Medicine Men

In the middle of the 14th century, the centers of medical knowledge were the universities at Bologna, Montpellier, and Paris. One of the professors linked to Bologna who trained several future doctors was Taddeo Alderotti.

Alderotti was born in Florence but moved to Bologna where he taught several men like Gentile da Cingoli, the emperor's doctor Bartolomeo da Varignana, and the anatomist Mondino de Luzzi.

Alderotti was a highly reputed doctor in his own right, and patients came from all over Italy to see him, making him a very wealthy man.

Another student at Bologna was Henri de Mondeville. Mondeville (c.1260 - 1320) was French, and studied at Montpellier and Paris before moving to Bologna to study under the prominent surgeon Theodoric Borgognoni, who had some new ideas about treating wounds. After studying under Borgognoni, he went back to the University of Montpellier as a professor of anatomy and surgery. He became royal surgeon to King Philip IV and his son King Louis X.

Mondeville wrote the first French surgical treatise, La Chirurgie ("Surgery"). Intending to write it in five sections, he only completed two from 1306, when he started, to his death in 1320. Some of his statements were opposed to current "wisdom," and it wasn't until centuries later that it was rediscovered in 1892 and Mondeville's ideas were justified.

What was so controversial? His approach to treating wounds, which he learned from Borgognoni. I'll explain the radical ideas of Theodore Borgognoni next time.

Mondino de Luzzi, Anatomist

Successful surgery benefits from knowledge of the body's interior, and the study of anatomy was not always easy to come by. Dissecting human bodies fell out of favor after the Classical Era. One Italian physician did extensive research in anatomy and restored the study of it. His name was Mondino de Luzzi, and he lived and worked in Bologna from c.1270 - 1326.

His father and grandfather were pharmacists, and his uncle taught medicine. Mondino himself taught medicine and surgery at the University of Bologna from 1306 to 1324. In 1316 he published an illustrated manual of details of the inside of the human body (sample to the left). The Anathomia corporis humani ("Anatomy of the human body") was the first of its kind.

He theorized a hierarchy of body parts based on what he considered most important. The abdomen was the "least noble" part of the body, and so should be dissected first. The thorax came next, and last was the head with its "higher and better organized" structures (the organs of the senses: eyes, ears, mouth). He also discussed different methods of dissection between simple versus complex structures, like muscles and arteries versus eyes. When dissecting muscles, he suggested letting the cadaver desiccate, rather than mess with a decaying cadaver. The Anathomia was a manual to explain Mondino's proper methods for dissection.

That doesn't mean he was right about everything. He claims the liver has five lobes, the stomach is round and its internal lining is where sensation happens and the external layer is where digestion takes place. He apparently never found an appendix in a cavern, even though he examined many intestines. He says the heart has three chambers, not four. Still, the text became a standard in medical knowledge for 300 years.

Mondino wasn't much interested in pathology of disease, which is just as important to medicine as understanding how the physical; body works, if not more so. Fortunately, there were others—contemporaries of Mondino's, in fact—of whom we shall speak...tomorrow.

Surgery in the Middle Ages

The Middle Ages saw illness as an imbalance in the humors of the body. Sometimes that could be treated by changing the diet. In the case of some illnesses, it might be determined that the body had too much of the "hot, wet" humor, blood, for which the treatment was to drain some of it.

Blood-letting was the simplest surgical procedure, but medieval surgeons were eager to accomplish more. Part of the history of surgery in Western Europe was tied to the needs of warfare. Consider John Bradmore's efforts to remove an arrow from Henry V. Another surgeon connected to royalty was John Arderne, the expert on a very particular and painful physical problem that he treated with surgery.

Monasteries and other religious organizations were more educated than the general population, and their access to books meant knowing more about medicine. There was one branch of medicine they avoided, however, even though the Egyptian and Greeks practiced it: dissection and surgery. The church was squeamish about surgery because it shed blood (and could lead to infection and death). The Fourth Lateran Council of 1215 prohibited clerics from surgery or any practice that shed blood. Dissection of corpses was also frowned on.

Lay people, however, continued to expand knowledge of anatomy. The Italian Cronica of Salimbene di Adam (1221 - c.1290) tells the story of an epidemic that was killing men and chickens. A physician of Cremona discovered through dissection that the chickens had abcesses in their hearts. The corpse of a human victim was dissected; the same abcesses were found. The physician put out a pamphlet warning people against eating chicken or eggs, assuming that they were causing the spread of the disease.

Italy was where great strides in anatomy and surgery took place. The Anatomical Theatre of Padua, begun in 1595, was the first permanent anatomical theater in the world, where students watched their teachers dissect bodies to learn human anatomy. Anatomical dissection in Italy had begun long before that, however. For that story, we have to look at Italian physician Mondino de Luzzi (c.1270 - 1326), and the Anathomia corporis humani of 1316. We'll look into him next time.