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

In general, when we consider how difficult was the task of making copies of works on surgery by hand, and especially such as contain numerous illustrations, the wonder grows that we should have so much about the surgery of these centuries rather than so little. Some of these works have been preserved for us by the merest chance. There have been many centuries since their time, when what these surgeons wrote would have been thought of very little value because physicians were not educated up to them. In spite of this liability to loss, which must have caused the destruction of many valuable works, we still have enough to show us what wonderful men were these surgeons of the thirteenth and fourteenth centuries, who anticipated our best thinking of the modern times in many of the most difficult problems. It is only during the last twenty-five years that anything like justice has been done them. The only way to know what these men did and taught is to read their own works, and these have been buried in manuscript or hidden away in large folio volumes, printed very early in the history of printing, and considered so valuable that consultation of them was almost resented by librarians. Anyone who talks about the lack of surgery in Europe during the thirteenth and fourteenth centuries is supremely ignorant of the real course of history at this time, and when in addition he attributes the failure of surgery to develop to a trumped-up opposition of the Church or ecclesiastics, he is simply making a ridiculous exhibition of intolerance and of foolish readiness to accept anything, however groundless, that may [{190}] enable him to make out a case against the ecclesiastical authorities.

It is curious to reflect that in spite of all this wonderful progress in surgery, somehow there has crept in the tradition which has been very generally accepted by historians not acquainted with the details of medical history, that surgery was neglected during the thirteenth and fourteenth centuries. The existence of this tradition, and its acceptance by men who had no idea that they were being influenced by that peculiar state of mind which considers that nothing good can come out of the Nazareth of the times before the reformation so-called, is of itself a warning with regard to the way history has been written, especially for the Teutonic and English-speaking peoples, that should carry weight in other departments of history beside medicine and surgery.

Even Pagel could not get entirely away from the old tradition which has existed for so long, that the Church, if she did not oppose, at least hampered the progress of surgery. While his first paragraph shows that he recognized the important advances that were made in the Middle Ages, he cannot rid himself of the prejudice that has existed so long and has tinged so much of the historical writing of the last four centuries. He furnishes an abundance of material himself to disprove the old opinion, and evidently has been influenced by this evidence, but cannot give up notions that have been part and parcel of his education from his earliest days in Protestant Germany. He says:--

"A set-back must also be recognized to some extent in surgery, especially attributable to the fact that as a consequence of the pressure of the Church upon scientific medicine, the representatives of medical [{191}] science felt themselves bound to neglect the practical art of surgical operation. Church regulations forbade the shedding of blood to churchmen, and not a few physicians were more than inclined to accept this prohibition as in accordance with their own feelings. For this reason the practice of surgery was left for the most part to the lower orders of those engaged in healing. This went to such an extent, that physicians even came to look upon surgery as an unworthy occupation. Even venesection, which was so commonly employed and which came to be indispensable to the practice of internal medicine, made it necessary to call for the services of a barber-surgeon."

As we shall see, there were many other and much more important factors at work in the degradation of surgery than the supposed repression of the Church. The time to which Pagel refers is in the earlier centuries of the Middle Ages, and not the later ones; yet it is from these later centuries that the supposed prohibitory decrees are all quoted. The contempt for surgery was due rather to the general lack of culture before the foundation of the universities than to any ecclesiastical repression. Just as soon as the great medical schools were opened--and that at Salerno came into existence in the early part of the tenth century if not earlier--surgery began to be in honor. Pagel himself confesses this in the very next paragraph of this brief conspectus of surgery, and shows how generally was the uplift of surgery made possible by university education, though there still remained many drawbacks to progress because of the jealousy of physicians.

"Gradually, however, a beneficial transformation of customs in this matter began to be manifest. Physicians [{192}] who were scientifically trained began to take up surgery with enthusiasm, and from that time (end of twelfth century) dates the visible uplift of this specialty. Eventually the most noteworthy literary events and remains of the representatives of the great schools of the Middle Ages--Salerno, Bologna, Paris and Montpelier--concern quite as much the department of surgery as of practical medicine. These medieval literary contributions constitute the principal steps in the historical development of scientific surgery. The Crusades represent an extremely important influence upon the perfecting of the surgery of wounds. Italian surgeons in large numbers took prominent parts therein. They took the abundant opportunities afforded them to gather experience, which they used to great advantage in their practice and in their teaching after their return home. From Roger, the first and most important of the representatives of the Salernitan school (whose life occupies the end of the twelfth and the beginning of the thirteenth century), and down to Guy de Chauliac (who died toward the end of the fourteenth century), in a space therefore of not quite two hundred years, a complete breach with the blood-fearing traditions of the Arabs was made. In no European land does one fail to find evidence of intense as well as successful scientific occupation with surgery."

As a reflection that throws a brilliant light on the true conditions that brought about the diminished estimation in which surgery came to be held, Guy de Chauliac has an interesting passage in which he suggests an explanation for it, which is surely much nearer the truth than any modern explanation is likely to be. He says that, after the time of the Arabs, who were all both physicians and surgeons, either because of the lack of interest of [{193}] physicians or their laziness, for the practice of surgery is a difficult matter, or because they came to be too much occupied with the ills which they might hope to cure by medicines alone, surgery became separated from medicine and passed down into the hands of mere mechanics. This is a complaint not infrequently heard even at the present day, that medicine and surgery are drawing too much apart for the good of either specialty. Both the Regius Professors of medicine in England have recently insisted that physicians must oftener be present at operations if they would really appreciate the value of diagnosis, while there has been for many years a feeling that surgery would be benefitted if surgeons did not always wish to have recourse to the knife, but appreciated how much good might be accomplished by other remedial measures. The great French Father of Surgery, then, was only expressing what was to be a perennial complaint in the domain of medicine and surgery when he explained the separation of the two departments of healing. He has nothing whatever to say of the evil influence upon surgery of any Church regulations, though he must have been in a position to realize their significance very well in this respect if they actually had any. He was himself, as we have said, a member of the Papal household; he was even a cleric, and seems to have encountered no difficulty at all not only in devoting himself to surgery, but even in lifting up that department of medicine from the slough of neglect into which it had fallen because of the lack of initiative of preceding generations in his native land.

It may be wondered, then, how the tradition of opposition to surgery, which is so common in history, had its origin. Nearly always for these exaggerated stories [{194}] there is some basis of truth. For instance, with regard to the opposition to Vesalius, the origin of the stories of persecution by the Church and ecclesiastical authorities is evidently the fact that he was very much opposed by the old-time physicians and surgeons, who believed in Galen and thought it worse than heresy to break with him. It is the opposition of scientists, or pseudo-scientists, to scientific progress that constitutes the real bar to advance, and has over and over again been attributed to religious motives, when it is really due to that very human overconservatism, which so constantly places men in the position of opponents to novelties of any kind, no matter how much of value they may eventually prove to have. There has always existed a certain prejudice against surgery on the part of physicians--meaning by that term, for the moment, those who devote themselves to internal medicine. This feeling has never quite died out. There were times in the Middle Ages when it was very marked. Not a little of the feeling is due to professional jealousy, and that, it is to be feared, like the poor, we shall have always with us.

Professor Allbutt has in the address at St. Louis, already quoted from, a very interesting passage with regard to the College of St. Côme at Paris, in which this jealousy between physicians and surgeons is very well brought out. I quote it here in order to illustrate once more that opposition of scientists to scientific advance, for personal reasons, which has always existed, is still one of the features of the history of science, and will probably always continue to be a noteworthy phase of scientific progress. It will serve at the same time to furnish to those who cannot think that these stories with regard to the hampering of surgical development are [{195}] entirely without foundation, some basis for them that will account for their universality, but will only render clearer the intolerance of those who have constantly perverted the meaning of this opposition to persecution on the part of Church authorities. Ecclesiastics not only had nothing to do with this, but more often than not were the active factors in such amelioration of the conditions it brought about as very much to lessen its effects.

Allbutt's story of the College of Surgeons of St. Côme at Paris is, as we have said, interesting from this standpoint. "Some of my readers may wonder how it is that in discoursing of medieval surgery I have not dwelt upon the Surgical College of St. Côme of Paris. Well, St. Côme did no great things for surgery. The truth is that, infected with the exclusiveness and dialectical conceits of all the schools of Paris, St. Côme was almost ready to sacrifice surgery itself if thereby it might choke off its parasites, the barbers. Lest they should be suspected of mixing their philosophy with facts, its members went about with their hands ostentatiously tied behind them. If perhaps Malgaigne speaks too contemptuously of St. Côme, it must be admitted that the college was in a false position throughout. In aping the Faculty of Medicine, it lost the touch of mother earth without gaining any harbourage in the deep waters of the proud. Nay, such is the Nemesis of pride, the barbers came to command the position. It did not suit the Faculty to see the barbers weakened; for in their weakness lay the strength of the surgeons of St. Côme, who sought incessantly to appear as lettered clerks, to attach their college to the university, and even to claim a place beside the Faculty itself. To bring St. Côme to its knees, and to check the presumptuous claims of this corporation on the [{196}] privileges of the Faculty of Medicine, on a liberal education in arts and medicine, on a place in the university, on the suppression of unqualified surgical practice, and less, honourably, on relief from handicraft and urgent calls, the Faculty had to coquette with the barbers. Medicine, proclaimed the Faculty when it suited its purpose, contains the theoretical and the practical side of surgery; a surgeon is therefore but the servant of a physician. If St. Côme sought to provide lectures in surgery, the Faculty, which kept possession of teaching licenses and desired in the surgeon a docile assistant, took the teaching from the college and invited the barbers to lectures of its own. In their duplicity and conceit of caste, physicians of the Faculty condescended even to publish books on surgery, books as arid and as insincere as their lectures. On the other hand, in the person of the King's Barber, the barbers had a secret and potent influence at Court. The Faculty persisted in denying to St. Côme all 'esoteric' teaching, all diagnosis, and all use of medical therapeutics. Aristotle was pronounced to be unfavorable to the 'vulgarizing of science.' Joubert was attacked for editing Guy, but replied with dignity (in the notes of his edition). While the Faculty thus tried to prevent the access to letters of a presumptuous body of artisans, St. Côme in mimic arrogance disdained the barbers, sought to deny them the name of surgeon, and was jealous of the diffusion of technical knowledge among them in the vernacular tongue." [Footnote 26]