Guy de Chauliac: pre-eminent surgeon of the Middle Ages.

Guy de Chauliac (c1300-1368) trained in Toulouse and the University of Montpellier from where he achieved the highest possible degree of Master of medicine. He undertook fellowships in Bologna (anatomical dissection) and Paris (surgery) and was qualified as a physician not a Barber Surgeon. He took Holy Orders and was appointed as physician to three Avignon-based Popes. He survived an epidemic of the Black Death (1348-1350), suffering an axillary bubo. His book Chirugia Magna was written in medieval Latin in 1363, then circulated in manuscript form before its first printing in 1478. There were 70 editions as it became the most influential surgical text for over 200 years, particularly in France, spanning the period from the late 14th century until Paré (1510-1590). He divided surgery into swellings, wounds, ulcers, fractures and dislocations, and special diseases. Well researched and referenced, based on evidence and experience, he succeeded in incorporating antiquarian and contemporary thinking from French, Arabian, Italian (Bologna), Egyptian and Greek scholars about anatomy, surgical disease and treatment. He was a strong advocate for evaluating outcomes, knowing when not to operate, professionalism and the non-technical competencies. His framework of professionalism was based on four domains: being learned, expert, ingenious and adaptable. The surgical aspirants and leaders of the following two centuries recognized the academic, professional and practical value of his teaching through their reference to and use of Chirugia Magna. The Cowlishaw collection in the Royal Australasian College of Surgeons' library contains four French copies, under the title La Grande Chirugie.