Book Iv. Contains Such Anatomical Descriptions As May Be Helpful to

the practical surgeon. From these, however, it is evident that the writer had never dissected the human cadaver. Book V. is devoted to the subject of cauterizing and to the consideration of those remedial agents which are commonly employed in surgery. The instruments used for cauterizing purposes were made of different metals, gold or silver being preferred for the more delicate ones, and brass and iron for the others. Immediately after the cauterization it was customary to apply butter, or the fat of some animal, or oil scented with roses, to the burned part.

Saliceto’s other treatise--the Summa conservationis etc.--is also divided into five books, which contain chapters devoted to all the more important branches of internal medicine and to questions of diet, of the physician’s behavior in the presence of a patient, etc. Especially interesting are his remarks about the importance of considering the psychological effect produced upon the patient by such matters as the physician’s manner of feeling the pulse, his carefulness to inquire about the patient’s various symptoms (how the night was passed, what food and drink had been taken, etc.)--an effect which oftentimes is “greater than that produced by instruments and medicines.” In discussing the subject of prognosis, Saliceto makes the remark that it is always proper for the physician to hold out to the patient hope of recovery, although he urges at the same time the wisdom of telling the whole truth to the friends of the patient. He also lays great stress upon the importance of “not holding any conversation with the lady of the house upon confidential matters.” Neuburger gives a number of other extracts from this most interesting work; but I must abstain from devoting any more space to this one mediaeval author, whose manner of writing makes it difficult to realize that the treatise which he has written belongs to the thirteenth century and not to a very recent period.

Roland of Parma.--Roland, who was born in the city of Parma and who spent a part of his life in Bologna, not only edited the work of his teacher, Roger of Salerno, but also wrote a concise treatise on surgery that is entitled “Rolandina.” Neuburger speaks of this book as differing but little from Roger’s “Practica chirurgiae.” “It contains, however, the report of a case of penetrating wound of the chest in which Roland showed not a little courage by daring to cut off, flush with the skin, a portion of lung tissue which happened to protrude from the wound, and then applying a simple dressing.”

The treatise known by the title “Glossulae quatuor magistrorum super chirurgiam Rogerii et Rolandi” was written by an unknown author or perhaps by several authors. It represents a collection of commentaries on the works of the two who are mentioned in the title of the book, and should probably be classed as a part of the literature of the Salerno School of Medicine.

Mondino the Anatomist.--Mondino, who was the first physician, after an interval of about fifteen hundred years, to revive the practice of dissecting human bodies, was born at Bologna at about 1275 A. D. He received his professional training at the medical school of his native city and was given the degree of Doctor in 1290, at the age of fifteen(!). Not long afterward he began to teach anatomy in the same institution and continued to serve in this capacity up to the time of his death in 1326. The physicians who aided him in his anatomical researches were Ottone Agenio Lustrulano, his prosector, and a woman named Alessandra Gilliani, from Perriceto.

Mondino’s method of teaching anatomy was to deliver his lectures with the dissected cadaver directly before him; that is, he demonstrated the correctness of his statements as fast as he made them. (See Fig. 9.) Such a method was entirely new at the time and proved immensely popular, attracting students to Bologna in large numbers. Partly in this way and partly by means of the treatise on anatomy which he wrote (“Anatomia Mundini”), he became the instructor of numerous generations of physicians. His treatise remained the authoritative guide in anatomy up to the middle of the sixteenth century.

The original, which is in the library of the University of Montpellier, France, appears in a manuscript copy of Guy de Chauliac’s Chirurgia magna (fourteenth century). Eugen Holländer of Berlin, the author of Die Medizin in der klassischen Malerei, has courteously given permission to copy the reproduction. The many defects which appear in this picture are due to the fact that the reproduction was taken directly from the original miniature, now six hundred years old. Holländer gives the following description of this interesting scene:

“In one of the rooms of the hospital a woman’s dead body is lying upon a table. Alongside the bed in which she died a nun is praying for her soul. Two physicians are busily engaged in the work of dissecting the body. An instructor is reading out of a book, for the benefit of the students who are crowding into the room, such portions of the text as apply to the case in hand, and at the same time he is directing their attention to the uterus which one of the dissectors is lifting out of the abdominal cavity. Owing to the defective state of the original miniature it is not possible to state positively what part the three women who stand near the head of the corpse are taking in the scene, but it is not unlikely that they too are physicians, especially as their presence on such an occasion would be quite in harmony with the customs of that period of time.”]

In one place in his “Anatomy” Mondino states explicitly that he dissected two human cadavers in the month of January, 1315. This statement renders it possible to fix the exact date when the practice of making such dissections--which had been carried on for a considerable period of time about 250 B. C.--was first resumed. If one reflects upon the nature of the obstacles which in 1315 stood in the way of a revival of this practice,--for example, the deep-seated prejudice against it entertained by all classes of the community, and the very strong opposition of the ecclesiastic authorities to what they honestly believed to be a desecration of the human body,--one will readily appreciate how great was the courage displayed by Mondino when he almost openly undertook his first dissection. The subsequent career of this famous teacher of anatomy justifies the belief that his determination to take the course which he did was based upon the profound conviction that the first step toward increasing the scanty stock of knowledge possessed at that time with regard to the structure of the human body in all its parts, must necessarily be one in continuation of that which Erasistratus and his associates had taken centuries earlier, but which had not been succeeded by a sufficient number of other steps in the same direction. The series of discoveries in anatomy, physiology and pathology which resulted from Mondino’s courageous and intelligent act, form a part of the history of modern medicine, and do not therefore call for consideration in this place. We may simply add that much information of a very interesting character is furnished by Neuburger (op. cit.) with regard to the manner in which Mondino and his immediate successors carried on their instruction in anatomy from that time forward.

The Medical School at Bologna, as may well be imagined, gained great fame from the possession of such distinguished teachers as those whose careers I have briefly sketched--Hugo and Theodoric of Lucca, William of Saliceto, and Mondino; and it retained a large part of this celebrity throughout the fourteenth and fifteenth centuries, despite the appearance on the scene, toward the end of this time, of several formidable claimants for high honors in the domain of medical research and education--viz., the schools at Montpellier and Paris, in France, and that of Padua, in Italy.

Lanfranchi and the Medical School of Paris.--According to Edouard Nicaise medicine was not taught publicly at Paris previously to 1160 A. D. The teaching was carried on at that time by associations of physicians, and it was only during the following century (about 1250 A. D.) that something like a university was established in that city. Up to the end of the sixteenth century (1595 A. D.), during the reign of Henry IV., this institution remained under the control of the Church. Its functions--so far at least as medicine was concerned--were limited to the bestowing of degrees, for it possessed at that time no organization of instructors and no permanent quarters in which the teaching might be carried on systematically; a church (see Fig. 10) or the Dean’s residence serving as the locality in which the lectures were commonly delivered.

During the middle part of the thirteenth century and for a long time afterward, the practice of surgery, which was then of a rather primitive type, was entirely in the hands of two classes of men--the barbers and the so-called surgeons. As time went on, the surgeons began to feel the necessity of securing better protection for their material interests, which were being more and more encroached upon by the barbers--a class of men who were not privileged by the authorities to include in their field of activities anything beyond hair-cutting, shaving, cupping, the extraction of teeth, the application of leeches, the incision of boils and perhaps one or two other simple operations. For this reason, therefore, and also probably because they too felt in some measure the effects of the Renaissance spirit which was then abroad in the land, they organized themselves (1254 A. D.) into an association which bore the name of “College of Saint Cosmas” (Collège de St. Côme). One of the early acts of this association was to establish the rule that all applicants for membership should pass successfully an examination as to their fitness before they could be admitted. Very little is known about the doings of the organization during the early years of its existence. Later, as we shall see, it played a very important part in the history of medicine in France.

(From Meaux Saint-Marc’s L’École de Salerne.)

The present cut is evidently a modern copy of a much earlier original.]

From the account given by Nicaise it appears that no regular instruction in anatomy was given in the University of Paris until after the fourteenth century, and then only from three to five times a year, when the body of a person who had been hung was publicly dissected. “Such a dissection lasted seven days and was a veritable scientific festival.” No official cliniques were held and the only way in which the student of medicine could obtain some practical acquaintance with disease and with the methods of treatment was by attaching himself to a physician or a surgeon, or to a barber.

From the preceding brief and very incomplete account the reader will, I trust, be able to form some idea of the condition of affairs, medical and surgical, in Paris at the time when Lanfranchi arrived in that city.

Lanfranchi, says Neuburger, was born in Milan, Italy, and was undoubtedly the most distinguished among the pupils of Saliceto at Bologna. After leaving the medical school he practiced both medicine and surgery for a certain length of time in his native city; but finally, becoming involved in the quarrels between the Guelphs and the Ghibellines, he--like many other Italian physicians--was obliged to take refuge in France. In Lyons, which was his first place of residence, he engaged for a short time in the practice of medicine and also wrote his first treatise on surgery--“Chirurgia Parva.” Then, after traveling from one place to another in the provinces, he finally (1295 A. D.) settled permanently in Paris. In that city he very soon acquired a large practice, and, at the same time, built up for himself a great reputation as a teacher of medicine. The Collège de St. Côme elected him a member of that organization and profited greatly from the fame which his teaching brought to the institution. It is said that Jean Passavant, who was at that time the Dean of the Medical Faculty of Paris, aided Lanfranchi in his work by every means in his power. As a result Paris, during a considerable period of time, was one of the few places in which genuine clinical instruction was given to all those who desired to acquire a practical acquaintance with disease. His larger treatise, the “Chirurgia Magna,” was completed in 1296. It was dedicated to the King of France, Philip IV., commonly called “Phillippe le Bel,” and its intrinsic merits assured him a permanent reputation as a surgeon. This work, which was translated years ago into English and has recently (1894) been published by the “Early English Text Society,” under the title “Lanfrank’s Science of Cirurgie,” consists of five separate fasciculi or parts. A few extracts from the text of this celebrated work may prove of interest to the reader. Not having access to the English version just mentioned, I shall have to translate from the version (partly Latin and partly German) supplied by Neuburger.