Also the said statute and decree, etc., had been made on account of and against ignorant women and foolish usurpers who were then exercising the office of practice in Paris, and who are either dead or so ancient and decrepit that they are not able to exercise the said office, as it appears from the tenor of the said statute and decree, etc., which were made a hundred and two years ago, at which time the said Jacoba was not, nor was she for sixty years afterwards, in the nature of things; indeed, she is young, thirty or thereabouts, as it appears from her aspect....
Also it is better and more becoming that a woman clever and expert in the art should visit a sick woman, and should see and look into the secrets of nature and her private parts, than a man, to whom it is not permitted to see and investigate the aforesaid, nor to feel the hands, breasts, belly and feet, etc., of women. Indeed a man ought to avoid and to shun the secrets of women and their intimate associations as much as he can. And a woman would allow herself to die before she would reveal the secrets of her illness to a man, because of the virtue of the female sex and because of the shame which she would endure by revealing them. And from these causes many women and also men have perished in their illnesses, not wishing to have doctors, lest they see their secret parts....
Also, supposing without prejudice that it is bad that a woman should visit, care for, and investigate, as has been said, it is, however, less bad that a woman wise, discreet, and expert in the aforesaid matters has done and does these things, since the sick persons of both sexes, who have not dared to reveal the aforesaid secrets to a man, would not have wished to die. Thus it is that the laws say that lesser evils should be permitted, so that greater ones may be avoided. For this reason, since the said Jacoba is expert in the art of medicine, it is, therefore, better that she be permitted to make visits, in order to exercise the office of practice, than that the sick should die, especially since she has cured and healed all those....
Also, it has been ascertained and thus proved, that some sick persons of both sexes, seized by many severe illnesses and enduring the care of very many expert masters in the art of medicine, have not been able to recover at all from their illnesses, although the masters applied as much care and diligence to these as they were able. And the said Jacoba, called afterwards, has cured these sick persons in a short time, by an art which is suitable for accomplishing this.
From Chartulary of the University of Paris, H. Denifle and E. Chatelain, eds. (Paris: Delalain, 1891); trans. M.M.M.
The History of Surgery
GUI DE CHAULIAC
1363
THE workers in this art, from whom I have had knowledge and theory, and from whom you will find observations and maxims in this work, in order that you may know which has spoken better than the other, should be arranged in a certain order.
The first of all was Hippocrates [5th century B.C.] who (as one reads in the Introduction to Medicine) surpassed all the others, and first among the Greeks led medicine to perfect enlightenment. For according to Macrobius and Isidore, in the fourth book of the Etymologies ... medicine had been silent for the space of five hundred years before Hippocrates, since the time of Apollo and Aesculapius, who were its first discoverers. He lived ninety-five years, and wrote many books on surgery, as it appears from the fourth of the Therapeutics and many other passages of Galen. But I believe that on account of the good arrangement of the books of Galen the books of Hippocrates and of many others have been neglected.
Galen [2nd century A.D.] followed him, and what Hippocrates sowed, as a good labourer he cultivated and increased. He wrote many books, indeed, in which he included much about surgery, and especially the Book on Tumors Contrary to Nature, written in summary; and the six first Books on Therapeutics, containing wounds and ulcers, and the last two concerning boils and many other maladies which require manual operation. In addition, seven books which he arranged, Catageni (that is, about the composition of medicaments according to kinds), of which we have only a summary. Now he was a master in demonstrative science in the time of the Emperor Antoninus [Marcus Aurelius], after Jesus Christ about one hundred and fifty years. He lived eighty years, as is told in The Book of the Life and Customs of the Philosophers. Between Hippocrates and Galen there was a very long time, as Avicenna says in the fourth of the Fractures, three hundred and twenty-five years, as they gloss it there, but in truth there were five hundred and eighty-six years.
After Galen we find Paul [of Aegina, 7th century] who ... did many things in surgery; however, I have found only the sixth book of his Surgery.
Going on we find Rhazes [d c. 923], Albucasis [d. c. 1013], and Alcaran [?], who (whether they were all one and the same, or several) did very well, especially in the Books for Almansor [by Rhazes] and in the Divisions, and in the Surgery called Albucasis. In these as Haly Abbas [late 10th century] says, he put all his particulars, and in all the Continens (which is called Helham in Arabic) he repeated the same things, and he collected all the sayings of the ancients, his predecessors ; but because he did not select and is long and without conclusion, he has been less prized.
Haly Abbas was a great master, and besides what he sowed in the books on The Royal Disposition, he arranged on surgery the ninth part of his Second Sermon.
Avicenna [980-1037], illustrious prince, followed him, and in very good order (as in other things) treated surgery in his fourth book.
And we find that up to him all were both physicians and surgeons, but since then, either through refinement or because of too great occupation with cures, surgery was separated and left in the hands of mechanics. Of these the first were Roger [of Salerno, fl. c.1170], Roland [of Parma, fl. c.1200], and the Four Masters [anonymous], who wrote separate books on surgery, and put in them much that was empirical. Then we find Jamerius [fl. c.1230-1252] who did some rude surgery in which he included a lot of nonsense; however, in many things he followed Roger. Later, we find Bruno [of Longoburgo, fl. c.1252], who, prudently enough, made a summary of the findings of Galen and Avicenna, and of the operations of Albucasis; however, he did not have all the translation of the books of Galen and entirely omitted anatomy. Immediately after him came Theodoric [Borgognoni, 1205-1298], who gathering up all that Bruno said, with some fables of Hugh of Lucca [d. c.1252- 1258], his master, made a book out of them.
William of Saliceto [c.1210-c.1280] was a man of worth who composed two compendia, one on medicine and the other on surgery; and in my opinion, what he treated he did very well. Lanfranc [d. before 1306] also wrote a book in which he put scarcely anything but what he took from William; however, he changed the arrangement.
At that time Master Arnald of Villanova [d. 1311] was flourishing in both skills, and wrote many fine works. Henry of Mondeville [d. c. 1325] began in Paris a very notable treatise in which he tried to make a marriage between Theodoric and Lanfranc, but being prevented by death he did not finish the treatise.
In this present time, in Calabria, Master Nicholas of Reggio [d. 1350], very expert in Greek and Latin, has translated at the order of King Robert many books of Galen and has sent them to us at court; they seem to be of finer and more perfect style than those which have been translated from the Arabic. Finally there appeared a faded English rose [Rosa Anglica of John of Gaddesden, d. 1361] which was sent to me, and I have seen it. I had thought to find in it sweetness of odour, but I have found only the fables of the Spaniard, of Gilbert, and of Theodoric.
In my time there have been operating surgeons, at Toulouse, Master Nicholas Catalan; at Montpellier, Master Bonet, son of Lanfranc; at Bologna, Masters Peregrin and Mercadant; at Paris, Master Peter of Argentière; at Lyons (where I have practised for a long time), Peter of Bonant; at Avignon, Master Peter of Arles and my companion, Jean of Parma.
And I, Guy of Chauliac, surgeon and master in medicine, from the borders of Auvergne, diocese of Mende, doctor and personal chaplain to our lord the pope, I have seen many operations and many of the writings of the masters mentioned, principally of Galen; for as many books of his a
s are found in the two translations, I have seen and studied with as much diligence as possible, and for a long time I have operated in many places. And at present I am in Avignon, in the year of our Lord 1363, the first year of the pontificate of Urban V. In which year, from the teachings of the above named, and from my experiences, with the aid of my companions, I have compiled this work, as God has willed.
The sects which were current in my time among the workers in this art, besides the two general ones, which are still in vigour, namely, that of the Logicians or rationalists, and that of the Empiricists (condemned by Galen in the Book of Sects and throughout the Therapeutics ), were five.
The first was of Roger, Roland, and the Four Masters who, indiscriminately for all wounds and boils, produced healing or suppuration with their poultices and cataplasms ; relying for this on the fifth of the Aphorisms, “The loose are good, the hard are bad.”
The second was of Bruno and Theodoric who indiscriminately dried up all wounds with wine alone, relying for this on the fourth of the Therapeutics, “The dry comes closer to the healthy, and the wet to the unhealthy.”
The third sect was of Wiliam of Saliceto and of Lanfranc, who wishing to hold the middle ground between the above, cared for or dressed all wounds with unguents and sweet salves, relying for this on the fourth of the Therapeutics, that there is only one way to healing, namely, that it be done safely and painlessly.
The fourth sect is composed of all the men at arms or Teutonic Knights and others following war; who treat all wounds with conjurations and liquors, oil, wool, and cabbage leaves, relying on this, that God has put his efficacy in words, in herbs, and in stones.
The fifth sect is composed of women and many ignorant ones who entrust those sick with all maladies only to the saints, relying on this: the Lord has given it to me as it has pleased Him; the Lord will take it from me when it shall please Him; blessed be the name of the Lord, Amen.
And because such sects will be refuted in the course of this book, let them be put aside for the present. But I am amazed at one thing, that they follow each other like cranes. For one says only what the other has said. I do not know whether it is from fear or love that they scorn to hear anything except what is traditional or proved by authority. They have read Aristotle badly in the second of the Metaphysics where he shows that these two things most of all prevent the sight and knowledge of the truth. Let us abandon such friendships and fears, for Socrates or Plato is our friend, but truth is still more a friend. It is a holy and worthy thing to honour truth in the first place. Let them follow the dogmatic doctrine of Galen approved in the Book of Sects and throughout the Therapeutics, which is entirely composed of experience and reason, in which one seeks things and scorns words. And he himself has taught the means of seeking truth, in the book on The Constitution of the Dogmatic Art, chapter seven, which under a certain epilogue he put in the third book of the Natural Faculties, chapter ten, in this way: he who would know something better than the others must suddenly be very different from the others (that is, at the beginning and by nature, and by first knowledge). And when he is a boy, or at the age of puberty, he must be seized with a certain amorous rage for the truth; he must not cease to study day and night, to learn all that has been said by the most famous of the ancients. And when he shall reach the flower of his age and learning, then he must judge what he has learned by examining it very well for a long time and perceive all that agrees with the things which are clearly apparent, and all that disagrees with them, and thus choose the one, and reject the other. To such a one, I hope my observations will be very useful; but to the others, these writings will be as superfluous as a fable told to an ass.
I do not say, however, that it is not a very good thing to cite witnesses in one’s discourse, for Galen in many places, besides reason and experience, which are for all men the two instruments of judging (as he says in the first of the Therapeutics, chapter three), brings in the third, by witnesses. Of which in the first of the Miamin or Compositions according to Plans, he says that the belief in things which one writes increases with the agreement of those who repeat them; and therefore he says that he will write down all the medicaments which have been made up by expert doctors. And thus I shall do (as I have said) in my procedure, with the aid of the glorious God.
Let us return to our theme, and put down the conditions which are requisite to every surgeon, who wishes by art to exercise on the human body the aforesaid manner and form of operating, which conditions Hippocrates, who guides us well in everything, concludes with a certain subtle implication, in the first of the Aphorisms:life is short, and art prolix, time and chance sharp or sudden, experience fallacious and dangerous, judgment difficult. But not only the doctor must busy himself in doing his duty but also the sick person and the attendants, and he must also put in order external things.
There are then four conditions which are valued here, according to Arnald, a very eloquent Latinist. Some are required of the surgeon, others of the sick, others of those present, others in those things which come in from outside.
The conditions required of a surgeon are four: the first is that he be educated; the second, that he be skilled; the third, that he be ingenious; the fourth, that he be well behaved. It is then required in the first place that the surgeon be educated, not only in the principles of surgery, but also of medicine, both in theory and practice.
In theory he must know things natural, non-natural and unnatural. And first, he must understand natural things, principally anatomy, for without it nothing can be done in surgery, as will appear below. He must also understand temperament, for according to the diversity of the nature of bodies it is necessary to diversify the medicament (Galen against Thessales, in all the Therapeutics ). This is shown by the virtue and strength of the patient. He must also know the things which are not natural, such as air, meat, drink, etc., for these are the causes of all sickness and health. He must also know the things which are contrary to nature, that is sickness, for from this rightly comes the curative purpose. Let him not be ignorant in any way of the cause; for if he cures without the knowledge of that, the cure will not be by his abilities but by chance. Let him not forget or scorn accidents; for sometimes they override their cause, and deceive or divert, and pervert the whole cure, as is said in the first to Glauconius.
In practice, he must know how to put in order the way of living and the medicaments; for without this surgery, which is the third instrument of medicine, is not perfect. Of which Galen speaks in the Introduction: as pharmacy has need of regimen and of surgery, so surgery has need of regimen and pharmacy.
Thus it appears that the surgeon working in his art should know the principles of medicine. And with this, it is very fitting that he know something of the other arts. That is what Galen says in the first of his Therapeutics against Thessales, that if the doctors have nothing to do with geometry, or astronomy, or dialectics, or any other good discipline, soon the leather workers, carpenters, smiths, and others, leaving their own occupations, will run to medicine and make themselves into doctors.
In the second place, I have said he must be skilled and have seen others operate; I add the maxim of the sage Avenzoar [12th century], that every doctor must have knowledge first of all, and after that he must have practice and experience. To the same testify Rhazes, in the fourth Book for Almansor, and Haly Abbas on the testimony of Hippocrates, in the first of his Theory.
Thirdly, he must be ingenious, and of good judgment and good memory. That is what Haly Rodan [11th century] says in the third of his Techni; the doctor must have good memory, good judgment, good motives, good presence, and sound understanding, and that he be well formed, for example, that he have slender fingers, hands steady and not trembling, clear eyes, etc.
Fourth, I have said, he should be well mannered. Let him be bold in safe things, fearful in dangers, let him flee false cures or practices. Let him be gracious to the sick, benevolent to his companions, wise in his predictions. Let him be chaste, sobe
r, compassionate, and merciful; not covetous, or extortionate, so that he may reasonably receive a salary in proportion to his work, the ability of his patient to pay, the nature of the outcome, and his own dignity.
The conditions required of the sick man are three: that he be obedient to the doctor, as the servant is to the master, in the first of the Therapeutics; that he have faith in the doctor, in the first of the Prognostics; that he be patient, for patience conquers malice, as it is said in other writing.
The conditions for the attendants are four, that they be peaceable, polite or agreeable, faithful, and discreet.
The conditions for things coming from outside are many, all of which ought to be arranged for the advantage of the sick, as Galen says, at the end of the commentary of the Aphorisms mentioned above.
From La grande chirurgie de Guy de Chauliac, E. Nicaise, ed. (Paris: F. Alcan, 1890); trans. J.B.R.
The Mirror of Wisdom
The Place of Logic in Philosophy
PETER ABELARD
Twelfth century
WE MAY open our introduction to logic by examining something of the characteristic property of logic in its genus which is philosophy. Boëthius says that not any knowledge whatever is philosophy, but only that which consists in the greatest things; for we do not call all wise men philosophers, but only those whose intelligence penetrates subtle matters. Moreover, Boëthius distinguishes three species of philosophy, speculative, which is concerned with speculation on the nature of things, moral, for the consideration of the honourable-ness of life, rational, for compounding the relation of arguments, which the Greeks call logic. However, some writers separated logic from philosophy and did not call it, according to Boëthius, a part of philosophy, but an instrument, because obviously the other parts work in logic in a manner, when they use its arguments to prove their own questions. As, if a question should arise in natural or moral speculation, arguments are derived from logic. Boëthius himself holds, against them, that there is nothing to prevent the same thing from being both an instrument and a part of a single thing, as the hand is both a part and an instrument of the human body. Logic moreover seems itself often its own instrument when it demonstrates a question pertaining to itself by its own arguments, as for example: man is the species of animal. It is none the less logic, however, because it is the instrument of logic. So too it is none the less philosophy because it is the instrument of philosophy. Moreover, Boëthius distinguishes it from the other two species of philosophy by its proper end, which consists in compounding arguments. For although the physicist compounds arguments, it is not physics but only logic which instructs him in that.
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