Part 12 (1/2)
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 scholars.h.i.+ps, 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 a.s.sume 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 Hispa.n.u.s, 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 p.r.o.ne 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 pa.s.sage quoted from Chauliac himself which shows how freely dissection was practised at the Italian universities in the fourteenth century. This pa.s.sage 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 pa.s.sage in Guy de Chauliac which tells of having frequently seen dissections, must be considered as referring to Bologna. This pa.s.sage 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-s.n.a.t.c.hing, 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 att.i.tude 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.
Like many another distinguished member of his profession, Chauliac did not settle down in the scene of his ultimate labors at once, but was something of a wanderer. His own words are, ”_Et per multa tempora operatus fui in multis partibus_.” Perhaps out of grat.i.tude to the clerical patrons of his native town to whom he owed so much, or because of the obligations he considered that he owed them for his education, he practised first in his native diocese of Mende; thence he removed to Lyons, where we know that he lived for several years, for in 1344 he took part as a canon in a chapter that met in the Church of St. Just in that city. Just when he was called to Avignon we do not know, though when the black death ravaged that city in 1348 he was the body-physician of Pope Clement VI, for he is spoken of in a Papal doc.u.ment as ”_venerabilis et circ.u.mspectus vir, dominus Guido de Cauliaco, canonicus et praepositus ecclesiae Sancti Justi Lugduni, medicusque domini Nostri Papae_.” All the rest of his life was pa.s.sed in the Papal capital, which Avignon was for some seventy years of the fourteenth century. He served as chamberlain-physician to three Popes, Clement VI, Innocent VI, and Urban V. We do not know the exact date of his death, but when Pope Urban V went to Rome in 1367, Chauliac was putting the finis.h.i.+ng touches on his ”Chirurgia Magna,” which, as he tells us, was undertaken as a _solatium senectutis_--a solace in old age. When Urban returned to Avignon for a time in 1370 Chauliac was dead. His life work is summed up for us in this great treatise on surgery, full of antic.i.p.ations in surgical procedures that we are p.r.o.ne to think much more modern.
Nicaise has emphasized the principles which guided Guy de Chauliac in the choice and interpretation of his authorities by a quotation from Guy himself, which is so different in its tone from what is usually supposed to have been the att.i.tude of mind of the men of science of the time that it would be well for all those who want to understand the Middle Ages better to have it near them. Speaking of the surgeons of his own and immediately preceding generations, Guy says: ”One thing particularly is a source of annoyance to me in what these surgeons have written, and it is that they follow one another like so many cranes. For one always says what the other says. I do not know whether it is from fear or from love that they do not deign to listen except to such things as they are accustomed to and as have been proved by authorities. They have to my mind understood very badly Aristotle's second book of metaphysics where he shows that these two things, fear and love, are the greatest obstacles on the road to the knowledge of the truth. Let them give up such friends.h.i.+ps and fears. 'Because while Socrates or Plato may be a friend, truth is a greater friend.' Truth is a holy thing and worthy to be honored above everything else. Let them follow the doctrine of Galen, which is entirely made up of experience and reason, and in which one investigates things and despises words.”
After all, this is what great authorities in medicine have always insisted on. Once every hundred years or so one finds a really great observer who makes new observations and wakes the world up. He is surprised that men should not have used their powers of observation for themselves, but should have been following old-time masters. His contemporaries often refuse to listen to him at first. His observations, however, eventually make their way. We blame the Middle Ages for following authority, but what have we been always doing but following authority, except for the geniuses who come and lift us out of the rut and illuminate a new portion of the realm of medicine. After they have come, however, and done their work, their disciples proceed to see with their eyes and to think that they are making observations for themselves when they are merely following authority. When the next master in medicine comes along his discovery is neglected because men have not found it in the old books, and usually he has to suffer for daring to have opinions of his own. The fact of the matter is that at any time there is only a very limited number of men who think for themselves. The rest think other people's thoughts and think they are thinking and doing things. As for observation, John Ruskin once said, ”Nothing is harder than to see something and tell it simply as you saw it.” This is as true in science as in art, and only genius succeeds in doing it well.
Chauliac's book is confessedly a compilation. He has taken the good wherever he found it, though he adds, modestly enough, that his work also contains whatever his own measure of intelligence enabled him to find useful (_quae juxta modicitatem mei ingenii utilia reputavi_).
Indeed it is the critical judgment displayed by Chauliac in selecting from his predecessors that best ill.u.s.trates at once the practical character of his intellect and his discerning spirit. What the men of his time are said to have lacked is the critical faculty. They were encyclopedic in intellect and gathered all kinds of information without discrimination, is a very common criticism of medieval writers. No one can say this of Chauliac, however, and, above all, he was no respecter of authority, merely for the sake of authority. His criticism of John of Gaddesden's book shows that the blind following of those who had gone before was his special _bete noir_. His bitterest reproach for many of his predecessors was that ”they follow one another like cranes, whether for love or fear, I cannot say.”
Chauliac's right to the t.i.tle of father of surgery will perhaps be best appreciated from the brief account of his recommendations as to the value of surgical intervention for conditions in the three most important cavities of the body, the skull, the thorax, and the abdomen.
These cavities have usually been the dread of surgeons. Chauliac not only used the trephine, but laid down very exact indications for its application. Expectant treatment was to be the rule in wounds of the head, yet when necessary, interference was counselled as of great value.
His prognosis of brain injuries was much better than that of his predecessors. He says that he had seen injuries of the brain followed by some loss of brain substance, yet with complete recovery of the patient.
In one case that he notes a considerable amount of brain substance was lost, yet the patient recovered with only a slight defect of memory, and even this disappeared after a time. He lays down exact indications for the opening of the thorax, that _noli me tangere_ of surgeons at all times, even our own, and points out the relations of the ribs and the diaphragm, so as to show just where the opening should be made in order to remove fluid of any kind.
In abdominal conditions, however, Chauliac's antic.i.p.ation of modern views is most surprising. He recognized that wounds of the intestines were surely fatal unless leakage could be prevented. Accordingly he suggested the opening of the abdomen and the sewing up of such intestinal wounds as could be located. He describes a method of suture for these cases and seems, like many another abdominal surgeon, even to have invented a special needleholder.
To most people it would seem absolutely out of the question that such surgical procedures could be practised in the fourteenth century. We have the definite record of them, however, in a text-book that was the most read volume on the subject for several centuries. Most of the surprise with regard to these operations will vanish when it is recalled that in Italy during the thirteenth century, as we have already seen, methods of anaesthesia by means of opium and mandragora were in common use, having been invented in the twelfth century and perfected by Ugo da Lucca, and Chauliac must not only have known but must have frequently employed various methods of anaesthesia.
In discussing amputations he has described in general certain methods of anaesthesia in use in his time, and especially the method by means of inhalation. It would not seem to us in the modern time that this method would be very successful, but there is an enthusiastic accord of authorities attesting that operations were done at this time with the help of this inhalant without the infliction of pain. Chauliac says:
”Some prescribe medicaments which send the patient to sleep, so that the incision may not be felt, such as opium, the juice of the morel, hyoscyamus, mandrake, ivy, hemlock, lettuce. A new sponge is soaked by them in these juices and left to dry in the sun; and when they have need of it they put this sponge into warm water and then hold it under the nostrils of the patient until he goes to sleep. Then they perform the operation.”
Many people might be p.r.o.ne to think that the hospitals of Chauliac's time would not be suitable for such surgical work as he describes. It is, however, only another amusing a.s.sumption of this self-complacent age of ours to think that we were the first who ever made hospitals worthy of the name and of the great humanitarian purpose they subserve. As a matter of fact, the old-time hospitals were even better than ours or, as a rule, better than any we had until the present generation. In ”The Popes and Science,” in the chapter on ”The Foundation of City Hospitals,” I call attention to the fact that architects of the present day go back to the hospitals of the Middle Ages in order to find the models for hospitals for the modern times. Mr. Arthur Dillon, a well-known New York architect, writing of a hospital built at Tonnerre in France, toward the end of the thirteenth century (1292), says:
”It was an admirable hospital in every way, and it is doubtful if we to-day surpa.s.s it. It was isolated; the ward was separated from the other buildings; it had the advantage we so often lose of being but one story high, and more s.p.a.ce was given to each patient than we can now afford.
”The ventilation by the great windows and ventilators in the ceiling was excellent; it was cheerfully lighted; and the arrangement of the gallery s.h.i.+elded the patients from dazzling light and from draughts from the windows and afforded an easy means of supervision, while the division by the roofless low part.i.tions isolated the sick and obviated the depression that comes from sight of others in pain.
”It was, moreover, in great contrast to the cheerless white wards of to-day. The vaulted ceiling was very beautiful; the woodwork was richly carved, and the great windows over the altars were filled with colored gla.s.s. Altogether it was one of the best examples of the best period of Gothic Architecture.”[24]
The fine hospital thus described was but one of many. Virchow, in his article on hospitals quoted in the same chapter, called attention to the fact that in the thirteenth and fourteenth centuries every town of five thousand or more inhabitants had its hospital, founded on the model of the great Santo Spirito Hospital in Rome, and all of them did good work.