The Popes and Science

V

Bull of Pope John XXII. in which he authorizes the foundation of a University in the City of Cahors, his birthplace, as a memorial of his interest in the townspeople and a monument of his zeal for education.

Confirmatio erectionis Universitatis studiorum in civitate Cadurcensi.

Ioannes episcopus servus servorum Dei, ad perpetuam rei memoriam.

Cum civitas Cadurcensis, quam excellentiae divinae bonitas multiplicium gratiarum bonis et dotibus decoravit, propter ipsius commoditates et conditiones quamplurimas apta non modicum generali Studio censeatur, nos reipublicae multipliciter expedire credentes, quod in civitate praefata fiat et emanet fons scientiarum irriguus, de cuius plenitudine hauriant universi, litteralibus cupientes imbui documentis, et etiam cultores sapientiae inserantur et provehantur diversarum facultatum dogmatibus eruditi, facundi et undique illustrati, fructum uberem, largiente Domino, suo tempore producturi; attendentes quoque sincerae fidei puritatem, ac eximiae devotionis affectum, quos dilecti filii consules et Universitas eiusdem civitatis ad nos et Romanam Ecclesiam habere noscuntur: ex praedictis causis, porrectis etiam nobis pro parte consulum et Universitatis praedictae humilibus et devotis supplicationibus inclinati, auctoritate apostolica statuimus et ordinamus, quod in civitate praedicta perpetuis futuris temporibus generale. Studium habeatur et vigeat in qualibet licita facultate, quodque praefatum Studium, ac eius Universitas, ac doctores, magistri, licentiati, baccalaurei et scholares pro tempore commorantes causa studiorum ibidem, omnibus privilegiis, liberatibus et immunitatibus, concessis Studio Tholosamensi ac Universitati eius, plene et libere gaudeant et utantur.

Nulli ergo omnino hominum etc.

Datum Avenione vii idus iunii, pontificatus nostri anno xvi.

Dat. die 7 iunii 1332, pont. anno xvi.

APPENDIX III.

MEDIEVAL LAW FOR THE REGULATION OF THE PRACTICE OF MEDICINE

It is usually presumed that the practice of medicine was on a very low plane during the Middle Ages, and that while only little was known about medical science, the methods of practicing the medical art were crude, as befitted an earlier time in evolution before modern advances had come. Any such impression is founded entirely on ignorance of the conditions which actually existed. In his studies in the history of anatomy in the Middle Ages, Von Töply [Footnote 48] quotes the law for the regulation of the practice of medicine issued by the Emperor Frederick II. in 1240 or 1241. The Law was binding on the two Sicilies, and shows exactly the state of medical practice in the southern part of Italy at this time. Everything that we think we have gained by magnificent advances in modern times is to be found in this law. A physician must have a diploma from a university and a license from the government; he must have studied three years before taking up medicine–then three years in a medical school, and then must have practiced with a physician for a year before he will be allowed to take up the practice of medicine on his own account. If he is to take up surgery, he must have made special studies in anatomy. The law is especially interesting because of its regulation of the purity of drugs, in which it anticipates by nearly seven centuries our Pure Drug Law of last year. (This law was published in the form here given in the "Journal of the American Medical Association," January, 1908.)

[Footnote 48: Studien zur Geschichte der Anatomie im Mittelalter von Robert Ritter Von Töply. Leipzig, 1898.]

"While we are bent upon making regulations for the commonweal 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 and sufficient knowledge. This document must be presented to us, or in our absence from the kingdom to the person who remains behind in our stead, and must be followed by the obtaining of a license to practice 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 practice medicine without such permission from our authority.

"Since 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." (Under logic at this time was included the study of practically all the subjects that are now taken up in the arts department of our universities. Huxley, in his address before the University of Aberdeen on the occasion of his inauguration as Rector of that University, said that "the scholars [of the early days of the universities] studied Grammar and 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." Huxley, Science and Education Essays, page 197. New York, D. Appleton & Co., 1896.–J. J. W.)

"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 license to practice, 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 practice medicine until he has during a full year devoted himself to medical practise with the 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 practice, 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 a formal oath, under whose inspection electuaries and syrups and other medicines be prepared according to law and only be sold after such inspection. In Salerno in particular, we decree that this inspectorship shall be limited to those who have taken their degrees 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.

"Every physician given a license to practice must take an oath that he shall faithfully fulfil all the requirements of the law, and in addition, 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 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." (A tarrene in gold was equal to about thirty cents of our money. Money had at least twenty times the purchasing power at that time that it has now. At the end of the thirteenth century, according to an Act of the English Parliament, a workman received 4d [eight cents] a day for his labor, and according to the same Act of Parliament the following prices were charged for commodities: A pair of shoes cost eight cents, that is, a day's wages. A fat goose cost seven cents, less than a day's wages. A fat sheep unshorn cost thirty-five cents; shorn, about twenty-five cents. For four days pay a man could get enough meat for himself and family to live on for a week, besides material out of which his wife could make excellent garments for the family. A fat hog cost twice as much as a fat sheep, and a bullock about six times as much.–J. J. W.) "From a patient whom he visits outside of the village or the wall of the town, the physician has a right to demand for a day's service not more than three tarrenes, to which maybe 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." (Apparently many different ways of getting round this regulation had already been invented, and the idea of these expressions seemed to be to make it very clear in the law that any such business relationship, no matter what the excuse or method of it, is forbidden.–J. J. W.) "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 upon 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." (90 cents an ounce seems very dear, but this is the maximum.) "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 medicines conscientiously, according to the rules of their art, and as far as it is humanely 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 these regulations is committed, should allow any fraud in the matters that are entrusted to them, they shall be condemned to punishment by death."

APPENDIX IV.

CHURCH DECREES RELATING TO MEDICINE

Besides the Papal documents referred to in the body of this book and quoted in the original in the Appendix to the first edition immediately preceding this, there is a series of decrees of Councils and Synods of the Church which are sometimes referred to as representing a distinct policy of opposition on the part of the Church to science and particularly medical and surgical practice, as if their purpose had been to force people to have recourse to prayers and relics and pilgrimages and masses rather than to take advantage of medical knowledge and surgical experience for the relief of their ills. The Papal documents quoted and discussed in the previous edition of this book proved to have no such meaning as was attributed to them and the history of the medical sciences as traced, shows that these Church regulations were not misconstrued either in their own or subsequent generations in such a way as to have the effect of interfering with the development of medical science or medical education as has been claimed. Their citation in support of the thesis of Church opposition to science, theoretic or applied, is entirely without justification.

Exactly this same thing is true with regard to the other documents that are referred to as having a parallel and confirmatory significance of Church opposition to medical science, or medical or surgical practice, or medical teaching. It requires no lengthy explanation to see that the decrees referred to are simply ecclesiastical disciplinary regulations, aimed at putting an end to certain abuses that had arisen in religious matters, and well calculated to prevent their further occurrence. The Church authorities recognized as will anyone who understands the circumstances that men who had devoted their lives in religious orders exclusively to the work of religion, should not be permitted to neglect their religious vocations because of devotion to some secular profession. They were forbidden to practice and to study medicine, but the practice of law was forbidden to them quite as well and for the same reason. There was no question of limiting the number of persons who might take up medical study, but all those who had bound themselves for life to religious duties must not withdraw from these to take up secular occupations. The case against the Church as opposed to science, and above all medicine and surgery, must indeed be weak when it has to be bolstered up by recondite references to documents such as these, the purport of which is so clear and the good sense of which is as evident now as it was when they were issued.

Everyone recognizes that absorbing professional occupations such as the practice of medicine or of law keeps men from devoting themselves to the intellectual or the spiritual life. The opposite is also felt to be the case and there is still a profound distrust of the lawyer or the physician who devotes himself to literature or to any intellectual avocation, for the feeling is that he cannot be practically successful at his profession. This feeling is often a mere prejudice and great lawyers and great physicians have often been litterateurs of distinction, but as a rule there is incompatibility between the two modes of occupation. In the medieval period it was felt that there was the same incompatibility between proper devotion to the spiritual life and the professions, and as members of religious orders had given up worldly affairs and interests in order to devote themselves to other-worldliness and had taken vows of poverty, chastity and obedience for that purpose, it was sincerely felt that they should not engage in gainful occupations and professional work that distracted them from the religious profession which they had taken up. Hence these decrees.

The only way to make perfectly clear the meaning of these decrees in their proper place in history both as regards education in general and medical education, is to give the text of the documents in the accompanying translation. I owe the text of them to Father Corbett of the Seminary of St. Charles Borromeo at Overbrook, Pa., who supplied me with the similar documents for the first edition of this work. The translations are made from the recognized authoritative edition of the decrees of the Church councils and synods issued at Paris in 1671, the title page of which reads as follows: "Sacrosancta concilia ad regiam editionem exacta quae nunc quarta parte prodit auctior studio Philip. Labaei et Gab. Cossartii, Soc. Jesu Prebyterorum, Tomus Decimus, 1053–1197, Lutetiae Parisiorum 1671." [Footnote 49]

[Footnote 49: I feel that I should say that when there was question of publishing these documents I consulted Dr. Garrison, the Assistant Librarian of the Surgeon General's Library at Washington and the author of the best history or medicine in English, as to the Church decrees that ought to be published in their entirety in order to make their meaning perfectly clear. I have followed the list suggested by him.]

The Council of Rheims held under Pope Innocent II, A.D. 1131, Canon VI, forbidding monks or regular canons to study law or medicine for the sake of gain.

"An evil custom as we consider it and detestable has grown up by which monks and regular canons after having received the habit and made their profession, spurning the rule of their blessed masters Benedict and Augustine, learn secular law and medicine for the sake of temporal gain. Inflamed by the fire of avarice they make themselves the patrons of causes [that is the attorneys of legal proceedings] and when they ought to be devoting themselves to psalmody and hymns, confiding in the support of a fine voice and the variety of their pleas, they confound justice and injustice, right and wrong. Imperial constitutions attest that it is absurd, nay even an opprobrium, for members of the clerical order to wish to be skilled in forensic disputation. We decree that violators of the religious life of this kind should fall under the severe judgment of the apostolical authority, for as they have neglected the cure of souls and in no way attend to the purpose of their order, promising health for filthy lucre, they make themselves guardians of human bodies. And since an impure eye is the index of an impure heart and since religion ought not to deal with those things even to talk about which brings the blush of shame to the cheek of honesty, in order therefore that the monastic and canonical order should be preserved inviolably pleasing to God in its holy purpose, we interdict by the apostolical authority that any such proceeding should be allowed hereafter. Bishops therefore and abbots and priors who consent to such an enormity shall be deprived of their own dignities."

The Council of Tours held under Pope Alexander III, A.D. 1163, Canon VIII. That religious should avoid secular studies.

"Not only does the envy of the old enemy of mankind bring him to labor greatly to destroy the infirm members of the Church, but he also puts his hand to securing the desirable members of the Church and strives even to supplant the elect according to the saying of the Scriptures 'for the elect are his food.' He plumes himself if he can bring about the fall of many, but especially if he can bring down some more distinguished member of the Church by making him lukewarm. Hence it is that he knows how to transfigure himself after his usual fashion into an angel of light, so that under the pretext of caring for the health of ailing brethren and more faithfully carrying out ecclesiastical business he leads members of the regular religious orders to the study of law and of physical problems which have to be given attention outside of the cloister. For this reason, so that spiritual men under the pretext of science may not again become involved in mundane affairs and themselves lose their interior life while they are thinking to provide for others in the exterior, we have decreed by the assent of the present council in the endeavor to meet this evil, that no one at all after taking the vows of religion or the making of religious profession should be allowed to absent himself from the cloister for the study of medicine and physic. If however he has already absented himself and shall not have returned to his cloister within the space of two months he is to be avoided by all as excommunicate, and if he should presume to try the effect of patronage in no case should he be heard. On his return to the cloister he must always be the last of the brothers in the choir and unless by the special indult or permission of the Holy See must lose hope of all promotion."

The Council of Paris, A.D. 1212, Second Part, Canon XX.

"Since certain of the members of the regular orders under the pretense of caring for the bodies of ailing brother members and of more faithfully managing ecclesiastical affairs, to use the words of the Lateran Council, have not hesitated to go out of their cloisters to learn mundane law and give themselves to the study of physical problems in order to give their time to jurisprudence and medicine and on account of that are lacking in the interior life because they are devoting themselves to care for external things, we walking closely in the footsteps of that council decree that unless within the space of two months such students of law and medicine return to their cloisters, in spite of the permission of their abbot, which he is not empowered to give, they are to be excommunicated and avoided by all; and in no case if they should endeavor to use patronage to aid them are they to be admitted.

"We prohibit also anyone who enters the cloister for the sake of religion to go out of it in order to go to school; whatever a student may wish he should learn in the cloister. Those who are now in the schools should within two months return to the cloister."

Decree of the Council of Montpellier held under Pope Alexander III, 1162.

Since the proceedings of this Council are not extant the records of it are preserved in two monuments. One an Epistle of Pope Alexander to the Bishop of Verona and the other the decrees of the Council of Montpellier held in 1195 which enacted similar legislation.

Cap. 15. "The Council prohibited besides under the full severity of ecclesiastical discipline any monk or canon regular or other member of a religious order to take up the study of secular laws or medicine. Anyone violating this statute must be canonically published by the diocesan Bishops according to the decree promulgated in this matter under Pope Alexander in the Council of Montpellier."

It has been suggested that this exclusion of monks and religious from the study of medicine by Church ordinance practically shut out all the clerics, that is, all the educated men of the medieval period, from the medical profession. Any such idea, however, could only have occurred to one who does not realize that at any given time there are only a comparatively few religious and a great many secular clergymen. Practically all those who could read and write in the Middle Ages were known as clerks, that is clerics, and were under the protection of the Church, most of them indeed receiving minor orders, and if all the clergy were to have been excluded from the medical profession this contention would be true. So far is it from the truth, however, that a number of the great physicians and surgeons of the thirteenth and fourteenth centuries belonged to the clerical orders, not a few of them were priests and some of the greatest of them, like Theodoric, were actually bishops. It was only the religious, that is the men who had specially devoted their lives to monasticism, who were forbidden to take up the study of medicine because it did not comport with their monastic vocation.