the evolution of modern medicine-第21章

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James　J。　Walsh　of　New　York　has　written　a　book　of　extraordinary　interest　called　〃The　Thirteenth；　Greatest　of　Centuries。〃　　I　have　not　the　necessary　knowledge　to　say　whether　he　has　made　out　his　case　or　not　for　art　and　for　literature。　　There　was　certainly　a　great　awakening　and；　inspired　by　high　ideals；　men　turned　with　a　true　instinct　to　the　belief　that　there　was　more　in　life　than　could　be　got　out　of　barren　scholastic　studies。　With　many　of　the　strong　men　of　the　period　one　feels　the　keenest　mental　sympathy。　Grosseteste；　the　great　Clerk　of　Lincoln；　as　a　scholar；　a　teacher　and　a　reformer；　represents　a　type　of　mind　that　could　grow　only　in　fruitful　soil。　　Roger　Bacon　may　be　called　the　first　of　the　modernscertainly　the　first　to　appreciate　the　extraordinary　possibilities　which　lay　in　a　free　and　untrammelled　study　of　nature。　A　century　which　could　produce　men　capable　of　building　the　Gothic　cathedrals　may　well　be　called　one　of　the　great　epochs　in　history；　and　the　age　that　produced　Dante　is　a　golden　one　in　literature。　Humanity　has　been　the　richer　for　St。　Francis；　and　Abelard；　Albertus　and　Aquinas　form　a　trio　not　easy　to　match；　in　their　special　departments；　either　before　or　after。　　But　in　science；　and　particularly　in　medicine；　and　in　the　advance　of　an　outlook　upon　nature；　the　thirteenth　century　did　not　help　man　very　much。　　Roger　Bacon　was　〃a　voice　crying　in　the　wilderness；〃　and　not　one　of　the　men　I　have　picked　out　as　specially　typical　of　the　period　instituted　any　new　departure　either　in　practice　or　in　science。　　They　were　servile　followers；　when　not　of　the　Greeks；　of　the　Arabians。　　This　is　attested　by　the　barrenness　of　the　century　and　a　half　that　followed。　　One　would　have　thought　that　the　stimulus　given　by　Mundinus　to　the　study　of　anatomy　would　have　borne　fruit；　but　little　was　done　in　science　during　the　two　and　a　half　centuries　that　followed　the　delivery　of　his　lectures　and　still　less　in　the　art。　While　William　of　Wykeham　was　building　Winchester　Cathedral　and　Chaucer　was　writing　the　Canterbury　Tales；　John　of　Gaddesden　in　practice　was　blindly　following　blind　leaders　whose　authority　no　one　dared　question。

The　truth　is；　from　the　modern　standpoint　the　thirteenth　was　not　the　true　dawn　brightening　more　and　more　unto　the　perfect　day；　but　a　glorious　aurora　which　flickered　down　again　into　the　arctic　night　of　mediaevalism。

To　sum　upin　medicine　the　Middle　Ages　represent　a　restatement　from　century　to　century　of　the　facts　and　theories　of　the　Greeks　modified　here　and　there　by　Arabian　practice。　　There　was；　in　Francis　Bacon's　phrase；　much　iteration；　small　addition。　The　schools　bowed　in　humble；　slavish　submission　to　Galen　and　Hippocrates；　taking　everything　from　them　but　their　spirit　and　there　was　no　advance　in　our　knowledge　of　the　structure　or　function　of　the　body。　The　Arabians　lit　a　brilliant　torch　from　Grecian　lamps　and　from　the　eighth　to　the　eleventh　centuries　the　profession　reached　among　them　a　position　of　dignity　and　importance　to　which　it　is　hard　to　find　a　parallel　in　history。



CHAPTER　IV

THE　RENAISSANCE　AND　THE　RISE　OF　ANATOMY　AND　PHYSIOLOGY

THE　〃reconquest　of　the　classic　world　of　thought　was　by　far　the　most　important　achievement　of　the　fifteenth　and　sixteenth　centuries。　It　absorbed　nearly　the　whole　mental　energy　of　the　Italians。。。。　The　revelation　of　what　men　were　and　what　they　wrought　under　the　influence　of　other　faiths　and　other　impulses；　in　distant　ages　with　a　different　ideal　for　their　aim；　not　only　widened　the　narrow　horizon　of　the　Middle　Ages；　but　it　also　restored　self…confidence　to　the　reason　of　humanity。〃＇1＇

＇1＇　J。　A。　Symonds：　　The　Renaissance　in　Italy；　the　Revival　of　Learning；　1877；　p。　52。


Everywhere　throughout　the　Middle　Ages　learning　was　the　handmaid　of　theology。　Even　Roger　Bacon　with　his　strong　appeal　for　a　new　method　accepted　the　dominant　mediaeval　convictionthat　all　the　sciences　did　but　minister　to　their　queen；　Theology。　　A　new　spirit　entered　man's　heart　as　he　came　to　look　upon　learning　as　a　guide　to　the　conduct　of　life。　A　revolution　was　slowly　effected　in　the　intellectual　world。　It　is　a　mistake　to　think　of　the　Renaissance　as　a　brief　period　of　sudden　fruitfulness　in　the　North　Italian　cities。　　So　far　as　science　is　concerned；　the　thirteenth　century　was　an　aurora　followed　by　a　long　period　of　darkness；　but　the　fifteenth　was　a　true　dawn　that　brightened　more　and　more　unto　the　perfect　day。　　Always　a　reflex　of　its　period；　medicine　joined　heartily　though　slowly　in　the　revolt　against　mediaevalism。　　How　slowly　I　did　not　appreciate　until　recently。　Studying　the　earliest　printed　medical　works　to　catch　the　point　of　view　of　the　men　who　were　in　the　thick　of　the　movement　up　to　1480　which　may　be　taken　to　include　the　first　quarter　of　a　century　of　printing　one　gets　a　startling　record。　　The　mediaeval　mind　still　dominates：　of　the　sixty…seven　authors　of　one　hundred　and　eighty…two　editions　of　early　medical　books；　twenty…three　were　men　of　the　thirteenth　and　fourteenth　centuries；　thirty　men　of　the　fifteenth　century；　eight　wrote　in　Arabic；　several　were　of　the　School　of　Salernum；　and　only　six　were　of　classical　antiquity；　viz。；　Pliny　（first　1469）；　Hippocrates　（1473）　＇Hain　＇*＇7247＇；　Galen　（1475）　＇Hain　7237＇；　Aristotle　（1476）；　Celsus　（1478）；　and　Dioscorides　（1478）。＇**＇

＇*＇　This　asterisk　is　used　by　Hain　to　indicate　that　he　had　seen　a　copy。Ed。

＇**＇　Data　added　to　a　manuscript　taken　from　the　author's　summary　on　〃Printed　Medical　Books　to　1480〃　in　Transactions　of　the　Bibliographical　Society；　London；　1916；　XIII；　5…8；　revised　from　its　〃News…Sheet〃　（February；　1914）。　〃Of　neither　Hippocrates　nor　Galen　is　there　an　early　edition；　but　in　1473　at　Pavia　appeared　an　exposition　of　the　Aphorisms　of　Hippoerates；　and　in　1475　at　Padua　an　edition　of　the　Tegni　or　Notes　of　Galen。〃　　Ibid。；　p。　6。　Osler's　unfinished　Illustrated　Monograph　on　this　subject　is　now　being　printed　for　the　Society　of　which　he　was　President。Ed。


The　medical　profession　gradually　caught　the　new　spirit。　It　has　been　well　said　that　Greece　arose　from　the　dead　with　the　New　Testament　in　the　one　hand　and　Aristotle　in　the　other。　There　was　awakened　a　perfect　passion　for　the　old　Greek　writers；　and　with　it　a　study　of　the　original　sources；　which　had　now　become　available　in　many　manuscripts。　Gradually　Hippocrates　and　Galen　came　to　their　own　again。　Almost　every　professor　of　medicine　became　a　student　of　the　MSS。　of　Aristotle　and　of　the　Greek　physicians；　and　before　1530　the　presses　had　poured　out　a　stream　of　editions。　A　wave　of　enthusiasm　swept　over　the　profession；　and　the　best　energies　of　its　best　minds　were　devoted　to　a　study　of　the　Fathers。　　Galen　became　the　idol　of　the　schools。　A　strong　revulsion　of　feeling　arose　against　the　Arabians；　and　Avicenna；　the　Prince；　who　had　been　clothed　with　an　authority　only　a　little　less　than　divine；　became　anathema。　Under　the　leadership　of　the　Montpellier　School；　the　Arabians　made　a　strong　fight；　but　it　was　a　losing　battle　all　along　the　line。　This　group　of　medical　humanistsmen　who　were　devoted　to　the　study　of　the　old　humanities；　as　Latin　and　Greek　were　called　has　had　a　great　and　beneficial　influence　upon　the　profession。　They　were　for　the　most　part　cultivated　gentlemen　with　a　triple　interestliterature；　medicine　and　natural　history。　How　important　is　the　part　they　played　may　be　gathered　from　a　glance　at　the　〃Lives〃　given　by　Bayle　in　his　〃Biographic　Medicale〃　（Paris；　1855）　between　the　years　1500　and　1575。　　More　than　one　half　of　them　had　translated　or　edited　works　of　Hippocrates　or　Galen；　many　of　them　had　made　important　contributions　to　general　literature；　and　a　large　proportion　of　them　were　naturalists：　Leonicenus；　Linacre；　Champier；　Fernel；　Fracastorius；　Gonthier；　Caius；　J。　Sylvius；　Brasavola；　Fuchsius；　Matthiolus；　Conrad　Gesner；　to　mention　only　those　I　know　best；　form　a　great　group。　Linacre　edited　Greek　works　for　Aldus；　translated　works　of　Galen；　taught　Greek　at　Oxford；　wrote　Latin　grammars　and　founded　the　Royal　College　of　Physicians。＇*＇　Caius　was　a　keen　Greek　scholar；　an　ardent　student　of　natural　history；　and　his　name　is　enshrined　as　co…founder　of　one　of　the　most　important　of　the　Cambridge　colleges。　Gonthier；　Fernel；　Fuchs　and　Mattioli　were　great　scholars　and　greater　physicians。　　Champier；　one　of　the　most　remarkable　of　the　group；　was　the　founder　of　the　Hotel　Dieu　at　Lyons；　and　author　of　books　of　a　characteristic　Renaissance　type　and　of　singular　bibliographical　interest。　　In　many　ways　greatest　of　all　was　Conrad　Gesner；　whose　mors　inopinata　at　forty…nine；　bravely　fighting　the　plague；　is　so　touchingly　and　tenderly　mourned　by　his　friend　Caius。＇2＇　Physician；　botanist；　mineralogist；　geologist；　chemist；　the　first　great　modern　bibliographer；　he　is　the　very　embodiment　of　the　spirit　of　the　age。＇2a＇　On　the　flyleaf　of　my　copy　of　the　〃Bibliotheca　Universalis〃　（1545）；　is　written　a　fine　tribute　to　his　memory。　I　do　not　know　by　whom　it　is；　but　I　do　know　from　my　reading　that　it　is　true：

＇*＇　Cf。　　Osler：　　Thomas　Linacre；　Cambridge　University　Press；　1908。Ed。

＇2＇　Joannis　Caii　Britanni　de　libris　suis；　etc。；　1570。

＇2a＇　See　J。　C。　Bay：　　Papers　Bibliog。　Soc。　of　America；　1916；　X；　No。　2；　53…86。


〃Conrad　Gesner；　who　kept　open　house　there　for　all　learned　men　who　came　into　his　neighborhood。　　Gesner　was　not　only　the　best　naturalist　among　the　scholars　of　his　day；　but　of　all　men　of　that　century　he　was　the　pattern　man　of　letters。　He　was　faultless　in　private　life；　assiduous　in　study；　diligent　in　maintaining　correspondence　and　good…will　with　learned　men　in　all　countries；　hospitablethough　his　means　were　small　to　every　scholar　that　came　into　Zurich。　　Prompt　to　serve　all；　he　was　an　editor　of　other　men's　volumes；　a　writer　of　prefaces　for　friends；　a　suggestor　to　young　writers　of　books　on　which　they　might　engage　themselves；　and　a　great　helper　to　them　in　the　progress　of　their　work。　　But　still；　while　finding　time　for　services　to　other　men；　he　could　produce　as　much　out　of　his　own　study　as　though　he　had　no　part　in　the　life　beyond　its　walls。〃

A　large　majority　of　these　early　naturalists　and　botanists　were　physicians。＇3＇　The　Greek　art　of　observation　was　revived　in　a　study　of　the　scientific　writings　of　Aristotle；　Theophrastus　and　Dioscorides　and　in　medicine；　of　Hippocrates　and　of　Galen；　all　in　the　Greek　originals。　That　progress　was　at　first　slow　was　due　in　part　to　the　fact　that　the　leaders　were　too　busy　scraping　the　Arabian　tarnish　from　the　pure　gold　of　Greek　medicine　and　correcting　the　anatomical　mistakes　of　Galen　to　bother　much　about　his　physiology　or　pathology。　　Here　and　there　among　the　great　anatomists　of　the　period　we　read　of　an　experiment；　but　it　was　the　art　of　observation；　the　art　of　Hippocrates；　not　the　science　of　Galen；　not　the　carefully　devised　experiment　to　determine　function；　that　characterized　their　work。　　There　was　indeed　every　reason　why　men　should　have　been　content　with　the　physiology　and　pathology　of　that　day；　as；　from　a　theoretical　standpoint；　it　was　excellent。　The　doctrine　of　the　four　humors　and　of　the　natural；　animal　and　vital　spirits　afforded　a　ready　explanation　for　the　symptoms　of　all　diseases；　and　the　practice　of　the　day　was　admirably　adapted　to　the　theories。　There　was　no　thought　of；　no　desire　for；　change。　　But　the　revival　of　learning　awakened　in　men　at　first　a　suspicion　and　at　last　a　conviction　that　the　ancients　had　left　something　which　could　be　reached　by　independent　research；　and　gradually　the　paralyt