The Popes and Science / The History of the Papal Relations to Science During the Middle Ages and Down to Our Own Time

by James J. Walsh

Some of his remarks are very curiously interesting to the modern. He seems to have had the idea that portions of metal which had penetrated the body as the result of explosions, for gun-powder was already being used, might be removed by means of a magnet. He would not have been a distinguished surgeon without inventing a needle-holder, and accordingly we find that he was one of the first of a long line of such inventors. He invented certain instruments also for the removal of arrow-heads, which because of their form and hooks become firmly imbedded in the tissues. Mondeville had no such fear of trephining as Lanfranc had, though he did not hesitate to emphasize the value of expectant treatment in most of these cases of injury to the head that might seem at first to demand the trephine.

Pagel notes the fact that when he prescribed drinks for his patients this medieval surgeon suggested that certain verses of the psalms which were usually recited, according to the custom of the times, whenever anything was administered to a patient, should be said. Pagel considers it quite natural that as a believing physician he should have realized how much his believing patients would be influenced for the better by such a procedure. He did not place any supreme faith in its efficacy, but [{179}] knew that it could do no harm, and had probably seen, as has many a physician and surgeon of the modern time, that such a practice does good, if not by the direct interference of Providence, then at least by the calmness of mind which it superinduces in the patient. In the same way Mondeville was not averse to his patients going on pilgrimages. He did not expect that they would all be cured miraculously, but according to Pagel, his discussion of this subject is quite modern. Travel and change of scene would do good anyhow in many cases, expectancy would help the patient's condition, and the hope aroused was also good. The best merit, however, of this French surgeon is undoubtedly the immense influence which he exerted over his great successor, Guy de Chauliac.

We are really only beginning to accumulate knowledge with regard to the surgery of the thirteenth and fourteenth centuries. Pagel has devoted three very full pages, in his compressed account of surgery, to John Yperman, a surgeon of the early fourteenth century of whom practically nothing was known until about twenty-five years ago, when the Belgian historian Broeck brought to light his works and gathered some details of his life. He was a pupil of Lanfranc's, and at the end of the thirteenth century studied at Paris on a scholarship provided by his native town of Ypres, which deliberately sent him in order that he might become expert in surgery. This may seem a strange thing for a medieval town to do, at least it may seem so to those who have been accustomed to think little of the Middle Ages, but it will not to anyone who knows anything about the wonderful civic spirit of the Free Towns. In the chapter on Science at the Medieval Universities I have quoted [{180}] from Prince Kropotkin's work on Mutual Aid in the Medieval Towns, and further consultation of that as a ready reference, would make all cause for ignorant surprise with regard to the culture and the enterprise of medieval towns disappear. Ypres, while a town of only fifteen thousand inhabitants now, was one of the most important towns of Flanders in the Middle Ages, noted for its manufacture of linens and fine laces, and has a handsome cathedral dating from the thirteenth century and a town hall, the famous Cloth Hall, from the same period, which is one of the most beautiful architectural monuments in Europe and one of the finest municipal buildings in the world.

After his return Yperman settled down in his native town and practiced surgery until his death, which probably took place about 1330. He obtained a great renown, and this has been maintained so that in that part of the country even yet, an expert surgeon is spoken of as an Yperman. He is the author of two works in Flemish. One of these is what Pagel calls an unimportant compilation on internal medicine, but the headings of the chapters as he gives them can scarcely fail to attract the attention of the modern physician. He treats of dropsy, rheumatism, under which occur the terms coryza and catarrh, icterus, phthisis (he calls the tuberculous, tysiken), apoplexy, epilepsy, frenzy, lethargy, fallen palate, cough, shortness of breath, lung abscess, hemorrhage, blood-spitting, liver abscess, hardening of the spleen, affections of the kidney, bloody urine, diabetes, incontinence of urine, dysuria, strangury, gonorrhoea and involuntary seminal emissions--all these terms are quoted directly from Pagel.

All this would seem to show that Yperman was a [{181}] thoroughly representative medical man. When I add that Pagel says he shows a well marked striving to free himself from the bondage of authority and that most of his therapeutic prescriptions rest upon his own experience, it will be seen that he deserves the greatest possible credit. His work in medicine, however, Pagel considers as nothing compared to his work in surgery. A special feature of this is the presence of seventy illustrations of instruments of the most various kinds, together with a plate showing the anatomical features of the stitching of a wound of the head. The work as we have it is only a fragment. The last part of it which treated of the extremities is defective. If anyone thinks for a moment that surgery was a neglected specialty at the end of the thirteenth and the beginning of the fourteenth century, he should consult the text of this, or even Pagel's brief account of its contents. Some of the features of it are noteworthy. There is a chapter devoted to intoxications, which includes the effects of cantharides as well as alcohol, and treats of the bites of snakes, scorpions, and of hydrophobia due to the bites of mad hounds. There is scarcely a feature of modern surgery of the head that is not touched upon very sensibly in this work.

The best proof, however, at once of the flourishing state of surgery during the fourteenth century and of the utter absurdity of saying that surgery did not develop because of the opposition of the Church or of ecclesiastics, and above all of the Popes, is to be found in the life of Guy de Chauliac, who has been deservedly called the Father of Modern Surgery and whose contributions to surgery occupy a prominent place in every history of medicine that one picks up. While the works of other [{182}] great writers in surgery of the thirteenth and fourteenth centuries have as a rule only come to be commonly known during the latter part of the nineteenth century, Guy de Chauliac's position and the significance of his work and his writings have been a commonplace in the history of medicine for as long as it has been written seriously. We have already stated in several places in this volume his relations to the Popes. He was a chamberlain of the Papal Court while it was at Avignon, and while he was teaching and developing surgery at the University of Montpelier he was also body physician to three of the Popes, and the intimate friend and influential adviser to whom they turned for consultation in matters relating to medical education and to science generally.

In the present chapter, then, we shall only discuss the contributions to surgery of this surgeon of the Popes, at a time when, according to President White, because of Church opposition, surgery was considered dishonorable; "when the greatest monarchs were often unable to secure an ordinary surgical operation, and when it required an edict of the German Emperor in order that dishonor should no longer attach to the surgical profession." This is what Chauliac accomplished, according to Professor Allbutt:

"Of his substantial advances in surgery no sufficient account is possible; but some chief points, with the aid of Haeser, Malgaigne, and Nicaise, I may briefly sum up thus: He pointed out the dangers of surgery of the neck, among them that of injuring the voice by section of the recurrent laryngeal nerve, a precaution he probably learned from Paul. He urges a low diet for the wounded, as did Mondeville and many others. He uses sutures well and discreetly (p. 9), but with far too many salves. [{183}] On fractures of the skull he is at his best; he noted the escape of cerebro-spinal fluid, and the effect of pressure on the respiration. It is somewhat strange that in days of war the study of chest wounds had been rather neglected by Galen, Haly, and Avicenna; their practice, however, was to leave them open, lest pus should gather about the heart. Theodoric and Henry ordered chest wounds to be closed 'lest the vital spirits escape.' Guy also closed these wounds, unless there were any effusion to be removed. In empyema he objects to caustics and prefers the knife. For haemorrhages he used sutures--a little too closely perhaps--styptics, cautery or ligature. Sinuses he dilated with tents of gentian root, or he incised them upon a director. On ulcers his large experience is fully manifest. He describes the carcinomatous kind as hopeless, unless the mass can be excised at a very early stage and the incision followed by caustics. If in fractures and dislocations he tells us nothing new, these sections testify to a remarkable fulness of knowledge at a period when the Hippocratic treatises were unknown. Haeser says that in respect of position in fractured femur he was the best physician in the Middle Ages."

Guy de Chauliac's Cauteries:--5, 6, 7, 8, cauteries called from their shapes: knife, sword, olive, date kernel; 9, cautery with protective nail to be inserted cold; 10, protective plate for cauteries.