by Will Durant
IV. THE HEALERS
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.
V. THE PHILOSOPHERS
Though the age of the system-makers had passed, philosophy was still vigorous; indeed in the fourteenth century it shook the whole dogmatic structure of Christendom. A change of emphasis ended the sway of the theologians in philosophy: the leading thinkers now took a major interest in science, like Buridan, or in economics, like Oresme, or in Church organization, like Nicholas of Cusa, or in politics, like Pierre Dubois and Marsilius of Padua. Intellectually these men were quite the equal of Albertus Magnus, Thomas Aquinas, Siger de Brabant, Bonaventura, and Duns Scotus.
Scholasticism—both as a method of argument and exposition and as an attempt to show the consistency of reason with faith—continued to dominate the northern universities. Aquinas was canonized in 1323; thereafter his fellow Dominicans, especially at Lo
uvain and Cologne, felt it a point of honor to maintain his doctrine against all challenges. The Franciscans, as a loyal opposition, preferred to follow Augustine and Duns Scotus. One unmoored Dominican, William Durand of Saint-Pourçain, shocked his order by going over to the Scotists. At thirty-eight (c. 1308) he began a vast commentary, which he finished in old age. As he progressed he abandoned Aristotle and Aquinas, and proposed to put reason above the authority of “any doctor, however famous or solemn”—here was a philosopher with some sense of humor.53 While remaining overtly orthodox in theology, he prepared for the uncompromising nominalism of Ockham by restoring the conceptualism of Abélard: only individual things exist; all abstract or general ideas are merely the useful shorthand concepts of the mind. William’s friends called him Doctor Resolutissimus; his opponents called him Durus Durandus—Durand the Hard—and warmed themselves with the hope that the fires of hell would soften him at last.
William of Ockham was much harder, but did not wait till death to burn; his whole life was one of hot controversy, cooled only by occasional imprisonment, and the compulsion of the times to phrase his heat in Scholastic form. He admitted in philosophy no authority but experience and reason. He took his theorems passionately, and set half of Europe by the ears in defending his views. His life, adventures, and aims prefigure Voltaire’s, and perhaps his effect was as great.
We cannot say precisely where or when he was born; probably at Ockham in Surrey, toward the end of the thirteenth century. While yet young he entered the Franciscan order, and about the age of twelve he was sent to Oxford as a bright lad who would surely be a shining light in the Church. At Oxford, and perhaps at Paris, he felt the influence of another subtle Franciscan, Duns Scotus; for though he opposed the “realism” of Scotus, he carried his predecessor’s rationalist critique of philosophy and theology many steps further to a skepticism that would dissolve alike religious dogmas and scientific laws. He taught for six years at Oxford, and may have taught at Paris. Apparently before 1324—while still a tyro in his twenties—he wrote commentaries on Aristotle and Peter Lombard, and his most influential book, Summa totius logicae—a summary of all logic.
It seems at first sampling to be a dreary desert of logic-chopping and technical terminology, a lifeless procession of definitions, divisions, subdivisions, distinctions, classifications, and subtleties. Ockham knew all about “semantics”; he deplored the inaccuracy of the terms used in philosophy, and spent half his time trying to make them more precise. He resented the Gothic edifice of abstractions—one mounted upon the other like arches in superimposed tiers—that medieval thought had raised. We cannot find in his extant works precisely the famous formula that tradition called “Ockham’s razor”: entia non sunt multiplicanda praeter necessitatem—entities are not to be multiplied beyond need. But he expressed the principle in other terms again and again: pluralitas non est ponenda sine necessitate—a plurality (of entities or causes or factors) is not to be posited (or assumed) without necessity;54 and frustra fit per plura quod potest fieri per pauciora—it is vain to seek to accomplish or explain by assuming several entities or causes what can be explained by fewer.55 The principle was not new; Aquinas had accepted it, Scotus had used it.56 But in Ockham’s hands it became a deadly weapon, cutting away a hundred occult fancies and grandiose abstractions.
Applying the principle to epistemology, Ockham judged it needless to assume, as the source and material of knowledge, anything more than sensations. From these arise memory (sensation revived), perception (sensation interpreted through memory), imagination (memories combined), anticipation (memory projected), thought (memories compared), and experience (memories interpreted through thought). “Nothing can be an object of the nterior sense” (thought) “without having been an object of the exterior sense” (sensation);57 here is Locke’s empiricism 300 years before Locke. All that we ever perceive outside ourselves is individual entities—specific persons, places, things, actions, shapes, colors, tastes, odors, pressures, temperatures, sounds; and the words by which we denote these are “words of first intention” or primary intent, directly referring to what we interpret as external realities. By noting and abstracting the common features of similar entities so perceived, we may arrive at general or abstract ideas—man, virtue, height, sweetness, heat, music, eloquence; and the words by which we denote such abstractions are “words of second intention,” referring to conceptions derived from perceptions. These “universals” are never experienced in sensation; they are termini, signa, nomina—terms, signs, names—for generalizations extremely useful (and dangerous) in thought or reason, in science, philosophy, and theology; they are not objects existing outside the mind. “Everything outside the mind is singular, numerically one.”58 Reason is magnificent, but its conclusions have meaning only in so far as they refer to experience—i.e., to the perception of individual entities, or the performance of individual acts; otherwise its conclusions are vain and perhaps deceptive abstractions. How much nonsense is talked or written by mistaking ideas for things, abstractions for realities! Abstract thought fulfills its function only when it leads to specific statements about specific things.
From this “nominalism” Ockham moved with devastating recklessness into every field of philosophy and theology. Both metaphysics and science, he announced, are precarious generalizations, since our experience is only of individual entities in a narrowly restricted area and time; it is mere arrogance on our part to assume the universal and eternal validity of the general propositions and “natural laws” that we derive from this tiny sector of reality. Our knowledge is molded and limited by our means and ways of perceiving things (this is Kant before Kant); it is locked un in the prison of our minds, and it must not pretend to be the objective or ultimate truth about anything.59
As for the soul, it too is an abstraction. It never appears in our sensations or perceptions, external or internal; all that we perceive is will, the ego asserting itself in every action and thought. Reason itself and all the glory of intellect are tools of the will; the intellect is merely the will thinking, seeking its ends by thought.60 (This is Schopenhauer.)
God Himself seems to fall before this razor philosophy. Ockham (like Kant) found no conclusive force in any of the arguments used to prove the existence of deity. He rejected Aristotle’s notion that the chain of motions or causes compels us to assume a Prime Mover or First Cause; an “infinite regress” of motions or causes is no more inconceivable than the unmoved Mover or uncaused Cause of Aristotle’s theology.61 Since nothing can be known save through direct perception, we can never have any clear knowledge that God exists—non potest sciri evidenter quod Deus est. 62 That God is omnipotent or infinite, omniscient or benevolent or personal, cannot be shown by reason; much less can reason prove that there are three persons in one God, or that God became man to atone for Adam and Eve’s disobedience, or that the Son of God is present in the consecrated Host.63 Nor is monotheism more rational than polytheism; there may be more worlds than one, and more gods to govern them.64
What then remained of the majestic edifice of Christian faith, its lovely myths and songs and art, its God-given morality, its fortifying hope? Ockham recoiled before the ruin of theology by reason, and in a desperate effort to save a social order based on a moral code based on religious belief, he proposed at last to sacrifice reason on the altar of faith. Though it cannot be proved, it is probable that God exists, and that He has endowed each of us with an immortal soul.65 We must distinguish (as Averroës and Duns Scotus had advised) between theological truth and philosophical truth, and humbly accept in faith what proud reason doubts.
It was too much to expect that this caudal appendage in honor of “practical reason” would be accepted by the Church as atoning for Ockham’s critique of pure reason. Pope John XXII ordered an ecclesiastical inquiry into the “abominable heresies” of the young friar, and summoned him to appear at the papal court in Avignon. Ockham came, for we find him, in 1328, in a papal prison there, with two other
Franciscans. The three escaped, and fled to Aiguesmortes; they embarked in a small boat, and were picked up by a galley that took them to Louis of Bavaria at Pisa. The Pope excommunicated them, the Emperor protected them. William accompanied Louis to Munich, joined Marsilius of Padua there, lived in an anti-papal Franciscan monastery, and issued from it a torrent of books and pamphlets against the power and heresies of the popes in general, and of John XXII in particular.
As he had in his metaphysics outdone the skepticism of Scotus, so now in his practical theory Ockham carried to daring conclusions the anticlericalism of Marsilius of Padua. He applied his “razor” to the dogmas and rites that the Church had added to early Christianity, and demanded a return to the simpler creed and worship of the New Testament. In a pugnacious Centiloquium theologicum he brought before the tribunal of his reason a hundred dogmas of the Church, and argued that many of them led logically to intolerable absurdities. If, for example, Mary is the Mother of God, and God is father of us all, Mary is the mother of her father.66 Ockham questioned the Apostolic Succession of the popes, and their infallibility; on the contrary, he urged, many of them had-been heretics, and some had been criminals.67 He advocated a lenient treatment of heresy, proposing that all expression of opinion be left free except for the dissemination of conscious falsehood.68 What Christianity needed, he thought, was a return from the Church to Christ, from wealth and power to simplicity of life and humility of rule. The Church should be defined not as the clergy alone but as the whole Christian community. This entire fellowship, including the women, should choose representatives, including women, to a general council, and this council should choose and govern the pope. Church and state should be under one head.69