196 INTERNAL MEDICINE 



men to grow from a vigorous root; while inward medicine, with- 

 drawing itself more and more from the laboratory of nature, hardened 

 into the shell which till the seventeenth century was but a counter- 

 feit. The surgeons of the thirteenth, fourteenth, and fifteenth cen- 

 turies, reared in humble apprenticeships, not illiterate only, but for- 

 bidden the very means of learning, lay under heavy disadvantages; 

 yet, such is the virtue of practical experience, inductive method, 

 and technical resource, that by them the reform of medicine was 

 made. Towards the end of the fifteenth century, indeed, this pro- 

 gress had slackened, soon to be reinforced, however, by new and 

 urgent problems, not of the schools, but of direct rough and tumble 

 with nature. Of these new problems, of which Pare became the 

 chief interpreter, new epidemics and the wounds of firearms were 

 the chief. 



In medicine from the twelfth to the eighteenth centuries Italy 

 led the world; in the schools of Salerno, Naples, Bologna, Padua, 

 was contained a strong lay and imperial tradition which gave pause 

 to clerical ascendency. Bologna, until the predominance of her 

 law school, was indeed a large and plenteous mother to medicine 

 in its full orb; but already in Salerno far-seeing men had begun 

 to dread the divorce of surgery from inner medicine. The import- 

 ant Salernitan treatise of the end of the twelfth century, The 

 Glosses of the Four Masters on the Surgery of Roger and Roland, 

 edited by Daremberg and de Renzi, begins with a lament on the 

 decadence of surgery, which they attribute to two causes; namely, 

 the division of surgery from medicine, and the neglect of anatomy. 

 By the wisdom of Bologna and Naples, where chairs of surgery 

 were founded, this ill-starred divorce was postponed; in his Uni- 

 versity of Naples indeed Frederick the Second made it a condition 

 that surgery should be an essential part of medicine, should occupy 

 as long a course of study, and should be established on anatomy 

 "without which no operator can be successful." 



Roger's Practica Chirurgiae was written in 1180, and though of 

 course it rests upon the traditional surgery of his day, there are 

 not a few points of interest in the book, such as certain descrip- 

 tions suggestive of syphilis. For hemorrhage Roger used styptics, 

 the suture, or the ligature; the ligature he learned no doubt from 

 Paul of Egina; but Roger, like most or all qualified physicians of 

 the period, was a "wound-surgeon" only, that is, he did not un- 

 dertake the graver operations. He was in favor, as a rule, of im- 

 mediate extraction of weapons from their wounds; but in these 

 wounds, even after extraction, he encouraged suppuration by 

 stimulating applications within and around them, and dressed 

 them with ointments on lint. To these points, especially to the 

 promotion of pus, and the unctuous dressings, permit me again to 



