'Anyone else?' he asked, standing and pacing back and forth in front of the fireplace. Bulbeck's hand shot up. Bartholomew motioned for him to answer.
'Trepanation,' he said, casting a mischievous glance at Gray, 'is the surgical practice of removing a part of the skull to relieve pressure on the brain.'
'Surgery!' spat one of the Franciscans in disgust. 'A tradesman's job!'
Bartholomew wandered over to him. 'A patient comes to you with severe headaches, spells of unconsciousness, and uncoordinated movements. What do you do, Brother Boniface?'
'Bleed him with leeches,' Brother Boniface replied promptly.
Bartholomew thrust his hands in the folds of his tabard and suppressed a sigh of resignation. Wherever he went, people saw bleeding as a panacea for all manner of ailments, when other, far more effective but less dramatic, methods were to hand. He had lost many a patient to other physicians because of his refusal to leech on demand, and some had not lived to regret it. 'And what will that do?'
'It will relieve the patient of an excess of bad humours and reduce the pressure in the brain. Without the use of surgery,' he concluded smugly.
'And what if that does not work, and the patient becomes worse?' asked Bartholomew, sauntering to the window and sitting on one of the stone window seats, hands still firmly in his gown to prevent himself from grabbing the arrogant friar and trying to shake some sense into him.
'Then it is God's will that he dies, and I give him last rites,' said Boniface.
Bartholomew was impressed at this reasoning. Would that all his cases were so simple.' But anyone who becomes ill and who is not given the correct treatment may die,' he said, 'and any of you who are unprepared to apply the cure that will save the patient should not become physicians.'
There was a sheepish silence. Bartholomew continued.
'Under certain circumstances there may be a surgical technique that can be used to save a patient's life. If it were God's will that these people should die, He would not have made it possible to use the technique in the first place. But the point is that many people who might have died have been saved because a surgeon has known how to do it. You need not perform the operation yourselves, but you should be prepared to hire the services of a barber-surgeon who will do it for you. Your first duty as a physician is always to save life, or to relieve painful symptoms.'
'My first duty is to God!' exclaimed Boniface, attempting piety, but betrayed by the malice that glittered in his eyes.
'Physicians serve God through their patients,' said Bartholomew immediately, having had this debate many times with Father William. 'God has given you the gift of healing through knowledge, and the way in which you use it is how you serve Him. If you choose to ignore the knowledge He has made available to you without good reason, then your service to Him is flawed.'
'Do you believe you serve God without using the leeches He saw fit to provide for that purpose?' asked Boniface blithely.
"I try to save my patients' lives with the most effective method,' replied Bartholomew. 'If I was certain leeching a patient would secure his recovery, I would leech him.
But when my own experience dictates that there are other, more effective, cures for certain ailments than leeches, it would be wrong of me not to use them.'
'Does trepanation hurt the patient?' asked Robert Deynman suddenly, causing stifled laughter among the other students, and effectively ending Bartholomew's debate with Boniface. Deynman was Bartholomew's least able student, who had been accepted by Michaelhouse because his father was rich. Bartholomew eyed him closely, wondering if the question was intended to needle him, but a glance into the boy's guileless eyes told him that this was just another of his unbelievably stupid questions. Bartholomew felt sorry for him. He tried hard to keep up with the others, but study was entirely beyond him. The thought of Deynman let loose on patients made Bartholomew shudder, and he hoped he would never pass his disputations.
'Yes,' he answered slowly. 'It can be painful.' He wanted to ask how Deynman thought having a hole sawn in his head would feel, but did not want to embarrass the student in front of the others, especially the Franciscans.
'But there are things we can do to alleviate some of the discomfort. What are they?'
He stood up again and went back to the fireplace, kicking at the rushes as Bulbeck recited a list of the drugs and potions that might be used to dull the senses. 'What about laudanum?' he snapped. They had discussed Dioscorides' recommendations for doses of laudanum the previous day, and Bulbeck had already forgotten it.
Bulbeck faltered, and then added it to his list.
'How much would you give to a child you were going to operate on?' he demanded.
Bulbeck faltered again and the others looked away.
'Three measures,' said Deynman.
'For a child?' said Bartholomew incredulously, his resolution not to embarrass Deynman forgotten in his frustration. 'Well, you would certainly solve the problem of pressure on the brain. You would kill it! Master Gray?
Come on! Think!'
'One measure,' guessed Gray wildly.
Bartholomew closed his eyes and tipped his head back and then looked at his students in resignation. 'You will kill your patients with ignorance,' he said quietly. "I have told you at least twice now how much laudanum is safe to give children and you still do not know. Tomorrow we will discuss Dioscorides's De Materia Medica and the medicinal properties of opiates. Bulbeck will read it here this afternoon, and I want everyone to attend.
Anyone who does not know correct dosages need not come tomorrow.'
He turned on his heel and stalked out of the conclave, hoping he had frightened them into learning. He was frustrated that they did not learn faster when there was such a dire need for physicians, but he would not make their disputations easier. Badly-taught physicians could be worse than none at all.
The bell began to ring for dinner and Bartholomew went to wash his hands. Michael was already speeding across to the hall so he could grab a few mouthfuls before the others arrived. The Franciscans gathered together before processing silently across the beaten-earth of the yard. Father William, the fanatic whom, rumour had it, had been dismissed from the inquisition for over-zealousness, was their acknowledged leader.
Bartholomew took his place next to Michael at the table that stood on a raised dais at the south end of the hall where the Fellows sat in a row. The large monk had tell-tale crumbs on his face and there were obvious gaps in the bread-basket. To Bartholomew's left sat Father Aidan, another Franciscan. Aidan was prematurely bald with two prominent front teeth and small blue eyes that never changed expression. Bartholomew had been told that he was an outstanding theologian, although his few attempts at conversation had been painful.
Aidan sat next to William, while next to him sat Kenyngham, his wispy white hair standing almost at right angles to his scalp. Next to the Master was Roger Alcote, and Piers Hesselwell sat on the end. Hesselwell taught law, and always wore fine clothes under his scholar's tabard.
It had been difficult to find a Master of Law, for life in post-plague England was sunny indeed for lawyers. The plague took many individuals who had not made wills, while many wills that had been made were contested bitterly, and there was work aplenty for the lawyers. Few were willing to exchange potentially meteoric careers as practising lawyers for poorly paid positions as University teachers.
The last students slipped into place at the two long trestle tables that ran at right angles to the high table in the main body of the hall, and the buzz of conversation and shuffling died away. After the meal, the tables would be stored along the walls so that the hall could be used for teaching.