the evolution of modern medicine-第19节

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　Then　at　every　season　of　the　year　　There　are　crowds　of　guests　and　travellers　here；　　Pilgrims　and　mendicant　friars　and　traders　　　　　　From　the　Levant；　with　figs　and　wine；　　And　bands　of　wounded　and　sick　Crusaders；　　　　　　Coming　back　from　Palestine。


There　were　medical　and　surgical　clinics；　foundling　hospitals；　Sisters　of　Charity；　men　and　women　professorsamong　the　latter　the　famous　Trotulaand　apothecaries。　　Dissections　were　carried　out；　chiefly　upon　animals；　and　human　subjects　were　occasionally　used。　In　the　eleventh　and　twelfth　centuries；　the　school　reached　its　height；　and　that　remarkable　genius；　Frederick　II；　laid　down　regulations　for　a　preliminary　study　extending　over　three　years；　and　a　course　in　medicine　for　five　years；　including　surgery。　Fee　tables　and　strict　regulations　as　to　practice　were　made；　and　it　is　specifically　stated　that　the　masters　were　to　teach　in　the　schools；　theoretically　and　practically；　under　the　authority　of　Hippocrates　and　Galen。　　The　literature　from　the　school　had　a　far…reaching　influence。　One　book　on　the　anatomy　of　the　pig　illustrates　the　popular　subject　for　dissection　at　that　time。＇6＇　The　writings；　which　are　numerous；　have　been　collected　by　De　Renzi。＇7＇

＇6＇　〃And　dissections　of　the　bodies　of　swine　　As　likest　the　human　form　divine。〃Golden　Legend。

＇7＇　S。　de　Renzi：　Collectio　Salernitana；　5　vols。；　Naples；　1852…1859；　P。　Giacosa：　Magistri　Salernitani；　Turin；　1901。


The　〃Antidotarium〃　of　Nicolaus　Salernitanus；　about　1100；　became　the　popular　pharmacopoeia　of　the　Middle　Ages；　and　many　modern　preparations　may　be　traced　to　it。

The　most　prominent　man　of　the　school　is　Constantinus　Africanus；　a　native　of　Carthage；　who；　after　numerous　journeys；　reached　Salernum　about　the　middle　of　the　eleventh　century。　He　was　familiar　with　the　works　both　of　the　Greeks　and　of　the　Arabs；　and　it　was　largely　through　his　translations　that　the　works　of　Rhazes　and　Avicenna　became　known　in　the　West。

One　work　above　all　others　spread　the　fame　of　the　schoolthe　Regimen　Sanitatis；　or　Flos　Medicinae　as　it　is　sometimes　called；　a　poem　on　popular　medicine。　　It　is　dedicated　to　Robert　of　Normandy；　who　had　been　treated　at　Salernum；　and　the　lines　begin：　〃Anglorum　regi　scripsit　schola　tota　Salerni　。　。　。　〃　It　is　a　hand…book　of　diet　and　household　medicine；　with　many　shrewd　and　taking　sayings　which　have　passed　into　popular　use；　such　as　〃Joy；　temperance　and　repose　Slam　the　door　on　the　doctor's　nose。〃　A　full　account　of　the　work　and　the　various　editions　of　it　is　given　by　Sir　Alexander　Croke；＇8＇　and　the　Finlayson　lecture　（Glasgow　Medical　Journal；　1908）　by　Dr。　Norman　Moore　gives　an　account　of　its　introduction　into　the　British　Isles。

＇8＇　Regimen　Sanitutis　Salernitanum；　a　Poem　on　the　Preservation　of　Health　in　Rhyming　Latin　Verse；　Oxford；　D。A。　Talboys；　1830。


BYZANTINE　MEDICINE

THE　second　great　stream　which　carried　Greek　medicine　to　modern　days　runs　through　the　Eastern　Empire。　　Between　the　third　century　and　the　fall　of　Constantinople　there　was　a　continuous　series　of　Byzantine　physicians　whose　inspiration　was　largely　derived　from　the　old　Greek　sources。　The　most　distinguished　of　these　was　Oribasius；　a　voluminous　compiler；　a　native　of　Pergamon　and　so　close　a　follower　of　his　great　townsman　that　he　has　been　called　〃Galen's　ape。〃　　He　left　many　works；　an　edition　of　which　was　edited　by　Bussemaker　and　Daremberg。　　Many　facts　relating　to　the　older　writers　are　recorded　in　his　writings。　　He　was　a　contemporary；　friend　as　well　as　the　physician；　of　the　Emperor　Julian；　for　whom　he　prepared　an　encyclopaedia　of　the　medical　sciences。

Other　important　Byzantine　writers　were　Aetius　and　Alexander　of　Tralles；　both　of　whom　were　strongly　under　the　influence　of　Galen　and　Hippocrates。　　Their　materia　medica　was　based　largely　upon　Dioscorides。

From　Byzantium　we　have　the　earliest　known　complete　medical　manuscript；　dating　from　the　fifth　centurya　work　of　Dioscoridesone　of　the　most　beautiful　in　existence。　　It　was　prepared　for　Anicia　Juliana；　daughter　of　the　Emperor　of　the　East；　and　is　now　one　of　the　great　treasures　of　the　Imperial　Library　at　Vienna。＇9＇　From　those　early　centuries　till　the　fall　of　Constantinople　there　is　very　little　of　interest　medically。　A　few　names　stand　out　prominently；　but　it　is　mainly　a　blank　period　in　our　records。　　Perhaps　one　man　may　be　mentioned；　as　he　had　a　great　influence　on　later　agesActuarius；　who　lived　about　1300；　and　whose　book　on　the　urine　laid　the　foundation　of　much　of　the　popular　uroscopy　and　water…casting　that　had　such　a　vogue　in　the　sixteenth　and　seventeenth　centuries。　His　work　on　the　subject　passed　through　a　dozen　Latin　editions；　but　is　best　studied　in　Ideler's　〃Physici　et　medici　Graeci　minores〃　（Berlin；　1841）。

＇9＇　It　has　been　reproduced　by　Seatone　de　Vries；　Leyden；　1905；　Codices　graeci　et　latini　photographice　depicti；　Vol。　X。


The　Byzantine　stream　of　Greek　medicine　had　dwindled　to　a　very　tiny　rill　when　the　fall　of　Constantinople　（1453）　dispersed　to　the　West　many　Greek　scholars　and　many　precious　manuscripts。


ARABIAN　MEDICINE

THE　third　and　by　far　the　strongest　branch　of　the　Greek　river　reached　the　West　after　a　remarkable　and　meandering　course。　The　map　before　you　shows　the　distribution　of　the　Graeco…Roman　Christian　world　at　the　beginning　of　the　seventh　century。　You　will　notice　that　Christianity　had　extended　far　eastwards；　almost　to　China。　　Most　of　those　eastern　Christians　were　Nestorians　and　one　of　their　important　centres　was　Edessa；　whose　school　of　learning　became　so　celebrated。　　Here　in　the　fifth　century　was　built　one　of　the　most　celebrated　hospitals　of　antiquity。

Now　look　at　another　map　showing　the　same　countries　about　a　century　later。　　No　such　phenomenal　change　ever　was　made　within　so　short　space　of　time　as　that　which　thus　altered　the　map　of　Asia　and　Europe　at　this　period。　　Within　a　century；　the　Crescent　had　swept　from　Arabia　through　the　Eastern　Empire；　over　Egypt；　North　Africa　and　over　Spain　in　the　West；　and　the　fate　of　Western　Europe　hung　in　the　balance　before　the　gates　of　Tours　in　732。　This　time　the　barbaric　horde　that　laid　waste　a　large　part　of　Christendom　were　a　people　that　became　deeply　appreciative　of　all　that　was　best　in　Graeco…Roman　civilization　and　of　nothing　more　than　of　its　sciences。　The　cultivation　of　medicine　was　encouraged　by　the　Arabs　in　a　very　special　way。　　Anyone　wishing　to　follow　the　history　of　the　medical　profession　among　this　remarkable　people　will　find　it　admirably　presented　in　Lucien　Leclerc's　〃Histoire　de　la　medecine　arabe〃　（Paris；　1876）。　An　excellent　account　is　also　given　in　Freind's　well…known　〃History　of　Medicine〃　（London；　1725…1726）。　Here　I　can　only　indicate　very　briefly　the　course　of　the　stream　and　its　freightage。

With　the　rise　of　Christianity；　Alexandria　became　a　centre　of　bitter　theological　and　political　factions；　the　story　of　which　haunts　the　memory　of　anyone　who　was　so　fortunate　as　to　read　in　his　youth　Kingsley's　〃Hypatia。〃　　These　centuries；　with　their　potent　influence　of　neoplatonism　on　Christianity；　appear　to　have　been　sterile　enough　in　medicine。　I　have　already　referred　to　the　late　Greeks；　Aetius　and　Alexander　of　Tralles。　　The　last　of　the　Alexandrians　was　a　remarkable　man；　Paul　of　AEgina；　a　great　name　in　medicine　and　in　surgery；　who　lived　in　the　early　part　of　the　seventh　century。　He　also；　like　Oribasius；　was　a　great　compiler。　In　the　year　640；　the　Arabs　took　Alexandria；　and　for　the　third　time　a　great　library　was　destroyed　in　the　〃first　city　of　the　West。〃　　Shortly　after　the　conquest　of　Egypt；　Greek　works　were　translated　into　Arabic；　often　through　the　medium　of　Syriac；　particularly　certain　of　Galen's　books　on　medicine；　and　chemical　writings；　which　appear　to　have　laid　the　foundation　of　Arabian　knowledge　on　this　subject。

Through　Alexandria　then　was　one　source：　　but　the　special　development　of　the　Greek　science　and　of　medicine　took　place　in　the　ninth　century　under　the　Eastern　Caliphates。　　Let　me　quote　here　a　couple　of　sentences　from　Leclerc　（Tome　I；　pp。　91…92）：

〃The　world　has　but　once　witnessed　so　marvellous　a　spectacle　as　that　presented　by　the　Arabs　in　the　ninth　century。　This　pastoral　people；　whose　fanaticism　had　suddenly　made　them　masters　of　half　of　the　world；　having　once　founded　their　empire；　immediately　set　themselves　to　acquire　that　knowledge　of　the　sciences　which　alone　was　lacking　to　their　greatness。　Of　all　the　invaders　who　competed　for　the　last　remains　of　the　Roman　Empire　they　alone　pursued　such　studies；　while　the　Germanic　hordes；　glorying　in　their　brutality　and　ignorance；　took　a　thousand　years　to　re…unite　the　broken　chain　of　tradition；　the　Arabs　accomplished　this　in　less　than　a　century。　They　provoked　the　competition　of　the　conquered　Christians　a　healthy　competition　which　secured　the　harmony　of　the　races。

〃At　the　end　of　the　eighth　century；　their　whole　scientific　possessions　consisted　of　a　translation　of　one　medical　treatise　and　some　books　on　alchemy。　　Before　the　ninth　century　had　run　to　its　close；　the　Arabs　were　in　possession　of　all　the　science　of　the　Greeks；　they　had　produced　from　their　own　ranks　students　of　the　first　order；　and　had　raised　among　their　initiators　men　who；　without　them；　would　have　been　groping　in　the　dark；　and　they　showed　from　this　time　an　aptitude　for　the　exact　sciences；　which　was　lacking　in　their　instructors；　whom　they　henceforward　surpassed。〃

It　was　chiefly　thr