Nevertheless surgery advanced more rapidly in this period than any other branch of medicine, partly because it was forced to deal with conditions rather than theories, partly through plentiful opportunity to treat the wounds of soldiers. Roger of Salerno, about 1170, published his Practica chirurgiae, the earliest surgical treatise in the Christian West; for three centuries it remained a classic text. In 1238 Frederick II ordered that a corpse should be dissected in every five-year period at Salerno;75 such dissection of cadavers was practiced regularly in Italy after 1275.76 In 1286 a Cremona physician opened a corpse to study the cause of a current pestilence; this is the first known case of a post-mortem examination. In 1266 Teodorico Borgognoni, Bishop of Cervia, began a long struggle of Italian medicine against the Arabic notion that suppuration must first be encouraged in the treatment of wounds; his discussion of aseptic treatment is a classic of medieval medicine. Guglielmo Salicetti—William of Saliceto (1210–77)—professor of medicine at Bologna, made notable improvements in his Chirurgia (1275); it associated surgical diagnosis with a knowledge of internal medicine, used careful clinical records, showed how to suture divided nerves, and advocated the knife—as allowing better healing, and leaving less scar—in preference to the cautery so popular with Moslem practitioners. In a general treatise—Summa conservationis et curationis—William ascribed chancre and bubo to intercourse with an infected courtesan, gave a classical description of dropsy as due to hardening and narrowing of the kidneys, and offered excellent advice on hygiene and diet for every age of life.
His pupils Henri de Mondeville (1260?-1320) and Guido Lanfranchi (d. 1315) brought the medical lore of Bologna to France. Like Teodorico, de Mondeville improved asepsis by advocating a return to Hippocrates’ method of maintaining simple cleanliness in a wound. Lanfranchi, exiled from Milan in 1290, went to Lyons and Paris, and wrote a Chirurgia magna which became the recognized text of surgery at the University of Paris. He laid down a principle that rescued surgery from barberism: “No one can be a good physician if he is ignorant of surgery; and no one can properly perform operations if he does not know medicine.”77 Lanfranchi was the first to use neurotomy for tetanus, and intubation of the esophagus, and gave the first surgical description of concussion of the brain. His chapter on injuries of the head is one of the peaks in the history of medicine.
Surgical sleeping draughts are mentioned by Origen (185–254) and Bishop Hilary of Poitiers (c. 353). The usual method of anesthesia in medieval Christendom was by inhaling, and probably drinking, a mixture based on mandragora (mandrake), and generally containing also opium, hemlock, and mulberry juice; mention of this “soporific sponge” occurs from the ninth century onward.78 Local anesthesia was induced by a poultice soaked in a similar solution. The patient was awakened by applying fennel juice to his nostrils. Surgical instruments had as yet made no progress since the Greeks. Obstetrics had fallen behind the practice of Soranus (C. A.D. 100) and Paul of Aegina (C. A.D. 640). Caesarean section was discussed in the literature, but apparently not practiced. Embryotomy—mutilation of the foetus for removal from the womb—was in many cases performed because the obstetrician rarely understood version. Delivery was accomplished in specially designed chairs.79
Hospitals were now advanced far beyond anything known in antiquity. The Greeks had had asklepieia, religious institutions for the treatment of the sick; the Romans had maintained hospitals for their soldiers; but it was Christian charity that gave the institution a wide development. In 369 St. Basil founded at Caesarea in Cappadocia an institution called after him the Basilias, with several buildings for patients, nurses, physicians, workshops, and schools. St. Ephraim opened a hospital at Edessa in 375; others rose throughout the Greek East, and in specialized variety. The Byzantine Greeks had nosocomia for the sick, brephotrophia for foundlings, orphanotrophia for orphans, ptochia for the poor, xenodochia for poor or infirm pilgrims, and gerontochia for the old. The first hospital in Latin Christendom was founded by Fabiola at Rome about 400. Many monasteries provided small hospitals, and several orders of monks—Hospitalers, Templars, Antonines, Alexians—and nuns arose to care for the sick. Innocent III organized at Rome in 1204 the hospital of Santo Spirito, and under his inspiration similar institutions were set up throughout Europe; Germany alone had, in the thirteenth century, over a hundred such “hospitals of the Holy Spirit.” In France the hospitals served the poor and old and the pilgrim, as well as the sick; like the monastic centers they offered hospitality. About 1260 Louis IX established at Paris an asylum, Les Quinze-vingt; originally a retreat for the blind, it became a hospital for eye diseases, and is now one of the most important medical centers in Paris. The first English hospital known to history (not necessarily the first) was established at Canterbury in 1084. Usually the service in these hospitals was provided free for those who could not pay, and (except in monastic hospitals) the attendants were nuns. The apparently cumbersome costume of these “angels and ministers of grace” took form in the thirteenth century, probably to protect them from communicable disease; hence, perhaps, the shearing of the hair and the covering of the head.80
Two special diseases evoked special defenses. “St. Anthony’s fire” was a skin ailment—perhaps erysipelas—so severe that an order of monks, the Congregation of the Antonines, was founded about 1095 to treat its victims. Leper hospitals are mentioned by Gregory of Tours (c. 560); the Order of St. Lazarus was organized to serve in these leprosaria. Eight diseases were regarded as contagious: bubonic plague, tuberculosis, epilepsy, scabies, erysipelas, anthrax, trachoma, and leprosy. A victim of any of these was forbidden to enter a city except under segregation; or to engage in selling food or drink. The leper was required to give warning of his approach by horn or bell. Usually his disease expressed itself in purulent eruptions on face and body. It was only mildly contagious, but probably medieval authorities feared that it could be spread by coitus. Possibly the term was used to include what would now be diagnosed as syphilis; but there is no certain reference to syphilis before the fifteenth century.81 No special provision seems to have been made for the care of the insane before the fifteenth century.
The Middle Ages, too poor to be clean or properly fed, suffered more than any other known period from epidemics. The “Yellow Plague” devastated Ireland in 550 and 664, killing, we are unreliably informed, two thirds of the population.82 Similar pestilences struck Wales in the sixth century, England in the seventh. A malady known to the French as mal des ardents—which was described as burning out the intestines—swept through France and Germany in 994, 1043, 1089, and 1130. Plagues of “leprosy” and scurvy may have come from returning Crusaders. The plica polonica, a disease of the hair, was apparently brought to Poland by the Mongol invasion of 1287. The harassed population ascribed these epidemics to famines, droughts, swarms of insects, astral influences, poisoning of wells by Jews, or the wrath of God; the likelier causes were the crowded condition of the small walled towns, poor sanitation and hygiene, and a consequent lack of defense against infections carried by returning soldiers, pilgrims, or students.83 We have no mortality statistics for the Middle Ages, but it is probable that not more than half of those born reached maturity. The fertility of women labors to atone for the stupidity of men and the bravery of generals.
Public sanitation improved in the thirteenth century, but never in the Middle Ages did it regain its excellence under Imperial Rome. Most cities and wards appointed officials to care for the streets,84 but their work was primitive. Moslem visitors to Christian towns complained—as Christian visitors now to Moslem towns—of the filth and smell of the “infidel cities.”85 At Cambridge, now so beautiful and clean, sewage and offal ran along open gutters in the streets, and “gave out an abominable stench, so… that many masters and scholars fell sick thereof.”86 In the thirteenth century some cities had aqueducts, sewers, and public latrines; in most cities rain was relied upon to carry away refuse; the pollution of wells made typhoid cases numerous; and the water used for baking and brewing
was usually—north of the Alps—drawn from the same streams that received the sewage of the towns.87 Italy was more advanced, largely through its Roman legacy, and through the enlightened legislation of Frederick II for refuse disposal; but malarial infection from surrounding swamps made Rome unhealthy, killed many dignitaries and visitors, and occasionally saved the city from hostile armies that succumbed to fever amid their victories.
VI. ALBERTUS MAGNUS: 1193–1280
Three men stand out in this period as devotees of science: Adelard of Bath, Albert the Great, and Roger Bacon.
Adelard, after studying in many Moslem countries, returned to England and wrote (c. 1130) a long dialogue, Quaestiones naturales, covering many sciences. It begins Platonically by describing Adelard’s reunion with his friends. He asks about the state of affairs in England; he is told that the kings make war, judges take bribes, prelates drink too much, all promises are broken, all friends are envious. He accepts this as a genial summary of the natural and unchangeable condition of things, and proposes to forget it. His nephew inquires what has Adelard learned among the Moslems? He expresses a general preference for Arabic as against Christian science; they challenge him; and his replies constitute an interesting selection from all the sciences of the age. He inveighs against the bondage of tradition and authority. “I learned from my Arabian masters under the leading of reason; you, however, captivated by… authority, follow your halter. For what else should authority be called than a halter?” Those who are now counted as authorities gained their reputation by following reason, not authority. “Therefore,” he tells his nephew, “if you want to hear anything more from me, give and take reason…. Nothing is surer than reason… nothing is falser than the senses.”88 Though Adelard relies too confidently on deductive reasoning, he gives some interesting replies. Asked how the earth is upheld in space, he answers that the center and the bottom are the same. How far would a stone fall if dropped into a hole bored through the center of the earth to the other side?—he answers, Only to the center of the earth. He states clearly the indestructibility of matter, and argues that universal continuity makes a vacuum impossible. All in all, Adelard is a brilliant proof of the awakening intellect in Christian Europe in the twelfth century. He was enthusiastic about the possibilities of science, and proudly calls his age—the age of Abélard—modernus,89 the climax of all history.
Albertus Magnus had a little less of the scientific spirit than Adelard, but so cosmic a curiosity that the very immensity of his product won him the name Great. His scientific, like his philosophical, works took mostly the form of commentaries on the corresponding treatises of Aristotle, but they contain now and then fresh breaths of original observation; amid a cloud of quotations from Greek, Arabic, and Jewish authors he finds some opportunities to look at nature in the first person. He visited laboratories and mines, studied diverse metals, examined the fauna and flora of his native Germany, noted displacements of land by sea, sea by land, and explained thereby the fossil shells in rocks. Too much of a philosopher to be a thorough scientist, he allowed a priori theories to color his vision, as when he claimed to have seen horsehairs in water change into worms. But, like Adelard, he rejected the explanation of natural phenomena in terms of the will of God; God acts through natural causes, and man must seek Him there.
His notion of experiment was obscured by his confidence in Aristotle. A famous passage in Book X of his De vegetabilibus stirs us with the words Experimentum solum certificat, which seems to say that “only experiment gives certainty.” But the word experimentum had then a broader meaning than now; it meant experience rather than experiment, as appears from the context of the passage: “All that is here set down is the result of our own experience, or has been borrowed from authors whom we know to have written what their personal experience has confirmed; for in these matters experimentum solum certificat.” Even so, it was a wholesome advance. Albert laughs at such mythical creatures as the harpies or the griffin, and the animal legends of a then popular book, the Physiologus, and he notes that “philosophers tell many lies.”90 Sometimes, not often, he performed experiments, as when he and his associates proved that a beheaded cicada continued for a while to sing. But he trusted Pliny’s authority with saintly innocence, and believed too simply the tales told him by such notorious liars as hunters and fishermen.91
He yielded to his times in accepting astrology and divination. He attributes marvelous powers to gems and stones, and claims to have seen with his own eyes a sapphire that cured ulcers. He thinks, like undoubting Thomas, that magic is real, and is due to demons. Dreams sometimes foretell events. In corporeal matters “the stars are in truth rulers of the world”; the conjunctions of the planets probably explain “great accidents and great prodigies”; and comets may signify wars and the death of kings. “There is in man a double spring of action—nature, and the will; the nature is ruled by the stars, the will is free; but unless the will resists it is swept along by nature.” He believes that competent astrologers may in considerable measure prophesy the events of a man’s life, or the issue of an enterprise, from the position of the stars. He accepts, with certain reserves, the alchemic (today the nuclear physicist) theory of the transmutation of elements.92
His best scientific work was in botany. He was the first botanist since Theophrastus (so far as we know) to consider plants for their own sake instead of for their use in agriculture or medicine. He classified plants, described their color, odor, parts, and fruit, studied their feeling, sleep, sex, and germination, and ventured an essay on husbandry. Humboldt was surprised to find in Albert’s De vegetabilibus “exceedingly acute remarks on the organic structure and physiology of plants.”93 His enormous work De animalibus is largely a paraphrase of Aristotle, but here, too, we find original observation. Albert tells of “sailing the North Sea for the sake of research [experimenti causa], and landing on islands and sandy shores to collect” objects for study.94 He compared similar organs in animals and man.95
From the vantage point of our hindsight these works contain many mistakes; viewed against the intellectual background of their time they are among the major achievements of the medieval mind. Albert was recognized in his own lifetime as the greatest teacher of his age, and he lived long enough to be quoted as an authority by men like Peter of Spain and Vincent of Beauvais, who both died before him. He could not rival Averroës or Maimonides or Thomas in keenness of judgment or philosophic grasp; but he was the greatest naturalist of his time.
VII. ROGER BACON: C. 1214–92
The most famous of medieval scientists was born in Somerset about 1214. We know that he lived till 1292, and that in 1267 he called himself an old man.96 He studied at Oxford under Grosseteste, and caught from the great polymath a fascination for science; already in that circle of Oxford Franciscans the English spirit of empiricism and utilitarianism was taking form. He went to Paris about 1240, but did not find there the stimulation that Oxford had given him; he marveled that so few Parisian professors knew any learned language besides Latin, that they gave so little time to science, and so much to logical and metaphysical disputes that seemed to Bacon criminally useless for life. He “majored” in medicine, and began to write a treatise on the relief of old age. To get data he visited Italy, studied Greek in Magna Graecia, and there became acquainted with some works of Moslem medicine. In 1251 he returned to Oxford, and joined the teaching staff. He wrote in 1267 that in the preceding twenty years he had spent “more than £2000 in the purchase of secret books and instruments,” and in training young men in languages and mathematics.97 He engaged Jews to teach him and his students Hebrew, and to help him read the Old Testament in the original. About 1253 he entered the Franciscan Order, but he seems never to have become a priest.
Sick of the metaphysics of the schools, Bacon gave himself with passion to mathematics, natural science, and philology. We must not think of him as a lone originator, a scientific voice crying out in the scholastic wilderness. In every field he was indebted to his
predecessors, and his originality was the forceful summation of a long development. Alexander Neckham, Bartholomew the Englishman, Robert Grosseteste, and Adam Marsh had established a scientific tradition at Oxford; Bacon inherited it, and proclaimed it to the world. He acknowledged his indebtedness, and gave his predecessors unmeasured praise. He recognized also his debt—and the debt of Christendom—to Islamic science and philosophy, and through these to the Greeks, and suggested that the “heathen” savants of Greece and Islam had also, in their own fashion, been inspired and guided by God.98 He had a high regard for Isaac Israeli, Ibn Gabirol, and other Hebrew thinkers, and had the courage to say a good word for the Jews who lived in Palestine at the time of the crucifixion of Christ.99 He learned avidly not only from learned men, but from any man whose practical knowledge in handicraft or husbandry could augment his store. He writes with unwonted humility:
It is certain that never, before God is seen face to face, shall a man know anything with final certainty…. For no one is so learned in nature that he knows all… the nature and properties of a single fly…. And since, in comparison with what a man knows, those things of which he is ignorant are infinite, and beyond comparison greater and more beautiful, he is out of his mind who extols himself in regard to his own knowledge…. The wiser men are, the more humbly they are disposed to receive the instruction of another, nor do they disdain the simplicity of the teacher, but behave humbly toward peasants, old women, and children, since many things are known to the simple and unlearned which escape the notice of the wise…. I have learned more important truths from men of humble station than from all the famous doctors. Let no man, therefore, boast of his wisdom.100
He labored with such fervor and haste that in 1256 his health broke down; he retired from university life, and for ten years we lose track of him. Probably in this period he composed some of his minor works—De speculis comburentibus (On Burning Glasses), De mirabili potestate artis et naturae (On the Marvelous Power of Invention and Nature), and Computus naturalium (Computation of Natural Events). Now also he planned his “Principal Work”—Scriptum principale, a one-man encyclopedia to be in four volumes: (1) grammar and logic; (2) mathematics, astronomy, and music; (3) natural science—optics, geography, astrology, alchemy, agriculture, medicine, and experimental science; and (4) metaphysics and morals.