1847.] Fernel-Ambrose Paré. 405 properties of remedies and the nature of disease which neither is nor ever can be attained, and their employment should be rejected by all enlightened practitioners as foolish and deceptive. A second precept of Fernel's, respecting the Expectant mode of treating disease, is worthy of approbation, as circumscribing this within its just limits. He recommends us, when a disease is obscure in its characteristics and not very urgent in its indications, not to be too hasty in resorting to medicines, but to trust more to Nature and regimen, by the instrumentality of which its true character will often be revealed or even its cure effected. A groping medication is usually injurious, and if your patient compels you to do something, at least avoid by your circumspection doing mischief. A third precept, Fernel considers the capital one, namely, that we must seek for and destroy the cause or causes of a disease before attacking the disease itself, which otherwise is liable to constant reproduction. Many affections are not dependent moreover upon a single cause but upon a series of causes, each of which must be destroyed in the order of its generation. As most of these causes were of a hypothetical character, and endlessly subdivided, the attacking them thus in succession gave rise to the most complex and fanciful treatment. Fernel recognised but three modes of medication. The Evacuating, the Purgative, and the Alterative. By the first, excess of the humours is disposed of, by the second these are purified, and by the third, parts whose action had become vitiated are restored to their normal condition. He endeavoured to diminish the number of articles then overloading the Materia Mediea; and makes no mention of the newly-introduced metals, mercury, antimony, gold, and copper. These substances were, in fact, then in the hands of quacks and charlatans, and prescribed with so little discrimination as to produce oftentimes effects as disastrous as the diseases they were employed to remove. It is not surprising, therefore, that a judicious writer, of the highest authority as a medical teacher, should have felt the necessity of caution. 5. Surgery. The progress of Surgery has been usually in advance of that of internal pathology, in consequence of the greater ease with which external diseases may be observed and treated. During the Middle Ages, however, it fell into a yet lower position than did medicine; for, while the latter was in the hands of the only educated portion of the community, the priests, it was practised by barbers, bath-men and the refuse of society. Sprengel states that, in Germany, for a lad to become apprenticed in trade, it was necessary for him to prove that his family did not contain barbers, shepherds, bath-men, or skinners-classes who, in that country alone, furnished the surgeons. The rest of Europe was in no better condition, if we except some few doctors in Italy and Guy de Chauliac in France, who imparted a temporary brilliancy to the art. In explanation of this utter neglect of an art so obviously and especially useful, at a period when wars and combats were so frequent, we must remember that the Church interdicted its priests from its practice, in consequence of which it was followed as a purely mechanical employment by various ignorant members of Society. Most of these operators were perambulatory, and each confined himself to some particular class of operations, as cataract, lithotomy, hernia, &c., often operating by secret processes, which were transmitted as an inheritance from father to son. The elevation of the profession only commenced after the dissipation of the prejudices against dissections; but its progress was very slow until the 16th century, when most of the great anatomists of that period, as Berenger, Vesalius, Fallopius, Fabricius, &c. were also distinguished surgeons; and other distinguished men also joined a profession now become honourable, but no name is so distinguished at the present epoch as that of Ambrose Paré. Paré, born of poor parents, and apprenticed to a country barber-surgeon, was brought, about the year 1532, to Paris by the great desire he felt to qualify himself for the more important duties of the profession. He studied with such earnestness during three years at the Hotel Dieu as to attract the attention and approbation of its surgeons. In 1536, he joined the army as a surgeon; and relates in his account of the campaign that, being unprovided with the boiling oil, then thought requisite for cauterizing the wounds, he could not sleep for anxiety, and his extreme surprise at finding that the patients deprived of it had suffered less than the others. The doctrines of the day taught that wounds from fire-arms were of a poisonous character, only to be treated by cauterizing them with boiling oil or the red-hot-iron, and the internal administration of alexipharmies. "Chance put him in the way," says M. Malgaigne, " of making his first discovery; but what was not chance was that quickness and depth of judgment, that boldness of resolution, which immediately induced him-a youth without name or influence, and yet more without any literary or philosophical education-to single out and combat a doctrine universally recognised and maintained by the highest surgical authorities of the period." His reputation rapidly increased, and after the campaign of 1543, Sylvius, whose lectures attracted crowded auditories, expressed a wish to see him, and listened with deep attention to his opinions. He entreated him to publish them, and in 1545, appeared his little work on gun-shot wounds, which amply testified that a new epoch had arrived in French Surgery. In 1552, he performed the signal service to humanity of substituting ligature of the vessels after amputation for their cauterization. He was made surgeon to several successive sovereigns, but, amidst the noise of camps, a large practice, and multiplied occupations, he found time to read all that was published concerning his art, and to compose himself a great number of works. "He enriched almost every branch of surgery with some discovery or improvement, and, so far from imitating the secresy so much in vogue at the period, he freely communicated all he knew, and indeed felt it a matter of conscience to make it public." 6. Obstetrics were studied by a few of the principal surgeons of this period, but by none so specially as by Guillemeau, pupil and friend of Paré. To him are due the earliest of modern improvements, among which may be especially mentioned the precept of terminating the labour artificially in the cases of great hemorrhage and convulsions. Although the Cæsarean operation had been known from the remotest periods, it was only employed in ancient times for the removal of a foetus from a woman recently dead. A law of Numa Pompilius ordains (as indeed does the Catholic Church at the present day) the opening of the belly of every woman dying with a 1847.] New Diseases-The Occult Sciences. 407 child in her womb. The earliest authentic example of the operation having been performed on the living woman is not of later date than the fifteenth century. 7. Clinical Instruction.-Nothing corresponding to the idea we attach to this term was in force during the Middle Ages. In place of narratives, formed upon the plan of Hippocrates' admirable "Epidemics," we find nothing but sterile disputations upon the principle of life, the essential character and latent causes of disease, &c. Upon the Revival of Letters, even at the period we are now engaged in, the studies were more philological than practical, and that admirable spirit of investigation manifested in some of the ancient writings, now again brought to light, was yet some time in finding imitators. Eventually, however, it did so, as stated in the following extract: "Nothing proves better how much progress the art of observing and describing pathological phenomena had made progress, than the great number of new diseases mentioned by the authors of this period. We read in their writings for the first time of whooping-cough, sweating sickness, scorbutus, plica, raphania, and syphilis. Can we believe that all these affections, some of which so deeply modify the econ omy, made their irruption upon Europe at the same time? Is it probable that the changes wrought in the commercial and political relations of nations, the discovery of the New World, long sea-voyages now become so frequent-in a word, the modifications introduced into the public and private hygienic observances by so many events characterizing the epoch-may have given sudden rise to this deluge of new evils? No one, I think, would venture to maintain this. It is more probable, I would almost say it is certain, that the majority of these diseases were of sufficiently old existence; but that there did not before exist observers sufficiently attentive to discern their proper characters or historians exact enough to describe them. "The physicians of our own times are divided in opinion only concerning one of these, Syphilis. Some incline to the belief that it was spontaneously developed in Europe towards the end of the 15th century; others, that it was imported from the New World; while the greater number regard it but as a degeneration of one of the numerous modifications of lepra or elephantiasis which were so prevalent in the Middle Ages."-Tom. II. p. 90. M. Renouard examines these opinions at considerable length, and expresses his belief in the accuracy of the last-named. 8. Theories and Systems.-A mixture of Galenism and Arabism formed the dominant theory of the University Schools of entire Europe. The most distinguished teachers, with some few exceptions, employed their entire sagacity, in reconciling the ancient doctrines-those professed by Plato and Aristotle, Hippocrates and Galen, Rhazes and Avicenna. Of these, John Fernel, surnamed the "modern Galen," as we have already mentioned, attained a vast influence among his contemporaries, his compilation from the ancients retaining its authority in the Schools long after his decease. 9. The Occult Sciences.-Amidst the general prevalence of the GalenoArabic doctrines in the schools of Europe, certain voices might be heard protesting against their reception. These had little influence, having to propose, in lieu of doctrines which had received the sanction of ages, only the crudest essays and most fantastic lucubrations. The partisans of the Occult Sciences were among those who most resisted the yoke of authority. "Full of confidence in their own powers, they would only receive the law from themselves. Some of them were not deficient in sagacity, imagination, or boldness; but the majority wanted connection in their ideas, propriety in their language, and dignity in their conduct. Prophets or demons, they had among themselves no community of principles, but lived generally isolated from each other and from the rest of the world, rendering themselves remarkable only by their eccentrici ties, their contrarieties, and even their misfortunes. Instead of duly guiding the car of reason, these sectarians, who first gave the signal of revolt against received opinions, would have induced its yet farther deviation had the world followed their foolish direction. Nevertheless, we find in their writings some useful truths amidst a load of trashy reveries. They founded no doctrine worthy the attention of philosophers, but, by their declamations, they forced the true savant to quit the narrow path of the past, to review the principles of our knowledge, from which revision a scientific reform sprung up during the ensuing period."-Tom. II. p. 111. The first founder of the Occult Sciences mentioned in history is Cornelius Agrippa, a man of great and varied acquirements, but possessed of a restless temperament and caustic humour, which prevented his following a fixed and regular life. Sometimes the physician of princes, and at others a vagabond in the face of Europe, or the inhabitant of some of its gaols, he composed a curious and extravagant work upon the Uncertainty and Vanity of the Sciences. M. Renouard, after alluding to some of the extravagances it contains, observes: "Errors of science, superstitious prejudices, religious exaltation, and the thirst for riches, concurred at the same period to propagate the follies of the cabal; and never were there seen such numbers of sorcerers, possessed, astrologers, and alchemists, never were prophesies, visions and prodigies of all kinds so common. No remarkable event could occur but immediately it was pretended that it had been announced by this or that precursory sign. How frequently the expectation of the end of the world predicted for a period near at hand, threw entire nations into consternation, and carried anxiety and terror equally to the bosom of the palace as to that of the cottage! In no country were these cabalistic reveries so universally adopted as in Germany, where mysticism maintained them much longer than elsewhere. Luther himself partook of these vulgar prejudices and superstitions, and contributed much to their propagation. He frequently speaks of his struggles with the devil; and relates how the wicked spirit would appear to him as a monk and tempt him with captious syllogisms. He blames physicians for attributing to natural causes a variety of evils of which the devil is alone the author. "The history of the period every where presents the spectacle of the reign of darkness struggling with nearly equal power and success against that of light and truth."-Tom. II. p. 118. Jerome Cardan was another of these eccentric beings possessed of vast abilities, but lost to the world for want of due regulation and guidance. "His immense acquisitions," says M. Dezeimeris, "his extraordinary sagacity, his great freedom of thought, and his masculine and elevated style, would have placed him at the head of the most justly celebrated writers of the 16th century, had he not united to these qualities so confirmed a taste for paradox and the marvellous, a childish credulity, a scarcely conceivable 1847.] Paracelsus. 409 superstition, an unsupportable vanity and unlimited boasting." But of all the professors of occult science, the most famous was indisputably Paracelsus. Still, famous as he was in his day, we think M. Renouard has occupied too large a space in refuting his errors and absurdities. Certainly he may find good excuse for this in opposing the views of an observer generally so accurate as M. Malgaigne, but who, in regard to Paracelsus, captivated by some of his expressions in approval of the exercise of observation, (which, however, he never himself put in force,) sees much cause of admiration that even a superficial examination of his writings on medicine must at once dispel. Indeed, the only ground for notice Paracelsus can claim, is his popularizing the employment of various mineral preparations, now among the most powerful agents of our materia medica. But, whatever good may have eventually resulted from this, it is impossible but that the indiscriminate and careless use of these potent instruments in the hands of himself and successors, must have led to much and dire mischief. To this topic we shall return in our notice of Gui Patin's letters, in which it forms a frequent theme. In the mean time, we may conclude this part of our subject with a quotation borrowed by M. Renouard from Sprengel. "A revolution which has Mysticism for its basis will find much easier access among the common race of men than one founded on good sense, because the chimera of the imagination are always presented in the most vivid colours, and excite the mind much more than the severe deductions of cool reasoning. In the 16th century, Germany enlightened entire Europe by her reforming spirit. The great genius of Luther rendered to his cotemporaries and to posterity the inappreciable service of striking a death-blow to the mysticism of catholicism and the scholastic philosophy. Paracelsus adopted the same plan; but the following circumstances prevented his system being received with the same favourable and general reception as that of the theological reformer. "1. Medicine is a science of experience which must be learned to be known. It reposes on reasoning and the deductions of experience, and consequently any doctrine which rejects the testimony of reasoning and represents experience as useless, can never meet with much success among physicians. 2. The system of Paracelsus was not only based upon mysticism, but upon the grossest fanaticism. In fact, superstition reigned tyrannically throughout the course of the 16th century; but to endeavour to give these very prejudices the appearance of scientific doctrine, was an idea too revolting to common sense to be generally adopted. 3. Lastly, Paracelsus was not the man to secure success for his system. He was a barbarian, an ignoramus, who despised every science, just because he was totally unacquainted with any. Although he spoke much of the divine light the source of all knowledge, his manners and vagabond life furnished no proof of his participating in it. "Nevertheless, his doctrine found, and especially in Germany, more partisans than would have been supposed. According to my calculation, three-fourths of his successors were Germans, but most of them were persons entirely destitute of education, and ignorant of science, who cast themselves into the midst of his mystical system just because it seemed to conceal their want of instruction and inaptitude. Others employed the medicaments and arcana of Paracelsus, endeavouring to reconcile his theory with the system of Galen; while, lastly, the Rosicrucians applied it in a much more precise manner than had hitherto been done to theology and philosophy."-History of Med., Chap. III. |