Kitabı oku: «The Popes and Science», sayfa 13

PAPAL PHYSICIANS

Most of what historical writers generally, who follow the old traditions of the medieval eclipse of medicine, have to say with regard to the supposed Papal opposition to the development of medical science, is founded on the assumption that men who believed in miracles and in the efficacy of prayer for the relief of disease could not possibly be interested to any serious degree in scientific medicine. As Dr. White says, "out of all these inquiries came inevitably that question whose logical answer was especially injurious to the development of medical science: why should men seek to build up scientific medicine and surgery, when relics, pilgrimages, and sacred observances, according to an overwhelming mass of concurrent testimony, have cured and are curing hosts of sick folk in all parts of Europe." He goes even farther than this, however, when he suggests that "it would be expecting too much from human nature to imagine that Pontiffs who derived large revenues from the sale of the Agnus Dei, or priests who derived both wealth and honors from cures wrought at shrines under their care, or lay dignitaries who had invested heavily in relics, should favor the development of any science which undermined their interests."

On the strength of assumptions such as these, that "medieval belief in miracles of healing must have checked medical science," and that therefore it did actually prevent the development of scientific medicine, statements are made with regard to the history of medicine that are utterly at variance with the plain facts of history. Once more, as in the case of the supposed failure of surgery to develop during the Middle Ages, it is a deduction that has been made from certain supposed principles, and not an induction from the actual facts as we know them. Such historians would be the first to emphasize the narrowness of the schoolmen for their supposed dependence on deduction, but what they have to say on medical history is entirely deductive, and unfortunately from premises that will not stand in the presence of the story of the wonderful rise and development of medical science and medical education, mainly under the patronage of ecclesiastics, in the Middle Ages.

The argument may be stated formally with perfect fairness as follows: When men believe in miracles they cannot build up scientific medicine and surgery; but men believed in miracles in the Middle Ages, therefore they did not build up scientific medicine and surgery. When stated thus baldly in formal scholastic form, the argument loses most of the glamor that has been thrown around it. This is one of the advantages of the old scholastic method–it strips argument to its naked significance. Logic asserts herself and rhetoric loses its force.

With regard to the major premise that when men believe in miracles they will not successfully pursue investigations in the medical science, there are two answers. One of these concerns the actual attitude of mind towards scientific medicine of men who believe in miracles, for we have such men still with us, and have always had them all during the past seven centuries. The other portion of the answer concerns what men who were distinguished scientific investigators thought of miracles, and how much they accomplished for the medical sciences while all the time maintaining their belief in the possibility of miraculous intervention for the cure of disease.

Apparently the writers who insist on the incompatibility of the belief in miracles with devotion to scientific medicine do not realize that the greater number of thinking physicians during the last seven centuries, and quite down to our own day, have been ready to confess their belief in the possibility of miraculous healing, yet have tried to do everything in their power to relieve suffering and cure human ills by the natural means at their command. Their attitude has been very much that attributed to Ignatius of Loyola, who said to the members of his order: "Do everything that you can with the idea that everything depends on you, and then hope for results just as if everything depended on God." There is no lack of logic in this; and the physician of the present day who realizes his impotency in the presence of so many of the serious ailments of mankind is not a scoffer at the attitude of mind that looks for help from prayer; but if he is sensible, welcomes the placidity of mind this will give his patient, even if he does not, as many actually do, however, believe in the possible interposition of supernatural forces.

If Prof. White knew anything about the lives of the men whose names are most distinguished in the history of medicine during the thirteenth, fourteenth and fifteenth centuries, we would have heard nothing of his almost incomprehensible negation of the existence of scientific medicine, during centuries when so many men who have stamped their names indelibly on the history of the medical sciences were doing their work and writing. If he had taken any pains to learn even a few details of the personal relations of these old-time makers of medicine to the Popes, we would have heard none of this utter absurdity of Papal opposition to medicine or ecclesiastical hampering of medical science. To answer Prof. White's argument, that "it would be expecting too much from human nature to imagine that Pontiffs should favor the development of any science which undermined their interests," the simple story of the men the Popes choose as their own medical advisers, and who because of the prestige of their appointment as Papal Physicians helped to raise up in the eyes of the people the dignity of the medical profession which they represented, will be quite enough. It will also serve to show how different is history founded on an assumption from history founded on actual facts.

The best, most easily obtainable, and most impressive data for the inductive method of reaching the truth as regards the relation of the Popes to medical science and (because of the fact that physicians were the scientists par excellence of the Middle Ages) to all science, will be found in a brief consideration of the lives of the men who occupied the position of Papal Physician during the last seven centuries. I do not think that this group of men has ever been treated together before; at least I have been unable to find any work on the subject. While I am able to present a considerable amount of interesting material in brief form with regard to them, I am sure that there are many of them whom I have omitted. Practically up to the day of going to press I have been finding new references that led to further precious information with regard to this most wonderful group of men in medical history. It will be well understood, then, that impressive as the consideration of the work and character of the men whose names I have found must be, this does not represent all the truth in the matter, but can be supplemented without much difficulty from other sources.

If the Popes had been interested only in the miraculous healing of disease, and had wished to teach the lesson that men should depend solely for their recovery from serious symptoms and ailments of all kinds on prayers and relics and pilgrimages, then they would either have had no physicians at all in regular attendance on them, or at least their physicians would not have been selected from among the men who were doing most to advance the cause of practical and scientific medicine and of medical education. The very opposite of this is the case. The Papal physicians were as a rule the most scientific medical men of their time. This is not a pious exaggeration, but is literally true for seven centuries of history, as we shall see presently. The wonder of it is that there were not some charlatans among them. The physicians whom educated people select are not, as physicians we'll know, always worthy examples of progressive medical men. Literary folk particularly seem to have a distinct tendency to want to be different from other people, and their physicians are often the veriest theorizers. A medical friend who occasionally quotes, but perverts the old line, "the people people have for friends are often very queer," says, half in jest of course, but alas! more than half in earnest, that "the people literary folk and the clergy have for doctors are the queerest ducks (docs.) of all."

It is only too true that clergymen are especially prone to be erratic in the choice of their medical advisers and lacking in a critical judgment as to the remedies and methods of treatment of which they become the willing recipients, and occasionally even the sponsors as regards other people, who look up to their judgment for other reasons with confidence. Prof. Osler once said that the nearer to the Council of Trent the clergyman, the nearer he was likely to be to truth and common sense in medical matters; but then perhaps all would not agree with him. It is all the more surprising under the circumstances, and very greatly to their credit, that the Popes should have had as their physicians a list of men whose names are the brightest on the roll of great contributors to medical literature and some of the most distinguished among the great discoverers in medical science.

This fact alone constitutes the most absolute contradiction of the declarations as to supposed Church opposition to medicine that could possibly be given. No better means of encouraging, fostering, and patronizing medical science could be thought of than to give the prestige and the emoluments of physician to the head of the Church to important makers of medicine in every generation. The physicians to the rulers of Europe have not always been selected with as good judgment, and, as I have already said, there is no list of physicians to any European Court, nor indeed any list of names of medical men connected together by any bond in history–no list, for instance, of any medical faculty of a university–which can be compared for prestige in scientific medicine with the Papal Physicians.

Before the beginning of the thirteenth century very little is known of the medical attendants of the Popes. We point out in the following chapter that the Papacy was closely in touch with the medical school at Salernum. It seems not unlikely, and indeed there are some traditions to that effect, that in cases of severe illnesses of the Popes, important members of the medical faculty were sometimes summoned from the South of Italy to Rome. The relations of the Popes to the neighboring abbey of Monte Cassino might, as we have said, suggest this. We have, however, very few details in this matter. With the beginning of the great thirteenth century, however, the records of human achievement in every line are better kept, and at once we begin to know something definite about Papal Physicians. The first one of decided prominence was Guy or Guido of Montpelier, who was summoned to Rome by Pope Innocent III. in order that he might re-establish the hospital of the Santo Spirito at Rome, in accordance with what were considered to be the latest ideas in the matter of hospital building and the enlightened care of the sick. How well he accomplished this work, and how well he deserves to head the glorious roll of Papal Physicians, will be seen in the chapter on The Popes and City Hospitals.

The next of the Papal Physicians of whom much is known in the history of medicine was Richard the Englishman, usually spoken of as Ricardus Anglicus. He was the physician to the famous Pope Gregory IX. (1237-1241). Richard, who was born in England not long before the beginning of the thirteenth century, died shortly after the middle of that century. For a time he was at Paris, and accordingly is sometimes spoken of as Ricardus Parisiensis. According to Gabriel Naudé he was at Paris after the death of his patient, Gregory IX., and towards the end of his life retired to the Abbey of St. Victor, to spend his last days in recollection and prayer. In this he anticipated another great English physician with a European reputation–Linacre–who, three centuries later, after having been the royal physician for many years to King Henry VIII., became a clergyman. It is interesting to realize that, early in history as Richard's life occurs, some works attributed to him contain definite information with regard to anatomy. Most of this, it is true, is taken from Hippocrates, Galen, and the Arabs, but some of it seems to be the result of his own personal experience, on the living, if not on the dead.

After Richard, the next of the physicians to the Popes who has an important place in the history of medicine is the famous Thaddeus Alderotti, who lived for more than eighty years during the thirteenth century. He has the added interest for this generation of having been a self-made man, for he was the son of very poor parents of the lowest rank. Up to his thirtieth year he remained without any special education. He made his living, it is said, by selling candles. Having acquired a little competency, at the age of thirty he began with great zeal the study of philosophy and of medicine, two sciences which in the old days were supposed to go very well together, though, unfortunately, they are often rigidly separated from each other in later times. Fifteen years after he began the study of medicine we hear of him as a medical teacher, and then ten years later he began to be famous as a writer on all sorts of medical topics. He became the physician of Pope Honorius IV., himself one of the most liberal and broadly educated of men, and as the result of the confidence awakened by his occupancy of this honorable position, he secured an immense success in practice and made an enormous fortune. Alderotti's work represents what is best in medicine for the whole of the thirteenth century.

A curiously interesting episode that deserves a place in the history of Papal Physicians occurred during Alderotti's life. One of the Popes elected to fill the Papal chair had been earlier in life a physician. This was the famous Peter of Spain, though he was really a Portuguese, who, under the name of John XXI., occupied the Papal throne during the years 1276-1277. Peter of Spain had been one of the most distinguished natural scientists of this interesting century. Dr. J. B. Petella, in an article published in Janus about ten years ago, entitled A Critical and Historical Study of the Knowledge of Ophthalmology of a Philosopher Physician who became Pope, gives an excellent account of the life of Pope John XXI. [Footnote 27]

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

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

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

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

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

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

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

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

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

The last of the Papal Physicians connected with the Pontifical Court at Avignon was almost as illustrious as any of his predecessors. He was the well-known Joannes de Tornamira, who was the body physician to Gregory XI. until that Pontiff brought the Papal Court back to Rome. Then Tornamira became the chancellor of the University of Montpelier. He wrote an introduction to the study of medicine, meant for the use of students and young physicians, called a Clarificatorium, which, according to Puschmann's History of Medicine, was the most used text-book of medicine during the fourteenth and fifteenth centuries. Besides this he wrote a long and important work On Fevers and the Accidents of Fevers, in which he sums up all the medical knowledge of the time on these subjects.

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

One of the first writers on medical cases who did not indulge much in theory was Baverius de Baveriis, of Imola, who died about 1480, and who was the physician to Pope Nicholas V. shortly before and after the middle of the fifteenth century. In the light of the fact that a recent Papal physician, Dr. Lapponi, has written a book on hypnotism and spiritism, it is interesting to find that his predecessor in the post of Papal Physician four centuries and a half ago, discussed the differential diagnosis of hysteria, catalepsy, epilepsy and syncope. He also discusses certain interesting cases of vertigo due to stomach trouble, and in general anticipates very unexpectedly neurotic conditions that are supposed to have been recognized in medicine much later than his time. Perhaps the most startling thing to be found in his works is his recommendation of iron for chlorosis, which he claimed to have treated with the greatest success by means of this remedy. Of course, there was no idea at the time that chlorosis was due in any sense to a lack of iron in the system, and its value as a therapeutic agent must have come entirely from empiric considerations; but then most of our advances in drug therapeutics have come by no better way.

Another of the distinguished Papal Physicians of the fifteenth century was John of Vigo (1460-1520), who, as Professor Allbutt notes, was attached to the court of the fighting Pontiff, Julius II., and as a consequence saw much of field surgery. His text-book of surgery, printed at Rome in the early part of the sixteenth century, went through an enormous number of editions. No standard surgical treatise had appeared since that of Guy de Chauliac, and Vigo's continued to be the standard for the next full century. He was a shrewd and skilful as well as a learned physician. His surgical acumen deserves to be noted. He recognized that fracture of the inner table of the skull might take place without that of the outer, and made some very practical remarks with regard to gangrene and its causes. He attributed gangrene in certain cases to faulty bandaging in fractures, and discussed its origin also as the result of severe cold. He treated syphilis with mercurial inunctions, a practice still followed by the best specialists in this line. His greatest claim to fame, however, is founded on the fact that he was the first to write a surgical treatise on wounds made by firearms.

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