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 MEDICINE

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MEDICINE

complet.ed his surgery in 1275, shows srpat individu- ality anil a keen tliafi'uistic oye. Similarly his pupil Lanfranchi strongly rcconinicndtHl the rcutn'on of sur- gery anil internal nicdieine. Lanfranehi, banished in 12SM) from his native eity, Milan, transplanted Italian surgery to Paris. There the surgeons, like the physi- cians of th(- faculty, had, since 1200, been formed into a corporation, the CoUi'ge de St. Cosme (since 1713 Academic de Chirurgie), to which Lanfranclii was ad- mitted. His "Chirurgia magna" (Ars conipleta), fin- ished in 1296, is full of casuistic notes and shows us the author as an equally careful and lucky operator. The first important French surgeon is Henri de Mondeville (r2(jO-l.'520), originally a teacher of anatomy at Mont- pellier, whose treatise, although for the most part a compilation, does not lack originahty and perspicuity. The culminating point in French surgery at this period is marked by the appearance of Guy de Chauliac (Chaulhac, d. about 1370). He completed his .studies at Bologna, Montpellier, and Paris; later he entered the ecclesiastical state (canon of Reims, 135S), and ■was physician-in-ordinary to popes Clement VI, Inno- cent VI, and Urban V. From liim we have a descrip- tion of the terrible plague which he witnessed in 1348 at Avignon. His " Chirurgia magna " treated the sub- ject with a completeness never previously attained, and gave its author during the following centuries the rank of a first-class authority. Among contemporary surgeons in other civilized countries we must mention John Ardern (d. about 1.399), an Englishman, who studied at Montpellier and lived subseciuently in Lon- don, famous for his skill in operating for anal fistulae, and Jehan Yperraan of the Netherlands (d. about 1329), who studied in Paris under Lanfranchi. Be- sides these surgeons who had a fixed abode, there were a number of itinerant practitioners who offered their services at fairs; as, specializing usually in certain operations (hernio- and lithotomy), they often pos- sessed great skill, and their advice and assistance were sought by people of the upper elas.ses.

Signs of Improvement: Humanlsm. — A short survey of the scholastic period gives us the following picture: On the appearance of Araliic literature in Latin translations, Hippocratic medicine was driven from its last stronghold, Salerno. Then came the rule of Arabism, of the syst«m of Galen in Arabic form equipped with all sorts of sophistic subtleties. The works of Rhazes and Avicenna possessed the greatest authority. The latter's "Canon", written in clear language and covering the entire field of medicine, be- came the gospel of physicians. The literatin'e of these times is rich in writings but very poor in thought; for people were content when the long-winded com- mentaries gave them a better understanding of the Arabs, whom they deemed infallible. A good many things were incomprehensible, first of all the names of diseases and drugs, which translators rendered incor- rectly. A comparative investigation of the Greek au- thors was practically impossible, as both their works and a knowledge of the Greek language had dis- appeared from among the Romance nations. Thus it happened that special books had to be written from which were learned foreign words and their meanings. The " Synonyma Medicina; " (Clavis sanationis) by the physician Simon of Genoa (Januensis, 1270-1303) and the "Pandectae medicine" of Mattha?us Sylvaticus (d. 1342), both of which were alphabetically arranged, were much in vogue. Woe to the physician who dareil to douljt the authority of the Araljs! Only men of strong mind could successfully carry out such a dan- gerous undertaking. The influence of scholasticism in medicine was manifold. It encouraged the obser- vation of nature at the bedside and logical think- ing, but it also stimulated the love of disputation, wherein the main object was to force a possibly inde- pendent idea into the strait-jacket of the ruhng sys- tem, and thus avoid all imputation of medical heresy.

Signs of improvement are noticed first in anatomy (Mondino) ami subsequently in surgery, which is based upon it.

The impulse to follow a new path came, however, from without, first of all from a study of the Greek language, and then directly through the famous poet Francesco Petrarca (1304-74), the zealous patron of humanistic studies and thus of the Renaissance. Pe- trarch's instructor in the Greek language was the monk Barlaam, who procured for his pupil, Loontius Pilatus, a position as public teacher of the language in Florence in 1350. In later times, especially after the fall of Constantinople in 1453, numerous Gieek schol- ars came to Italy. With the spread of a knowledge of Greek and the enthusiasm for the Hellenic master- pieces in art and science, there arose also an interest in classical Latin and a diligent search for manu- scripts of Gra'co-Roman antiquity, and efforts along these lines were, as is well known, energetically sup- ported by the popes. The West now became ac- C)uainted with the works of the okl Greek pre-Aristo- telean philosophers and physicians in their original tongue, a fact which marks the beginning of the fall of the Arabian teaching. Petrarch fought as champion along the whole line of battle, especially against scholasticism and the medicine of that period. There is no doubt that his zeal was exaggerated in many re- spects. He blames the physicians of his time because they philosophize and do not cure. Medicine, he says, is a practical art and, therefore, may not be treated ac- cording to the same methods for the investigation of truth as philosophy. The greatest misfortune had been the appearance of Arabism with all its supersti- tions (astrology, alchemy, uroscopy). On the other hand, he speaks with great respect of surgery; the rea- son for this is patent, since he was a friend of the most important surgeon of his time, Guy de Chauliac. There is no dmibt that there were then in Italy many excellent physicians who, like Petrarch, recognized the existence of a wrong tendency in medicine, but they were far too weak to break the fetters of Arabism. The road to improvement had already been pointed out by Mondino, the anatomist of Bologna, but a com- plete change of view did not occur until the sixteenth century.

The Black Death op the Fourteenth Century. — Associated with the name of Petrarch is the memory of the most terrible epidemic of liistoric times. The Black Death (bubonic plague with pulmonary infec- tion), originating in Eastern Asia, passed through In- tlia to Asia Minor, Arabia, Egj'pt, Northern Africa, and directly to Europe by the Black Sea. In Europe the epidemic began in 1346, and spread first of all in the maritime cities of Italy (especially Genoa) and Sicily; in 1347 it appeared in Constantinople, Cyprus,. Greece, Malta, Sardinia, and Corsica, and, towards the end of the .year, at Marseilles; in 134S in Spain, Southern France (Avignon), Paris, the Netherlands, Italy, Southern England and London, Schleswig-Hol- stein, and Norway, and, in December, in Dalmatia and Jutland; in 1349 in the Austrian Alpine countries, Vienna, and Poland; in 1350 in Russia, where in 1353 the last traces disappeared on the shores of the Black Sea. The entire period was preceded by peculiar natural phenomena, as flootis, tidal waves, and ab- normally damp weather. Petrarch, who witnessed the plague at Florence, declared that posterity would regard the description of all its horrors as fables. The loss of human life in Europe, the population of which is estimated to have been 100 millions, is said to have amounted to twenty-five millions. The disease usually began suddenly and death occurred within three days, and often after a few hours. Physicians were quite powerless in face of the enormous extent of the pestilence. Great self-sacrifice was shown by the clergy, especially by the Franciscans, who are said to have" lost 100,000 (?) members through the epidemic.