Kitabı oku: «The Popes and Science», sayfa 11

As we have said, one hundred years ago De Maistre declared that history had been a conspiracy against the truth. At last a universal recognition is coming of the fact that history has been written entirely too much from the personal standpoint of the historian without due reference to contemporary documents and authorities, or with the citation of only such references from these as would support the special contention of the writer. Even the writers of history whose reputation has been highest have suffered from this fault, and the consequence is that on disputed points it is more important to know what party a historian belongs to than what he writes.

Is it not time that at least our educators should cease accepting this old traditional opinion with regard to the times before the reformation so-called, and get at the truth in the matter, or as near it as possible. These educators of the thirteenth and fourteenth centuries were zealous and earnest beyond cavil. That everyone admits. It is supposed, however, that they were ridiculously ignorant and superstitious. Only those who are themselves ridiculously ignorant and superstitious, for the real meaning of superstition is persistence in accepting a supposed truth that is a survival (superstes) from a previous state of knowledge, after the reasons for its acceptance have been shown to be groundless, will continue to believe this absurd proposition. If the educator of the modern day will only study with the sympathy they deserve, the lives of the earliest educators of modern times, the professors, the officials, and the ecclesiastical authorities as well as the Papal patrons of the universities of the thirteenth and fourteenth centuries, we shall hear no more of the Church during the Middle Ages having been opposed to education, nor to science, nor to any other department of human knowledge.

THE CHURCH AND SURGERY DURING THE MIDDLE AGES

It is with regard to surgery that the opposition of the Church is sometimes supposed to have been most serious in its effects upon the progress of medical science and its applications for the relief of human suffering. President White has stated this, as usual, very emphatically in certain paragraphs of his chapter on From Miracles to Medicine, especially under the caption of Theological Discouragement of Medicine. He says, for instance:–

"As to surgery, this same amalgamation of theology with survivals of pagan beliefs continued to check the evolution of medical science down to the modern epoch. The nominal hostility of the Church to the shedding of blood withdrew, as we have seen, from surgical practice the great body of her educated men; hence surgery remained down to the fifteenth century a despised profession, its practice continued largely in the hands of charlatans, and down to a very recent period the name 'barber-surgeon' was a survival of this. In such surgery, 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 toothache."

In another and earlier portion of the same chapter, under the heading "Theological Opposition to Anatomical Studies," he states the reasons why this low state of surgical practice existed. Once more it is declared to be because of a prohibitory decree, or several of them, directed against the practice of surgery by ecclesiastical authorities. These decrees, we shall find, as was true of previous supposed prohibitions, are entirely perverted from their real meaning by President White, who has the happy faculty of lighting upon mares' nests of Papal decrees and decrees of councils and neglecting to pay any attention to the real history of the science of which he writes. President White says:

"To those arguments against dissection was now added another one which may well fill us with amazement. It is the remark of the foremost of recent English philosophical historians, that of all organizations in human history, the Church of Rome has caused the greatest spilling of innocent blood. No one conversant with history, even though he admit all possible extenuating circumstances and honor the older Church for the great circumstances which can undoubtedly be claimed for her, can deny this statement. Strange is it, then, to note that one of the main objections developed in the Middle Ages against anatomical studies was the maxim that 'The Church abhors the shedding of blood.'"

"On this ground, in 1248, the Council of Le Mans forbade surgery to monks. Many other councils did the same, and at the end of the thirteenth century came the most serious blow of all: for it was then that Pope Boniface VIII., without any of that foresight of consequences which might well have been expected in an infallible teacher, issued a decretal forbidding a practice which had come into use during the Crusades, namely, the separation of the flesh from the bones of the dead whose remains it was desired to carry back to their own country." Note always the return to Pope Boniface's bull and always the perversion of the meaning of the word infallibility.

I have already stated the real significance of Boniface's bull. It neither forbade, nor did its interpretation in any way hamper, the development of anatomy. Just exactly the same thing is true with regard to the Papal regulations or decrees of councils that are claimed to have hampered surgery. President White and others have insisted that the prohibition of surgery to monks and priests prevented the development of surgery or was responsible for the low state of surgical practice. Here once more we are in the presence of a deduction, and not of an induction that represents the actual facts in the case. Most students at the universities were clerks, that is, had the privileges of clergymen, and were, as a rule, in minor orders. All the great surgeons of this time, and they were many, were ecclesiastics.

The climax of President White's treatment of the relationship of the Church to surgery and of the intense opposition manifested by ecclesiastics to surgical progress, and, I may add, the climax of absurdity as far as the real history of surgery is concerned, comes in the last paragraph of this portion of his chapter on From Miracles to Medicine, which President White has placed under the title Theological Opposition to Anatomical Studies. He says:

"So deeply was the idea rooted in the mind of the Universal Church that for over a thousand years surgery was considered dishonorable; the greatest monarchs were often unable to secure an ordinary surgical operation; and it was only in 1406 that a better beginning was made, when the Emperor Wenzel of Germany ordered that dishonor should no longer attach to the surgical profession."

President White insists over and over again that whatever surgery there was, and especially whatever progress was made in surgery, was due to the Arabs, or at least to Arabian initiative. Gurlt, in his History of Surgery, [Footnote 21] which we have referred to elsewhere, is very far from sharing this view. I need scarcely say that Gurlt is one of our best authorities in the history of surgery. In his sketch of Roger, the first of the great Italian surgeons of the thirteenth century who came after the foundation of the universities, Gurlt says that, "though Arabian writings on surgery had been brought over to Italy by Constantine Africanus a hundred years before Roger's time, those exercised no influence over Italian surgery in the next century, and there is not a trace of the surgical knowledge of the Arabs to be found in Roger's work." His writing depends almost entirely upon the surgical traditions of his time, the experience of his teachers and colleagues, to whom in two places he has given due credit, and on the Greek writers. There are no traces of Arabisms to be found in Roger's writing, while they are full of Grecisms. Roger represents the first important writer on surgery in modern times, and his works have been printed several times because of their value as original documents.

[Footnote 21: Geschichte der Chirurgie und ihrer Ausübung. Von Dr. E. Gurlt, Vol. I., p. 701.]

It is wonderfully amusing to anyone who knows Gurlt's History of Surgery, [Footnote 22] that the distinguished old professor of the University of Berlin, looked up to as so well informed as to the history of the branch of medical science to which he had devoted a long life, should have wasted some three hundred pages of his first volume on the History of Surgery in Middle and West Europe during the Middle Ages, for they are mainly taken up with the consideration of the period when President White asserts that there was no surgery in Europe. Gurlt even protests that he has not as much space as he would like to devote to these old-time masters of surgery, who did so much to lay the foundation of modern surgical practices. Those who have paid any attention to President White's assertion with regard to surgery at this time, should at least look over Gurlt. They will thus realize what a dangerous thing it is to attempt large conclusions in the history of a department of knowledge of which one knows nothing. They will also realize how easy it is for a writer with some prestige, to lead others astray in a matter of history, by simply making assertions without taking the trouble to see whether they are supported by the facts in the case or not.

[Footnote 22: Geschichte der Chirurgie und ihrer Ausübung. Von Dr. K. Gurlt, Geh. Med. Rath, Prof, der Chirurgie an der Königlichen Friedrich-Wilhelms-Universität zu Berlin. Berlin, 1898.]

The modern American historian of Theology and Science says, "for over a thousand years surgery was considered dishonorable." For the sake of contrast with this opinion of President White's, read for a moment the following remarks which constitute the opening sentences of Pagel's paragraphs on Surgery from 1200 to 1500, in Puschmann's Handbuch of the History of Medicine, already referred to. Before making the quotation, let me recall attention to the fact that Professor Pagel is the best informed living writer on the history of medicine. This book was issued in 1902. It is universally conceded to contain the last words on the history of medical development. There is no doubt at all about its absolute authoritativeness. President White has been calling on his imagination; Professor Pagel has consulted original documents in the history of surgery. He says:

"A more favorable star shone during the whole Middle Ages over surgery than over practical medicine. The representatives of this specialty succeeded earlier than did the practical physicians in freeing themselves from the ban of scholasticism. In its development a more constant and more even progress cannot fail to be seen. The stream of literary works on surgery flows richer during this period. While the surgeons are far from being able to emancipate themselves from the ruling pathological theories, there is no doubt that in one department, that of manual technics, free observation came to occupy the first place in the effort for scientific progress. Investigation is less hampered and concerns itself with practical things and not with artificial theories. Experimental observation was in this not repressed by an unfortunate and iron-bound appeal to reasoning." I am tempted to add as a reflection, deduction was not allowed to replace attention to facts, though it has in some supposed surgical history of this period.

Pagel continues: "Indeed, the lack of so-called scholarship, the freshness of view free from all prejudice with which surgery, uninfluenced by scholastic presumption, was forced to enter upon the objective consideration of things, while most of the surgeons brought with them to their calling an earnest vocation in union with great technical facility, caused surgery to enter upon ways in which it secured, as I have said, greater relative success than did practical medicine."

President White has evidently never bothered to look into a history of surgery at all, or he would not have fallen into the egregious error of saying that the period from 1200 to 1400 was barren of surgery, for it is really one of the most important periods in the development of modern surgery. Further evidence as to this is rather easy to obtain.

I have cited two German authorities in the history of medicine and surgery. Here is an English writer who is quite as authoritative. In the address on The Historical Relations of Medicine and Surgery to the end of the Sixteenth Century, which Professor Clifford Allbutt, the Regius Professor of Physic at the University of Cambridge, delivered by special invitation at the Congress of Arts and Sciences of St. Louis in 1904, this distinguished authority in the history of medicine had much to say with regard to the wonderful development of surgery in the thirteenth and fourteenth centuries, that is, during the period when, if we were to accept President White's declarations, surgery either did not exist, or else had been relegated to such mere handicraftsmen that no real scientific progress in it could possibly be expected. As Professor Allbutt was trying only to give a twentieth century audience some idea of the magnificent work that had been accomplished by fellow members of his profession of medicine seven centuries before, and had no idea of discussing the influence, favorable or otherwise, of the Church upon the progress of medical science, I have preferred to quote directly from this address for evidence of the surgery of these centuries, than to gather the details from many sources, when it might perhaps be thought that I was making out a more favorable case than actually existed, for the sake of the Church and the Popes.

"Both for his own great merits as an original and independent observer and as the master of Lanfranc, William Salicet (Gugliemo Salicetti of Piacenza, in Latin G. Placentinus or de Saliceto–now Cadeo) was eminent among the great Italian physicians of the latter half of the thirteenth century. Now, these great Italians were as distinguished in surgery as in medicine, and William was one of the protestants of the period against the division of surgery from inner medicine–a division which he regarded as a separation of medicine from intimate touch with nature. Like Lanfranc and the other great surgeons of the Italian tradition, and unlike Franco and Paré, he had the advantage of the liberal university education of Italy; but, like Paré and Würtz, he had large practical experience in hospital and in the battlefield. He practiced first at Bologna, afterwards in Verona. William fully recognized that surgery cannot be learned from books only. His surgery contains many case histories, for he rightly opined that good notes of cases are the soundest foundation of good practice; and in this opinion and method Lanfranc followed him. William discovered that dropsy may be due to a "durities renum"; he substituted the knife for the Arabist abuse of the cautery; he investigated the causes of the failure of healing by first intention; he described the danger of wounds of the neck; he sutured divided nerves; he forwarded the diagnosis of suppurative disease of the hip; and he referred chancre and phagedaena to "their proper causes."

Anyone who knows the history of surgery and of supposed modern progress in medicine will recognize at once that many of these ideas of Salicet are anticipations of discoveries supposed to have been made in the nineteenth century. The connection between dropsy and hardening of the kidneys is a typical example of this. The fact that William should have insisted that surgery cannot be learned from books is an open contradiction of what is so frequently said about scholasticism having invaded the realm of medicine, and the study of books having replaced the study of patients. It is not surprising that with his study of cases William should have recognized the danger of wounds of the neck, nor that he should have taught the suture of divided nerves. It cannot fail to be a matter of surprise, however, that he should have any hint of the possibility of union by first intention, for that is supposed to be quite recent, and the knowledge he displays of venereal diseases is supposed to have come into medicine and surgery at least two centuries later.

Allbutt next takes up Salicet's great pupil Lanfranc. "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 older 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 as he was, Lanfranc nevertheless saw but the more clearly the danger of separating surgery from medicine. 'Good God!' he exclaims, 'why this abandoning of operations by physicians to lay persons, disdaining surgery, as I perceive, because they do not know how to operate … an abuse which has reached such a point that the vulgar begin to think that the same man cannot know medicine and surgery… I say, however, that no man can be a good physician who has no knowledge of operative surgery; a knowledge of both branches is essential.' (Chir. Magna.) Is it not strange that this ancient was wiser than most of us are even yet."

Striking as all this is, much more that is of interest might be added to it from Pagel's account of Lanfranc's work. Pagel says that he has excellent chapters on the affections of the eyes, the ears and mouth, the nose, even the teeth, and treats of hernia in a very practical, common sense way. He warns against the radical operation, and says in phrases that have often been repeated even in our own time, that many surgeons decide on operations too easily, not for the sake of the patient, but for the sake of the money there is in them. He believes that most of the danger and inconvenience of the hernia can be removed by means of a properly fitting truss. He treats of stone in the kidney, but insists that the main thing for this affection is prophylaxis. He suggests that stone in the bladder should first be treated by internal remedies; but in severe cases advises extraction. Lanfranc's discussion of cystotomy, Pagel characterizes "as prudent, yet rational," for he considers that the operation should not be feared too much nor delayed too long. In patients suffering from the inconvenience which comes from large quantities of fluid in the abdomen, he advises paracentesis abdominis. He warns, however, against putting the patient in danger from such an operation without due consideration and only when symptoms absolutely demand it.

Pagel says that Lanfranc must be considered as one of the greatest of the surgeons of the Middle Ages and the real founder of the French School of Surgery which continued to be the most prominent in the world down to the nineteenth century. Lanfranc had equalled, if not surpassed, his great master William Salicet. His own disciple, Mondeville, accomplished almost as much for surgery as his master, however. Both of them were destined to be thrown into the shade for succeeding generations by another great French surgeon of the next half-century, Guy de Chauliac. Pagel can scarcely say enough of the capacity as a teacher of Lanfranc. The seeds of surgical doctrine which he sowed bore fruit richly. His important successors in French surgery walked for the most part in his tracks and thus furnished the best proof of the enduring character of his capacity as a teacher.

The next great name in thirteenth century surgery, for we are not yet out of that fruitful period, is Henri de Mondeville. He was known by his contemporaries and immediate successors as the most cultured of the surgeons. Whatever he wrote bears the traces of his wide reading and of his respect for authority, yet shows also his power to make observations for himself, and his name is due much more to his independent work both in the technics and the diagnostics of surgery, than to his reputation for scholarship or the depth of his culture. Lanfranc (whose name was Lanfranchi) had been an Italian. Mondeville was born in Normandy sometime about the beginning of the last quarter of the thirteenth century. The place of his education is not absolutely sure, but there is good authority for saying that he was, for a time at least, in Bologna. On his return from Italy he passed some time, just at the beginning of the fourteenth century, in Montpelier. He seems to have looked for a professorship at Montpelier, but instead received the appointment as surgeon to the French king, Philip Le Bel. This brought him to Paris, where the first portion of his book on surgery was written about 1306. This was not completed until 1312. His work was interrupted by several campaigns on which he attended the king along the Northern coast. When he again took up his work of writing, he revised what he had written at first by the light of the experience that he had acquired in the campaign. Pagel says that his style is lively and clear and often full of meat. Many of his own opinions and experiences are incorporated in his work, and in spite of his tendency to display his erudition by quotations, his originality is not seriously interfered with.

Some of his remarks are very curiously interesting to the modern. He seems to have had the idea that portions of metal which had penetrated the body as the result of explosions, for gun-powder was already being used, might be removed by means of a magnet. He would not have been a distinguished surgeon without inventing a needle-holder, and accordingly we find that he was one of the first of a long line of such inventors. He invented certain instruments also for the removal of arrow-heads, which because of their form and hooks become firmly imbedded in the tissues. Mondeville had no such fear of trephining as Lanfranc had, though he did not hesitate to emphasize the value of expectant treatment in most of these cases of injury to the head that might seem at first to demand the trephine.

Pagel notes the fact that when he prescribed drinks for his patients this medieval surgeon suggested that certain verses of the psalms which were usually recited, according to the custom of the times, whenever anything was administered to a patient, should be said. Pagel considers it quite natural that as a believing physician he should have realized how much his believing patients would be influenced for the better by such a procedure. He did not place any supreme faith in its efficacy, but knew that it could do no harm, and had probably seen, as has many a physician and surgeon of the modern time, that such a practice does good, if not by the direct interference of Providence, then at least by the calmness of mind which it superinduces in the patient. In the same way Mondeville was not averse to his patients going on pilgrimages. He did not expect that they would all be cured miraculously, but according to Pagel, his discussion of this subject is quite modern. Travel and change of scene would do good anyhow in many cases, expectancy would help the patient's condition, and the hope aroused was also good. The best merit, however, of this French surgeon is undoubtedly the immense influence which he exerted over his great successor, Guy de Chauliac.

We are really only beginning to accumulate knowledge with regard to the surgery of the thirteenth and fourteenth centuries. Pagel has devoted three very full pages, in his compressed account of surgery, to John Yperman, a surgeon of the early fourteenth century of whom practically nothing was known until about twenty-five years ago, when the Belgian historian Broeck brought to light his works and gathered some details of his life. He was a pupil of Lanfranc's, and at the end of the thirteenth century studied at Paris on a scholarship provided by his native town of Ypres, which deliberately sent him in order that he might become expert in surgery. This may seem a strange thing for a medieval town to do, at least it may seem so to those who have been accustomed to think little of the Middle Ages, but it will not to anyone who knows anything about the wonderful civic spirit of the Free Towns. In the chapter on Science at the Medieval Universities I have quoted from Prince Kropotkin's work on Mutual Aid in the Medieval Towns, and further consultation of that as a ready reference, would make all cause for ignorant surprise with regard to the culture and the enterprise of medieval towns disappear. Ypres, while a town of only fifteen thousand inhabitants now, was one of the most important towns of Flanders in the Middle Ages, noted for its manufacture of linens and fine laces, and has a handsome cathedral dating from the thirteenth century and a town hall, the famous Cloth Hall, from the same period, which is one of the most beautiful architectural monuments in Europe and one of the finest municipal buildings in the world.

After his return Yperman settled down in his native town and practiced surgery until his death, which probably took place about 1330. He obtained a great renown, and this has been maintained so that in that part of the country even yet, an expert surgeon is spoken of as an Yperman. He is the author of two works in Flemish. One of these is what Pagel calls an unimportant compilation on internal medicine, but the headings of the chapters as he gives them can scarcely fail to attract the attention of the modern physician. He treats of dropsy, rheumatism, under which occur the terms coryza and catarrh, icterus, phthisis (he calls the tuberculous, tysiken), apoplexy, epilepsy, frenzy, lethargy, fallen palate, cough, shortness of breath, lung abscess, hemorrhage, blood-spitting, liver abscess, hardening of the spleen, affections of the kidney, bloody urine, diabetes, incontinence of urine, dysuria, strangury, gonorrhoea and involuntary seminal emissions–all these terms are quoted directly from Pagel.

All this would seem to show that Yperman was a thoroughly representative medical man. When I add that Pagel says he shows a well marked striving to free himself from the bondage of authority and that most of his therapeutic prescriptions rest upon his own experience, it will be seen that he deserves the greatest possible credit. His work in medicine, however, Pagel considers as nothing compared to his work in surgery. A special feature of this is the presence of seventy illustrations of instruments of the most various kinds, together with a plate showing the anatomical features of the stitching of a wound of the head. The work as we have it is only a fragment. The last part of it which treated of the extremities is defective. If anyone thinks for a moment that surgery was a neglected specialty at the end of the thirteenth and the beginning of the fourteenth century, he should consult the text of this, or even Pagel's brief account of its contents. Some of the features of it are noteworthy. There is a chapter devoted to intoxications, which includes the effects of cantharides as well as alcohol, and treats of the bites of snakes, scorpions, and of hydrophobia due to the bites of mad hounds. There is scarcely a feature of modern surgery of the head that is not touched upon very sensibly in this work.

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]