[Original]
When we come to inquire the reason for this—in other words, why an art so useful as surgery, and one which made such requirements for knowledge, sagacity, and dexterity, whose necessity was almost continually felt, particularly during these troublous times of almost constant warfare, should be so neglected by men who could best comprehend its utility and respond to its requirements—it is difficult to find a satisfactory answer. The social condition of the times sheds some light upon the question. The nations of southern Europe were socially divided at that time into the nobility, who were nearly always at war; the clergy, who monopolized learning and filled the so-called liberal professions; and, finally, the common people, who were common prey for both the other classes, and who yet had to support both without having any privileges of their own. While the practice of medicine was a clerical right, the canon of the church prohibited physicians from drawing blood, under pain of excommunication; and hence surgery, shunned by the priests, to whom it naturally belonged in connection with the practice of medicine, fell into the hands of the ignorant and vulgar, who practiced it in a purely mechanical way, without knowledge or appreciation of its possibilities. In addition to this, there was an almost total lack of detailed and precise anatomical knowledge, and but small reason to expect that the ignorant practitioners of surgery would feel the need of such knowledge. Moreover, most of the operators were itinerants, going from city to city, stopping so long as they had cases to operate upon or until some reverse forced them to depart. Most of these men limited themselves to one or two sorts of operations. Some operated for cataract, others for stone, others for hernia, nearly every one having a secret method which was transmitted to his posterity as a heritage.
In the history of medicine certain family names of itinerant operators have been preserved; for example, the Branca, the Norsini, in Italy, and the Colot in France.
Under such conditions there could be no such thing as the profession of the surgeon. The prejudice against dissection did not begin to abate until the thirteenth century, when a very few of the clergy dared, in a very timid manner, to perform surgical operations. Their numbers increased in the course of the fourteenth and fifteenth centuries, and in the sixteenth had become considerable. Most of the great anatomists of that period—such as Benivieni, de Carpi, Vesalius, Fallopius, and Fabricius ab Aquapendente—were great surgeons.
In due time it came about that while the clerical physicians were willing to descend to the rank of operators, the lay-surgeons aspired to the rank of doctors of medicine. This transformation took place especially in France, the only country where at that time there was a special college of surgeons—the small Brotherhood of St. Come, already alluded to, which was always contending against the faculty on one hand and against the barber-surgeons on the other, with varying results, and which, at last, sought peace with the university and was received by it. This took place in 1515, and was the renaissance of surgery, not only for Paris, but for the whole world. By this reunion the faculty acquired authority over the barbers, who were admitted to their lectures and took courses in anatomy and surgery, gradually attaining a knowledge which entitled them to be called barber-surgeons; their rights were not curtailed, but made more difficult of procurement, for, in addition to passing their initiation for the privilege of becoming barbersurgeons, they also had to pass an examination before the physicians and the two surgeons of the king, at Chatelet, for the right to practice surgery. The surgeons, as the price of their submission to the faculty, had, beside the university privilege, a sort of supremacy over the barbers; and thus it happened that the barbers were admitted to the rank of surgeons at St. Come, and that the surgeons of St. Come were admitted as barber-surgeons by the faculty of medicine. In this double capacity they approached nearer the profession of medicine, from which they should never have been separated, while surgery became an art which received numerous improvements. We must now devote a little time to the consideration of at least two or three of the men who most contributed to extend and elevate it.
Among those who most contributed to make the period of which we are now speaking a glorious one, raising himself from the lowest walks of life to the attainment of the highest professional honors, is Ambroise Paré, whose name will never die while the art of surgery is taught. Paré was born about the year 1510, at Laval, of poor parents. He was an early apprentice to the provincial barber-surgeons, after which a natural ambition for improvement led him to Paris (about the year 1532), where he studied three years at the Hôtel-Dieu, and obtained the confidence of his teachers to such an extent that he sometimes operated for them. He never learned Latin, the language at that time of the books and of the schools. Paré was most fond of recalling his hospital experience; he counted it among the highest honors of his life that he should have enjoyed what he there did enjoy, and gives us to suppose that he was a favorite upon whom peculiar favors were conferred. In one of his writings, a physician of Milan having expressed astonishment at so young a man's knowledge, he remarks with pride: "But the good man did not know that I had been house-surgeon for three years at the Hôtel-Dieu de Paris." The functions of the barber apprentices in the hospital in those days were probably to make dressings and bleedings, and sometimes post-mortem examinations ordered by the chiefs, to assist the latter in their operations, and to act in case of emergency; in other words, to do about as the internes at present do. They probably found there a precious and rare opportunity for anatomical dissection, but it does not appear that they had regular clinical instruction.
