who suddenly fall into a frenzy and lose their memory, who were to
    reside there till cured; with an oratory to the said hospital to the
    invocation of the Blessed Virgin Mary.'"

The passages from Aëgineta at the beginning of this chapter represent a
thorough understanding of mental diseases often supposed not to exist at
this time. Often it is presumed that this thorough appreciation of
insanity gradually disappeared during subsequent centuries, and was not
revived until almost our own time. It is quite easy, however, to
illustrate by quotations from the second half of the Middle Ages a like
sensible treatment of the subject of insanity by scientific and even
popular writers. How different was the attitude of mind of the medieval
people toward lunacy from that which is usually assumed as existing at
that time may be gathered very readily from the paragraph in
"Bartholomeus' Encyclopædia" with regard to madness. I doubt whether in a
brief discussion so much that is absolutely true could be better said in
our time. Insanity, according to old Bartholomew, was due to some poison,
autointoxication, or strong drink. The treatment is prevention of injury
to themselves or others, quiet and peaceful retirement, music, and
occupation of mind. The paragraph itself is worth while having near one,
in order to show clearly the medieval attitude toward the insane of even
ordinarily well-informed folk, for Bartholomew was the most read book of
popular information during the Middle Ages.

Bartholomew himself was only a compiler of information--a very learned
man, it is true, but a clergyman-teacher, not a physician. Translations of
his book were probably more widely read in England, in proportion to the
number of the reading public, than any modern encyclopædia has ever been.
He said:

    "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-hound [mad dog], 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    withdrawn from cause and matter of dread and busy thoughts.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._"
    (Italics ours.)

Bartholomew recognizes the two classes of causes of mental disturbance,
the mental and the physical, and, it will be noted, has nothing to say
about the spiritual--that is, diabolic possession. Writing in the
thirteenth century, diabolism was not a favourite thought of the men of
his time, and Bartholomew omits reference to it as a cause of madness
entirely. Food and drink, and especially strong spirituous liquor, are set
down as prominent causes. It may seem curious in our time that the bite of
a mad dog, or a "wood hound," as Bartholomew put it, should be given so
important a place; but in the absence of legal regulation rabies must have
been rather common, and the disease was so striking from the fact that its
onset was often delayed for a prolonged interval after the bite, that it
is no wonder that a popular encyclopædist should make special note of it.

The effect of alcohol in producing insanity was well recognized during the
Middle Ages, and many writers have alluded to it. Pagel, in the chapters
on Medieval Medicine in Puschmann's "Handbook," says that Arculanus, of
whom there is mention in the chapter on Oral Surgery and the Minor
Surgical Specialities, has an excellent description of alcoholic insanity.
The ordinary assumption that medieval physicians did not recognize the
physical factors which lead up to insanity, and practically always
attributed mental derangement to spiritual conditions, especially to
diabolic possession, is quite unfounded so far as authoritative physicians
were concerned. Their suggestions as to treatment, above all in their care
for the general health of the patient and the supplying of diversion of
mind, was in principle quite as good as anything that we have been able to
accomplish in mental diseases down to the present time. Their insanity
rate, and above all their suicide rate, was much lower than ours, for life
was less strenuous and conscious, and though men and women often had to
suffer from severe physical strains and stresses, their free outdoor life
made them more capable of standing them.

The history of human care for the insane, it is often said by those who
are reviewing the whole subject briefly, may be represented by the steps
in progress from the presumption of diabolical possession, and exorcism
for its relief, to intelligent understanding, sympathetic treatment, and
gentle surveillance, with the implication that this has all been a gradual
evolution. There is no doubt that during the Middle Ages even physicians
often thought of possession by the devil as the cause of irrational states
of mind. Not only some of the genuinely insane--though not all, be it
noted--but also sufferers from dreads and inhibitions of various kinds,
the victims of tics and uncontrollable habits, especially the childish
repetition of blasphemous words, and sufferers from other psychoses and
neuroses, were considered to be the victims of diabolic action. Exorcism
then became a favourite form of treatment of all these conditions, but
its general acceptance came about because it was so often successful. The
mental influence of the ceremonies of exorcism was often quite as
efficient in the cure of these mental states as mesmerism, hypnotism,
psycho-analysis, and other mental influences in the modern time.

It may particularly be compared in this regard to psycho-analysis in our
own day, for this cures patients by making them feel that they have been
the victims of some very early evil impression, usually sexual in
character, which has continued unconsciously to them to colour all their
subsequent mental life. Some of the curious theories of secondary
personality, the subliminal self and what has recently been called "our
hidden guest," represent in other terms what the medieval observers and
thinkers expressed in their way by an appeal to diabolic influence. They
felt that there was a spirit influencing these patients quite independent
of themselves in some way, and their thoroughgoing belief in a personal
devil led them to think that there must be some such explanation of the
phenomena. Even great scientists in the modern time who have studied
psychic research have not been able to get away entirely from the feeling
that there is something in such possession, and have admitted that there
may be even alien influence by an evil spirit. The more one studies the
question from all sides, and not merely from a narrow materialistic
standpoint, the less one is ready to condemn the medievalists for their
various theories of diabolic possession. The Christian Church still
teaches not only its possibility but its actual occurrence.

Such conservative thinkers as Sir Thomas More, one of England's greatest
Lord Chancellors, the only one who ever cleared the docket of the Court of
Chancery, continued to believe in it nearly a century after the Middle
Ages had closed, but above all is quite frank in the expression of his
opinion that some of the mutism, the tics, and bad habits, and repeated
blasphemies, attributed to it, may be cured by soundly thrashing the young
folks who are subject to them. Neurological experts will recall similar
experiences in the modern time. Charcot's well-known story of the little
boy whose _tic_ was the use of the word uttered by the corporal at
Waterloo, and was cured by being soundly licked by some playmates at the
Salpêtrière gate, is a classic. Some of the medieval cruelty represented
unfortunate developments from the observations that had been made that a
number of the impulsive neuroses and psychoneuroses could be favourably
modified, or even entirely corrected, by attaching to the continuance of
the habit a frequently repeated memory of distinctly unpleasant
consequences that had come upon the patient because of it. Our experience
in the recent war called to attention a great many cases of mutism,
functional blindness, tremors, and incapacities of all kinds, some of
which were cured by painful applications of electricity. The medieval use
of the lash for such cases can be better understood now as the result of
this very modern set of clinical observations.

In the meantime it must not be forgotten that the people of the Middle
Ages, even when they thought of insane and psychoneurotic persons as the
subjects of diabolic possession, felt themselves under the necessity of
providing proper physical care for these victims of disease or evil
spirits, and as we know actually made excellent provision for them. Not
only were the insane given shelter and kept from injuring themselves and
others, but in many ways much better care was provided for them than has
been the custom down almost to our own time. They had many fewer insane to
care for; life was not so strenuous, or rather fussy, as it is in our
time; large city life had not developed, and simple existence in the
country was the best possible prophylactic against many of the mental
afflictions that develop so frequently in the storm and stress of
competitive industrial city existence. This prophylaxis was accidental,
but it was part of the life of the time that needs to be appreciated,
since it represents one of the helpful hints that the Middle Ages can
give us for the reduction of our own alarmingly increasing insanity rate.

They had no large asylums such as we have now, but neither did they have
any poor-houses; yet we have come to recognize how readily they solved the
social evils of poverty. The almshouses at Stratford, with their
accommodations for an old man and his wife living together, are a typical,
still extant example of this. Each small community cared for its own
sufferers. They did not solve their social problems in the mass fashion
which we have learned is so liable to abuse, but each little town cared to
a great extent for its own mentally ailing. They were able to do this
mainly because hospitals were rather frequent; and psychic cases were, at
the beginning, cared for in hospitals, and when in milder state their near
relatives were willing to take more bother in caring for them than in our
time. Delirious states due to fever had not yet been definitely
differentiated from the acute insanities, and all these cases then were
taken in by the hospitals. This was an excellent thing for patients,
because they came under hospital care early; and one of the developments
that must come in our modern hospitals is a psychopathic ward in every one
of them, for patients will be saved the worst developments of their
affection.

The better-to-do classes found refuges for their non-violent insane in
certain monasteries and convents, or in parts of monastic establishments
particularly set aside for this purpose. When the patient was of the
higher nobility, he was often put in charge of a monk or of several
religious, and confined in a portion of his own or a kinsman's castle and
cared for for years. There are traditions of similar care for the
peasantry who were connected with monastic establishments, and sometimes
small houses were set apart for their use on the monastery grounds. As
cities grew in extent, certain hospitals received mental patients as well
as the physically ailing, keeping them segregated. After a time some of
these hospitals were entirely set aside for this purpose. Bedlam in
England, which had been the old Royal Bethlehem Hospital for the care of
all forms of illness, came to be just before the end of the thirteenth
century exclusively for the care of the insane. In Spain particularly the
asylums for the insane were well managed, and came to be models for other
countries. This development in Spain is sometimes attributed to the Moors,
but there is absolutely no reason for this attribution, except the desire
to minimize Christianity's influence, even though this effort should
attempt the impossible feat of demonstrating Mohammedanism as an organizer
of charity and social service.

Some of the developments of their care for the insane in the Middle Ages
are very interesting. Before this period closed, there was a custom
established at Bedlam by which those who had been insane but had become
much better were allowed to leave the institution. This was true, even
though apparently there might be no friends to care for them particularly,
or to guarantee their conduct or their return, in case of redevelopment of
their symptoms. This amounted practically to the open-door system. The
authorities of the hospital, however, made one requirement. Those who had
been insane and were allowed to leave Bedlam were required to wear a badge
or plate on the arm, indicating that they had been for some time in this
hospital for the insane. These people came to be known as Bedlamites, or
Bedlams, or Bedlamers, and attracted so much sympathy from the community
generally that some of the ne'er-do-wells, the tramps and sturdy vagrants
who have always been with the world as a problem quite as well as the
insane, obtained possession of these insignia by fraud or stealth, and
imposed on the charity of the people of the time.

It is easy to understand that wherever these patients were recognized by
their badges as having been for a time in an asylum for the insane, they
were treated quite differently from ordinary people. Though allowed to
leave the asylum, and left, as it were, without surveillance, they were
really committed to the care of the community generally. No one who knows
the history is likely to irritate a person who has been insane, nor are
such people treated in the same spirit as those who are supposed to have
been always normal, but out of pity and sympathy they are particularly
cared for. They are not expected to live the same workaday existence as
mentally healthy individuals, but their pathway in life is smoothed as
much as possible. Many an unfortunate incident in modern times is due to
the fact that a previous inmate of an asylum is irritated beyond his power
to control himself in the ordinary affairs of life by those who know
nothing of his previous mental weakness. It is not unlikely that our
open-door system will have to be supplemented by some such arrangement as
this medieval requirement of a badge, and that we can actually get
suggestions from the medieval people with regard to the care of the insane
that will be valuable for us.

Another very interesting development of care for the mentally afflicted
was the organization of institutions like the village of Gheel in Belgium,
in which particularly children who were of low-grade mentality were cared
for. This was practically the origin of what has come in our time to be
called the colony system of caring for defectives. We now have colonies
for imbeciles of various grades, and village systems of caring for them.
At Gheel the system developed, it might be said, more or less
accidentally, but really quite naturally. St. Dympna was an Irish
girl-martyr whose shrine, said to be on the site of her martyrdom, existed
in the village of Gheel. Her intercession was said to be very valuable in
helping children of low-grade mentality. These were brought to the shrine,
sometimes from a long distance, and when the prayers of relatives were not
answered immediately the children were often left near the shrine in the
care of some of the villagers, to have the benefit of the martyr's
intercession for a prolonged period. As a consequence of this custom, many
of the houses of the village came to harbour one or more of these mentally
defectives, who were cared for by the family as members of it.

The religious feelings, and particularly the impression that the
defectives were under the special patronage of the patron saint of the
village, not only kept them from being abused or taken advantage of in any
way, but made them an object of special care. They were given various
simple tasks to perform, and the public spirit of the community cared for
them. It was only with the development of modern sophistication that the
tendency to take advantage of social defectives came and special
government regulations had to be made and inspectors appointed. This
system of caring for these defective children, however, was eminently
satisfactory. Other villages took up the work, especially in the Low
Countries and in France. The village and colony system of caring for the
insane, which we are now developing with so much satisfaction, was
entirely anticipated under the most favourable circumstances, and with
religious sanctions, during the Middle Ages. Not a few of the defectives,
when they grew up, came to be attached in various humble occupations to
monastic establishments. Here they were out of the current of the busy
life around them, and were cared for particularly. They were not
overworked but asked to do what they could, and given their board and
clothes and the sympathetic attention of the religious. There are many
more of such cases at the present time than are at all appreciated. They
emphasize how much of this fraternal care there must have been in the
Middle Ages.

Between the village system of caring for defectives, and the germ of the
colony idea in their recognition of the value of the country or small town
as a dwelling-place for those suffering from backwardness of mind or
chronic bodily ills that disturb mentality, and the "open-door system" for
the insane, as practised at Bedlam and other places, the Middle Ages
anticipated some of the best features of what is most modern in our care
for mental patients. Their use of severe pain as a corrective for the
psychoneuroses, even when they thought of them in connection with diabolic
possession, is another striking instance of their very practical way of
dealing with these patients in a manner likely to do them most good. We
have had to make our own developments in these matters, however, before we
could appreciate the true value of what they were doing in the Middle
Ages.

APPENDIX I

Law of the Emperor Frederick II. (1194-1250) regulating the practice of
Medicine.[18]

"While we are bent on making regulations for the common weal of our loyal
subjects we keep ever under our observation the health of the individual.
In consideration of the serious damage and the irreparable suffering which
may occur as a consequence of the inexperience of physicians, we decree
that in future no one who claims the title of physician shall exercise the
art of healing or dare to treat the ailing, except such as have beforehand
in our University of Salerno passed a public examination under a regular
teacher of medicine and been given a certificate, not only by the
professor of medicine, but also by one of our civil officials, which
declares his trustworthiness of character and sufficiency of knowledge.
This document must be presented to us, or in our absence from the kingdom,
to the person who remains behind in our stead in the kingdom, and must be
followed by the obtaining of a licence to practise medicine either from
us or from our representative aforesaid. Violation of this law is to be
punished by confiscation of goods and a year in prison for all those who
in future dare to practise medicine without such permission from our
authority.

"Since the students cannot be expected to learn medical science unless
they have previously been grounded in logic, we further decree that no one
be permitted to take up the study of medical science without beforehand
having devoted at least three full years to the study of logic.[19] After
three years devoted to these studies he (the student) may, if he will,
proceed to the study of medicine, provided always that during the
prescribed time he devotes himself also to surgery, which is a part of
medicine. After this, and not before, will he be given the licence to
practise, provided he has passed an examination, in legal form, as well as
obtained a certificate from his teacher as to his studies in the preceding
time. After having spent five years in study he shall not practise
medicine until he has during a full year devoted himself to medical
practice with advice and under the direction of an experienced physician.
In the medical schools the professors shall during these five years devote
themselves to the recognized books, both those of Hippocrates as well as
those of Galen, and shall teach not only theoretic but also practical
medicine.

"We also decree as a measure intended for the furtherance of public health
that no surgeon shall be allowed to practise, unless he has a written
certificate, which he must present to the professor in the medical
faculty, stating that he has spent at least a year at that part of
medicine which is necessary as a guide to the practice of surgery, and
that, above all, he has learned the anatomy of the human body at the
medical school, and is fully equipped in this department of medicine,
without which neither operations of any kind can be undertaken with
success nor fractures be properly treated.

"In every province of our kingdom which is under our legal authority, we
decree that two prudent and trustworthy men, whose names must be sent to
our court, shall be appointed and bound by formal oath, under whose
inspection electuaries and syrups and other medicines be prepared
according to law and be sold only after such inspection. In Salerno in
particular we decree that this inspectorship shall be limited to those who
have taken their degree as masters in physic.

"We also decree by the present law that no one in the kingdom except in
Salerno or in Naples [in which were the two universities of the kingdom]
shall undertake to give lectures on medicine or surgery, or presume to
assume the name of teacher, unless he shall have been very thoroughly
examined in the presence of a government official and of a professor in
the art of medicine. [No setting up of medical schools without the proper
authority.]

"Every physician given a licence to practise must take an oath that he
shall faithfully fulfil all the requirements of the law, and in addition
that whenever it comes to his knowledge that any apothecary has for sale
drugs that are of less than normal strength, he shall report him to the
court, and besides that he shall give his advice to the poor without
asking for any compensation. A physician shall visit his patient at least
twice a day and at the wish of his patient once also at night, and shall
charge him, in case the visit does not require him to go out of the
village or beyond the walls of the city, not more than one-half tarrene in
gold for each day's service.[20] From a patient whom he visits outside of
the village or the wall of the town, he has a right to demand for a day's
service not more than three tarrenes, to which may be added, however, his
expenses, provided that he does not demand more than four tarrenes
altogether.

"He (the regularly licensed physician) must not enter into any business
relations with the apothecary nor must he take any of them under his
protection nor incur any money obligations in their regard. Nor must any
licensed physician keep an apothecary's shop himself. Apothecaries must
conduct their business with a certificate from a physician according to
the regulations and on their own credit and responsibility, and they shall
not be permitted to sell their products without having taken an oath that
all their drugs have been prepared in the prescribed form, without any
fraud. The apothecary may derive the following profits from his sales:
Such extracts and simples as he need not keep in stock for more than a
year, before they may be employed, may be charged for at the rate of three
tarrenes an ounce. Other medicines, however, which in consequence of the
special conditions required for their preparation or for any other reason,
the apothecary has to have in stock for more than a year, he may charge
for at the rate of six tarrenes an ounce. Stations for the preparation of
medicines may not be located anywhere but only in certain communities in
the kingdom as we prescribe below.

"We decree also that the growers of plants meant for medical purpose shall
be bound by a solemn oath that they shall prepare their medicines
conscientiously according to the rules of their art, and so far as it is
humanly possible that they shall prepare them in the presence of the
inspectors. Violations of this law shall be punished by the confiscation
of their movable goods. If the inspectors, however, to whose fidelity to
duty the keeping of the regulations is committed, should allow any fraud
in the matters that are entrusted to them, they shall be condemned to
punishment by death."

APPENDIX II

Bull of Pope John XXII., issued February 18, 1321, as a charter for the
Medical Department of the University of Perugia.[21]

"While with deep feelings of solicitous consideration we mentally revolve
how precious the gift of science is and how desirable and glorious is its
possession, since through it the darkness of ignorance is put to flight
and the clouds of error completely done away with so that the trained
intelligence of students disposes and orders their acts and modes of life
in the light of truth, we are moved by a very great desire that the study
of letters in which the priceless pearl of knowledge is found should
everywhere make praiseworthy progress, and should especially flourish more
abundantly in such places as are considered to be more suitable and
fitting for the multiplication of the seeds and salutary germs of right
teaching. Whereas some time ago, Pope Clement of pious memory, our
predecessor, considering the purity of faith and the excelling devotion
which the city of Perugia, belonging to our Papal states, is recognized to
have maintained for a long period towards the Church, wishing that these
might increase from good to better in the course of time, deemed it
fitting and equitable that this same city, which had been endowed by
Divine Grace with the prerogatives of many special favours, should be
distinguished by the granting of university powers, in order that by the
goodness of God men might be raised up in the city itself pre-eminent for
their learning, decreed by the Apostolic authority that a university
should be situated in the city and that it should flourish there for all
future time with all those faculties that may be found more fully set
forth in the letter of that same predecessor aforesaid. And, whereas, we
subsequently, though unworthy, having been raised to the dignity of the
Apostolic primacy, are desirous to reward with a still richer gift the
same city of Perugia for the proofs of its devotion by which it has proven
itself worthy of the favour of the Apostolic See, by our Apostolic
authority and in accordance with the council of our brother bishops, we
grant to our venerable brother, the Bishop of Perugia, and to those who
may be his successors in that diocese, the right of conferring on persons
who are worthy of it the licence to teach (the Doctorate) in canon and
civil law, according to that fixed method which is more fully described
and regulated more at length in this our letter.

"Considering, therefore, that this same city, because of its convenience
and its many favouring conditions, is altogether suitable for students and
wishing on that account to amplify the educational concessions hitherto
made because of the public benefits which we hope will flow from them, we
decree by Apostolic authority that if there are any who in the course of
time shall in that same university attain the goal of knowledge in medical
science and the liberal arts and should ask for licence to teach in order
that they may be able to train others with more freedom, that they may be
examined in that university in the aforesaid medical sciences and in the
arts and be decorated with the title of Master in these same faculties. We
further decree that as often as any are to receive the decree of Doctor in
medicine and arts, as aforesaid, they must be presented to the Bishop of
Perugia, who rules the diocese at the time, or to him whom the bishop
shall have appointed for this purpose, who having selected teachers of the
same faculty in which the examinations are to be made, who are at that
time present in the university to the number of at least four, they shall
come together without any charge to the candidate and, every difficulty
being removed, should diligently endeavour that the candidate be examined
in science, in eloquence, in his mode of lecturing, and anything else
which is required for promotion to the degree of doctor or master. With
regard to those who are found worthy, their teachers should be further
consulted privately, and any revelation of information obtained at such
consultations as might redound to the disadvantage or injury of the
consultors is strictly forbidden. If all is satisfactory the candidates
should be approved and admitted and the licence to teach granted. Those
who are found unfit must not be admitted to the degree of doctor, all
leniency or prejudice or favour being set aside.

"In order that the said university may in the aforesaid studies of
medicine and the arts so much more fully grow in strength, according as
the professors who actually begin the work and teaching there are more
skilful, we have decided that until four or five years have passed some
professors, two at least, who have secured their degree in the medical
sciences at the University of Paris, under the auspices of the Cathedral
of Paris, and who shall have taught or acted as masters in the
before-mentioned University of Paris, shall be selected for the duties of
the masterships and the professorial chairs in the said department in the
University of Perugia, and that they shall continue their work in this
last-mentioned university until noteworthy progress in the formation of
good students shall have been made.

"With regard to those who are to receive the degree of doctor in medical
science, it must be especially observed that all those seeking the degree
shall have heard lectures in all the books of this same science which are
usually required to be heard by similar students at the University of
Bologna or of Paris, and that this shall continue for seven years. Those,
however, who have elsewhere received sufficient instruction in logic or
philosophy having applied themselves to these studies for five years in
the aforesaid universities, with the provision, however, that at least
three years of the aforesaid five or seven year term shall have been
devoted to hearing lectures in medical science in some university and
according to custom, shall have been examined under duly authorized
teachers and shall have, besides, read such books outside the regular
course as may be required, may, with due observation of all the
regulations which are demanded for the taking of degrees in Paris or
Bologna, also be allowed to take the examination at Perugia."

INDEX

  Abdallah, 41

  Abdominal wounds, 98

  Abella, 157

  Abulcasis, 35, 78

  Abul Farag, 33

  Adalbert of Mainz, 63

  Adale, 41

  Ægidius, 64

  Ægina, Paul of, 6, 27, 33, 138, 146, 149, 184, 186

  Æginetus. _See_ Ægina, Paul of

  Ætius, 4, 28, 138, 146

  Aëtius, 27

  Albert the Great, 110

  Albertus Magnus, 14, 18

  Alcohol, 194

  Alessandra Giliani, 164

  Alexander of Tralles, 4, 27, 29, 146

  Alexandria, 33

  Ali Abbas, 35

  Alphanus, 41

  Anæsthesia, 100, 104, 105, 120

  Anselm of Havelberg, 63

  Anthemios, 5

  Antiseptic surgery, 104
    wine as, 101

  Arabian culture, 8
    surgeons, 149

  Arabians, 139

  Arabs, 46

  Archbishop of Lyons, 63

  Arculanus, 147, 150

  Ardern, John, 85, 123, 127

  Aretæus, 186

  Argelata, Pietro d', 125

  Aristotle, 18
    study of, 16

  Armato, Salvino de, 152

  Arnold de Villanova, 66
    aphorisms of, 67

  Arsenic in syphilis, 124

  Artificial teeth, 142

  Asepsis, 95, 101

  Asylums, 191

  Aue, Hartmann von der, 64

  Aurelius Celsus, 26

  Authorities of medieval physicians, 20

  Authority, influence of, 12

  Autointoxication, 83

  Avenzoar, 35, 77

  Averroes, 35

  Avicenna, 35, 47, 76, 149

  Baas, 181

  Bachtischua, 7

  Bacon, Roger, 14, 110

  Bandages, stiffened, 123

  Barber surgeons, 115

  Bartholomæus Anglicus, 81

  Bartholomew on causes of insanity, 192

  Basil Valentine, 84

  Baths, 32
    for melancholia, 184

  Bedlam, 188

  Bedlamites, 201

  Belisarius, Hospital of, 171

  Benedictine convents, 159

  Bernard de Gordon, 70, 72, 153

  Bernard of Morlaix, 49

  Bile in eye diseases, 152

  Bladders of animals, 78

  Bleeding, 55, 84

  Blood-letting, 32

  Bologna, 40

  Bones, number of, 54

  Bougies, 123

  Branca, 106
    Antonio, 107

  Bruno da Longoburgo, 96

  Brunschwig, Hieronymus, 135

  Bubonic plague, 77

  Calomel, 85

  Care of the insane, 34, 183, 189

  Care of the sick, 24, 25

  Cassiodorus, 25

  Cataract, 151

  Cautery, 100, 126

  Celsus, Aurelius, 26

  Charter of the University of Perugia, 212

  Chauliac, Guy de, 11, 66, 71, 72, 105, 109, 118, 123, 139, 140, 153, 167

  Christian hospitals, 24

  Cleanliness, 95

  Clyster apparatus, 127

  Cold compresses, 30

  Compilation, 3

  Constantine, 36, 45

  Contrecoup, 92

  Convents, Benedictine, 159

  Corbeil, Gilles de, 64

  Cosmetics, 77

  Crusades, 89, 181

  Dental instruments, 143

  Dentistry, 138

  Depressed fractures, 93

  De Renzi, 37, 41, 44, 45, 47, 76, 155, 156

  Diabolic possession, 195, 196

  Diet, 31, 36
    for melancholies, 185

  Dioscorides, 26

  Dioscoros, 5

  Diphtheria, 27, 128

  Diseases of nervous system, 30
    of women, 156

  Drainage, 97
    tubes, 125

  Duke, Robert, 46

  Duns Scotus, 110

  Dura mater, infection of, 93

  Ebers Papyrus, 137

  Education, characters of medieval, 12

  Elias, 41

  Elinus, 41

  English, King of the, 40

  Epileptic conditions, 30

  Exorcism, 195

  Eye diseases, bile in, 152
    wash, urine of infants as, 152

  Fabiola, Hospital of, 171

  Fee, law as to, 44

  Fever, 32

  Filaria medinensis, 77

  Fistulæ, 100

  Fistulas, 127

  Four masters of Salerno, 47, 91

  Fracture of the skull, 91
    of the thigh, extension in, 123

  Fractures of the skull, 94
    depressed, 93

  Frederick II., 42
    law of, 43, 206

  Gaddesden, John of, 70, 119

  Galen, 18, 19, 26, 47, 72, 116

  Gariopontus, 41

  Gerssdorff, Hans von, 135

  Gilbert, 69

  Giovanni of Arcoli, 143

  Glaucoma, 152

  Gonorrhoea, 123

  Gregory, Major, 189
    of Tours, 181

  Guarna, Rebecca, 157

  Guerini, 142, 143

  Guido of Montpellier, 64

  Gurlt, 9, 47, 69, 90, 93, 95, 96, 99, 106, 110, 113, 121, 146, 156

  Guy de Chauliac. _See_ Chauliac

  Guy of Montpellier. _See_ Montpellier

  Hæmoptysis, 30

  Hangman's rope, 28

  Hare-lip, 134

  Hartmann von der Aue, 64

  Headache, 30

  Hemicrania, 30

  Herbs, 26

  Hernia, 68
    operations too frequent, 122
    radical cure of, 121
    reduction of, 122

  Hernias, 99

  Herodotus, 137

  Hippocrates, 26, 47

  Holy Ghost Hospital, 172

  Hospital, 64, 65
    at Lübeck, 178
    for lunatics, 187
    of Bedlam, 188
    of Belisarius, 171
    of Fabiola, 171
    of Pope Symmachus, 171
    of St. Basil, 170
    of St. Jean, 178
    of Tonnerre, 176

  Hospitals, 169
    Christian, 24
    for lepers, 181
    of the Holy Ghost, 172
    royal, 174

  Hotel Dieu, 188

  "Hudibras," 107

  Hugh of Lucca, 96, 104

  Humours, 54

  Hymns, Latin, 48

  Hysteria, 34

  Indian surgeons, 106

  Infection of dura mater, 93

  Infirmaries in monasteries, 24

  Inhalations, steam, 29

  Insane, care of the, 34, 183, 189

  Insanity, 194
    lash for, 198

  Intestine, suture of, 134

  Intestines, wounds of, 99

  Italy the postgraduate medical centre, 118

  John of Salisbury, 64
    of Gaddesden, 70, 119

  King of the English, 49

  Laceration of the middle meningeal artery, 92

  Lanfranc, 11, 80, 96, 110

  Lash for insanity, 198

  Latin hymns, 48

  Law as to fee, 44
    of Frederick II., 43, 206

  Lepers, hospitals for, 181

  Ligatures, 125

  "Lilium Medicinæ," 73

  Linear cicatrices, 101

  Lister, Lord, 103

  Louis IX., 110

  Lübeck, hospital at, 178

  Lunatics, hospital for, 187

  Lucca, Hugh of, 96, 104

  Lyons, Archbishop of, 63

  Manzolini, Madame, 165

  Mad dog, 68, 80

  Magnetism, 15

  Maimonides, 35, 79

  Medical oath, 44
    schools at universities, 74
    superstitions, 22

  Medici, 164

  Medicine and surgery, relations of, 115
    popular, 22

  Medieval education, characters of, 12
    medicine, periods of, 21
    textbooks, 88

  Melancholics, diet for, 185

  Mental defectives, colonies for, 202

  Meningeal artery, laceration of, 92

  Mercuriade, 157

  Mercury, use of, 123

  Mesue, 47

  Methrodoros, 5

  Metrorrhagia, 33

  Middle Ages, limits of, vii

  Milk, 29, 52
    bath, 78

  Monasteries, infirmaries in, 24

  Mondeville, Henri de, 11, 66, 114, 116

  Mondino, 96, 164

  Monte Cassino, 39

  Montpellier, Guy de, 10, 61, 173

  Moorish physicians, 62

  Morbus Gallicus, 124

  Morley, Henry, 17

  Morgagni, 84

  Muratori, 76

  Nasal cautery, 148
    polypi, 147
    speculum, 149

  Nature study, 13

  Needling for cataract, 151

  Nefretykes, 85

  Nerve suture, 113

  Nervous system, 30

  Nicaise, 166

  Nose, surgery of the, 106

  Number of bones, 54
    of veins, 54

  Nurses, order of, 180

  Nutrition _per rectum_, 77

  Oath, medical, 44

  Oesophagus tube, 123

  Ophthalmology, 151

  Opium, 29

  Order of nurses, 180

  Ordronaux, 47, 50

  Oribasius, 28

  Orthodontia, 139

  Pagel, 56, 127, 194

  Pammachius, 171

  Paris, 40, 110

  Passavant, Jean, 111

  Paul of Ægina, 6, 27, 33, 138, 146

  Peregrinus, 15

  Perineum, rupture of, 157

  Perugia, Charter of the University, 212

  Pfolspeundt, Heinrich von, 133, 134

  Physician, conduct of the, 58

  Physicians, Moorish, 62

  Pitard, Jean, 114

  Plague, bubonic, 77

  Plastic surgery, 106, 134

  Polypi, nasal, 147

  Pontus, 41

  Pope Symmachus, Hospital of, 171

  Popular medicine, 22

  Power, D'Arcy, 127

  Psycho-analysis, 196

  Pure drug law, 43

  Pus, 103

  Puschmann, 56

  Putrefaction, 97

  Rabies, 81, 128

  Rectal feeding, 78
    surgery, 127

  Red light treatment, 70, 82

  Regimen, 48, 49
    sanitatis, 47

  Renal disease, 85

  Rhazes, 35, 148

  Roger, 42, 56, 70, 90, 103

  Roland, 56, 103

  Rolando, 91

  Roman medicine, origin of, 2

  "Rosa Anglica," 70

  Rupture of the perineum, 157

  St. Basil, Hospital of, 170

  St. Benedict, 24

  St. Bernard, 63
    of Clairvaux, 161

  St. Hildegarde, 160

  St. Jean, Hospital of, 178

  Saintsbury, Professor, 48

  Salerno, 7, 37, 75, 155
    curriculum at, 38

  Salerno, school of, 57

  Salicet, William of, 96, 105

  Salisbury, John of, 64

  Salvino de Armato, 152

  Santa Sophia, architect of, 5

  School of Salerno, 57

  Scotus, Duns, 40

  Sects in surgery, 116

  Sick, care of the, 24, 25

  Skin of the snake, 28

  Skull, fractures of, 91, 94
    opening the, 92

  Smallpox, 35, 70

  Snake, skin of, 28

  Sore throat, 31

  Spectacles, 73, 152

  Steam inhalations, 29

  Stiffened bandages, 123

  Students, 65

  Superstitions, medical, 22

  Surgeon, training of, 117

  Surgeons, Arabian, 140
    barber, 11
    Indian, 106
    temperance in, 97

  Surgery, antiseptic, 104
    of the nose, 106
    plastic, 106, 134
    rectal, 127
    sects in, 116

  Surgical specialities, 136

  Syphilis, 123
    arsenic treatment of, 124

  Tagliacozzi, 107

  Taranta, Valesco de, 71

  Tartar, removal of, 141

  Teeth, artificial, 142
    cleaning of, 140
    filling of, 145
    preservation of, 139, 144
    straightening of, 139

  Temperaments, 54

  Temperance in surgeons, 97

  Testicle excision in hernia operations, 121

  Tetanus, 130

  Textbooks, medieval, 88

  Theodoric, 70, 96, 102, 113

  Therapeutics, 23

  Thigh, fracture of, 123

  Thomas Aquinas, 110

  Thyroid gland, 28

  Tonnerre, Hospital of, 176

  Tooth-powder, 140

  Tracheotomy, 147, 150

  Trallianus, 4

  Trephining, 93, 94

  Trichiasis, 153

  Trotula, 155

  Truss, 73, 122

  Union by first intention, 100

  Universities, medical schools at, 74

  Urine of infants as eye-wash, 152

  Use of mercury, 123

  Uvula, affections of the, 150

  Valentine, Basil, 84

  Valesco de Taranta, 71

  Veins, number of, 54

  Vicious sexual habits, 28

  Vigo, John de, 145

  Viollet le Duc, 176

  Virchow, 171, 174, 181

  William of Salicet, 96, 105

  Wine as antiseptic, 101

  Women, diseases of, 156
    in medicine, 10
    physicians, 166
    professors, 155
    students, 155

  Wood dogge, 129

  Wood-hound, 193

  Wounds, abdominal, 98
    dry treatment of, 125
    of intestines, 99
    treatment of, 98

  Yperman, 123, 131

PRINTED IN GREAT BRITAIN BY BILLING AND SONS, LTD., GUILDFORD

FOOTNOTES:

[1] Fordham University Press, New York, 1911.

[2] _Popular Science Monthly_, May, 1911.

[3] Philadelphia: Lippincott, 1871.

[4] The Latin lines run thus:

  Si vis incolumem, si vis te reddere sanum,
  Cures tolle graves, iras crede profanum.
  Parce mero--coenato parum, non sit tibi vanum
  Surgere post epulas; somnum fuge meridianum;
  Ne mictum retine, nec comprime fortiter anum;
  Hæc bene si serves, tu longo tempore vives.

[5] English translations of the _Regimen_ were made in 1575, 1607, and
1617. The two latter were printed; the former exists in manuscript in the
Library of Corpus Christi College, Oxford. The opening lines of the
edition of 1607 deserve to be noted because they are the origin of an
expression that has been frequently quoted since.

  The Salerne Schoole doth by these lines impart
  All health to England's King, and doth advise
  From care his head to keepe, from wrath his harte.
  Drink not much wine, sup light, and soone arise.
  When meat is gone long sitting breedeth smart;
  And after noone still waking keepe your eies,
  When mou'd you find your selfe to nature's need,
  Forbeare them not, for that much danger breeds,
  _Use three physitians still--first Dr. Quiet,
  Next Dr. Merry-man, and third Dr. Dyet_.

[6] Some of these old medical traditions come down to us from many more
centuries than we have any idea of until we begin to trace them.
Ordinarily it is presumed that the advice with regard to the taking of
small amounts of fluid during meals comes to us from the modern
physiologists. In "The Babees Book," a volume on etiquette for young folks
issued in the thirteenth century, there is among other advices, as, for
instance, "not to laugh or speak while the mouth is full of meat or
drink," and also "not to pick the teeth with knife or straw or wand or
stick at table," this warning: "While thou holdest meat in mouth beware to
drink; that is an unhonest chare; and also physick forbids it quite." It
was "an unhonest chare" because the drinking-cups were used in common, and
drinking with meat in the mouth led to their soiling, to the disgust of
succeeding drinkers. All the generations ever since have been in slavery
to the expression that "physic forbids it quite," and now we know without
good reason.

[7] The book called "The Hundred Merry Jests" suggests that the wagtail is
light of digestion because it is ever on the wing, and therefore had, as
it were, an essential lightness.

[8] International Clinics, vol. iii., series 28.

[9] "Historical Relations of Medicine and Surgery down to the Sixteenth
Century." London, 1904.

[10] The subsequent disuse of anæthesia seems an almost impossible mystery
to many, but the practically total oblivion into which the practice fell
is incomprehensible. This is emphasized by the fact that while it dropped
out of medical tradition, the memory of it remained among the poets, and
especially among the dramatists. Shakespeare used the tradition in "Romeo
and Juliet." Tom Middleton, in the tragedy of "Women Beware Women" (Act
IV., Scene i., 1605), says:

  "I'll imitate the pities of old surgeons
   To this lost limb, who, ere they show their art,
   Cast one asleep, then cut the diseased part."

[11] "Physicke is so studied and practised with the Egyptians that every
disease hath his several physicians, who striveth to excell in healing
that one disease and not to be expert in curing many. Whereof it cometh
that every corner of that country is full of physicians. Some for the
eyes, others for the head, many for the teeth, not a few for the stomach
and the inwards."

[12] The Ebers Papyrus shows that special attention was paid to diseases
of the eyes, the nose, and throat, and we have traditions of operations
upon these from very early times. Conservative surgery of the teeth, and
the application of prosthetic dental apparatus, being rather cosmetic than
absolutely necessary, might possibly be expected not to have developed
until comparatively recent times; but apart from the traditions in Egypt
with regard to this speciality, which are rather dubious, we have abundant
evidence of the definite development of dentistry from the long ago. The
old Etruscans evidently paid considerable attention to prosthetic
dentistry, for we have specimens from the Etruscan tombs which show that
they did bridge work in gold, supplied artificial teeth, and used many
forms of dental apparatus. At Rome the Laws of the Twelve Tables (_circa_
450 B.C.) forbade the burying of gold with a corpse except such as was
fastened to the teeth, showing that the employment of gold in the mouth
for dental repair must have been rather common. We have specimens of gold
caps for teeth from the early Roman period; and there is even a
well-confirmed tradition of the transplantation of teeth, a practice which
seems to have been taken up again in the later Middle Ages, and then
allowed to lapse once more until our own time.

[13] Dr. Petells, discussing this use of livers (_Janus_, 1898), says that
there has been some tendency to revert to the idea of biliary principles
as of value in external eye diseases.

[14] "Gesammelte Abhandlungen aus dem Gebiete der Oeffentliche Medizin,"
Hirschwald, Berlin, 1877.

[15] See Walsh, "The Thirteenth, Greatest of Centuries," New York, seventh
edition, 1914.

[16] Burdett, "Hospitals and Asylums of the World."

[17] London, 1909.

[18] To be found in Huillard-Brehollis' "Diplomatic History of Frederick
II. with Documents" (issued in twelve quarto volumes, Paris, 1851-1861).

[19] Under logic at this time was included the study of practically all
the subjects that are now included under the term the seven liberal arts.
Huxley, in his address before the University of Aberdeen, on the occasion
of his inauguration as rector of that university, said: "The scholars (of
the early days of the universities, first half of the thirteenth century)
studied grammar, rhetoric, arithmetic and geometry, astronomy, theology
and music." He added: "Thus their work, however imperfect and faulty,
judged by modern lights, it may have been, brought them face to face with
all the leading aspects of the many-sided mind of man. For these studies
did really contain, at any rate in embryo--sometimes, it may be, in
caricature--what we now call philosophy, mathematical and physical science
and art. And I doubt if the curriculum of any modern university shows so
clear and generous a comprehension of what is meant by culture as the old
trivium and quadrivium does." Science and Education Essays, p. 197. New
York, D. Appleton and Co. 1896.

[20] A tarrenus or tarrene in gold was equal to about thirty cents of our
money. Money at that time had from ten to fifteen times the purchasing
power that it has at the present time. An ordinary workman at this time in
England received about four pence a day, which was just the price of a
pair of shoes, while a fat goose could be bought for two and a half pence,
a sheep for one shilling and two pence, a fat hog for three shillings, and
a stall-fed ox for sixteen shillings (Act of Edward III. fixing prices).

[21] The University of Perugia had already achieved a European reputation
for its Law School, and this Papal document was evidently meant to
maintain standards, and keep the new Medical School up to the best
criteria of the times. The original Latin of this document, as well as of
the Law of Frederick II., may be found in Walsh, "The Popes and Science,"
Fordham University Press, New York, 1908. They are quoted directly from
the official collection of Papal Bulls.

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