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Notes on medical scholarship and the broad intellectual milieu in sixteenth-century Portugal.
None of the Portuguese medical writers of the sixteenth century appears to have entirely fulfilled such a wide range of requirements. Neither did they share the same interests or approaches. Yet the model portrayed in Miranda's dialogue provides an apt general picture of the ideals and characteristics of a group of physicians whose work and circumstances are the central concern of this article.
Medical scholarship in early modern Portugal is considered here as part of a broader academic context including all European countries which received and produced printed books and manuscript compilations on the main subjects of the day (philosophy, theology, law, medicine and literature). It developed 'after the establishment of printing as a means of disseminating texts, and before the development of strong vernacular and national intellectual traditions'. (2) As is well known, in this context a cultural heritage from medieval Western Europe, whose scope and authority had been increased and to an extent changed by the rediscovery of Greek and Roman authors, coexisted with an increasing, although by no means pre-eminent, range of new information, brought about by the growth of observational, experimental and mathematical approaches in various academic fields. Broad changes in this picture, linked with the prevalence of the latter development, are considered to have occurred during the seventeenth century. Through the study of medical writers and the ways in which they related to their cultural environment, I shall attempt to offer a nuanced account of the influences on Portuguese scholarship in the sixteenth century.
The physicians analysed here had in common formal qualifications and social and professional status. Without exception they were university-educated and combined at least two of the most prestigious medical occupations of the day, those of university teacher, author and physician to a powerful clientele. For this reason in this article emphasis is placed on medicine as taught in the universities. It was generally accepted that universities, although preserving a basically medieval curriculum, provided the breeding ground for most innovations in medical science and education in sixteenth-century Europe.
An enquiry into academic medicine illuminates the doctrines which constituted the intellectual infrastructure of practices and beliefs broadly disseminated among medical practitioners. I shall attempt in some measure to compare the way concepts occur in different areas of medicine, for example among practitioners outside the academic world, and university-educated physicians. Aside from this, I shall make no attempt to cover issues relevant to the general subject of medicine in the sixteenth century, such as the social diversity of medical practitioners, surgery, and herbal medicine and pharmacology. I shall say very little about clinical instruction in hospitals and nothing at all on, for example, the plague and new diseases of the time such as syphilis. To cover such a wide range of topics would go far beyond the scope of this article. What follows is an attempt to provide answers to various questions: what are the most prominent influences to be found in the academic medical world of sixteenth-century Portugal? In which ways have medical writers drawn upon these influences and how are they combined in their works? In which social and institutional context did this occur? How did developments in this context affect medicine and medical education? In order to answer these questions I should like to consider first aspects of the social and institutional links of the authors studied.
The preliminary pages of Miranda's Dialogo da perfeycam..., which is dedicated to King Sebastiao, who reigned 1568-78, contain two poems praising the king, the maritime feats of the Portuguese nation and its overseas wars and dominion. The dialogue also contains poems addressed to Joao III's widow, Queen Catarina (?-1578), and Cardinal Henrique (1512-80), who were both regents during Sebastiao's minority (1557-67). In the dedication of the dialogue to the young monarch, Miranda refers to its contents as 'as letras, experiencia, & honestidade, & outras virtudes que ha de ter o bom medico, pera ter cuydado de auisar aos Reys & Principes na saude, & os curar nas doencas, & como ha de ter diligencia grandissima e continua com os pacientes'. (3)
Many and various sources related to Portugal in the sixteenth century testify to the existence of close links between academic medicine and the centres of political power. The dedication of books is one such source since patronage usually went with such dedications. Of the medical texts studied, Antonio Luiz's Problematum libri quinq (1539), (4) and Enrique de Cuellar's Ad libros tres predictionum Hippocr. (1543), (5) are dedicated to King Joao III, with both authors making reference to the monarch's military virtues and colonial power. Afonso Rodrigues de Guevara's In pluribus ex ijs quibus Galenus impugnatur ab Andrea Vesalio... (1559) is dedicated to Queen Catarina, but is principally concerned with praising Joao III (who had already died by the time Guevara's work was published) for his role in promoting the development of the university. (6) Thomaz Rodrigues da Veiga's Opera omnia in Galeni libros (first published in 1587) was dedicated to King Sebastiao before the king's death. (7) Other medical works were dedicated to members of the political elite, including Pierre Brissot's Apologetica disceptatio, qua docetur per quae loca sanguis mitti debeat in visceru inflammationibus... (published posthumously in 1525), dedicated to Joao III's brother, Cardinal Afonso; (8) Antonio Luiz's De Re Medica Opera (1540), dedicated to the scholar and senior administrator Joao de Barros (1496-1570); (9) and Garcia Lopes' Commentarii De Varia Rei Medicae Lectione (1564), dedicated to the governor and military commander Joao Mascarenhas. (10)
This phenomenon was not peculiar to Portugal, but to be a member of the royal entourage seems to have been especially important in Portugal as most activities were connected with the court and depended upon its support. The king could grant to his proteges a professorship at the university, since he made the appointments himself. Joao III personally chose teachers such as Enrique de Cuellar (c. 1483-c. 1544), who taught Galen in the Cadeira de prima (1537-44); Thomaz Rodrigues da Veiga (1513-79), who taught the Hippocratic Corpus and Rhazes in the Cadeira de vespera (1538-57), and Galen in the Cadeira de prima (1557-79); and Antonio Luiz (d. 1565), who taught Aristotle (1547-48) and Galen (1547-50) in one of the so-called minor cadeiras of medicine at the University of Coimbra. (11)
To be a physician to the royal family was another prestigious position at court. The French physician Pierre Brissot's controversial ideas on which part of the body a venesection should be performed (discussed in more detail below) acquired notoriety among Portuguese doctors when he treated King Manuel for 'pleurisy' (1518), against the opinion of the chief physician (physico-mor) of the kingdom. Thomaz Rodrigues da Veiga, who descended from a family of physicians to the Iberian kings, gained prestige from the fact that he was physician to the royal family. (12) This was also the case with Garcia Lopes. A passage from his Commentarii de Varia Rei Medicae Lectione consists of a discussion on the Hippocratic-Galenic doctrine on the influence of environmental-climatic factors upon the human body, relating to the ages of man. Garcia Lopes' main concern was to address the problem, in medical terms, of seven-year old King Sebastiao travelling from Lisbon to Santarem. (13)
A brief account of the Spanish Afonso Rodrigues de Guevara's long stay in Portugal illustrates the different aspects of the relationship between academic medicine and the court, and the personal advantages that could result from such links. Guevara, licentiate in medicine at the University of Siguenza, Spain, had later studied anatomy in Bologna. He was a wellknown teacher of anatomy at the University of Valladolid when he was invited by Joao III to teach at Coimbra, as part of the restructuring of the university supported by the monarch. He met the king and queen in 1550. According to his book, he dissected the heart of an animal in the presence of the royal couple, in keeping with the current approach to anatomy as a spectacle. (14) Guevara began teaching at Coimbra in 1556, shortly before the death of Joao III. He was much favoured by Queen Catarina. In 1557 a chair of surgery was created for him at the university. Despite now being in charge of two disciplines, anatomy and surgery, it is recorded in acta of the university council that he was frequently absent, travelling to the court in Lisbon and to Spain. Of the anatomical dissections which he refers to in his book, including those of human bodies, Guevara mentions only once dissections performed at the University of Coimbra during the time he was teaching there, and these were on animals. (15)
In 1561, Guevara moved to Lisbon, being appointed physician to the queen and to the Hospital de Todos os Santos, where he was given the task of organizing the teaching of anatomy and surgery. Although a directive stating his obligation to practise anatomy at the hospital is known, there are no sources indicating whether or how anatomical dissections were performed. To sum up, there is every indication that, despite being a competant anatomist, potentially capable of exerting an important influence on practical anatomy and observation, Guevara did not actually do very much either at the university or in the hospital. His participation at court and in military activities seems to have been more marked than his efforts as an educator. This is evident from the fact that he was among the soldiers and noblemen imprisoned at Alcacer-Kebir in 1578, where the prime of Portuguese nobility, King Sebastiao among them, was defeated and slain in an attempt to invade Morocco. (16)
Afonso de Guevara provides an example of the sort of attraction that the court in Lisbon held for scholars who were supposed to live and work in Coimbra, and of the willingness of the central powers to allow courtier-scholars to ignore university regulations. But this appears not to have been the only example of royal interference to protect university teachers who flouted regulations. In his investigation based on acta of the university council, Teixeira de Carvalho notes that, in order to justify flouting the rules, 'a autorizacao do conselho ou do reitor era facil de obter e, quando faltava, o lente partia para Lisboa e voltava de la armado com uma provisao regia que tudo resolvia a seu favor'. (17) Indeed, if it can be said that the university was favoured by a number of measures taken by Portuguese kings of the sixteenth century in regard to the improvement of material conditions, staff and curriculum, it was also in many ways limited by the kings' interference in its administration.
Aside from unfortunate developments such as those outlined above, medical teaching at the University of Coimbra during the sixteenth century was also provided by those who were eminent for their competence both as educators and practitioners, although they mainly worked within the broad framework inherited from their predecessors. Thomaz Rodrigues da Veiga is perhaps the most distinguished example. The great esteem in which Veiga was held is expressed in numerous passages from works published by his pupils. Among them is the work on medical deontology of Henrique Jorge Henriques, entitled Retrato del Perfecto Medico (1595), in which Veiga is referred to as an 'admirable, y perfecto Medico, que otro hasta el dia de oy no ha auido dende (sic) los Gentiles'. (18) Thomaz Rodrigues da Veiga had an exemplary and successful medical career. He was born into a family of renowned physicians to the Iberian kings and he himself served a powerful clientele, including King Joao III and King Sebastiao, and the regent Cardinal Henrique. He studied medicine in Salamanca and began teaching at the University of Coimbra at the age of twenty-five. Despite being a descendant of a Jewish family, in his favour was the fact that his ancestors had long severed relations with the Hebrew faith and customs. Unlike other Jewish physicians, therefore, he was not excluded from teaching at the university and had no need to leave Portugal because of religious persecution. His long career as a teacher and doctor was complemented by his writing. He wrote a number of commentaries on Galen and one on the Hippocratic text, De victus ratione. (19)
Although Veiga cites doctors of the modern school such as Andreas Vesalius (1514-64), Joannes Argenterius (1513-72) and Jean Fernel (1497-1558) in his commentaries on Galen's work, bearing witness to his familiarity with new approaches to medicine, he had great respect for ancient authors, especially Galen. In the preface to his Opera omnia in Galeni libros, he says that 'Ex libris, quos hactenus de re Medica scriptos nostra probauit aetas, nullus est, quem vniuersi, qui huic disciplinae nomina dederunt, aut crebrius, aut maiore cum vilitate manibus versent quam Galen monumenta'. (20) Veiga was clearly referring to the Greek texts of Galen or Latin translations of them according to canons of the studia humanitatis, from which some widely criticized errors in Arabic and medieval Latin versions had been eliminated.
Thomaz Rodrigues da Veiga's concern with the study and interpretation of Galen and Hippocrates reflects the extent to which the humanist interest in firsthand knowledge of the original Greek texts found its way into the intellectual medical domain in sixteenth-century Portugal.
Humanism was introduced into Portugal through most of the channels discussed in Paul Oskar Kristeller's 'The European Diffusion of Italian Humanism'. (21) It was introduced by foreign scholars such as the Italian Cataldus Siculus, who arrived there in 1485 to be tutor to Joao II's son Jorge; (22) the Flemish Nicholas Cleynaerts (c. 1493-1542), who worked for the royal family for several years and was tutor to Joao III's brother Henrique, who was later to be regent and king; (23) and the humanists contracted to teach at the College of Arts, among them being the Scottish George Buchanan (1506-82). (24) Portuguese students, political and religious envoys sent to Italy, Spain, France and the Low Countries, many of them sponsored by the crown, also played an important part in this process. This was the case with Henrique Caiado (Hermicus Caiadus) who was a pupil of Poliziano and Philippus Beroaldus the Elder (1453-1505) in Italy, (25) and the historian Damiao de Gois (1501-72) who was Portuguese ambassador to Flanders and Germany. (26) An important channel of humanist influence was the dedication of books and the patronage implied by this. Thinkers such as Erasmus (1466?-1536) and the Spanish Joannes Ludovicus Vives (1492-1540) dedicated books to Joao III. (27) Humanist literature, published and in manuscript, together with translations and commentaries on classical scholarship produced by the humanists, were brought to Portugal by all the means referred to here. (28)
The result of this was the creation by Joao III of the College of Arts, which was modelled on the humanist educational programme, and the growth of the disciplines of grammar, rhetoric, poetry, history and moral philosophy, which became the new fashionable interests for Portuguese scholars. Most of the academic texts of the time, as well as activities at court, testify to this development. But more relevant to this investigation than the studia humanitatis were the attitudes deriving from their influence, of unconditional respect for ancient culture and its modern Italian revival, and hence of a more dogmatic and philological approach to ancient texts. Also of particular importance was the large body of ancient Greek and Latin texts on science and philosophy, circulated by the humanists.
Emphasis on classical scholarship was not the most prominent feature of intellectual activity related to maritime and colonial enterprises. An unprecedented development in naval engineering, naval instruments, nautical astronomy and cartography resulted from the sponsorship of princes such as Henrique 'the Navigator' (1394-1460) and Joao II. Techniques previously developed by the Italians in the Mediterranean were adapted by the Portuguese (and Spanish) to the quite different conditions of navigation across the Atlantic ocean, leading to the growth of a modern trend in methodical reasoning based on observations in Portugal. (29) Major figures involved in this trend were the Catalan cosmographer, cartographer and maker of nautical instruments Jacome de Maiorca (first half of the fifteenth century), the Jewish astronomer Abraao Zacuto (c. 1452-c. 1525) and the mathematician Pedro Nunes (1502-78).
Empiricism was to lead to other developments in Portuguese scholarship. Advances in navigation systems meant that previously unseen, and sometimes wrongly identified, phenomena and lands could now be compared with ancient texts and current European scholarship. Aside from astronomy and geography, this tendency is apparent in studies of eastern medicinal plants and drugs. Here the empirical trend had its full expression in Garcia de Orta's Coloquios dos simples e drogas e cousas medicinais da India (1563), a study of the herbs and drugs of India, in which the results of direct observation are critically compared with the works of such authorities as Galen, Dioscorides and Pliny. (30)
In medicine, aside from botanical and pharmacological studies, the growth of empiricism was only marginal. This is particularly true of anatomy. It is possible to say that, because of the reception of ideas from other European countries, especially Italy, Spain and France, medical writers in Portugal displayed a certain degree of awareness of empirical observation in medicine. Nonetheless, they were mainly related to the tradition of textual commentary which dominated the European intellectual life of the time.
The adoption of ideas derived from Renaissance Neoplatonism seems an almost natural consequence in a context where Florentine models were fashionable. Yet more fundamental factors are involved in this phenomenon. First there is the question, which obviously applies to Europe as a whole, of the adequacy of Platonism to bridge the 'profound intellectual gap between dogmatic theology which had its basis in faith, and Aristotelian scholasticism which was then largely limited to logic and physics', as proposed by Kristeller, (31) or 'to placing man in the ideal centre of the world', according to Nicola Abbagnano. (32) Secondly, specific features of Portuguese culture contributed to the influence of Neoplatonism there. Renaissance Neoplatonism has been defined as the 'receptive body' and the 'organic whole' which sustained ideas stemming from hermetic, orphic, neopythagorean, astrological, cabalistic and other influences of the period, (33) some of which were established trends in the Iberian peninsula long before the Quattrocento. This is the case with astrology and Jewish philosophical and religious ideas. It was, in fact, in the Iberian peninsula that cabalistic thought, adopted by one of the most distinguished Florentine Platonists, Giovanni Pico della Mirandola (1463-94), originated. Earlier historical conditions appear to have constituted a favourable ground for the adoption of influences emanating from Italian Neoplatonism. Moreover, in the context of Portugal, they implied the importance of particular attitudes and beliefs relating to the syncretic trend at issue here, such as astrology and the cabala. (34)
There is evidence from the treatises studied of the predominance of more dogmatic and philological approaches to ancient texts. For example, in the first chapter of De Varia Rei Medicae Lectione Garcia Lopes claims that 'si quae video, quae a magni Hippo. aut Gal. sententia aliena sunt, ea confodeo, incito, et, si fieri potest, extirpo, ne alumnos verae medecinae, (quae non est alia, quam quae ab Hipp. et Gal. scribitur) ita suo foetore corrumpant'. (35) Hence a central preoccupation of his book, which treats a range of issues relating to therapeutics, is to recover the 'purity' of the doctrines of Galen and Hippocrates by pointing out additions and misinterpretations of Arabic authors. Such is also a main concern of Enrique de Cuellar. In Ad libros tres predictionum Hippocr., Cuellar's textual focus is expressed by his quotation of both Hippocrates' text on prognosis and Galen's comments on it, which are followed by his own commentaries. The general aim of 'going back to the Greeks' is also expressed in the writers' wish to state clearly that they have drawn their information from such sources. An example is Antonio Luiz's eagerness to emphasize that he based his Problematum libri quinq on Greek authors, quoting 'Auctores quos in hoc concinnando opere secutu sum: graeci fuere, atq; ij imprimis Galenus, Proclus, Plutarchus, Plato, Aristoteles, Alcinous, Alexander, diuus Dionysius, et alij innumeri'. (36)
Portuguese medical writers were acknowledged for producing improved editions of Galen's texts, including works unknown in the Middle Ages. Galen's De Placitis Hippocratis et Platonis and De Usu Partium are quoted in most texts studied. The former is known not to have been translated before the Renaissance, whilst the latter was available only in abridged form before the fourteenth century. (37)
The introduction of Hippocratic studies to Portugal was mainly due to Pierre Brissot (1478-1522), who lived there 1518-22. It appears that his visit to Portugal was initially connected with plans to go to India, to develop studies in medical botany and drugs. Before this, in Paris, he had been involved in a medical controversy relating to venesection, where he supported genuine Hippocratic and Galenic concepts and procedures opposed to Arabic medicine. This controversy was concerned with the question of the elimination of unwanted humours by 'revulsion' or 'derivation', therapeutic procedures which were to be performed on different parts of the body according to the site of the complaint. Brissot expressed his ideas particularly with reference to 'pleurisy', a disease which he had the opportunity to treat in 1514. This could have been either what is now designated as 'pleurisy' or some related pulmonary disease. Brissot, adopting Hippocratic and Galenic concepts, condemned the Arabic practice of slow bleeding (sometimes extracting only one or two drops of blood) from the site most distant from the affected part. He contended that a considerable quantity of blood should be extracted and that in 'pleurisy' it did not matter whether venesection was practised on the right or the left side, since the affected region was drained by the vena cava. He also claimed that for revulsive phlebotomy, in a Hippocratic sense, enough distance could be achieved by bleeding the arm on the affected side. It was thus a mistake to choose, as was common practice, the saphenous vein.
In 1518, Brissot treated people affected by 'pleurisy' in Evora, including King Manuel. He put his own principles into practice, in opposition to the opinion of the chief physician of the kingdom, Dionysio. A controversy was also generated in Portuguese medical circles, echoes of which can be found in the sources for this study. (38) The two main rivals developed their opinions in print. Brissot's arguments, particularly in relation to bleeding in 'pleurisy', were developed in the Apologetica disceptatio... Dionysio's text has been lost. (39)
If in many respects the opinion of past authorities has been accepted without criticism by Portuguese medical writers, it is important to note that this has not always been the case. I have already mentioned Afonso de Guevara, who was undoubtedly best able to work by observation of the authors studied, and who was willing to disagree on occasion with Galen, the author to whom he paid special tribute. The same holds true for Rodrigo de Castro (1546-1627). In his De universa mulierum Medicina (1603) Castro makes use of anatomical and clinical observation to elucidate questions where there was disagreement between medical authorities, or to point out any errors, although he also relied heavily upon them. (40) The acceptance of ideas of the neoterici, which differed from ancient authorities, is also found, although rarely, in medical texts in Portugal. For example, Garcia Lopes, based on Gabriele Falloppia's Observationes anatomicae (1561), rejects the Hippocratic aphorism that the cause of miscarriage at two or three months, for no apparent reason, was the result of the accumulation of mucus in the blood vessels which connect the embryo to the uterus (cotyledons), thereby rendering them unable to hold the weight of the embryo, which would then detach. Lopes argued that such cases of miscarriage were caused by the interruption of the embryo's nourishment due to obstruction caused by the mucus, rather than the bursting of the blood vessels. (41) From the examples mentioned it may be inferred that uncritical acceptance of received authority coexisted with attempts to bring it into question. This is not a distinctive feature of Portuguese writers; Ian Maclean notes that it 'reflects well the hesitancies [...] inherent in Renaissance modes of thought'. (42)
As is well known, the initial interest in classical languages by Renaissance humanists also extended to vernaculars. This is evident in the use of Iberian vernaculars by Portuguese medical writers in some of the works studied. Miranda's Dialogo da perfeycam... and Henriques' Retrato del Perfecto Medico are written in Portuguese and Spanish respectively. Joao de Barros' Ropicapnefma, which is among the non-medical sources in this study, is written in Portuguese. Attempts to write medical texts in vernaculars, or to translate authoritative texts into them, appear to have generated an awareness of the difficulty of translating concepts and terms from Latin and Greek into languages unequipped to express notions of human biology. This is indicated in a passage from the Dialogo da perfeycam... in which Miranda notes the deficiency of vernacular words corresponding to Latin and Greek terms. Miranda ascribes this deficiency to the influence of the languages of people considered by him to be 'barbarian', who inhabited the Iberian peninsula (meaning Goths and Muslims). (43)
The inclusion of literary pieces in medical works also derived from humanist influences. Epigrams and other forms of poetry addressed to patrons, authors and readers, or describing the work they accompany, are often found in academic medical texts. The dedications themselves are written in the rhetorical style characteristic of the humanists, quoting Greek mythology, Roman and Greek thinkers and statesmen, and the like. The existence of links between academic medicine and the literary world is also revealed by Andre Falcao de Resende in 'Microcosmographia, e Descripcao do Mundo Pequeno, que e o Homem', a long poem which consists of a general description of human anatomy presented as a metaphorical journey into a human body, and said to have been based on anatomical treatises. (44)
The Portuguese were not alone in their tendency to 'humanize' different aspects of medicine. As is well known, the philological and literary concerns referred to above are characteristic of medical scholarship in all European countries participating in the interchange of books, scholars and ideas during the sixteenth century. Such concerns are in many ways linked to the Renaissance 'love of all things Greek'. The variety of ways in which Renaissance thinkers attempted to 'humanize' medicine include studies on botany and pharmacology in connection with the search for classical drugs, (45) an activity which, in Portugal, as noted above, was mainly developed outside the university and without the participation of anyone featured in this article. It should be pointed out that Portuguese thinkers working in this field sometimes revealed a rather critical attitude towards authors such as Galen and Dioscorides.
Sixteenth-century attempts to 'humanize' medicine also included efforts to adapt late medieval Latin and Arabic textbooks to 'the literary tastes, philological scholarship, and scientific needs of the age'. (46) A suggestion of this tendency in Portuguese medicine is provided by Miranda's reference to a knowledge of Arabic being a necessary skill of a competent doctor, enabling him to read Arab authorities in the original. Humanist influences upon the medicine of the time included the zeal to establish better standards of surgical procedure, by making available to surgeons genuine Galenic and Hippocratic medicine. (47) The Portuguese surgeon Antonio da Cruz, who was educated according to such principles, committed himself to increasing access to theoretically informed surgery. This is his justification for writing Recopilacao de Curgia in the vernacular. (48)
Humanist influences are only one aspect of 'the links between medicine and the rest of Renaissance intellectual life'. (49) Medicine figures among the most important disciplines in the university curriculum in Portugal, together with law (canon and civil) and theology. In this respect the Portuguese curriculum is similar to that of northern universities and differs from the Italian, in which theological faculties were absent. As in European universities in general, medicine in Portugal was closely related to the arts. From the regulations of 1559 it can be inferred that the Portuguese university is closer to the northern model, in which a full arts education was a pre-condition to the study of medicine, whereas in Italy arts and medicine were read together. But it seems that, in practice, both schemes were accepted by the University of Coimbra. (50)
The arts curriculum in Coimbra was chiefly based on Aristotelian logic and natural philosophy, with less emphasis on moral philosophy and metaphysics, astronomy, mathematics, geometry, and perspective. It required the student's initial mastery of Latin and provided intensive training in disputation or formal debate. (51) These were roughly the subjects and practices which predominated elsewhere in Europe between the fourteenth and sixteenth century. (52)
It appears that the principal aspect of the relationship between medicine and the arts was its influence upon the intellectual training of university-educated physicians. Hence, in the light of the curriculum outlined above, it is not surprising to find that medical writers of the sixteenth century were in many respects philosophically oriented. This is not only the result of an education in the arts. The 'philosophy-medicine connection', as has been argued by Schmitt, has long historical roots. It is found in varying forms in all medical authorities, from the Hippocratic writers and Galen through Aristotle to Avicenna and Averroes. (53)
In the sixteenth century much philosophical awareness came from the continuing discussion on issues in the disputed borderland between Aristotelian and Galenic authority. The familiar question as to whether the heart or the brain was the ruling organ of the body, and in what sense, was one of those issues. It frequently featured in medical texts in sixteenth-century Portugal. (54)
Philosophically-minded physicians of the Renaissance were not only influenced by Aristotelian, but also by Platonic philosophy. Galen, still the foremost medical authority of the time, has drawn upon Plato. As noted by Phillip De Lacy, Galen belongs 'among those Platonists who found large areas of agreement between Plato and Aristotle and even the Stoics'. (55) This bent towards the conciliation of Aristotle and Plato is found among Portuguese Renaissance doctors. As already noted in respect of the broad academic milieu of early modern Portugal, Platonic influences also found their way into medicine through humanism. Such development is particularly evident in the first half of the sixteenth century and by no means influenced all Portuguese academic physicians.
As one might expect, it is especially prominent in the works of Antonio Luiz, which were written before 1540 and combined medicine with other aspects familiar to one with any humanist education. Luiz's knowledge of Greek, Latin and Hebrew, as well as a panegyric he addressed to Joao III, testify to his philological and literary interests. (56) His works also have a strong philosophical orientation. Medicine is examined along with topics such as moral and natural philosophy, logic, astronomy and so on. The role of the occult in medicine is found in his writings. (57) Luiz's wide range of intellectual interests is recorded in his Panagyrica oratio and also in the trial by the Portuguese Inquisition (1539), which investigated his Jewish ancestry and unorthodox beliefs. (58) In a passage from De Re Medica Opera Luiz says, after Galen, that medicine is a liberal art connected with practice, rather than a scientia ('quam medicinam nuncupamus, est una artium factiuarum, e non scietia'). (59) However, there is every indication that the medical practice he refers to in his books is drawn from the works he comments on, rather than a reference to case histories he has dealt with as a physician.
Clearly Antonio Luiz's interests were focused on theory, not on the practice of medicine. Yet doctors who, unlike Luiz, combined the activities of medical author and university teacher with attending patients were also taught that disciplines such as logic, natural philosophy and astrology were necessary adjuncts to medicine. Such conviction can be traced back to the Italian universities of the thirteenth century. It is expressed in the Conciliator of Pietro d'Abano (1257-c. 1315), which was widely circulated among European scholars up to the end of the sixteenth century and was known to Portuguese authors. (60)
That disciplines such as natural philosophy and astrology were considered to be associated with medicine at the University of Coimbra is suggested by the mention of this idea in the works on medical deontology of two physicians who had studied there, Jeronimo de Miranda and Henrique Jorge Henriques. But if natural philosophy provided future doctors with a mainly theoretical grounding in general physical science, astrology seems to have been more closely connected with the practice of medicine. (61) The two characters of Henriques' Retrato del Perfecto Medico, a theologian and a physician, the latter representing the author himself, agree that the influences of heavenly bodies on man were to be taken into account in prognosis and the prescription of treatments such as venesection and purgation. A range of authorities including Ptolemy, Aristotle, Hippocrates and Rhazes is cited in support of this view. The passage from the Retrato del Perfecto Medico on the relevance of astrology to medicine testifies to the prominent role of Arabic authors in the dissemination of this idea, an importance that was presumably linked with their role as general reference for practising physicians. (62)
Evidence that practitioners outside the academic domain also accepted the medical relevance of astrology is provided by other sources, particularly the widely circulated almanac Reportorio dos Tempos of Valentim Fernandes, published in at least nine editions between 1518 and 1573. (63) The Reportorio was said to be primarily directed at navigators, but it seems to have been intended for more general use as well. The Portuguese Reportorio is a version of Andre de Li's Spanish edition, translated and modified by Fernandes to Portuguese needs in respect of maritime voyages. It contains calendars, descriptions of techniques of navigation, astronomical data, some information relating to agriculture, astrology and a section on astrological medicine. (64)
On the other hand, a passage from Miranda's Dialogo da perfeycam... suggests that not all doctors agreed on the usefulness of astrology. (65) This is consistent with the absence of any mention of the subject in many of the academic medical texts studied.
When one considers the complexity of the influences briefly outlined above, on the whole it is apparent that, as Andrew Wear, Roger French and Iain Lonie put it,
The sixteenth century medical writers felt that they were making a break with their Arabic and medieval past. They believed that they were creating a Reformation for medicine of which the central feature was the purification and assimilation of Greek knowledge. But the spirit of a Reformation is a more radical thing than its practice, and.[...] the most obvious signs of change lay in the rhetoric and in the ideological positions adopted by medical men. (66)
The sources for this study provide proof of the continuation of medieval influences upon medicine in Portugal, along with Renaissance innovations. Aristotle's medical theories continued to be upheld. Although doctors identified themselves primarily with a Hippocratic-Galenic medical tradition, there is proof in the treatises studied that Aristotle was still a powerful influence. (67) The same holds true for Arabic medical writers, especially Avicenna, their most distinguished representative in the sixteenth century. Sections of Avicenna's Canon and Rhazes' ad Almansorem continued to be a part of the curriculum of Portuguese universities, as they did in university curricula elsewhere in Europe. Garcia Lopes says of Avicenna that he was 'cultivated and revered'. The context in which this is said--a discussion on whether a clyster should always precede venesection, or only in certain cases--suggests once again that Arabic authorities were most relevant to practical medicine. (68)
Changes in academic medicine in sixteenth-century Portugal are slight and in general not easy to ascertain. Nonetheless, hints that they occurred are provided by a comparison of texts written in the first half of the sixteenth century with those produced after the middle of the century. I should like to consider first Joao de Barros' Ropicapnefma which, despite being a literary text, is an interesting source of enquiry into medicine in Portugal during the first decades of the sixteenth century. (69) The Ropicapnefma is an allegorical dialogue on moral philosophy, representing human existence in the form of trade deals. Its characters 'Will' and 'Understanding', having abandoned 'Reason' (that is, human reason enlightened by Christian revelation) for an association with 'Time', had become merchants of vice. At the end of life they meet 'Reason', who tries to lead them back to Christian faith and salvation. In this text Barros refers a number of times to the figure of the physician and the practice of medicine of the time.
Medical concepts referred to in the Ropicapnefma are simplified anatomical and physiological notions derived from Galen, such as the division of mental activity into distinct processes (common sense, imagination, fantasy, cognition and memory) allocated to specific sites within the brain. (70) The division of the powers of the mind into five distinct types seems to have been based on Avicenna's commentary on Aristotle's De anima. (71) A division of mental activity bearing on the same pattern, although using a threefold scheme (imaginative, estimative and mnemonic powers) is found in Resende's poem 'Microcosmographia' which, as already noted, was based on anatomical treatises written in the first half of the sixteenth century. (72) The medieval concept of the existence of different mental powers, allocated to distinct sites in the brain, does not occur in the remaining texts studied, most of them having been published, and presumably written, in the second half of the sixteenth century.
Antonio Luiz's medical treatises were written a decade after Barros' Ropicapnefma and, unlike texts written later in the century, here the mention of empirical observation is entirely absent. Luiz's works can also be taken as examples of an early sixteenth-century approach to medicine in Portugal with respect to the humanist aim of excluding spurious works from the canon of ancient authorities. Luiz seems to have accepted as Galen's the tract entitled An Animal Sit Id, Quod in Utero Est, which was falsely attributed to Galen. (73) This work is clearly referred to as not having been written by Galen in Rodrigo de Castro's De universa mulierum Medicina, which was published at the beginning of the seventeenth century. (74)
Finally, the question of change in medical knowledge in Portugal is illuminated by an analysis of the way doctors used and placed their confidence in analogical thought. GeoCrey Lloyd points out the existence of a connection between the development of scientific method in Greek thought and a somewhat more cautious use of analogical argument. He suggests that the clarification of certain logical relationships (particularly those of similarity and identity, and the different modes of opposition) occurred simultaneously with the growth of the 'demand for demonstrability' in Greek thought from the earliest times to Aristotle. (75) This illuminates the question of the growth of more empirical-observational approaches in Renaissance scholarship. A similar connection is postulated by Michel Foucault regarding developments in early modern Western thought. Foucault notes the emergence, during the seventeenth century, of a critical attitude towards language, which was thenceforth considered to represent things and phenomena instead of being a natural sign of them. A fundamental aspect of the development of scientific thought is the recognition that the linguistic sign is arbitrary, not essentially involved with the thing signified but bound to the conventions of a language. This is said to have replaced the tradition of commentary and the pre-eminence of resemblance, the main mode of addressing the world in the sixteenth-century, which is based on the idea of the existence of a substantial unity between words and things. (76) Hence differences between the Portuguese medical authors are illustrated by the different uses of analogy in their works, as well as the extent to which this occurs. (77) The most obvious example is the difference between the substantial number of representations of the human body based on analogy from the works of Antonio Luiz and a more cautious use of analogical reasoning in the works of some of the remaining authors, and most notably in Afonso de Guevara. Such difference is considered here to express the development of a certain concern with empirical observation in medicine, as the sixteenth century proceeds and prior to the decline of the academic establishment as a whole, at the end of the century.
Generally in Renaissance universities the medical curriculum did not express adequately the intellectual context of academic medicine, when considered in isolation from other aspects of this field. Although throughout Europe curricula were rather similar, the academic and professional atmosphere of the different medical faculties could vary widely. In certain cases, as Nancy Siraisi says, 'institutions in which an essentially medieval curriculum continued to be taught were simultaneously [...] centres of Renaissance innovation in anatomy, physiology, and medical education'. (78) In Portugal, unlike medical faculties elsewhere in Europe, the opportunities for changing the curricula came about during the process of remodelling and transfering the university from Lisbon to Coimbra, starting in 1537. Thus it is considered that the preservation of a basically medieval medical curriculum in Coimbra reflects, to an extent, the links between the teaching of medicine in Portugal and a framework inherited from the late medieval period, just as the introduction of innovations reflects Renaissance changes.
The medical curriculum in sixteenth-century Portugal is described in the university regulations of 1504 (which were essentially maintained when the university was transferred to Coimbra) and of 1559, as well as in royal decrees and acta of the university council. Other regulations promulgated by Joao III were put in place at Coimbra, 1544-45, but these are now lost.
A brief examination of textbooks and the relative importance and order of the creation of chairs at Coimbra illuminates the question of continuity and change in medical teaching in sixteenth-century Portugal. The first to be established, and the highest in the hierarchy, was the Cadeira de prima (1537), in which Galen's works were taught (Tegne; De locis affectis; De morbo et symptomate; De differentiis febrium; De simplicibus). The second chair in rank, and second to be established, the Cadeira de vespera (1538), was dedicated to the teaching of Hippocratic texts (Aphorisms, On regimen, Epidemics, and Prognosis) and Rhazes' ninth book of the Almansor. The Cadeira de terca (1540) was based on Avicenna's Canon. Other texts by Galen on therapeutics were read in two other courses, called 'minor chairs' (1546). One of them also included the teaching of Aristotle. (79) In 1556, a chair of anatomy was created (anatomical studies at Coimbra are discussed in more depth below). Surgery was read together with anatomy from 1557 onwards. This curriculum was, for the most part, retained in the university regulations of 1559. (80)
Needless to say, the emphasis on Galenic texts and Arabized interpretations of Galenic thought, which was the main feature of many courses at Coimbra, essentially conformed to late medieval and early Renaissance medical curricula throughout Europe. It reflects the growth of the branch of medicine concerned with the particulars of disease and treatment in European centres of learning, and in particular at Portuguese universities, especially in the fifteenth century. (81)
As already suggested, the development of anatomical studies in Portugal proved to be unsuccessful for a number of reasons. Aside from the factors already mentioned, in all probability the secondary role given to empirical observation in the medical faculty in general contributed to this. Yet the creation of a chair in anatomy between 1550 and 1556 suggests an attempt to introduce Renaissance innovations in medical teaching to Portugal. The appointment of an experienced teacher of anatomy trained in Bologna confirms the attempt to bring medical teaching up to date in relation to fashionable models of the time. It is also expressed by the adoption of a Renaissance Latin translation of Galen's De Usu Partium as a textbook. Such measures were accompanied by others, referred to in the university regulations of 1559. These stipulate that two anatomies on the bodies of patients who had died in the hospital should take place every year. The dissections should be attended by 'todos os lentes e estudantes de Medicina e Cirurgia e barbeiros e todos os mais, que commodamente poderem estar na dita casa'. Apart from anatomies of human bodies, six dissections of 'membros de animais brutos que lhe parecer que conformao mais com a compreicam humana' should be performed every year. (82)
However much these measures may represent the influence of new developments of the time, and Afonso de Guevara may have been committed at one time to anatomical observation, there is every indication that at the University of Coimbra the practice of anatomy was conceived as a 'teaching device' rather than a 'research device'. One of the essential differences said to exist between the anatomy practised in the Middle Ages and the Renaissance was the purpose of dissection. (83) Those who studied at Coimbra testify to the orientation of anatomical studies there: Miranda and Henriques refer to anatomy as necessary to medical training, to be able to demonstrate on the body what has been learned from a book. (84) Guevara relied heavily on the authority of Galen. Proof of his support of Galen's ideas is his book, which is a defence of Galen from Vesalius' criticism of his theory of human anatomy. That Galen's views were undisputed in Coimbra is also suggested by a passage from the Retrato del Perfecto Medico, in which Henriques claims that 'Sospechar, o presumir que Galeno no hizo anatomia en los cuerpos humanos, es ignoracia, y osarlo affirmar, es muy gra locura'. (85)
If anatomical dissections took place in the Hospital de Todos os Santos in Lisbon they seem to have been performed for teaching purposes. This is suggested by the work of Antonio da Cruz, who studied surgery in Lisbon. Cruz, whose work as a surgeon necessarily implied encounters with the human body, relies heavily upon the chapter on anatomy in Guy de Chauliac's Chirurgia Magna (1363) in the Recopilacao de Curgia. At the beginning of the seventeenth century, Cruz subscribed to the idea that the psychic spirit was produced from arterial blood in the rete mirabile, a network of blood vessels believed to exist at the base of the human brain, a notion which was viewed with scepticism by critics of Galen in the Renaissance. (86) On the other hand, along with ideas drawn from Greek and Arabo-Latin sources, Cruz refers to his own observations on anatomical dissections. (87) He also quotes from the Historia de la composicion del cuerpo humano (1556) of the Spanish anatomist Juan Valverde di Hamusco (c. 1520-c. 1588).
This brief account of anatomy at the University of Coimbra serves to illustrate that, as seems to be the case with other Renaissance medical curricula, the curriculum for medicine there did not express adequately developments in academic medicine, when considered in isolation. If anatomical dissections of the human body were practised in Coimbra they were in all likelihood rare, despite what was prescribed in the university regulations. This is not specific to Portugal. Concerning anatomical knowledge in England before 1640 Webster notes that, in the colleges at Oxford and Cambridge, 'dissection appears not to have been practised more than sporadically although the Edwardian statutes prescribed two anatomies for each incepting MD'. (88) In England, as in Portugal, the absence of anatomical studies resulted in the pre-eminence of Galen in general medical teaching.
Clinical instruction at Coimbra provides an example of a certain conflict between university regulations and the actual conduct and intellectual ambience of academic medicine. The main sources relating to clinical theory in Portugal are the university statutes of 1559 and 1591. Rocha Brito also refers to the teaching of medicine in the Hospital Real de Coimbra in acta of the university council of 1562, 1563 and 1567. (89) Although regular visits of teachers and students to the hospital are prescribed in the statutes, and the hospital is said to have been remodelled for this purpose with the transfer of the university to Coimbra, (90) none of the texts studied refers to the observation of patients in hospital. The few references to clinical observation which occur in these texts concern patients attended privately by the medical authors.
It may be helpful at this point briefly to examine the kinds of medicine practised in Portugal during the sixteenth century. It is evident that academically-trained physicians belonged to a very restricted group, when compared to the variety of practitioners who were in charge of the medical care of most people at that time. However, it is difficult to give an account of medical practises other than those performed by university-educated doctors. This is connected with the general difficulty of dealing with artisans in an historical work, since their method of transmitting knowledge was partly, if not exclusively, oral. A few sources provide information about surgeons, barbers, apothecaries and other people engaged in the practice of medicine who were not university-trained. In a description of Lisbon written c. 1552, Cristovao Rodriguez de Oliveira refers to the existence of fifty-seven physicians (most of whom, in all probability, had not acquired their training at university); (91) sixty surgeons; forty-six apothecaries; 197 barbers (including barber-surgeons and others); twenty-five midwives; and twenty women who administered the clyster ('cristaleiras'). (92) Henrique Jorge Henriques, in the Retrato del Perfecto Medico, notes that two thousand healers, whose medical knowledge was acquired without formal education, the so-called 'empirics', had been established throughout Portugal. (93) The regulations of the Hospital de Todos os Santos in Lisbon (examined below) and other documents such as the licences issued by the Chief Physician of the Realm, mention a variety of healers including nurses, people who administered the clyster, people who treated cataracts, hernia healers, specialists in different kinds of wounds, healers using herbs and the sign of the Cross, and so on. (94)
This account suggests that, along with a university education in medicine, there existed another kind of formal qualification for the practice of medicine, namely the possession of a licence from royal officials. The earliest recorded initiative by the public authorities to evaluate, attest to the competence, and legitimate the activities of medical and surgical practitioners in Portugal dates from 1392 (by Joao I). From this date a number of royal decrees were issued, ordering those who desired to practise medicine and surgery to be examined by the chief physician and the chief surgeon respectively, and thus obtain a licence ('carta de habilitacao'). Until 1559, this also applied to physicians who had graduated from university. It gave rise to conflicts between the medical faculty and the chief physician. (95) So far as I am aware there is no information in the Portuguese historiography of medicine on organizations of practitioners such as medical colleges and guilds during the sixteenth century.
As to the relationship between different kinds of practitioners, some information is provided by documents from the Hospital de Todos os Santos. This hospital was created by Joao II, who sought to organize it along the lines of the hospitals of Florence and Siena. It had four wards: one surgical; one clinical; a third ward for female patients having any treatment, except for venereal disease; and a fourth ward for cases of venereal disease. (96) The hospital regulations were established around 1504 and specify that two surgeons, two surgical apprentices, one barber-surgeon, one apothecary and nurses should comprise the staff, together with a physician and administrators.
A hierarchical organization of medical practice in the Hospital de Todos os Santos is suggested by its regulations and other administrative documents. Generally, university graduates in medicine occupied the highest places, followed by skilled surgeons, then barber-surgeons, and finally apothecaries and other practitioners. (97) This is also loosely consistent with the organization of the Hospital Real de Coimbra, according to its regulations and the chapters of the university statutes (of 1559 and 1591) concerned with clinical studies. (98) However, there is evidence of the growth of an elite of learned surgeons whose professional activities were valued in equal terms to those of graduate physicians. The importance of barbersurgeons increased as the sixteenth century proceeded.
Together with the sources above, Antonio da Cruz's Recopilacao de Curgia bears witness to the existence of a group of surgeons having a great deal in common with academic physicians. Antonio da Cruz studied surgery in Lisbon and in the Hospital of Guadalupe in Spain, and worked as a surgeon at the Hospital de Todos os Santos (1579-1626). (99) He seems to have been a pioneer among educated surgeons in Portugal. As noted earlier, he declared he had written his book in the vernacular to promote access to technical books by members of his class not skilled in Latin. Cruz was not, however, the only Portuguese surgeon to occupy a high position in the medical hierarchy. Furthermore, the nine editions of his Recopilacao de Curgia (1601-1711) constitute evidence of the increasing number of surgeons who sought books on surgery and were able to make use of them in the vernacular; but only the beginning of this development is within the temporal limits of this study.
The earliest official document on apothecaries in Portugal is a law of 1450, in which they are included in a list of places to be visited by tax collectors. In 1461 a division of the areas of competence of physicians, surgeons and apothecaries was determined in a royal decree. Regulations for apothecaries in the city of Lisbon were issued in 1497. These, like the decree of 1461, determined that apothecaries should prepare prescriptions written by physicians and surgeons, but only apothecaries were allowed to sell such preparations. Among the instruments considered necessary for the practice of apothecaries, the regulations of 1497 list five books by Arabic and other medieval authors between the tenth and fourteenth centuries, including the fifth book of Avicenna's Canon and a medieval compilation of Dioscorides and Galen. (100) These determinations were loosely repeated in other laws of the sixteenth century. They occur, for example, in the Alvara sobre os Fisicos of 1561, referred to above. Like surgeons and barber-surgeons, the importance of apothecaries in the medical hierarchy seems to have grown during the sixteenth century. Miranda's Dialogo da perfeycam... refers to a law conferring 'equal dignity' to apothecaries and physicians. (101)
The regulations and decrees mentioned in this section, as well as other sources such as the tract on astrological medicine from Valentim Fernandes' Reportorio dos Tempos, provide some information on the kinds of medical treatment generally practised in sixteenth-century Portugal. The Reportorio dos Tempos was an almanac containing useful day-to-day information for artisans. Its medical section is concerned with information on when and how phlebotomy, cupping and purgation should be performed. This was based on the doctrine of the influence of the twelve signs of the zodiac on parts of the body. The existence of this kind of data in a widely circulated almanac suggests that it was likely to be the most relevant to surgeons, barber-surgeons and other practitioners. Like the medical section in the Reportorio, the Pratica de Barbeiros of Manoel Leytao (1604) describes phlebotomy as among the 'most profitable medicines'. Leytao remarks that
Entre os remedios mais proveitosos, de que assim na Medicina, como na Chirurgia costumao os Medicos mais usar, he a sangria; porque conforme a doutrina de todos, antes que o remedio bocal se applica primeiro procede a evacuacao da sangria presuposto cristel, a assim a sangria he o melhor remedio, e o primeiro, que em as enfermidades se pode applicar. (102)
That phlebotomy was also an important therapeutic practice among university-educated physicians of the time is testified to by the controversy between Pierre Brissot and the chief physician Dionysio (referred to above). Other aspects of Portuguese academic medical treatises are consistent with this. Phlebotomy is mentioned as a therapeutic procedure in all the medical texts I have studied.
Finally, passages from Joao de Barros' Ropicapnefma suggest that therapies such as phlebotomy, cauterizing, and the application of ointments were current in Barros' context. (103) The range of healing techniques mentioned by Barros includes the use of theriac, the all-purpose medicine known to have been prescribed from late antiquity onwards. Theriac contained a great and varying number of ingredients, the principal one being viper's flesh. (104)
The relationship between Jews and medicine requires some comment, since Jewish practitioners were numerous in Portugal and many academic physicians belonged to this group. Here I shall focus on the intellectual domain.
The preponderance of Jews in Portuguese medicine appears to be connected with the general historical relaiton of the Jewish people with medicine and medical practice. The great number of Jewish practitioners in sixteenth-century Portugal is partly due to the expulsion of the Jews from Spain in 1492. (105) However, long before this date Portuguese kings employed Jewish medical practitioners and there were many of them, as well as Jewish surgeons, in the kingdom. (106)
The compulsory mass baptism of Jews at the end of the fifteenth century initially contributed to an increase in the economic and professional importance of the Jewish community in Portuguese society. During the period preceding the height of the Inquisition, Jewish scholars, officially considered 'neo-Christians' but in certain cases secretly preserving Hebrew tradition and custom, occupied prominent positions at court and in the university. For example, Antonio Luiz and Thomaz Rodrigues da Veiga, to mention two doctors whose works are analysed in this study, taught at the university despite being descendants of Jewish families. If Veiga's family had long severed relations with the Jewish faith, this seems not to have been the case with Antonio Luiz, whose Jewish ancestry was well known at the time. (107) The Jewish physicians Rodrigo de Castro and Garcia Lopes were held in high esteem among the Portuguese political elite. (108) Thus it may be said that the usual distinction between Jewish and Christian doctors, with the former excluded from the university, does not readily apply to Portugal. (109) Yet the only physician in whose work influences from the Hebrew religion and custom are found, Rodrigo de Castro, (110) was not a university teacher before leaving Portugal to live in Hamburg (c. 1588).
Much has been said of the historical relation of Jews to the knowledge and practice of medicine in various times and places, and in the Iberian peninsula during the medieval and Renaissance periods in particular. For this reason, some of the first questions I attempted to address in this study were: Is there a specific Jewish tradition in medicine? If so, of what does it consist? The answers to these questions are not straightforward. As noted by Harry Friedenwald, 'no medical works have come down to us from the ancient Hebrews. Our only sources of knowledge are such medical and hygienic references as are found in their sacred, historical and legal literature', of which the Bible is the most prominent. (111) Friedenwald provides evidence of the presence of Jewish physicians in Christian and Islamic societies, and their links with Greek and Arabic medical scholarship from late antiquity onwards. (112) These links mean that the most important ideas and written sources used by Jewish practitioners and scholars were drawn from Greek and Islamic medicine. Only a number of medical and medico-religious practices, particularly in the field of hygiene (baths, the direct prophylaxis of disease, the weekly day of rest), seem to have originated in ancient Jewish tradition. Thus it may be said that, strictly speaking, no separate Hebrew tradition in medicine developed and was received in Europe in the manner of the development and transmission of a Greco-Islamic tradition.
Isaac Judaeus (c. 850-c. 940), born in Egypt, and Moses Maimonides (1135-1204), who was born in Cordova and spent most of his adult life in Egypt, are two distinguished Jewish medical writers of the Middle Ages whose work testifies to the reliance of Jewish doctors upon ancient Greek medicine. The sixth aphorism of Judaeus' 'Guide for Physicians' (Musar Harofim) states that 'the best physician is he who busies himself in reading attentively most of the writings of the ancient physicians, especially the works of Galen, the prince of physicians'. The eleventh aphorism expresses the Hippocratic-Galenic confidence in nature's healing power: 'the physician does not make the cure. He merely prepares and clears the way for Nature, who is the real healer'. (113) Maimonides, whose principal medical work is the Aphorisms according to Galen, also shared the esteem for Greek physicians, especially Galen. (114) Both Judaeus and Maimonides had strong connections with Arabic medicine, the latter having written all his medical works in Arabic. (115)
A consequence of this, in the context of sixteenth-century Portugal, is that in general no influence other than Greco-Arabic, which could itself be said to have derived from a specific Hebrew medical tradition, is found in academic medical texts. The pre-eminent role of Jewish practitioners in Portugal is distinguished by its complex intersections with ethnic-religious conflicts between Christians and Jews. This is illustrated in a passage from Joao de Barros' Ropicapnefma, in which one character, who argues in support of secular values, the 'Will', asks ironically: 'Qual foi o medico judeu ou mouro que nao fosse a sua vista mais saudavel a um cristao infermo que a dum triste e carregado confessor?'. (116)
From the end of the fifteenth century some sources indicate an increasing distrust and suspicion of 'neo-Christian' physicians and apothecaries in Portugal. Royal decrees are one such source. In 1498, Manuel I, in response to a request of the assembly of nobles, commons and the clergy, forbade practitioners and apothecaries to write prescriptions in foreign languages. A decree of 1524, by Joao III, forbade possession of Hebrew books except for physicians and surgeons who did not know Latin, who were then allowed to retain their Hebrew medical books. (117) Measures such as these, restrictive and at the same time protective of the activities of converts, suggest that conflicting attitudes of antagonism and dependence existed towards them on the part of the Christian population.
The source for the most regrettable series of events testifying to Christian antagonism to Jewish practitioners is the Portuguese Inquisitional Rolls. Based on these records Harry Friedenwald notes that 'the idea that Jewish and Neo-Christian physicians deliberately poisoned their patients gradually developed into an elaborate myth which gained force with the confessions secured under torture'. Many were burnt at the stake after confessing to the murder of Christians. Many others left Portugal to settle elsewhere in Europe, often reverting to Judaism. (118)
The departure of so many Jews is regarded by some authors cited in this article as a factor contributing to the Portuguese cultural decline in the second half of the sixteenth century, in as much as it deprived Portugal of important scholars. As regards medicine, there is every indication that distinguished physicians such as Amatus Lusitanus, Rodrigo de Castro, and Garcia Lopes left Portugal because of religious persecution. (119) Generally, since medical procedures of varying kinds were to a great extent performed by Jews, persecution and distrust had an adverse effect upon Portuguese medicine as a whole. As in Spain, where Arabic medicine suffered as a result of religious persecution, in Portugal conditions became progressively less favourable to the preservation and development of medical scholarship and practice among Jewish practitioners. (120) Furthermore, such conditions are said to have discredited the medical profession in the eyes of the Portuguese people. (121)
The magnitude of ethnic-religious intolerance of Jews and its adverse effect upon scholarship are distinctive features of sixteenth century Portugal, in relation to other European countries. There is every reason to believe that these were decisive factors contributing to the direction in which medicine developed in Portugal at the end of the sixteenth century, which were by no means mirrored elsewhere in Europe. Developments in Portuguese medicine did not progress with changes in attitudes, moving towards the pre-eminence of empirical observation and experiment, which had generally occurred in Europe.
Another factor that appears to have contributed to the distinctive developments of Portuguese medicine is the revival of Aristotelianism advanced by the Jesuit Fathers, which implied the reinforcement of the traditional model of education in theology, law and science that prevailed from the end of the sixteenth century. An aspect of the growth of the Society of Jesus was its competition with the university for the dominant role in scholarly education. This affected the position of the university as the leading academic institution in Portugal.
Let us consider the specific conditions of the medical faculty together with changes in the university as a whole since, in general, the growth of specialized medical education was closely related to the development of medicine as a discipline and as a profession. (122) Concerning the course of medicine in particular, the Portuguese university had long competed with Spanish universities, particularly the University of Salamanca, which became renowned for medical teaching in the sixteenth century and offered a much shorter course in medicine than Coimbra. For these reasons, the medical faculty of Salamanca was in many ways preferred to Coimbra by both Portuguese and Spanish students. (123) Most of the medical writers referred to here graduated from Salamanca. Competition from Spanish universities in general also seems to have been a factor in the decline of medicine in Portugal.
Developments in branches of medicine, approaches and concepts were in many ways related to the more general cultural and institutional aspects outlined above. It is generally accepted that Renaissance medicine is distinct from medieval medicine not only because of the rediscovery of Greek texts promulgated by the humanists, but also because of the advances in practical anatomy, physiology and clinical observation, as well as medical botany. Of all these only the last can be said to have undergone a change of approach in the development of empirical-observation in Portugal, and this occurred in isolation to other areas of medicine. Developments in medicine during the Renaissance played a fundamental part in the process of extinction of Galenism. Because they either occurred marginally in Portugal, or did not take place at all, Galen continued to dominate medicine. New doctrines, although known by Portuguese thinkers, did not produce innovations in academic medical thought in Portugal.
Historical developments in the institutional and intellectual context outlined in this article are suggested by dates and places of publication of the medical treatises studied. Aside from Cruz's Recopilacao de Curgia (1601), the last two medical texts published in Portugal within the period of this study are Miranda's Dialogo da perfeycam...(1562) and Veigas's Commentarij in libros Claud. Galeni duos, de febrium differentijs (1578). From the date of the publication of the Dialogo da perfeycam... onwards, medical works by Portuguese authors were mainly published in Antwerp, where some of the Portuguese Jewish community had emigrated, and also in Hamburg, Lyons and Salamanca. As already suggested, factors contributing to these developments include the dependence on patronage and control by the sovereign, whose capacity to promote a wide number of projects was limited by political and economic reasons; the restoration of Aristotelian scholasticism; and the general decline of Portuguese society in the second half of the sixteenth century. Along with these, the exodus of Jews from Portugal represented a significant academic loss as a whole, and to medicine in particular. It might perhaps be said that, by the end of the sixteenth century, Portuguese medical authors existed almost exclusively outside Portugal, in the European countries in which many of them had settled. Portuguese doctors continued their work in more tolerant communities elsewhere in Europe. By accepting them, some of these communities created the conditions for an intellectual flourishing that would not occur in Portugal. (124)
(1) Jeronimo de Miranda, Dialogo da perfeycam e partes que sam necessarias ao bom medico (Lisbon: 1562), fols [10.sup.v]-[16.sup.r].
(2) Ian Maclean, The Renaissance Notion of Woman: A study in the fortunes of scholasticism and medical science in European intellectual life (Cambridge: Cambridge University Press, 1987), p. 2.
(3) Miranda, fol. [4.sup.r].
(4) Antonio Luiz, Problematum libri quinq (Lisbon: 1539).
(5) Enrique de Cuellar, Ad libros tres predictionum Hippocr. (Coimbra: 1543).
(6) Afonso Rodrigues de Guevara, In pluribus ex ijs quibus Galenus impugnatur ab Andrea Vesalio Bruxelesi in costructione & usu partium corporis humani, defensio (Coimbra: 1559). There was only one university in Portugal during the period covered by this study. Since its foundation in the late thirteenth century it had been sited alternately in Coimbra and Lisbon. The direct interference in the running of the university by the king appears to have begun during the reign of Manuel I (1495-1521), who promulgated new statutes c. 1504. In 1537, on the initiative of King Joao III, the university was transferred to Coimbra. The king was regarded as being deeply committed to its improvement, and was not only responsible for providing better material conditions such as installations and funds, but also appointing some of the staff. See A. Tavares de Sousa, 'A Transferencia da Universidade para Coimbra em 1537 e o Ensino da Medicina', in A Sociedade e a Cultura de Coimbra no Renascimento (Actas do Simposio Internacional) (Coimbra: Epartur, 1982), pp. 165-93 (pp. 166-67). The Society of Jesus in Evora founded a university in 1559, but its activities, begun some years later, are only of marginal interest to this study. See Antonio Jose Saraiva, Historia da Cultura em Portugal, 3 vols (Lisbon: 1950-62), ii, 208.
(7) Thomaz Rodrigues de Veiga, Opera omnia in Galeni libros edita (Lyons: 1587; Lyons: 1593).
(8) Pierre Brissot, Apologetica disceptatio, qua docetur per quae loca sanguis mitti debeat in visceru inflammationibus, presertim in pleuritite (Paris: 1525).
(9) Antonio Luiz, De Re Medica Opera (Lisbon: 1540).
(10) Garcia Lopes, Commentarii De Varia Rei Medicae Lectione (Antwerp: 1564).
(11) Alberto da Rocha Brito, A Faculdade de Medicina no Seculo XVI (Coimbra: Coimbra Editora, 1937), pp. 5-15; Jose Sebastiao da Silva Dias, Os Descobrimentos e a Problematica Cultural do Seculo XVI (Lisbon: Presenca, 1988), pp. 43-44.
(12) On the relationship of Brissot and Veiga with the Portuguese royal family, see respectively Maximiano Lemos, Historia da Medicina em Portugal: Doutrinas e Instituicoes, 2 vols (Lisbon: 1899), I, 302; and Harry Friedenwald, 'The Doctors Da Veiga', in Friedenwald, The Jews and Medicine. Essays, 2 vols (New York: Ktav Publishing House; Baltimore: Johns Hopkins University Press, 1967), I, 290-94.
(13) Garcia Lopes, fol. [6.sup.v].
(14) Guevara, dedication. On anatomical dissection as entertainment in the mid-sixteenth century, see Luke Wilson, 'William Harvey's Prelectiones: The Performance of the Body in the Renaissance Theater of Anatomy', Representations, 17 (1987), 62-95 (p. 69).
(15) Guevara, p. 269.
(16) On Guevara, see Lemos, I, 221-23; S. Costa Santos, O Inicio da Escola de Cirurgia do Hospital Real de Todos os Santos, 1504-1565 (Lisbon: 1925), p. 23; Rocha Brito, pp. 56-62.
(17) J. M. Teixeira de Carvalho, 'A Anatomia em Coimbra no Seculo XVI', Revista da Universidade de Coimbra, 2 (1913), 540-64 (p. 544).
(18) Henrique Jorge Henriques, Retrato del Perfecto Medico (Salamanca: 1595), p. 117. On praise of Veiga in medical works, see Lemos, Historia da Medicina, I, 313.
(19) Thomaz Rodrigues da Veiga, Tomvs primvs Commentariorvm in Clavdii Galeni opera,... Complectens interpretationem Artis medicae, & librorum sex De locis affectis (Antwerp: 1564); Commentarij in libros Claud. Galeni duos, de febrium differentijs (Coimbra: 1578); Commentarii in libros Hippocratis de victus ratione (Lyons: 1586); Opera omnia.
(20) Veiga, Opera omnia, preface.
(21) Paul Oskar Kristeller, Renaissance Thought and the Arts (Princeton: Princeton University Press, 1990), pp. 69-88.
(22) Americo da Costa Ramalho, Estudos sobre a Epoca do Renascimento (Coimbra: Imprensa da Universidade, 1969), pp. 33-41; 'A Introducao do Humanismo em Portugal', repr. from Hvmanitas, 23-24 (1972), 433-52; and 'Quelques aspects de l'introduction de l'Humanisme au Portugal', in L'Humanisme Portugais et l'Europe (Actes du xxie. Colloque International d'Etudes Humanistes, Tours, 1978) (Paris: Calouse Gulbenkian Foundation and Centre Culturel Portugais, 1984), pp. 33-49.
(23) Manuel Goncalves Cerejeira, O Renascimento em Portugal. Clenardo, 2 vols (Coimbra: Coimbra Editora, 1974-75), I, 13-16.
(24) Saraiva, II, 189-91.
(25) Kristeller, p. 73.
(26) Joaquim de Vasconcellos, Albrecht Durer e a sua Influencia na Peninsula (Coimbra: Imprensa da Universidade, 1929), p. 50.
(27) Cerejeira, II, 136.
(28) For a fuller account of humanism in Portugal in the Renaissance, see L'Humanisme Portugais et l'Europe.
(29) David W. Waters, 'Science and the Techniques of Navigation in the Renaissance', in Art, Science and History in the Renaissance, ed. by Charles S. Singleton (Baltimore: Johns Hopkins University Press, 1967), pp. 189-237 (p. 197).
(30) See Luis de Albuquerque, 'Sobre o Empirismo Cientifico em Portugal no Seculo XVI', in A Sociedade e a Cultura de Coimbra, pp. 9-25; and 'Science et Humanisme...', in L'Humanisme Portugais et l'Europe.
(31) Kristeller, pp. 90-91.
(32) Nicola Abbagnano, 'Renaissance Humanism', in Dictionary of the History of Ideas, ed. by P. P. Wiener, 5 vols (New York: Scribner, 1973), IV, 129-36 (p. 131).
(33) Brian Vickers, 'Introduction', in Occult and Scientific Mentalities in the Renaissance, ed. by Brian Vickers (Cambridge: Cambridge University Press, 1984), pp. 1-55 (pp. 3, 6).
(34) See Helder Macedo, Do Significado Oculto da Menina e Moca (Lisbon: Moraes, 1977), pp. 128-29.
(35) Garcia Lopes, fol. [1.sup.v].
(36) Luiz, fol. [3.sup.r].
(37) Owsei Temkin, Galenism: Rise and Decline of a Medical Philosophy (Ithaca and London: 1973), p. 100; R. K. French, 'De Juvamentis Membrorum and the Reception of Galenic Physiological Anatomy', Isis, 70 (1979), 96-109 (p. 97).
(38) Guevara, pp. 151, 171; Garcia Lopes, fol. 73v; Miranda, fols [17.sup.r]-[17.sup.v].
(39) On Pierre Brissot and his controversy with Dionysio, see J. B. de C. M. Saunders and C. D. O'Malley, 'Andreas Vesalius Bruxellensis: The Bloodletting Letter of 1539', in Studies and Essays in the History of Science and Learning, Offered in Homage to George Sarton on the Occasion of his Sixtieth Birthday, ed. by Montague Francis Ashley Montagu (New York: Schuman, 1947), pp. 3-74 (pp. 12-19); Lemos, I, 301-04; and Ricardo Jorge, 'Comentos a Vida, Obra e Epoca de Amato Lusitano', Arquivos de Historia da Medicina Portuguesa, New Series, 5th-7th years, (1914-16), vii, 49-52; and 'A Renascenca medica em Portugal (Pierre Brissot e Amato Lusitano)', Lusitania, 1 (1924), 187-92. The article by Saunders and O'Malley also deals with the concept of pleurisy. For Galen's views on the therapeutic properties of phlebotomy, see Jerome J. Bylebyl, 'The Medical Side of Harvey's Discovery: The Normal and the Abnormal', in William Harvey and His Age: The Professional and Social Context of the Discovery of the Circulation, ed. by J. J. Bylebyl (Baltimore and London: Johns Hopkins University Press, 1979), pp. 28-102 (pp. 42-43).
(40) See, for example, Rodrigo de Castro, De universa mulierum Medicina... (Hamburg: 1603), pp. 27, 37, 65.
(41) Lopes, fols [75.sup.r]-[78.sup.v].
(42) Maclean, p. 4.
(43) Miranda, fols [9.sup.r]-[9.sup.v].
(44) Luis Lobera de A vila, Libro de Anatomia. Declaration en suma breve de la organica y maravillosa composition del microcosmo o menor mundo, que es el hombre, ordenada por artificio maravilloso em forma de sueno o ficcion (1542); and Bernardino de Monserrate, Libro de la Anathomia del hobre (Valladolid: 1550). See Luis de Pina, 'As "Anatomias" de Avila (1542) e Monserrate (1550) e a "Microcosmografia" de Falcao de Resende', reprinted from Jornal do Medico, 41 (1942); and A Cultura Anatomica em Portugal no Seculo XVI e a 'Microcosmografia' de Andre Falcao de Resende (Coimbra: 1946), p. 61.
(45) R. Palmer, 'Pharmacy in the republic of Venice in the sixteenth century', in The Medical Renaissance of the Sixteenth Century, ed. by Andrew Wear, Roger French and Iain Lonie (Cambridge: Cambridge University Press, 1985), pp. 100-17.
(46) Siraisi, p. 17. See also Nancy G. Siraisi, 'The changing fortunes of a traditional text: goals and strategies in sixteenth-century Latin editions of the Canon of Avicenna', in Wear et al., pp. 16-41; and Wear, 'Explorations...', in Wear et al., pp. 118-45.
(47) Vivian Nutton, 'Humanist surgery', in Wear et al., pp. 75-99.
(48) Antonio da Cruz, 'Prologue', in Recopilacao de Cirvgia, 4th edn (Lisbon: 1630), reproduced in Costa Santos, A Escola de Cirurgia do Hospital Real de Todos os Santos 1565-1775 (Lisbon: 1925), p. 7.
(49) 'Introduction', in Wear et al., p. ix.
(50) Estatutos da Universidade de Coimbra (1559), (Coimbra: Universidade de Coimbra, 1963). On the practices of both the northern and the Italian model regarding the relationship between arts and medicine at the Portuguese university, see Silva Dias, A Politica Cultural da Epoca de D. Joao III, 2 vols (Coimbra: 1969), I, Chapter 5. On other European universities, see Schmitt, 'Aristotle among the physicians', in Wear et al., pp. 1-15 (p. 271, note 1).
(51) Estatutos da Universidade... (1559), pp. 314-21.
(52) N. G. Siraisi, Medieval and Early Renaissance Medicine (Chicago and London: University of Chicago Press, 1990), p. 66; Schmitt, p. 4.
(53) Schmitt, pp. 2-3.
(54) Images used by medical writers to express their views on this question are examined in Ligia Bellini, 'Representations of the Human Body in Sixteenth-Century Portugal' (unpublished doctoral thesis, University of Essex, 1992), Chapter 5.
(55) P. De Lacy, 'Galen's Platonism', American Journal of Philology, 93 (1972), 29; also 27-39.
(56) Panagyrica oratio elegantissima (Lisbon: 1539). For biographical information on Antonio Luiz, see Luis de Pina, O Quinhentista Professor Antonio Luis na Historia da Psicologia e da Psiquiatria (Coimbra: 1957); and Silva Dias, I, 228-39.
(57) This is expressed in the epigram accompanying the Problematum libri quinq, 'Sed tamen abstrusas rerum cognoscere causas/ Dum studeo...', fol. [2.sup.v]; and in his De Occvltis Proprietatibus (Lisbon: 1540).
(58) Silva Dias, I, 229-30.
(59) Luiz, De Re Medica..., fol. [91.sup.r].
(60) On Pietro d'Abano's Conciliator, see Schmitt, pp. 3-4 and note 18. The Conciliator is referred to by Luiz in De Re Medica..., fols [109.sup.r]-[15.sup.r].
(61) It is important to note, however, that this was not always the case. See Bellini, Chapter 4.
(62) Henriques, pp. 212-15.
(63) Antonio Joaquim Anselmo, Bibliografia das Obras Impressas em Portugal no Seculo XVI (Lisbon: Biblioteca Nacional, 1926) refers to twelve editions (numbers 113, 229, 231, 238, 408, 558, 566, 578, 628, 647, 666, and 679) between 1518 and 1593. Alberto Navarro refers to nine editions, between 1518 and 1573; he also quotes J. Bensaude's opinion that there existed eleven sixteenth-century editions of the Reportorio: 'Os Reportorios dos Tempos', in Navarro, Ensaios Bio-Bibliograficos (Lisbon: 1961), pp. 9-57 (pp. 23-28).
(64) For an analysis of the medical contents of the Reportorio dos Tempos, see Bellini, pp. 133-38.
(65) Miranda, fols [10.sup.v]-[11.sup.r.]
(66) Wear et al., p. xi.
(67) Bellini, Chapter 5.
(68) Garcia Lopes, fols [41.sup.r]-[44.sup.r] (fol. 42r).
(69) An analysis of Barros' Ropicapnefma from the point of view of the medical knowledge of the time is found in Y. David-Peyre, 'Le Theme de la Maladie et le Personnage du Medecin dans Ropica Pnefma', Bulletin des Etudes Portugaises, 27, New Series (1966), 89-118.
(70) Joao de Barros, Ropicapnefma (Lisbon: 1532), facsimile edition, modernized text, notes and study by Israel S. Revah, 2 vols (Lisbon: 1952, 1955), II, 34; also 29-34. According to Barros, 'Ropicapnefma' is an expression derived from Greek meaning 'spiritual merchandise' (p. 6).
(71) See Siraisi, Medieval and Early Renaissance Medicine, p. 82.
(72) Andre Falcao de Resende, Microcosmographia (Coimbra: [1865]), pp. 3-62 (Canto II. 25-26).
(73) Luiz, De Re Medica..., fol. 81v. See also Galeni liber falso adscriptus an animal sit id, quod in utero est, in Claudii Galeni Opera Omnia, ed. by C. G. Kuhn, 20 vols (Leipzig: 1821-33), XIX, 158-81.
(74) Castro (list of authors quoted in the book).
(75) Geoffrey Ernest Richard Lloyd, Polarity and Analogy: Two Types of Argumentation in Early Greek Thought (Cambridge: Cambridge University Press, 1966): see the conclusion to Part Three. Also relevant regarding the use of analogy in science are Agnes Arber, 'Analogy in the History of Science', in Studies and Essays [...] Offered in Homage to George Sarton, pp. 219-33; and Mary Brenda Hesse, Models and Analogies in Science (Notre Dame: University of Notre Dame Press, 1966).
(76) Michel Foucault, The Order of Things: An Archaeology of the Human Sciences (London: 1989), p. 78. For the relationship between language and reality as a key issue in the differentiation between occult and scientific cognitive processes, see Vickers, 'Analogy versus identity: the rejection of occult symbolism, 1580-1680', in Occult and Scientific Mentalities, pp. 95-163.
(77) This issue is explored in more depth in Bellini, Chapter 5.
(78) Siraisi, Medieval and Early Renaissance Medicine, p. 192.
(79) Lemos, pp. 170-79; Rocha Brito, pp. 21-22.
(80) Estatutos da Universidade... (1559), pp. 295-302.
(81) Siraisi, Medieval and Early Renaissance Medicine, p. 152.
(82) Estatutos da Universidade... (1559), pp. 300-02. On anatomical studies at the University of Coimbra, see also Rocha Brito 'As primeiras disseccoes humanas na Universidade de Coimbra. O primeiro teatro anatomico', Folia Anatomica Vniversitatis Conimbrigensis, 17 (1942), note 4.
(83) French, p. 109.
(84) Miranda, fols [13.sup.r]-[13.sup.v]; Henriques, pp. 208-10.
(85) Henriques, p. 212.
(86) Cruz, Recopilacam de Cirurgia (Lisbon: 1688), pp. 23-24. For a discussion of the notion of the rete mirabile and its function, see Temkin, pp. 141-42.
(87) Cruz, pp. 25, 34, 35.
(88) Charles Webster, The Great Instauration: Science, Medicine and Reform 1626-1660 (London: Duckworth, 1975), p. 121.
(89) Rocha Brito, A Faculdade..., pp. 22-26; and Estatutos da Universidade... (1559), pp. 311-14.
(90) Teixeira de Carvalho, III, 581-82.
(91) In 1540, the Faculty of Medicine had only ten students, out of a total of 612 in the entire University of Coimbra. Teophilo Braga, Historia da Universidade de Coimbra nas suas relacoes com a instrucao publica portuguesa, 4 vols (Lisbon: 1892-1902), I, 466. One should note, however, that many Portuguese physicians graduated from the University of Salamanca.
(92) Svmmario e qve brevemente se contem alguas covsas (assi ecclesiaticas como secvlares) que han a cidade de Lisboa (c. 1552), quoted in Costa Santos, 'Sobre barbeiros sangradores do hospital de Lisboa', Arquivos de Historia da Medicina Portuguesa, New Series, 12th year (1921), pp. 129-35 and 171-82; 13th year (1922), pp. 1-19, 7.
(93) Henriques, p. 110.
(94) M. Ferreira de Mira, Historia da Medicina Portuguesa (Lisbon: 1947), pp. 99-100.
(95) Lemos, I, 78-81, 189-91, 211-12; Tavares de Sousa, p. 168; Alvara sobre os Fisicos, Lisbon, 12 July 1561; Ley passada nouamente sobre os fisicos da vniuersidade de Coimbra anno de 1566, Lisbon, 28 April 1566.
(96) Ruy Diaz d'Ysla, Tractado cotra el mal serpentino... (Sevilla: 1539); and Oliveira, Svmmario..., quoted in Lemos, I, 155-59; and an excerpt from Francisco Moncon, El principe christiano (1544), Archivos de Historia da Medicina Portuguesa (1894), IV, 20-26.
(97) Lemos, I, 155-60; Costa Santos, O Inicio da Escola...; and 'Sobre barbeiros...'.
(98) Teixeira de Carvalho, III, 582; Estatutos da Universidade...(1559), pp. 311-14; and Rocha Brito, A Faculdade..., pp. 23-26.
(99) Lemos, II, 9; Costa Santos, A Escola..., pp. 4-6.
(100) Ferreira de Mira, pp. 57-59.
(101) Miranda, fol. [10.sup.r].
(102) Pratica de Barbeiros (Lisbon: 1604), quoted in Costa Santos, 'Sobre barbeiros...', pp. 129-30.
(103) Barros, pp. 39, 47, 79, 134.
(104) For a description of the theriac, see Charles Joseph Singer and Edgar Ashworth Underwood, A Short History of Medicine (Oxford: Clarendon Press, 1962), pp. 675-76.
(105) Jorge, pp. 19-20; and Pina, 'Alguns Aspectos Historicos das Relacoes Medicas Luso-Espanholas', Revista de Las Ciencias, 18 (1952), 397-411 (pp. 398-99).
(106) Ferreira de Mira, pp. 50-52; Friedenwald, 'History of the Jewish physicians of Spain, Portugal and Southeastern France', in Friedenwald, II, 613-700 (pp. 691-94).
(107) Silva Dias, A Politica Cultural..., I, 229.
(108) Lemos, I, 257-59, 307.
(109) On the exclusion of Jews from teaching in faculties of medicine in Europe, see Siraisi, Medieval and Early Renaissance Medicine, pp. 58-59.
(110) Bellini, Chapter 4.
(111) Friedenwald, 'The Bibliography of Ancient Hebrew Medicine', in Friedenwald, I, 99-145 (p. 99).
(112) Friedenwald, 'Jewish physicians in Italy: their relation to the Papal and Italian states', pp. 551-612 (pp. 551-88), and 'History of the Jewish physicians of Spain...' both in Friedenwald, II. See also Siraisi, Medieval and Early Renaissance Medicine, pp. 29-31.
(113) 'Guide for Physicians (Musar Harofim) by Isaac Judaeus ([880]-[932]). Translated from the Hebrew, with Introduction, by Saul Jarcho', Bulletin of the History of Medicine, 15 (1944), 180-88 (pages 183 and 184 respectively).
(114) Friedenwald, 'Moses Maimonides the Physician', in Friedenwald, I, 193-216 (pp. 201-16).
(115) Friedenwald, 'Moses Maimonides the Physician' and 'Manuscript copies of the medical works of Isaac Israeli', in Friedenwald, I, 185-92.
(116) Barros, II, 28.
(117) Friedenwald, 'History of the Jewish physicians of Spain...', in Friedenwald, II, 696.
(118) Friedenwald, 'History of the Jewish physicians of Spain...', in Friedenwald, II, 697-98.
(119) Lemos, I, 228, 259, 307.
(120) On morisco medicine as part of the general process of alienation of morisco culture in sixteenth-century Spain, see L. Garcia Ballester, Historia social de la medicina en la Espana de los siglos XIII al XVI (Madrid: 1976), I; and 'Academicism versus empiricism in practical medicine in sixteenth-century Spain with regard to morisco practitioners', in Wear et al., pp. 246-70.
(121) Lemos, I, 185.
(122) For the classic example of Italy, see Bylebyl, 'The School of Padua: humanistic medicine in the sixteenth century', in Health, medicine, and mortality in the sixteenth century, ed. by Charles Webster (Cambridge: Cambridge University Press, 1979), pp. 335-70 (pp. 336-38).
(123) Lemos, I, 182-84; and Jorge, pp. 40-62.
(124) I received financial support from the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico--CNPq, of the Ministry for Science and Technology of Brazil, for this research.
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I first thought it was the QD too, but the OP says he hooked up the gas line to his liquid QD and the gas is getting through fine. But I'm totally stumped on this one...unless something is blocking the pickup tube that moves when you push gas in, and gets sucked back when trying to get beer out....
OK - thanks for all the help and advice. I decided today to rack the beer out into a fermenter and disassemble the Keg to see whats was wrong. Turns out that the O-Ring that sits between the tube (long curved tube) on the Liquid Out had spilt and seperated. I guess gas was mixing with the beer at the post as there was no seal! - I replaced the seal, and then cooled the keg down and put under pressure....today NO PROBLEM! perfect beer - Perfect carbonation - EXCELLENT! I feel so much better now.

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no, that is not how it gets through breastmilk. It gets passed through breastmilk because it's in the bloodstream.
was the engorged tick that was on the dog the "larger dog tick"? (I'm assuming) because they don't carry lyme disease, or are you just worried since it has the dogs blood in it that has lymes?
Its the smaller deer tick (or black legged tick that carries Lymes)
I would really love to know the outcome of the tick issue our great grandaughter just did the same thing and I am really concerned please let me know r-mail me at jerjazz@comcast. thank you
Well this is still an issue for me about my great grandaughter chewing on the engorged tick, although everyone that I talked to today has said the same thing that the stomach acids would kill any bacteria and issues with the blood, I hope so.
I called poison control, Vet, pediatrician and looked online for answers. I hope that if anyone else has questions regarding this issue this will help to calm your mind. If anything occurs from this episode I will be sure to post to let others know.
The research I did at the time this happened seemed to indicate that children under six months of age may not make enough stomach acid to kill the spirochete, but around six months of age the stomach acid ramps up, and transmission does not occur after that time. This conclusion was based on studies they did in mice.
I also ended up remembering that hunters have eaten rare deer meat without getting lyme, which supports the theory that stomach acid destroys it. For us, the lyme was coming from the blood of our dog, which my baby had swallowed, so eating rare deer meat was an apt comparison, and made me feel better. FWIW.
He hasn't had anything that seemed like lyme symptoms since then, although I did treat him for intestinal parasites (because I had parasites, and because I remembered that he could get intestinal parasites from a dog's blood). When I treated him for intestinal parasites, some rashes he had cleared up, he gained some weight, and the circles under his eyes disappeared. I don't know whether he got the parasites from me in utero or from swallowing the dog's blood, but it seemed he had them. Hope this helps!
Glad to hear your DS didn't show any symptoms of lyme's. Do you mind sharing how you treated him for the parasites? Thanks.
I'll second the parasite option as a great way of keeping the immune system functioning at it's peak ANYWAY. Traditionally people did parasite cleanses once or twice a year at least *along with* using herbs and spices in cooking that would keep them at bay. We just don't do that anymore and I don't think it benefits us at all.
Mbravebird Thank you so much for sending me your answer, I would be very interested in the parasite cleanse you gave
to your child in case we may need to do that also. Again thank so much oh how long has it been since your child had this issue?
My whole story of the parasite issue with myself is at http://www.howigotmyhealthback.com .
There are lots of treatment options there, but when I treated the baby I just did the very basic simple ones that I knew were safe -- the dried papaya seeds, and occasionally some cloves. I would grind them up (I used a mortar and pestle) and give it to him sandwiched between either coconut milk ice cream or a blob of honey, and then chase it with some water (the cloves can burn, so don't let them stay in the mouth for too long.) He loved it, as long as it didn't stay in his mouth long enough to let him taste the ground up stuff.
He's 21 months now, and it was just a couple of months ago that I did about two weeks of the above parasite treatment for him. It was a year ago that he swallowed the dog's blood, so he was 9 months old then.
Yes, this! Not doing parasite cleanses or incorporating as much parasite-discouraging foods is a real change from the way it used to be. We've developed cultural amnesia about it. 60% of people who have chronic hives test positive for parasites, and when treated all 60% stop having hives. And yet when we go to the doctor for a hives issue, they don't even know about those stats. I too think that we should all be doing more regular parasite cleanses -- not in a fear based way, but just in a self-care way.
absolutely-there doesn't need to be any fear involved. You can do it with the changes of the season to get into a rhythm. Think about the longest and shortest days of the year to start a gentle process. It is a way oh honoring our bodies (and our ancestry!) and will benefit us greatly.
I also take daily measures (diet and clay) to make sure I'm functioning at my peak because it's just how I feel better.
I don't generally use herbs, but I do love them for this particular issue. In moderation. Homeopathy and flowers are also amazing assets.


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