Chapter V., Part Iii., Mention Is Made of Spectacles. So Far As Now

appears, this is the first time that these useful contrivances are referred to in medical literature; and the casual manner in which the author speaks of them suggests the idea that they had already been known for some time. Possibly Roger Bacon, who interested himself in researches in the department of optics and who was a contemporary of Gordonius, may have had something to do with the invention of spectacles.

At the ceremony of the marriage of the Duchess Juta of Austria to Count Louis of Oettingen, at Vienna in 1319, Pietro Buonaparte, the Podesta of Padua, created considerable excitement by wearing a pair of spectacles which he had received a short time previously from Salvino degli Armati of Florence, the reputed inventor of these contrivances. It is not generally known that the printing of books in very large and bold type during the latter part of the fifteenth and the early part of the sixteenth centuries was done expressly for the benefit of far-sighted readers--this defect in vision characterizing a very large percentage of the learned men of that period. The great number of books which, during those early days of the art of printing, were published in this style, emphasizes the fact that the usefulness of spectacles was not generally appreciated until after the lapse of many scores of years. Being very expensive they were within the reach of only persons of wealth, and, in addition, they were extremely difficult to obtain. As late as during the year 1572, Augustus, Elector of Saxony, moved by a strong wish to possess a pair of spectacles, despatched a special messenger first to Leipzig and then to Augsburg with instructions to purchase them for him at the great annual fair. This agent, however, was unsuccessful in the attempt, and, accordingly, in the summer of 1574, he was instructed to ride on as far as Venice. But, on arriving there, he was informed that no glasses would be ground before the month of October. He was consequently obliged to remain in that city until the autumn, at which time he sent word to his master that the optician’s charge for the instrument would be 50 thalers (equivalent to $250 at the present value of money). The Elector, it appears, was only too glad to pay this sum for the coveted article. The first spectacles made were equipped with only convex glasses, for the use of far-sighted persons. It was not until about two hundred years later that the art of grinding concave glasses for the relief of short-sighted individuals was discovered.

Guy de Chauliac.--After the lapse of a few years there appeared a man who was destined to add greatly to the fame of the Medical School of Montpellier--not in the way in which Arnold of Villanova had accomplished this result, but by the publication of the first systematic treatise on surgery which was written in Western Europe during the Middle Ages. This man was Guy de Chauliac, about whose early life very little is known. He was born in the village of Chauliac, in Auvergne, France, toward the end of the thirteenth century, his parents being simple peasants; and during early boyhood he probably attended the school connected with the village church. His medical studies were begun at Toulouse and completed at Montpellier. But, at some time later than 1326, he went to Bologna and perfected his knowledge of anatomy under the guidance of Bertrucius, Mondino’s successor. After leaving Bologna Guy visited Paris, arriving there subsequently to the deaths of Lanfranchi, Pitard and Henri de Mondeville. Although he remained in that great city only a short time, he appears to have formed a warm friendship with several of the instructors in the medical school.

About the year 1330 he took up his residence in Lyons. His appointment to the position of Canon of Saint-Just, a church which is located in that city, doubtless made it necessary for him to adopt this course. And yet it is most improbable that he spent much of his time in Lyons, for his other duties--his attendance at the Papal Court in Avignon, as private physician to three Popes in succession, and the numerous calls made upon him for professional advice and especially for surgical assistance by people living at a long distance from Lyons--compelled him repeatedly to absent himself from his home, sometimes for several days at a time. In 1348 the plague visited Avignon and carried off large numbers of people, the poet Petrarch’s Laura being one of the victims. During that terrible epidemic Guy was most faithful in his devotion to Clement VI. and to many others who needed his professional services. In 1357 he was promoted by Innocent VI. to the office of Provost of Saint-Just. In 1363 when--according to, his own declaration--he was an old man, he wrote the treatise on surgery which has rendered his name famous in the history of medicine. His death occurred about July 23, 1368.

Guy was not, as some writers have asserted, a professor of surgery in the University of Montpellier; he was simply a physician who had won at that institution the title of “Master in Medicine”--the highest grade conferred by the university authorities, and one which necessarily implied that the recipient had given a certain number of public readings on medical topics. And yet in actual practice Guy manifested a strong preference for the management of diseases which demanded surgical treatment. His writings, furthermore, make it clear that he had a strong affection for the institution in which he had been both a student and in some measure an instructor.

The book which Guy de Chauliac wrote, and which bears the title “La Grande Chirurgie,” is described by Malgaigne, one of the most distinguished French surgeons of the nineteenth century, in the following terms: “I do not hesitate to say that, with the single exception of the book written by Hippocrates, there is not a work on surgery, no matter in what language written, which ranks higher than, or is even equal to, the magnificent treatise of Guy de Chauliac.” Although most surgeons of the present day will scarcely assent to praise of such an extravagant nature, they will undoubtedly agree in according to this admirable author of the fourteenth century a high place of honor in the Temple of Fame. Nicaise, the editor of the most recent version of Guy de Chauliac’s treatise, speaks of him as the “founder of didactic surgery.” From 1363 A. D., the date of its first publication in manuscript, to 1478, a period of more than one hundred years, Guy’s book was universally regarded as the authoritative treatise on surgery. But this branch of medicine, it must not be forgotten, was, at that period of the Middle Ages, held in very small esteem by physicians generally, and therefore it is almost certain that Guy received no encouragement whatever from any outside source. All the greater credit, therefore, is due him for the admirable manner in which he carried on the task which he had set before himself during the last years of his life. Extraordinary as it appears to us to-day, the Montpellier School of Medicine, toward the end of the fifteenth century (that is, only a comparatively short time after Guy’s death), issued a decree that thereafter their pupils were not to study nor to practice surgery. From this and other well-authenticated facts it appears that the prejudice which existed at that period among physicians against surgery, was strong enough to render them blind to the reality that it was through the instrumentality of this very branch of medical activity that the school at Montpellier had gained such an increase in celebrity. They were unable to dispossess their minds of the idea that operative and all other surgical procedures were derogatory to the dignity of the educated physician.

Guy de Chauliac wrote his treatise originally in Latin--not the Latin of the classical authors, but a Latin greatly deformed by the introduction of French, Arabic and Provençal terms--barbaric Latin, as it is often called. This language was commonly employed at the University of Montpellier and at all other universities at that period; but, as Nicaise states, the style of his writing is so concise, and at the same time so intelligible, that it would scarcely be possible to translate it into modern French without the loss of much of that which constitutes the charm of the book. It was for the latter reason that he decided to write his version of Guy’s treatise in old French--the French of the thirteenth and fourteenth centuries. In order that our readers, most of whom are doubtless more or less familiar with the finished language of modern French literature, may see for themselves to what extent the latter differs from its fourteenth century ancestor, I shall introduce here a single paragraph of Nicaise’s text. I have chosen it, more or less at random, from the admirable chapter which Guy has written on wounds in general.

Consequemment playes mortelles non necessairement, ains pour la pluspart, sont petites playes, et superficielles és susdites parties, et qui penetrent iusques à icelles et aux chefs des muscles. La raison est, parce que si elles ne sont bien traitées, il advient qu’on en meurt: et si sont bien traitées, on en guerit: ainsi que i’ay veu de la partie posterieure du cerveau, de laquelle sortit un peu de la substance du cerveau, ce qui fut reconnu par l’offense de la mémoire, laquelle il recouvra apres la curation. Ie ne dis pas toutesfois qu’on vesquit, s’il en sortoit toute une cellule, comme Theodore raconte d’un cellier. Aussi Galen ne dit pas, de deux blessez qu’il vit guerir en Smyrne du vivant de son maistre Pelope, qu’il en fust sorty de la substance de cerveau, ains seulement que le cerveau avoit esté blessé: Ne, de celuy qu’il vist guery en Smyrne (comme il recite au huitiesme de l’Usage), il ne dit pas qu’il en sortit de la substance du cerveau, ains qu’il fust blessé en l’un des ventricules gemeaux. Et avec ce on pensoit qu’il fust guery par le vouloir de Dieu. Car si tous deux eussent esté blessez, il n’eust gueres duré, comme il dit: et de ce il conclud l’utilite de la duplication de quelques instruments, ainsi qu’a esté dit cy dessus en l’anatomie. Et tant de cettui-cy, que de ceux-là, la guerison rare est fort rarement faite, comme il est dit au commentaire dessus allegué.

There are many places in Guy’s treatise where his description of a surgical condition, or of the proper measures to adopt for the relief or cure of such condition, would doubtless prove interesting to our readers, and would in any event aid them materially in forming an independent judgment as to the man’s character in general and also with regard to his qualifications as a surgeon. But all of these descriptions, when rendered in their entirety into English, occupy much space, and for this reason I shall be obliged to furnish here merely a few extracts from some of the more interesting portions of the text.

In the chapter which Guy devotes to wounds of nerves, cords and ligaments--all of which structures were classed by him, as well as by Galen, as belonging to the category of nerves--this author divides them into punctured and incised wounds, bruises and concussions. As to the first variety he says that they may be divided into closed punctured and open punctured wounds.

In the incised wounds two kinds may be distinguished: those in which the nerve is incised in the direction of its length and those in which the cut is made across the fibres. A further subdivision is practicable, viz., into wounds accompanied by more or less destruction of the substance of the nerve or its envelopes, and those in which such loss has not occurred. Among other differences worthy of mention are these: pain, spasmodic phenomena, and abscess formation are present in certain cases and absent in others. From all of which symptoms useful indications as to the treatment needed may be deduced.

In the section relating to the treatment of such traumatic affections of nerves, Guy makes the remark that the measures called for are, for the most part, the same as those required for wounds involving simply the fleshy parts of the body.

The element of pain, however, is one of the factors which distinguish wounds of a nerve from ordinary flesh wounds, and it may necessitate some slight modification of the treatment. Aside from this, one of the first things that should be done is to remove from the wound all foreign substances; after which the edges of the cavity should be brought together and held firmly in this position by appropriate means. Last of all, care should be taken to protect the parts. These are the general principles which are to guide the surgeon’s action. As to the special details, they must depend upon the different conditions presented by each individual case. Thus, for example, if we are dealing with a punctured wound of a nerve, there will be no edges of an excavation to bring together.

If the object which produced the puncture is still lodged in the tissues, it must, as a matter of course, be withdrawn. After which, the further measures to be adopted may be enumerated under the following heads: careful regulation of the manner of living; removal from the system of all material which--attracted to the wounded part by the pain--might there cause irritation or inflammation; and protection of the body against any harm that might come to it through the occurrence of convulsions. These three measures are indicated for all wounds of nerves. But, in the case of a punctured wound, still other procedures should be employed, as will be discussed under a fourth head.

The four heads mentioned by Guy may be briefly stated in the following terms: I. The patient should be put upon a light and very simple diet; and, in addition, he should be given a bed that is soft and humid (“humidus et mollis”). His surroundings should be kept quiet, and nothing should be permitted to disturb his peace of mind. II. To protect his tissues from the injurious influence of any superfluous matters of an irritating nature that may be circulating in the blood (i.e., cacochyme), a vein on the opposite side of the body should be opened and a certain amount of this fluid withdrawn. In certain cases, furthermore, it may be well, in addition, to administer an aperient remedy. III. If convulsions develop, the head, neck and the entire back should be anointed with well-warmed linseed oil or common (? olive) oil, as recommended by Galen. IV. Special measures should be adopted for providing a free outlet for any pus that may form in the deeper parts of the wound; and here again Galen recommends for this purpose the employment of one of several medicinal preparations which he enumerates. “But the more certain course,” Guy adds, “is to make an opening in the skin either with the razor or with the actual cautery (which latter, according to Henri de Mondeville, is the better plan of the two), and then to apply some subtle drying remedy which possesses the power to penetrate into the deepest recesses of the injured nerve--for example, savin oil.” (Guy has a good deal more to say on the subject of wounds of nerves, but the few extracts given above should suffice.)

It is now a well-known fact that Guy de Chauliac was in the habit of treating fractures of the thigh by the employment of the weight and pulley as means of keeping up a continuing extension of the damaged limb. As his description of the method in question is very brief, it may not seem out of place to reproduce it here. Translated into English it reads as follows:--

As to the plan which I employ, it is this: After making fast to the fractured thigh splints which extend down as far as the feet, I reinforce the support which they give, either by placing the limb in a box or by applying to its sides bundles of straw (appuyements). [These are shown in the left-hand lower corner of Fig. 12.] I then attach to the foot a mass of lead as a weight, taking care to pass the cord which supports the lead over a small pulley in such a manner that it shall pull upon the leg in a longitudinal direction. And if it then be found that there is not complete equality between the fractured limb and its fellow as regards length, the discrepancy may be corrected by gently pulling upon the former. Every nine days the limb should be cautiously handled; and at the end of about fifty days it will be found that firm union has taken place.

One more remark seems to be called for in reference to the fact that Guy de Chauliac, although he was avowedly a surgeon, managed to win as great a reputation and as high a social position as was possessed by any physician of that period. The medical practitioner, it will be remembered, held himself, during the Middle Ages, and was universally held, to be a much higher type of man than the surgeon. The relative standing of the two is well shown in the accompanying sketch (Fig. 13), in which all the details (attitude, head gear, gown, etc.) have evidently been carefully studied by the artist. Guy, however, through the sheer force of his character, and also probably because he was known to have won the highest medical honor (the grade of “Master of Medicine”) which it was in the power of the university to confer, pushed his way to the top, and held, for a period of twenty years, the position of private physician to three Popes in succession--Clement VI., Innocent VI. and Urban V. In other words, the prevailing prejudices and jealousies were not sufficiently powerful to block the triumphant career of this man of solid merit and high character.

As it appeared in the sixteenth century.

(From Chirurgie de Pierre Franco, edited by E. Nicaise, Paris, 1895.)]

The State of Medicine and Surgery in Countries Other than Italy and France During the Later Portion of the Middle Ages.--From the account given by Neuburger it appears that the seeds planted by the famous teachers of medicine and surgery in Italy and France during the thirteenth and fourteenth centuries had begun to take root in England and in the Low Countries to the north of France, and were in fact already producing some good fruit in those lands. Thus, for example, there have been handed down to our time the names of four physicians who attained a certain degree of eminence in England during the thirteenth and fourteenth centuries--Gilbertus Anglicus, John of Gaddesden, John Mirfeld and John Arderne.

Gilbertus Anglicus, who was the first English medical writer to secure a certain degree of celebrity among the physicians of continental Europe, wrote a compendium of medicine that was commonly called the “Laurea anglica.” The book contains, along with some good original observations and the records of his own experience, not a few wearisome theoretical discussions; and at the same time it reveals the fact that the author was inclined to favor remedial measures of a superstitious nature. In the last chapter of his compendium, however, he makes the very practical suggestion that distillation may be resorted to when one desires to purify water that is contaminated. Gilbertus, after obtaining his preliminary training in England in the early part of the thirteenth century, visited some of the leading schools on the continent, among others those of Salerno and Montpellier, in which latter city he appears to have practiced medicine for a certain length of time.

John of Gaddesden, who is also spoken of as Johannes Anglicus, was born about 1280 A. D. and died in 1361. He was therefore a contemporary of Guy de Chauliac. He is said to have been a Fellow of Merton College, Oxford, and to have held the positions of Prebendary of St. Paul’s, London, and of private physician to the royal family. He was also the author of a medical treatise which was generally known by the title, “Rosa Anglica” (first printed in 1492). Neuburger speaks of this book as being an imitation of Gourdon’s “Lilium Medicinae,” but of a somewhat inferior grade, and he quotes two or three passages which show that medicine was in a very low stage of development in England at the beginning of the fourteenth century. Gaddesden, for example, advises his confrères to adopt the rule of always securing their honorarium before they undertake the treatment of a sick person. In another part of the book he states that he treated one of the sons of Edward II. for small-pox and secured excellent results, not merely as regards the perfect restoration of his health, but also as regards the complete prevention of any pitting of his face. He attributes this success to the fact that he enveloped the patient in a red cloth and took pains to have every object in the vicinity of the bed draped in red.

John Mirfeld, who lived during the second half of the fourteenth century, completed his medical studies in Oxford, then entered the Monastery of St. Bartholomew’s in London, and devoted himself thenceforward to work in connection with the hospital belonging to that institution. Among the books which he wrote there are a few that deal with matters of interest to the physician. Such, for example, are a glossary which bears the title “Synonyma Bartholomaei,” a work called the “Breviarium Bartholomaei,” and a shorter treatise on prognosis--the “Speculum.” None of these, however, possesses any special importance.

Reproduction of a miniature at the head of Guy de Chauliac’s La Grande Chirurgie, edited by E. Nicaise, Paris, 1890.]

John Arderne was born in England 1307 A. D., probably obtained his medical training in Montpellier, accompanied the English Army to France in the character of a “Sergeant-Surgion,” and was present at the battle of Crécy (1346 A. D.). During the succeeding twenty-four years he practiced medicine in Wiltshire and Newark, and then settled for the remainder of his life in London. Although his practice included both internal diseases and those which required surgical treatment, the great reputation which he acquired was based chiefly upon his success in the latter field. Most of his writings, it appears, are still in the form of manuscript. They deal chiefly with surgery and are accompanied by drawings of the instruments which he employed. They possess one feature which distinguishes them from the majority of medical writings of the Middle Ages, viz., they abound in reports of cases observed and treated by the author; and, furthermore, the methods of treatment which he recommends are in most instances rational and of a relatively simple nature. The only one of Arderne’s treatises which has been printed is that relating to fistula in ano. It bears the title, “John Arderne--Treatises of Fistula in Ano, Haemorrhoids, and Clysters; from an early fifteenth-century manuscript translation,” and is edited by D’Arcy Power, Early English Text Society, Original Series, 139; London and Oxford, 1910. Arderne, we are told by Neuburger, puts forward two claims: 1, that he succeeded in curing a large number of cases of anal fistula, in proof of which he gives the names of the persons upon whom he operated successfully, many of whom are high up in the social scale; and, 2, that no other surgeon of whom he has any knowledge, either in England or on the continent of Europe, is able to cure the disease.

The three English physicians of whom I have here given very brief accounts, can scarcely be said to compare favorably with those men who, during the same period, brought fame to the medical schools of Bologna, Padua, Montpellier and Paris; and this fact suggests the question, Do these men really represent the best type of physicians who lived in England during the fourteenth century? The great English poet Chaucer, in his “Canterbury Tales” (written at about the same period of time), furnishes us with a portrait of a man who appears to have been well informed with regard to the earlier Greek and Arabian medical authorities as well as with the leading physicians of his own time, and who in addition was clever both in ascertaining the causes and nature of his patients’ maladies and in prescribing for them the proper remedies. As this physician’s name is not mentioned, we cannot be sure that he was not one of the three to whom reference has just been made. By the description given by the poet, who probably was personally acquainted with the man whose portrait he draws, one is tempted to believe that he was a physician of a higher type than any one of the three named above. Chaucer’s account reads as follows:--

There was also a Doctor of Phisik, In al this worlde was ther non him like To speke of phisik and of surgerye; For he was grounded in astronomye. He kepte his pacient wondrously and we In all houres by his magik natural. Well coude he gesse the ascending of the star Wherein his patientes fortunes settled were. He knew the cause of every maladye, Were it of cold, or hete, or moyst, or drye, And where they engendered, and of what humour; He was a very parfit practisour. The cause once knowen and his right mesúre, Anon he gaf the syke man his cure. Ful redy hadde he his apothecaries, To sende him drugges, and electuaries, For eche of them made the other for to wynne; Their friendshipe was not newe to begynne. Wel knew he the old Esculapius, And Discorides, and eek Rufus; Old Ypocras, Haly and Galien; Serapyon, Razis, and Avycen; Averrois, Damascen, and Constantyn; Bernard, and Gatisden, and Gilbertyn. Of his diete mesuráble was he, For it was of no superfluitee, But of gret norishing and digestible.

With the names of the three English physicians mentioned above, there should be associated that of Jehan Yperman, who was born in Ypern, Flanders, during the latter half of the thirteenth century, obtained his professional training in Paris under Lanfranchi, and then, in 1303 or 1304, accepted the position of Physician to the Hospital of Belle, a small Flemish town. In 1318 he settled permanently in Ypern, his native city, and in a comparatively short time won completely the confidence and esteem of his fellow townsmen through his attentiveness to their wants when they were ill and through the great skill which he manifested in his work as a surgeon. He died 1329 A. D.

Yperman’s writings deal with both medical and surgical topics. Of those which have been translated from the Latin into French are: “La chirurgie de maitre J. Yperman,” Anvers, 1863; “Traité de médecine pratique de maitre J. Yperman,” Anvers, 1863; and “Traité de médecine pratique de maitre J. Yperman,” Anvers, 1867. A perusal of these works, says Neuburger, easily convinces one that Yperman was not only a skilful and clever surgeon, but also a physician of independent judgment and wide experience.

Revival of the Practice of Dissecting Human Bodies.--It was in Italy that dissecting was carried on during the fourteenth century more vigorously than elsewhere in Europe. At first the only persons who made such investigations for scientific purposes were individual physicians or groups of physicians; and, in addition, they were obliged to carry on the work in a secret manner--that is, by stealing from recently dug graves the corpses which were necessary for such studies. It is related, for example, that in 1319 one of the teachers in the Medical School at Bologna and four of his pupils were brought before the Court of Law under the charge of having clandestinely disinterred, for purposes of dissection, the body of a man who had been hung for some crime. At first the authorities merely winked at such transgressions, but at the same time they made no attempts to have the law against dissecting annulled or at least modified. Then, at a somewhat later period, the conviction became general among the intelligent members of the community that, unless work of this nature were officially sanctioned, no real advance in the knowledge of human anatomy could be made, and--what was probably of even greater importance in their estimation--that Bologna might at the same time lose a good deal of its superiority over its rivals as a centre of learning; and accordingly it was found practicable to grant the desired sanction with many modifying restrictions attached. Then, with the further lapse of time, other medical schools fell into line and secured from the authorities similar privileges for their teachers and pupils. Thus, in 1368, the Senate of Venice authorized the medical school of that city to make a public dissection of a human body once every year; and, eight years later, the University of Montpellier acquired the same privilege. In 1391 John I. of Spain was equally generous in his treatment of the Medical School at Lerida. After the opening of the fifteenth century no further difficulties of a serious nature were experienced by the teachers of anatomy in procuring at least some material for dissecting purposes, and with each succeeding year such facilities steadily increased. Unfortunately, however, there did not follow a corresponding increase in the knowledge of human anatomy. As a matter of fact, it was not until during the sixteenth century that any really valuable work was accomplished in this branch of medicine. Guy de Chauliac, in the first chapter of his treatise (“La Grande Chirurgie”), gives the following description of the manner in which Bertrucius taught anatomy in Bologna at the beginning of the fourteenth century, and from this account it is easy to understand why the additions to our stock of information in this department of medicine were so few and so unimportant during this long period. The so-called dissecting, it clearly appears, was in reality a not very profitable combination of purely anatomical work of a primitive character and a search for evidences of pathological changes. The clinical history of the individual whose body was undergoing examination does not seem to have played any part in the investigation. Here is De Chauliac’s account:--

After placing the dead body on a bench, my master proceeded with his instructions, devoting thereto four separate sittings. At the first of these he passed in review those parts or organs which are concerned in nutrition; his reason for considering them first being that they are the earliest to undergo decomposition. At the second sitting he devoted himself to the spiritual organs of the body; at the third, to the animal parts; and at the fourth, to the extremities. Following the example furnished by Galen in his commentary on the book entitled “The Sects,” he maintained that there were nine things which should be taken into consideration when one examines the different parts of the body, to wit: their situation; their nature, color, bulk, number, and shape; their connections or relations; their actions and their utility; and the diseases which may affect them. Conducted in this manner the study of anatomy, he maintained, may prove helpful to the physician in recognizing diseases, in making prognoses, and in selecting a suitable plan for treatment.

Puschmann, quoting from Hyrtl, says that when Professor Galeazzo di Santa Sofia, who had been called from Padua to Vienna to fill the Chair of Anatomy in the medical school of that city, made his first public dissection of a human body (1404 A. D.) in the Bürgerspital, the sittings covered a period of eight days; at the end of which time he collected as much money as he could from those who had attended the course, and turned it over to the treasurer of the Faculty. Then followed a period of twelve years during which not a single public dissection of a human body was made in Vienna. In 1440 the Faculty were greatly rejoiced over the prospect of receiving from the authorities the body of a criminal who was to be hung on a certain day; but, when the time arrived and the body had actually been delivered to them, they were grievously disappointed by the sudden coming to life of the supposed corpse. Instead of dissecting him for the benefit of science, the doctors bestirred themselves in the man’s behalf, obtained a pardon in due form, and sent him back to his home in Bavaria under the escort of the college janitor. Not very long afterward, however, he committed a fresh crime, and this time was effectively hung. History does not state whether the dissection then came off, or not.

The Medical Faculty of the University of Tübingen established the rule in 1497 that one human body should be publicly dissected every three or four years; it being understood that during the progress of the dissection the professor should read aloud to the class appropriate portions of Mondino’s treatise on anatomy. The instruction in this department of medical science was of the same general character in all the other universities of Germany at that period. Anatomical drawings, of a very crude type, were employed as substitutes for actual dissection.

At Padua, in Northern Italy, the science of medicine had already before the end of the first half of the fifteenth century made a decided advance, in proof of which several circumstances may be mentioned. In the first place, the importance of the study of anatomy had by this time become so generally recognized that no special difficulty appears to have been encountered in securing the erection, in 1446, of an anatomical theatre; and during this same period several physicians connected with the medical school acquired considerable celebrity by their publication of important treatises on topics belonging to the domain of general pathology and therapeutics, and by the wide influence which they exerted as teachers. Among the number of those who helped in these ways to spread the fame of the Medical School of Padua may be mentioned Hugo Benzi, Antonio Cermisone, Giovanni Savonarola and Bartolommeo Montagnana.

Hugo Benzi (or Hugo of Siena) taught philosophy as well as medicine in different institutions of learning--at Pavia, Piacenza, Florence, Bologna, Parma, Padua and Perugia. His death probably occurred at Ferrara about the year 1439. In addition to commentaries on Hippocrates, Galen and Avicenna, he wrote several practical works (“Consilia”) on such topics as periodical insanity, stomachic vertigo, naso-pharyngeal polypi, epilepsy, lachrymal fistula, etc.

Antonio Cermisone was a native of Padua, became a teacher of medicine first in Pavia and afterward in Padua, wrote several useful treatises about various diseases, and finally died about 1441.

Giovanni Michele Savonarola--the grandfather of the celebrated Girolamo Savonarola, who was burned at the stake for heresy 1498 A. D.--held the Chair of Medicine in Padua from about 1390 to 1462, and also subsequently for a certain length of time in Ferrara. He was the author of a number of treatises on practical medical topics--such, for example, as fevers (first published in Venice in 1498), the art of preparing simple and compound aqua vitae (Basel, 1597), an introduction to the practice of medicine (1553), the baths of Italy and of the rest of the world (Venice, 1592), the different kinds of pulse, etc. (Venice, 1497)--and he also wrote a large work covering the entire field of medicine and modeled on the pattern of Avicenna’s “Canon.” The book is divided into six parts, each of which is preceded by an introduction that is devoted to the anatomico-physiological bearings of that particular part; and here, in addition, there are to be found scattered throughout the text references to surgical procedures. Among the references of this character the following deserve to be mentioned as worthy of some notice: the description of a speculum for use in operations upon the interior of the nose; a reference to direct laryngoscopy; the description of an instrument closely resembling the well-known syringotome; the treatment of curvature of the spine by mechanical means, etc. The book also reveals the fact that, already at this period of the history of medicine (the middle of the fifteenth century), physicians were beginning to take a more active part than they had previously done in the management of confinement cases, which as a rule were left entirely to the care of midwives. The records also show that medical men were interesting themselves more and more, as time went on, in sanitary science as applied to municipal affairs. In most communities the need for such was indeed most urgent at that time. The reforms of this nature were pushed with special vigor in those parts of Italy which were governed by that enlightened ruler of the Hohenstaufen family, Frederic II., King of Sicily and Roman Emperor. The cultivation of personal hygiene was also pursued very systematically during the later Middle Ages, the Regimen Salernitanum serving as the guide in such matters.

Taken all together the conditions in the physician’s world were in anything but a promising state toward the end of the fifteenth century; but the dawn of better times, of modern medicine, was near at hand, and already signs of its approach were beginning to be recognizable in different parts of Western Europe.