We have previously referred to the influence of the Byzantine civilization in transmitting the learning of antiquity across the abysm of the dark age. It must be admitted, however, that the importance of that civilization did not extend much beyond the task of the common carrier. There were no great creative scientists in the later Roman empire of the East any more than in the corresponding empire of the West. There was, however, one field in which the Byzantine made respectable progress and regarding which their efforts require a few words of special comment. This was the field of medicine.

The Byzantines of this time could boast of two great medical men, Aetius of Amida (about 502-575 A.D.) and Paul of Aegina (about 620-690). The works of Aetius were of value largely because they recorded the teachings of many of his eminent predecessors, but he was not entirely lacking in originality, and was perhaps the first physician to mention diphtheria, with an allusion to some observations of the paralysis of the palate which sometimes follows this disease.

Paul of Aegina, who came from the Alexandrian school about a century later, was one of those remarkable men whose ideas are centuries ahead of their time. This was particularly true of Paul in regard to surgery, and his attitude towards the supernatural in the causation and treatment of diseases. He was essentially a surgeon, being particularly familiar with military surgery, and some of his descriptions of complicated and difficult operations have been little improved upon even in modern times. In his books he describes such operations as the removal of foreign bodies from the nose, ear, and esophagus; and he recognizes foreign growths such as polypi in the air-passages, and gives the method of their removal. Such operations as tracheotomy, tonsellotomy, bronchotomy, staphylotomy, etc., were performed by him, and he even advocated and described puncture of the abdominal cavity, giving careful directions as to the location in which such punctures should be made. He advocated amputation of the breast for the cure of cancer, and described extirpation of the uterus. Just how successful this last operation may have been as performed by him does not appear; but he would hardly have recommended it if it had not been sometimes, at least, successful. That he mentions it at all, however, is significant, as this difficult operation is considered one of the great triumphs of modern surgery.

But Paul of Aegina is a striking exception to the rule among Byzantine surgeons, and as he was their greatest, so he was also their last important surgeon. The energies of all Byzantium were so expended in religious controversies that medicine, like the other sciences, was soon relegated to a place among the other superstitions, and the influence of the Byzantine school was presently replaced by that of the conquering Arabians.


The thirteenth century marks the beginning of a gradual change in medicine, and a tendency to leave the time-worn rut of superstitious dogmas that so long retarded the progress of science. It is thought that the great epidemics which raged during the Middle Ages acted powerfully in diverting the medical thought of the times into new and entirely different channels. It will be remembered that the teachings of Galen were handed through mediaeval times as the highest and best authority on the subject of all diseases. When, however, the great epidemics made their appearance, the medical men appealed to the works of Galen in vain for enlightenment, as these works, having been written several centuries before the time of the plagues, naturally contained no information concerning them. It was evident, therefore, that on this subject, at least, Galen was not infallible; and it would naturally follow that, one fallible point having been revealed, others would be sought for. In other words, scepticism in regard to accepted methods would be aroused, and would lead naturally, as such scepticism usually does, to progress. The devastating effects of these plagues, despite prayers and incantations, would arouse doubt in the minds of many as to the efficacy of superstitious rites and ceremonies in curing diseases. They had seen thousands and tens of thousands of their fellow-beings swept away by these awful scourges. They had seen the ravages of these epidemics continue for months or even years, notwithstanding the fact that multitudes of God-fearing people prayed hourly that such ravages might be checked. And they must have observed also that when even very simple rules of cleanliness and hygiene were followed there was a diminution in the ravages of the plague, even without the aid of incantations. Such observations as these would have a tendency to awaken a suspicion in the minds of many of the physicians that disease was not a manifestation of the supernatural, but a natural phenomenon, to be treated by natural methods.

But, be the causes what they may, it is a fact that the thirteenth century marks a turning-point, or the beginning of an attitude of mind which resulted in bringing medicine to a much more rational position. Among the thirteenth-century physicians, two men are deserving of special mention. These are Arnald of Villanova (1235-1312) and Peter of Abano (1250-1315). Both these men suffered persecution for expressing their belief in natural, as against the supernatural, causes of disease, and at one time Arnald was obliged to flee from Barcelona for declaring that the "bulls" of popes were human works, and that "acts of charity were dearer to God than hecatombs." He was also accused of alchemy. Fleeing from persecution, he finally perished by shipwreck.