MONTPELLIER AND MEDICAL EDUCATION IN THE WEST
After Salerno the next great medical school was that of Montpellier in the
South of France. The conditions which brought about its original
establishment are very like those which occasioned the foundation of
Salerno. Montpellier, situated not far from the Mediterranean, came to be
a health resort. Patients flocked to it from many countries of the West of
Europe; physicians settled there because patients were numerous, and
medical instruction came to be offered to students. Fame came to the
school. The fundamental reason for this striking development of the
intellectual life seems to have been that Montpellier was not far from
Marseilles, which had been a Greek colony originally and continued to be
under Greek influence for many centuries. As a consequence of this the
artistic and intellectual life of the southern part of France was higher
during the earlier Middle Ages than that of any other part of Europe,
except certain portions of South Italy. The remains of the magnificent
architecture of the Roman period are well known, and Provence has always
been famous for its intellectual and literary life. Among a people who
were in this environment, we might well look for an early renaissance of
education.
It is not surprising, then, that one of the earliest of the medical
schools of modern history around which there gradually developed a
university should have come into existence in this part of the world. What
is even more interesting perhaps for us, is that this medical school has
persisted down to our own day, and has always been, for nearly ten
centuries now, a centre of excellent medical education.
There gathered around the story of its origin such legends as were noted
with regard to the history of Salerno, and there is no doubt that Jewish
and Moorish physicians who became professors there contributed not a
little to the prestige of the school and the reputation that it acquired
throughout Europe. The attempt to attribute all of the stimulus for the
intellectual life at Montpellier to these foreign elements is, however,
simply due to that paradoxical state of mind which has so often tried to
minimize the value of Christian contributions to science and the
intellectual life, even by the exaggeration of the significance of what
came from foreign and un-Christian sources. Proper recognition must be
accorded to both Jewish and Moorish factors at Montpellier, but the one
important element is that these foreign professors brought with them, even
though always in rather far-fetched translations, the ideas of the great
Greek masters of medicine to which the region and the people around
Montpellier were particularly sensitive, because of the Greek elements in
the population, and hence the development of a significant centre of
education here.
The date of the rise of the medical school at Montpellier is, as suggested
by Puschmann, veiled in the obscurity of tradition. There seems to be no
doubt that it goes back to as early as the tenth century, it was already
famous in the eleventh, and it attracted students from all over Europe
during the twelfth century. When Bishop Adalbert of Mainz came thither in
1137, the school possessed buildings of its own, as we learn from the
words of a contemporary, Bishop Anselm of Havelberg. St. Bernard in a
letter written in 1153 tells that the Archbishop of Lyons, being ill,
repaired to Montpellier to be under the treatment of the physicians there.
Perhaps the most interesting feature of this letter is the fact that the
good Archbishop not only spent what money he had with him on physicians,
but ran into debt.
The two schools, Salerno and Montpellier, came to be mentioned by writers
of the period as representing the twins of medical learning of the time.
John of Salisbury, a writer of the early thirteenth century, declares that
those who wished to devote themselves to medicine at this time went either
to Salerno or Montpellier. Ægidius or Gilles de Corbeil, the well-known
physician, and Hartmann von der Aue, the Meistersinger, both mention
Salerno and Montpellier, usually in association, in their writings, and
make it very clear that in the West at least the two names had come to be
almost invariably connected as representing rival medical schools of about
equal prominence.
The reputation of Montpellier spread in Italy also, however, and we have
the best evidence for this from an incident that took place in Rome at the
beginning of the thirteenth century, which is more fully dwelt on in the
chapter on Medieval Hospitals. Pope Innocent III. wanted to create a model
hospital at Rome, and made inquiries as to who would be best fitted to
organize such an institution. He was told of the work of Guy or Guido of
Montpellier, who was a member of the Order of the Holy Ghost and had made
a great hospital at Montpellier. Accordingly Guy was summoned to Rome, and
the establishment of the Santo Spirito Hospital was entrusted to him. It
was on the model of this that a great many hospitals were founded
throughout the world, for Pope Innocent insisted that every diocese in
Christianity should have a hospital, and Bishops who came on formal visits
to the Holy See were asked to inspect the Santo Spirito for guidance in
their own diocesan hospital establishments. Many of the hospitals
throughout the world came as a result to be hospitals of the Holy Ghost
and this contribution alone of Montpellier to the medical world of the
time was of great significance and must have added much to her prestige.
[Illustration: HOLY GHOST HOSPITAL (LÜBECK)
_From "The Thirteenth: Greatest of Centuries," by J. J. Walsh_]
Montpellier, like Salerno, seems to have attracted students to its medical
school from all over the world. There were undoubtedly many English there,
and probably also Irish and Scotch, though the journey must have been much
longer and more difficult to make than is that from America to Europe at
the present time. Of course there came many from Spain and from North
France and the Netherlands. The fact that a number of Italians went there
before the close of the Middle Ages shows how deeply interested were the
men of this time in knowledge for its own sake, and indicates that
something of that internationality of culture which we are priding
ourselves on at the present time, because our students from all countries
go far afield for postgraduate work and there is an interchange of
professors, existed at this period. In spite of the fact that books were
only written by hand, the teaching of distinguished professors had a wide
diffusion, and students were quite ready to go through the drudgery of
making these handwritten copies of a favourite master's work. They had
plenty of common sense as well as powers of observation, and some of their
writing is still of great practical value.
A number of men who are famous in the history of medicine made their
medical studies at Montpellier in the twelfth and thirteenth centuries.
Among them are Mondeville, who afterwards taught surgery at Paris; and Guy
de Chauliac, who was a Papal Physician at Avignon and at the same time a
professor at Montpellier, probably spending a certain number of weeks, or
perhaps months, each year in the university town. Sketches of these men,
and of other students and teachers at Montpellier who reached distinction
in surgery, will be found in the chapter on Surgeons of the West of
Europe. Some other distinguished Montpellierians deserve brief mention.
One of the distinguished professors at Montpellier was the well-known
Arnold de Villanova, of whose name there are a number of variants,
including even Rainaldus and Reginaldus. In 1285 he was already a famous
physician, and was sent for to treat Peter III., King of Aragon, who was
severely ill. In 1299 he was summoned on a consultation to the bedside of
King Philip the Handsome (le Bel) at Paris. After this we hear of him in
many places, as at the Court of Pope Benedict XI. at Rome, and in 1308 as
the physician and friend of Pope Clement V. at Avignon. His writings were
printed in a number of editions in the Renaissance time, Venice 1505,
Lyons 1509, 1520, 1532, Basel 1585, and his medical and astronomical and
chemical works in separate volumes at Lyons in 1586.
His aphorisms are well known, and used to be frequently quoted during the
Middle Ages and afterwards, and some of them deserve to be remembered even
at the present time. For instance, he said: "Where the veins and arteries
are notably large, incision and deep cauterization should be avoided."
"When cauterization is to be done the direct cautery should be used;
caustic applications are only suitable for very timid patients." "The lips
of a wound will glue together of themselves if there is no foreign
substance between them, and in this way the natural appearance of the part
will be preserved." "In large wounds sutures should be used, and silk
thread tied at short distances makes the best sutures." "The infection of
the dura mater is followed in most cases by death." "A collection of pus
is best dissolved by incision and cleaning out of the purulent material."
"To put off the opening of an abscess brings many dangers with it." "In
most cases of scrofula external applications are better than the use of
the knife. Scrofulous patients always have other sources of infection
within them, and so it does them no good to operate externally." "Tranquil
and pure air is the best friend for convalescents."
Villanova advised that the bite of a mad dog should not be permitted to
heal at once, but the wound should be enlarged and allowed to bleed
freely, leeches and cups being used to encourage bleeding, and healing
should not be permitted for forty days. He believed very thoroughly in
drainage, and in the dilation of narrow fistulous openings. He describes
anthrax or carbuncle, and has chapters on various painful conditions for
which he employs the terms arthritis, sciatica, chiragra, podagra, and
gonagra.
Villanova's treatment of the subject of hernia shows how thoroughly
conservative he was, and how careful were his observations. In young
persons in recent hernias he advised immediate complete reposition of the
contents of the sac, the bringing together of the hernial opening by means
of adhesive plaster, above which a bandage was placed, and the patient
should be put to bed with the feet and legs elevated and the head
depressed for ten to fifteen days or more if necessary. He says that
"there are some--especially surgeons--who claim that they can cure hernia
by incision, and some others by means of a purse-string ligature, and
still others by the cautery or by some cauterizing material [they
manifestly had our complete catalogue of 'fakes' in the matter]; but I
prefer not to mention these procedures, since I have seen many patients
perish under them, and others brought into serious danger of death, and I
do not think that the surgeon will acquire glory or an increase of his
friends from such perilous procedures, and I do not approve their use."
One of the important writers of Montpellier was Gilbertus Anglicus
(Gilbert the Englishman), who is called in one of the old translations of
Mesue Doctor _Desideratissimus_, which I suppose might be Anglicized
"loveliest of doctors." After his studies in England he went for graduate
work to some of the famous foreign universities, and is named as a
chancellor of Montpellier. His best-known work is his "Compendium
Medicinæ," which bore as its full title "The Compendium of Medicine of
Gilbert the Englishman; useful not only to physicians, but to clergymen
for the treatment of all and every disease." Gurlt says that it contains
little that is original, being a copy of Roger of Parma and Theodoric of
Lucca, with a number of quotations from the Arabs, nearly all of whom
Gilbert seems to have read with considerable attention. It is interesting
to find that Gilbert was definitely of the opinion that cancer is
incurable except by incision or cauterization. He declares that it yields
to no medicine except surgery.
Another of the men whose names are connected with Montpellier was John of
Gaddesden, often called _Joannes Anglicus_. He was a student of Merton
College, and received his degree of doctor of medicine at Oxford. He
studied afterwards at Montpellier and also at Paris, and settled down to
practise in London. He treated the son of King Edward II. for smallpox,
and having wrapped him in red cloth and made all the hangings of his bed
red, so that the patient was completely surrounded by this colour, he
declared that he made "a good cure, and I cured him without any vestiges
of the pocks." The treatment is interesting, as an anticipation in a
certain way of Finsen's red light treatment for smallpox in our own time.
Hanging the room, and especially the doors and the windows, with red when
smallpox was to be treated was a favourite treatment down at Montpellier.
Gaddesden's book is called by the somewhat fanciful name "Rosa Anglica."
Bernard Gordon of Montpellier had written a "Lilium Medicinæ," and we
have a "Flos Medicinæ" from Salerno, so that flower names for medical
textbooks were evidently the fashion of the time.
Gaddesden's book is almost entirely a compilation, and except in the
relation of his surgical experience, contains little that is new. Guy de
Chauliac was quite impatient with it, and declared that "lately there had
arisen a foolish Anglican rose which was sent to me and I looked it over.
I expected to find the odour of sweetness in it, but I found only some old
fables." The criticism is, however, as Gurlt remarks, too severe and not
quite justified, representing rather Guy's high ideal of the originality
that a new textbook should possess, than a legitimate critical opinion. If
our own textbooks were to be judged by any such lofty standard, most of
them would suffer rather severely.
Another of the well-known teachers at Montpellier was Valesco de Taranta.
There are the usual variants of his name, his first name being written
also Balesco, and his last name sometimes Tharanta. He was a Portuguese
who studied in Lisbon, and later in Montpellier, where he taught
afterwards and was considered one of the distinguished professors of his
day, being for a time chancellor. He became so well known that he was
summoned in consultation to the French King Charles VI., and there is some
doubt as to whether he did not become his regular physician. One of his
works, the "Philonium Pharmaceuticum et Chirurgicum de medendis omnibus,
cum internis tum externis, humani corporis affectionibus," had the honour
of being printed at Lyons in two editions in 1490, and one at Venice the
same year, at Lyons 1500, Venice 1502, Lyons 1516, 1521, 1532, 1535,
Venice 1589, and Lyons 1599. It has also been reprinted subsequently in a
number of editions, so that it must have been a much-read book. Valesco
had two favourite authors, Galen and Guy de Chauliac. The fact that he
should have appreciated two such great men so thoroughly is of itself the
best evidence of his own ability and critical judgment. His book, from the
number of printed editions, must have been in the hands of practically all
the progressive physicians of the southern part of France, at least during
the fifteenth, sixteenth, and part of the seventeenth centuries.
A very well-known teacher of Montpellier, who has had a reputation in
English-speaking countries because his name was supposed to indicate that
he was a Scotchman, was Bernard Gordon or de Gordon, whose name is,
however, also written Gourdon. He was a teacher at Montpellier at the end
of the thirteenth and the beginning of the fourteenth century. His
textbook of medicine, in accordance with the custom of the time, is
called by the flowery title "Lilium Medicinæ," the Lily of Medicine.
While much of his information was derived from the Arabs, some of his
teaching was an advance on theirs, and he described the acute fevers,
leprosy, scabies, anthrax, as well as erysipelas, and still more strangely
phthisis, as contagious. Dr. Garrison has called attention in his "History
of Medicine" to the fact that the book is notable as containing the first
description of a modern truss, and a very early mention of spectacles
under the Latin name _oculus berellinus_. In recent years it has come to
be the custom to think of Gordon or Gourdon as probably not of Scotch but
of French origin--that is, born somewhere in the confines of what we now
call France. There are a number of French places of the name of Gourdon
from any of which he might have come.
Montpellier represented for the West of Europe then very nearly what
Salerno did for Italy and Eastern Europe. It very probably attracted many
of the English and Scotch students of medicine, though not all the names
supposed to be of British origin have proved to be so with the development
of our knowledge. Montpellier has survived, however, while Salerno
disappeared as a force in medical education. Its story would well deserve
telling in detail, and doubtless the new national spirit of the French
after the war will prove an incentive to the writing of it.