BY ISAAC TANG

“Th[e] accumulation [of the sciences] from age to age is essential. Thanks to it, we are like children on the neck of a giant, as we can see all that the giant sees, and a bit more besides.”

– Guy de Chauliac (c1300-1368)

It is July, 1368 in Lyon. When his student arrives, Guy de Chauliac is sitting at his desk. Summer light, floral fragrances and the chimes of church-bells pour through the open window. He looks up with a smile of recognition creeping across his wizened face, beneath strands of white hair. His voice is soft and trembling, but his greeting is warm. His hands clasp a leather-bound book, with the words Chirurgia Magna partially visible, as if physically protecting the treasures of knowledge he has documented over his life as a surgeon to three popes in Avignon. Then reaching towards the student, he winces in pain and rubs around his shoulder. “Arthritis,” he says apologetically. “But that is also where the bubo was, back in the day.”

“From the plague?” asks the student. De Chauliac nods. After a pause, the student queries cautiously, “What was it like during the height of the plague?”

De Chauliac shivers. “Terrible.” His eyes gaze vacantly out the window, as the internal visions of his mind take over. “We first heard reports of it sweeping through the east after a triple conjunction of Jupiter, Saturn and Mars. Divine punishment for the Turks and Tartars who were advancing with their powerful armies, we thought and gloated – for no-one expected it to crush us too.

“When it reached Avignon, the scale was unimaginable. Death glided through the alleyways, crept up the stairs and seeped beneath the doors. When we physicians encountered failure after failure, we became distressed at our ignorance and helplessness. Have we not read Hippocrates, Galen and Avicenna? Did we not attend prestigious universities and study under eminent professors? Yet when we saw the sick, imploring for help with sunken ghoulish eyes, violent bouts of bloodied coughing, the putrid-smelling gangrene, we hung our heads in shame – we were useless. No amount of herbs, vinegar baths, exotic potions or bloodletting could defend against our invisible foe. Many doctors quickly packed their belongings and fled before they died like their patients.”

“But you didn’t flee,” says the student.

De Chauliac turns and answers coldly. “I was afraid to be called a coward. I stayed and observed the nature of the plague and found two types. One was incredibly contagious and caused intense fevers and haemoptysis. The other was slower but agonising to watch, creating swelling tumours (or buboes) in the groin and armpits. As people fell like cards, I watched the threads of society unravel before me, for the plague unearthed another plague, a plague we have suffered since the Original Sin. Our enmities, our selfishness, our deepest fears were laid bare.

“Families abandoned each other, every man for himself and the sick died alone. The son was

not heard, the daughter not found and the priest absent, too fearful to administer the holy rites one final time. Courageous monks and nuns who initially tended the afflicted were soon no more, for the plague took them too. Others, as if the suffering were not enough, became flagellants and savagely whipped themselves to pulp overrunning with blood. Disregarding ecclesiastical censures and excommunications, oh how they harrowed those witnessing their grisly processions from dawn to dusk! But as the multiplying coffins were carried and marched sombrely through the oppressive night, the weeping that reverberated within the cold city walls gradually metamorphosed into the monstrous shriek of the dragon. People began turning against each other, perpetrating ghastly, horrendous crimes.”

Here, de Chauliac pauses and purses his lips in grief before continuing. “People wanted someone to blame. They hounded beggars and lepers and forced them out the towns. They suddenly found witches and heretics everywhere, deserving to be stabbed, hanged, burned. Pilgrims and friars were dragged through the streets, their robes ripped and soiled. Then people began rounding up the Jews, accusing them of the most outrageous things: poisoning the wells, manufacturing maladies. While they fought and murdered, the plague ploughed through indiscriminately, tearing down the rich, the poor, Catholics and Jews.

“Pope Clement VI, in whose service I was at the time, was appalled to witness this barbarity and chaos as he sat enthroned, almost comedically, between two huge bonfires to purify the surrounding air from pestilence. He published papal decrees calling for the protection of Jews and labelling their persecutors as unwitting followers of the Deceiver. Sadly, the ears of Hatred are deaf and its hands swift to destruction. Widespread massacres, mass burning of Jews, plundering and ransacking of their houses erupted through the continent, bursting like the purulent tumours of the plague.”

As he shudders from the torrent of memories, a sparrow descends and alights on the windowsill between the pots of furry sage and slender thyme, warbling in the green light filtered through the leaves of an apple tree. Calmed by its coloraturas, de Chauliac smiles. “What a beautiful day,” he sighs. “A day like this could erase even the darkest recollections. I once thought I would never live to this age, when I got the plague myself. I teetered at the edge of life and death for weeks but, by the will of God, I escaped – like a bird from the fowler’s snare.”

Wistfully, he muses, “Look at the marigolds unfolding their golden heads. Look at the roses overhanging the window with their deep hue. Whilst we mourn the dead, the earth foretells a renaissance.” He hands his book to the student who flips through the pieces of parchment that come alive with black ink. There are instructions about anaesthesia, wound management, trephination, inguinal hernia repair, treatments for fractures, medical professional standards and, of course, the plague.

“Each successive generation stands on their predecessors like a child on the shoulders of giants. Whilst we only see an imposing mountain now, they will one day see the ocean beyond, an ocean of knowledge and wisdom regarding all kinds of diseases and cures.” He faces his student and wonders aloud, “But will they suppress the second plague, the plague unseen, that lurks within us?”

References

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Getz F. Inventarium sive Chirurgia Magna. Vol. 1 [Internet]. Bulletin of the History of Medicine; 1998 [cited 2020 Apr 28]. Available from: https://muse.jhu.edu/article/4125.

Hajar R. The Air of History (Part II) Medicine in the Middle Ages. Heart Views. 2012;13(4):158-62.

Keys TE. The Plague in Literature. Bull Med Libr Assoc. 1944;32(1):35-56.

Thevenet A. Guy de Chauliac (1300-1370): the “father of surgery”. Ann Vasc Surg. 1993;7(2):208-12.

Watters DA. Guy de Chauliac: pre-eminent surgeon of the Middle Ages. ANZ J Surg. 2013;83(10):730-4.