At the ceremony of the marriage of the Duchess Juta of Austria to Count Louis of Oettingen, at Vienna in 1319, Pietro Buonaparte, the Podesta of Padua, created considerable excitement by wearing a pair of spectacles which he had received a short time previously from Salvino degli Armati of Florence, the reputed inventor of these contrivances. It is not generally known that the printing of books in very large and bold type during the latter part of the fifteenth and the early part of the sixteenth centuries was done expressly for the benefit of far-sighted readers—this defect in vision characterizing a very large percentage of the learned men of that period. The great number of books which, during those early days of the art of printing, were published in this style, emphasizes the fact that the usefulness of spectacles was not generally appreciated until after the lapse of many scores of years. Being very expensive they were within the reach of only persons of wealth, and, in addition, they were extremely difficult to obtain. As late as during the year 1572, Augustus, Elector of Saxony, moved by a strong wish to possess a pair of spectacles, despatched a special messenger first to Leipzig and then to Augsburg with instructions to purchase them for him at the great annual fair. This agent, however, was unsuccessful in the attempt, and, accordingly, in the summer of 1574, he was instructed to ride on as far as Venice. But, on arriving there, he was informed that no glasses would be ground before the month of October. He was consequently obliged to remain in that city until the autumn, at which time he sent word to his master that the optician’s charge for the instrument would be 50 thalers (equivalent to $250 at the present value of money). The Elector, it appears, was only too glad to pay this sum for the coveted article. The first spectacles made were equipped with only convex glasses, for the use of far-sighted persons. It was not until about two hundred years later that the art of grinding concave glasses for the relief of short-sighted individuals was discovered.
Guy de Chauliac.—After the lapse of a few years there appeared a man who was destined to add greatly to the fame of the Medical School of Montpellier—not in the way in which Arnold of Villanova had accomplished this result, but by the publication of the first systematic treatise on surgery which was written in Western Europe during the Middle Ages. This man was Guy de Chauliac, about whose early life very little is known. He was born in the village of Chauliac, in Auvergne, France, toward the end of the thirteenth century, his parents being simple peasants; and during early boyhood he probably attended the school connected with the village church. His medical studies were begun at Toulouse and completed at Montpellier. But, at some time later than 1326, he went to Bologna and perfected his knowledge of anatomy under the guidance of Bertrucius, Mondino’s successor. After leaving Bologna Guy visited Paris, arriving there subsequently to the deaths of Lanfranchi, Pitard and Henri de Mondeville. Although he remained in that great city only a short time, he appears to have formed a warm friendship with several of the instructors in the medical school.
About the year 1330 he took up his residence in Lyons. His appointment to the position of Canon of Saint-Just, a church which is located in that city, doubtless made it necessary for him to adopt this course. And yet it is most improbable that he spent much of his time in Lyons, for his other duties—his attendance at the Papal Court in Avignon, as private physician to three Popes in succession, and the numerous calls made upon him for professional advice and especially for surgical assistance by people living at a long distance from Lyons—compelled him repeatedly to absent himself from his home, sometimes for several days at a time. In 1348 the plague visited Avignon and carried off large numbers of people, the poet Petrarch’s Laura being one of the victims. During that terrible epidemic Guy was most faithful in his devotion to Clement VI. and to many others who needed his professional services. In 1357 he was promoted by Innocent VI. to the office of Provost of Saint-Just. In 1363 when—according to, his own declaration—he was an old man, he wrote the treatise on surgery which has rendered his name famous in the history of medicine. His death occurred about July 23, 1368.
Guy was not, as some writers have asserted, a professor of surgery in the University of Montpellier; he was simply a physician who had won at that institution the title of “Master in Medicine”—the highest grade conferred by the university authorities, and one which necessarily implied that the recipient had given a certain number of public readings on medical topics. And yet in actual practice Guy manifested a strong preference for the management of diseases which demanded surgical treatment. His writings, furthermore, make it clear that he had a strong affection for the institution in which he had been both a student and in some measure an instructor.
The book which Guy de Chauliac wrote, and which bears the title “La Grande Chirurgie,” is described by Malgaigne,[70] one of the most distinguished French surgeons of the nineteenth century, in the following terms: “I do not hesitate to say that, with the single exception of the book written by Hippocrates, there is not a work on surgery, no matter in what language written, which ranks higher than, or is even equal to, the magnificent treatise of Guy de Chauliac.” Although most surgeons of the present day will scarcely assent to praise of such an extravagant nature, they will undoubtedly agree in according to this admirable author of the fourteenth century a high place of honor in the Temple of Fame. Nicaise, the editor of the most recent version of Guy de Chauliac’s treatise, speaks of him as the “founder of didactic surgery.” From 1363 A. D., the date of its first publication in manuscript, to 1478, a period of more than one hundred years, Guy’s book was universally regarded as the authoritative treatise on surgery. But this branch of medicine, it must not be forgotten, was, at that period of the Middle Ages, held in very small esteem by physicians generally, and therefore it is almost certain that Guy received no encouragement whatever from any outside source. All the greater credit, therefore, is due him for the admirable manner in which he carried on the task which he had set before himself during the last years of his life. Extraordinary as it appears to us to-day, the Montpellier School of Medicine, toward the end of the fifteenth century (that is, only a comparatively short time after Guy’s death), issued a decree that thereafter their pupils were not to study nor to practice surgery. From this and other well-authenticated facts it appears that the prejudice which existed at that period among physicians against surgery, was strong enough to render them blind to the reality that it was through the instrumentality of this very branch of medical activity that the school at Montpellier had gained such an increase in celebrity. They were unable to dispossess their minds of the idea that operative and all other surgical procedures were derogatory to the dignity of the educated physician.
Guy de Chauliac wrote his treatise originally in Latin—not the Latin of the classical authors, but a Latin greatly deformed by the introduction of French, Arabic and Provençal terms—barbaric Latin, as it is often called. This language was commonly employed at the University of Montpellier and at all other universities at that period; but, as Nicaise states, the style of his writing is so concise, and at the same time so intelligible, that it would scarcely be possible to translate it into modern French without the loss of much of that which constitutes the charm of the book. It was for the latter reason that he decided to write his version of Guy’s treatise in old French—the French of the thirteenth and fourteenth centuries. In order that our readers, most of whom are doubtless more or less familiar with the finished language of modern French literature, may see for themselves to what extent the latter differs from its fourteenth century ancestor, I shall introduce here a single paragraph of Nicaise’s text. I have chosen it, more or less at random, from the admirable chapter which Guy has written on wounds in general.
Consequemment playes mortelles non necessairement, ains pour la pluspart, sont petites playes, et superficielles és susdites parties, et qui penetrent iusques à icelles et aux chefs des muscles. La raison est, parce que si elles ne sont bien traitées, il advient qu’on en meurt: et si sont bien traitées, on en guerit: ainsi que i’ay veu de la partie posterieure du cerveau, de laquelle sortit un peu de la substance du cerveau, ce qui fut reconnu par l’offense de la mémoire, laquelle il recouvra apres la curation. Ie ne dis pas toutesfois qu’on vesquit, s’il en sortoit toute une cellule, comme Theodore raconte d’un cellier. Aussi Galen ne dit pas, de deux blessez qu’il vit guerir en Smyrne du vivant de son maistre Pelope, qu’il en fust sorty de la substance de cerveau, ains seulement que le cerveau avoit esté blessé: Ne, de celuy qu’il vist guery en Smyrne (comme il recite au huitiesme de l’Usage), il ne dit pas qu’il en sortit de la substance du cerveau, ains qu’il fust blessé en l’un des ventricules gemeaux. Et avec ce on pensoit qu’il fust guery par le vouloir de Dieu. Car si tous deux eussent esté blessez, il n’eust gueres duré, comme il dit: et de ce il conclud l’utilite de la duplication de quelques instruments, ainsi qu’a esté dit cy dessus en l’anatomie. Et tant de cettui-cy, que de ceux-là, la guerison rare est fort rarement faite, comme il est dit au commentaire dessus allegué.
There are many places in Guy’s treatise where his description of a surgical condition, or of the proper measures to adopt for the relief or cure of such condition, would doubtless prove interesting to our readers, and would in any event aid them materially in forming an independent judgment as to the man’s character in general and also with regard to his qualifications as a surgeon. But all of these descriptions, when rendered in their entirety into English, occupy much space, and for this reason I shall be obliged to furnish here merely a few extracts from some of the more interesting portions of the text.
In the chapter which Guy devotes to wounds of nerves, cords and ligaments—all of which structures were classed by him, as well as by Galen, as belonging to the category of nerves—this author divides them into punctured and incised wounds, bruises and concussions. As to the first variety he says that they may be divided into closed punctured and open punctured wounds.
In the incised wounds two kinds may be distinguished: those in which the nerve is incised in the direction of its length and those in which the cut is made across the fibres. A further subdivision is practicable, viz., into wounds accompanied by more or less destruction of the substance of the nerve or its envelopes, and those in which such loss has not occurred. Among other differences worthy of mention are these: pain, spasmodic phenomena, and abscess formation are present in certain cases and absent in others. From all of which symptoms useful indications as to the treatment needed may be deduced.