THIRTEENTH-CENTURY MEDICINE
The thirteenth century marks the beginning of a gradual change in
medicine, and a tendency to leave the time-worn rut of
superstitious dogmas that so long retarded the progress of
science. It is thought that the great epidemics which raged
during the Middle Ages acted powerfully in diverting the medical
thought of the times into new and entirely different channels. It
will be remembered that the teachings of Galen were handed
through mediaeval times as the highest and best authority on the
subject of all diseases. When, however, the great epidemics made
their appearance, the medical men appealed to the works of Galen
in vain for enlightenment, as these works, having been written
several centuries before the time of the plagues, naturally
contained no information concerning them. It was evident,
therefore, that on this subject, at least, Galen was not
infallible; and it would naturally follow that, one fallible
point having been revealed, others would be sought for. In other
words, scepticism in regard to accepted methods would be aroused,
and would lead naturally, as such scepticism usually does, to
progress. The dev 14314w2222o astating effects of these plagues, despite
prayers and incantations, would arouse doubt in the minds of many
as to the efficacy of superstitious rites and ceremonies in
curing diseases. They had seen thousands and tens of thousands of
their fellow-beings swept away by these awful scourges. They had
seen the ravages of these epidemics continue for months or even
years, notwithstanding the fact that multitudes of God-fearing
people prayed hourly that such ravages might be checked. And they
must have observed also that when even very simple rules of
cleanliness and hygiene were followed there was a diminution in
the ravages of the plague, even without the aid of incantations.
Such observations as these would have a tendency to awaken a
suspicion in the minds of many of the physicians that disease was
not a manifestation of the supernatural, but a natural
phenomenon, to be treated by natural methods.
But, be the causes what they may, it is a fact that the
thirteenth century marks a turning-point, or the beginning of an
attitude of mind which resulted in bringing medicine to a much
more rational position. Among the thirteenth-century physicians,
two men are deserving of special mention. These are Arnald of
Villanova (1235-1312) and Peter of Abano (1250-1315). Both these
men suffered persecution for expressing their belief in natural,
as against the supernatural, causes of disease, and at one time
Arnald
was obliged to flee from
"bulls" of popes were human works, and that "acts of charity were
dearer to God than hecatombs." He was also accused of alchemy.
Fleeing from persecution, he finally perished by shipwreck.
Arnald was the first great representative of the school of
was active in attempting to re-establish the teachings of
Hippocrates and Galen. He was one of the first of a long line of
alchemists who, for several succeeding centuries, expended so
much time and energy in attempting to find the "elixir of life."
The Arab discovery of alcohol first deluded him into the belief
that the "elixir" had at last been found; but later he discarded
it and made extensive experiments with brandy, employing it in
the treatment of certain diseases--the first record of the
administration of this liquor as a medicine. Arnald also revived
the search for some anaesthetic that would produce insensibility
to pain in surgical operations. This idea was not original with
him, for since very early times physicians had attempted to
discover such an anaesthetic, and even so early a writer as
Herodotus tells how the Scythians, by inhalation of the vapors of
some kind of hemp, produced complete insensibility. It may have
been these writings that stimulated Arnald to search for such an
anaesthetic. In a book usually credited to him, medicines are
named and methods of administration described which will make the
patient insensible to pain, so that "he may be cut and feel
nothing, as though he were dead." For this purpose a mixture of
opium, mandragora, and henbane is to be used. This mixture was
held at the patient's nostrils much as ether and chloroform are
administered by the modern surgeon. The method was modified by
Hugo of Lucca (died in 1252 or 1268), who added certain other
narcotics, such as hemlock, to the mixture, and boiled a new
sponge in this decoction. After boiling for a certain time, this
sponge was dried, and when wanted for use was dipped in hot water
and applied to the nostrils.
Just how frequently patients recovered from the administration of
such a combination of powerful poisons does not appear, but the
percentage of deaths must have been very high, as the practice
was generally condemned. Insensibility could have been produced
only by swallowing large quantities of the liquid, which dripped
into the nose and mouth when the sponge was applied, and a lethal
quantity might thus be swallowed. The method was revived, with
various modifications, from time to time, but as often fell into
disuse. As late as 1782 it was sometimes attempted, and in that
year the King of Poland is said to have been completely
anaesthetized and to have recovered, after a painless amputation
had been performed by the surgeons.
Peter of Abano was one of the first great men produced by the
than that of the shipwrecked Arnald had he not cheated the
purifying fagots of the church by dying opportunely on the eve of
his execution for heresy. But if his spirit had cheated the
fanatics, his body could not, and his bones were burned for his
heresy. He had dared to deny the existence of a devil, and had
suggested that the case of a patient who lay in a trance for
three days might help to explain some miracles, like the raising
of Lazarus.
His great work was Conciliator Differentiarum, an attempt to
reconcile physicians and philosophers. But his researches were
not confined to medicine, for he seems to have had an inkling of
the hitherto unknown fact that air possesses weight, and his
calculation of the length of the year at three hundred and
sixty-five days, six hours, and four minutes, is exceptionally
accurate for the age in which he lived. He was probably the first
of the Western writers to teach that the brain is the source of
the nerves, and the heart the source of the vessels. From this it
is seen that he was groping in the direction of an explanation of
the
circulation of the blood, as demonstrated by
centuries later.
The work of Arnald and Peter of Abano in "reviving" medicine was
continued
actively by Mondino (1276-1326) of
"restorer of anatomy," and by Guy of Chauliac: (born about 1300),
the "restorer of surgery." All through the early Middle Ages
dissections of human bodies had been forbidden, and even
dissection of the lower animals gradually fell into disrepute
because physicians detected in such practices were sometimes
accused of sorcery. Before the close of the thirteenth century,
however, a reaction had begun, physicians were protected, and
dissections were occasionally sanctioned by the ruling monarch.
Thus Emperor Frederick H. (1194-1250 A.D.)--whose services to
science we have already had occasion to mention--ordered that at
least one human body should be dissected by physicians in his
kingdom every five years. By the time of Mondino dissections were
becoming more frequent, and he himself is known to have dissected
and demonstrated several bodies. His writings on anatomy have
been called merely plagiarisms of Galen, but in all probability
be made many discoveries independently, and on the whole, his
work may be taken as more advanced than Galen's. His description
of the heart is particularly accurate, and he seems to have come
nearer to determining the course of the blood in its circulation
than any of his predecessors. In this quest he was greatly
handicapped by the prevailing belief in the idea that
blood-vessels must contain air as well as blood, and this led him
to assume that one of the cavities of the heart contained
"spirits," or air. It is probable, however, that his accurate
observations, so far as they went, were helpful stepping-stones
to
Guy of Chauliac, whose innovations in surgery reestablished that
science on a firm basis, was not only one of the most cultured,
but also the most practical surgeon of his time. He had great
reverence for the works of Galen, Albucasis, and others of his
noted predecessors; but this reverence did not blind him to their
mistakes nor prevent him from using rational methods of treatment
far in advance of theirs. His practicality is shown in some of
his simple but useful inventions for the sick-room, such as the
device of a rope, suspended from the ceiling over the bed, by
which a patient may move himself about more easily; and in some
of his improvements in surgical dressings, such as stiffening
bandages by dipping them in the white of an egg so that they are
held firmly. He treated broken limbs in the suspended cradle
still in use, and introduced the method of making "traction" on a
broken limb by means of a weight and pulley, to prevent deformity
through shortening of the member. He was one of the first
physicians to recognize the utility of spectacles, and
recommended them in cases not amenable to treatment with lotions
and eye-waters. In some of his surgical operations, such as
trephining for fracture of the skull, his technique has been
little improved upon even in modern times. In one of these
operations he successfully removed a portion of a man's brain.
Surgery was undoubtedly stimulated greatly at this period by the
constant wars. Lay physicians, as a class, had been looked down
upon during the Dark Ages; but with the beginning of the return
to rationalism, the services of surgeons on the battle-field, to
remove missiles from wounds, and to care for wounds and apply
dressings, came to be more fully appreciated. In return for his
labors the surgeon was thus afforded better opportunities for
observing wounds and diseases, which led naturally to a gradual
improvement in surgical methods.
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