medicine heard such language filled with so much nobility and so full of
matter in so few words."
Chauliac was in every way worthy of his great contemporaries and the
period in which his lot was cast. Ordinarily we are not apt to think of
the early fourteenth century as an especially productive period in human
history, but such it is. Dante's Divine Comedy was entirely written
during Chauliac's life. Petrarch was born within a few years of Chauliac
himself; Boccaccio in Italy, and Chaucer in England, wrote while
Chauliac was still alive. Giotto did his great painting, and his pupils
were laying the deep, firm foundations of modern art. Many of the great
cathedrals were being finished. Most of the universities were in the
first flush of their success as moulders of the human mind. There are
few centuries in history that can show the existence of so many men
whose work was to have an enduring influence for all the after time as
this upon which Chauliac's career shed so bright a light. The preceding
century had seen the origin of the universities and the rise of such
supremely great men as Albertus Magnus, Roger Bacon, Thomas Aquinas, and
the other famous scholars of the early days of the mendicant orders, and
had made the intellectual mould of university training in which men's
minds for seven centuries were to be formed, so that Chauliac, instead
of being an unusual phenomenon is only a fitting expression of the
interest of this time in everything, including the physical sciences
and, above all, medicine and surgery.
For some people it may be a source of surprise that Chauliac should
have had the intellectual training to enable him to accomplish such
judicious work in his specialty. Many people will be apt to assume that
he accomplished what he did in spite of his training, genius succeeding
even in an unfavorable environment, and notwithstanding educational
disadvantages. Those who would be satisfied with any such explanation,
however, know nothing of the educational opportunities provided in the
period of which Chauliac was the fruit. He is a typical university man
of the beginning of the fourteenth century, and the universities must be
given due credit for him. It is ordinarily assumed that the universities
paid very little attention to science and that scientists would find
practically nothing to satisfy in their curricula. Professor Huxley in
his address on "Universities, Actual and Ideal," delivered as the
Rectorial Address at Aberdeen University in 1874, declared that they
were probably educating in the real sense of the word better than we do
now. (See quotation in "The Medical School at Salerno.")
In the light of Chauliac's life it is indeed amusing to read the
excursions of certain historians into the relationship of the Popes and
the Church to science during the Middle Ages. Chauliac is typically
representative of medieval science, a man who gave due weight to
authority, yet tried everything by his own experience, and who sums up
in himself such wonderful advance in surgery that during the last twenty
years the students of the history of medicine have been more interested
in him than in anyone who comes during the intervening six centuries.
Chauliac, however, instead of meeting with any opposition, encountered
encouragement, liberal patronage, generous interest, and even enjoyed
the intimate friendship of the highest ecclesiastics and the Popes of
his time. In every way his life may be taken as a type of what we have
come to know about the Middle Ages, when we know them as we should, in
the lives of the men who counted for most in them, and do not accept
merely the broad generalizations which are always likely to be deceptive
and which in the past have led men into the most absurd and ridiculous
notions with regard to a wonderful period in human history.
That Guy de Chauliac was no narrow specialist is abundantly evident from
his book, for while the "Great Surgery" treats of the science and art of
surgery as its principal subject, there are remarks about nearly
everything else relating to medicine, and most of them show a deep
interest, a thorough familiarity, and an excellent judgment. Besides we
have certain expressions with regard to intellectual matters generally
which serve to show Guy as a profound thinker, who thoroughly
appreciated just how accumulations of knowledge came to men and how far
each generation or member of a generation should go and yet how limited
must, after all, be the knowledge obtained by any one person. With
regard to books, for instance, he said, "for everyone cannot have all
the books, and even if he did have them it would be too tiresome to read
them all and completely, and it would require a godlike memory to
retain them all." He realized, however, that each generation, provided
it took the opportunities offered it, was able to see a little bit
farther than its predecessor, and the figure that he employs to express
this is rather striking. "Sciences," he said, "are made by additions. It
is quite impossible that the man who begins a science should finish it.
We are like infants, clinging to the neck of a giant; for we can see all
the giant sees and a little more."
One of the most interesting features of the history of Guy de Chauliac
is the bibliography of his works which has been written by Nicaise. This
is admirably complete, labored over with the devotion that characterized
Nicaise's attitude of unstinted admiration for the subject. Altogether
he has some sixty pages of a quarto volume with regard to the various
editions of Guy's works.
The first manuscript edition of Guy de Chauliac was issued in 1363, the
first printed edition in 1478. Even in the fourteenth century Guy's
great work was translated into all the languages generally used in
Europe. Nicaise succeeded in placing 34 complete manuscripts of the
"Great Surgery": 22 of these are in Latin, 4 are in French, 3 are in
English, 2 only in Provencal, though that was the language spoken in the
region where much of Chauliac's life was passed, and one each in
Italian, in Low Dutch, and in Hebrew. Of the English manuscripts, one is
number twenty-five English of the Bibliotheque Nationale, Paris; a
second is number 3666 English of the Sloane collection in the British
Museum, and a third is in the Library of the University of
Cambridge.[26]
Paulin Paris, probably one of the best of recent authorities on the age
and significance of old manuscripts, says in the third volume of his
"Manuscrits Francais," page 346, "This manuscript [of Guy de Chauliac's
"Great Surgery"] was made, if not during the life, then certainly very
shortly after the death of the author. It is one of the oldest that can
be cited, and the fact that an English translation was made so near to
the time of the original composition of the book attests the great
reputation enjoyed by Guy de Chauliac at this time, and which posterity
has fully confirmed."
The Sloane copy in the British Museum contains some medical recipes at
the end by Francis Verney. It was probably written in the fifteenth
century. Its title is:
"The inventorie or the collectorie in cirurgicale parte of
medicine compiled and complete in the yere of our Lord 1363,
with some additions of other doctours, necessary to the
foresaid arte or crapte (crafte?)."[27]
What we find in the period of manuscripts, however, is as nothing
compared to the prestige of Guy de Chauliac's work, once the age of
printing began. Nicaise was able to find sixty different printed
editions of the "Great Surgery." Nine others that are mentioned by
authors have disappeared and apparently no copies of them are in
existence. Besides there are sixty editions of portions of the work, of
compendiums of it and commentaries on it. Altogether 129 editions are
extant. Of these there are sixteen Latin editions, forty-three French,
five Italian, four Low Dutch, five Catalan, and one English. Fourteen
appeared in the fifteenth century, thirty-eight in the sixteenth
century, and seventeen in the seventeenth century. The fourteen editions
belonging to the _incunabula_ of printing, issued, that is, before the
end of the fifteenth century, show what lively interest there was in the
French surgeon of the preceding century, since printing presses at this
precious time were occupied only with the books that were considered
indispensable for scholars. The first edition of the "Great Surgery" was
printed in 1478 at Lyons. Printing had only been introduced there five
years before. This first edition, _primus primarius_ or _editio
princeps_, was a French translation by Nicholas Panis. In 1480 an
Italian edition was printed at Venice. The first Latin edition was
printed also in Venice in 1490.
It would be only natural to expect that the successors of Guy de
Chauliac, and especially those who had come personally in contact with
him, would take advantage of his thorough work to make still further
advances in surgery. As matter of fact, decadence in surgery is noted
immediately after his death. Three men taught at the University of
Montpellier at the end of the fourteenth and the beginning of the
fifteenth century, John de Tornamira, Valesco de Taranta, and John
Faucon. They cannot be compared, Gurlt says, with Guy de Chauliac,
though they were physicians of reputation in their time. Faucon made a
compendium of Guy's work for students. Somehow there seemed to be the
impression that surgery had now reached a point of development beyond
which it could not advance. Unfortunate political conditions, wars, the
withdrawal of the Popes from Avignon to Rome, and other disturbances,
distracted men's minds, and surgery deteriorated to a considerable
extent, until the new spirit at the time of the Renaissance came to
inject fresh life into it.
XII
MEDIEVAL DENTISTRY--GIOVANNI OF ARCOLI
If there is one phase of our present-day medicine and surgery that most
of us are likely to be quite sure is of very recent development it is
dentistry. Probably most people would declare at once that they had
every reason to think that the science and art of dentistry, as we have
it now, developed for the first time in the world's history during the
last generation or two. It is extremely interesting to realize then, in
the light of this almost universal persuasion, founded to a great extent
on the conviction that man is in process of evolution and that as a
consequence we must surely be doing things now that men never did
before, to find that dentistry, both as an art and science, is old; that
it has developed at a number of times in the world's history, and that
as fortunately for history its work was done mainly in indestructible
materials, the teeth themselves and metal prosthetic apparatus, we have
actual specimens of what was accomplished at a number of periods in the
olden times. Surprising as it will seem to those who hear of it for the
first time, dentistry reached high perfection even in what we know as
ancient history. It is rather easy to trace scientific and craftsmanlike
interest in it during the medieval period and in the magnificent
development of surgery that came just at the end of the Middle Ages,
dentistry shared to such degree that some of the text-books of the
writers on surgery of this time furnish abundant evidence of
anticipations of many of the supposedly most modern developments of
dentistry.
There are a number of historical traditions with regard to dentistry and
the treatment of the teeth in Egypt that can be traced back to good
authorities in Egyptology of a generation or more ago, but it is rather
hard to confirm the accounts we have by actual specimens; either none
were found or for some reason those actually discovered are now not
readily available for study. Among the Phenicians however, though we
have good reasons to think that they learned their arts and crafts from
the Egyptians, there is convincing evidence of a high development of
dentistry. M. Ernest Renan, during an exploring expedition in Phenicia,
found in the old necropolis at Sidon a set of teeth wired together, two
of which were artificial. It was a striking example of bridgework, very
well done, and may now be seen in the Louvre. It would be more than a
little surprising, from what we know of the lack of inventiveness on the
part of the Phenicians and their tendency to acquire their arts by
imitation, if they had reached such a climax of invention by themselves.
Since they adapted and adopted most of their arts and crafts from Egypt,
with which they were in close commercial relations, it has been argued
with some plausibility that the Egyptians may have had many modes of
dental prosthesis, but removed all artificial teeth and dental
appliances from the mouth of corpses before embalming them, in
preparation for the next world, because there was some religious
objection to such human handiwork being left in place for the hereafter,
as they hoped for it.
There is a well-authenticated tradition of intimate intercourse in a
commercial way between the old Etruscans who inhabited the Italian hill
country and the Phenicians, so that it is no surprise to find that the
oldest of Etruscan tombs contain some fine examples of bridgework. An
improvement has come over Phenician work however, and bands of gold
instead of wire are used for holding artificial teeth in place. Guerini,
whose "History of Dentistry" is the standard work on the subject, on a
commission from the Italian government, carefully studied these
specimens of Etruscan dental work in the museums of Italy, and has made
some interesting observations on them. In one specimen, which is
especially notable, two incisor teeth are replaced by a single tooth
from a calf. This was grooved in such a way as to make it seem like two
separate teeth. Guerini suggests a very interesting and quite unexpected
source for this. While examining the specimen he wondered where the old
Etruscan dentist had obtained a calf's tooth without a trace of wear on
it. He came to the conclusion that he must have cut into the gums of a
young calf before the permanent tooth was erupted in order to get this
structure absolutely unworn for his purpose. A number of examples of
bridgework have been found in the old Etruscan tombs. The dates of their
construction are probably not later than 500 B.C., and some of them are
perhaps earlier than 700 B.C.
The Etruscans affected the old Romans in the matter of dentistry, so
that it is easy to understand the passage in the "Laws of the Twelve
Tables," issued about 450 B.C., which, while forbidding the burial of
gold with corpses, made a special exception for such gold as was
fastened to the teeth. Gold was rare at Rome, and care was exercised not
to allow any unnecessary decrease of the visible supply almost in the
same way as governments now protect their gold reserves. It may seem
like comparing little things with great, but the underlying principle is
the same. Hence this special law and its quite natural exception.
In Pope Julius' Museum in Rome there is a specimen of a gold cap made of
two plates of gold riveted together and also riveted to bands of metal
which were fastened around the neighboring teeth in order to hold the
cap in place. This is from later Republican times at Rome. At the end of
the Republic and the beginning of the Empire there appear to have been
many forms of dental appliances. Martial says that the reason why one
lady's teeth--whose name he does not conceal--are white and
another's--name also given--were dark, was that the first one bought
hers and the second still had her own. In another satiric poem he
describes an elderly woman as so much frightened that when she ran away
her teeth fell out, while her friends lost their false hair. Fillings of
many kinds were used, dentrifices of nearly every kind were invented,
and dentistry evidently reached a high stage of development, though we
have nowhere a special name for dentist, and the work seems to have been
done by physicians, who took this as a specialty.
While in the Middle Ages there was, owing to conditions, a loss of much
of this knowledge of antiquity with regard to dentistry, or an
obscuration of it, it never disappeared completely, and whenever men
have written seriously about medicine, above all about surgery in
relation to the face and the mouth, the teeth have come in for their
share of scientific and practical consideration. Aetius, the first
important Christian writer on medicine and surgery, discusses, as we
have seen in the sketch of him, the nutrition of the teeth, their
nerves, "which came from the third pair and entered the teeth by a small
hole existing at the end of the root," and other interesting details of
anatomy and physiology. He knows much about the hygiene of the teeth,
discusses extraction and the cure of fistula and other details. Paul of
AEgina in the next century has much more, and while they both quote
mainly from older authors there seems no doubt that they themselves had
made not a few observations and had practical experience.
It was from these men that the Arabian physicians and surgeons obtained
their traditions of medicine, and so it is not surprising to find that
they discuss dental diseases and their treatment rationally and in
considerable detail. Abulcasis particularly has much that is of
significance and interest. We have pictures of two score of dental
instruments that were used by them. The Arabs not only treated and
filled carious teeth and even replaced those that were lost, but they
also corrected deformities of the mouth and of the dental arches.
Orthodontia is sometimes said to be of much later origin and to begin
many centuries after Abulcasis' time, yet no one who knows of his work
can speak of Orthodontia as an invention after him. In this, however, as
in most of the departments of medicine and surgery, the Arabs were
merely imitators, though probably they expanded somewhat the practical
knowledge that had come to them.
When the great revival in surgery came in the twelfth and thirteenth
centuries it is not surprising that there should also have been an
important renewal of interest in dentistry. A detailed review of this
would take us too far afield, but at least something may be said of two
or three of the great representative surgical writers who touched on
this specialty.
About the middle of the fourteenth century that prince of surgeons, and
model of surgical writers, Guy de Chauliac, wrote his great text-book of
surgery, "Le Grande Chirurgie." An extremely interesting feature of this
work is to be found in the chapters that treat of diseases of the teeth.
These are not very comprehensive, and are evidently not so much the
result of his experience, as the fruit of his reading, yet they contain
many practical valuable ideas that are supposed to be ever so much later
than the middle of the fourteenth century. His anatomy and physiology at
least are not without many errors. His rules for the preservation of the
teeth show that the ordinary causes of dental decay were well recognized
even as early as this. Emphasis was laid on not taking foods too hot or
too cold, and above all not to follow either hot or cold food by
something very different from it in temperature. The breaking of hard
things with the teeth was recognized as one of the most frequent causes
of such deterioration of the enamel as gives opportunity for the
development of decay. The eating of sweets, and especially the sticky
sweets--preserves and the like--was recognized as an important source of
caries. The teeth were supposed to be cleaned frequently, and not to be
cleaned too roughly, for this would do more harm than good. We find
these rules repeated by succeeding writers on general surgery, who touch
upon dentistry, or at least the care of the teeth, and they were not
original with Guy de Chauliac, but part of the tradition of surgery.
As noted by Guerini in his "History of Dentistry," the translation of
which was published under the auspices of the National Dental
Association of the United States of America,[28] Chauliac recognized the
dentists as specialists. Besides, it should be added, as is evident from
his enumeration of the surgical instruments which he declares necessary
for them, they were not as we might easily think in the modern time mere
tooth pullers, but at least the best among them treated teeth as far as
their limited knowledge and means at command enabled them to do so, and
these means were much more elaborate than we have been led to think, and
much more detailed than we have reason to know that they were at
certain subsequent periods.
In fact, though Guy de Chauliac frankly confesses that he touches on the
subject of dentistry only in order to complete his presentation of the
subject of surgery and not because he has anything of his own to say
with regard to the subject, there is much that is of present-day
interest in his brief paragraphs. He observes that operations on the
teeth are special and belong to the _dentatores_, or dentists, to whom
doctors had given them over. He considers, however, that the operations
in the mouth should be performed under the direction of a physician. It
is in order to give physicians the general principles with which they
may be able to judge of the advisability or necessity for dental
operations that his short chapters are written. If their advice is to be
of value, physicians should know the various methods of treatment
suitable for dental diseases, including mouth washes, gargles,
masticatories, anointments, rubbings, fumigations, cauterizations,
fillings, filings, and the various manual operations. He says that the
_dentator_ must be provided with the appropriate instruments, among
which he names scrapers, rasps, straight and curved spatumina,
elevators, simple and with two branches, toothed tenacula, and many
different forms of probes and canulas. He should also have small
scalpels, tooth trephines, and files.
Chauliac is particularly emphatic in his insistence on not permitting
alimentary materials to remain in cavities, and suggests that if
cavities between the teeth tend to retain food material they should even
be filed in such a way as to prevent these accumulations. His
directions for cleansing the teeth were rather detailed. His favorite
treatment for wounds was wine, and he knew that he succeeded by means of
it in securing union by first intention. It is not surprising, then, to
find that he recommends rinsing of the mouth with wine as a precaution
against dental decay. A vinous decoction of wild mint and of pepper he
considered particularly beneficial, though he thought that dentifrices,
either powder or liquid, should also be used. He seems to recommend the
powder dentifrices as more efficacious. His favorite prescription for a
tooth powder, while more elaborate, resembles to such an extent, at
least some, if not indeed most of those, that are used at the present
time, that it seems worth while giving his directions for it. He took
equal parts of cuttle bone, small white sea-shells, pumice stone, burnt
stag's horn, nitre, alum, rock salt, burnt roots of iris, aristolochia,
and reeds. All of these substances should be carefully reduced to powder
and then mixed. His favorite liquid dentifrice contained the following
ingredients,--half a pound each of sal ammoniac and rock salt, and a
quarter of a pound of sacharin alum. All these were to be reduced to
powder and placed in a glass alembic and dissolved. The teeth should be
rubbed with it, using a little scarlet cloth for the purpose. Just why
this particular color of cleansing cloth was recommended is not quite
clear.
He recognized, however, that cleansing of the teeth properly often
became impossible by any scrubbing method, no matter what the dentifrice
used, because of the presence of what we call tartar and what he called
hardened limosity or limyness (_limosite endurcie_). When that condition
is present he suggests the use of rasps and spatumina and other
instrumental means of removing the tartar.