In the science and practice of medicine, as in literature and art, northern Europe was half a century or more behind Italy; and even Italy had by 1300 barely regained the medical knowledge reached by Galen and Soranus a thousand years before. But the medical schools at Montpelier, Paris, and Oxford were making good progress, and the greatest surgeons of this age were French. The profession was now well organized, and defended its privileges lustily; but as the demand for health always exceeded the supply, herbalists, apothecaries, midwives, wandering leeches, and barber surgeons—not to mention quacks—everywhere competed with trained practitioners. The public, inviting disease by wrong living, and then seeking infallible diagnoses and cheap overnight cures, made the usual complaints about mercenary or murderous doctors. Froissart considered it “the object of all medical men to gain large salaries” 45—as if this were not a disease endemic to all civilization.
The most interesting medical men of the age were the surgeons. They had not yet persuaded the physicians to recognize them as equals; indeed, the University of Paris would admit no student to its school of medicine in the fourteenth century except on his oath never to perform a surgical operation. Even bloodletting, which had already become a panacea, was forbidden to physicians, and had to be left to their underlings. Barbers were still used by the people for many operations; but the barber surgeons were now abandoning tonsorial practice, and were specializing in surgery; in 1365 there were forty such barber surgeons in Paris; in England they continued till 1540.
An ordinance of 1372 restricted them in France to the treatment of “wounds not of a character likely to cause death”; and thereafter major operations could be legally performed only by “master surgeons” dedicated to their specialty. A Royal College of Surgeons was chartered at Edinburgh in 1505.
The great names in surgery, in the first half of the fourteenth century, were Henri de Mondeville and Guy de Chauliac. Froissart might have noted that Mondeville, though always in great demand, remained poor to the end of his days, and carried on his work despite his own asthma and tuberculosis. His Chirurgia (1306–20), the first work on surgery by a Frenchman, covered the whole field with a thoroughness and competence that earned a new standing for surgeons. His distinctive contribution was the application and development of a method which he had learned from Theodoric Borgognoni at Bologna for treating wounds by complete cleansing, prevention of suppuration, exclusion of air, and dressings with wine. He defended his innovations by warning against a supine acceptance of Galen or other classic authorities. “Modern authors,” he wrote, using a favorite medieval adjective, “are to the ancient like a dwarf placed upon the shoulders of a giant; he sees all that the giant sees, and farther still.”46
The generation after him produced the most famous of medieval surgeons. Born of peasant stock in the French village that gave him its name, Guy de Chauliac so impressed the lords of the manor that they paid his tuition at Toulouse, Montpelier, Bologna, and Paris. In 1342 he became papal physician at Avignon, and held that difficult position for twenty-eight years. When the Black Death struck Avignon he stayed at his post, ministered to the victims, contracted the pestilence, and barely survived. Like any man, he committed serious errors: he blamed the plague now on an unfortunate conjunction of planets, now on Jews aiming to poison all Christendom; and he retarded the surgery of wounds by rejecting Mondeville’s simple cleansing method and returning to the use of plasters and salves. But for the most part he lived up to the finest traditions of his great profession. His Chirurgia magna (1363) was the most thorough, systematic, and learned treatise on surgery produced before the sixteenth century.
Social and individual hygiene hardly kept pace with the advances of medicine. Personal cleanliness was not a fetish; even the King of England bathed only once a week, and sometimes skipped. The Germans had public bathslarge vats in which the bathers stood or sat naked, sometimes both sexes together;47 Ulm alone had 168 such Badestuben in 1489. In all Europe—not always excepting the aristocracy—the same article of clothing was worn for months, or years, or generations. Many cities had a water supply, but it reached only a few homes; most families had to fetch water from the nearest fountain, well, or spring. The air of London was befouled by the odor of slaughtered cattle, till such carnage was forbidden in 1371. The smell of latrines detracted from the idyllic fantasies of rural life. London tenements had but one latrine for all occupants; many houses had none at all, and emptied their ordure into the yards or streets. Thousands of privies poured into the Thames; a city ordinance of 1357 denounced this, but the practice continued. In 1388, prodded by several returns of the plague, Parliament passed the first Sanitary Act for all England:
For that so much dung and filth of the garbage and entrails, as well of beasts killed as of other corruptions, be cast and put in ditches, rivers, and other waters... that the air is greatly corrupt and infect, and many maladies and other intolerable diseases do daily happen, as well to inhabitants... as to others repairing or traveling thither .... it is accorded and assented, That proclamation be made... throughout the realm of England... that all they which do cast and lay all such annoyances... shall cause them utterly to be removed... upon pain to lose and forfeit to our Lord the King.48
Similar ordinances were promulgated in France about this time. In 1383 Marseille, following the example of Ragusa (1377), ordered the isolation of plague-stricken persons for forty days—a quarantine. Epidemics continued to occur—the sweating sickness in England (1486, 1508), diphtheria and smallpox in Germany (1492)—but with diminished virulence and mortality. Though sanitation was lax, hospitals were relatively abundant; in 1500 England had 460, York alone had sixteen.49
The treatment of the insane gradually passed from superstitious reverence or barbaric cruelty to semi-scientific care. In 1300 the corpse of a girl who had claimed to be the Holy Ghost was dug up and burned by ecclesiastical order, and two women who expressed belief in her claim perished at the stake.50 In 1359 the Archbishop of Toledo commissioned the civil authorities to burn alive a Spaniard who professed to be a brother of the Archangel Michael, and to visit heaven and hell daily.51 Matters improved in the fifteenth century. A monk named Jean Joffre, filled with compassion for lunatics who were being hooted through the streets of Valladolid by a mob, established there an asylum for the insane (1409); and his example was followed in other cities. The hospital of St. Mary of Bethlehem, founded in London in 1247, was transformed into an insane asylum in 1402, and the word Bethlehem, corrupted into Bedlam, became a synonym for a place of insanity.
Confirmed lepers were still outcast from society, but leprosy almost disappeared from Western Europe in the fifteenth century. Syphilis took its place. Possibly a development of the gros vérole previously known in France, possibly an importation from America,*it appeared definitely in Spain in 1493, in Italy in 1495; it spread so widely in France that it came to be called morbus gallicus; and some cities in Germany were so ravaged by it that they begged exemption from taxation.52 As early as the end of the fifteenth century we hear of mercury being used in treating it. The progress of medicine ran a brave race then as now with the inventiveness of disease.