Surgical Education in the Middle Ages

 Surgical Education in the Middle Ages

By Michael McVaugh

DYNAMIS. Acta Hisp. Med. Sci. Hist. Illus., vol.20 (2000)

Abstract: The new surgical texts of the thirteenth century suggest that their authors wished their subject to appear as a learned discipline, yet it was still communicated by individual practitioners privately to one or two disciples, not in a university setting. But by 1300, surgery was beginning to be taught formally as part of medicine in many Italian studia, for example, by Dino del Garbo at Siena, though Henri de Mondeville´s programme to accomplish the same at Paris (1306-16) was unsuccessful. Surgery continued to be taught in Italian schools in the fourteenth and fifteenth centuries, though it was of much lower status than medicine, as is revealed at Bologna and Padua; during the same period, surgeons in Paris eventually achieved a limited association with the faculty of medicine there. Dissections and models were perhaps used in university teaching of surgery, which nevertheless appears to have been primarily text-based.

Introduction: In a famous passage from the historical overview of medieval surgery with which Guy de Chauliac (d. 1368) introduced his Introductorium or Chirurgia Magna, Guy described its development as—implicitly—one that in the past two hundred years had moved out of the darkness of empiricism into the illumination of scholarly learning.

[Before Avicenna] everyone was both physician and surgeon, but afterwards, whether because of greed or because of too much to do, surgery was set apart and given into the hands of mechanics. The first of these were Ruggiero, Rolando, and the Four Masters, who wrote separate works of surgery into which they put much of an empirical character… Afterwards came Bruno, who correctly adopted the teachings of Galen and Avicenna and the techniques of Albucasis, though he did not have a complete translation of Galen’s books and left out anatomy almost entirely. Immediately after him came Teodorico, who wrote his book by stealing everything that Bruno said and adding a few tales from his master Ugo da Lucca. Guglielmo da Saliceto was a notable figure, and wrote two texts, one in medicine and one of surgery, and in my judgement he wrote well about what he treated. Lanfranco also wrote a book in which he put very little besides the things he found in Guglielmo, though he reordered them… At Paris, Henri de Mondeville began a treatise in which he tried to harmonize Teodorico and Lanfranco, but it was left incomplete at his death.

As though to reinforce this view of irregular but steady progress towards a structured scientific surgery, Guy’s portrait of the ideal medieval surgeon begins by insisting on his learning:

As regards theory he has to understand the res naturales, res non naturales, and res contra naturam. First he has to understand the res naturales, especially anatomy, without which nothing can be done in surgery… Let him understand complexional doctrine too, because medicines must be adapted to the different bodily natures… and the same is true of the faculties. He also has to understand the res non naturales, air and food and drink and the like, since these are the causes of all health and illness. He must also understand the res contra naturam, especially disease, because the program of treatment is derived directly from this, and let him not be ignorant of cause, because if he cures without understanding it the reward should be not his but fortune’s. And let him not overlook symptoms, for they sometimes are more important than the cause itself and overturn the whole course of treatment… In practice he must know how to regulate diet and drugs, because without them surgery, medicine’s third tool, cannot be brought to perfection

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