CHAPTER XXIV
DURING THE LATTER HALF OF THE MIDDLE AGES SURGERY ASSUMES THE MOST PROMINENT PLACE IN THE ADVANCE OF MEDICAL SCIENCE
During the first half of the fourteenth century, as has been shown in the preceding chapter, Henri de Mondeville was largely successful in rendering Paris the most prominent centre of medical activity in France, if not in Western Europe generally. His life, however, was short, and his position as one of the leading surgeons of the French Army subjected him to many and prolonged interruptions, for which reasons he was not able to complete his excellent treatise on surgery. No physician of the same intellectual capacity and of equally strong character appears to have been living in Paris at the time of De Mondeville’s death, and consequently the importance of that city as a centre of medical education diminished rapidly after that event. On the other hand, the Medical School at Montpellier in the southern part of France began at about this period, under the influence of Arnold of Villanova (probably a small town in Catalonia, Spain, in the diocese of Valencia), to acquire importance.
Arnold of Villanova and the Medical School of Montpellier.—Arnold of Villanova was born about 1240 A. D., of humble parentage. He obtained his early education in a Dominican cloister, and afterward devoted all his energies to the study of languages (especially Hebrew), theology, philosophy, the natural sciences (physics, alchemy), and medicine. Paris and Montpellier were the principal cities in which he prosecuted those studies. Already as early as the year 1270, Arnold had attained considerable celebrity as a physician. Between the years 1289 and 1299 he appears to have made his home in Montpellier, and to have been very actively engaged both as a practicing physician and as a teacher of medicine. It was in that city also that he wrote the more important of his numerous medical treatises. At a later period of his life he appears largely to have lost his interest in medicine, for in 1299 we find him acting as an ambassador from the King of Aragon, whose private physician he was, to the Court of Philippe le Bel, King of France, and deeply entangled, during his stay in Paris, in disputes with the theologians of that city respecting certain religious doctrines. He was also at the same time busily engaged in championing various ecclesiastic reforms which he was anxious to see inaugurated. His opponents haled him before the tribunal of the Inquisition and succeeded in having him cast into prison, where he remained until he expressed a willingness to retract the obnoxious opinions which he had advanced. The same tribunal pronounced his treatise “De Adventu Antichristi” to be heretical. After these persecutions Arnold endeavored to procure aid and comfort from Popes Boniface VIII. and Benedict XI. The former was inclined in his favor, but Benedict manifested no disposition to aid him. Boniface’s sentiments were doubtless influenced by the fact that Arnold had treated him successfully for stone in the bladder; and Neuburger incidentally states that, in the effecting of this cure, not only medical and dietetic treatment had been employed, but also two other measures—viz., the application of a bandage or truss which encircled the loins snugly, and the wearing (by the patient) of a magic seal ring upon which was engraved the effigy of a lion.[68] When Pope Clement V. (1305–1315 A. D.) removed the papal seat from Rome to Avignon, in France, Arnold was relieved from the charge of heresy and reinstated in the respect of his contemporaries. He became the trusted adviser of royalty, won the sympathy of Jayme II. and of his brother, Frederic III., King of Sicily, for his broad-minded views regarding religious matters, and was both hated and feared by his enemies. According to trustworthy chronicles, Arnold of Villanova died at sea in 1311, within sight of the coast of Genoa, while he was on a voyage (probably from Sicily) to visit the Court of Clement V. In 1316 the Inquisition pronounced most of his philosophical and theological writings heretical, and ordered them to be destroyed.
A complete collection of the medical writings of Arnold of Villanova, so far at least as they were then known to exist, was printed at Lyons, France, in 1586. It is said that many of the treatises which this author wrote have been lost. Of those which have come down to our time there are only three which call for any special comment—Arnold’s “Breviarium,” a compendium of the practice of medicine; his “Commentary on the Regimen Salernitanum,” the sales of which, according to Neuburger, reached an enormous figure; and a work which bears the title “Parabolae medicationis secundum instinctum veritatis aeternae, quae dicuntur a medicis regulae generales curationis morborum.” (Basel, 1560.) The latter treatise, which might with propriety be given the simple title of “General Rules regarding the Treatment of Diseases,” is dedicated (1300 A. D.) to Philippe le Bel, King of France. It contains a number of chapters on the principles of general pathology, and others on special pathology and therapeutics, with relation both to internal diseases and to those which particularly interest the surgeon. It also furnishes 345 aphorisms, many of which embody truths of the highest importance and reveal the author to have been a man of independent judgment, of wide experience, and of a philosophical type of mind.
In the “Parabolae” and the “Breviarium,” says Neuburger, are to be found the most marked evidences of the knowledge and ability which this great physician possessed. He then adds:—
Arnold attached much importance to hygiene and the proper regulation of the diet as effective measures in preventing diseases, and he formulated an admirable set of rules for the ordering of one’s manner of living. In these he gives prominence to the value of baths, to the importance of taking a certain amount of physical exercise, and to the selection of the right kinds of food. He also describes in detail how wine may be utilized advantageously in cases of illness. As regards the choice of remedies to be employed he says that the physician should be guided by a very careful consideration of the patient’s age, temperament, habits of living, etc.; and, so long as there remains any doubt about the correctness of the diagnosis, he should employ only mild and indifferent remedies. The greatest care, he adds, should be exercised in the preparation of the drugs that are to be administered, and one should be very cautious about prescribing substances which have not been sufficiently tried.
Arnold’s writings are full of precepts which, like those quoted above, show him to have been an excellent practitioner of medicine as well as a man of sound common sense. And yet at the same time he appears to have been more or less tainted with the prevailing belief in astrology, in the efficacy of amulets (as in the case of Pope Boniface referred to on a previous page), etc. His enemies gave him the reputation of being a sorcerer upon whom the Devil had bestowed the power of transmuting metals,—a reputation which undoubtedly was based upon the fact that Arnold interested himself greatly in alchemistic processes, often referring to them as closely resembling such organic phenomena as generation, birth, growth, etc. But, in our judgment of the man, we should be careful to remember that during the thirteenth century a belief in alchemy, astrology, the efficacy of amulets, the influence of supernatural agencies, etc., was almost universal. Even theologians maintained that it was a sin for a practitioner of medicine to neglect the influence of certain constellations. Indeed, there are even to-day, not a few very sensible people in whose minds exists a lingering belief in the interference of supernatural agencies in human affairs.
The importance of the influence which Arnold of Villanova exerted upon the progress of medical science, and more especially upon the fame of the Medical School of Montpellier, should not be estimated exclusively from the value of his writings nor from the character of the work which he performed as an instructor in that school. In the thirteenth and fourteenth centuries physicians as a class did not hold so high a position socially in Western Europe as they were probably entitled to hold, and consequently Arnold’s later career, in which he showed himself to be a wise, broad-minded, and very able statesman and as an enthusiastic champion of greater liberty of thought in the domain of religion, must be looked upon as having aided very materially in raising the profession of medicine to a higher rank and in adding éclat to the School of Montpellier.
Contemporaries and Successors of Arnold of Villanova at Montpellier.—During Arnold’s lifetime there does not appear to have been another physician at Montpellier who could be compared with him in professional ability or in general culture. There was one, however, who attained considerable fame as a medical author, and who certainly deserves at least a brief notice in this place—Bernard de Gourdon, also known as Gordonius.
Bernard de Gourdon[69] began teaching medicine in Montpellier in 1285 A. D. He was the author of a treatise which bore the title “Lilium Medicinae,” and which enjoyed an unusual degree of popularity for a long period of time. The earliest printed edition appeared in Lyons in 1474 and was followed by several others in 1491, 1550, 1559 and 1574. One of the latest editions is that of Frankfort, 1617. The book was also translated into both French and Spanish. In his description of the seven parts into which the book is divided, the author says, by way of praising his own work: “In the lily there are many different kinds of blossoms and in each one of these there are seven grains of a golden character.” The book treats of fevers, poisonings, abscesses, tumors, wounds and ulcers, of diseases of the liver, spleen, kidneys and bladder, of affections of the eyes, and of numerous other topics. The work as a whole, says Neuburger, lacks depth and thoroughness, and reveals the author to be overfond of employing drugs, especially in combination, and by no means free from a belief in the efficacy of amulets and other supernatural remedies. It contains, however, one or two references to matters of historical interest. For example, in Chapter V., Part III., mention is made of spectacles. So far as now appears, this is the first time that these useful contrivances are referred to in medical literature; and the casual manner in which the author speaks of them suggests the idea that they had already been known for some time. Possibly Roger Bacon, who interested himself in researches in the department of optics and who was a contemporary of Gordonius, may have had something to do with the invention of spectacles.