Chapter XI: New Englandism 433 (4)

Indeed the mathematics of the mediaeval universities is the best proof of the seriousness of their devotion to science and, may it also be said, of their success. Cantor, in his "History of Mathematics," and he is the great authority in the matter, devotes nearly 100 pages of his second volume to the mathematicians of the thirteenth century alone, two of whom, Leonard of Pisa and Jordanus Nemorarius, did so much in arithmetic, in the theory of numbers, and in geometry, {115} as to work a revolution in mathematics. They had great disciples like John of Holywood (probably a town near Dublin), Johannes Campanus and others. No wonder that at the end of the century Roger Bacon said, "For without mathematics nothing worth knowing in philosophy can be obtained," and again, "for he who knows not mathematics cannot know any other science; what is more, he cannot discover his own ignorance or find its proper remedy." The fourteenth and fifteenth centuries saw even more important work done. Cantor has half a dozen men in the fifteenth century to whom he devotes more than twenty-five pages each. How the place of this in mediaeval teaching can have escaped the notice of those who insist so much on the neglect of science during the Middle Ages, is hard to understand. This alone would convict them of ignorance of what they are talking about.

The educational genius of the great university century, the thirteenth, the man who influenced his contemporaries and succeeding generations more than any other, was Thomas Aquinas, to whom the Church, for his knowledge and goodness, gave the title of saint. If any further proof that these centuries were interested in science were needed, or that the universities in which he was the leading light as scholar and professor in the thirteenth century, and as the great master to whom all looked reverentially after, were developing scientific studies, it would be found in {116} his works. Philosophy is developed scientifically in his "Contra Gentes" and theology, scientifically in his great "Summa." It is the very austerity of the scientific qualities of these books that have made them forbidding for many modern readers, who, therefore, have failed to understand the scientific spirit of the time. St. Thomas Aquinas, however, was, as I suggested at the beginning of this, deeply interested in every form of information with regard to what we now call physical science. He evidently drank in with avidity all that had been observed with regard to living creatures and, when we come to analyze his works with care and read his books with the devotion of his own students, we find many anticipations of what is most modern in our science.

The indestructibility of matter, matter and form, that is the doctrine of the unity of the basis of matter, the conservation of energy in the sense that the forms of matter change but do not disappear, all these were commonplaces in his thought and teaching. I have recently had occasion to point out how close he came to that thought in modern biology which is probably considered to be one of our most modern contributions to the theory of evolution. It is expressed by the formula of Herbert Spencer, "Ontogeny recapitulates phylogeny." According to this the completed human being repeats in the course of its development the history of the race, that is to say, the varying phases of foetal development {117} in the human embryo, from the single cell in which it originates up to the perfect being as it is born into the world, retrace the history by which from the single-cell being man has gradually developed. The whole theory of evolution is supposed by many people to be modern, but of course it is not. This particular phase of it, however, is thought surely to be modern. It is sometimes spoken of as the fundamental law of biogeny. In recent years serious doubts have been thrown on it, but with that we have nothing to do here.

It is very curious to find, however, that St. Thomas, in his teaching with regard to the origin and development of the human being, says, almost exactly, what the most ardent supporters of this so-called fundamental biogenetic law proclaimed in recent years. He says that "the higher a form is in the scale of being and the farther it is removed from mere material form, the more intermediate forms must be passed through before the finally perfect form is reached. Therefore, in the generation of animal and man--these having the most perfect forms--there occur many intermediate forms in generations and consequently destruction, because the generation of one being is the destruction of another." St. Thomas does not hesitate to draw his conclusions from this doctrine without hesitation. He proclaims that the human material is first animated by a vegetative soul or principle of life, and then by an animal soul and only ultimately, when the matter has {118} been properly prepared for it, by a rational soul. He said:

"The vegetative soul, therefore, which is first in the embryo, while
it lives the life of a plant, is destroyed, and there succeeds a
more perfect soul, which is at once nutrient and sentient, and for
that time the embryo lives the life of an animal: upon the
destruction of this there succeeds the rational soul, infused from
without."

His discussion of the position of the Church and of faith to science is extremely interesting, because here once more he faces a modern problem. Aquinas was very sensitive with regard to the imposition upon Christians of things which supposedly they had to believe on the score of faith, though they were really not of faith at all. Some of his expressions in this matter are very strong and he was especially fond of quoting St. Augustine, who was very emphatic on this point. One of these typical passages deserves to find a place here because, while the word philosophy is used, it is evidently science in our modern sense of the word that is intended. Augustine talks of what the philosophers have said of the heavens or the stars and the motion of the sun and moon, meaning of course the astronomers, who were in the old days classed as natural philosophers. This passage, then, which contains the opinions of the two greatest teachers of the Church in the West may well serve as a guide for those who are interested in science, and a warning for those who would {119} obtrude faith too far into scientific questions, and thus limit investigation and hamper that freedom of intellect which is so important for the development of science. St. Thomas said in his introduction to the reply to Master John of Vercelli:

"I have endeavored to reply but with this protest at the outset,
that many of these articles do not pertain to the teachings of
faith, but rather to the dogmas of the philosophers. But it works a
great injury either to assert or deny as belonging to sacred
doctrine such things as do not bear upon the doctrine of piety. For
Augustine says, 'When I hear certain Christians ignorant of those
things (namely, what philosophers have said of the heavens, or the
stars, or the motion of the sun and moon) or misunderstanding them,
I look with patience upon such men: nor do I see any reason to
hinder them, when of thee, Lord Creator of all things, they do not
believe unworthy things, if perhaps they be ignorant of the
structure, and condition of corporal creatures. But they are a
hindrance if they think these things belong to the very doctrine of
piety; and more, pertinaciously, dare to affirm that of which they
are ignorant.' But that they may be the cause of injury Augustine
shows. 'It is very disgraceful,' he says, 'and pernicious and
especially to be avoided, that a Christian speaking of these things
as though according to Christian teaching should so rave that any
infidel may hear; so that, as it is said, seeing him altogether in
the wrong, he may {120} scarcely contain his mirth. And it is not so
hurtful that one man should be seen to err, as that our writers are
believed by those who are without [the Church] to have such
opinions, and to the ruin of those whose salvation is our care they
are scorned and contemned as unlearned.' Whence it seems safer to me
that those things which philosophers have commonly held, and are not
repugnant to our faith, should neither be asserted as dogmas of
faith, although at times they may be introduced under the names of
the philosophers, nor so denied as contrary to the faith, as to give
occasion to the wise of this world of contemning the teaching of the
faith."

Is it any wonder that Professor Saintsbury of the University of Edinburgh, whose training in the old Scotch universities has given him a breadth of sympathy not common in our time, and whose wide knowledge of the literature of that period as well as its philosophy and education, and whose training in the discussion of the criticism of all time in his "History of Criticism" has made his opinion of special value, should have sympathetically turned to these old teachers and deprecated a little bitterly the modern attitude towards them? He said:

"Yet there has always in generous souls who have some tincture of
philosophy, subsisted a curious kind of sympathy and yearning over
the work of these generations of mainly disinterested scholars, who,
whatever they were, were {121} thorough, and whatever they could not
do, could think. And there have even, in these latter days, been
some graceless ones who have asked whether the science of the
nineteenth century, after an equal interval, will be of any more
positive value--whether it will not have even less comparative
interest than that which appertains to the scholasticism of the
thirteenth."

I have always considered, however, that the easiest way to show the modern student of science how supremely scientific in his temper was St. Thomas, is to quote for him the passage from that great teacher with regard to the Resurrection. In every way, that is typically modern. St. Thomas faces the question that after death men's bodies decay, the material of them is taken up and used in many other living beings, so that how can we dare to believe that we shall rise again on the last day with the same bodies that we now have? St. Thomas discusses this knotty problem straightforwardly and solves it more satisfactorily, even for all the knowledge that we have of it now, than has ever been done.

"What does not bar numerical unity in a man while he lives on
uninterruptedly clearly can be no bar to the identity of the arisen
man with the man that was. In a man's body while he lives there are
not only the same parts in respect of matter, but also in respect of
species. In respect of matter there is a flux and reflux of parts.
Still that fact does not bar the man's numerical unity {122} from
the beginning to the end of his life. The form and species of the
several parts continue throughout life, but the matter of the parts
is dissolved by the natural heat, and new matter accrues through
nourishment. Yet the man is not numerically different by the
difference of his component parts at different ages, although it is
true that the material composition of the man at one stage of his
life is not his material composition at another. Addition is made
from without to the stature of a boy without prejudice to his
identity, for the boy and the adult are numerically the same man."

The most important feature of the scientific teachings of the mediaeval universities has been left till the last because it is the clinching confirmation of a claim that these were essentially scientific universities. It is to be found in the position of the medical schools and the state of medical teaching during the Middle Ages. So curiously has the history of education been written, and, above all, of medical education, that to most people this would seem to be surely the department of education which would prove just the opposite. We have heard so much about Church opposition to anatomy and Church opposition to surgery, of its repression of the development of medical science and even medical art, because the Church wanted to make people believe in the value of masses, relics and prayers--and pay for them--that most people are quite sure that there {123} was no medical education of any significance in the Middle Ages. Nothing shows more clearly how viciously the history of education has been written than the existence of such false impressions. Not only are they utterly unfounded, but they are based on supreme ignorance of one of the greatest periods in the history of medicine that we have in all the world's history. Not only were the schools excellent and the teaching progressive, but there was a fine development of medical science and, above all, of surgery. Surgery is supposed to be particularly the department of medicine that did not develop. We have learned better in recent years, and now we know that there was no greater period in the history of surgery than that from 1200 to 1400 when, alas! following so-called history, we used to think there was no surgery.

The first question that any one who knows anything about the subject asks with regard to the progress in medicine of a particular time or country is, what was the standard of its medical education? What was the standard of admission to the medical schools, how many years of medical studies were required? To this question the Middle Ages have a wonderful answer that has not been realized until recent years. We now have Frederick II's famous law for the regulation of the practice of medicine and the maintaining of standards in medical schools. This law was promulgated in the Two Sicilies, the southern part of {124} Italy and Sicily proper. According to it no one was allowed to practise medicine who had not studied for four years in a recognized university and then practised for one year with a physician before receiving his license to practise by himself. If he wanted to practise surgery he had to spend an additional special year in the study of anatomy. The university medical schools were graduate schools and did not admit a student unless he had completed the undergraduate course.

Of course it may be thought that this was due entirely to the great Emperor Frederick, who was far ahead of his time and who, therefore, anticipated the progress of medical teaching by many centuries. We have, however, many other documents which illustrate the state of medical education at this time. The charters of the medical schools were granted by the Popes and were very explicit in what they required of the new faculties in order that standards might be maintained. Pope John XXII, for instance, at the beginning of the fourteenth century, issued charters for medical schools at Perugia and Cahors. He required that there should be four years of medical study and three years of preliminary work. He went into details to secure the maintenance of standards. The original faculties of these schools would all have to be doctors in medicine from either Paris or Bologna, and it must be their duty to establish in the new schools the standards of their {125} Almae Matres. Examinations were to be conducted under oath, men were not to be granted degrees unless they deserved them, the votes of professors rejecting candidates or graduating them were to be under oath-bound secrecy, so as to have them absolutely free from personal influence, and every precaution was taken to secure the highest possible standards.

It was as a consequence of their direct attachment to these old mediaeval medical schools that the medical schools founded here in America in the sixteenth century at once began with high standards. Three years of preliminary work was required and four years of medicine. In the United States no preliminary requirements were demanded; and for a full century only two years of medical study, which really consisted of but two terms of four months each, was the requirement. The old mediaeval medical schools were originally attached to the universities, and it is a well-known rule in the history of education that whenever the medical schools are independent then standards are sure to be low. Whenever the university controls the medical school and it is a real graduate department, then standards of admission and of graduation are properly maintained. It is surprising to think that the old mediaeval universities should be able to give us lessons in this matter and should put us to shame for our slip-shod nineteenth-century medical education in the United States, but this is a simple fact. Contrast {126} the South American countries where the mediaeval traditions with which they were founded constrained them to give four, five and even six years to medicine before granting a degree. Go a step further and see how devoted to science were the Universities of Lima (Peru) and Mexico, centuries before we did any serious scientific work in the United States, and all because they were direct descendants of the old mediaeval universities.

The feeling of certain modern educators would be that it did not matter how much time these mediaeval universities gave to medicine since, after all, they had nothing of any value to teach in medicine. Even educated people have been led to believe that there was nothing in medicine and, above all, in the surgery of those times to be of any value. Probably no opinion is more foolishly ignorant or more ridiculously absurd than this, though it is a commonplace among people who are sure they know something about history, and, above all, among those who consider themselves authorities in the history of education, and of the development of science. In surgery a magnificent development was made at this time of which I shall have something to say later. In medicine there was much less anticipation of our modern progress, but even here there was much that demands our respect. One of the university men, Simon of Genoa, worked out the dosage of opium and indicated its uses. Anodyne drugs were {127} employed much more generally and successfully than we are apt to think; various methods of anaesthesia, one of them by inhalation, of which I shall say more when talking of surgery, were invented and a large number of drugs and simples were experimented with. Down at Montpellier Bernard Gordon suggested red light for smallpox.

This is not much of a record, perhaps, but we must not forget what Professor Richet, the Director of the Physiological Laboratory of the University of Paris, said not long since in an article on "Physicians and Medicine" in _La Revue de Deux Mondes._ It is startling but chasteningly true. "The therapeutics of any generation has always been quite absurd to the second succeeding generation." Indeed it is one of the almost disheartening things in the history of medicine to see how treatments come in, are widely accepted and hailed as great advances in therapeutics and then gradually disappear. They bled a great deal and they purged not a little, in accordance with the teaching in the medical schools of the universities of the thirteenth and fourteenth centuries, but then they bled a great deal and purged a great deal more, according to the teaching of the medical schools of the beginning of the nineteenth century. There have been many periods in the interval when purging and bleeding were, and very properly, not nearly so popular.

It was in preventive medicine particularly that {128} these progressive medical men of the early university days secured their triumphs. They made separate hospitals for the lepers all over Europe, and by segregation succeeded in wiping out that disease, though it was as widely spread as tuberculosis in our day and presented just as serious a problem. Indeed the most encouraging incentive for our present tuberculosis campaign is drawn by many authorities from the experience with leprosy, which was eventually obliterated as an endemic popular disease, by strict segregation methods. These same generations created special hospitals for erysipelas and thus prevented the spread of this disease in the ordinary hospitals, where it used to be so serious a factor for morbidity if not for mortality. Men forgot this later and the disease became a serious problem once more in all the hospitals of even a generation ago. The hospital organization worked out by these university men is the finest jewel in the crown of their accomplishment as applied scientists. Pope Innocent III, himself a University of Paris man, founded the Santo Spirito Hospital in Rome, summoning for that purpose the best authority on hospitals in Europe, Guy of Montpellier, and then required the bishops of the world to erect similar hospitals in their dioceses. This was done, and it is Virchow, whose sympathies were anything but favorable to the Popes, who has been most loud in his praise of the wonderful hospital organization of these centuries. Every town in {129} Europe of 5,000 inhabitants or more had a hospital, and there were hospitals in many of the smaller towns.

It would be easy to think that these hospitals were rudely built, were badly ventilated, were ill-arranged and, above all, were likely to be houses for the perpetuation of disease rather than for the regaining of health. We are prone to think that we are the first generation to solve the problem of hospital construction. We know what poorly-constructed, badly-planned institutions were the hospitals of three generations ago. What, then, must have been the hospital buildings of centuries ago? This argument has no place in history; the worst hospitals in the world and in history were erected at the end of the eighteenth and the beginning of the nineteenth century. Some of the best hospitals ever constructed date from the thirteenth, fourteenth and fifteenth centuries. This was a time when great architects were successfully solving the construction problems for cathedrals, municipal buildings, colleges and the like, and they solved them quite as successfully for hospitals. Some of these hospitals were models in their way. One of them, built toward the end of the thirteenth century, by the sister of St. Louis, Marguerite of Bourgogne, with its large windows high in the walls, in single-story buildings, with arrangements for the segregation of patients, with the kitchens in a separate building, with beautiful {130} frescoes on the walls so that patients' minds might be occupied and not left to their own often disturbing devices as with our bare wall, with a stream of running water divided so as to pass on both sides of the hospital, is a model of construction for all time.

It was in surgery rather than medicine, however, that these great mediaeval university medical schools left their impress upon the history of medicine. During the thirteenth, fourteenth and fifteenth centuries we have a series of wonderful teachers of surgery, whose achievements we know not by tradition nor by fragments of their writings, but by the text-books which they wrote and which constituted the teaching for generations and sometimes for centuries after their time. Gurlt, the great German historian of surgery, devotes some 300 pages of the first volume of his "History of Surgery" to the surgical accomplishments of the Middle Ages. He even protests that space compels him to abbreviate the story of what these old-time masters of surgery did to lay the foundation of modern surgical practices. It is a commonplace in the American writing of history that there was no surgery at this time. President White says that, "for over a thousand years surgery was considered dishonorable until the German Emperor Wenceslas, in 1403, ordered that it should be held in honor again." The two centuries immediately preceding this date represent the {131} greatest period in the history of surgery down to our own time, and because of its originality probably greater in real achievement than even our vaunted age.

It is sometimes the custom to say that this surgery was derived from the Arabs. This is supposed to rob the mediaeval universities of any prestige that may come to them for this marvellous progress. Gurlt, however, in his "History of Surgery," in his sketch of Roger (Ruggiero), who was the first of the great surgeons of the thirteenth century, who taught at the Italian universities, says: "Though Arabian writings on surgery had been brought over to Italy by Constantine Africanus 100 years before Roger's time, these exercised no influence over Italian surgery in the next century, and there is not a trace of the influence of the Arabs to be found in Roger's work." When Gurlt says this it is because he has deliberately studied the question, and we can be absolutely sure, therefore, that whatever we find in surgery at this time comes to us from these great mediaeval universities themselves, and is not imported from abroad.

After Roger, who was at Bologna for a time after having been in Paris, and who then became a Papal physician, there are a series of great names that deserve to be mentioned. Four names are connected together by association as master and pupil for what may be termed four generations of surgical progress. From the birth {132} of the first to the death of the last represents about 100 years. That 100 years is a gloriously fruitful century in the history of surgery. The first of the group is William of Salicet, of whom Professor Clifford Allbutt, the Regius Professor of Physic at the University of Cambridge, in his address on the "Historical Relations of Medicine and Surgery to the End of the Sixteenth Century," delivered by special invitation at the Congress of Arts and Sciences at the World's Fair in St. Louis in 1904, has the highest praise. Allbutt says: "Like Lanfranc and the other great surgeons of the Italian tradition, and unlike Franco and Pare, William had the advantage of the liberal university education of Italy; but like Pare and Wurtz, he had a large practical experience in hospitals and on the battlefield and fully recognized that surgery cannot be learned from books only." Allbutt praises him and rightly for his careful notes of cases and then tells us something of his accomplishments in surgery. He says: "William discovered that dropsy may be due to a _durities renum_ six centuries before Bright; he substituted the knife for the Arabist abuse of the cautery; _he investigated the causes of the failure of healing by first intention_ (Italics ours), he described the danger of wounds of the neck; he sutured divided nerves; he forwarded the diagnosis of suppurative diseases of the hip; and he referred chancre and phagedaena to their proper causes."

{133}

His pupil Lanfranc equalled his master in devotion to practical surgery and surpassed him in his development of the great science of medicine. Pagel, the well-known German historian of medicine, says that, in his text-book Lanfranc has excellent chapters on the affections of the eyes, the ears and mouth, the nose, even the teeth, and treats of hernia in a very practical common-sense way. He warns against the radical operation and says, in words that come home to us with strange familiarity at the present time, that many surgeons decide on operations too easily, not for the sake of the patient but for the sake of the money that is in them. Lanfranc's discussion of cystotomy, Pagel characterizes as prudent but rational, for he considers that the operations should not be feared too much but not delayed too long. In patients suffering from the inconvenience which comes from large quantities of fluid in the abdomen he advises _paracentesis abdominis_, but warns against putting the patient in danger from such an operation without due consideration. Pagel says that Lanfranc must be considered as one of the greatest surgeons of the Middle Ages and the real establisher of the prestige of the French school of surgery which maintained its prominence down to the nineteenth century.

Lanfranc had been invited to Paris to take the chair of surgery, because the authorities of the university wanted to add prestige to the medical school, which was not as well known as the school {134} of philosophy. The fame of William of Salicet had spread throughout academic Europe, and so Lanfranc was offered the chair at the University of Paris in order to carry his master's message there. The next in the succession of great teachers at Paris was Mondeville, who found less to do in an original way than his master Lanfranc and his protomaster William, but who accomplished much for surgery. All that he did was thrown into the shade by what was accomplished for succeeding generations by the next in the series, Guy de Chauliac, who studied for a time in Paris under Mondeville, though his early medical education was obtained at Montpellier, but had also had the advantage of spending a year in Italy at the various medical schools which were famous at that time. These two incidents, Lanfranc's invitation to Paris to be a teacher there from Italy more than a thousand miles away, and Guy de Chauliac's studies in all the important universities of Europe of the time before he took up his own work, illustrate better than any words of ours can the ardent enthusiasm for study, the thoroughgoing anticipation of our most modern methods in education. Mondeville, like Chauliac, had made very nearly the same round of the universities. It is a custom, not a chance incident, that we have to deal with here.

Guy de Chauliac has been given the name of the father of modern surgery. Any one who wants to see why should read the text-book on surgery that {135} Chauliac wrote and which for two centuries after his time (he died about the middle of the fourteenth century) continued to be the most used text-book of surgery in the medical schools of Europe. Chauliac, for instance, describes the treatment of conditions within all three of the important cavities of the body, the skull, the thorax and the abdomen. Pagel has three closely-printed pages in small type of titles alone of subjects in surgery which Chauliac treated with distinction. His description of instruments and methods of operation is especially full and suggestive. He describes the passage of a catheter, for instance, with the accuracy and complete technique of a man who knew the difficulties of it in complicated cases from practical experience. He even recognizes the dangers for the patient from the presence of anatomical anomalies of various kinds and describes certain of the more important of them. He has very exact indications for trephining. For empyema he advises opening of the chest and indicates where and how. He says very frankly that in wounds of the abdomen the patient will die if the intestines have been perforated and left untreated, and he describes a method of suturing wounds of the intestines in order to save the patient's life.

His treatment of bone surgery and of fractures and dislocations is especially interesting and shows how far these very practical men had reached conclusions resembling those of our time. {136} It was in hernia particularly that Chauliac's surgical genius manifested itself. He operated for hernia and its radical cure, placing the patient in an exaggerated Trendelenberg position, head down, feet fastened to a slanting board. For such work anatomy had to be known very well, and Chauliac had made special studies at Bologna under Bertruccio, the successor of Mondino. Chauliac once declared that the surgeon ignorant of anatomy carves the human body as a blind man would carve wood. Of ulcers of all kinds Chauliac writes from a knowledge evidently derived from experience. Of ulcers due to cancer he has much to say. He considers them hopeless unless they can be excised at a very early stage and the incision followed by caustics. For carcinomatous ulcers there is not much that we can do beyond this, even in our day. It is no wonder that the great historians of medicine have been unanimous in praise of this wonderful scientific genius. For my lecture on "Old-Time Medical Education," before the Johns Hopkins Historical Club, last year, I quoted some of those opinions. Portal, for instance, says of him, "It may be averred that Guy de Chauliac said nearly everything that modern surgeons say and that his work is of infinite price, but unfortunately too little pondered." Malgaigne declares Chauliac's "Chirurgia Magna," "A masterpiece of learned and luminous writing." Pagel says, "Chauliac represents the summit of attainment in mediaeval {137} surgery, and he laid the foundation of that primacy in surgery which the French maintained down to the nineteenth century." Professor Clifford Allbutt says of Chauliac's treatise, "This great work I have studied carefully and not without prejudice; yet I cannot wonder that Fallopius compared the author with Hippocrates or that John Freind calls him the prince of surgeons. The book is rich, aphoristic, orderly and precise." In a word it has all the qualities that are usually said to be lacking in the work of mediaeval scientists, and it is a standing reproach to those who ignorantly have made so little of the work of these wonderful men of the olden time, who anticipated so many of the features of our modern medicine and surgery that we are prone to think of as representing climaxes in human progress, indications of a wonderful human evolution.

Two other names of great professors of surgery deserve to be mentioned because they make it very clear that this wonderful development of surgery was not confined to France and Italy, but made itself felt all over Europe. One of these is John Ypermann, a surgeon of the early fourteenth century, of whom almost nothing was known until about twenty-five years ago, when the Belgian historian, Broeck, brought to light his works and gathered some details of his life. He was a pupil of Lanfranc, and at the end of the thirteenth century studied at Paris on a scholarship voted by his native town of Ypres, {138} which provided maintenance and tuition fees for him at the great French university expressly in order that he might become expert in surgery. We are likely to think of Ypres as an unimportant town, but it was one of the great industrial centres of Europe and one of the most populous, busy towns of Flanders in the Middle Ages, noted for its manufacture of linens and fine laces. The famous Cloth Hall, erected in the thirteenth century, one of the most beautiful architectural monuments in Europe, and one of the finest buildings of its kind in the world, was the result of the same spirit that sent Ypermann to Paris.

After his return Ypermann settled down in his native town and obtained great renown not only at home, so that in that part of the country an expert surgeon is still spoken of as an Ypermann, but he became famous throughout all the Teutonic countries. He is the author of two books in Flemish. One of these is on medicine. Pagel calls it an unimportant compilation. The terms that occur in it, however, are enough to show us how much more than we are likely to think, these old masters in medicine discussed problems that are still puzzling us. He treats of dropsy, rheumatism, under which occur the terms coryza and catarrh, icterus, phthisis (he calls the tuberculous tysiken), apoplexy, epilepsy, frenzy, lethargy, fallen palate, cough, shortness of breath, lung abscess, hemorrhage, blood-spitting, liver abscess, hardening of the spleen, affections of the kidney, {139} bloody urine, diabetes, incontinence of urine, dysuria, strangury, gonorrhea and involuntary seminal emissions--all these terms are quoted directly from Pagel.

His work in medicine, however, is as nothing compared to his writings on surgery. A special feature of his book is the presence of seventy illustrations of instruments of the most various kinds, together with a plate showing the anatomical features of the stitching of a wound in the head. Even Pagel's brief account of its contents will be a source of never-ending surprise for those who think that surgery has developed entirely in our time. Even in this work on surgery, however, there are many things that we now treat under medicine. As this gives us an opportunity to show how much more of medicine was known at this time than is usually thought, I venture to quote some of Pagel's brief resume of the contents of a single chapter. This is a chapter devoted to intoxications, which includes the effect of cantharides as well as alcohol, and treats of the bites of snakes, scorpions and of the fatal effects of wounds due to the bite of mad dogs.

The other great surgeon and surgical writer of the time, for there must have been many distinguished surgeons and only a few writers, if we can trust to common experience in that matter, was John Ardern, an English surgeon. He was educated in Montpellier, practised for a time in France, then settled for some years in the {140} small town of Newark in Nottinghamshire, and then for nearly thirty years in London. His "Practice of Surgery," as yet existing only in manuscript, is another one of these wonderful contributions to the applied sciences of anatomy and medicine at a time when such applications are often supposed to have been absent. He was an expert operator and had a wide reputation for his success in the treatment of diseases of the rectum. He was the inventor of a new clyster apparatus. Daremberg, the medical historian, who saw a copy of Ardern's manuscript in St. John's College, Oxford, says that it contained numerous illustrations of instruments and operations. We fortunately possess an excellent manuscript copy in the Surgeon General's Library at Washington, and sometime it is hoped this will be edited and published.

The most interesting feature of the work of all of these men is their dependence on personal observation and not on authority. Guy de Chauliac's position in this matter can be very well appreciated from his criticism of John of Gaddesden's book in which he bewails the blind following of those who had gone before. His bitterest reproach for many of his predecessors was that, "They followed one another like cranes, whether for fear or love he would not say." Pagel praises Ypermann for the well-marked striving which he has noted in him to free himself from the bondage of authority, and because most of his therapeutic {141} descriptions rest upon his own experience. William of Salicet, at the beginning of this great period of surgery, had insisted that notes of cases were the most valuable sources of wisdom in medicine and surgery. The last of them, Ardern, gave statistics of his cases and was quite as proud as any modern surgeon of the large number that he had operated on. He gives these carefully and accurately.

I have dwelt on the medical side of these universities mainly, of course, because this is more familiar to me as a historian of medicine than their work in other scientific departments, but also to a great extent because the medical schools gathered unto themselves nearly all the scientific knowledge of the time. Botany, mineralogy, climatology, meteorology were all studied for the sake of what could be learned from them for the benefit of medicine. Even astronomy which was then the old astrology, was cultivated seriously, because of the supposed effect of the stars on human constitutions. For this we surely cannot blame these mediaeval students of science since four centuries later Galileo and even Kepler were still making horoscopes for their patrons and laying down laws from astronomy that were supposed to be applicable to medicine. Even Copernicus studied astronomy and medicine side by side and this combination of studies was not at all infrequent.

The medical schools, then, are the real index of {142} the serious interest of the mediaeval universities in science. Our scientific departments in modern universities have developed other interests, because of various applications that these have to life and its concerns. Always in scientific universities applied science is sure to encroach upon the domain of pure science, and no one knows that better than we do, for we have been bewailing the presence of machine shops and boiler factories on the university grounds. The old universities did not teach applied mechanics or engineering, but that does not mean that these subjects were not taught. There were special technical schools conducted by the gilds by means of apprenticeship and the journeyman training, which enabled them to teach those who cared to have it all the knowledge necessary for construction work of various kinds. The wonderful architectural engineering exhibited in the cathedrals, university buildings, town halls and castles of this time, and the magnificent bridges, some of which are still in existence, show us that the technical subjects were by no means neglected. [Footnote 9] Our mediaeval forefathers in education had the wisdom not to let the technical subjects interfere with pure science too much, as they inevitably do whenever the two are brought too closely together. Culture is always overshadowed by the practical, but not to the ultimate benefit of the race.

[Footnote 9: See Address on "Ideal Education of the Masses."]

The proof for us here in America, close at {143} hand, that these universities of the Middle Ages were thoroughly scientific in spirit and not only capable of, but actually active and successful in scientific investigation, is to be found in our earliest American universities. We are prone to think, because of the curiously defective way in which our histories of education have been written, that the only things worth while talking about in the origins of education here in America are to be found in English America. Recent investigations have shown how utterly deceived we were by foolish self-conceit in this matter. Long before the English-American universities were founded, and still longer before they began to do any serious work in education, there were important universities having literally thousands of students in attendance in the Spanish-American countries. The University of Mexico and the University of Lima in Peru were both founded about the middle of the sixteenth century. Harvard came nearly a century later, Yale a full century and a half, Princeton more than two centuries. The contrast between our English-American institutions of learning, however, and their Spanish-American rivals in accomplishment and numbers in attendance is still more striking than the mere dates of foundation.

Of course there were chairs of many sciences, strange as that may seem to us with our ridiculous traditions with regard to the history of education. These Spanish-American universities were {144} the direct descendants of the old mediaeval universities. They were in close relationship with Salamanca, Valladolid and Alcala. They were the progeny of scientific universities and they were, of course, occupied mainly with science. In spite of the fact that already the influence of the Renaissance, with its classical studies as the basis of education, had begun to make itself felt, these Spanish-American universities retained, to a great extent, the scientific curriculum. Nor must it be thought that they were shilly-shally institutions of learning, doing nothing in reality, but making a great pretence of studying many things. To know the very opposite we turn to Bourne, himself at the time a professor at Yale, and writing one of the volumes of a series edited by Professor Albert Bushnell Hart, who holds the chair of history at Harvard, to be told in very definite emphatic terms how successfully investigations in science and scientific education were carried on in Mexico. Professor Bourne says:

"Not all the institutions of learning founded in Mexico in the
sixteenth century can be enumerated here, but it is not too much to
say that in number, range of studies and standard of attainments by
the officers they surpassed anything existing in English America
until the nineteenth century. _Mexican scholars made distinguished
achievements in some branches of science, particularly medicine and
surgery, but pre-eminently linguistics, history and anthropology._
{145} Dictionaries and grammars of the native languages and
histories of the Mexican institutions are an imposing proof of their
scholarly devotion and intellectual activity. Conspicuous are
Toribio de Motolinia's 'Historia de las Indias de Nueva Espana,'
Duran's 'Historia de las Indias de Nueva Espana,' but most important
of all Sahagun's great work on Mexican life and religion."

The scientific products of these universities in America are interesting because almost as a rule we know absolutely nothing about them in English America, and, therefore, conclude there must have been none. The first book written on a medical topic in America was the "Secretos de Chirurgia," written by Dr. Pedrarias de Benavides, which was published at Valladolid in Spain in 1567. The first book on medicine actually published in this country was "Opera Medicinalia," by Francisco Bravo. [Footnote 10] On Columbus' second expedition, however, a Dr. Chanca who had been physician-in-ordinary to the King and Queen of Spain, was sent with the expedition as what we would now call a scientific attache. On his return he wrote a volume of scientific observations that he had made in America. Some of these were doubtless written while he was over here, though the book was published in Spain. Dr. Ybarra of New York recently published a resume of this in the Smithsonian Publications and an article on it in the _Journal of the American Medical Association_. {146} It shows very well how wide were the scientific interests of the physicians of the time and how ardent their investigation of science, for there is scarcely a phase of modern science that would be touched on by the corps of scientists now attached to such an expedition which does not receive some serious treatment in Dr. Chanca's book. Thus early did the Spanish-Americans take up scientific investigation seriously.

[Footnote 10: Published in Mexico, 1570.]

Professor Bourne of Yale, in his chapter on the "Transmission of the European Culture," in the third volume of the American Nation Series, [Footnote 11] says (p. 17): "Early in the eighteenth century the Lima University [Lima, Peru] counted nearly 2,000 students and numbered about one hundred and eighty doctors [in its faculty] in theology, civil and canon law, medicine and the arts. Ulloa reports that 'the university makes a stately appearance from without, and its inside is decorated with suitable ornaments.' _There were chairs of all the sciences_, and 'some of the professors have, notwithstanding the vast distance, gained the applause of the literati of Europe.' The coming of the Jesuits contributed much to the real educational work in America. They established colleges, one of which, the little Jesuit College at Juli, on Lake Titicaca, became a seat of genuine learning."

[Footnote 11: Harpers, New York, 1908.]

A distinguished professor of medicine in this country to whose attention this state of medical {147} education in the Spanish-American countries, so different from what is thought, was called, said: "What a surprise it is to find that while we have been accustomed to think that the _primum mobile_ [the active initiative] in education in this country came from the Anglo-Saxons, we now find that they were long anticipated in every department of education by the Spaniards, though we have been rather accustomed to despise them for their backwardness." With regard to the establishment of the first American medical school, it is no longer a surprise to find that it was established in Mexico, just as soon as we realize that the Mexican University was closely in touch with the traditions of the mediaeval universities generally and these all established medical schools as university departments. The standards of these mediaeval medical schools were transported to America and maintained. Our medical schools in the United States got away from the universities, became mere preparatory institutions, granted degrees for just as little study as possible, two terms of four months each in most cases, sometimes given in the same calendar year and requiring no preliminary training. We are reforming this now for a generation, but just inasmuch as we are, far from advancing, we are going straight back to the mediaeval universities and their standards and methods.

With all this evidence before us it seems perfectly clear that these old mediaeval universities {148} must be considered to have been scientific universities in our fullest modern sense of the term. They devoted all their time to the study of phenomena around them and the attempt to find the principles underlying them. They went at it somewhat differently in many departments of science than those which are now employed, but in all their practical work at least, they anticipated our methods as well as many of our results. The great professors wrote text-books and students who were ardent in the pursuit of knowledge copied out those text-books by hand. They had no way of easily multiplying them almost indefinitely, as we have at the present time. Probably nothing shows so well the enthusiastic zeal of these times in the pursuit of scientific knowledge as the fact that so many copies of these textbooks still remain for us. Much has been lost by war and fire, and still more by wanton destruction by people who could not understand, for there were many intervening generations that sold these old manuscripts by the ton for the use of grocers to wrap up butter and any other commodity. If we only had the wealth of manuscript that was originally created it would be easy to fill in the gaps in our knowledge, and show the wonderful scientific scholarship of these mediaeval universities.

As it is, there cannot be the slightest doubt that these were great scientific universities. How, then, has the opposite tradition of science only {149} coming to cultivation in our time obtained a foothold; above all, how has it happened that men have insisted that there was no science in these old days because the Church was opposed to science and would not permit its study or allow of scientific investigation? If we were to believe many writers who have been taken very seriously, anatomy was conducted only under the pain of death, chemistry made one liable to all sorts of penalties and other forms of science were absolutely banned. There is no reason at all for any such declarations from what we know of the history of science. The place where such groundless assertions are found is in the so-called history of religion. The _odium theologicum_ was very bitter, and ignorant men said things without knowing, and then their statements were copied by others who knew even less.

Probably there is no more serious blot on the history of education and, above all, the history of science, than the fact that men supposed to be scholarly have been so ready to accept absolutely ignorant statements with regard to the state of science during the Middle Ages. It would be amusing, if it were not so amazing, to recall the utter lack of scholarship that characterized the men who wrote such things, but above all the generations that accepted such history as solemn truth and even conferred academic dignities and degrees on such men. Take a book like Dr. Draper's "Conflict of Science and Religion." It {150} is founded on the uttermost lack of knowledge of the subjects of which he speaks. It is true that he has consulted historical writers. They were all secondary authorities. He had never gone back to look up a single original document of any kind. He was a physician; supposedly at least, then, he should know the history of medicine. He knows nothing at all about the great medical schools of the thirteenth and fourteenth centuries; of the great period of surgery that occurred at this time he has no inkling. Had he cared really to know anything about the period he could have seen some of the text-books written by these men. Instead we have an exhibition, in his book, of the most consummate assumption of knowledge associated with sublime ignorance and bitter condemnation for old institutions, educational and ecclesiastical, in matters of which he knows nothing, though if he did know, his opinion would surely be just the opposite to that he has expressed.

To a great degree this is true of President White's "A History of the Warfare of Science with Theology." Secondary authorities constantly figure in it, and they are quoted from, as a rule, with the definite idea of proving a particular thesis--that theology is opposed to science. Of course it is very different to that of Draper, there is much more of true scholarship in it, but it is sad to think that the prestige of a president of a great university who had been a professor of {151} history should have been lent to statements so egregiously misleading as those which are constantly to be found in his work. Even sadder it is to think that this has been accepted by many people as a scholarly work and as representing the last word on the subject.