« PrécédentContinuer »
teenth centuries. Considerable space has been devoted to this, because it represents not only an important phase of the history of medicine, and recalls the names and careers of great makers of medicine, but also because it illustrates exquisitely the possibility of important discoveries in medicine being made, applied successfully for years, and then being lost or completely forgotten, though contained in important medical books that were always available for study. The more we know of this great period in the history of surgery, the more is the surprise at how much was accomplished, and how many details of our modern surgery were anticipated. Most of us have had some inkling of the fact that anaesthesia is not new, and that at various times in the world's history men have invented methods of producing states of sensibility in which more or less painless operations were possible. Very few of us have realized, however, the perfection to which anaesthesia was developed, and the possibility this provided for the great surgeons of the later medieval centuries to do operations in all the great cavities of the body, the skull, the thorax, and the abdomen, quite as they are done in our own time and apparently with no little degree of success.
Of course, any such extensive surgical intervention even for serious affections would have been worse than useless under the septic conditions that would surely have prevailed if certain principles of antisepsis were not applied. Until comparatively recent years we have been quite confident in our assurance that antisepsis and asepsis were entirely modern developments of surgery. More knowledge, however, of the history of surgery has given a serious set-back to this self-complacency, and now we know that the later medieval surgeons understood practical antisepsis very well, and applied it successfully. They used strong wine as a dressing for their wounds, insisted on keeping them clean, and not allowing any extraneous material of any kind, ointments or the like, to be used on them. As a consequence they were able to secure excellent results in the healing of wounds, and they were inclined to boast of the fact that their incisions healed by first intention and that, indeed, the scar left after them was scarcely noticeable. We know that wine would make a good antiseptic dressing, but until we actually read the reports of the results obtained by these old surgeons, we had no idea that it could be used to such excellent purpose. Antisepsis, like anaesthesia, was marvellously anticipated by the surgical forefathers of the medieval period.
It has always seemed to me that the story of Medieval Dentistry presented an even better illustration of a great anticipatory development of surgery. This department represents only a small surgical specialty, but one which even at that period was given over to specialists, who were called dentatores. Guy de Chauliac's review of the dentistry of his time and the state of the specialty, as pictured by John of Arcoli, is likely to be particularly interesting, because if there is any department of medical practice that we are sure is comparatively recent in origin, it is dentistry. Here, however, we find that practically all our dental manipulations, the filling of teeth, artificial dentures, even orthodontia, were anticipated by the dentists of the Middle Ages. We have only the compressed account of it which is to be found in text-books of general surgery, and while in this they give mainly a heritage from the past, yet even this suffices to give us a picture very surprising in its detailed anticipation of much that we have been inclined to think of as quite modern in invention and discovery.
Medicine developed much more slowly than surgery, or, rather, lagged behind it, as it seems nearly always prone to do. Surgical problems are simple, and their solution belongs to a great extent to a handicraft. That is, after all, what chirurgy, the old form of our word surgery, means. Medical problems are more complex and involve both art and science, so that solutions of them are often merely temporary and lack finality. During the Middle Ages, however, and especially towards the end of them, the most important branches of medicine, diagnosis and therapeutics, took definite shape on the foundations that lie at the basis of our modern medical science. We hear of percussion for abdominal conditions, and of the most careful study of the pulse and the respiration. There are charts for the varying color of the urine, and of the tints of the skin. With Nicholas of Cusa there came the definite suggestion of the need of exact methods of diagnosis. A mathematician himself, he wished to introduce mathematical methods into medical diagnosis, and suggested that the pulse should be counted in connection with the water clock, the water that passed being weighed, in order to get very definite comparative values for the pulse rate under varying conditions, and also that the specific gravity of fluids from the body should be ascertained in order to get another definite datum in the knowledge of disease. It was long before these suggestions were to bear much fruit, but it is interesting to find them so clearly expressed.
At the very end of the Middle Ages came the father of modern pharmaceutical chemistry, Basil Valentine. Already the spirit that was to mean so much for scientific investigation in the Renaissance period was abroad. Valentine, however, owes little to anything except his own investigations, and they were surprisingly successful, considering the circumstances of time and place. His practical suggestions so far as drugs were concerned did not prove to have enduring value, but then this has been a fate shared by many of the masters of medicine. There were many phases of medical practice, however, that he insisted on in his works. He believed that the best agent for the cure of the disease was nature, and that the physician's main business must be to find out how nature worked, and then foster her efforts or endeavor to imitate them. He insisted, also that personal observation, both of patients and drugs, was more important than book knowledge. Indeed, he has some rather strong expressions with regard to the utter valuelessness of book information in subjects where actual experience and observation are necessary. It gives a conceit of knowledge quite unjustified by what is really known.
What is interesting about all these men is that they faced the same problems in medicine that we have to, in much the same temper of mind that we do ourselves, and that, indeed, they succeeded in solving them almost as well as we have done, in spite of all that might be looked for from the accumulation of knowledge ever since.
It was very fortunate for the after time that in the period now known as the Renaissance, after the invention of printing, there were a number of serious, unselfish scholars who devoted themselves to the publication in fine printed editions of the works of these old-time makers of medicine. If the neglect of them that characterized the eighteenth and early nineteenth centuries had been the rule at the end of the fifteenth and during the sixteenth century, we would almost surely have been without the possibility of ever knowing that so many serious physicians lived and studied and wrote large important tomes during the Middle Ages. For our forefathers of a few generations ago had very little knowledge, and almost less interest, as to the Middle Ages, which they dismissed simply as the Dark Ages, quite sure that nothing worth while could possibly have come out of the Nazareth of that time. What they knew about the people who had lived during the thousand years before 1500 only seemed to them to prove the ignorance and the depths of superstition in which they were sunk. That medieval scholars should have written books not only well worth preservation, but containing anticipations of modern knowledge, and, though of course they could not have known that, even significant advances over their own sci