Guy De Chauliac

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 fro 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 regularly 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 taken 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 France, made his medical studies at

Montpellier, and then went on a journey of hundreds of miles 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

ecclesiastics 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' teachings well beyond the point where he received

them, and after years of personal experience he 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 1370. 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 medicine at that time;

and though his own style, as must be 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 he 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 deserved 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

fellow-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 Angliae' 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 dissections in

different ways.



In Roth'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 universities 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 conducted 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.[23]



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 he had spent some time at the great French university

where Lanfranc, after having studied under William of Salicet in Italy,

had gone to establish 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 native 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 establishment of a good

school of surgery in connection with the university. 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

operatus 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, he

practised first 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 black death ravaged that city in 1348 he was the body-physician

of Pope Clement VI, for he is spoken of in a Papal document as

venerabilis et circumspectus vir, dominus Guido de Cauliaco, canonicus

et praepositus ecclesiae Sancti Justi Lugduni, medicusque domini Nostri

Papae. 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-physician 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 1367, 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 deign 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 things, 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, this 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

contemporaries 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 judgment 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 criticism 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 bete 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.



Chauliac'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 indications

for the opening of the thorax, that noli 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, Chauliac'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 be 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

anaesthesia 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 subserve. 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.[24]



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 until the end of the nineteenth century. He

suggested that trusses could not be 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 he 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 some methods still

used more or less irregularly. They 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 testicle 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 he 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, some of the finer elements of the

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

meddlesomeness 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 tithymal 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 ils

donnent beaucoup de promesses, et peu, d'operations.



It is no wonder that Chauliac has been enthusiastically 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 Chauliac'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 Ambroise 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. Portal, in his History of

Anatomy and Surgery, says, 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.[25]



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. He 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 he

recovered, to become the most influential among his 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; not 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 him, 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. Petrarch 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 show 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, be 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 1363, 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 34 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.[26]



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] 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 Sloane copy in the British Museum contains 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 yere of our Lord 1363,

with some additions of other doctours, necessary to the

foresaid arte or crapte (crafte?).[27]



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, primus 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 beginning 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.