advantage of every aid. He was probably the first to use illustrations
in teaching anatomy. Guy de Chauliac, whose teacher in anatomy for some
time Mondeville was, says in the first chapter of his "Chirurgia Magna"
that pictures do not suffice for the teaching of anatomy and that actual
dissection is necessary. The passage runs as follows: "In the bodies of
men, of apes, and of pigs, and of many other animals, tissues should be
studied by dissections and not by pictures, as did Henricus, who was
seen to demonstrate anatomy with thirteen pictures."[21] What Chauliac
blames is the attempt to replace dissections by pictorial
demonstrations. Hyrtl, however, suggests that this invention of
Mondeville's was probably very helpful, and was brought about by the
impossibility of preserving bodies for long periods as well as the
difficulty of obtaining them.
YPERMAN
One of the maxims of the old Greek philosophers was that good is
diffusive of itself. As the scholastics put it, _bonum est diffusivum
sui_. This proved to be eminently true of the old universities also, and
especially of their training in medicine and in surgery. We have the
accounts of men from many nations who went to the universities and
returned to benefit their own people. Early in the thirteenth century
Richard the Englishman was in Italy, having previously been in Paris and
probably at Montpellier. Bernard Gordon, probably also an Englishman,
was one of the great lights in medicine down at Montpellier, and his
book, "Lilium De Medicina," is well known. Two distinguished surgeons
whose names have come down to us, having studied in Paris after Lanfranc
had created the tradition of great surgical teaching there, came to
their homes to be centres of beneficent influence among their people in
this matter. One was Yperman, of the town of Ypres in Belgium; the other
Ardern of England. Yperman was sent by his fellow-townsmen to Paris in
order to study surgery, because they wanted to have a good surgeon in
their town and Paris seemed the best school at that time. Ypres was at
this period one of the greatest commercial cities of Europe, and
probably had a couple of hundred thousand inhabitants. The great hall of
the cloth gild, which has been such an attraction for visitors ever
since, was built shortly before the town determined upon the very
sensible procedure of securing good surgery beyond all doubt by having a
townsman specially educated for that purpose.
Yperman's work was practically unknown to us until Broeck, the Belgian
historian, discovered manuscript copies of his book on surgery and
gathered some details of his life. After his return from Paris, Yperman
obtained great renown, which maintained itself in the custom extant in
that part of the country even yet of calling an expert surgeon an
Yperman. He is the author of two works in Flemish. One of these is a
smaller compendium of internal medicine, which is very interesting,
however, because it shows the many subjects that were occupying
physicians' minds at that time. He treats of dropsy, rheumatism, under
which occur the terms coryza and catarrh (the flowing diseases),
icterus, phthisis (he calls the tuberculosis, tysiken), apoplexy,
epilepsy, frenzy, lethargy, fallen palate, cough, shortness of breath,
lung abscess, hemorrhage, blood-spitting, liver abscess, hardening of
the spleen, affections of the kidney, bloody urine, diabetes,
incontinence of urine, dysuria, strangury, gonorrhea, and involuntary
seminal emissions--all these terms are quoted directly from Pagel's
account of his work; the original is not available in this country.
JOHN ARDERN
In English-speaking countries of course we are interested in what was
done by Englishmen at this time. Fortunately we have the record of one
great English surgeon of the period worthy to be placed beside even the
writers already mentioned. This is John Ardern, whose name is probably a
modification of the more familiar Arden, whose career well deserves
attention. I have given a sketch of his work in "The Popes and
Science."[22] He was educated at Montpellier, and practised surgery for
a time in France. About the middle of the century however, according to
Pagel, he went back to his native land and settled for some twenty years
at Newark, in Nottinghamshire, and then for nearly thirty years longer,
until about the end of the century, was in London. He is the chief
representative of English surgery during the Middle Ages. His
"Practica," as yet unprinted, contains, according to Pagel, a short
sketch of internal medicine, but is mainly devoted to surgery. Contrary
to the usual impression with regard to works in medicine and surgery at
this time, the book abounds in references to case histories which Ardern
had gathered, partly from his own and partly from others' experience.
The therapeutic measures that he suggests are usually very simple, in
the majority of cases quite rational, though, of course, there are many
superstitions among them; but Ardern always furnished a number of
suggestions from which to choose. He must have been an expert operator,
and had excellent success in the treatment of diseases of the rectum. He
seems to have been the first operator who made careful statistics of his
cases, and was quite as proud as any modern surgeon of the large
numbers that he had operated on, which he gives very exactly. He was the
inventor of a new clyster apparatus.
Fortunately we possess here in America, in the Surgeon General's Library
at Washington, a very interesting manuscript containing Ardern's
surgical writings, though it has not yet been published. Even a little
study of this and of the notes on it prepared by an English bibliophile
before its purchase by the Surgeon General's Library, serves to show how
valuable the work is in the history of surgery. There are illustrations
scarcely less interesting than the text. Some of these illustrations
were inserted by the original writer or copyist, and some of them later.
In general, however, they show a rather high development of the
mechanics of surgery at that time. Some of the pages have spaces for
illustrations left unfilled, so that evidently the copyist did not
complete his work. The titles of certain of the chapters are
interesting, as illustrating the fact that our medical and surgical
problems were stated clearly in the olden time, and thinking physicians,
even six centuries ago, met them quite rationally. There is, for
instance, a chapter headed "Against Colic and the Iliac Passion,"
immediately followed by the subheading, "Method of Administering
Clysters." The iliac passion, _passio iliaca_ of the old Latin, is
usually taken to signify some obstruction of the intestines causing
severe pain, vomiting, and eventually fecal vomiting. A good many
different forms of severe painful conditions, especially all those
complicated by peritonitis, were included under the term, and the modern
student of surgery is likely to wonder whether these old observers had
not noted that the right iliac region was particularly prone to be the
source of fatal conditions. There is a chapter entitled "Against Pain in
the Loins and the Kidneys," followed by the chapter subheading, "Against
Stone in the Kidneys." There is a chapter with the title, "Against
Ulceration of the Bladder or the Kidneys." Another one, with the title
"Against Burning of the Urine and Excoriation of the Lower Part of the
Yard." Gonorrhea is frankly treated under the name _Shawdepisse_,
evidently an English alliteration of the corresponding French word. As
to the instrumentation of such conditions and for probing in general,
Ardern suggests the use of a lead probe, because it may readily be made
to bend any way and not injure the tissues.
MEDIEVAL SURGERY
Even this brief account of the surgeons who taught and studied at the
medieval universities demonstrates what fine work they did. It is surely
not too much to say that the chapter on university education mainly
concerned with them is one of the most interesting in the whole history
of the universities. Their story alone is quite enough to refute most of
the prevalent impressions and patronizing expressions with regard to
medieval education. Their careers serve to show how interested were the
men of many nations in the development of an extremely important
application of science for the benefit of suffering humanity. Their work
utterly contradicts the idea so frequently emphasized that the great
students of the Middle Ages were lacking in practicalness. Besides,
they make very clear that we have been prone to judge the Middle Ages
too much from its speculative philosophies. It has been the custom to
say that speculation ruled men's minds and prevented them from making
observations, developing science, or applying scientific principles.
There was much speculation during the Middle Ages, but probably not any
more in proportion than exists at the present day. We were either not
acquainted with, or failed to appreciate properly, until comparatively
recent years, the other side of medieval accomplishment. Our ignorance
led us into misunderstanding of what these generations really did. It
was our own fault, because during the Renaissance practically all of
these books were edited and printed under the direction of the great
scholars of the time in fine editions, but during the eighteenth century
nearly all interest was lost in them, and we are only now beginning to
get back a certain amount of the precious knowledge that they had in the
Renaissance period of this other side of medieval life. We have learned
so much about surgery because distinguished scholars devoted themselves
to this phase of the history of science. Doubtless there are many other
phases of the history of science which suffered the same fate of neglect
and with regard to which the future will bring us equally startling
revelations. For this reason this marvellous chapter in the history of
surgery is a warning as well as a startling record of a marvellous epoch
of human progress.
XI
GUY DE CHAULIAC
One of the most interesting characters in the history of medieval
medicine, and undoubtedly the most important and significant of these
Old-Time Makers of Medicine, is Guy de Chauliac. Most of the false
notions so commonly accepted with regard to the Middle Ages at once
disappear after a careful study of his career. The idea of the careful
application of scientific principles in a great practical way is far
removed from the ordinary notion of medieval procedure. Some
observations we may concede that they did make, but we are inclined to
think that these were not regularly ordered and the lessons of them not
drawn so as to make them valuable as experiences. Great art men may have
had, but science and, above all, applied science, is a later development
of humanity. Particularly is this supposed to be true with regard to the
science and practice of surgery, which is assumed to be of comparatively
recent origin. Nothing could well be less true, and if the thoroughly
practical development of surgery may be taken as a symbol of how capable
men were of applying science and scientific principles, then it is
comparatively easy to show that the men of the later Middle Ages were
occupied very much as have been our recent generations with science and
its practical applications.
The immediate evidence of the value of old-time surgery is to be found
in the fact that Guy de Chauliac, who is commonly spoken of in the
history of medicine as the Father of Modern Surgery, lived his
seventy-odd years of life during the fourteenth century and accomplished
the best of his work, therefore, some five centuries before surgery in
our modern sense of the term is supposed to have developed. A glance at
his career, however, will show how old are most of the important
developments of surgery, as also in what a thoroughly scientific temper
of mind this subject was approached more than a century before the close
of the Middle Ages. The life of this French surgeon, indeed, who was a
cleric and occupied the position of chamberlain and
physician-in-ordinary to three of the Avignon Popes, is not only a
contradiction of many of the traditions as to the backwardness of our
medieval forbears in medicine, that are readily accepted by many
presumably educated people, but it is the best possible antidote for
that insistent misunderstanding of the Middle Ages which attributes
profound ignorance of science, almost complete failure of observation,
and an absolute lack of initiative in applications of science to the men
of those times.
Guy de Chauliac's life is modern in nearly every phase. He was educated
in a little town of the south of France, made his medical studies at
Montpellier, and then went on a journey of hundreds of miles into Italy,
in order to make his post-graduate studies. Italy occupied the place in
science at that time that Germany has taken during the nineteenth
century. A young man who wanted to get into touch with the great
masters in medicine naturally went down into the Peninsula. Traditions
as to the attitude of the Church to science notwithstanding, Italy where
education was more completely under the influence of the Popes and
ecclesiastics than in any other country in Europe, continued to be the
home of post-graduate work in science for the next four centuries.
Almost needless to say, the journey to Italy was more difficult of
accomplishment and involved more expense and time than would even the
voyage from America to Europe in our time. Chauliac realized, however,
that both time and expense would be well rewarded, and his ardor for the
rounding out of his education was amply recompensed by the event. Nor
have we any reason for thinking that what he did was very rare, much
less unique, in his time. Many a student from France, Germany, and
England made the long journey to Italy for post-graduate opportunities
during the later Middle Ages.
Even this post-graduate experience in Italy did not satisfy Chauliac,
however, for, after having studied several years with the most
distinguished Italian teachers of anatomy and surgery, he spent some
time in Paris, apparently so as to be sure that he would be acquainted
with the best that was being done in his specialty in every part of the
world. He then settled down to his own life work, carrying his Italian
and French masters' teachings well beyond the point where he received
them, and after years of personal experience he gathered together his
masters' ideas, tested by his own observations, into his "Chirurgia
Magna," a great text-book of surgery which sums up the whole subject
succinctly, yet completely, for succeeding generations. When we talk
about what he accomplished for surgery, we are not dependent on
traditions nor vague information gleaned from contemporaries and
successors, who might perhaps have been so much impressed by his
personality as to be made over-enthusiastic in their critical judgment
of him. We know the man in his surgical works, and they have continued
to be classics in surgery ever since. It is an honorable distinction for
the medicine of the later fourteenth, the fifteenth, and sixteenth
centuries that Guy de Chauliac's book was the most read volume of the
time in medicine. Evidently the career of such a man is of import, not
alone to physicians, but to all who are interested in the history of
education.
Chauliac derives his name from the little town of Chauliac in the
diocese of Mende, almost in the centre of what is now the department of
Lozere. The records of births and deaths were not considered so
important in the fourteenth century as they are now, and so we are not
sure of either in the case of Chauliac. It is usually considered that he
was born some time during the last decade of the thirteenth century,
probably toward the end of it, and that he died about 1370. Of his early
education we know nothing, but it must have been reasonably efficient,
since it gave him a good working knowledge of Latin, which was the
universal language of science and especially of medicine at that time;
and though his own style, as must be expected, is no better than that of
his contemporaries, he knew how to express his thoughts clearly in
straightforward Latin, with only such a mixture of foreign terms as his
studies suggested and the exigencies of a new development of science
almost required. Later in life he seems to have known Arabic very well,
for he is evidently familiar with Arabian books and does not depend
merely on translations of them.
Pagel, in the first volume of Puschmann's "Handbook of the History of
Medicine," says, on the authority of Nicaise and others, that Chauliac
received his early education from the village clergyman. His parents
were poor, and but for ecclesiastical interest in him it would have been
difficult for him to obtain his education. The Church supplied at that
time to a great extent for the foundations and scholarships, home and
travelling, of our day, and Chauliac was amongst the favored ones. How
well he deserved the favor his subsequent career shows, as it completely
justifies the judgment of his patrons. He went first to Toulouse, as we
know from his affectionate mention of one of his teachers there.
Toulouse was more famous for law, however, than for medicine, and after
a time Chauliac sought Montpellier to complete his medical studies.
For English-speaking people an added interest in Guy de Chauliac will be
the fact that one of his teachers at Montpellier was Bernard Gordon,
very probably a Scotchman, who taught for some thirty-five years at this
famous university in the south of France, and died near the end of the
first quarter of the fourteenth century. One of Chauliac's
fellow-students at Montpellier was John of Gaddesden, the first English
Royal Physician by official appointment of whom we have any account.
John is mentioned by Chaucer in his "Doctor of Physic," and is usually
looked upon as one of the fathers of English medicine. Chauliac did not
think much of him, though his reason for his dislike of him will
probably be somewhat startling to those who assume that the men of the
Middle Ages always clung servilely to authority. Chauliac's objection to
Gaddesden's book is that he merely repeats his masters and does not dare
to think for himself. It is not hard to understand that such an
independent thinker as Chauliac should have been utterly dissatisfied
with a book that did not go beyond the forefathers in medicine that the
author quotes. This is the explanation of his well-known expression,
"Last of all arose the scentless rose of England ['Rosa Angliae' was the
name of John of Gaddesden's book], in which, on its being sent to me, I
hoped to find the odor of sweet originality, but instead of that I
encountered only the fictions of Hispanus, of Gilbert, and of
Theodoric."
The presence of a Scotch professor and an English fellow-student,
afterwards a royal physician, at Montpellier, at the beginning of the
fourteenth century, shows how much more cosmopolitan was university life
in those times than we are prone to think, and what attraction a great
university medical school possessed even for men from long distances.
After receiving his degree of Doctor of Medicine at Montpellier Chauliac
went, as we have said, to Bologna. Here he attracted the attention and
received the special instruction of Bertruccio, who was attracting
students from all over Europe at this time and was making some
excellent demonstrations in anatomy, employing human dissections very
freely. Chauliac tells of the methods that Bertruccio used in order that
bodies might be in as good condition as possible for demonstration
purposes, and mentions the fact that he saw him do many dissections in
different ways.
In Roth's life of Vesalius, which is usually considered one of our most
authoritative medical historical works not only with regard to the
details of Vesalius' life, but also in all that concerns anatomy about
that time and for some centuries before, there is a passage quoted from
Chauliac himself which shows how freely dissection was practised at the
Italian universities in the fourteenth century. This passage deserves to
be quoted at some length because there are even serious historians who
still cite a Bull of Pope Boniface VIII, issued in 1300, forbidding the
boiling and dismembering of bodies in order to transport them to long
distances for burial in their own country, as being, either rightly or
wrongly, interpreted as a prohibition of dissection and, therefore,
preventing the development of anatomy. In the notes to his history of
dissection during this period in Bologna Roth says: "Without doubt the
passage in Guy de Chauliac which tells of having frequently seen
dissections, must be considered as referring to Bologna. This passage
runs as follows: 'My master Bertruccius conducted the dissection very
often after the following manner: the dead body having been placed upon
a bench, he used to make four lessons on it. In the first the
nutritional portions were treated, because they are so likely to become
putrefied. In the second, he demonstrated the spiritual members; in the
third, the animate members; in the fourth, the extremities.'" (Roth,
"Andreas Vesalius." Basel, 1896.)
Bertruccio's master, Mondino, is hailed in the history of medicine as
the father of dissection. His book on dissection was for the next three
centuries in the hands of nearly every medical scholar in Europe who was
trying to do good work in anatomy. It was not displaced until Vesalius
came, the father of modern anatomy, who revolutionized the science in
the Renaissance time. Mondino had devoted himself to the subject with
unfailing ardor and enthusiasm, and from everywhere in Europe the
students came to receive inspiration in his dissecting-room. Within a
few years such was the enthusiasm for dissection aroused by him in
Bologna that there were many legal prosecutions for body-snatching, the
consequence doubtless of a regulation of the Medical Department of the
University of Bologna, that if the students brought a body to any of
their teachers he was bound to dissect it for them. Bertruccio,
Mondino's disciple and successor, continued this great work, and now
Chauliac, the third in the tradition, was to carry the Bolognese methods
back to France, and his position as chamberlain to the Pope was to give
them a wide vogue throughout the world. The great French surgeon's
attitude toward anatomy and dissection can be judged from his famous
expression that "the surgeon ignorant of anatomy carves the human body
as a blind man carves wood." The whole subject of dissection at this
time has been fully discussed in the first three chapters of my "Popes
and Science," where those who are interested in the matter may follow it
to their satisfaction.[23]
After his Bologna experience Chauliac went to Paris. Evidently his
indefatigable desire to know all that there was to be known would not be
satisfied until he had spent some time at the great French university
where Lanfranc, after having studied under William of Salicet in Italy,
had gone to establish that tradition of French surgery which, carried on
so well by Mondeville his great successor, was to maintain Frenchmen as
the leading surgeons of the world until the nineteenth century (Pagel).
Lanfranc, himself an Italian, had been exiled from his native country,
apparently because of political troubles, but was welcomed at Paris
because the faculty realized that they needed the inspiration of the
Italian medical movement in surgery for the establishment of a good
school of surgery in connection with the university. The teaching so
well begun by Lanfranc was magnificently continued by Mondeville and
Arnold of Villanova and their disciples. Chauliac was fortunate enough
to come under the influence of Petrus de Argentaria, who was worthily
maintaining the tradition of practical teaching in anatomy and surgery
so well founded by his great predecessors of the thirteenth century.
After this grand tour Chauliac was himself prepared to do work of the
highest order, for he had been in touch with all that was best in the
medicine and surgery of his time.