The growth of medicine from the earliest times to about 1800

by Albert H. Buck

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.

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.