An Epitome of the History of Medicine

by Roswell Park

Connected with this school, also, or well known as having studied there, were many men whose names became more or less famous—among them John Arden, who settled in London about the middle of the fourteenth century; Vinario, a contemporary of Guy de Cliauliac, and the well-known surgeon and anatomist Henri de Mondeville, who was a teacher of Guy de Chauliac. But an idea of the doctrines prevalent in the medical literature of this part of the world, at this time, may be had from the fact that most writers chose titles for their works after the style of ballad singers: for instance, those describing the plague and venereal diseases were called Flowers and Lilies of Medicine; the Rosa Anglica of John Gaddesden was another example. Matters had arrived at such a pass, indeed, that men of science no longer hesitated to confess superstition and mingle it openly with deceit, to oppose the interests of the most needy, and to extort from their fellow-creatures fees in proportion to their supposed ability to pay.

In the time of Charlemagne each cathedral possessed a school in which were taught arithmetic, theology, singing, and sometimes medicine; the Episcopal College had medical teachers who gave advice and dressed wounds at the doors of the Church of Notre Dame, Paris; but when the medical profession had been divorced from the sacerdotal by councils and popes, many of these cathedral schools closed. In order to preserve the jurisdiction which they for a long time had exercised over the learned professions, many were erected into universities, and thus the clergy gave instruction in philosophy, theology, and later in medicine. During the thirteenth century arose many of the great universities in Europe, notably those of Bologna, Padua, and Naples, in Italy; of Paris, Montpellier, and Toulouse, in France; of Valencia and Tortosa, in Spain; of Oxford, in England. Pope Innocent III by papal bull guaranteed that the professors and students at Paris should be exempt from all excommunications save those which emanated directly from the Holy See; French sovereigns conferred many privileges upon the universities, and soon the members of the University of Paris formed practically a second city, with its own laws, customs, police, citizens, and magistrates. Still, however, all science belonged to the clergy, and its teachers, though removed from the cloister, were none the less Roman Catholic; so that the popes reigned over the people through the parish clergy, and over the latter by the clerical teachers and professors. Nevertheless, in all candor it must be acknowledged that these studious men, thus associated together for mutual instruction and emulation in learning, contributed, in a large measure, to elevate Christian civilization above all others, though several generations were required to secure the results calculated to make men celebrated; hence the early periods of the universities developed very few names. Many were conspicuous by their love of instruction, but not by originality of research. Men undertook expensive and wearisome voyages without encouragement or hope of reward, simply to obtain some rare manuscript or to hear some renowned professor; and they appeal to us of the nineteenth century by their devotion, if not by the results of their work.

Among the somewhat scattered and more or less eminent men of this period was Gerard, of Cremona in Lombardy, a man of great purity and studiousness, who arduously pursued all that Latin authors could teach him, and, not being able to procure in Italy certain manuscripts which dated from the time of Ptolemy, determined to go to Toledo in search of an Arabian translation. At this time he was unacquainted with Arabic, but soon mastered it, and—armed with this powerful resource, which no other physician had possessed since the time of Constantine the African—he could not see so many Arabic works devoted to all branches of science as were gathered at the Spanish University without a desire to translate and transmit the same to his own country; hence he gave the remainder of his life to this work. He rendered into Latin the treatises of Hippocrates and Galen, of Serapion, and of all the famous Arabian authors from the time of Phazes, including the Canon of Avicenna and the work on surgery by Albucassis. He died at the age of seventy-three, in 1187, at Cremona, and left all his books to the monastery of St. Lucy, within whose walls he was buried.

William of Salicet, born at Plaisance in the first years of the thirteenth century, became a professor in the University of Bologna, and later at Verona. He wrote extensively on medicine, and earned a reputation as a surgeon that preserves his fame to the present day. It is claimed that his status in medical literature depends, in large measure, upon the fact that he was, perhaps, the first to refuse slavish obedience to preceding authors, preferring, instead, to draw upon the results of personal study and experience. He died in 1280.

Lanfranc, or Lanfranchi (according to whether one prefers his French or Italian name), studied under William of Salicet. Of his early life very little is known, save that he practiced surgery in Milan at the time of the great dissension between the Guelphs and Ghibellines, and, for attaching himself to the weaker party, was exiled and forced to seek an asylum in France; he resided in Lyons for several years, and here wrote a work on minor surgery; in 1295 he went to Paris on the invitation of the faculty of medicine, opened a course on surgery which met with great success, and then published a second and larger treatise on the subject. It is said of him by Malgaigne that, less from his fault perhaps than that of his age, after his death (about 1315) surgery began to decline. From the time of Brunus, who practiced in Padua in 1250, the barbers had done the scarifying and bleeding. After the time of Lanfranchi there were others who applied leeches and often cauteries, and even the women meddled with surgery and in all operations competed with the barbers; the lay surgeons held themselves rivals to the clergy. Lanfranchi inherited from his old master, William, an aversion for them all, and often had to contend with uneducated and incompetent laymen. Clerical surgeons regarded operations as beneath their dignity; and Lanfranchi, who deplored this condition of affairs, confessed he had sometimes bled with his own hands, but had never operated for ascites, hernia, cataract, or stone.

John Pitard has descended to fame not as a writer, but as the founder of the surgical schools of St. Come and St. Damien, which occupy so eminent a position in the surgical annals of France. In 1306 he was surgeon to the King of France, Philip le Bel, and the sworn surgeon of Chatelet. The College of St. Come, in 1311, was only a little brotherhood of lay-surgeons, who gradually grew in importance as the result of the obstinate struggles sustained,—on the one hand, against the faculty of medicine, and, on the other, against the barber-surgeons. Malgaigne has, with great patience and clearness, shown that the importance of this body of men has been greatly exaggerated by historians; he has traced their various turns of fortune from beginning to end; I shall have occasion to consider them again farther on.

Mondino, sometimes known as Mundinus, born in 1275, became a professor in the University of Bologna, and died in 1327. He was the author of a celebrated treatise on anatomy, said to have reached twenty-five editions, and which was the first of its kind since Galen. This science had been greatly neglected; in Salernum, for instance, they were, for a long time, contented with the treatise of Copho on the anatomy of the hog, and most of the anatomical knowledge of the age was apparently derived from this source; Mondino resurrected the study and pursued it with interest and enthusiasm, though under the greatest difficulties. His works for more than two centuries, along with the writings of Galen and the Arabic authors, served for anatomical demonstration, although very incomplete,—as witness the statement:—

"Beneath the veins of the forearm we see many muscles and many large and strong cords, of which it is not necessary to attempt the anatomy on such a corpse (i.e., a recent one), but on one dried in the sun for three years, as I have shown otherwise, in developing the number and the anatomy of those of the superior and inferior extremity."

On the other hand, he took the opposite course to discover and demonstrate the nerves, and advised maceration in running water. It required almost superhuman boldness to substitute demonstrations on the human cadaver for those upon swine, yet this was done by Mondino; and at the time the prejudice against dissection was so general that for more than a century after Mondino—who died in 1327—no one dared, at least publicly, to emulate his example. It was in the year 1315 that he publicly dissected the bodies of two women in Bologna. Anatomical study was further complicated at this time by certain bulls of Pope Boniface VIII, forbidding evisceration or boiling or cooking any part of the human body; these deliverances were really aimed, not against scientific investigation, but at the absurd custom introduced by the crusaders of cutting up and boiling the bodies of their relatives who died in infidel countries, in order to send them home for burial in holy ground; nevertheless, the papal injunction certainly operated to discourage and prohibit anatomical dissection, since nearly two hundred years later the University of Tübingen was obliged to apply to Pope Sixtus IV for permission to authorize dissection.

Guy de Chauliac, born in Gévaudan about 1300. was the most famous physician and surgeon in Christendom during the Arabic period. He studied at the cathedral college of Mende, which at that time was quite celebrated, and was taught medicine at Montpellier under the best masters of his day. It is probable, also, that he studied in Paris, and certain that later, in Bologna, he saw dissections made. Dissatisfaction with the writings of the ancients and the knowledge which he obtained at the schools stimulated his own powers of observation, and he became, in every respect, an original student and acquired a degree of erudition far more extended than that possessed by any of his contemporaries. He practiced in various places, longest at Lyons; and finally entered the service of Pope Clement VI, at Avignon, and probably enjoyed the same honor under Innocent V and Urban V; when the latter was made pope, in 1362, de Chauliac became his chaplain, or chapel-reader. In 1363 he published a work on surgery called The Inventory, upon which his fame chiefly rests, though several other volumes emanated from his pen. None knew better than he how to unite respect for the ancients with justice toward contemporaries, and he cited a large number of Greek, Arabian, and Latin authors, some of whom are now utterly unknown. The sciences, he declared, are "created by successive additions; the same man cannot lay the foundation and perfect the superstructure. We are as children carried on the neck of a giant; aided by the labors of our predecessors we see all that they have seen, and something beside." In tracing the character of a surgeon he recommends that he be "learned, expert, ingenious, bold where he is sure, timid when in doubt, avoiding bad cures and practices, being gracious to the sick, generous and compassionate, wise in prediction, chaste, sober, pitiful, and merciful; not covetous nor extortionate, but receiving moderate fees according to the circumstances of his patients, the character of the case, and his own dignity."