Part 16

"The changes have been rung by medical historians upon a casual reference in Mondino's chapter on the uterus to the bodies of two women and one sow which he had dissected, as if these were the first and the only cadavers dissected by him. The context involves no such construction. He is enforcing a statement that the size of the uterus may vary, and to illustrate it remarks that 'a woman whom I anatomized in the month of January last year, viz., 1315 Anno Christi, had a larger uterus than one whom I anatomized in the month of March of the same year.' And further, he says that 'the uterus of a sow which I dissected in 1316 (the year in which he was writing) was a hundred times greater than any I have seen in the human female, for she was pregnant and contained thirteen pigs.' These happen to be the only reference to specific bodies that he makes in his treatise. But it is a far cry to wring out of these references the conclusion that these are the only dissections he made. It is quite true that if we incline to enshroud his work in a cloud of mystery and to figure it as an unprecedented awe-inspiring feature to break down the prejudices of the ages, it is easy to think of him as having timidly profaned the human body by his anatomizing zeal in but one or two instances. His own language, however, throughout his book is that of a man who was familiar with the differing conditions of the organs found in many different bodies; a man who was habitually dissecting."

(Quotations from the work of Mundinus showing his familiarity with dissections. The leaf and line references are to the Dryander edition, Marburg, 1541.)

"I do not consider separately the anatomy of component parts, because their anatomy does not appear clearly in the fresh subject, but rather in those macerated in water." (Leaf 2, lines 8-13.)

"... these differences are more noticeable in the cooked or perfectly dried body, and so you need not be concerned about them, and perhaps I will make an anatomy upon such a one at another time and will write what I shall observe with my own senses, as I have proposed from the beginning." (Leaf 60, lines 14-17.)

"What the members are to which these nerves come cannot well be seen in such a dissection as this, but it should be liquefied with rain water, and this is not contemplated in the present body." (Leaf 60, lines 31-33.)

"After the veins you will note many muscles and many large and strong cords, the complete anatomy of which you will not endeavor to find in such a body but in a body dried in the sun for three years, as I have demonstrated at another time; I also declared completely their number, and wrote the anatomy of the muscles of the arms, hands, and feet in a lecture which I gave over the first, second, third, and fourth subjects." (Leaf 61, lines 1-7.)

Very probably the best evidence that we have of the comparative frequency at least of dissection at this time is to be found in the records of a trial for body-snatching that occurred in Bologna. The details would remind one very much of what we know of the difficulties with regard to dissection in America a couple of generations ago, when no bodies were provided by law for dissection purposes. In the course of some studies for the history of the New York State Medical Society (New York, 1906) I found that nearly every one of the first half dozen presidents of the New York Academy of Medicine, which is not much more than sixty years old, had had body-snatching experiences when they were younger. Dr. Samuel Francis, the medico-historical writer, tells of a personal expedition across the ferry in the winter time, bringing a body from a Long Island graveyard. In order to avoid the constables on the Long Island side and the police on the New York side, because there had been a number of cases of body-snatching recently and the authorities were on the lookout, the corpse was placed sitting beside the physician who drove the wagon, with a cloak wrapped around it, as if it were a living person specially protected against the cold. Similar experiences were not unusual. The lack of bodies for dissection is sometimes attributed to religious scruples, but they have very little to do with it, as at all times men have refused to allow the bodies of their friends to be treated as anatomical material. This is the natural feeling of abhorrence and not at all religious. It is only when there are many unclaimed bodies of strangers and the poor, as happens in large cities, that there can be an abundance of anatomical material.

The details of this body-snatching case are strangely familiar to those who know the history of similar cases before the middle of the nineteenth century. The case occurred in 1319 in Bologna, just four years after Mondino's public dissections. Four students were involved in the charge of body-snatching, all of them from outside the city of Bologna itself, three from Milan and one from Piacenza. In modern experience, too, as a rule, students from outside of the town where the medical college was situated, were always a little readier than natives to violate graveyards. These four students were accused of having gone at night to the Cemetery of St. Barnabas, outside the gate of San Felice,--suburban graveyards were usually the scene of such exploits,--and to have dug up the body of a certain criminal named Pasino, who had been hanged a few days before. They carried the body to the school in the Parish of San Salvatore, where Alberto Zancari was teaching. The resurrection had been accomplished without witnesses, but there were several witnesses who testified that they recognized the body of Pasino in the school and students occupied with its dissection. If evidence for the zeal of the medical students of that time for dissection were needed, surely we have it in the testimony at this trial. At a time when body-snatching has become a criminal offence usually there have been many repeated occurrences of it before the parties are brought to trial, so that it seems not unlikely that a good many dissections of illegally secured bodies were being done at Bologna at this time.

We know of a regulation of the University in force at this time, which required the teachers at the University to do an anatomy or dissection for students if they secured a body for that purpose. The students seem to have used all sorts of influence, political, monetary, diplomatic, and ecclesiastical, in order to secure the bodies of criminals. Sometimes when they failed in their purpose they waited until after burial and then took the body without leave. When we recall the awfully deterrent condition in which bodies must have been that were thus provided for dissecting purposes, it is easy to understand that the enthusiasm of the students for dissection must have been at a very high pitch. Certainly it was far higher than at the present day, when, in spite of the fact that our dissecting-rooms have very few of the old-time dangers and unpleasantnesses, dissection is only practised with assiduity if special care is exercised in requiring attendance and superintending the work of the department.

In my book on "The Popes and Science" I have gathered the traditions relating to Mondino's assistants in the chair of anatomy at Bologna. They furnish abundant evidence of the fact that dissections, far from being uncommon, must have been not at all infrequent at the north Italian universities at this time. Curiously enough, one of these assistants was a young woman who, as was not infrequently the custom at this time in the Italian universities, was matriculated as a student at Bologna. She took up first philosophy, and afterwards anatomy, under Mondino. While it is not generally realized, co-education was quite common at the Italian universities of the thirteenth and fourteenth centuries, and at no time since the foundation of the universities has a century passed in Italy without distinguished women occupying professors' chairs at some of the Italian universities. This young woman, Alessandra Giliani, of Persiceto, a country district not far from Bologna, took up the study of anatomy with ardor and, strange as it may appear, became especially enthusiastic about dissection. She became so skilful that she was made the prosector of anatomy, that is, one who prepares bodies for demonstration by the professors.

According to the "Cronaca Persicetana," quoted by Medici in his "History of the Anatomical School at Bologna":

"She became most valuable to Mondino because she would cleanse most skilfully the smallest vein, the arteries, all ramifications of the vessels, without lacerating or dividing them, and to prepare them for demonstration she would fill them with various colored liquids, which, after having been driven into the vessels, would harden without destroying the vessels. Again, she would paint these same vessels to their minute branches so perfectly and color them so naturally that, added to the wonderful explanations and teachings of the master, they brought him great fame and credit." The whole passage shows a wonderful anticipation of our most modern methods--injection, painting, hardening--of making anatomical preparations for class and demonstration purposes.

Some of the details of the story have been doubted, but her memorial tablet, erected at the time of her death in the Church of San Pietro e Marcellino of the Hospital of Santa Maria de Mareto, gives all the important facts, and tells the story of the grief of her fiance, who was himself Mondino's other assistant.[17] This was Otto Agenius, who had made for himself a name as an assistant to the chair of anatomy in Bologna, and of whom there were great hopes entertained because he had already shown signs of genius as an investigator in anatomy. These hopes were destined to grievous disappointment, however, for Otto died suddenly, before he had reached his thirtieth year. The fact that both these assistants of Mondino died young and suddenly, would seem to point to the fact that probably dissection wounds in those early days proved even more fatal than they occasionally did a century or more ago, when the proper precautions against them were not so well understood. The death of Mondino's two prosectors in early years would seem to hint at some such unfortunate occurrence.

As regards the evidence of what the young man had accomplished before his untimely death, probably the following quotation, which Medici has taken from one of the old chroniclers, will give the best idea:

"What advantage indeed might not Bologna have had from Otto Agenius Lustrulanus, whom Mondino had used as an assiduous prosector, if he had not been taken away by a swift and lamentable death before he had completed the sixth lustrum of his life!"

How well the tradition created by Mondino continued at the university will be best understood from what we know of Guy de Chauliac's visit to the medical school here about the middle of the century. The great French surgeon tells us that he came to Bologna to study anatomy under the direction of Mondino's successor, Bertruccius. When he wrote his preface to his great surgery he recalled this teaching of anatomy at Bologna and said, "It is necessary and useful to every physician to know, first of all, anatomy. For this purpose the study of books is indeed useful, but it is not sufficient to explain those things which can only be appreciated by the senses and which need to be seen in the dead body itself." He advises his students to consult Mundinus' treatise but to demonstrate its details for themselves on the dead body. He relates that he himself had often, _multitoties_, done this, especially under the direction of Bertruccius at Bologna. Curiously enough, as pointed out by Professor Pilcher, Mondino had used this same word _multitotiens_ (the variant spelling makes no difference in the meaning) in speaking about his own work. In describing the hypogastric lesion he mentions that he had demonstrated certain veins in it many times, _multitotiens_.

Mondino was just past fifty when he finished his little book and permitted copies of it to be made. Though the book occurs so early in the history of modern book-making the author offers his excuses to the public for writing it, and quotes the authority of Galen, to whom he turns in other difficult situations, for justification. As prefaces go, Mondino's is so like that of many an author of more recent date that his words have a bibliographic, as well as a personal, interest. He said:

"A work upon any science or art--as saith Galen--is issued for three reasons: first, that one may satisfy his friends. Second, that he may exercise his best mental powers. Third, that he may be saved from the oblivion incident to old age. Therefore, moved by these three causes, I have proposed to my pupils to compose a certain work on medicine.

"And because a knowledge of the parts to be subjected to medicine (which is the human body, and the names of its various divisions) is a part of medical science, as saith Averrhoes in his first chapter, in the section on the definition of medicine, for this reason among others, I have set out to lay before you the knowledge of the parts of the human body which is derived from anatomy, not attempting to use a lofty style, but the rather that which is suitable to a manual of procedure."

Some of the early editions of Mondinus' book are said, according to old writers, to have contained illustrations. None of these copies have come down to us, but the assertion is made so definitely that it seems likely to have been the case. The editions that we have contain wood engravings of the method of making a dissection as frontispiece, so that it would not be difficult to think of further such illustrations having been employed in the book itself. As we note in the chapter on "Great Surgeons of the Medieval Universities," Mondeville, according to Guy de Chauliac, had pictures of anatomical preparations which he used for teaching purposes. It is easy to understand that the value of such aids would be recognized at a time when the difficulty of preserving bodies made it necessary to do dissections hurriedly so as to get the rapidly decomposing material out of the way.

Beyond his book and certain circumstances connected with it we know very little about Mondino. What we know, however, enables us to conclude that, like many another great teacher, he must have had the special faculty of inspiring his students with an ardent enthusiasm for the work that they were taking under him. Hence the body-snatching and other stories. Mondino continued to be held in high estimation by the Bolognese for centuries after his death. Dr. Pilcher calls attention to the fact that his sepulchral tablet, which is in the portico of the Church of San Vitari in Bologna, and a replica of which he was allowed to have made in order to bring it to America, is the only one of the sepulchral tablets in the great churches of Florence, San Domenico, San Martino, the Cathedral and the Cloister of San Giacomo degli Ermitani, which has not been removed from its original location and placed in the halls of the Civic Museum. Their removal he considers "a kind of desecration which does violence to one's sense of sanctity and propriety." "Fortunately, thus far, the Mondino Tablet has escaped the spoiler." Very probably Dr. Pilcher's replica of the tablet which he was required to deposit in the Civic Museum at the time when the copy was made to be brought to America may save the tablet to be seen in its original position for many generations.

Mondino's career is of special interest because it foreshadows the life and accomplishment of many another maker of medicine of the after time. He did a great new thing in medicine in organizing regular public dissections, and then in making a manual that would facilitate the work. He waited patiently for years before completing his book in order that it might be the fruit of long experience, and so be more helpful to others. He was so modest as to require urging to secure the publication. He had the reward of his patience in the popularity of his little work for centuries after his time. The glimpse that we get of his relations to his young assistants, Agenius and Alessandra, seems to show us a teacher of distinct personal magnetism. Undoubtedly the reputation of his book did much for not only the medical school of the University of Bologna, but also for the medical schools of other north Italian universities, and helped to bring to them the crowds of students that flocked there during the fourteenth and fifteenth centuries.

Taddeo and Mondino turned the attention of the medical students of their generations Bolognawards. Before that time they had mainly gone to Salerno. After their time most of the ardent students of medicine felt that they must study for a time at least at Bologna. Other important medical schools of Italian universities at Padua, at Vicenza, at Piacenza, arose and prospered. During the time when the political troubles of Italy reached a climax about the middle of the fourteenth century, while the Popes were at Avignon, there was a remission in the attendance at all the Italian universities, but with the Popes' return to Rome and the coming of even comparative peace to Italy, Bologna once more became the term of medical pilgrimages for students from all over the world. In the meantime Mondino's book went forth to be the most used text-book of its kind until Vesalius' great work came to replace it. To have ruled in the world of anatomy for two centuries as the best known of teachers is of itself a distinction that shows us at once the teaching power and the scientific ability of this professor of anatomy of Bologna in the early fourteenth century.

X

GREAT SURGEONS OF THE MEDIEVAL UNIVERSITIES

Strange as it may appear to those who have not watched the development of our knowledge of the Middle Ages in recent years the most interesting feature in the medical departments and, indeed, of the post-graduate work generally of the medieval universities, is that in surgery. There is a very general impression that this department of medicine did not develop until quite recent years, and that particularly it failed to develop to any extent in the Middle Ages. A good many of the historians of this period, indeed, though never the special historians of medicine, have even gone far afield in order to find some reason why surgery did not develop at this time. They have insisted that the Church by its prohibition of the shedding of blood, first to monks and friars, and then to the secular clergy, prevented the normal development of surgery. Besides they add that Church opposition to anatomy completely precluded all possibility of any genuine natural evolution of surgery as a science.

There is probably no more amusing feature of quite a number of supposedly respectable and presumably authoritative historical works written in English than this assumption with regard to the absence of surgery during the later Middle Ages. Only the most complete ignorance of the actual history of medicine and surgery can account for it. The writers who make such assertions must never have opened an authoritative medical history. Nothing illustrates so well the expression of the editors of the "Cambridge Modern History" referred to more than once in these pages that "in view of changes and of gains such as these [the jointing of original documents] it has become impossible for historical writers of the present day to trust without reserve even to the most respected secondary authority. The honest student finds himself continually deserted, retarded, misled by the classics of historical literature." Fortunately for us this sweeping condemnation does not hold to any great extent for the medical historical classics. All of the classic historians of medicine tell us much of the surgery of the thirteenth and fourteenth centuries, and in recent years the republication of old texts and the further study of manuscript documents of various kinds have made it very clear that there is almost no period in the history of the world when surgery was so thoroughly and successfully cultivated as during the rise and development of the universities and their medical schools in the thirteenth and fourteenth centuries.

It is interesting to trace the succession of great contributors to surgery during these two centuries. We know their teaching not from tradition, but from their text-books so faithfully preserved for us by their devoted students, who must have begrudged no time and spared no labor in copying, for many of the books are large, yet exist in many manuscript copies.

Modern surgery may be said to owe its origin to a school of surgeons, the leaders of whom were educated at Salerno in the early part of the thirteenth century, and who, teaching at various north Italian universities, wrote out their surgical principles and experiences in a series of important contributions to that department of medical science. The fact that the origin of the school was at Salerno, where, as is well known, Arabian influence counted for much and for which Constantine's translations of Arabian works proved such a stimulus a century before, makes most students conclude that this later medieval surgical development is simply a continuation of the Arabian surgery that, as we have seen, developed very interestingly during the earlier Middle Ages. Any such idea, however, is not founded on the realities of the situation, but on an assumption with regard to the extent of Arabian influence. Gurlt in his "History of Surgery" (Vol. I, page 701) completely contradicts this idea, and says with regard to the first of the great Italian writers on surgery, Rogero, that "though Arabian works on surgery had been brought over to Italy by Constantine Africanus a hundred years before Roger's time, these exercised no influence over Italian surgery in the next century, and there is scarcely a trace of the surgical knowledge of the Arabs to be found in Roger's works."