The growth of medicine from the earliest times to about 1800

by Albert H. Buck

In the early period of the Renaissance surgery was apparently the first of the practical branches of medicine to spring forward into active life. Anatomy,—that is, human anatomy,—the foundation that is absolutely necessary to the solid growth of surgery, scarcely existed before the beginning of the sixteenth century; and it is therefore not surprising that the records of the past reveal to us so very few instances of men who attained any eminence as surgeons. When this fact is taken into consideration I cannot help feeling that, in the sketches which I drew, on earlier pages, of Theodoric of Cervia, William of Saliceto, Lanfranchi of Milan (and later of France), Henri de Mondeville and Guy de Chauliac, I gave to these men only a small fraction of the credit to which they were justly entitled. Indeed, the excellence of the work done by them and recorded in the treatises which they published, is so great as to arouse the suspicion that they had clandestinely acquired more knowledge of human anatomy than they dared to admit. The life of a dissector of human bodies, it should be remembered, was by no means safe in those days.

But the lack of a trustworthy knowledge of anatomy was not the only hindrance to a healthy development of the art of surgery. There were other obstacles which, up to a comparatively late period in the sixteenth century, continued to block the advance of this art. Of these, the principal one was perhaps the custom—not by any means considered at that period professionally dishonorable—of keeping secret the technique of certain operative procedures like that of cutting for stone in the bladder or that of the radical cure of hernia. Such knowledge was treated as private property, and was very carefully handed down from father to son, or was sold for a large sum of money to certain surgeons who engaged, under oath, not to reveal the details to others. Thus we are assured by Haeser that two such eminent surgeons as Ambroise Paré and Fabricius of Hilden were obliged to pay handsomely for the information which they received from certain specialists concerning their particular methods of procedure. It is from such scraps of information which come to our knowledge casually that we often learn the actual truth concerning the advance made at a given period of time by a certain department of medical science. Although it is not possible to fix the date when the custom to which I have just referred was definitely abandoned, it may be stated as a fact that after the seventeenth century very few instances of such ownership of surgical secrets are discoverable in the records.

Inasmuch as at the very beginning of the Renaissance surgery was looked upon, in the southern and central parts of Europe, as an occupation of a somewhat menial character, the regularly organized medical schools made very inadequate provision for the proper education and training of those young men who were disposed to adopt a surgical career. During the fourteenth and fifteenth centuries surgery was still tolerated at Montpellier, but after the papal seat had been removed from Avignon to Rome—that is, after 1479,—the pupils of that university were forbidden to do any surgical work. In 1490, however, a course in surgery was provided for the exclusive use of barbers. At first the instruction was given in Latin, but, as these men did not understand this language, the professor was soon compelled to employ a barbaric Latin (half French and half Latin) in making his comments upon the text of the lecture. This state of affairs lasted for more than a century. In fact, it was not until after Paré, Franco and Wuertz had demonstrated by their remarkable careers how honorable was this branch of the science of medicine, that provision was made at Montpellier (in 1597) for regular instruction in surgery. But even then, for a period of several years, it was found to be a very difficult matter to keep the peace between the two groups of students—the medical and the surgical; the governing authorities being finally obliged, in order to prevent the encounters which frequently took place between the rival bodies, to appoint four a.m. as the hour when the instruction in surgery was to be given. Those students who were pursuing the course in medicine looked upon the surgical pupils as intruders, as men unworthy to associate with them, and they availed themselves of every possible opportunity for making their connection with the university unpleasant.

In Paris, during the twelfth and thirteenth centuries the surgeons formed themselves into corporations. Minor surgery was left entirely in the hands of the barbers (a word which is derived from the Latin “barbarus,” uncultivated) and barber-surgeons. They were largely itinerant practitioners and army surgeons. As they traveled from one city to another, the more enterprising ones announced their approach by means of a sort of herald who proclaimed loudly the cures which his chief was able to accomplish. In the course of time the surgeons who lived in Paris formed themselves into the so-called “College of Surgeons.” At a later date (1255) there was established in that city by Jehan Pitard, the surgeon of Louis the Ninth (“Saint Louis,” 1215–1270), a more perfect organization under the name of the “College of Saint Cosmas,” which was placed under the protection of Saints Cosmas and Damian. The members of this Brotherhood were known as “Surgeons of the Long Robe,” to distinguish them from the Barber-Surgeons or “Surgeons of the Short Robe”; and they were also known as “Maitres Chirurgiens Jurés.” Through the influence of Pitard this organization received from the King a set of governing rules or constitution.

It may prove interesting to learn who Cosmas and Damian were, how they came to be canonized, and for what reasons the organizers of the new brotherhood preferred them to all others, as guardian saints. Cosmas and Damian were the youngest of five brothers who belonged to a family of some distinction in Arabia. They chose the career of peripatetic physicians, and gave their services free to those who might have need of them. They spent some time in the Province of Cilicia, Asia Minor, and while in that country they met the death of martyrs, somewhere about 287 A. D., during the persecutions of the Christians which occurred in the reign of Diocletian. In the church pictures they are represented as physicians, each one of whom holds in his hand either a vessel containing a remedial preparation, or a staff around which the emblematic serpent is twined, or (less frequently) a surgical instrument of some kind. During the time of the Crusades there existed an Order of Knights of Saint Cosmas and Saint Damian, who devoted themselves specially to the care of sick pilgrims and to the freeing of those who were held as prisoners.

In all the large cities of France there existed, during the fourteenth and fifteenth centuries, corporations of surgeons, the great majority of whom belonged to the class or grade of barbers. These men were not permitted by their rules to use the knife, and, as a result, great jealousy existed between them and the few who, having passed the required examination, were authorized to perform cutting operations and to assume the title of “Masters in Surgery.” In 1493, as the result of an effort made by the barbers of Paris as a body, to gain some knowledge of medical science, they obtained from the university permission to purchase a corpse which had not yet been removed from the gallows. They had, it appears, engaged a doctor of medicine to give them instruction in anatomy, and it was upon a dissection of this body that the teaching was to be based. In 1494 the Faculty made provision for giving the barbers a regular course of lectures on surgery; and, eleven years later (1505), additional privileges having in the meantime been granted them by the university, they organized the “Corporation of Barber Surgeons, or Surgeons of the Short Robe.” In the oath which the members of this organization were obliged to take, it is expressly stated, among other things, that “they will give due honor and reverence to the Faculty, and will not administer any laxative or alterative drug.”

From 1601 to 1731, when the Académie de Chirurgie was founded, there was an almost continuous series of squabbles between the surgeons and the barbers, on the one hand, and the Medical Faculty of the University, on the other. At a still earlier period, dating back even to the fourteenth century, the quarrels were between the surgeons (École de St. Côme) and the barbers, but, during the seventeenth century and the early part of the eighteenth, the surgeons and the barbers seem to have harmonized their interests and to have made common cause against the Faculty. An edict was issued by Louis the Twelfth in 1613 to the effect that the two corporations (the surgeons and the barbers) should be fused into a single organization; and, even before this, it had become customary to employ the words “surgeon” and “barber” as synonymous terms. Finally, in the years 1644, 1645 and 1656, further agreements were entered into by the two bodies. After the founding of the Academy of Surgery in 1731 nothing further is heard of barber-surgeons.

In the account which I have thus far given of the agencies that were available during the Renaissance for the perpetuation and increase of medical knowledge, I make reference only to the established medical schools and to the less pretentious but much more practical teaching organizations furnished by the guilds or brotherhoods. In my remarks I have said little or nothing about hospitals, which—potentially, at least,—have a great deal to do with the advance of medical knowledge, especially in the department of surgery. Unfortunately, my efforts to procure information relating to this subject have not been rewarded with much success and I shall therefore not be able to furnish more than a few disconnected and very imperfect details.

At the beginning of the sixteenth century the city of Lyons possessed (and it still possesses) the oldest hospital in France—viz., the Hôtel-Dieu,—which was founded by Childebert the First in 542 A. D. The city itself was at that period second in importance only to Paris, and in some respects it was the equal of the metropolis in celebrity. The art of printing was introduced there in 1472, and the presses of that city were soon reckoned the best in Europe. Many medical books were published at Lyons. François Rabelais (1483–1553), the celebrated author of the humorous and satirical works “Gargantua” and “Pantagruel,” was a regularly educated physician, and during his residence at Lyons he edited various works of Hippocrates and Galen. Michael Servetus, who displayed such marked ability by his researches in regard to the circulation of the blood, was also a resident of Lyons from 1530 to 1543. Some idea of the way in which a large hospital was managed in those early days may be gained from the following statement of facts: In 1619 as many as five patients were permitted to occupy one bed in Hôtel-Dieu at Lyons. Although the hospital possessed accommodations for a total of five hundred and forty-nine patients (including pilgrims and poor people), there was only one medical man whose duty it was to look after the surgical cases, and he resided outside the building. At a somewhat later date there was provided a “chirurgien principal,” whose duty it was to give the needed surgical care to this class of patients, and who was obliged to reside in the hospital. When this chief surgeon required assistance in the dressing of wounds, etc., he was authorized to make use of the “apothecary’s boy.” The stock of surgical instruments possessed by the hospital in 1543 comprised the following items: One uterine speculum; one trephine, which was composed of thirteen separate parts; one mouth-plug, for use in keeping the jaws separated; one ear speculum; and one elevatorium. All these facts, taken together, furnish strongly corroborative evidence of the statement made by von Gurlt in his Geschichte der Chirurgie, viz., that in France, during the sixteenth century, the occupation of surgeon was considered by the community but little better than that of a hair-cutter. It is therefore not surprising that the great hospital of Lyons should have been managed at that time in accordance with such a low sanitary standard and with an almost total disregard of the purposes for which a hospital exists. So far as I am able to learn, the conditions just described were not peculiar to the city of Lyons. “During the reign of Francis the First (1515–1547) there were in the main room (thirty-six feet wide) of the Infirmary of Hôtel-Dieu at Paris,” says Boisseau, “six rows of beds (three feet wide), each one of which accommodated ordinarily three (at times even four) sick persons, who necessarily were very uncomfortable. This is not all; for there were also in this same infirmary seven or eight beds which were designed to accommodate from twenty-five to thirty infants or young children, the great majority of whom died from the poor quality of air which they had to breathe in that institution.” I do not need to furnish additional proofs in corroboration of the truth of the statement that during the Renaissance the French civil hospitals contributed practically nothing to the advance of medical science. It is possible that in Italy these institutions may have been better managed, for, in the account which he gives of his trip to Rome, Luther speaks of having visited a hospital which particularly attracted his notice by reason of its orderliness and the conspicuous cleanliness of every part of the building. As an offset, however, to this favorable testimony I should state that in some documents discovered in comparatively recent times there are memoranda relating to the duties of the medical staff in the civil hospital of Padua (1569)—a city in which was located the most famous medical school to be found anywhere in Europe during the sixteenth century. These memoranda read as follows: “There shall be a doctor of physic upon whom rests the duty of visiting all the poor patients in the building, females as well as males; a doctor of surgery whose duty it is to apply ointments to all the poor people in the hospital who have wounds of any kind; and a barber who is competent to do, for the women as well as for the men, all the other things that a good surgeon usually does.” (The word “surgeon” is evidently employed here in the sense of barber-surgeon, and not in the modern sense of the word.) This testimony and that furnished on a preceding page with regard to the management at the two leading civil hospitals in France amply justify the statement that during the sixteenth century medicine received no aid whatever from these institutions in its efforts to advance.

For the sake of orderliness I shall, from this point onward, arrange the information which I may find it desirable to furnish, under the headings of the different countries of Europe; and in carrying out this plan I shall begin with Germany, as it was there that the oldest fifteenth-century treatises on practical surgery were first printed.