CHAPTER THIRTY
THE TESTING OF RAMÓN CALLICÓ
By the end of the second year of Yonah’s apprenticeship the way of his life seemed clear and determined, and each day continued to be an excitement to him as he absorbed what Nuño taught. Their practice extended widely into the countryside surrounding Saragossa, and they were kept busy in the dispensary and riding out to tend to patients who were unable to come to them. Most of Nuño’s patients were the common people of the town and the farms. Occasionally he was summoned by a nobleman in need of a physician and he always responded, but he told Yonah that noble patients were imperious and apt to be reluctant to pay physicians for their work, and he didn’t seek them out. But on the twentieth of November in the year 1504, he received a summons he could not ignore.
Late that summer both King Ferdinand and Queen Isabella had been taken with a debilitating illness. The king, a robust man whose constitution was conditioned by years of hunting and warfare, had quickly recovered, but his wife had grown steadily weaker. Now Isabella had taken a precipitous turn for the worse while visiting the town of Medina del Campo, and Ferdinand had sent a frantic summons to half a dozen physicians, including Nuño Fierro, the physician of Saragossa.
“But surely you are not able to go,” Yonah protested gently. “It is a ride of ten days to Medina del Campo. Eight days if you kill yourself.” He meant the words literally, for he knew Nuño was not robust and shouldn’t attempt such a trip.
But the physician was adamant. “She is my queen. A monarch in need must be attended no less faithfully than a common man or woman.”
“At least allow me to travel with you,” Yonah said.
But Nuño refused. “You must remain here to continue to provide care for our patients,” he said.
When Yonah and Reyna united to plead that he must have someone to assist him along the way, Nuño conceded the argument and hired Andrés de Ávila, a man of the town, to accompany him, and the two of them rode off early the next morning.
* * *
They returned too soon, and in foul and wet weather. Yonah had to help Nuño from his horse. While Reyna saw that the physician immediately had a hot bath, Ávila told Yonah what had occurred.
The trip had been everything Yonah had feared. Ávila said they had ridden four and a half days. By the time they had reached an inn just beyond the town of Atienza, he had been concerned that Nuño was too fatigued to go on.
“I convinced him to stop for a meal and a rest that would allow us to proceed. But within the inn we found people engaged in drinking to the memory of Isabella.”
Ávila said that Nuño had asked hoarsely if the drinkers knew for certain that she had died, and other travelers from the west assured him that even then the monarch’s body was being borne south to Granada for interment in the royal tomb.
Nuño and Ávila had spent a sleepless, louse-bitten night on the inn’s sleeping floor, and in the morning they began to ride east, back to Saragossa. “This time we traveled at a slower pace,” Ávila said, “but it has been an ill-starred journey in every way, and the entire last day of the ride has been through the cold and driving rain.”
Despite the bath Yonah was alarmed to observe Nuño’s weariness and pallor. He placed the physician into his bed at once and Reyna plied him with hot drinks and nourishing food. After a week of bed rest he was somewhat recovered, but the fruitless ride toward a dying queen of Spain had sorely sapped and limited his strength.
* * *
The time came when Nuño experienced a trembling of his hands that made it impossible for him to use the surgical instruments his brother had made for him. Yonah used them instead, with the physician standing next to him, instructing, explaining, asking questions that challenged and taught the apprentice.
Before an amputation of a crushed little finger, he had Yonah feel his own finger with the fingertips of his other hand. “Do you feel a place—the slight gap where bone meets bone? That is where the crushed finger should be severed, but you must leave the skin uncut higher up, well before the amputation. Do you know why?”
“We must construct a flap,” Yonah said, and the older man nodded in satisfaction.
While Yonah deeply regretted Nuño’s misfortune, yet it was an advantage in his training, because throughout the entire last year of his apprenticeship he performed far more surgery than would otherwise have been the case.
He felt guilty because Fierro was channeling his strength toward teaching him, but when he expressed the thought to Reyna she shook her head. “I believe the need to teach you is keeping him alive,” she said.
Indeed, when the fourth year of the apprenticeship came to an end, there was a gleam of triumph in Nuño Fierro’s eyes. At once, he acted to bring Yonah before the medical examiners of the district. Each year, three days before Christmas, the municipal officers elected two physicians of the district to be examiners of candidates for medical licensing. Nuño had served as an examiner and knew the process well.
“I would have preferred that you wait for testing until the departure of one of the present examiners, Pedro de Calca,” he told Yonah. For many years Calca had envied and resented the physician of Saragossa. But Nuño’s intuition told him not to delay. “I cannot wait another year,” he told Yonah. “And I believe you are ready.” The next day, he rode to the municipal building of Saragossa and made the appointment for Yonah’s examination.
* * *
On the morning of testing, the student and the teacher left the hacienda early and rode their horses slowly through the bright morning warmth. They spoke little in their nervousness. It was too late for priming Yonah’s intellect; they had had four long years for that.
The municipal building smelled of dust and several centuries of human traffic, though that morning only Yonah, Nuño, and the two examiners were there.
“Gentlemen, I have the honor of presenting Señor Ramón Callicó for your examination,” Nuño said calmly.
One of the examiners was Miguel de Montenegro, a small, grave man with silver hair, beard, and mustache. Nuño had known him well for many years and had assured Yonah that Montenegro would be serious and conscientious about his responsibilities as an examiner, yet fair.
The other examiner, Calca, was a smiling, hearty man with red hair and a small, sharp beard. He wore a tunic encrusted with dried and clotted blood, pus, and mucus. Nuño already had disdainfully described the tunic to Yonah as “the man’s boastful advertisement of his trade,” and had warned Yonah that Calca had read Galen and little else, so that most of his questions would come from Galen.
The four of them sat at the table. Yonah told himself that two and a half decades before, Nuño Fierro had sat in this room and taken his examination, and several decades before that, Gabriel ben Nissim Sporanis had done so too, in a time when a physician could announce that he was a Jew.
Each examiner would have two rounds of questioning, and Montenegro went first, his due as the senior physician. “If you please, Señor Callicó. I would like you to speak to us about the advantages and disadvantages of prescribing theriac as an antidote against fevers.”
“I shall begin with the disadvantages,” Yonah said, “for they are few and can quickly be dealt with. The medication is complex to assemble, containing up to seventy constituent herbs, and therefore it is difficult to compound and expensive to buy. Its chief advantage is that it is a proven and effective agent against fevers, intestinal ailments, and even some kinds of poisonings.…” He could feel himself unwind as he moved easily from point to point, trying to make his exposition complete without being excessive. Montenegro appeared to be satisfied. “My second question deals with the differences between quartan and tertiary fevers.”
“Tertian fevers appear every third day, counting the day of occurrence as the first day. Quartan fevers appear every four days. These fevers are most likely to occur where the climate is warm and moist, and often are accompanied by chills, sweats, and great weakness.”
“Quickly and briefly answered. To cure hemorrhoids, would you remove them by knife?”
“Only if nothing else would help. Often the pain and unpleasantness can be controlled by a healthful diet that avoids sharp, salty, or very sweet foods. If there is copious bleeding, styptic medication can be applied. If they swell but do not bleed, they may be lanced or drained with leeches.”
Montenegro nodded and sat back, indicating that it was Pedro de Calca’s turn.
Calca stroked his red beard. “Speak to us, please, of the Galenic system of humoral pathology,” he said, and settled back in his chair.
Yonah was ready and he drew a breath. “It originated as a few ideas expressed by the Hippocratic school and was modified by other early medical philosophers, especially Aristotle. Galen molded their ideas into a theory that said all things are composed of four elements—fire, earth, air, and water—producing the four qualities of hot, cold, dry, and wet. When food and drink are taken into the body, they are cooked by natural heat and transformed into four humors, blood, phlegm, yellow bile, and black bile. Air corresponds to blood, which is wet and hot, water to phlegm, which is wet and cold, fire to yellow bile, which is dry and hot, and earth to black bile, which is dry and cold.
“Galen wrote that a portion of these substances is carried by the blood to nourish the various organs of the body, while the rest is excreted as waste. He said that the proportions in which the qualities are combined in the body are very important. An ideal mixture of qualities produces a person in a state of well-being. Too much or too little of a humor upsets the balance, resulting in illness.”
Calca played with his beard again: stroke, stroke. “Tell us about innate heat and the pneuma.”
“Hippocrates and Aristotle, and then Galen, wrote that the heat within the body is the substance of life. This internal heat is nourished by the pneuma, a spirit which is formed in the purest blood of the liver and carried by the veins. Yet it cannot be seen. It—”
“How do you know it cannot be seen?” Calca interrupted, and Yonah felt Nuño’s warning knee press hard against his own.
Because thus far we have dissected the veins and the organs of three cadavers, and Nuño has shown me only tissue and blood and pointed out that we were unable to see anything that might be called the pneuma. He was a fool; Calca would realize that the only one who could know such a thing was someone who had opened a body and witnessed it. For a moment, terror seized his vocal cords.”
“It is … something I have read.”
“Where have you read this, Señor Callicó? For it seems to me I have never heard whether the pneuma can be seen or cannot be seen.”
Yonah paused. “It was not in Avicenna or in Galen that I read it,” he said, as though trying to recall. “I believe it was in Teodorico Borgognoni.”
Calca looked at him.
“Quite so,” said Miguel de Montenegro. “That is it. I recall reading it in Teodorico Borgognoni myself,” and Nuño Fierro nodded in agreement.
Calca nodded as well. “Borgognoni, of course.”
As his second round of questioning, Montenegro asked Yonah to compare the treatment of a fractured bone with the treatment of a dislocation. They listened to his answer without comment and then Montenegro asked him to list the factors necessary for health.
“Uncontaminated air, food and drink, sleep to rest the body’s forces and wakefulness to make the sense active, moderate physical exercise to expel residues and impurities, elimination of wastes, and sufficient joy to make the body prosperous.”
“Tell us how disease is spread during epidemic,” Calca said.
“Poisonous miasmas are formed by decaying corpses or the fetid waters of swamps. Warm, moist air charged with corruption gives off noxious odors that, if breathed in by healthy persons, may infect and sicken their bodies. During epidemics, the healthy should be encouraged to flee, going far enough so that miasmas cannot be carried to them on the wind.”
There followed quick strokes of the red beard and a rapid series of questions about the urine: “What does urine signify when it is somewhat yellow?”
“It contains a measure of bile.”
“And when the urine is the color of fire?”
“It contains a great deal of bile.”
“Dark red piss?”
“In one who has not been eating saffron, it contains blood.”
“If the urine is seen to contain sediment?”
“It indicates internal weakness of the patient. If the sediment looks like bran and has a bad odor, it indicates that there is ulceration within the ducts. If the sediment has decomposed blood, it marks a phlegmonous tumor.”
“If one sees sand in the urine?” Calca asked.
“It reveals a calculus or stone.”
There was a silence.
“I am satisfied,” Calca said.
“I am satisfied also. A fine candidate who reflects his teacher,” Montenegro said, and proceeded to take down from a shelf the great leather-bound municipal volume. He recorded in it the names of the examiners and the nominator, as well as the intelligence that Señor Ramón Callicó of Saragossa had been examined and duly accepted and licensed as a physician on the seventeenth day of October, Anno Domini 1506.
* * *
On the way home teacher and pupil lolled in their saddles and chortled like children of drunkards.
“I believe I read it in Teodorico Borgognoni! I believe I read it in Teodorico Borgognoni!” Nuño mocked him.
“But Señor Montenegro … Why did he support me?”
“Miguel de Montenegro is a good and celebrated Catholic, the favorite physician of the Church and a man who is called upon to travel far and wide when a bishop or cardinal suffers illness. Yet he is a true medical scientist who makes up his own mind about what is science and what is sin. He and I dissected together several times when we were younger. I am sure he perceived at once why you could attest so confidently regarding the appearance of something internal to the body.”
“I am grateful to him, and fortunate.”
“Yes, you are fortunate, but you performed in a manner that does you great credit.”
“I was most fortunate in my teacher, Maestro,” he said.
“You should refer to me as your maestro no longer, for now we are colleagues,” Nuño said, but Yonah shook his head.
“Two men will always have my gratitude,” he said. “Both of them are Fierro. And each will ever be maestro to me.”