Guy de Chauliac

French writer and historian

• Born: c. 1290
• Birthplace: Chauliac, Auvergne, France
• Died: July 25, 1368
• Place of death: Avignon, France

Guy de Chauliac wrote the most important treatise on surgery during the later Middle Ages. For more than two centuries, he was considered the leading authority on such diverse medical topics as dissection, surgical procedure, professional ethics, leprosy, anatomical structure, pharmaceutical drugs, dental care, ophthalmology, and plague origins, symptoms, and preventions.

Early Life

Of agrarian, peasant stock, Guy de Chauliac (gee-duh-shohl-yahk) exhibited intellectual abilities early in his youth and was supported in his subsequent academic pursuits by the lords of Mercœur. He first studied medicine in Toulouse and completed his initial medical training in Montpellier under Raymond of Molières. Later, in Bologna, he mastered anatomy under Niccolò Bertruccio, renowned for his pioneering achievements in describing the construction and operation of the brain. Guy perfected his surgical techniques under Alberto of Bologna.

Bologna was vitally important to Guy’s career because of its long and distinguished medical history. As early as the middle of the twelfth century, it had a medical faculty that taught Latin translations of Arabic texts, especially those of Avicenna. Of particular significance to Guy’s development were the writings of William of Saliceto, a surgeon who produced a treatise in 1275 describing human dissection; Thaddeus of Florence, who encouraged scholar-physicians to make direct translations from the Greek masters; and Mondino dei Liucci, who publicly dissected corpses. Mondino’s Anatomia, a practical manual of dissection completed in 1316, was the most popular textbook on anatomy before that of Vesalius in the sixteenth century. Finally, Henry of Mondeville, a fellow student of Mondino at Bologna, brought these techniques in the first decade of the fourteenth century to Montpellier. All of these brilliant masters played a major role in Guy’s perspective, procedure, and philosophy of medicine.

After his university career, Guy practiced medicine in Paris from 1315 to 1320. Thereafter, he served for an extended period of time in Lyon, where he also was a canon and provost of Saint-Just; he acquired similar posts later at Reims and at Mende. For much of his later life he resided in Avignon, where he was the personal physician to Clement VI, Innocent VI, and Urban V. He also served these pontiffs as a personal auditor and judge.

It was during these Avignonese years that Guy witnessed some of the most catastrophic events in human history: the Black Death of the mid-1300’, which killed approximately one-third of Europe’s population, and the initial bloody episodes of the Hundred Years’ War (1337-1453) between England and France. In this tragic setting, Guy wrote the most important medical text of the later Middle Ages.

Life’s Work

In 1363, Guy finished his masterpiece the Chirurgia magna (The Cyrurgie of Guy de Chauliac, 1971) and dedicated it to his former colleagues and masters at Montpellier, Bologna, Paris, and Avignon. Systematic and comprehensive, this work contains a synthesis of the best medical ideas of his age, an intensive analysis of earlier literature, especially the treatises of Galen, Aristotle, Rhazes, Albucasis, Avicenna, and Averroës, and a litany of hundreds of his own personal observations.

The Cyrurgie of Guy de Chauliac consists of seven major sections (tractates), but it is preceded by an introduction (capitulum singulare) that provides personal information on Guy’s life and advises physicians to acquire a liberal education, maintain a proper diet, keep excellent care of their instruments, and conduct correct surgical procedures. He warned them not to shun patients out of fear as was commonplace during the outbreaks of the Black Death and lambasted the fables perpetrated by some of his predecessors. He cautioned against relying on the occult even though he himself occasionally slipped and recommended occult remedies. Guy was concerned with the total education of physicians, their health and physical appearance, their office procedures and equipment, and their ethics and personal deportment. Not since Hippocrates had this facet of the profession been given such intensive emphasis.

In the first section of The Cyrurgie of Guy de Chauliac, Guy presents a brief exegesis on anatomy based largely on Galen and Bertruccio. More detailed than the anatomical treatise of Mondino, it stresses the need for all surgeons to be knowledgeable in all facets of this discipline. Some of the format was based on Guy’s experience of assisting at dissections and postmortems.

The next section is one of the most popular, durable, and influential in the book. Dealing generally with carbuncles, abscesses, and tumors, Guy recommended operating on cancer in its earliest stages. He described in detail the plague that had recently ravaged Avignon. Based on personal observation and a brief bout with the disease, he described its origins in Asia, its causes (unfortunately ascribing them to a number of popular superstitions), its contagious nature, and its prevention. Concerning plague symptoms, Guy lists fever, pains in the side or chest, coughing, shortness of breath, rapid pulse, vomiting of blood, and the appearance of buboes in the groin, under the armpit, or behind the ears. Distinguishing between the bubonic and pneumonic types, he recommended such divergent preventive measures as the avoidance of damp places, the burning of aromatic wood, the abstention from violent exercise and hot baths, and the use of antidotes and drugs.

Section 3 deals with various kinds of wounds, diets for wounded persons, diseases contracted after being wounded, and treatments. Once again, it was unfortunate that he recommended the Galenic method of applying salves and ointments. His contemporary Mondeville had pioneered in the antiseptic treatment of wounds that included cleaning them with wine, stitching their edges, keeping them dry and clean, and permitting nature to heal them. These techniques became standard by the later stages of the Hundred Years’ War. Nevertheless, Guy did provide valuable insights in his discussions of the escape of the cerebrospinal fluid, the effect of pressure on respiration, the closing of chest wounds, and the extreme caution needed in treating abdominal wounds.

After describing the numerous types of ulcers in section 4, Guy devoted the entire next section to fractures and dislocations. Although he contributed little original to existing literature, he provided a detailed procedure for treating fractures with splints, pulleys, and weights. His treatments for dislocations of the hands and feet endured for centuries.

In section 6, Guy covered such diverse topics as sciatica, leprosy, localized illnesses, bladder stones, proper eye and dental care, and medical and dental equipment. His work in leprosy was of great importance. He drew attention to the excessive greasiness of a leper’s skin and recommended segregation and proper medical treatment. So successful were these methods that by the sixteenth century there was a dramatic reduction in the number of new cases and some of the methods were applied to other diseases. He may have been the first to recommend the use of the catheter to diagnose stones in the bladder. He prescribed a powder made from cuttlebones and other substances for cleaning teeth, the use of ox bone for the replacement of lost teeth, and the fastening of gold wire around loose teeth for strengthening. He even prescribed spectacles as a remedy for poor sight after salves and lotions had failed. The last section catalogs an extremely comprehensive antidotary in which Guy lists about 750 medical substances. In the process, he was one of the first physicians to warn patients about the dangers of excessive or sustained drug use.

Significance

Guy was the most famous and successful surgical writer of the Middle Ages. His Chirurgia magna was translated into French, Provençal, Catalan, Italian, English, Dutch, Hebrew, and Irish. Although criticized by some modern writers for his lack of originality, his primary intention was to summarize the knowledge of the most significant medical writers of his own and of preceding ages. Even the longer title of his work Inventorium sive collectorium in parte chirurgiciali medicine (the inventory or collectory of surgery) testifies to this overall goal. Consequently, he became a founder of didactic surgery a teacher of surgery as well as a practicing physician-scientist.

Although never a professor of surgery in a prestigious university, Guy had the title of master of medicine conferred on him by the administrative authorities of the University of Montpellier shortly before his death. His surgical work was unparalleled until Ambroise Paré amended it toward the end of the sixteenth century, while his anatomical observations served as the scientific model until 1534 when Vesalius published his great treatise. In the fields of surgery, medicine, and anatomy, Guy served as a standardizer, transmitter, and synthesizer. He was a harbinger of the many significant breakthroughs in these fields that occurred in the scientific revolution.

Bibliography

Campbell, Anna M. The Black Death and Men of Learning. New York: Columbia University Press, 1931. A classic study, with excellent coverage of the medical opinions of fourteenth century physicians on one of the greatest medical catastrophes in recorded history.

Crombie, A. C. Augustine to Galileo: The History of Science, A.D. 400-1650. London: Falcon Press, 1952. Extols Guy’s position as the leading medical writer in Western Europe prior to the sixteenth century.

Hall, A. R. The Scientific Revolution: 1500-1800. 2d ed. Boston: Beacon Press, 1966. This work includes a discussion of the great debt that Ambroise Paré, the most famous sixteenth century French surgeon, owed to The Cyrurgie of Guy de Chauliac.

Kibre, Pearl. Studies in Medieval Science: Alchemy, Astrology, Mathematics, and Medicine. London: Hambledon Press, 1984. Discusses treatises by Guy and other contemporary medical writers found in the medieval libraries of Western Europe.

Mellick, S. A. “The Montpellier School and Guy de Chauliac.” Australian and New Zealand Journal of Surgery 69, no. 4 (April, 1999): 297-301. Profiles Guy and his work, especially The Cyrurgie of Guy de Chauliac, and places the surgeon within the history of the ancient French university at Montpellier.

O’Boyle, Cornelius. The Art of Medicine: Medical Teaching at the University of Paris, 1250-1400. Boston: Brill, 1998. Discusses the history of the study and practice of medicine as art at the time of Guy. Includes an extensive bibliography and index.

Sarton, George. Introduction to the History of Science: Science and Learning in the Fourteenth Century. Vol. 3. Baltimore: Williams and Wilkins, 1947-1948. Comprehensively covers Guy’s contributions to medieval anatomy and surgery. A landmark study in the history of science.

Sedgwick, W. T., and H. W. Tyler. A Short History of Science. Reprint. New York: Macmillan, 1939. This study describes Guy’s debt to his Bolognese medical masters and to Henry of Mondeville, who brought the Italian methods to Montpellier.

Singer, Charles. A Short History of Anatomy from the Greeks to Harvey. Reprint. Mineola, N.Y.: Dover, 1957. Highlights Guy’s position as a standardizer of medieval surgical practices.

Thorndike, Lynn. A History of Magic and Experimental Science: The Fourteenth and Fifteenth Centuries. Vols. 3 and 4. New York: Columbia University Press, 1934. Chapter 30 is devoted to Guy and his contemporary physicians, with a special emphasis on the impact of the Black Death on their work and their respective societies.

Wallner, Bjorn, ed. The Middle English Translation of Guy de Chauliac’s Anatomy, with Guy’s Essay on the History of Medicine. Lund, Sweden: CWK Gleerup, 1964. A valuable late fourteenth or early fifteenth century rendering of a portion of The Cyrurgie of Guy de Chauliac.