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Atlas of Common Pain Syndromes 3rd Edition Steven P.
Waldmann Digital Instant Download
Author(s): Steven P. Waldmann
ISBN(s): 9781455733552, 1455733555
Edition: 3rd
File Details: PDF, 35.64 MB
Year: 2011
Language: english
 Atlas of
Common Pain
Syndromes
This page intentionally left blank
 Atlas of
Common Pain
Syndromes
Third Edition
Steven D. Waldman, MD, JD
Clinical Professor of Anesthesiology
Professor of Medical Humanities and Bioethics
University of Missouri—Kansas City School of Medicine
Kansas City, Missouri
 1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899

Atlas of Common Pain Syndromes ISBN: 978-1-4377-3792-9

Copyright © 2012, 2008, 2002 by Saunders, an imprint of Elsevier Inc.

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This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using
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they should be mindful of their own safety and the safety of others, including parties for whom they have a
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Library of Congress Cataloging-in-Publication Data

Waldman, Steven D.
Atlas of common pain syndromes / Steven D. Waldman. – 3rd ed.
   p. ; cm.
 Includes bibliographical references and index.
 ISBN 978-1-4377-3792-9 (hardcover : alk. paper) 1. Pain–Atlases. I. Title.
[DNLM: 1. Pain–Atlases. 2. Syndrome–Atlases. WL 17]
 RB127.W347 2012
616'.0472–dc23 2011016163

Acquisitions Editor: Pamela Hetherington

Developmental Editor: Sabina Borza
Publishing Services Manager: Anne Altepeter
Team Manager: Radhika Pallamparthy
Senior Project Manager: Doug Turner
Project Manager: Antony Prince
Design Direction: Ellen Zanolle
Illustrator: Jennifer C. Darcy

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

 To Tillie Waldman……….
Devoted mother, grandmother,
and lover of animals, antiques, and dining out!
This page intentionally left blank
Preface

To help practitioners move beyond the constraints of our ­common Z-pack and ­completed a course of Avelox. She went to the student
diagnostic construct is the motivation for Atlas of Common Pain health service on two separate ­occasions, and both times the doc-
Syndromes. The first contemporary pain ­management text to tor ­concurred with the working diagnosis of bronchitis or early
focus on pain diagnosis rather than treatment, the first edition of pneumonia. A ­subsequent trip to the local emergency department
Atlas of Common Pain Syndromes was in a way a “coming of age” yielded the same diagnosis. Her admitting diagnosis to the inten-
text for the ­specialty of pain management. In fact, the ­editors at sive care unit was for respiratory failure. Antibiotics were given,
Elsevier and I seriously questioned whether a bunch of “needle and breathing ­treatments ­administered. Finally, a ­second-year
wavers and pill pushers” would have any interest in actually diag- medical student suggested that perhaps all this coughing was the
nosing pain as the focus of the specialty. Our fears were unjus- result of whooping cough, which she had just read about in her
tified because both Atlas of Common Pain Syndromes and Atlas medical microbiology class. At first, everyone laughed and rolled
of Uncommon Pain Syndromes have found their place among their eyes…….Two beats……silence and then……the correct
the best-selling textbooks on the subject of pain. In the totally diagnosis was made.
revamped ­third edition, we have included: You may be wondering why I include this story in the
• Eighteen new chapters ­preface to a book about pain management. It seems to me that
• A completely refreshed full-color art program that empha- we, as medical practitioners, continue to limit ourselves to
sizes the anatomic ­relationship with the actual pain ­specific, ­personalized constructs that each of us devise to diag-
syndrome nose ­painful conditions. Within our constructs is the frequent
• Greatly expanded physical ­examination ­sections with many ­admonition against ­hunting for zebras when we hear hoof
new full-color photographs and ­illustrations to make it eas- beats, to move toward the center of the bell curve, to cleave to
ier for the clinician to render the correct pain d
­ iagnosis ­evidence-based medicine. However, if taken to extremes, these
• More extensive use of radiographic imaging, including ­parameters limit how we process our patients' histories and the
many new ­ultrasound images acknowledging the emerging scope of our diagnoses. It is my hope that the third edition of
role of this imaging modality in the diagnosis of painful Atlas of Common Pain Syndromes will continue to help clinicians
conditions. ­recognize, ­diagnose, and treat painful conditions they otherwise
And, for the first time, the user can access the entire ­contents of would not have even thought of and as a result provide more
the book on Expert Consult at www.expertconsult.com. effective care for patients in pain.
Recently, a medical student told me that, after several weeks
of confusing diagnoses, she was finally diagnosed with ­pertussis.
Now keep in mind that we are located in Kansas City, not
Acknowledgment
Bangladesh. I asked several questions. “Were you immunized as I want to give a special thanks to my editors at Elsevier, Pamela
a child?” Yes. “Had you recently traveled abroad?” No. “What Hetherington and Sabina Borza, for their keen insights, great advice,
was the pertussis like?” Horrible! Having never seen a case of and amazing work ethic.
­pertussis, I then asked the most obvious question. “How was it
diagnosed?” The student initially thought that she had picked
up a bad case of ­bronchitis on her pediatrics rotation. She took a Steven D. Waldman, MD, JD

vii
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Random documents with unrelated
content Scribd suggests to you:
specimen that a man of letters could give of refined and polished
diction may be questioned, but he goes on to remark (in a sentence
which, considering the zeal of its writer for grammatical accuracy,
exhibits a rather remarkable confusion of tenses),—“the writers of
the thirteenth century display an incredible ignorance, not only of
pure idiom, but of the common grammatical rules. Those who
attempted to write verse have lost all prosody, and relapse into
Leonine rhymes and barbarous acrostics. The historians use a hybrid
jargon intermixed with modern words. The scholastic philosophers
wholly neglected their style, and thought it no wrong to enrich the
Latin, as in some degree a living language, with terms that seemed
to express their meaning.... Duns Scotus and his followers in the
next century carried this much further, and introduced a most
barbarous and unintelligible terminology, by which the school
metaphysics were rendered ridiculous in the revival of literature.”
That the thirteenth century witnessed a great decay of Latinity is
not to be denied, though, as has been before shown, this decay and
the neglect of classical studies had set in before the rise of the
mendicant orders and is in no way to be attributed to them. Oxford
enjoyed the reputation of talking the very worst Latin in Europe,
whence arose the proverb, Oxoniensis loquendi mos. Certainly, if the
grammatical errors condemned in the visitation articles of John of
Peckham, as reported by Wood, were common in the schools, there
is not much to be said in their defence. The prevalence of law
studies, too, helped on the decline of rhetoric, for the diction of the
jurists was, if possible, worse than that of the scholastics; and the
inferiority, apparent during the reign of Edward II., in the schools of
divinity, philosophy, and arts, is attributed by the learned Dominican,
Holcot, to the over-abundance of law lectures. Granting, however, a
full share in the corruption of Latinity to have been the work of the
schoolmen, it is difficult to understand how they can be said to have
committed a “wrong” by “enriching the Latin with terms which
seemed to convey their meaning.” It is usually supposed to be the
object of language to convey one’s thoughts, and writers who had to
express the nice distinctions of Christian theology would have been
puzzled had they been bound to confine themselves to the
Ciceronian phraseology. They did, therefore, what Cicero himself had
done before them, and coined words and idioms to express ideas
which were not current in the Augustan age. The writings of the
scholastics must be regarded as in some sort scientific works, in
which the object was not elegance of style, but accuracy of sense.
We are not, therefore, necessarily to conclude that the Latin of Duns
Scotus was an example of the best that the age could produce; on
the contrary, many instances might be cited to prove that even this
unfortunate thirteenth century possessed scholars whose Latin was
at least as pure as the English of some of their critics. Thus the Bull
of Gregory X. for the canonisation of St. Louis, is cited by M. Artaud,
the biographer of Dante, as “a very model of pure Latinity.” Cicero’s
Rhetoric was so far from being devoured by the moths, that it was
almost the very first work chosen for translation into Italian prose,
and appeared in the vulgar idiom in 1257, the translator being
Galeotto, the professor of grammar at the university of Bologna. But,
putting aside all exceptional cases of those who still studied and
imitated the classics, may we not reasonably complain of the
narrowness of that criticism which stigmatises as barbarous
everything which does not belong to one style, or reflect the
phraseology of one arbitrarily chosen period? “It is strange,”
observes Rohrbacher, “that every one supposes and repeats that the
scholastics and the cloisters of the Middle Ages produced no book
capable of pleasing the world and becoming popular; and yet, for
centuries past, the world has read and delighted in a book of
scholastic morality, composed in the Middle Ages by a monkish
superior for the use of his novices, and that this book which has
been read, known, and admired by everybody, is especially a popular
book; and has been translated into every language, and gone
through thousands of editions.” He is speaking of the Following of
Christ, which, according to very probable conjectures, appears to
have been composed in the thirteenth century, by John Gersen of
Cabanaco, abbot of the Benedictine abbey of St. Stephen, at Vercelli.
[253]
 Again: among the writers who displayed such incredible ignorance
as to write Leonine verse were the authors of a sacred poetic
literature which will defy all the attacks of time, and which no classic
revival can ever render obsolete. The “Dies Iræ,” the “Ave Maris
Stella,” the “Stabat Mater,” the “Veni Sancte Spiritus,” the “Hymns of
the Blessed Sacrament,” and those innumerable sequences so
familiar to every Christian ear, owe nothing of their inspiration to
classic sources. It is even possible that they may set at defiance the
rules of Latin prosody; but all sense of harmony must be destroyed
before we can designate the language in which they are composed
as a “hybrid jargon.” And who were the writers of these exquisite
compositions, which gave a voice to popular Christian devotion, and
still preserve, like some choice balm, not merely the dogmas of the
faith, but the very unction of a believing age? They were, for the
most part, monks, schoolmen, and friars, the very men who stand
charged with a conspiracy against literature and common sense. St.
Peter Damian, Adam of St. Victor, Pope Innocent III., the Franciscan
Jacopone, the Dominican St. Thomas, and we may add, the gifted
and unfortunate Abelard, the very type and representative of the
earlier scholastics—these are the barbarians to whom we are
indebted for that mediæval lyric poetry, much of which has been
incorporated into the office of the Church. In the seventeenth
century France grew ashamed of her ancient hymnology, and
committed the task of liturgical reform to Santeuil, the half-scholar,
half-buffoon, to the Jansenist Coffin, and the Deist De Brienne. The
hymns of Fortunatus and St. Ambrose were then exchanged for
studied imitations of Horace, from the pen of a writer who boasted
that he was ready to be hung up at a lamp-post if he were detected
in writing a single bad verse, though one of his Jesuit critics has
cruelly enumerated no fewer than a hundred and eight. But
whatever be the merit of his poetry, the Catholic sense has long
since passed its verdict on the question, and declared the unction of
the ancient lyrics to be worth the pure Latinity of a thousand such
writers as Jean Baptiste Santeuil.[254]
 Both orders of Mendicant Friars gave to the English Church great
prelates as well as great scholars; Kilwarby the Dominican and
Peckham the Franciscan, two of the grandest of our English
primates, may be taken as fair representatives of their respective
orders. In the first we see the Oxford and Paris doctor, learned in
scriptural and patristic lore, the “great clerk,” as Godwin calls him,
who “disputed excellently in divers exercises,” and who, as primate,
distinguished himself by his bold, uncompromising resistance to the
tyranny of powerful nobles, and his efforts for the advancement of
learning and the correction of public morals. After filling the see of
Canterbury for six years, “he was obliged to fly from the king’s
anger,” says Harpsfield, and, retiring to Rome, resigned the English
primacy and became Cardinal Bishop of Porto.[255] His successor
was the Franciscan, John of Peckham, appointed like himself by
papal provision. How little was there of a worldly spirit in these
appointments, so loudly and captiously condemned, when a Pope
could put aside so powerful a personage as Robert Burnel, the
chancellor of the greatest king of England who had reigned since the
Conquest, in order to promote one, by birth a poor Sussex peasant,
whose only recommendations were his exquisite scholarship and his
saintly life! Peckham’s learned reputation was not indeed of an
ordinary kind. He was a doctor both of Paris and Oxford, and a pupil
at the latter university of St. Bonaventure; he had made the tour of
all the Italian universities, and in the Pope’s own palace had lectured
on sacred letters to a crowd of bishops and cardinals, who were
proud to call themselves his pupils, and who every day as he passed
through their ranks to his pulpit arose from their seats to show him
reverence. Wadding speaks of his singularly noble countenance and
graceful demeanour, and adds that, besides his other learned
acquirements, he was an excellent poet.
His appointment to the primacy being, strange to say, unopposed
by the Crown, he began his administration by calling a Provincial
Synod, among the acts of which is that memorable one which
enjoins every parish priest to explain to his flock the fundamentals of
the Faith, laying aside all the niceties of school distinction, and which
draws out in admirable and lucid terms what may be called an
abridgment of Christian doctrine, under the heads of the Creed, the
Ten Commandments, the Two Evangelical Precepts, the Seven Works
of Mercy, the Seven Deadly Sins, and those that proceed from them,
the Seven Contrary Virtues, and the Seven Sacraments.[256]
Moreover, we find him appointing parochial schoolmasters in holy
Orders for teaching the children of the poor.
Peckham not only visited his whole diocese, but travelled over the
greater part of England, informing himself of the exact state of
cathedrals, monasteries, clergy, and people, and making war on
pluralism, and every other abuse which be discovered. He also
showed himself very active in reforming the disorders that had crept
into the universities, and at his visitation, held at Oxford in 1283,
condemned a considerable number of false propositions, as well in
theology, as in grammar, philosophy, and logic. His fearless
independence of character did not shrink from presenting a
remonstrance against the tyranny of Edward I., and administering a
rebuke to the great Earl of Warren for allowing his deer and cattle to
trample down a poor man’s field of corn. The immense list of his
works, as given by Pitseus, shows that he was not of the number of
those who neglected the arts. Besides his “Concordance of the
Scriptures,” and his theological and scholastic works, there are
poems, treatises on geometry, optics, and astronomy, others on
mystical divinity, others on the pastoral office intended for the use of
the parochial clergy, and some apparently drawn up to facilitate the
instruction of the poor. Yet this illustrious man, undoubtedly one of
the greatest of our English primates, was never in private life
anything but the simple Friar Minor. “He was stately in gesture, gait,
and outward show,” says Harpsfield, “yet of an exceeding meek,
facile, and liberal temper.” At his own table sumptuously furnished
for his guests, he ate only the coarsest viands, always travelled on
foot, and chose to perform the humblest offices in his cathedral
church, such as lighting the waxen tapers on the altar. It is a
significant fact, that he always retained a prebend attached to the
see of Lyons, in case he might at any time be forced to fly from
England; and Godwin tells us, that after his time this benefice
continued annexed to the see of Canterbury, in order to provide
against the case of the more than probable exile of the Primates.
Our last specimen of an Oxford Don of the thirteenth century shall
be taken from a different class; no Worcestershire yeoman, or
Sussex peasant boy, but the son of the greatest and noblest of the
English barons, Cantilupe, Earl of Pembroke, marshal and protector
of the realm during the stormy minority of Henry III. Thomas
Cantilupe, his eldest son, was educated first at court, and then at
the universities of Oxford, Paris, and Orleans; and whether at court
or in the schools, he displayed the same piety and delicacy of
conscience. Deeply learned both in canon and civil law, he was
raised by king Henry to the post of Lord Chancellor, and was also
elected Chancellor of the University of Oxford. But on the accession
of Edward I. he obtained leave to resign his dignities, and retired to
Oxford, where he trusted he might spend the rest of his life in the
practice of study and devotion. He took his degree of Doctor of
Divinity in the church of the Dominicans, on which occasion his old
master and spiritual director, Robert Kilwarby, then Archbishop of
Canterbury, was present, and scrupled not publicly to declare his
belief that he had never forfeited his baptismal innocence. He was
then fifty-four years of age. “So help me God,” were the archbishop’s
words, “I believe him to be this day as pure from all actual sin as on
the day of his birth. And if any man ask, let him know that from his
childhood I have heard his confessions, and read his life and
conscience as clearly as a man may read an open book.”[257]
After attending the second Council of Lyons, he was elected
Bishop of Hereford, and in the government of his diocese found
himself, singularly enough, opposed to his saintly metropolitan, John
of Peckham, who, as he conceived, overstrained his authority as
Primate. Yet though he staunchly defended the rights of his Church,
and was constantly engaged in vexatious disputes with some of the
great barons, no one ever dreamt of charging him with a haughty or
ambitious spirit. The speciality of his sanctity was charity, and it was
said of him that he was never seen angry, save when a whisper of
detraction met his ear.
Such were some of the Oxford doctors and chancellors of this
period, and such the prelates chosen from their ranks. Not indeed
that we would be thought desirous of representing our ancient
universities as exclusively schools of saints; the slightest
acquaintance with the academic annals suffices to show that they
were disgraced by many scandals, and were too often the scenes of
lawless outrages and contentions, which, in our days of higher
civilisation, must naturally excite both wonder and disgust. Moreover,
the halls of Oxford were haunted by a spirit very different from that
which pervaded the cloisters of Jarrow. The world had entered there,
with all its false maxims, and scholars were not ashamed to
squabble for benefices, and often, on the motive of self-interest, to
take part with the Crown against the Church. Still, when all has been
said that impartial candour demands, we cannot doubt that many
precious traditions must have been preserved in the university
schools, and that they moulded many a poor scholar in the old
saintly and beautiful type. Moreover, we are approaching the time
when the most flagrant evils of the universities were about to
receive a partial remedy by the establishment of the collegiate
system, which soon became tacitly accepted as the educational
system of England. It aimed, and to a great degree successfully, at
combining the discipline of the old monastic schools with the larger
intellectual advantages of the universities. The reputed priority is
ordinarily assigned to University College, which, on the ground of its
supposed foundation by Alfred, claims to be the first in point of
antiquity of the Oxford foundations. But its real existence as a
college dates only from the time of William, Archdeacon of Durham,
by whose will a sum of money was assigned for the maintenance of
a body of masters, who, in 1280, were required to live together in
one house, and receive a body of statutes. But Merton College had
already received its royal charter in 1264, and one year previously to
that date, John Baliol, father to the unfortunate Scottish King, had
taken some steps towards the foundation of the college which bears
his name. His intentions were carried into effect by his widow, the
Lady Devorgilla, who, at the instigation of her Franciscan confessor,
Richard Stickbury, founded the college in honour of the Holy Trinity,
Our Lady, and St. Catherine the Martyr. It would be pleasant to
present to the reader the heiress of the ancient princes of Galloway,
as she appears in semi-monastic costume, in her Oxford portrait, or
to reproduce those exquisitely engrossed statutes, which provide
that the students of Baliol shall be present at the divine offices on
Sundays and holidays, and shall on other days frequent the schools;
that they shall always speak Latin in common, and if they neglect to
do so, shall be served last at table; that a sophism shall be disputed
among them once a week, and that they be allowed a penny a day
for their sustenance, and two pence on Sundays! But as our object is
only to notice those collegiate foundations which in a marked way
influenced the system of education, we shall pass on to Merton,
avowedly the first English college incorporated by charter, and the
model on which most of the subsequent foundations, both of Oxford
and Cambridge were raised. Its founder, Walter de Merton, Bishop of
Rochester and Chancellor of the realm, may be, in fact regarded as
the originator of the collegiate system, and is designated in his
monumental inscription unius exemplo, omnium quotquot extant
collegiorum Fundator, maximorumque Europæ totius ingeniorum
felicissimus parens. The immense evils of the university system,
which was practically no system at all, early attracted his attention,
and determined him on making the experiment of gathering a
certain number of scholars from the halls and hostels where they
now congregated subject to a merely nominal discipline, and placing
them under the control of masters and tutors in a spacious building
under semi-monastic rules. What was designed with so much
sagacity was executed with corresponding magnificence, and the
Domus Scholarium de Merton became the curiosity of its age.
Architectural splendour was not at first considered any necessary
part of a collegiate foundation, but the various tenements purchased
by Bishop Merton were reduced to a regular quadrangular form, and
a college chapel was included in the original design, two chaplains
being appointed for “the ministration of Divine service.” In 1265, the
parish church of St. John Baptist was made over to the founder by
the monks of Reading, and granted to the perpetual use of the
scholars. Their studies appear to have differed in no way from those
of the other Oxonians, but Wood considers the appointment of a
grammar-master to indicate that Bishop Merton designed to put
some check on the decay of arts.
Among the early benefactresses to this college was one who might
almost be called its co-foundress, Ella Longspée, Countess of
Warwick, and daughter to that other Ella, Countess of Salisbury, who
had obtained the conversion of her ferocious husband, Longspée,
through the instrumentality of St. Edmund.[258] The friendship of the
elder Ella with the saintly archbishop appears to have inspired both
her daughters with a singular goodwill towards Oxford, and Ella in
particular made large donations of lands and endowments to the
Merton scholars. Such was the success of the new foundation that
the king himself recommended it to Hugh de Balsham, Bishop of Ely,
as a model for his proposed Cambridge College of Peterhouse; and
the example once set, was soon taken up by others. The
Benedictines had possessed houses of studies in Oxford from a very
early period, but the proposal was now made to found a regular
college, intended, in the first instance, exclusively for students from
Gloucester Abbey, but the benefits of which were afterwards
extended to those of St. Alban’s, Glastonbury, Tavistock, Chertsey,
Coventry, Evesham, St. Edmundsbury, Winchcombe, and Malmsbury,
all of which contributed to the expense of rearing the necessary
buildings. The real founder of Gloucester College, however, was not
an abbot, but a baron, John Giffard, Lord of Brimesfield, and
husband of Maud Longspée, whose persuasions doubtless had great
share in promoting his munificence. In 1291, a general chapter was
held at Abingdon of the monks of the province of Canterbury, and a
tax imposed on all the Benedictine houses of the province, to raise
the necessary funds.
The result was the erection of a grand and commodious pile of
buildings, some of which remain to this day, and form a part of the
modern Worcester College. The apartments occupied by the
students of the different religious houses were separate one from
another, and distinguished by their arms or rebusses. Thus, we see
the cross-keys for St. Peter’s of Gloucester, a comb and a ton, with
the letter W, for Winchcombe, and so of the rest. Each abbey sent a
certain number of students at a time, who were governed by a prior,
elected by themselves, called the “Prior Studentium,” and who had a
rule adapted to suit their peculiar requirements. They were enjoined
not to mix familiarly with the secular students, to have divinity
disputations once a week, and to practise preaching, both in Latin
and English. A chair of theology was afterwards founded for their
special instruction. In short, Gloucester College was a true religious
seminary, and continued to enjoy a high character for learning down
to the time of the general suppression of religious houses. Wood
gives many interesting particulars of the college, and the good
scholars whom it produced. Whethamstede, abbot of St. Alban’s in
the reign of Henry VI., of whom we shall have hereafter to speak
more at length, was at one time the “Prior Studentium,” and
afterwards bestowed such large benefactions on the house as to be
called its second founder. He put in the five painted windows of the
chapel, built a vestiary and a library, and presented many books.
Moreover, he adorned the images of the Crucifix and the Saints with
“deprecatory rhymes.” His dear and learned friend, Humphrey of
Gloucester, likewise enriched the library with several valuable
manuscripts. The first Benedictine of this college who took his
doctor’s degree was William Brok, who graduated in divinity in 1298.
The inception of a university doctor was in those days a stately
ceremony, and on this occasion the Benedictines thought it well to
celebrate the auspicious event with more than ordinary splendour.
Six abbots of the order, therefore, attended the customary
procession on horseback, besides “monks, priors, obedientiaries, and
claustral clerks, a hundred noblemen and esquires,” and most of the
Benedictine bishops of the province of Canterbury. The Durham
monks were not long before they provided themselves with a similar
seminary, and in 1286 obtained lands for the erection of their college
from Dame Mabel Wafte, abbess of Godstow. The endowments of
this establishment were intended half for lay and half for religious
students. They also had their “Prior Studentium,” and the good
repute of their learning induced Richard of Bury, the celebrated
Bishop of Durham, to leave them his magnificent library of books.
The site of this foundation is now occupied by the more modern
Trinity College.
These religious establishments, it is not to be doubted, had a
considerable share in promoting the extension of the collegiate
system now fairly introduced into Oxford. The Merton scholars soon
attracted notice; of whom the most famous was Duns Scotus, who
after leaving the university entered among the Franciscan friars of
Newcastle, and returning to Oxford to study a second time under the
doctors of his own order, won perhaps the highest renown which
attaches to the name of any English divine since the days of Bede.
[259] The reign of Edward II. witnessed the foundation of two more
colleges. Oriel claims as its founder that unfortunate monarch
himself, who, whatever may have been his faults, was an undoubted
patron of letters. It is probable, however, that he had little more
than a nominal share in the foundation, which was the real work of
his almoner, Adam de Brom. Exeter owes its name to its founder,
Walter Stapleton, Bishop of Exeter, and both these were, more or
less, in their statutes and general spirit, copies of Merton. The
effects of the changes thus introduced into the university system are
differently estimated by different writers. By many the diminution in
the number of students which became apparent in the fourteenth
century, is attributed to the increase of colleges. These of course
could only accommodate a limited number, whereas any amount of
students might swarm in the hostels and lodging-houses which were
formerly their only resort. However, if the old adage, that quality is
to be preferred to quantity, is to be held of any force, this can hardly
be said to be a disadvantage. Six thousand students living under
regular discipline were perhaps better than thirty thousand,
containing a large proportion of “varlets;” and although in our days
the collegiate system may be regarded as having a tendency to
aristocratical exclusiveness, this was far from being its intention or
result in the early period of its institution. The endowments were for
poor scholars, and by poor scholars they were mostly enjoyed. It
appears probable also that the successive pestilences which
desolated Oxford in the reign of Edward III., and the troubles
occasioned by Wickliffe and his followers, had a great deal to do
with the decrease of the scholars. Besides which, it must be borne in
mind that the rage for scholastic learning which characterised the
thirteenth century, gave place in England during the fourteenth to a
rage for French conquests. So completely did the brilliant successes
achieved by the two Edwards root this passion in the English mind,
that the cultivation of letters was little regarded, and perhaps after
Wickliffe’s time it was looked on by some with a not unnatural
suspicion. Many of the colleges had become tainted with Lollardism,
and remained under a cloud; the tide of popular favour had set in
for the showy chivalry of the day, and clerks and scholars went
somewhat out of fashion. The close tie which had hitherto knit
together the schools of Oxford and Paris was henceforth totally
sundered, nor is it easy to estimate the injury thus accruing to the
English university, which in the thirteenth century enjoyed the freest
intercommunion with the French and Italian academies. The narrow
insular spirit which thus sprang up, and which was nourished by the
anti-Roman tendencies of English legislation, was fatal to intellectual
progress. Hence the learned renown of our universities certainly
declined, but so far was this from being the result of the collegiate
system that it is evident the noble foundations of Wykeham,
Waynflete, Fleming, Chicheley, and Henry VI., were undertaken with
the view of supplying a remedy to the existing evils, and as a means
of effecting a revival of learning among the English clergy.
The history of these foundations belongs however to a later date.
For the present we must leave our semibarbarous island (for so,
under favour, must baronial England doubtless have been regarded
by dwellers south of the Alps), and see what kind of scholarship was
flourishing in the more classic atmosphere of Italy at the very time
when the first stones were being laid of our ancient Oxford cloisters.
 CHAPTER XVII.
DANTE AND PETRARCH.
a.d. 1300 TO 1400.
In what has hitherto been said of the universities, which in the
thirteenth century had fairly established themselves as the great
organs of education, it has not been possible to convey any just or
satisfactory notion of the exact nature of those studies fostered
within their schools. The reader will perhaps have gathered a
general idea that a great change had been gradually effected since
the days of St. Anselm; that humane letters were becoming
neglected, and that scholastic philosophy and canon law had even
threatened at one time to discourage the cultivation of Scriptural and
patristic studies; that theology, on the other hand, had become
digested into a scientific system by the great scholastic doctors, who
had reinstated the study of the Scriptures and the Biblical tongues,
but who had not done much to restore polite letters; and finally, that
the physical sciences had made a certain sensible advance. This
general statement has in it a fair amount of truth; nevertheless,
general statements are such unsatisfactory things, that the desire
rises to one’s mind that some scholar of our old universities could be
put on his examination before a Royal Commission, and tell us with
his own lips what he did, and what he did not, learn from his
mediæval teachers. The wish is not so extravagant as it might
appear. Fortunately for our purpose, one scholar existed who
gathered in himself the learning of Padua, Bologna, Paris, and
Oxford Universities, for he studied successively at them all, and has
left the result in writings, which for six centuries have been
submitted to close critical examination, and are still in our hands. A
glance through their pages promises, therefore, to give us some
information on the point in question.
 It was probably some time in the reign of Edward I., that among
the 30,000 students who crowded the inns and hostels of old
Oxford, there appeared an Italian of middle age, of whose previous
career at other universities we know no more, than that at Padua
and Bologna he had addicted himself to moral and natural
philosophy; that at Paris he was held to be a first-rate theologian;
and that returning thither a second time, after political troubles had
driven him into exile, he had held a disputation against fourteen
opponents, had taken his bachelor’s degree, and was only prevented
by an empty purse from graduating as master; and finally, that both
at Paris and elsewhere he had evinced a marked predilection for the
mystical interpretation of the Holy Scriptures. These are all the
traces that he has left behind him in the schools, and yet how well
we know him! The countenances of Shakespeare or Byron, or Sir
Walter Scott, are not more familiar to us than the grand and
melancholy features of Dante Alighieri, whom we claim as an Oxford
student, on the authority of John de Serraville, Bishop of Fermo, a
writer who, as he lived only a century later than the poet, may be
supposed to have derived his information from contemporary
sources.[260] Plain in dress, temperate in his habits, polished and
dignified in his manners, which were, however, dashed with more
than a touch of sarcasm,—a man of few words, given to long fits of
abstraction, his form a little stooping, his sight early impaired by
excessive application to his books; something of an artist, and such
a lover of music that, as he tells us, it had power to soothe him even
in the worst of times, an exquisite caligrapher, as they attest who
have seen his writing, and describe it as magra e lunga, e molto
corretta, a close and curious observer of nature, and above all, of
the phenomena of the starry heavens, a perfect scholar, yet, withal,
a soldier too, well skilled in all the martial exercises that became his
rank—such was he whom we have ventured to select as the
representative man of the Catholic universities as they existed before
that new era of taste and literature which was ushered in by his
countryman Petrarch.
 Dante is acknowledged by all critics to have been the most
learned of the poets, not excepting Milton, the character of whose
genius so closely resembles his own. His learning was characteristic
of his age: the extraordinary prominence given in his poem to the
scholastic theology and philosophy tells us at once in what century it
was composed. Aristotle, Christianised and interpreted by St.
Thomas, is the master whom he follows;[261] yet perhaps he is not
quite so exclusive an Aristotelian as most scholastics of his time, for
it is evident that he had studied Plato with almost equal attention,
specially the Timæus of that philosopher, to which he frequently
refers. He, however, invariably gives the preference to Aristotle,
whom he calls, “the master among the wise;” whereas Petrarch
assigns the first place to Plato. But “Dante the Theologian,” as he is
called in his epitaph, had other masters besides the Greeks. He who
had won his bachelor’s degree in fair fight against fourteen
opponents, a reminiscence to which he refers in his poem, had to be
furnished with arms from the scholastic arsenal. Accordingly, when
he describes himself as undergoing the questioning of the Apostles
on the subject of Faith, Hope, and Charity, he gives his answers in
the language of the Master of the Sentences, as well as of St. Denys
the Areopagite, and St. Augustine. His diction is thickly sown with
the phraseology of the schools, with “quiddities,” “syllogisms,”
“propositions,” “demonstrations,” and the like; yet when he comes to
make his profession of faith, how sublimely does he rise above these
technicalities, and declare that his belief rests neither on physical nor
metaphysical proof, but on the testimony of the Holy Ghost, on
Moses, the Prophets, the Psalms, and the Gospels.[262] Elsewhere he
appeals to the teaching of St. Jerome, St. Isidore, St. Gregory, St.
Bernard, and most of the other Latin Fathers, and names with loving
reverence not a few of those monastics and schoolmen with whom
we have made acquaintance in the foregoing pages, such as Bede
and Rabanus, St. Peter Damian, Peter Comestor, Hugh and Richard
of St. Victor, and Albert the Great. But above all these appear St.
Thomas and St. Buonaventura, the former of whom is, beyond all
doubt, the guide of Dante in philosophy and theology, and whom he
introduces in the thirteenth canto of the Paradiso, speaking in his
own person, and using the scientific phraseology of the schools.
The political opinions set forth by Dante are no less characteristic
of the mediæval university student than his theological views. Born
of a family attached to a party of the Guelphs, he himself kept aloof
for some time from either faction, and, as Chief Prior of Florence,
aimed at holding an even balance between them. This line of
conduct gave little satisfaction to the Neri, as the Florentine Guelphs
were called; and they accused him, as it would seem not without
cause, of concealing, under the show of impartiality, a secret leaning
towards the Ghibellines. On occasion of a popular insurrection, the
Priors agreed to banish the leaders of both parties; on this the
Guelphs leagued to call in the assistance of Charles of Valois,
Captain-General to Pope Boniface VIII. This appeal to the protection
of the hated lilies of France moved Dante to an act of severity which
proved his own ruin. The banished chiefs of the Bianchi were
recalled, while those of the Neri remained in exile. Driven to
extremity, the Guelphs despatched an envoy to Rome, entreating the
Pope to put the pacification of Florence into the hands of Charles of
Valois. Dante hastened to Rome to oppose this demand, but in his
absence another popular émeute broke out, the Neri triumphed,
their exiles were recalled, and in their turn decreed banishment and
loss of goods against their enemies. The original document is still
preserved, in which, to the sentence of confiscation is added that of
burning alive, decreed against Dante and fourteen other citizens,
should they ever again set foot in Florence.[263]
It must be admitted that if the writings of Dante exhibit after this
time all the bitterness of “Ghibelline bile,” there was some excuse to
be made for him. Almost against his own will he had been thrown
from his position of theoretic impartiality into the arms of the
Ghibelline faction. Not that he ever entirely embraced their cause; he
had good sense enough to admit that truth is seldom to be found in
the ranks of party, and owned in after years that it was hard to say
whether Guelph or Ghibelline were most to be blamed for the evils
which their animosities had brought upon Italy.[264] He felt for the
sufferings of his country scarcely less than for his own; and the only
remedy which he saw for the miseries resulting from the rage of
factions was the establishment of a firm monarchical government,
such as was presented in the theory of the Holy Roman Empire. This
fancy he dwelt on and idealised till he came to believe that Empire a
thing of divine institution, applying to it the words of the Apostle,
“There is laid up for me a crown of righteousness.” The
extravagances into which he suffered himself to be led on this
subject are not entirely to be referred to the influence of his
university studies, yet it is certain that the principles current in all
the great academies offered nothing to correct the absolutism of his
political creed. Bologna had received her “Habita” from the Emperor
Frederic II., in reward for the good services which her lawyers had
rendered him in supporting his claims against the Italian Communi.
Paris was on the very eve of supporting the sacrilegious enormities
of Philip le Bel. At Oxford, the greatest law school north of the Alps,
the imperial jurisprudence formed the favourite study; and though,
with that happy inconsequence which is the national characteristic,
the English would none of it for practical purposes, yet they learnt
enough from their law studies to induce them to support a course of
legislation, the ultimate result of which was the establishment of a
royal supremacy.
In all these academies the supremacy of the temporal power was,
in one form or other, the favourite political dogma, and the tendency
of their teaching was, perhaps, more directly anti-Papal than that of
the Italian poet, for Dante’s Ghibellinism, bitter and resentful as it
was, never clouded the instincts of his faith. He regarded Boniface
VIII. as his personal enemy, and attributed to his intervention the
revolution that had driven him into exile. With the terrible anger of
his silent nature which suppressed every outward demonstration of
passion, he pursued and made war upon him with his pen; yet the
hatred he felt for the man never blinded him as to the character of
his office. When he comes to speak of the outrages committed
against him at the instigation of Philip le Bel, he forgets that it is his
enemy who is being thus dealt with, and gives expression to the
deep religious sense of a child of Holy Church in lines for ever
memorable. He beholds Christ once more mocked and derided in the
person of His Vicar, he sees the gall and vinegar renewed, execrates
the cruelty of the new Pilate and the new thieves, and weeps over
the sufferings of the Church, whose woes are now, he says, the
theme of every prayer.[265] Indeed, in all save his politics, Dante
reflects the spirit of the ages of faith. The grim grotesqueness which
mingles with his most terrible pictures breathes the identical
character to be found in the illuminations and sculptures of the same
period, evincing an intense sense of certain grave realities which the
mediæval artists never shrank from picturing to the mind and eye.
The liturgical spirit, too, is there, reminding us almost at every page
that we are reading the words of one who lived when the office of
the Church was still the Prayer Book of the faithful, and when
university students, like St. Edmund, or Jordan of Saxony, were
accustomed to rise at midnight and attend the singing of Matins in
their parish church.[266] Some of the most exquisite passages of his
poem owe their beauty to the skill with which he has woven into his
verse passages and phrases from the Psalms, the Breviary Hymns,
and other devotions of the Church. Yet Dante was very far from
being exclusively a theologian and a scholastic. His writings offer
sufficient evidence that the scholars of the thirteenth century were
familiar with other Latin than that of Duns Scotus. He had closely
studied all the Latin poets, and sometimes translates or paraphrases
entire lines from Virgil. His mind was so steeped in the history and
mythology of the ancients, that many of his pages, if translated,
might be taken for quotations from Milton; for like him he possessed
the art of stringing together a series of classic names and allusions,
the melody of which makes us willing to pardon their pedantry. One
example may suffice, which shall be given in its English dress, the
better to convey the resemblance which it bears to kindred Miltonic
passages. It is the poet Virgil who is speaking to Statius, and
describing the state of the good heathen in limbo:—
 There oft times,
We of that mount hold converse, on whose top
For aye our nurses live. We have the bard
Of Pella, and the Teian; Agatho,
Simonides, and many a Grecian else
Ingarlanded with laurel. Of thy train
Antigone is there, and Deïphile,
Argia, and, as sorrowful as erst,
Ismene, and who showed Langia’s wave;
Deidamia with her sisters there,
And blind Tiresias’ daughter, and the bride,
Sea-born of Peleus.[267]

Every one of the names here named are Greek, and it is clear that
Dante was well acquainted with the stories of the Greek poets; but
was he also acquainted with their language? This is a question
fiercely debated by his commentators, and considered to be still an
unresolved problem. In his prose work, the “Convito,” he has
criticised an erroneous translation from Aristotle, and in one of the
finest passages of the “Purgatorio” introduces a Greek word, which
alone has furnished matter for a voluminous controversy.[268] These
and other passages have led many to give him credit for being
possessed of Greek scholarship. The point is not decided, but the
probability appears to be that his knowledge of the language was at
any rate not very profound. In the same way he may be said to have
been not totally unacquainted with Hebrew and Arabic, for several
explanations of Hebrew words occur in his works, and the
mysterious words which he places with so tremendous and dramatic
an effect in the mouth of Nimrod,[269] are declared by one critic to
be Arabic, and by another to be Syriac; but are more probably, as
Bianchi observes, a jumble of sounds chosen from the Oriental
dialects, and intended to convey a notion of the confusion of
tongues, and to startle the ear with their uncouth cabalistic sound.
Without claiming for our poet the merit of Hebrew and Oriental
learning, we may at least gather from such passages that he had
studied in schools where these tongues were not entirely unknown,
where the decree of Clement V. was probably carried out, and
professors were to be found who could furnish him with enough of
Eastern erudition to serve his purpose. On other points his
acquirements were, however, far less superficial. The trivium and
quadrivium in all their branches are easy enough to be traced
through his writings. He is known to have been a proficient in music.
He refers to the quadrature of the circle and other problems of
geometry, but astronomy was evidently his science of predilection,
and occupies a very considerable place in his poem. He wrote at a
time when the Pythagorean system was the only accepted theory,
and his scientific allusions can of course only be explained according
to its supposed laws. But he did not draw all his ideas from the
books of the ancients. In his “Convito,” after giving the various
explanations of the Milky-way furnished by Pythagoras, Anaxagoras,
and others, some of them sufficiently absurd, he decides in favour of
the opinion that there is a multitude of fixed stars in that part of the
heavens, so small (or, as we should now say, so distant), that we
cannot separately distinguish them, but which cause the appearance
of whiteness. The other views, he observes, seem devoid of reason.
The astronomer, Ideler, was the first to point out that Dante’s
description in the opening canto of the “Purgatorio” of the four stars,
[270] which he makes symbolic of the four cardinal virtues, betrays a
knowledge of the constellation of the Southern Cross, of which he
may have heard from the Genoese and Pisan mariners who had
visited Cape Comorin, and which he may even have seen depicted
on that curious globe constructed by the Arabs in 1225, where it was
distinctly marked. He had attentively studied geography, and notices
many such points as find a place in our manuals of the globes, such
as the intersection of the great circles, as they are exhibited on the
armillary sphere; and reminds us that within the torrid zone at
certain seasons no shadows fall, on account of the sun being then
directly overhead.[271] Tiraboschi gives him credit for anticipating a
supposed discovery of Galileo’s, that wine is nothing but the heat of
the sun mingled with the juice of the grape; and Maffei comments
on the “marvellous felicity” with which he expresses his scientific
ideas. The theory of the attraction of gravitation[272] is stated as
distinctly in his pages as in those of Vincent de Beauvais; and his
allusions to the nature of plants and the habits of animals, and
particularly of birds, seem to evince, not merely a familiarity with the
works of Albert the Great, but the observant eye of a real naturalist.
[273] His artistic feeling appears in a thousand passages, which were
afterwards given a visible shape by Orcagna, and so many other
painters of the early Florentine school; as well as in some wonderful
landscape-painting in words, which, as Humboldt says, “manifest
profound sensibility to the aspect of external nature.” Such is his
description, imitated by so many later Italian poets, of the birds
beginning their morning songs in the pine forest of Chiassi, of the
dawning light trembling on the distant sea, of the goatherd watching
his flocks among the hills, and of the flowery meadow illuminated by
a sudden ray of sunlight darting through the broken clouds.[274] He
never directly alludes to those grand creations of Christian art, the
cathedrals, most of which were coeval in their rise with the
European universities. Yet he continually reminds us that he lived
when religious artists were carving the sacred sculptures on their
walls, or filling their windows with a mystic splendour, and that he
had felt the power of those vaulted aisles, which he had, perhaps,
visited as a pilgrim.[275]
Enough has been said to indicate the nature of Dante’s learning,
which was undoubtedly the learning of his time. It differed from that
of his contemporaries in degree, but not in kind. When Mr. Berington
gives expression to his delight at having at last found a man who
could admire Virgil, he shows not only a very imperfect appreciation
of the acquirements of mediæval scholars, but even of the poet
whom he condescends to praise. Dante’s aim was avowedly to write
a popular poem; he desired to be read, not merely by the learned,
but by the mass of his countrymen; and it was with this object that
he sacrificed his first intention of writing in Latin verse, and chose
the rude Italian vernacular, not without a certain regret, but with the
design of being more widely intelligible, for, to use his own words,
“we must not give meat to sucklings.” We may safely dare to affirm
that had not the Latin classics been freely admitted into the Christian
schools of the thirteenth century, Dante would never have ventured
to have chosen Virgil as his representative of Moral Philosophy. And
if the world to which he addressed himself had not known something
—perhaps a good deal—of classical history and poetry, his poem
could not have achieved the popularity at which he successfully
aimed. But it is probable that on this point things were not greatly
changed from what they had been in the days of his ancestor
Cacciaguida, when, as he tells us, the ladies of Florence, as they sat
with their maidens,

Drawing off
The tresses from the distaff, lectured them
Old tales of Troy, and Fesole, and Rome.[276]

Certain it is that the erudition of the “Divina Commedia” proved no

obstacle to its popularity. There is nothing in the history of literature
that can be at all compared with the instantaneous conquest which it
achieved over the Italian public. Within thirty years of the poet’s
death an Archbishop of Milan appointed a carefully-chosen
commission of learned men to write a commentary on the poem;
Florence, which had cast him out of her walls when living, now
founded a public lecture to explain his works; and in 1373, called on
Bocaccio to deliver this lecture in the Church of St. Stefano, at the
annual salary of a hundred florins.
We are not, however, concerned with the literary history of Dante,
who is only here spoken of as the representative scholar of his
times. His profound learning has never been disputed; yet it is
worthy of remark that if it be good criticism to measure a man’s
scholarship solely by the style of his Latin compositions, we should
have to number the author of the “Divina Commedia” among the
other writers whose “incredible ignorance” disgraced their age. His
prose treatises, De Monarchia and De Vulgari Eloquio, in substance
learned and full of acute observation, are declared to be rude and
unclassical in style; a fact which suggests doubts how far this
standard of criticism is a just one. It was fortunate indeed that he
abandoned his first purpose of writing his poem in the Latin tongue,
and chose rather that vernacular idiom which he raised to the dignity
of a language. How he dealt with it is the real marvel; he built up his
verse, much as the Athenians constructed their walls in the days of
Themistocles, laying hold of any material that came in his way,
quarrying words and phrases out of the Latin at his pleasure, filling
up chinks and vacancies with verbs and adjectives which, whatever
may have been their plebeian origin, became ennobled by his use;
and creating many a good strong word of mighty meaning which it
would have been well if his countrymen could have persuaded
themselves to retain. After his time the formation of the Italian
language rapidly developed, and the majestic mass which had been
hewn into shape by Dante, received a finer and softer polish from
Bocaccio and Petrarch.
Of the latter poet we now have to speak; for any sketch of
mediæval scholarship would be imperfect without some notice of
him who is commonly regarded as the restorer of polite letters. The
father of Petrarch had been banished from Florence at the same
time with Dante; and when a child, he himself had once beheld the
great poet, whose fame he was in some respects destined to
surpass. When he was nine years old his parents removed to
Avignon in France, where the establishment of the papal court drew
many Italians. There for four years he learnt as much grammar,
logic, and rhetoric as the schools of Avignon and Carpentras could
teach, and that does not appear to have been much. However, even
at this age his classic tastes betrayed themselves. Whilst his
comrades were still reading Æsop’s fables and the verses of Prosper,
he studied the works of Cicero, which delighted his ear long before
he understood their sense. Then came another four years at
Montpelier, after which he went to Bologna, and there studied civil
law for three years more. But as soon as he found himself removed
from his father’s watchful eye the study of jurisprudence somewhat
languished. “It was thus,” he says, “that I spent, or rather wasted,
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