Northern Europe Behind Italy
In medical science and practice northern Europe, like its art and literature, lagged half a century or more behind Italy, and even Italy in 1300 possessed only as much medical knowledge as Galen and Soranus had reached a thousand years before. Yet the medical schools of Montpellier, Paris and Oxford made notable progress, and the greatest surgeons of the age were French. The medical profession was now a fully organized trade and defended its privileges and rights with zeal and prejudice. But since there were more patients than physicians, sellers of medicinal herbs, apothecaries, midwives, wandering healers and barbers everywhere competed with trained doctors.
People, who through bad living admitted illness into their bodies and then demanded a certain diagnosis and an overnight cure, usually complained of physicians as mercenary and murderous. Froissart said that the aim of all physicians was to collect larger fees, as if this were not a trait of the whole civilized world.
Physicians, Barbers and Surgeons
Surgeons were the most interesting healers of the age, though physicians did not yet regard them as their equals. In fact the University of Paris in the fourteenth century admitted no student to its medical school unless he swore never to perform any surgical operation. Even bloodletting, which had become a general remedy, was forbidden to physicians and had to be left to inferiors. The public still put barbers to many uses, but barber-surgeons were gradually setting aside the barber's work and specializing in surgery. In 1365 there were about forty of them in Paris. In England they continued their combined trade until 1540. In France a decree of 1372 limited their treatment to wounds that were not fatal, and from then on major operations were by law the work of master surgeons according to their specialty. In 1505 the Royal College of Surgeons was founded at Edinburgh.
Mondeville and Guy de Chauliac
In the first half of the fourteenth century the greatest names in surgery were Henri de Mondeville and Guy de Chauliac. Mondeville, always in great need, remained poor to the end of his life and carried on his work despite asthma and consumption. His Surgery (1306–1320), the first surgical book written by a Frenchman, covered every subject so competently and completely that it won a new standing for surgeons. His outstanding contribution was to apply and develop a method he had learned from Theodoric Borgognoni at Bologna for dressing wounds: cleanse the wound thoroughly, prevent suppuration, protect it from the air, and dress it with wine. Defending these innovations against the unquestioning acceptance of ancient physicians like Galen, he wrote that a modern author stands to an ancient one like a dwarf sitting on a giant's shoulders: he sees what the giant sees, and more.
The next generation produced the most famous surgeon of the Middle Ages. Guy de Chauliac was born into a peasant family near the village whose name he bears and so impressed its lords that they paid for his education at Toulouse, Montpellier, Bologna and Paris. In 1342 he became physician to the pope at Avignon and held this important post for twenty-eight years. When the Black Death fell on Avignon he stayed at his post and treated the sick; he caught the disease himself and barely survived. Like any human being he made gross errors: he sometimes put the plague down to an ill-omened conjunction of the stars and sometimes to Jews who, it was said, meant to poison all Christendom. By rejecting Mondeville's simple dressing method and returning to poultices and ointments he delayed the progress of surgery. But in most matters he knew the best and newest methods of his great craft. His Great Surgery (1363) was the most complete, systematic and learned treatise on surgery written before the sixteenth century.
Cleanliness and Filth
Personal and public hygiene did not keep pace with medicine. Personal cleanliness had little standing; even the king of England bathed only once a week and sometimes skipped it. The Germans had public bathhouses, large tubs in which bathers, sometimes men and women together, sat or stood unclothed; Ulm alone had 168 of them in 1498. Throughout Europe, except among the aristocracy, though not always, a garment was worn for months, years or generations.
Many towns had a water supply, but it reached only a few houses, and most families had to fetch water from the nearest spring or well. London's air was fouled by the stench of slaughtered sheep and cattle until such slaughtering was forbidden in 1371. The smell of privies did little to improve the charm of rural life. London's rented houses had a single privy for all tenants, and many had none, so residents emptied their waste in the yard or the street. Thousands of privies drained into the Thames; an order forbade this in 1357, but in practice it continued.
In 1388, after repeated outbreaks of plague, the English Parliament passed the first sanitary law for the whole country. It declared that because much filth from drains, offal, carcasses and other foulness was thrown into ditches, rivers and other waters, the air had become exceedingly foul and corrupt and unbearable diseases afflicted residents, travelers and others daily; it therefore ordered it proclaimed throughout England that anyone who threw out or left such filthy or harmful things must remove them entirely, or incur, by the king's order, a fine and damages.
Quarantine and Hospitals
About the same time France issued similar orders. In 1383 Marseille, following Dubrovnik (1377), ordered plague victims isolated from other people for forty days (quarantine). Contagious diseases appeared one after another: the sweating sickness in England (1468–1508), and diphtheria and smallpox in Germany (1492), though these were not as deadly as the earlier plagues. Though public sanitation was poor, hospitals were relatively numerous: in 1500 England had 460 hospitals and York alone sixteen (the book's figures).
The Care of the Insane
The treatment of madness slowly emerged from superstitious reverence or brutal cruelty into something like semi-scientific protection. In 1300 the Church had the body of a girl who had claimed to be the Holy Spirit dug from its grave and burned, and two women who professed belief in her claim were sent to the fire. In 1359 the archbishop of Toledo ordered the civil authorities to burn alive a Spaniard who had confessed that he was the brother of Michael and visited heaven and hell daily. This improved somewhat in the fifteenth century. A monk, Juan Gilabert Jofré, moved by pity for the insane who were mocked and hooted at by mobs in the streets of Valladolid, founded an asylum for them in that city (1409), and other cities followed his example. The Hospital of St. Mary of Bethlehem, founded in London in 1247, became an asylum in 1402, and the word "Bethlem" was corrupted to "Bedlam" and became a synonym for madhouse.
Leprosy Fades, Syphilis Arrives
Lepers were still outcasts, but leprosy almost vanished from western Europe in the fifteenth century. Syphilis took its place. Perhaps it developed from smallpox, already known in France, or perhaps it was a gift of America; it appeared in Spain in 1493 and Italy in 1495, spread so widely in France that it was called the "French disease," and so ravaged some German towns that they asked to be excused from paying taxes. We hear that from about the end of the fifteenth century mercury was used to treat it.
The progress of medicine, as in our own time, has been a brave race against the appearance of unknown diseases.