An even more striking example than the life and work of Aëtius as evidence for the encouragement and patronage of medicine in early Christian times, is to be found in the career of Alexander of Tralles, whose writings have been the subject of most careful attention in the Renaissance period and in our own, and who must be considered one of the great independent thinkers in medicine. While it is usually assumed that whatever there was of medical writing during the Middle Ages was mere copying and compilation, here at least is a man who could not only judiciously select, but who could critically estimate the value of medical opinions and procedure, and weighing them by his own experience and observation, turn out work that was valuable for all succeeding generations. The modern German school of medical historians have agreed in declaring him an independent thinker and physician,who represents a distinct link in medical tradition.
He came of a distinguished family, in which the following of medicine as a profession might be looked upon as hereditary. His father was a physician, and it is probable that there were physicians in preceding generations, and one of his brothers, Dioscoros, was also a successful physician. Altogether four of his brothers reached such distinction in their life work that their names have come down to us through nearly fifteen hundred years. The eldest of them was Anthemios, the builder of the great church of Santa Sophia in Constantinople. As this is one of the world's great churches, and still stands for the admiration of men a millennium and a half after its completion, it is easy to understand that Anthemios' reputation is well founded. A second brother was Metrodoros, a distinguished grammarian and teacher, especially of the youthful nobility of Byzantium, as it was then called, or Constantinople, as we have come to call it. A third brother was a prominent jurist, also in Constantinople. The fourth brother, Dioscoros, like Alexander, a physician, remained in his birthplace, Tralles, and acquired there a great practice.
It was with his father at Tralles that Alexander received his early medical training. The father of a friend and colleague, Cosmas, who later dedicated a book to Alexander, was also his teacher, while he was in his native city. As a young man, Alexander undertook extensive travels, which led him into Italy, Gaul, Spain, and Africa, everywhere gathering medical knowledge and medical experience. Then he settled down at Rome, probably in an officialposition, and practised medicine successfully until a very old age. He was probably eighty years of age when, some time during the first decade of the seventh century, he died.
Puschmann, who has made a special study of Alexander's life and work, suggests that since some of his books have the form of academic lectures he was probably a teacher of medicine at Rome. As might be expected from what we know of the relations of the rest of the family to the nobility of the time, it is easy to understand, especially in connection with hints in Alexander's favorite modes of therapeutics, that costliness of remedies made no difference to his patients, that he must have had the treatment of some of the wealthiest families in Rome.
His principal work is a Treatise on the Pathology and Therapeutics of Internal Diseases, in twelve books. The first eleven books were evidently material gathered for lectures or teaching of some kind. The twelfth book, in which considerable use of Aëtius' writings is made, was written, according to Puschmann, toward the end of Alexander's life, and was meant to contain supplementary matter, comprising especially his views gathered from observation as to the pathology of internal diseases. A shorter treatise of Alexander is with regard to intestinal parasites. There are many printed editions of these books, and many manuscript copies are in existence. Alexander was often quoted during the Middle Ages, and in recent years, with the growth of our knowledge of medical history, he has come to be a favorite subject of study.
Alexander's first book of pathology and therapeutics treats of head and brain diseases. For baldness, the first symptom of which is falling out of the hair, he counsels cutting the hair short, washing the scalp vigorously, and the rubbing in of sulphur ointments. For grey hair he suggests certain hair dyes, as nutgalls, red wine, and so forth. For dandruff, which he described as the excessive formation of small flake-like scales, he recommends rubbing with wine, with certain salves, and washing with salt water.
He gives a good deal of attention to diseases of the nervous system. He has a rather interesting chapter on headache. The affection occurs in connection with fevers, after excess in drinking, and as a consequence of injury to the skull. Besides, it develops as a result of disturbances of the natural processes in the head, the stomach, the liver, and the spleen. Headache, as the first symptom of inflammation of the brain, is often the forerunner of convulsions, delirium, and sudden death. Chronic or recurrent headache occurs in connection with plethora, diseases of the brain, biliousness, digestive disturbances, insomnia, and continued worry. Hemicrania has its origin in the brain, because of the presence of toxic materials, and specially their transformation into gaseous substances. It also occurs in connection with abdominal affections. This latter remark particularly is directed to the cases which occur in women.
For apoplexy and the consequent paralysis, Alexander considered venesection the best remedy. Massage, rubbings, baths, and warm applicationsare recommended for the paralytic conditions. He had evidently had considerable experience with epilepsy. It develops either from injuries of the head or from disturbances of the stomach, or occasionally other parts of the body. When it occurs in nursing infants, nourishment is the best remedy, and he gives detailed directions for the selection of a wet nurse, and very careful directions as to her mode of life. He emphasizes very much the necessity for careful attention to the gastro-intestinal tract in many cases of epilepsy. Planned diet and regular bowels are very helpful. He rejects treatment of the condition by surgery of the head, either by trephining or by incisions, or cauterization. Regular exercise, baths, sexual abstinence are the foundation of any successful treatment. It is probable that we have returned to Alexander's treatment of epilepsy much more nearly than is generally thought. There are those who still think that remedies of various kinds do good, but in the large epileptic colonies regular exercise, bland diet, regulation of the bowels, and avoidance of excesses of all kinds, with occupation of mind, constitute the mainstay of their treatment.
Alexander has much to say with regard to phrenitis, a febrile condition complicated by delirium, which, following Galen, he considers an affection of the brain. It is evidently the brain fever of the generations preceding the last, an important element of which was made up of the infectious meningitises. Alexander suggests its treatment by opiates after preliminary venesection, rubbings, lukewarm baths, and stimulating drinks. Every disturbance of thepatient must be avoided, and visitors must be forbidden. The patient's room should rather be light than dark. His teaching crops up constantly in the centuries after his time, until the end of the nineteenth century, and while we now understand the causes of the condition better, we can do little more for it than he did.
Alexander divided mental diseases into two, the maniacal and melancholic. Mania was, however, really a further development of melancholia, and represented a high grade of insanity. Under melancholy he groups not only what we denominate by that term, but also all depressed conditions, and the paranoias, as also many cases of imbecility. The cause of mental diseases was to be found in the blood. He counselled the use of venesection, of laxatives and purgatives, of baths and stimulant remedies. He insisted very much, however, on mental influence in the disease, on change of place and air, visits to the theatre, and every possible form of mental diversion, as among the best remedial measures.
After his book on diseases of the head, his most important section is on diseases of the respiratory system. In this he treats first of angina, and recommends as gargles at the beginning light astringents; later stronger astringents, as alum and soda dissolved in warm water, should be employed. Warm compresses, venesection from the sublingual veins, and from the jugular, and purgatives in severe cases, are the further remedies. He treats of cough as a symptom due to hot or cold, dry or wet dyscrasias. Opium preparations carefully used are thebest remedies. The breathing in of steam impregnated with various ethereal resins, was also recommended.
He gives a rather interestingly modern treatment of consumption. He recommends an abundance of milk with a strong nutritious diet, as digestible as possible. A good auxiliary to this treatment was change of air, a sea voyage, and a stay at a watering-place. Asses' and mares' milk are much better for these patients than cows' and goats' milk. There is not enough difference in the composition of these various milks to make their special consumption of import, but it is probable that the suggestive influence of the taking of an unusual milk had a very favorable effect upon patients, and this effect was renewed frequently, so that much good was ultimately accomplished. For hemoptysis, especially when it was acute and due as Alexander thought to the rupture of a blood vessel in the lungs, he recommended the opening of a vein at the elbow or the ankle—in order to divert the blood from the place of rupture to the healthy parts of the circulation. He insisted that the patients must rest, that they should take acid and astringent drinks, that cold compresses should be placed upon the chest (our ice bags), and that they should take only a liquid diet at most lukewarm, or, better, if agreeable to them, cold. When the bleeding stopped, a milk cure was very useful for the restoration of these patients to strength.
It is not surprising, then, to find that Alexander suggests a thoroughly rational treatment for pleurisy. He recognizes this as an inflammationof the membrane covering the ribs, and its symptoms are severe pain, disturbance of breathing, and coughing. In certain cases there is severe fever, and Alexander knows of purulent pleurisy, and the fact that when pus is present the side on which it is is warmer than the other. Pleurisy can be, he says, rather easily confounded with certain liver affections, but there is a peculiar hardness of the pulse characteristic of pleurisy, and there is no expectoration in liver cases, though it also may be absent in many cases of pleurisy. Sufferers from liver disease usually have a paler color than pleuritics. His treatment consists in venesection, purgatives, and, when pus is formed, local incision. He recommends the laying on of sponges dipped in warm water, and the internal use of honey lemonade. Opium should not be used unless the patient suffers from sleeplessness.
Some of the general principles of therapeutics that Alexander lays down are very interesting, even from our modern standpoint. Trust should not be placed in any single method of treatment. Every available means of bringing relief to the patient should be tried. "The duty of the physician is to cool what is hot, to warm what is cold, to dry what is moist, and to moisten what is dry. He should look upon the patient as a besieged city, and try to rescue him with every means that art and science places at his command. The physician should be an inventor, and think out new ways and means by which the cure of the patient's affection and the relief of his symptoms may be brought about." The most important factor in his therapeutics is diet.Watering-places and various forms of mineral waters, as well as warm baths and sea baths, are constantly recommended by him. He took strong ground against the use of many drugs, and the rage for operating. The prophylaxis of disease is in Alexander's opinion the important part of the physician's duty. His treatment of fever shows the application of his principle: cold baths, cold compresses, and a cooling diet, were his favorite remedies. He encouraged diaphoresis nearly always, and gave wine and stimulating drugs only when the patient was very weak. He differentiates two kinds of quartan fever. One of these he attributes to an affection of the spleen, because he had noticed that the spleen was enlarged during it, and that, after purgation, the enlarged spleen decreased in size.
Alexander was a strong opponent of drastic remedies of all kinds. He did not believe in strong purgatives, nor in profuse and sudden blood-lettings. He opposed arteriotomy for this reason, and refused to employ extensive cauterization. His diagnosis is thorough and careful. He insisted particularly on inspection and palpation of the whole body; on careful examination of the urine, of the feces, and the sputum; on study of the pulse and the breathing. He thought that a great deal might be learned from the patient's history. The general constitution is also of importance. His therapeutics is, above all, individual. Remedies must be administered with careful reference to the constitution, the age, the sex, and the condition of the patient's strength. Special attention must always be paid to nature's efforts to cure, and these must be encouraged as far as possible. Alexander had no sympathy at all with the idea that remedies must work against nature. His position in this matter places him among the dozen men whose name and writings have given them an enduring place in the favor of the profession at all times, when we were not being carried away by some therapeutic fad or imagining that some new theory solved the whole problem of the causation and cure of disease.
Gurlt, in his "History of Surgery," has abstracted from Alexander particularly certain phases of what the Germans call external pathology and therapeutics. For instance, Alexander's treatment of troubles connected with the ear is very interesting. Gurlt declares that this chapter alone provides striking evidence for Alexander's practical experience and power of observation, as well as for his knowledge of the literature of medicine. He considers that only a short abstract is needed to show that.
For water that has found its way into the external ear, Alexander suggests a mode of treatment that is still popularly used. The patient should stand upon the leg corresponding to the side on which there is water in his ear, and then, with head leaning to that side, should hop or kick out with the other leg. The water may be drawn out by means of suction through a reed. In order to get foreign bodies out of the external auditory canal, an ear spoon or other small instrument should be wrapped in wool and dipped in turpentine, or some other sticky material. Occasionally he has seen sneezing, especially if the mouth and nose are covered with a cloth, and thehead leant toward the affected side, bring about a dislodgment of the foreign body. If these means do not succeed, gentle injections of warm oil or washing out of the canal with honey water should be tried. Foreign bodies may also be removed by means of suction. Insects or worms that find their way into the ear may be killed by injections of acid and oil, or other substances.
Gurlt also calls attention to Alexander's careful differentiation of certain very dangerous forms of inflammation of the throat from others which are rather readily treated. He says, "Inflammation of the throat may, under certain circumstances, belong to the severest diseases. The patients succumb to it as a consequence of suffocation, just as if they were choked or hanged. For this reason, perhaps, the affection bears the name synanche, which means constriction." He then points out various other forms of inflammation of the throat, acute and chronic, suggesting various names and the differential diagnostic signs.
One of the most surprising chapters of Alexander's knowledge of pathology and therapeutics is to be found in his treatment of the subject of intestinal worms, which is contained in a letter sent by him to his friend, Theodore, whose child was suffering from them. He describes theoxyuris vermiculariswith knowledge manifestly derived from personal observation. He dwells on the itching in the region of the anus, caused by theoxyuris, and the fact that they probably find their way into the upper part of the digestive tract because of the soiling of the hands. He knew that the tapewormsoften reached great length,—he has seen one over sixteen feet long,—and also that they had a life cycle, so that they existed in two different forms. He describes the roundworms as existing in the intestines, but occasionally wandering into the stomach to be vomited. His vermifuges were the flowers and the seeds of the pomegranate, the seeds of the heliotrope, castor-oil, and certain herbs that are still used, by country people, at least, as worm medicines. For roundworms he recommended especially a decoction ofartemisia maritima, coriander seeds, and decoctions of thyme. Our return to thymol for intestinal parasites is interesting. For theoxyurishe prescribed clysters of ethereal oils. We have not advanced much in our treatment of intestinal worms in the fifteen hundred years since Alexander's time.
Another extremely important writer in these early medieval times, whose opportunities for study in medicine and for the practice of it, were afforded him by Christian schools and Christian hospitals, was Paul of Ægina. He was born on the island of Ægina, hence the name Æginetus, by which he is commonly known. There used to be considerable doubt as to just when Paul lived, and dates for his career were placed as widely apart as the fifth and the seventh centuries. We know that he was educated at the University of Alexandria. As that institution was broken up at the time of the capture of the city by the Arabs, he cannot have been therelater than during the first half of the seventh century. An Arabian writer, Abul Farag, in "The Story of the Reign of the Emperor Heraclius," who died 641, says that "among the celebrated physicians who flourished at this time was Paulus Æginetus." In his works Paul quotes from Alexander of Tralles, so that there seems to be no doubt now that his life must be placed in the seventh century.
The most important portion of Paul's work for the modern time is contained in his sixth book on surgery. In this his personal observations are especially accumulated. Gurlt has reviewed it at considerable length, devoting altogether nearly thirty pages to it, and it well deserves this lengthy abstract. Paul quotes a great many of the writers on surgery before his time, and then adds the results of his own observation and experience. In it one finds careful detailed descriptions of many operations that are usually supposed to be modern. Very probably the description quoted by Gurlt of the method of treating fishbones that have become caught in the throat will give the best idea of how thoroughly practical Paul is in his directions. He says: "It will often happen in eating that fishbones or other objects may be swallowed and get caught in some part of the throat. If they can be seen they should be removed with the forceps designed for that purpose. Where they are deeper, some recommend that the patient should swallow large mouthfuls of bread or other such food. Others recommend that a clean soft sponge of small circumference to which a string is attached be swallowed,and then drawn out by means of the string. This should be repeated until the bone or other object gets caught in the sponge and is drawn out. If the patient is seen immediately after eating, and the swallowed object is not visible, vomiting should be brought on by means of a finger in the throat or irritation with the feather, and then not infrequently the swallowed object will be brought up with the vomit."
In the chapter immediately following this, XXXIII, there is a description of the method of opening the larynx or the trachea, with the indications for this operation. The surgeon will know that he has opened the trachea when the air streams out of the wound with some force, and the voice is lost. As soon as the danger of suffocation is over, the edges of the wound should be freshened and the skin surfaces brought together with sutures. Only the skin without the cartilage should be sutured, and general treatment for encouraging union should be employed. If the wound fails to heal immediately, a treatment calculated to encourage granulations should be undertaken. This same method of treatment will be of service whenever we happen to have a patient who, in order to commit suicide, has cut his throat. Paul's exact term is, perhaps, best translated by the expression, slashed his larynx.
One of the features of Paul's "Treatise on Surgery" is his description of a radical operation for hernia. He describes scrotal hernia under the name enterocele, and says that it is due either to a tearing or a stretching of the peritoneum. It may be the consequence either of injury or of violent effortsmade during crying. When the scrotum contains only omentum, he calls the condition epiplocele; when it also contains intestine, an epiplo-enterocele. Hernia that does not descend into the scrotum he calls bubonocele. For operation the patient should be placed on the back, and, the skin of the inguinal region being stretched by an assistant, an oblique incision in the direction in which the blood vessels run should be made. The incision should then be stretched by means of retractors, until the contents of the sac can be lifted out. All adhesions should be broken up and the fat be removed, and the hernia replaced within the abdomen. Care should be taken that no loop of intestine is allowed to remain. Then a large needle with double thread made of ten strands should be run through the middle of the incision in the end of the peritoneum, and tied firmly in cross sutures. The outer structures should be brought together with a second ligature, and the lower end of the incision should have a wick placed in it for drainage, and the site of operation should be covered with an oil bandage.
The Arab writer, Abul Farag, to whose references we owe the definite placing of the time when Paul lived, said that "he had special experience in women's diseases, and had devoted himself to them with great industry and success. The midwives of the time were accustomed to go to him and ask his counsel with regard to accidents that happen during and after parturition. He willingly imparted his information, and told them what they should do. For this reason he came to be known as the Obstetrician." Perhaps the term should be translatedthe man-midwife, for it was rather unusual for men to have much knowledge of this subject. His knowledge of the phenomena of menstruation was as wide and definite. He knew a great deal of how to treat its disturbances. He seems to have been the first one to suggest that in metrorrhagia, with severe hemorrhage from the uterus, the bleeding might be stopped by putting ligatures around the limbs. This same method has been suggested for severe hemorrhage from the lungs as well as from the uterus in our own time. In hysteria he also suggested ligature of the limbs, and it is easy to understand that this might be a very strongly suggestive treatment for the severer forms of hysteria. It is possible, too, that the modification of the circulation to the nervous system induced by the shutting off of the circulation in large areas of the body might very well have a favorable physical effect in this affection. Paul's description of the use of the speculum is as complete as that in any modern text-book of gynæcology.
Another distinguished Christian medical scientist was Theophilus Protosbatharius, who belonged to the court of the Greek Emperor Heraclius, in the seventh century. He seems to have had a life very full of interest and surprisingly varied duties. He was a bishop, and, at the same time, commander of the imperial bodyguard, and the author of a little work on the fabric of the human body. The most surprising chapter in the history of the book isthat for some two centuries, in quite modern times, it was used as a text-book of anatomy at the University of Paris. It was printed in a number of editions early in the history of printing, at least one very probably before 1500, and several later.
There are very interesting phases of medicine delightfully surprising in their modernity to be found here and there in many of these early Christian writers on medicine. For instance, in a compend of medicine written by one Leo, who, under the Emperor Theophilus, seems to have been a prominent physician of Byzantium (the compend was written for a young physician just beginning practice), we find the following classification of hydrops or abdominal dilatation: "There are three kinds; the first is ascites, due to the presence of watery fluid, for which we do paracentesis; second, tympany, when the abdomen is swollen from the presence of air or gas. This may be differentiated by percussion of the belly. When air is present the sound given forth is like that of a drum, while in the first form ascites the sound is like that from a sack [the word used is the same as for a wine sack]; the third form is called anasarca, when the whole body swells."
It has often been the subject of misunderstanding as to why medicine should have developed among the Latin Christian nations so much more slowly than among the Arabs during the early Middle Ages. Anyone who knows the conditions in which Christianity came into existence in Italy will not be surprised at that. The Arabs in the East were in contact with Greek thought, and that is eminently prolific and inspiring. At the most, the Christians inItaly got their inspiration at second hand through the Romans. The Romans themselves, in spite of intimate contact with Greek physicians, never made any important contributions to medical science, nor to science of any kind. Their successors, the Christians of Rome and Italy, then could scarcely be expected to do better, hampered especially, as they were, by the trying social conditions created by the invasion of the barbarians from the North. Whenever the Christians were in contact with Greek thought and Greek medicine, above all, as at Alexandria, or in certain of the cities of the near East, we have distinguished contributions from them.
That this is not a partial view suggested by the desire to make out a better case for Christianity in its relation to science will be very well understood, besides, from the fact that a number of the original physicians of Arab stock who attracted attention during the first period of Arabian medicine, that is, during the eighth and ninth centuries, were Christians. There are a series of physicians belonging to the Christian family Bachtischua, a name which is derived from Bocht Jesu, that is, servant of Jesus, who, from the middle of the eighth to the middle of the eleventh century, acquired great fame. The first of them, George (Dschordschis), after acquiring fame elsewhere, was called to Bagdad by the Caliph El-Mansur, where, because of his medical skill, he reached the highest honors. His son became the body-physician of Harun al-Raschid.In the third generation Gabriel (Dschibril) acquired fame and did much, as had his father and grandfather, for the medicine of the time, by translations of the Greek physicians into Arabian.
These men may well be said to have introduced Greek medicine to the Mohammedans. It was their teaching that aroused Moslem scholars from the apathy that had characterized the attitude of the Arabian people toward science at the beginning of Mohammedanism. As time went on, other great Christian medical teachers distinguished themselves among the Arabs. Of these the most prominent was Messui the elder, who is also known as Janus Damascenus. Both he and his father practised medicine with great success in Bagdad, and his son became the body-physician to Harun al-Raschid either after or in conjunction with Gabriel Bachtischua. Like his colleague or predecessor in official position, he, too, made translations from the Greek into Arabic. Another distinguished Arabian Christian physician was Serapion the elder. He was born in Damascus, and flourished about the middle of the ninth century. He wrote a book on medicine called the "Aggregator," or "Breviarium," or "Practica Medicinæ," which appeared in many printed editions within the century after the invention of printing. During the ninth century, also, we have an account of Honein Ben Ischak, who is known in the West as Johannitius. After travelling much, especially in Greece and Persia, he settled in Bagdad, and, under the patronage of the Caliph Mamum, made many translations. He translated most of the old Greek medical writers,and also certain of the Greek philosophic and mathematical works. The accuracy of his translations became a proverb. His compendium of Galen was the text-book of medicine in the West for many centuries. It was known as the "Isagoge in Artem Parvam Galeni." His son, Ishac Ben Honein, and his nephew, Hobeisch, were also famous as medical practitioners and translators.
Still another of these Arabian Christians, who acquired a reputation as writers in medicine, was Alkindus. He wrote with regard to nearly everything, however, and so came to be called the philosopher. He is said altogether to have written and translated about two hundred works, of which twenty-two treat of medicine. He was a contemporary of Honein Ben Ischak in the ninth century. Another of the great ninth-century Christian physicians and translators from the Greek was Kostaben Luka. He was of Greek origin, but lived in Armenia and made translations from Greek into Arabic. Nearly all of these men took not alone medical science, but the whole round of physical science, for their special subject. A typical example in the ninth century was Abuhassan Ben Korra, many of whose family during succeeding generations attracted attention as scholars. He became the astronomer and physician of the Caliph Motadhid. His translations in medical literature were mainly excerpts from Hippocrates and Galen meant for popular use. These Christian translators, thoroughly scientific as far as their times permitted them to be, were wonderfully industrious in their work as translators, great teachers in every senseof the word, and they are the men who formed the traditions on which the greater Arabian physicians from Rhazes onward were educated.
It would be easy to think that these men, occupied so much with translations, and intent on the re-introduction of Greek medicine, might have depended very little on their own observations, and been very impractical. All that is needed to counteract any such false impression, however, is to know something definite about their books. Gurlt, in his "History of Surgery," has some quotations from Serapion the elder, who is often quoted by Rhazes. In the treatment of hemorrhoids Serapion advises ligature and insists that they must be tied with a silk thread or with some other strong thread, and then relief will come. He says some people burn themmedicinis acutis(touching with acids, as some do even yet), and some incise them with a knife. He prefers the ligature, however. He calmly discusses the removal of stones from the kidney by incision of the pelvis of the kidney through an opening in the loin. He considers the operation very dangerous, however, but seems to think the removal of a stone from the bladder a rather simple procedure. His description of the technique of the use of a catheter and of a stylet with it, and apparently also of a guide for it in difficult cases, is extremely interesting. He suggests the opening of the bladder in the median line, midway between the scrotum and the anus, and the placing of a canula therein, so as to permit drainage until healing occurs.
Even this brief review of the careers and thewritings of the physicians of early Christian times shows how well the tradition of old Greek medicine was being carried on. There was much to hamper the cultivation of science in the disturbances of the time, the gradual breaking up of the Roman Empire, and the replacement of the peoples of southern Europe by the northern nations, who had come in, yet in spite of all this, medical tradition was well preserved. The most prominent of the conservators were themselves men whose opinions on problems of practical medicine were often of value, and whose powers of observation frequently cannot but be admired. There is absolutely no trace of anything like opposition to the development of medical science or medical practice, but, on the contrary, everywhere among political and ecclesiastical authorities, we find encouragement and patronage. The very fact that, in the storm and stress of the succeeding centuries, manuscript copies of the writings of the physicians of this time were preserved for us in spite of the many vicissitudes to which they were subjected from fire, and war, and accidents of various kinds for hundreds of years, until the coming of printing, shows in what estimation they were held. During this time they owed their preservation to churchmen, for the libraries and the copying-rooms were all under ecclesiastical control.
Any account of Old-Time Makers of Medicine without a chapter on the Jewish Physicians would indeed be incomplete. They are among the most important factors in medieval medicine, representing one of the most significant elements of medical progress. In spite of the disadvantages under which their race labored because of the popular feeling against them on the part of the Christians in the earlier centuries and of the Mohammedans later, men of genius from the race succeeded in making their influence felt not only on their own times, but accomplished so much in making and writing medicine as to influence many subsequent generations. Living the segregated life that as a rule they had to, from the earliest times(the Ghettos have only disappeared in the nineteenth century), it would seem almost impossible for them to have done great intellectual work. It is one of the very common illusions, however, that great intellectual work is accomplished mainly in the midst of comfortable circumstances and as the result of encouraging conditions. Most of our great makers of medicine at all times, and never more so than during the past century, have been the sons of the poor, who have had to earn their own living, as a rule, before they reached manhood, and who have always had the spur of that necessity which has been so well called the mother of invention. Their hard living conditions probably rather favored than hampered their intellectual accomplishments.
It is not unlikely that the difficult personal circumstances in which the Jews were placed had a good deal to do at all times with stimulating their ambitions and making them accomplish all that was in them. Certain it is that at all times we find a wonderful power in the people to rise above their conditions. With them, however, as with other peoples, luxury, riches, comfort, bring a surfeit to initiative and the race does not accomplish so much. At various times in the early Middle Ages, particularly, we find Jewish physicians doing great work and obtaining precious acknowledgment for it in spite of the most discouraging conditions. Later it is not unusual to find that there has been a degeneration into mere money-making as the result of opportunity and consequent ease and luxury. At a number of times, however, both in Christian and in Mohammedan countries, great Jewish physicians arose whose names have come to us and with whom every student of medicine who wants to know something about the details of the course of medical history must be familiar. There are men among them who must be considered among the great lights of medicine, significant makers always of the art and also in nearly all cases of the science of medicine.
A little consideration of the history of the Jewish people and their great documents eliminates any surprise there may be with regard to their interest in medicine and successful pursuit of it during the Middle Ages. The two great collections of Hebrew documents, the Old Testament and the Talmud, contain an immense amount of material with reference to medical problems of many kinds. Both of these works are especially interesting because of what they have to say of preventive medicine and with regard to the recognition of disease. Our prophylaxis and diagnosis are important scientific departments of medicine dependent on observation rather than on theory. While therapeutics has wandered into all sorts of absurdities, the advances made in prophylaxis and in diagnosis have always remained valuable, and though at times they have been forgotten, re-discovery only emphasizes the value of preceding work. It is because of what they contain with regard to these two important medical subjects that the Old Testament and the Talmud are landmarks in the history of medicine as well as of religion.
Baas, in his "Outlines of the History of Medicine," says: "It corresponds to the reality in both the actual and chronological point of view to consider the books of Moses as the foundation of sanitary science. The more we have learned about sanitation in the prophylaxis of disease and in the prevention of contagion in the modern time, the more have we come to appreciate highly the teachings of these old times on such subjects. Moses made a masterly exposition of the knowledge necessary to prevent contagious disease when he laid down the rules with regard to leprosy, first as to careful differentiation, then as to isolation, and finally as to disinfection after it had come to be sure that cure had taken place. The great lawgiver could insist emphatically that the keeping of the laws of God not only was good for a man's soul but also for his body."
With this tradition familiarly known and deeply studied by the mass of the Hebrew people, it is no surprise to find that when the next great Hebrew development of religious writing came in the Talmud during the earlier Middle Ages, that also contains much with regard to medicine, not a little of which is so close to absolute truth as never to be out of date. Friedenwald, in his "Jewish Physicians and the Contributions of the Jews to the Science of Medicine," a lecture delivered before the Gratz College of Philadelphia fifteen years ago, summed up from Baas' "History of Medicine" the instructions in the Talmud with regard to health and disease. The summary represents so much more of genuine knowledge of medicine and surgery than might be expected at the early period at which it waswritten, during the first and second century of our era, that it seems well to quote it at some length.
"Fever was regarded as nature's effort to expel morbific matter and restore health; which is a much safer interpretation of fever, from a practical point of view, than most of the theories bearing on this point that have been taught up to a very recent period. They attributed the halting in the hind legs of a lamb to a callosity formed around the spinal cord. This was a great advance in the knowledge of the physiology of the nervous system. An emetic was recommended as the best remedy for nausea. In many cases no better remedy is known to-day. They taught that a sudden change in diet was injurious, even if the quality brought by the change was better. That milk fresh from the udder was the best. The Talmud describes jaundice and correctly ascribes it to the retention of bile, and speaks of dropsy as due to the retention of urine. It teaches that atrophy or rupture of the kidneys is fatal. Induration of the lungs (tuberculosis) was regarded as incurable. Suppuration of the spinal cord had an early, grave meaning. Rabies was known. The following is a description given of the dog's condition: 'His mouth is open, the saliva issues from his mouth; his ears drop; his tail hangs between his legs; he runs sideways, and the dogs bark at him; others say that he barks himself, and that his voice is very weak. No man has appeared who could say that he has seen a man live who was bitten by a mad dog.' The description is good, and this prognosis as to hydrophobia in man has remained unaltered till in our day when Pasteur published his startling revelation. The anatomical knowledge of the Talmudists was derived chiefly from dissection of the animals. As a very remarkable piece of practical anatomy for its very early date is the procuringof the skeleton from the body of a prostitute by the process of boiling, by Rabbi Ishmael, a physician, at the close of the first century. He gives the number of bones as 252 instead of 232. The Talmudists knew the origin of the spinal cord at the foramen magnum and its form of termination; they described the œsophagus as being composed of two coats; they speak of the pleura as the double covering of the lungs; and mention the special coat of fat about the kidneys. They had made progress in obstetrics; described monstrosities and congenital deformities; practised version, evisceration, and Cæsarian section upon the dead and upon the living mother. A. H. Israels has clearly shown in his 'Dissertatio Historico-Medica Inauguralis' that Cæsarian section, according to the Talmud, was performed among the Jews with safety to mother and child. The surgery of the Talmud includes a knowledge of dislocation of the thigh bone, contusions of the skull, perforation of the lungs, œsophagus, stomach, small intestines, and gall bladder; wounds of the spinal cord, windpipe, of fractures of the ribs, etc. They described imperforate anus and how it was to be relieved by operation. Chanina Ben Chania inserted natural and wooden teeth as early as the second century, C. E."
"Fever was regarded as nature's effort to expel morbific matter and restore health; which is a much safer interpretation of fever, from a practical point of view, than most of the theories bearing on this point that have been taught up to a very recent period. They attributed the halting in the hind legs of a lamb to a callosity formed around the spinal cord. This was a great advance in the knowledge of the physiology of the nervous system. An emetic was recommended as the best remedy for nausea. In many cases no better remedy is known to-day. They taught that a sudden change in diet was injurious, even if the quality brought by the change was better. That milk fresh from the udder was the best. The Talmud describes jaundice and correctly ascribes it to the retention of bile, and speaks of dropsy as due to the retention of urine. It teaches that atrophy or rupture of the kidneys is fatal. Induration of the lungs (tuberculosis) was regarded as incurable. Suppuration of the spinal cord had an early, grave meaning. Rabies was known. The following is a description given of the dog's condition: 'His mouth is open, the saliva issues from his mouth; his ears drop; his tail hangs between his legs; he runs sideways, and the dogs bark at him; others say that he barks himself, and that his voice is very weak. No man has appeared who could say that he has seen a man live who was bitten by a mad dog.' The description is good, and this prognosis as to hydrophobia in man has remained unaltered till in our day when Pasteur published his startling revelation. The anatomical knowledge of the Talmudists was derived chiefly from dissection of the animals. As a very remarkable piece of practical anatomy for its very early date is the procuringof the skeleton from the body of a prostitute by the process of boiling, by Rabbi Ishmael, a physician, at the close of the first century. He gives the number of bones as 252 instead of 232. The Talmudists knew the origin of the spinal cord at the foramen magnum and its form of termination; they described the œsophagus as being composed of two coats; they speak of the pleura as the double covering of the lungs; and mention the special coat of fat about the kidneys. They had made progress in obstetrics; described monstrosities and congenital deformities; practised version, evisceration, and Cæsarian section upon the dead and upon the living mother. A. H. Israels has clearly shown in his 'Dissertatio Historico-Medica Inauguralis' that Cæsarian section, according to the Talmud, was performed among the Jews with safety to mother and child. The surgery of the Talmud includes a knowledge of dislocation of the thigh bone, contusions of the skull, perforation of the lungs, œsophagus, stomach, small intestines, and gall bladder; wounds of the spinal cord, windpipe, of fractures of the ribs, etc. They described imperforate anus and how it was to be relieved by operation. Chanina Ben Chania inserted natural and wooden teeth as early as the second century, C. E."
There is a famous summing up of the possibilities of life and happiness in the Talmud that has been often quoted—its possible wanting in gallantry being set down to the times in which it was written. "Life is compatible with any disease, provided the bowels remain open; any kind of pain, provided the heart remain unaffected; any kind of uneasiness, provided the head is not attacked; all manner of evils, except it be a bad woman."
There are many other interesting suggestions inthe Talmud. Sometimes they have come to be generally accepted in the modern time, sometimes they are only curious notions that have not, however, lost all their interest. The crucial incision for carbuncle is a typical example of the first class and the suggestion of the removal of superfluous fat from within the abdomen or in the abdominal wall itself by operation is another. That they had some idea of the danger of sepsis may be gathered from the fact that they suspected iron surgical instruments and advised the use of others of less enduring character.
The Talmud itself was indeed a sort of encyclopedia in which was gathered knowledge of all kinds from many sources. It was not particularly a book of medicine, though it contains so many medical ideas. In many parts of it the authors' regard for science is emphatically expressed. Landau, in his "History of Jewish Physicians," closes his account of the Talmud with this paragraph:
"I conclude this brief review of Talmudic medicine with some reference to how high the worth of science was valued in this much misunderstood work. In one place we have the expression 'occupation with science means more than sacrifice.' In another 'science is more than priesthood and kingly dignity.'"[4]
"I conclude this brief review of Talmudic medicine with some reference to how high the worth of science was valued in this much misunderstood work. In one place we have the expression 'occupation with science means more than sacrifice.' In another 'science is more than priesthood and kingly dignity.'"[4]
After all this of national tradition in medicine before and after Christ, it is only what we might quite naturally expect to find, that there is scarcely a century of the Middle Ages which does not contain at least one great Jewish physician and sometimes there are more. Many of these men made distinct contributions to medical science and their names have been held in high estimation ever since. Perhaps I should say that they were held in high estimation until that neglect of historical studies which characterized the eighteenth century developed, and that there has been a reawakening of interest in our time. We forget this curious decadence of the later seventeenth and eighteenth centuries which did so much to obscure history and especially the history of the sciences. Fortunately the scholars of the sixteenth and early seventeenth centuries accomplished successfully the task of printing many of the books of these old-time physicians and secured their publication in magnificent editions. These were bought eagerly by scholars and libraries all over Europein spite of the high price they commanded in that era of slow, laborious printing. The Renaissance exhibits some of its most admirable qualities in its reverence for these old workers in science and above all for the careful preparation by its scholars of the text of these first editions of old-time physicians. The works have often been thus literally preserved for us, for some of them at least would have disappeared among the vicissitudes of the intervening time, most of which was anything but favorable to the preservation of old-time works, no matter what their content or value.
During the second and third centuries of our era, while the Talmudic writings were taking shape, three great Jewish physicians came into prominence. The first of them, Chanina, was a contemporary of Galen. According to tradition, as we have said, he inserted both natural and artificial teeth before the close of the second century. The two others were Rab or Raw and Samuel. Rab has the distinction of having studied his anatomy from the human body. According to tradition he did not hesitate to spend large sums of money in order to procure subjects for dissection. At this time it is very doubtful whether Galen, though only of the preceding generation, ever had the opportunity to study more than animals or, at most, a few human bodies. Samuel, the third of the group, was an intimate friend of Rab's, perhaps a disciple, and his fame depends rather on his practice of medicine than of research in medical science. He was noted for his practical development of two specialties that cannot but seem to us rather distant from each other. His reputation as a skilful obstetrician was only surpassed by the estimation in which he was held as an oculist. He seems to have turned to astronomy as a hobby, and was highly honored for his knowledge of this science. Probably there is nothing commoner in the story of great Jewish physicians than their successful pursuit of some scientific subject as a hobby and reaching distinction in it. Their surplus intellectual energy needed an outlet besides their vocation, and they got a rest by turning to some other interest, often accomplishing excellent results in it. Like most great students with a hobby, the majority of them were long-lived. Their lives are a lesson to a generation that fears intellectual overwork.
During the fourth century we have a number of very interesting traditions with regard to a great Jewish physician, Abba Oumna, to whom patients flocked from all over the world. He seems particularly to have been anxious to make his services available to the scholars of his time. He looked upon them as brothers in spirit, fellow-laborers whose investigations were as important as his own and whose labors for mankind he hoped to extend by the helpfulness of his profession. In order that it might be easy for them to come to him without feeling abashed by their poverty, and yet so that they might pay him anything that they thought they were able to, he hung up a box in his anteroom in which each patient might deposit whatever he felt able to give. His kindliness towards men became the foundation for many legends. Needless to say he was often imposed upon, but that seems to have made no difference to him, and he went on straightforwardly doingwhat he thought he ought to do, regardless of the devious ways of men, even those whom he was generously assisting. While we do not know much of his scientific medicine, we do know that he was a fine example of a practitioner of medicine on the highest professional lines.
With the foundation of the school at Djondisabour in Arabistan or Khusistan by the Persian monarch Chosroes, some Jewish physicians come into prominence as teachers, and this is one of the first important occasions in history when they teach side by side with Christian colleagues. Djondisabour seems distant from us now, lying as it does in the province just above the head of the Persian Gulf, and it is a little hard to understand its becoming a centre of culture and education, yet according to well-grounded historical traditions students flocked here from all parts of the world, and its medical instruction particularly became famous. According to the documents and traditions that we possess, clinical teaching was the most significant feature of the school work and made it famous. As a consequence graduates from here were deemed fully qualified to become professors in other institutions and were eagerly sought by various medical schools in the East.
With the rise of the strong political power of the Mohammedans enough of peace came to the East at least to permit the cultivation of arts and sciences to some extent again, and then at once the eminence of Jewish physicians, both as teachers and practitioners of medicine, once more becomes manifest. The first of the race who comes into prominence isMaser Djawah Ebn Djeldjal, of Basra. To him we owe probably more than to anyone else the preservation of old scientific writings and the cultivation of arts and sciences by the Mohammedans. He prevailed on Caliph Moawia I, whose physician he had become, to cause many foreign works, and especially those written in Greek, to be translated into Arabic. He seems to have taken a large share of the labor of the translation on himself and prevailed upon his pupil, the son of Moawia, to translate some works on chemistry. The translation for which Maser Djawah is best known is that of the Pandects of Haroun, a physician of Alexandria. The translation of this work was made toward the end of the seventh century. Unfortunately the "Pandects" has not come down to us, either in original or translation, but we have fragments of the translation preserved by Rhazes, the distinguished Arabian medical writer and physician of the ninth century, and there seems no doubt that it contained the first good description of smallpox, a chapter in medicine that is often—though incorrectly—attributed to Rhazes himself. Rhazes quoted Maser Djawah freely and evidently trusted his declarations implicitly.
The succeeding Caliphs of the first Arabian dynasty did not exhibit the same interest in education, and above all in science, that characterized Moawia. Political ambition and the desire for military glory seem to have filled up their thoughts and perhaps they had not the good fortune to fall under the influence of physicians so wise and learned as Maser Djawah. More probably, however, they themselveslacked interest. Toward the end of the seventh century they were succeeded by the Abbassides. Almansor, the second Caliph of this dynasty, was attacked by a dangerous disease and sent for a physician of the Nestorian school. After his restoration to health he became a liberal patron of science and especially medical science. The new city of Bagdad, which had become the capital of the realm of the Abbassides, was enriched by him with a large number of works on medicine, which he caused to be translated from the Greek. He did not confine himself to medicine, however, but also brought about translations of works with regard to other sciences. One of these, astronomy, was a favorite. He made it a particular point to search out and encourage the translation of such books as had not previously been translated from Greek into Arabic. While he provided a translation of Ptolemy he also had translations made of Aristotle and Galen.
It is not surprising, then, that the school of Bagdad became celebrated. Jewish physicians seem to have been most prominent in its foundation, and the most distinguished product of it is Isaac Ben Emran, almost as celebrated as a philosopher as he is as a physician. One of his expressions with regard to the danger of a patient having two physicians whose opinions disagree with regard to his illness has been deservedly preserved for us. Zeid, an Emir of one of the chief cities of the Arabs in Barbary, fell ill of a tertian fever and called Isaac and another physician in consultation. Their opinions were so widely in disaccord that Isaac refused to prescribe anything, and when the Emir, who had great confidencein him, demanded the reason, he replied, "disagreement of two physicians is more deadly than a tertian fever." This Isaac, who is said to have died in 799, is the great Jewish physician, one of the most important members of the profession in the eighth century. His principal work was with regard to poisons and the symptoms caused by them. This is often quoted by medical writers in the after time.
The prominent Jewish physician of the ninth century was Joshua Ben Nun. Haroun al-Raschid, whose attempts to secure justice for his people are the subject of so much legendary lore, and whose place in history may be best recalled by the fact that he is a contemporary of Charlemagne, was particularly interested in medicine. He founded the city of Tauris as a memorial of the cure of his wife. He was a generous patron of the school of Djondisabour and established a medical school also at Bagdad. He provided good salaries for the professors, insisted on careful examinations, and raised the standard of medical education for a time to a noteworthy degree. The greatest teacher of this school at Bagdad was Joshua Ben Nun, sometimes known as the Rabbi of Seleucia. His teaching attracted many students to Bagdad and his fame as one of the great practitioners of medicine of this time brought many patients. Among his disciples was John Masuée, whose Arabian name is so different, Yahia Ben Masoviah, that in order to avoid confusion in reading it is important to know both. Almost better known, perhaps, at this time was Abu Joseph Jacob Ben Isaac Kendi. Fortunately for the after time, these men devoted themselves not only to their own observations and writings but made a series of valuable translations. Joshua Ben Nun seems to have been particularly zealous in this matter, following the example of Maser Djawah of Basra.
Bagdad then became a centre for Arabian culture. Mahmoud, one of Haroun's successors, provided in Bagdad a refuge for the learned men of the East who were disturbed by the wars and troubles of the time. He became a liberal patron of literature and education. When the Emperor Michael III of Constantinople was conquered in battle, one of the obligations imposed upon him was to send many camel loads of books to Bagdad, and Aristotle and Plato were studied devotedly and translated into Arabic. The era of culture affected not only the capital but all the cities, and everywhere throughout the Arabian empire schools and academies sprang up. We have records of them at Basra, Samarcand, Ispahan. From here the thirst for education spread to the other cities ruled by the Mohammedans, and each town became affected by it. Alexandria, the cities of the Barbary States, those of Sicily and Provence, where Moorish influences were prominent, and of distant Spain, Cordova, Seville, Toledo, Granada, Saragossa, all took up the rivalry for culture which made this a glorious period in the history of the intellectual life.
Already, in the chapter on "Great Physicians in Early Christian Times," I have pointed out that many of the teachers of the Arabs were Christian physicians. Here it is proper to emphasize the other important factor in Arabian medicine, the Jewish physicians, who influenced the great Arabian rulers,and were the teachers of the Arabs in medicine and science generally. These Christian and Jewish physicians particularly encouraged the translation of the works of the great Greek physicians and thus kept the Greek medical tradition from dying out. It is not until the end of the ninth, or even the beginning of the tenth, century that we begin to have important contributors to medicine from among the Arabs themselves. Even at this time they have distinguished rivals among Jewish physicians. Indeed these acquired such a reputation that they became the physicians to monarchs and even high ecclesiastics, and we find them nearly everywhere throughout Europe. Their success was so great that it is not surprising that after a time the vogue of the Jewish physicians should have led to jealousy of them and to the passage of laws and decrees limiting their sphere of activity.
The great Jewish physician of the ninth century was Isaac Ben Soliman, better known as Isaac el Israili, and who is sometimes spoken of as d'Israeli. He was a pupil of Isaac Ben Amram the younger, probably a grandson of another Isaac Ben Amram, who, after having become famous in Bagdad, went to Cairo and became the physician of the Emir Zijadeth III. The younger Isaac established a school, and it was with him that Israeli obtained his introduction to medicine. He practised first as an oculist and then became body-physician to the Sultan of Morocco. Because of the sympathy of his character and his unselfishness he acquired great popularity. Hyrtl refers to him respectfully as "that scholarly son of Israel." Curiously enough, considering racialfeeling in the matter, he never married, and when asked why he had not, and whether he did not think that he might regret it, he replied, "I have written four books through which my memory will be better preserved than it would be by descendants." The four books are his "Treatise on Fevers," his "Treatise on Simple Medicines and Ailments," a treatise on the "Elements," and a treatise "On the Urine." Besides these, we have from him shorter works, "On the Pulse," "On Melancholy," and "On Dropsy." His hope with regard to his fame from these works was fulfilled, for they were printed as late as 1515 at Leyden, and Sprengel declared them the best compendium of simple remedies and diet that we have from the Arabian times. One of his translators into Latin has called him the monarch of physicians.
Some of his maxims are extremely interesting in the light of modern notions on the same subjects. He declared emphatically that "the most important duty of the physician is to prevent illness." "Most patients get better without much help from the physician by the power of nature." He emphasized his distrust of using many medicines at the same time in the hope that some of them would do good. He laid it down as a rule: "Employ only one medicine at a time in all your cases and note its effects carefully." He was as wise with regard to medical ethics as therapeutics. He advised a young physician, "Never speak unfavorably of other physicians. Every one of us has his lucky and unlucky hours." It is pleasant to learn that the old gentleman lived to fill out a full hundred years of life, and that in hisdeclining years he was surrounded by the good will and the affection of many who had learned to know his precious qualities of heart and mind. More than of any other class of physicians do we find the large human sympathies of the Jewish physicians of the Middle Ages praised by their contemporaries and succeeding generations.
During the next centuries a number of Jewish physicians became prominent, though none of them until Maimonides impressed themselves deeply upon the medical life of their own and succeeding centuries. Very frequently they were the physicians to royal personages. Zedkias, for instance, was the physician to Louis the Pious and later to his son Charles the Bald. His reputation as a physician was great enough to give him the popular estimation of a magician, but it did not save him from the accusation of having poisoned Charles when that monarch died suddenly. There seem to be no good grounds, however, for the accusation. There were a number of schools of medicine, in Sicily and the southern part of Italy, in which Jewish, Arabian, and Christian physicians taught side by side. One of these teachers was Jude Sabatai Ben Abraham, usually known by the name of Donolo, who was famous both as a writer on medicine and on astronomy. Donolo studied and probably taught at Tarentum, and there were similar schools at Palermo, at Bari, and then later on the mainland at Salerno. The foundation of Salerno, in which Jewish physicians also took part, we shall discuss later in the special chapter devoted to that subject.
One of the great translators whose work meantvery much for the medical science of his own and succeeding generations was the distinguished Jewish physician, Faradj Ben Salim, sometimes spoken of as Farachi Faragut or Ferrarius, who was born at Girgenti in Sicily. He made his medical studies in Salerno and did his work under the patronage of Charles of Anjou towards the end of the thirteenth century. His greatest work is the translation of the whole of the "Continens" of Rhazes. The translation is praised as probably the best of its time made in the Middle Ages. Faradj came at the end of a great century, when the intellectual life of Europe had reached a high power of expression, and it is not surprising that he should have proved equal to his environment. This translation has also some additions made by Faradj himself, notably a glossary of Arabian names.
In Spain also Jewish physicians rose to distinction. The most distinguished in the tenth century was Chasdai Ben Schaprut. Like many other of the great physicians of this time, he had studied astronomy as well as the medical sciences. He became the physician of the Caliph Abd-er-Rahman III of Cordova. He seems also to have exercised some of the functions of Prime Minister to the Caliph, and took advantage of diplomatic relations between his sovereign and the Byzantine Emperor to obtain some works of Dioscorides. These he translated into Arabian with the help of a Greek monk, whom he seems also to have secured through the diplomatic relations. Undoubtedly he did much to usher in that enthusiasm for education and study which characterized the next centuries, the eleventh and twelfth,at Cordova in Spain, when such men as Avenzoar, Avicenna, and Averroës attracted the attention of the educational world of the time. Jewish writers have sometimes claimed one of the most distinguished of these, Avenzoar himself, as a Jew, but Hyrtl and other good authorities consider him of Arabic extraction and point to the fact that his ancestors bore the name of Mohammed. This is not absolutely conclusive evidence, but because of it I have preferred to class Avenzoar among the Arabian physicians.
The one historical fact of importance for us is that everywhere in Europe at that time Jews were being accorded opportunities for the study and practice of medicine. There are local incidents of persecution, but we are not so far away from the feelings that brought these about as to misunderstand them or to think that they were anything more than local, popular manifestations. The more we know about the details of the medical history of these times the deeper is the impression of academic freedom and of opportunities for liberal education.
Much has been said about the intolerance of ecclesiastical authorities toward the Jews, and of Church decrees that either absolutely forbade their practice of the medical profession and their devotion to scientific study, or at least made these pursuits much more difficult for them than for others. Of course it has to be conceded, even by those who most insistently urge the existence of formal legislation in the matter, that in spite of these decrees and intolerance and opposition, Jews continued to practise medicine and to be the chosen physicians ofkings and even of high ecclesiastical dignitaries, as well indeed of the Popes themselves. This, it is usually declared, must be attributed to the surpassing skill of the Jewish physicians, causing men to overcome their prejudices and override even their own legal regulations. There is no doubt at all about the skill of Jewish physicians at many times during the Middle Ages. There is no doubt also of the sentiment of opposition that often developed between the Christian peoples and the Jews. Any excuse is good enough to justify men, to themselves at least, in putting obstacles in the paths of those who are more successful than they are themselves. Religion often became a cloak for ill-will and persecution.
The state of affairs that has been presumed however, according to which laws and decrees were being constantly issued forbidding the practice of medicine to Jews by the ecclesiastical authorities, while at the same time they themselves and those who were nearest to them were employing Jewish physicians, is an absurdity that on the face of it calls for investigation of the conditions and from its very appearance would indicate that the ordinary historical assumption in the matter must be wrong.
I have been at some pains, then, to try to find out just what were the conditions in Europe with regard to the practice of medicine by the Jews. There is no doubt that at Salerno, where the influence of the Benedictines was very strong and where the influence of the Popes and the ecclesiastical authorities was always dominant, full liberty of studying and teaching was from the earliest days allowed to the Jews. Down at Montpellier it seems clear thatJewish physicians had a large part in the foundation of the medical school, and continued for several centuries to be most important factors in the maintenance of its reputation and the upbuilding of that fame which draw students from even distant parts of Europe to this medical school of the south of France. During the ninth, tenth, eleventh, and twelfth centuries Jewish physicians were frequently in attendance on kings and the higher nobility, on bishops and archbishops, cardinals, and even Popes. Every now and then the spirit of intolerance among the populace was aroused, and occasionally the death of some distinguished patient while in a Jewish physician's hands was made the occasion for persecution. We must not forget, after all, that even as late as Elizabeth's time, when Shakespeare wrote "The Merchant of Venice," he was taking advantage of the popular sentiment aroused by the execution of Lopez, the Queen's physician, for a real or supposed participation in a plot against her Majesty's life. Shylock was presented the next season for the sake of adventitious popularity that would thus accrue to the piece. The character was played so as to depict all the worst traits of the Jew, and was scornfully laughed at at every representation. This is an index of the popular feeling of the time. Bitter intolerance of the Jew has continued. Down almost to our own time the Ghettos have existed in Europe, and popular tumults against them continue to occur. Quite needless to say, these do not depend on Christianity, but on defective human nature.
During the Middle Ages the best possible criterion of the attitude of the Church authorities towards theJews is to be found in the legislation of Pope Innocent III. He is the greatest of the Popes of the Middle Ages; he shaped the policy of the Church more than any other; his influence was felt for many generations after his own time. His famous edict with regard to them was well known: "Let no Christian by violence compel them to come dissenting or unwilling to Baptism. Further, let no Christian venture maliciously to harm their persons without a judgment of the civil power or to carry off their property or change their good customs which they have hitherto in that district which they inhabit." Innocent himself and several of his predecessors and successors are known to have had Jewish physicians. Example speaks even louder than precept, and the example of such men must have been a wonderful advertisement for the Jewish physicians of the time.
Besides Innocent III, many of the Popes of the twelfth and thirteenth centuries issued similar decrees as to the Jews. It may be recalled that this was the time when the Papacy was most powerful in Europe and when its decrees had most weight in all countries. Alexander II, Gregory IX, and Innocent IV all issued formal documents demanding the protection of the Jews, and especially insisting that they must not be forced to receive Baptism nor disturbed in the celebration of their festivals. Clement VI did the same thing in the next century, and even offered them a refuge from persecution throughout the rest of France at Avignon. Distinguished Jewish scholars, who know the whole story from careful study, have given due credit to the Popes for all that they did for their people. They have even declared thatif the Jews were not exterminated in many of the European countries it was because of the protection afforded by the Church. We have come to realize in recent years that persecution of the Jews is not at all a religious matter, but is due to racial prejudice and jealousy of their success by the peoples among whom they settle. All sorts of pretexts are given for this persecution at all times. Formal Church documents and the personal activities of the responsible Church officials show that during the Middle Ages the Church was a protector and not a persecutor of the Jews.
There is abundant historical authority for the statement that the Popes were uniformly beneficent in their treatment of the Jews. In order to demonstrate this there is no need to quote Catholic historians, for non-Catholics have been rather emphatic in bringing it out. Neander, the German Protestant historian, for instance, said: