The Catholic Church and Healing
by
James J Walsh
1928
Part 2
CHAPTER
IV
THE DOCTRINE
OF INFECTION. DISEASE PREVENTION
The greatest contribution
at once to medical science and to the health and happiness of mankind in the field of medicine was the elaboration
of the doctrine of infection and of that of disease prevention by prophylactic measures. Churchmen beginning in
the days of the Fathers of the Church took up the problem of the eradication of leprosy following the injunctions
laid down in Leviticus, and as a result there came the recognition of contagion and the possibility of its prevention.
This was an absolutely new idea in the history of medicine.
It seems very strange
to us that the wise old Greeks usually so acute in observation did not discover the principle of infection and
contagion, but they did not. Sudhoff, the German historian of medicine, so dependable in such generalizations,
said in his Essays in the History of Medicine: (1).
The fundamental idea of infection and a definite grasp of the prophylactic measures implicit in it, failed entirely
to take root in classical antiquity. He adds that it was not until the fifth century of the Christian era that
in the course of medical tradition we first encounter an explicit statement of the transmission of disease by contact
(contact infection) and its restriction by isolation. He goes so far as to say quite emphatically that:
"It was reserved
for the actual Middle Ages to elaborate serious official measures against the spread of epidemics which were consciously
and even dutifully derived from the leper ritual of the Jews with its fundamental concept of isolation. Long before
this in the east the Book of Leviticus had already engendered a school of thought in this matter quite apart from
Judaism. This came to fruition particularly among the Fathers of the Christian Church. In his ever memorable hospital
city of Cesarea, Basil the Great materialized the centric idea of charitable sick nursing in the loftiest manner,
and even provided for and erected an isolation house or home for lepers".
The eradication of
leprosy, which has been treated in the preceding chapter demonstrates how thoroughly and successfully the Middle
Ages applied the idea of disease prevention by definite regulation and restriction of contact.
The entire system
of legal restriction and quarantine, as we know it now, was brought forth in connection with these ideas as a result
of the effort to overcome the epidemics of bubonic plague which ravaged Europe so mercilessly in the latter half
of the fourteenth century. Even priests were placed under the obligation to notify the authorities as to every
case of plague that became known to them in administering Extreme Unction to the dying. The most meticulous precautions
were taken against the spread of disease. Letters brought in by pose were fumigated. Gold money was disinfected,
the bedding of plague patients was burned, domestic animals were placed under control because there was more than
a suspicion aroused that they could under certain circumstances be the carriers of disease. Finally the cities
were kept clean through the control of streets and water supplies.
This
had all developed out of the state of mind which had come into existence in connection with the system of warding
off the contagion of leprosy. As the result of this, people came to see allied conditions due to infection in a
more intelligent and clear-eyed way and they were more ready to submit to regulations, and physicians were ever
so much more convinced of the good that might be accomplished this way. In connection with this, as Sudhoff says,
In the thirteenth century so forward in science and knowledge the general concept of contagious diseases became
current.
The definite organization
of what we would call a crusade of information among the people for the prevention of disease took place and a
set of mnemonic verses was elaborated so that people might carry the necessary information about with them easily
and communicate it to others in a form under which it was likely to be remembered. In a time when reading was not
common and printing had not yet been invented and when the writing out of such verses required a good deal of labor,
the composition of them in a readily memorizable form solved the problem of the popular diffusion of information
with regard to contagion and the prophylaxis of disease.
By the
beginning of the fourteenth century, no less than thirteen infectious diseases, from which people were to protect
themselves and the carriers of which were to be avoided, found a place in these mnemonic verses. These diseases
as enumerated by Sudhoff were plague, the exanthematous fevers, that is the febrile conditions associated with
eruptions of the skin, typhoid, typhus and scarlet fever, measles and the like, phthisis, anthrax, trachoma and
gonorrheal conjunctivitis, scabies and erysipelas and manifestly a series of rather serious infections which passed
under the name of that disease or were called the fire of St. Anthony or other names suggested by the redness and
fever and throbbing which accompany them.
The crusade
of popular information, moreover, was complemented by the development and legal institution of practical sanitary
regulation. Municipal authorities were required to put patients suffering from these diseases outside
the city gates and keep them there for a definite time. Thirty days were supposed to be enough at first but after
a while forty days were required and as the ecclesiastical term for this period was a quarantine, this word was
adopted into sanitary use and now we speak of quarantine not as a length of time but as segregation from others.
This would seem to indicate how close the ecclesiastical authorities were to the development of quarantine practices
and of the prophylaxis of disease generally. Above all, the civil authorities forbade those suffering from disease
or who were intimately in contact with patients from having anything to do with traffic and articles of food and
drink as well as other materials of intimate human association with the person that might be expected to carry
the disease. (2)
Sudhoff
has emphasized particularly that this organization of prophylaxis against contagious disease, which had remained
hidden from the Greeks, occurred during the Middle Ages which are so often spoken of contemptuously as regards
their science or medicine. He said, "all this is the achievement of the 'gloomy Middle Ages' hitherto penalized
as the period of medical scholasticism though now with tardy justice recognized as having accomplished good work".
He adds that, "in the matter of recognition of contagion and prophylaxis by isolation, the most rigorous line
was taken at the instance of physicians by the city authorities of northern Italy and southern France". At
this time the popes were in residence at Avignon in southern France and many of the distinguished physicians of
the time were among the papal physicians. The doctrine of contagion and the possibility of prevention continued
to exist in Italy to a much more definite degree than in other countries. Both in Italy and in Spain there were
laws that recognized the contagiousness of tuberculosis, insisted on quarantine for the disease and required the
destruction of everything with which patients had been in contact.
Dr.
Flick, in his Development of our Knowledge of Tuberculosis (3), says that as the result of the recognition of the contagiousness of disease there
is a tradition that the Indians in that part of America colonized by the Spaniards remained free from tuberculosis
for a much longer period than those who were in that part of the country colonized by England and France. He suggests
that, so far as this was true, it no doubt was due to interference with emigration of tuberculosis people to America
by the laws of Spain. Unfortunately after a time the doctrine of the non-contagiousness of consumption gained a
foothold and the result was a great increase in the disease until in our own time more definite precautions with
regard to its possible spread were taken. The Renaissance and its intense preoccupation with Greek medicine undid
not a little of the good work in the prevention of disease which the Middle Ages had accomplished. The feeling
of scholars was that if the Greeks did not have it then it was not worth while paying any attention to it.
Toward
the end of the first half of the sixteenth century Fracastorius, the distinguished Italian physician of Verona,
redeemed the Renaissance period in this regard by restating the theory of contagion. The popularization of Fracastorius
ideas, especially among the clergy, came as the result of Father Athanasius Kircher s book on the pest or bubonic
plague which was written in Rome in the generation that witnessed Galileo s trial. Father Kircher thought that
he had seen little animalcules or living things that produce disease. He had observed cases of plague in a nunnery
where they had been very careful to prevent all communication with the outside world. He attributed the spread
of the disease inside the walls of the nunnery to the visits of a cat and thus revived the idea of intermediate
carriers of disease which had been the subject of so much solicitude during the Middle Ages. The medieval achievement
in the recognition of infection and the practice of disease prevention is one of the great triumphs in medicine.
(1)
New York, 1926
(2)
It was only after the New York legislature In the second half of the nineteenth century was brought to the realization
that clothing was being manufactured in slum quarters of New York City, where sometimes smallpox and typhoid fever
and even Asiatic cholera were rife, and that this clothing might be carried out of the city and so transport the
disease to other portions of the state, that we were able to secure, a little more than a generation ago, the enactment
of the sanitary code and the establishment of the Department of Health which has done so much to bring about improvement
in New York s health and reduce the death rate. It is surprising to find that the medieval cities, six centuries
before New York, succeeded in accomplishing the same purpose.
(3)
Philadelphia, 1925.
CHAPTER V
MONASTIC
MEDICINE, THE TRADITION
OF ANESTHESIA,
MEDICAL TEACHING
With the fall of the
Roman Empire and the further invasion of the Roman world by the barbarians, culture and civilization to a very
great extent disappeared and only what the monasteries preserved of the intellectual life remained. The monks were
more interested in religion than in medicine, but the copyists in the monasteries saved many of the medical classics
from disappearing. Besides, the charity of Christ urged them to the care of the ailing, and this led them to the
preservation of precious medical traditions. The monasteries were houses of call for travelers and as a result
inevitably had to assume the care of ailing travelers who contracted or developed disease on their journey.
Besides,
most of the monasteries had tenant farmers on their estates and the monks were interested in their health. Finally
there was the infirmary in the monasteries for the ailing monks as well as in the convents for sick nuns; and infirmarians
were provided with expert knowledge, as far as possible, to care for the ailing. These infirmarians gathered whatever
medical knowledge they could obtain, making use of the monastic medical traditions to the best advantage.
The Rule
of Benedict, founder of the monks of the West, said: Before all things and above all things care must be taken
of the sick. Benedict himself died of fever contracted while caring for the poor near Monte Cassino. An example
of this kind on the part of their founder could not fail to be fruitful. The Benedictine monasteries became the
repository of important traditions in medicine and surgery, and their scriptoriums or writing rooms preserved many
of the old Greek medical writings from perishing from the face of the earth in the midst of the contemporary neglect
of the intellectual life during the invasion of the barbarians in the early Middle Ages. (1). Their gardens supplied
the herbs which were considered to be so precious for the treatment of the various human ills even down to our
own day. The beginnings of modern medical education can be traced mainly to monastic influence.
The relationship
between medicine and the monasteries in the early days is well illustrated also in the career of Cassiodorus. Early
in life he attracted the attention of King Theodoric, of whom he became prime minister. After the death of the
king, Cassiodorus at the age of fifty felt that he could do more good by his example in the religious life.
A
few years previously Benedict had founded the religious order, afterwards to be called the Benedictines, at Monte
Cassino, and it was undoubtedly in imitation of Benedict s institution that Cassiodorus erected the monastery of
Vivarium on his own estate. Here he lived to the ripe old age of ninety-three, spending almost as much of his life
as a monk as he had spent in the world. Cassiodorus himself drew up the rule of is monastery, and he emphasized
the fact that monks should make researches and devote themselves to the increase of knowledge. He called attention
particularly to the needs of the monastery in the matter of a knowledge of medicine on the part of its infirmarians,
and he equipped the monastery library with a number of the best-known medical books of the Greeks. There is a definite
tradition that he made it an obligation upon the infirmarians who had charge of the sick in the monasteries to
consult the works of Hippocrates and Galen and to be guided by them in their care of the ailing. Herbal or Galenical
medicine as it is called, after Galen the great Greek physician of Marcus Aurelius at Rome, owes the preservation
of the traditions of therapy and the supply of the ingredients for the practice of it to the monasteries. (2).
Shakespeare
s picture of the monk in medicine is not a poetic fancy but a portrayal of the realities of history. Friar Lawrence
in Romeo and Juliet represents a survival of the tradition that monastery gardens were the usual source of plants
and simples of various kinds that would be beneficial for ailing mankind. Friar Lawrence himself in the play suggests
that he knew not only the qualities of plants but also of minerals. He was a true Galenist:
Oh micle
is the powerful grace that lies
In herbs, plants,
Stones and their true qualities:
For naught so vile
but on the earth doth live,
But to the earth some
special good doth give.
It is
the friar who proposes to Juliet the brave and wise strategem of taking the potion which shall set her to sleep
for a definite period until Romeo may come and take her from the tomb and bear her away with him to await a time
when it may be possible for them to bring about a reconciliation between their two families. The fact that this
tradition of anesthesia or narcosis continued to be passed on from generation to generation in the monasteries
is now well recognized.
This
tradition of the use of anesthesia for surgical purposes has now been traced back to Alexandria when the great
medical school there made its magnificent contributions to medicine and surgery. The first definite mention of
anesthesia in modem history is in the writings of St. Hilary of Poitiers. The passage was written about 356. For
those who think of anesthesia as a modern discovery it is astounding to read the straight- forward account, as
Hilary presents it, of how men could be brought under the influence of an anesthetic and have various rather serious
operations, even the amputation of limbs, performed on them without suffering any pain. Here are Hilary s own words.
They occur in the midst of a discussion of the psychology of sensation. (3).
When
the body is pricked or pierced, it is the soul which pervades it that is conscious and suffers pain. For instance
a flesh wound is felt even to the bone while the fingers feel nothing when we cut the nails which protrude from
the flesh. And if through some disease a limb becomes withered, it loses the feeling of the living flesh: it can
be cut or burned, it feels no pain whatever, because the soul is no longer mingled with it. Also when through some
grave necessity part of the body must be cut away, the soul can be lulled to sleep by drugs, which overcome the
pain, and produce in the mind a death-like forgetfulness of its power of sense. Then the limb can be cut off without
pain. The flesh is dead to all feelings, and does not heed the deep thrust of the knife because the soul within
is asleep.
Sudhoff,
the German historian of medicine, has collected the references to the use of the spongia
somnifera, sleep-bringing sponge, in his Archives of the History of Medicine.
(4). They are all monastic in association. There is a very definite reference to it in the Antido
tarium Nicolii which comes from Salerno. For a time it was thought that
the idea originated there. Later a reference to the spongia was found in the Bamberger Antidotarium.
This
dates from the ninth century. Then a reference of the same kind was found in the Cassineser
Rezeptar, that is the prescription book or collection of recipes for
medical purposes in use at Monte Cassino, the great motherhouse of the Benedictines. Manifestly the sleep sponge
had been known in the earlier half of the Middle Ages. The practice of anesthesia for surgical purposes seems to
have been part of the tradition of the Irish monks.
Dr.
More Madden called attention to the fact that a Celtic materia medico, that is a work which describes the various drug materials used in medicine and surgery
in the twelfth century, contains a reference to a compound containing mandrake and other materials to be used before
cuttings and punctures in order that there might not be pain with them. It said further, By means of this it is
possible for anyone to secure sleep by just smelling it. In the note to the chapter Ancient Irish Medicine in my
volume, The World s Debt to the Irish,
(5), there is this paragraph:
In proof
of the antiquity of the use of anaesthetics in the Irish monastic tradition. Dr. More Madden quoted a passage from
Jocelyn s life of Kentigern or St. Mungo, patron of Glasgow, a book written sometime between 1185 and 1199. This
life which is edited from the unique manuscript in the British Museum (Cott. vat. c. viii) of the twelfth century,
was written by the celebrated Jocelyn of Furness, the biographer of St. Patrick, and is dedicated to another Jocelyn,
bishop of Glasgow. That passage runs,
It is
perfectly clear to us that many having taken the drink of oblivion which physicians called the lethargion, have as a result gone to sleep;
incisions in their members and at times cauterizations even in their most vital pares or abrasions have occurred
without their feeling them in the least. After they were awaked from their sleep they were entirely ignorant of
the fact that anything had been done to them.
In the
original medieval Latin the passage runs:
Constat
nibilominus nobis multos, sumptu potu oblivionis quem physici letbargion vacant obdormire; et in membris incisionem,
et aliquotiens adustionem et in vitalibuo, abrasionem perpessos, minime sensisse, et post somni excussionem, quae
erga sese actiata fuerant ignorasse.
Arthur Oehm, in the
Hemmeter Festschrift number of Medical Life (6) says that:
In the
sixth century monasteries were notably founded by Irish and Scotch monks who had been better able to maintain and
preserve the heritage of Greece in the arts and sciences than the continental institutions, being removed from
the destructive turmoil of the continent . . . .
We know
from statements of Columban, from the correspondence of Boniface and especially from the works of the Venerable
Bede that the monks of Ireland and England did not neglect matters pertaining to medicine and made use of this
knowledge at the bedside . . . they gradually transplanted medical ideas (largely derived from their classical
learning) all over the territory that they traversed. Some of these monks came to have a great reputation for their
skill in medicine.
A very
interesting illustration of the Church s care for those in need and of the very intelligent efforts that were made
to help them, anticipating measures that were supposed to be developed ever so much later in the world s history,
is the account which the Venerable Bede gives of the teaching of the deaf by St. John of Beverly. Up to this time
it had usually been considered that people thus afflicted had but very slight intelligence. John of Beverly who
had had a varied career, after his retirement from the archbishopric of York devoted himself to the teaching of
these unfortunates. As a younger man he was a member of the community under St. Hilda at Whitby.
Afterwards
he was bishop of Hexham and then Archbishop of York. After resigning this see to his pupil, Wilfrid, John established
a monastery at Inderawood, afterwards called Beverly, which became an extremely important educational center. It
was in connection with this that his special efforts were extended to the deaf mutes.
One of
these deaf mutes proved to have unusual intelligence so John devoted himself to enabling the young man to develop
his mental ability. Venerable Bede, who was himself a pupil of John, tells that the saint taught his deaf and dumb
pupil to read the lips and to speak. The great English church historian was very much inclined to think that his
success must be considered almost miraculous and that it was the merits of St. John which brought to the young
man the blessing of speech.
People who read the
story in Venerable Bede, before the day when we actually had the experience that the deaf could not only be taught
to read the lips but also to articulate for themselves, would surely have dismissed it as representing one of those
curious tendencies to believe the impossible which was so characteristic of the Middle Ages, or else they would
have set it own as one of the miracles that friends came to relate of saints in order to bring them into honor.
John
of Beverly was a Benedictine and his work probably continued for some time among his brethren and then was lost
sight of. He died sometime toward the end of the first quarter of the eighth century and we have no further record
of attempts to teach the deaf and dumb until the sixteenth century in Spain when a Father Pedro Ponce de Leon (7)
also a Benedictine, taught many deaf pupils. It had become the custom to think once more that these poor afflicted
ones were dummies not only physically but mentally, but Father de Leon whose charity was inexhaustible found that
all that was needed was time and patient teaching to bring out their intelligence. (8).
The beginning
of medical education in modern history came with the foundation of the medical school at Salerno, a city in southern
Italy some thirty miles away from Naples. There is some question as to how far the Benedictine school at Salerno
was an important factor in the establishment of the medical school there. The Benedictine school, a foundation
from Monte Cassino not far away, can be traced back to the ninth century. There is no doubt that a rather close
relationship existed between this school and the professors of medicine. The greatest figure in the medical school
at Salerno was Constantine Africanus who brought back with him from his travels in the orient an immense amount
of information with regard to medicine. He had collected also a large number of manuscripts.
Constantine
became the intimate friend of Abbot Desiderius of Monte Cassino. This friendship developed while Desiderius as
a simple monk was teaching in the Benedictine school of Salerno. When Desiderius was elected the abbot of Monte
Cassino, Constantine became a monk at Monte Cassino and continued his great work of providing foundation stones
for modern medicine. The medical school at Salerno became the great medium for the diffusion of the medical writings
which Constantine in the peace of Monte Cassino was engaged so sedulously in giving to the world of his time.
Professor
Sudhoff declares that the influence which Constantine Africanus exerted at Salerno was profound. His personal relations
to the Salernitan school were transient but his medical publications were of great importance. Those most certainly
written by him found a willing and almost eager reception and application in practice. He became the exponent of
an extensive new endogenous literature. Constantine s works represented the beginning of modern medicine.
Much
of what he wrote was adopted and adapted from the Arabic medical writers; but there was no little jealousy between
Christians and Arabs, and the result had been a neglect of Arabic medicine which because of the intimate contact
of the Arabs in Asia Minor with the old Greek medical sources was very valuable. When published by Constantine
under his own name and with the prestige afforded by his brotherhood in the order of the Benedictines of Monte
Cassino, these works attracted attention and meant very much for the beginning of the development of European medicine.
After
Constantine one of the greatest figures at Salerno was Alphanus, usually designated the first because there are
several of that name. He was a Benedictine monk, known by his contemporaries as both poet and physician, who was
afterwards raised to the bishopric of Salerno. This succession of events illustrates very clearly how intimate
the relations of the Benedictines and the pioneer medical school at Salerno continued to be for centuries, for
Alphanus lived in the twelfth century.
As the
latter half of the Middle Ages began, there is evidence for the important place of the Benedictines in medicine
because of the works of an abbess of a Benedictine nunnery which have attracted much attention in recent years.
She is now proclaimed to have been the most important writer on scientific and medical subjects in the twelfth
century. She is known in history as St. Hildegarde, and was the abbess of Disibodenberg not far from Bingen on
the Rhine.
Some
most surprising hints of medical knowledge are to be found in her works. She seems to have had some inkling of
the circulation of the blood and, surprisingly enough, she wrote about problems of heredity and certain sex subjects
that might have been expected to be outside of her sphere of attention.
When we recall, however,
that in the preceding century a Benedictine nun Hroswitha of Gandersheim wrote the first comedies of modern time
with the declaration that they were written to supersede the reading of Terence, objectionable because of sex elements
in his plays, it is easy to understand Hildegarde s writing on these subjects. Some of the expressions of modern
commentators with regard to Hildegarde s writing reveal their appreciation of her work. Melanie Lepinska in her
Paris thesis on Hildegarde just at the beginning of the twentieth century, suggests that:
Hildegarde foretold
auto-infections and seemed almost to foretell or to comprehend the circulation of the blood, she recognized the
brain as the regulator of all the vital processes and as the centre of life, understood the influence of the nervous
system and the spinal cord on the process of development. ... In short a profound intellect reflecting on all subjects
with the intuition of genius full of experience, embracing the whole science of her time: so does she appear in
her first medical work.
Hildegarde
is of interest particularly because she represents the culmination of the traditions of medical lore and of hospital
care for the ailing in the Benedictine nunneries. Much is due to her own genius but undoubtedly, also, much is
due to her knowledge of what had gone before and to the accumulation of information which the nuns had secured
in their work down the centuries since their foundation. A recent tribute to St. Hildegarde is the article on The
Scientific Views and Visions of St. Hildegarde, by Dr. Charles Singer, which is the leading article in the volume.
Studies in the History and Method of Science (9).
This is really a monograph on the subject for it contains nearly sixty pages of a quarto volume. Dr. Singer thus
speaks of her work:
Hildegarde was a woman
of extraordinarily active and independent mind. She was not only gifted with a thoroughly efficient intellect but
was possessed of great energy and considerable literary power and her writings cover a wide range betraying the
most varied activities and remarkable imaginative faculties.
What
she knew about science is contained in two volumes bearing the names Liber
simplicis medicinae and Liber
compositae medicinae. Most of what Hildegarde wrote comes to us in a
single copy, of none is there more than four copies, showing how near we came to missing all knowledge of her entirely.
Undoubtedly
there were many other writings, and some of them on medical subjects, by these nuns as well as the monks of the
Middle Ages, but these disappeared with the vicissitudes of time. The reformation, so-called, worked sad havoc
with monastic libraries. Some of them contained the most precious materials for the understanding of medieval life
and knowledge. They were destroyed partly through neglect but mainly through contempt for medieval scholars and
their work.
END
NOTES
(1). Sometimes there
is a distinct surprise to find what these old monastic scriveners had preserved. One can scarcely help but have
the feeling that they must have rather thoroughly appreciated the value of some ideas that are usually supposed
to have been quite beyond their ken. The frontispiece or the recently issued Hippocrates
with an English Translation by Dr. E. Withington (Oxford University Press,
1927) is a reproduction of the Apollonius illustration of the shouldering method of reducing the shoulder joint.
In this illustration the patient is represented as taken on another s shoulders, and by manipulation in this position
the dislocated shoulder is replaced. Dr. Withington says of it: It is doubtless a fairly accurate copy of the one
thousand years older original by Apollonius himself or the artist he employed. The surprise is to find how
well the medieval scrivener or artist of the eleventh century appreciated the value of the illustration for the
understanding of the method and therefore reproduced it.
(2).
It has sometimes been suggested that the monastery gardens would be scarcely large enough for the supply of all
the simples that were needed or at least were used, but then monastery gardens can be employed for purposes like
this with very great economy. We must not forget that almost in our time Mendel did his great work and succeeded
in working out his important laws of heredity in a monastery garden that was scarcely as large as a small-sized
city lot.
(3)
De Trinitate,
Book X, ch. 14, quoted in Schnaff-Wace, Nicene and Post-Nicene Fathers,
Vol. IX, p. 185, chap. 2.
(4)
Archiv fur Geschichte der Medizin, B. XIII, Heft. 3, 4, 1921.
(5)
Boston, 1926.
(6)
New York, April, 1927
(7)
1520-1584.
(8)
This subject is discussed more fully in my volume, Spain's
Golden Century, N. Y., 1928.
(9)
Clarendon Press, Oxford, 1917.
CHAPTER VI
THE CARE OF THE INSANE
There has been more
misunderstanding, in the modern time, of the relations of the Church to healing because of ignorance of the stand
taken by medieval ecclesiastics toward insanity and the insane, than for any other reasons. It is usually said
that until modern times insanity was thought to be due to possession by an evil spirit, and therefore the only
way to treat the insane was by exorcising these spirits. It is presumed by many that the position taken by the
Church in this important matter discouraged physicians from studying mental disease and led to an utter failure
of anything like proper care for these poor patients who were, as we understand so well now, sufferers from disease
just as much as those who had bodily ills of various kinds.
The idea,
however, that there was a very general acceptance of the notion that insanity was practically always caused by
possession by evil spirits is entirely without substantiation in what we have come to know of the history of the
Middle Ages. That idea is very largely due to the presumption with regard to spirit possession that grew up during
the witchcraft delusion. It must not be forgotten, however, that the witchcraft delusion is not medieval but modern
in its date and was at its height during the seventeenth century.
There
is only one way that the attitude of the Church and churchmen toward the insane in the Middle Ages can be determined
and that is through the formal teaching of theologians and those who wrote books touching the subject that were
approved by the ecclesiastical authorities of the time. These furnish a very different impression from anything
like the belief in insanity as due to the possession of evil spirits. We have one very striking testimony in this
matter and that comes from the compendium of information compiled by Bartholomew the Englishman (Bartholomaeus
Anglicus) for the use of priests.
There are a great
many practical questions on which priests ought to be well informed, and these Bartholomew, who was a learned Franciscan
friar, gathered into a single volume of encyclopedic character so that answers might be readily available for anyone
seeking information. His book was very much read and continued to be used as a manual of information for some four
centuries. It exists in a large number of manuscript copies which would indicate that Bartholomew was one of the
most widely read of the serious authors of the Middle Ages.
Even
before the invention of printing the book had been translated into half a dozen modern languages. It was originally
written in Latin but the French translation made by an Augustinian, Jean Corbichon, is itself a literary monument
in French and there are further translations into Italian, Spanish, English and Provencal.
After
printing came in, Bartholomew s book, the title of which is De proprietatibus
rerum, The Properties of Things, was published in a number of editions,
no less than three times as an incunabulum that is before 1501 and more than a dozen times afterwards. There was
evidently great call for the book. It was meant particularly for priests, and was evidently used by all the clerics
that is, by practically all those who could read at that time.
What
Bartholomew has to say with regard to insanity represents the opinion of the churchmen of his time better than
could be obtained from any other source. His work was actually used as a textbook in the schools of theology and
may be quoted confidently as constituting the source of knowledge on all these dubious questions. Bartholomew condensed
what he had to say with regard to the causes, the symptoms and treatment of insanity into a single brief paragraph.
Bartholomew
knows all the causes of insanity and mentions them. They are passion, overwork, overthought, sorrow, too deep study
and fear. These are the mental causes. But he knows also that there are physical factors that bring about disturbance
of mentality. Insanity may come as the result of an infection, from the bite of a mad dog or some other venomous
animal. Bartholomew was aware, moreover, that insanity may come from overeating as well as from the overdrinking
of strong wine.
He warns that not
all the patients suffer in the same way, and he describes the two principal forms of mania or excitement and melancholia
or depression. These two continued to be the center of attention until the end of the nineteenth century.
Bartholomew
warns of the possibility of the insane hurting themselves or others. For this reason they must be restrained. As
for their treatment, there must be such change of environment as will renew their health and strength and they
must be withdrawn from business and from the source of their dreads and whatever else may be disturbing. Finally
music must be provided for their entertainment and occupation secured for them. A change of environment, entertainment,
occupation, these are the very latest developments in our care of the insane. Here is Bartholomew s paragraph from
the translation by Berthelet made nearly four hundred years ago but with the spelling modified so as to make it
easier to understand at the present time.
Madness
cometh sometime of passions of the soul, as of business and of great thoughts, of sorrow and of too great study,
and of dread: sometime of the biting of a wood (mad) hound, or some other venomous beast; sometime of melancholy
meats, and sometime of drink of strong wine. And as the causes be diverse, the tokens and signs be diverse. For
some cry and leap and hurt and wound themselves and other men, and darken and hide themselves in privy and secret
places. The medicine of them is, that they be bound, that they hurt not themselves and other men. And namely, such
shall be refreshed, and comforted, and withdrawn from cause and matter of dread and busy thoughts. And they must
be gladded with instruments of music, and some deal be occupied.
This
paragraph of instruction for priests with regard to insanity is one of the best brief formulas on the subject that
we have. I doubt whether any one could do better at the present time than was actually accomplished by this medieval
friar who wrote sometime about 1240. His influence, more than that of any other, continued to be felt on the subject
until long after the Reformation. Unfortunately the development of the witchcraft delusion and the decadence of
hospitals after the Reformation brought about the serious neglect of the insane and popularized the idea of possession
by evil spirits.
The Catholic
countries were ever so much less affected by the witchcraft delusion than the reformed countries, and the deterioration
of hospitals was not nearly so marked in them. In Italy and in Spain the hospitals for the care of the insane continued
to be maintained under much better conditions than those in the countries which had been disturbed by Luther s
movement. The medieval monasteries undoubtedly were often an asylum for the feeble-minded and for the milder insane,
as well as for the simple-minded who get along very well if they are only allowed to work quietly and peacefully,
and if people do not try to impose on them. The children of the nobility who were not quite right in mind were
cared for by the monks, but the monastery afforded provision for the others for charity s sake and gave them an
opportunity to work and be occupied and thus secure the only happiness possible for them.
We have
come to realize in our time that the farm system of caring for such people is best for them in every way, especially
if they can be given the opportunity to do regular work under conditions that are not too hard. Even at the present
time there are a good many monasteries and nunneries where there are two or three or more simple-minded persons
who found it extremely difficult to get along with ordinary employers and yet find it easy to get along with the
Sisters, and who work faithfully for years and are about as happy as people can be. There were no institutions
for these people in the older times, and the monasteries supplied the place of them and accomplished what we are
only just beginning to do again by means of our colony and village systems of caring for the milder insane.
Special
care for the insane was provided at first in the general hospitals in connection with other ailing people. This
may seem an unfavorable condition, but manifestly special arrangements were made for them; and what alienists desire
at the present time is that special wards should be set aside in the general hospitals for the care of the insane,
so that they may be under observation early in their cases. As it is, even at the present time, the stigma supposed
to attach to insanity, for which there is no good reason, often keeps people from sending patients to the asylum
until there are already outspoken symptoms of insanity. If sent earlier many of these cases might be saved from
the further development of their affection and placed in conditions under which improvement rather than deterioration
would take place.
After
a time special hospitals or asylums for the insane were organized. Bethlehem hospital in London in the thirteenth
century, after having been a general hospital, came to be used exclusively for the insane. As a result the word
Bethlehem, in the speech of the Londoners softened into Bedlam, came to have the special significance of anything
related to insanity. The insane people were known as Bedlamers or Bedlamites and still later as Bedlam beggars,
though attached to this expression there is a very interesting social and medical development that must be touched
upon because it tells the story of one phase of arrangements for the care of the insane. In the later Middle Ages
the insane were not yet rigorously confined; but if they had shown any improvement and their delusions were over
and they had become capable to some extent at least of caring for themselves, they were allowed to leave the hospital
for a time.
There
was a condition, however, that they should wear a badge indicating that they had been for a time under surveillance
at Bedlam. It might seem to modern ideas to be a hardship thus to expose them to public recognition but it worked
to their advantage. All those who came in contact with them took pity on the poor fellows who had been in the asylum
and gave them charity, but above all were careful not to irritate them nor to impose on them. In other words, the
Bedlamers were committed to the care of the general public at the time when feeling for the fellow man ran high
and they fared very well.
This
fact was noted by the sturdy vagrants (validi vagrantes) of all kinds who tried to secure one of these Bedlam badges because possession of it
gave them a chance for an easy life. Such abuses of charity are very well known and never more so than in our own
time. On the death of possessors of Bedlam badges others who had no right to wear them proceeded to make use of
them. Occasionally they stole them from rightful owners. The state of affairs which developed can be understood
best from Shakespeare s presentation of a counterfeit Bedlamer, in the person of Gloucester s legitimate son, in
King Lear.
In all
this story of care for the insane in the Middle Ages there was no question of possession by the evil spirits nor
was there in the first phase of development of care for the insane which occurred in the little town of Gheel in
Belgium.
St.
Dympna, an Irish girl, who had come over with the missionaries from Ireland and who in her lifetime had been very
much interested in the insane and feeble-minded children, was martyred in Belgium. After her death feeble-minded
children and mild young insane patients were brought to her shrine in the hope of relief or cure through her intercession.
The friends
of the patients did not expect immediate cure so they left them to be cared for in the families of the villagers
near the shrine. This practice has continued for more than a thousand years and has been eminently successful.
Mrs. Vernon Kellogg, the wife of the United States Food Commissioner in Belgium during the war, described (1) her
personal experiences in Gheel and brought out the fact that very probably this is the ideal system for caring for
such patients.
What
we find, then, in the history of care for the insane under Christianity is very different from the common impression
with regard to it. First there is the colony system or village method of caring for the insane which developed
at Gheel and is now looked upon as probably the best way to care for these patients. Secondly there is the open-door
system of caring for the insane with provision for committing the insane when they are out of the asylum to the
special care of the public. The place that the idea of spirit possession takes as the cause of insanity or exorcism
in its treatment is of very minor importance. Bartholomew s succinct paragraph shows how thoroughly insanity was
understood.
The great
abuses in the care of the insane which had to be corrected during the nineteenth century and some of which are
in existence at the present time developed in connection with the deterioration of hospitals after the Reformation.
Both Spain and Italy maintained much better institutions for the care of the insane than the other countries of
Europe. The use of chains and manacles for the control of the insane is not a medieval but a modern abuse. When
the reform of insane asylums was taken up seriously, the Sisters institutions were particularly valuable in introducing
high standards of gentleness and sympathy in the care for these poor unfortunates. The most serious conditions
prevailed in the State institutions and particularly in the county poorhouses in various parts of the world where
the insane and the paupers were under the same roof. Even yet many of these institutions are a disgrace to modern
civilization.
(1)
Atlantic Monthly, 1926.
CHAPTER VII
THE CHURCH AND SURGERY
One of
the greatest surprises in the development of documentary history in our generation was the discovery that there
had been a magnificent evolution of surgery during the twelfth and thirteenth centuries in Italy, beginning with
the great medical school at Salerno but spreading all over the Italian peninsula and making its way into France
and England. For this chapter in history we are not dependent on vague traditions but fortunately are in possession
of the actual textbooks of the professors who taught surgery in the Italian and French universities of the time.
The preservation of them before printing through the laborious process of hand copying is a tribute to the thoroughgoing
appreciation of the generations that copied them so faithfully, and fortunately most of them were printed among
the incunabula (before 1501) and made safe from the vicissitudes of time.
These
textbooks are a revelation. It was astounding to find that surgeons at the end of the Middle Ages, supposed to
be so lacking in this department, had actually been doing much better surgery than the surgeons of the nineteenth
century ventured upon until a decade or two, at least, after Lister came to revolutionize modern surgery.
This
was all the more surprising because a special historical tradition had been created in the English-speaking countries
that the practice of surgery was forbidden by the Church in order to encourage the use of prayer and Masses and
relics and the visitation of shrines from which the Church would derive more revenue. Professor Andrew D. White,
in his work, The Warfare of Science with Theology,
declared that, invoking as a guiding principle, ecclesia abhorret a sanguine ( the Church abhors the shedding of blood) ecclesiastics prevented the development of
surgery. He adds:
So deeply
was the idea rooted in the mind of the universal Church that for over a thousand years surgery was considered dishonorable.
The greatest monarchs were often unable to secure an ordinary surgical operation and it was only in 1406 that a
better beginning was made when the Emperor Wentzel of Germany ordered that dishonor should no longer attach to
the surgical profession.
The situation
thus conjured up enables him to emphasize ecclesiastical hypocrisy by the suggestion that the Church was not chary
of shedding blood in other ways.
As a
matter of fact during the two centuries and a half immediately preceding this date given by President White there
was a marvelous development of surgery. The outstanding surprise of medical history has been the discovery and
revelation of this fact in the past generation. Pagel, the well-known German historian of medicine says:
A more
favorable star shone during the whole Middle Ages over surgery than over practical medicine . . . . The stream
of works on surgery flows surgery has a huge volume concerned almost entirely with surgeons who did their work
during the very richly during this period.
Gurlt
in his great history of surgery has a hugh volume concerned almost entirely with surgeons who did their work during
the very centuries when President White says there was no surgery. The historian of The
Warfare of Science with Theology had evidently never looked into the
history of surgery.
The beginning
of the great development of surgerywas at Salerno in the last quarter of the twelfth century. The first important
textbook was written by Roger and then came his pupil Rolando who wrote a commentary on his master s work. This
combined textbook was subsequently annotated by a group of South Italian surgeons known as the Four Masters. Gurlt
himself, one of our most distinguished surgeons at the end of the nineteenth century who went back to the originals,
declared that this textbook shows clearly that writers drew their opinions from a rich experience. They were intent
on observation rather than theory, and their textbook is a treasure house of valuable hints for the surgeons not
only of their day but of all generations since.
These
surgeons from Salerno, for instance, knew the possibility of fracture of the skull by contrecoup.
They say, Quite frequently though the blow comes on the anterior part
of the cranium fracture occurs on the opposite side. They tell the story of a boy wounded in the head by a thrown
stone apparently without serious result though he died the next day. When his cranium was opened a large amount
of black blood was found coagulated beneath his dura mater.
Since then many a
boy has died, after being hit on the head by a missile, because his surgeon did not realize the possibility of
rupture of the middle meningeal artery.
Professor
Clifford Allbutt, Regius Professor of Medicine at Cambridge (England), in his Historical
Relations of Medicine and Surgery Down to the Sixteenth Century, (1)
says of their method of caring for wounds:
They
washed the wound with wine scrupulously removing every foreign particle; then they brought the edges together,
not allowing wine nor anything else to remain within dry adhesive surfaces were their desire. Nature, they said,
produces the means of union in a viscous exudation or natural balm. ... In older wounds they did their best to
obtain union by cleansing, desiccation and refreshing of the edges.
The experience
of surgeons during the Great War brought them round to many of these old-fashioned ideas once more. Theodoric comes
nearest to us of all these old surgeons. He wrote in 1266:
For
it is not necessary as Roger and Roland (of Salerno) have written, as many of their disciples teach and as all
modern surgeons profess, that
pus should be generated in wounds. No error can be greater than this. Such a practice is indeed to hinder nature,
prolong the disease and to prevent the conglutination and consolidation of the wounds.
And yet
for five hundred years after his time laudable pus was the best that surgery could hope to secure after surgical
intervention. Theodoric himself was a bishop and wrote his textbook on surgery mainly in order to preserve the
teaching of his father, the famous Ugo of Lucca. He was very proud of the work that his father had done and he
boasted of the linear cicatrices hich he used to secure without the use of any ointment.
He impugned
the use of poultices with oil on the wounds and declared that powders were too drying and besides they had a tendency
to cake and thus prevent drainage. The literal meaning of the words which Theodoric uses saniem
incarcerare is to incarcerate sanious material. One is not surprised
after that to find that Theodoric has many hints as to the practical treatment of surgical affections that are
anticipations of developments of our time.
Theodoric
was followed by William of Salicet who imitated Theodoric in getting away from the Arabic abuse of the cautery
and brought the knife back again to its proper place as the ideal surgical instrument.
Gurlt,
in his history of surgery, devotes more than ten pages of rather fine print to William and his work, insisting
that William depended much more upon his own experience than upon what was to be found in textbooks. He knew what
had been written before his time, very well, but as a rule he did not quote from his predecessors unless he had
tried the recommendations for himself or unless similar cases had come under his own observation.
The next
of these great Italian surgeons masquerades under a French name because he was professor of surgery at Paris. This
is Lanfranc whose family name however was Lanfranchi or Lanfranco and who is sometimes spoken of as Alanfrancus.
He practiced as a physician and surgeon in Milan until banished from there by the Visconti about 1290. He removed
to Lyons where he attracted so much attention that he was offered a professorship of surgery in Paris. Gurlt says
he attracted almost an incredible number of scholars to Paris and by hundreds they accompanied him to the bedside
of his patients and witnessed his operations.
Lanfranc
completed his surgery called Chirurgia Magna
in 1296 and dedicated it to Philippe Le Bel, the reigning French king. He thus described the character that a surgeon
should possess:
A surgeon
should have a temperate disposition well under control ... he should have well formed hands, long slender fingers,
a strong body not inclined to tremble and with all his members trained to the capable fulfilment of the wishes
of his mind. He should be of a deep intelligence and of a simple, modest, brave but not audacious disposition.
He should be well grounded in natural science and should know not only medicine but every part of philosophy; he
should know logic well so as to be able to understand what is written and should talk well so as to support what
he has to say by good reasons.
Lanfranc
clearly had a high ideal for his profession. He had some very practical hints for young surgeons. For instance:
The
surgeon should not love difficult cases and should not allow himself to be tempted to undertake those that are
desperate. He should help the poor as far as he can but he should not hesitate to ask for good fees from the rich.
The
next of the great surgeons of this period was the successor of Lanfranc at Paris, Henri de Mondeville. Old writers
usually quote him as Henricus. The first edition of his book ever printed we owe to Professor Pagel who published
it at Berlin in 1892. Gurit in his History has given over forty pages, much of it being small type, with regard
to Mondeville because of the special interest there is in his writing. This would represent a volume of good size
because Gurlt s pages are large. He was a great teacher of surgery. Here is his idea of the training of a surgeon:
A surgeon
who wishes to operate regularly ought first for a long time to frequent places in which skilled surgeons operate
frequently and he ought to pay careful attention to their operations and commit their technique to memory. Then
he ought to associate himself with them in doing operations. A man cannot be a good surgeon unless he knows both
the art and science of medicine and especially anatomy. The characteristics of a good surgeon are that he should
be moderately bold, not given to disputation before those who do not know medicine, operate with foresight and
wisdom, not beginning dangerous operations until he has provided himself with everything necessary for lessening
the danger . . . . He must be highly moral, should care for the poor for God s sake, see that he is well paid by
the rich, should comfort his patients by pleasant discourse and should always accede to their requests if these
do not interfere with the cure of the disease.
He had
been a student of Lanfranc as may be seen by these expressions, but he went much farther than his master and was
evidently a great-souled member of his profession. He emphasized very much the need of keeping the patient s mind
in favorable condition.
Let
the surgeon take care to regulate the whole regimen of the patient s life for joy and happiness, by promising that
he will soon be well, by allowing his relatives and special friends to cheer him and by having some one to tell
him Jokes.
Let him be solaced
also by music on the viol or psaltery. The surgeon must forbid anger, hatred and sadness in the patient and remind
him that the body grows fat from joy and thin from sadness.
Mondeville
has much to say with regard to the assistants who share with the surgeon his care of the patients. He feels that
they often put obstacles and difficulties in the way of convalescents. He insists then that:
The
surgeon must be careful in the selection of nurses and attendants for some of them obey very well while he is present
but do as they like and often just exactly the opposite of what he has directed when he is away.
Just
what the status of these attendants of whom Mondeville talks was at that time, we are not sure. There would seem
to have been both men and women trained for the special purpose of caring for patients. Some of these were undoubtedly
medical students, others were young physicians, but still others must have been what we would call nurses or orderlies.
There
is scarcely a feature of modern surgery that Mondeville does not touch on in his writings. The picture of the surgeon
of France at the end of the fourteenth century, as he gives it, affords a very interesting demonstration of how
thoroughly surgery developed in the later Middle Ages. This rather detailed account is all the more interesting
when confronted with the impression that prevailed in many minds that the Church had so hampered the evolution
of surgery that even monarchs found it difficult to have operations done on them. These surgeons of the thirteenth
and fourteenth century were actually doing very much better surgery, as can be readily seen from their textbooks,
than was being done anywhere in the world between 1800 and 1850.
Mondeville
s personal attitude toward the Church is very well illustrated by his dedication of his textbook of surgery. He
says in the preface, that he:
Began
to write it for the honor and praise of Christ Jesus and the Virgin Mary, of the saints and martyrs, Cosmas and
Damien, and of King Philip of France as well as his four children and on the proposal and request of Master William
of Brescia, distinguished professor in the science of medicine and formerly physician to Popes Boniface IV and
Clement, the present pope.
There
is good reason to think that most of these medieval surgeons who reached distinction were in Holy Orders.
We know
that Theodoric was a bishop and that William of Salicer was in minor orders, as probably also Lanfranc. Guy de
Chauliac, the father of French surgery as he has been called, was the canon of a cathedral; and while this does
not necessarily imply that he was in major orders, he was surely a cleric. Mondeville was very much disturbed,
however, by the presumption of some priests in assuming direction of patients and giving them medical advice. He
said that some of the clergy of his time seemed to think that a knowledge of medicine was infused into them with
the sacrament of Holy Orders. He deprecated that idea very much. (2).
Chauliac,
the next of these great surgeons, was born in the south of France, but like all those who reached distinction at
this time he was educated in Italy. He describes the many dissections that were made in Bologna where his master
Bertruccio taught anatomy by dissection. This is the period when President White says there were no dissections
because the Church was opposed to them. The great French surgeon s attitude toward anatomical knowledge by actual
study of the cadaver can be judged from his well-known expression that:
The
surgeon, ignorant of anatomy, carves the human body like a blind man carving wood.
After
his Bologna experience Chauliac went to Paris where Lanfranc was developing the Italian surgical tradition on French
soil and attracting an incredible number of students to Paris. Lanfranc s successor was Mondeville, who was followed
by Guy de Chauliac; and these three lifted French surgery up to a plane which according to Pagel, the German historian
of medicine, enabled Frenchmen to maintain their position as the leading surgeons of the world until the nineteenth
century.
Chauliac
had a series of experiences at other places and then settled down in Lyons and achieved a great reputation. It
was while here that he was summoned to become papal physician and he served in this capacity for three popes. Clement
VI, Innocent VI and Urban V. It was in the leisure afforded him by this position that he wrote his Chirurgia Magna
which, as he tells us, was undertaken as solatium senectutis, a solace for his old age.
Many
other surgeons in succeeding centuries reached distinction in the universities founded under decrees of the popes.
The careers of a number of them may be read in my volume on Medieval Medicine (3) With the decadence of hospitals surgery sank to an almost incredible degree until
only minor surgery and surgical operations in the face of impending death continued to be done. Nothing is
more surprising than this deterioration of surgery and yet it is easily explained. For good surgery three conditions
are necessary good hospitals, good nursing, good surgery. The Reformation brought decadence to the hospitals, suppressed
the nurses, and the surgeons lost their skill under the impossible conditions that resulted. Modern surgery dates
from Lister and the reform of hospitals fifty years ago.
END NOTES
(1) London,
1904.
(2)
President White in his The Warjare of
Science with Theology quotes certain
papal decrees forbidding surgery to monks as the reason for the failure of surgery to develop. In my volume on:
The Popes and Science (Fordham University Press, fourth edition, 1915) [See elsewhere on this site]. I quoted all
the Church regulations with regard to the prohibition of medicine and surgery to monks. These same decrees also
forbade the study of law. It was felt that it was unsuitable for members of religious orders to be occupied with
such mundane affairs. The decrees themselves are worded in such a way as to make it very clear that their purpose
is only the guidance of religious in the paths of the spiritual life. The amusing feature of the subject is that
actually at the very time when because of these decrees, as President White so confidently asserted, there was
no surgery there was a magnificent development of the subject, the wonder of the modern world when it was rediscovered.
Manifestly this very development of profound interest in surgery tempted some of the religious to devote themselves
to the subject and the resulting abuse led to the issuance of the Church decree. That they had no diriment effect
on the development of surgery is very clear from the history of this specialty as we have it.
(3). Black, London,
1920
Part 3
Published by: The ChurchinHistory Information Centre
http://www.churchinhistory.org/
This version: 23rd March 2008