The growth of medicine from the earliest times to about 1800

by Albert H. Buck

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.

FIG. 9. THE OLDEST KNOWN PICTORIAL REPRESENTATION OF A FORMAL DISSECTION OF THE HUMAN BODY.

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.”