It was partly to show his gratitude for this welcome that he wrote his Ars Completa Totius Chirurgia, as is shown by the following extract from the preface, which also indicates the readiness with which he imparted his knowledge by clinical instruction: "Wherefore to the honour of God, of the most blessed and glorious Virgin, of the blessed confessor Ambrose and all the saints; out of the respect to Philip, the most potent and most Christian king; out of love to thee, dearest Bernard; urged by the prayers and precepts of the venerable masters of physic, and from fraternal affection to the intelligent students of medicine, who do me the honour of accompanying me, I attempt this great work for the common use, and especially for my son". Among the many things which attract our notice in this work his remarks on the treatment of hæmorrhage are perhaps the most interesting. Pressure is the first and best method. A child three years old fell down with a knife in its hand, and cut a vein in its neck. Lanfranc saved its life by holding his finger for more than an hour on the bleeding spot, while his assistant went to fetch a styptic application consisting of frankincense, aloes, white of egg and hare's fur. But he is acquainted with ligature and even torsion: "A boy at Milan, fifteen years old, was stabbed in the arm by another boy. The bleeding could not be stopped by the ordinary methods, so I judged it necessary to dissect out the vessel and tie it. The boy's mother, however, sent for a certain laicus,' who utterly reprobated my opinion, and promised to cure the patient. He stayed, and I departed; but the bleeding continued off and on till the patient was nearly dead. I was sent for but declined to go. Then a physician acquainted with the parents' friends rebuked them and the boy's mother for rejecting my advice for that of the 'idiota,' and told them it was the only way to save his life. A surgeon was asked if he could perform what I had recommended, and replied he could, so he incised the skin over the vessel, 'et illam contorsit in manibus, et ligavit cum filo'."

The link between Italian and French surgery is formed by Henry of Mondeville (or Hermondeville), the pupil of

HENRY OF MONDEVILLE.

213

Lanfranc and tutor of Guy of Chauliac. "Henry of Hermondeville (says the latter) began a very notable treatise in which he strove to make a marriage between Theodoric and Lanfranc, but his death prevented its completion," which was, perhaps, the reason that it remained unprinted till 1892, when it was published by Dr. Pagel of Berlin.

The treatise is notable in many respects, especially from the light it throws upon professional habits and customs, but we must confine ourselves for the present to a few short extracts: "It is very dangerous for a surgeon, who is not of repute, to operate in any way different to that in common use; as did Master J. Pitard and I, who first introduced Theodoric's method of dressing wounds into France, using it at Paris and in many military expeditions. And we were opposed by all, especially by the physicians, and suffered much abuse and many threats from the vulgar and our own colleagues, so that we should have given it up entirely, God knows, had not his serene highness Charles, Count of Valois, aided us, and others who had seen our cures performed in the armies; and the truth also aided us, for whose sake it is better to die than to adhere to a falsehood, for is not God the truth itself, and did not He die for it? But had we not been strong in the faith, and men of repute with the king and the princes, and some little learned (aliquantulum literati), we should have had to have given up that method." In questions of diagnosis the effect of any drugs the patient may have been taking must be considered: "If we find ardor urinæ followed by difficulty of micturition, we know that these occur after the application of cantharides; similarly, if a person who has used ointment for some infectious disorders (propter aliquas infectiones) gets inflammation of the mouth and corrosion. of the gums, we at once judge that it is due to mercury". It is the surgeon's duty to keep up his patient's spirits in every possible way, and he recommends that a musician (joculator) should be brought in "who may solace him by playing on a viol, or ten-stringed psaltery". "Or false letters may be written relating the decease of his enemies, or those

from whose death he expects advantage; if, for example, he is canon of one or more churches, he should be told that the bishop is dead and he is elected. His dreams, also, should be favourably interpreted, as in the case of a man who was canon of four prebends, and who dreamt two staves were brought him. Next day he told this to his comrades while riding, and one said: 'Sir, you are canon of this and that, your bishops are dead, and it is impossible but that at least two pastoral staves will be brought you'. Then he rode faster in his joy, with a loose rein, and his horse fell, and he brake both his legs, and walked ever after with those staves he had dreamt of." “When you are treating a wound or accident the friends, etc., should be excluded, for they may faint and cause a disturbance; but sometimes a higher fee may be got from persons present fainting and breaking their heads against wood and the like than from the principal patient." Henry has always a keen eye for the fee: "Never dine with a patient who has not paid you; it will be cheaper to get your dinner at an inn, for such feasts are usually deducted from the surgeon's fee". "I have never found any one so rich, or even so honest, of any condition, religious or other, who was ready to pay what he had promised, unless obliged and convicted." The case, however, was not so bad after all: "You surgeons, who serve the rich faithfully for good payment, and tend the poor for charity, need not fear fire, wind, or rain, nor need you enter a monastery, or wander about the world for a living; for by your art you may save your souls, and live in comfort and die in peace in your own homes. Rejoice, therefore, for great is your reward in heaven, as necessarily follows from the word of the Lord by the prophet in the psalm, Blessed is the man that considereth the sick and needy, the Lord shall deliver him in the time of trouble."

NOTE.

The surgical works of Roger, Roland, Bruno, Theodoric, Saliceto, and Lanfranc are printed with those of Guy of Chauliac, Guido de

THE CLOSE OF THE MIDDLE AGES.

215

Cauliaco, Ars Chirurgica, Venice, 1546. The commentary of the "four masters may be found in the Collectio Salernitana. A mediæval English version of Lanfranc's surgery will shortly be published by the Early English Text Society. Guy's severe judgment upon him has been partly atoned for by Malgaigne, who says that Lanfranc's chapter on head injuries is the ablest mediæval treatise on the subject. Guy himself admits that the French surgeons were so ignorant that when the king's daughter dislocated her shoulder, the court practitioners all failed to diagnose it, and thought it was an inflammation. Gulielmus de Saliceto, Liber in Scientia Medicinali, Venice, 1489. Die Chirugie des Heinrich von Mondeville, by Dr. J. L. Pagel, Berlin, 1892. The J. Pitard here mentioned was surgeon to St. Louis, whom he accompanied on his crusade. He was also founder of the College of St. Côme (Cosmas), but, like Hugh of Lucca, he wrote nothing himself, and is known only through the works of his contemporaries.

XXXVIII. THE CLOSE OF THE MIDDLE AGES. THE interval between the end of the thirteenth century and the beginning of the Renaissance (1300-1450) is marked by many signs of the approaching dawn, but we must here confine ourselves to the work of Mondino of Bologna, "restorer of anatomy," Guy of Chauliac, "restorer of surgery," and the chief writers of those "consilia," or consultations, which form the characteristic medical literature of the period.

In contrast to the ancient Greeks, the early Christians looked upon their living bodies with contempt, but they regarded them after death with even more than Greek reverence, for was not every particle destined to be raised in glory? Human anatomy was, therefore, out of the question, and even the dissection of animals might bring upon the surgeon an accusation of sorcery, or of attempting to restore the pagan arts of divination. We have seen, however, that the students of Salerno studied the anatomy of the pig as early as the eleventh century, and in the thirteenth the Emperor Frederick II. ordered that a human body should be dissected at least once in five years. Some scanty knowledge

might also be obtained from another source contrasting strangely with those now employed. During the Crusades princes and nobles were wont to take with them, as part of their camp furniture, a large cauldron, in which, in case of death, their bodies were boiled, and the bones extracted and brought back to their fatherland. So was it done to many bishops and knights who accompanied Frederick Barbarossa to Italy in 1167, and to that emperor himself when he was drowned in the river Saleph. St. Louis, of France, Philip the Bold, and his queen, were treated in the same way till, in A.D. 1300, the practice was entirely prohibited by a bull of Pope Boniface VIII.. As already indicated, post-mortem examinations were by no means unknown in the thirteenth century, and human anatomy was probably studied more frequently than is generally supposed. It was certainly practised by Peter of Abano, and Peter of Abano was a friend of Mundinus or Mondino de Luzzi. The latter became professor at Bologna about 1290, and in 1316 he published his Anatomia, the first work since the days of the Alexandrine anatomists founded on actual dissection of human subjects, in which he is said to have been assisted by a learned lady, Alexandra Giliani.

66

Bologna now became the foremost of medical schools, and among the students attracted thither by the fame of Mondino and his pupils was Guy of Chauliac, who also studied at Montpellier and Paris, and afterwards became surgeon and caplanus commensalis" to three Popes, Clement VI., Innocent VI., and Urban V. (1352-78). Guy holds the same position in surgery as Mondino does in anatomy, both are said to have "restored" their respective arts, that is their works possessed sufficient originality and excellence to take the place of translations from Galen and Albucasis, but the creation of a new anatomy and a new surgery was reserved for their greater successors, Vesalius and Ambrose Paré.

Guy of Chauliac was not only the ablest practitioner, but also the most cultured surgeon of his age. He reverences the Greeks and Arabs, especially "our father Galen," and