Chapter IX: Epilogue: 351 (3)

When the Latin translations from the Arabic reached the readers for whom they were intended, they were eagerly studied. The texts were, however, by no means permitted to remain in their pristine state, but were submitted to exactly the same process to which their Arabic authors had themselves subjected their Aristotelian and Galenic models. The Christian writers of the West treated the Latin translations of Rhazes, of Avicenna, of Isaac and of Albucasis (p. 67), as subjects for commentary. Their works were expanded, annotated, castigated again and again, and without any new inflow of ideas. The result is a progressive elaboration of form and deterioration of content throughout the centuries. Vast masses of argument, rebuttal, refutation and confirmation drowned again the human spirit which hardly recovered from its submersion until the sixteenth century.

§ 4. _The Universities._

Nevertheless, when these translations were new to Europe, and especially in the thirteenth century, they caused much stir. In this awakening a large part was played by the Universities. These were established in numbers during the thirteenth and the following centuries. University life gradually came to exercise a profound effect on social, political and intellectual conditions. In most of the Universities Medical Faculties grew up. The medical teaching was entirely theoretical and there was no clinical instruction, though at the beginning of the fourteenth century some advance was made by the introduction of brief and superficial anatomical demonstrations (p. 74).

As a type of Medieval University, we may take Bologna, which was an important center of learning from a very early date (Fig. 27). As the Universities multiplied, they began to some extent to ‘specialize’. Bologna had appeared first as a Law School and continued to develop along the same line. In the second half of the thirteenth century it was by far the most important seat of legal learning in Europe.

An organized Medical Faculty existed there as far back as 1156. The teaching at Bologna, as in other medical schools, consisted entirely of readings of Latin translations from Arabic which were becoming ever more accessible. Yet it was at Bologna that public dissection was first practised. The early advent of dissection has often impressed the historian. There was still no botany worthy of the name, no zoology, hardly any naturalistic art, no experimental science, no systematic record of observation in any department. Yet dissection had become recognized at Bologna by the end of the first quarter of the fourteenth century. The question is why men, so little interested in Nature and Nature’s ways, should have lent themselves to so repellent a process as dissection of the human body? The answer is that the earliest reason for examining the human body was simply the gathering of evidence for legal processes. As time went on, post-mortem examination passed into anatomical study. But still dissection did no more, and was asked to do no more, than verify Avicenna--whom nobody doubted. It was, in fact, little but an aid to the memory of students.

At Bologna we can trace the rise of a surgical school beginning about the end of the twelfth century. Prominent among its early surgeons was William of Saliceto (1215?-1280?). He wrote a very able treatise on Surgery, containing a section on Anatomy. The anatomical portion is borrowed from the current Arabian anatomies, but contains some evidence of direct access to the dead human body. He includes in his work a good description of trephining the skull (Fig. 23).

A most interesting contemporary of William of Saliceto was Thaddeus of Florence (1223-1303), who also taught at Bologna. This man perceived the importance of access to Greek sources, as distinct from Graeco-Arabic, and he encouraged the preparation of good Latin translations of medical works direct from the Greek. He stamped his personality on the whole development of Medicine at Bologna, and he is bound up with the beginning of dissection. But if Medicine owed a debt to Thaddeus for introducing better texts and better Anatomy, he did grave harm to the subject in another direction. The scholastic and argumentative form assumed by medieval Medicine is largely due to him, and it is to the assumption of this form that we owe the almost complete absence of scientific advance between the thirteenth and sixteenth centuries.

§ 5. _Medieval Anatomy, Surgery and Internal Medicine._

At the very end of the thirteenth century there came to Bologna a Norman student, Henri de Mondeville (about 1270-1320). In 1301 he settled at the famous Medical School at Montpellier in Southern France, and thus transplanted to France the medical, surgical and anatomical traditions of Bologna. Those traditions were of Arabic origin, and mainly borrowed from Avicenna.

Contemporary with de Mondeville was one whose method of teaching shines as a good deed in a naughty world. Mondino di Luzzi (_c._ 1270-1326) was a pupil of Thaddeus and a fellow-student of Henri de Mondeville. He worked systematically at Anatomy and dissected the human body in public. His treatise on Anatomy, written in 1316, is the first modern work on the subject. Those who preceded him incorporated their anatomical work in larger treatises on Surgery, and do not refer directly to their own anatomical experiences. With Mondino this is changed. His work is essentially a practical manual of the subject and he is with justice called the ‘Restorer of Anatomy’. He had read widely among the Arabian anatomists, and naturally borrowed from them. Nevertheless, his work contains a considerable number of references to actual anatomical procedure. Moreover, he deals not only with Anatomy in our modern sense, but also includes Physiology and much discussion of the application of anatomical and physiological principles to Medicine and Surgery. His book thus gives a good deal of insight into the scientific knowledge of the day.

The professor stands in his ‘chair’, a great pulpit or ‘cathedra’, reading from his book--hence the English academic titles ‘Reader’ and ‘Lecturer’ or ‘Lector’ (that is, ‘one who reads’). The body is dissected by a menial, whose work is guided by an assistant, who, with wand, points out (Latin _demonstrat_, hence our modern title _Demonstrator_) the lines of incision. Students in academic dress stand around, but do not themselves dissect. ]

We would emphasize the fact that Mondino dissected _in person_. In this respect he was wiser than his successors until the time of Vesalius. As dissection gained formal inclusion in the curriculum, the professor became more haughty, further removed from the object of his study. Leaving his position by the body, where he might demonstrate to his students, he ascended his high professorial chair, a great elevated structure provided with steps and a reading-desk. From there he read from his text-book while a junior colleague pointed out the line of incision and a menial performed the actual dissection (Fig. 28). All was thus done at third-hand and according to the written word. We are in the scholastic period, and must not expect any frequent appeal to Nature. Having once got into his chair, it took a good deal to persuade the professor to descend from that dignified position. Thus, it is saying much for Mondino that he was his own demonstrator. He took the first and perhaps the greatest step. It was two centuries and more before the next step was taken.

Most typical of medieval surgeons was Guy de Chauliac (1300-68), who studied at Montpellier, Paris, and Bologna, and practised at Montpellier and afterwards at Avignon, where he was a member of the Papal Court. He was a man of much learning, and his _Great Surgery_ became the standard treatise on the subject during the later Middle Ages. It fixed medieval practice. It is to be found in scores of manuscripts and was frequently translated and printed. Among the good points of his practice is his acceptance of responsibility for certain operations, such as those for rupture and for cataract, which at that time were usually left to wandering charlatans who regarded themselves as specialists. A famous passage in his work describes the use of a narcotic inhalation frequently used during the Middle Ages and into modern times. Of such a narcotic it is written that:

I’ll imitate the pities of old surgeons
To this lost limb, who, ere they show their art,
Cast one asleep, then cut the diseased part.

(Thomas Middleton, _Women beware women_. First acted 1622.)

The general character of Internal Medicine during the later Middle Ages was below that of Surgery. Modern clinical Medicine is firmly based on such sciences as Physiology, Pharmacology, Pathology, Biochemistry and Epidemiology. In the Middle Ages and far beyond, Physiology was still that of Galen, which had lost in exactness what it had gained in bulk from the Arabic and Latin commentators. Pathology was still that of the four humors. The knowledge of drugs was empirical, and the sciences of Pharmacology and Biochemistry as yet were not; while the medieval conception of the nature of epidemics was the very perversion of reason and common sense. Nevertheless, as we shall see, the Middle Ages ultimately succeeded in instituting a limited number of effective preventive measures.

§ 6. _Medieval Hospitals and Hygiene._

Undoubtedly an important development of medieval Medicine is its hospital system. The public hospital arose in pagan antiquity out of the Temples of Aesculapius and the military valetudinaria (p. 49). The conception was seized on by Christianity and developed beyond all knowledge. In the early Christian centuries, _hospitalia_, ‘guest chambers’ or ‘guest houses’, were set aside for the numerous _hospites_, or ‘pilgrims’. Similar buildings under the same title came to be instituted for the care of orphans, the aged, the blind, and other victims of fortune. Thus arose the medieval hospital system, of which ours is the direct outgrowth.

In matters of Hygiene the Middle Ages are a byword. The health conditions of a medieval town were far below those of the same town under the Roman Empire. Water-supply was deficient, drains were absent, streets and houses filthy and overcrowded, rooms unventilated. Nevertheless, there is one important hygienic conception for which our own age owes a considerable debt to that which preceded it. Despite their scientific acumen in many departments, it is yet true to say that among the physicians of classical antiquity we find no consistent view of the transmission of infection by contact. Indeed the whole idea of infection was effectively absent from them, so that preventive measures based upon it could not be developed. It was reserved for the Middle Ages to conceive serious official measures against the spread of epidemics. These measures were consciously derived from the leper ritual of the Bible with its fundamental concept of isolation.

FIG. 29. A HOSPITAL WARD in sixteenth century Paris. In the left aisle, a nun folds the hands of a dying patient, while a priest gives the Sacrament to another in the same bed. In front, nuns sew shrouds. The right aisle is more cheerful. Nuns minister to two patients in one bed, while a convalescent, fortunate in having a bed to himself, vigorously takes nourishment. In the centre nuns receive postulants and a royal founder kneels in prayer.

]

During the early centuries of the Christian era, Leprosy, which had till then been confined to the East, crept along the Mediterranean littoral and thence northward throughout Europe. The disease was from the first regarded as contagious, and various regulations were introduced to isolate and separate the unfortunate sufferers. The medieval treatment of lepers is one of the dark incidents of man’s inhumanity to man. The leper was banished from human society. He was declared legally dead. He was excluded even from church or allowed to attend only in special seats where a special basin of holy water was assigned to him. How rigorously this segregation from the ranks of free people was carried out by law is well known. The cruel edicts were, however, effective. In the course of centuries it freed Europe from Leprosy, of which it is said there were at one time some 20,000 cases in France alone. Thus about one person in 200 would have been a leper, and the burden of the leper on the community was comparable to that, let us say, of the feeble-minded and insane with us.

Leper inspection, the regular examination of all suspects and carriers of leprosy, became a most elaborate business. It was entrusted to a special branch of the civil service and was gradually freed from ecclesiastical control.

This preventive method of combating a chronic disease, which, as we know now, has a very low infectivity, had a peculiar and unlooked-for result. The meticulous system of warding off the contagion of leprosy so occupied the attention of physicians that they came to see allied conditions in the same light. So it was that in the thirteenth century the general concept became current of disease as contagious. A number of other diseases besides leprosy were recognized as infectious. Among these were Plague, fevers with obvious rashes, Phthisis, Granular Conjunctivitis, the Itch and Erysipelas. Municipal authorities were from time to time ordered to put patients suffering from one or other such diseases outside the city gates. They were forbidden to traffic in articles of food and drink and were placed under restrictions not unlike those of lepers. The devastating epidemic of the Black Death of 1347-8 brought restrictions of this order into special force. Thus the Black Death had somewhat the same effect on the health administration of the day that the Cholera outbreaks of the thirties of the nineteenth century had upon modern Europe. The health service began to be put into more efficient order.

In the later Middle Ages there were actually instances in which the Pest was averted or successfully combated by these means. This seems to have been the case of Milan and Venice between the years 1370 and 1374. At that time the Plague was again advancing through Europe. The most drastic regulations were invoked to prevent infected persons from entering the cities, and these regulations came into force well in advance of the disease.

There is one incident in this medieval attempt to prevent Plague that has left a mark on our language. The Republic of Ragusa, on the eastern side of the Adriatic, adopted and extended the regulations that had been so successful at Venice. A landing-station was established far from the city and the harbor. There incoming suspects had to spend thirty days in the open air and sunlight, and any who had traffic with them were isolated. The period of thirty days was spoken of as the _Trentina_. Later this was found to be not long enough. The thirty days became forty days, the _Quarantina_, whence we have the word _Quarantine_. The system of quarantine gradually spread through Europe. It was accompanied by very drastic destruction, by burning, of all goods belonging to the infected.

These attempts to arrest epidemic disease were sometimes successful and the elaboration of quarantine measures was among the few advances with which we may credit the Middle Ages. The fact that we can now dispense with quarantine must not blind us to its value in conditions other than our own.

IV

THE REBIRTH OF SCIENCE

(FROM ABOUT 1500 TO ABOUT 1700)

§ 1. _The Anatomical Awakening._

During the Middle Ages beliefs about physiology were always based on Galen. They were frequently confused and often the result of a misunderstanding of his work. In the fifteenth century, however, took place the so-called _Renaissance_ or _Revival of Learning_. Greek works which had been trickling in since the thirteenth century began to be recovered more rapidly, and to be more accurately studied. The first step towards any improvement on the views of Galen was naturally a proper understanding of what he had really said. For that there was needed a better knowledge of Greek than had been possessed by the Middle Ages. In the fifteenth century Greek scholarship made great advances and there was enthusiasm for classical learning. Accurate translations of the Greek works of Galen were made. The printing press was invented about the middle of the fifteenth century. Towards its end printed copies of the improved translations began to appear. So it came about that the Revival of Learning produced a revival of the ancient scientific knowledge.

This scientific revival led to a new interest in Anatomy. During the Middle Ages the occasional dissections at the Universities were merely supposed to illustrate Avicenna and Galen (Fig. 28 and p. 72). Dissection became much more widely practised in the fifteenth century, but it was nearly the middle of the sixteenth century before any real and open discussion of Galen’s views took place in the Universities.

There were, moreover, other influences at work. Along with the revival of learning there was also a renaissance of art. Some of the great Renaissance artists--Michelangelo, Raphael and Dürer among them--began to study the human form very closely. They soon found that to represent it accurately some knowledge of Anatomy, and especially of the bones and muscles, was needed. The artists, therefore, began also to dissect. Among these great artists were some who took more than a purely artistic interest in the structure and workings of the body. Of these the most important for us was Leonardo da Vinci (1452-1518). He was a man of enormously powerful and inquiring mind, and his achievements in science are at least as remarkable as his works of art. He had determined to write a text-book of anatomy and physiology. Though he did not publish it, many of his beautifully illustrated note-books on these subjects have survived.

Leonardo was the first to question the views of Galen. He made careful first-hand investigations on the bodies of men and animals, and performed many physiological experiments. Though a man of the most lofty genius, centuries ahead of his time, yet his outlook is, in many respects, typical of his age. His interest in anatomical investigation is therefore not surprising, for such inquiries were then astir. It happened that he was particularly interested in the heart and blood-vessels. He reached the correct conclusion that, contrary to Galen, the branches of the air-tubes in the lungs do not come into relation with the heart, but, after branching and gradually diminishing in size, they finally end _blindly_. He inflated the lungs with air and found that, whatever the force used, air could not be driven from the air-tubes into the heart. He therefore inferred quite correctly that Galen’s _arteria venalis_ (our ‘pulmonary vein’) did not convey air to the heart, as the followers of Galen believed.

Leonardo then turned to examine the structure and form of the heart itself. He prepared more accurate drawings of it than had been made by any before him, making sections and dissections and examining its valves (Fig. 30). Ultimately he succeeded in grasping the nature and action of the valves at the root of the great arteries as they arise from the heart, and he verified his view by remarkable experiments. He proved that the valves allowed the blood to pass in only one direction, and prevented its regurgitation. Yet Leonardo gives no complete or clear description of the action of the heart. He could not emancipate himself from the old idea of the passage of the blood from the right ventricle through the septum into the left ventricle (Fig. 21), though he sometimes seems doubtful about it.

FIG. 30. DRAWING OF DISSECTION OF THE HEART by Leonardo da Vinci. The modern names of some of the more important parts have been added.

]

It must be remembered that Leonardo did not publish his researches. It is only recently that his note-books have become fully accessible. But although Leonardo’s work remained in manuscript, it must not be assumed that his views were wholly without effect on his contemporaries. At any rate, soon after his time the questions that he had raised concerning the heart and blood-vessels were attracting others and were generally regarded as forming an important problem needing solution.

The task of writing an anatomical text-book based on direct observation, to which Leonardo did but put his hand, was achieved by one who was only four years old at the time when the great artist died. The central place in the unfolding drama is occupied by Andreas Vesalius of Brussels (1514-64). This extraordinary man studied first at the University of Louvain and afterwards at Paris. Anatomical instruction at these Universities had not improved much, if at all, on that of the Middle Ages. Vesalius soon tired of hearing long passages of Galen read out by the professor. He therefore resolved to go to northern Italy, where newer methods were being practised. Padua was the place of his choice. He immediately made his mark there, and was himself appointed professor when only twenty-four years of age. He established a scientific tradition at Padua which that University has retained to this day.

No sooner was Vesalius settled at Padua than he applied himself with unparalleled diligence to lecturing and research. Students crowded to hear him (Fig. 31). To aid them he issued, in 1538, a short guide to anatomy and physiology. An examination of this shows that his physiological views were still those of Galen and Aristotle. After its issue Vesalius found that Galen and Aristotle were by no means always to be trusted. The realization of this led him constantly to doubt any statement by them. His scepticism was sometimes excessive, but it led him to put every statement made by his predecessors to the test of experience. This gives his later work an epoch-making value.

It shows a dissection scene at Padua. In the center stands Vesalius dissecting a female body. At the head of the table stands an articulated skeleton. At its foot are dissecting instruments. Eager students throng around. In the foreground attendants are squabbling. On one side an attendant holds a monkey, one on the other a dog, for Vesalius had often to resort to animal in lieu of human anatomy. Shut off by a bar are members of the lay public. Gallants, grey-bearded scholars, monks, and an enthusiastic bookworm may be discerned among them. Other observers crowd in from every vantage point, even from the windows in the roof. The naked man to the left has been used by Vesalius to demonstrate the surface markings of the underlying organs. The whole scene is busy and vigorous in the extreme. It should be contrasted with the academic calm of Fig. 28 drawn fifty years earlier. ]

During the next four years Vesalius had ampler opportunities to dissect than he had yet encountered. He devoted a fiery energy to the preparation of his great work. _The Fabric_ (that is ‘workings’, compare German ‘Fabrik’) _of the Human Body_ was printed in 1543, a magnificent and beautifully illustrated volume. It is a landmark in the History of Science, and a wonderfully full record of a prodigious number of accurately recorded discoveries and investigations made by a single observer.

The masterpiece of Vesalius is not only the foundation of modern Medicine as a science, but the first great positive achievement of Science itself in modern times. As such it ranks with another work that appeared in the same year, the treatise of Nicholas Copernicus, _On the Revolutions of the Celestial Spheres_. The work of Copernicus removed the Earth from the center of the Universe; that of Vesalius revealed the real structure of man’s body. Between the two they destroyed for ever the medieval theories on the subjects of which they treat. But the work of Copernicus is one of close and subtle reasoning, still retaining many medieval elements, and is hardly a great exposition of what we now call the ‘Experimental Method’. The work of Vesalius far more nearly resembles a modern scientific monograph than does the treatise of Copernicus.

The achievement of Vesalius was very well received by the scientific world. Nevertheless, soon after its publication, Vesalius resigned his professorship to take up the position of a court physician to the Emperor Charles V, the great monarch of the age. He was then only twenty-nine years old, but his scientific career was closed.

The edition of the _Fabric_ was soon exhausted, and the demand for more copies was met by imitations of the work by other hands. At last, in 1555, Vesalius was induced to issue a second edition. This contains certain changes in point of view that are important for the subsequent development of physiology. Vesalius now no longer merely hints his doubts as to the character of Galen’s physiology; he openly asserts that he is unable to verify its fundamental bases.

We may take a single instance of this new outspokenness. In his description of the septum of the heart, he had written in the first edition:

‘The septum of the ventricles of the heart is very dense. It
abounds with pits on both sides. Of these pits none, so far
as the senses can perceive, penetrate from the right to the
left ventricle. We are thus forced to wonder at the art of the
Creator, by which the blood passes from right to left ventricle
through pores which elude the sight.’ (Compare Fig. 21, p. 59.)

This passage is altered to something quite different in the second edition, where he writes:

‘Although sometimes these pits are conspicuous, yet none, so
far as the senses can perceive, passes from the right to the
left ventricle. I have not come across even the most hidden
channels by which the septum of the ventricles is pierced. Yet
such channels are described by teachers of Anatomy, who have
absolutely decided that the blood is taken from the right to
the left ventricle. I, however, am in great doubt as to the
action of the heart in this part.’

He further sets forth his whole policy with reference to Galen’s view in the following interesting passage:

‘In considering the structure of the heart and the use of its
parts, I bring my words for the most part into agreement with
the teachings of Galen; not because I think these on every
point in harmony with the truth, but because, in referring at
times to new uses and purposes for the parts, I still distrust
myself. Not long ago I would not have dared to diverge a hair’s
breadth from Galen’s opinion. But the septum is as thick, dense
and compact as the rest of the heart. I do not, therefore, see
how even the smallest particle can be transferred from the
right to the left ventricle through it. When these and other
facts are considered, many doubtful matters arise concerning
the blood-vessels.’

The work terminates with a little chapter _On the dissection of living animals_. We note that this, while dealing skilfully with the methods of physiological experiment, does not exhibit any very marked advance on the views of Galen.

Among the experiments on living animals that Vesalius enumerates are excision of the spleen, the loss of which he showed was consistent with life; and the cutting of the nerves that supply the organ of voice, with resultant loss of that faculty. He demonstrated that longitudinal section of a muscle interferes little with its function, but cross section produces disability in proportion to the injury. Such experiments had been performed by Galen, who had also reached the same conclusion as Vesalius, that it is through the spinal cord that the brain acts on the various muscles of the limbs and trunk. Vesalius repeated Galen’s experiments on section of the spinal cord (p. 58). The most striking of his experiments were those on respiration. Here he showed that, even though the chest-wall be pierced, the animal may be kept alive if the lungs are continuously aerated by means of a bellows, and that a flagging heart may be revived by similar means.

The work of Vesalius at once placed the knowledge of the human body in a new position. It cannot be said that he completed the task of describing the naked-eye structure of the human body. Yet he went so far towards this that no dramatic improvement has since been made upon his methods. It is a fair statement that the whole of modern Descriptive Anatomy may be treated as a comment and correction and amplification of Vesalius. His work moreover stimulated a host of investigators.

It is beautifully and dramatically posed, and the drawing is remarkably accurate. The figure leans against a tomb, contemplating a skull. In the front left-hand corner of the top of the tomb is a part of the bony structure which supports the organ of voice (H).

The inscription on the tomb may be translated ‘Man’s spirit lives. The rest is Death’s portion’.

The inscription at the top may be translated: ‘A delineation from the side of the bones of the human body, freed from the other structures which they support and placed in their correct positions.’ ]

§ 2. _The Anatomical Reaction on Surgery._

The immediate effect of the new knowledge of Anatomy was an improvement in Surgery. The Wars of Religion of the sixteenth and seventeenth centuries were fierce and prolonged, and the army surgeons of the time had much experience of the treatment of wounds. The most prominent of the military practitioners was the Frenchman, Ambroise Paré (1517-90). He perceived the importance of anatomical knowledge and adapted his discoveries to the needs of Surgery. Paré did much to elevate the surgeon’s profession from a despised handicraft to a position equal to that of other branches of the healing art.

Apart from the introduction of anatomical discipline into Surgery, Paré’s four contributions to the surgical art were, firstly, his discovery that gunshot wounds are not ‘poisonous’ as had theretofore been thought, and that therefore they do not require the application of boiling oil, but are best healed by soothing applications; secondly, the cognate doctrine that bleeding after amputations should be arrested, not by the terrible method of indiscriminate use of the red-hot cautery, but by simple ligature; thirdly, his advocacy of the method of turning the child in its mother’s womb before delivery in certain abnormal cases; and fourthly, his ingenious devising of artificial limbs (Fig. 33). None of these four was without precedent. Nevertheless, the eminence, skill, and wide experience of Paré were the main factor in the spread of these practices. But the greatest of all Paré’s contributions to surgery was the service of his own personality, the example of his steadfast efforts to increase his knowledge of human anatomy and his skill in the art, and his constant emphasis on the surgeon’s duty to exert his utmost efforts to avoid or relieve the patient’s suffering.

FIG. 33. ARTIFICIAL ARMS AND HANDS, designed and figured by Ambroise Paré, and used by him for wounded soldiers from about 1560 onwards.

]

In a famous passage Paré describes how he, a ‘freshwater soldier’, on his first campaign, watched the other surgeons following the old rule of treating all gunshot wounds with boiling oil. At first he formed his practice on theirs. The theory was that gunshot wounds contained a poison, which the boiling oil was believed to drive out. Paré tells of his agitation when one evening, his supplies having run out, men had to be treated without the boiling oil. Next morning he was astonished to find that every man whose wounds had been treated only with a salve had rested fairly comfortably, while all who had undergone the customary treatment were, as we may well believe, in great pain. ‘Then I resolved within myself never so cruelly to burn poor wounded men.’ Another saying of the shrewd old surgeon is the famous adage ‘I dressed him and God cured him.’

Paré’s works were frequently reprinted and translated into various European languages, including English. They exercised the widest influence on surgical craft in the sixteenth and seventeenth centuries. Like Vesalius, he is an example and type of a large class. In every country surgeons arose who made an effort to utilize the new anatomical knowledge.

§ 3. _The Renaissance of Internal Medicine._

Internal Medicine lagged behind Surgery at this period. The anatomical reforms of Vesalius were unaccompanied by any commensurate advance in physiological knowledge, and without a scientific Physiology there can be no science of Internal Medicine. The practice of the physicians thus remained in effect that of the Middle Ages. The ruling idea was still that of the ‘four humors’ corresponding to the four ‘temperaments’ (Fig. 13, p. 34, and compare Fig. 34, p. 97).

There are, however, three respects in which we see an improvement of the physician’s art during the sixteenth and first half of the seventeenth century.

Firstly, there was some improvement in the medical texts that were habitually read. More reliable translations were now available. Notably the great Hippocratic works became more widely disseminated. They formed a substitute for the old texts translated or mistranslated from the Arabic.

Secondly, the extension of geographical knowledge and the formation of settlements and colonies brought new drugs upon the market. These were often a mixed blessing, for some of the drugs were useless and others dangerous. Nevertheless, to this process Medicine owes several important contributions, among them Ipecacuanha, Cinchona (p. 326), and, by no means least, Tobacco (Fig. 35). Apart from the amenities introduced by Tobacco, it was for long of great value as a narcotic drug. Moreover, there was a corresponding advance in Botany. The movement was cursed with the ‘practical’ spirit, and only those plants thought to have an application as drugs were exactly figured and described. Nevertheless, the beautifully illustrated herbals of the sixteenth and seventeenth centuries exercised, by the care and accuracy of their execution, an exemplary influence on the development of Biological Science in general and of Medical Science in particular.

Thirdly, there was some advance in the knowledge of the natural history of infectious disease. A rational theory of the nature of infection was placed before the public as early as 1546 by the Veronese physician, Girolamo Fracastoro (1483-1553). He regarded infection as due to the passage of minute bodies from the infector to the infected. These hypothetical minute bodies had the power of self-multiplication. The conception bore a superficial resemblance to the modern germ theory of disease. An important contribution to the conception of epidemics was also made by the French physician Guillaume de Baillou (1538-1616), who reintroduced the old Hippocratic idea of ‘Epidemic Constitution’, i.e. that particular seasons and particular years are of their nature subject to particular diseases. The idea was extended and developed by the English physician Thomas Sydenham (1624-89), and it still has its value.

FIG. 34. FIGURE ILLUSTRATING THE ‘FOUR TEMPERAMENTS’, from the Guild Book of the Barber-Surgeons of York, now in the British Museum. The figure was prepared about 1500. Above, to the left, is the _Melancholy_ man, and to the right the _Sanguine_. Below to the left is the _Choleric_ man, and to the right the _Phlegmatic_. On the scroll work is written in English ‘Ther ar the iiij umors, thath ar oderwysse calde the iiij complecconis thath ar resceuid un to the iiij elementis, Hafyng the kynd of humors’, which may be rendered ‘There are the 4 humors, that are otherwise called the 4 complexions, that are received unto the 4 elements, having the nature of humors’. For the theory compare Fig. 13, p. 34.

]

In connection with their epidemiological work these three men, Fracastoro, de Baillou, and Sydenham, made significant additions to the knowledge of particular infectious conditions. Thus, during the sixteenth and seventeenth centuries there arose an exact body of teaching concerning acute infectious diseases which was the necessary prelude to the introduction of more effective preventive measures at a later date. To one infectious disease we may refer more particularly.

During the Middle Ages there had smouldered in various districts an obscure disease, sometimes more or less dimly distinguished under various specific names, but most frequently confused with Leprosy. Towards the end of the fifteenth century this disease, which was still imperfectly distinguished in men’s minds from Leprosy, broke out in epidemic and virulent form all over Europe. It caused great destruction of life and developed everywhere as a problem of national importance. Various titles were given it, such as ‘pox,’ ‘the French disease’, ‘the Spanish disorder’. Only tardily was it recognized that the disease was usually of venereal origin. Not till 1530, on the suggestion of Fracastoro, did it receive its modern cognomen _Syphilis_. From the time of its recognition, Syphilis has been pursued by a portentous mass of literature, the mere sifting and verification of which is a formidable task. Alarm, misunderstanding, religious feeling, false modesty, wilful misrepresentation, and change in type of the disease itself have all contributed their quota of obscurantism and fable to a naturally difficult subject (Figs. 35 and 36). Fracastoro did something to bring order out of the confusion. To him also we owe the first good scientific descriptions of several other destructive diseases, among which Typhus fever, now known to be conveyed by lice (p. 258), takes a prominent place.

FIG. 35. THE EARLIEST PICTURE showing the use of Tobacco. From a work on Brazil, printed in Paris in 1558. In the center of a native hut stands an Indian suffering from Syphilis. Behind him, on the left, a man smokes a huge cigar over him as a curative measure. Right and left his arms are held by two figures who seek to suck the poison out of him. Another offers him a curative plant. Behind him is a ‘hammock’--the word is of American-Indian origin and means ‘tobacco-bed’. Above his head are a monkey, a parrot, and a bale of tobacco.

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De Baillou (1538-1616) first described Whooping Cough, and was the first to use the word _Rheumatism_ in the modern sense. He was moreover the first, since Hippocrates, to distinguish between Rheumatism and Gout. De Baillou’s works deeply influenced Sydenham, who held very similar epidemiological views, and uses a somewhat similar vocabulary (p. 100).

We have seen how the knowledge of Anatomy forwarded Surgery, while, with the lag in Physiology, Internal Medicine remained in a backward state. It is well to recall however that a knowledge of Anatomy and Physiology will not, of themselves, make a man a scientific physician. The object which presents itself to a physician is neither a living anatomy nor a physiological model. It is a sick and suffering patient. The physician’s first task is to examine exactly the phenomena of sickness and suffering, and in doing this the first demand on his knowledge will be the history and fate of others who have endured like sickness and suffering. When he has ranged these instances in his mind he may turn, for explanation and relief, to the resources suggested by other sciences, Anatomy and Physiology among them. But all the Anatomy and Physiology in the world will not aid the practitioner who is unacquainted with the natural history of disease. This is the truth that was firmly seized by Thomas Sydenham.

The Natural History of Disease was a subject which Sydenham pursued with lifelong devotion. Before his time the phenomena of disease had been classified, subdivided, discussed, and treated with all the subtlety and skill of scholastic thought. Men had now and again shaken themselves free from the shackles of the medieval system, and had here and there corrected the views of Galen or amplified the limited achievements of their predecessors. Yet none before Sydenham had set himself to consider all the actual cases of disease that lay before him as a subject of scientific description and analysis. That was the great achievement of the ‘English Hippocrates’. We should not find it easy to point to any important discovery to associate with his name. But he did more than discover. He initiated a new mode of approach. He was the founder of modern Clinical Medicine.

In 1666 Thomas Sydenham published his classic work, _The Method of Treating Fevers_, dedicated to his friend Robert Boyle, ‘the Father of Chemistry’ (pp. 124-6). The book opens with the almost Hippocratic phrase ‘A disease, in my opinion, how prejudicial soever its cause may be to the body, is no more than a vigorous effort of Nature to throw off the morbific matter, and thus recover the patient’. We have here the _healing power of Nature_ of Hippocrates (p. 21), which had been obscured and overlaid in the twenty centuries which lay between the two great physicians. The works of Sydenham may reasonably be regarded as the first great commentary on the Hippocratic theme. Sydenham set well on its way the conception of infectious conditions as specific entities, a conception which has since been illuminated by the germ theory of disease (p. 224 ff.).

From a work printed in Germany in 1496. The Virgin sits enthroned on clouds, crowning a crusader, who kneels at her right hand. The Holy Child on her knee sends forth the plague of Syphilis as a scourge on mankind. Two women, spotted with the rash of the disease, kneel in supplication before her on her left. In the foreground of the picture lies a corpse dead of the disease, the speckled ravages of which may be seen upon it.

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§ 4. _The First Physical Synthesis._

Manifestations of the Human Spirit are not accustomed to confine themselves exactly within the convenient limits of the centuries. Nevertheless, it happens that in the History of Science the year 1600 does, in fact, correspond to something of the character of a real change in the current attitude to Nature. That year really ushers in the era of physical experiment. The last of the great transitional thinkers who mark the waning of Renaissance philosophy was Giordano Bruno, the martyr of science.

Giordano Bruno (1548-1600), who was no practical scientist, had eagerly incorporated into his often fantastic philosophy the ill-worked-out conclusions of Copernicus (p. 88). Nominally adopting the Copernican theory, he modified it fundamentally. Copernicus, having placed the Sun at the center of the World, and made the Earth and other planets circle round it, had still left the stars at a fixed and definite distance, as had the ancient astronomers. The limitation of the sphere of the fixed stars was obnoxious to Giordano, and he removed the boundaries of the Universe to an infinite distance, in accordance with the principles of his philosophy. The change may seem unimportant save for astronomy, but, in fact, it came to influence every department of scientific thought, for the endlessness of Nature is implicit in the modern scientific attitude.

Giordano was burned at the stake at Rome, after seven years’ imprisonment, in 1600. In the same year the experimental era was ushered in with the work of William Gilbert (1544-1603), _On the Magnet_, in which he not only demonstrates experimentally the properties of magnets but also shows that the Earth itself is a magnet. In the same year, too, Tycho Brahe (1546-1601) handed over the torch to Johannes Kepler. Tycho was the last of the older astronomers who worked on the Aristotelian view of circular and uniform movements of heavenly bodies. Kepler was the real founder of the modern astronomical system. The period from 1600 onward lies with new men, Galileo (1564-1642) and Kepler (1571-1630) among astronomers and physicists, Harvey (1578-1657) among biologists, Descartes (1596-1650) among philosophers.

The seventeenth century opened with an extraordinary wealth of scientific discovery. As we glance at the mass of fundamental work produced during that period, we perceive the major departments of Science, as we know them to-day, becoming clearly differentiated. The acceptance of Observation and Experiment as the only method of eliciting the Laws of Nature reaches an ever-widening circle. Even to enumerate the names of the seventeenth-century pioneers would be a formidable task. The sciences penetrated to the Universities and influenced the curricula. The number of scientific men became so large and so influential that separate organizations were formed by them in the interests of their studies. It is the age of the foundation of the ‘Academies’, of which the English Royal Society is a type.

From the multitude of workers on these subjects we can but select a few names. In the first half of the century Galileo and Kepler are the main exponents of natural law. Descartes takes his place here as the first since antiquity who sought to explain the phenomenal universe on a unitary basis. In the second half of the period comes the mighty figure of Newton, whose researches ushered in that phase in our story in which we live to-day.

The early training of Galileo Galilei had been scholastic and Aristotelian. By 1590, however, he had begun to doubt, and was making experiments on the rate of acceleration of falling bodies. His conclusions were demonstrated in 1591 from the leaning tower of Pisa. By that famous experiment he showed, in the most public manner, the error of the Aristotelian view that the rate of fall was a function not of the weight of the object but of the period of fall. Revolutionary also was Galileo’s work of 1604. In that year a new star appeared in the constellation _Serpentarius_. He demonstrated that this star was situated beyond the planets and among the remote heavenly bodies. Now this remote region was regarded in the Aristotelian scheme as absolutely changeless. Although new stars had been previously noticed, they had been considered to belong to the lower and less perfect regions nearer to earth. To the same lower region, according to the then current theory, belonged such temporary and rapidly changing bodies as meteors and comets. But Galileo had attacked the incorruptible and unchangeable heavens.

In 1609 Galileo made accessible two instruments that were to have a deep influence on the subsequent development of Science, the Telescope and Microscope. It is with the former instrument that his name is most frequently associated. His first discoveries made by means of the Telescope were issued in 1610. That year was crowded with important observations especially on the inner planets and notably on Venus. It had been rightly claimed in criticizing the Copernican hypothesis that, if the planets resemble the Earth in revolving round the Sun, only such parts of them should be luminous as are exposed to the Sun’s rays. In other words, they should exhibit phases like the Moon. Such phases in Venus were now actually observed by Galileo. In the following year he described sunspots and traced them round the Sun’s disk.

We need not follow the further astronomical observations of Galileo, nor need we discuss the contest with the older school on which he embarked. It is sufficient to remind ourselves that the appearance of a new star, the behavior of the rings of Saturn, the observations of the phases of Venus and of the Sun’s spots, struck a blow at the Aristotelian astronomy comparable to that delivered against the Aristotelian physics by the falling weights from the leaning tower of Pisa. Aristotelian astronomy demanded heavens eternally changeless. Here were changes and new appearances in the heavens, clearly visible to all who would see.

During these years too, Galileo was laying firm the foundations of the science of Mechanics. Out of his mechanical researches came a new way of looking at the objects of Nature which has profoundly influenced the entire subsequent course of science. That way is best expressed in Galileo’s own words, which place him among the philosophers whose thought influences all those who deal with scientific themes.

‘As soon as I form a conception of a material or corporeal
substance, I simultaneously feel the necessity of conceiving
that it has boundaries and is of some shape or other; that
relatively to others it is great or small; that it is in this
or that place, in this or that time; that it is in motion or
at rest; that it touches, or does not touch, another body;
that it is unique, rare, or common; nor can I, by any act of
imagination, disjoin it from these qualities. But I do not find
myself absolutely compelled to apprehend it as necessarily
accompanied by such conditions as that it must be white or
red, bitter or sweet, sonorous or silent, smelling sweetly
or disagreeably; and if the senses had not pointed out these
qualities language and imagination alone could never have
arrived at them. Therefore I think that these tastes, smells,
colors, &c., with regard to the object in which they appear to
reside, are nothing more than mere names. They exist only in
the sensitive body, for when the living creature is removed
all these qualities are carried off and annihilated, although
we have imposed particular names upon them, and would fain
persuade ourselves that they truly and in fact exist. I do
not believe that there exists anything in external bodies for
exciting tastes, smells and sounds, &c., except size, shape,
quantity, and motion. If ears, tongues, and noses were removed,
I am of opinion that shape, quantity, and motion would remain,
but there would be an end of smells, tastes, and sounds, which
abstractedly from the living creature I take to be mere words.’

This passage is a veritable Charter of Science. From Galileo’s day to ours, men of science have occupied

themselves in measuring size, shape, quantity, and motion, the ‘primary qualities’, and expressing their knowledge in that measured form. They have relegated colors, smells, tastes, sounds, and other sense-impressions to the position of ‘secondary qualities’, and have tried to express them, when they express them at all, in terms of the primary qualities. We need not enter on the philosophical discussion as to how far the primary qualities are in truth more real than the secondary, but it is a fact that, since the time of Galileo, Science has come to be regarded more and more widely as an exact process. _Science is Measurement._ It is a conception that has affected the medical no less than the other sciences, and it is a conception that Medicine, for good or ill, owes to Galileo.

FIG. 37. SANCTORIUS IN HIS BALANCE. Sanctorius was able to eat and even to sleep in his balance, counterpoised by a weight working on the principle of the steelyard. He was thus able to test his weight under various conditions, and notably to estimate the amount of the ‘insensible’ perspiration. His were the first experiments on ‘Metabolism’ (see p. 108).

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§ 5. _The Revival of Physiology._

The first to apply Galilean principles of measurement to biological matters was Sanctorius (1561-1636), a professor at Padua. He described a thermometer for use in taking the temperature of the human body (Figs. 39 and 40), and an apparatus for comparing the rate of pulse beats (Fig. 41). Both these he modified from devices suggested by Galileo (Fig. 38). It is an indication of the transitional character of the Science of the time that he describes these instruments in a commentary on a medieval translation of the _Canon_ of Avicenna (p. 67). He also sought to compare the weight of the body at different times and in different circumstances. In the process of doing this, he demonstrated that the body loses weight by mere exposure, a process which he ascribed to ‘insensible perspiration’ (Fig. 37). By these experiments he laid the foundation of the modern study of ‘Metabolism’ (p. 220).

FIG. 38. The principle of Galileo’s thermometer. A tube ending in a bulb A is inverted over a mercury bath B. If the temperature fall the air in A will contract and mercury be drawn up into the tube. If the temperature rise the air in A will expand and mercury be driven out of the tube. The height of the mercury can be read on the scale SS. The reading will not be accurate because the instrument is, in fact, also a barometer, since the mercury in B is exposed to the atmospheric pressure, which will therefore affect the rise in the tube.

FIG. 39. The application of the same system by Sanctorius who used a curved tube.

FIG. 40 is not, as might be thought, a man trying to swallow a centipede, but the adaptation of the instrument of Sanctorius as a clinical thermometer.

FIG. 41. Galileo’s simple and effective ‘pulsimeter’. It consists only of a weight suspended on a thread. This thread is held in the hand and the weight made to oscillate as a pendulum. As the thread is shortened the oscillations increase in frequency. The process is continued until the pendulum oscillates to time with the pulse. The length of the free thread is then read off on the accompanying scale. It was used by Sanctorius.

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While Sanctorius was engaged in this pioneer work at Padua, the movement that Vesalius had inaugurated there was making further conquests in the purely biological line. Vesalius had been succeeded at Padua by a series of anatomists of great eminence. Perhaps the most prominent among these was Jerome Fabricius (1537-1619), usually called ‘of Aquapendente’, after the small Tuscan village where he was born. This Fabricius of Aquapendente taught at Padua for over fifty years, from 1565 till his death at eighty-two in 1619. He made many contributions to the advancement of anatomy, most of which had physiological bearings. Thus, he was the effective founder of modern embryology and the author of the first illustrated work on that subject, in which he describes the formation of the chick in the egg. He was the first to give accurate figures of the structure of the eye. He developed the mechanics of muscular motion. He added to his qualities as an observer the power of attracting younger men.