After Salicet's lifetime the focus of interest in surgery changes from Italy to France, and what is still more complimentary to William, it is through a favorite disciple of his that the change takes place. This was Lanfranchi, or Lanfranco, sometimes spoken of as Alanfrancus, who practised as physician and surgeon in Milan until banished from there by Matteo Visconti about 1290. He then went to Lyons, where in the course of his practice he attracted so much attention that he was offered the opportunity to teach surgery in Paris. He attracted what Gurlt calls an almost incredible number of scholars to his lessons in Paris, and by hundreds they accompanied him to the bedside of his patients and attended his operations. The dean of the medical faculty, Jean de Passavant, urged him to write a text-book of surgery, not only for the benefit of his students at Paris but for the sake of the prestige which this would confer on the medical school. Deans still urge the same reasons for writing. Lanfranc completed his surgery, called "Chirurgia Magna," in 1296, and dedicated it to Philippe le Bel, the then reigning French King. Ten years later he died, but in the meantime he had transferred Italian prestige in surgery from Italy to France and laid the foundations in Paris of a thoroughly scientific as well as a practical surgery, though this department of the medical school had been in a sadly backward state when he came.

In the second chapter of this text-book, the first containing the definition of surgery and general introduction, Lanfranc describes the qualities that in his opinion a surgeon should possess. He says, "It is necessary that a surgeon should have a temperate and moderate disposition. That he should have well-formed hands, long slender fingers, a strong body, not inclined to tremble and with all his members trained to the capable fulfilment of the wishes of his mind. He should be of deep intelligence and of a simple, humble, brave, but not audacious disposition. He should be well grounded in natural science, and should know not only medicine but every part of philosophy; should know logic well, so as to be able to understand what is written, to talk properly, and to support what he has to say by good reasons." He suggests that it would be well for the surgeon to have spent some time teaching grammar and dialectics and rhetoric, especially if he is to teach others in surgery, for this practice will add greatly to his teaching power. Some of his expressions might well be repeated to young surgeons in the modern time. "The surgeon should not love difficult cases and should not allow himself to be tempted to undertake those that are desperate. He should help the poor as far as he can, but he should not hesitate to ask for good fees from the rich."

Many generations since Lanfranc's time have used the word nerves for tendons. Lanfranc, however, made no such mistake. He says that the wounds of nerves, since the nerve is an instrument of sense and motion, are, on account of the greater sensitiveness which these structures possess, likely to involve much pain. Wounds along the length of the nerves are less dangerous than those across them. When a nerve is completely divided by a cross wound Lanfranc is of the opinion, though Theodoric and some others are opposed to it, that the nerve ends should be stitched together. He says that this suture insures the redintegration of the nerve much better. After this operation the restoration of the usefulness of the member is more complete and assured.

His description of the treatment of the bite of a rabid dog is interesting. A large cupping glass should be applied over the wound so as to draw out as much blood as possible. After this the wound should be dilated and thoroughly cauterized to its depths with a hot iron. It should then be covered with various substances that were supposed to draw, in order as far as possible to remove the poison. His description of how one may recognize a rabid animal is rather striking in the light of our present knowledge, for he seems to have realized that the main diagnostic element is a change in the disposition of the animal, but above all a definite tendency to lack playfulness. Lanfranc had seen a number of cases of true rabies, and describes and suggests treatment for them, though evidently without very much confidence in the success of the treatment.

The treatment of snake bites and the bites of other poisonous animals was supposed to follow the principles laid down for the bite of a mad dog, especially as regards the encouragement of free bleeding and the use of the cautery.

Lanfranc has many other expressions that one is tempted to quote, because they show a thinking surgeon of the old time, anticipating many supposedly modern ideas and conclusions. He is a particular favorite of Gurlt's, who has more than twenty-five large octavo, closely printed pages with regard to him. There is scarcely any development in our modern surgery that Lanfranc has not at least a hint of, certainly nothing in the surgery of a generation ago that does not find a mention in his book. On most subjects he has practical observations from his own experience to add to what was in surgical literature before his time. He quotes altogether more than a score of writers on surgery who had preceded him and evidently was thoroughly familiar with general surgical literature. There is scarcely an important surgical topic on which Gurlt does not find some interesting and personal remarks made by Lanfranc. All that we can do here is refer those who are interested in Lanfranc to his own works or Gurlt.

MONDEVILLE

The next of the important surgeons who were to bring such distinction to French surgery for five centuries was Henri de Mondeville. Writers usually quote him as Henricus. His latter name is only the place of his birth, which was probably not far from Caen in Normandy. It is spelled in so many different ways, however, by different writers that it is well to realize that almost anything that looks like Mondeville probably refers to him. Such variants as Mundeville, Hermondaville, Amondaville, Amundaville, Amandaville, Mandeville, Armandaville, Armendaville, Amandavilla occur. We owe a large amount of our information with regard to him to Professor Pagel, who issued the first edition of his book ever published (Berlin, 1892). It may seem surprising that Mondeville's work should have been left thus long without publication, but unfortunately he did not live long enough to finish it. He was one of the victims that tuberculosis claimed among physicians in the midst of their work. Though there are a great number of manuscript copies of his book, somehow Renaissance interest in it in its incompleted state was never aroused sufficiently to bring about a printed edition. Certainly it was not because of any lack of interest on the part of his contemporaries or any lack of significance in the work itself, for its printing has been one of the surprises afforded us in the modern time as showing how thoroughly a great writer on surgery did his work at the beginning of the fourteenth century. Gurlt, in his "History of Surgery," has given over forty pages, much of it small type, with regard to Mondeville, because of the special interest there is in his writing.[20]

His life is of particular interest for other reasons besides his subsequent success as a surgeon. He was another of the university men of this time who wandered far for opportunities in education. Though born in the north of France and receiving his preliminary education there, he made his medical studies towards the end of the thirteenth century under Theodoric in Italy. Afterwards he studied medicine in Montpellier and surgery in Paris. Later he gave at least one course of lectures at Montpellier himself and a series of lectures in Paris, attracting to both universities during his professorship a crowd of students from every part of Europe. One of his teachers at Paris had been his compatriot, Jean Pitard, the surgeon of Philippe le Bel, of whom he speaks as "most skilful and expert in the art of surgery," and it was doubtless to Pitard's friendship that he owed his appointment as one of the four surgeons and three physicians who accompanied the King into Flanders.

Besides his lectures, Mondeville had a large consultant practice and also had to accompany the King on his campaigns. This made it extremely difficult for him to keep continuously at the writing of his book. It was delayed in spite of his good intentions, and we have the picture that is so familiar in the modern time of a busy man trying to steal or make time for his writing. Unfortunately, in addition to other obstacles, Mondeville showed probably before he was forty the first symptoms of a serious pulmonary disease, presumably tuberculosis. He bravely fought it and went on with his work. As his end approached he sketched in lightly what he had hoped to treat much more formally, and then turned to what was to have been the last chapter of his book, the Antidotarium or suggestions of practical remedies against diseases of various kinds because his students and physician friends were urging him to complete this portion for them. We of the modern time are much less interested in that than we would have been in some of the portions of the work that Mondeville neglected in order to provide therapeutic hints for his disciples. But then the students and young physicians have always clamored for the practical—which so far at least in medical history has always proved of only passing interest.