From student notes of the teaching of William de Congenis, at Montpellier ca. 1225, we can recognize that surgical education fitted not too uneasily into an academic environment at that moment, when universities and medical faculties were beginning to shape their institutional identity. But medical institutionalization over the next two hundred years operated in a variety of ways to strengthen rather than break down a nascent hierarchical distinction between medical and surgical learning. At Montpellier, medical masters acquired many surgical skills themselves and abandoned the most difficult operations to non-academic restauratores; surgeons per se were not part of the university. In the north Italian universities, Padua and Bologna, separate chairs of surgery did come into existence within medical faculties in the fourteenth century, yet surgical education never achieved more than second-class status there, and professors of surgery typically tried to move up into medical chairs; anatomy remained a medical subject until the beginning of the sixteenth century.

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