The Popes and Science

Dr. Payne in his article on the History of Medicine in the Encyclopaedia Brittanica said: "In civil history there is no real break. A continuous thread of learning and practice must have connected the last period of Roman medicine with the dawn of science in the Middle Ages. But the intellectual thread is naturally traced with greater difficulty than that which is the theme of civil history; and in periods such as that from the fifth to the tenth century in Europe, it is almost lost. The chief homes of medical as of other learning in these disturbed times were the monasteries. Though the science was certainly not advanced by their labors, it was saved from total oblivion, and many ancient medical works were preserved in Latin or the vernacular versions. It was among the Benedictines that the monastic studies of medicine first received a new direction and aimed at a higher standard. The study of Hippocrates, Galen, and other classics was recommended by Cassiodorus (sixth century), and in the original mother abbey of Monte Cassino medicine was studied, though there was probably not what could be called a medical school there; nor had this foundation any connection (as has been supposed) with the famous school of Salerno."

A review of some of the interesting features of the early history of medical education will serve to show that, not only was there no ecclesiastical interference with the new developing science, but, on the contrary, without the personal aid and the intelligent patronage of ecclesiastics of all degree, and especially of archbishops and Popes, the development of medical teaching that took place at Salerno would probably not have had the significance in history that it now enjoys. While there was no institutional connection between the medical school of Salerno and the Benedictine Monastery at Monte Cassino, it is known that at the end of the seventh century there was a branch Benedictine monastery at Salerno, and some of the prelates and higher clergy occupied posts as teachers in the school, and even became distinguished for medical acquirements.

Though the Salernitan medical school proper was a secular institution, there is no doubt that the Benedictines had great influence in it and had fostered its formation. How close the monks of Monte Cassino were allied to the Popes, everyone knows. The Benedictines considered themselves the special wards of the Papacy, and a number of the Abbots of Monte Cassino, or monks belonging to the community, and of men who had been educated in the monastery, had been raised to the Papacy during the Middle Ages. The origin of modern medical teaching is thus closely associated not only with the Benedictines, but through them with the Popes, without whose encouragement and sanction the work would not have flourished as it did.

In advance of the formal establishment of medical schools, in the modern sense of the word, two Popes were distinguished before their elevation to the Papacy for their attainments in all the sciences, and especially in medicine, one of whom actually founded an important school of thought in medicine, while the other was a professor at Salerno. The first of these is the famous Gerbert, who, under the name of Sylvester II., was Pope at the end of the millenium and carried Christianity over what was supposed to be the perilous period of the completion of the first thousand years, when the end of the world was so universally looked for. Gerbert was famous for his attainments in every branch of science, and indeed so many wonderful traditions have collected around his name in this matter that one hesitates to accept most of them. There seems to be no doubt, however, that he was the beloved master of Fulbert of Chartres, who did much for medicine in France at the beginning of the eleventh century and who was the founder of the so-called school of Chartres and himself the teacher of John of Chartres, who became the physician to King Henry I., of France, and of Peter of Chartres and Hildier and Goisbert.

Before the end of the eleventh century Pope Victor III., who had been the Abbot of Monte Cassino, was elected Pope much against his will. He occupied the Papal throne only for about a year and a half. He had been especially recommended by Pope Gregory VII., the famous Hildebrand, as a very suitable successor. Desiderius, as he was called before becoming Pope, was one of the best scholars of his time, and had taught for some years with great distinction at Salerno. It is not known absolutely that he taught medicine, but, as the university of Salerno is usually considered not to have been founded until the middle of the next century, and as before that time the main teaching faculty was that of the medical school and all other teaching was subordinated to it, Desiderius must surely be considered as a teacher at least of medical students. At that time a physician was expected to know something more than merely his profession. Mathematics and philosophy were the two favorite subjects to which, besides medicine, they devoted themselves. The presence of the future Pope at Salerno is, moreover, the best possible index of the sympathy between the ecclesiastical authorities and the medical school.

Besides there are definite records of the friendship which existed between Alphanus, Archbishop of Salerno, and Desiderius, while they were both members of the Benedictine Community of Monte Cassino. Alphanus subsequently taught medicine at Salerno, and some of his writings on medicine have been preserved for us. He was the author of a work bearing the title De Quatuor Elementis Corporis Humani, a treatise on the four elements of the human body, which is a compendium of most of the knowledge of anatomy and physiology of the time, though it also contains much more than the information with regard to the merely physical side of man's being. The fact that Alphanus should have been promoted from the professorship in the medical faculty to the Archbishopric of Salerno is only another proof of the entire sympathy which existed between the Church and the professors of medical science at that time.

During the thirteenth century universities were founded in some twenty important cities in Europe, and in connection with most of them a medical school was established. These educational institutions were the result of the initiative of ecclesiastics; their officials all belonged to the clerical body, most of their students were considered as clerics–and indeed this was the one way to secure them against the calls for military service which would otherwise have disturbed the enthusiasm for study–and the Popes were considered the supreme authority over all the universities. In spite of this thoroughly ecclesiastical character of the universities and educational institutions, there is not a hint of interference with the teaching of medical science and abundant evidence of its encouragement. Indeed, for anyone who knows the story of the universities of the thirteenth century, it is practically impossible to understand how there could have arisen any tradition of ecclesiastical opposition to education in any form, and there is not a trace of foundation for the stories with regard to ecclesiastical intolerance of science, which are supposed to be supported by certain Papal decrees.

The best possible demonstration of the maintenance of the most amicable relations between churchmen and physicians during the century in which these decrees were issued is also the most interesting fact in the history of medicine during the thirteenth century. It is not generally known that one of the most distinguished physicians of the thirteenth century, one who wrote a book on the special subject of eye diseases that is still a classic, afterwards became Pope under the name of John. He is variously known as John XIX., John XX., or John XXI., according as certain occupants of the Papal throne are considered to be of authority or not. He was educated at Paris, and probably spent some time at Montpelier. Under the name of Peter of Spain, though he was what we should now call a Portuguese, he subsequently taught physic at the University of Sienna. Here he wrote the famous little work on the Diseases of the Eye, which was reviewed by Dr. Petella, physician-in-chief of the Royal Italian Marine, in Janus, the International Archives for the History of Medicine and for Medical Geography in 1898. Petella does not hesitate to proclaim him one of the greatest men of his time. Daunou, one of the continuators of the Benedictines' literary history of France, [Footnote 28] says that this Peter of Spain was one of the most notable persons in Europe in his generation.

[Footnote 28: Histoire Litteraire de la France, Vol. XVI. This is the famous work begun by the Benedictines of St. Maur.]

Pope John XXI., before his accession to the Papacy, had certainly accomplished remarkable work in medicine, and of a kind that makes his writings of great interest even at the present day. There is scarcely an important pathological condition of the eye which does not receive some consideration in this little book, and it is a constant source of surprise in reading it to find, with their limited knowledge and lack of instruments, what good diagnosticians the ophthalmologists of the thirteenth century were. Cataract is described, for instance, under the name of "water that descends into the eye," and a distinction is made between cataract from internal and external causes. Hardening of the eye is mentioned and is declared to be very serious in its effects. There seems no doubt that this was glaucoma. Conditions of the lids, particularly, were differentiated and treated by rational measures, some of them quite modern in substance. A curious anticipation of modern therapeutics is the frequent recommendation of extracts of the livers of various fishes for external and internal use, that is a reminder of the present employment of cod-liver oil. The book is acknowledged to be a classic in medicine. The fact that its author should have become Pope later, is the best proof that instead of opposition there was the greatest sympathy between medicine and ecclesiasticism in his time.

With these thoroughly amicable relations between the Church and the medical schools during the thirteenth and preceeding centuries, it will not be so much of a surprise as it might otherwise be, to learn of the foundation of the Medical School of Rome and of the continuation of Papal patronage of it even while the Popes were absent at Avignon. University records do not say much about it during the next two centuries. With the coming of the Renaissance, however, and the entrance of a new spirit into education, the Popes also were touched by the educational time-spirit, and there came a rejuvenation of the University of the City, which now acquired a new name, that of the Sapienza, and became the home of some of the most distinguished teaching in Europe in every department. Early in the sixteenth century the medical department of the Sapienza, or Papal University at Rome, became one of the most noteworthy institutions of Europe because of the work in medicine accomplished there, and had among its faculty the most distinguished investigators in medical science, and especially in that department of medicine–anatomy–which by an unfortunate tradition the Popes are said to have hampered.

The most important event in the history of the institution, after its foundation, was its establishment in the home which it was to occupy down to our own time. Its new habitation was prepared for it by the Pope who has probably been the most maligned in history–Alexander VI. A magnificent site was appropriated for it, and the construction of suitable buildings begun. A little more than a decade later, Leo X., another one of the misunderstood Popes, came to the conclusion that the two universities in Rome, that of the Papal Court and that of the City, would do better work if combined into one, and accordingly this combination was effected. This made provision for one very strong teaching faculty in Rome. The final steps for the completion of the union of the two universities were taken by Pope Alexander VII., and the buildings which the new university was to occupy were finished in a manner worthy of the great institution of learning which it was hoped to create in Rome.

The first of the great professors who made the Papal Medical School famous was Realdo Colombo, often spoken of as Columbus simply, who was invited to teach in Rome by Pope Paul III., the same Pope who issued the bull founding the Jesuits. Some people might consider the two actions as representing contrary tendencies in education, but they are not such as know either the history of the Jesuits, or of the constant endeavor of the Popes to foster education. Columbus came to Rome, as we have said, with the prestige of having succeeded Vesalius at Padua, and later having been specially tempted by the reigning prince in Pisa, who wanted to create a great medical school in connection with his university in that city, which he was at that moment trying to raise to distinction, to accept the professorship of anatomy there.

Vesalius was still alive at this time, and the period when, if we would credit certain historians who emphasize the opposition between the Church and science, it was dangerous to dissect human bodies had not yet passed. It is interesting to read the account of Columbus's reception in Rome, and the interest manifested in his work by all classes in the Roman University at this time. His course in anatomy was so enthusiastically attended that, as he himself tells in a letter to a friend, he often had several hundred persons in his audience when he gave his anatomical demonstrations on the cadaver. These were not all medical students, but many of them were ecclesiastics, and some of them important members of the hierarchy. Even cardinals manifested their interest in anatomy, and occasionally attended the public dissections–public, that is, as far as the University is concerned–which were made by Columbus.

Columbus's enthusiasm for anatomy was such that, as Dr. Fisher said of him in the Annals of Anatomy and Surgery, Brooklyn, 1878-1880, "he dissected an extraordinary number of human bodies, and so devoted himself to the solution of problems in anatomy and physiology that he has been most aptly styled the Claude Bernard of the sixteenth century." In one year, for instance, he is said to have dissected no less than fourteen bodies, demonstrating, as Dr. Fisher has said, that "it was an age of remarkable tolerance for scientific investigation."

Besides being an investigator, Columbus was a great teacher, and many of our modern methods of instruction in medical schools had their origin in the system of demonstrations introduced by him. His descriptions of the demonstrations for students upon living animals, show that some of the most recent ideas in medical teaching were anticipated by this Roman professor of anatomy and medicine in the Renaissance period. His demonstrations of the heart and blood-vessels and of the actions of the lungs are particularly complete, and must have given his students a very practical working knowledge of these important physiological functions. In a word, the medical teaching of the Roman University, under him at this time, far from being merely theoretic and distant from actual experience and demonstration, was thoroughly modern in its methods.

It is no wonder, then, that practically all the ecclesiastical visitors who came in such numbers to Rome, made it a custom at this time to attend one or more of Columbus's anatomical lectures. They were looked upon as one of the features of the Roman university life of the time. How much good was accomplished by this can scarcely be estimated. The example must have had great influence especially on members of faculties of various educational institutions who came to the Papal See. To some degree at least these interesting teaching methods must have aroused in such men the desire to see them emulated in their own teaching institutions, and therefore must have done much to advance medical education. The fact that these things were done in the Papal Medical School only emphasized the significance of them for ecclesiastics, and made them more ready to bring about their imitation in other teaching centers.

How well the Popes were justified in their estimation of Columbus's genius as an anatomical investigator will be best appreciated from his discovery of the pulmonary circulation, which formed, as Harvey confesses at the beginning of his work on the circulation, the foundation on which Harvey's great discovery naturally arose. It is probable that Columbus would not have come to Rome, in spite of the flattering offers held out to him, only that he was already the personal friend of a number of high ecclesiastics, and even of the Pope who extended the invitation. How well the Popes continued to think of Columbus after his years of work in the Roman Medical School will be well understood from the fact that, when his great work De Re Anatomica was published after his death by his sons, Pope Pius IV. accepted the dedication of it. This was of course not an unusual thing, for many books on other sciences were dedicated to the Popes, and the example thus set was subsequently imitated. Twenty-five years later, Professor Piccolomini dedicated his Anatomical Lectures to Pope Sixtus V. Subsequent anatomical publications of the Papal Medical School were issued under like patronage. The famous edition of Eustachius's anatomical sketches, published under the editorship of Lancisi, is a notable example of this, and went to press mainly at the expense of Pope Clement XI., who realized how valuable they were likely to be for the teaching of anatomy.

These two great discoverers in anatomy, Columbus and Eustachius, were succeeded, as is so often the case in the history of university faculties, by a man more capable of writing about great discoveries than of making them himself. This was Piccolomini, who devoted himself to showing how much the ancients had taught about anatomy, though at the same time he also made clear the place occupied by modern anatomical discoveries. While his name is not attached to any great discovery in the science of anatomy, he is generally acknowledged to have been one of the great teachers of his time and one who was needed just then in order to make people realize how the old and the new in anatomy must be coordinated. Piccolomini's successor in the chair of anatomy at Rome was another original genius and investigator whose name, however, and fame has never been as great among English-speaking people as in Italy, or among the Latin races generally. The fact that he was a rival of Harvey's in the matter of the discovery of the circulation of the blood has always made the Italians exaggerate his position in medical history, while it has undoubtedly made English writers of medical history diminish the importance of his work.

Historians of science consider him worthy to be called the greatest living scientist of his time–the end of the sixteenth century. He was not only a scientific physician, but he was an authority in all the sciences related to medicine, and indeed had profound interests in every branch of physical science. His contemporaries looked up to him as a leader in scientific thought. To anyone who examines the question of the discovery of the circulation of the blood with freedom from bias, there can be no doubt but that the honor for this discovery has been unduly taken away from Caesalpinus in English-speaking countries, to be conferred solely on Harvey. Not that there is any wish to lessen the value of Harvey's magnificent original work, nor make little of his wonderful powers of observation, nor of the marvelous experimental and logical method by which he followed out his thoughts to their legitimate conclusion, but that I would insist on giving honor where honor is due, though most writers in English refuse to give Caesalpinus's claims a proper share of attention.

The Italians have always declared that Caesalpinus was the real discoverer of the circulation, and there is no doubt that his career occurs just at that point in the evolution of the medical sciences, and especially anatomy and physiology in Italy, where this discovery would naturally come. Lest it should be thought, however, that my interest in the Popes and the Papal Medical School has led me to exaggerate the claims of Caesalpinus as a great naturalist and medical scientist, I prefer to quote the description of him given by Professor Michael Foster in his lectures on the History of Physiology, delivered in this country as the Lane Lectures, at the Cooper Medical College in San Francisco, and published by the Cambridge University Press, 1901. Professor Foster was not one to exaggerate the claims of any Italian, and least of all of any Italian who might be supposed to have a claim that would stand against Harvey's. The soupçon of Chauvinism in his treatment of Servetus and Columbus in this regard is indeed rather amusing. He said:–

"Of a very different stamp to Columbus was Andreas Caesalpinus. Born at Arezzo in 1519, he was for many years Professor of Medicine at Pisa, namely, from 1567 to 1592, when he passed to Rome, where he became Professor at the Sapienza University and Physician to Pope Clement VIII., and where at a ripe old age he died in 1603.

"If Columbus lacked general culture, Caesalpinus was drowned in it. Learned in all the learning of the ancients and an enthusiastic Aristotelian, he also early laid hold of all the new learning of the time. Naturalist as well as physician, he taught at Pisa botany as well as medicine, being from 1555 to 1575 Professor of Botany, with charge of the Botanic garden founded there in 1543, the first of its kind–one remaining until the present day."

Professor Foster admits that Caesalpinus had a wonderful power of synthetising knowledge already in hand and anticipating conclusions in science that were to be confirmed subsequently. In his Medical Questions, though the work is written in rambling, discursive vein, he enunciated views which, however he arrived at them, certainly foreshadowed or even anticipated those which were later to be established on a sound basis. Foster quotes a passage in which Caesalpinus made it very clear that he thoroughly understood the mechanism of the circulation and grasped every detail essential to it. After quoting this passage, which it must be confessed is rambling, Foster thus sums up what Caesalpinus has to say with regard to the circulation:–

"He thus appears to have grasped the important truth, hidden, it would seem, from all before him, that the heart, at its systole, discharges its contents into the aorta (and pulmonary artery), and at its diastole receives blood from the vena cava (and pulmonary vein)."

"Again, in his Medical Questions he seems to have grasped the facts of the flow from the arteries to the veins, and of the flow along the veins to the heart."

That there was no change of Papal policy in the next century can be gathered from an interesting phase of Papal interest in science which, though not directly concerned with medicine, eventually resulted in important theoretic advances in medical science. This was the encouragement of Father Kircher's work at Rome. Father Kircher was the Jesuit who made the first scientific museum. As the result of his general interest in things scientific he wrote a little book on the pest. In this book he stated in very clear terms the modern doctrine of the origin of disease from little living things, which he called corpuscles. Because of this Tyndall attributes to Father Kircher the first realization of the role that bacteria play in disease. Even more wonderful than this, however, was Father Kircher's anticipation of modern ideas with regard to the conveyance of disease. He insisted that contagious diseases, as a rule, were not carried, as had been thought, by the air, but were conveyed from one person to another, either directly, or by the intermediation of some living thing. He considered that cats and dogs were surely active in conveying diseases, and he even reached the conclusion that insects were also important in this matter. His expressions with regard to this are not of the indefinite character which one often encounters in the supposed anticipation of important principles in medicine, but are very precise and definite. Father Kircher is quoted by Dr. Howard Kelly, of Baltimore, in his life of Major Walter Reed, whose work in showing that yellow fever is transmitted by mosquitoes is well known, as saying in one place, "Flies carry the plague," and in another place, "There can be no doubt that flies feed on the internal secretions of the diseased dying, then flying away they deposit their excretions on the food in neighboring dwellings, and persons who eat it are thus infected." It is interesting to find that the Professor of the Practice of Medicine in the Papal University at Rome when this book was published, far from resenting, as many professors of medicine might, the excursion of an outsider into his science, said Father Kircher's book "not only contains an excellent resume of all that is known about the pest or plague, but also many valuable hints and suggestions on the regional spread of the disease which had never before been made." He did not hesitate to add that it was marvelous for a man, not educated as a physician, to have reached such surprising conclusions, which seemed worthy of general acceptance. All this, it may be said in passing, was within a few years after the trial of Galileo. In this next century the Popes continued their special efforts to secure the greatest teachers of anatomy and physiology for their Roman medical school. One of the results was the appointment of Malpighi, whose name has deservedly become attached to more structures in the human body because of tissues which he first studied in detail, than any other man in the history of medicine. Malpighi represents the beginning of most of the comparative biological sciences, and his original observations upon plants, upon the lower animals, on fishes and then on the anatomical structure of man and the higher animals, stamp him as an investigating genius of the highest order. He was the personal friend of Innocent XI., who wished to have him near him at Rome as his own medical adviser, and besides desired the prestige of his fame and the stimulating example of his investigating spirit for the students of the medical school of the Sapienza. The closing years of Malpighi's life were rendered happier, and his wonderful researches were as well rewarded as such work can be, by the estimation in which he was held at Rome.