The Thirteenth, Greatest of Centuries

by James J. Walsh

The scholastic theology and philosophy of the Thirteenth Century have come to us in absolute purity. The huge tomes which represent the indefatigable labors of these ardent scholars were well preserved by the subsequent generation which thought so much of them, and in spite of the absence of printing have come down to us in perfectly clear texts. It is easy to neglect them and to say that a study of them is not worth while. They represent, however, the post-graduate work and the research in the department of philosophy and theology of these days, and any university of modern time would consider itself honored by having their authors among its professors and alumni. Any one who does not think so need only turn to the volumes themselves and read them with understanding and sympathy, and there will be another convert to the ranks of that growing multitude of scholars, who have learned to appreciate the marvelous works of our university colleagues of the Thirteenth Century.

With regard to law, not much need be said here, since it is well understood that the foundations of our modern jurisprudence (see chapters on Legal Origins), as well as the methods of teaching law, were laid in the Thirteenth Century and the universities were the most active factors, direct and indirect, in this work. The University of Bologna developed from a law school. Toward the end of the Twelfth Century Irnerius revived the study of the old Roman law and put the curriculum of modern Civil Law on a firm basis. A little later Gratian made his famous collection of decretals, which are the basis of Canon [{82}] Law. Great popes, during the Thirteenth Century, beginning with Innocent III., and continuing through such worthy emulators as Gregory IX. and Boniface VIII., made it the special glory of their pontificates to collect the decrees of their predecessors and arrange and publish them, so that they might be readily available for consultation.

French law assumed its modern form, and the basis of French jurisprudence was laid, under Louis IX., who called to his assistance, in this matter, the Professors of Law at the University of Paris, with many of whom he was on the most intimate terms. His cousin, Ferdinand of Castile, laid the foundation of the Spanish law about the same time under almost similar circumstances, and with corresponding help. The study of law in the English universities helped to the formulation of the principles of the English Common Law in such simple connected form as made them readily accessible for consultation. Just before the beginning of the last quarter of the Thirteenth Century, Bracton, of whose work much more will be said in a subsequent chapter, drew up the digest of the English Common Law, which has been the basis of English jurisprudence ever since. It took just about a century for these countries, previously without proper codification of the principles of their laws, to complete the fundamental work to such a degree, that it is still the firm substructure on which rests all our modern laws. Legal origins, in our modern sense, came not long before the Thirteenth Century; at its end the work was finished, to all intents and purposes. Of the influence of the universities and of the university law departments, in all this there can be no doubt. The incentive, undoubtedly, came from their teachings. The men who did so much for legal origins of such far-reaching importance, were mainly students of the universities of the time, whose enthusiasm for work had not subsided with the obtaining of their degrees.

It is in medicine, however, much more than in law or theology, that the eminently practical character of university teaching during the Thirteenth Century can be seen, at least in the form in which it will appeal to a scientific generation. We are so accustomed to think that anything like real progress in medicine, and especially in surgery, has only come in very [{83}] recent years, that it is a source of great surprise to find how much these earnest students of a long distant century anticipated the answers to problems, the solutions of which are usually supposed to be among the most modern advances. Professor Allbutt, the Regius professor of Physic in the University of Cambridge, a position, the occupant of which is always a leader in English medical thought, the present professor being one of the world's best authorities in the history of medicine, recently pointed out some of these marvels of old-time medicine and surgery. In an address On the Historical Relations of Medicine and Surgery to the end of the Sixteenth Century, delivered at the Congress of Arts and Sciences at the St. Louis Exposition in 1904, he (Prof. Allbutt) spoke with regard to one of the great university medical teachers of the Thirteenth Century as follows:

"Both for his own great merits, as an original and independent observer, and as the master of Lanfranc, William Salicet (Guglielmo Salicetti of Piacenza, in Latin G. Placentinus de Saliceto—now Cadeo), was eminent among the great Italian physicians of the latter half of the Thirteenth Century. Now these great Italians were as distinguished in surgery as in medicine, and William was one of the protestants of the period against the division of surgery from inner medicine; a division which he regarded as a separation of medicine from intimate touch with nature. Like Lanfranc and the other great surgeons of the Italian tradition, and unlike Franco and Ambroise Paré, he had the advantage of the liberal university education of Italy; but, like Paré and Wurtz, he had large practical experience in hospital and on the battlefield. He practised first at Bologna, afterward in Verona. William fully recognised that surgery cannot be learned from books only. His Surgery contains many case histories, for he rightly opined that good notes of cases are the soundest foundation of good practice; and in this opinion and method Lanfranc followed him. William discovered that dropsy may be due to a 'durities renum'; he substituted the knife for the Arabist abuse of the cautery; he investigated the causes of the failure of healing by first intention; he described the danger of wounds of the neck; he sutured divided nerves; he forwarded the diagnosis of [{84}] suppurative disease of the hip, and he referred chancre and phagedaena to their real causes."

This paragraph sets forth some almost incredible anticipations of what are usually considered among the most modern phases of medicine and surgery. Perhaps the most surprising thing is the simple statement that Salicet recognized that surgery cannot be learned from books alone. His case histories are instructive even to the modern surgeon who reads them. His insistence on his students making careful notes of their cases as the soundest foundation of progress in surgery, is a direct contradiction of nearly everything that has been said in recent years about medieval medicine and especially the teaching of medicine. (See Appendix.)

William's great pupil, Lanfranc, followed him in this, and Lanfranc encouraged the practise at the University of Paris. There is a note-book of a student at the University of Paris, made toward the end of the Thirteenth Century, carefully preserved in the Museum of the University of Berlin. This notebook was kept during Lanfranc's teaching and contains some sketches of dissections, as well as some illustrations of operative procedures, as studied with that celebrated surgeon. The tradition of case histories continued at the University of Paris down to the beginning of modern surgery.

Some of the doctrines in medicine that William of Salicet stated so clearly, sound surprisingly modern. The connection, for instance, between dropsy and durities renum (hardening of the kidneys) shows how wonderfully observant the old master was. At the present time we know very little more about the dropsical condition associated with chronic Bright's disease than the fact that it constantly occurs where there is a sclerosis or contraction of the kidney. Bright in his study of albuminuria and contracted kidney practically taught us no more than this, except that he added the further symptom of the presence of albumin in the urine. It must have been only as the result of many carefully studied cases, followed by autopsies, that any such doctrine could have come into existence. There is a dropsy that occurs with heart disease; there is also a dropsy in connection with certain affections of the liver, and yet the most frequent cause is just this hardening of the kidneys [{85}] spoken of by this middle-of-the-Thirteenth Century Italian professor of medicine, who, if we would believe so many of the historians of medicine, was not supposed to occupy himself at all with ante and post-mortem studies of patients, but with the old-time medical authorities.

Almost more surprising than the question of dropsy is the investigation as to the causes of the failure of healing by first intention. The modern surgeon is very apt to think that he is the only one who ever occupied himself with the thought, that wounds might be made to heal by first intention and without the occurrence of suppuration or granulation. Certainly no one would suspect any interest in the matter as far back as the Thirteenth Century. William of Salicet, however, and Lanfranc, both of them occupied themselves much with this question and evidently looked at it from a very practical standpoint. Many careful observations must have been made and many sources of observational error eliminated to enable these men to realize the possibilities of primary union, especially, knowing as they did, nothing at all about the external causes of suppuration and considering, as did surgeons for nearly seven centuries afterward, that it was because of something within the patient's tissues that the cases of suppuration had their rise.

Unfortunately, the pioneer work done by William and his great disciple did not have that effect upon succeeding generations which it should have had. There was a question in men's minds as to whether nature worked better by primary union or by means of the suppurative process. In the next century surgeons took the wrong horn of the dilemma and even so distinguished a surgeon as Guy de Chauliac, who has been called, not without good cause, the father of surgery, came to the conclusion that suppuration was practically a necessary process in the healing of large wounds at least, and that it must be encouraged rather than discouraged. This doctrine did not have its first set-back until the famous incident in Ambroise Paré's career, when one morning after a battle, coming to his patients expecting to find many of them very severely ill, he found them on the contrary in better condition than the others for whom he had no forebodings. In accord with old custom [{86}] he poured boiling oil into the wounds of all patients, but the great surgeon's supply of oil had failed the day before and he used plain water to cleanse the wounds of a number, fearing the worst for them, however, because of the poison that must necessarily stay in their wounds and then had the agreeable disappointment of finding these patients in much better condition than those whom he had treated with all the rules of his art, as they then were. Even this incident, however, did not serve to correct entirely the old idea as to the value of suppuration and down to Lister's time, that is almost the last quarter of the Nineteenth Century, there is still question of the value of suppuration in expediting the healing of wounds, and we hear of laudable pus and of the proper inflammatory reaction that is expected to bring about wound repair.