Part 17

"Gradually, however, a beneficial transformation of customs in this matter began to be manifest. Physicians {192} 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 {193} 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 {194} 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. Come 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 {195} 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.

Allbutt's story of the College of Surgeons of St. Come at Paris is, as we have said, interesting from this standpoint. "Some of my readers may wonder how it is that in discoursing of medieval surgery I have not dwelt upon the Surgical College of St. Come of Paris. Well, St. Come did no great things for surgery. The truth is that, infected with the exclusiveness and dialectical conceits of all the schools of Paris, St. Come was almost ready to sacrifice surgery itself if thereby it might choke off its parasites, the barbers. Lest they should be suspected of mixing their philosophy with facts, its members went about with their hands ostentatiously tied behind them. If perhaps Malgaigne speaks too contemptuously of St. Come, it must be admitted that the college was in a false position throughout. In aping the Faculty of Medicine, it lost the touch of mother earth without gaining any harbourage in the deep waters of the proud. Nay, such is the Nemesis of pride, the barbers came to command the position. It did not suit the Faculty to see the barbers weakened; for in their weakness lay the strength of the surgeons of St. Come, who sought incessantly to appear as lettered clerks, to attach their college to the university, and even to claim a place beside the Faculty itself. To bring St. Come to its knees, and to check the presumptuous claims of this corporation on the {196} privileges of the Faculty of Medicine, on a liberal education in arts and medicine, on a place in the university, on the suppression of unqualified surgical practice, and less, honourably, on relief from handicraft and urgent calls, the Faculty had to coquette with the barbers. Medicine, proclaimed the Faculty when it suited its purpose, contains the theoretical and the practical side of surgery; a surgeon is therefore but the servant of a physician. If St. Come sought to provide lectures in surgery, the Faculty, which kept possession of teaching licenses and desired in the surgeon a docile assistant, took the teaching from the college and invited the barbers to lectures of its own. In their duplicity and conceit of caste, physicians of the Faculty condescended even to publish books on surgery, books as arid and as insincere as their lectures. On the other hand, in the person of the King's Barber, the barbers had a secret and potent influence at Court. The Faculty persisted in denying to St. Come all 'esoteric' teaching, all diagnosis, and all use of medical therapeutics. Aristotle was pronounced to be unfavorable to the 'vulgarizing of science.' Joubert was attacked for editing Guy, but replied with dignity (in the notes of his edition). While the Faculty thus tried to prevent the access to letters of a presumptuous body of artisans, St. Come in mimic arrogance disdained the barbers, sought to deny them the name of surgeon, and was jealous of the diffusion of technical knowledge among them in the vernacular tongue." [Footnote 26]

[Footnote 26: As showing how professional jealously may exist in such ways in the modern times as to hinder progress, the following paragraph, which is the opening portion of Professor Allbutt's address, has seemed to me to deserve quotation here. It will illustrate a phase of the subject that is probably utterly unexpected by those unfamiliar with the inner history of medicine in our time, but which is not so surprising to physicians who know the jealousy with which men guard their specialties from what they consider the interference of others, in hospital work and in teaching, though this exclusiveness often proves detrimental both to the breadth of development of the student and to the good health of the patient.

"It was, I think, in the year 1864, when I was a novice on the Honorary Staff of the Leeds General Infirmary, that the unsurgical division of us was summoned in great solemnity to discuss a method of administration of drugs by means of a needle. This method having obtained some vogue, it behooved those who practiced 'pure' medicine to decide whether the operation were consistent with the traditions of purity. For my part, I answered that the method had come up early, if not originally, in St. George's Hospital, and in the hands of a house physician--Dr. C. Hunter; that I had accustomed myself already to the practice and proposed to continue it; moreover, that I had recently come from the classes of Professor Trousseau, who, when his cases demanded such treatment, did not hesitate himself to perform paracentesis of the pleura, or even incision of this sac, or of the pericardium. As, for lack not of will but of skill and nerve, I did not intend myself to perform even minor operations, my heresy, as one in thought only, was indulgently ignored, and we were set free to manipulate the drug needle if we felt disposed to this humble service."]

{197}

In conclusion, we may say that, in the Middle Ages, once men had lifted themselves up from the condition into which they had been plunged by the incursions of the barbarians, there was nothing like the neglect of surgery which is sometimes said to have existed. Surgery had its normal development, and reached as high a stage as medicine in that beginning Renaissance, which is the characteristic feature of the twelfth, thirteenth, and fourteenth centuries. The traditions of a low state of surgery at this time are all false and founded on insufficient knowledge of the real conditions, which have been so clearly revealed to us by the investigation of original documents in the last twenty-five years. This was, in fact, one of the greatest periods in the history of surgery that the world has ever known. Whatever of difficulty in development surgery encountered was due not to any Church opposition, but to unfortunate conditions that arose in the practice of medicine. Professional jealousy and shortsightedness was the main element in it. Even this, however, did not prevent the very wonderful development of surgery that came {198} during the Middle Ages, and that made this department of human knowledge quite as progressive and successful as any other, in that marvelous period when the universities came into existence in the form which they have maintained ever since.

{199}

PAPAL PHYSICIANS.

Most of what historical writers generally, who follow the old traditions of the medieval eclipse of medicine, have to say with regard to the supposed Papal opposition to the development of medical science, is founded on the assumption that men who believed in miracles and in the efficacy of prayer for the relief of disease could not possibly be interested to any serious degree in scientific medicine. As Dr. White says, "out of all these inquiries came inevitably that question whose logical answer was especially injurious to the development of medical science: why should men seek to build up scientific medicine and surgery, when relics, pilgrimages, and sacred observances, according to an overwhelming mass of concurrent testimony, have cured and are curing hosts of sick folk in all parts of Europe." He goes even farther than this, however, when he suggests that "it would be expecting too much from human nature to imagine that Pontiffs who derived large revenues from the sale of the Agnus Dei, or priests who derived both wealth and honors from cures wrought at shrines under their care, or lay dignitaries who had invested heavily in relics, should favor the development of any science which undermined their interests."

On the strength of assumptions such as these, that "medieval belief in miracles of healing must have checked medical science," and that therefore it did actually prevent the development of scientific medicine, statements are made with regard to the history of {200} medicine that are utterly at variance with the plain facts of history. Once more, as in the case of the supposed failure of surgery to develop during the Middle Ages, it is a deduction that has been made from certain supposed principles, and not an induction from the actual facts as we know them. Such historians would be the first to emphasize the narrowness of the schoolmen for their supposed dependence on deduction, but what they have to say on medical history is entirely deductive, and unfortunately from premises that will not stand in the presence of the story of the wonderful rise and development of medical science and medical education, mainly under the patronage of ecclesiastics, in the Middle Ages.

The argument may be stated formally with perfect fairness as follows: When men believe in miracles they cannot build up scientific medicine and surgery; but men believed in miracles in the Middle Ages, therefore they did not build up scientific medicine and surgery. When stated thus baldly in formal scholastic form, the argument loses most of the glamor that has been thrown around it. This is one of the advantages of the old scholastic method--it strips argument to its naked significance. Logic asserts herself and rhetoric loses its force.

With regard to the major premise that when men believe in miracles they will not successfully pursue investigations in the medical science, there are two answers. One of these concerns the actual attitude of mind towards scientific medicine of men who believe in miracles, for we have such men still with us, and have always had them all during the past seven centuries. The other portion of the answer concerns what men who were distinguished scientific investigators thought of {201} miracles, and how much they accomplished for the medical sciences while all the time maintaining their belief in the possibility of miraculous intervention for the cure of disease.

Apparently the writers who insist on the incompatibility of the belief in miracles with devotion to scientific medicine do not realize that the greater number of thinking physicians during the last seven centuries, and quite down to our own day, have been ready to confess their belief in the possibility of miraculous healing, yet have tried to do everything in their power to relieve suffering and cure human ills by the natural means at their command. Their attitude has been very much that attributed to Ignatius of Loyola, who said to the members of his order: "Do everything that you can with the idea that everything depends on you, and then hope for results just as if everything depended on God." There is no lack of logic in this; and the physician of the present day who realizes his impotency in the presence of so many of the serious ailments of mankind is not a scoffer at the attitude of mind that looks for help from prayer; but if he is sensible, welcomes the placidity of mind this will give his patient, even if he does not, as many actually do, however, believe in the possible interposition of supernatural forces.

If Prof. White knew anything about the lives of the men whose names are most distinguished in the history of medicine during the thirteenth, fourteenth and fifteenth centuries, we would have heard nothing of his almost incomprehensible negation of the existence of scientific medicine, during centuries when so many men who have stamped their names indelibly on the history of the medical sciences were doing their work and {202} writing. If he had taken any pains to learn even a few details of the personal relations of these old-time makers of medicine to the Popes, we would have heard none of this utter absurdity of Papal opposition to medicine or ecclesiastical hampering of medical science. To answer Prof. White's argument, that "it would be expecting too much from human nature to imagine that Pontiffs should favor the development of any science which undermined their interests," the simple story of the men the Popes choose as their own medical advisers, and who because of the prestige of their appointment as Papal Physicians helped to raise up in the eyes of the people the dignity of the medical profession which they represented, will be quite enough. It will also serve to show how different is history founded on an assumption from history founded on actual facts.

The best, most easily obtainable, and most impressive data for the inductive method of reaching the truth as regards the relation of the Popes to medical science and (because of the fact that physicians were the scientists _par excellence_ of the Middle Ages) to all science, will be found in a brief consideration of the lives of the men who occupied the position of Papal Physician during the last seven centuries. I do not think that this group of men has ever been treated together before; at least I have been unable to find any work on the subject. While I am able to present a considerable amount of interesting material in brief form with regard to them, I am sure that there are many of them whom I have omitted. Practically up to the day of going to press I have been finding new references that led to further precious information with regard to this most wonderful group of men in medical history. It will be well {203} understood, then, that impressive as the consideration of the work and character of the men whose names I have found must be, this does not represent all the truth in the matter, but can be supplemented without much difficulty from other sources.

If the Popes had been interested only in the miraculous healing of disease, and had wished to teach the lesson that men should depend solely for their recovery from serious symptoms and ailments of all kinds on prayers and relics and pilgrimages, then they would either have had no physicians at all in regular attendance on them, or at least their physicians would not have been selected from among the men who were doing most to advance the cause of practical and scientific medicine and of medical education. The very opposite of this is the case. The Papal physicians were as a rule the most scientific medical men of their time. This is not a pious exaggeration, but is literally true for seven centuries of history, as we shall see presently. The wonder of it is that there were not some charlatans among them. The physicians whom educated people select are not, as physicians we'll know, always worthy examples of progressive medical men. Literary folk particularly seem to have a distinct tendency to want to be different from other people, and their physicians are often the veriest theorizers. A medical friend who occasionally quotes, but perverts the old line, "the people people have for friends are often very queer," says, half in jest of course, but alas! more than half in earnest, that "the people literary folk and the clergy have for doctors are the queerest ducks (docs.) of all."

It is only too true that clergymen are especially prone to be erratic in the choice of their medical advisers and {204} lacking in a critical judgment as to the remedies and methods of treatment of which they become the willing recipients, and occasionally even the sponsors as regards other people, who look up to their judgment for other reasons with confidence. Prof. Osler once said that the nearer to the Council of Trent the clergyman, the nearer he was likely to be to truth and common sense in medical matters; but then perhaps all would not agree with him. It is all the more surprising under the circumstances, and very greatly to their credit, that the Popes should have had as their physicians a list of men whose names are the brightest on the roll of great contributors to medical literature and some of the most distinguished among the great discoverers in medical science.

This fact alone constitutes the most absolute contradiction of the declarations as to supposed Church opposition to medicine that could possibly be given. No better means of encouraging, fostering, and patronizing medical science could be thought of than to give the prestige and the emoluments of physician to the head of the Church to important makers of medicine in every generation. The physicians to the rulers of Europe have not always been selected with as good judgment, and, as I have already said, there is no list of physicians to any European Court, nor indeed any list of names of medical men connected together by any bond in history--no list, for instance, of any medical faculty of a university--which can be compared for prestige in scientific medicine with the Papal Physicians.

Before the beginning of the thirteenth century very little is known of the medical attendants of the Popes. We point out in the following chapter that the Papacy was closely in touch with the medical school at Salernum. {205} It seems not unlikely, and indeed there are some traditions to that effect, that in cases of severe illnesses of the Popes, important members of the medical faculty were sometimes summoned from the South of Italy to Rome. The relations of the Popes to the neighboring abbey of Monte Cassino might, as we have said, suggest this. We have, however, very few details in this matter. With the beginning of the great thirteenth century, however, the records of human achievement in every line are better kept, and at once we begin to know something definite about Papal Physicians. The first one of decided prominence was Guy or Guido of Montpelier, who was summoned to Rome by Pope Innocent III. in order that he might re-establish the hospital of the Santo Spirito at Rome, in accordance with what were considered to be the latest ideas in the matter of hospital building and the enlightened care of the sick. How well he accomplished this work, and how well he deserves to head the glorious roll of Papal Physicians, will be seen in the chapter on The Popes and City Hospitals.