Portal de Periódicos da CAPES

Surgeons in the time of plague: Guy de Chauliac in fourteenth-century France

2020; Elsevier BV; Volume: 6; Issue: 4 Linguagem: Inglês

10.1016/j.jvscit.2020.07.006

2468-4287

Justin Barr, Walton O. Schalick, Cynthia K. Shortell,

Historical Studies and Socio-cultural Analysis

Coronavirus disease-19 has engulfed our world. With millions sickened and hundreds of thousands dead, the disease has utterly upended life around the globe. Although devastating, the coronavirus represents one of countless pandemics that have assailed humanity throughout history. The most famous of these, the Black Death, struck globally in the thirteenth to fifteenth centuries, but peaked in Europe between 1347 and 1351. Bedeviling the curative efforts of doctors, kings, sorcerers, and priests alike, the plague killed at least one-third of the continent's population. Guy de Chauliac, a medieval practitioner known later as the father of Western surgery, worked courageously caring for patients through the Black Death (Fig).1Guy de Chauliac (c 1300-1368) – father of surgery.JAMA. 1965; 191: 408-409Crossref PubMed Scopus (2) Google Scholar,2Thevenet A. Guy de Chauliac (1300-1370): the "father of surgery".Ann Vasc Surg. 1993; 7: 208-212Abstract Full Text PDF PubMed Scopus (12) Google Scholar Examining Guy's experience exposes how medical providers in the Middle Ages understood and treated this disease. It also provides a sterling example of a surgeon committed to his patients above all else that we would do well to heed in this modern time of uncertainty. Little is known about Guy's early life. He studied medicine at Bologna and Montpellier, two of the leading universities of the period. At a time when medicine and surgery frequently opposed each other, Guy attempted to unite the two professions, and he himself simultaneously trained as a physician (medicus) while practicing as a surgeon (cyrigicus).3McVaugh M.R. The rational surgery of the Middle Ages. 235. Sismel, Firenze2006Google Scholar In his magnum opus, Inventarium sive Chirurgia magna (1363), Guy melded contemporary experiences with a wide panoply of ancient and medieval sources into a synthetic whole. There, he described various methods of vascular control, including vessel ligation. Chirurgia magna brought him great renown and was used as a standard textbook for the next three centuries by luminaries such as Ambroise Paré.4McVaugh M.R. Ogden M. Guigonis de Caulhiaco (Guy de Chauliac). Inventarium sive Chirurgia magna. Brill, Leiden1997Google Scholar Guy became a papal physician in the 1340s, tending to Pope Clement VI as the plague swept through Avignon, France, in 1348 (at the time, the Papal Court had moved to Avignon for political reasons). The arrival of the disease confounded physicians and patients alike, but the common appellation grandis mortalitas indicated how quickly all parties recognized its severity.5Arrizabalaga J. Facing the Black Death: perceptions and reactions of university medical practitioners.in: García-Ballester L. French R. Arrizabalaga J. Cunningham A. Practical medicine from Salerno to the Black Death. Cambridge University Press, Cambridge1994: 237-288Google Scholar Confronted by a new and devastating pathology, the medical world struggled to explain the pestilence; more than 281 plague treatises appeared between 1350 and 1500 that attempted to elucidate the etiology of the disease and prescribe effective remedies for it.6Siraisi N.G. Medieval and early Renaissance medicine. University of Chicago Press, Chicago1990Crossref Google Scholar Despite the predominance of religion in the medieval world, university-trained physicians and surgeons often appealed to naturalistic causes. These ranged from theories of impure miasmas seeping from the ground to cosmological explanations surrounding the parlous arrangement of planets, particularly the conjunction of Saturn, Mars, and Jupiter in Aquarius at 1:00 pm on March 20, 1345.5Arrizabalaga J. Facing the Black Death: perceptions and reactions of university medical practitioners.in: García-Ballester L. French R. Arrizabalaga J. Cunningham A. Practical medicine from Salerno to the Black Death. Cambridge University Press, Cambridge1994: 237-288Google Scholar Meanwhile, lay people could believe the plague contagious or attribute it to well-poisonings, a theory that led to massacres of Jews throughout the continent in an oft-repeated tendency to blame minority groups for public health disasters.7McKay R. Patient zero and the making of the AIDS epidemic. University of Chicago Press, Chicago2017Crossref Google Scholar In this setting of confusion, death, and disillusionment, Guy recorded a carefully abstracted, epidemiologic summary of the plague, emphasizing both its clinical features and its social impacts.8Bergdolt K. Der schwarze Tod in Europa: Die Große Pest und das Ende des Mittelalters. C.H. Beck, Bremen1994: 65-69Google Scholar Of the latter, he observed, "it was so contagious (especially that which involved spitting of blood) that one man caught it from another not just when living nearby but simply by looking at him; so much so that people died without servants and were buried without priests. Father would not visit son, nor son, father; charity was dead, and hope prostrate." As in contemporary times, medical responses were severely strained, so much so that, "physicians felt useless and ashamed, inasmuch as they did not dare visit the sick for fear of infection; and when they did visit them they could do very little and accomplished nothing."9Grant E, ed. A source book in medieval science. Cambridge (MA): Harvard University Press. p. 773.Google Scholar Becoming one of the best-known plague treatises, this document bolstered Guy's reputation and became a standard reference for contemporary clinicians studying the Black Death. Despite the apparent futility, Guy himself did not flee, unlike some physicians who abandoned their charges. Ministering to his patients, he contracted a continuous fever and "aposteme in the groin, surviving only due to god's will." He lived long enough to see a recrudescence of the plague in 1360, when he was again called to service.10Paravicini-Bagliani A. Il corpo del papa. Einaudi, Torino1994: 195-196Google Scholar Guy exemplifies the importance and value of studying novel diseases that appear in our lifetimes and, most importantly, that our commitment to caring for patients should remain an unbreakable bond, no matter the circumstances.