Showing posts with label Guy de Chauliac. Show all posts
Showing posts with label Guy de Chauliac. Show all posts

Monday, March 14, 2016

Midwives

When Guy de Chauliac mentioned midwives in his great work on surgery, it was only a mention: he declined to express details because the field was dominated by women; men were not even allowed into the room when a woman was giving birth. In fact, "One Henne Vanden Damme, for having hid behind a staircase to eavesdrop upon his wife, she being in labour of childbirth, which thing doth not befit a man, for the said eavesdropping was fined 15 livres." [source]

Later in the Middle Ages, there was regulation of midwifery, but midwives, unlike doctors, were not associated with any formal training. In fact, some of the early manuals produced on midwifery—by the rare individuals in the profession who were literate—do not even demonstrate current medical knowledge. Midwives never formed into guilds, as other professions did with regularity. So far as we know, the qualifications for becoming a midwife were gained from on-the-job experience. Even Trotula, the famous female doctor and professor of medicine, discussed many female conditions but not the subject of childbirth.

According to Joseph and Frances Gies:
During labor the midwife rubs her patient's belly with ointment to ease her travail and bring it to a quicker conclusion. She encourages the patient with comforting words. If the labor is difficult, sympathetic magic is invoked. The patient's hair is loosened and all the pins removed. Servants open all the doors, drawers, and cupboards in the house and untie all the knots.
...
When the baby is born, the midwife ties the umbilical cord and cuts it at four fingers' length. She washes the baby and rubs him all over with salt, then gently cleanses his palate and gums with honey, to give him an appetite.
[Life in a Medieval City, pp.60-1]
Some historians have noted that the regulation of midwifery started generally around the same time as persecutions for witchcraft. This is, of course, not true in all countries, but it would be difficult to miss the similarity between two different practices of trying to place controls on a segment of society that was in a position of potential harm, either through neglect (on the part of midwives) or design (on the part of witches).

Tuesday, April 30, 2013

A Pain in the Ass

(I apologize if the title—or the topic—is too crude for some.)

The poor fellow to the right (the one half showing) is suffering from an anal fistula, described thusly:
... a small channel that can develop between the end of the bowel and the skin near the anus.
... can cause bleeding and discharge when passing stools - and can be painful. ...
In some cases, an anal fistula causes persistent drainage. In other cases, where the outside of the channel opening closes, the result may be recurrent anal abscesses. The only cure for an anal fistula is surgery. [WebMD]
Nowadays it is called a "pilonidal cyst." At the very least, inconvenient; in many cases, extremely painful, especially when sitting down.

At a time when many men spent long stretches of time bouncing on horseback, these fistula-in-ano (to give it the Latin phrase) were debilitating. Fortunately, soldiers of Edward III's time had a solution in the skill of John of Gaunt's favorite physician and surgeon.

John Arderne (1307-1392) left us very little information about his early life. It seems he was a surgeon in Nottinghamshire. During the Hundred Years War, he probably traveled with the army; his writing suggests a well-traveled man with wide experience of the world as well as medical practices.

He produced the definitive work on treating this particular medical problem. His writing describes the cause and the treatment, and describes the surgical instruments needed for his procedures. He also shows knowledge of Galen & Guy de Chauliac, Avicenna, and Dioscorides.

Arderne was ahead of his time in some ways. He advised opium to dull pain during surgery, and the code of conduct proper for a physician. In the matter of fees, he was fine with charging a rich patient whatever the traffic would bear, but felt that the poor should be treated for free. He was also a great believer in cleanliness, and in not fussing with a wound once treated, but allowing the healing process to proceed untampered with.

That is not to say that he was "modern." He also subscribed to the belief that parts of the body were aligned with astrological signs, and that the time of the year could influence the efficacy of surgery on parts of the body.

Tuesday, July 24, 2012

John of Gaddesden

With us there was a doctor of physic;
In all this world was none like him to pick
For talk of medicine and surgery;
For he was grounded in astronomy.
Prologue to the Canterbury Tales

Doctor, from the Ellesmere MS.
John of Gaddesden (c.1280-1361) was a "Doctor of Physik" who was quite well-known in his day, so much so that modern scholars looking to find analogs for the characters in Chaucer's Canterbury Tales have suggested he is the likeliest candidate for Chaucer's "doctor of physic." As a fan of both Chaucer and historical detail, I'm going to weigh in and say . . . maybe.

Who was Gaddesden, and why was he considered the model for Chaucer's pilgrim? For one thing, he had written Rosa medicinæ (The rose of medicine; sometimes called the Rosa Anglicæ), a compendium of medical information called so because it was in five parts, like the five sepals of a rose. In it, he quotes numerous authorities from the past; Chaucer's list of authorities with whom his doctor is familiar lines up nicely with Gaddesden's sources. Also, Gaddesden had a reputation for charging high fees, and Chaucer makes it clear that his doctor loved gold.

To be honest, however, Gaddesden's book was quoting the same authorities that anyone would quote when compiling a book on medicine. It was completely unoriginal. Even his title seems derivative, probably based on Lilium medicinæ (the Lily of medicine) by Bernard Gordon, produced at Montpellier in 1303. Gordon, a Scotsman, was one of the teachers of Guy de Chauliac. Chauliac, in turn, taught Gaddesden. What did Chauliac think of his student's work? Not much; he said of it:
Last of all arose the scentless rose of England, 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.
Those who write about Gaddesden being Chaucer's doctor usually justify it also be calling them "contemporaries." Let's look at the timeline: the Canterbury Tales probably wasn't started until 1387. Even if the Prologue were the first thing he wrote—highly unlikely—this was a quarter century after Gaddesden's death; a death that would have taken place when Chaucer was about 20 years old and had been connected to the household of Prince Lionel, the second son of King Edward III, only for a few years. Gaddesden seems to have been attached to the household of Edward, the Black Prince, who would have spent much of Gaddesden's later years on the continent while Chaucer was in England.

They could have crossed paths, but probably not significantly, and Gaddesden would have been long out of the public eye and consciousness when Chaucer came into his own as a poet. For Chaucer to write up a physician who quoted historical authorities, knew astrology, and loved gold probably just meant that he had met typical physicians.

Monday, July 23, 2012

Great Surgeon

The history of medicine includes many brave and progressive thinkers who were not willing to follow the herd or be content with what was already known. One such in the Middle Ages was Guy de Chauliac. Born about 1300, he studied at a university in Montpellier known for its expertise in medicine. After becoming a Master of Medicine and Surgery around 1325, he went to Bologna for further study. His reputation became such that he was invited to Avignon to be personal physician to Pope Clement VI, then Pope Innocent VI and Pope Urban V. The papal connection gave him access to a library that included the texts of the Greek physician Galen in their original; most of Europe knew Galen through less accurate Latin translations.

He possibly saved Clement's life during the spread of the Black Death, when he advised the pope to stay near blazing fires. Although many physicians fled Avignon at the arrival of the Plague, Chauliac stayed to study the disease and treat people. He determined that it was contagious, but couldn't figure out the method of contagion. Still, he advised bloodletting, a healthy diet, and exposure to pure air (hence the fires, which would have serendipitously served to keep fleas away). He also realized that there were two diseases involved because of different sets of symptoms: the initial Bubonic Plague, and the follow-up Pneumonic Plague which found its foothold in the weakened population and killed much more swiftly. Chauliac spoke out strongly against those who blamed the Jews for the Plague, explaining that scientifically it made no sense to consider them at fault.

Tools for withdrawing an arrow.
His value to the rest of the world and history was the writing of Chirurgia magna (Great [book of] Surgery) in 1363. Its seven volumes covered every imaginable medical topic of the day: intubation, surgery, disease, anesthesia, hernia, cataracts, ulcers, bloodletting, cauterization of wounds, and the use of special instruments (some of which he designed himself, such as an elaborate contraption for withdrawing an arrow from flesh). Chauliac drew on the past, quoting Galen (129-c.200) and Avicenna (Abu Ali al-Husayn ibn Abd Allah ibn Sina, c.980-1037). He placed great emphasis on learning anatomy, saying that "A surgeon who does not know his anatomy is like a blind man carving a log."

Chauliac was not always accurate. He believed, for instance, that pus was an important part of the healing process and should be left alone. Nevertheless, his Chirurgia became a standard text for the next three centuries, translated into several European languages. Unfortunately for future generations, anti-Islam sentiment caused many translators to leave out knowledge from Islamic scholars, resulting in a less complete and less accurate work. Still, he has been labeled the "Father of Modern Surgery," and his great work was the standard text until the 17th century.