monk, a poet, a physician, and finally the Bishop of Salerno.