Part Iii. Deals With Skin Diseases and Various Forms of Tumors,

including those of the thyroid gland; and with diseases of the eye, the ear and the nasal cavities; with the various kinds of hernia; with renal and cystic calculi; with hemorrhoids, varicose veins, etc.; with abdominal dropsy; and with still other affections. In bloodletting he recommends the practice of opening the vein longitudinally. He is very emphatic in his manner of insisting that medicine and surgery should not be divorced, and that the operation of drawing blood should not be intrusted to barbers.

After the death or retirement of Lanfranchi during the first decade of the fourteenth century, Paris appears to have played, at least for a few years, a comparatively small part in the history of medical teaching. Her rivals at Montpellier, in the south of France, and at Bologna and Padua, in Italy, far outstripped her during this period. There was one physician at Paris, however,--Henri de Mondeville,--who would probably have proved a worthy successor of Lanfranchi if circumstances had not seriously interfered with his acting the part of a teacher.

Henri de Mondeville.--Henri de Mondeville, says Edouard Nicaise, was born about 1260 A. D. in Normandy. In his native village--Mondeville or Mandeville, or Amondaville, all of which names are found in the manuscripts--he was known simply as Henri, but in the outside world and in medical literature he is mentioned, in accordance with the prevailing custom of that period, as Henri de Mondeville. After studying medicine for a certain length of time in Paris and Montpellier, he went to Italy and became the pupil of Theodoric of Bologna. He is said to have been passionately fond of surgery, which at that period was, in France, a much despised branch of medicine. In Italy, on the contrary, such men as William of Saliceto, Hugo of Lucca, Theodoric and Lanfranchi had raised surgery to a position of great honor, and Henri de Mondeville cherished the hope that he also might be able to accomplish the same result in France. Upon his return to Paris he was chosen one of the physicians (there were four in all) of the royal household, and from that time onward he was frequently obliged to set aside, for longer or shorter periods, all his personal interests (private practice, lecturing to medical students, hospital service at Hôtel-Dieu, etc.) in order to attend the King or the Comte de Valois on some military expedition. This sort of service, however, was by no means time lost, for it afforded him the opportunity to acquire great experience in the treatment of wounds, an experience which reveals itself on almost every page of his treatise on surgery. And yet there came a time (1312) when de Mondeville complained bitterly of these interruptions, for which he received no pay and which interfered seriously with his literary work. Despite these hindrances, he appears to have made a fair degree of progress in the writing of his book, for at the date last named he gave a public reading of the first two sections “before a large and noble assemblage of medical students and other distinguished personages.” The portrait of de Mondeville which is here reproduced is a copy of the miniature which appears in one of the manuscripts of his treatise that was prepared 1314 A. D., and is now preserved in the Bibliothèque Nationale at Paris. Nicaise furnishes the following details regarding the original miniature.

Inasmuch as the MS. bears the date 1314 the portrait must have been painted while De Mondeville was still living. The master is represented wearing a violet-colored gown, red stockings, and a black skull-cap. He is thin, his beard is scanty and of a grey color like the hair of his head, his features are finely cut, and he appears to be a fairly tall man. So far as one may judge from this portrait De Mondeville’s age was then about fifty.

The date of his death is not known exactly, but it must have been somewhere about 1320 A. D.

Nicaise sums up de Mondeville’s personal history and his contributions to the science of medicine somewhat as follows: He was a man of warm impulses, who loved the truth and despised all shams. He never hesitated to speak his opinion about others, the King himself not being excluded from his criticisms. He was also quite frank in his exposures of the ignorance of both nobles and members of the clergy. He was not in the least degree superstitious. He remained unmarried throughout life and seems to have entertained a slight disposition to find fault with women, for he attacks somewhat violently their mode of life and their extravagance, especially in the case of the women of Montpellier. Although he possessed a great reputation and a very large clientele of patients, he did not acquire a fortune. He is quoted as saying: “I was obliged from the very first to work hard for a living.” Suppuration, according to the view of de Mondeville, was not a necessary phenomenon in the healing of wounds.

(From Nicaise’s Version, Paris, 1893.)

From a miniature at the head of a manuscript which bears the date A. D. 1313, now preserved in the Bibliothèque Nationale at Paris.]

About the year 1316 the condition of de Mondeville’s health--he probably had pulmonary tuberculosis--began to give him serious cause for anxiety lest he might not live long enough to complete his book; and, as a matter of fact, the treatise which we now possess shows that his fears proved to be well grounded. The important subjects of fractures, dislocations and hernia, for example, are mentioned only casually. Those subjects, however, which he did discuss are treated in a very clear and practical manner. Thus, for example, his instructions with regard to the proper manner of treating wounds is most satisfactory. Theodoric and he were the great champions of the so-called dry treatment, which had been introduced at some remote period of antiquity, but which apparently had not met with general acceptance. Then, again, in his remarks on the subject of amputations, he taught that the ligaturing of the severed arteries after the removal of the amputated part, was universally recognized as the proper course to adopt and should never be neglected.

In Chapter VII. of the first section of his treatise, de Mondeville gives a description of the anatomy of the heart and related blood-vessels, and at the same time furnishes an unusually clear account of the physiology of the circulation which was universally accepted by the physicians of that period, as it had already been by those of earlier centuries. It seems desirable to reproduce this account here in order that it may serve for purposes of comparison with that which Harvey was to give three centuries later. It is only by making such a comparison that the physicians of our time can appreciate the vast importance which attaches to Harvey’s wonderful discovery. De Mondeville’s account, abbreviated wherever it seemed practicable to do this, reads as follows:--

The heart is the most important of all the organs. It transmits to the other members of the body vitalizing blood, heat and spirit. Its muscular tissue, unlike ordinary muscle, is composed of three kinds of fibres, and it is not under the control of the will. It has the shape of a pineapple and is located in the centre of the chest, like a prince in the middle of his kingdom. Its lower extremity is directed somewhat to the left of the chest, as we are assured by the Philosopher (Aristotle) in his history of animals. There are two reasons why it points toward the left: 1., in order that it may not press upon the liver or be pressed upon by it; and 2., in order that it may not communicate its heat to the left side (the cool side) of that organ.

It is important to note the fact that the heart is the only structure which contains blood in its substance; in all the other members of the body the blood is contained in the veins. The base of the heart is situated at its highest point and represents the broadest portion of the organ; it is attached to the posterior wall of the chest by a few ligaments, than which no stronger are to be found in any part of the body. These bands do not touch the heart at any point except at the top, where they take their origin; and their great strength is explained by the fact that it is their duty to hold the heart firmly in its proper position.

The heart possesses two ventricles or cavities, of which the left one--by reason of the natural position of the organ as a whole--is a little higher than the right. Between these two cavities there is placed a partition which in its turn contains a small cavity--termed by some the third ventricle. Above each of the larger ventricles there is a sort of appendix--cartilaginous in structure, but flexible and at the same time strong,--which contains a cavity and has some resemblance to a cat’s ear. These structures, to which the common people have given the name auricles, alternately contract and dilate. The purpose for which they exist is to serve as reservoirs for the blood and air that are needed for the nourishment and cooling of the heart.

To the right ventricle there comes a many-branched vein which conducts to the heart a coarse, thick and warm blood destined to nourish that organ. The portion of this abundant fluid which is not needed for this purpose is then rendered less coarse and thick by some subtle power possessed by the heart itself, after which it is driven into the cavity that is located within the partition wall which separates the ventricles the one from the other. From this smaller cavity, this so-called third ventricle, in which it receives additional heat and at the same time undergoes further thinning as well as some kind of digestion and purification, the blood passes on into the left ventricle and there undergoes a further change--one which is characterized by the development of that element which we call spirit, something clearer, more subtle, more pure, more glorious than any known substance in the human body, and therefore more nearly allied in its nature to celestial things. This new element forms a friendly and very appropriate link between the body and the soul; it is the direct agent or instrument of the latter, conveying to man the different faculties with which he may be endowed.

From the left ventricle of the heart, alongside its auricle, two arteries are given off. One of them, which is only furnished with one tunic (as in the case of a vein) and which is called the arteria venalis (pulmonary vein), carries to the lungs the blood which they require for their nourishment, and breaks up into many branches after entering these structures; the other artery is provided with two tunics and is called the grand artery (the aorta). From the latter vessel are given off the numberless arteries which are distributed throughout the entire body--vessels which transport to every organ and structure both the blood which they need for their nourishment and the spirit required for their revivification. When this spirit passes into the ventricles of the brain it is subjected to a new species of digestion, which converts it into the spirit of the soul. Similarly, when it enters the liver it becomes a nutritive spirit; when it enters the testicles, a generative spirit, and so on through all the different organs.