James Walsh - The Thirteenth, Greatest of Centuries

What has thus been learned about him will serve of itself and without more ado, to stamp all that has been said about the unpractical character of the medical teaching of the medieval universities as utterly unfounded. Because men have not taken the trouble to look up the teaching of these times, and because their works were until recent years buried in old folios, difficult to obtain and still more difficult to read when obtained, it has been easy to ignore their merit and even to impugn the value of their teaching completely. William of Salicet was destined, moreover, to be surpassed in some ways by his most distinguished pupil, Lanfranc, who taught at the University of Paris at the end of the Thirteenth Century. Of Lanfranc, in the address already quoted from, Professor Allbutt has one very striking paragraph that shows how progressive was the work of this great French surgeon, and how fruitful had been the suggestive teaching of his great master. He says:

"Lanfranc's 'Chirurgia Magna' was a great work, written by a reverent but independent follower of Salicet. He distinguished between venous and arterial hemorrhage, and used styptics (rabbit's fur, aloes, and white of egg was a popular styptic in elder surgery), digital compression for an hour, or in severe cases ligature. His chapter on injuries of the head is one of the classics of medieval surgery. Clerk (cleric) as he was, Lanfranc nevertheless saw but the more clearly the danger of separating surgery from medicine."

Certain assertions in this paragraph deserve, as in the case of Lanfranc's master, to be discussed, because of their anticipations of what is sometimes thought to be very modern in surgery. The older surgeons are supposed to have feared hemorrhage very much. It is often asserted that they knew little or nothing about the ligature and that their control of hemorrhage was very inadequate. As a matter of fact, however, it was not primary hemorrhage that the old surgeons feared, but secondary hemorrhage. Suppuration often led to the opening of an important artery, and this accident, as can well be understood, was very much dreaded. Surgeons would lose their patients before they could come to their relief. How thoroughly Lanfranc knew how to control primary hemorrhage can be appreciated from the quotation just made from Dr. Allbutt's address. The ligature is sometimes said to have been an invention of Ambroise Paré, but, as a matter of fact, it had been in use for at least three centuries before his time, and perhaps even longer.

Usually it is considered that the difficult chapter of head injuries, with all the problems that it involves in diagnosis and treatment, is a product of the Nineteenth Century. Hence do we read, with all the more interest, Allbutt's declaration that Lanfranc wrote what is practically a classical monograph, on the subject. It is not so surprising, then, to find that the great French surgeon was far ahead of his generation in other matters, or that he should even have realized the danger of separating surgery from medicine. Both the Regius professors of medicine at the two great English universities, Cambridge and Oxford, have, since the beginning of the Twentieth Century, made public expression of their opinion that the physician should see more of the work of the surgeon, and should not depend on the autopsy room for his knowledge of the results of internal disease. Professor Osler, particularly, has emphasized his colleague, Professor Allbutt's opinion in this matter. That a surgical professor at the University of Paris, in the Thirteenth Century, should have anticipated these two leaders of medical thought in the Twentieth Century, would not be so surprising, only that unfortunately the history of medieval teaching has, because of prejudice and a lamentable tradition, not been read aright.

Occasionally one finds a startling bit of anticipation of what is most modern, in medicine as well as in surgery. For instance, toward the end of the Thirteenth Century, a distinguished English professor of medicine, known as Gilbert, the Englishman, was teaching at Montpelier, and among other things, was insisting that the rooms of patients suffering from smallpox should be hung entirely with red curtains, and that the doors and the windows should be covered with heavy red hangings. He claimed that this made the disease run a lighter course, with lessened mortality, and with very much less disfigurement. Smallpox was an extremely common disease in the Thirteenth Century, and he probably had many chances for observation. It is interesting to realize that one of the most important observations made at the end of the Nineteenth Century by Dr. Finsen, the Danish investigator whose studies in light and its employment in therapeutics, drew to him the attention of the world, and eventually the Nobel prize of $40,000 for the greatest advance in medicine was, that the admission of only red light to the room of smallpox patients modified the disease very materially, shortened its course, often prevented the secondary fever, and almost did away completely with the subsequent disfigurement.

It is evident that these men were searching and investigating for themselves, and not following blindly in the footsteps of any master. It has often been said that during the Middle Ages it was a heresy to depart, ever so little, from the teaching of Galen. Usually it is customary to add that the first writer to break away from Galen, effectually, was Vesalius, in his De Fabrica Corporis Humani, published toward the end of the second quarter of the Sixteenth Century. It may be said, in passing, that, as a matter of fact, Vesalius, though he accomplished much by original investigation, did not break so effectually with Galen as would have been for the best in his own work, and, especially, for its influence on his successors. He certainly did not set an example of independent research and personal observation, any more fully, than did the medical teachers of the Thirteenth Century already mentioned, and some others, like Mondaville and Arnold of Villanova, whose names well deserve to be associated with them.

One reason why it is such a surprise to find how thoroughly practical was the teaching of the Thirteenth Century university medical schools, is because it has somehow come to be a very general impression that medicine was taught mainly by disputations, and by the consultation of authorities, and that it was always more important to have a passage of Galen to support a medical notion, than, to have an original observation. This false impression is due to the fact that the writers of the history of medical education have, until recent years, drawn largely on their imaginations, and have not consulted the old-time medical books. In spite of the fact that printing was not discovered for more than two centuries later, there are many treatises on medicine that have come down to us from this early time, and the historians of medicine now have the opportunity, and are taking the trouble, to read them with a consequent alteration of old-time views, as to the lack of encouragement for original observation, in the later Middle Ages. These old tomes are not easy reading, but nothing daunts a German investigator bound to get to the bottom of his subject, and such men as Pagel and Puschmann have done much to rediscover for us medieval medicine. The French medical historians have not been behind their German colleagues and magnificent work has been accomplished, especially by the republication of old texts. William of Salicet's surgery was republished by Pifteau at Toulouse in 1898. Mondaville's Surgery was republished under the auspices of the Society for the Publication of old French Texts in 1897 and 1898. These republications have made the works of the old-time surgeons readily available for study by all interested in our great predecessors in medicine, all over the world. Before this, it has always been necessary to get to some of the libraries in which the old texts were preserved, and this, of course, made it extremely difficult for the ordinary teacher of the history of medicine to know anything about them. Besides, old texts are such difficult reading that few, except the most earnest of students, have patience for them, and they are so time-taking as to be practically impossible for modern, hurried students.