The Popes and Science

The best proof, however, at once of the flourishing state of surgery during the fourteenth century and of the utter absurdity of saying that surgery did not develop because of the opposition of the Church or of ecclesiastics, and above all of the Popes, is to be found in the life of Guy de Chauliac, who has been deservedly called the Father of Modern Surgery and whose contributions to surgery occupy a prominent place in every history of medicine that one picks up. While the works of other great writers in surgery of the thirteenth and fourteenth centuries have as a rule only come to be commonly known during the latter part of the nineteenth century, Guy de Chauliac's position and the significance of his work and his writings have been a commonplace in the history of medicine for as long as it has been written seriously. We have already stated in several places in this volume his relations to the Popes. He was a chamberlain of the Papal Court while it was at Avignon, and while he was teaching and developing surgery at the University of Montpelier he was also body physician to three of the Popes, and the intimate friend and influential adviser to whom they turned for consultation in matters relating to medical education and to science generally.

In the present chapter, then, we shall only discuss the contributions to surgery of this surgeon of the Popes, at a time when, according to President White, because of Church opposition, surgery was considered dishonorable; "when the greatest monarchs were often unable to secure an ordinary surgical operation, and when it required an edict of the German Emperor in order that dishonor should no longer attach to the surgical profession." This is what Chauliac accomplished, according to Professor Allbutt:

"Of his substantial advances in surgery no sufficient account is possible; but some chief points, with the aid of Haeser, Malgaigne, and Nicaise, I may briefly sum up thus: He pointed out the dangers of surgery of the neck, among them that of injuring the voice by section of the recurrent laryngeal nerve, a precaution he probably learned from Paul. He urges a low diet for the wounded, as did Mondeville and many others. He uses sutures well and discreetly (p. 9), but with far too many salves. On fractures of the skull he is at his best; he noted the escape of cerebro-spinal fluid, and the effect of pressure on the respiration. It is somewhat strange that in days of war the study of chest wounds had been rather neglected by Galen, Haly, and Avicenna; their practice, however, was to leave them open, lest pus should gather about the heart. Theodoric and Henry ordered chest wounds to be closed 'lest the vital spirits escape.' Guy also closed these wounds, unless there were any effusion to be removed. In empyema he objects to caustics and prefers the knife. For haemorrhages he used sutures–a little too closely perhaps–styptics, cautery or ligature. Sinuses he dilated with tents of gentian root, or he incised them upon a director. On ulcers his large experience is fully manifest. He describes the carcinomatous kind as hopeless, unless the mass can be excised at a very early stage and the incision followed by caustics. If in fractures and dislocations he tells us nothing new, these sections testify to a remarkable fulness of knowledge at a period when the Hippocratic treatises were unknown. Haeser says that in respect of position in fractured femur he was the best physician in the Middle Ages."

This is the period, it must not be forgotten, when, according to President White, surgery was in such a state that the application of various ordures relieved fractures; the touch of the hangman cured sprains; the breath of a donkey expelled poison; friction with a dead man's tooth cured a toothache. [Footnote 23]

[Footnote 23: Quite as curious notions as these which President White mentions still exist in popular medicine in our own day. I have myself known a man to blow the dried excrement of the dog into the throat of his child suffering from diphtheria, and he assured me that it cured him. In the country districts they still use ordure poultices for sprains of various kinds, and I have known doctors prescribe them. I have seen an intelligent woman smoking dried angleworms in a pipe for toothache. I sincerely hope, however, that no serious(!) historian of the twenty-fifth century will gather up side remarks like the present with regard to such curious customs–real superstitions that have nothing to do with religion, as most supersititions have not–and state them as showing the ignorance of our generation, and above all as indicating the low state of medicine in our time.]

Lest it should be thought that possibly Professor Allbutt had been rather partial to the great Father of Modern Surgery in his enthusiasm for these medieval surgeons, it seems worth while to compress here something of what Pagel has to say with regard to this great man, who represents in himself a full hundred years of progress in surgery. He wrote an immense text-book of surgery, from which his teaching may be learned with absolute authenticity. The great significance attached to Guy's writings by his contemporaries and successors will be readily appreciated from the immense number of manuscript copies, original editions in print, and the many translations which are extant. This monument of scientific surgery has for dedication a sentence that would alone and of itself obliterate all the nonsense that has been talked about Papal opposition to the development of surgery. It runs as follows:–

(I dedicate this work) "To you my masters, physicians of Montpelier, Bologna, Paris, and Avignon, especially you of the Papal Court with whom I have been associated in the service of the Roman Pontiffs. The exact words as given by Pagel are "Vobis dominis meis medicis Montispessulani, Bononiae, Parisiis atque Avinionis, praecipue papalibus, quibus me in servitio Romanorum pontificum associavi."

Pagel has three closely printed pages in small type of titles alone of subjects which Chauliac treated with distinction. His description of instruments and methods of operation is especially full and suggestive. He knew how to prescribe manipulations and set forth the principles on which they were founded. Scarcely anything was added to his method of taxis for hernia for five centuries after his time. He describes the passage of a catheter with the accuracy and complete technic of a man who knew all the difficulties of it in complicated conditions. He recognizes the dangers that arise for the surgeon from the presence of anatomical anomalies of various kinds, and describes certain of the more important of them. He did not hesitate to suggest some very serious operations. For instance, for empyema he advises opening of the chest. He has very exact indications for trephining. He recognizes the absolute fatality of wounds of the abdomen, in which the intestines were opened, if they were left untreated, and describes a method of suturing wounds of the intestines in order to save the patient's life. In a word, there is nothing that has been attempted in these modern times, with our aseptic precautions and the advantage of anaesthesia, which this father of surgery did not discuss very practically and with excellent common sense as well as surgical acumen.

Chauliac's career is interesting because it is that of a self-made man of the Middle Ages, which brings out the fact that men do not differ so much as might be thought at this distance of time, and shows that there were chances for a man to rise by his own genius from a lowly to a lofty position at this time of the Middle Ages, when it is usually supposed that men were excluded from such opportunities. Allbutt says of him:

"Still, Guy of Chauliac, who flourished in the second half of the fourteenth century, was enabled to feed his virile and inquisitive spirit on rich sources of learning. While he succeeded to the stores of Arnold (of Villanova) and Gordon with his just and cautious reason and wealth of experience, he cast out of them much of the sorcery, jugglery, astrology and mysticism which were their reproach. Chauliac is a village in the Auvergne, and Guy was but a farmer's lad. It was by the aid of powerful friends that he studied at Toulouse and Montpelier, took orders and the degree of Master of Medicine; in his time there was no degree of Doctor of Medicine in France. Then he studied anatomy at Bologna under Bertruccio, the successor of Mondino, a study which, with Henry (de Mondeville) he regarded as the foundation of surgery. The surgeon ignorant of anatomy, he says, "carves the human body as a blind man carves wood." [Footnote 24]

[Footnote 24: This is a very striking reflection on the necessity for the study of anatomy for the practice of surgery to have been made within a half century after the supposed prohibition of dissection by the Popes, and at a time when, according to President White, "even such serious matters as fractures, calculi and difficult parturition, in which modern science has achieved some of its greatest triumphs, were dealt with by relics," and when "there were religious scruples against dissection," and surgery "was denounced by the Church," and when "pastoral medicine had checked all scientific effort in medical science." And the reflection was made by a chamberlain of the Papal household.]

"Thence he paid a brief visit to Paris, where for a moment, by the renown of Lanfranc, Jean Pitard, and Henry of Mondeville, surgery was in the ascendant. For the moment the Church and the faculty had not succeeded in paralyzing the scientific arm of medicine. [Footnote 25] Guy began practice in Lyons, whence he was called to Avignon by Clement VI. as 'venerabilis et circumspectus vir, dominus Guido de Cauliaco, canonicus et propositus ecclesiae Sancti Justi Lugduni, medicusque domini nostri Papae.' In Avignon he stayed, while other physicians fled, to minister to the victims of the plague (A.D., 1348), and he may have attended Laura in spite of Petrarch's tirades against all physicians and even against Guy himself. His description of this epidemic is terrible in its naked simplicity. He did not, indeed, himself escape, for he had an attack with bubo, and was ill for six weeks. He gave succor also in a later epidemic in Avignon, in 1360. His 'Chirurgia Magna' or Inventarium seu Collectorium Artis Chirurgicalis Medicinae–so called in distinction to the meagre little handbooks or Chirurgiae Parvae compiled from the larger treatises–was in preparation in 1363. This great work I have studied carefully, and not without prejudice; and yet I cannot wonder that Fallopius compared the author to Hippocrates, or that John Freind calls him the Prince of Surgeons. It is rich, aphoristic, orderly and precise. As a clerk he wrote in Latin, in the awkward hybrid tongue that medical Latin then was, containing many Arabian, Provençal and French words, but very little Greek."

[Footnote 25: It is worthy of remark, how even Prof. Allbutt, in a passage like this, where he is providing abundant material for the contradiction of the English Protestant tradition of the supposed opposition of the Church to science, and especially to surgery, yet cannot break away from the influence of that tradition entirely. It has been bred in him, and even while showing its falsity he is not entirely convinced himself, because the old mode of view has so firm a hold on him that he is not open to conviction. A little later in this same passage he speaks of taking up the study of Chauliac, prejudiced against him, and being convinced of his greatness against his will. Verily history has been a conspiracy against the truth, in which many people have joined almost unconsciously, led astray by feeling, not intellect.]

We have seen that there was great surgery in Italy, in France, and in the Netherlands, but it had also crossed the channel into England.

There was a famous English surgeon during the fourteenth century by the name of John Ardern. He was educated at Montpelier and practiced surgery for a time in France. About the middle of the century, however, according to Pagel, he went back to his native land and settled for some twenty years at Newark, in Nottinghamshire, and then for nearly thirty years longer, until nearly the end of the century, was in London. He is the chief representative of English surgery during the Middle Ages. His Practice, as yet unprinted, contains, according to Pagel, a short sketch of internal medicine, but is mainly devoted to surgery. Contrary to the usual impression with regard to works in medicine and surgery at this time, the book abounds in references to case histories which Ardern had gathered, partly from his own and partly from others' experience. The therapeutic measures that he suggests are usually very simple, in the majority of cases quite rational, though, of course, there are many superstitions among them; but Ardern always furnished a number of suggestions from which to choose. He must have been an expert operator, and had excellent success in the treatment of diseases of the rectum. He seems to have been the first operator who made statistics of his cases, and was quite as proud as any modern surgeon, of the large numbers that he had operated on, which he gives very exactly. He was the inventor of a new clyster apparatus.

Daremberg, the medical historian, who saw a copy of Ardern's manuscript in St. John's College, Oxford, says that it contains numerous illustrations of instruments and operations. His work seems really to be a series of monographs or collection of special articles on different subjects, which Ardern had made at various times, rather than a connected work. Pagel bewails the fact that a more thorough consideration of Ardern's work is impossible, because the greater part of what he wrote remains as yet unprinted.

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 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 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 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 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 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 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.