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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


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.