Monday, October 21, 2019
Men In Medicine | Medieval Male Physicians And Doctors | Mondino | Italian Surgeon And Anatomy Teacher
Men In Medicine | Medieval Male Physicians And Doctors | Mondino | Italian Surgeon And Anatomy Teacher
The most important contributions to medical science made by the Medical School of Salerno at the height of its development were in surgery.
The text-books written by men trained in her halls or inspired by her teachers were to influence many succeeding generations of surgeons for centuries. Salerno’s greatest legacy to Bologna was the group of distinguished surgical teachers whose text-books we have reviewed in the chapter, “Great Surgeons of the Medieval Universities.”
Bologna herself was to win a place in medical history, however, mainly in connection with anatomy, and it was in this department that she was to provide incentive especially for her sister universities of north Italy, though also for Western Europe generally.
The first manual of dissection, that is, the first handy volume giving explicit directions for the dissection of human cadavers, was written at Bologna. This was scattered in thousands of copies in manuscript all over the medical world of the fourteenth and early fifteenth centuries.
Even after the invention of printing, many editions of it were printed. Down to the sixteenth century it continued to be the most used text-book of anatomy, as well as manual of dissection, which students of every university had in hand when they made their dissection, or wished to prepare for making it, or desired to review it after the body had been taken away, for with lack of proper preservative preparation, bodies had to be removed in a comparatively short time.
Probably no man more influenced the medical teaching of the fourteenth and fifteen centuries than Mundinus, or, as he was called in the Italian fashion, Mondino, who wrote this manual of dissection.
Mundinus quem omnis studentium universitas colit ut deum (Mundinus, whom all the world of students cultivated as a god), is the expression by which the German scholar who edited, about 1500, the Leipzig edition of Mundinus’ well-known manual, the Anathomia, introduces it to his readers.
The expression is well worth noting, because it shows what was still the reputation of Mundinus in the medical educational world nearly two centuries after his death.
Until the time of Vesalius, whose influence was exerted about the middle of the sixteenth century, Mondino was looked up to by all teachers as the most important contributor to the science of anatomy in European medicine since the Greeks. He owed his reputation to two things: his book, of which we have already spoken, and then, the fact that he reintroduced dissection demonstrations as a regular practice in the medical schools.
His book is really a manual of making anatomical preparations for demonstration purposes. These demonstrations had to be hurried, owing to the rapid decomposition of material consequent upon the lack of preservatives. The various chapters were prepared with the idea of supplying explicit directions and practical help during the anatomical demonstrations, so that these might be made as speedily as possible.
The book does not comprise much that was new at that time, but it is a good compendium of previous knowledge, and contains some original observations. It was entirely owing to its form as a handy manual of anatomical knowledge and, besides, because it was an incentive to the practice of human dissection, that it attained and maintained its popularity.
Mondino followed Galen, of course, and so did every other teacher in medicine and its allied sciences, until Vesalius’ time. Even Vesalius permitted himself to be influenced overmuch by Galen at points where we wonder that he did not make his observations for himself, since, apparently, they were so obvious.
The more we know of Galen, however, the less surprised are we at his hold over the minds of men. Only those who are ignorant of Galen’s immense knowledge, his practical common sense, and the frequent marvellous anticipations of what we think most modern, affect to despise him.
His works have never been translated into any modern language except piecemeal, there is no complete translation, and one must be ready to delve into some large Latin, if not Greek, volumes to know what a marvel of medical knowledge he was, and how wise were the men who followed him closely, though, being human, there are times when necessarily he failed them.
For those who know even a little at first hand of Galen, it is only what might be expected, then, that Mondino, trying to break away from the anatomy of the pig, which had been before this the basis of all anatomical teaching in the medical schools (Copho’s book, used at Salerno and Bologna before Mondino’s was founded on dissections of the pig), should have clung somewhat too closely to this old Greek teacher and Greek master.
The incentive furnished by Mondino’s book helped to break the tradition of Galen’s unquestioned authority. Besides this, the group of men around Mondino, his master, Taddeo Alderotti, with his disciples and assistants, form the initial chapter in the history of the medical school of Bologna, which gradually assumed the place of Salerno at this time.
There is no better way of getting a definite idea of what was being done in medicine, and how it was being done, than by knowing some of the details of the life of this group of medical workers.
Mondino di Liucci, or Luzzi, is usually said to have been born about 1275. His first name is a diminutive for Raimondo. It used to be said of him that, like many of the great men of history, many cities claimed to be his birthplace. Five were particularly mentioned—Florence, Milan, Bologna, Forli, and Friuli.
There is, however, another Mondino, a distinguished physician, who was born and lived at Friuli, and it is because of confusion with him that the claim for Friuli has been set up. Florence and Milan are considered out of the question. Mondino was probably born in or near Bologna.
The fact that there should have been this multiple set of claims shows how much was thought of him. Indeed, his was the best known name in the medical schools of Europe for nearly two centuries and a half. He seems to have been a particularly brilliant student, for tradition records that he had obtained his degree of doctor of medicine when he was scarcely more than twenty.
This seems quite out of the question for us at the present time, but we have taken to pushing back the time of graduation, and it is not sure whether this is, beyond peradventure, so beneficial as is usually thought.
That his early graduation did not hamper his intellectual development, the fact that, in 1306, when he was about thirty-one years of age, he was offered the professorial chair in anatomy, which he continued to occupy with such distinction for the next twenty years, would seem to prove.
His public dissections of human bodies, probably the first thus regularly made, attracted widespread attention, and students came to him not only from all over Italy, but also from Europe generally. In this, after all, Mondino was only continuing the tradition of world teaching that Bologna had acquired under her great surgeons in the preceding century. (See “Great Surgeons of the Medieval Universities.”)
Mondino came from a family that had already distinguished itself in medicine at Bologna. His uncle was a professor of physic at the university. His father, Albizzo di Luzzi, seems to have come from Florence not long after the middle of the thirteenth century, for the records show that, about 1270, he formed a partnership with one Bartolommeo Raineri for the establishment of a pharmacy at Bologna.
Later this passed entirely under the control of the Mondino family, and came to be known as the Spezieria del Mondino. In it were sold, besides Eastern perfumes, spices, condiments, probably all sorts of toilet articles, and even rugs and silks and feminine ornaments.
The stricter pharmacy of the earlier times developed into a sort of department store, something like our own. The Mondini, however, insisted always on the pharmacy feature as a specialty, and the fact was made patent to the general public by a sign with the picture of a doctor on it.
This drug shop of the Mondini continued to be maintained as such, according to Dr. Pilcher, until the beginning of the nineteenth century.
One of the fellow students of Mondino at the University of Bologna had been Mondeville. He came from distant France to take a course in surgery with Theodoric, whose high reputation in the olden time, vague with us half a century ago, is now amply justified by what we know of him from such ardent students and admirers as Pagel and Nicaise.
Not long after Mondino’s death, Guy de Chauliac came from France to reap similar opportunities to these, which had proved so fruitful for Mondeville. The more that we learn about this time the more do we find to make it clear how deeply interested the generation was in education in every form, artistic, philosophic, but, also, though this is often not realized, scientific.
The long distances, so much longer in that time than in ours, to which men were willing, and even anxious, to go, in order to obtain opportunities for research, and to get in touch with a special master, the associations with stimulating fellow pupils of other lands, the scientific correspondences, almost necessarily initiated by such circumstances, all indicate an enthusiasm for knowledge such as we have not been accustomed to attribute to this period.
On the contrary, we have been rather inclined to think them neglectful of all education, and have, above all, listened acquiescently while men deprecated the lack of interest in things scientific displayed by these generations. Indeed, many writers have gone out of their way to find a reason for the supposed lack of interest in science at this time, and have proclaimed the Church’s opposition to scientific education and study as the cause.
At this time Italy was the home of the graduate teaching for all Europe. The Italian Peninsula continued to be the foster-mother of the higher education in letters and art, but also, though this is less generally known, in science, for the next five centuries. Germany has come to be the place of pilgrimage for those who want higher opportunities in science than can be afforded in their own country only during the latter half of the nineteenth century.
France occupied it during the first half of the nineteenth century. Except for short intervals, when political troubles disturbed Italy, as about the middle of the fourteenth century, when the removal of the Popes to Avignon brought their influence for education over to France and a short period at the beginning of the eighteenth century, when the Netherlands for a time came into educational prominence, Italy has always been the European Mecca for advanced students.
Practically all our great discoverers in medicine, until the last century, were either Italians, or else had studied in Italy. Mondino, Bertruccio, Salicet, Lanfranc, Baverius, Berengarius, John De Vigo, who first wrote on gun-shot wounds; John of Arcoli, first to mention gold filling and other anticipations of modern dentistry; Varolius, Eustachius, Cæsalpinus, Columbus, Malpighi, Lancisi, Morgagni, Spallanzani, Galvani, Volta, were all Italians. Mondeville, Guy de Chauliac, Linacre, Vesalius, Harvey, Steno, and many others who might be named, all studied in Italy, and secured their best opportunities to do their great work there.
It would be amusing, if it were not amazing, to have serious writers of history in the light of this plain story of graduate teaching of science in Italy for over five centuries, write about the opposition of the Church to science during the Medieval and Renaissance periods.
It is particularly surprising to have them talk of Church opposition to the medical sciences. The universities of the world all had their charters from the Popes at this time, and were all ruled by ecclesiastics, and most of the students and practically all of the professors down to the end of the sixteenth century belonged to the clerical order.
The universities of Italy were all more directly under the control of ecclesiastical authority than anywhere else, and nearly all of them were dominated by papal influence. Bologna, while doing much of the best graduate work in science, especially in medicine, was, in the Papal States, absolutely under the rule of the Popes.
The university was, practically, a department of the Papal government. The medical school at the University of Rome itself was for several centuries, at the end of the Middle Ages, the teaching-place where were assembled the pick of the great medical investigators, who, having reached distinction by their discoveries elsewhere, were summoned to Rome in order to add prestige to the Papal University.
All of them became special friends of the Popes, dedicated their books to them, and evidently looked to them as beneficent patrons and hearty encouragers of original scientific research.
While this is so strikingly true of medical science as to make contrary declarations in the matter utterly ridiculous, and to suggest at once that there must be some motive for seeing things so different to the reality, the same story can be told of graduate science in other departments.
It was to Italy that men came for special higher studies in mathematics and astronomy, in botany, in mineralogy, and in applied chemistry, so far as it related to the arts of painting, illuminating, stained-glass making, and the like. No student of science felt that he had quite exhausted the opportunities for study that were possible for him until he had been down in Italy for some time.
To meet the great professors in Italy was looked on as sure to be a source of special incentive in any department of science. This is coming to be generally recognized just in proportion as our own interest in the arts and crafts, and in the history of science, leads us to go carefully into the details of these subjects at first hand.
The editors of the “Cambridge Modern History,” in their preface, declared ten years ago that we can no longer accept with confidence the declaration of any secondary writer on history. This is particularly true of the medieval period. We must go back to the writers of those times.
If it seems surprising that the University of Bologna should have come into such great prominence as an institute for higher education at this time, it would be well to recall some of the great work that is being done in this part of Italy in other departments at this time.
Cimabue laid the foundation of modern art towards the end of the thirteenth century, and during Mondino’s life Giotto, his pupil, raised an artistic structure that is the admiration of all generations of artists since. Dante’s years are almost exactly contemporary with those of Giotto and of Mondino.
If men were doing such wondrous work in literature and in art, why should not the same generation produce a man who will accomplish for the practical science of medicine what his friends and contemporaries had done in other great intellectual departments.
In recent years we have come to think much more of environment as an influence in human development and accomplishment than was the custom sometime ago. The broader general environment in Italy, with genius at work in other departments, was certainly enough to arouse in younger minds all their powers of original work.
The narrower environment at Bologna itself was quite as stimulating, for a great clinical teacher, Taddeo Alderotti, had come, in 1260, from Florence to Bologna, to take up there the practice and teaching of medicine. It was under him that Mondino was to be trained for his life work.
To understand the place of Mondino, and of the medical school of Bologna, in his time, and the reputation that came to them as world teachers of medicine, we must know, first, this great teacher of Mondino and the atmosphere of progressive medicine that enveloped the university in the latter half of the thirteenth century.
In the chapter on “Great Surgeons of the Medieval Universities” we call particular attention to the series of distinguished men, the first four of whom were educated at Salerno, and who came to Bologna to teach surgery. They were doing the best surgery in the world, much better than was done in many centuries after their time; indeed, probably better than at any period down to our own day.
Besides, they seem to have been magnetic teachers who attracted and inspired pupils. We have the surgical contributions of a series of men, written at Bologna, that serve to show what fine work was accomplished. At this time, however, the field of medicine was not neglected, though we have but a single great historical name in it that has lived.
This was Taddeo Alderotti, a man who lifted the medical profession as high in the estimation of his fellow citizens at Florence as the great painters and literary men of his time did their departments, and who then moved to Bologna, because of the opportunity to teach afforded him by the university.
It is sometimes a little difficult for casual students of the time to understand the marvellous reputation acquired by this medieval physician. It should not be, however, when we recall the enthusiastic reception and procession of welcome accorded to Cimabue’s Madonna, and the almost universal acclaim of the greatness of Dante’s work, even in his own time.
In something of that same spirit Bologna came to appreciate Taddeo, as he is familiarly known, looked upon him as a benefactor of the community, and voted to relieve him of the burden of paying taxes. He came to be considered as a public institution, whose presence was a blessing to his fellow citizens, and whose goodness to them should be recognized in this public way.
One is not surprised to hear Villani, the well-known contemporary historian, speak of him as the greatest physician in Christendom.
The feelings of the citizens of Bologna, it may well be confessed, were not entirely unselfish, or due solely to the desire to encourage a great scientific genius.
Few men of his generation had done more for the city in a material way quite apart from whatever benefits he conferred upon the health of its citizens than Dr. Taddeo. It was he who organized medical teaching in the city on such a plane that it attracted students from all over the world. Bologna had had a great law school before this, founded by Irnerius, to which students had come from all over the world.
With the advent of Taddeo from Florence, and his success as a medical practitioner, there began to flock to his lectures many students who spread his fame far and wide. The city council could scarcely do less than grant the same privileges to the medical students and teachers of Taddeo’s school as they had previously accorded to the faculty of law and its students.
The city council recognized quite as clearly as any board of aldermen in the modern time how much, even of material benefit, a great university was to the building up of a city, though their motives were probably much higher than that, and their enlightened policy had its reward in the rapid growth of Bologna until, very probably at the end of the thirteenth century, it had more students than any university of the modern time. The number was not less than fifteen thousand, and may have been twenty thousand.
To this great university success Taddeo and his medical school contributed not a little. The especially attractive feature of his teaching seems to have been its eminent practicalness. He himself had made an immense success of the practice of medicine, and accumulated a great fortune, so much so that Dante, in his “Paradiso,” when he wishes to find a figure that would represent exactly the opposite to what St. Dominic, the founder of the Dominicans, did for the love of wisdom and humanity, he takes that of Taddeo, who had accomplished so much for personal reputation and wealth.
This might easily lead to the impression that Taddeo’s teaching was unscientific, or merely empiric, or that he himself was a narrow-minded maker of money, intent only on his immediate influence, and hampered by exclusive devotion to practical medicine. Nothing could be farther from the truth than any such impression.
Taddeo was not only the head of a great medical school, a great teacher whom his students almost worshipped, a physician to whom patients flocked because of his marvellous success, a fine citizen of a great city, whom his fellow citizens honored, but he was a broad-minded scholar, a philosopher, and even an author in branches apart from medicine.
In that older time it was the custom to combine the study of philosophy and medicine. For centuries after that period in Italy it was the custom for men to take both degrees, the doctorate in philosophy and in medicine at the same time. Indeed, most of those whose work has made them famous, down to and including Galvani, did so.
Taddeo wrote commentaries on the works of Hippocrates and Galen, but he also translated the ethics of Aristotle, and did much to make the learning of the Arabs easily available for his students. His was a broad, liberal scholarship.
Dr. Lewis Pilcher, in his article on “The Mondino Myth,” does not hesitate to say that “to the spirit which, from his professorial chair, Taddeo infused into the teaching and study of medicine undoubtedly is due the high position which for many generations thereafter the school of Bologna continued to maintain as a centre of medical teaching.”
Of course, erudition had its revenge, and carried Taddeo too far. The difficult thing in human nature is to stay in the mean and avoid exaggeration. His methods of illustrating medical truths from many literary and philosophical sources often caused the kernel of observation to be hidden beneath a blanket of speculation or, at least, to be concealed to a great extent.
Even the Germans, who have insisted most on this unfortunate tendency of Taddeo, have been compelled to confess that there is much that is valuable in what he accomplished, and that even his modes of expression were not without a certain vivacity which attracted attention and doubtless added materially to his success as a teacher. Pagel, in Puschmann’s “Handbuch,” says: “It cannot be denied [this is just after he has quoted a passage of Taddeo with regard to dreams] that Taddeo’s expressions have a certain liveliness all their own that gives us some idea why he was looked upon as so good a teacher, a teacher who, as we know now, also gave instruction by the bedside of patients.”
Pagel adds, “Taddeo’s greatest merit and his highest significance in medical education consist in the fact that a great many (zahlreiche) physicians followed directly in his footsteps and were counted as his pupils. They were all men, as we know them, who as writers and practitioners of medicine succeeded in going far beyond the level of mediocrity in what they accomplished.”
This was the teacher who most influenced young Mondino when he came to the University of Bologna, for it seems not unlikely that as a medical student he was actually the pupil of Taddeo, then in a vigorous old age. If not, he was at least brought under the direct influence of the teaching tradition created during more than thirty years by that wonderful old man.
Knowing what we do of Taddeo it is not surprising that his pupil should have accomplished work that was to influence succeeding generations more than any other of that wonderful thirteenth century. Dr. Pilcher in the article on “The Mondino Myth,” so often placed under contribution in this sketch, says that “It needs no great stretch of the imagination to picture somewhat of the effect that contact with such a man as Taddeo di Alderotto might have, in molding the character of his young neighbor and pupil, the chemist’s son, who a few years later, by his devotion to the study of human anatomy, was to re-establish the practical pursuit of study on the human cadaver as the common privilege of the skilled physician, and was to engrave his own name deeply on the records of medicine.”
Under this worthy compatriot and contemporary of the great Florentines, Mondino was inspired to be the teacher that did so much for Bologna. Until recent years it has usually been the custom to give too much significance to the work of the men whose names stand out most prominently in the early history of departments of the intellectual life. Mondino’s reputation has shared in this exaggerative tendency to some extent, hence the necessity for realizing what was accomplished before his time and the fact that he only stands as the culmination of a progressive period.
Carlyle spoke of Dante as the man in whom “ten silent centuries found a voice.” The centuries, however, were only silent because the moderns did not know how to listen to their message. We know now that every country in Europe had a great contributor to literature in the century before Dante. The Cid, the Arthur Legends, the Nibelungen, the Troubadours, naturally led up to Dante.
He was only the culmination of a great period of literature. We know now that men had worked in art before Cimabue and Giotto, and had done impressive work that made for the progress of art. These names, however, have come to represent in many minds the sort of solitary phenomena that Dante has seemed sometimes even to scholars.
Because Mondino did such good work in medical teaching it is sometimes declared, even in rather serious histories, that he was the first to accomplish anything in his department, and that before his time there is a blank. Some historians, for instance, have insisted that Mondino was the first to do human dissections, and that he did at most but two or three.
Only those who are unacquainted with the magnificent development of surgery that took place during the preceding century, the evidence for which is so abundantly given in modern historians of medicine and especially in Gurlt’s great work on the history of surgery, from which we have quoted enough to give a good idea of the extent to which the movement went, are likely to accept any such declaration.
There could not have been all that successful surgery without much dissection not only of animals but also of human bodies. The teaching of dissection was not regularly organized until Mondino’s time, but it seems very clear that even he must have dissected many more bodies than the number usually attributed to him.
Professor Lewis Stephen Pilcher of Brooklyn, who made a special study of Mondino traditions in Bologna itself, and collected some of the early editions of his books, feels so acutely the absurdity of the ordinarily accepted tradition in this matter, that he has written a paper on the subject bearing the suggestive title, “The Mondino Myth.”
He says: “We are accustomed to think of the practice of dissection as having been re-created by Mondino, and at once fully developed, springing into acceptance.
The year 1315 is the generally accepted date for the first public anatomical demonstration upon a human body made by Mondino, and yet it is true that among the laws promulgated by Frederick II, more than seventy-five years before (a.d. 1231), was included a decree that a human body should be dissected at Salernum at least once in five years in the presence of the assembled physicians and surgeons of the kingdom, and that in the regulations established for admission to the practice of medicine and surgery in the kingdom it was decreed that no surgeon should be admitted to practice unless he should bring testimonials from the masters teaching in the medical faculty, that he was ‘learned in the anatomy of human bodies, and had become perfect in that part of medicine without which neither incisions could safely be made nor fractures cured.’
“Salernum was notable in its legalization of the dissection of human bodies before the first public work of Mondino, for, according to a document of the Maggiore Consiglio of Venice of 1308, it appears that there was a college of medicine at Venice which was even then authorized to dissect a body every year.
Common experience tells us that the embodiment of such regulations into formal law would occur only after a considerable preceding period of discussion, and in this particular field of clandestine practice. It is too much to ask us to believe that in all this period, from the date of the promulgation of Frederick’s decree of 1231 to the first public demonstration by Mondino, at Bologna in 1315, the decree had been a dead letter and no human body had been anatomized.
It is true there is not, as far as I am aware, any record of any such work, and commentators and historians of a later date have, without exception, accepted the view that none was done, and thereby heightened the halo assigned to Mondino as the one who ushered in a new era. Such a view seems to me to be incredible.
Be that as it may, it is undeniable that at the beginning of the 14th century the idea of dissecting the human body was not a novel one; the importance of a knowledge of the intimate structure of the body had already been appreciated by divers ruling bodies, and specific regulations prescribing its practice had been enacted.
It is more reasonable to believe that in the era immediately preceding that of Mondino human bodies were being opened and after a fashion anatomized.
All that we know of the work of Mondino suggests that it was not a new enterprise in which he was a pioneer, but rather that he brought to an old practice a new enthusiasm and better methods, which, caught on the rising wave of interest in medical teaching at Bologna, and preserved by his own energy as a writer in the first original systematic treatise written since the time of Galen, created for him in subsequent uncritical times the reputation of being the Restorer of the practice of anatomizing the human body, the first one to demonstrate and teach such knowledge since the time of the Ptolemaic anatomists, Erasistratus and Herophilus.
“The changes have been rung by medical historians upon a casual reference in Mondino’s chapter on the uterus to the bodies of two women and one sow which he had dissected, as if these were the first and the only cadavers dissected by him. The context involves no such construction.
He is enforcing a statement that the size of the uterus may vary, and to illustrate it remarks that ‘a woman whom I anatomized in the month of January last year, viz., 1315 Anno Christi, had a larger uterus than one whom I anatomized in the month of March of the same year.’ And further, he says that ‘the uterus of a sow which I dissected in 1316 (the year in which he was writing) was a hundred times greater than any I have seen in the human female, for she was pregnant and contained thirteen pigs.’
These happen to be the only reference to specific bodies that he makes in his treatise. But it is a far cry to wring out of these references the conclusion that these are the only dissections he made. It is quite true that if we incline to enshroud his work in a cloud of mystery and to figure it as an unprecedented awe-inspiring feature to break down the prejudices of the ages, it is easy to think of him as having timidly profaned the human body by his anatomizing zeal in but one or two instances.
His own language, however, throughout his book is that of a man who was familiar with the differing conditions of the organs found in many different bodies; a man who was habitually dissecting.”
(Quotations from the work of Mundinus showing his familiarity with dissections. The leaf and line references are to the Dryander edition, Marburg, 1541.)
“I do not consider separately the anatomy of component parts, because their anatomy does not appear clearly in the fresh subject, but rather in those macerated in water.” (Leaf 2, lines 8-13.)
“… these differences are more noticeable in the cooked or perfectly dried body, and so you need not be concerned about them, and perhaps I will make an anatomy upon such a one at another time and will write what I shall observe with my own senses, as I have proposed from the beginning.” (Leaf 60, lines 14-17.)
“What the members are to which these nerves come cannot well be seen in such a dissection as this, but it should be liquefied with rain water, and this is not contemplated in the present body.” (Leaf 60, lines 31-33.)
“After the veins you will note many muscles and many large and strong cords, the complete anatomy of which you will not endeavor to find in such a body but in a body dried in the sun for three years, as I have demonstrated at another time; I also declared completely their number, and wrote the anatomy of the muscles of the arms, hands, and feet in a lecture which I gave over the first, second, third, and fourth subjects.” (Leaf 61, lines 1-7.)
Very probably the best evidence that we have of the comparative frequency at least of dissection at this time is to be found in the records of a trial for body-snatching that occurred in Bologna. The details would remind one very much of what we know of the difficulties with regard to dissection in America a couple of generations ago, when no bodies were provided by law for dissection purposes.
In the course of some studies for the history of the New York State Medical Society (New York, 1906) I found that nearly every one of the first half dozen presidents of the New York Academy of Medicine, which is not much more than sixty years old, had had body-snatching experiences when they were younger. Dr. Samuel Francis, the medico-historical writer, tells of a personal expedition across the ferry in the winter time, bringing a body from a Long Island graveyard.
In order to avoid the constables on the Long Island side and the police on the New York side, because there had been a number of cases of body-snatching recently and the authorities were on the lookout, the corpse was placed sitting beside the physician who drove the wagon, with a cloak wrapped around it, as if it were a living person specially protected against the cold.
Similar experiences were not unusual. The lack of bodies for dissection is sometimes attributed to religious scruples, but they have very little to do with it, as at all times men have refused to allow the bodies of their friends to be treated as anatomical material. This is the natural feeling of abhorrence and not at all religious. It is only when there are many unclaimed bodies of strangers and the poor, as happens in large cities, that there can be an abundance of anatomical material.
The details of this body-snatching case are strangely familiar to those who know the history of similar cases before the middle of the nineteenth century. The case occurred in 1319 in Bologna, just four years after Mondino’s public dissections. Four students were involved in the charge of body-snatching, all of them from outside the city of Bologna itself, three from Milan and one from Piacenza.
In modern experience, too, as a rule, students from outside of the town where the medical college was situated, were always a little readier than natives to violate graveyards. These four students were accused of having gone at night to the Cemetery of St. Barnabas, outside the gate of San Felice,—suburban graveyards were usually the scene of such exploits,—and to have dug up the body of a certain criminal named Pasino, who had been hanged a few days before.
They carried the body to the school in the Parish of San Salvatore, where Alberto Zancari was teaching. The resurrection had been accomplished without witnesses, but there were several witnesses who testified that they recognized the body of Pasino in the school and students occupied with its dissection.
If evidence for the zeal of the medical students of that time for dissection were needed, surely we have it in the testimony at this trial. At a time when body-snatching has become a criminal offense usually there have been many repeated occurrences of it before the parties are brought to trial, so that it seems not unlikely that a good many dissections of illegally secured bodies were being done at Bologna at this time.
We know of a regulation of the University in force at this time, which required the teachers at the University to do an anatomy or dissection for students if they secured a body for that purpose. The students seem to have used all sorts of influence, political, monetary, diplomatic, and ecclesiastical, in order to secure the bodies of criminals.
Sometimes when they failed in their purpose they waited until after burial and then took the body without leave. When we recall the awfully deterrent condition in which bodies must have been that were thus provided for dissecting purposes, it is easy to understand that the enthusiasm of the students for dissection must have been at a very high pitch.
Certainly it was far higher than at the present day, when, in spite of the fact that our dissecting-rooms have very few of the old-time dangers and unpleasantnesses, dissection is only practiced with assiduity if special care is exercised in requiring attendance and superintending the work of the department.
In my book on “The Popes and Science” I have gathered the traditions relating to Mondino’s assistants in the chair of anatomy at Bologna. They furnish abundant evidence of the fact that dissections, far from being uncommon, must have been not at all infrequent at the north Italian universities at this time.
Curiously enough, one of these assistants was a young woman who, as was not infrequently the custom at this time in the Italian universities, was matriculated as a student at Bologna. She took up first philosophy, and afterwards anatomy, under Mondino.
While it is not generally realized, co-education was quite common at the Italian universities of the thirteenth and fourteenth centuries, and at no time since the foundation of the universities has a century passed in Italy without distinguished women occupying professors’ chairs at some of the Italian universities.
This young woman, Alessandra Giliani, of Persiceto, a country district not far from Bologna, took up the study of anatomy with ardor and, strange as it may appear, became especially enthusiastic about dissection.
She became so skilful that she was made the prosector of anatomy, that is, one who prepares bodies for demonstration by the professors.
According to the “Cronaca Persicetana,” quoted by Medici in his “History of the Anatomical School at Bologna”:
“She became most valuable to Mondino because she would cleanse most skilfully the smallest vein, the arteries, all ramifications of the vessels, without lacerating or dividing them, and to prepare them for demonstration she would fill them with various colored liquids, which, after having been driven into the vessels, would harden without destroying the vessels.
Again, she would paint these same vessels to their minute branches so perfectly and color them so naturally that, added to the wonderful explanations and teachings of the master, they brought him great fame and credit.” The whole passage shows a wonderful anticipation of our most modern methods—injection, painting, hardening—of making anatomical preparations for class and demonstration purposes.
Some of the details of the story have been doubted, but her memorial tablet, erected at the time of her death in the Church of San Pietro e Marcellino of the Hospital of Santa Maria de Mareto, gives all the important facts, and tells the story of the grief of her fiancé, who was himself Mondino’s other assistant.
This was Otto Agenius, who had made for himself a name as an assistant to the chair of anatomy in Bologna, and of whom there were great hopes entertained because he had already shown signs of genius as an investigator in anatomy. These hopes were destined to grievous disappointment, however, for Otto died suddenly, before he had reached his thirtieth year.
The fact that both these assistants of Mondino died young and suddenly, would seem to point to the fact that probably dissection wounds in those early days proved even more fatal than they occasionally did a century or more ago, when the proper precautions against them were not so well understood.
The death of Mondino’s two prosectors in early years would seem to hint at some such unfortunate occurrence.
As regards the evidence of what the young man had accomplished before his untimely death, probably the following quotation, which Medici has taken from one of the old chroniclers, will give the best idea:
“What advantage indeed might not Bologna have had from Otto Agenius Lustrulanus, whom Mondino had used as an assiduous prosector, if he had not been taken away by a swift and lamentable death before he had completed the sixth lustrum of his life!”
How well the tradition created by Mondino continued at the university will be best understood from what we know of Guy de Chauliac’s visit to the medical school here about the middle of the century. The great French surgeon tells us that he came to Bologna to study anatomy under the direction of Mondino’s successor, Bertruccius.
When he wrote his preface to his great surgery he recalled this teaching of anatomy at Bologna and said, “It is necessary and useful to every physician to know, first of all, anatomy. For this purpose the study of books is indeed useful, but it is not sufficient to explain those things which can only be appreciated by the senses and which need to be seen in the dead body itself.”
He advises his students to consult Mundinus’ treatise but to demonstrate its details for themselves on the dead body. He relates that he himself had often, multitoties, done this, especially under the direction of Bertruccius at Bologna. Curiously enough, as pointed out by Professor Pilcher, Mondino had used this same word multitotiens (the variant spelling makes no difference in the meaning) in speaking about his own work. In describing the hypogastric lesion he mentions that he had demonstrated certain veins in it many times, multitotiens.
Mondino was just past fifty when he finished his little book and permitted copies of it to be made. Though the book occurs so early in the history of modern book-making the author offers his excuses to the public for writing it, and quotes the authority of Galen, to whom he turns in other difficult situations, for justification.
As prefaces go, Mondino’s is so like that of many an author of more recent date that his words have a bibliographic, as well as a personal, interest. He said:
“A work upon any science or art—as saith Galen—is issued for three reasons: first, that one may satisfy his friends. Second, that he may exercise his best mental powers.
Third, that he may be saved from the oblivion incident to old age. Therefore, moved by these three causes, I have proposed to my pupils to compose a certain work on medicine.
“And because a knowledge of the parts to be subjected to medicine (which is the human body, and the names of its various divisions) is a part of medical science, as saith Averrhoes in his first chapter, in the section on the definition of medicine, for this reason among others, I have set out to lay before you the knowledge of the parts of the human body which is derived from anatomy, not attempting to use a lofty style, but the rather that which is suitable to a manual of procedure.”
Some of the early editions of Mondinus’ book are said, according to old writers, to have contained illustrations. None of these copies have come down to us, but the assertion is made so definitely that it seems likely to have been the case. The editions that we have contain wood engravings of the method of making a dissection as frontispiece, so that it would not be difficult to think of further such illustrations having been employed in the book itself.
As we note in the chapter on “Great Surgeons of the Medieval Universities,” Mondeville, according to Guy de Chauliac, had pictures of anatomical preparations which he used for teaching purposes. It is easy to understand that the value of such aids would be recognized at a time when the difficulty of preserving bodies made it necessary to do dissections hurriedly so as to get the rapidly decomposing material out of the way.
Beyond his book and certain circumstances connected with it we know very little about Mondino. What we know, however, enables us to conclude that, like many another great teacher, he must have had the special faculty of inspiring his students with an ardent enthusiasm for the work that they were taking under him.
Hence the body-snatching and other stories. Mondino continued to be held in high estimation by the Bolognese for centuries after his death. Dr. Pilcher calls attention to the fact that his sepulchral tablet, which is in the portico of the Church of San Vitari in Bologna, and a replica of which he was allowed to have made in order to bring it to America, is the only one of the sepulchral tablets in the great churches of Florence, San Domenico, San Martino, the Cathedral and the Cloister of San Giacomo degli Ermitani, which has not been removed from its original location and placed in the halls of the Civic Museum.
Their removal he considers “a kind of desecration which does violence to one’s sense of sanctity and propriety.” “Fortunately, thus far, the Mondino Tablet has escaped the spoiler.” Very probably Dr. Pilcher’s replica of the tablet which he was required to deposit in the Civic Museum at the time when the copy was made to be brought to America may save the tablet to be seen in its original position for many generations.
Mondino’s career is of special interest because it foreshadows the life and accomplishment of many another maker of medicine of the after time. He did a great new thing in medicine in organizing regular public dissections, and then in making a manual that would facilitate the work.
He waited patiently for years before completing his book in order that it might be the fruit of long experience, and so be more helpful to others. He was so modest as to require urging to secure the publication. He had the reward of his patience in the popularity of his little work for centuries after his time.
The glimpse that we get of his relations to his young assistants, Agenius and Alessandra, seems to show us a teacher of distinct personal magnetism. Undoubtedly the reputation of his book did much for not only the medical school of the University of Bologna, but also for the medical schools of other north Italian universities, and helped to bring to them the crowds of students that flocked there during the fourteenth and fifteenth centuries.
Taddeo and Mondino turned the attention of the medical students of their generations Bologna wards. Before that time they had mainly gone to Salerno. After their time most of the ardent students of medicine felt that they must study for a time at least at Bologna.
Other important medical schools of Italian universities at Padua, at Vicenza, at Piacenza, arose and prospered. During the time when the political troubles of Italy reached a climax about the middle of the fourteenth century, while the Popes were at Avignon, there was a remission in the attendance at all the Italian universities, but with the Popes’ return to Rome and the coming of even comparative peace to Italy, Bologna once more became the term of medical pilgrimages for students from all over the world. In the meantime Mondino’s book went forth to be the most used text-book of its kind until Vesalius’ great work came to replace it.
To have ruled in the world of anatomy for two centuries as the best known of teachers is of itself a distinction that shows us at once the teaching power and the scientific ability of this professor of anatomy of Bologna in the early fourteenth century.
Excerpt From – Old-Time Makers Of Medicine By James Joseph Walsh
Women In Medicine | Medieval Women Physicians And Doctors
Very probably the most interesting chapter for us of the modern time in the history of the medical school at Salerno is to be found in the opportunities provided for the medical education of women and the surrender to them of a whole department in the medical school, that of Women’s Diseases.
While it is probable that Salerno did not owe its origin to the Benedictines, and it is even possible that there was some medical teaching there for all the centuries of the Middle Ages from the Greek times, for it must not be forgotten that this part of Italy was settled by Greeks, and was often called Magna Graecia, there is no doubt at all that the Benedictines exercised great influence in the counsels of the school, and that many of the teachers were Benedictines, as were also the Archbishops, who were its best patrons, and the great Pope Victor III, who did much for it. For several centuries the Benedictines represented the most potent influence at Salerno.
For most people who are not intimately familiar with monastic life, and, above all, with the story of the Benedictines, their prestige at Salerno might seem to be enough of itself to preclude all possibility of the education of women in medicine at Salerno.
For those who know the Benedictines well, however, such a departure as the accordance of opportunities for women to study medicine would seem eminently in keeping with the practical wisdom of their rules and the development of their work.
From the beginning the Benedictines recognized that a monastic career should be open to women as well as to men, and Benedict’s sister, Scholastica, established convents for them, as her brother did the Benedictine monasteries, thus providing a vocation for women who did not feel called upon to marry.
That the members of the order should recognize the advisability of affording women the opportunity to study medicine, and of handing over to them the department of women’s diseases in a medical school in which they had a considerable amount of authority, seems, then, indeed, only what might have been expected of them.
We are prone in the modern time to think that our generation is the first to offer to women any facilities or opportunities for education in medicine. We are prone, however, just in the same way, to consider that a number of things that we are doing are now being done for the first time.
As a matter of fact, it is extremely difficult to find any important movement or occupation that is not merely a repetition of a previous interest of mankind. The whole question of feminine education we are apt to think of as modern, forgetting that Plato insisted in his “Republic,” as absolutely as any modern feminist, that women should have the same opportunities for education as men, and that at Rome, at the end of the Republic and the beginning of the Empire, the women occupied very much the same position in social life as our own at the present time.
Their husbands supplied the funds, and they patronized the artists, gave receptions to the poets, lionized the musicians, and, in general, “went after culture” in a way that is a startling reminder of what we are familiar with in our own time.
Just as soon as Christianity began to influence education, women were given abundant opportunities for higher education in all forms. In Ireland, the first nation completely converted to Christianity,—where, therefore, the national policy in education could be shaped by the Church without hindrance,—St. Brigid’s school at Kildare was scarcely less famous than St. Patrick’s at Armagh.
It had several thousand students, and, to a certain extent at least, co-education existed. In Charlemagne’s time, with the revival of education on the Continent, the women of the Imperial Court attended the Palace School, as well as the men. In the thirteenth century we find women professors in every branch at Italian universities. Some of them were at least assistants in anatomy.
The Renaissance women were, of course, profoundly educated. In a word, we have many phases of feminine education, though with intervals of absolutely negative interest, down the centuries.
There had evidently been quite a considerable amount of opportunity, if not of actual encouragement, for women in medicine, both among the Greeks and the Romans, in the early centuries of the Christian era. Galen, for instance, quotes certain prescriptions from women physicians. One Cleopatra is said to have written a book on cosmetics.
This name came afterwards to be confounded with that of Queen Cleopatra, giving new prestige to the book, but neither Galen nor Aëtius, the early Christian physician, both of whom quote from her work, speak of her as anything except a medical writer. Some monuments to women physicians from these old times have escaped the tooth of time.
There was the tomb of one Basila, and also of a Thecla, both of whom are said to have been physicians. Two other names of Greek women physicians we have, Origenia and Aspasia, the former mentioned by Galen, the latter by Aëtius in his “Tetrabiblion.” Daremberg, the medical historian, announced in 1851 that he had found a Greek manuscript with the title, “On Women’s Diseases,” written by one Metrodora, a woman physician. He promised to publish it.
It was unpublished at the time of his death, but could not be found among his papers. There is a manuscript on medical subjects, bearing this name, mentioned in the catalogue of the Greek Codices of the Laurentian Library at Florence, but this is said to give no indication of the time when its author lived. We have evidence enough, however, to show that Greek women physicians were not very rare.
The Romans imitated the Greeks so faithfully—one might almost say copied them so closely—that it is not surprising to find a number of Roman women physicians. The first mention of them comes from Scribonius Largus, in the first century after Christ. Octavius Horatianus, whom most of us know better as Priscian, dedicated one of his books on medicine to a woman physician named Victoria.
The dedication leaves no doubt that she was a woman in active practice, at least in women’s diseases, and it is a book on this subject that Priscian dedicates to her. He mentions another woman physician, Leoparda. The word medica for a woman physician was very commonly used at Rome.
Martial, whose epigrams have been a source of so much information in medical history, especially on subjects with regard to which information was scanty, mentions a medica in an epigram.
Apuleius also uses the word. There are a number of inscriptions in which women physicians are mentioned. Among the Christians we find women physicians, and Theodosia, the mother of St. Procopius, the martyr, is said to have been very successful in the practice of both medicine and surgery.
She is numbered among the martyrs, and occurs in the Roman Martyrology on the 29th of May. Father Bzowski, the Polish Jesuit, who compiled “Nomenclatura Sanctorum Professione Medicorum” (Rome, 1621; the book is usually catalogued under the Latin form of his name, Bzovius), has among his list of saints who were physicians by profession a woman, St. Nicerata, who lived at Constantinople in the reign of the Emperor Arcadius, and who is said to have cured St. John Chrysostom of a serious disease.
The organization of the department of women’s diseases at Salerno, under the care of women professors, and the granting of licenses to women to practise medicine, is not so surprising in the light of this tradition among Greeks and Romans, taken up with some enthusiasm by the Christians.
We are not sure just when this development took place. The first definite evidence with regard to it comes in the life of Trotula, who seems to have been the head of the department. Some of her books are well known, and often quoted from, and she contributed to a symposium on the treatment of disease, in which there are contributions, also, from men professors of Salerno at the time.
She seems to have flourished about the middle of the eleventh century. Ordericus Vitalis, a monk of Utica, who wrote an ecclesiastical history, tells of one Rudolph Malcorona, who, in 1059, came to Utica and remained there for a long time with Father Robert, his nephew. “This Rudolph had been a student all his life, devoting himself with great zeal to letters, and had become famous for his visits to the schools of France and Italy, in order to gather there the secrets of learning.
As a consequence he was well informed not only in grammar and dialectics, but also in astronomy and in music. He also possessed such an extensive knowledge of the natural sciences that in the town of Salerno, where, since ancient times, the best schools of medicine had existed, there was no one to equal him with the exception of a very wise matron.”
This wise matron has been identified with Trotula, many of the details of whose life have been brought to light by De Renzi, in his “Story of the School of Salerno.” According to very old tradition, Trotula belonged to the family of Ruggiero.
This was a noble family of Salerno, many of the members of which were distinguished in their native town at least, but the name is not unusual in Italy, as readers of Dante and Boccaccio are likely to know. It was, indeed, as common as our own Rogers, of which it is the Italian equivalent.
De Renzi has made out a rather good case for the tradition that Trotula was the wife of John Platearius I—so called because there were probably three professors of that name. Trotula was, according to this, the mother of the second Platearius, and the grandmother of the third, all of them distinguished members of the faculty at Salerno.
Her reputation extended far beyond her native town, and even Italy itself, and, in later centuries, her name was used to dignify any form of treatment for women’s diseases that was being exploited. Rutebeuf, one of the trouvères, thirteenth-century French poets, has a description of the scene in which one of the old herbalist doctors who used to go round and collect a crowd by means of songs and music, and then talk medicine to them—just as is done even yet in many of the smaller towns of this country—is represented as saying to the crowd when he wants to make them realize that he is no ordinary quacksalver, that he is one of the disciples of the great Madame Trot of Salerno.
The old-fashioned speech runs somewhat as follows: “Charming people: I am not one of these poor preachers, nor the poor herbalists, who carry little boxes and sachets, and who spread out before them a carpet. I am the disciple of a great lady, who bears the name of Madame Trot of Salerno. And I would have you know that she is the wisest woman in all the four quarters of the world.”
Two books are attributed to Trotula; one bears the title, “De Passionibus Mulierum,” and the other has been called “Trotula Minor,” or “Summula Secundum Trotulam,” and is a compendium of what she wrote.
This is probably due to some disciple, but seems to have existed almost in her own time. Her most important work bears two sub-titles, “Trotula’s Unique Book for the Curing of Diseases of Women, Before, During, and After Labor,” and the other sub-title, “Trotula’s Wonderful Book of Experience (experimentalis) in the Diseases of Women, Before, During, and After Labor, with Other Details Likewise Relating to Labor.”
The book begins with a prologue on the nature of man and of woman, and an explanation of how the author, taking pity on the sufferings of women, came to devote herself to the study of their diseases. There are many interesting details in the book, all the more interesting because in many ways they anticipate modern solutions of difficult problems in women’s diseases, and the care of the mother and child before, during, and after labor.
For instance, there are a series of rules on the choice of the nurse, and on the diet and the régime which she should follow if the child is to be properly nourished without disturbance.
Probably the most striking passage in her book is that with regard to a torn perineum and its repair. This passage may be found in De Renzi or in Gurlt. It runs as follows: “Certain patients, from the severity of the labor, run into a rupture of the genitalia. In some even the vulva and anus become one foramen, having the same course.
As a consequence, prolapse of the uterus occurs, and it becomes indurated. In order to relieve this condition, we apply to the uterus warm wine in which butter has been boiled, and these fomentations are continued until the uterus becomes soft, and then it is gently replaced.
After this the tear between the anus and vulva we sew in three or four places with silk thread. The woman should then be placed in bed, with the feet elevated, and must retain that position, even for eating and drinking, and all the necessities of life, for eight or nine days. During this time, also, there must be no bathing, and care must be taken to avoid everything that might cause coughing, and all indigestible materials.”
There is a passage, also, almost more interesting with regard to prophylaxis of rupture of the perineum. She says, “In order to avoid the aforesaid danger, careful provision should be made, and precautions should be taken during labor somewhat as follows: A cloth should be folded in somewhat oblong shape, and placed on the anus, so that, during every effort for the expulsion of the child, that should be pressed firmly, in order that there may not be any solution of the continuity of tissue.”
Her book contains, also, some directions for various cosmetics. How many of these are original, however, is difficult to say. Trotula’s name had become a word to conjure with, and many a quack in the after time tried to make capital for his remedies in this line by attributing them to Trotula.
As a consequence, many of these remedies gradually found their way into the manuscript copies of her book, and subsequent copyists incorporated them into the text, until it became practically impossible to determine which were original. There are manuscripts of Trotula’s work in Florence, Vienna, and Breslau.
Some of these contain chapters not in the others, undoubtedly added by subsequent hands. In one of these, that at Florence, from which the edition of Strasburg was printed in 1544, and of Venice, 1547, one of the Aldine issues, there is a mention in the last chapter of spectacles.
We have no record of these until the end of the thirteenth century, when this passage was probably added. It was also printed at Basle, 1566, and at Leipzig as late as 1778, which would serve to show how much attention it has attracted even in comparatively recent times.
After Trotula we have a number of women physicians of Salerno whose names have come down to us. The best known of these bear the names Constanza, Calendula, Abella, Mercuriade, Rebecca Guarna, who belonged to the old Salernitan family of that name, a member of which, in the twelfth century, was Romuald, priest, physician, and historian, Louise Trencapilli, and others.
The titles of some of their books, as those of Mercuriade, who occupied herself with surgery as well as medicine, and who is said to have written on “Crises,” on “Pestilent Fever,” on “The Cure of Wounds,” and of Abella, who acquired a great reputation with her work on “Black Bile,” and on the “Nature of Seminal Fluid,” have come down to us. Rebecca Guarna wrote on “Fevers,” on the “Urine,” and on the “Embryo.” The school of Salernitan women came to have a definite place in medical literature.
While, as teachers, they had charge of the department of women’s diseases, their writings would seem to indicate that they studied all branches of medicine. Besides, there are a number of licenses preserved in the archives of Naples in which women are accorded the privilege of practicing medicine.
Apparently these licenses were without limitation. In many of these mention is made of the fact that it seems especially fitting that women should be allowed to practice in women’s diseases, since they are by constitution likely to know more and to have more sympathy with feminine ills.
The formula employed as the preamble of this license ran as follows: “Since, then, the law permits women to exercise the profession of physicians, and since, besides, due regard being had to purity of morals, women are better suited for the treatment of women’s diseases, after having received the oath of fidelity, we permit, etc.”
Salerno continued to enjoy a reputation for training women physicians thoroughly, until well on in the fifteenth century, for we have the record of Constance Calenda, the daughter of Salvator Calenda, who had been dean of the faculty of medicine at Salerno about 1415, and afterwards dean of the faculty at Naples. His daughter, under the diligent instruction of her father, seems to have obtained special honors for her medical examination.
Not long after this, Salerno itself lost all the prestige that it had. The Kings of Naples endeavored to create a great university in their city in the thirteenth century. They did not succeed to the extent that they hoped, but the neighboring rival institution hurt Salerno very much, and its downfall may be traced from this time. Gradually its reputation waned, and we have practically no medical writer of distinction there at the end of the fourteenth century, though the old custom of opportunities for women students of medicine was maintained.
This custom seems also to have been transferred to Naples, and licenses to practise were issued to woman graduates of Naples.
This never achieved anything like the reputation in this department that had been attained at Salerno. Salerno influenced Bologna and the north Italian universities profoundly in all branches of medicine and medical education, particularly in surgery, as can be seen in the chapter on “Great Surgeons of the Medieval Universities,” and the practice of allowing such women as wished to study medicine to enter the university medical schools is exemplified in the case of Mondino’s assistant in anatomy, Alessandra Giliani, though there are also others whose names have come down to us.
The University of Salerno had developed round a medical school. It was the first of the universities, and, in connection with its medical school, feminine education obtained a strong foothold. It is not surprising, then, that with the further development of universities in Italy, feminine education came to be the rule.
This rule has maintained itself all down the centuries in Italy, so that there has not been a single century since the twelfth in which there have not been one or more distinguished women teachers at the Italian universities. University life gradually spread westward, and Paris came into existence as an organized institution of learning after Bologna, and, doubtless, with some of the traditions of Salerno in the minds of its founders.
Feminine education, however, did not spread to the West. This is a little bit difficult to understand, considering the reverence that the Teutonic peoples have always had for their women folk and the privileges accorded them. A single unfortunate incident, that of Abélard and Héloïse, seems to have been sufficient to discourage efforts in the direction of opportunities for feminine education in connection with the Western universities.
Perhaps, in the less sophisticated countries of the North and West of Europe, women did not so ardently desire educational opportunities as in Italy, for whenever they have really wanted them, as, indeed, anything else, they have always obtained them.
In spite of the absence of formal opportunities for feminine education in medicine at the Western universities, a certain amount of scientific knowledge of diseases, as well as valuable practical training in the care of the ailing, was not wanting for women outside of Italy.
The medical knowledge of the women of northern France and Germany and England, however, though it did not receive the stamp of a formal degree from the university and the distinction of a license to practice, was none the less thorough and extensive.
It came in connection with certain offices in their own communities, held by members of religious orders. Genuine information with regard to what the religious were doing during the Middle Ages was so much obscured by the tradition of laziness and immorality, created at the time of the so-called reformation in order to justify the confiscation of their property by those whose one object was to enrich themselves, that we have only come to know the reality of their life and accomplishments in comparatively recent years.
We now know that, besides being the home of most of the book knowledge of the earlier Middle Ages, the monasteries were the constant patrons of such practical subjects as architecture, agriculture in all its phases, especially irrigation, draining, and the improvement of land and crops; of art, and even what we now know as physical science. Above all, they preserved for us the old medical books and carried on medical traditions of practice.
The greatest surprise has been to find that this was true not only for the monks, but also for the nuns.
One of the most important books on medicine that has come to us from the twelfth century is that of a Benedictine abbess, since known as St. Hildegarde, whose life was spent in the Rhineland.
Her works serve to show very well that in the convents of the tenth, eleventh, and twelfth centuries there was much more of interest in things intellectual than we have had any idea of until recent years, and that, indeed, one of the important occupations of convent life was the serious study of books of all kinds, some of them even scientific, as well as the writing of works in all departments.
The century before St. Hildegarde there is the record of Hroswitha, who wrote a series of dramas in imitation of Terence, that were meant to replace, for the monks and nuns of that period, the reading of that rather too human author.
Hroswitha, like Hildegarde, was a German, and we have the record, also, of another religious writer, abbess of the Odilian Cloister, at Hohenberg, who wrote a book called “Hortus Deliciarum, the Garden of Delights,” a book of information on many subjects not unlike our popular encyclopedias of the modern time, the title of which shows that the place of information in life was considered to be the giving of pleasure.
While this work deals mainly with Biblical and theological and mystical questions, there are many purely scientific passages and many subjects of strictly medical interest treated.
The life of the Abbess Hildegarde is worthy of consideration, because it illustrates the period and makes it very clear that, in spite of the grievous misunderstanding of their life and work, so common in the modern time, these old-time religious had most of the interests of the modern time, and pursued them with even more than modern zeal and success, very often.
Her career illustrates very well what the foundation of the Benedictines had done for women. When St. Benedict founded his order for men, his sister, Scholastica, wanted to do a similar work for women. We know that the Benedictine monks saved the old classics for us, kept burning the light of the intellectual life, and gave a refuge to men who wanted to devote themselves in leisure and peace to the things of the spirit, whether of this world or the other.
We have known much less of the Benedictine nuns until now the study of their books shows that they provided exactly the same opportunities for women and furnished a vocation, a home, an occupation of mind, and a satisfaction of spirit for the women who, in every generation, do not feel themselves called to be wives and mothers, but who want to live their lives for others rather than for themselves and their kin, seeking such development of mind and of spirit as may come with the leisure and peace of celibacy.
Hildegarde was born of noble parents at Böckelheim, in the county of Sponheim, about the end of the eleventh century (probably 1098). In her eighth year she went for her education to the Benedictine cloister of Disibodenberg. When her education was finished, she entered the cloister, of which, at the age of about fifty, she became abbess. Her writings, reputation for sanctity, and her wise saintly rule attracted so many new members to the community that the convent became overcrowded.
Accordingly, with eighteen of her nuns, Hildegarde withdrew to a new convent at Rupertsberg, which English and American travellers will remember because it is not far from Bingen on the Rhine. Here she came to be a centre of attraction for most of the world of her time.
She was in active correspondence with nearly every important man of her generation. She was an intimate friend of Bernard of Clairvaux, who was himself, perhaps, the most influential man in Europe in this century. She was in correspondence with four Popes, and with the Emperors Conrad and Frederick I, and with many distinguished archbishops, abbots, and abbesses, and teachers and teaching bodies of various kinds.
These correspondences were usually begun by her correspondents, who consulted her because her advice in difficult problems was considered so valuable.
In spite of all this time-taking correspondence, she found leisure to write a series of books, most of them on mystical subjects, but two of them on medical subjects. The first is called “Liber Simplicis Medicine,” and the second “Liber Composite Medicine.”
These books were written in order to provide information mainly for the nuns who had charge of the infirmaries of the monasteries of the Benedictines. Almost constantly someone in the large communities, which always contained aged religious, was ailing, and then, besides, there were other calls on the time and the skill of the sister infirmarians.
There were no hotels at that time, and no hospitals, except in the large cities. There were always guest houses in connection with monasteries and convents, in which travelers were permitted to pass the night, and given what they needed to eat. There are many people who have had experiences of monastic hospitality even in our own time. Sometimes travelers fell ill.
Not infrequently the reason for traveling was to find health in some distant and fabulously health-giving resort, or at the hands of some wonder-working physician. Such high hopes are nearly always set at a distance. This of itself must have given not a little additional need for knowledge of medicine to the infirmarians of convents and monasteries.
There were around many of the monasteries, moreover, large estates; often they had been cleared and made valuable by the work of preceding generations of monks, and on these estates peasants came to live. Workingmen and workingwomen from neighboring districts came to help at harvest time, and, after a chance meeting, were married and settled down on a little plot of ground provided for them near the monastery.
As these communities grew up, they looked to the monasteries and convents for aid of all kinds, and turned to them particularly in times of illness. The need for definite instruction in medicine on the part of a great many of the monks and nuns can be readily understood, and it was this need that Hildegarde tried to meet in her books.
The first of her books that we have mentioned, the “Liber Simplicis Medicinæ,” attracted attention rather early in the Renaissance, and was deemed worthy of print. It was edited at the beginning of the sixteenth century by Dr. Schott at Strasburg, under the title, “Physica S. Hildegardis.”
Another manuscript of this part was found in the library of Wolfenbuttel, in 1858, by Dr. Jessen. This gave him an interest in Hildegarde’s contributions to medicine, and, in 1859, he noted in the library at Copenhagen a manuscript with the title “Hildegardi Cure et Cause.”
On examination, he was sure that it was the “Liber Compositæ Medicinæ” of the saint. The first work consists of nine books, treating of plants, elements, trees, stones, fishes, birds, quadrupeds, reptiles, and metals, and is printed in Migne’s “Patrologia,” under the title “Subtilitatum Diversarum Naturarum Libri Novem.” The second, in five books, treats of the general diseases of created things, of the human body and its ailments, of the causes, symptoms, and treatment of diseases.
It would be very easy to think that these are small volumes and that they contain very little. We are so apt to think of old-fashioned so-called books as scarcely more than chapters, that it may be interesting to give some idea of the contents and extent of the first of these works.
The first book on Plants has 230 chapters, the second on the Elements has 13 chapters, the third on Trees has 36 chapters, the fourth on various kinds of Minerals, including precious stones, has 226 chapters, the fifth on Fishes has 36 chapters, the sixth on Birds has 68 chapters, the seventh on Quadrupeds has 43 chapters, the eighth on Reptiles has 18 chapters, the ninth on Metals has 8 chapters.
Each chapter begins with a description of the species in question, and then defines its value for man and its therapeutic significance. Modern scientists have not hesitated to declare that the descriptions abound in observations worthy of a scientific inquiring spirit.
We are, of course, not absolutely sure that all the contents of the books come from Hildegarde. Subsequent students often made notes in these manuscript books, and then other copyists copied these into the texts. Unfortunately we have not a number of codices to collate and correct such errors. Most of what Hildegarde wrote comes to us in a single copy, of none are there more than four copies, showing how near we came to missing all knowledge of her entirely.
Dr. Melanie Lipinska, in her “Histoire des Femmes Médecins,” a thesis presented for the doctorate in medicine at the University of Paris in 1900, subsequently awarded a special prize by the French Academy, reviews Hildegarde’s work critically from the medical standpoint. She says that the saint distinguishes a double mode of action of different substances, one chemical, the other physical, or what we would very probably call magnetic.
She discusses all the ailments of the various organs, the brain, the eyes, the teeth, the heart, the spleen, the stomach, the liver. She has special chapters on redness and paleness of the face, on asthma, on cough, on fetid breath, on bilious indigestion, on gout.
Besides, she has other chapters on nervous affections, on icterus, on fevers, on intestinal worms, on infections due to swamp exhalations, on dysentery, and a number of forms of pulmonary diseases. Nearly all of our methods of diagnosis are to be found, hinted at at least, in her book.
She discusses the redness of the blood as a sign of health, the characteristics of various excrementitious material as signs of disease, the degrees of fever, and the changes in the pulse. Of course, it was changes in the humors of the body that constituted the main causes for disease in her opinion, but it is well to remind ourselves that our frequent discussion of auto-intoxication in recent years is a distinct return to this.
Some of Hildegarde’s anticipations of modern ideas are, indeed, surprising enough. For instance, in talking about the stars and describing their course through the firmament, she makes use of a comparison that is rather startling.
She says: “Just as the blood moves in the veins which causes them to vibrate and pulsate, so the stars move in the firmament and send out sparks as it were of light like the vibrations of the veins.” This is, of course, not an anticipation of the discovery of the circulation of the blood, but it shows how close were men’s ideas to some such thought five centuries before Harvey’s discovery.
For Hildegarde the brain was the regulator of all the vital qualities, the centre of life. She connects the nerves in their passage from the brain and the spinal cord through the body with manifestations of life. She has a series of chapters with regard to psychology normal and morbid.
She talks about frenzy, insanity, despair, dread, obsession, anger, idiocy, and innocency. She says very strongly in one place that “when headache and migraine and vertigo attack a patient simultaneously they render a man foolish and upset his reason. This makes many people think that he is possessed of a demon, but that is not true.” These are the exact words of the saint as quoted in Mlle. Lipinska’s thesis.
It is no wonder that Mlle. Lipinska thinks St. Hildegarde the most important medical writer of her time. Reuss, the editor of the edition of Hildegarde published in Migne’s “Patrology,” says: “Among all the saintly religious who have practised medicine or written about it in the Middle Ages, the most important is without any doubt St. Hildegarde….”
With regard to her book he says: “All those who wish to write the history of the medical and natural sciences must read this work in which this religious woman, evidently well grounded in all that was known at that time in the secrets of nature, discusses and examines carefully all the knowledge of the time.” He adds, “It is certain that St. Hildegarde knew many things that were unknown to the physicians of her time.”
When such books were read and widely copied, it shows that there was an interest in practical and scientific medicine among women in Germany much greater than is usually thought to have existed at this time. Such writers, though geniuses, and standing above their contemporaries, usually represent the spirit of their times and make it clear that definite knowledge of things medical was considered of value.
The convents and monasteries of this time are often thought of by those who know least about them as little interested in anything except their own ease and certain superstitious practices.
As a matter of fact, they cared for their estates, and especially for the peasantry on them, they provided lodging and food for travelers, they took care of the ailing of their neighborhood, and, besides, occupied themselves with many phases of the intellectual life.
It was a well-known tradition that country people who lived in the neighborhood of convents and monasteries, and especially those who had monks and nuns for their landlords, were much happier and were much better taken care of than the tenantry of other estates.
For this a cultivation of medical knowledge was necessary in certain, at least, of the members of the religious orders, and such books as Hildegarde’s are the evidence that not only the knowledge existed, but that it was collected and written down, and widely disseminated.
Nicaise, in the introduction to his edition of Guy de Chauliac’s “Grande Chirurgie,” reviews briefly the history of women in medicine, and concludes:
“Women continued to practice medicine in Italy for centuries, and the names of some who attained great renown have been preserved for us. Their works are still quoted from in the fifteenth century.
“There was none of them in France who became distinguished, but women could practice medicine in certain towns at least on condition of passing an examination before regularly appointed masters. An edict of 1311, at the same time that it interdicts unauthorized women from practicing surgery, recognizes their right to practice the art if they have undergone an examination before the regularly appointed master surgeons of the corporation of Paris.
An edict of King John, April, 1352, contains the same expressions as the previous edict. Du Bouley, in his ‘History of the University of Paris,’ gives another edict by the same King, also published in the year 1352, as a result of the complaints of the faculties at Paris, in which there is also question of women physicians.
This responded to the petition: ‘Having heard the petition of the Dean and the Masters of the Faculty of Medicine at the University of Paris, who declare that there are very many of both sexes, some of the women with legal title to practice and some of them merely old pretenders to a knowledge of medicine, who come to Paris in order to practice, be it enacted,’ etc. (The edict then proceeds to repeat the terms of previous legislation in this matter.)
“Guy de Chauliac speaks also of women who practiced surgery. They formed the fifth and last class of operators in his time. He complains that they are accustomed to too great an extent to give over patients suffering from all kinds of maladies to the will of Heaven, founding their practice on the maxim ‘The Lord has given as he has pleased; the Lord will take away when he pleases; may the name of the Lord be blessed.’
“In the sixteenth century, according to Pasquier, the practice of medicine by women almost entirely disappeared. The number of women physicians becomes more and more rare in the following centuries just in proportion as we approach our own time. Pasquier says that we find a certain number of them anxious for knowledge and with a special penchant for the study of the natural sciences and even of medicine, but very few of them take up practice.”
Just how the lack of interest in medical education for women gradually deepened, until there was almost a negative phase of it, only a few women in Italy devoting themselves to medicine, is hard to say. It is one of the mysteries of the vicissitudes of human affairs that ups and downs of interest in things practical as well as intellectual keep constantly occurring.
The number of discoveries and inventions in medicine and surgery that we have neglected until they were forgotten, and then had to make again, is so well illustrated in chapters of this book, that I need only recall them here in general.
It may seem a little harder to understand that so important a manifestation of interest in human affairs as the education and licensure of women physicians should not only cease, but pass entirely out of men’s memory, yet such apparently was the case. It would not be hard to illustrate, as I have shown in “Cycles of Feminine Education and Influence” in “Education, How Old the New” (Fordham University Press, 1910), that corresponding ups and downs of interest may be traced in the history of feminine education of every kind.
Excerpt From – Old-Time Makers Of Medicine By James Joseph Walsh
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