Among the men who, during the thirteenth century, exerted more or less influence upon the growth of medical knowledge there are three who deserve to receive some consideration at our hands. They were not physicians, but yet some of their writings deal with topics which are closely related to the science of medicine. They are: Albert von Bollstädt, a German who is generally known as Albertus Magnus, one of the greatest scholastic philosophers of the Middle Ages; Vincent of Beauvais (Vincentius Bellovacensis), a French Dominican monk, who was reader to Louis IX., and who compiled a general encyclopaedia which brought him great fame at that period; and Roger Bacon, an Englishman who, by reason of the extraordinary extent of his knowledge and his remarkable powers of observation, was given the name of “Doctor mirabilis.”

Albertus Magnus.—Albertus Magnus was born at Lauingen, Swabia, in 1193 A. D., obtained his education in Italy (at the University of Padua, during the latter part of his stay), joined the Order of the Dominicans on arriving at the age of thirty, and afterwards, throughout his long life, devoted himself largely to teaching, particularly at Paris and Cologne. He was a prolific writer and his works, particularly those which treat of topics belonging to the domain of natural history, were greatly appreciated. The effect, however, which they produced upon a certain class of readers was to persuade them that he was a great magician. The chief distinction of his writings lies in the fact that they contain a large number of original observations which he made during the course of his journeys afoot through Germany in the character of Provincial of the Dominican Order. This habit of exercising entire independence in the use of his reasoning powers was something quite rare in those days. His observations were directed chiefly to matters belonging to the domains of zoölogy, botany, climatology, mineralogy, chemistry and physics. The following significant advice, says Neuburger, is attributed to him: “As regards the doctrines which relate to questions of belief and of morality, it is the part of wisdom to attach greater authority to Saint Augustine than to the philosophers; in matters belonging to the domain of medicine put your chief trust in Galen and in Hippocrates; in natural history, however, your best guide is Aristotle.” Neuburger adds that, throughout the writings of Albertus Magnus, there appear interesting statements relating to anatomy, physiology, psychology, and the plants and minerals which may be used for remedial purposes.

An edition of the writings of Albertus Magnus (21 folio volumes) was published in Lyons by Petrus Jamy in 1651. The work was republished in Paris in 1892 and following years.

Vincent of Beauvais.—Vincent of Beauvais, France, a Dominican monk who lived during the first half of the thirteenth century and was the tutor of Louis the Ninth’s children, devoted the major part of his time to literary work. He wrote many theological treatises and also edited a large encyclopaedia in which information is furnished regarding everything that was known at that time. Several hundred authors aided him in compiling this work, which is entitled “Speculum Majus.” It is arranged in three parts, one of which (“Speculum Naturale”) consists of 33 books that are divided into 3740 chapters; and quite a number of the divisions are devoted to topics relating to medicine. The authors, from whose writings this medical information has been abstracted, are Hippocrates, Aristotle, Dioscorides, Haly Abbas, Rhazes, Avicenna and several others—not to mention the Church Fathers and other encyclopaedic writers connected with the Church. The first printed edition of this great work appeared toward the end of the fifteenth century (1473–1475 A. D.); the last, or one of the last, in 1624. Lack of space will not permit me to give any details concerning the works of a somewhat similar character which were prepared, about the same time, by the English Franciscan monk Bartholomaeus of Glanvilla (1260); by the Dominican, Thomas of Cantimpré (1204–1280 A. D.), a pupil of Albertus Magnus; and by others.

Roger Bacon.—Roger Bacon was born about 1210 A. D. in Ilchester, Somersetshire, England, and received his early training at Oxford. When he was thirty years of age he went to Paris and, after devoting himself assiduously for seven years to the study of various branches of learning, he received the Doctor’s degree (1247). The wish to acquire a thorough knowledge of whatever subject he undertook to study constituted a prominent feature of his character. He was fond of languages, but he had an even greater love for mathematics, particularly in connection with astronomy, and for experimental work in the department of chemistry. It is said that he expended a large sum of money (£2000) upon these chemical investigations. He left Paris in 1250, returned to England, and not long afterward joined the Order of the Franciscans. Robert Grossetête, Bishop of Lincoln, and the Franciscan monk Adam of Marisco—two men whom Neuburger describes as theologians of a very liberal type—exercised a strong influence upon Bacon at this period of his life. They confirmed him in the belief that familiarity with the learned languages was an acquisition greatly to be prized, and at the same time they gave him every encouragement to pursue his researches in mathematics and in natural history. For a certain length of time he was an instructor at Oxford, but his views with regard to ecclesiastic and moral questions and the discoveries which he made in physics (especially in optics) were beyond the comprehension of his contemporaries, who did not hesitate to pronounce them works of the Devil and to subject Bacon to all sorts of punishments and deprivations. Fortunately for him and for the cause of science the newly elected Pope, Clement IV. (1266), came to his rescue in those dark days and granted him—under the promise of absolute secrecy—permission to continue his researches without hindrance and to perfect the plans which he had in mind for reforms of different kinds. I cannot follow this pioneer of scientific research work, this man who was several centuries ahead of the time in which he lived, through all the vicissitudes of his interesting and extraordinarily fruitful life; I may simply add that his death occurred about the year 1294; that he left behind him many important treatises, only a small portion of which have thus far been published,[58] and that from these alone one is justified in classing Roger Bacon as one of the greatest thinkers whom history has recorded. So far as is now known, he wrote very little concerning medicine, and—strange to say—he seems to have attached considerable importance to astrology; indeed, he went so far as to blame the physicians of his day for their ignorance regarding this science, “as a result of which they neglect the best part of medicine.” In strange contrast with these views, which to-day we characterize as foolishness, is Bacon’s famous dictum: “Experiment is a firmer and more trustworthy basis of knowledge than argument”—a maxim which is the guiding principle of modern medicine.

The Medical School of Bologna.—The Medical School of Bologna first began to assume a certain degree of prominence in the early part of the thirteenth century, under the teaching of Thaddeus Alderotti—also frequently called Thaddeus of Florence.

Thaddeus Alderotti.—Thaddeus Alderotti, who was born at Florence, Italy, 1223 A. D., of humble parentage, began the study of philosophy and medicine at Bologna only after he had reached manhood; but he was such an earnest student and made such good use of his opportunities that in 1260 he was chosen to serve as one of the teachers in the school. Throughout a period of many years he filled the office so acceptably that his colleagues bestowed upon him the name of “Master of Physicians.” Before this time arrived, however, his lack of funds was sorely felt, for he was obliged, in order to support himself, to offer consecrated wax candles for sale at the entrance of the church. He is reported to have been not merely a most learned physician, but also a very successful practitioner. He was called into consultation from all parts of the country, so highly was his opinion valued by other physicians; and thus in due time he accumulated a large fortune. His charges were by no means small. It is related, for example, that Pope Honorius IV. sent for him to come to Rome, and, after the treatment was completed, paid him a fee of 10,000 gold pieces[59]—but not until after he had expressed surprise that Thaddeus should have charged as much as 100 gold pieces per day for his services. To this demurrer on the part of the Pope, Thaddeus replied that the petty princes and even the simple nobles made no objection to paying him 50 or more gold pieces per day. It is scarcely necessary to add that the Holy Father did not wish to be outdone by his inferiors.

Alderotti died 1303 A. D.

Among the writings of Thaddeus Alderotti which have come down to our time there are to be found a number of autobiographical references which are not without interest. In one place, for example, he mentions the fact that he occasionally walks in his sleep, and then proceeds (in Latin) to discuss the phenomenon of sleep-walking as observed in his own case. I give here a free translation of the text printed in Neuburger’s History:—

Of the four medical schools to which a brief reference was made on a preceding page, that of Bologna was probably the first to attain a certain degree of celebrity; and it owed this distinction very largely to the work done by men who were primarily surgeons, viz.: Hugo of Lucca; Theodoric, Hugo’s son; William of Saliceto; and possibly, to a very slight extent, Roland of Parma, who spent only a part of his professional life in Bologna. But there was one other who, while he was not a surgeon, yet contributed very greatly to the fame of the Bologna school and at the same time to the real advance in surgical knowledge which characterized the work of the men whose names have just been mentioned—viz., Mondino. These men, especially Mondino, cultivated the study of anatomy much more earnestly than their rivals at Salerno had ever done, and the surgical methods which they adopted were of a more scientific character than those practiced by Roger. In the treatment of wounds, for example, instead of striving to bring about healing by the application of remedies which stimulate suppuration, they favored the dry method; in which practice they were justified not only by their own experience but also by Galen’s teaching: “A dry state of the wound approaches more nearly to what may be considered the normal condition, whereas a moist state is surely unhealthy.” (Methodi medend., IV., 5.) As an offset to the latter authority the Salerno surgeons quoted that particular aphorism of Hippocrates (V., 67) which reads: “Laxa bona, cruda vero mala.”—almost the very opposite of Galen’s doctrine. Then again, the Bologna surgeons effected improvements in other directions: They materially restricted the use of the red-hot cautery iron, and they cast aside as useless many of the complicated apparatuses which had previously been employed in the treatment of fractures and dislocations. It is evident from these facts that the Bologna surgeons were not, as were most of the physicians of the twelfth and thirteenth centuries (Thaddeus of Florence perhaps excepted), slavish followers of the ancients or even of the more modern Arabs, but men who thought independently and who were not afraid to use their own powers of observation.

Hugo of Lucca.—Hugo Borgognoni, more commonly called Hugo of Lucca—was born in that city about the middle of the twelfth century, served as municipal physician to the city of Bologna, accompanied the Bolognese Crusaders on their expedition to Syria and Egypt, was present at the siege of Damietta in 1219 A. D., and died a short time before 1258, at the age of nearly one hundred. He acquired a great reputation as a surgeon and brought up several sons who followed in the same walk of life, among the number being Theodoric, who gained even greater celebrity than his father in the domain of surgery. As Hugo himself left no writings of any kind, we are largely dependent, for a knowledge of his achievements, on the treatises which his son Theodoric wrote. From this source we learn that Hugo recommended, for use in surgical operations, the employment of narcotizing sponges like those described on page 253, and was also an advocate of the plan of treating wounds by the dry method (compresses soaked in wine over which simple dressings were applied). In the treatment of empyema, of abscesses, of penetrating wounds of the chest, and of both complicated and simple wounds of the skull, he emphasized the wisdom of adopting simple measures, of interfering with the parts as little as possible, of abstaining from the use of the probe, and of observing strict cleanliness. In cases of fracture of a rib it was his practice to place the patient in a bath, and then, with fingers which had been thoroughly oiled, to attempt the replacement of the separated ends of the fractured bone. Neuburger regards Hugo of Lucca as the founder of the Bologna School of Surgery.

Theodoric of Lucca, known also as Bishop Theodoric, was born 1206 A. D. While still quite a young man he joined the recently established order of preachers, and not long afterward was appointed Almoner (Poenitentiarius)[60] to Pope Innocent IV. Eventually he became Bishop of Cervia, near Ravenna. By special permission of the Pope, he was able to complete the surgical training which he had received from his father, Hugo of Lucca; and thus, while he still held the office of Bishop, he practiced surgery to some extent in Bologna. In course of time his practice became very extensive and also very lucrative; as a result of which he was able to leave a large fortune to various charitable institutions. The first printed edition of his work on surgery appeared in Venice in 1498, and was followed by numerous later issues.

Theodoric, says Neuburger, was a most uncompromising advocate of the dry method of treating wounds. His (Theodoric’s) words are these: “For it is not necessary—as Roger and Roland have said, as most of their disciples teach, and as almost all modern surgeons practice—to favor the generation of pus in wounds. This doctrine is a very great error. To follow such teaching is simply to put an obstacle in the way of nature’s efforts, to prolong the diseased action, and to prohibit the agglutination and final consolidation of the wound.”[61]

In his enumeration of the different means that may be employed for arresting hemorrhage, Theodoric mentions cauterization, tamponading, the application of a ligature, and the complete division of the injured blood-vessel. He attached great importance to the proper feeding of the patient. In Book III., chapter 49, of his treatise on surgery, he gives minute instructions with regard to the proper manner of employing a salve made with quicksilver, and at the same time he mentions the fact that he observed a flow of saliva as one of the results of its use.

The expressions “healing by first intention” and “healing by second intention” are encountered for the first time in the writings of Brunus, a surgeon who practiced in the cities of Verona and Padua about the middle of the thirteenth century, and who was a vigorous advocate of the dry method of treating wounds. His two treatises (“Chirurgia magna” and “Chirurgia minor”) were printed in Venice in 1546. Neuburger says that although a large part of the text in these volumes consists of extracts from Galen, Avicenna, Hippocrates, Abulcasis and other authorities, there are to be found at the same time not a few observations of an original character.

William of Saliceto.—William of Saliceto (Guglielmo da Saliceto) is accorded by Neuburger the honor of being Bologna’s greatest surgeon—if not, indeed, the greatest surgeon of that period. He was born in the early part of the thirteenth century and spent a large portion of his professional life in Bologna, where he not only practiced medicine but also acted in the capacity of a teacher of this science. During the latter part of his career he lived in Verona, where he held the position of Municipal Physician and Attending Physician of the City Hospital. He died about the year 1280.

Saliceto’s work on surgery is of a thoroughly practical character and reveals the author to have been a born surgeon.[62] In addition to the “Cyrurgia,” which was first printed in Piacenza 1476 A. D., he wrote a treatise which bears the title “Summa conservationis et curationis” (printed first in Piacenza in 1475). The “Surgery” is divided into five books, preceded by a short chapter on general methods, etc. Book I. is devoted to affections of the cranium, eruptions on the head, eye diseases, ear diseases (snaring of ear polypi), nasal polypi, abscesses in the axilla, affections of the mammary gland, tumors in different parts of the body, venereal lesions in the groin, and a long list of other surgical maladies. Book II. describes wounds of all sorts, including those produced by arrows (with reports of cases), penetrating wounds of the chest and abdomen (with instructions about sewing both longitudinal and transverse wounds of the intestine), etc. Under the head of penetrating wounds of nerves (declared by the author to be very dangerous), Saliceto recommends enlargement of the wound, the application of oil, and the employment of opium or hyoscyamus to quiet the pain. Book III. treats the subject of fractures and dislocations in a most thorough manner. Mention is made of the crepitation noise heard in fractures (sonitus ossis fracti) and a warning is given not to apply the bandages too tightly and to be careful to change the dressings every three or four days. The instructions given with regard to the reduction of dislocations are said by Neuburger to be most sensible. 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.”[63] “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.

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[64] 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.[65] 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).[66] 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 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.

Part I. of the Chirurgia Parva mentions some of the characteristics which a surgeon should possess. He should, for example, have well-formed hands, with fingers that are long and slender; his body should be strong and firm in its movements; his hands and fingers should respond quickly to the workings of the mind; his mind should be of a subtle type; in character he should not be over-bold, but self-reliant and yet modest; he should have a good supply of common sense; he should be well-informed not only in medicine, but also in all the branches of philosophy; he should be a good logician; he should be familiar with the writings of medical authors; he should be virtuous and ethical; he should be trustworthy; he should not be avaricious nor envious; ... and, finally, he should be thoroughly familiar with all the diseases to which the human body is liable. In one place Lanfranchi refers to the fact that exposure to the air favors the production of pus in a wound. Among the methods which may be employed for arresting hemorrhage he mentions digital compression and ligaturing of the bleeding vessels. He recommends that a wounded individual should abstain from wine and from an over-nutritious diet. No attempt, he says, should be made to extirpate, with the knife or by means of the actual cautery, an ulcerated cancer, unless it appears probable that by such means complete destruction of the tumor may be effected. In traumatic tetanus dependent upon an injury of a tendon or nerve trunk he recommends complete division of the wounded structure.

Part II. is devoted to the consideration of wounds of the different parts of the body, taken in regular order from the head to the feet. The descriptions, in each instance, are preceded by an adequate account of the region affected. In his discussion of fractures of the skull he speaks of the diagnostic value of the rough and jarring sound perceived by the patient when the physician taps with a rod upon the injured skull; and he also states that an aid to diagnosis may be derived from the fact that a person whose skull is fractured experiences pain at the seat of the injury when somebody passes the ends of his finger-nails along a string which the patient holds suspended between his teeth.[67] According to Neuburger the description which Lanfranchi gives of the various symptoms observed in cases of fracture of the skull is admirable. In the section relating to the treatment of such fractures he warns against the tendency to resort too readily to the use of the trephine, and expresses the belief that this instrument should be employed only when the fractured bone is depressed or when there is evidence of irritation of the dura mater.

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.

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.

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:—