A Touch of France: The Medical Faculty of Montpellier: one thousand years of medicine






Christian RÉGNIER, MD
Pierre and Marie Curie University (UPMC – Paris 6)
International Society for the History of Medicine (ISHM)
Paris, FRANCE

The Medical Faculty of Montpellier: one thousand years of medicine


by C. Régnier, France



Hard by the shores of the Mediterranean stands the oldest medical faculty in Europe. Founded in 1220, the university at Montpellier in the south of France was a crucible of learning for Jewish, Arab, and Latinspeaking physicians. It enjoyed the protection and indulgence of the counts of Toulouse, the kings of Aragon, Popes, and then the kings of France. As famous in the Middle Ages as the medical schools of Salerno, Padua, Bologna, or Paris, the Medical Faculty of Montpellier to this day enjoys an autonomy that enables it to admit students from throughout Europe. In the 1500s, when Montpellier’s economic prosperity declined, the town councilors understood that, if it was to keep its regional influence, Montpellier had to continue as a university town with the best teachers. Despite the religious conflicts that ravaged the town in the 17th century, the intellectual appeal of the Montpellier Faculty of Medicine lasted until the Revolution in 1789. Nearly half of all doctors practicing in France at the time had qualified in Montpellier. During the 18th century, the Montpellier school defended the medical-philosophical doctrine of “vitalism,” which sought to overturn ideas about human physiology, hitherto explained in terms of the laws of mechanics and chemistry alone. Paul-Joseph Barthez, a physician from Montpellier whose reputation had spread throughout Europe and who authored articles on medicine and surgery for the Encyclopedia of Diderot and d’Alembert, was a fervent advocate of vitalism, which was debated throughout Europe until the 20th century. A victim of Parisian centralism, the Montpellier Faculty of Medicine fell on hard times in the first half of the 19th century, but from 1860, with the development of viticulture, and then again in the 1960s as French settlers were repatriated after Algerian independence, the faculty expanded, a blossoming that has continued to the present day.

Medicographia. 2015;37:221-232 (see French abstract on page 232)



Standing on two low hills, the site of today’s Montpellier was, in the 2nd century bC, crossed by the Via Domitia, the first Roman road to link Gaul, Italy, and Spain, along which salt from the Mediterranean was transported to Northern Europe. Montpellier itself, however, was not founded until 985, when Count bernard II de Melgueil granted William I of Montpellier ten hectares of arable land known variously as Mons Pessulus, “lock hill” (for its strategic position), Mons Pastellorum, “hill of pastels” (for the quality of the pigments used in dyeing cloth), or Mons Pistillarius, “hill of grocers” (because of its flourishing commerce), all of which may explain the etymology of the town’s name.1,2

The land was crossed by one of the paths along the Way of Saint James, and the village, developed around the William family château, served as a stopping place for pilgrims to Santiago de Compostela. Merchants, tradesmen, and Arab and Jewish grocers-cum-physicians came to Montpellier, and by the early 1200s the town’s population of five thousand was comparable to that of Nîmes or Narbonne. Deftly playing the game of political alliances, the William dynasty brought prosperity to Montpellier. Famed for its textile manufacturing, cosmopolitan Montpellier expanded to include two active ports (Juvénal and Lattes) and turned its hand to maritime trade with the great Mediterranean ports.1,2



The Montpellier Faculty of Medicine and Saint-Pierre Cathedral.
© Christophe Boisvieux/Corbis




A section of the Via Domitia at the Ambrussum (Villetelle), in the
close vicinity of Montpellier.
© De Agostini Picture Library/C. Pratt/Bridgeman Images.



Writing of Montpellier in 1165, Rabbi benjamin of Tudela noted that: “This is a place well situated for commerce. It is about a parasang [6 kilometers] from the sea, and men come for business there from all quarters, from Edom, Ishmael, the land of Algarve, Lombardy, the dominion of Rome the Great, from all the land of Egypt, Palestine, Greece, France, Asia, and England. People of all nations are found there doing business through the medium of the Genoese and Pisans. In the city there are scholars of great eminence.”3

Montpellier, crucible of Jewish, Islamic, and Christian medicine

The unofficial teaching of medicine began in Montpellier at the start of the 12th century. Epistolary exchanges between travelers passing through praise the “highly skillful and renowned physicians” who practiced there. by the late 1100s, Montpellier was already home to a small community of physicians who received students from southern Europe.4 William VIII, Lord of Montpellier, asserted the town’s medical tradition by authorizing all teachers to lecture on medicine, regardless of their background or religious denomination. The town was a melting pot of three sources of medical knowledge: Christian through the Schola Medica Salernitana, Arabic by virtue of Hispano-Mauresque medicine, and the Jewish medical tradition. This also ended incessant squabbling between physicians seeking to monopolize medical practice and the dissemination of learning. From its inception, the Medical Faculty of Montpellier adopted a motto that affirmed its Hippocratic liberalism: Olim Cous nunc Monspeliensis Hippocrates, “In times past, Hippocrates was from Cos; now he is from Montpellier.”2,5-7

In 1220, the Universitas medicorum of Montpellier was granted its first statutes, establishing a monopoly in the teaching and practice of medicine. Holders of the title Master Teacher of the Montpellier Faculty were accorded the right to practice medicine hic et ubique terrarum—here and anywhere on Earth. A distinction was drawn between Master Teachers who transmitted the medical tradition of Salerno, in Latin, and those who taught, in Arabic, the medical learning of the Arab world. Teaching consisted in reading, commenting upon, and debating— sometimes quite freely—classic Greek and Arabic medical texts. The students (laymen and monks) had a free choice of teacher and, when they felt ready, asked to sit the exams for a license to practice medicine. The first statutes did not specify the length of studies, nor how diplomas were to be awarded, but additional statutes 20 years later regulated stud- ies and their length, the examination procedures, and the graduation ceremony, measures that changed little over the centuries and remained in force until the French Revolution.4,5,7,8



Map of Montpellier (Monspessulanus) published in 1572 by Braun and Hogenberg in
Civitatis Orbis Terrarum I. © Historic Cities – The Hebrew University of Jerusalem & The Jewish National & University Library.


Between the 11th and 13th centuries, eight hospitals were built outside the town of Montpellier by the William dynasty (which came to an end in 1204, for want of a male heir). Each hospital had a few dozen beds and was visited by the town’s physicians, surgeons, and apothecaries. The most famous of these hospitals was founded by the monk physician Gui de Montpellier and served Pope Innocent III as a model for the whole of Italy.2,6,9

Gilles de Corbeil, physician to King Philip II of France (reigned 1180-1223), asserted that Montpellier was the only medical school in his kingdom. Competition came from the School of Salerno (Southern Italy), which at the time was the main medical teaching center of Christendom.4,10

Papal protection and burgeoning influence

For commerce, as for the arts and sciences, Montpellier’s influence was at its greatest under the Kings of Aragon and under the watchful care of the 14th-century Avignon Papacy.

The University of Montpellier was created in 1289 by a papal bull (charter) issued by Pope Nicholas IV, as the faculties of law and medicine and the school of arts were merged. Whereas several schools were authorized to dispense medical knowledge, only the faculty had the right to grade the students. After three years of studies, a diploma was awarded following an open and public debate on the writings of Hippocrates and Galen. All the teachers took part in the debate, which was held in the Saint-Firmin Church or at the basilica of Notre- Dame-des-Tables. The teachers were canons and the chancellor of the faculty was always appointed by the bishop. The students directly paid the teachers, who came to their homes to teach them, and indeed until the 14th century the Medical Faculty had no building intended for this purpose.4-6,8,11



Eye surgery, from Book of Surgery by Rogier de Salerne (vellum,
14th century). © Musée Atger, Faculté de Médecine, Montpellier,
France/Bridgeman Images.




Surgical instruments from a treatise by Abul Qasim Kalaf bin
al-Abbas al Zahrawi (Albucasis), 14th century.
© Musée Atger, Faculté de Médecine, Montpellier, France/Bridgeman Images.



The teachers could perform dissections in their homes. Contrary to a widely held view, the Church did not forbid anatomical dissections. Legal proceedings were, however, brought in cases of desecration of graves and body-snatching. Pope boniface VIII forbade, upon pain of excommunication, the dismembering of cadavers and their boiling to strip flesh from the bones, in an attempt to counter the widespread practice of reducing bodies to expedite their transport or to dispose of mortal remains in more than one tomb.5,6,8,11

In spite of this direct supervision by the Supreme Pontiffs, the faculty enjoyed a certain autonomy. This spirit of independence was perpetuated over the centuries as Montpellier successively welcomed Jewish and Arab emigrants expelled from Spain, survivors of the Albigensian Crusade against the Cathars, and Calvinists.

Because of this, teaching in Montpellier was freer and less dogmatic than in Paris, where the university was dependent on the court of the French kings. The university was close to the papal court, a forum for the discussions of intellectuals from throughout Christian Europe, and Montpellier physicians treated Popes and cardinals. Teachers and students alike fostered ties with the intellectual world of the Mediterranean basin,4-6,10 and during the 13th century Montpellier’s influence was comparable to that of the great Italian centers of learning at Padua and bologna. Over this period, the town’s population quadrupled to 40 000, second in France only to Paris.4,5

Town and gown: economic decline and rising prestige

The incorporation of Montpellier into France in 1350 did not alter the status of the town, which was administered by six noblemen from different guilds who were elected on the first day of March every year. Good administrators, skilled diplomats, these so-called consuls brought prosperity by providing the town with a powerful commercial fleet, by concluding alliances with the great ports of Italy and Spain, by obtaining from Pope Urban V the right to trade with “infidels,” and by supplying the courts of Europe with rare and much sought after oriental produce. A student at Montpellier, resident in Avignon, Pope Urban V used funds from the Holy See to build the monastery of Saints-benoît-et-Germain (which became the Faculty of Medicine in the 18th century). The College of Twelve Physicians was founded to accommodate and provide sustenance to poor students. The Kings of France regularly gave donations to the Medical Faculty of Montpellier, enabling it to balance the books1,2,5,6 and train more physicians (128 in the 14th century).4

In 1450, the Royal College of Medicine was set up in new premises near Saint Matthew’s Church and, for the first time, the Medical Faculty was housed within its own four walls. Louis XII, in 1498, enacted new rules for the organization of the Medical Faculty of Montpellier, Paris being the only faculty in the kingdom to teach medicine regularly and to award recognized diplomas. Four physician-teachers were appointed by the king and paid from the privy purse. They were held accountable for their teaching by the students, who formed a brotherhood that watched over its interests and was represented by a “procurator” who played an important role in running the faculty, both in terms of the budget and the remuneration of the teachers. In the early 16th century, the Medical Faculty decided it needed a treasurer, a beadle housed at the Royal College of Medicine, and a secretary charged with recording diplomas and organizing examinations. Even though the royal power ceaselessly increased its influence over the Medical Faculty, the bishop of Montpellier retained, until the Revolution, the right to inspect the administration of the faculty.4,6



Dissection lesson at the Faculty of Medicine in Montpellier. From La Grande Chirurgie by Guy (or Gui) de Chauliac, 1363 (vellum).
© Musée Atger, Faculté de Médecine, Montpellier, France/Bridgeman Images.




Layout of the Montpellier Botanical Garden, the oldest in France, created by Pierre Richier de Belleval in 1593.
© Muséum National d’Histoire Naturelle. Dist. RMN-Grand Palais/image du MNHN, Bibliothèque Centrale.






The Montpellier consuls continually promoted the development of the university and of the Medical Faculty to sustain the town’s intellectual appeal. The departure of the Popes from Avignon (in 1419) triggered a decline in Montpellier’s prosperity, exacerbated by increased commerce in the Rhône Valley and the silting up of the ports of Lattes and Aigues-Mortes, the town’s main outlets to the sea. This benefited Marseille, which was attached to the French crown in 1481, and which had become an active, rival port. During the 15th century, Montpellier’s population dropped to 15 000.1,2



François Gigot de Lapeyronie, also spelled la Peyronie (1678-
1747), first-surgeon to King Louis XV. Painting by Hyacinthe Rigaud
(1659-1743), at the Paris Museum of History of Medicine.
© Bridgeman Images.



The Reformation reached Montpellier in the 16th century and swayed its intellectuals, wealthy merchants, and artisans, but violent clashes between Protestants and Catholics during the French Wars of Religion drove the town to ruin. Yet the Medical Faculty of Montpellier, famed as it was for its prestigious professoriat, was still able to attract students from all over Europe. In the mid-1500s, teachers were given the right to elect their chancellor and the main disciplines (surgery, pharmacy, botany, and anatomy) were defined. Thereafter, teachers were recruited following a competitive exam at which candidates competed before a board of examiners in answering randomly chosen questions on medicine.

The 16th century saw the building in Montpellier of the first anatomy amphitheater in France and the creation of chairs of anatomy and of surgery. From then onwards, the reputation of the Montpellier anatomists and surgeons steadily grew and new anatomical descriptions abounded: the caro quadrata sylvii (muscle) and os sylvii (lenticular process of incus) of Jacobus Sylvius, (Gaspard) bauhin’s (ileocecal) valve, the reservoir of (Jean) Pecquet or receptaculum chyli, and Raymond Vieussens, who gave his name to a centrum (centrum semiovale), a brain ventricle (cavity of septum pellucidum), foramina (openings of smallest cardiac veins), a valve (superior medullary velum), an isthmus (limbus of fossa ovalis), an ansa (subclavian loop), ganglia (celiac ganglia), and veins (innominate cardiac veins).2,4,5

In 1593, Henri IV encouraged the creation of France’s oldest botanical garden, the Jardin des Plantes de Montpellier, by Pierre Richer de belleval, holder of the newly created Chair of botany at Montpellier. The gardens are still one of the finest examples of Montpellier’s cultural heritage.5,6,1

The teaching of Arab medical authors dwindled from the 15th century and by 1646 had disappeared altogether. Likewise, the teaching of Greek medicine was progressively removed from the program of studies during the 17th century. In 1715, the number of teachers increased from four to eight, and thereafter bore the title professor and occupied chairs. New disciplines emerged, such as chemistry, the chair of which was created in 1673.4,6

The doctrine of vitalism in Montpellier

Having rid itself of ancient theories, 18th-century medicine incorporated chemistry and physics in an attempt to explain the phenomena of life. This was a time characterized by lively debates and heated controversies between medical movements, schools of thought, and the defenders of medical and philosophical doctrines. This intense intellectual activity heralded medicine’s entry into the modern era, with the emergence of new subjects like biology, physiology, anatomical pathology, and histology.

In France, the doctrine of vitalism was born in Montpellier, enunciated by Théophile de bordeu and Paul-Joseph barthez, professors famed throughout 18th-century Europe. This doctrine asserted that the phenomena of life were not subject solely to the laws of physics and chemistry, but also to a “vital force.” Collaborator at the Journal des Savants, barthez was the author of over 2000 articles on medicine and surgery for the Encyclopedia of Diderot and d’Alembert. barthez held that man comprised three elements: organized matter or body, the soul, and the vital (or life) force. He believed that medicine and the study of life should shed the century-old straitjacket imposed by the “mechanistic” theory of Descartes. With the development of the microscope and observations of living tissue, anatomists were certain that the phenomena of life could no longer be explained just by the laws of mechanics. barthez wondered whether the vital principle had an independent existence or instead infused life into the human body.6,13-16









Entrance to the old building of the Montpellier Faculty of Medicine, flanked by the statues of François Gigot de Lapeyronie (left) and
Paul-Joseph Barthez (right). © FRILET/SIPA.



In a talk at the Medical Faculty of Montpellier in 1792, the chemist Jean Antoine Chaptal characterized the “vitalist spirit” by the view that he who studies bodily functions alone will never be a physician, because while he thinks he knows man, in fact all he knows is the outer shell, the carcass. Such an approach, Chaptal argued, would overlook the fine connections between man and his surroundings, reciprocal action and reaction with other bodies, the great system of movement that fashions from all living things the organs of a larger whole.15,16 The vitalist theory of the Montpellier school created a stir throughout Europe. Fiercely contested in Paris, it was seen as far removed from the anatomical and clinical studies that Parisian physicians deemed essential to pathophysiological understanding. The physicians of the Medical Faculty of Paris had their own “organicist” school of thought, based on the anatomical and clinical method.

In the late 18th century, Xavier bichat applied the vitalist principle to his definition of life as an ensemble of functions that oppose death. This vitalist theory was combatted by Jeanbaptiste de Lamarck, the originator of the theory of transformism, or the transmutation of species, and in the 19th century by Claude bernard, who deemed it incompatible with the principles of “experimental medicine”: “Vitalism runs counter to the scientific spirit (…) At the heart of vitalist doctrines there is an irreparable error, which is to lend real existence (…) to something immaterial, something which in reality is just a notion of the spirit.” The vitalist theory debate between physicians raged on unabated for years.6,13-16

Revolutionary upheaval

The French Revolution passed almost unnoticed in Montpellier, which was spared bloody riots and mass executions. The consuls who administered the town gave way to an elected town council directed by a mayor. The “enlightened” bour- geoisie infiltrated the administrative machinery and took control. Somewhat predisposed to moderate revolutionary ideas, the bourgeoisie lived through the Revolution without mishap. The populations of the town and the surrounding countryside, however, suffered greatly from food shortages, military requisitions, and, above all, a cholera epidemic, which killed one-tenth of them (2500 people).1,2,17

The National Convention in 1793 promulgated the dissolution of “antiquated” universities and the closure of “medieval” schools. Already closed were the corporations, the academies, and the learned societies, charged with having “sequestered” learning. In Montpellier, far from the prying eyes of the political powers in Paris, the Medical Faculty unobtrusively continued throughout the Revolution to accept and train students and to award diplomas.

A decree the following year ordered the reopening of the School of Health in Montpellier (and also those of Paris and Strasbourg) and stipulated the number of students admitted to each: 300 in Paris, 150 in Montpellier, and 100 in Strasbourg. Typical of the Paris-centric mentality of the elected members of the National Convention, the law arbitrarily reduced student numbers in Montpellier and imposed Paris as the leading Medical Faculty in France. The Paris School also benefited from institutions such as the Collège de France and the Museum of Natural History, which facilitated research. This harmonization of teaching and courses at the three medical schools ended the Montpellier Faculty of Medicine’s centuries-old tradition of independence.14,17

Montpellier’s physicians nonetheless remained influential in France and elsewhere in Europe. An early 19th-century survey by the Ministry of the Interior indicated that of 2398 physicians practicing in France, 1101 had trained in Montpellier, 226 in Toulouse, 195 in Caen, and 72 in Paris. It should be borne in mind, however, that many physicians, having started their studies in Paris, completed them in Montpellier, where the enrolment fees were lower.4,14,17

In 1795, the Montpellier Medical School moved into its current premises, the Saint benoît monastery adjoining the Saint-Pierre Cathedral. Jean- Antoine Chaptal had the anatomy lecture hall built and saw to the transfer from Paris of a collection of wax anatomical models by the 18th-century Tuscan artist Felice Fontana, for display in the newly created museum of anatomy.

Chaptal appointed Gabriel Prunelle inspector of libraries and of book depositories and charged him with the creation of the Medical Faculty’s library, which currently holds 300 incunabula (books printed before 1501), 100 000 volumes printed before 1800, and all the theses of the medical faculties of Montpellier and Paris since the 17th century. Known to all medical students in France, this catalog of riches was the fruit of Gabriel Prunelle’s vigorous policy of acquisition of works and of library collections throughout Europe.14,17

In the early 1800s, the Medical Schools once more became Faculties of Medicine, the doctorate was restored, and the wearing of professorial gowns was rehabilitated, in a move towards the organization of an imperial university, which reintroduced competitive exams for the recruitment of professors.

Epilogue

In the mid–19th-century, the town of Montpellier suffered demographic, economic, and even academic decline. The Faculty of Medicine lost its shine and was training only 700 students a year. But the town’s fortunes turned once more. The spectacular growth of the railroad network expedited the transportation of large volumes of wine and Languedoc and Montpellier developed winegrowing, leading to a flourishing wine trade.1 The number of medical students rose to 1500 by the early 1900s and to nearly 3000 on the eve of World War 2.4



Anatomical wax head by Felice Fontana (1730-185), at the Museum of Anatomy
of the Faculty of Medicine of Montpellier. © Pascal Parrot.



Boosted by the return of French settlers repatriated after Algerian independence in 1962, Montpellier, as the capital of Languedoc, regained its regional influence in politics, culture, economics, and learning. Most of the university’s faculties were rebuilt or refurbished and the number of students rose to 50 000 by 1990.4 by mid-2014 the University of Montpellier I, the heir to the School of Medicine founded in 1220, counted over 22 000 medical students.

References
1. Cholvy G, ed. Histoire de Montpellier. Toulouse, France: Privat; 1984.
2. Thomas E. Montpellier: Guide à l’Étranger Dans Cette Ville et Dans ses Environs (ed.1857). Montpellier, France: Hachette bNF; 1857.
3. Adler MN. The Itinerary of Benjamin of Tudela: Critical Text, Translation and Commentary. New York, NY; Philip Feldheim; 1907.
4. bonnet H. La Faculté de Médecine de Montpellier, Huit Siècles d’Histoire et d’Éclat. Montpellier, France: Sauramps Médical; 1992.
5. Astruc J. Mémoires Pour Servir à l’Histoire de la Faculté de Médecine de Montpellier. Paris, France: P.G. Cavelier; 1767.
6. Dulieu L, ed. La Médecine à Montpellier du XIIe au XXe Siècle, Paris, France: Hervas, 1986.
7. Mandin A, Jeanneau T. La donation des premiers statuts de la Faculté de Médecine de Montpellier. In: Grmek MD, ed. Histoire de l’École Médicale de Montpellier. Colloque du 110e Congrès National des Sociétés Savantes (1985). Paris, France: CTHS; 1985.
8. Jacquard D. La scolastique médicale. In: Grmek MD, ed. Histoire de la Pensée Médicale en Occident, Tome 1, Antiquité et Moyen Âge. Paris, France: Seuil; 1995.
9. Dumas R. Les Hôpitaux de Montpellier – Mille Ans d’Histoire. Montpellier, France: Sauramps Médical; 2012.
10. Mac Vaugh M. Montpellier et la renommée thérapeutique de ses médecins au début du XIVe siècle. In: Grmek M D, ed. Histoire de l’École Médicale de Montpellier. Colloque du 110e Congrès National des Sociétés Savantes (1985). Paris, France: CTHS; 1985.
11. Castan P. Naissance Médiévale de la DissectionAnatomique. Montpellier, France: Saurans; 1985.
12. Rossi M, Lhoir J. Le Jardin des Plantes de Montpellier : De la Médecine à la Botanique. Montpellier, France: Éditions Quæ; 2013.
13. Rey R. L’âme, le corps et le vivant. In: Grmek MD, ed. Histoire de la Pensée Médicale en Occident, Tome 2, De la Renaissance aux Lumières. Paris, France: Seuil; 1995.
14. Raynaud D. La controverse entre organicisme et vitalisme: étude de sociologie des sciences. Rev Fr Sociol. 1998;39:721-750.
15. Lavabre-bertrand T. L’Évolution du Vitalisme à Montpellier de Barthez à Lordat, Mémoire de DEA de Philosophie et d’Histoire des Sciences, Paris 1, 1986.
16. Long b. Le vitalisme de Paul Joseph barthez. In: Grmek MD, ed. Histoire de l’École Médicale de Montpellier. Colloque du 110e Congrès National des Sociétés Savantes (1985). Paris, France: CTHS; 1985.
17. Goupil A. Le chimiste Jean Antoine Chaptal et l’École médicale de Montpellier. In: Grmek MD, ed. Histoire de l’École Médicale de Montpellier. Colloque du 110e Congrès National des Sociétés Savantes (1985). Paris, France: CTHS, 1985.