The Thirteenth, Greatest of Centuries

by James J. Walsh

Certain assertions in this paragraph deserve, as in the case of Lanfranc's master, to be discussed, because of their anticipations of what is sometimes thought to be very modern in surgery. The older surgeons are supposed to have feared hemorrhage very much. It is often asserted that they knew little or nothing about the ligature and that their control of hemorrhage was very inadequate. As a matter of fact, however, it was not primary hemorrhage that the old surgeons feared, but secondary hemorrhage. Suppuration often led to the opening of an important artery, and this accident, as can well be understood, was very much dreaded. Surgeons would lose their patients before they could come to their relief. How thoroughly Lanfranc knew how to control primary hemorrhage can be appreciated from the quotation just made from Dr. Allbutt's address. The ligature is sometimes said to have been an invention of Ambroise Paré, but, as a matter of fact, it had been in use for at least three centuries before his time, and perhaps even longer.

Usually it is considered that the difficult chapter of head injuries, with all the problems that it involves in diagnosis and treatment, is a product of the Nineteenth Century. Hence do we read, with all the more interest, Allbutt's declaration that Lanfranc wrote what is practically a classical monograph, on the subject. It is not so surprising, then, to find that the great French surgeon was far ahead of his generation in other matters, or that he should even have realized the danger of separating surgery from medicine. Both the Regius professors of medicine at the two great English universities, Cambridge and Oxford, have, since the beginning of the Twentieth Century, made public expression of their opinion that the physician should see more of the work of the surgeon, and should not depend on the autopsy room for his knowledge of the results of internal disease. Professor Osler, particularly, has emphasized his colleague, Professor Allbutt's opinion in this matter. That a surgical professor at the University of Paris, in the Thirteenth Century, should have anticipated these two leaders [{89}] of medical thought in the Twentieth Century, would not be so surprising, only that unfortunately the history of medieval teaching has, because of prejudice and a lamentable tradition, not been read aright.

Occasionally one finds a startling bit of anticipation of what is most modern, in medicine as well as in surgery. For instance, toward the end of the Thirteenth Century, a distinguished English professor of medicine, known as Gilbert, the Englishman, was teaching at Montpelier, and among other things, was insisting that the rooms of patients suffering from smallpox should be hung entirely with red curtains, and that the doors and the windows should be covered with heavy red hangings. He claimed that this made the disease run a lighter course, with lessened mortality, and with very much less disfigurement. Smallpox was an extremely common disease in the Thirteenth Century, and he probably had many chances for observation. It is interesting to realize that one of the most important observations made at the end of the Nineteenth Century by Dr. Finsen, the Danish investigator whose studies in light and its employment in therapeutics, drew to him the attention of the world, and eventually the Nobel prize of $40,000 for the greatest advance in medicine was, that the admission of only red light to the room of smallpox patients modified the disease very materially, shortened its course, often prevented the secondary fever, and almost did away completely with the subsequent disfigurement.

It is evident that these men were searching and investigating for themselves, and not following blindly in the footsteps of any master. It has often been said that during the Middle Ages it was a heresy to depart, ever so little, from the teaching of Galen. Usually it is customary to add that the first writer to break away from Galen, effectually, was Vesalius, in his De Fabrica Corporis Humani, published toward the end of the second quarter of the Sixteenth Century. It may be said, in passing, that, as a matter of fact, Vesalius, though he accomplished much by original investigation, did not break so effectually with Galen as would have been for the best in his own work, and, especially, for its influence on his successors. He certainly did not set an example of independent research [{90}] and personal observation, any more fully, than did the medical teachers of the Thirteenth Century already mentioned, and some others, like Mondaville and Arnold of Villanova, whose names well deserve to be associated with them.

One reason why it is such a surprise to find how thoroughly practical was the teaching of the Thirteenth Century university medical schools, is because it has somehow come to be a very general impression that medicine was taught mainly by disputations, and by the consultation of authorities, and that it was always more important to have a passage of Galen to support a medical notion, than, to have an original observation. This false impression is due to the fact that the writers of the history of medical education have, until recent years, drawn largely on their imaginations, and have not consulted the old-time medical books. In spite of the fact that printing was not discovered for more than two centuries later, there are many treatises on medicine that have come down to us from this early time, and the historians of medicine now have the opportunity, and are taking the trouble, to read them with a consequent alteration of old-time views, as to the lack of encouragement for original observation, in the later Middle Ages. These old tomes are not easy reading, but nothing daunts a German investigator bound to get to the bottom of his subject, and such men as Pagel and Puschmann have done much to rediscover for us medieval medicine. The French medical historians have not been behind their German colleagues and magnificent work has been accomplished, especially by the republication of old texts. William of Salicet's surgery was republished by Pifteau at Toulouse in 1898. Mondaville's Surgery was republished under the auspices of the Society for the Publication of old French Texts in 1897 and 1898. These republications have made the works of the old-time surgeons readily available for study by all interested in our great predecessors in medicine, all over the world. Before this, it has always been necessary to get to some of the libraries in which the old texts were preserved, and this, of course, made it extremely difficult for the ordinary teacher of the history of medicine to know anything about them. Besides, old texts are such difficult reading that few, except the most earnest of students, [{91}] have patience for them, and they are so time-taking as to be practically impossible for modern, hurried students.

Unfortunately, writers of the history of medicine filled up this gap in their knowledge, only too frequently, either out of their imaginations, or out of their inadequate authorities, with the consequence of inveterating the old-time false impression with regard to the absence of anything of medical or surgical interest, even in the later Middle Ages.

Another and much more serious reason for the false impression with regard to the supposed blankness of the middle age in medical progress, was the notion, quite generally accepted, and even yet not entirely rejected, by many, that the Church was opposed to scientific advance in the centuries before the reformation so-called, and that even the sciences allied to medicine, fell under her ban. For instance, there is not a history of medicine, so far as I know, published in the English language, which does not assert that Pope Boniface VIII., by a Bull promulgated at the end of the Thirteenth Century, forbade the practise of dissection. To most people, it will, at once, seem a natural conclusion, that if the feeling against the study of the human body by dissection had reached such a pass as to call forth a papal decree in the matter, at the end of the century, all during the previous hundred years, there must have been enough ecclesiastical hampering of anatomical work to prevent anything like true progress, and to preclude the idea of any genuinely progressive teaching of anatomy.

There is not the slightest basis for this bit of false history except an unfortunate, it is to be hoped not intentional, misapprehension on the part of historical writers as to the meaning of a papal decree issued by Boniface VIII. in the year 1300. He forbade, under pain of excommunication, the boiling of bodies and their dismemberment in order that thus piecemeal they might be transported to long distances for burial purposes. It is now well known that the Bull was aimed at certain practises which had crept in, especially among the Crusaders in the East. When a member of the nobility fell a victim to wounds or to disease, his companions not infrequently dismembered the body, boiled it so as to prevent putrefaction, or at least delay decay, and then transported it long distances to his home, in [{92}] order that he might have Christian burial in some favorite graveyard, and that his friends might have the consolation of knowing where his remains rested. The body of the Emperor Frederick Barbarosa, who died in the East, is said to have been thus treated. Boniface was one of the most broadly educated men of his time, who had been a great professor of canon and civil law at Paris when younger, and realized the dangers involved in such a proceeding from a sanitary standpoint, and he forbade it, requiring that the bodies should be buried where the persons had died. He evidently considered that the ancient custom of consecrating a portion of earth for the purpose of burial in order that the full Christian rites might be performed, was quite sufficient for noble as for common soldier.

For this very commendable sanitary regulation Boniface has been set down by historians of medicine as striking a death blow at the development of anatomy for the next two centuries. As a matter of fact, however, anatomy continued to be studied in the universities after this Bull as it had been before, and it is evident that never by any misapprehension as to its meaning was the practise of dissection lessened. Curiously enough the history of human dissection can only be traced with absolute certainty from the time immediately after this Bull. It is during the next twenty-five years at the University of Bologna, which was always closely in touch with the ecclesiastical authorities in Italy and especially with the Pope, that the foundations of dissection, as the most important practical department of medical teaching, were laid by Mondino, whose book on dissection continued to be the text book used in most of the medical schools for the next two centuries. Guy de Chauliac who studied there during the first half of the Fourteenth Century says he saw many dissections made there. It was at Montpellier, about the middle of the century, when the Popes were at Avignon not far away, that Guy de Chauliac himself made attendance at dissections obligatory for every student, and obtained permission to use the bodies of criminals for dissection purposes. At the time Chauliac occupied the post of chamberlain to the Popes. All during the Fourteenth and Fifteenth centuries constant progress was making in anatomy, especially in Italy, and some of it was accomplished at Rome [{93}] by distinguished teachers of anatomy who had been summoned by the popes to their capital in order to add distinction to the teaching staff at the famous Papal School of Science, the Sapienza, to which were attached during the next two centuries many of the distinguished scientific professors of the time.

This story with regard to the papal prohibition of dissection has no foundation in the history of the times. It has had not a little to do, however, with making these times very much misunderstood and one still continues to see printed references to the misfortune, which is more usually called a crime, that prevented the development of a great humanitarian science because of ecclesiastical prejudice. This story with regard to anatomy, however, is not a whit worse than that which is told of chemistry in almost the same terms. At the beginning of the Fourteenth Century Pope John XXII. is said to have issued a Bull forbidding chemistry under pain of excommunication, which according to some writers in the matter is said to have included the death penalty. It has been felt in the same way as with regard to anatomy, that this was only the culmination of a feeling in ecclesiastical circles against chemistry which must have hampered its progress all during the Thirteenth Century.