Toward the end of the fifteenth and during the early part of the sixteenth centuries accounts concerning syphilis began to be published in the medical literature of Spain, Italy and France. The word “syphilis,” it is true, does not appear in any of these records, for it had not yet been coined; but the accounts themselves leave no room for doubt that this was the disease to which the authors of these records referred. The prevailing views with regard to the origin and nature of syphilis differed somewhat in the three countries named. In Spain, for example, it was a common belief that the disease originated in an unfavorable conjunction of the stars[100] and yet at the same time it was generally admitted that it was a disease which belonged in the category of luxuries and might be avoided if one were careful not to have intercourse with dissolute women. For a brief period of time there were physicians in all three of the Latin countries who maintained that syphilis had been imported, in the first instance, from America by the men who made the voyage with Columbus and by the earliest Spanish explorers of South America; but it was soon shown that this theory was not compatible with certain known facts—such, for example, as the published reports made by the Spanish physicians Pintor and Torrella,[101] who describe cases of syphilis which they had treated prior to 1493 (the year in which the first discoverers returned from America). In Italy, according to Giovanni da Vigo, the author of an excellent treatise on surgery (“Practica in arte chirurgica copiosa,” Rome, 1514), the disease was first observed in Europe in December, 1494, soon after the arrival of Charles the Eighth’s (France) army at Naples; and only a short time elapsed before there developed, as a result of this great accession of French soldiers, a veritable epidemic of what then began to be known quite generally as “morbus gallicus” or “the French disease.” The King himself, it is stated, was among the number of those who contracted the infection.

So far as I am able to discover, the term “syphilis” was first introduced into medical literature by Fracastoro, the distinguished physician of Verona, who published in 1530 a Latin poem bearing the title: “Syphilis sive morbus gallicus.” These verses were received everywhere with great favor, were translated into several modern languages, and speedily put an end forever to the employment of the insulting term “morbus gallicus.”

A few more words with reference to the origin and distribution of syphilis throughout the world may not seem inappropriate in this place. J. K. Proksch, the author of the most recent history of this disease,[102] says it has been fully proved that syphilis existed among the inhabitants of India as long ago as during the Middle Ages, and he adds that the evidence thus far collected justifies the further belief that it was not an uncommon malady among the ancient Greeks and Romans, and even among the Babylonians and Assyrians. Doubtless a good deal of what was called “leprosy” in early times was in reality syphilis. Another syphilographer—Raphael Finckenstein—makes the following sensible remarks about the efforts that have been made to ascertain the precise date when this disease first appeared in Europe:—[103]

Some account of the treatment of this form of venereal disease comes next in order. It is commonly believed, says the author just quoted, that it was from the Spanish physicians of the sixteenth century that we learned how to treat syphilis by the methodical employment of mercurial preparations. (See footnote at the bottom of page 542.) He adds that there was published by Juan Almenar at Venice, in 1502, a book which bears the title: “A treatise on the Morbus Gallicus, in which it is demonstrated how the patient may be treated in such a successful manner that the disease will never return, nor will any objectionable lesions develop in the mouth; and yet, during the progress of the treatment, the patient is not required to remain in bed.” The author of this book, who was a resident of Valencia, Spain, was a man of noble birth. His treatise passed through eight successive editions, the last of which was printed at Basel in 1536. Almenar’s plan of treatment was to employ mercurial inunctions in such moderate doses as not to induce salivation. If, at the end of a few days, he saw evidences of an approach of this symptom, he substituted baths and evacuant remedies (rhubarb and senna) for a short time, and also prescribed a more nourishing diet and the taking of various internal remedies. Then, later, the inunctions were resumed. The exact duration of such a course of treatment is not stated. So far as I am able to judge from the account given by Finckenstein, Almenar found it necessary in some cases to repeat the series of mercurial inunctions as many as four times. His aim, in other words, was to accomplish a radical cure of the disease, whereas his contemporaries, who were mainly ignorant and uneducated physicians, were satisfied to carry out a purely symptomatic treatment. Morejon, the historian of Spanish medicine, expresses the belief that Almenar was the first to use steam baths in the treatment of syphilis. Both Hensler and Simon, the best modern authorities with regard to the history of syphilis, agree that Almenar’s inunction method of treating this disease forms, notwithstanding its crudeness in certain respects, the basis of all modern methods of the same general character. Unfortunately, the physicians of a later period did not follow the relatively mild and safe inunction method advocated by Almenar, but so modified it for the worse that it became a common thing for men to say that the cure was worse than the disease.

A Few Special Advances Worthy of Note.—The beginnings of medical journalism belong to the second half of the seventeenth century. In 1665, for example, there appeared for the first time, a medical article in the “Journal des Scavans,” and during the same year similar articles were printed in the “Philosophical Transactions of the Royal Society of London.” According to August Hirsch the earliest periodical that was devoted entirely to the interests of the medical profession was the “Journal des découvertes en médecine,” which was first published in 1679 and continued, in 1680, under the title of “Le Temple d’Esculape.” Then followed soon afterward: “Le Journal des Nouvelles Découvertes en Médecine” (1681–1683); “Le Mercure Savant” (1684); “Le Zodiacus Medico-Gallicus” (1680–1685), which was published in Latin in Geneva, by Bonet; etc.

In addition to the more important advances in anatomy and physiology that have already been mentioned on previous pages, the following deserve to receive at least a passing notice: In the department of anatomy and physiology, William Briggs (1642–1704), one of the physicians of St. Thomas’ Hospital, London, published at Cambridge in 1676, under the title of “Ophthalmographia,” a most important contribution to the anatomy and physiology of the eye; and there were four other English anatomists who, during the seventeenth century, gained well-merited credit by the original work which they did in the fields of anatomy and physiology—viz., Thomas Willis (1622–1675), Francis Glisson (1597–1677), Thomas Wharton (1610–1673), and Nathaniel Highmore (1613–1684). The part played by Germany in these gains in anatomy and physiology, during the period now under consideration, was chiefly that of a sympathetic recipient; for the political conditions at that time were entirely unfavorable to any active participation on the part of the physicians of that country. Early in the eighteenth century, however, they began in earnest to do their share of work in advancing the science of medicine.

The relationship of the physical sciences to the theory and practice of medicine is not of an intimate nature, and it will therefore not be necessary for me to do more than briefly to enumerate the more important of the discoveries of this character which occurred during the sixteenth and seventeenth centuries.

Galileo (1564–1642), a native of Pisa, Italy, was the creator of the science of motion, and he gave the first satisfactory demonstration of equilibrium on an inclined plane. He devised an imperfect species of thermometer, a proportional compass, and the refracting telescope, by means of which latter instrument he made a number of other important discoveries in the domain of astronomy. His pupil, Evangelista Torricelli (1608–1647), also a native of Italy, discovered the barometer, and in addition arrived at many fundamental truths in mechanics and hydrostatics. Otto von Guericke (1602–1686), a native of Magdeburg, Germany, invented the air pump. Sir Isaac Newton (1642–1727), born at Woolsthorpe, Lincolnshire, one of the world’s greatest authorities in natural philosophy, was the first to formulate clearly the law of gravitation. Edme Mariotte (1620–1684), a native of Burgundy, France, was the discoverer of what is commonly known as “Mariotte’s law”—i.e., a law of elastic fluids, according to which the elastic force is exactly in the inverse proportion of the space which the mass of fluid occupies. He also discovered that the part of the retina at which it meets the optic nerve is not capable of conveying the impression of sight. Finally, Denis Papin (1647–1710), a Frenchman, invented the first steam engine, of an embryonic and not very practical type; for in this apparatus the piston floated on the water in a separate cylinder.

The inventions which I have here briefly enumerated represent the more important discoveries that were made in physical science during the sixteenth and seventeenth centuries.

The Beginnings of a Modern Pharmacopoeia, and One of the Last Attempts of the Disciples of Galen to Maintain Their Ascendancy in Therapeutics.—In the domain of pharmacology the first attempt in modern times to organize this department of practical medicine was made by an apothecary in Barcelona in 1497, and was published by him in printed form in 1521. (Von Gurlt.) This pharmacopoeia was doubtless wholly unknown beyond the borders of Spain. Not far from one hundred years later,—i.e., in the early part of the seventeenth century,—Theodore Turquet de Mayerne, who was born in 1573, in a small village near the city of Geneva, made the second attempt in modern times to organize the pharmacological department of practical medicine. After showing quite early in life a fondness for the study of chemistry, he devoted himself particularly to the investigation of the remedies that are produced in the chemist’s laboratory; the preparations of antimony attracting his especial interest. A little before this time the physicians of Paris were split up into two strongly antagonistic parties as regards the propriety of administering this metal in any form as a remedy; but those who opposed its therapeutic employment finally managed to secure from Parliament, in 1566, a decree prohibiting its use. While this quarrel was in progress, de Mayerne visited Paris (1602) and established himself in that city as an independent lecturer on chemistry. As the regular faculty still held the belief that the teachings of Galen were the only safe guide for physicians to follow, de Mayerne’s action must have appeared to them like an impudent challenge. In one of his writings he strongly recommended the employment of antimonial preparations,—remedies introduced originally by the much-hated Paracelsus,—and he even went so far as to offer some for sale. This was too much for the disciples of Galen to bear without a protest, and consequently in 1603 the Parliament issued a new decree, in accordance with which de Mayerne was prohibited from practicing medicine in Paris. This measure appears to have proved successful in putting a stop effectively to his obnoxious teachings, for we learn that shortly afterward he was known to be living in London, where, in 1611, he was appointed the Physician-in-Ordinary to King James the First, and later to Charles the First. He died in 1655.

Jean Astruc, the distinguished French medical author of the eighteenth century, speaks rather disparagingly of de Mayerne’s attempt to organize a pharmacopoeia. An earlier, more successful, and much more creditable attempt of this nature was made by Valerius Cordus, whose “Dispensatorium pharmacorum omnium” was first published at Nürnberg in 1535. This work, which subsequently bore the title “Pharmacopoeia Augustana,” up to the year 1627 passed through at least seven editions and was utilized to a greater or less extent by the authors or editors of nearly all later pharmacopoeias. To go still further back, the most ancient pharmacopoeia of which we have any knowledge is that which bears the title of “Antidotarium Nicolai,” the author of which work was Nicolaus, the President or Dean of the Medical School at Salerno. The book was written originally during the first half of the twelfth century, but it did not appear in print, at Venice, until the year 1471, and then only in an incomplete form. Quite recently a French translation of the book has been made and published (1896) by Paul Dorveaux, of the Paris School of Pharmacy. Most of the preparations there described have long since been abandoned, but a few of them—such, for example, as citrine ointment, honey of roses, oxymel, and oil of roses—are still to be found in the pharmacopoeias of some nations.

Itinerant Lithotomists.—For an unknown number of years preceding the sixteenth century it had been a well-established custom for members of the medical profession in France, and also, doubtless, in neighboring countries, to intrust—as the Hippocratic oath enjoined—all cases of stone in the bladder to expert lithotomists. Such special knowledge and skill were not easily acquired, and so it came about that there were very few individuals who were acknowledged to be experts and who were really capable of teaching the art, and these few guarded most carefully the knowledge which they had gained. During the period of time which we are now considering, certain members of the Collot and Pineau families were the most distinguished lithotomists in France, and the records show that in the year 1600 Jehan Paradis and Nicolas Serre petitioned the Government for official recognition of their special rights to enjoy a monopoly of operative work of this character. “We ask that you give orders that all poor patients who may apply to Hôtel-Dieu (the great city hospital of Paris) or to the Bureau-of-the-Poor for relief from stone in the bladder, be turned over to our care for proper treatment. The poor will receive this treatment gratis, and those who can afford to pay will be charged a very reasonable fee. And you will do well if you prohibit all other persons from meddling with such cases in any manner.” In a document bearing the date 1646 mention is made of four lithotomists—Philippe and Charles Collot, Jacques Girault and Antoine Ruffin—who had erected in the Faubourg Saint-Antoine, Paris, a building which was intended to serve as a hospital “in which, at any time during the entire year, those who are afflicted with stone in the bladder may be lodged, fed, nursed and subjected to proper treatment,—the poor without charge of any kind, and the well-to-do at a proper rate of remuneration.”

In Franco’s time (middle of the sixteenth century) cutting for stone in the bladder was by no means an uncommon operation, and was almost always performed by itinerant lithotomists (“inciseurs”). The Collots had, for many years, possessed almost a monopoly of this business. Laurent Collot, who was the first one of the family to engage in the work, was Royal Lithotomist in 1556, and handed down to his son all the knowledge on this subject which he had acquired through long experience. François Tolet was another of these popular lithotomists who flourished in Paris during the sixteenth and seventeenth centuries. He died in 1724 at the age of seventy-seven. His treatise on lithotomy, which was published in Paris in 1681, and subsequently passed through several editions, is said by Dezeimeris to contain the records of a large number of his own cases and to show clearly that he was a surgeon of sound judgment. No better treatise on this subject, he adds, was published during that period of the history of medicine.

In addition to those whom I have just mentioned there were two French monks who gained wide celebrity as operators for stone in the bladder, viz., Frère Jacques de Beaulieu and Frère Côme. The last-named belongs to the early part of the eighteenth century, and should therefore—in accordance with the plan which I have been following—not receive consideration in the present account; but, in view of the fact that these are the only two monks who, during the Renaissance and the period immediately following, gained conspicuous credit for the honorable and efficient service which they rendered, not merely to the science of medicine but also to the cause of humanity, I believe that I cannot do better than to place the two sketches together as if they both belonged strictly to one and the same period of time.

(a) Frère Jacques—or Brother James, who was born in 1561 at the village of Létendonne, near Lons-le-Saulnier, Central France,—learned the art of operating for stone in the bladder from an Italian surgeon named Paulony, and acted as his assistant or associate up to the time when he became a monk of the Order of Saint Francis—that is, of that branch of the Order which had its chapter house at Feuillants in Languedoc. He traveled about the country offering to treat gratuitously all persons affected with stone in the bladder who were willing to trust him, and he made it a rule, whenever such a thing was possible, always to operate in the presence of one or more physicians or surgeons. He was also ready at all times to give instruction to those who wished to learn his method of procedure. He never asked to be remunerated, but was always pleased to receive from his patients a written testimonial of what he had done for them. Out of the moneys which he received from the rich he retained only that which he required for his own support and for the purchase of such instruments as he from time to time required; the balance he distributed among the poor. He was very faithful in performing his religious duties, and he succeeded in gaining the good will and esteem of everybody with whom he had any dealings.

For a long time it was customary in France to credit Frère Jacques (Fig. 26) with the invention of the lateral method of operating for stone in the bladder. This, however, was an error, for Franco, on page 95 of E. Nicaise’s reproduction of the 1561 edition, describes this operation clearly. It must therefore have been invented a long time before Frère Jacques was born. The text (rendered into English) reads as follows: “... the incision should be made between the anus and the testicles, two or three finger-breadths to one side of the commissure or perinaeum [median line of the perinaeum].” This is said to be the earliest clear description of the first step of the lateral operation of which we have any knowledge.

In 1697, when Frère Jacques visited Paris, he had already attained wide celebrity as a lithotomist; the number of his successful operations—all of which had been performed according to the lateral method of procedure—having reached a grand total of several thousand. He therefore had a right to suppose that his visit would prove acceptable to the physicians of that metropolis; but the published account of this visit reveals plainly the fact that the surgeons of that city were not at all pleased that an itinerant lithotomist from one of the provinces should have the effrontery to request permission of the authorities to exhibit his method before the Medical Faculty of Paris. His request, however, was granted, and he was allowed to operate on a man, forty years old, at Hôtel-Dieu. He performed the operation before a large assembly of physicians, and, after the stone had been successfully extracted, the patient made a prompt recovery. A short time afterward he operated upon another patient at Fontainebleau in the presence of several physicians, one of whom was Monsieur Félix, the First Surgeon of the King, Louis the Fourteenth. In this case also, as well as in several later cases, Frère Jacques was entirely successful, and he now began to be treated by the public with marked consideration. But, in a short time, owing to the jealousy exhibited by a large clique of Paris surgeons, who were encouraged to pursue this course by Mery, the Head Surgeon of Hôtel-Dieu, Frère Jacques was finally forced to leave Paris. I cannot follow him on his further wanderings throughout Europe, from the leading cities of Holland, Belgium and Switzerland to Vienna and Rome. In 1716 he retired to Besançon and lived there quietly up to the time of his death in 1719. But even then his enemies—men to whom he had never done the slightest harm—did their best to destroy the last traces of his existence. A visit made to Besançon by one of his acquaintances not long after our Franciscan monk’s death, revealed the fact that his name had been erased from the church registry of deaths. The lateral method of operating for stone, which had been revived and thoroughly developed by him, still finds favor among the best surgeons of our own day; and the names of those mean-spirited men who tried so hard to injure him have long since passed into complete oblivion.

(b) Frère Jean de Saint-Côme,—or Brother John of Saint Cosmas,—whose real name was Jean Baseilhac, was born in 1703 at Poyestruc, Department of Hautes-Pyrenées, France. He received his instruction in the principles of medicine from his father and his grandfather, both of whom were regularly enrolled Masters in Surgery. In 1722, when there could no longer be any doubt about young Baseilhac’s settled purpose to fit himself for the practice of medicine, his father sent him to Lyons, where his uncle, who was himself a surgeon, would be able to superintend the boy’s further training. Through the latter’s influence, young Baseilhac was allowed to enter the Hôtel-Dieu of that city as one of its regular pupils. At the end of two years—i.e., in 1724—he left Lyons and went to Paris, where he hoped to add materially to his stock of professional knowledge. His first step, after reaching the metropolis, was to enter the service of a surgeon in active practice; and then, aided by the latter’s influence, he succeeded (in 1726) in entering the Paris Hôtel-Dieu as one of the regular pupils. Soon after he had completed his term of service at the hospital, he was appointed Physician-in-Ordinary to the Prince-Bishop of Bayeux, in Normandy. The death of the latter in 1728, less than two years after Baseilhac had entered his service, came as a great blow to the young surgeon, for he had learned to esteem him very highly. In his will the Bishop left a small legacy to Baseilhac—that is, a sum of money sufficient to pay for the regular course of instruction at the Medical School of Saint Cosmas in Paris, and also to procure a complete outfit of surgical instruments. In 1740 he became a member of the Feuillants Branch of the Franciscan monks, it being understood, however, that he was to be allowed the special privilege of practicing surgery among the poorer classes. Through accidental circumstances he was led gradually to drop general surgery and to confine his work to operations for stone. His official name at this time was “Frère Jean de Saint-Côme,” or simply “Frère Côme.” (Fig. 27.) As he gained in experience as a lithotomist, he became convinced that the method which his predecessor, Frère Jacques, had practiced with such great success, was preferable to the more complicated and more dangerous plan commonly pursued by surgeons at that time, and thereafter he adopted it in all his cases. But he modified the procedure to a certain extent; that is, he invented an instrument by means of which the actual cutting of the perinaeum was accomplished with a concealed knife (see Fig. 28). The chief advantage to be gained by the employment of this instrument consisted—as was claimed by Frère Jean and his nephew, Pascal Baseilhac,—in the fact that in this way the danger of making the incision in the wrong place, or of too great length, was materially diminished.

The first patient upon whom the new instrument was tried (October 8, 1748), was a dealer in lime, sixty years of age and in rather delicate health. In less than three weeks after the operation, he was entirely cured. Subsequently the instrument was employed in a large number of instances, and the method was found to be most satisfactory; successful results being obtained—on the average—in twelve out of thirteen cases, whereas the best results previously obtained by the method commonly employed at that period was 50 per cent of cures. At a still later date the statistics showed even better results—viz., 96 cures in one group of 100 cases, and 316 cures in a second group of 330 cases.

Owing to the rapidly increasing number of patients affected with stone in the bladder who wished to be operated upon by Frère Jean himself, he established in Paris in 1753, near the Saint Honoré gateway, a special hospital for lithotomy cases, and kept it in active service up to the time of his death. The laboring classes, and the poor in general, were not expected to pay any fees, and indeed money was often bestowed upon these people when they left the hospital, to enable them to return comfortably to their villages; those in moderate circumstances were asked to pay only the expenses that had been incurred in their behalf; and the well-to-do made such voluntary contributions as they thought proper toward the support of the hospital. The registers of the institution showed that, first and last, over one thousand operations had been performed there, either by Frère Jean or by his nephew, Pascal Baseilhac. Our monk’s death occurred on July 8, 1781.

THE END