Guy De Chauliac
( Originally Published 1911 )
One of the most interesting characters in the history of medieval medicine, and undoubtedly the most important and significant of these Old-Time Makers of Medicine, is Guy de Chauliac. Most of the false notions so commonly accepted with regard to the Middle Ages at. once disappear after a careful study of his career. The idea. of the careful application of scientific principles in a great practical way is far removed from the ordinary notion of medieval procedure. Some observations we may concede that they did make, but we are inclined to think that these were not reguharly ordered and the lessons of them not. drawn so as to make them valuable as experiences. Great art men may have had., but science and, above all, applied science, is a later development. of humanity. Particularly is this supposed to be true with regard to the science and practice of surgery, which is assumed to be of comparatively recent origin. Nothing could well be less true, and if the thoroughly practical development of surgery may be taker as a symbol of how capable men were of applying science and scientific principles, then it is comparatively easy to show that the men of the later Middle Ages were occupied very much as have been our recent generations with science and its practical applications.
The immediate evidence of the value of old-time surgery is to be found in the fact that Guy de Chauliac, who is commonly spoken of in the history of medicine as the Father of Modern Surgery, lived his seventy-odd years of life during the fourteenth century and accomplished the best of his work, therefore, some five centuries before surgery in our modern sense of the term is supposed to have developed. A glance at his career, however, will show how old are most of the important developments of surgery, as also in what a thoroughly scientific. temper of mind this subject was approached more than a century before the close of the Middle Ages. The life of this French surgeon, indeed, who was a cleric and occupied the position of chamberlain and physician-in-ordinary to three of the Avignon Popes, is not only a contradiction of many of the traditions as to the backwardness of our medieval forbears in medicine, that are readily accepted by many, presumably educated people, but it is the best possible antidote for that insistent misunderstanding of the Middle Ages which attributes profound ignorance of science, almost complete failure of observation, and an absolute lack of initiative in applications of science to the men of those times.
Guy de Chauliac's life is modern in nearly every phase. He was educated in a little town of the south of Fiance, made his medical studies at Montpellier, and then went on a journey of hundreds of mihes into Italy, in order to make his post-graduate studies. Italy occupied the place in science at that time that Germany has taken during the nineteenth century. A young man who wanted to get into touch with the great masters in medicine naturally went down into the Peninsula. Traditions as to the attitude of the Church to science notwithstanding, Italy where education was more completely under the influence of the Popes and ecclesiasties than in any other country in Europe, continued to be the home of post-graduate work in science for the next four centuries. Almost needless to say, the journey to Italy was more difficult of accomplishment and involved more expense and time than would even the voyage from America to Europe in our time. Chauliac realized, however, that both time and expense would be well rewarded, and his ardor for the rounding out of his education was amply recompensed by the event. Nor have we any reason for thinking that what he did was very rare, much less unique, in his time. Many a student from France, Germany, and England made the long journey to Italy for post-graduate opportunities during the later Middle Ages.
Even this post-graduate experience in Italy did not satisfy Chauliac, however, for, after having studied several years with the most distinguished Italian teachers of anatomy and surgery, he spent some time in Paris, apparently so as to be sure that he would be acquainted with the best that was being done in his specialty in every part of the world. He then settled down to his own life work, carrying his Italian and French masters' teaehings well beyond the point where he received them, and after years of personal experience lie gathered together his masters' ideas, tested by his own observations, into his " Chirurgia Magna," a great text-book of surgery which sums up the whole subject succinctly, yet completely, for succeeding generations. When we talk about what he accomplished for surgery, we are not dependent on traditions nor vague information gleaned from contemporaries and successors, who might perhaps have been so much impressed by his personality as to be made over-enthusiastic in their critical judgment of him. We know the man in his surgical works, and they have continued to be classics in surgery ever since. It is an honorable distinction for the medicine of the later fourteenth, the fifteenth, and sixteenth centuries that Guy de Chauliac's book was the most read volume of the time in medicine. Evidently the career of such a man is of import, not alone to physicians, but to all who are interested in the history of education.
Chauliac derives his name from the little town of Chauliac in the diocese of Mende, almost in the centre of what is now the department of Lozere. The records of births and deaths were not considered so important in the fourteenth century as they are now, and so we are not sure of either in the case of Chauliac. It is usually considered that he was born some time during the last decade of the thirteenth century, probably toward the end of it, and that he died about 1270. Of his early education we know nothing, but it must have been reasonably efficient, since it gave him a good working knowledge of Latin, which was the universal language of science and especially of medieine at that time; and though his own style, as must he expected, is no better than that of his contemporaries, he knew how to express his thoughts clearly in straightforward Latin, with only such a mixture of foreign terms as his studies suggested and the exigencies of a new development of science almost required. Later in life he seems to have known Arabic very well, for be is evidently familiar with Arabian books and does not depend merely on translations of them.
Pagel, in the first volume of Puschmann's " Handbook of the History of Medicine," says, on the authority of Nicaise and others, that Chauliac received his early education from the village clergyman. His parents were poor, and but for ecclesiastical interest in him it would have been difficult for him to obtain his education. The Church supplied at that time to a great extent for the foundations and scholarships, home and travelling, of our day, and Chauliac was amongst the favored ones. How well he deseryed the favor his subsequent career shows, as it completely justifies the judgment of his patrons. He went first to Toulouse, as we know from his affectionate mention of one of his teachers there. Toulouse was more famous for law, however, than for medicine, and after a time Chauliac sought Montpellier to complete his medical studies.
For English-speaking people an added interest in Guy de Chauliac will be the fact that one of his teachers at Montpellier was Bernard Gordon, very probably a Scotchman, who taught for some thirty-five years at this famous university in the south of France, and died near the end of the first quarter of the fourteenth century. One of Chauliac's
students at Montpellier was John of Gaddesden, the first English Royal Physician by official appointment of whom we have any account. John is mentioned by Chaucer in his " Doctor of Physic," and is usually looked upon as one of the fathers of English medicine. Chauliac did not. think much of him, though his reason for his dislike of him will probably be somewhat startling to those who assume that the men of the Middle Ages always clung servilely to authority. Chauliac's objection to Gaddesden's book is that he merely repeats his masters and does not. dare to think for himself. It is not hard to understand that. such an independent thinker as Chauliac should have been utterly dissatisfied with a book that did not go beyond the forefathers in medicine that the author quotes. This is the explanation of his well-known expression, " Last of all arose the scentless rose of England [` Rosa An-was the name of John of Gaddesden's book], in which, on its being sent to me, I hoped to find the odor of sweet originality, but instead of that I encountered only the fictions of Hispanus, of Gilbert, and of Theodoric."
The presence of a Scotch professor and an English fellow-student, afterwards a royal physician, at Montpellier, at the beginning of the fourteenth century, shows how much more cosmopolitan was university life in those times than we are prone to think, and what, attraction a great university medical school possessed even for men from long distances.
After receiving his degree of Doctor of Medicine at Montpellier Chauliac went, as we have said, to Bologna. Here he attracted the attention and received the special instruction of Bertruccio, who was attracting students from all over Europe at this time and was making some excellent demonstrations in anatomy, employing human dissections very freely. Chauliac tells of the methods that Bertruccio used in order that bodies might be in as good condition as possible for demonstration purposes, and mentions the fact that he saw him do many disseetions in different ways.
In Both's life of Vesalius, which is usually considered one of our most authoritative medical historical works not only with regard to the details of Vesalius' life, but also in all that concerns anatomy about that time and for some centuries before, there is a passage quoted from Chauliac himself which shows how freely dissection was practised at. the Italian uniyersities in the fourteenth century. This passage deserves to be quoted at some length because there are even serious historians who still cite a Bull of Pope Boniface VIII, issued in 1300, forbidding the boiling and dismembering of bodies in order to transport them to long distances for burial in their own country, as being, either rightly or wrongly, interpreted as a prohibition of dissection and, therefore, preventing the development of anatomy. In the notes to his history of dissection during this period in Bologna Roth says : " Without doubt the passage in Guy de Chauliac which tells of having frequently seen dissections, must be considered as referring to Bologna. This passage runs as follows: My master Bertruccius eonducted the dissection very often after the following manner: the dead body having been placed upon a bench, he used to make four lessons on it. In the first the nutritional portions were treated, because they are so likely to become putrefied. In the second, he demonstrated the spiritual members; in the third, the animate members; in the fourth, the extremities.' " (Roth, " Andreas Vesalius." Basel, 1896.)
Bertruccio's master, Mondino, is hailed in the history of medicine as the father of dissection. His book on dissection was for the next three centuries in the hands of nearly every medical scholar in Europe 'who was trying to do good work in anatomy. It was not displaced until Vesalius came, the father of modern anatomy, who revolutionized the science in the Renaissance time. Mondino had devoted himself to the subject with unfailing ardor and enthusiasm, and from everywhere in Europe the students came to receive inspiration in his dissecting-room. Within a few years such was the enthusiasm for dissection aroused by him in Bologna that there were many legal prosecutions for body-snatching, the consequence doubtless of a regulation of the Medical Department of the University of Bologna, that if the students brought a body to any of their teachers he was bound to dissect it for them. Bertruccio, Mondino's disciple and successor, continued this great work, and now Chauliac, the third in the tradition, was to carry the Bolognese methods back to France, and his position as chamberlain to the Pope was to give them a wide vogue throughout the world. The great French surgeon's attitude toward anatomy and dissection can be judged from his famous expression that " the surgeon ignorant of anatomy carves the human body as a blind man carves wood." The whole subject of dissection at this time has been fully discussed in the first three chapters of my " Popes and Science," where those who are interested in the matter may follow it to their satisfaction.'
After his Bologna experience Chauliac went to Paris. Evidently his indefatigable desire to know all that there was to be known would not be satisfied until be had spent some time at the great French university where Lanfranc, after having studied under William of Salicet in Italy, had gone to estab that tradition of French surgery which, carried on so well by Mondeville his great successor, was to maintain Frenchmen as the leading surgeons of the world until the nineteenth century (Pagel). Lanfranc, himself an Italian, had been exiled from his natiye country, apparently because of political troubles, but was welcomed at Paris because the faculty realized that they needed the inspiration of the Italian medical movement in surgery for the es-tabl ishment of a good school of surgery in connection with the uniyersity. The teaching so well begun by Lanfranc was magnificently continued by Mondeville and Arnold of Villanova and their disciples. Chauliac was fortunate enough to come under the influence of Petrus de Argentaria, who was worthily maintaining the tradition of practical teaching in anatomy and surgery so well founded by his great predecessors of the thirteenth century. After this grand tour Chauliac was himself prepared to do work of the highest order, for he had been in touch with all that was best in the medicine and surgery of his time.
Like many another distinguished member of his profession, Chauliac did not settle down in the scene of his ultimate labors at once, but was something of a wanderer. His own words are, " Et per multa tempora operates fui in multis partibus." Perhaps out of gratitude to the clerical patrons of his native town to whom he owed so much, or because of the obligations he considered that he owed them for his education, be practised fhrst in his native diocese of Mende; thence he removed to Lyons, where we know that he lived for several years, for in 1344 he took part as a canon in a chapter that met in the Church of St. Just in that city. just when he was called to Avignon we do not know, though When the Hack death ravaged that city in 134 he was the body-physician of Pope Clement VI, for he is spoken of in a Papal document as " venerabilis et circuinspect us vir, dominus Guido de Cauliaco, canonicus et prapositus ecclesiae Sancti Justi Lugduni, medicusque¬ domini Nostri Pape." All the rest of his life was passed in the Papal capital, which Avignon was for some seventy years of the fourteenth century. He served as chamberlain-physieian to three Popes, Clement VI, Innocent VI, and Urban V. We do not know the exact date of his death, but when Pope Urban V went to -Rome in 0367, Chauliac was putting the finishing touches on his " Chirurgia Magna," which, as he tells us, was undertaken as a solatium senectutis—a solace in old age. When Urban returned to Avignon for a time in 1370 Chauliac was dead. His life work is summed up for us in this great treatise on surgery, full of anticipations in surgical procedures that we are prone to think much more modern.
Nicaise has emphasized the principles which guided Guy de Chauliac in the choice and interpretation of his authorities by a quotation from Guy himself, which is so different in its tone from what is usually supposed to have been the attitude of mind of the men of science of the time that it would be well for all those who want to -understand the Middle Ages better to have it near them. Speaking of the surgeons of his own and immediately preceding generations, Guy says: " One thing particularly is a source of annoyance to me in what these surgeons have written, and it is that they follow one another like so many cranes. For one always says what the other says. I do not know whether it is from fear or from love that they do not design to listen except to such things as they are accustomed to and as have been proved by authorities. They have to my mind understood very badly Aristotle's second book of metaphysics where he shows that these two thing, fear and love, are the greatest obstacles on the road to the knowledge of the truth. Let them give up such friendships and fears. Because while Socrates or Plato may be a friend, truth is a greater friend. Truth is a holy thing and worthy to be honored above everything else. Let them follow the doctrine of Galen, which is entirely made up of experience and reason, and in which one investigates things and despises words."
After all, tins is what great authorities in medicine have always insisted on. Once every hundred years or so one finds a really great observer who makes new observations and wakes the world up. He is surprised that men should not have used their powers of observation for themselves, but should have been following old-time masters. his comtemporaries often refuse to listen to him at first. His observations, however, eventually make their way. We blame the Middle Ages for following authority, but what have we been always doing but following authority, except for the geniuses who come and lift us out of the rut and illuminate a new portion of the realm of medicine. After they have come, however, and done their work, their disciples proceed to see with their eyes and to think that they are making observations for themselves When they are merely following authority. When the next master in medicine comes along his discovery is neglected because men have not found it in the old books, and usually he has to suffer for daring to have opinions of his own. The fact of the matter is that at any time there is only a very limited number of men who think for themselves. The rest think other people's thoughts and think they are thinking and doing things. As for observation, John Ruskin once said, " Nothing is harder than to see something and tell it simply as you saw it." This is as true in science as in art, and only genius succeeds in doing it well.
Chauliac's book is confessedly a compilation. He has taken the good wherever he found it, though he adds, modestly enough, that " his work also contains whatever his own measure of intelligence enabled him to find useful (quae juxta modicitatem mei ingenii utilia reputavi). Indeed it is the critical judgement displayed by Chauliac in selecting from his predecessors that best illustrates at once the practical character of his intellect and his discerning spirit. What the men of his time are said to have lacked is the critical faculty. They were encyclopedic!. in intellect and gathered all kinds of information without discrimination, is a very common criti of medieval writers. No one can say this of Chauliac, however, and, above all, he was no respecter of authority, merely for the sake of authority_ His criticism of John of Gaddesden's book shows that the blind following of those who had gone before was his special Me noir. His bitterest reproach for many of his predecessors was that " they follow one another like cranes, whether for love or fear, I cannot say."
Chauliae's right to the title of father of surgery will perhaps be best appreciated from the brief account of his recommendations as to the value of surgical intervention for conditions in the three most important cavities of the body, the skull, the thorax, and the abdomen. These cavities have usually been the dread of surgeons. Chauliac not only used the trephine, but laid down. very exact indications for its application. Expectant treatment was to be the rule in wounds of the head, yet when necessary, interference, was counselled as of great value. His prognosis of brain injuries was much better than that of his predecessors. He says that he had seen injuries of the brain followed by some loss of brain substance, yet with complete recovery of the patient.. In one case that he notes a considerable amount of brain substance was lost, yet the patient recovered with only a slight defect of memory, and even this disappeared after a time. He lays down exact indieations for the opening of the thorax, that me tangere of surgeons at all times, even our own, and points out the relations of the ribs and the diaphragm, so as to show just where the opening should be made in order to remove fluid of any kind.
In abdominal conditions, however, Chiauliae's anticipation of modern views is most surprising. He recognized that wounds of the intestines were surely fatal unless leakage could be prevented. Accordingly he suggested the opening of the abdomen and the sewing up of such intestinal wounds as could lie located. He describes a method of suture for these cases and seems, like many another abdominal surgeon, even to have invented a special needleholder.
To most people it would seem absolutely out of the question that such surgical procedures could be practised in the fourteenth century. We have the definite record of them, however, in a text-book that was the most read volume on the subject for several centuries. Most of the surprise with regard to these operations will vanish when it is recalled that in Italy during the thirteenth century, as we have already seen, methods of anaesthesia by means of opium and mandragora were in common use, having been invented in the twelfth century and perfected by Ugo da Lucca, and Chauliac must not only have known but must have frequently employed various methods of anaesthesia.
In discussing amputations he has described in general certain methods of ansthesia in use in his time, and especially the method by means of inhalation. It would not seem to us in the modern time that this method would be very successful, but there is an enthusiastic accord of authorities attesting that operations were done at this time with the help of this inhalant without the infliction of pain. Chauliac says:
Some prescribe medicaments which send the patient to sleep, so that the incision may not be felt, such as opium, the juice of the morel, hyoscyamus, mandrake, ivy, hemlock, lettuce. A new sponge is soaked by them in these juices and left to dry in the sun; and when they have need of it they put this sponge into warm water and then hold it under the nostrils of the patient until he goes to sleep. Then they perform the operation."
Many people might be prone to think that the hospitals of Chauliac's time would not be suitable for such surgical work as he describes. It. is, however, only another amusing assumption of this self-complacent age of ours to think that we were the first who ever made hospitals worthy of the name and of the great humanitarian purpose they sub-serve. As a matter of fact, the old-time hospitals were even better than ours or, as a rule, better than any we had until the present generation. In " The Popes and Science," in the chapter on " The Foundation of City Hospitals," I call attention to the fact that architects of the present day go back to the hospitals of the Middle Ages in order to find the models for hospitals for the modern times. Mr. Arthur Dillon, a well-known New York architect, writing of a hospital built at Tonnerre in France, toward the end of the thirteenth century (1292), says:
" It was an admirable hospital in every way, and it is doubtful if we to-day surpass it. It was isolated; the ward was separated from the other buildings; it had the advantage we so often lose of being but one story high, and more space was given to each patient than we can now afford.
" The ventilation by the great windows and ventilators in the ceiling was excellent; it was cheerfully lighted; and the arrangement of the gallery shielded the patients from dazzling light and from draughts from the windows and afforded an easy means of supervision, while the division by the roofless low partitions isolated the sick and obviated the depression that comes from sight. of others in pain.
" It was, moreover, in great contrast to the cheerless white wards of to-day. The vaulted ceiling was very beautiful ; the woodwork was richly carved, and the great windows over the altars were filled with colored glass. Altogether it was one of the best examples of the best period of Gothic Architecture."
The fine hospital thus described was but one of many. Virchow, in his article on hospitals quoted in the same chapter, called attention to the fact that in the thirteenth and fourteenth centuries every town of five thousand or more inhabitants had its hospital, founded on the model of the great Santo Spirito Hospital in Rome, and all of them did good work. The surgeons of Guy de Chauliac's time would indeed find hospitals wherever they might be called in consultation, even in small towns. They were more numerous in proportion to population than our own and, as a rule, at. least as well organized as ours were until the last few years.
It is no wonder that with such a good hospital organization excellent surgery was accomplished. Hernia was Chauliac's specialty, and in it his surgical judgment is admirable Mondeville before his time did not hesitate to say that many operations for hernia were done not for the benefit of the patient, but for the benefit of the surgeon, a very striking anticipation of remarks that one sometimes hears even at the present time. Chauliac discussed operations for hernia very conservatively. His rule was that a truss should be worn, and no operation attempted unless the patient's life was endangered by the hernia. It is to him that we owe the invention of a well-developed method of taxis, or manipulation of a hernia, to bring about its reduction, which was in use untih the end of the nineteenth century. He suggested that trusses could not he made according to rule, but must be adapted to each individual case. He invented several forms of truss himself, and in general it may be said that his manipulative skill and his power to apply his mechanical principles to his work are the most characteristic of his qualities. This is particularly noteworthy in his chapters on fractures and dislocations, in which lie suggests various methods of reduction and realizes very practically the mechanical difficulties that were to be encountered in the correction of the deformities due to these pathological conditions. In a word, we have a picture of the skilled surgeon of the modern time in this treatise of a fourteenth-century teacher of surgery.
Chauliac discusses six different operations for the radical cure of hernia. As Gurlt points out, he criticises them from the same standpoint as that of recent surgeons. The object of radical operations for hernia is to produce a strong, firm tissue support over the ring through which the cord passes, so that the intestines cannot descend through it. It is rather interesting to find that the surgeons of this time tried to obliterate the canal by means of the cautery, or inflammation producing agents, arsenic and the like, a practice that recalls sonic methods still used more or less irregularly. Thcy also used gold wire, which was to be left in the tissues and is supposed to protect and strengthen the closure of the ring. At this time all these operations for the radical cure of hernia involved the sacrifice of the testiele because the old surgeons wanted to obliterate the ring completely, and thought this the easiest way. Chauliac discusses the operation in this respect and says that he has seen many cases in which men possessed of but one testicle have procreated, and this is a case where the lesser of two evils is to be chosen.
Of course Guy de Chauliac would not have been able to operate so freely on hernia and suggest, following his own experience, methods of treatment of penetrating wounds of the abdomen only that lie had learned the lessons of antiseptic surgery which had been gradually developed among the great surgeons of Italy during the preceding century. The use of the stronger wines as a dressing together with insistence on the most absolute cleanliness of the surgeon before the operation, and careful details of cleanliness during the operation, made possible the performance of many methods of surgical intervention that would otherwise surely have been fatal. Probably nothing is harder to understand than that after these practical discoveries men should have lost sight of their significance, and after having carefully studied the viscous exudation which produces healthy natural union, should have come to the thought of the necessity for the formation of laudable pus before union might be expected. The mystery is really no greater than that of many another similar incident in human history, but it strikes us more forcibly because the discovery and gradual development of antiseptic surgery in our own time has meant so much for us. Already even in Chauliac's practice, however, sonic of the finer elements of tile technique that made surgery antiseptic to a marked degree, if not positively aseptic in many cases, were not being emphasized as they were by his predecessors, and there was a beginning of surgical meddlesomenes reasserting itself.
it must not be thought, however, that it was only with the coarse applications of surgery that Chauliac concerned himself. He was very much interested in the surgical treatment of eye diseases and wrote a monograph on cataract, in which he gathers what was known before his time and discusses it in the light of his own experience. The writing of such a book is not so surprising at this time if we recall that in the preceding century the famous Pope John XXI, who had been a physician before he became Pope, and under the name of Peter of Spain was looked up to as one of the distinguished scientists of his time, had written a book on eye diseases that has recently been the subject of much attention.
Pope John had much to say of cataract, dividing it into traumatic and spontaneous, and suggesting the needling of cataract, a gold needle being used for the purpose. Chauliac 's method of treating cataract was by depression. His care in the selection of patients may be appreciated from his treatment of John of Luxembourg, King of Bavaria, blind from cataract, who consulted Chauliac in 1336 while on a visit to Avignon with the King of France_ Chauliac refused to operate, however, and put off the King with dietary regulations.
In the chapter on John of Arcoli and Medieval Dentistry we call attention to the fact that Chauliac discussed dental surgery briefly, yet with such practical detail as to show very clearly how much more was known about this specialty in his time than we have had any idea of until recent years. He recognized the dentists as specialists, calls them dentatores, but thinks that they should operate under the direction of a physician—hence the physician should know much about teeth and especially about their preservation. He enumerates instruments that dentists should have and shows very clearly that the specialty had reached a high state of development. A typical example of Chauliac's common sense and dependence on observation and not tradition is to be found in what he has to say with regard to methods of removing the teeth without the use of extracting instruments. It is characteristic of his method of dealing with traditional remedies, even though of long standing, that he brushes them aside with some impatience if they have not proved themselves in his experience.
" The ancients mention many medicaments, which draw out the teeth without iron instruments or which make them more easy to draw out; such as the milky juice of the titlhymal with pyrethrum, the roots of the mulberry and caper, citrine arsenic, aqua fortis, the fat of forest frogs. But these remedies promise much and accomplish but little-----mais its (torment Idea beaucoup de promesses, et peu d 'operations."
It is no wonder that Chauliac has been enthusi praised. Nicaise has devoutly gathered many of these praises into a sheaf of eulogies at the end of his biography of the great French surgeon. He tells us that Fallopius compared him to Hippocrates. John Calvo of Valencia, who translated the " Great. Surgery " into Spanish, looks upon him as the first law-giver of surgery. Freind, the great English physician, in 1725 called him the Prince of Surgeons. Ackermann said that Guy de ChauIiac's text-book will take the place of all that has been written on the subject down to his time, so that even if all the other works had been lost his would replace them. Dezimeris, commenting on this, says that " if one should take this appreciation literally, this surgeon of the fourteenth century would be the first and, up to the present time, the only author who ever merited such an eulogy," " At least," he adds, " we cannot refuse him the distinction of having made a work infinitely superior to all those which appeared up to this time and even for a long time afterwards. Posterity rendered him this justice, for he was for three centuries the classic par excellence. He rendered the study easy and profitable, and all the foreign nations the tributaries of our country." Peyrihle considered Guy's " Surgery " as the most valuable and complete work of all those of the same kind that had been published since Hippocrates and added that the reading of it was still useful in his time in 1784. Begin, in his work on Arnbroise Pare, says " that Guy has written an immortal book to which are attached the destinies of French surgeons." Malgaigne, in his " History of Surgery," does not hesitate to say, " I do not fear to say that, Hippocrates alone excepted, there is not a single treatise on surgery,—Greek, Latin, or Arabic,--which I place above, or even on the same level with, this magnificent work, The Surgery of Guy de Chauliac.' " Daremberg said, " Guy seems to us a surgeon above all erudite, yet expert and without ever being rash. He knows, above all, how to choose what is best in everything." Verneuil, in his " Conference sur Les Chirurgiens Erudits," says, " The services rendered by the Great Surgery were immense; by it there commenced for France an era of splendor. It is with justice, then, that posterity has decreed to Guy de Chauliac the title of Father of French surgery."
'The more one reads of Chauliac's work the less is one surprised at the estimation in which he has been held wherever known. It would not be hard to add a further sheaf of compliments to those collected by Nicaise. Modern writers on the history of medicine have all been enthusiastic in their admiration of him, just in proportion to the thoroughness of their acquaintance with him.
Finally, it may be averred that Guy de Chauliac said nearly everything which modern surgeons say, and that his work is of infinite price but unfortunately too little read, too little pondered." Malgaigne declares Chauliac's " Chirurgia Magna " to be " a masterpiece of learned and luminous writing." Professor Clifford Allbutt, the -Regius Professor of Physic at the University of Cambridge, says of Chauliac's treatise: " This great work I have studied carefully and not without prejudice; 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."
If to this account of his professional career it be added that Chauliac's personality is, if possible, more interesting than his surgical accomplishment, some idea of the significance of the life of the great father of modern surgery will be realized. We have already quoted the distinguished words of praise accorded him by Pope Clement VI. That they were well deserved, Chauliac's conduct during the black death which ravaged Avignon in 1348, shortly after his arrival in the Papal City, would have been sufficient of itself to attest. The occurrence of the plague in a city usually gave rise to an exhibition of the most arrant cowardice, and all who could, fled. In many of the European cities the physicians joined the fugitives, and the ailing were left to care for themselves. With a few notable exceptions, this was the case at Avignon, but Guy was among those who remained faithful to his duty and took on himself the self-sacrificing labor of caring for the sick, doubly harassing because so many of his brother physicians were absent. lie denounces their conduct as shameful, yet does not boast of his own courage, but on the contrary says that he was in constant fear of the disease. Toward the end of the epidemic he was attacked by the plague and for a time his life was despaired of. Fortunately lie recovered, to become the most influential among Lis colleagues, the most highly admired of the physicians of his generation, and the close personal friend of all the high ecclesiastics, who had witnessed his magnificent display of courage and of helpfulness for the plague-stricken during the epidemic. He wrote a very clear account of the epidemic, which leaves no doubt that it was true bubonic plague.
After this fine example, Chauliac's advice to brother physicians in the specialty of surgery carried added weight. In the Introductory chapter of his " Chirurgia Magna " he said:
" The surgeon should be learned, skilled, ingenious, and of good morals. Be bold in things that are sure, cautious in dangers; avoid evil cures and practices; be gracious to the sick, obliging to his colleagues, wise in his predictions. Be chaste, sober, pitiful, and merciful; rhot covetous nor extortionate of money; but let the recompense be moderate, according to the work, the means of the sick, the character of the issue or event, and its dignity."
No wonder that Malgaigne says of Lim, " Never since Hippocrates has medicine heard such language filled with so much nobility and so full of matter in so few words."
Chauliac was in every way worthy of his great contemporaries and the period in which his lot was cast. Ordinarily we are not apt to think of the early fourteenth century as an especially productive period in human history, but such it is. Dante's Divine Comedy was entirely written during Chauliac's life. Tetrarch was born within a few years of Chauliac himself ; Boccaccio in Italy, and Chaucer in England, wrote while Chauliac was still alive. Giotto did his great painting, and his pupils were laying the deep, firm foundations of modern art. Many of the great cathedrals were being finished. Most of the universities were in the first flush of their success as moulders of the human mind. There are few centuries in history that can show the existence of so many men whose work was to have an enduring influence for all the after time as this upon which Chauliac's career shed so bright a light. The preceding century had seen the origin of the universities and the rise of such supremely great men as Albertus Magnus, Roger Bacon, Thomas Aquinas, and the other famous scholars of the early days of the mendicant orders, and had made the intellectual mould of university training in which men's minds for seven centuries were to be formed, so that Chauliac, instead of being an unusual phenomenon is only a fitting expression of the interest of this time in everything, including the physical sciences and, above all, medicine and surgery.
For some people it may be a source of surprise that Chauliac should have had the intellectual training to enable him to accomplish such judicious work in his specialty. Many people will be apt to assume that he accomplished what he did in spite of his training, genius succeeding even in an unfavorable environment, and notwithstanding educational disadvantages. Those who would be satisfied with any such explanation, however, know nothing of the educational opportunities provided in the period of which Chauliac was the fruit. He is a typical university man of the beginning of the fourteenth century, and the universities must be given due credit for him. It is ordinarily assumed that the universities paid very little attention to science and that scientists would find practically nothing to satisfy in their curricula. Professor Huxley in his address on " Universities, Actual and Ideal," delivered as the Rectorial Address at Aberdeen University in 1874, declared that they were probably educating in the real sense of the word better than we do now. (See quotation in " The Medical School at Salerno.")
In the light of Chauliac's life it is indeed amusing to read the excursions of certain historians into the relationship of the Popes and the Church to science during the Middle Ages. Chauliac is typically representative of medieval science, a man who gave due weight to authority, yet tried everything by his own experience, and who sums up in himself such wonderful advance in surgery that during the last twenty years the students of the history of medicine have been more interested in him than in anyone who comes during the intervening six centuries. Chauliac, however, instead of meeting with any opposition, encountered encouragement, liberal patronage, generous interest, and even enjoyed the intimate friendship of the highest ecclesiastics and the Popes of his time. In every way his life may be taken as a type of what we have come to know about the Middle Ages, when we know them as we should, in the lives of the men who counted for most in them, and do not accept merely the broad generalizations which are always likely to be deceptive and which in the past have led men into the most absurd and ridiculous notions with regard to a wonderful period in human history.
That Guy de Chauliac was no narrow specialist is abundantly evident from his book, for while the " Great Surgery " treats of the science and art of surgery as its principal subject, there are remarks about nearly everything else relating to medicine, and most of them slow a deep interest, a thorough familiarity, and an excellent judgment. Besides we have certain expressions with regard to intellectual matters generally which serve to show Guy as a profound thinker. who thoroughly appreciated just how accumulations of knowledge came to men and how far each generation or member of a generation should go and yet how limited must, after all, he the knowledge obtained by any one person. With regard to books, for instance, he said, " for everyone cannot have all the books, and even if he did have them it would be too tiresome to read them all and completely, and it would require a godlike memory to retain them all." He realized, however, that each generation, provided it took the opportunities offered it, was able to see a little bit farther than its predecessor, and the figure that he employs to express this is rather striking. " Sciences," he said, " are made by additions. It is quite impossible that the man who begins a science should finish it. We are like infants, clinging to the neck of a giant; for we can see all the giant sees and a little more."
One of the most interesting features of the history of Guy de Chauliac is the bibliography of his works which has been written by Nicaise. This is admirably complete, labored over with the devotion that characterized Nicaise's attitude of unstinted admiration for the subject. Altogether he has some sixty pages of a quarto volume with regard to the various editions of Guy's works.
The first manuscript edition of Guy de Chauliac was issued in 13(33, the first printed edition in 1478. Even in the fourteenth century Guy's great work was translated into all the languages generally used in Europe. Nicaise succeeded in placing 31 complete manuscripts of the " Great Surgery ": 22 of these are in Latin, 4 are in French, 3 are in English, 2 only in Provencal, though that was the language spoken in the region where much of Chauliac's life was passed, and one each in Italian, in Low Dutch, and in Hebrew. Of the English manuscripts, one is number twenty-five English of the Bibliotheque Nationale, Paris; a second is number 3666 English of the Sloane collection in the British Museum, and a third is in the Library of the University of Cambridge.'
Paulin. Paris, probably one of the best of recent authorities on the age and significance of old manuscripts, says in the third volume of his Manuscrits Francais," page 346, " This manuscript. [of Guy de Chauliac's " Great Surgery 'I was made, if not during the life, then certainly very shortly after the death of the author. It is one of the oldest that can be cited, and the fact that an English translation was made so near to the time of the original composition of the book attests the great reputation enjoyed by Guy de Chauliac at this time, and which posterity has fully confirmed."
' The beginning of the manuscript copy in the "BibIiotheque Nationale " is extremely interesting as an example of the English of the period, and alongside of It it seems worth while to quote the closing sentence as Nicaise reproduces them ;
"In godes name here bygyneth the inventarie of gadryng to gedre medecyne in the partye of cyruygic compilede and fulfilled in the zero (yerefl of our Loord 1363 by Guide de Cauliaco cirurgene and doctor of physik in the fulclere studye of Mountpylerz.
"On page 191, verso.—Here endeth the cyrurgie of Maistre Guyd' de Cauliaco dottoure of phisik."
The University of Cambridge copy has the title in the colophon. It runs as fellows " Ye inventorye of Guydo de Caulhiaco Doctor of Phisyk and Cirurgicn in Ye Universitie of Mount Pessulanee of Montpeleres." The fly-leaf contains the words, " :resit Christ save ye soule of mich.' It is rather interesting to note how much closer to modern English is this copy, made probably not much more than half a century later than the first one and, above all, how much more nearly the spelling has come. At this time, however, and, indeed, for more than a century later, spelling had no fixed rule, and a man might spell the same word quite differently even on the same page. The difference between doctor spelled thus in the early edition, and doctours in the later one. probably means nothing more than personal peculiarities of the original translator or copyist, some medical recipes at the end by Francis Verney. It was probably written in the fifteenth century. Its title is:
" The inventorie or the collectorie in cirurgicale parte of medicine compiled and complete in the yore of our Lord 1363, with some additions of other doe-tours, necessary to the foresaid arte or crapte (crafte?)."
What we find in the period of manuscripts, however, is as nothing compared to the prestige of Guy de Chauliac's work, once the age of printing began. Nicaise was able to find sixty different printed editions of the " Great Surgery." Nine others that are mentioned by authors have disappeared and apparently no copies of them are in existence. Besides there are sixty editions of portions of the work, of compendiums of it and commentaries on it. Altogether 129 editions are extant. Of these there are sixteen Latin editions, forty-three French, five Italian, four Low Dutch, five Catalan, and one English. Fourteen appeared in the fifteenth century, thirty-eight in the sixteenth century, and seventeen in the seventeenth century. The fourteen editions belonging to the incunabula of printing, issued, that is, before the end of the fifteenth century, show what lively interest there was in the French surgeon of the preceding century, since printing presses at this precious time were occupied only with the books that were considered indispensable for scholars. The first edition of the " Great Surgery " was printed in 1478 at Lyons. Printing had only been introduced there five years before. This first edition, p•imus primarius or editio princeps, was a French translation by Nicholas Panis. In 1480 an Italian edition was printed at Venice. The first Latin edition was printed also in Venice in 1490.
It would be only natural to expect that, the successors of Guy de Chauliac, and especially those who had come personally in contact with him, would take advantage of his thorough work to make still further advances in surgery. As matter of fact, decadence in surgery is noted immediately after his death. Three men taught at the University of Montpellier at the end of the fourteenth and the be-. ginning of the fifteenth century, John de Tornamira, Valesco de Taranta, and John Faucon. They cannot be compared, Gurlt says, with Guy de Chauliac, though they were physicians of reputation in their time. Faucon made a compendium of Guy's work for students. Somehow there seemed to be the impression that surgery had now reached a point of development, beyond which it could not advance. Unfortunate political conditions, wars, the withdrawal of the Popes from Avignon to Rome, and other disturbances, distracted men's minds, and surgery deteriorated to a considerable extent, until the new spirit at the time of the Renaissance came to inject fresh life into it.