Being an account of the medical history, death and necropsy in the case of the Venerable Ignatius of Loyola (1491-1556), General of the Company of Jesu

Laforet, Eugene G.

English

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The Linacre QuarterlyVolume 24 | Number 3 Article 6August 1957De Militis Magni CorporeEugene G. LaforetFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationLaforet, Eugene G. (1957) "De Militis Magni Corpore," The Linacre Quarterly: Vol. 24 : No. 3 , Article 6.Available at: http://epublications.marquette.edu/lnq/vol24/iss3/684 You have great regard for the con­cept of the dignity of man which cannot but help influence your con­tinued service to your fellowmen.Working together in mutual trust and confidence with respect forone another, and with an abidingfaith in God, yv,1 will not fail inthe work entrusted to you. Andso, gertlemen, I salute you, andthe ma;·v other Catholic physi­cians NJ have been apostolic leaders ,· !he medical profession. May I leave you with the ,, Jrdsof Dr. Francis W. Peabocl of Harvard: The good physician knows t pa.tients thru and thru, and his kno, ,dge is bought dearly. Time, sympath and understanding must be lavish!: dis­pensed; but the reward is to be 1und in that personal bond which forr thegreatest satisfactions of. the prac e ofmedicine. One of the essential qL ities is interest in humanity; for the se, ,t ofthe care of the patient is caring f • the patient. Thank you and may God less you in your work. THE MISSION AR·' SOCIETY OF ST. FRANCIS XAVIER SUPPORTED BY THE XAVERfAN MISSION GUILD WOULD BE GRATEFUL FO,I ANY DRUG SAMPLES OUR READERS COULD SEND. MAILED TO THE FOLLOWING ADDRESS, THEY WILL BE PACKAGED FOIi SHIPMENT TO INDIA. MRS. GABRIEL PIRO, 3733 BOTH STREET, JACKSON HEIGHTS, L. I., NEW YORK LINACRE QUARTERLY DE MILITIS M ·.GNI CORPORE , .r'AL HISTORY, DEATH AND NEC­BEING AN. ACCOUNT OF TH�:!. ;·NERABLE IGNATIUS OF LOYOLA ROPSY IN THE CASE OFRrL (' .lHE COMPANY OF JESUS(1491-1556). GENE Eugene G r '1foret, M.D. * IVILIZATION is replete v.1t.· C instances in which disease lt;i! so modified the course of h1sto.', that at times it seems almost tl'.c major natural determinant of man, I h Cuttled navies. progress. t as s . . l destroyed armies, razed c1t1es. ana.devastated nations. Even on an individual scale, it is often i�possr hie to assess the far-reachmg e -fects on mankind of the illness. _m­firmity, injury, or death of an im-How would portant personage. d the story of man be written ha Alexander the Great not prema­turely died of a febrile illness at the height of his power? Had Cae­sar not been stabbed? Had Na_po­leon been free of a gastro-intestmal disease?l Had Lincoln not been shot? It is against such a back­ground that the medical history of Ignatius of Loyola may be con­sidered, for the army which he commanded has outlived many andout-fought all. Ignatius, the last of eleven chil­dren, was born in 1491 at the fam-• Dr. Laforet is Assistant in Surgery, Boston Universitl/ School of MeSd,cine and Resident in Thoracic Surgery, a_nai torium Division Boston City Hosp,ta , Boston Massachusetts. This is his secondarticle 'tor the THE LINACRE QUARTERLY, He collaborated with Reverend Thomas! F Casey to give us "Medical Aspects o the Holy Eucharist: A Physiological and Canonical Study" ( February, l955) AucusT, 1957 ily castle of Loyola in the Prnvince of Guipuzcoa, Spain. Of his early medical history little is known save the fact that as a member of a no­ble Basque family he probably en­joyed better nutrition and gen�r�l health than many of his less pnv1-leged fellows. Certainly he had no gross physical disabilities because he freely chose and lustily pursued a military career in a day when victory in combat Wes still largely the result of individual prowess and conditioning. And so, at �ge 30 we find him defending the cita­del of Pamplona, the capital . of Navarre, against the �ttackmg French. But already man s mgen­uity for self-destruction had made remarkable progress and the can­non was conquering the cmrass. On May 20, J52J,2 in the foll vigor of his martial life, Ignat'.us sustained the battle injury which molded more than any other event the course of his life and that of countless others. Accounts of the precise mode of wounding vary. �miliar Napoleonic pose h'.'s been attributed to his attempt· at assuagmg_ the . stric distress of a peptic ulcer by ����al pressure. Although this may b� somewhat apocryphal, no less an authob . than Berkeley Moynihan has su • �;,i;.ibed to it. On the basis of a pamstak­. investigation Lord Moymhan has also ��icredited the theory that the famous exile's death on St, Helena was due togastric carcinoma. 85 The soldier himself is said to have stated that a cann0n-ball passed between his legs. injuring both.a However, a casualty's version of the mechanism of trauma sustained in the heat of battle may often be unreliable. Moce objective ac­counts4 appear to indicate that the left leg was stru.:k by a stone de­tached from a wall by the cannon­ball, while the ball itself, "by a fatal rebound, struck and shivered the right." The wound of the left lower extremity was by far the less severe and there is reason to belie":e that it involved only the soft tissue on the medial aspect of the lower thigh. No special sur­gical attention was rendered it and t�ere. i� n� mention �f a persisting d1sabtl1ty m Ignatius later life. Itprobably healed slowly by second­ary intention despite the topical medications favored by surgeons of the day. The injury to the right leg. however, was an extremely grave one which even today would be fraught with danger. Ignatius appears to have sustained a com­pound comminuted fracture of the proximal third of the right tibia with antero-superior displacement o� the distal fragment. "Twentypieces of bone" are said to have been removed from the wound by the French surgeons who re, the fracture and in general ac ed the prisoner what appea have been the best care ava under field conditions. The patient's condition rem, ied precarious for a period of t, Ive to fifteen days, at the end of "' ich time it was decided to evacuat the casualty to Loyola for more d, ni-tive .treatment, since "the gr ity of his wounds rendered it n, es­sary to obtain more skillful ac ice than could be procured in  the ar­my." But on arrival at Loyola re­duction of the fracture was fc ,nd to have been lost. It was sp ..:u­lated that the patient had !-�en moved too soon or that the ; mb had been poorly immobiliz d5. O_pen reduction was perfon ed without anesthesia. Post-operat ve­ly the patient deteriorated. ,, ith fever, anorexia, and weakness. in­doubtedly due to sepsis. Neverthe­less. osteomyelitis either did ,10t supervene or was extremely ben ·gn since the wound finally healed without sinus formation. The ini­tial removal of the devitalized bone fragments appears to have been well-considered. After a long per­iod of convalescence, constitutional s_yml;'toms regressed and the pa­tient s general condition stabilized. There was considerable shortening of th� right lower extremity. with anterior and proximal displacement of the distal tibia, a portion of which was exposed and protruded anteriorly to the level of the knee. Bony union was good and the ex­tremity was serviceable. �ed rd­to ble 2Also stated to be the Monday after P�ntecost, 19 May 1521. Cf. Bartoli, D.: p,sto�y of the Life and Institute of St. {fnatrus de Lo_yola, Founder of the So­ciety of Jesus, Edward Dunigan and Bro-ther. Catholic Publishing House New York, 1855. . 3Gonzales' account, quoting Ignatius,cited by Rose, S.: St. Ignatius Loyola and the Early Jesuits, Burns and Oate Ld., London, 1891. s. 4Ribandiera's acco1tnt, cited by Rose,op. sit. 86 5Gene!H: Life of St. Ignatius of Loy­ola, Benziger Brothers, New York, 19 J 7. LINACRE QUARTERLY But to the young soldier the prospect of limping and of being unable to wear the fashionable' tight hose of the era was a glun one. And so began what he late· mocked as his "martyrdom of van ity." At his urgent request. th· understandably reluctant surgeon· rongeured the exposed bone ar,· performed an osteotomy at tl fracture site, again without am·•; thesia. "During the whole opern-· tion he supported his sufferin•,1s with such perfect equanimity anJ so impassive a countenance, that one might have supposed him tc. be a dead body given up to the dissecting-knife, rather than a !iv -ing being undergoing the most acute torture." Following the sur­gery, increasing traction was ap­plied daily by means of an "iron machine" in order to secure length­ening. The precise nature of the apparatus is not known but appar­ently such instructions were in general use at the time. Ambroise Pare, writing in the same period. was acquainted with their appli­cation. His observations. reflecting the fracture doctrine of the time. are of interest: "But if the bone bee dislocated or  forth of joynt, then presently after the extension thereof. it will be requisite to bend it somewhat about, and so to draw it _in. The Surgeon is sometimes forced to use engines for this worke, especially if the luxation be inveterate, if the broken or lux­ated bones be great; and that in strong and rustick bodies, and such as have large joynts: for that then there is need of g reater strength, ·than is in the hand of the Surgeon alone. For, by how much the AUGusT, 1957 ,uscles of the Patient are the .tronger, by so much will they bee ... ontracted more powerfully up­wards towards their originals. "0 Hut the end result of the "martyr­dom of vanity" was n�t ideal. Al­though the gross deformity was largely corrected. Ignatius was left ,vith permanent shortening of the right lower extremity and limped noticeably for the remainder of his life. It was only during his convalescence from the elective surgery that he seriously under­took the soul-searching which was to bear such fruit for himself and others. Perhaps the inept surgeons were more important instruments of God's grace than were the skilled French cannoneers. The subsequent life of Ignatius was marked by generally poor health, with recurring episodes of abdominal pain and fever. Despite what has been variously described as his "habitual indisposition" and "usual debility," he pushed for­ward relentlessly with. his educa­tion, travel, and austerities. From April, 1522 to January. 1523 he remained at Manresa, at times working as a menial in the local hospital. He was in close attend� ance on patients ill of plague and other communicable diseases and. although there is no evidence that he contracted any illness by such contact, fever and abdominal pain· were especially severe during this interval. In addition, he experi­enced a brief reactive depression OKeynes, G. (ed.): The Apologie and T realise of Ambroise Pare, Containing the Voyages Made into Divers Places with Many of his Writings upon Sur­gery, The University of Chicago Press, Chicago. I 952. 87 from which he made an uneventful recovery. In July, 1523, having reached Venice, Ignatius booked passage for Jerusalem, sailing de­spite a prostrating bout with fever.Returned from his disappointingventure in tht. Holy Land, he worked in Barcr·lona during 1524. Here his activi, ies so disturbed certain elements that he sustainedtwo bt•c1tings intended, no 'doubt. to sen as a warning. However,the ex.... :dier was not readily de­terred h physical violence. As adirect reot:ir of his role in the affairof the Con .�nt of the Angels, he was again cet�acked, this time by two Mooris/; slaves. The pawns served their master well and Igna­tius, bruised and battered, was left with a cerebra] concussion. His companion is said by some to have died as a result of the assault. ButIgnatius, after a stormy conva­lescence, resumed his labors. Never entirely well, episodes of abdomi­nal pain and fever dogged him at Alcala, Salamanca, a n d Paris. With il1-hea1th probably the least of his obstacles, Ignatius finallyachieved his goal, a goal which, paradoxically, was far different from the one he had visualized inthe cave at Manresa. In April,1541, he became the first com­mander of the Company of Jesus,with headquarters in Rome andlieutenants from Germany to Japan. sired to retire to a house b, ing­zng to the Society, situate, be­tween Santa Balbina and the :iths of Antoninus. His fellow-J(' uits, however, felt that the air o that uninhabited quarter of the city might prove injurious to his h 11th.Ignatius consulted his frienc and physician, Alexander Petr, 1ius. who inspected the area ant ex­pressed the opinion that th air was by no means unhealthy. It is evident that malaria ( "bad- ir") was the disease which was f, ired for the Roman marshes had ,Jred infected mosquitoes since the 'ime of Caesar. On his physician· ad­vice, Ignatius acccordingly de art­ed for the retreat but soon ret1 ned to the infirmary at Rome·. His �on­dition had somewhat decline( but his medical attendants felt tha · ad­ditional rest was all that wa, re­quired. Because of a Iow-g.·ade fever, "some trifling remeC:ies"were prescribed. The fever persist­ed for four to five days but th( pa­tient's status occasioned no undue concern. Petronius was more op­timistic than Ignatius, who knew that his earthly exile was nearly over. Early in the morning of July 31, 1556, he quietly expired. Little reliable evidence is at hand regard­ing the nature of the final illness but it has generally been consid­ered to have been perniciosa ( ma­laria). Victory assured, the scarredbody of the old soldier finally be­gan to crumble. In early July,1556, Ignatius became more feeble.Rome at the time was at war withNaples and her c;arousing troopsmade rest impossible. Ignatius de-88 Autopsy was performed in the presence of Ignatius· companions. Father Polanco, his secretary, de­scribed the findings in a general letter to members of the Society notifying them of their leader's death. "It was necessary to have recourse to autopsy, in order to LINACRE QUARTERLY embalm the body; and this exami­nation afforded us fresh cause for edification and astonishment. The intestines were found to be com­pletely dried up; the result, ac cording to the opinion of the phy­sicians, of his Jong abstinences. ·. , His liver, already hard and dne,� up, also contained several stone another effect of his constant fas! ing." Among those present at th,, necropsy was Matteo Realdo_ Cr,· lombo (1516-1559), the emmeut anatomist who had succeeded Ve-· salius as professor of anatomy al Padua in 1544 and who was ur­rently physician to Pope Paul IV. He has described the gross path­ologic findings.1 "Furthermo.::e. [ have had occasion to remove with my own hands virtually countl7ss multi-hued calculi from the kid­neys, lungs. liver, and portal vei�, as in the case of the Venewb,e Ignatius, General of the Company of Jesus, whose autopsy you and Jacob Bonus witnessed personally. Por I encountered small stones zn 7Colombo, M. R.: De Re A.natomica. liber XV: De /is quae Raro in_ Anato­mia Reperiuntur, �x T.Y(!0graph,t1 Nico­lai Beuilacquae Trident1m, 1559. * FILM AVAILABLE ..... * ,·eters, bladder, colon, hemo�­"J.Oid veins, and umbilicus. And m 11e gall bladder, which was re­.oved, there were numerous cal:, uli of various colors and shapes. In the light of present knowl­, dge it would see� f�asible that.he urinary tract lith1as1s may hav_e 'ollowed the prolonged immob1h­zation to which Ignatius had been �uhjected following his compound fracture at Pamplona. There seems little doubt that the episodes of abdominal pain and fever were ��� lated to the calculous cholecystttts and the appearance of the liver at necropsy suggests that biliary cirrhosis may have been the end result of repeated bouts with ob­structive cholangitis and cholangi­olitis. It is perhaps not remarkable that Ignatius was unable to with­stand the terminal onslaught of malaria. What is remarkable is that a severely wounded war vet­eran, chronically ill, freq�ently febrile, and poorly nounshed, should have been able to perform such enduring work for his God and for his fellowmen. * AN .INTERESTING MOVIE "THE MEDICAL WITNESS" IS AVAILABLE FROM THE WM. S. MERRELL COMPANY CINCINNATI 15, OHIO 0 BE EXCELLENT TO SHOW AT A CATHOLIC THIS 30-MINUTE, 16 MM. SOUND FILM WOUL YSICIAN'S TESTIMONY AS A WITNESS IN PHYSICIANS' GUILD MEETING. IT CONCERNS A PH A MEDICAL CASE. • Professional Service, FOR PARTICULARS WRITE DIRECTLY TO THE ABOVE FIRM, Attenbont Op RENTAL FEE AND AVAILABILITY OF THE FILM. AUGUST, 1957 89 

De Militis Magni Corpore

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De Militis Magni Corpore

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