The Popes and Science

Allbutt's story of the College of Surgeons of St. Côme at Paris is, as we have said, interesting from this standpoint. "Some of my readers may wonder how it is that in discoursing of medieval surgery I have not dwelt upon the Surgical College of St. Côme of Paris. Well, St. Côme did no great things for surgery. The truth is that, infected with the exclusiveness and dialectical conceits of all the schools of Paris, St. Côme was almost ready to sacrifice surgery itself if thereby it might choke off its parasites, the barbers. Lest they should be suspected of mixing their philosophy with facts, its members went about with their hands ostentatiously tied behind them. If perhaps Malgaigne speaks too contemptuously of St. Côme, it must be admitted that the college was in a false position throughout. In aping the Faculty of Medicine, it lost the touch of mother earth without gaining any harbourage in the deep waters of the proud. Nay, such is the Nemesis of pride, the barbers came to command the position. It did not suit the Faculty to see the barbers weakened; for in their weakness lay the strength of the surgeons of St. Côme, who sought incessantly to appear as lettered clerks, to attach their college to the university, and even to claim a place beside the Faculty itself. To bring St. Côme to its knees, and to check the presumptuous claims of this corporation on the privileges of the Faculty of Medicine, on a liberal education in arts and medicine, on a place in the university, on the suppression of unqualified surgical practice, and less, honourably, on relief from handicraft and urgent calls, the Faculty had to coquette with the barbers. Medicine, proclaimed the Faculty when it suited its purpose, contains the theoretical and the practical side of surgery; a surgeon is therefore but the servant of a physician. If St. Côme sought to provide lectures in surgery, the Faculty, which kept possession of teaching licenses and desired in the surgeon a docile assistant, took the teaching from the college and invited the barbers to lectures of its own. In their duplicity and conceit of caste, physicians of the Faculty condescended even to publish books on surgery, books as arid and as insincere as their lectures. On the other hand, in the person of the King's Barber, the barbers had a secret and potent influence at Court. The Faculty persisted in denying to St. Côme all 'esoteric' teaching, all diagnosis, and all use of medical therapeutics. Aristotle was pronounced to be unfavorable to the 'vulgarizing of science.' Joubert was attacked for editing Guy, but replied with dignity (in the notes of his edition). While the Faculty thus tried to prevent the access to letters of a presumptuous body of artisans, St. Côme in mimic arrogance disdained the barbers, sought to deny them the name of surgeon, and was jealous of the diffusion of technical knowledge among them in the vernacular tongue." [Footnote 26]

[Footnote 26: As showing how professional jealously may exist in such ways in the modern times as to hinder progress, the following paragraph, which is the opening portion of Professor Allbutt's address, has seemed to me to deserve quotation here. It will illustrate a phase of the subject that is probably utterly unexpected by those unfamiliar with the inner history of medicine in our time, but which is not so surprising to physicians who know the jealousy with which men guard their specialties from what they consider the interference of others, in hospital work and in teaching, though this exclusiveness often proves detrimental both to the breadth of development of the student and to the good health of the patient.

"It was, I think, in the year 1864, when I was a novice on the Honorary Staff of the Leeds General Infirmary, that the unsurgical division of us was summoned in great solemnity to discuss a method of administration of drugs by means of a needle. This method having obtained some vogue, it behooved those who practiced 'pure' medicine to decide whether the operation were consistent with the traditions of purity. For my part, I answered that the method had come up early, if not originally, in St. George's Hospital, and in the hands of a house physician–Dr. C. Hunter; that I had accustomed myself already to the practice and proposed to continue it; moreover, that I had recently come from the classes of Professor Trousseau, who, when his cases demanded such treatment, did not hesitate himself to perform paracentesis of the pleura, or even incision of this sac, or of the pericardium. As, for lack not of will but of skill and nerve, I did not intend myself to perform even minor operations, my heresy, as one in thought only, was indulgently ignored, and we were set free to manipulate the drug needle if we felt disposed to this humble service."]

In conclusion, we may say that, in the Middle Ages, once men had lifted themselves up from the condition into which they had been plunged by the incursions of the barbarians, there was nothing like the neglect of surgery which is sometimes said to have existed. Surgery had its normal development, and reached as high a stage as medicine in that beginning Renaissance, which is the characteristic feature of the twelfth, thirteenth, and fourteenth centuries. The traditions of a low state of surgery at this time are all false and founded on insufficient knowledge of the real conditions, which have been so clearly revealed to us by the investigation of original documents in the last twenty-five years. This was, in fact, one of the greatest periods in the history of surgery that the world has ever known. Whatever of difficulty in development surgery encountered was due not to any Church opposition, but to unfortunate conditions that arose in the practice of medicine. Professional jealousy and shortsightedness was the main element in it. Even this, however, did not prevent the very wonderful development of surgery that came during the Middle Ages, and that made this department of human knowledge quite as progressive and successful as any other, in that marvelous period when the universities came into existence in the form which they have maintained ever since.

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.