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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


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.

It is often said that at this time surgery was mainly in the hands of

barbers and the ignorant. Henri de Mondeville, however, is a striking

example in contradiction of this. He must have had a fine preliminary

education and his book shows very wide reading. There is almost no one

of any importance who seriously touched upon medicine or surgery before

his time whom Mondeville does not quote. Hippocrates, Aristotle,

Dioscorides, Pliny, Galen, Rhazes, Ali Abbas, Abulcasis, Avicenna,

Constantine Africanus, Averroes, Maimonides, Albertus Magnus, Hugo of

Lucca, Theodoric, William of Salicet, Lanfranc are all quoted, and not

once or twice but many times. Besides he has quotations from the poets

and philosophers, Cato, Diogenes, Horace, Ovid, Plato, Seneca, and

others. He was a learned man, devoting himself to surgery.

It is no wonder, then, that he thought that a surgeon should be a

scholar, and that he needed to know much more than a physician. One of

his characteristic passages is that in which he declares it is

impossible that a surgeon should be expert who does not know not only

the principles, but everything worth while knowing about medicine, and

then he added, just as it is impossible for a man to be a good

physician who is entirely ignorant of the art of surgery. He says

further: This our art of surgery, which is the third part of medicine

(the other two parts were diet and drugs), is, with all due reverence to

physicians, considered by us surgeons ourselves and by the non-medical

as a more certain, nobler, securer, more perfect, more necessary, and

more lucrative art than the other parts of medicine. Surgeons have

always been prone to glory in their specialty.

Mondeville had a high idea of the training that a surgeon should

possess. He says: A surgeon who wishes to operate regularly ought first

for a long time to frequent places in which skilled surgeons operate

often, and he ought to pay careful attention to their operations and

commit their technique to memory. Then he ought to associate himself

with them in doing operations. A man cannot be a good surgeon unless he

knows both the art and science of medicine and especially anatomy. The

characteristics of a good surgeon are that he should be moderately bold,

not given to disputations before those who do not know medicine, operate

with foresight and wisdom, not beginning dangerous operations until he

has provided himself with everything necessary for lessening the danger.

He should have well-shaped members, especially hands with long, slender

fingers, mobile and not tremulous, and with all his members strong and

healthy so that he may perform all the good operations without

disturbance of mind. He must be highly moral, should care for the poor

for God's sake, see that he makes himself well paid by the rich, should

comfort his patients by pleasant discourse, and should always accede to

their requests if these do not interfere with the cure of the disease.

It follows from this, he says, that the perfect surgeon is more than

the perfect physician, and that while he must know medicine he must in

addition know his handicraft.

Thinking thus, it is no wonder that he places his book under as noble

patronage as possible. He says in the preface that he began to write it

for the honor and praise of Christ Jesus, of the Virgin Mary, of the

Saints and Martyrs, Cosmas and Damian, and of King Philip of France as

well as his four children, and on the proposal and request of Master

William of Briscia, distinguished professor in the science of medicine

and formerly physician to Pope Boniface IV and Benedict and Clement, the

present Pope. His first book on anatomy he proposed to found on that of

Avicenna and on his personal experience as he has seen it. The second

tractate on the treatments of wounds, contusions, and ulcers was founded

on the second book of Theodoric with whatever by recent study has been

newly acquired and brought to light through the experience of modern

physicians. He then confesses his obligations to his great master, John

Pitard, and adds that all the experience that he has gained while

operating, studying, and lecturing for many years on surgery will be

made use of in order to enhance the value of the work. He hopes,

however, to accomplish all this briefly, quietly, and above all,

charitably. There are many things in the preface that show us the

reason for Mondeville's popularity, for they exhibit him as very

sympathetically human in his interests.

While Mondeville is devoted to the principle that authority is of great

value, he said that there was nothing perfect in things human, and

successive generations of younger men often made important additions to

what their ancestors had left them. While his work is largely a

compilation, nearly everywhere it shows signs of the modification of his

predecessors' opinions by the results of his own experience. His method

of writing is, as Pagel declares, always interesting, lively, and often

full of meat. He had a teacher's instinct, for in several of the

earlier manuscripts his special teaching is put in larger letters in

order to attract students' attention.... He seems to have introduced or

re-introduced into practice the idea of the use of a large magnet in

order to extract portions of iron from the tissues. He made several

modifications in needles and thread holders and invented a kind of

small derrick for the extraction of arrows with barbs. Besides, he

suggested the surrounding of the barbs of the arrows with tubes, to

facilitate extraction. In his treatment of wounds, Pagel considers that

as a writer and teacher he is far ahead of his predecessors and even of

those who came after him in immediately subsequent generations. One of

his great merits undoubtedly is that Guy de Chauliac, the father of

modern surgery, in his text-book turned to him with a confidence that

proclaims his admiration and how much he felt that he had gained from


One of the most interesting features of Mondeville's work is his

insistence on the influence of the mind on the body and the importance

of using this influence to the best advantage. It is especially

important in Mondeville's opinion to keep a surgical patient from being

moody. Let the surgeon, says he, take care to regulate the whole

regimen of the patient's life for joy and happiness by promising that he

will soon be well, by allowing his relatives and special friends to

cheer him and by having someone to tell him jokes, and let him be

solaced also by music on the viol or psaltery. The surgeon must forbid

anger, hatred, and sadness in the patient, and remind him that the body

grows fat from joy and thin from sadness. He must insist on the patient

obeying him faithfully in all things. He repeats with approval the

expression of Avicenna that often the confidence of the patient in his

physician does more for the cure of his disease than the physician with

all his remedies. Obstinate and conceited patients prone to object to

nearly everything that the surgeon wants to do, and who often seem to

think that they surpass Galen and Hippocrates in science and wisdom, are

likely to delay their cure very much, and they represent the cases with

which the surgeon has much difficulty.

Mondeville thought that nursing was extremely important and that without

it surgery often failed of its purpose. He says, For if the assistants

are not solicitous and faithful, and obedient to the surgeons in each

and every thing which may make for the cure of the disease, they put

obstacles and difficulties in the way of the surgeon. It is especially

important that the patient's nutrition should be cared for and that the

bandages should be managed exactly as the surgeon directs. He has no use

for garrulous, talkative nurses, and does not hesitate to say that

sometimes near relatives are particularly likely to disturb patients.

Especially are they prone to let drop some hint of bad news which the

surgeon may have revealed to them in secret, or even the reports that

they may hear from others, friends or enemies, and this provokes the

patient to anger or anxiety and is likely to give him fever. If the

assistants quarrel among themselves, or are heard murmuring, or if they

draw long faces, all of these things will disturb the patients and

produce worry and anxiety or fear. The surgeon therefore must be careful

in the selection of his nurses, for some of them obey very well while he

is present, but do as they like and often just exactly the opposite of

what he has directed when he is away.

We do not know enough of the details of Mondeville's life to be sure

whether he was married or not. It is probable that he was not, for all

of these surgeons of the thirteenth century before Mondeville's time,

Theodoric, William of Salicet, Lanfranc, and Guy de Chauliac, after him

belonged to the clerical order; Theodoric was a bishop; the others,

however, seem only to have been in minor orders. It is therefore from

the standpoint of a man who views married life from without that

Mondeville makes his remarks as to the difficulty often encountered when

wives nurse their husbands. He says that the surgeon has difficulty

oftener when husbands or wives care for their spouses than at other

times. This is much more likely to take place when the wives are caring

for the husbands. In our days, he says, in this Gallican part of the

world, wives rule their husbands, and the men for the most part permit

themselves to be ruled. Whatever a surgeon may order for the cure of a

husband then will often seem to the wives to be a waste of good

material, though the men seem to be quite willing to get anything that

may be ordered for the cure of their wives. The whole cause of this

seems to be that every woman seems to think that her husband is not as

good as those of other women whom she sees around her. It would be

interesting to know how Mondeville was brought to a conclusion so

different from modern experience in the matter.

For those who are particularly interested in medical history one of the

sections of Henry's book has a special appeal, because he gives in it a

sketch of the history of surgery. We are little likely to think, as a

rule, that at this time, full two centuries before the close of the

Middle Ages, men were interested enough in the doings of those who had

gone before them to try to trace the history of the development of their

specialty. It is characteristic of the way that the scholarly Mondeville

views his own life work that he should have wanted to know something

about his predecessors and teach others with regard to them. He begins

with Galen, and as Galen divides the famous physicians of the world into

three sects, the Methodists, the Empirics, and the Rationalists, so

Mondeville divides modern surgery into three sects: first, that of the

Salernitans, with Roger, Roland, and the Four Masters; second, that of

William of Salicet and Lanfranc; and third, that of Hugo de Lucca and

his brother Theodoric and their modern disciples. He states briefly the

characteristics of these three sects. The first limited patients' diet,

used no stimulants, dilated all wounds, and got union only after pus

formation. The second allowed a liberal diet to weak patients, though

not to the strong, but generally interfered with wounds too much. The

third believed in a liberal diet, never dilated wounds, never inserted

tents, and its members were extremely careful not to complicate wounds

of the head by unwise interference. His critical discussion of the three

schools is extremely interesting.

Another phase of Mondeville's work that is sympathetic to the moderns is

his discussion of the irregular practice of medicine and surgery as it

existed in his time. Most of our modern medicine and surgery was

anticipated in the olden time; but it may be said that all of the modes

of the quack are as old as humanity. Galen's description of the

travelling charlatan who settled down in his front yard, not knowing

that it belonged to a physician, shows this very well. There were

evidently as many of them and as many different kinds in Mondeville's

time as in our own. In discussing the opposition that had arisen between

physicians and surgeons in his time and their failure to realize that

they were both members of a great profession, he enumerates the many

different kinds of opponents that the medical profession had. There were

barbers, soothsayers, loan agents, falsifiers, alchemists, meretrices,

midwives, old women, converted Jews, Saracens, and indeed most of those

who, having wasted their substance foolishly, now proceed to make

physicians or surgeons of themselves in order to make their living under

the cloak of healing.

What surprises Mondeville however, as it has always surprised every

physician who knows the situation, is that so many educated, or at least

supposedly well-informed people of the better classes, indeed even of

the so-called best classes, allow themselves to be influenced by these

quacks. And it is even more surprising to him that so many well-to-do,

intelligent people should, for no reason, though without knowledge,

presume to give advice in medical matters and especially in even

dangerous surgical diseases, and in such delicate affections as diseases

of the eyes. It thus often happens that diseases in themselves curable

grow to be simply incurable or are made much worse than they were

before. He says that some of the clergymen of his time seemed to think

that a knowledge of medicine is infused into them with the sacrament of

Holy Orders. He was himself probably a clergyman, and I have in the

modern time more than once known of teachers in the clerical seminaries

emphasizing this same idea for the clerical students. It is very evident

that the world has not changed very much, and that to know any time

reasonably well is to find in it comments on the morning paper. We are

in the midst of just such a series of interferences with medicine on the

part of the clergy as this wise, common-sense surgeon of the thirteenth

century deprecated.

In every way Mondeville had the instincts of a teacher. He took

advantage of every aid. He was probably the first to use illustrations

in teaching anatomy. Guy de Chauliac, whose teacher in anatomy for some

time Mondeville was, says in the first chapter of his Chirurgia Magna

that pictures do not suffice for the teaching of anatomy and that actual

dissection is necessary. The passage runs as follows: In the bodies of

men, of apes, and of pigs, and of many other animals, tissues should be

studied by dissections and not by pictures, as did Henricus, who was

seen to demonstrate anatomy with thirteen pictures.[21] What Chauliac

blames is the attempt to replace dissections by pictorial

demonstrations. Hyrtl, however, suggests that this invention of

Mondeville's was probably very helpful, and was brought about by the

impossibility of preserving bodies for long periods as well as the

difficulty of obtaining them.