MEDICINE – Hippocratic Oath – Vatican Library, cod. Urb. greco 64, f. 166 (11th century).
vigo 1928; R. Palmarocchi, *L. de' M.*, *La cultura*, 12 (1933), pp. 300 ff.; R. Mazzucconi, *Lorenzaccio* (*L. de' M.*), Milano 1937.
MEDICINE. – By “medicine” is meant any expression of defence against evil, whether grounded in empirical knowledge or arising from interpretation and speculation aimed at combating disease, alleviating painful symptoms, and in one way or another rendering the morbid entity intelligible.
From this standpoint, the healing art embraces both the crudest empiricism of primitive peoples and of our own rural communities, magical practices, recourse to the preternatural and supernatural, and finally that body of knowledge which constitutes the patrimony of contemporary science. Here we shall concern ourselves only with the latter, since it is truly the fruit of reasoned thought and therefore of greater interest.
Originally, the interpretation of pathological phenomena and the consequent endeavour to avert them were framed within a religious and animistic conception. Thus diseases were interpreted as the effect of divine punishment or wrath, or else personified as mysterious, invisible entities whose baleful effects were nonetheless perceptible.
The naturalistic interpretation of biological and physiopathological phenomena begins in the 6th century BC in the Italian schools (Brutium, Sicily), especially through the work of Alcmaeon of Croton and Empedocles of Agrigentum. It was then that the principle of biological experiment was born, and in the first attempts at inquiry (v. ANATOMY; PHYSIOLOGY) the first biological law of isonomia was formulated, establishing the basis of health in the harmony and proportion of the parts constituting the organism. Medical practice also received a notable impulse through Democedes. The biological-medical doctrinaire, through the concept of the Empedoclean element, was transformed into the humoral principle in the school of Cos, where Hippocrates (v. c. 460 BC), delineating the perfect figure of the physician, laid both morally and professionally the foundations of true medicine. Clinical practice was born, together with semeiology; the first medical books were written, later collected under the comprehensive title of the *Corpus Hippocraticum*. From Greece medicine passed into Alexandria, where Herophilus and Erasistratus founded two celebrated schools. Devoted chiefly to anatomical and physiological study, these schools provoked in reaction the rise of the empirical school (3rd century BC) through the work of Philinus of Cos and Serapion of Alexandria, a school which, abandoning all doctrinaire systems, rested on the celebrated tripod: autopsia, analogy, historicon. The Alexandrian schools, however, soon degenerated, becoming tainted with magic.
In Rome, medicine is chronologically linked to the Graeco-Alexandrian era. Alongside indigenous elements of empiricism, magic and religious interpretation, Rome for six hundred years had no recognised physicians, relying instead on domestic medicine, invocations to indigenous deities (Etruscan, Latin), and public health regulations. An exponent of domestic medicine is Cato the Elder. In 290 BC the cult of Asclepius was introduced from Greece, and shortly thereafter the first Greek physicians arrived (Arcagathus). Of obscure and dubious personality, these wandering practitioners were followed by better exponents (Asclepiades), so that a decree of Caesar (46 BC) granted Roman citizenship to foreign physicians who remained in Rome; through their efforts three schools arose in Rome: the Methodic, based on atomistic principles and anti-Hippocratic (Asclepiades, Themison, Musa, Soranus of Ephesus, Caelius Aurelianus); the Pneumatic, Hippocratic-humoral (Athenaeus of Attaleia); and the Eclectic (Agathinus of Sparta, Aretaeus of Cappadocia, Archigenes of Apamea, Rufus of Ephesus).
The founding of these schools spans the period from 50 BC to AD 100. The Roman element is represented by Celsus, author of *De re medica* (AD 25–35), and by Pliny, a naturalist rather than a physician. The highest expression of medicine in the Roman age is Galen (v. AD 138–201), an eclectic who gathered together the best elements of the various doctrinal systems and constructed one that remained unassailable for fifteen centuries and more. While in the East the Byzantine schools continued, with such exponents as Oribasius, Aëtius, Alexander and Paul (4th–7th centuries).
In the West, after the brief interval of the reign of Theodoric, during which medicine flourished thanks to Cassiodorus (v.), culture dispersed. It is found again, however, in the monastic schools, where herb gardens were cultivated, monks were trained as infirmarians, infirmaries and hospitals were opened. Medicine was also studied in the cathedral schools under the heading of “physics.” This movement of monastic and clerical medicine (v. MONASTICISM) was not long-lived (7th–10th centuries) and concluded with the rise of lay medicine, the most notable example of which was the Schola Medica Salernitana, initially clerical-lay and later lay. It first appears in records around the 10th century, and its period of splendour closed in the 13th century with the rise of the universities. Every branch of medical and surgical discipline was cultivated there with great honour; among its finest exponents were Archbishop Alfanus, the deacon Guarimpotus, the clerk Peter, the monk Constantine the African, the families of the Platearii and the Ferrari, the surgeons Roger and Roland, the oculists Zacharias, Benvenutus Grafeus, the urologists Urso, Gilles of Corbeil and Maurus. Women were not lacking: the midwife Trotula, Abella, Calenda, etc. The best-known work was the *Regimen Salernitanum*. Contemporary with the Schola Salernitana was that of Montpellier, its rival and likewise of high repute.
Parallel to this, the Arab school developed in the East, continuing the classical tradition through the schools founded by the Nestorians and the School of Athens (closed by Justinian) in Syria, Mesopotamia and Persia. The Arabs advanced therapeutics and alchemy, which gave rise to pharmacy, and produced notable works that became fundamental in the West when Arab learning was introduced there, especially through Constantine the African. Principal exponents in the first period were Mesue the Elder and Serapion the Elder (9th–10th centuries), in the second Rhazes (850–923), Avicenna (980–1037), Albucasis (1013–1106), in the third Averroës (1126–98), Abenzoar (1113–62), Maimonides (1135–1204). Arab learning entered Europe especially through the schools of Montpellier and Padua.
With the rise of the universities, medicine found its most natural and secure outlet. The school of Bologna was celebrated, where Taddeo degli Alderotti (1223–95) established the clinical method; Torrigiano dei Torrigiani (d. 1327); Buono, Dino and Tommaso del Garbo. The anatomist Mondino de’ Liuzzi (1270–1326) introduced the study of anatomy on the cadaver; Hugh and Theodoric Borgognoni (1205–98) taught and practised surgery there, introducing important modifications in wound treatment.
Equally renowned was the school of Padua, with its Averroist tendencies; its teachers included Peter of Abano (1250–1316), the S. Sofia family, the Dondi dell’Orologio, etc. Italian surgery reached its highest exponents in Guido Lanfranchi (13th–14th centuries) and William of Saliceto (1210–77), as well as the already mentioned Theodoric.
Abroad, the schools of Montpellier became famous, where Arnaud of Villeneuve (1235–1315) taught, one of the champions of scientific freedom alongside Roger Bacon (1214–92). Foreign surgeons included Henry de Mondeville, Guy de Chauliac (b. 1300), Jean Yperman, etc.
The Renaissance is heralded by the revival of classical studies, especially in anatomy (v.) and by the second formulation of the circulation of the blood (v. PHYSIOLOGY). In medicine, Theophrastus Paracelsus (1493–1541) revolutionized old thought by establishing the chemical-biological concept, while G. Fracastoro (1478–1553) gave primacy to the microbial world in his *De contagione et contagiosis morbis*. Other notable figures include F. Ingrassia (1510–80), G. B. Codronchi (1547–1628), and F. Fedele in legal medicine; G. Cardano (1501–76) in psychiatry and criminology; G. Mercuriale, G. Trunconi, O. F. Ferrari, and others in pediatrics. Surgery boasts the names of A. Paré (1510–90), M. Santo (b. 1488) for bladder stone operations, C. Bartiseh in ophthalmology (1583), B. Maggi for amputations, and others. In obstetrics, the Caesarean section on a living woman was introduced.
The true scientific Renaissance began in the 17th century, chiefly through the work of G. Galilei, who established the experimental method. Anatomy expanded into microscopic investigation (v. ANATOMY), and physiology laid its first foundations. In medicine, two main trends emerged: iatrochemistry and iatromechanics, led respectively by J. B. van Helmont (1577–1644), F. de la Boe (1614–72), S. Santorio (1561–1636), and A. Borelli (1608–79), while the Hippocratic clinical approach was revived by T. Sydenham (1624–89). Notable physicians included G. Baglivi (1668–1707), L. Bellini (1643–1704), G. M. Lancisi (1654–1720), and others. Pathological anatomy began to take shape, and surgery was renewed in wound treatment thanks to C. Magati (1579–1647). Other notable surgeons were M. A. Severino (1580–1656), P. E. Dionis (d. 1718), and F. Hildanus (1560–1634). In obstetrics, the invention of the obstetric forceps by P. Chamberlen (1647) and the work of F. Mauriceau (1637–1709), S. Mercuri, and others stand out. In psychiatry, P. Zacchia (1584–1659), primarily a legal physician and author of the first systematic treatise on the subject, should be remembered. In dermatology, D. Cestoni (1637–1718) and G. C. Bonomo discovered the parasitic origin of scabies (mite); in therapy, the antipyretic action of cinchona bark (1640) was explored in a celebrated work by F. Toti. B. Ramazzini (1633–1714) founded occupational hygiene. F. Folli devised the system of blood transfusion (1654), and intravenous injection techniques were introduced into practice.
In the 18th century, the old medical thought, not yet defeated, resurfaced in the work of G. E. Stahl (1660–1734), an animist, and to some extent in F. Hoffmann (1660–1742). From Hoffmann, through W. Cullen (1712–90) and G. Brown (1735–88), the concept of the nervous system’s importance in vital phenomena developed, culminating in G. Rasori’s subversive theory of stimulus and counter-stimulus (1766–1837), which opposed Hippocratic humoralism. Thus, the conflict that marked the crisis between old and modern thought exploded. A return to ancient ideas appeared in F. Mesmer’s (1734–1815) astrologism, mingled with intuitions of magnetism, while S. Hahnemann (1755–1843) created homeopathy (v.), in clear opposition to official medicine. Thanks to G. B. Morgagni, pathological anatomy took its place alongside clinical medicine.
The Hippocratic approach was followed by E. Boerhaave (1668–1738) and van Swieten (1700–1720), while in Italy, D. Cotugno and G. B. Borsieri (1725–87) distinguished themselves. In semiotics, L. Auenbrugger’s introduction of percussion (1781) should be noted. Surgery advanced through the work of A. Scarpa (1752–1832), G. A. Brambilla (1728–1800), a military surgeon, J. and W. Hunter, P. Pott, L. Heister, and others. Obstetrics developed especially in France through the efforts of N. Puzos (1686–1753), A. Levret (1703–80), G. Palfyn (1650–1730). In Italy, P. Assalini (1759–1840) and F. Asdrubali (1756–1832) are noteworthy, as are W. Hunter and W. Smellie in England. Ophthalmology advanced particularly in cataract surgery (G. David and A. Maitre Jean). The treatment of the insane became more humane through V. Chiarugi (1759–1820), while F. Pinel (1745–1826) studied insanity more theoretically, and G. Gall (1758–1828) founded phrenology (v.). The organization of public hygiene found a staunch advocate in P. Frank (1745–1821), author of a treatise on political medicine. Hydrotherapy spread and gained acceptance, while electrotherapy took its first steps. Preventive medicine acquired a powerful weapon against smallpox through E. Jenner’s (1749–1823) vaccination discovery in 1796. Thus, medicine moved toward its definitive systematization, which would be realized in the 19th century.
The development of pathological anatomy, increasingly linked with clinical practice, the establishment of modern microbiology, advances in semiotics, the conscious application of antisepsis and the discovery of asepsis, the implementation of surgical anesthesia, the refinement of techniques, the proliferation of instruments, the growth of allied sciences, and many other factors enabled medicine, in the 19th century, to finally emancipate itself from a past to which it was still, albeit unknowingly, so bound.
Apart from advances in biology, physiology, and anatomy—which greatly contributed to medicine—two figures were chiefly responsible for its new life: pathological anatomy and microbiology. Clinical medicine, in turn, benefited greatly from auscultation, introduced by G. Laënnec (1781–1826) with the stethoscope, and from various laboratory examinations, which began with Cotugno in the previous century and were officially established by Bright and Fehling. In 1895, G. Roentgen (1845–1923) discovered X-rays, opening a new field of investigation. Bacteriology was elevated to a science by L. Pasteur (1822–95), building on earlier discoveries of microbes, of which A. Bassi (1773–1856) had priority. A. R. Koch (1843–1910) perfected techniques and discovered numerous pathogenic agents, including that of tuberculosis. Pathological anatomy was further established by figures such as Laënnec, R. Virchow (1821–1902), founder of cellular pathology, Cruveilhier, Charcot, and others.
From E. Metchnikoff (1845–1916) and H. Buchner, studies on immunity began, which, thanks to the latter, led to the discovery of serum therapy. Meanwhile, clinical medicine boasts the illustrious names of G. Laënnec, G. Skoda, G. N. Corvisart, F. Broussais, R. Bright, M. Bufalini, S. Tommasi, G. Baccelli, A. Cardarelli, A. De Giovanni, A. Murri, and C. Forlanini, to whose name is tied the treatment of pneumothorax (1882). Modern neuropsychiatry recognizes in M. Charcot (1825–93) its principal founder, while C. Lombroso (1836–1909) established modern criminology. Dermatology was born in the schools of F. Hebra (1815–80) and P. Unna (1850–1929), while F. Ricord (1799–1889) established the classic distinction between gonorrhea and syphilis. Surgery benefited from the discovery of antisepsis, implemented by E. Bottini (1837–1905) and J. Lister (1827–1912), but already anticipated in obstetrics by J. F. Semmelweis (1818–65) and in anesthesia through the experiments of O. Wells (laughing gas), Jackson and Morton (ether), and Simpson (chloroform). As a consequence of Pasteur’s studies, antisepsis gave way to asepsis, while pharmacology entered a distinctly experimental phase; the syringe for injections was devised by Pravaz in 1851, and G. Baccelli resumed the use of intravenous injections in 1890. The studies of P. Ehrlich on arsphenamines opened the way to the new field of chemotherapy, of which sulfonamides represent the most recent achievement. Endocrinology, now of such great importance, originated in 1889 with Brown-Séquard’s experiments on rejuvenation of guinea pigs through injections of testicular extracts. The development of hydrotherapy is linked to the name of V. Priessnitz (1799–1851); in 1898 the Curies discovered radium, while electro-roentgen therapy assumed greater and improved development. Preventive medicine advanced in the field of malarial prophylaxis with G. B. Grassi’s discovery of the transmitting agent, the anopheles mosquito, and with the description of the life cycle of the malarial parasite in birds (R. Ross) and in humans (Grassi).
Modern medicine marks a return to Hippocratic tendencies, so much so that it is called neo-Hippocratic. On the other hand, the high refinement of technique and of the sciences collateral to medicine provides such aids to clinical practice that its task is rendered much easier and more limited. The fundamental bases of 20th-century medicine are still those of the end of the previous century, with the addition of a broader knowledge of physiopathological phenomena; a meticulous investigation of anatomopathological findings, and refined experimentation in the fields of general pathology and clinical medicine allow for a more precise interpretation of the pathogenesis of morbid phenomena. Meanwhile, advances in bacteriology and ongoing studies on ultraviruses open new horizons to general biological knowledge, offering broad prospects for modifying certain classical etiological and pathogenic concepts, and providing effective means of treatment with sera and vaccines. Parasitology meanwhile sheds ever greater light on obscure points regarding the transmission of certain diseases and the knowledge of the causal agent and intermediate host, making the struggle against parasitosis easier and more effective.
On these foundations, pathological knowledge and therapeutic means for diseases of the blood, its morphological elements, and hemopoietic organs (bone marrow, spleen, lymphatic glands)—previously quite limited—have made great strides. Similarly, diseases of the renal system have become much better understood thanks to advances in chemical-biological knowledge and refined functional examination. Framed within the modern concept of “allergy,” bronchial asthma, pollinosis, food intolerances, urticaria, anaphylactic crises, serum sickness, and idiosyncrasies reveal a common pathogenic basis. Diseases of the endocrine glands (v. ENDOCRINE, GLANDOLE, GLANDS) have opened a new horizon for the study of pathology and constitution. Collaterally, the so-called deficiency diseases, caused by vitamin deficiencies (v.), have assumed ever greater importance, and their study, day by day, reveals unsuspected horizons.
Surgery, thanks to the high perfection achieved in investigative and surgical instruments and technical refinement, has ventured into the boldest interventions in the neurological, pulmonary, and circulatory fields.
Prophylaxis and hygiene, enriched by the contributions of microbiology, parasitology, climatology, and epidemiology, succeed in preventing the spread of infectious diseases; while therapy, equipped with increasingly effective means—up to and including antibiotics (penicillin, streptomycin, chloromycetin, etc.)—continues to advance and triumph over a wide range of infectious diseases.
MEDICINA PASTORALE. – A particular discipline that, through the study of the relationships between medicine and morality, aims to provide the clergy with medical knowledge that may be useful to them for understanding specific topics in moral theology and canon law. Here, the term “medicine” is taken in its broadest sense, namely as “the science that, from the study of man—both physically and psychically, healthy and sick—and from the environmental circumstances surrounding him, seeks to understand the conditions of biological equilibrium in order to preserve it in a state of health or restore it in cases of morbid imbalance.”
The legitimacy of the relationship between morality and medicine is founded on the identity of the material subject, namely man, even if differing in formal terms—spiritual in the former, material-immaterial (physical-psychic) in the latter. Just as the union of the spiritual and material parts in us is intimate in the relationship of form and substance, so too are the ties between medicine and morality deep and profound, and the legitimacy of pastoral medicine as a distinct science with its own object of study is thereby established.
From a juridical standpoint, the priest’s work unfolds in a particular form, seemingly more solemn, if not more common, when he acts as a judge in diocesan tribunals or in the Apostolic tribunals of the Signatura and the Rota, or decides administratively on certain matters within the competence of the Sacred Congregations (Sacraments, Rites, Holy Office, etc.), to resolve issues of which those connected with medical topics will be fully grasped by him only if he possesses the medical aspect of the matter (e.g., in Rotal cases for declarations of nullity of marriage; in the Congregation of the Sacraments regarding dispensations *super rato*; in the Congregation of Rites to determine the miraculous nature of a cure in canonization processes). In such cases, the judge relies on the work of technical experts in the relevant fields; yet a specific knowledge, even if general in scope, is always necessary for him to weigh the value of the arguments, accept or reject them.
MEDICINA PASTORALE
Apart from this juridical activity, the priest more commonly acts as a judge when, in the tribunal of Penance, he weighs guilt and assesses its gravity in terms of the penitent’s degree of responsibility; or, even in the external forum, he must resolve cases of conscience concerning matters of a medical nature, or lay down norms for new social activities connected with developments in biological science (e.g., regarding the practical applications of eugenics, artificial insemination, the treatment of mental illness through psychoanalysis, narcoanalysis, or ablative operations on the cerebral hemispheres). Before rendering judgment on such questions, the moralist priest must study and thoroughly understand them from a medical standpoint.
From an educational perspective, the priest is particularly the one who points out the path and means of virtue. It must not be forgotten that his work essentially unfolds on a supernatural plane, and that in guiding souls along the paths of perfection, “the means at his disposal rest upon the action of grace” (A. G. G. Melli, *La direzione spirituale e le anomalie mentali*, in *Reden*, 31 [1950], p. 278). Yet the contributions that pedagogy and medicine can provide must not be neglected. In practice, moreover, a clear boundary cannot be drawn between the normal and the abnormal, and in the infinite variety of individual types to which the priest as educator directs his efforts, it is not uncommon to encounter latent abnormality, which also requires the contribution of pastoral medicine. It may be observed that both priest and physician demand—and find—a strenuous and lengthy preparation, one so exacting that it can scarcely be mastered fully by any single individual except exceptionally. This is not to say, however, that the spiritual director must make diagnoses—every physician knows how difficult this is—but rather that he should suspect when an individual under his examination and guidance is on the borderline of, or already outside, the limits of normality, and should direct him to a psychiatrist, proceeding thereafter in collaboration. The priest can do this only if his general education includes pastoral medicine.
Also essential for the priest as educator are the principles concerning the procreative function, both in terms of the activity of the individual and the mutual relationship in marriage—namely, the problems of educating in chastity and the physical exercise of Christian marriage. If the priest is prudently but sufficiently informed on these topics, he will more readily and clearly grasp the meaning of what is said or asked of him in confession or elsewhere; he will be able to question with greater precision and delicacy, and to admonish or advise with greater effectiveness.
It is therefore not surprising that the historical development of these two sciences has been closely intertwined—first parallel, then contemporary, and finally collaborative. Indeed, while in the centuries following the year 1000 the first formal relationships between pastoral medicine and law, and between pastoral medicine and moral theology, began to take shape, subsequently a clear collaboration among medicine, canon law, and moral theology emerged. In the Decretals of Gregory IX (1234), under the title *De probationibus*, mention is made of medical assessments in cases of marital nullity, and John XXII (1316–34), in reorganizing the tribunal that came to be known as the Sacred Roman Rota, in the decretal *Ratio iuris exigit* (1331) speaks of medical expertise to assist the tribunal.
A scholar of pastoral medicine proper appears only in the first half of the seventeenth century, when the Roman physician P. Zacchia (q.v.) set forth in his *Quaestiones medico-legales* (3 vols., Lyon 1701) an orderly body of doctrine not only on medico-legal and hygienic matters but also on pastoral medicine. Zacchia’s work remained authoritative until the early nineteenth century, both for its unquestioned value and because pastoral medicine was still largely bound to older positions of scientific dogmatism. Apart from this, the union of pastoral medicine with moral theology continued to flourish. For example, in the moral theology of St. Alphonsus Maria de Liguori (1748), the entire treatment of “de sexto” and that on marriage rests upon medical knowledge and on pastoral medicine. Similarly, among other works, in the monographs of P. Florentinus (*De hominibus dubiis baptizandis*, Lyon 1658) and F. E. Cangiamila (*Sacra embryologia*, Palermo 1758) on the questions of fetal animation and the baptism of the dying fetus. In the latter part of the nineteenth century, more systematic and modern works began to appear, drawing on the steady progress of pastoral medicine; for example, *Pastoral-medicine* by Von Olivers (Freiburg 1802) and *Medicina pastoralis* by C. Capellmann (Paris 1893). In recent years, no small number of works on the subject have been published (q.V. bibliography), many of them of high quality, taking account of the latest advances in pastoral medicine and incorporating the most recent medico-moral questions. These are now discussed publicly in specialized and general journals, at conferences, congresses, and so forth.